Distinction between dementia and MCI
For the diagnosis of a dementia syndrome a restriction of daily living skills is necessary. These include activities such as washing, dressing, eating, personal hygiene and the control of body wastes including using the toilet. The charateristic complaints must be made over a period of min. 6 months. In contrast, in MCI there are subjective or slightly objectified impairments in memory or thinking power without leading to a restriction of daily living skills.
To meet the criteria for an MCI, other organic disorders or brain dysfunctions have to be excluded first. The subsequent diagnostic process usually begins with the fact that a related party, or a relative describes the cognitive changes of the person concerned. The attending physician first determines whether the condition is age-appropriate normal, or there are signs of dementia – after a detailed medical history with the involvement of caregivers, the patient’s state image can be better defined using neuropsychological short tests and possibly with more extensive test batteries. This recessed differential diagnosis should include an investigation of cognitive areas such as learning, memory, orientation, spatial cognition, attention, language and action planning.
In most cases, the person is experiencing a memory impairment while other cognitive skills are largely intact. The changes therefore relate to so-called „higher“ cognitive functions, but significant restrictions in everyday life are not yet noticeable.
In a talk sensitive issues would be such as whether the patient still pursues his hobbies, can cope with complex financial transactions, can use new objects and tools, often repeats questions, or sometimes forgets the date and year.
Also incisive biographical events need to be considered: Dementia symptoms can suddenly intensify temporally associated with critical life events, when former compensatory mechanisms are no longer effective. Many people experience the loss of cognitive performance in response to stressful life events, such as the own serious physical illness, care or death in the family, or other life crises circumstances, such as with retirement concomitant changes in lifestyle. Suspicions that the observed abnormalities in the concerned person are just a reaction to these situational changes often turn out wrong and can mask the beginning of a true dementia.
Especially in early progressions relatives can give evidence of slight restrictions of memory or changes in the nature or behavior of the patient. Patients and their families are asked whether the complaints occurred suddenly or insidiously and whether temporally associated sleeping problems, mood swings or other symptoms (such as numbness, paralysis, speech or vision problems) were observed, or the medication was changed.
If the doctor determines that the patient is neither within the age norm, nor meets the criteria for dementia and can cope with activities of everyday life, but a decline in cognitive skills is described, MCI can be assumed.