Age related illnesses, Mental Health | November 3, 2014 | Author: The Super Pharmacist
Mild cognitive impairment is perhaps best defined as a chronic state of reduced mental abilities. In clinical terms, mild cognitive impairment is used when someone has impaired cognition but does not meet criteria for dementia, such as Alzheimer's disease. Some people consider mild cognitive impairment as a precursor for dementia, while others consider it a consequence of normal aging. While these definitions are important to researchers, for patients what is important is that they have lost some of their mental faculties and they want to know how to regain them.
Most people with mild cognitive impairment will experience a progressive worsening of their condition over time. In some people, the speed at which mild cognitive impairment worsens is quite rapidly. In these individuals, it is likely that mild cognitive impairment represents an early form of Alzheimer's disease. In other people, mild cognitive impairment only slowly worsens over time. In these individuals, it is likely that mild cognitive impairment is a consequence of normal aging.
It is generally accepted that older people with mild cognitive impairment have a threefold greater risk of developing Alzheimer's disease. It is important to remember, however, that as many as four in 10 people with mild cognitive dementia will actually improve within one to three years. Alzheimer's disease, on the other hand, is universally progressive and is not known to reverse once it has started. Nonetheless, researchers are interested in finding ways to prevent, slow down, or even reverse mild cognitive impairment.
As with all conditions, prevention is ideal. So far, our best approach for preventing mild cognitive impairment is to identify risk factors and, when possible, avoid that factor or mitigate the risk. Some risk factors are unavoidable. For instance, aging is a strong risk factor for mild cognitive impairment and dementia, but who is going to willingly stop aging? Likewise, certain genetic factors are associated with developing dementia, but these are unavoidable. Nonetheless, what is good for the body is also good for the mind. High blood pressure, type II diabetes, obesity, and heart disease all increase the risk of developing mild cognitive impairment. Therefore, effectively treating or preventing these conditions presumably also prevents mild cognitive impairment.
Diets that contain ample vegetables and polyunsaturated fats appear to protect against mild cognitive impairment. In fact, modest alcohol consumption is also protective.
Another approach that seems to be helpful is called mental reserve. In other words, performing brain training exercises, keeping an active mind, and challenging oneself with mental stimulation appears to be protective in mild cognitive impairment. People who attain a higher educational level, and mentally complex work, or who consistently tacks their brains throughout life tend to avoid or slow the decline of cognitive impairment.
As mentioned, staying mentally active or developing greater mental reserve appears to slow the progression of mild cognitive impairment. Mental reserve is something that is developed early in life, perhaps as early as in the womb or during infancy, but can also be cultivated throughout life through intellectual challenge and effort. The type of mental stimulation (e.g. memory, attention, language) is not terribly important as long as it is rigorous. Again, what is good for the body is good for the brain. Patients with mild cognitive impairment who participated in exercise programs enjoyed some improvement in cognitive function. Atherosclerosis should be treated aggressively, since there is a strong link between blood vessel disease in the brain and mild cognitive impairment.
Drug treatments to slow down the progression of mild cognitive impairment have been disappointing. Drugs used with success to treat Alzheimer's disease, such as donepezil, galantamine, and rivastigmine, have been ineffective in slowing the progression of mild cognitive impairment. These drugs are also associated with several undesirable side effects. In fact, the side effects of these drugs almost always outweigh their possible clinical benefit in mild cognitive impairment. Researchers have found that some forms of dementia, particularly Alzheimer's disease, is associated with inflammation in the brain. Consequently, researchers have attempted to use anti-inflammatory drugs to treat mild cognitive impairment. These have also been unsuccessful. Rofecoxib (better known as Vioxx and no longer available on the market due to unwanted cardiovascular side-effects) was given to 1,457 patients with mild cognitive impairment for an average of four years and did nothing to affect the progression of the condition or improve cognition.
Several vitamins and supplements have been tried in clinical studies and failed to improve mild cognitive impairment. Notable failures include vitamin E, vitamin B6, vitamin B12, folic acid, acetyl-l-carnitine, omega-3 fatty acids, and ginkgo biloba.
While on their own each ingredient was not significantly better than placebo, it is conceivable that diets which include two or more of these ingredients may be helpful as part of a comprehensive diet plan.
Huperzine A is commonly used in Traditional Chinese Medicine to treat cognitive impairments, but it has not been rigorously studied in clinical trials.
Clinical trials of drugs, vitamins, or supplements in the treatment of mild cognitive impairment have been disappointing. No agent tested, thus far, is better than placebo. Prevention appears to more effective than treatment, as it is with most conditions. Physical and mental exercise appears to have the strongest beneficial impact on mild cognitive impairment. A healthy diet rich in vegetables and the right kinds of fats and oils appears to be protective as well. Likewise, aggressively treating or controlling diseases that affect the blood vessels (high blood pressure, atherosclerosis, type 2 diabetes) can potentially slow the progression of mild cognitive impairment or reduce the risk of it occurring.
Manly JJ, Tang MX, Schupf N, Stern Y, Vonsattel JP, Mayeux R. Frequency and course of mild cognitive impairment in a multiethnic community. Ann Neurol. Apr 2008;63(4):494-506.
Larrieu S, Letenneur L, Orgogozo JM, et al. Incidence and outcome of mild cognitive impairment in a population-based prospective cohort. Neurology. Nov 26 2002;59(10):1594-1599.
Visser PJ, Kester A, Jolles J, Verhey F. Ten-year risk of dementia in subjects with mild cognitive impairment. Neurology. Oct 10 2006;67(7):1201-1207.
Roberts RO, Knopman DS, Przybelski SA, et al. Association of type 2 diabetes with brain atrophy and cognitive impairment. Neurology. Apr 1 2014;82(13):1132-1141.
Roberts RO, Geda YE, Knopman DS, et al. Cardiac disease associated with increased risk of nonamnestic cognitive impairment: stronger effect on women. JAMA Neurol. Mar 1 2013;70(3):374-382.
Ganguli M, Fu B, Snitz BE, Hughes TF, Chang CC. Mild cognitive impairment: incidence and vascular risk factors in a population-based cohort. Neurology. Jun 4 2013;80(23):2112-2120.
Roberts RO, Geda YE, Cerhan JR, et al. Vegetables, unsaturated fats, moderate alcohol intake, and mild cognitive impairment. Dement Geriatr Cogn Disord. 2010;29(5):413-423.
Roberts RO, Cerhan JR, Geda YE, et al. Polyunsaturated fatty acids and reduced odds of MCI: the Mayo Clinic Study of Aging. J Alzheimers Dis. 2010;21(3):853-865.
Lojo-Seoane C, Facal D, Juncos-Rabadan O. [Does intellectual activity prevent cognitive impairment? Relationships between cognitive reserve and mild cognitive impairment]. Rev Esp Geriatr Gerontol. Nov-Dec 2012;47(6):270-278.
Martin M, Clare L, Altgassen AM, Cameron MH, Zehnder F. Cognition-based interventions for healthy older people and people with mild cognitive impairment. Cochrane Database Syst Rev. 2011;1(1).
Lautenschlager NT, Cox KL, Flicker L, et al. Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial. JAMA. Sep 3 2008;300(9):1027-1037.
Chertkow H, Massoud F, Nasreddine Z, et al. Diagnosis and treatment of dementia: 3. Mild cognitive impairment and cognitive impairment without dementia. CMAJ. May 6 2008;178(10):1273-1285.
Birks J, Flicker L. Donepezil for mild cognitive impairment. Cochrane Database Syst Rev. 2006(3):CD006104.
Winblad B, Gauthier S, Scinto L, et al. Safety and efficacy of galantamine in subjects with mild cognitive impairment. Neurology. May 27 2008;70(22):2024-2035.
Feldman HH, Ferris S, Winblad B, et al. Effect of rivastigmine on delay to diagnosis of Alzheimer's disease from mild cognitive impairment: the InDDEx study. Lancet Neurol. Jun 2007;6(6):501-512.
Russ TC, Morling JR. Cholinesterase inhibitors for mild cognitive impairment. Cochrane Database Syst Rev. 2012;9:CD009132.
Thal LJ, Ferris SH, Kirby L, et al. A randomized, double-blind, study of rofecoxib in patients with mild cognitive impairment. Neuropsychopharmacology. Jun 2005;30(6):1204-1215.
Farina N, Isaac MG, Clark AR, Rusted J, Tabet N. Vitamin E for Alzheimer's dementia and mild cognitive impairment. Cochrane Database Syst Rev. 2012;11:CD002854.
Balk EM, Raman G, Tatsioni A, Chung M, Lau J, Rosenberg IH. Vitamin B6, B12, and folic acid supplementation and cognitive function: a systematic review of randomized trials. Arch Intern Med. Jan 8 2007;167(1):21-30.
Snitz BE, O'Meara ES, Carlson MC, et al. Ginkgo biloba for preventing cognitive decline in older adults: a randomized trial. JAMA. Dec 23 2009;302(24):2663-2670.
Sydenham E, Dangour AD, Lim WS. Omega 3 fatty acid for the prevention of cognitive decline and dementia. Cochrane Database Syst Rev. 2012;6:CD005379.
Hudson S, Tabet N. Acetyl-L-carnitine for dementia. Cochrane Database Syst Rev. 2003(2):CD003158.
Kidd PM. Alzheimer's disease, amnestic mild cognitive impairment, and age-associated memory impairment: current understanding and progress toward integrative prevention. Altern Med Rev. Jun 2008;13(2):85-115.
Yue J, Dong BR, Lin X, Yang M, Wu HM, Wu T. Huperzine A for mild cognitive impairment. Cochrane Database Syst Rev. 2012;12:CD008827.