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The value of early detection
The clinical value of MCI lies in the ability to identify a pathological process early and act on the modifiable factors that can influence its course. Sleep, cardiovascular health, physical and cognitive activity, mood, and the treatment of coexisting conditions are all levers that can shift the trajectory of MCI. An initial assessment establishes a reference point that makes it possible to track changes over time and guide future clinical decisions.
Mild Cognitive Impairment (MCI) Assessment in Montréal
Recognizing decline that goes beyond normal aging.
Mild cognitive impairment sits in the clinical zone between normal aging and dementia. The neuropsychological assessment establishes a precise picture of cognitive functioning, clarifies what falls under MCI, and guides appropriate follow-up.
Mild Cognitive Impairment
The clinical zone between normal aging and dementia
Mild cognitive impairment refers to an objective decline in one or more cognitive functions that exceeds what is expected for a person’s age, without reaching the threshold that defines dementia. A person with MCI retains most of their independence in daily activities, but family members, or the person themselves, may notice that certain tasks become more difficult, that recent memory lapses accumulate, or that a cognitive slowdown sets in. MCI is not a disease in itself, but a clinical state that can remain stable, improve, or progress to dementia depending on the underlying cause.
Expertise directly rooted in this disorder | Doctoral thesis (Psy.D.) · Université du Québec à Montréal · 2023
Mood and sleep symptoms in Parkinson's disease in relation to mild cognitive impairment
Mild cognitive impairment is at the heart of Dr. Diab’s doctoral research. This expertise feeds directly into the clinical assessment offered at the practice and makes the reading of a cognitive profile particularly precise in neurodegenerative contexts.
The research documents the relationships between mood symptoms, sleep disturbances, and the emergence of mild cognitive impairment in people living with Parkinson’s disease. The study combines neuropsychological assessment, neurological examination, and polysomnography to characterize a clinical profile rarely documented in private practice in QuĂ©bec. It sits at the intersection of neurology, sleep, and the neuropsychology of aging.
Subtypes
Amnestic MCI and non-amnestic MCI
MCI presents in two broad clinical forms, depending on which cognitive functions are most affected. Amnestic MCI is characterized by a predominant impairment of memory, with or without impairment of other functions. It is the most studied form and the one most often associated with an increased risk of progression to Alzheimer’s disease. Recent episodic memory is typically affected, with lapses that are not easily recovered with cues.
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Non-amnestic MCI
Non-amnestic MCI includes profiles where memory is relatively preserved but other cognitive functions are affected, such as attention, executive functions, language, or visuospatial cognition. This form points more toward other underlying causes, such as vascular dementia, dementia with Lewy bodies, or a cognitive disorder linked to Parkinson’s disease. The distinction between subtypes shapes the clinical interpretation and follow-up recommendations.
Progression and protective factors
MCI does not always lead to dementia
MCI is a cognitive state whose course varies considerably from person to person. Longitudinal studies suggest that about a third of people with MCI progress to dementia within the following five years, a third remain stable, and another third see their functioning improve, particularly when the picture is explained by a reversible factor such as depression or an untreated sleep disorder. Documented protective factors include quality sleep, regular physical activity, cognitive and social engagement, treatment of mood disorders, and management of cardiovascular factors. It is precisely to act on these levers that early detection matters.
Longitudinal follow-up
Why ongoing follow-up is an integral part of the process
The initial assessment establishes a baseline clinical picture, and longitudinal follow-up documents how it evolves. Here is the typical schedule for neuropsychological follow-up of MCI.
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T0. Initial assessment
Complete characterization of the current cognitive profile, identification of the functions affected, ruling out reversible causes, and formulation of recommendations. This assessment serves as the baseline against which later assessments will be compared.
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6 months. First reassessment
A check on short-term change, particularly relevant when the initial assessment raised diagnostic uncertainty or when a modifiable intervention has been put in place. It helps confirm stability or objectively identify change.
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12 months. Annual follow-up
Comparison with the initial assessment to document the trajectory over one year. This window is usually enough to distinguish stable MCI, improving MCI, or progressing MCI. Recommendations are adjusted accordingly.
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24 months +. Longer-term follow-up
Depending on the trajectory observed, follow-up can become less frequent or, conversely, more frequent. The two to five year window is the key period for distinguishing MCI that remains benign from MCI that progresses to dementia, along with the clinical decisions that follow.
Signs to watch for in older adults
What might prompt an assessment for yourself or a loved one
Here are signs commonly reported that go beyond what is expected of normal aging and that may justify a clinical assessment.
- Recent memory lapses that accumulate and that the person cannot recover with cues, such as forgetting an important conversation a few hours later
- Difficulty retaining new information, such as a doctor's instructions or the content of a book just read
- Cognitive slowdown noticed by the person or by loved ones, that is not explained by fatigue or a passing low mood
- Difficulty carrying out a complex, previously familiar task, such as preparing a recipe, managing finances, or planning a trip
- Subjective memory complaints lasting more than a few months, even if loved ones do not yet perceive a major change
- A change in cognitive performance associated with a sleep disturbance, a depressed mood, or a recent medical event
- Recurring family concern about the person's memory or judgment, without a clear medical diagnosis having been made
- A need for clinical clarity before an important decision, such as retirement, a power of attorney, a move, or estate planning
MCI Assessment
The tests used to detect and characterize mild cognitive impairment
The assessment combines widely recognized screening tools with a complete neuropsychological battery that helps refine the cognitive profile.
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Clinical and collateral interview
Medical, medication, and developmental history. A description of cognitive complaints, and how the difficulties began and evolved. An interview with a loved one when possible, to cross reference perceptions and document changes observed in daily life.
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Cognitive screening tools
Administration of screening tools such as the MoCA (Montreal Cognitive Assessment) or the MMSE when indicated. These tools provide a quick reference point but do not replace the complete battery, particularly in cases of MCI where impairments can be subtle.
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Detailed neuropsychological battery
An in-depth evaluation of episodic memory, attention, executive functions, language, and visuospatial cognition. Integrating these measures makes it possible to distinguish amnestic MCI from non-amnestic MCI and to point toward the most likely underlying cause.
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Integrated analysis and recommendations
Connecting the cognitive profile with the clinical history, with comorbidities such as depression, anxiety, or sleep disorders, and with current medical factors. Formulation of recommendations for the person, for their loved ones and, where relevant, for the treating physician.
Before you consult
The most frequently asked questions about MCI
If your question isn’t on this list, reach out directly to discuss it.
Mild Cognitive Impairment refers to an objective decline in one or more cognitive functions that goes beyond what is expected for the person’s age, without reaching the threshold of dementia. The person retains most of their independence in daily life. MCI is not a disease in itself but a clinical state that can remain stable, improve, or progress depending on the underlying cause.
No. Longitudinal studies suggest that about a third of people with MCI progress to dementia, a third remain stable, and a third see their functioning improve, particularly when a modifiable factor such as depression or a sleep disorder is identified and treated. Longitudinal follow-up helps clarify the trajectory.
Normal aging comes with a modest cognitive slowdown and mild memory difficulties that do not affect daily life. MCI is distinguished by a decline that is objectively measured through standardized tests, that goes beyond the variation expected for the person’s age, and that is noticed by the person or their loved ones. The clinical assessment allows for this distinction to be made.
An early assessment makes it possible to identify reversible causes such as depression, a sleep disorder, or a medication effect, to act on modifiable factors that can influence the trajectory, and to establish a reference point for follow-up. It also allows the person and their family to anticipate and plan with a clear understanding of the situation.
The MoCA and the MMSE are screening tools used in many clinical settings. They provide an initial benchmark but are not enough on their own to characterize MCI. A complete neuropsychological battery evaluates episodic memory, attention, executive functions, language, and visuospatial cognition, which makes it possible to distinguish between subtypes and point toward the most likely underlying cause.
Most private insurance plans partially or fully cover assessments carried out by a psychologist who is a member of the Ordre des psychologues du Québec. Fees are eligible for the federal and provincial medical expense tax credit. The exact terms vary from plan to plan and should be confirmed with your insurer before the first appointment.