Mild 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.
Tags: AD, Alzheimer's Disease, Alzhiemer's, Dementia, MCI, medication, Memory Disorders, Mild cognitive impairment
Alzheimer's Disease, Dementia, Memory Disorders, Neuropsychology | orlandopsychcom | 
September 11, 2011 2:00 pm | 
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It was a bit shocking. The wife remarked on the comments of her husband’s neurologist. He was rumored to malign memory enhancing drugs used in the treatment of Alzheimer’s Disease. He was of the opinion that this class of drugs benefited the drug companies more than the victims of a senile dementia. The wife was understandably confused by the disparity between the opinion of the neurologist and the claims of the drug companies. The shock was the public admission of what many physicians voice in private.
Over the last ten years, most patients I’ve evaluated with a change in mental status, due to any cause, have already been prescribed memory enhancing medications. The drug companies caution that these drugs should be limited to the victims of a senile dementia of the Alzheimer’s type. It is very common to observe these drugs used in the treatment of stroke and head injuries. Is this a good thing?
Unfortunately, this clinician has never witnessed a significant increase of verbal memory performance as a consequence of these medications. This experience applies both to the preferred use of these drugs in the treatment of Alzheimer’s, as well as off-label use of memory enhancing medications. It is not intended as a blanket condemnation, rather it reflects the lack of statistically significant benefit displayed on well-normed tests of verbal memory. There may be many people who have a significant increase of verbal memory with the use of these drugs, but none of these responders have been evaluated by this clinician. Memory enhancing drugs that boost the neurotransmitter acetylcholine may display increased agitation, weight loss, and even chronic nausea with vomiting. These reactions are fortunately not universal. This clinician has witnessed the resolution of these symptoms many times after a reduction or discontinuation of the medication. Personal experience of medication that affects glutamate levels in the brain is that they are neither very harmful or helpful in the treatment of moderate to severe Alzheimer’s Disease.
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The latter stages of Alzheimer’s Disease are often fraught with weight loss and agitation. Victims of a senile dementia become too inattentive to sit through a whole meal, requiring frequent prompts and even hand feeding to keep up their body weight. By the middle stages of Alzheimer’s, the loss of other cognitive functions largely negates a mild increase in verbal memory. These mid-stage patients would still have trouble with planning, praxis, attention, judgment, flexibility, etceteras. Even a significant increase in verbal memory would not return these victims to an independent lifestyle. Memory enhancing drugs that commonly produce symptoms of weight loss and agitation should be used with obvious caution.
This clinician’s advice is to proceed with, you guessed it, caution. Consider having a neuropsychologist perform pre and post testing to measure any significant increase in verbal memory as a consequence of these medications. If there is not a significant increase in verbal memory after a six week trial, consider requesting the attending physician to reduce and eventually discontinue the medication. If an acetylcholine boosting medication is utilized, and the patient develops weight loss and agitation, work with the physician to determine if the symptoms are secondary to the memory medication. Senile dementia of the Alzheimer’s type is a horrid disease that can cripple an entire family. Pills without a clear benefit should be considered as a risk to the patient over time; possibly creating undesired symptoms and interacting with other medications in an unpredictable fashion. I strongly suggest to formulate conclusions based upon observation-not advertising.
