Mild Cognitive Impairment (MCI)

We live in a world where an increasing number of our elders are suffering with dementia. This heartbreaking disease often begins with Mild Cognitive Impairment (MCI). Although there is currently no standard approved treatment for mild cognitive impairment, at The London Psychiatry Centre, we provide rTMS following a specialised cognitive protocol designed to maximise benefits for patients with MCI before it develops into dementia. For individuals with MCI, early intervention with rTMS could be a crucial step in slowing cognitive decline and improving quality of life.

Helping our patients to reduce the risk of dementia and maintain their independence for as long as possible.

What is mild cognitive impairment?

Mild cognitive impairment is a condition that lies between the normal cognitive decline associated with ageing and more severe decline, such as dementia. It affects memory, thinking skills, and decision-making but is not severe enough to interfere significantly with daily life. However, people with MCI will often notice subtle cognitive changes that go beyond what they would expect from normal ageing.

Mild cognitive impairment symptoms

If you or someone you know has MCI, you may notice some of the following symptoms:

Forgetfulness, such as missing appointments or frequently losing track of items
• Difficulty following conversations or navigating familiar environments
• Trouble focusing on tasks or making decisions
• Feeling overwhelmed when planning or problem-solving
• Slower processing of information

Although these symptoms can be mild, they may affect day-to-day activities, reducing quality of life and causing frustration or anxiety. Importantly, MCI is also a risk factor for developing dementia, which makes early identification and intervention critical.

MCI and the risk of dementia

Does MCI always lead to dementia? Research shows that people with MCI have a higher likelihood of developing dementia. According to studies, about 10–15% of individuals with MCI progress to dementia each year, compared to 1–2% in the general older population without MCI. Alzheimer’s disease is the most common form of dementia in people with MCI, but other types, such as vascular dementia, can also occur.

Dementia is characterised by a more severe decline in cognitive function, where everyday tasks become increasingly challenging. Symptoms include memory loss, disorientation, language difficulties, and mood changes. In advanced stages, individuals may require full-time care due to their inability to manage basic self-care activities.

The impact of dementia on daily life

Dementia is a progressive condition that drastically affects both the individual and their loved ones. Early on, patients may experience confusion, have trouble remembering recent events, or struggle to find the right words. As the condition worsens, these challenges grow more profound. People with dementia often lose the ability to live independently, requiring assistance with daily tasks like dressing, cooking, and personal hygiene. The emotional toll on both the patient and caregivers can be immense, leading to feelings of helplessness, frustration, and depression.

Mental health disorders and dementia

Individuals with mental health disorders such as depression, anxiety, and bipolar disorder are more likely to develop dementia later in life. Studies indicate that late-life depression is associated with a nearly two-fold increase in the risk of developing dementia. This is part of what is known as neuroprogression and is a cumulative effect of inflammation, stress, failure of neuroplasticity, and genetic vulnerabilities. Moreover, people with schizophrenia, and other psychotic disorders have also been shown to have a higher prevalence of dementia, possibly due to structural brain changes caused by the long-term effects of these illnesses. Given this elevated risk, it is essential to monitor cognitive health closely in people with existing mental health conditions, as early intervention can improve outcomes.

The role of rTMS in preventing dementia in people with MCI

Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive treatment that uses magnetic pulses to stimulate nerve cells in the brain. Originally developed for depression, rTMS has shown promise in treating cognitive disorders, including MCI. This is particularly exciting as there are limited treatments currently available for preventing the progression of MCI to dementia.

rTMS works by targeting specific brain regions involved in memory, attention, and problem-solving –areas often affected in MCI and early dementia. By stimulating these regions, rTMS enhances neural connectivity and brain plasticity, potentially slowing cognitive decline and improving memory function.

How we use rTMS with the cognitive protocol

At The London Psychiatry Centre, we administer rTMS following a specialised cognitive protocol designed to maximise benefits for patients with MCI. This involves targeting key areas of the brain associated with cognition, such as the dorsolateral prefrontal cortex (DLPFC), which is crucial for memory and executive function.

Patients receive rTMS treatments over a series of sessions, typically lasting 30-60 minutes each, depending on the protocol. Most patients experience little to no discomfort during the procedure, and side effects are generally mild and short-lived.

Why choose rTMS for MCI?

There are several reasons why you may choose rTMS as a treatment for MCI:

1. Non-invasive: rTMS does not require surgery or medication, making it a reasonably low-risk option.
2. No major side effects: Compared to pharmaceutical treatments, rTMS has fewer side effects and is well-tolerated by the majority of patients.
3. Evidence-backed: Studies, at the highest level of evidence have shown that rTMS can improve cognitive performance in people with MCI, potentially delaying or preventing the onset of dementia (Kochunov, P., et al. (2021). “Schizophrenia and the Brain’s Connectome: Progress and Challenges in the Use of Brain Imaging to Understand, Predict and Treat Psychiatric Disorders.” Schizophrenia Research).
4. Long-term benefits: By boosting brain plasticity, rTMS may offer lasting improvements in memory and cognitive function, offering hope for people at risk of dementia (Rutherford, G., et al. (2020). “The Use of rTMS for Treatment of Cognitive Impairments in Alzheimer’s Disease: A Systematic Review.” Neuropsychiatric Disease and Treatment. Chou, Y. H., et al. (2020). “Cognitive Effects of rTMS in Mild Cognitive Impairment: A Review and Meta-Analysis.” Alzheimer’s & Dementia.)

At The London Psychiatry Centre, we believe not only in treating “episodes” in sufferers life, but also are the first and only clinic to address neuroprogression by providing cutting-edge, personalised treatment plans for our patients.

For individuals with MCI, early intervention with rTMS could be a crucial step in slowing cognitive decline and improving quality of life.

By combining our cognitive rTMS protocol with ongoing monitoring and care, we aim to reduce the risk of dementia and help our patients maintain their independence for as long as possible.