The Aging Intellect

Cognitive aging and how to manage it.

Non-Progressive Mild Cognitive Impairment: Case Examples 1

Some with mild cognitive impairment do not progress to dementia: Case examples

 

Mild cognitive impairment (MCI) is a transitional state of cognitive decline that is below the average age-related fall off in mental skills but above the threshold for dementia. It is also called "early" or "minimal dementia," sometimes "mild Alzheimer's disease." The primary identifying characteristics are gradually increasing memory problems and deteriorating mental skills in at least one other area. Typically other domains such as work, hobbies, social relations, and self-care are compromised as well. Each year, 10-15 percent of individuals diagnosed with MCI progress to dementia.

My review of nine longitudinal studies of people diagnosed with MCI found that a large proportion of these individuals do not progress as expected to dementia at follow-up 3-5 years later.  About a third of these individuals remained stable while a surprising 14 percent returned to non-impaired status.

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It is obviously in our interest to learn as much as we can about the lifestyle habits of those patients with non-progressive MCI. A search of the scientific literature, however, returned no reports about of those behaviors and lifestyle habits that distinguish MCI patients who remain stable or revert to not impaired status from those that develop dementia.

In an effort to increase our understanding of those behaviors under our control that may increase the likelihood of someone diagnosed with MCI not progressing to dementia, it seemed to me that a place to start would be with case examples. Several months ago I wrote a blog about non-progressive MCI and asked the readers if they knew of such cases. Several individuals with what appears to be non-progressive MCI replied. Here is the first installment of these cases, a man and a woman with cognitive impairment who have managed to halt or dramatically slow the movement toward dementia and live reasonably full lives in spite of their limitations.

Art: I am a retired physician and an Emeritus Professor of Medicine.  Also, I have Alzheimer's disease.  Looking back, I now recognize my memory problems arose 10 years ago when I was 76.  I chaired a monthly program about medical ethics.  I knew most of the speakers and found it easy and enjoyable to introduce them. That year I began to be more forgetful. I had to read the prepared material to make the introductions. My memory for names started to slip, never faces. '"Senior moments', I concluded. 

Over the last decade I had two transitory ischemic attacks and my mental difficulties worsened.  The final blow was the occasion one year ago when I received a citation for service in my hospital.  I stood up to thank them and found that I could not say a word.  "Aging brain", I said, and sat down.

That's when I made an appointment to see my doctor. After doing a few tests of my memory in the office, the doctor ordered other tests and a brain scan.  The diagnosis was mild Alzheimer's disease. The diagnosis didn't surprise my wife, though I was in shock because I had been in total denial (a common failing when doctors are patients). 

I was started on a medicine that has been used for many years and which has many side effects.  I had tried the medication on a few Alzheimer's patients in my practice with no benefit.  My doctor had me continue it, though I was kicking and screaming, and the side effects eventually disappeared.  This drug was continued and another was added later on, which turned out to be helpful.

In two months I was much better and I am now close to normal most of the time. I can continue to live at home with the help of my wife and the care of my doctor. There are still bad days when I have difficulty speaking, do not know the names of my grandchildren, can neither add nor subtract, or find my way home. 

No one seems to know why my condition has improved, but here are my thoughts I want to share with you: When you want to recall things, carry a little note pad and write it down. When you cannot remember a name, make a little joke and ask them to repeat it—then write it down.  Read books.  Take walks.  If you cannot walk, exercise in bed.  Draw and paint.  Garden, if you can.  Do puzzles and games.  Try new things.  Organize your day.  Learn to prepare food, eat, dress, wash, and go to bed in an efficient way.  Eat a healthy diet that includes fish twice a week, fruits and vegetables and omega 3 fatty acids. Finally, don't be ashamed to talk to your friends and your family.  People want to help you.

Edwina:I was diagnosed with Temporal Arteritis at age 54, which is an inflammation of the blood vessels in the brain. I found out that this condition sometimes leads Alzheimer's disease if not treated. I was immediately put on prednisone therapy.  After one year, the dosage was decreased, but I was not able to get below five mg daily without developing chronic "brain fog." Because I sometimes couldn't focus my attention when I needed to, I had to resign my job as an accountant for a large firm. A neurologist diagnosed me with mild cognitive impairment and I was put on full disability by Social Security.

Over the next five years I also had physical challenges too—neuropathy, polymyalgia rheumatica, balance problems, and osteoporosis. I fell and broke my wrist, which left me with a deformity that makes my writing hard to read.    

Never having been a person prone to vegetating, right after the diagnosis I stayed active on the Internet, did crossword puzzles, kept reading, and did anything I could think of to make sure I did not grow any more cobwebs in my brain. Also, I eat a reasonable diet, and still enjoy gardening. I see my primary care MD and my neurologist regularly and take all my medicine. 

About 10 years ago, I finished an MBA at an online degree granting university. After getting my degree I started teaching accounting courses for that school. Teaching online gives me plenty of time to put the course together, answer questions, and grade exams.

Two and a half years ago, I began volunteering at my church to help them convert from paper and pencil accounting methods to excel and set up online bill paying. I oversee a small team of volunteers that now manages the money. This job is supposed to be only a day and half a week, but I probably spend another 20 hours working at home.

Periodically I have "senior moments." I recognize faces but I am lousy at remembering names of people. Sometimes I have moments of fogged over concentration and memory, and wonder if I'll ever be able to function capably again. The inability to remember facts and temporary confusion do take longer to "resolve" now than they used to.  But on the plus side I have learned that if I do not attach too much importance to it and simply relax, at some point within the next hour or day, the forgotten information will eventually surface.

I'm now 70 years old, and it's been more than 15 years that I have been living with this mental impairment.  I know I am going downhill, but I don't think I am headed for dementia.  I have always considered my mental capabilities a God-given talent and an integral part of my personal identity.  So I am determined to work around the problems as they come up. Overall, I consider myself fairly healthy and quite happy and content with my life.

On the basis of these case reports, it appears that supportive professional help, healthy lifestyle habits, remaining engaged in useful activities, and continued efforts at mental stimulation, can halt or slow the progress to dementia. Other case histories will be welcomed.

These cases and others that will follow next month are rarely discussed examples of the large number of people diagnosed with MCI who do not progress to dementia as expected. These anecdotal reports may give comfort and hope to other MCI patients who are struggling to maintain their mental acuity.

Selected References

Li, L., Wang, Y., Yan, J., Chen., Y., Zhou, R., Yi, X., Shi, Q., & Zhou, H. (2011). Clinical predictors of cognitive decline in patients with mild cognitive impairment: The Chongqing aging study. Journal of Neurology, 76, 1485-1491.

Petersen, R. C. (2004). Mild cognitive impairment as a diagnostic entity. Journal of Internal Medicine, 256, 183-191.

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.

 


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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