Delayed Diagnosis of Mild Cognitive Impairment: Experts Call for Change
In 2016, Jonel Dershem began experiencing problems with her memory after undergoing breast cancer surgery. Initially attributing the lapses to chemotherapy and a busy lifestyle, Dershem, an obstetrician from Voorhees, N.J., dismissed the issue. Her family, friends, and doctor also overlooked the symptoms. However, nearly six years later, in December 2022, Dershem was finally diagnosed with mild cognitive impairment (MCI). While her delayed diagnosis is not uncommon, experts argue that this needs to change.
MCI is a condition that causes disruptions in daily life without rendering individuals unable to function. It is often a precursor to dementia but not always. Ronald Petersen, director of the Mayo Clinic Alzheimer’s Disease Research Center, explains that MCI is a subtle condition. While missing a golf date once is not concerning, repeated occurrences coupled with worries from family members may indicate MCI. People with MCI can still perform tasks like driving, paying bills, and doing taxes, albeit less efficiently.
A study published in the journal Alzheimer’s & Dementia projected that 14.4 million people in the United States would have MCI by 2025, and 19.3 million by 2050. In 2018, the American Academy of Neurology estimated that approximately 1 in 10 people aged 70 to 74 had MCI, increasing to 1 in 4 for those aged 80 to 84. However, the detection rates for MCI are alarmingly low. Research indicates that around 92 percent of people with MCI remain undiagnosed. Historically disadvantaged groups, such as Black and Hispanic Americans, have even lower detection rates.
Experts emphasize the importance of early detection and diagnosis of MCI. Soeren Mattke, director of the Brain Health Observatory at the University of Southern California, warns against waiting until someone is obviously symptomatic. By then, it may be too late. Dershem’s current doctor, David Weisman, highlights the significance of catching MCI early to delay its progression. He has been treating Dershem with lecanemab since February 2023. Lecanemab, approved by federal regulators, reduces the buildup of amyloid beta, a protein associated with Alzheimer’s disease. While it can modestly slow dementia’s progress, it cannot stop the decline or reverse lost ground.
Diagnosis is crucial not only to delay progression but also to identify potential causes other than Alzheimer’s disease or related disorders. Petersen explains that MCI symptoms can result from various factors, including brain tumors and medication side effects. The emergence of amyloid-fighting medications like lecanemab and donanemab has given hope to many doctors. However, these drugs are effective only when the disease is caught early and may have dangerous side effects.
While some cognitive decline is a natural part of aging, more severe cognitive gaps should not be ignored. It is essential to prioritize memory concerns and consult a doctor promptly. Weisman advises patients to make it clear that getting answers is a priority during medical appointments. If necessary, consulting a geriatric psychiatrist or neurologist can provide further insights.
Preparing for an evaluation involves taking an online test before the appointment and sharing the results with the doctor. The Self-Administered Gerocognitive Exam (SAGE) is a recommended test. Doctors may conduct additional tests, such as neuropsychological assays, blood tests, or MRI scans, to identify possible physical problems. PET scans or spinal taps may be used to search for signs of Alzheimer’s disease or Lewy body dementia. New blood tests are also being developed to simplify diagnosis.
It is crucial to involve a personal “historian” in medical appointments, someone who can provide insights into the onset and pace of cognitive decline. Dershem’s son, Bryce, played this role for her, raising concerns about her memory loss during an appointment with a neurologist. Similarly, Karen Sandone noticed her husband’s memory issues and accompanied him to a neurologist. However, when he received his evaluation results alone, she realized that he couldn’t understand or remember the information. Her husband was later diagnosed with early-onset Alzheimer’s disease.
Following an MCI diagnosis, taking care of the brain becomes paramount. Petersen recommends managing other illnesses, adhering to exercise guidelines, getting sufficient sleep, limiting alcohol and stress, and maintaining an active social life. Diet also plays a role, with unsaturated fats associated with slower cognitive decline and reduced risk of Alzheimer’s disease. Memory training programs and memory-support tools like calendars and notes can also help slow decline.
Eventually, individuals diagnosed with MCI should consider making plans for the future, including alternative arrangements for driving, designating a surrogate decision-maker for healthcare and finances, and executing a will.
Despite the challenges posed by MCI, there is some positive
