Forgetting names or having a hard time recalling a fact is common for everyone, but as people get older, they worry that this is a sign they’re developing dementia. It may or may not be, says Nathaniel Chin, M.D., member of AFA’s Medical, Scientific and Memory Screening Advisory Board. That is why it is so important that we do cognitive testing early. Chin is also the medical director of the Wisconsin Alzheimer’s Disease Research Center and the Wisconsin Registry for Alzheimer’s Prevention Study.
Sometimes these difficulties are mild cognitive impairment, or MCI. This is a memory loss condition that precedes dementia in some cases, but sometimes it can be reversed or stay stable, Chin says.
“We describe MCI as someone having a memory or thinking complaint representing a decline from their baseline (i.e., from what they have been accustomed to). However, their day-today activities still are very much intact; we see no functional impairment,” says Chin. “But when we do a cognitive test, we find that the person has an impairment or low score.
“With MCI, it’s entirely possible that you will have MCI going forward. It doesn’t get dramatically worse, and you will pass away with MCI. It’s also possible that you will progress to dementia, but it’s also possible that you will get better and have a diagnosis of being cognitively healthy again.”
Chin said it’s hard for clinicians to know the underlying causes of MCI and whether it will remain or advance to dementia. Among the factors that can bring on MCI that can be corrected are reactions to medication, sleep apnea, thyroid issues, hearing or vision loss or mood disorders such as depression.
“This is why it’s important to get routine follow-ups regarding your cognitive health,” Chin says. “One of the key changes needed for us in this country is to talk openly about our memory and thinking abilities so that we can identify the earliest changes and have an intervention as soon as possible.”
MCI early symptoms
Chin emphasizes that the earliest changes
are thinking changes, not your ability
to perform daily functions. “That’s the
key part of having MCI. You are still
functionally intact.”
If you are experiencing a memory
change, it typically involves forgetting
events or conversations, repeating stories,
or misplacing items. If language happens
to be the first part of your brain affected,
then you might experience difficulty
finding words, problems understanding
words, problems reading, or writing.
Visual or spatial problems, such as getting
lost or not recognizing familiar faces,
can also occur, particularly in cases of
diseases that may later be diagnosed as
Parkinson’s or Lewy Body disease.
To deal with the symptoms of MCI,
Chin recommends using compensatory
strategies such as sticky notes, a calendar
or whiteboard and putting your keys and
wallet in the same place whenever you
come home.
Risk factors for developing MCI
Men are more likely to develop MCI,
individuals with less education and those
carrying the Alzheimer’s gene APOE4.
Other risk factors are vascular conditions
such as diabetes, high blood pressure,
being overweight, having high cholesterol
and smoking. Having mood conditions,
particularly if they are untreated, is also a
risk factor.
“These are all things that we can start
working on and addressing. We just need
to know to do that, which takes talking to
your primary care provider,” Chin says.
More than MCI
We define dementia as a thinking syndrome.
At least two areas of a person’s thinking
ability are now considered impaired
(such as articulating and understanding
what they hear). This is leading to
difficulty in communicating, focusing
and making sense of information.
“Now there’s an impairment in their
day-to-day function, even with a set of
compensatory strategies such as sticky
notes and phone alerts. They can’t do something they used to be able to do (e.g.,
grocery shop, balance their checkbook,
cook from a recipe, dress themselves).
That’s a key defining feature,” Chin says.
“We don’t think of underlying
medical problems and psychiatric
illnesses as causes of dementia. It’s the
accumulating brain changes that are
causing these functional changes,”
Chin says.
Getting a cognitive evaluation
Chin says an evaluation is important, but
this doesn’t happen in just one
doctor visit.
“It’s a multi-step process that should
start with your primary care provider, but
you will likely need to see a specialist too,”
Chin says. “That’s why it’s important for
people to get in as early as possible, which
means as soon as they are experiencing
these changes. A clinician will want to get
a thorough history. It’s also essential that
the person brings someone they know
and trust with them. The information
family members and friends can provide
can be extremely helpful.”
The clinician will need to
consider when the problems
started, what kind of symptoms
the person is experiencing and
how they are impacting the
person’s day-to-day abilities.
Clinicians will also want to
know if the symptoms started
after a fall, a new medication
or a stroke.
“We need to know your medical
history because we want to know what
risk factors you have. Eventually, blood
work will be ordered, and that’s to look for
those reversible factors.”
Chin says dementia is chronic and
persistent and usually caused by a brain
disease or brain injury. “Early assessment
and support improve outcomes. I can’t
emphasize this enough,” Chin says.
“One of the key changes needed for us in this country is to talk openly about our memory and thinking abilities so that we can identify the earliest changes and have an intervention as soon as possible.”
–Nathaniel Chin, M.D.
Memory screening
Individuals concerned about declining thinking abilities can schedule a virtual memory screening (via phone or computer) with the Alzheimer’s Foundation of America. Go to Virtual Memory Screenings | Alzheimer’s Foundation of America to learn more about memory screenings or call 866-232-8484 and ask for the Memory Screening department. A memory screening does not provide a diagnosis, but it will determine if additional evaluation is necessary. You can also explore cognitive symptoms via IQ Code and AD8 forms; both are available online.
Adapted from the AFA’s Care Connection webinar “Mild Cognitive Impairment: What Is It? And How Does It Relate to Alzheimer’s Disease?” which can be found at this link. Other resources can be found at alzfdn.org/webinar_ archive/.