Mild cognitive impairment (MCI) is a condition in which people have more memory or thinking problems than other people their age. The symptoms of MCI are not as severe as those of Alzheimer’s disease or a related dementia. People with MCI can usually take care of themselves and carry out their normal daily activities.

People with MCI are at a greater risk of developing Alzheimer’s disease or a related dementia. Estimates vary as to how many people who have MCI will develop dementia. Roughly one to two out of 10 people age 65 or older with MCI are estimated to develop dementia over a one-year period. However, in many cases, the symptoms of MCI stay the same or even improve.

Many factors can cause problems with memory and thinking. There is no single cause of MCI, and it’s more likely to occur as someone ages. Estimates vary, but roughly 10% to 20% of people over age 65 have MCI, with the risk increasing as someone gets older. Other factors like genetics and certain conditions — including diabetes, depression, and stroke — may affect a person’s risk for MCI.

In some cases, memory and thinking problems may be caused by conditions that are treatable. For example, a bad reaction to medication, emotional problems, drinking too much alcohol, blood clots or tumors in the brain, or a head injury can all cause serious memory problems that can be resolved with treatment.

Middle-aged woman doing physical activity to reduce risk for dementia.

Reducing Your Risk for Dementia

We don’t yet know for certain whether lifestyle and behavior changes can prevent dementia, but leading a healthy lifestyle may help.

Symptoms associated with MCI lie in the space between what are considered normal age-related changes and dementia. Signs of MCI include losing things often, forgetting to go to important events or appointments, and having more trouble coming up with words than other people of the same age. It’s common for family and friends to notice these changes. Movement difficulties and problems with the sense of smell have also been linked to MCI.

If you or a loved one is experiencing symptoms of MCI, discuss these with your doctor. Your doctor can perform medical tests and assessments to help determine whether the source of memory problems is something treatable or may be MCI. He or she may also suggest that you see someone who specializes in the diagnosis of memory disorders, such as a neurologist, psychiatrist, or neuropsychologist.

There is currently no treatment or medication for MCI, but there are things you can do that may help you stay healthy and manage changes in your thinking. Keeping your mind active is one thing that may benefit your brain. The following tips may help you feel better, and could help your memory:

People with MCI may worry that their memory problems will progress to Alzheimer’s disease or a related dementia. Because MCI may be an early sign of a more serious memory problem, it’s important to see your doctor every six to 12 months to track any changes in your memory and thinking skills over time.

If symptoms do progress to dementia, getting a diagnosis early can help you and your family prepare for the future. While there are no medications to stop or reverse Alzheimer’s disease or a related dementia, there are medicines that may help slow down certain symptoms, such as memory loss or behavioral problems.

If you are concerned about memory problems, talk with your doctor. If you or someone you know has recently been diagnosed with MCI, explore the resources on this website and referenced below to find out more about care, support, and research. The person with MCI may also consider participating in research by joining a clinical trial or study. Many studies are recruiting people with MCI to test early interventions that could slow or stop the progression of cognitive impairment.

Scientists have demonstrated that a new blood test can accurately predict the presence of beta-amyloid plaques in the brain, according to a new study funded in part by NIA. Published in Neurology, the study analyzed the ability of a blood test to predict the presence of Alzheimer’s disease-associated protein beta-amyloid in the brain. The new blood test, which performs comparably to existing brain scan- or spinal tap-based tests, could lower costs and expand the availability of diagnostic studies for Alzheimer’s disease.

Alzheimer’s is characterized by the buildup of a protein called beta-amyloid, which forms sticky plaques on the brain and can cause brain cells to die. Testing for the presence of these amyloid plaques on the brain is an important part of Alzheimer’s diagnosis and research. For people experiencing memory problems, checking for amyloid in the brain helps health care providers determine whether Alzheimer’s is the potential cause. It also can help doctors determine which patients will respond to drugs that target amyloid. For people without any signs of dementia, the presence of amyloid plaques on the brain may help researchers enroll participants in clinical trials for treatments to prevent or delay the onset of cognitive symptoms.

There are two well-established ways to determine if beta-amyloid is in the brain. One measures the amount of beta-amyloid present in cerebrospinal fluid, the fluid that surrounds the brain and spine, through a spinal tap. The other uses a PET brain scan to produce images of beta-amyloid on the brain. Although both methods are accurate, they are expensive, invasive, and have limited availability. Recently, a highly sensitive blood test for beta-amyloid was developed, but there were concerns about how the test would perform in the clinic on blood samples that had been collected and processed in different ways. To address these concerns, researchers from Washington University; University of California, San Francisco; University of Pennsylvania; University of Melbourne and Edith Cowan University in Australia; and Lund University in Sweden studied how well the blood test could predict the presence of amyloid plaques visible on a PET brain scan, using samples that were collected and processed in different ways.

Across all the blood samples, the scientists found that the blood test could effectively predict the presence of beta-amyloid in the brain. The test became even more accurate when the research team took into account the version of APOE (a gene linked to Alzheimer’s disease risk) that each person had. Using blood samples will make it easier to screen healthy people for potential enrollment in clinical trials that test interventions to prevent or treat Alzheimer’s disease.

Although the new test shows promise, one major limitation is that the blood samples used in the study were from majority white, affluent individuals, and the authors note that the results may not be generalizable to other demographic groups. Overall, the authors suggest this new blood test could be a powerful tool that expands the ability to diagnose Alzheimer’s. The researchers estimate that replacing brain imaging and spinal tap studies with blood tests could drastically reduce costs, increase the availability of tests, and even improve clinical trial recruitment of diverse groups of people.

These activities relate to NIH’s Alzheimer’s and Related Dementias Research Implementation Milestones:

by Carol Leish, MA

The Ventura County Area Agency on Aging offers different types of Fall Prevention Classes. These classes include: A Matter of Balance; Stepping On; Tai Chi: Moving for Better Balance; and, Walk with Ease. These classes, which are part of the Fall Prevention Program, strives to assist adults to maintain their independence at home.

A Matter of Balance is an 8-week, 2 hours per week class. It is designed for those 60 and older who are inactive with poor balance, who have fallen, and who may have developed a fear of falling. It helps to improve balance and strength of individuals. Stepping On is a 7- week class that meets 2 hours per week in which participants 65 and older have access to a physical therapist; a vision expert; a public safety expert and a pharmacist in order to realize how vision issues can be linked to falls and how medications affect someone’s links to falls. Participants will also learn strength and balance exercises.

Tai Chi: Moving for Better Balance is a 12-week class that meets twice weekly for 1.5 hours each class. It includes easy-to-do exercises that increases strength, stamina, mindfulness and body awareness to provide better balance. Walk with Ease is a 6-week structured walking class that starts out with walking a minimum od 30 minutes a day. It includes health information and motivational tips. Both Tai Chi: Moving for Better Balance and Walk with Ease are for those who are 60 and older.

“There is an educational aspect that deals with nutrition and emotional/physical wellness in all the classes offered,” according to Jannette Jauregui, MSJ, Public Information Officer at the Ventura County Area Agency on Aging. “The classes are all evidence-based, designed with those 60 and older in mind. Studies have been done to show the effectiveness of the classes in improving and strengthening balance and mobility. A Fall Prevention Forum will be offered in September of this year.”

All classes are FREE and open to any Ventura County resident 60 or older. For more information, call: (805) 477-7800 (option 6), or email: [email protected]. Find more information at: https://www.vcaaa.org/our-services/fall-prevention/.

(Future articles will focus on other programs offered by the Ventura County Area Agency on Aging dealing with: Care Management; Information provided by the Assistance Team; and, the Senior Nutrition Program.)

Alzheimer’s disease is a brain disorder that slowly destroys memory and thinking skills, and, eventually, the ability to carry out the simplest tasks. In most people with Alzheimer’s, symptoms first appear later in life. Estimates vary, but experts suggest that more than 6 million Americans, most of them age 65 or older, may have dementia caused by Alzheimer’s.

Alzheimer’s disease is currently ranked as the seventh leading cause of death in the United States and is the most common cause of dementia among older adults.

Dementia is the loss of cognitive functioning — thinking, remembering, and reasoning — and behavioral abilities to such an extent that it interferes with a person’s daily life and activities. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend completely on others for help with basic activities of daily living.

The causes of dementia can vary, depending on the types of brain changes that may be taking place. Other dementias include Lewy body dementia, frontotemporal disorders, and vascular dementia. It is common for people to have mixed dementia — a combination of two or more types of dementia. For example, some people have both Alzheimer’s disease and vascular dementia.

Alzheimer’s disease is named after Dr. Alois Alzheimer. In 1906, Dr. Alzheimer noticed changes in the brain tissue of a woman who had died of an unusual mental illness. Her symptoms included memory loss, language problems, and unpredictable behavior. After she died, he examined her brain and found many abnormal clumps (now called amyloid plaques) and tangled bundles of fibers (now called neurofibrillary, or tau, tangles).

Scientists continue to unravel the complex brain changes involved in Alzheimer’s disease. Changes in the brain may begin a decade or more before symptoms appear. During this very early stage of Alzheimer’s, toxic changes are taking place in the brain, including abnormal buildups of proteins that form amyloid plaques and tau tangles. Previously healthy neurons stop functioning, lose connections with other neurons, and die. Many other complex brain changes are thought to play a role in Alzheimer’s as well.

The damage initially appears to take place in the hippocampus and the entorhinal cortex, which are parts of the brain that are essential in forming memories. As more neurons die, additional parts of the brain are affected and begin to shrink. By the final stage of Alzheimer’s, damage is widespread and brain tissue has shrunk significantly.

Memory problems are typically one of the first signs of cognitive impairment related to Alzheimer’s. Some people with memory problems have a condition called mild cognitive impairment (MCI). With MCI, people have more memory problems than normal for their age, but their symptoms do not interfere with their everyday lives. Movement difficulties and problems with the sense of smell have also been linked to MCI. Older people with MCI are at greater risk for developing Alzheimer’s, but not all of them do so. Some may even revert to normal cognition.

The first symptoms of Alzheimer’s vary from person to person. For many, decline in nonmemory aspects of cognition, such as word-finding, vision/spatial issues, and impaired reasoning or judgment may signal the very early stages of the disease. Researchers are studying biomarkers (biological signs of disease found in brain images, cerebrospinal fluid, and blood) to detect early changes in the brains of people with MCI and in cognitively normal people who may be at greater risk for Alzheimer’s. More research is needed before these techniques can be used broadly and routinely to diagnose Alzheimer’s in a health care provider’s office.

by National Institute on Aging

Undergoing cataract removal was associated with a lower risk of developing dementia among older adults, according to a new study, supported in part by NIA. Published in JAMA Internal Medicine on Dec. 6, 2021, the study suggests that the improvement in the quality of life for the affected individual and family is likely considerable given the substantial association and its lasting effect beyond 10 years.

Dementia affects nearly 50 million people worldwide. With no cure currently, efforts to reduce the risk or delay dementia onset are increasingly important. Several studies suggest sensory loss may be a potentially modifiable risk factor for dementia later in life. The prevalence of hearing (1 out of 3) and vision impairment (1 out of 5) in adults age 70 or older in the United States is high. Because sensory impairment and dementia are both strongly associated with aging, more knowledge about the association may have important implications for adults as they age, particularly if interventions to improve sensory function reduce dementia risk.

For this prospective, longitudinal cohort study, researchers analyzed data from a subset of participants from the Adult Changes in Thought (ACT) study – an ongoing population-based cohort of randomly selected members of Kaiser Permanente Washington. Participants were 65 years or older, were dementia-free at the start of the study, and were diagnosed with cataracts before the onset of dementia. Of the 3,038 participants, 59% were women, 41% were men and 91% were self-reported white race. Data used in the analyses was collected from 1994 through September 2018.

Researchers found that participants who underwent cataract removal surgery had nearly 30% lower risk of developing dementia compared with participants without surgery, even after controlling for numerous additional demographic and health risks. In comparison, glaucoma surgery, which doesn’t restore vision, did not have a significant association with dementia risk. One of the major strengths of this study is that it was based on a large prospective, community-based, observational cohort that allowed for years of follow-up starting before participants developed dementia. However, researchers noted that because the study population was predominately white, the findings may not be representative of other groups. Recent enrollment efforts for the ACT study include new strategies to recruit a more diverse population.

Some of the limitations of this study were that participants were primarily white individuals, and researchers evaluated only the participant’s first cataract surgery and it’s unknown whether subsequent surgery in the other eye impacted dementia risk. If validated in future studies, cataract surgery may have clinical relevance in older adults at risk of developing dementia.

According to the researchers, participants who underwent cataract removal surgery had a lower risk of developing dementia compared with participants without surgery. However, they note that additional studies are needed to determine how cataract removal impacts dementia risk.

This research was supported by NIA grants R01AG060942, P50AG005136, and U01AG006781.

Reference: Lee CS, et al. Association between cataract extraction and development of dementia. JAMA Internal Medicine. 2021; doi:10.1001/jamainternmed.2021.6990

Emerald Nguyen, Social and Behavioral Science Administrator,
Division of Behavioral and Social Research (DBSR).

NIA recognizes that far too many people continue to struggle due to climate change and related weather conditions. Now more than ever, it’s crucial to better understand the science of changing climates and their impact on the health and well-being of older adults. The 2020 report of The Lancet Countdown on health and climate change identified older adults as a vulnerable population experiencing excess morbidity and mortality associated with extreme weather, such as alarming heatwaves, widespread wildfires, and violent hurricanes. NIA behavioral and social research program priorities (PDF, 433K) include supporting research to investigate older adults’ health outcomes and their preparedness, adaptation, and resilience to climate change and extreme weather conditions.

Research on older adult health and well-being affected by climate change builds on NIA’s established interest in disaster preparedness, our support for research institutions affected by disasters, and our partnerships with other federal agencies to support older adults in emergencies. NIA recently awarded six grants for projects in response to the Environmental Influences on Aging: Effects of Extreme Weather and Disaster Events on Aging Processes funding opportunity. NIA’s expanding interests in this area of research include but are not limited to:

Impacts of exposure to air pollution, heat, and wildfires, and other extreme weather events on health and well-being in midlife and later life.

The impact of age-related change in affective, social, and cognitive factors on individual responses to extreme weather events.

How individuals initiate and maintain the behavior changes needed for preparedness and adaptation to extreme weather events.

The contribution of extreme weather events and related natural disasters to social structure and social adversity, and their effects on aging processes across the life course in studies of animals in their natural habitats.

Impacts of extreme weather events on individuals with functional limitations or disabilities, persons living with Alzheimer’s disease and related dementias, as well as caregivers/care partners.

by DiversityEconomicsHealth Care Research

Three recent studies, funded in part by NIA, analyzed aspects of the Medicare Advantage program, including quality incentives and the use of hospitalization services and spending. According to a study published in JAMA Health Forum, the Medicare Advantage program reduces the use of hospitalization services and spending for beneficiaries as compared to traditional Medicare. Two other studies published in Health Affairs found that the Medicare Advantage quality bonus program has not improved plan quality or enrollment. Moreover, one of the studies found that the Medicare Advantage double bonus payments create a racial disparity in the distribution of Medicare funds, largely affecting Black Medicare beneficiaries.

Medicare Advantage is a federally funded health insurance program in the United States that provides Medicare benefits through private insurance company plans. Different Medicare Advantage plans, sometimes called “Part C” or “MA Plans,” have their own health care networks, including doctors and care facilities.

In 2012, Medicare introduced the quality bonus program to award financial incentives to Medicare Advantage plans that achieve high-quality ratings. The plans are rated from one to five stars based on more than 40 factors that evaluate how well the plan delivers care, such as preventive services, chronic disease management, and customer service. For highly rated Medicare Advantage plans, Medicare pays a bonus equal to 5% of the amount the plan receives for benefits administration. This bonus doubles to 10% for plans in counties that have a history of high enrollment and low fee-for-service Medicare spending — when the doctor or clinic is paid separately for each service provided to a patient.

To compare the effects of enrolling in a Medicare Advantage plan versus traditional Medicare, a research team from Harvard University and the University of Pennsylvania analyzed insurance claims data from a single private insurance company. This allowed researchers to evaluate health care use and spending by older adults as they moved from group or individual health insurance plans to Medicare.

During the first year of Medicare coverage, Medicare Advantage beneficiaries had lower hospital use and spending estimated at $95 per beneficiary per month, relative to traditional Medicare. This resulted in 63 fewer stays in the hospital or a nursing facility per 1,000 beneficiaries per year. No significant changes in the use or spending for professional services, such as doctor visits, were found. In comparison to traditional Medicare, Medicare Advantage was associated with a 36% overall reduction in total health care spending in the first year of coverage. These findings were published in JAMA Health Forum.

A national study led by a team from the University of Michigan used health insurance claims data to evaluate the effectiveness of the Medicare Advantage quality bonus program on improving plan performance. Claims information from 2009 to 2018 was collected for adults, age 50 to 74 years, enrolled in either a Medicare Advantage plan or a commercial health insurance plan without a quality bonus incentive. The researchers evaluated the data for changes in nine indicators of Medicare health care plan quality in both groups, before and after the start of the bonus program.

Although the bonus program was associated with significant quality improvement for Medicare Advantage beneficiaries on four measures, there were significant declines on four other measures and no significant change in the overall quality performance of the Medicare Advantage plans. These findings, published in Health Affairs, suggest that in contrast to the program’s goal, the quality bonus did not improve the overall quality of the Medicare Advantage plans.

The findings from these studies provide important insights for policymakers to consider when making decisions about future Medicare payment policies. Additional research is needed to help understand quality differences for beneficiaries in Medicare Advantage plans and the potential impact of the double bonus payments on racial health disparities in Black beneficiaries.

This research was supported in part by NIA grants P01AG032952 and 2P01AG032952-11.

by National Institute on Aging

Asking questions is key to good communication with your doctor. If you don’t ask questions, he or she may assume you already know the answer or that you don’t want more information. Don’t wait for the doctor to raise a specific question or subject; he or she may not know it’s important to you. Be proactive. Ask questions when you don’t know the meaning of a word (like aneurysm, hypertension, or infarct) or when instructions aren’t clear (for example, does taking medicine with food mean before, during, or after a meal?).

Due to COVID-19, health care providers may offer more telehealth services to keep patients and health care providers safe. You can talk to your health care provider online through video or email, or by phone.

Sometimes, doctors need to do blood tests, X-rays, or other procedures to find out what is wrong or to learn more about your medical condition. Some tests, such as Pap tests, mammograms, glaucoma tests, and screenings for prostate and colorectal cancer, are done regularly to check for hidden medical problems.

Before having a medical test, ask your doctor to explain why it is important, what it will show, and what it will cost. Ask what kind of things you need to do to prepare for the test. For example, you may need to have an empty stomach, or you may have to provide a urine sample. Ask how you will be notified of the test results and how long they will take to come in.

Questions to ask your doctor before a medical test

Why is the test being done?

What steps does the test involve? How should I get ready?

Are there any dangers or side effects?

How will I find out the results? How long will it take to get the results?

What will we know after the test?

When the results are ready, make sure the doctor tells you what they are and explains what they mean. You may want to ask your doctor for a written copy of the test results. If the test is done by a specialist, ask to have the results sent to your primary doctor.

Can I find information about medical tests online?

Yes—there is a lot of information online about medical tests. The National Library of Medicine’s MedlinePlus website provides links to many trustworthy resources. You can get information on preparing for lab tests, explanations of different tests, and tips on interpreting lab test results.

A diagnosis identifies your disease or physical problem. The doctor makes a diagnosis based on the symptoms you are experiencing and the results of the physical exam, laboratory work, and other tests.

Ask the doctor to tell you the name of the condition and why he or she thinks you have it. Ask how it may affect you and how long it might last. Some medical problems never go away completely. They can’t be cured, but they can be treated or managed.

Questions to ask your doctor about your diagnosis

What may have caused this condition? Will it be permanent?

How is this condition treated or managed? What will be the long-term effects on my life?

How can I learn more about my condition?

Understand your medications

Your doctor may prescribe a drug for your condition. Make sure you know the name of the drug and understand why it has been prescribed for you. Ask the doctor to write down how often and for how long you should take it.

Make notes about any other special instructions. If you are taking other medications, make sure your doctor knows what they are, so he or she can prevent harmful drug interactions. Check with your doctor’s office before taking any over-the-counter medications.

Let the doctor know if your medicine doesn’t seem to be working or if it is causing problems. If you want to stop taking your medicine, check with your doctor first.

Get answers to commonly asked questions about medicines and learn more about how you can save money on costly prescriptions.

Don’t hesitate to ask the doctor about the cost of your medications. If they are too expensive for you, the doctor may be able to suggest less expensive alternatives. You can ask if there is a generic or other less expensive choice. You could say, for instance: “It turns out that this medicine is too expensive for me. Is there another one or a generic drug that would cost less?”

For more information about questions to ask the doctor

Centers for Disease Control and Prevention (CDC)
800-232-4636
888-232-6348 (TTY)
[email protected]
www.cdc.gov