Who Knows What “Mild Cognitive Impairment” Means?

You hear the term now and again, “MCI”. Someone might say it’s what your aging loved one has. Is it a diagnosis? Doctors use the term, but no one seems to exactly pin down what it means. How mild is “mild” and what does it mean in terms of diminished capacity? Here is a way to define it:

Mild Cognitive Impairment refers to a degree of cognitive decline that is in between the cognitive changes associated with normal aging and those associated with clinical features of dementia. Many people who get a diagnosis of MCI do go on to develop dementia, but some do not. We can say it’s an in-between condition-neither black nor white in terms of degree of impairment.

What does it mean for aging parents when a medical provider uses it for them? Here is a real example that illustrates the difficulty understanding the meaning of the term when an elder in your life is living with it. What should the family members do when it is identified? This family took action. Many do not, as the elder in question resists any change.

Case Study

Aging mom (A.M.) is 89 years of age and has been living alone in her own home. She got confused in her car on her way home and was found driving on the wrong side of the road. A Good Samaritan brought her home. Fortunately, she did not hit any other cars. Her adult children insisted she see her doctor. The doctor did some testing and concluded that cognitive decline was the cause of her confusion. She diagnosed A.M. with mild cognitive impairment. The doctor said she must not drive anymore. A.M. had been stuggling quietly for some time with confusion when driving, and was secretly frightened. She is willing to admit that she has to give up the keys.

A.M. can’t remember what is in her bank account. Recently there was fraudulent activity and cash was stolen by hackers. Her kids have taken over paying bills and have insisted that A.M. must also give up managing her own finances. She is very reluctant to allow her kids to take over her money management.

A.M. is very independent. She can take care of herself physically, though she does need her cane to walk. She wears hearing aids, but is able to follow the conversation around her very well when she can hear. She is clear about her likes and dislikes and communicates them emphatically. She is oriented to the date, and place where she is. Her short term memory is poor. That poor memory interferes with her safety, being alone in her home. She should not live alone any longer as she could forget to turn off the stove or the water faucet, which has already happened. She is a person who still functions independently in some ways but is in danger in numerous others when left alone.

The Grey Zone

A.M. is a good example of a person in what we call “the gray zone”. MCI is this grey zone, neither totally able to manage alone nor totally unable to do so. She is partly independent and partly dependent. She is able to do a lot for herself but she needs help with her finances particularly. Her adult children worked with her to cooperate. Since A.M. didn’t trust her kids with her money, all agreed to appoint a licensed fiduciary to handle her bills and watch her bank accounts for her. Her daughter and A.M. got the legal authority in place for the fiduciary to step on. She and the fiduciary went to both of her banks to make sure the fiduciary’s name is on the accounts. The fiduciary now has legal power of attorney to manage the finances.

Companion Care

A.M. will allow a companion live in with her to keep an eye on her safety. She can still do the things around the house and in the community she likes to do. Her kids did the research and found a good person for the job. The companion will do all the driving. For now, she has just what she needs. She accepts, with some reluctance, that her independence is getting limited by her memory loss. She may be more cooperative with these changes in her life than most, partly because she does not have to move out of her house. She has the support she needs to remain safe, at least for the time being. If A.M.’s memory and ability to care for herself decline, she may develop dementia. The family knows this and is planning for the possibility.

The Takeaways

1. Mild cognitive impairment can be a warning sign that dementia is developing. Take it seriously.
2. At the first signs of confusion or memory loss, get testing from doctors who are willing to be involved in assessing the elder’s safety. Use the information to plan for the needed changes in your aging loved one’s life.
3. Financial decision-making capacity is the first ability to decline when MCI is present. Do not allow your aging parent or other loved one with MCI to do all financial transactions without any supervision. Financial abuse such as what A.M. experienced is much more likely for anyone with cognitive decline.

For further information on keeping an aging loved one financially safer when they’re in the grey zone, see Chapter 10 in The Family Guide to Aging Parents: Answers to Your Legal, Financial and Healthcare Questions. Learn the specifics on just how to protect them from financial abuse.