Dementia and mild cognitive impairment—a brief review
Dementia is a chronic condition characterized by severe persisting impairments of short-term and long-term memory and severe deficits in other areas of cognitive functioning such as abstract reasoning, language, impaired capacity to perform routine daily tasks, and loss of ability to recognize familiar objects, places or people. Alzheimer’s disease, the most common form of dementia, is a progressive neurodegenerative disease that accounts for two thirds of all cases of dementia. It has been estimated that roughly one half of all individuals over the age of 85 have Alzheimer’s disease. Genetic risk factors, chronic nutrient deficiencies, toxic injury to the brain, coronary artery disease, chronic stress and prolonged social isolation or restricted intellectual activity increase the risk of developing Alzheimer’s disease. The degenerative changes in the brain that lead to Alzheimer’s disease are related to deposits of an abnormal brain protein called amyloid-beta which sets off wide-spread inflammation and the formation of free radicals that damage or destroy neurons.
Medical causes of dementia include vascular disease that affects the arteries of the brain, Parkinson’s disease, other neurodegenerative disorders, traumatic brain injury (TBI), HIV/AIDS, severe cerebro-vascular accidents (i.e. ‘stroke’), and the cumulative toxic effects of chronic alcohol or substance abuse. Diets high in saturated fats are associated with increased risk of developing Alzheimer’s disease while diets high in fish are associated with relatively reduced risk. Moderate wine consumption (1-2 glasses/day) reduces the risk of Alzheimer’s disease but chronic alcohol abuse probably increases the risk of dementia.
It is important to distinguish the progressive and irreversible changes seen in dementia from the temporary and reversible changes in cognition associated with a state of acute confusion called ‘delirium.’ Serious medical illnesses or acute intoxication with alcohol or drugs often manifest as delirium in which cognitive functioning is grossly impaired. Successful treatment of the underlying cause or causes of delirium restores the brain to its healthy state and cognitive functioning rapidly returns to normal. Anyone who is experiencing rapidly progressing decline in cognitive functioning should be referred urgently to the nearest hospital emergency room or urgent care center to rule out medical causes of these symptoms.
Many individuals experience moderate or severe cognitive impairment as an indirect result of other mental health problems such as severe depressed mood, anxiety, bipolar disorder, psychosis, chronic sleep deprivation, or chronic alcohol or drug abuse. The successful treatment of a mental health problem that is impairing cognitive functioning often results in a return of normal cognitive functioning.
Mild cognitive impairment (MCI) is a less severe form of cognitive impairment that is often temporary but may progress to Alzheimer’s disease or other severe irreversible forms of dementia. MCI sometimes takes place with normal aging, chronic nutritional deficiencies, less severe strokes, thyroid disease, and chronic alcohol or narcotic abuse. Correcting the underlying medical cause or causes of MCI usually results in rapid improvement of symptoms of cognitive impairment.
Limitations of conventional treatments of dementia and mild cognitive impairment
Most currently available pharmacologic treatments of Alzheimer’s disease work by inhibiting the enzyme that breaks down the neurotransmitter acetylcholine, thus increasing available levels of this molecule which plays a critical role in learning and memory. These so-called cholinesterase inhibitors have significant adverse effects, and are only effective against mild or early symptoms of Alzheimer’s disease, but not other forms of dementia. Early promising results of studies on tacrine, the first commercially marketed acetylcholinesterase inhibitor, were offset by findings of significant hepatotoxicity. Second generation acetylcholinesterase inhibitors (donepezil, rivastigmine and galantamine) are no more effective than tacrine but require less frequent dosing and have fewer associated safety issues. Other drug classes that have been investigated for possible cognitive enhancing benefits in dementia include the monoamine oxidase inhibitors (MAOI), estrogen replacement therapy (ie, in cognitively impaired post-menopausal women), naloxone, and various neuropeptides including vasopressin and somatostatin. Most studies on prescription drug treatments of dementia and mild cognitive impairment have yielded equivocal or negative results. Promising novel biomedical treatments of Alzheimer’s disease currently being investigated in clinical trials include a vaccine that may immunize individuals against formation of amyloid beta, secretase inhibitors, anti-inflammatory agents and statins.
Individuals who are severely cognitively impaired frequently experience depressed mood, anxiety and psychotic symptoms. Contemporary biomedical management of such mixed symptom patterns relies on combinations of drugs increasing the risk of adverse effects and toxic interactions. Behavioral disturbances, including agitation and aggressive behavior toward care-givers, are commonly encountered in demented individuals. Even though cholinesterase inhibitors offer only transient improvements in the early stages of dementia, these drugs have become standard-of-care biomedical approach to Alzheimer’s disease and other forms of dementia in Western countries because of consistent findings of reduced agitation. In addition to pharmacological management, behavioral interventions, environmental enrichment and social support mitigate some of the cognitive and behavioral symptoms of dementia.
Non-medication treatments of dementia and mild cognitive impairment
The limited effectiveness of available mainstream treatments of dementia and mild cognitive impairment invites serious consideration of non-medication approaches. Natural supplements used to treat mild cognitive impairment or slow the rate of progression of dementia, include certain B vitamins, Ginkgo biloba, idebenone, acetyl-L-carnitine (ALC), huperzine-A and other herbals.
Other alternative approaches that sometimes slow the rate of progression of dementia or decrease the severity of mild cognitive impairment or dementia, include regular exercise, bright light exposure therapy, music, access to ‘wander gardens,’ and a multi-sensory stimulation approach called ‘snoezelen.’ Regular physical activity reduces the risk of developing dementia but does not improve symptoms of cognitive impairment in demented individuals. Using weak electrical current to stimulate the brain may result in temporary improvements in word recall and face recognition in mildly demented individuals.
If you or a loved one are struggling with symptoms of mild cognitive impairment or dementia and taking a medication that isn’t helping, you are experiencing adverse effects, or you simply can’t afford to continue taking a medication that is working, you will benefit from my book Dementia and Mild Cognitive Impairment: The Integrative Mental Health Solution. The book provides practical information about a variety of non-medication approaches that will help you function better such as herbals and other natural supplements, whole body approaches, meditation and mind-body practices, and many others.
Dementia and Mild Cognitive Impairment: The Integrative Mental Health Solution will help you:
• Understand dementia and mild cognitive impairment better
• Take inventory of your symptoms
• Learn about non-medication treatments of memory loss and other symptoms of cognitive impairment
• Develop a customized treatment plan that is right for you
• Re-evaluate your treatment plan and make changes if your initial plan doesn’t work
Click here to preview or buy my book, Dementia and Mild Cognitive Impairment: The Integrative Mental Health Solution.