What Are The Common Causes Of Dementia What Should Be Considered In The Differential Diagnosis Of Dementia
Once a clinician has determined that a patient meets criteria for dementia, further assessment is needed to determine its specific etiology. While no cure exists for true dementia of any etiology, the varying causes for dementia entail differing natural histories, characteristics, and prognoses that will inform care and planning. Table 1 provides the proportion of total dementia cases for the irreversible dementia etiologies.59
Dementia with Lewy bodies is another etiology to consider. It is distinguished by -synuclein inclusions in neurons and general brain atrophy.2 Patients with DLB often experience impairment in cognitive processing speed, executive function, alertness, and attention.10 These symptoms begin gradually, progress over months to years, and fluctuate in severity.2 They are also accompanied by parkinsonism, in which patients show signs of bradykinesia, rigidity, stooped posture, and the slow and shuffling gait associated with Parkinson disease.2,10 Patients often report detailed visual hallucinations, such as a rabbit running across the room.
Clinicians should also consider medical conditions, such as normal pressure hydrocephalus . Patients with NPH often present with impaired cognition, ataxia , and urinary incontinence.10 Executive function is often impaired, and symptoms may closely resemble those of vascular dementia.
More Habits More Impact
The 2015 FINGER trial a randomized controlled trial found less cognitive decline over two years in older adults who maintained a combination of habits, such as eating a healthy diet, exercising regularly, and taking part in social events. The adults in the study did not have MCI, but some were at risk for Alzheimer’s disease. Similar trials are being conducted around the world.
Dr. Salinas says people with MCI can take a cue from these types of findings to maintain as many healthy habits as possible. That includes not only exercising, eating right, and staying connected with other people, but also engaging in mentally stimulating activities and taking medications as prescribed.
There are no guarantees, but the evidence suggests these steps may delay or even prevent progression to dementia. “The people who spend the most time cognitively stable are often the ones who stick to lifestyle recommendations,” says Dr. Salinas.
I Heard There Are Two Types Of Mci
MCI that primarily affects memory is known as amnestic MCI. With amnestic MCI, a person may start to forget important information that he or she would previously have recalled easily, such as:
- Appointments, conversations or recent events
- The names of certain friends and/or new caregivers
- Whether a medication was taken on time and in the right dosage
- The way to familiar locations
Nonamnestic MCI affects thinking skills other than memory, such as:
- Ability to make sound decisions
- Ability to judge the time or sequence of steps needed to complete a complex task
- Visual perception
- Executive functioning
- Language
The worried well. These are people who seek a medical diagnosis for their memory loss but, upon testing, do not meet the threshold for MCI. That doesnt mean they are not experiencing issues with memory loss but the cognitive issues are due to normal aging, stress, anxiety or other issues. Often the worried well can improve with therapy services and simple memory compensation strategies, such as using calendars and notepads.
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I Have Some Memory Loss Do I Have Mci
Not necessarily. All of us have had occasions when we walked into a room and forgot why we were there. But what happens when we do? We retrace our steps and try to figure it out. The difference between normal aging and cognitive impairment is the ability to identify the issue and problem-solve the solutions.
With typical aging:
- You may experience slower recall or forget only parts of an event
- You remain able to follow spoken and written instructions
- You may have difficulty concentrating
- Your capacity to learn stays intact, however new information may take longer to absorb
- You may have occasional word-finding difficulty, but are able to recall the word given time
- You may misplace an item, but you have the ability to problem-solve possible locations of the item
- You may have occasional memory issues, but not significant enough to affect daily living. For example, you may forget the name of a person who you see occasionally
Some good news for people who have been diagnosed with MCI:
- 1 out of 5 people diagnosed with MCI will go back to normal cognitive functioning within 3 4 years of their MCI diagnosis.
- Many people with MCI remain stable for several years without progressing to Alzheimers disease or dementia.
How Is Mild Cognitive Impairment Managed
There currently is no standard treatment or approved medication for MCI, but there are things a person can do that may help them stay healthy and deal with changes in their thinking.
Because MCI may be an early sign of more serious memory problems, it’s important to see a doctor or specialist every six to 12 months. A doctor can help track changes in memory and thinking skills over time. Keeping a record of any changes can also be helpful.
People with MCI might also consider participating in clinical trials or studies. Clinical trials are research studies that help test if a treatment, like a new drug, is safe and effective in people. People with and without memory problems can take part in clinical trials, which may help themselves, their families, or future generations.
To find out more about participating in clinical trials for people with memory problems and people without cognitive impairment, visit Alzheimers.gov or call the Alzheimers and related Dementias Education and Referral Center toll-free at 1-800-438-4380.
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Others Say Risk Reduction Is Possible With Or Without Testing
In another commentary published with the USPSTF report, Carol Brayne, MD, a professor of public health medicine at the University of Cambridge in the United Kingdom, writes that, risk reduction for cognitive impairment includes stopping smoking and moderating alcohol intake promoting healthful diet and physical activity and preventing and managing hypertension, cardiovascular disorders, diabetes, and depression. Clinicians can recommend these approaches to reduce risk to all older adults without the need for any cognitive screening.
Mild Cognitive Impairment Vs Dementia
Having short-term troubles with memory does not necessarily mean you are suffering from dementia. It takes at least two types of impairments that significantly disrupt your day to day activities to get you a diagnosis of dementia.
There is a possible connection between mild cognitive impairment and dementia. However, they are not same and affect people both similarly and differently. Mild cognitive impairment and dementia are not the same. Though persons suffering from mild cognitive impairment are at a greater risk of developing dementia, being affected by mild cognitive impairment does not necessarily mean that it will lead to dementia over time.
Mild cognitive impairment and dementia are not the same. In order to see the differences between the two conditions, let us first have a look at what both these conditions actually mean.
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Is There A Conclusive Test That Diagnoses Mci
Not currently. According to the Alzheimers Association, MCI is a clinical diagnosis representing a doctors best professional judgment. There are currently no tests or procedures to demonstrate conclusively that a person has MCI.
The demarcations between normal cognition and MCI, and between MCI and Alzheimers, are difficult to define. Clinical judgment and cognitive testing over time is needed. Therefore, experts recommend that a person diagnosed with MCI be re-evaluated every six months to determine if symptoms are staying the same, improving or growing worse.
The Mayo Clinic web site has a good overview of MCI Tests & Diagnosis.
The Alzheimers Association and the National Institute on Aging have convened expert workgroups to update the diagnostic criteria and guidelines for MCI.
Screening For Cognitive Impairment Given An I For Insufficient Evidence
They didnt give it a D rating, which would be against the use of screening they gave it an I for insufficient evidence, notes Howard Fillit, MD, the founding executive director and chief science officer for the Alzheimers Drug Discovery Foundation and a geriatrician and neurologist at Mount Sinai Medical Center in New York City.
The report is actually an update of a similar one issued by the USPSTF in 2014. Although its unclear how many clinicians take these types of recommendations on board, the report could change how so-called mild cognitive impairment and dementia are diagnosed and treated and its release isnt without controversy.
Indeed, on the day the task force recommendations were released, the ADDF noted that even though the task force report does not imply people with memory or related cognitive problems should forego assessment, there is a risk that some will interpret the reports no evidence finding as negative evidence.
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Anxiety: Another Important Symptom
Anxiety symptoms have been studied less than depression, and the relationship between anxiety and cognition is complex. The reported prevalence of anxiety in MCI patients ranged between 9.9%52% . A meta-analysis showed that the prevalence of anxiety in patients with MCI was 14.3% in community-wide samples and was 31.2% in clinic-based samples . Such inconsistencies in reported prevalence may be attributed to differences in recruitment strategies and methodology . There is a high rate of comorbid depressive disorders in MCI patients with anxiety, confirming a positive correlation between the two neuropsychiatric disturbances in both demented and non-demented older people . Anxiety symptoms have been found to have a strict interaction with executive functions in MCI, and thus they may be a marker of incipient cognitive decline in MCI .
Anticipatory anxiety is significantly associated with earlier conversion to AD, but this association does not remain significant following an adjustment for cognitive status at the baseline anxiety for upcoming events and purposeless activity frequently co-occur, which indicates anticipatory anxiety may be a marker of severity rather than an independent predictor of disease progression . Devier showed that different risk profiles have been described for state vs. trait anxiety: state anxiety was not a significant predictor of future conversion to AD, but higher trait anxiety predicted a lower risk of future conversion to AD .
Who Is At Risk For Cognitive Decline
The risk factors for dementia include modifiable and nonmodifiable components. Modifiable risk factors include low education level, hearing loss, traumatic brain injury, hypertension, alcohol consumption greater than 21 drinks/week, obesity, smoking, depression, social isolation, physical inactivity, diabetes, and air pollution.13 Approximately 35% of dementia cases may be attributed to some combination of these factors.
Age is the strongest risk factor for dementia, with the incidence of AD doubling every 10 years among adults over the age of 60 years.3336 Over 80% of adults with dementia are above the age of 75 years, and incidence rates appear to increase beyond 90 years of age.13 In contrast, dementia is rare in younger populations, with 2 recent studies suggesting a cumulative incidence rate of 1113 cases per 100,000 person-years for those younger than age 65 years.13,37,38
Genetics also contributes to developing dementia. Individuals with a parental history of dementia are approximately twice as likely to suffer from AD or another form of dementia.13,39,40 However, this risk is inversely related to parental age at onset. FTD also exhibits some degree of heritability, and a family history of FTD may justify screening for common mutations associated with the disease.41
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What Is The Treatment For Mci
No medications are currently approved by the FDA to treat MCI. Additionally, the drugs that are approved to treat the symptoms of Alzheimers disease have not shown any lasting benefit in delaying or preventing the progression of MCI to dementia.
However, recent research has overwhelming concluded that diet, exercise, cognitive stimulation and maintaining social relationships have beneficial effects for those who have memory loss, with amazing brain protective properties that can actually prevent the onset of Alzheimers for some people.
At Senior Living Residences we are proud of our innovation and foresight in creating a treatment program based on this exciting and evolving body of knowledge. The elements of our Compass Memory Support program benefit residents of our Assisted Living communities who are experiencing all stages of memory loss from mild memory loss due to normal aging to Mild Cognitive Impairment to diagnosed Alzheimers disease and other dementias.
Relationship Between Mci & Alzheimers Disease
Sometimes MCI is called early Alzheimers disease, even though MCI does not always progress to Alzheimers. There is some disagreement amongst physicians and researchers about when to diagnose MCI versus an Alzheimers disease diagnosis. The symptoms of the two can be so similar that the same person could get an MCI diagnosis from one doctor and an early-stage Alzheimers disease diagnosis from a different doctor. There is also some disagreement about when a person who was originally diagnosed with MCI, and has worsening symptoms, should be diagnosed with Alzheimers disease instead.
According to the Alzheimers Association, individuals who have been diagnosed with MCI, particularly with memory issues, are more likely to later develop Alzheimers disease or a related dementia. Approximately 32% of individuals diagnosed with MCI develop Alzheimers disease within 5 years.
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What Strategies Exist To Prevent Or Decrease The Risk Of Developing Dementia
The prevention and slowing of dementia progression primarily targets modifiable risk factors.49 Clinicians should aim to promote a systolic blood pressure of 130 mm Hg from age 40 onward. Patients should be encouraged to wear hearing aids when necessary and counseled on effective measures for preventing hearing loss through adequate protection and avoidance of excess damaging noise. Whenever possible, patients should be counseled to avoid second-hand smoke and areas of dense smog. They should also be counseled to quit smoking if they are currently smoking cigarettes. Alcohol use should also be kept to a moderate amount or less. Risk for TBI should be addressed by preventing falls in the home and community, and mobility assessments may be useful to determine need for walking supports or home installments. Obesity should be addressed early on, ideally by midlife, through promotion of healthy lifestyle behaviors and, when appropriate, medical or surgical treatment.
Finally, clinicians may advocate for wider access to education and learning opportunities in early and middle life, which will serve to decrease the risk of dementia throughout the population.
Can Mci Be Treated
Currently, there is no specific treatment for MCI. A number of studies are investigating different treatments, such as the cholinesterase inhibitors used to treat Alzheimers disease, Ebixa, nonsteroidal anti-inflammatory drugs , Vitamin E and statins . At this stage no drug therapy for MCI has proven effective, but work continues. As new medical treatments for Alzheimers disease arise, it is likely they will also be tested in people with MCI. Studies involving drug trials have shown preliminary evidence that drug treatments can effectively delay the progression to dementia.
Cognitive training has been suggested as useful for MCI and it is important to maintain a healthy diet, have regular physical exercise, and maintain good general health particularly controlling blood pressure, lowering cholesterol levels, and stopping smoking.
In most cases, a person diagnosed with MCI will not undergo any medical treatment but will be regularly monitored for changes in their memory. Counselling may assist people with MCI to find ways to adjust to the changes they are experiencing and to learn about ways to compensate for their memory difficulties.
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What Happened To Mr A
After reading about MCI, dementia, and the evaluation of cognitive decline, the medical resident took a thorough cognitive history and performed a bedside cognitive assessment. He found evidence of problems in memory and executive function. He also administered the MoCA, on which Mr A scored 23/30. Neuroimaging conducted during his hospital admission showed no evidence of a prior cerebral infarct or significant ischemic damage or other notable pathology.
Concerned about possible dementia, the resident contacted Mr As primary care provider and helped schedule a follow-up visit. He sat down with Mr A and his wife and explained that Mr As memory problems might be related to a larger cognitive issue. Both Mr A and his wife were very concerned and immediately asked if he had Alzheimers.
I dont know, the resident said, Im so sorry for how scary this must be for you, on top of all you just went through. But I want you to know that, whatever might be going on, we will make sure that you are aware of how things are going, and that you are able to live your life in a meaningful way. I know these topics are frightening, but there are many ways we can promote healthy aging, and many ways we can support those who are having some more trouble than they used to.
Submitted: October 27, 2020 accepted February 9, 2021. September 16, 2021.Potential conflicts of interest: None.Funding/support: None.
What Is Mild Cognitive Impairment
Some older adults have more memory or thinking problems than other adults their age. This condition is called mild cognitive impairment, or MCI.
There is no single cause of MCI. The risk of developing MCI increases as someone gets older. Conditions such as diabetes, depression, and stroke may increase a persons risk for MCI.
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Suggestions For Family Members / Caregivers
Remain positive and encouraging toward loved ones with MCI. Be patient. Dont interrupt your loved ones and allow them enough time to recall information. Continue to treat your loved ones like adults. This includes the way you speak to them. Dont leave them out of conversations when you are talking about them, and avoid talking down to them. When loved ones repeat a question or story, respond as if its the first time youve heard it. Your loved one will benefit from continued physical and social interaction and feelings of independence and usefulness. Pets, plants and household tasks can help him/her feel needed and useful.
General strategies that help caregivers support their loved one with dementia are good to keep in mind when interacting with someone who has MCI. There are proven communication techniques, ways to encourage socialization, and coping methods for emotional and behavioral issues that make day-to-day life easier for someone who is having a harder time thinking because of MCI.