This the second installment of case reports of individuals with non-progressive mild cognitive impairment (MCI). It follows the March 27th blog that described the cases of Art and Edwina. These individuals contacted me after reading an earlier report about non-progressive MCI.
I write about these cases for three reasons: (1) to provide actual cases that support research findings showing that a substantial proportion of individuals diagnosed with MCI do not progress to dementia; (2) to describe lifestyle patterns that are linked to cases of non-progressive MCI; and (3) to summarize empirical evidence from studies of people with non-progressive MCI that may explain why certain behaviors and attitudes lower the risk of dementia. Meet Margaret and Annette.
Margaret: I care for Margaret, my 94-year-old mother who was diagnosed with mild to moderate Alzheimer’s disease three years ago. Mostly to help her balance and general health, my sister and I enrolled her in a community gym about 2 years ago. When she moved to Florida to live with my husband and me, we continued at a gym for seniors. I take her 3 times/week, and she does the treadmill, exercise bike and other machines. She also walks a few blocks down our street with me every morning right after awakening, and she attends two 4-hour activity groups per week. One day a week she goes to daycare at a small respite facility.
We've concluded the gym has been a lifesaver in terms of stabilizing her dementia. But other things have probably helped too. Since my sister and I have been caring for her, she’s had a good diet and takes her medication regularly/correctly. My mother has a lot of energy needs to get outside the house at least once/day or otherwise she becomes more agitated. I also take her out to get her hair and nails done regularly and goes out to dinner with my husband and me several times per month.
Finally, we think that talk therapy has helped my mother. Just before she was diagnosed, Mom talked to a social worker weekly for about 6 months. She had a lot of anger toward her parents, especially her mother, which she vented. She agrees that this really helped her outlook.So, exercise, staying active, diet, medication, therapy, a secure environment, has all been CRITICAL in giving her the best life possible.
My sister and I have concluded that we need to do the same things for ourselves as we’ve done for our mother! It’s helped us lose our own fears about aging and Alzheimer’s.
Annette: I have had a long history of severe stress and physical and psychological problems. I have long struggled with cognitive difficulties, episodes of confusion and disorientation, and “brain fog.” In 1998 the doctor told me that my SPECT scan was abnormal, revealing organic changes in my brain, specifically mild, global cerebral perfusion deficits along with mild distractibility. I was 39 that year.
Stress makes it worse. Three years ago over the Thanksgiving weekend I lost four days of memory when I learned that my daughter was suicidal. I still have no recollection of the rest of that day after I found out, and the several days following. My neighbors were worried about me and called the police. I later found out they took me to a hospital because when they arrived at my home they found me confused and disoriented. A neuropsychological report said that I had slowed mental processing, mild distractibility, and reduced cognitive efficiency that would employment difficult.
Being in the hospital set me on a path of intensive research into my physical and mental condition and caused me to face up to the fact that I needed to help myself. When I sat down and looked at my life, the various diagnoses, the profound stresses and losses I’ve had to cope with, I realized I have had a low-grade depression for 17 years that has contributed to my loss of physical and mental health. Here is a record of what I found out about my life:
1980s—Received a GED after dropping out of high school; no full time work since 19; causes were fibromyalgia related chronic pain in chest and back and constant fatigue unrefreshed by 12-14 hours of sleep; marked cognitive difficulties too, including periods of disorientation and “brain fog;” occasional blackouts, and loss of consciousness; marital difficulties and divorce; began working as administrative assistant in a psychologist’s private practice.
1990s—Continued working part time for the psychologist and also was hired as a telemarketer for the Heart Association; diagnosed with Chronic Fatigue Syndrome, basically sleeping around the clock; also difficulty with word retrieval, memory, and concentration; weak in organizational skills; daughter placed in respite care so I could rest from care-giving and try to recover; after a few weeks police notified me that my daughter had been sexually abused while in the respite home; this led to episodes of disorientation where I was quite sure where I was, and engaged in conversations where I felt I was not making any sense; met my 2nd husband.
2000s—Unable because of physical and cognitive problems to work; placed on disability; became very active in the church—writing prisoners in North America and SE Asia and mentoring church members; feel loved as a member of a church family now that was never experienced as a child, especially the incredible power of touch; now making healthier choices for myself and growing in the wisdom of God.
The episodes of brain fog and not being able to think clearly, though they are less disruptive now that I understand more about them—what makes them worse, what minimizes their effects. Sometimes when I am having a bad morning or bad day I leave this automatic reply for incoming emails: ““Experiencing cognitive/memory issues, please forgive me if I forget to respond to your message at this time.”
For me, what has been most helpful is when someone takes the time to help me understand/clarify what I find confusing. Fortunately I have a family doctor who has been a wonderful support to me over the years with my own issues and those of my children.
The second most helpful thing has been to understand how nutrition plays a role in healthy brain function as well as the importance of exercise. Knowledge helps because I can’t change what I’m not aware of. My research about my condition(s) has been like an emotional, physical, mental, and spiritual autopsy on the years behind me. Sometimes I have felt like a detective tracking leads, researching, reading, and taking notes.
My spiritual beliefs as a Christian have been a strong foundation for me; moving forward step by step believing that I am not on this journey alone and whatever I need will be provided to me. The prayers of my friends and my faith community were especially helpful to me when my 2nd husband died in 2007.
For a period of time I fell asleep listening to The Biology of Hope by Norman Cousins. I have attended a number of seminars intended for professionals in an effort to better understand the topics (primarily grief/mourning, loss, the effect of trauma on the brain and body) related to my life experiences. These seminars have also afforded me the opportunity to investigate my own diagnosis in the hope of understanding what changes I needed to make in my lifestyle.
Also I continue to do brain exercises online; I try to eat foods that are healthy for my brain to work effectively; and I exercise daily.When I think about my life, and consider all that I have had to deal with, including mild cognitive deficits, and think objectively about what I have been able to accomplish, I consider my journey of recovery and healing to be "amazing." The journey continues.
These cases of Margaret and Annette, and Art and Edwina in the earlier blog provide clinical verification of the findings from longitudinal research that a number of individuals diagnosed with MCI do not progress to dementia during the period of follow-up. Annette has been stable for more than a decade and Margaret has been holding her own for over three years.
These cases show too that MCI comes in many forms—from Margaret’s clearly diagnosed mild to moderate Alzheimer’s disease to Annette’s mental problems related to cerebral hypo-perfusion that could be the result of chronic fatigue syndrome or some other medical condition. But both suffer mild cognitive impairment.
These cases demonstrate that changes in lifestyle patterns that can retard the movement to dementia can come early or rather late in life. While Annette began to alter her attitude and ways of behaving in her 40s, Margaret was 91 when her daughters encouraged her to begin an exercise program to combat her cognitive decline.
Overall, these cases lend support to the argument that the same healthy lifestyle habits that are linked to optimal cognitive aging also are correlated with halting or dramatically slowing the further mental deterioration of people with MCI. For instance, all exhibited characteristics of what has been called the “hardy personality”—remaining committed to minimizing the effects of MCI rather letting nature take it course; believing that they could slow or reverse the progression of the MCI by their own mental attitude and actions; and feeling challenged by the diagnosis of having MCI rather than feeling overwhelmed and giving up.
Like optimal cognitive agers, these individuals all had an unusually high activity level. Sometimes this was exhibited in the form of regular exercise—Margaret working out three times a week in her 90s. More often the activity shows itself in many hours of volunteer work and/or vigorous mental exercises that may stimulate the mind (Annette,).
They all ate healthily. While their medical history was not detailed in their self reports, my impression is that their diets and physical activity level enabled them to avoid major chronic diseases known to impair cognition such as heart conditions, hypertension, and type 2 diabetes.
All had active social networks that supported them. Margaret had her two daughters; Annette had a church community of caring people; their social networks also included their doctors that provided excellent care.
Recent research reports about individuals with non-progressive MCI verify that many of the lifestyle habits of Margaret and Annette, as well as Edwina and Art, are associated with a greater likelihood of remaining free of dementia. For instance, both exercise and playing mental games are beneficial; cardiovascular disease and type 2 diabetes increase the odds of dementia for MCI sufferers; larger social networks slows the progression while stress speeds it up.
Rarely a month passes without a promising new development that lowers the probability of developing dementia. These healthy lifestyle habits may well stop or slow cognitive decline while those with MCI await a definitive cure.