7 September 2015
6 reasons to detect Mild Cognitive Impairment
Amnestic mild cognitive impairment is a strong predictor of Alzheimer's disease but what are the main benefits of detecting it?
Dementia and Alzheimer’s disease have seen a huge increase in coverage within the media over the last few years. Research has shown that individuals with mild cognitive impairment (MCI) have a significantly increased risk of developing Alzheimer's disease within a few years, compared to people with normal cognitive function. But what are the main benefits of detecting MCI?
What is MCI and how is it related to dementia and Alzheimer’s disease?
MCI is a reduction in cognitive functions, such as memory, attention, language and visuo-spatial skills. These deficits are normally noticed by the individual and those close to them and can also be detected and quantified by cognitive testing. It is not severe enough, however, to interfere with daily life, which means it cannot normally be categorised as dementia. MCI has been found to be a predictor of Alzheimer’s disease and dementia in many patients, with it being estimated that people with MCI are three to five times more likely to develop some form of dementia compared to someone without MCI. In some patients, however, this progression never happens and there is even improvement in some cases. It is therefore important to try and make testing of MCI more accurate in order to separate those most at risk.
One way of doing this is isolating those areas of cognitive performance that may be most likely to predict dementia. Amnestic MCI is characterised by problems with episodic memory and targeting tests at measuring episodic memory performance specifically can be the best for predicting subsequent Alzheimer’s disease. Albert et al. (2011) found that deterioration in episodic memory is the most common cognitive impairment seen in patients with MCI who eventually receive a diagnosis of Alzheimer’s disease. Early and accurate detection of MCI could allow Alzheimer’s disease to be targeted in its earliest stages before severe, irreversible deterioration of the brain occurs.
1. Opens doors to planning for the future
Identifying those patients who are most at risk of developing Alzheimer’s disease could allow them to plan for the future and the many complications that arise in suffering from the disease for both the patient and those around them. It means important decisions such as setting up a Lasting Power of Attorney, deciding who will care for them and where they will live through the various stages of the disease can be made before cognitive and mental function is compromised and the decision taken out of their hands. It also takes the pressure of responsibility off their loved ones who would otherwise have to make the decision in the later stages of the disease. Not only are these kinds of decisions important on a personal level, but laws such as the Court of Protection can mean it is very important to consider them early on.
2. Provides a basis for treating and managing
Although there is not currently a drug treatment for MCI (Karakaya et al., 2013) some studies have suggested that there may be ways to reduce the rate of decline in cognitive ability and make it less likely that it progresses to a form of dementia. These strategies include:
- Exercising regularly to improve the circulatory system which can benefit the blood supply to the brain (Hahn & Andel, 2011).
- Controlling cardiovascular risk factors to help protect the heart and blood vessel network that supports the brain.
- Participating in mentally stimulating and engaging activities to exercise the brain in order to maintain brain function as much as possible.
- Implementing dietary modifications such as taking a supplement of omega-3 fatty acids (Hahn & Andel, 2011).
Patients that have been diagnosed with MCI can also be monitored and GPs can refer the patient to a memory clinic for more detailed testing to occur over time. This allows people to have earlier access to the available treatments if the impairments do in fact develop into some form of dementia. As well as this, a formal diagnosis allows other more practical issues such as whether it is still safe for the individual to drive to be considered.
3. Reduces anxiety
Being able to define and distinguish between the various memory impairments that may affect older individuals more accurately will help raise awareness around them. The earlier individuals that suffer from MCI can be diagnosed, the less likely they are to experience anxiety when they become aware that they are having difficulties and worrying about what it may mean. Further, if individuals are diagnosed early with dementia, as aided by MCI diagnoses, they can be further informed that it is possible to live well with dementia and told about strategies to help with their memory problems and slow the rate of decline.
4. Reduces the number/length of acute hospital episodes
Providing a clear and accurate diagnosis as early on as possible could reduce the number and/or length of acute hospital admissions by allowing proper care plans to be put in place. It may also help to delay the need for admission to more expensive long-term care in the later stages of the disease.
5. Supports better understanding of how the disease progresses
Diagnosing more patients with MCI and dementia earlier will allow clinicians to build a more in depth knowledge of how these progress and the different paths this progression might follow. As well as this, if a greater number of individuals know they have a memory impairment and they do so as early as possible, they may be able to support further academic research into the disease process. They can also take part in clinical trials to develop further treatments both for reducing the likelihood of dementia following MCI and slowing the transition from MCI to dementia or even to find a cure for dementia. Alongside the clinical perspective, there are also legal considerations that may be helped by earlier and more accurate diagnosis of MCI and greater knowledge of the disorder. For example, it could help improve Deprivation of Liberty Safeguards and help to ensure that Deprivation of Liberty does not occur.
6. Supports reduction of stigma
The more informed people are, the more likely it is that the stigma surrounding memory and cognitive impairments can be reduced. Diagnosing people with MCI earlier and increasing the knowledge people have of memory impairments will help reduce the stigma often attached to having a form of memory impairment, especially when it develops into dementia. There has already been great progress in the reduction of stigma thanks to the initiatives such as ‘Dementia Friends’ from the Alzheimer’s Society.
How can we use cognitive testing to improve the use of MCI as a diagnostic tool for dementia?
It has been proven that the Cantab Paired Associates Learning test as part of Cantab Mobile can be used to diagnose MCI. For example, the OPTIMA study reported that PAL error scores are able to distinguish adults with MCI from healthy older adults with a sensitivity of 0.83 and a specificity of 0.82 (Chandler et al., 2008). Because MCI does not always worsen to become a form of dementia, it is important to find a balance between allowing people to prepare for this scenario but not unnecessarily worrying those whose impairments plateau. This is where cognitive testing can be used to identify those patients most at risk. Cantab Mobile is a touchscreen testing method that can provide detailed assessments of the cognitive decline seen in those with Amnestic MCI. For example, it was found that patients with Amnestic MCI showed poorer performance on the PAL test than healthy older controls or those with Non-Amnestic MCI (Saunders & Summers, 2011). Hence, Cantab Mobile can be used to separate the more at risk patients with Amnestic MCI allowing us to provide all of the potential benefits of early diagnosis.
Albert, M. S., DeKosky, S. T., Dickson, D., Dubois, B., Feldman, H. H., Fox, N. C., … Phelps, C. H. (2011). The diagnosis of mild cognitive impairment due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer’s & Dementia : The Journal of the Alzheimer's Association, 7(3), 270– 9
Chandler, J., Marsico, M., Harper-mozley, L. M., Vogt, R., Peng, Y., Lesk, V., & Jager, C. A. De. (2008). Cognitive assessment: Discrimination of impairment and detection of decline in Alzheimer’s disease and mild cognitive impairment. Alzheimer’s and Dementia, 4(4), T551–T552.
Hahn, E. A., & Andel, R. (2011). Nonpharmacological therapies for behavioral and cognitive symptoms of mild cognitive impairment. Journal of aging and health, 23(8), 1223-1245.
Karakaya, T., Fußer, F., Schröder, J., & Pantel, J. (2013). Pharmacological Treatment of Mild Cognitive Impairment as a Prodromal Syndrome of Alzheimer’s Disease. Current Neuropharmacology, 11(1), 102.
Saunders, N. L., & Summers, M. J. (2011). Longitudinal deficits to attention, executive, and working memory in subtypes of mild cognitive impairment. Neuropsychology, 25(2), 237.
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