Better Care for Older Adults With Mild Impairment of Cognition or Behavior-View Presentation

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Video Summary

The symposium focuses on recognizing and improving care for people in the “gray zone” between normal aging and dementia—mild cognitive impairment (MCI) and the newer concept of mild behavioral impairment (MBI). Dr. Seba Hussain Crowter reviews the spectrum from normal cognitive aging (slower processing but preserved function and often improved vocabulary/wisdom) through subjective cognitive decline, to MCI (modest objective decline in one or more cognitive domains with largely preserved independence) and dementia. She emphasizes MCI’s prevalence, heterogeneous outcomes (progression, stability, or reversion), and the importance of assessing all six cognitive domains, not just memory. MBI is defined as later-life, persistent (≥6 months) new behavioral/personality change—apathy, mood dysregulation, impulse control problems, social inappropriateness, or psychotic symptoms—and is linked to neurodegeneration, worse cognitive testing, higher dementia risk, and substantial caregiver burden.<br /><br />Both speakers highlight that MCI/MBI are often missed in primary care due to time limits, bias about “normal aging,” cognitive reserve, and inadequate screening. The MoCA is presented as the most sensitive common cognitive screener. Evaluation should include patient and informant history, labs, and selective imaging.<br /><br />Dr. Ellison reviews treatments: traditional dementia drugs (cholinesterase inhibitors, memantine) have modest dementia benefits but generally do not help MCI. He explains Alzheimer’s biomarker frameworks (ATN) and growing use of blood biomarkers (especially phospho-tau) to improve diagnostic precision. Disease-modifying anti-amyloid monoclonal antibodies (lecanemab, donanemab) can slow decline in biomarker-confirmed early Alzheimer’s (including MCI due to AD) but require careful eligibility screening and MRI monitoring for ARIA risks.<br /><br />Dr. Matt Cohn presents lifestyle-based risk reduction (Lancet modifiable risks) and multi-domain trials (e.g., FINGER), then describes BrainWISE, a community group program teaching exercise, MIND diet, hearing health, memory strategies, sleep/stress management, and goal-setting to support behavior change. Q&A addresses sleep apnea, benzodiazepines, supplements, and practical counseling/legal planning after an MCI diagnosis.

Keywords

mild cognitive impairment (MCI)

mild behavioral impairment (MBI)

subjective cognitive decline

normal cognitive aging

cognitive domains assessment

Montreal Cognitive Assessment (MoCA)

primary care screening gaps

Alzheimer’s disease biomarkers (ATN)

blood biomarkers phospho-tau

anti-amyloid monoclonal antibodies

lecanemab and donanemab

ARIA MRI monitoring

lifestyle risk reduction (FINGER/BrainWISE/MIND diet)