What are the recommendations to preserve mild cognitive impairment?

Recommendations to Preserve Mild Cognitive Impairment

To preserve cognitive function in individuals with mild cognitive impairment (MCI), a comprehensive approach focusing on physical activity, nutrition, hearing health, sleep quality, and cognitive stimulation is strongly recommended. 1

Physical Exercise

• Aerobic exercise and/or resistance training of at least moderate intensity is recommended to improve cognitive outcomes among people with MCI 1
• Physical activity interventions involving aerobic exercise are specifically recommended for improving cognitive outcomes in MCI patients 1
• There is promising evidence supporting mind-body exercises such as Tai Chi and Qigong for cognitive improvement in MCI, though larger trials are needed 1
• Regular physical activity interventions can reduce the risk of progression to dementia, including Alzheimer's disease and vascular dementia 1

Nutrition

• Adherence to a Mediterranean diet is strongly recommended to decrease the risk of cognitive decline 1
• High consumption of mono- and polyunsaturated fatty acids with low consumption of saturated fatty acids is recommended 1
• Increased fruit and vegetable intake is recommended for cognitive preservation 1
• Dietary patterns rich in omega-3 fatty acids, B vitamins, and probiotics have shown positive effects on cognition in MCI patients 2

Hearing Health

• All individuals with MCI should be questioned about symptoms of hearing loss, specifically asking if they have difficulty hearing in everyday life 1
• If hearing loss is reported, audiometry should be conducted by a qualified audiologist, and if confirmed, audiologic rehabilitation should be recommended 1
• Following WHO guidelines for risk reduction of cognitive decline, including audiological examination, review of potentially ototoxic medications, and referral to otolaryngology when indicated 1

Sleep Management

• A careful sleep history, including assessment of sleep time and symptoms of sleep apnea, should be included in the assessment of any patient with MCI 1
• Adults with sleep apnea should be treated with continuous positive airway pressure (CPAP), which may improve cognition and decrease the risk of dementia 1
• Targeting 7-8 hours of sleep per night and avoiding severe sleep deprivation (<5 hours) may improve cognition and decrease dementia risk 1

Cognitive Training and Stimulation

• Empirically supported individual computer-based and group cognitive training should be proposed to people with MCI when accessible 1
• Individuals should be advised to increase or maintain engagement in cognitively stimulating activities such as stimulating pastimes, volunteering, and lifelong learning 1
• A variety of cognitively stimulating activities is preferable, though no particular activities can be specifically recommended at this time 1

Social Engagement and Education

• Attention to social circumstances and supports is recommended, including opportunities for social engagement 1
• Support for educational attainment is recommended, particularly in early life but also for ongoing educational experiences in mid and later life 1

Medication Management

• Exposure to medications with highly anticholinergic properties should be minimized in older persons 1
• Alternative medications should be used for specific indications where medications with anticholinergic properties are indicated 1
• Cholinesterase inhibitors and memantine should be deprescribed for individuals with MCI as they are not indicated for this condition 1

Diagnostic Considerations

• MCI is characterized by slightly deteriorated performance in neuropsychological cognitive tests with minimal impact on instrumental activities of daily living 3
• Cognitive test scores for individuals with MCI are typically between 1 and 1.5 standard deviations below the mean for their age and education peers 3
• Neuropsychological evaluation is the best way to demonstrate cognitive deficits and diagnose MCI 3

Important Caveats and Pitfalls

• Simple memory tests like the three-word recall in the MMSE may not be sensitive enough to detect subtle memory impairments in early stages of cognitive decline 4
• More sensitive tests such as the Montreal Cognitive Assessment (MoCA) and specialized memory tests should be used for evaluation 4
• Factors that may influence test results, such as age, education level, and professional experience, should be considered when evaluating memory 4
• Longitudinal evaluations are important to monitor cognitive decline over time and identify atypical presentations of memory impairments 4