Mild Cognitive Impairment is a condition that falls somewhere between normal age-related memory loss and Alzheimer’s disease or a similar impairment. Not everyone with MCI develops dementia. And like dementia, MCI is not an illness, but a cluster of symptoms that describe changes in how the people think or process information. Memory problems are the most common indicators of MCI. A person with MCI may also experience difficulties with judgment, thinking and language beyond what one might expect with normal aging. For unknown reasons, MCI appears to affect men more than women.
Family members and friends who notice these problems might not express concern because the early symptoms can mimic normal, age-related changes. People suffering from MCI often recognize they are having trouble but are still able to carry on most of their usual activities and live independently.
The diagnosis of MCI relies on the fact that the individual is able to perform all their usual activities successfully, without more assistance from others than they previously needed.
Types
Amnestic vs. Non-Amnestic MCI – In amnestic MCI, memory is significantly impaired. Other cognitive functions are spared. Alzheimer’s disease is believed to cause amnestic MCI. In non-amnestic MCI, memory remains intact, but one (single domain) or more (multiple domain) other cognitive abilities (e.g., language, visual-spatial skills, executive functioning) are significantly impaired.
Single Domain vs. Multiple Domain MCI – In single domain MCI, only memory or one other domain of cognition is impaired. In multiple domain MCI, memory plus one or more other cognitive abilities are affected.
Causes
Current evidence indicates that MCI often, but not always, arises from a lesser degree of the same types of brain changes seen in Alzheimer’s disease or other forms of dementia. Some of these changes have been identified in autopsy studies of people with MCI. These changes include –
- Abnormal clumps of beta-amyloid protein (plaques) and microscopic protein clumps characteristic of Alzheimer’s disease (tangles)
- Lewy bodies, which are microscopic clumps of another protein associated with Parkinson’s disease, dementia with Lewy bodies and some cases of Alzheimer’s disease
- Small strokes or reduced blood flow through brain blood vessels
Brain-imaging studies show that the following changes may be associated with MCI –
- Shrinkage of the hippocampus, a brain region important for memory
- Plaques throughout the brain
- Enlargement of the brain’s fluid-filled spaces (ventricles)
- Reduced use of glucose, the sugar that’s the primary source of energy for cells, in key brain regions
Brain imaging and medical research have shown that some people with MCI also have the plaques, neurofibrillary tangles and shrinkage in the memory center of the brain that is observed in those with Alzheimer’s disease (AD).
Other problems (which may be reversible) can contribute to memory loss, including: medication interactions (from both presciption and over-the-counter drugs), infections, vitamin shortages, malnutrition, thyroid and other metabolic disturbances, depression and drug/alcohol abuse.
It’s important to note that some people with MCI never get worse, and do not develop Alzheimer’s. Current studies find that approximately half of the people diagnosed with MCI will experience continued progression of the symptoms leading to a diagnosis of Alzheimer’s disease or a similar dementia.
Risk Factors
The causes of MCI may not be clear, but it appears some of the same risks for Alzheimer’s disease are risks for MCI. Those risks include:
- Being 65 or older
- Having a family history of MCI, Alzheimer’s disease, or another form of dementia
- Having certain medical conditions, such as high blood pressure, diabetes, stroke, high cholesterol, or heart disease
- Substance abuse, alcohol abuse
- Lack of exercise
There are many factors that may influence cognitive decline –
- Cerebrovascular events.
- Hyperparathyroidism, hypoparathyroidism.
- Hypoperfusion – eg, heart failure.
- Head trauma, including recurrent trauma of having been a boxer.
- Deficiencies of folate, vitamin B12 and vitamin B6 are associated with neurological and psychological dysfunction, and are potential factors for cognitive impairment and the development of dementia in the elderly
- Open heart surgery with cardiopulmonary bypass.
- Medication use, especially sedatives.
- Hepatic impairment.
- Sleep disorders – eg, obstructive sleep apnoea.
- Psychological stress.
- Drug or alcohol abuse.
- Toxins, infections, metabolic (eg, hypoglycaemia) and structural causes.
Symptoms
The term MCI describes a set of symptoms, rather than a specific disease. A person with MCI has mild problems with one or more of the following –
- Memory – for example, forgetting recent events or repeating the same question
- reasoning, planning or problem-solving – for example, struggling with thinking things through
- Attention – for example, being very easily distracted
- Language – for example, taking much longer than usual to find the right word for something
- Visual depth perception – for example, struggling to interpret an object in three dimensions, judge distances or navigate stairs.
These symptoms will have been noticed by the individual, or by those who know them. For a person with MCI, these changes may cause them to experience minor problems or need a little help with more demanding daily tasks (eg paying bills, managing medication, driving). However, MCI does not cause major problems with everyday living. If there is a significant impact on everyday activities, this may suggest dementia.
Most healthy people experience a gradual decline in mental abilities as part of ageing. In someone with MCI, however, the decline in mental abilities is greater than in normal ageing. For example, it’s common in normal ageing to have to pause to remember directions or to forget words occasionally, but it’s not normal to become lost in familiar places or to forget the names of close family members.
If the person with MCI has seen a doctor and taken tests of mental abilities, their problems will also be shown by a low test score or by falling test scores over time. This decline in mental abilities is often caused by an underlying illness.
Treatment
No medications are currently approved by the U.S. Food and Drug Administration (FDA) to treat mild cognitive impairment. Drugs approved to treat symptoms of Alzheimer’s disease have not shown any lasting benefit in delaying or preventing progression of MCI to dementia.
The following coping strategies may be helpful for those with MCI. Some studies suggest that these strategies may help slow decline in thinking skills, although more research is needed to confirm their effect.
- Exercise on a regular basis to benefit the heart and blood vessels, including those that nourish the brain.
- Control cardiovascular risk factors to protect the heart and blood vessels, including those that support brain function.
- Participate in mentally stimulating and socially engaging activities, which may help sustain brain function.
Treating other conditions that can affect mental function
Other common conditions besides MCI can make people feel forgetful or less mentally sharp than usual. Treating these conditions can help improve your memory and overall mental function. Conditions that can affect memory include –
- High blood pressure – People with MCI tend to be more likely to have problems with the blood vessels inside their brains. High blood pressure can worsen these problems and cause memory difficulties.
- Depression – When people are depressed, they often feel forgetful and mentally “foggy.” Depression is common in people with MCI. Treating depression may help improve memory, while making it easier to cope with the changes in the life.
- Sleep apnea– In this condition, the breathing repeatedly stops and starts while people are asleep, making it difficult to get a good night’s rest. Sleep apnea can make people feel excessively tired during the day, forgetful and unable to concentrate. Treatment can improve these symptoms and restore alertness.
Alternative Treatment
Curcumin is the compound that gives turmeric, the popular curry spice, its vibrant yellow color and has been shown to protect against neurodegeneration and mild cognitive impairment.
Resveratrol – Another anti-inflammatory powerhouse is resveratrol, the compound found in the skins of grapes and also found in Japanese knotweed. In addition to combatting inflammation and acting as a potent antioxidant, resveratrol has also been shown to increase blood flow to the brain, stimulate brain growth and synaptic connections, inhibit plaque formation in the brain, and reduce the damage caused by strokes, inflammation, and seizures.
Vitamins (particularly vitamin E), play a significant role in slowing the progression from mild cognitive impairment to Alzheimer’s disease.
Phospholipids are fats that make up the membranes of cells. Phosphatidylserine is a phospholipid that determines how well cell membranes communicate with each other. Low phosphatidylserine levels are associated with memory loss and depression. Studies have shown phosphatidylserine can significantly improve cognitive function, including in people with mild cognitive impairment and Alzheimer’s disease.
Magnesium-L-threonate – A deficiency in magnesium has been linked with memory impairment, slow recovery after a brain injury, and accelerated aging of brain cells. While magnesium citrate, glycinate, or malate are often recommended, researchers say they don’t cross the blood-brain barrier and therefore, are not effective. However, a newer, synthetic form of magnesium called magnesium-L-threonate has been shown to cross the blood-brain barrier, enhance memory and prevent impairment, thus lowering the risk of mild cognitive impairment.
Reference –
http://emedicine.medscape.com/article/951840-treatment
http://www.nejm.org/doi/full/10.1056/NEJM197109302851407
http://www.healthline.com/health/metachromatic-leukodystrophy#Outlook6
http://www.webmd.com/brain/leukodystrophy-metachromatic
http://www.brains4brain.eu/developing-treatment-options-for-metachromatic-leukodystrophy-mld/
http://www.cdc.gov/aging/pdf/cognitive_impairment/cogimp_poilicy_final.pdf
http://www.alzheimer.ca/en/About-dementia/Treatment-options
http://www.alz.org/dementia/mild-cognitive-impairment-mci.asp#treatment