Skip to main content

Mild Cognitive Impairment and Caregiver Burden: A Critical Review and Research Agenda


Aging is a global phenomenon that is accompanied by an increase in the number of persons with non-communicable diseases including dementia. Since this development requires public health attention to meet the needs of the increasing numbers of elderly persons and their caregivers, scientific and clinical research in the area of dementia and cognitive disorders during the last decade has shifted to focus on the early diagnosis of the disease and, more specifically, on mild cognitive impairment (MCI). MCI is associated with severe consequences at the societal, individual and familial levels. However, compared to the wealth of studies in the area of caregiver burden and Alzheimer’s disease, research in the area of MCI and caregiver burden is still developing. The aim of the present paper was to provide an analysis of the status of research regarding caregiver burden in MCI. This review indicated that despite important advances, gaps in the knowledge and understanding of caregiver burden in MCI remain. Only a clear delineation of the uniqueness of the concept of burden of care in MCI, accompanied by methodologically rigorous studies, will inform the development of interventions geared to reduce the burden of family members of persons with MCI.


  1. 1.

    Gainotti G. Origins, controversies and recent developments of the MCI construct. Curr Alzheimer Res. 2010;7:271–9.

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Olzaren J, Torrero P, Cruz I, Aparicio E, Sanz A, Mula N, et al. Mild cognitive impairment and dementia in primary care: the value of medical history. Fam Pract. 2011;28:385–92.

    Article  Google Scholar 

  3. 3.

    Werner P, Korczyn AD. Mild cognitive impairment: conceptual assessment, ethical, and social issues. Clin Interv Aging. 2008;3:413–20.

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Frank AR, Petersen RC. Mild cognitive impairment. In: Handbook of clinical neurology. Duyckaerts C, Litvan I, (editors). Elsevier Health Sciences; 2008.

    Google Scholar 

  5. 5.

    Pater C. Mild cognitive impairment (MCI)–the novel trend of targeting Alzheimer’s disease in its early stages–methodological considerations. Curr Alzheimer Res. 2011;8:798–807.

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Luppa M, Heinrich S, Matschinger H, Hensel A, Luck T, Riedel-Heller SG, Konig HH. Direct costs associated with mild cognitive impairment in primary care. Int J Geriatr Psychiatry. 2008;23:963–71.

    Article  PubMed  Google Scholar 

  7. 7.

    Austrom M, Lu Y. Long term caregiving: helping families of persons with mild cognitive impairment cope. Curr Alzheimer Res. 2009;6:392–8.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Dean K, Wilcock G. Living with mild cognitive impairment: the patient’s and carer’s experience. Int Psychogeriatr. 2012;17:1–11.

    Google Scholar 

  9. 9.

    Frank L, Lloyd A, Flynn JA, Kleinman L, Matza LS, Margolis MK, et al. Impact of cognitive impairment on mild dementia patients and mild cognitive impairment patients and their informants. Int Psychogeriatr. 2006; 18: 151–62.

    Article  PubMed  Google Scholar 

  10. 10.

    Joosten-Weyn Banningh L, Vernooij-Dassen M, Olde Rikkert M, Teunisse JP. Mild cognitive impairment: coping with an uncertain label. Int J Geriatr Psychiatry. 2008;23:148–54.

    Article  PubMed  Google Scholar 

  11. 11.

    Lingler JH, Nightingale MC, Erlen JA, Kane AL, Reynolds III, CF, Schulz R, DeKosky ST. Making sense of Mild Cognitive Impairment: a qualitative exploration of the patient’s esperience. Gerontologist. 2006;46:791–800.

    Article  PubMed  Google Scholar 

  12. 12.

    Brataas HV, Bjugan H, Wille T, Hellzen O. Experiences of day care and collaboration among people with mild dementia. J Clin Nurs. 2010;19:2839–48.

    Article  PubMed  Google Scholar 

  13. 13.

    Lu YYF, Haase JE. Content validity and acceptability of the Daily Enhancement of Meaningful Activity Program: intervention for mild cognitive impairment patient-spouse dyads. J Neurosci Nurs. 2011;43:317–38.

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Lu YF, Austrom MG, Perkins SM, Bakas T, Farlow MR, He F, et al. Depressed mood in informal caregivers of individuals with mild cognitive impairment. Am J Alzheimers Dis Other Demen. 2007;22:273–85.

    Article  PubMed  Google Scholar 

  15. 15.

    Davies HD, Newkirk LA, Pitts CB, Coughlin CA, Sridhar SB, Zeiss L, Zeiss AM. The impact of dementia and mild memory impairment (MMI) on intimacy and sexuality in spousal relationships. Int Psychogeriatr. 2010;22:618–28.

    Article  PubMed  Google Scholar 

  16. 16.

    Garand L, Dew MA, Urda B, Hagerty Lingler J, DeKosky ST Reynolds III CF. Marital quality in the context of mild cognitive impairment. West J Nurs Res. 2007;29:976–92.

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Garand L, Dew MA, Urda B, Lingler JH, Dekosky ST, Reynolds CF. Caregiving burden and psychiatric morbidity in spouses of persons with mild cognitive impairment. Int J Geriatr Psychiatry.2005; 20: 512–22.

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Savla J, Roberto KA, Blieszner R, Cox M, Gwazdauskas F. Effects of daily stressors on the psychological and biological well-being of spouses of persons with mild cognitive impairment. J Gerontol B Psychol Sci Soc Sci. 2011;66:653–64.

    Article  PubMed  Google Scholar 

  19. 19.

    Etters L, Goodall D, Harrison B. Caregiver burden among dementia patient caregivers: a review of the literature. J Am Acad Nurse Pract. 2008;20:423–8.

    Article  PubMed  Google Scholar 

  20. 20.

    Pearlin LI, Mullan JT, Sample SJ, Skaff MM. Caregiving and the stress process: an overview of concepts and their measures. Gerontologist. 1990;30:583–94.

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Pinquart M, Sörensen S. Ethnic differences in stressors, resources, and psychological outcomes of family caregiving: a meta-analysis. Gerontologist. 2005;45:90–106.

    Article  PubMed  Google Scholar 

  22. 22.

    Campbell P, Wright J, Oyebode J, Job D, Crome P, Bentham P, et al. Determinants of burden in those who care for someone with dementia. Int J Geriatr Psychiatry. 2008;23:1078–85.

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    Carretero S, Garcés J, Ródenas F, Sanjosé V. The informal caregiver’s burden of dependent people: theory and empirical review. Arch gerontol geriatr. 2009; 491:74–9.

    Article  Google Scholar 

  24. 24.

    Reisberg B, Ferris SH, de Leon MJ, Franssen ESE, Kluger, A, Mi P, et al. Stage-specific behavioral, cognitive, and in vivo changes in community residing subjects with age-associated memory impairment and primary degenerative dementia of the Alzheimer type. Drug Develop Resear. 1998;15:101–14.

    Article  Google Scholar 

  25. 25.

    Ellison JM. A 60-year-old woman with mild memory impairment: review of mild cognitive impairment. JAMA. 2008;300:1566–74.

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Portet F, Ousset PJ, Visser PJ, Frisoni GB, Nobili F, Scheltens P, et al. Mild cognitive impairment (MCI) in medical practice: a critical review of the concept and new diagnostic procedure. Report of the MCI Working Group of the European Consortium on Alzheimer’s Disease. J Neurol Neurosurg Psychiatry. 2006;77:714–8.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  27. 27.

    Ward A, Arrighi HM, Michels S, Cedarbaum JM. Mild cognitive impairment: disparity of incidence and prevalence estimates. Alzheimer Dement. 2012; 8:14–21.

    Article  Google Scholar 

  28. 28.

    Neugroschl J, Wang S. Alzheimer’s disease: diagnosis and treatment across the spectrum of disease severity. Mt Sinai J Med. 2011;78:596–612.

    Article  PubMed  PubMed Central  Google Scholar 

  29. 29.

    Petersen RC, Knopman DS, Boeve BF, Geda YE, Ivnik RJ, Smith GE, et al. Mild cognitive impairment: ten years later. Arch Neurol. 2009;66:1447–55.

    Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Ganguli M, Chang CC, Snitz BE, Saxton JA, Vanderbilt J, Lee CW. Prevalence of mild cognitive impairment by multiple classifications: The Mongongahela-Youghiogheny Healthy Aging Team (MYHAT) project. Am J Geriatr Psychiatry. 2010;18:674–83.

    Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    Petersen RC, Roberts RO, Knopman DS, Geda, YE, Cha RH, Pankratz VS, et al. Prevalence of mild cognitive impairment is higher in men: The Mayo Clinic Study of Aging. Neurology. 2010;75:889–97.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Yesavage J A, O’Hara R, Kraemer H, Taylor JL, Ferris S, Gely-Nargeot M, et al. Modeling the prevalence and incidence of Alzheimer’s disease and mild cognitive impairment. J Psychiatr Res. 2002;36:281–6.

    Article  PubMed  Google Scholar 

  33. 33.

    Luck T, Luppa M, Briel S, Riedel-Heller SG. Incidence of mild cognitive impairment: a systematic review. Dement Geriatr Cogn Disord. 2010;29:164–75.

    Article  PubMed  Google Scholar 

  34. 34.

    Adams KB. The transition to caregiving. J Gerontol Soc Work. 2006;47:3–29.

    Article  PubMed  Google Scholar 

  35. 35.

    Wolfs CA, Kessels A, Severens JL, Brouwer W, de Vugt ME, Verhey FR, Dirksen CD. Predictive factors for the objective burden of informal care in people with dementia: a systematic review. Alzheimer Dis Assoc Disord. 2012;26:197–204.

    Article  PubMed  Google Scholar 

  36. 36.

    Hilgeman MM, Allen RS, DeCoster J, Burgio LD. Positive aspects of caregiving as a moderator of treatment outcome over 12 months. Psychol Aging. 2007;22:361–71.

    Article  PubMed  PubMed Central  Google Scholar 

  37. 37.

    McLennon SM, Habermann B, Rice M. Finding meaning as a mediator of burden on the health of caregivers of spouses with dementia. Aging Ment Health. 2011;15:522–30.

    Article  PubMed  Google Scholar 

  38. 38.

    Blieszner R, Roberto KA. Care partner responses to the onset of mild cognitive impairment. Gerontologist. 2010;50:11–22.

    Article  PubMed  Google Scholar 

  39. 39.

    Bruce JM, McQuiggan M, Williams V, Westervelt H, Tremont G. Burden among spousal and child caregivers of patients with mild cognitive impairment. Dement Geriatr Cogn Disord. 2008;25:385–90.

    Article  PubMed  Google Scholar 

  40. 40.

    Gallagher D, Mhaolain AN, Crosby L, Ryan D, Lacey L, Coen RF, et al. Dependence and caregiver burden in Alzheimer’s disease and mild cognitive impairment. Am J Alzheimers Dis Other Demen. 2011;26:110–4.

    Article  PubMed  Google Scholar 

  41. 41.

    Fisher GG, Franks MM, Plassman BL, Brown SL, Potter GG, Lleweylln D, et al. Caring for individuals with dementia and cognitive impairment, not dementia: findings from the Aging, Demographics, and Memory Study. J Am Geriatr Soc. 2011;59:488–94.

    Article  PubMed  PubMed Central  Google Scholar 

  42. 42.

    Kuo LM, Shyu YIL. Process of ambivalent normalisation: experience of family caregivers of elders with mild cognitive impairment in Taiwan. J Clin Nurs. 2010;19:3477–84.

    Article  PubMed  Google Scholar 

  43. 43.

    World Health Organization. Dementia: a public health priority. UK: WHO Library; 2012.

    Google Scholar 

  44. 44.

    Martin Y, Gilbert P, Mcewan K, Irons C. The relation of entrapment, shame and guilt to depression in carers of people with dementia. Aging Mental Health. 2006;10,101–6.

    CAS  Article  PubMed  Google Scholar 

  45. 45.

    Bedard M, Molloy DW, Squire L, Dubois S, Lever JA, O’Donnell M. The Zarit Burden Interview: a new short version and screening version. Gerontologist. 2001;41:652–7.

    CAS  Article  PubMed  Google Scholar 

  46. 46.

    Schulz R, Beach SR. Caregiving as a risk factor for mortality: The Caregiver Health Effects study. JAMA. 1999;282:2215–9.

    CAS  Article  PubMed  Google Scholar 

  47. 47.

    Montgomery RJV, Gonyea JG, Hooyman NR. Caregiving and the experience of subjective and objective burden. Fam Relations. 1985;34:19–26.

    Article  Google Scholar 

  48. 48.

    Zarit SH, Reever KE, Bach-Peterson J. Relatives of the impaired elderly: correlates of feelings of burden. Gerontologist. 1980;20,649–55.

    CAS  Article  PubMed  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Perla Werner PhD.

Rights and permissions

Open Access  This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

To view a copy of this licence, visit

The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Werner, P. Mild Cognitive Impairment and Caregiver Burden: A Critical Review and Research Agenda. Public Health Rev 34, 16 (2012).

Download citation

  • Published:

  • DOI:

Key words

  • Mild cognitive impairment
  • caregiver burden