Dr. Kenneth Cooper: Cognitive Impairment

How does it relate to Alzheimer's and dementia?

Dr. Kenneth Cooper: Cognitive Impairment

How does it relate to Alzheimer's and dementia?

On the minds of so many as we age is cognitive impairment. As a follow-up to one of my earlier articles, Alzheimer’s and Dementia: Can They Be Prevented? (December 2021), let’s explore more about cognitive impairment—also referred to as mild cognitive impairment (MCI). As it relates to dementia and Alzheimer’s, MCI is the stage between the typical decline in memory and thinking that happens with age and the more serious decline of dementia. 

As we age, it is normal to lose some short-term memory. If there is something you at first cannot recall but later you can, chalk that up to aging—the “senior moment.” If what you are trying to recall does not come back, that could be the onset of early dementia. 

MCI, that middle stage, may include a problem with memory, language or judgment. People with MCI may be aware that their memory or mental function has “slipped.” Family and close friends may note changes, but these changes are not enough to impede daily life. 

MCI can develop for multiple reasons. Some individuals living with MCI may progress to dementia; others will not. Of those diagnosed with MCI, after just one year, up to 15% had advanced to the first stages of dementia—whereas some people’s symptoms may decline or improve. For neurodegenerative diseases, MCI can mark an early stage of the disease, including for Alzheimer’s if the hallmark changes in the brain (amyloid plaque or tau protein) are present. For some people, MCI reverts to normal cognition or remains stable. MCI could be mistakenly diagnosed in some cases, such as when a medication causes cognitive impairment. If someone is experiencing cognitive changes, they should seek professional medical help promptly for diagnosis and possible treatment.

The magnitude of MCI may surprise you as it did me. According to 2023 statistics, 6.7 million Americans, primarily over age 65, had a diagnosis of Alzheimer’s. Around 73% are age 75 or older. By 2050, this number is projected to reach nearly 13 million.

As for MCI, current estimates are already at 13 million Americans,  with an expected 18.6 million by 2040. One in three seniors dies with Alzheimer’s or another dementia, and it kills more than breast cancer and prostate cancer combined. In 2023, the cost of Alzheimer’s and dementia to the nation was $345 billion, projected to rise to nearly $1 trillion by 2050.

So how do we diagnose MCI and the stages of dementia?  

For many years at Cooper Clinic we have used the Montreal Cognitive Assessment, commonly referred to as the MoCA test, to diagnose the stages of dementia. The range of responses goes from 0 to 30. Above 25 (some say above 27) is normal. Whereas the average score for MCI is 22.1, those with Alzheimer’s average 16.2. So if there is a question about any of these stages of dementia, ask your personal physician to conduct this test or ask to be referred to someone who specializes in these medical problems, such as a neurologist or a psychologist.

Is MCI preventable or treatable?

Risk factors of dementia include the following, with the strongest being aging: low education level, diabetes, smoking, elevated cholesterol, obesity, inactivity, inadequate sleep (less than seven hours per night) and particularly sleep apnea. What causes these stages of dementia? In most cases, it appears to be the accumulation of amyloid plaque or tau protein in the brain. However, some people have a brain full of amyloid plaque and tau protein but never develop any symptoms. 

In a book by Dr. Stephen Kopecky,  a Mayo Clinic cardiologist, titled Live Younger Longer, he says the cause of dementia may be chronic inflammation, which acts as a spark to light the flame that activates the tau protein and amyloid plaque. To address the risk of chronic inflammation, take care to avoid those risk factors discussed above, particularly poor nutrition, decreased exercise, inadequate sleep and too much weight. 

Recent studies have shown the power of music over us is not purely psychological, but it is also physiological. Singing along with others to beloved songs causes the brain to secrete the chemical oxytocin, which is a naturally occurring hormone creating a warm sensation of bonding, unity and security, making us feel all “cuddly” toward our children or others we love. It also infuses us with feelings of spiritual awe and can alleviate chronic pain, disability and can be used as a treatment for autism and stabilization of Alzheimer’s symptoms that have been resistant to most forms of treatment (as shared in AARP Magazine, December 2023).

Prescription drugs now approved by the FDA may slow memory loss, but only modestly, and they are extremely expensive. However, several types of neurological diseases that increase with age may be prevented—and possibly treated—by simply changing your lifestyle. As I have said many times, no drug can replicate the benefits of an active lifestyle. The most important lifestyle factors are regular exercise and weight control.

I’ll leave you with this verse to consider from 2 Timothy 1:7: “For God has not given us a spirit of fear, but of power and of love and of a sound mind.” ©2024 Kenneth H. Cooper

Kenneth H. Cooper, M.D., MPH, known worldwide as “the father of aerobics,” is the founder and chairman of Cooper Aerobics in Dallas and chairman emeritus of The Cooper Institute.

Scripture quotation is taken from The Holy Bible, New King James Version.

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