TREATMENT of Minimal Cognitive Impairment

Medical Care

At present, no treatment for MCI exists. Several trials are currently underway to determine whether cholinesterase inhibitors, anti-inflammatory agents, and antioxidants may be beneficial in MCI. Smaller scale studies suggest that at least some cholinesterase inhibitors may improve the memory loss (Freo, 2001), although larger scale studies are necessary to ascertain this more rigorously. Unfortunately, results presented so far with donepezil have been disappointing, but the results of a large-scale trial with rivastigmine have not been released yet.

A practice parameter recommendation by the American Academy of Neurology states that patients with MCI should be identified and monitored because of their increased risk for AD and, to a lesser extent, other dementing conditions. Obviously, correcting (to the extent possible) any sensory and motor manifestations compounding the cognitive symptoms is important to minimize their impact on MCI.

Activity

Because physical, social, and mental activity are often recommended for patients with AD and MCI often heralds AD, many experts have thought that mentally challenging activities, such as crossword puzzles and "brain teasers" may be helpful in MCI. While definitive proof of the efficacy of these exercises is unavailable at the time of this writing, recommending them to patients with MCI seems advisable. Keep such exercises within reasonable levels of difficulty for the patient. Exercises should preferably be interactive rather than passive, and they should also be administered in a fashion that does not cause excessive frustration. Social isolation can be minimized through referral to senior community centers or a day treatment program. Cognitive retraining/rehabilitative strategies offer considerable promise in MCI (D. Loewenstein, PhD, oral communication, March 2005) and are therefore being explored.