by Nawab John Dar
Although no definitive method exists to halt the progression of MCI or prevent Alzheimer’s disease, adopting certain habits may reduce the risk.
June marks Brain and Alzheimer’s Awareness Month, offering a timely opportunity to reflect on the nature of memory. Moments of forgetfulness, misplacing a vehicle or struggling to recall a neighbour’s name, can provoke unease, particularly with age. When do these lapses reflect more than a fleeting distraction? Mild Cognitive Impairment, or MCI, occupies a space between routine forgetfulness and significant cognitive decline such as dementia.
With India’s ageing population projected to reach 323 million by 2050, and regions like Jammu and Kashmir already reporting above-average dementia rates, understanding MCI becomes vital to safeguarding cognitive health in later life.
What is Mild Cognitive Impairment?
MCI involves subtle but measurable changes in memory or thinking that do not disrupt daily function. Consider a retired shopkeeper in Srinagar who struggles to recall details of a recent conversation or finds it difficult to plan his weekly trip to the vegetable market. He continues to manage his household, attend prayers at the mosque, and engage with neighbours, yet these small lapses trouble him. This represents MCI, the brain exerting more effort, though not in decline.
Studies estimate that MCI affects between 6.7 and 26.06 per cent of individuals over 60. A 2023 study in Jammu and Kashmir recorded a dementia rate of 10.1 per cent among adults aged 60 and above, surpassing the national average of 7.4 per cent. This suggests that MCI may also be more prevalent in the region. Some individuals stabilise or show improvement, especially when the cause is correctable, such as a vitamin deficiency or thyroid disorder.
Approximately 29 per cent of people diagnosed with MCI revert to typical cognitive patterns over time. However, for others, MCI can progress to Alzheimer’s or other forms of dementia. Currently, 8.8 million Indians over 60 live with dementia, a number expected to rise to nearly 17 million by 2036.
There are two principal types of MCI. Amnestic MCI primarily affects memory and carries a higher risk of progression to Alzheimer’s disease. Non-amnestic MCI impacts cognitive functions such as language or executive planning and is often linked to vascular dementia. This poses a significant concern in areas where hypertension affects 13.83 to 17.76 per cent of older adults, and diabetes is present in 16.93 to 18.25 per cent.
Recognising and Diagnosing MCI
Doctors employ specific cognitive assessments to identify MCI. These tools are adapted to reflect local languages and cultural contexts to ensure comprehension across educational backgrounds. A formal diagnosis requires observed memory issues, measurable cognitive decline, intact daily functioning, and the absence of dementia.
The Montreal Cognitive Assessment, known as MoCA, was developed in Canada in 1996 by Dr Ziad Nasreddine and validated for clinical use in 2005. It is a ten-minute test involving word recall, clock drawing, and object naming. A score below 26 out of 30 suggests MCI. For instance, a 58-year-old tailor in Jammu who struggles to manage customer orders might be given the Urdu or Dogri version of MoCA. He may be asked to recall place names like ‘Tawi’ or ‘Katra’, or draw a clock set to 10:45, tasks designed to test attention and memory in a culturally relevant way. Research confirms that MoCA is effective when translated into regional languages such as Hindi, Urdu, and Kashmiri.
The Mini-Mental State Examination, or MMSE, was created in 1975 by Dr Marshal Folstein in the United States. It evaluates basic orientation and calculation, such as identifying the date or subtracting sevens from 100. A score below 24 may indicate cognitive impairment. A 72-year-old farmer in rural Kashmir who frequently repeats stories about his orchard may undergo the Kashmiri version of the MMSE. He might be asked to identify the season or spell simple words such as ‘house’. While the MMSE is less sensitive to early-stage MCI, it is useful for identifying more pronounced decline. Doctors in remote areas adjust the test to account for low literacy, replacing unfamiliar concepts with locally understood terms.
The Clinical Dementia Rating, or CDR, originated in the 1980s at Washington University under Dr John Morris. It differs from standardised tests by relying on structured interviews with patients and family members. A score of 0.5 typically corresponds to MCI. A retired clerk in Leh may be able to cook or attend prayers but require reminders about utility payments or festivals like Losar. Her family might be asked whether she forgets recent events or struggles to organise meals.
In regions with limited access to neurologists, community health workers often assist in collecting such information. While the CDR is standard in urban memory clinics, rural practitioners frequently use informal observations or tools such as the Mini-Cog, a brief test combining word recall and clock drawing, or the GPCOG, a general practitioner assessment, before referring patients for further evaluation.
To ensure an accurate diagnosis, neurologists often combine cognitive tests with neuroimaging and laboratory investigations to eliminate other possible causes. This integrated approach is particularly important in Jammu and Kashmir, where access to specialists remains limited and diagnosis must be adapted to local conditions.
The Many Faces of MCI
Mild Cognitive Impairment presents differently in each individual. A retired teacher in Delhi who struggles to recall recent headlines may be experiencing an early stage of memory-related MCI. In contrast, a homemaker in Srinagar who finds it difficult to manage both recollection and household organisation could be facing a more advanced stage. Clinicians categorise MCI into early, middle, or late phases based on the number of cognitive domains affected and the degree of assistance required.
In Jammu and Kashmir, where family care remains the primary form of elder support, this classification helps determine when to introduce additional aid, whether through structured reminders or help with domestic responsibilities.
Not every person with MCI progresses to dementia. Only between 5 and 15 per cent of cases convert to Alzheimer’s disease annually, meaning that 85 to 95 per cent remain stable or show improvement. Factors that increase the likelihood of progression include memory-related MCI, advanced age, and a family history of dementia. In Jammu and Kashmir, hypertension affects 20.4 per cent of older adults, while depression is present in 31 per cent of MCI cases. Both conditions significantly elevate the risk of deterioration.
The symptoms of MCI tend to be understated. Common signs include frequent misplacement of items, missing scheduled appointments, difficulty in finding words or losing track during conversations. A retired railway worker in Jammu might mislay his pension booklet or become disoriented during a conversation at a local tea stall. Emotional changes such as anxiety or sadness also accompany MCI.
Cultural norms sometimes prevent individuals from speaking openly about these concerns, but they are critical indicators. Depression, in particular, is a strong predictor of cognitive decline. Unlike dementia, however, MCI permits individuals to retain autonomy in most aspects of daily living, requiring only minimal assistance.
Managing Risk and Supporting Memory
Although no definitive method exists to halt the progression of MCI or prevent Alzheimer’s disease, adopting certain habits may reduce the risk. Controlling hypertension and diabetes, prevalent among 13.6 and 18.7 per cent of older adults respectively, can protect cognitive function, particularly in Jammu and Kashmir, where these health issues are widespread. Physical activity remains a cornerstone of brain health. Daily neighbourhood walks or basic stretching exercises at home are accessible routines that contribute to mental sharpness. Social engagement, through casual conversations with neighbours, participation in tea stall discussions, or involvement in community efforts such as organising market days, also strengthens cognitive resilience.
Dietary habits play a role. Locally available foods such as lentils, leafy greens, and turmeric possess anti-inflammatory properties and support memory preservation. Addressing emotional well-being is equally vital. Depression and sleep disturbances, present in 31 per cent of MCI cases, can dull mental acuity. Attending to these concerns contributes not only to cognitive clarity but to overall quality of life.
MCI is a preliminary indicator of possible cognitive decline, not a diagnosis of dementia. As India’s ageing population continues to expand and dementia rates in regions like Jammu and Kashmir rise, early intervention becomes increasingly urgent. Through routine health management and continued social connection, it remains possible to maintain a fulfilling life. This June, attention to brain health and support for those experiencing MCI offers a way forward, both for individuals and for the families who walk beside them.
(The author is a neuroscientist and Postdoctoral Fellow at the Salk Institute, California. His research focuses on Alzheimer’s disease, particularly the roles of iron, stress, and cell death. He also works to improve brain health access in underserved regions, including Jammu and Kashmir, through Teleprac Healthcare. Ideas are personal.)
