I have the good fortune to work with many young people. I like to tell them that I wish they had known me when I was younger and my mind was as agile as theirs. Although experience and judgment allows most of us to continue to function at a high level for most of our lives, as we age we do start to notice changes in our cognitive abilities. These changes can be alarming at first, but eventually, like our wrinkles, they become part of our transition through life.
If you are over the age of 50 there have been days when you got up from your comfortable living room chair, walked into your bedroom, looked around the room and asked yourself, "what was it I needed?" If later that same day you spent five minutes looking for your car keys or cell phone, you probably began to wonder if, just like your mother's Aunt Esther, you were developing early Alzheimer's disease. Add an episode of forgetting your child's phone number and you are liable to call a friend and ask them if they have noticed any differences in your thinking abilities. Could Alzheimer's disease be right around the corner?
Where is the line between age related memory loss and early Alzheimer's disease? We have a name for this transitional phase, it is called, Mild Cognitive Impairment or MCI.
Normal Aging and MCI
We are born with billions of nerve cells in our brain and almost as soon as we take our first breath we start to lose some of them -- so slowly that at first it doesn't have an impact on our cognitive abilities. Psychologists have estimated that our peak age to attain new knowledge is around age 25, making it more difficult to acquire new skills later in life. As we age we may not notice changes in our cognitive abilities until our 50s, with judgment and experience getting us through these later decades.
Normal aging affects our cognitive abilities in a variety of ways. The rate at which we acquire new information slows down as does our ability to perform specific tasks. Psychologists call this our speed of information processing. We may not do things as fast as the 25 year old, but we do get the job done or the problem solved. Our immediate and remote memory are still intact, but we may have trouble remembering something that happened earlier in the day like, where did I leave those keys? When meeting someone we haven't seen in a few months, we may not immediately know their name, but we do remember it a bit later. We have trouble finding the word we want to use and then, later in the day, while making dinner it pops into our head. This is all part of normal aging.
The loss of our cognitive abilities can be a slow, insidious process and the transition from normal aging to mild cognitive impairment (MCI) can be difficult to recognize and diagnose in its early phases. A new classification system for Alzheimer's disease (AD) recognizes that Mild Cognitive Impairment (MCI) may be an early phase of AD that may progress to dementia. However, at this time, it is difficult to predict which person will go on to develop AD and which one will not. People who will eventually develop AD may be free of symptoms for several years before they start to notice problems and it may take several more years to progress from MCI to AD. It is estimated that 10 to 15 percent of people with MCI progress to clinical AD each year or otherwise stated, it may take 6-10 years to go from MCI to AD.
When Should You Worry?
Earlier this year, the National Institute of Aging issued a set of guidelines that classifies MCI as a stage between the time when changes are taking place in the brain, but the person has no symptoms and a later stage when the person clearly has dementia. The cognitive changes in Mild Cognitive Impairment are not yet severe enough to interfere with day to day life and your usual activities.
If you have MCI and it does progress to AD, you need to make appropriate plans. But, how do you know if you have MCI or just normal age related memory loss? I have underlined and emphasized what are the most important features to consider. You may have MCI if you:
• Forget things frequently
• Forget important appointments and events
• Are overwhelmed by decisions
• Have trouble finding familiar places
• Are told by your family or friends that they have noticed these changes
• Notice that your problems are progressing
• Have difficulty learning new tasks
• Have trouble handling money or paying bills
What to Do If You Have MCI
No one wants to hear that their memory loss or cognitive problems are the symptoms of Alzheimer's disease and that their problems will continue to worsen. However, knowing what the future holds, gives both you and your family an opportunity to make plans. There is still time to do the things you want to do, but equally important is using that time to make plans for a future when you may not be able to make those decisions. It is important to make these plans whether or not you develop AD.
You should consider:
• Participating in a clinical research study on patients with MCI. While it may not change the course of your disease, it may help others in the future.
• Talk with your doctor about the things that you can do to maximize your health and cognitive abilities. These include diet, physical and mental exercise and the use of medications that may help cognition. Unfortunately we do not have medications to alter the course of Alzheimer's disease, but we can improve your mental abilities in the early phases of MCI and AD.
• Perform a thorough review of all of your financial and legal documents to be certain that everything is in order and the way you want it to be. Who will have your Power of Attorney and make decisions for you when you are no longer able to make them?
• Do you have a living will and have you told your family what type of care you would like when you can no longer make those decisions?
• Who will be the one to tell you when you can no longer drive your car? Decide this now as it is always a difficult decision and I have previously written on this topic.
• Tell your family where you would like to live. How will you handle the cost of care and who will supply the care if you want to remain at home? Consider visiting assisted living facilities or nursing facilities with your family. Most people are comfortable with "pre planning" for funerals, but we rarely plan for our long term care.
Tell us how you have dealt with early Alzheimer's disease and what advice you have for others.
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I have noticed that my mother's short term memory is awlful and she also has trouble making decisions (e.g. she vacillates frequently. She will make a decision and then 5 minutes later change her mind. She will continue to vacillate until someone steps in and makes the decision for her). The thing is, my mother had a stroke 10 years ago (at 63) and she has had trouble with her short term memory, decision making and patience since her stroke. She is still able to function on her own (she lives alone, drives, pays her own bills, cooks, clean shops for herself, etc.)
Maybe I am in denial but, I believe that it is the stroke that caused these problems and she is not in the early stages of AD.
Are there any physical test that can be given to determine whether a person truly has or is on their way to developing AD?
One day last year, my roommate was home from work. I made a comment about him being off work today and he looked shocked. He reminded me that he had been laid off the week before. He also reminded me that I had been dating someone for three months (I still have no memory of this) and that I had rented the apartment upstairs. I was shocked to see a signed lease on my desk.
Don't assume that just because you can't find the keys that it is old age (my seizures started at age 50)...that's how I started but it quickly progressed to the point that people are walking up to me all over my neighborhood saying hello and I have no idea who they are:) Lots of things mess with memory besides being over 50.
A: When you vote republican after 8 years of Bush.