A member of my family may have mild cognitive impairment (MCI) caused by Alzheimer’s disease. What should I do?

Supervised by Atsushi Iwata, Associate Professor, Department of Neurology, Graduate School of Medicine, University of Tokyo

If your family member shows symptoms suggestive of MCI caused by Alzheimer’s disease (MCI-AD), you may become anxious and want to take him/her to hospital immediately. However, persuading him/her to go to see a doctor without carefully considering the circumstances may not only hurt the person, but also influence his/her future treatment. We explain here how you should respond, step by step.

What should you look out for if you suspect that a member of your family may have MCI-AD

Recently, dementia has been a topic that has attracted growing interest on TV and the Internet. Therefore, some people experiencing even normal forgetfulness begin to worry about whether they may have dementia. However, it would be too early to conclude that the person has dementia merely because of frequent forgetfulness.

What do you need to know about the differences among Alzheimer-type dementia, MCI-AD, and aging

There are three possible causes of forgetfulness in the elderly: “Alzheimer-type dementia,” “MCI-AD” and “aging.”
“Aging” is a natural process associated with advancing age. In general, a gradual memory decline begins around the age of 60 years in humans. Therefore, elderly persons may experience occasional episodes of age-related forgetfulness, such as “unable to recall the names of people or things right away,” or “unable to recall the breakfast menu.” On the other hand, dementia and MCI are associated with brain diseases and cause forgetfulness of a fundamentally different nature from age-related forgetfulness, such as “unable to recognize familiar faces and things,” and “unable to recall the experience itself of having eaten breakfast.” Ultimately, it is for the doctor to determine if the forgetfulness in your family member is due to dementia or aging. However, it is important for the family to understand the characteristics of the forgetfulness and analyze carefully.

Characteristics of Alzheimer-type dementia

  • Forgetting the experience itself (e.g., not remembering whether he/she has already eaten his/her meal)
  • A decline not only in memory, but also in judgment and calculation abilities
  • Not understanding his/her own forgetfulness
  • Cognitive decline interfering with daily life

Characteristics of MCI-AD

  • Pre-stage dementia
  • More forgetful than peers of the same age, but always, not occasionally, aware of it
  • Remembering the experience itself, but often/soon forgetting the details of the experience
  • Experiencing some difficulties in daily living, but still able to live independently

Characteristics of age-related forgetfulness

  • Occasionally forgetting some details of an experience (e.g., remembering having eaten a meal, but unable to recall what he/she ate)
  • Being aware of the forgetfulness
  • Being able to recall with hints
  • Not interfering with daily life

Asking questions in a straightforward way could hurt one's self-esteem

If you still feel something is wrong with your family member, with a clear understanding of the difference between Alzheimer-type dementia and aging, you are advised to encourage him/her to see a doctor as soon as possible. However, directly telling him/her that “You may have dementia or MCI,” or “Why don’t you take a dementia test?” can hurt his/her self-esteem. Also, if the physician does not detect any problem, he/she may develop a suspicion towards you, because “I am normal, but he/she (you) suspected that I may have dementia,” which could negatively affect your future relationship with the subject.

How should you check it without hurting the person's feelings

If you suspect that a member of your family may have MCI-AD, first check the person carefully, without the person being aware that he/she is being checked.

Check for signs indirectly through conversation.

By confirming the memories and other cognitive capabilities of the person through everyday conversation, you can check for MCI-AD without the person becoming aware that you suspect he/she may have MCI-AD. For example, ask him/her, “What time did you say is your appointment with the doctor tomorrow?” or “Where did the incident happen?” during the natural flow of the conversation. It is recommended not to ask multiple questions at once, but to ask relevant questions at appropriate intervals, for example, over 3 days or so through daily conversation.

Check his/her daily life.

People with MCI-AD have fuzzy memories about the details of recent events. Therefore, conversation with them shows that they cannot clearly recall the contents of recent news and do not remember impressive special events that have taken place recently, such as ceremonial occasions. If you notice these signs, the person is highly likely to have MCI-AD.

If you find that the family member is highly likely to have MCI-AD, how should you take him/her to the hospital without hurting his/her feelings

It is very difficult to take a person to hospital without his/her consent. However, if left unattended, the condition could continue to progress. So, how can you get him/her to see a doctor without hurting his/her feelings?

Create a reason for seeing the doctor.

If you say “let us go to hospital” when the person is not sick, he/she will become suspicious. However, in recent years, there has been a growing number of “medical institutions caring for dementia patients” called “Medical Center for Dementia,” which also accept “consultation for future prevention measures.” The number of institutions, even small-scale medical institutions, providing specialty outpatient clinics such as “outpatient memory clinic,” has been on the rise. Thus, a system to make hospital visits easier is being established. Under this circumstance, you can say, “I am not worried about you now, but I want you to stay healthy in the future. So, would you like to visit this clinic with me to learn about good habits to keep the brain healthy”? This may allow you to take the person to the hospital more smoothly, while being considerate, by creating a reason (“for future prevention”) to visit the hospital. If he/she is still not convinced, you may gently explain to him/her his/her current condition, and persuade him/her to see a doctor.

Contact the hospital in advance.

Some elderly people are worried about or scared of seeing a doctor. It is quite possible that the person may say “I want to go home” after arriving at the hospital. It is recommended for you to contact the hospital in advance in order to request their help to allow the person to consult the physician as smoothly as possible.

Never force the person to see a doctor.

There may be situations in which the person flatly refuses to see the doctor. In such a case, it is important to decide on giving up seeing the doctor on that day and postpone the consultation. Because, if the person is forced to see a doctor under this circumstance, it may lead him/her to distrust his/her family and/or the medical institution, and possibly affect his/her future treatment. It is very important not to force the person to see the doctor when he/she is unwilling, and not to blame him/her or use harsh words. At the stage of MCI, a person is aware of his/her memory disturbance and can therefore undertake the hospital visit alone, by himself/herself. However, if the person is unable to clearly tell the doctor about his/her daily life during the consultation, it would be difficult for the physician to make a proper judgment. Therefore, it is recommended that the person visit the hospital with someone who usually lives with him/her, if possible, even if he/she is willing to see a doctor.

If the physician makes a diagnosis of MCI-AD, ensure that the person receives appropriate care

Generally, it is assumed that people with dementia tend to think that they are not sick. However, many people with MCI are aware of their condition. The person himself/herself is the one who is most worried about the change. Under such circumstances, if the diagnosis of MCI is confirmed, the person is likely to become severely depressed.
However, MCI can be improved by taking appropriate preventive measures. It is important that the family and other people around cooperate and support the person so that he/she can positively work on preventive measures.

Posted jointly with “Dementia-NET.”