Posts Tagged ‘Mild cognitive impairment’

Social Activities May Help Protect Memory

August 24, 2016

The title of this blog is identical to a title of an article by Elizabeth Agnvall in the April21, 2016 online AARP.  HM has a number of comments on this article the first of which is that this title is way, way too cautious.  There is no question that social activities help protect memory.  Although there is no claim that social activities prevent dementia, there is no doubt that they help reduce the risk of mild cognitive impairment, a condition that is often—but not always — a  precursor to Alzheimers.

The article reports results of a study of about 2000 men and women age 70 and older participating in the long-running Mayo Clinic Study of Aging.  Two numbers are reported regarding the reduced risk  of people who used the computer at least once a week.  In the article proper the number provided is 42%, but in a table summarizing the studies results it is 44 %.

Those who read magazines at least once a week had a 30% reduced risk of mild cognitive impairment

Those who had engaged in crafts (for example, knitting) at least once a week had a 16% reduced risk of mild cognitive impairment.

Those who engaged in playing games at least once a week had a reduced risk of 14% or mild cognitive impairment.

These are reduced risks from what?  Is the original risk 100%? 75%? 50%? 25%?

Apart from the risk of mild cognitive impairment HM wonders what are these people doing with the rest of their time?  Watching television?    Watching Lucy reruns? Presumably the reciprocals of these values are the percentages of people who are at risk?  This is my peer group and HM is astounded at the low level of these activities and the finding that such low levels resulted in reduced risk of mild cognitive impairment.  It appears that my peers are largely cognitively disengaged.  This is difficult to believe.

As readers of the healthy memory blog should know, our recommendation is to remain cognitively engaged through growth mindsets on a daily basis, along with daily physical activity, daily meditation, and daily social activity.  Such a regimen should yield much larger reduced risks of mild cognitive impairment.  It is quite possible that you will be one of those whose brain has the defining symptoms of Alzheimer’s, but who never experiences any of the behavioral or cognitive symptoms of Alzheimer’s.  In other words, you may never have known that you had Alzheimer’s.

© Douglas Griffith and healthymemory.wordpress.com, 2016. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Douglas Griffith and healthymemory.wordpress.com with appropriate and specific direction to the original content.

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Is It Smart to Be Tested for Dementia?

December 21, 2013

This blog post is derived from an article1 in the Health and Science section of the Washington Post. First of all, it is difficult to distinguish early dementia from mild cognitive impairment. These are those minor memory impairments we experience as we age. About one in five people older than 75 have such blips, and most cases never progress to dementia or Alzheimer’s. I would argue further that what are experienced as mild memory impairments might not even indicate mild cognitive impairment. We experience memory failures throughout our lives, but as we age we tend to attribute these failures as cognitive impairments that we fear will lead to dementia.

Moreover, some memory lapses that might seem to be like dementia might really be something else. Danish researchers reviewed the records of almost 900 patients thought to have dementia and found that 41% of them were in error. Alcohol abuse and depression were the most common reasons for the misdiagnoses.

Small strokes that damage the arteries in the brain can cause a type of memory loss known as vascular dementia which is not Alzheimer’s. Currently, an autopsy is the only definitive test of Alzheimer’s where the telltale amyloid plaques and neurofibrillary tangels are found. However, it should be realized that autopsies have been done and found these telltale indicators in individuals who never had any of the symptoms of Alzheimer’s or dementia while they were alive.

Recent tests using brain scanning can be misleading. If, after reading this blog post, you remain worried, the first step should be to see a gerontologist or neurologist specializing in dementia. The claim is that when a full evaluation is done by somebody who knows how to do it, the accuracy of the diagnosis is supposed to be in the range of 90%.

Absent these full evaluations done by specialists, routine screening tests can be quite misleading. Even with the best screening tests, about 20% of those who turn up positive for dementia don’t actually have it. Another 30% of the people who screen positive for dementia actually have only mild cognitive impairment, which won’t progress or cause them serious problems.

Moreover, there is even some question whether early diagnosis improves outcomes. It should be acknowledged that there is no cure or preventive vaccine for Alzheimer’s. All that drugs can do is to slow the progression of the disease. Here is where I part company with the experts. What is the point of prolonging the progression of the disease? To my mind, this is simply a matter of prolonging the suffering. Our medical system is not designed to give us the best medical care, but rather the most expensive medical care. There is a strong willingness to prolong suffering so doctors and drug companies can take advantage of their last opportunity to cash in!

Moreover, little is said about the concept of a cognitive reserve. The explanation for those who have the brain damage indicative of Alzheimer’s, but not the symptoms, have built of a cognitive reserve. This healthymemory blog is filled with posts and ideas on how to build a healthy memory and a cognitive reserve.

1Christie Aschwanden (2013). Just remember this: It may not be smart to get yourself tested for dementia. The Washington Post, December 17, E5.

© Douglas Griffith and healthymemory.wordpress.com, 2013. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Douglas Griffith and healthymemory.wordpress.com with appropriate and specific direction to the original content.

Alzheimer’s is the Most Expensive Malady in the United States

April 14, 2013

According to a recent Rand Study reported in the New England Journal of Medicine, Alzheimer’s is the most expensive malady in the United States, costing somewhere from $157 billion to $215 billion per year. This makes it more expensive than heart disease and cancer, the two biggest killers, but as patients ultimately die from Alzheimer’s, this is a matter of how the books are kept. It is not the drugs nor other medical treatments that is the biggest cost of Alzheimer’s and other types of dementia, but the care that is needed to get mentally impaired people through daily life. Dementia’s direct costs, including medicines and nursing homes, are $109 billion in 2010 dollars.

According to the RAND study, nearly 15% of people aged 71 or older have dementia. That is about 3.8 million people. It is estimated that by 2040 the number will balloon to 9.1 million people. According to Dr. Richard J. Hodes, the director of the National Institute on Aging, “ I don’t know of any other disease predicting such a huge increase. And as we have the baby boomer group maturing, there are going to be more older people with fewer children to be informal caregivers for them, which is going to intensify the problem even more.”

The prospects of a cure are remote and drug treatments promise only to delay the progression of the disease. 74 to 84 percent of the costs involves helping patients in nursing homes or at home manage the most basic activities of life as they become increasingly impaired cognitively and then physically. A case of dementia costs from $41,000 to $56,000 a year. The projection is that the total costs of dementia care will more than double by 2040, to a range of $379 billion to $511 billion. They ranged from $159 billion to $215 billion in 2010. It is estimated that 22 percent of the people aged 71 and older (about 5.4 million) have mild cognitive impairment. This means that the level of cognitive impairment is mild and does not reach the threshold for dementia. About 12% of these people develop dementia each year.

The preceding solely concerns the economics of dementia. The personal loss is tragic. A lifelong of learning and experiences increasingly slip from memory. Friends and family members might not be recognized. Eventually, the self is lost, and the person does not remember who he or she is or whether he or she is a he or a she.

The best hope an individual has of avoiding or mitigating this loss is to live a healthy lifestyle, not only physically, but also cognitively, and to build a cognitive reserve. Research has shown that there are individuals with plaque and neurofibril tangles who have not exhibited symptoms of dementia. The healthymemory blog is dedicated to helping individuals build this cognitive reserve.

© Douglas Griffith and healthymemory.wordpress.com, 2013. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Douglas Griffith and healthymemory.wordpress.com with appropriate and specific direction to the original content.

Early Testing For Alzheimer’s

March 20, 2013

Alzheimer’s disease often progresses slowly. In the early stages some level of mild cognitive impairment is experienced, but life proceeds as normal. Not everyone who experiences this mild cognitive impairment will progress into Alzheimer’s. They have a twelve percent chance of developing it each year. Some will never develop dementia or will develop it from causes other than Alzheimer’s disease.1

Substantial effort has gone into developing tests to identify those with mild cognitive impairment who will progress into Alzheimer’s. This is difficult as a definite diagnosis awaits finding the amyloid plaques and neurofibril tangles. Positron emission tomography (PET) scans have been done to search for amyloid plaques in the brain that may begin to appear before symptoms manifest themselves. Research has found that healthy people with these plaques in their brains are more likely to develop Alzheimer’s related dementia later in life. However, it should be remembered that although these plaques and tangles might be a necessary condition for Alzheimer’s, they are not a sufficient condition. They have been found in autopsies of people who never exhibited any symptoms. The notion is that they had a cognitive reserve that protected them from this damage.

Tests can employ PET scans and/or Magnetic Resonance Imaging (MRI) scans along with analyses of brain fluid. I have seen no data regarding the accuracy of these tests with respect to hits (correct diagnosis) versus false alarms (incorrectly diagnosing progression into Alzheimer’s). Moreover, none of the current tests can help determine whether a person with early signs will progress quickly to dementia or continue to live normally for years.2

MRI’s have been successful in treating a condition that is frequently been misdiagnosed as Alzheimer’s (See the healthymemory blog post, “A Treatable Condition Misdiagnosed as Alzheimer’s). The condition is Normal Pressure Hydrocephalus and occurs when the cerebrospinal fluid that surrounds the brain is not re-absorped. It is estimated that 5% of the people diagnosed with dementia have this condition. Unlike Alzheimer’s, this condition can be corrected.

It is somewhat ironic that early testing for Alzheimer’s can be beneficial for the diagnoses of conditions other than Alzheimer’s. Currently Alzheimer’s cannot be cured. Drugs can slow the progression of the disease, but one should consider, is this simply prolonging the agony of the sufferer? When there are opportunities for participating in a test of a new treatment, one can volunteer in the spirit of contributing to science and the development of a possible cure, but realizing that there will likely be adverse events and the likelihood of a personal cure is quite low.

There is some evidence that people can actually reduce their risk of dementia by quitting smoking, living a heart-healthy lifestyle, and treating any diabetes or hypertension that might be present. The healthymemory blog would add being both cognitively and physically active; to continue to grow cognitively, and to build and maintain social relationships. Most healthymemory blog posts address these topics. I would hope that they all make, at least, some small contribution to cognitive growth.

1Wolfe, S.M. (ed) (2013) Early Testing for Alzheimer’s. Public Citizen Health Letter, February, Vol 29, No. 2. 4-5.

© Douglas Griffith and healthymemory.wordpress.com, 2012. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Douglas Griffith and healthymemory.wordpress.com with appropriate and specific direction to the original content.

2Ibid.