Mild and Major Cognitive Impairment

Mild cognitive impairment (MCI) and major cognitive impairment, often referred to as dementia, represent different stages of cognitive decline. What differentiates the two is mainly the severity of symptoms and how much those manifestations impact the patient’s everyday life. MCI refers to a noticeable decline in cognitive abilities that is greater than expected for an individual’s age and educational background but does not significantly interfere with daily functioning. It is the state in between normal cognition and major cognitive impairment. Not all individuals with MCI will progress to major neurocognitive disorders, but they have a higher risk compared to those without MCI (Peterson, 2023).

Individuals with MCI may experience mild memory loss, particularly in recent events. They may also exhibit difficulties with other cognitive functions such as attention, language, problem-solving, or decision-making. Generally, they can still manage their day-to-day activities independently, although they may take longer or require more effort for complex tasks. They are often aware of their cognitive difficulties and may feel concerned or frustrated about their deficits (Peterson, 2023).

Major cognitive impairment refers to a more severe and progressive decline in cognitive functioning that significantly impacts daily life and independence, across one or more cognitive domains. It affects an individual’s ability to perform routine activities independently, such as self-care, managing finances, driving, or maintaining household tasks. Assistance or supervision may be required. They often have reduced insight into their cognitive deficits and may be less aware of their functional limitations. Major cognitive impairment is typically progressive, with decline worsening gradually over months or years. The rate of progression varies depending on the underlying cause and individual factors (Peterson, 2023).

Table 1. Cognitive Domains (Weinberg & Holiman, 2023).

CategoryDefinitionClinical Manifestations
Learning and memoryThe acquisition, retention, and retrieval of new information. It includes both immediate and delayed recall, recognition memory, and learning new skills or procedures.Difficulty in remembering recent eventsProblems with recalling past memoriesChallenges in learning and retaining new information
LanguageThe comprehension and production of spoken or written language. It includes tasks such as understanding and expressing ideas, following verbal instructions, reading, and writing.Word-finding difficultiesProblems with understanding and comprehending language (receptive and expressive deficits)/li>
Executive functionHigher-order cognitive processes responsible for planning, problem-solving, decision-making, and goal-directed behavior.Difficulty organizing and implementing tasksMaking inappropriate judgmentsLimited self-control
Complex attentionThe ability to focus, sustain attention, and shift attention appropriately in complex or demanding situations. It includes tasks such as divided attention, working memory, and selective attention.Trouble staying focusedEasily distractedDifficulty multitasking
Perceptual-motorThe ability to perceive and interpret information and use that to navigate and interact with the surrounding environment.Impaired spatial orientationProblems with depth perceptionDifficulty recognizing objects or facesUnable to accurately judge distances
Social cognitionThe ability to understand and interpret social cues, emotions, and intentions of others.Difficulty recognizing emotionsUnable to understand social normsTrouble maintaining appropriate social behavior
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