A Multifactor Approach to Mild Cognitive Impairment

Taha Qarni, BHSc; Arash Salardini, MD


Semin Neurol. 2019;39(2):179-187. 

In This Article

Management of MCI

Disease Modifying Interventions

Presently, there is no evidence for the use of medications as disease modifiers. However, given that vascular risk factors seem to be predictors of progression in vascular disease and AD, we recommend optimal management of modifiable vascular risk factors with the help of the primary care physician. At the very least, interventions to reduce vascular risk factors have been shown to benefit cardiac health and reduce the risk of strokes. Therefore, an absence of demonstrated efficacy in MCI should not be a barrier to these interventions.[42] We use the cut-offs used for stroke secondary prevention from the 2014 American Heart Association/American Stroke Association guidelines.[43] This is a practice we have adopted, but evidence for its application to cognitive disorders is lacking. Similarly, exercise has beneficial effects for a large number of conditions affecting the elderly and may be incorporated into the treatment of MCI.[44] We recommend our patients engage in at least three half-hour sessions of aerobic exercise weekly.

The decision to include cognitive interventions and supplements is less certain. There is no evidence that over-the-counter supplements change the clinical course of MCI.[45] When supplements have demonstrated efficacy for other conditions which the individual may suffer from, adding over-the-counter supplements may be helpful. Cognitive rehabilitation may help with particular tasks and improve feelings of self-efficacy. However, most insurance do not cover cognitive rehabilitation for MCI.[46]

Symptomatic Interventions

We find management of comorbid anxiety or depression with a small dose of an antidepressant improves the general functioning of our patients.

There is some (not strong) evidence that support the use of selective serotonin reuptake inhibitors in the MCI population.[47] Additionally, we find that in individuals with late-stage MCI who have a lot of symptomatic fluctuations, the use of cholinesterases may be helpful; however, evidence is lacking for this indication. The overall cognitive effect of the cholinesterases in several large heterogeneous cohort studies has been disappointing.[47]