Measures for difficulties occurring in people with mild cognitive impairment (MCI) caused by Alzheimer's disease
Supervised by Atsushi Iwata, Associate Professor, Department of Neurology, Graduate School of Medicine, University of Tokyo
Mild cognitive impairment caused by Alzheimer's disease (MCI-AD) does not greatly interfere with daily life activities, unlike dementia. However, it can cause difficulties, such as inability of the person to smoothly carry out the daily life activities that he/she had been able to before. This section explains the appropriate measures and approaches when your family member suffers from difficulties associated with MCI-AD.
MCI-AD does not greatly interfere with daily life activities, but may cause some difficulties.
There are several definitions for MCI-AD, which is a pre-stage of dementia. These definitions include “normal activities of daily living” and “objective evidence of impairment in one or more cognitive functions (memory, orientation, etc.).” More specifically, there is no problem in carrying out basic daily activities, such as eating, bathing and going to the toilet, but MCI is a state where some cognitive functions are impaired.
Although there are several definitions for cognitive function, it is a general term for various brain functions related to daily living, such as memory, language, judgment, calculation and executive functions. In patients with MCI-AD, at least one of these areas is impaired. The hallmark is impaired memory. Impairment of cognitive functions leads to changes such as “inability to smoothly carry out daily life activities that the person used to be able to carry out” and “is no longer able to understand what he/she could understand before.” Although MCI-AD does not interfere with the daily life activities, these aforementioned changes sometimes make it difficult for the family and other people around to respond appropriately to the situation.
Depending on the measures taken for the situation, the person may get hurt or become more emotional, possibly making the situation worse. What is important is to handle the situation by focusing on the problem itself, and not on the condition of the person. Here, let us see some cases to better understand how to deal with various problems occurring in people with MCI-AD:
Difficulty (1): Telling the same story, or checking the same thing, over and over again.
The most representative feature of cognitive decline in patients with MCI is forgetfulness. Even simple aging can cause forgetfulness, but the forgetfulness associated with MCI is characterized by remembering the experience, but forgetting the details. For example, the person remembers having made an appointment to meet somebody, but quickly forgets the time of the appointment. Also, in regard to news topics that everyone is talking about, the person cannot clearly recall the details of the news story. Therefore, he/she often tells the same story to the same people, or goes about checking the same thing with the same people, over and over again.
If you hear the same story repeatedly, you may get tired and respond in a thoughtless manner. However, it is important to understand that the person is not doing it intentionally. To his/her mind, he/she is saying it for the first time. Therefore, if you show your annoyance or blame the person, he/she may feel alienated and lonely, and consequently begin to feel very stressed.
Let us listen first. However, having to listen seriously each time can tire one out. Therefore, one must practice the art of gently listening without taking any serious notice of the contents each time. After the subjects are finished talking, you could tell him/her that you have heard the story several times, in a gentle tone, with a smile. This helps the person recognize his or her condition. After a few repetitions of such exchanges, the person would become aware of unconsciously repeating the same story several times, although he/she keeps forgetting the “contents of the story.” This naturally leads him/her to ask “Are you hearing this story for the first time?” during daily conversation. As a result, he/she may tell the same story less frequently, or an opportunity may arise to visit the medical institution for consultation.
Difficulty (2): Frequently losing things although he/she can finally find them himself/herself.
People with MCI frequently lose things because they forget where they put them, due to decline in memory. However, since they are capable of finding these things themselves, there appears to be no major interference with daily life activities.
However, as this condition becomes an everyday affair, his/her family members find it more and more troublesome, having to look for the missing items, which could lead to straining of their mutual relationship, and resultant severe stress on both parties.
Never get angry with or blame the person for frequently losing things. People with MCI themselves are aware of their “mistakes.” In such a situation, if you scold the person without giving him/her a chance to explain, he/she may lose confidence and come to mistrust others. It is recommended that the situation be handled by focusing on the frequent loss of things. For example, effective measures include clear identification of a designated place for each item of frequent use, attachment of name tags to the places, and making it a habit to confirm each time by asking, “Have you returned it to its rightful place after using it?” in daily life.
The important point to note here is that these approaches are not only for the persons with MCI, but also for all family members. Such approaches taken by all family members for the prevention of missing items can result in the person avoiding getting hurt and losing his/her self-esteem. Even if the person becomes suspicious of his/her family’s true intentions, these approaches allow one to have “conversations for finding it together,” such as “When did you use it?” and “Have you returned it to its place?” Therefore, these approaches also lead to a lower likelihood of quarrels.
With a clearer understanding of MCI, difficulties can be handled by small modifications.
These cases listed here have only some of difficulties. However, in both cases, the difficulties can be reduced by understanding the person with MCI and also by slightly modifying the communication strategies and lifestyle habits.
In fact, many of the difficulties that a person with MCI or dementia faces in his/her daily life activities can be resolved by simply modifying the family members’ attitude so also to take into account the point of view of the person with MCI.
It is said that persons diagnosed as having MCI feel high levels of anxiety.
Let us deepen the understanding between the person with MCI and his/her close ones and cooperate to cope with the difficulties.
Posted jointly with “Dementia-NET.”