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Mild cognitive impairment
Mild cognitive impairment is cognitive decline that is reported and measured on testing, while the patient remains independent in daily activities; the difference from dementia is function, and some patients progress to dementia, some remain stable and some improve.
Why it matters in the exam
The exam presents a patient with memory complaints, a slightly low MoCA and fully independent function, and asks for the diagnosis and the next step. The answer: mild cognitive impairment; exclude reversible causes (drugs, depression, B12, thyroid, sleep apnoea), recommend exercise and follow up — and do not start a cholinesterase inhibitor, which has not been shown to help in this condition.
According to the American Academy of Neurology guideline (2018), prevalence rises with age — from about 7% at age 60–64 to about 25% at age 80–84; about 15% of patients over 65 with mild impairment develop dementia within two years; exercise twice a week is recommended, and cognitive training may help. The amnestic (memory) type mainly raises the risk of Alzheimer disease.
In clinical questions there is sometimes a patient who is very worried about their memory but whose testing is normal — this is "subjective cognitive decline", not mild impairment, and it is managed with reassurance, treatment of risk factors and follow-up. In another case a family member reports repeated forgetting that the patient denies; information from an informant is very important, because lack of awareness of the deficit is more common in early dementia. Candidates are also asked about driving and managing money: in mild impairment there is usually no need to stop driving, but it is monitored, and aggravating factors such as poor hearing, loneliness and sedating drugs are treated.
The screening tests themselves are also asked about: the MoCA also tests executive function and is therefore more sensitive than the MMSE to mild impairment, and a borderline result is interpreted according to the patient's education, language and emotional state.
Key points
- Objective cognitive decline with independent function.
- Function separates mild impairment from dementia.
- Exclude drugs, depression, B12, thyroid and sleep apnoea.
- Exercise twice a week; no cholinesterase inhibitors.
- Reassess every 6–12 months.
Summary table
| Concept | Definition | Exam point |
|---|---|---|
| Mild cognitive impairment | Reported and objective decline in one or more domains, independent function | Function — the difference from dementia |
| Dementia | Cognitive decline that impairs independence in daily activities | IADL is affected |
| Amnestic type | Mainly memory | Increased risk of Alzheimer disease |
| Non-amnestic type | Language, attention, executive or spatial function | Lewy body, frontotemporal, vascular |
| Treatment | Exercise twice a week, risk factors, cognitive training | Cholinesterase inhibitors — not proven |
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Sources
- American Academy of Neurology practice guideline update — Mild cognitive impairment, 2018 — Prevalence, prognosis and treatment
- Hazzard's Geriatric Medicine and Gerontology, 8th edition (2022) — Mild cognitive impairment
- Dementia prevention, intervention, and care — Lancet Commission, 2024 update — Modifiable risk factors
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.