The Aging Intellect

Cognitive aging and how to manage it.

Not Everyone With Mild Cognitive Impairment Progresses To Dementia

Why do some with MCI remain stable or improve mentally?

Last Sunday(05/29/11) almost two columns of Letters to the Editor  appeared in the Opinion section  of The New York Times. Most were written by family members objecting to a piece  written by Brandeis scholar Margaret Morganroth Gullette. In her article she challenged the prevailing theory that most people who are diagnosed with mild cognitive impairment (MCI) will progress to dementia.  Unlike elders with normal varieties of mental decline who usually  avoid Alzheimer's disease,  the diagnosis of MCI  predicts serious intellectual deterioration within a few years.

Ms.  Gullette  pointed out that many people with mild impairment  learn to compensate for their cognitive losses. With a positive attitude and the support of loved ones they do not develop dementia. As might be anticipated,  those with loved ones who  suffered the ravages of Alzheimer's disease and other forms of dementia objected to the  portrait of elders with MCI living happy, fulfilling lives. Their experience  has been just the opposite: a proud, charming,  and beautiful grandmother declining into Alzheimer's disease and becoming crazed, violent and mute; a man beloved for his kindness and  humor deteriorating into an agitated, angry,  and fearful person with no connection to the world around him.   

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Professionals weighed in.  Neurologists who have watched their patients with MCI struggle to continue to function independently, worried that pointing out that not everyone with this diagnosis develops severe impairment minimizes the daily challenges that they  face to lead a normal life.

My own reaction to this heated discussion is that we need to learn more about the characteristics  those seniors with MCI who do not progress to dementia.  In my own research I looked closely  at  studies on three continents that followed people with MCI  for 3-5 years. At follow-up the investigators classified the patients as having progressed to dementia; stable; or no longer impaired. On average the investigators found that nearly half of the individuals did not progress to dementia as anticipated.  Even more surprising was that  one in seven were no longer impaired.

A great  deal of research has been published about the psychosocial characteristics of those more likely to progress to dementia. But no systematic study  has identified those behaviors or lifestyle habits  that distinguish those MCI patients  who do not progress to dementia, who remain stable or who revert to normal cognitive aging. What an important  research project this would be.

25 years ago 26% of US citizens 65+ were disabled.  The most recent surveys put the number at about 19%.  In an effort to understand the reasons for this declining disability, a great deal of research has been carried  out. Two factors that contributed are advances in medical technology and healthier lifestyle habits practiced by older adults.

There is  no shortage of testable theories to explain why some of those with MCI do not decline further. For example, we might speculate that  some of these newly diagnosed MCI patients   take matters  into their own hands and begin to practice healthy lifestyle habits such as exercising and eating healthily, which enhance the mind along with the body, retarding  the progression to dementia.  Another hypothesis is that  some people  diagnosed with MCI seek and receive  successful treatment on their own  that halt cognitive decline and/or  restored something approximating  normal intellectual functions.  Though medications and cognitive training have not been widely successful with MCI patients, some people have been helped.

I find myself wondering whether anyone reading this blog might be acquainted with  individuals diagnosed with MCI  who have has stabilized or have returned to normal cognitive aging.  If you know of anyone I would enjoy hearing  from you.

 

Selected References

Ravaglia, G ., Forti, P ., Montesi, F ., Lucicesare, A ., Pisacane, N ., Rietti, E ., et al . (2008) . Mild cognitive impairment: Epidemiology and dementia risk  in a large elderly Italian population . Journal of the American Geriatrics Society, 56, 51-58.

 Lopez, O . L ., Kuller, L . H ., Becker, J . T ., Dulberg, C ., Sweet, R . A ., Gach, H . M ., et al . (2007) . Incidence of dementia in mild cognitive impairment in the Cardiovascular Health Study Cognition Study . Archives of Neurology, 64, 416- 420.

 Tschanz, J . T ., Welsh-Bohmer, K . A ., Lyketsos, C . G ., Corcoran, C ., Green, R . C ., Hayden, K., et al ., & the Cache County Investigators . (2006) . Conversion to dementia from mild cognitive disorder: The Cache County Study. Neurology, 25, 229-234.

Huang, J ., Meyer, J . S ., Zhang, Z ., Wei, J ., Hong, X ., Wang, J ., et al . (2005) . Progression of mild cognitive impairment to Alzheimer's or vascular dementia versus normative aging among elderly Chinese . Current Alzheimer Research, 2, 571-578.

 

Douglas Hyde Powell, Ed.D., A.B.P.P., is a Clinical Instructor in Psychology at Harvard Medical School, and a Consultant in Psychology at McLean Hospital.

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