How can we differentiate between “normal” aging and mild cognitive impairment, the condition associated with early stages of neurodegenerative diseases like Alzheimer’s?
Aging can bring the occasional forgetting of a word or blanking on someone’s name in a conversation from time to time. Being Patient talked to experts about the red flags that can help differentiate typical age-related cognitive changes from early signs of the cognitive decline which may be associated with neurodegenerative diseases like Alzheimer’s.
“I am forgetting things. Should I be worried about Alzheimer’s?”
According to Dr. Sarah Kremen, the director of the Sidell-Kagan Alzheimer’s Disease Treatment Development Program at University of California, Los Angeles, people experiencing typical age-related cognitive changes can have difficulty retrieving information from the “rolodex” in their brains.
“This is common when people are trying to name something, either finding a word that they want to use, or frequently even [finding] proper nouns, which would include names of people or famous people,” Kremen told Being Patient.
That’s the “tip of the tongue” moment, when older adults can’t seem to find the right word even though they know it’s somewhere in the back of their minds. These moments, Kremen said, may become more frequent as people age. After all, it takes longer for the aging brain to sort through information in the rolodex.
Still, people can eventually remember the words they were searching for — perhaps a couple minutes or hours later.
“It’s an interesting thing that the more you try to hone in on the word you want at the time, the pressure of it makes it even worse [and the word] seems to elude you even more,” Kremen said. “But when your brain is relaxed and not really focused on that particular thing, it’s working in the background and [the brain] comes up with the information.”
“People still can record new memories,” she continued. “So they can remember what they did yesterday. They remember details of something they’ve read or conversations they’ve had. They can keep to their schedules because they know what it is. They can remember doctor’s appointments. They remember how to get to places.”
“How do I know whether I should get cognitive testing?”
On the other hand, Kremen said people with mild cognitive impairment (MCI) — a clinical syndrome describing people who experience cognitive deficits noticeable to themselves or others that can be documented in objective cognitive testing — may have a hard time remembering details of their conversations just a day or the week before. They may have difficulty remembering appointments. Unlike before, they may need to write down reminders to keep track of normal daily tasks.
“Oftentimes, there’s a lot of misplacement of small items like keys, sunglasses or your phone, and not remembering where you put them down. There’s that constant search everyday to figure out where they were put,” Kremen said.
While almost everyone has moments when they forget where they have placed an item, it’s a red flag when it happens nearly daily or weekly, intruding with one’s routine.
“What we hear when we talk to people’s families is that people may be repeating themselves,” Kremen said. “They don’t realize that in conversations, they’re telling the same stories.” Though others may be aware of their own repetitions. People with mild cognitive impairment may also ask the same questions.
Still, older adults with mild cognitive impairment can perform daily tasks such as working, driving, eating and showering independently.
“If I have mild cognitive impairment, does that mean I have Alzheimer’s?”
Older adults can have mild cognitive impairment due to Alzheimer’s, but people also suffer from the syndrome due to a host of other factors.
“There’s a lot of reasons why people have cognitive impairment,” Kremen said. “You can’t jump to the conclusion that ‘I have mild cognitive impairment, I must have Alzheimer’s disease.’”
For instance, people with obstructive sleep apnea, a condition when people’s breath stops for brief periods during sleep, can experience mild cognitive impairment. With proper treatment, clinicians can improve the cognitive abilities of these patients.
A review of people’s medication can also provide clues to the cause of older adults’ mild cognitive impairment. For one, Kremen said, medication for treating urinary incontinence can affect their cognition. Over-the-counter sleep medications, or the drug Ativan, commonly used to treat anxiety, may also lead to mild cognitive impairment.
Older adults with illnesses such as heart failure, urinary tract infection and thyroid problems can also have the syndrome, Kremen said. Clinicians can improve the cognitive abilities of patients with these conditions with appropriate treatment.
“Is my mild cognitive impairment due to Alzheimer’s?”
“Now on the flip side, if it is [due to] Alzheimer’s disease, then that’s important to know too obviously because that has an impact on the future of your life [and] your family’s life,” Kremen said.
An FDG PET scan, which shows the patterns of metabolism in the brain, can help clinicians paint a better picture of whether the patient has mild cognitive impairment due to Alzheimer’s, Kremen said. Clinicians can also conduct a lumbar puncture, which involves drawing a patient’s cerebrospinal fluid to analyze levels of beta-amyloid and tau, biomarkers of Alzheimer’s. In addition, results from a battery of neurocognitive tests can also help clinicians stitch together pieces of the puzzle. To improve accuracy and accessibility of diagnostics for Alzheimer’s, scientists are developing tools like blood tests and retinal scans.
In general, Kremen said, clinicians in academic institutions have become more aggressive in determining the causes of mild cognitive impairment. That way, if they determine that the syndrome is due to a neurodegenerative disease like Alzheimer’s, they can begin managing people’s symptoms early on, and prepare patients and their families for care planning.
“I have mild cognitive impairment due to Alzheimer’s. Can it be cured?”
According to Kremen, there is no approved medication for mild cognitive impairment. Exactly how long it takes for patients with mild cognitive impairment due to Alzheimer’s to progress to dementia of the Alzheimer’s type, losing their abilities to carry out daily activities independently as their symptoms worsen, depends from one individual to another.
In the meantime, Kremen recommends her patients with mild cognitive impairment due to Alzheimer’s to exercise for 30 minutes a day, which can be broken up into short walks throughout the day. Setting a good sleep routine and managing mental health is also crucial.