Mild Cognitive Impairment (MCI) is a catch-all term for people who show declines in their thinking abilities but whose problems are not interfering significantly with their ability to function.  Such people may complain of problems with memory or naming or modest confusion.  Nearly 10% of persons aged 70-79 suffer from MCI and approximately 18% of persons aged 80-89 warrant the diagnosis.  Nearly half of those who are given this diagnosis progressively deteriorate and develop a dementia disorder within 5 years.  The risk is even greater for persons with an amnestic variant of MCI.  Interventions at this stage or even earlier are important to help maintain an individual’s quality of life and independence for as long as possible.  Thus, accurate diagnosis of cognitive impairment at this stage is imperative. 

Medication induced memory problems

            Anti-depressant medications, statin drugs used to lower cholesterol, and lipid levels, and a host of other medications can interfere with normal cognitive function and produce impairment.  The impairment is reversible but often creates a kind of cost/benefit paradigm for those who take these drugs between the disorders they treat and the impact of the side effects.  It is crucial to distinguish between real cognitive degeneration and side effect induced cognitive deficits as well as to ascertain the severity of impairment.

The Dementias

            Dementia is a general term that indicates the presence of significant impairments in a person’s thinking and memory abilities.  These impairments are sufficiently great that they interfere with a person’s quality of life and ability to complete daily activities.  Such impairments must include a person’s learning and memory abilities, and at least one of the following:  expressive language, nonverbal communication, visuoperceptual abilities, and more complex, executive functioning skills (e.g., judgment, planning, organizing, reasoning, and problem-solving).  A dementia can develop from a variety of organic etiologies and can, in some cases, be somewhat reversible. 

Alzheimer’s disease (AD)

            Presently an estimated 5 million Americans suffer from Alzheimer’s disease, characterized by neurofibrillary tangles and neuritic plaques in the cortex of the brain.  These plaques cause progressive deterioration of the cortex.  Alzheimer’s is the most common form of dementia, and approximately one in two to three persons age 85 and older have the disease.  By 2030 an estimated 7.7 million Americans are predicted to develop the disease, a greater than 50% increase over today’s estimates.  The disease is characterized by amnestic memory loss, in addition to problems with language, nonverbal abilities, and more complex mental abilities.  Genetics can account for some cases of Alzheimer’s disease, but the largest risk factor for the disease is simply age.  A history of head injuries can also increase the chance of developing the disorder.  An individual with no family history of the disease has a 15% lifetime risk of developing the disease. 

Vascular Disease

            Also known as multi-infarct dementia, this type of cognitive disorder is associated with a step-wise progression of impairment, often seen with the repeated experience of strokes or mini-strokes, causing reduced blood flow to particular areas of the brain.  This type of dementia is typically characterized by a more subcortical pattern of deterioration, with greater declines in attention, concentration, and speed of thinking.  Cortical abilities are generally better preserved than in Alzheimer’s disease.  Approximately 1% of persons age 60 and older develop a vascular dementia; that rate increases to approximately 5% for individuals age 70-80. 

Lewy Body Disease

            Also viewed as a generally subcortical form of dementia, this disease is often associated with symptoms similar to Parkinson’s disease along with other extra pyramidal symptoms.  Lewy Body disease accounts for 12 to 20% of all those diagnosed with a dementia.  Visual or auditory hallucinations and delusions are often present along with frequent falls.  Of interest is that these psychotic symptoms are often aggravated by conventional anti-psychotic medications. Considerable variation in cognitive functioning may be seen with this dementia as all cases are not alike.  Fluctuating attention is a core feature of this dementia, in addition to poor nonverbal processing, and visuospatial deficits. 

Fronto-temporal disorder (FTD)

            FTD, accounting for about 20% of dementia cases, typically has an earlier onset than other forms of dementia, and the first signs of such are typically personality and/or behavioral changes.   Such changes may include impulsivity, disinhibition, social inappropriateness, perseveration, or apathy.  This type of dementia typically targets memory and more complex mental abilities.  The frontal and temporal lobes of the brain progressively deteriorate, while the posterior areas of the brain are spared.   

Dementia secondary to specific medical disorders

            Several kinds of neurological diseases and disorders may precipitate the development of a dementia disorder, including Parkinson’s Disease, Huntington’s Disease, and Multiple Sclerosis.  Some rare forms of cortical brain atrophy include primary progressive aphasia and semantic dementia (SD).  SD is a progressive neurodegenerative disorder characterized by loss of semantic memory in both the verbal and non-verbal domains. The most common presenting symptoms are in the verbal domain however (with loss of word meaning).

Depression

            In severely afflicted seniors depression may be mistaken for a dementia, and it is commonly called “pseudo-dementia.”  As we age the signs and symptoms of depression can change subtly, and seniors tend to express their mood problems with more physical complaints, such as being exhausted yet unable to sleep or having increased pain and other somatic problems.  A loss of appetite with weight loss can occur.  Depressed seniors may also express upset about their perceived cognitive declines, including problems with learning, memory, and attention.  Depression, though, is also a harbinger for the development of a dementia disorder, with nearly half of seniors with Alzheimer’s disease showing symptoms of depression two years before their diagnosis of AD.  Depression may cause neurochemical changes in the brain, which lead to deterioration and atrophy.  In some cases individuals may be developing the depression in reaction to their own problems.  In either case early accurate diagnosis is the key to appropriate interventions in order to maintain quality of life. 

Amnesias

            A particular form of Mild Cognitive Impairment, persons may present with an inability to learn and retain new information, without significant problems in other areas.  Such a problem may be an early sign of a developing neurodegenerative disorder or may be a pure disorder and may occur as a result of a hypoxic or anoxic insult to the brain. 

Other Conditions Diagnosed and Treated

Learning Disorders and Adult Attention Deficit

            Learning disorders, including dyslexia, and verbal processing disorders as well as disorders affecting mathematical learning are life long problems that begin in childhood.  People do not “grow out” of learning disorders and may require medication and/or tutoring to help optimize their ability to acquire new skills.  Others need professional organizers to help with executive function which includes dealing with organization and life management skills.