Mild cognitive impairment
GENERAL ASPECTS
What does the term mild cognitive impairment mean?
Mild cognitive impairment is the intermediate stage between normal cognitive aging and dementia, characterized by the loss of memory or any other cognitive function at an early age. Although it does not usually significantly alter the daily lives of those who suffer from it, it is known to increase the risk of dementia and other neurodegenerative pathologies such as Alzheimer’s disease.
What are the causes of mild cognitive impairment?
The causes of onset of mild cognitive impairment are multiple. In some cases it may originate as a consequence of a tumor or cerebral vascular disease, but it can also appear as a consequence of hypothyrodism, vitamin B12 or folic acid deficiency, consumption of toxic substances (including some drugs) or obstructive sleep apnea syndrome.
What are the symptoms of mild cognitive impairment?
Although aging usually involves some memory loss or forgetfulness, a person is considered to have mild cognitive impairment when he or she frequently forgets appointments or meetings with friends; frequently loses personal objects; becomes disoriented in familiar places; and finds it difficult to express certain words or follow instructions.
Will everyone with mild cognitive impairment develop Alzheimer’s disease?
No, but all people with Alzheimer’s disease or other dementia have previously suffered mild cognitive impairment.
Are there risk factors for developing mild cognitive impairment?
Yes, in addition to advanced age, there are certain factors that increase the risk, such as high blood pressure, diabetes, obesity, smoking, high cholesterol levels, obesity, sedentary lifestyle, and mental and social inactivity. In addition, these same factors also increase the risk of mild cognitive impairment progressing to dementia.
When is it necessary to consult a physician?
People with mild cognitive impairment or their family members are usually concerned that memory problems may progress to Alzheimer’s disease. It is important to consult a neurologist at that time as it may be an early sign of a more serious memory problem. It is also important to consult at the onset of symptoms as in some cases a treatable cause is found that can be improved or reversed with treatment.
It is useful to follow up on the evolution periodically. If symptoms progress, getting an early diagnosis can be helpful in preparing for the future. Although there are currently no medications to stop or reverse Alzheimer’s disease, there are drugs that can help delay some symptoms, and control behavioral problems if they appear.
Can mild cognitive impairment be prevented?
Prevention is based on incorporating a healthy lifestyle. The earlier it starts, the more effective it will be. Young people should start taking care of their brain health at this age, but it is never too late to do so. Following a Mediterranean-type diet(www.dietamediterranea.com), exercising, stimulating the mind and social life are positive. On the contrary, tobacco, alcohol, hypertension, diabetes, obesity, cholesterol, social isolation and a sedentary lifestyle are the great enemies.
DIAGNOSIS
The first step in diagnosing mild cognitive impairment is to perform a neurological assessment to determine whether or not it is present. This assessment begins with a personal interview in which the presence of a family member or person close to the patient is usually requested in order to know, as reliably as possible, the symptoms, how long the patient has been suffering from them and to verify whether the deterioration is not significantly impairing the patient’s social and working life.
After this consultation, a mental status examination is performed, which includes tests of attention, orientation, memory, use of language, visual recognition and abstraction capacity, among others. These tests are also useful to know what type of memory is most affected and if other mental functions are also affected, as well as to detect signs of other diseases such as Parkinson’s, vascular lesions, hydrocephalus or tumors.
This assessment is usually accompanied by a neuropsychological study, in which a series of tests, scales and questionnaires are performed to analyze cognitive function and behavioral changes, thus discriminating normal aging from pathological aging and allowing to objectively check the evolution of cognitive impairment over time.
If the person is found to have mild cognitive impairment, a blood test and cranial MRI are performed to detect or exclude other treatable problems that may affect memory, such as vitamin B12 deficiency, folic acid, hypothyroidism, vascular lesions in the brain, subdural hematoma, hydrocephalus or tumor. These patients undergo periodic neuropsychological studies to accurately monitor the evolution of cognitive impairment.
An early diagnosis allows interventions focused on delaying the onset of dementia and improving the quality of life of those affected, which also allows them to make decisions about their future.
TREATMENT
There is currently no specific treatment for mild cognitive impairment, but there is for the reversible causes that lead to it.
In particular, some drugs can alter cognitive functions, such as benzodiazepines (treatments for sleep disturbances or anxiety), opioids used for pain, or antihistamines. If this is the cause, the side effects will most likely disappear when the drug is withdrawn, although you should never stop taking them without your doctor’s supervision.
Initiating lifestyle changes can also improve symptoms of mild cognitive impairment, among which the following stand out:
- Control vascular risk factors such as hypertension, cholesterol, obesity or diabetes.
- Follow the Mediterranean diet rich in fresh produce, vegetables, legumes and fish, avoiding the consumption of animal fats, sugars and processed products.
- Avoid tobacco and alcohol consumption.
- Sleep between 7 and 8 hours a day.
- Exercise regularly. It is highly recommended to walk one hour a day.
- Spending time with family and friends.
- Strengthen memory by performing cognitively stimulating exercises such as reading, writing, dancing, listening to music, learning to play an instrument or a language, doing manual activities, solving crossword puzzles, attending cultural events or traveling,
- Undergo individual or group cognitive stimulation activities because they help improve concentration and memory, as well as mood, anxiety and depression levels.
On the other hand, some studies have suggested that the consumption of certain vitamins, such as vitamin E or D, and other substances may improve or prevent the symptoms of cognitive impairment, although there is a lack of solid scientific evidence in this regard and they should not be taken without the supervision of a physician. There is also a lack of knowledge about the effect of omega-3 fatty acids on mild cognitive impairment, although omega-3 supplementation is generally well tolerated and may support brain health.
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