Is it Normal or is it Alzheimer’s?

We’ve all that those moments when we forget basic information – someone’s name, what someone does for a living, or where we left our keys.  And every time that happens, we call it a “senior moment.”

We know that some level of cognitive decline is inevitable as we age.  As the brain ages, there is a general slowing of nervous system functioning, combined with a loss of neurons.  As a result, processing speed, memory, and attention are all affected.

But it is important to remember that this is normal.  With regular cognitive decline, the brain can adapt to these changes as long as it is kept active.

This makes it all the more difficult to know when your mother or father is suffering from normal age-related cognitive decline, or dementia, which has far more devastating consequences for the individual.

Mild Cognitive Impairment

In recent years, a new diagnosis has been developed, known as mild cognitive impairment.  MCI is defined as cognitive impairment beyond that expected based on the age and education of the patient, but that is not significant enough to interfere with daily activities.

This seems reasonable, except for the fact that researchers also view MCI as a transitional stage between normal aging and Alzheimer’s disease.

While I am neither a doctor nor a researcher, this linkage seems to contradict basic logic.

We know what causes Alzheimer’s.  Beta amyloid plaques and neurofibrillary tangles develop in or on the brain, destroying the neurons and synapses that control cognitive and bodily functions.

Through basic logic, we can understand that the process that causes these structures to form begins at some point prior to a patient becoming symptomatic.  Therefore, there cannot be such a thing as a transitional stage before Alzheimer’s.  You either have it or you don’t.

MCI, therefore, is a catchall diagnosis, used in the absence of a more concrete understanding of what is going on.  In other words, we know mom is forgetting things, but we really do not know why.

This is similar to the diagnosis of irritable bowel syndrome (IBS), which causes patients certain stomach discomfort without a real understanding as to the cause.  Ultimately, certain foods just don’t “agree” with them.

Implications of the MCI Diagnosis

Being diagnosed with MCI seems benign enough.  It allows family members to believe they have an idea of what is wrong, but they do not yet have to worry about full-blown Alzheimer’s.  However, the implications can be serious.

Without a proper diagnosis, a patient cannot know what is really wrong, and cannot get the right treatment.  If, for example, the patient has Alzheimer’s disease, he or she needs to know in order to seek the right pharmaceutical intervention, such as Aricept or Namenda, to slow the progression of the disease to some degree.

Having a diagnosis of MCI postpones the start of this type of pharmaceutical treatment.

The MCI diagnosis also has implications for care-related matters.

As an administrator, dealing with countless relatives of dementia patients, I have seen, all too clearly, the reality that people do not plan ahead, generally speaking, until it is too late.

When patients are diagnosed with MCI, they are told the likelihood of developing Alzheimer’s disease has increased.  But they are NOT told that they actually have Alzheimer’s.  Some of them may start planning, but many will not.  They will not start investigating different types of care, they will not explore the realities of Alzheimer’s disease from an emotional standpoint, nor will they start looking into how to afford long-term care.

How to Fix the Problem

By the year 2020, 1 in 7 Americans over the age of 65 will be diagnosed with Alzheimer’s disease.  The prevalence of the disease, combined with the rapidly aging population, should be enough to convince medical schools that all students must be trained in geriatrics.

All doctors should be trained to recognize the signs and symptoms of Alzheimer’s, and learn when and how to fully diagnose a patient.

Family members, in turn, must be vigilant.  They must not accept a diagnosis of MCI until all proper tests, especially a PET scan, have been conducted.

Getting diagnosed at an earlier stage of the disease will allow the patient to slow the progression through pharmaceutical intervention, and will allow the family more time to prepare for the frustrations of the disease.

And perhaps most importantly, they will be able to distinguish a senior moment from an Alzheimer’s moment.