Category: Neuropsychology

Mild Cognitive Impairment

Dr. Holzmacher's Business Logo for online psychotherapyMild Cognitive Impairment seems less threatening than its predecessors; such as “organic brain syndrome” and “minimal brain dysfunction.”  It sounds more benign than terms that contain the word “brain.”  Mild Cognitive Impairment is not an actual diagnostic code, but it is a term used by researchers and clinicians.  MCI reflects cognitive changes in the elderly that exceeds normal aging, yet does not meet the diagnostic criteria for Alzheimer’s Disease.  It is important to note that people diagnosed with MCI have retained their ability to perform all activities of daily living in an independent fashion.

Mild cognitive impairment has received much attention from the research community in recent years.  The interest is focused on what percentage of those with MCI actually convert to Alzheimer’s Disease.  This is not merely splitting hairs, as it would be a great asset to know which people in this group will actually manifest Alzheimer’s Disease.  Early diagnosis will allow more time for caretakers to plan and prepare.  An early diagnosis may also avoid surprises that utilize the emergency room and/or local law enforcement.

Current estimates of those that convert from MCI to AD are under twenty percent, but the percentage varies wildly within this restricted range.  Most suspected of MCI are brought to the attention of professionals due to a decrease in verbal memory.  Fewer are referred, in this clinician’s experience, from an onset of unusual behaviors.  This is important, because many progressive dementia’s initially present with a change in behavior prior to the onset of measurable cognitive deficit(s).  Measurable is highlighted because these people may actually exhibit a cognitive decline, but it may not be detectable by the current neuropsychological tests in use.  Current lab tests and medical imaging are ineffective at diagnosing MCI, as they are ineffective at diagnosing Alzheimer’s Disease.
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There are no particular medications or class of medications that could be recommended for the treatment of mild cognitive impairment.  As with Alzheimer’s Disease, exercise and keeping mentally active are likely helpful.  The beauty of mental and physical exercise is that even if it does not prevent the onset of AD, at least the person will still retain some benefit.  The early data suggests that effortful cognitive activity is more important than the passive variety.  For example, watching TV is a passive activity and completing a crossword is an effortful activity.

Once the diagnosis has been established, it is recommended to visit the neuropsychologist at least yearly.  Only a neuropsychologist will be able to accurately measure any change in cognitive skills, and differentiate the change from the effects of normal aging.  Remember that over eighty percent of people with mild cognitive impairment never manifest a progressive dementia.  The unfortunate remainder will require ongoing neuropsychological monitoring and behavioral planning.  Report any change in mental or physical functioning to the neuropsychologist and attending physician, as they are in a better position to know what is significant.  Nearly all people with mild cognitive impairment will profit from set routines and compensatory strategies.  Even though MCI sounds less threatening than its previous designations, it is still wise to monitor the disorder and treat symptoms as they arise.

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categories Alzheimer's Disease, Dementia, Memory Disorders, Neuropsychology | | datetime September 11, 2011 2:00 pm | comments Comments Off on Mild Cognitive Impairment

Casey Anthony on the Brain

Dr. Holzmacher's Business LogoThe women were sitting around the facility living room watching the Casey Anthony trial.  The assisted living facility had recently installed a big screen TV, and it has been tuned to the trial since it began.  The ladies were convinced of Casey Anthony’s guilt; that she murdered her daughter.  An elderly gentleman stood in back of the couch on which the ladies conversed.  One of the women asked the man if Casey Anthony was guilty.  He replied that he was unsure.  The women were in shock.

As voyeurs into this lurid spectacle, we are regaled with many incidental details.  There is certainly no smoking gun, nor any other direct evidence of guilt.  The bits of reality that float down are suspicious, but not damning.  Even unimaginative people could use the available clues to invent scenarios that do not involve murder.  The defense offered one such scenario, but failed to prove their contentions.  Perhaps it was an unnamed boyfriend that directly or indirectly caused the child’s death.  Perhaps it was a total stranger that directly or indirectly caused Kaylee Anthony’s death.  Perhaps Casey was concealing her complete indifference, and never believed that she would be charged with murder.  Perhaps Casey Anthony has no idea what befell her daughter.  The various stories told to family and police may have concealed her indifference, as opposed to concealing a murder.

The low probability of discovering the truth produces tension and viewership.  Few people would watch sporting events if the outcome was guaranteed.  The frustration and tension produced by uncertainty compels the public to watch for clues that could reveal the truth.  For most people, a state of uncertainty is intolerable over an extended period of time.  People may actually express relief at hearing bad news, not because they are masochistic, but because their need to know has been satisfied.  Since the Casey Anthony trial is unable to discover the truth, the uncertainty will remain, and so will the interest.
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Humans naturally form associations between events based upon time, similarity and function.  This does not mean these associations are accurate or even helpful, but it is the way our brains function.  Not limited to associating bits of information together, our brains find reasons why the associations exist.  For example, surgeons who stimulate brain regions while the patient is awake note particular reactions.  If the surgeon stimulates a motor area that lifts their arm, the patient will reply that they “felt” like moving that arm.  If a particular memory is aroused by electrical stimulation, the patient will find a commonplace cause for that particular recollection.  Our brains are machines that form associations and causal links.

The women viewing the Casey Anthony trial believed their causal associations entirely, and could not fathom someone choosing to be uncertain.  They latched on to the causal links formed by the prosecution, since it fit the few available clues.  The defense failed to produce a story that fit the available clues.   The public then had to choose between adopting the prefabricated causal links, or formulating their own conclusions.  Since it is easier to buy off the rack than have clothes tailor made, the judgment of the public was a foregone conclusion.  Do not fret at the passing of this news event.  Like other unsolved crimes, interest will remain on a reduced level.  Think Jimmy Hoffa and the Lindbergh baby.  We can now add Kaylee Anthony to the list.

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categories Memory Disorders, Psychology | | datetime July 3, 2011 11:01 am | comments Comments (1)

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