Aging: Between healthy aging and dementia

As we age, we are likely to experience minor memory lapses

As we age, we are likely to experience minor memory lapses, such as misplacing keys or forgetting an appointment or the name of a person. If we are able to retrace our steps and find our keys, realize that we missed an appointment and recall the person’s name at a later time, we are aging in a healthy way.

Some individuals might experience these symptoms more frequently than others of their age, due to a condition known as Mild Cognitive Impairment (MCI). It is estimated that around five per cent to 20 per cent of seniors have MCI.

A person with MCI experiences decline in memory, language, thinking and judgment that is greater than expected for his age. These changes might also have been observed by family members and friends, but they are not severe enough to affect the person’s daily functioning, or to be called as dementia.

Family members and friends might observe symptoms such as anxiety, depressed mood, apathy or lack of drive, and occasionally irritability and even agitation.

MCI is therefore considered as an intermediate stage between the expected cognitive decline of normal aging and the more serious decline of dementia.

Individuals with amnestic MCI have problems with memory while those with non-amnestic MCI could have challenges with language, thinking or decision making.

If you have MCI, it does not mean that it will inevitably progress to dementia. Some individuals remain stable at that level, a smaller percentage could revert back to normal, and about 10 per cent to 15 per cent could progress to dementia every year.

What causes MCI? There is no single cause for MCI. Current evidence shows that most frequently MCI arises from the same changes that causes Alzheimer’s Disease (clusters of protein called plaques &tangles) and other types of dementia (such as strokes or Lewy bodies), but of a lesser degree.

The strongest risk factors for MCI are increasing age, and having a specific form of the gene APOE E4. Other possible risk factors include diabetes, high blood pressure, high cholesterol, depression, smoking, physical inactivity, and lack of social and mental stimulation.

How is MCI diagnosed? There is no single test to diagnose MCI. Diagnosis is usually made on the basis of clinical interview with the person, input from a family member or a friend, objective cognitive testing, and imaging.

The criteria for diagnosing MCI include change in memory, or other cognitive functions such as language, planning or decision-making skills confirmed by a family member or friend, absence of overall mental or functional impairment, and mild level of cognitive impairment on mental state assessment.

Your doctor might order blood tests to assess Vitamin B12 level and thyroid function, conduct a neurological exam to exclude Parkinson’s disease, tumours or other conditions that can affect memory and function, and do imaging to exclude tumours, stroke etc.

If you are diagnosed with MCI, how would it be treated? There is no medication to treat MCI at this time. Your doctor would suggest cognitive/functional assessment every six to 12 months to monitor progression, and also advise cognitive interventions, steps to control cardiovascular risk factors, and behavioural interventions.

Cognitive interventions include challenging the brain through active learning, solving puzzles; memory training, language training, skills building, and cognitive rehabilitation using memory aids and strategies to enhance one’s capacity to tackle real-world difficulties, designed to achieve or maintain everyday functioning.

A recent study from Mayo Clinic reports that older individuals, who engage in mentally stimulating activities such as playing games, doing crafts, using a computer, and participating in social activities, are able to decrease their risk of cognitive decline by 22-30 per cent.

Behavioural interventions intended to promote physical activity, and social engagement, and to improve mood through music and/or art, and meditation are the most promising in terms of decreasing or delaying the progression to dementia. Of these, physical activity has shown to be the most beneficial in preventing dementia or reducing progression of MCI.

Mediterranean diet based on whole grains, green leafy vegetables, other vegetables, oily fish, nuts, and olive oil, is very beneficial in delaying the progression of MCI to dementia.

Reducing cardiovascular risk by maintaining blood pressure, cholesterol, blood sugar, and body weight in the healthy range has also been recommended.

If you are having any concerns about recent changes in your mental ability, it is a good idea to consult your physician. At the same time start exercising regularly, adopt a healthy diet, sign up for a new course/language class/hobby, and remain socially connected.

Padmaja Genesh, who holds a bachelor degree in medicine and surgery as well as a bachelor degree in Gerontology, has spent several years teaching and working with health care agencies. Please send your comments to padmajaganeshy@yahoo.ca

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