Increased ID, diagnosis of MCI may be a sign of hope
Mild cognitive impairment is often confused with or disregarded as “normal aging” but is not part of the typical aging process, according to the Alzheimer’s Association special report on MCI included with the organization’s “2022 Alzheimer’s Disease Facts and Figures.”
MCI is characterized by subtle changes in memory and thinking. These changes are serious enough to be noticed by the person affected and by family members and friends, but may not affect the individual’s ability to carry out everyday activities.
Symptoms of MCI may include forgetting conversations, misplacing items in the home, difficulty keeping a train of thought, losing the way to a once-familiar place, or feeling overwhelmed when making decisions or completing everyday tasks like paying a bill.
The special report estimates that 12 to 18 percent of people age 60 or older have MCI. While some individuals with MCI revert to normal cognition or remain stable, studies suggest that 10 to 15 percent of individuals with MCI go on to develop dementia each year according to the special report.
Identifying those living with MCI who are more likely to develop dementia is a major goal of current Alzheimer’s research and care providers to potentially enable earlier disease intervention and treatment said Dr. Joel Vandersluis, a Dayton neurologist with Neurology Diagnostics. Vandersluis sees patients with various cognitive issues, and also directs clinical studies on dementia and potential treatments.
“We see patients come in with a broad spectrum of cognitive issues, from those who are just concerned to those who are more advanced and can no longer function on a daily basis,” said Vandersluis. “While we may simply monitor some of these individuals, many patients end up with a diagnosis of MCI or Alzheimer’s disease.”
“We see individuals with MCI literally every day. It’s surprising how many are now being identified,” he added.
The increased number of patients being identified could be a sign of hope, according to Vandersluis. “Our experience has been that primary care physicians have done a good job of identifying cognitive issues, but I believe in part we are seeing increased numbers because there is more hope than ever before,” he said. “Doctors now have a reason to refer their patients to us.”
The Alzheimer’s Association reports that in 2021, there were 126 unique therapies in 152 clinical trials for Alzheimer’s disease registered in the U.S.
“Today we have more options to bring to the table. At any given time, we may have three to five ongoing clinical trials in MCI and dementia. We can offer patients methods to take control of their own care,” Vandersluis said.
Neurology Diagnostics has about 40 patients currently enrolled in a Trailblazer clinical study, which is reviewing the safety, efficacy and effectiveness of an Eli Lilly amyloid-targeting drug. Amyloid is a protein that builds up and eventually forms plaques in the brains of individuals with Alzheimer’s disease.
“One question we are trying to answer is, does this drug produce medically proven benefits? Early results have shown that twothirds of the study participants receiving the drug saw amyloid in their brains reduced to nearly normal levels within 76 weeks,” noted Vandersluis.
The study is now working to demonstrate that those encouraging results translate into measurable reductions or slowing of Alzheimer’s disease.
“People need to understand that participation in clinical trials is the best opportunity they have, as patients, to receive holistic, personal dementia care and
to make a dent in this disease and finally find a cure,” stated Vandersluis. “Through clinical trials, patients may have the chance to receive medications that could slow disease progression and help them maintain their quality of life longer — medications that they would not have access to otherwise.”
Patients in clinical trials receive very close monitoring by medical professionals, often much more than primary care physicians can provide in their offices. This provides an increased opportunity to catch cognitive impairment difficulties much earlier, and respond to subtle cognitive changes.
“Identifying those living with MCI who are more likely to develop dementia is a major goal of current Alzheimer’s research, potentially enabling earlier disease intervention and treatment,” said Eric Vanvlymen, executive director of the Alzheimer’s Association Miami Valley Chapter.
“One challenge is that many individuals, and primary care physicians, find it difficult to differentiate MCI from memory issues associated with the normal aging process,” he noted. “Surveys of the general public and primary care physicians reported in the MCI special report found many physicians and patients alike find it challenging to identify MCI.”
More than three-quarters of primary care physicians said in the survey that MCI due to Alzheimer’s is difficult to diagnose, and 51 percent do not feel comfortable diagnosing it.
In current health systems, MCI is a clinical diagnosis representing a doctor’s best professional judgment about the reason for a person’s symptoms. Although patient-reported symptoms and the results from screening tools and clinical exams provide clues about whether a person has MCI, there is no test that can give a definitive diagnosis.
According to the Alzheimer’s Association special report, this may, unfortunately, be a prolonged process, as diagnosis of MCI also requires ruling out other systemic issues or brain diseases. These could include Alzheimer’s disease, Parkinson’s disease, dementia with Lewy bodies (associated with rapid eye movement sleep abnormalities), cerebrovascular disease in the blood vessels that support the brain, or prion disease or cancer (characterized by more rapid cognitive decline).
The unfortunate truth is that with any dementia-related diagnosis, the longer a diagnosis takes, the more brain function that is lost.
“Distinguishing between cognitive issues resulting from normal aging, those associated with the broad syndrome of MCI, and those related to MCI due to Alzheimer’s is critical in helping individuals, their families and physicians prepare for future treatment and care,” concluded Vanvlymen.
While currently there is no specific treatment for MCI, in some cases, physicians may be able to identify reversible causes of cognitive impairment, such as depression, medication side effects or sleep apnea. They may also recommend exercise and healthy lifestyle interventions to help improve cognitive function and quality of life.
It is known that lifestyle factors such as nutrition and the amount of sleep, exercise and social interaction one engages in can positively affect life expectancy. Recent evidence also suggests that these factors may increase the proportion of years lived without Alzheimer’s.