The Mayo clinic defines Mild Cognitive Impairment as a transition stage between the cognitive decline of normal aging and the more serious problems caused by Alzheimer's disease. The disorder can affect many areas of thought and action—such as language, attention, reasoning, judgment, reading, and writing. However, the most common variety of mild cognitive impairment causes memory problems.


According to the American College of Physicians, Mild Cognitive Impairment affects about 20 percent of the population over 70. Many people with Mild Cognitive Impairment eventually develop Alzheimer's disease, although some remain stable and others even return to normal.


A study was completed by Linda K. McEvoy, Ph.D., assistant project scientist in the Department of Radiology at the University of California San Diego School of Medicine in La Jolla.


For the study, Dr. McEvoy and colleagues set out to determine if they could identify a pattern of regional atrophy characteristic of mild Alzheimer's disease in order to aid in the prediction of cognitive decline in patients with MCI.


In the study, the researchers analyzed brain MRI images from 84 patients with mild Alzheimer's disease, 175 patients with MCI, and 139 healthy controls, using with semi-automated, individually specific quantitative MRI methods. The results showed widespread cortical atrophy in some patients with MCI, involving all cortical areas except those involved with processing of primary motor and sensory information. However, most indicative of future cognitive decline were atrophy in parts of the medial and lateral temporal lobes and in the frontal lobes. This pattern was also present in the patients with mild Alzheimer's disease.


"Although these individuals are reporting problems mainly with memory, the atrophy involves more than just memory areas, extending into brain regions involved in planning, organization, problem solving and language," Dr. McEvoy said.


"Our results show that some individuals with MCI have the atrophy pattern characteristic of mild Alzheimer's disease, and these people are at higher risk of experiencing a faster rate of brain degeneration and a faster decline to dementia than individuals with MCI who do not show that atrophy pattern."


This study (and others) demonstrates the changes in the brain due to Alzheimer’s and the resulting change in function in the ability to use executive skills. Allen Cognitive Level 5 performance is often referred to as an Executive Function Disorder and is compared to Mild Cognitive Impairment. Although persons performing at Allen Level 5 may successfully live independently, they require some assistance with new and/or complex tasks. This is because their abilities to plan ahead, clearly understand the secondary effects of actions, organize, prioritize, and generalize learning from one situation to another are compromised. In addition, their best ability to problem solve is through trial and error. 


They are able to process multiple written and verbal materials, although they may be slow or make overt errors. Occupational performance demonstrates inefficiency and error when there are many details or subtle cues to consider.


The ability to formulate and follow plans and perform IADLs is difficult in daily life if these are complex. For example, this may be seen in complex medication management, (ordering medication to avoid running out, taking medication at specific times throughout the day, incorporating these times into different scheduled days, monitoring blood pressure and/or blood sugar throughout the day, recording the results and changing the dose of medication).


It is important to remember that when assessing for an Allen level through observation of functional performance, a level cannot be assigned until a pattern of behavior is observed. If a person runs out of medication, this does not mean the person is performing at Allen Cognitive Level 5. However, if the person frequently runs out of medication and frequently misses dosages, this is a pattern of behavior.


The leather lacing tool, the Allen Cognitive Level Screening Tool, is another way to assess for Allen Cognitive Level 5 performance. “The abilities to understand complex visual cues, secondary effects of one’s actions and to solve problems with material objects by inductive or deductive reasoning are put to use in completion of this task.” Riska-Williams, L., Allen, C., Austin, S., David, S., Earhart, C., McCraith, D., Maunal for the ACLS-5 and LACLS-5., 2007.


The diagnosis of Mild Cognitive Impairment is being recognized as an important intervention. Should this diagnosis indicate there will be a progression into Alzheimer’s disease, medications may be able to slow the rate of decline.


In addition, persons with Mild Cognitive Impairment require some assistance with complex IADLs. Without the recognition of the need for assistance, the person may not adequately complete important tasks such as financial and medication management. The person may experience frustration, even depression when noting the change in abilities. Providing simple supports and memory cues may reduce this frustration and help maintain the person’s independence.


Understanding of the Allen Cognitive Abilities model and competence in the administration of the evaluation tools related to the model can lead to an accurate assessment of Mild Cognitive Impairment. This early recognition of executive skills deficits may assist in maintaining independence and quality of life for the person with Mild Cognitive Impairment.


Mild impairments associated with Mild Cognitive Impairment (in the literature) coincide with the descriptions of performance at Allen Cognitive Level 5.