Which activity modifications are used in the treatment of mild cognitive impairment (MCI)?

Updated: Apr 22, 2019
  • Author: Sonal Mehta, MD; Chief Editor: Jasvinder Chawla, MD, MBA  more...
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Answer

Because physical, social, and mental activity are often recommended for patients with AD and because MCI often heralds AD, many experts have suggested that mentally challenging activities (eg, crossword puzzles and brain teasers) may be helpful for patients with MCI. Although there is no definitive proof that these exercises are efficacious, recommending them to patients with MCI seems advisable.

Such exercises should be kept to a level of difficulty that is reasonable for the patient. Ideally, they should be interactive rather than passive, and they should be administered in a fashion that does not cause excessive frustration. If an activity is not enjoyable or stimulating for the patient, it is unlikely to offer much cognitive benefit. In such cases, searching for other similar cognitive activities may be beneficial.

Social isolation can be minimized through referral to senior community centers or a day treatment program. Cognitive retraining and rehabilitative strategies offer considerable promise in MCI [35] and are therefore being explored.

A growing body of evidence suggests that physical activity and exercise are beneficial for brain health. A prospective study suggested that engaging in moderate exercise of any frequency in midlife or late life was associated with reduced odds of having MCI. [7]  According to one study, aerobic exercise was associated with a slight improvement in cognition. [36]  The 2017 update of the American Academy of Neurology guideline on mild cognitive impairment (MCI), which is endorsed by the Alzheimer's Association, recommends that patients with MCI exercise regularly as part of an overall approach to managing their symptoms. [37]  However, a 2018 study published in BMJ suggests rigorous exercise is not effective against dementia. Researchers assigned 329 participants to an aerobic and strength exercise program and 165 to usual care (n=494). The primary outcome was score on the Alzheimer’s disease assessment scale-cognitive subscale (ADAS-cog) at 12 months. Secondary outcomes included activities of daily living, neuropsychiatric symptoms, health-related quality of life, and carer quality of life and burden. Results show mean ADAS-cog score had increased to 25.2 (SD 12.3) in the exercise arm and 23.8 (SD 10.4) in the usual care arm, which indicates greater cognitive impairment in the exercise group, but the clinical significance of this finding is uncertain. Overall, the study found that a moderate to high intensity aerobic and strength exercise training program does not slow cognitive impairment in people with mild to moderate dementia. [38]

Another study showed certain activities to lower risk of MCI in cognitively normal individuals older than 70 years. These included playing games, reading magazines, being engaged in crafts, computer use, and social activities. Among these, being social and using computers were shown to reduce risk of MCI in people who were APOE4 carriers as well. [39]


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