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Cognitive Impairment and Dementia
Cognitive Impairment and Dementia

by: Karen Rowan
FNP and Psychiatric-Mental Health Clinical Nurse Specialist, CCHC Neurology

Our brains change over the course of our lives with far-reaching effects on what we are able to do and how we behave. While brain development starts a few weeks after conception, we are well into our 20s before our brains are fully developed. As we continue to age, natural and irreversible changes occur. Some of these aging brain changes do not cause significant problems with our abilities to think, perceive, learn and remember, or exercise reason and judgment. But when one or more areas of the brain functioning become impaired, a person may be showing signs of dementia.

Dementia is not a specific disease. It is a term that describes declines in memory and other cognitive (thinking) skills, severe enough to reduce one’s ability to perform everyday activities. Dementia is caused by microscopic damage to brain tissue, known as brain atrophy.

Alzheimer’s dementia (AD) is the most common type, accounting for about 60 percent of cases and affecting 5.4 million people in the United States. Symptoms typically arise after age 60. It is the sixth leading cause of death in the US. In early Alzheimer’s disease, people tend to have short-term memory loss, although their memories for remote events are largely intact. They may ask repetitive questions, have trouble handling money and paying bills, get lost, and misplace objects. They tend to take longer to complete daily tasks, use poor judgment, and may have mood and personality changes. In moderate AD, memory loss and confusion worsen. People begin to have problems recognizing friends and family. They may be unable to learn new things, carry out tasks with multiple steps, or cope with new situations. They may behave impulsively. Some have hallucinations, delusions, and paranoia. In severe AD, individuals are no longer able to communicate verbally and are completely dependent on others for their care. They will lose the ability to speak, walk, and eat. As the brain and body continue to fail, the person may be in bed all or most of the time.

Vascular dementia is the next most common type. It results from damage to blood vessels in the brain. Causes include diabetes, high blood pressure, unhealthy levels of fats in the bloodstream, smoking, sleep apnea, and stroke. Alzheimers disease and vascular dementia often occur together. Other neurodegenerative types of dementia include Lewy Body Dementia and Frontotemporal Dementia. It is valuable to seek early evaluation of symptoms of cognitive decline to check for reversible conditions. Medical evaluation for cognitive impairment looks for other conditions, such as thyroid disease, infections, vitamin deficiencies, depression, epilepsy, and brain tumors. These conditions can produce dementia-like symptoms, but can respond to treatments to correct underlying cause.

Neurologists perform examinations and neurocognitive testing as well as brain imaging studies, such as CT and MRI scans, to help determine if dementia is present. These studies may detect a condition call Mild Cognitive Impairment (MCI). By definition, MCI represents cognitive changes that are more than expected for age, but not significantly impairing enough to be defined as dementia. Having MCI, especially if it is associated with memory loss, puts a person at high risk of developing dementia within 3 to 5 years. Repeat cognitive testing can monitor for the onset of dementia.

Early recognition of cognitive decline is important to make the most of treatment options and plan for future needs. Family members and friends may be the first to recognize cognitive problems. Although there are currently no proven treatments to stop the progression of neurodegenerative dementias, there are two classes of medications which may be helpful. Donepezil (Aricept), galantamine (Razedyne) and rivastigmine (Exelon) are typically used initially for mild to moderate AD. Momentine (Nomenda) is used to treat moderate to severe AD and can be added to one of the cholinesterase inhibitors. These drugs work by regulating chemical neurotransmitters that transmit messages between nerve cells. Unfortunately, these drugs do not change the underlying disease process.

Research has shown that non-drug interventions that promote overall brain and body health are valuable in slowing cognitive decline for everyone, even people with dementia. A healthy heart and brain-healthy diet, often referred to as the Mediterranean diet, is based on plenty of fruits, vegetables, whole grains, legumes, fish, poultry and lean meat, plus healthy fats, such as those found in nuts and olive oil. Limit saturdated fats. Maintain a normal blood pressure. Regular aerobic conditioning with strength and flexibility training are components of a well-rounded exercise plan. Aerobic exercise, like walking and cycling, improves our cardiovascular fitness and can help maintain healthy weight and blood sugar levels, as well as promote better sleep and mood. Resistance training, such as using weights, strengthen muscles. Flexibility training, such as stretching, yoga and Tai Chi, helps with posture and balance. Good muscle strength and flexibility can help reduce the risk of fall injuries. Mental exercise is also important. Mentally stimulating hobbies, like reading, playing cards and games, doing crossword, jigsaw and number puzzles, are all good choices. Try writing down your memories, going to culture events like plays and concerts, and playing brain-training computer games. Staying socially active is another way to keep your brain healthy. Participating with others at church, in clubs and with friends and family keeps our brains stimulated.

If you or a loved one has concerns about cognitive decline or dementia, please ask your primary care provider for a referral to CCHC Neurology. We are located on Trent Road in New Bern and open 8:30-4:30 Monday-Friday.