For up to one in five Americans over age 65, getting older brings memory and thinking problems- along with the embarrassment of not being as “sharp” as they once were, and the worry that it will get much worse.
They might just call it “getting older”. But officially, when memory or cognitive problems don’t interfere significantly with daily living, doctors call them mild cognitive impairment, or MCI.
What can be done to prevent or slow MCI? And how much should seniors fear that their thinking or memory problems will get much worse? A pair of doctors from the University of Michigan Medical School and VA Ann Arbor Healthcare System have put together a definitive look at the evidence, based on a thorough review of recent studies about MCI.
Published in this week’s issue of the Journal of the American Medical Association, their review article should help doctors and the seniors they treat.
“MCI is hard for both clinicians and for patients and their families, because it’s a scary prospect – and because there’s still a lot we don’t know about this condition,” says Kenneth Langa, M.D., Ph.D., who co-authored the article with U-M and VA colleague Deborah Levine, M.D., MPH. “We still don’t have great answers to give patients and families, but the medical literature shows there are certainly factors that can influence the risk, severity, and progression of MCI. We hope this review will spread awareness of those, and help guide patient care.”
“While no medications have been proven to treat MCI successfully,” says Levine, “it’s still a treatable condition. Our review shows good evidence that aerobic exercise, mental activity, social engagement, and stroke prevention help reduce the risk of further cognitive decline.” She notes that the review of medical literature they conducted paid close attention to the quality of the evidence in each study.
Among the key findings of their review, and what they mean for seniors:
Speak up to your doctor about memory and thinking problems: The new paper offers doctors a step-by-step guide for what to do when a patient or his or her caregiver mentions concerns about memory and thinking problems. Specific lab tests for things like vitamin deficiencies, standard cognitive tests and a full physical and neurological exam can reveal important clues to factors that might be causing their symptoms.
Keep body and brain active: A number of studies have indicated that aerobic exercise and mental activities can have a small beneficial effect on thinking ability in older adults with MCI.
Keeping a stroke at bay helps the brain too: Since strokes are brain injuries caused by clots or holes in the blood vessels that keep brain tissue healthy, it makes sense that preventing a stroke can preserve memory and thinking ability. People who have had mini-strokes or survived a full-blown stroke should especially focus on preventing new strokes to keep their brain function as intact as possible as they age, Langa and Levine advise based on the evidence they reviewed. So should people diagnosed with MCI. Having a stroke can worsen cognition and raises the risk of progressing on to dementia.
Both Langa and Levine are faculty members in the Division of General Medicine at the U-M Medical School, and members of the U-M institute for Healthcare Policy and Innovation. Langa also holds positions in the U-M Institute for Social Research and School of Public Health. Levine has a joint appointment in the U-M Department of Neurology. The review article is part of the Care of the Aging Parent series, funded by the SCAN Foundation. Reference: JAMA, Dec. 17, 2014, Vol. 312 No. 23