Synopsis
Identify objective cognitive decline that has not removed everyday independence, investigate acute and treatable contributors, explain uncertainty without minimising symptoms, and arrange proportionate risk reduction and longitudinal reassessment.
- MCI describes measurable decline in one or more cognitive domains with broadly preserved independence and insufficient functional impact for dementia; it is a syndrome, not a single disease.
- Ask the person and, with consent, someone who knows them for concrete changes in memory, language, executive, visuospatial and social-cognitive tasks over time.
- Separate ordinary lapses from repeated decline, but do not use age, one normal screen or high premorbid ability to dismiss a consistent history.
- Exclude delirium first and assess depression, sleep, alcohol, medicines, hearing, vision, endocrine, nutritional, vascular and neurological contributors.
- Use an adapted validated cognitive instrument to describe domains; the score neither establishes aetiology nor reliably predicts an individual's progression.
- Daily function is the critical boundary: examine complex tasks closely and distinguish compensatory strategies from loss of independence.
- Not everyone with MCI develops dementia; some remain stable or improve, while others have an underlying neurodegenerative or vascular process.
- There is no general indication to start donepezil, rivastigmine, galantamine or memantine simply because MCI has been recorded.
- Optimise cardiovascular health, physical activity, sleep, sensory function, medication burden and meaningful cognitive and social activity for their broader benefits.
- Agree a review interval and earlier-return triggers, repeating function, mood, cognition and safety rather than chasing small score changes in isolation.
Key red flags
Abrupt or fluctuating inattention, drowsiness or agitation indicates possible delirium and needs same-day physiological assessment and cause treatment.
Sudden facial, arm, speech, visual or balance deficit requires emergency stroke assessment from the last-known-well time.
Weeks-to-months rapid progression, seizures, myoclonus, ataxia, focal signs or personality change requires expedited neurological assessment.
Getting lost, unsafe driving, missed essential medicines, financial exploitation or recurrent kitchen incidents may show that independence is no longer preserved.
Suicidal thinking, profound self-neglect, psychosis or severe depressive biological symptoms needs urgent mental-health and safety assessment rather than attribution to cognition.
A coercive relative, unexplained transactions, injury or neglect raises a safeguarding concern even when the person appears to agree.
Investigation priorities
Define domain, onset, trajectory, compensatory strategies, daily function and safety using concrete examples.
Management branches
Attention, arousal, cognition or neurological function changes over hours or days.
- Assess ABCDE, glucose, observations, focal neurology and immediate risk while obtaining the last reliable baseline.
- Treat delirium, stroke, seizure, infection, trauma or metabolic causes through the appropriate urgent pathway.
- Reassess cognition and everyday function after recovery rather than carrying an acute MCI label forward.
Persistent cognitive change is reported without an acute physiological or neurological emergency.
- Take person and consent-based collateral histories, examine function, mood, sleep, substances, senses, medicines and physical health.
- Use an adapted validated cognitive instrument and targeted investigations, referring for specialist or neuropsychological assessment when needed.
- Classify the current syndrome transparently, document uncertainties and address contributors, safety and modifiable health risks.