With age, many of us may become more forgetful. But being too forgetful and finding routine activities more challenging can be a warning sign of a health condition called mild cognitive impairment (MCI).

Like the risk of dementia which increases with age, some elderly folk may also experience MCI. This problem can be part of normal ageing where memory loss occurs. MCI is an intermediate stage between age-related memory impairment and the more serious early dementia.

Take the case of a senior accountant who was naturally good with numbers. One day, he found himself struggling with numbers. His wife had a hunch that something was wrong, and she was right.

Further tests indicated that her husband had MCI which later progressed to Alzheimer’s.

People with MCI are more forgetful than normal for their age. However, when they doing routine activities, they do not experience other cognitive problems associated with dementia such as disorientation or confusion, according to a science-based health website featuring advice from America’s top doctors and experts (www.healthafter50.com).

Routine tasks like paying bills, shopping and meal preparation may become challenging. They can still perform these activities but may take more time and perhaps make more mistakes. They may be less active socially but still lead independent lives.

About one in five older adults has some type of MCI. The website quoted a 2010 study of about 2,000 people; 16% of dementia-free people over the age of 70 were suffering from MCI.

Apparently, men were more likely to suffer from MCI than women, although women may get dementia at a later age. The study cites risk factors as being a carrier of the APOE e4 gene (a known risk factor for late-onset Alzheimer’s disease), never having married and having less than nine years of education.


Problem with numbers

Consultant geriatrician Datuk Dr Rajbans Singh recalls his first encounter with a patient with MCI.

The wife brought her accountant husband to his clinic.

“His mental score was perfect but she insisted that something was amiss. He was smart with numbers, but now he was forgetting them!” says Dr Rajbans.

After the visit, his wife sent her husband for more tests at a memory clinic in Singapore.

“For the first two years, the tests found him to be normal. He was actually suffering from MCI; on the third year, he was diagnosed with Alzheimer’s,” says Dr Rajbans.

He points out that sometimes, as in the accountant’s case, a mini mental test for memory may be inconclusive for MCI. However, a person’s history can reveal tell-tale signs of MCI.

Now Dr Rajbans reckons that even when a person’s mini mental test is normal and he is not suffering from Alzheimer’s, he may be suffering from MCI. A blood test or brain scan is needed to help with diagnosis.

Dr Rajbans is the founder and past president of Malaysian Healthy Ageing Society. He is also a member of the American Academy of Anti-Ageing Medicine and British Geriatrics Society.

Memory slips

Another case involves an 81-year-old teacher whose memory was not as sharp as it used to be.

“Previously, she could remember events that happened two days ago; now she can’t. Her husband already has Alzheimer’s. Her mental score was normal,” Dr Rajbans relates. Although she is suspected of having MCI, further tests are required – blood test and brain scan – to reach a diagnosis.

The blood test is to check for kidney failure, low haemoglobin or low thyroid function which can cause memory issues. A brain scan can detect stroke or brain swelling which can cause memory loss. Depression can also result in memory loss, explains Dr Rajbans.

“Most people will MCI would not come (for consultation) because their family members think it is part of normal ageing,” he says, adding that about 10% to 20% of MCI cases are likely to progress to Alzheimer’s.


Dr Rajbans cautions, “Most seniors with Alzheimer’s are above 60 years old but after 70, the risk of getting Alzheimer’s is 1:5 and after 80, it is 1:3.”

Sometimes the elderly turn up at the clinic in the later stages of Alzheimer’s. They are angry and confused; some are violent and suffer from hallucinations. “Some family members think the seniors are possessed and seek the help of bomohs before coming to see us,” says Dr Rajbans.

He added that these days, most educated family members would bring the elderly in for consultation when they are confused and show worrying signs of memory impairment.

He says: “We’ve to rule out what is causing memory problems – whether it’s a stroke, Alzheimer’s or other issues. Hallucinations can be part of a psychiatric problem. In such case, the person’s memory is very good but he has hallucinations. But in Alzheimer’s, short-term memory is affected and the person also has hallucinations.”

People with MCI find that their memory is not as sharp as before. They start forgetting things they don’t normally forget. Their judgment is also slightly affected, says Dr Rajbans.

“It is very controversial whether MCI is a normal part of ageing or whether it will progress to Alzheimer’s,” he says. “A certain percentage of people with MCI will get better, remain the same or deteriorate to Alzheimer’s.”

It is uncertain how some elderly folks get MCI but it may be the same process that leads to Alzheimer’s.

Some theories on probable causes of memory deficits are free radical damage, too much toxins, inflammation, not using the brain much, or genetics, says Dr Rajbans. Others cite vitamin or hormone deficiency, medication, mild stroke, and brain tumour.

Dr Rajbans clarifies that there is no real treatment for MCI.

“The drug for slowing down Alzheimer’s does not work for MCI,” he says.

Some people claim that taking supplements like omega-3 and ginkgo may help. Dr Rajbans suggests that seniors stay physically and mentally active to optimise brain activity.

“Many older people lose interest in physical and mental activities. This may aggravate cognitive decline,” he adds.

Social interaction, he says, is important and helps in delaying Alzheimer’s.