Ask Alex: Normal Aging vs. MCI

Dr. Alex Bahar-Fuchs is NewDays' Director of Neuropsychology and a leading expert in cognitive interventions for older adults.

Q: I'm 68 and sometimes forget names or where I put my keys. My friends say this is just "normal aging," but I'm worried it could be something more serious. How can I tell the difference between normal aging and mild cognitive impairment?

Dr. Alex:

I am often asked, "How can you tell the difference between forgetfulness which is part of normal aging and forgetfulness that is not?" Well, it is absolutely normal to occasionally forget the names of people, for example, that we know or where we have placed our belongings, and this happens frequently to people regardless of age.

However, when this happens to an older adult, it is more likely to raise questions, doubts, and fears because of the known association between aging and dementia.

It is also true, however, that there is some decline in certain cognitive abilities or thinking skills that are simply part of normal aging. As a result, older people sometimes might feel that they are more forgetful than they used to be.

Much of this has to do less with memory per se, and more with some of the basic processes that support memory function. For example, how fast our mind works, which is called processing speed, how effectively we can attend to things in the face of competing demands, which is divided attention, or how much information we can manipulate in our mind at any given time, which is called working memory.

Due to some decline in these processes in the course of normal aging, we might notice more difficulties. But in fact, the difficulties are usually in accessing the information rather than the information being truly lost. The difference between normal aging and mild cognitive impairment is both a matter of severity or the amount of cognitive challenges and the specific types of challenges.

When people develop what experts call mild cognitive impairment, or MCI, their performance on formal tests of cognitive abilities usually falls well below that of people of the same age and education but who have normal cognition. Usually, this happens in more than one type of thinking process. For example, in addition to memory being affected, it is possible that there will be impairments in other areas such as language or executive function.

In normal aging, people continue being able to do most things that they used to be able to do independently before, albeit sometimes a bit more slowly. In contrast, people with MCI are more likely to experience greater challenges when engaging in mentally demanding everyday activities like online banking or organizing a big holiday. Although they will often manage to mask this difficulty quite well by using a range of strategies to compensate for these difficulties.

MCI, and particularly in the early stages, may be difficult to distinguish from the changes seen as part of normal aging. And for this reason, a very large number of people with MCI are not diagnosed as such by a professional.

In the very early stages of MCI, a brief evaluation which is sometimes conducted by some doctors may not pick up on the cognitive changes because they are still quite subtle.

Researchers and clinicians are always trying to develop brief and sensitive tests that would differentiate between normal aging and normal aging cognitive challenges, and those that might indicate the early stages of MCI or dementia. One area that generates a lot of interest in recent years is how sensory decline, for example, a difficulty in the sense of smell in the absence of a known reason, may be a warning sign that someone is likely to be developing a neurodegenerative disease. And that the subtle cognitive challenges are therefore less likely to be benign.

It is always recommended to seek the advice of an expert, such as a clinical neuropsychologist, if a more thorough evaluation is required.

Early detection of cognitive decline, or MCI, that is due to an underlying neurodegenerative disease such as Alzheimer's, means that people are able to get treatment early. There are drug and non-drug treatments available that may play a role in delaying or slowing down the process of cognitive decline. In addition to the importance of a range of lifestyle approaches like increasing physical activity and improving sleep, a group of non-drug treatments referred to as cognitive treatments have been repeatedly shown to improve thinking skills, mood, and other outcomes in older people with and without MCI. And I invite you to take a look at our website for more information.

Have a question for Dr. Alex? Submit your cognitive health questions to hello@newdays.ai and it might be featured in our next Ask Alex post.