Treating mild cognitive impairment

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The scientific community continues to devote a lot of attention to the development of medications and other interventions that may help in the treatment of mild cognitive impairment, or MCI. Recently there have been a few promising leads, including FDA approval of drugs for treatment of MCI subtypes related to Alzheimer's disease.

Drugs for cognitive function

There is strong evidence that MCI represents an early stage of a neurodegenerative condition such as Alzheimer's disease that will ultimately lead to dementia. Although there is no cure as yet for Alzheimer's disease, a drug recently approved by the FDA can be prescribed to modestly slow the progression of early Alzheimer's and related subtypes of MCI. The drug can also help alleviate certain cognitive and behavioral symptoms, which accompany the condition.

Amyloid-targeting medications

Drugs in this category are designed to slow the progression of Alzheimer's disease and related types of MCI by targeting the buildup of abnormal proteins in the brain that cause the cognitive dysfunction.

Lecanemab. This intravenous (IV) drug, which received full FDA approval in July 2023, is a form of passive vaccination consisting of lab-created antibodies against the plaques of amyloid protein that accumulate in the brains of people with Alzheimer's disease. The drug, given by IV infusion every two weeks, is designed to clear these deposits and slow down the neurodegenerative process. It is covered by Medicare and other insurers,

Lecanemab is the first treatment of its kind to show clear evidence of clinical effectiveness in people with MCI. Scores on clinical scales showed less decline on measures of cognition and daily functioning over an 18-month period in people who took the drug than in those who received a placebo. Lecanemab can be prescribed to treat people with MCI or mild dementia due to Alzheimer's disease who have confirmed high levels of beta-amyloid in the brain.

Donanemab. In July 2024, the FDA approved this medication as the newest addition to the class of monoclonal antibody medications that target beta-amyloid accumulation in the brain. The 2023 results from a large, final-stage (phase 3) clinical trial showed that people with early symptoms of Alzheimer's disease randomly assigned to take the medication had significantly slower cognitive and functional decline, compared with those who received a placebo. Donanemab is given by IV infusion every four weeks. It is approved for treatment of MCI and mild Alzheimer's disease.

All of these anti-amyloid treatments carry side effects that can sometimes be severe.

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Medications to lower the risk of heart attack and stroke may help prevent MCI or impede development of dementia in someone who already has MCI.

Drugs that treat symptoms

Clinical trials that included people with MCI have been conducted with donepezil, rivastigmine, and galantamine, the three drugs most commonly used for treating memory and cognition problems of Alzheimer's dementia. However, none of these drugs has been shown to be effective in improving or delaying the decline in cognitive abilities or daily functioning in people with MCI. Therefore, they are not recommended for treatment of MCI.

Herbal supplements

Several widely used herbal and dietary supplements, including Ginkgo biloba and vitamin E, have been described as helpful for cognitive function and brain health, but clinical trials to date have not supported these claims.

Cardiovascular disease risk reduction

Blockages in the blood flow through the vessels in the brain can cause tissue damage that speeds the pace of cognitive decline in people with MCI. Lifestyle changes and medications aimed at lowering the risk of stroke and heart disease may also help prevent MCI or prevent progression from MCI to dementia. This holds true even for people who do not have evidence of existing brain injury. Some of these strategies include lowering blood pressure, quitting smoking, using statin medicines for high cholesterol, and taking blood thinners.

Cognitive training

Research has shown that structured cognitive training programs, either in a group setting or computer-based, may help compensate for or alleviate the process of cognitive decline in people with MCI or mild dementia. Cognitive training has shown benefits in overall cognition, memory, working memory, and executive function.

Some medical centers offer weekly cognitive stimulation groups that provide opportunities to learn memory-enhancement techniques and engage with other participants. Another alternative is participation in guided sessions that focus on a set of standardized tasks with varying levels of difficulty. The goal is to strengthen specific cognitive domains in order to extend skills beyond the rehearsed tasks. A third type of intervention is to have personalized cognitive rehabilitation sessions with a clinician who specializes in memory and other cognitive problems. These sessions emphasize the participants' personal goals in order to maximize physical and social function on a daily basis.

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It's unclear whether computerized brain fitness programs help overall memory or functioning, but research continues.

When it comes to the effectiveness of computerized brain-fitness programs, however, be wary of exaggerated claims about the results. While there is good evidence that these programs can improve your ability to perform the specific tasks in the program, it's unclear if this translates into helping overall memory or everyday functioning. That said, a couple of small studies have found that a few specific computer programs may extend the improvement to other cognitive domains, especially the speed of processing information within the brain. Bear in mind that these results are preliminary and must be replicated in larger studies to be considered valid.

Mindfulness training

Another avenue being explored is the impact of mindfulness on cognition. Mindfulness is broadly defined as a state of present-focused, nonjudgmental awareness. Growing evidence has linked mindfulness to cognitive and psychological improvements that could be relevant for MCI, including in the realms of attention, psychomotor function (physical actions that require conscious thought, such as riding a bike or playing a musical instrument), and possibly memory. Mindfulness-based interventions have also shown promise in improving mood and cognition in Parkinson's disease, multiple sclerosis, depression, and anxiety. These benefits may also extend to people with MCI.

Physical activity

Exercise is an important component for maintaining overall good health, including brain health, even for people who are already showing signs of cognitive impairment. In a study in JAMA, people in their 50s and older who reported memory problems but did not have dementia showed improvement on cognitive tests after six months of participating in a home-based exercise program.

In a subsequent study published in the British Journal of Sports Medicine, a six-month program of twice-weekly aerobic exercise was found to increase the volume of brain regions such as the hippocampus in older people with MCI. Additionally, a recent article that reviewed multiple studies on physical activity in people with MCI concluded that regular exercise improved cognition, functional independence, and psychological health.

In addition, data gathered from over 216,000 participants in the Behavioral Risk Factor Surveillance System (BRFSS) showed that people who regularly engaged in some form of physical activity were much less likely to express concern over their self-perceived sense of cognitive decline. The BRFSS is a state-based system that collects data from people in the United States on chronic health conditions and health-related behaviors. The benefit was most pronounced in people who exercised for 241 to 300 minutes per week, about 35 to 45 minutes a day.