Cognitive Impairment and Alzheimers

 

 A previous essay dealt with dementia. It included signs of dementia and guidelines for normal aging contrasted with dementia. Lifestyle factors were addressed along with some of the non-reversible dementias that included Alzheimer’s. There’s an estimated 6.2 million Americans 65 and older  living with Alzheimer’s dementia in 2021 of which 72% are aged 75 or older. One in nine people age 65 and older or 11.3%  have Alzheimer’s dementia. Almost ⅔ of Americans with Alzheimer’s are women. According to the Alzheimer’s Association,  “Someone in the United States develops Alzheimer’s dementia every 66 seconds.” The state with the highest rate of Alzheimer’s is Alaska. Although California ranks second among highest rates of life expectancy, it also ranks fifth In Alzheimer’s disease mortality per CDC.This essay deals with mild cognitive impairment and Alzheimer’s  Disease with a suggestion for a more comprehensive  treatment model.

Briefly, the progressive disease of Alzheimer’s was first identified by Alois Alzheimer  In 1907.He identified, with an autopsy, the proliferation of plaques and tangles in the brain. It is believed  that the pathology of Alzheimer’s  begins over 20 years before the symptoms  are noticed.   Result , the disease has been progressing for years.Even people in their 30s and 40s  are affected in areas of memory, and thinking. In essence,, baby boomers are the fastest-growing segment in our population

Unfortunately , even today,there is not 100% accuracy with the diagnosis. Despite that  fact, researchers have identified  areas of  Impaired cognitive functioning in different brain areas. Deficits include: progressive memory impairment; time and spatial disorientation; receptive language impairment; anomia or poor object reasoning; decreased word finding; vague statements with impaired abstract thinking; acalculia or  impaired  arithmetic calculation;agnosias or Impaired object and facial recognition; apraxia or difficulty performing purposeful movements;apractagnosia orInability to use objects correctly; personality changes; progressive decreased emotional expression;sleep disturbance; delusions, hallucinations, depression  and /or anxiety .

Alzheimer’s disease affects up to 50% of the people aged 85 and older.. There’s an increased frequency from age 50 onward. Not only that ,,Alzheimer’s pathology is found in 65 to 85% of all  dementias. This is an irreversible progressive disorder in which brain cells or neurons deteriorate resulting in the loss of cognitive functioning with major effects in the cerebral centers and to the hippocampus specifically. ‘

Dementia is a complicated diagnosis. For example,there are more than 50 kinds of neurodegenerative dementias including the most common which is Alzheimer’s. A study of 1400 older men and women  showed that 45% had plaques and tangles of Alzheimer’s  disease. Further, many people had a combination of two or more pathologies or dementias. Autopsies showed that most of the older people who get dementia, 65-85% have plaques and tangles of Alzheimer’s in their brains. However only 30% of these people had  Alzheimer’s disease. The rest have evidence of Alzheimer’s pathology  plus vascular dementia or stroke. Having more than one type of  dementia appears to accelerate deficits and speed of decline.

The  progressive disease of Alzheimer’s has been characterized by stages: 1. Mild confusional  state 2-7 years 2. Mild-to-moderate impairment-2 years 3.Moderate impairment–18 months 4. Severe impairment-21/2 years 5. Very severe impairment–1 to 2 !/2 years. In essence, the progression of this disease begins with procedural memory impairment such as recent facts and proceeds until  the person requires 24 hour maximum assistance.

There are many risk factors for Alzheimer’s  disease dementia which of course are related to genetics and lifestyle  choices. The following are a few: :increasing age; more women than men ;cardiovascular disease; insulin resistance; traumatic brain injury;chronic inflammation ;high blood pressure; estrogen deficiency; non stimulating mental lifestyle; low level of education;low socioeconomic status ;low level physical activity; job with low learning challenges , obesity; high cholesterol; smoking  drug and alcohol abuse ;chronic gum disease;diet low in fruits and vegetables; long-term stress; anxiety and depression. Incidentally, those that don’t get Alzheimer’s disease are independent living centenarians.

One can undergo a mental status examination; a neurocognitive evaluation; neuropsychological testing; various physical protocols  such as evaluating cerebral spinal fluid, Pittsburgh Compound  B; PET scan, laser test for accumulation of beta amyloid and several blood tests measuring levels of certain proteins altered by Alzheimer’s disease .Even at death the brain autopsy, can be misleading. So these  techniques and measurements still do not give a 100% certainty as far as an Alzheimer’s diagnosis.Yes they point  to the likelihood of an Alzheimer’s diagnosis.

Unfortunately ,at this point in time, there is no one comprehensive approach or program to treat mild cognitive decline or mild cognitive impairment due to Alzheimer’s. We have  controversial doctors like Dale Bredesen; functional medicine and nutrient treatment; aging programs in medical hospitals, Alzheimer's Associations, outpatient neurologists and neuropsychological testing.

Why not incorporate a program to address many of the symptoms experienced by those with mild cognitive impairment. We know that these individuals experience visual motor and perceptual difficulties; perceptual distortion; spatial visualization and orientation problems. We also know that some individuals , because of the difficulty with words, learn better either employing auditory or visual techniques. We also know that these individuals experience declarative memory; decreased word finding; and  acalculia difficulties.

With the above being said, it makes sense to create a post school learning environment. A school setting makes sense  because of the availability  and training of  elementary school teachers that can teach reading, grammar,writing, spelling, arithmetic and PE. Further, resources include the availability of teaching   music, art, board games,computer skills with the importance of interpersonal interaction .  Moreover, a team of a school nurse, reading disability teacher, speech pathologist and school psychologist are also important. In other words,teaching, learning and memory are skills first taught in elementary schools.I would also add  a nutritionist to provide breakfast and lunch employing a Mediterranean style diet.

Schools  can evaluate and learn to provide service with special consultation. Involve Medical Centers,  state health departments, federal government agencies and  monies,Medicare and  insurance companies  to fund a pilot program with a built in evaluation. This program  addresses mental stimulation, exercise, diet with the importance of interpersonal interaction. Individuuals would still have  their primary care physicians and neurologists to rely on for their physical health. 

Reference

  Institute  For Natural Resources, Understanding Dementia.