Page 331 - Encyclopedia of Nursing Research

298 n MILD COGNITIVE IMPAIRMENT

To date, MCI research has been predom- activities such as driving or using power
inantly biomedical and epidemiological, and tools (yueh-Feng et al., 2007). Problems with
M this is understandable given the relative new- executive functioning such as difficulties
ness of the concept and the ongoing effort to operating household appliances, declin-
attain diagnostic clarity and to better under- ing cooking skills, difficulties managing
stand its pathophysiology. Some nursing finances, and decline in home repair and
research has been conducted; however, much maintenance skills have also been reported
of which has focused on MCI caregivers. Key (Chirileanu et al., 2008). Although cognitive
studies have explored caregiver burden and symptoms have been the key features of
psychiatric morbidity in spouses (Garand, MCI, recent research has demonstrated that
Dew, Eazor, DeKosky, & Reynolds, 2005), like AD, people with MCI may also exhibit
depressed mood among informal caregivers behavioral symptoms. Garand et al. (2005,
(yueh-Feng, 2007), and marital quality among 2007), for example, found “repeatedly asking
couples where one person has MCI (Garand the same question,” “trouble remembering
et al., 2007). Future research endeavors might recent events,” “losing or misplacing things,”
continue to examine the etiology and preva- “forgetting what day it is,” and “talking little
lence of the various subtypes as well as the or not at all” to be common and to be among
continued identification of possible biomark- the most stressful symptoms for family
ers. Work on validating screening instru- caregivers. Lopez, Becker, and Sweet (2005)
ments and neuropsychological scales specific reported disruptive and psychotic behaviors
to MCI is also needed as is further clarity that are more usually found in established
on the various risk factors and in particular, dementia such as agitation, aggression, delu-
the manner in which these factors interact sions and hallucinations, and disorders of
(Prabhavalkar & Chintamaneni, 2010). From mood such as depression and apathy among
a nursing perspective, although further work some individuals with MCI. The presence
is required on the implications of MCI for of behavioral and psychological signs such
informal caregivers, this work might also as these generally indicate a high likelihood
extend to examinations of the effectiveness of of progression to overt dementia (Huang &
nursing interventions such as those based on Cummins, 2004).
the Progressively Lowered Stress Threshold MCI is associated with significant mor-
Model (Hall & Buckwalter, 1987); the Need- bidity and economic loss as well as distress
Driven Dementia-Compromised Behavior to individuals, families, and society (yeuh-
Model (Algase et al., 1996), or the Enriched Feng et al., 2007). Although some evidence
Model of Dementia (Kitwood, 1997), for suggests that the economic costs of MCI in
example, as these have been found helpful in primary care are not significantly different
the AD context. Clearly, nursing research also from those of individuals without cogni-
needs to focus on the person with MCI them- tive deficits (Luppa et al., 2008), many cases
selves. Considerations of the effects of MCI of MCI will progress to dementia. It is well
on patient coping, social support, depression, established that dementia is a costly illness.
grief, and anxiety, for example, would be use- Noneconomic costs to the individual include
ful at this time, as would work on behavioral anxiety and depression associated with prog-
symptoms associated with MCI. nostic uncertainty; performance difficulties
Patient problems are many and varied at work before diagnosis, which may lead
and depend on the MCI subtype, the exis- to retirement earlier than might have been
tence of comorbidities, and the degree of cog- expected; loss of intimacy, relationships, and
nitive impairment. Some people with MCI roles as the condition progresses; and loss
lack insight into the extent of their functional of dignity and personhood. Implications
deficits and hence may engage in unsafe for spouses and family are similar and also