Sunday, 19 April 2015


With age often comes an increase in the number and frequency of memory slips - forgetting where you put your keys, blanking on the name of an acquaintance, etc. These experiences, in turn, fuel fears that one has Alzheimer's or another form of dementia, leading to one crucial question: What's the difference between dementia and normal aging?

It's a challenging query to answer because what is considered "normal" aging for one person is not the same as what is normal for another. 

For example, studies have shown that a person's educational background can provide some protection against the onset of cognitive issues later on in life by enhancing their cognitive reserve. Typically, the more years of formal schooling an individual has, the more likely they are to be able to retain their intellectual capacity as they age. However, as is often the case when dealing with dementia, this is not a hard and fast rule. People with multiple graduate degrees can still get Alzheimer's, while those who didn't make it past high school may never encounter cognitive issues.

Occupying the middle ground between normal aging and dementia lies a disorder known as Mild Cognitive Impairment (MCI).

Here are 10 things to know about MCI:

·         One-in-five older adults may have MCI: Increasing age is probably the most well-known and widely-accepted risk factor for MCI. Studies have indicated that anywhere from five to 20 percent of people over 65 struggle with MCI.

·         The symptoms: Having trouble recalling the names of recent acquaintances, frequently misplacing important objects and being unable to follow the flow of normal conversation are all red flags that could indicate MCI. But the primary feature that distinguishes MCI from full-blown dementia is how much the person's cognitive issues are affecting their day-to-day lives. The more extreme the impact, the more likely it is that that individual has MCI.

·         MCI changes the brain: While it's not always the case, the brains of people with MCI often undergo certain visible physical changes. MRI scans of cognitively impaired individual's brains have shown a large accumulation of plaques, impaired glucose processing (neurons use glucose as an important source of fuel), larger ventricles and a smaller hippocampus. These changes have also been associated with Alzheimer's and other forms of dementia.

·         Getting an early diagnosis can help: Going to the doctor at the first sign of cognitive issues that affect everyday life is important because getting a formal diagnosis can help a person with MCI or dementia to gain access to memory care clinics and other important resources. Knowing what the future might hold also enables an older adults and their family to make important plans for the future. (Learn more about Planning Ahead for Elder Care).

·         How MCI is diagnosed: Finding the precise cause of cognitive impairment is tricky. Doctors will typically take a full medical and family history first, followed by a neurological exam, cognitive functioning evaluation(s), blood tests and brain scan(s).

·         There's more than one type: There are two distinct sub-types of MCI—amnestic and non-amnestic. The majority of individuals (about two-thirds) with MCI have the amnestic variant, the main symptom of which is memory loss. Non-amnestic MCI involves other cognitive concerns such as impaired judgement, and having problems with organization and planning.

·         There is no treatment: The FDA has yet to approve any treatments for MCI. Drugs used to treat Alzheimer's disease typically are not prescribed to people with MCI as the benefit of such interventions has yet to be proven in clinical trials.

·         MCI may increase Alzheimer's risk: MCI may increase an individual's risk of developing Alzheimer's disease or another form of dementia by as much as three to five times, according to recent research.Though it's not yet possible for doctors to determine whether a particular person's MCI will eventually morph into dementia.

·         Not everyone with MCI will develop dementia: Some individuals who have MCI stay stable and never develop dementia.

·         Some types of MCI can be reversed: Not all cases of MCI signal the onset of a degenerative neurological condition. Cardiovascular disease, infections, even certain medications can also cause MCI. In these instances, cognitive symptoms may be reversible with better medication management or certain lifestyle changes - another reason why experts suggest seeing a doctor at the first sign of cognitive trouble.

(Source:  Aging, 15 April 2015)

Wednesday, 1 April 2015


Treatment for managing dementia depends on its type and severity, but drug therapy often plays a role. Drugs can't cure dementia, but psychotropic medications, which include antipsychotics, antidepressants and anticonvulsants, are used with extreme caution in certain cases to help improve behavioural symptoms such as aggression, agitation, lack of inhibition and depression -- symptoms that caregivers tend to feel are more stressful or difficult to handle than the trademark memory loss associated with dementia.

For many people with dementia, the potential risks of psychotropics outweigh their potential benefits. All antipsychotics, including haloperidol (Haldol), olanzapine (Zyprexa), quetiapine (Seroquel) and risperidone (Risperdal), significantly increase the risk of death, perhaps because they also increase the risk of stroke, heart attack and falls.

The DICE approach. In exploring ways to improve symptoms without depending on potent psychotropic drugs, experts from the University of Michigan and Johns Hopkins Medicine developed DICE, a strategy designed to minimize problems by changing a patient's behaviour. The acronym DICE stands for describe, investigate, create and evaluate. The DICE approach is a collaboration among a caregiver, a clinician and, if feasible, the individual with dementia. DICE consists of the following four steps:

Describe: The caregiver describes to the clinician specific behavioural problems the patient is exhibiting and the circumstances and environment under which they occur. The person with dementia describes the situation if he or she has the ability to do so. Both the caregiver and patient convey the degree of distress this behaviour causes them.

Investigate: The clinician examines, excludes and identifies possible underlying medical and mental health causes for the patient's actions as well as drugs the patient may be taking that contribute to the behaviour. The clinician reviews the caregiver's handling of the behaviour and advises the caregiver on issues such as appropriate reaction and expectations. Finally, the clinician will examine the environment for possible improvements, such as reducing clutter or noise and improving lighting.

Create: The clinician and the caregiver create a plan to prevent or respond to either a specific action or general behaviour to enhance the environment and improve caregiver skills and well-being.

Evaluate: The clinician evaluates and assesses the patient's and caregiver's compliance with the suggested plan and makes any needed changes if the desired effects aren't achieved.

The Centers for Medicare and Medicaid Services recommend the DICE approach in an effort to reduce the need for psychotropic drugs. The authors caution that doctors should prescribe psychotropics only after they've made other attempts to change behaviour - unless patients have severe depression, psychosis or aggression that poses a risk to themselves or those around them. The study outlining the DICE approach appeared in the Journal of the American Geriatrics Society.

(Source:  Scientific American Health After 50, 30 March 2015)