Infographic: Mild Cognitive Impairment

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Source : Kindly Care

What is Mild Cognitive Impairment?

GINA SHAW wrote . . . . . . . . .

As athletic director for Free State High School in Lawrence, KS, Steve Grant supervised a staff of 60 coaches and countless games, tournaments, and other events in basketball, football, soccer, volleyball, swimming, wrestling, track, golf, tennis, and gymnastics. A campus fixture known as “Mr. Free State,” Grant could be walking down the hallway and be asked by a student, coach, or teacher about a game or practice time, and he would answer in detail without hesitation. “I set up all the games, hired the coaches, and dealt with the officials, and I knew all that stuff off the top of my head,” says Grant, now 74 and “semi-retired” from his lifelong education career. (He still substitute-teaches and volunteers as a golf coach.)

When Grant began referring to his calendar more frequently, he and his wife, Mary, knew something was off. “That might have been totally normal for someone else, but not for Steve,” says Mary, a retired second-grade teacher in the Lawrence public schools.

At first, the family physician was unconcerned and reassured the couple and their three grown children that lapses in Steve’s mastery of complicated scheduling were likely just due to normal aging. But then Steve and his family began noticing more signs of trouble: Steve’s reaction time when driving slowed down, especially at night, and his golf game deteriorated. “I was never a great golfer, but I could always shoot in the 80s, and my scores were getting much worse,” he says.

In late 2022, the Grants were referred to the Alzheimer’s Disease Research Center at the University of Kansas (KU) Medical Center, where Steve underwent a full neurologic exam and a series of tests to assess memory, executive function, and visuospatial abilities. Based on the results, he was diagnosed with mild cognitive impairment (MCI) in February 2023. “That was a blow,” Steve says. “I knew something was wrong, but I wasn’t expecting that.”

Approximately 12 to 18 percent of Americans ages 60 or older have mild cognitive impairment, according to the Alzheimer’s Association. This slight but noticeable decline in mental abilities can be a precursor to Alzheimer’s disease and is more severe than the normal memory loss that may come with aging. “Most of us don’t run quite as fast as we used to as we get older, and we don’t think quite as fast as we used to either,” says Jeffrey Burns, MD, co-director of the KU Alzheimer’s Disease Research Center. “These kinds of changes are expected. What we do not expect are changes that interfere with daily function.”

In February 2020, at the age of 50, Adriane Crouse of Jefferson City, MO, was diagnosed with young-onset MCI. She had been struggling the previous year to retain newer facts and information. As secretary of the senate for the state of Missouri, Crouse had deftly juggled duties involving the senate’s procedural rules and legislative process, and in a previous job for the state senate, she helped lawmakers draft their bills and amendments. So when she could not recall the name of a former co-worker who came to visit, “that was a real concern,” says Crouse, who went to a neurologist for an evaluation.

Crouse has since taken a job on the senate research staff that has fewer responsibilities. “Her long-term memories are still strong, but she’s been given easier jobs that she can handle,” says her husband, Brian, who is vice president of education for the Missouri Chamber of Commerce.

Signs of MCI vary from person to person, says Nicole Anderson, PhD, director of Baycrest’s Ben & Hilda Katz Interprofessional Research Centre in Geriatric and Dementia Care in Toronto. “When we assess someone for MCI, it’s important to talk with family members or others who know the person well, who can tell us what specific changes they’ve noticed and how the person is different from how he or she was previously.”

Neurologists don’t make comparisons with age-matched controls on memory tests, says Barbara Joy Snider, MD, PhD, FAAN, professor of neurology at Washington University School of Medicine in St. Louis. Instead, they look for what has changed specifically about that person’s memory. “Some people have incredibly detailed memories, so if that slips a little bit, they may still perform far above other people their age, but someone who knows them well will see that they have declined,” says Dr. Snider, who also works at Washington University’s Knight Alzheimer Disease Research Center.

The Grants’ experience is an example of this. Most people wouldn’t be able to remember a complicated schedule as Steve did for years. But when he lost that ability, he and his wife sensed that something was wrong.

Differences Worth Noting

Behaviors that could be a sign of MCI, rather than normal aging, include repeating yourself in a single conversation. “We may forget to whom we told that great joke and tell it to them again a few weeks later,” Dr. Anderson says. “But telling the same joke in the same conversation is not normal healthy aging.”

Neither is misplacing things or forgetting where you put them. “We all put the car keys down somewhere strange from time to time because we’re distracted,” says Dr. Anderson. “But if that starts happening a lot more frequently or with items that you never used to misplace, that may be a sign of MCI.”

The ways that behavior changes also could signal MCI, she says. For example, if you’ve typically left your eyeglasses in random places and you begin doing so more frequently as you age, that probably isn’t a concern. But if you always put the glasses on your nightstand and lately you’ve been leaving them in a kitchen cupboard or the refrigerator, that is a concern.

Another sign is when a particular mental task starts becoming difficult. “If you’re finding the tax forms much more challenging than in the past or having trouble organizing your bills when you always did those easily, that can be a red flag,” Dr. Burns says.

The difference between MCI and dementia is subtle, but people with MCI generally have memory loss or other cognitive problems that do not substantially interfere with their daily activities, says Dr. Burns. It may take people with MCI longer to do multi-step activities such as shopping for groceries or paying bills, but they are still mostly independent. It’s when cognitive impairments significantly interfere with the ability to function at work or do usual activities at home that neurologists generally consider people to have progressed from MCI to dementia.

The condition is typically an interim phase between normal aging and early-stage dementia, although in some cases MCI does not progress—or progresses extremely slowly—to dementia. Most people with MCI go on to develop worsening dementia, especially if it is due to a neurologic condition such as Alzheimer’s disease. For about one-third of people with MCI, it happens within five years of their diagnosis. Steve Grant, for instance, was told he had Alzheimer’s disease only six months after his MCI diagnosis, based on results of PET scans that revealed beta-amyloid plaques, which are one of the hallmarks of Alzheimer’s disease.

Other Possible Causes

Sometimes symptoms of MCI might be caused by overmedication, says Dr. Snider. A study involving people in their sixties, published in the International Journal of Clinical Pharmacy in 2018, found significantly higher rates of cognitive impairment among those on five or more medications. For people concerned about their cognitive function, a physician can do a full review of their medications and possibly eliminate unnecessary or duplicative ones.

Other causes of mild but noticeable memory problems include sleep disturbances, anxiety or depression, deficiency of certain vitamins (such as B12), and an underactive thyroid or other hormonal disruption.

A recent heart attack, stroke, or head injury also can affect cognitive function. “Often, a person who has had a heart attack or open-heart surgery has experienced a brief period when the brain was deprived of oxygen, and the hippocampus—a part of the brain that is vital for learning and memory—is very sensitive to oxygen,” says Dr. Anderson. “A transient ischemic attack or bigger stroke also can affect cognition. In general, though, these are one-time insults to the brain, and any associated mild cognitive impairment typically does not get any worse unless there are further strokes or cardiac events.”

The Value of a Diagnosis

A person experiencing memory changes that affect daily functioning should see a neurologist, who will take a thorough history, conduct a physical examination, and likely order blood work. Depending on the results, the neurologist may recommend one or more standardized cognitive tests—to assess memory, reasoning, attention, language, and visual, motor, and social functions—as well as various imaging studies, such as MRI and PET scans.

“We want to know what has been changing and the characteristics and timing of those changes,” says Dr. Burns. “We also want to know how patients function today compared to how they were a few years ago.” The cognitive tests help corroborate what the neurologist observed in the exam, says Dr. Burns. “Someone with MCI often will do fairly well across the board on a battery of memory and thinking tests, but their short-term memory will be impaired. That’s the classic story.”

An early diagnosis means people can be treated sooner, and many new treatments work best in the earliest stages of the disease, says Dr. Snider. In 2023, the FDA approved lecanemab (Leqembi) for the treatment of MCI and mild Alzheimer’s disease in people with evidence of elevated beta-amyloid in their brains. In clinical trials that led to the drug’s approval, lecanemab reduced the amount of amyloid plaques and slowed patients’ decline by 27 percent, based on performance on several standard cognitive and functional tests.

Source: Brain&Life

 

 

 

 

Musical Tests Can Detect Mental Deterioration in Old Age

Researchers at Tel Aviv University have developed a method that employs musical tests and a portable instrument for measuring brain activity to detect cognitive decline in old age. According to the researchers, the method, which is based on the measurement of 15 minutes of electrical activity in the brain while performing simple musical tasks, can be easily implemented by any staff member in any clinic, without requiring special training.

The researchers: “Our method enables routine monitoring and early detection of cognitive decline in order to provide treatment and prevent rapid, severe deterioration. Prophylactic tests of this kind are commonly accepted for a variety of physiological problems such as diabetes, high blood pressure or breast cancer; however, to date no method has yet been developed to enable routine, accessible monitoring of the brain for cognitive issues.” The researchers further note that tests of this kind are particularly important in light of increasing longevity and associated growth of the elderly population.

The study was led at Tel Aviv University by PhD student Neta Maimon from the School of Psychological Sciences and the Buchmann-Mehta School of Music, and Lior Molcho from Neurosteer Ltd, headed by Prof. Nathan Intrator from the Blavatnik School of Computer Science and the Sagol School of Neuroscience. Other participants included: Adi Sasson, Sarit Rabinowitz, and Noa Regev-Plotnick from the Dorot-Netanya Geriatric Medical Center. The article was published in the journal Frontiers in Aging Neuroscience.

As part of the study, the researchers developed a groundbreaking method combining a portable device for the measurement and innovative analysis of electroencephalography (EEG), developed by Neurosteer, and a short musical test of about 12-15 minutes, developed by Neta Maimon. During the test, the subject is connected to the portable EEG device by means of a adhesive band with only three electrodes attached to the forehead. The subject performs a series of musical-cognitive tasks according to audible instructions given automatically through earphones. The tasks include short melodies played by different instruments, with the subjects instructed to perform various tasks on them at varying levels of difficulty. For example, pressing a button each time any melody is played or pressing it only when the violin plays. In addition, the test includes several minutes of musically guided meditation designed to bring the brain to a resting state, as this state is known to indicate cerebral functioning in various situations.

Neta Maimon, who specializes in musical cognition, explains that music has great influence on different centers in the brain. On the one hand, music is known to be a quick mood stimulant, particularly of positive emotion. On the other hand, in different situations, music can be cognitively challenging, activating the frontal parts of the brain, especially if we try to concentrate on different aspects of the music, and at the same time perform a particular task.

According to Maimon, if we combine these two capabilities, we can create cognitive tests that are quite complex, yet also pleasant and easy to perform. Furthermore, music that is positive and reasonably rhythmic will enhance concentration and performance of the task. Thus, for example, the famous “Mozart effect,” showing improved performance on intelligence tests after listening to Mozart’s music, actually has nothing to do with Mozart’s music, but rather the fact that music creates a positive mood and stimulates us to a state that is optimal for performing intelligence and creativity tests.

Accordingly, the researchers hypothesized that with musical tools, it would also be possible to challenge the subjects to an extent that would enable testing of the brain’s frontal activity as well as raising their spirits, thus enhancing their performance on the test while the overall experience is pleasant.

The study included an experiment at the Dorot-Netanya Geriatric Medical Center. Neta Maimon: “Anyone hospitalized at Dorot, or any other geriatric rehabilitation institution, undergoes a standard test called “mini-mental,” designed to evaluate their cognitive condition as a routine part of the intake process. The test is conducted by an occupational therapist specially trained for it, and includes a variety of tasks. For example, enumerating the days of the week or months of the year backwards. In this test, up to 30 points can be accrued. A high score indicates normal cognition.

The experiment included the testing of 50 elderly people hospitalized at Dorot who scored 18-30 on the mini-mental test, indicating various levels of cognitive functioning. The participants performed the musical-cognitive tasks, administered automatically. The EEG device registered the electrical activity in the brain during the activity, with the results analyzed using machine learning technology. This allowed mathematical indices to be identified that were precisely correlated with the mini-mental test scores; in other words, we obtained new neuro-markers (brain markers) that may stand alone as indices of the subject’s cognitive status.

Maimon adds: “We have actually succeeded in illustrating that music is indeed an effective tool for measuring brain activity. The brain activity and response times to tasks correlated to the subjects’ cerebral conditions (correlating to the mini-mental score assigned to them). More importantly, all those who underwent the experiment reported that, on the one hand, it challenged the brain, but on the other it was very pleasant to perform.”

The researchers conclude: “Our method enables the monitoring of cognitive capability and detection of cognitive decline already in the early stages. all by simple and accessible means, with a quick and easy test that can be conducted in any clinic. This method is of special importance today due to the increase in longevity and accelerated population growth, particularly among the elderly. Today, millions of people around the world already suffer or are liable to suffer soon from cognitive decline and its dire consequences, and their number will only increase in the coming decades. Our method could pave the way towards efficient cognitive monitoring of the general population, and thus detect cognitive decline in its early stages, when treatment and prevention of severe decline are possible. It is therefore expected to improve the quality of life of millions around the world.”

Keren Primor Cohen, CEO, Ramot at TAU: “We are pleased that a company based on a technology developed at TAU continues its collaboration on creative and multidisciplinary research. Ramot will continue to promote and invest in novel technologies, as well as help TAU researchers to maximize their research’s potential.”

Source: Science Daily

 

 

 

 

Insomnia in Midlife May Manifest as Cognitive Problems in Retirement Age

The Helsinki Health Study at the University of Helsinki investigated the development of insomnia symptoms in midlife and their effects on memory, learning ability and concentration after retirement. The follow-up period was 15–17 years.

According to the study, long-term insomnia symptoms and later poorer cognitive functioning have a clear connection.

“The findings indicate that severe insomnia symptoms were associated with worse cognitive function among those who were on statutory pension,” says Doctoral Researcher Antti Etholén, describing the results of the study.

The study also found that the memory problems, and problems in learning ability and concentration increased as the insomnia symptoms were prolonged.

Sleeping well already in middle age

Prior research has shown that there are a number of mechanisms that can explain how sleep can affect cognitive functioning. What makes the recently published study exceptional is the long follow-up period for insomnia symptoms.

Among other things, the study demonstrated that if insomnia symptoms eased over the years, cognitive functioning was also found to be better at retirement age compared to the problems persisting.

According to the researchers, long-lasting insomnia symptoms should be considered as risk factors for poor cognitive functioning.

“Based on our findings, early intervention tackling insomnia symptoms, or measures aimed at improving the quality of sleep would be justified,” says Professor Tea Lallukka.

There are many ways to improve the quality of sleep, including the regularity of the sleep rhythm, the appropriate temperature and brightness of the sleeping environment, and the optimal timing of physical exercise, coffee consumption and eating.

However, Lallukka believes that intervention studies are still needed to ascertain the effects of measures in support of good sleep.

“In subsequent studies, it would be interesting to shed further light on, for example, whether the treatment of insomnia can also slow down the development of memory disorders,” Lallukka says. She points outs that only self-reported memory symptoms could be taken into consideration in the present study.

Source: University of Helsinki

Study Identifies How COVID-19 Linked to Alzheimer’s Disease-like Cognitive Impairment

A new Cleveland Clinic-led study has identified mechanisms by which COVID-19 can lead to Alzheimer’s disease-like dementia. The findings, published in Alzheimer’s Research & Therapy, indicate an overlap between COVID-19 and brain changes common in Alzheimer’s, and may help inform risk management and therapeutic strategies for COVID-19-associated cognitive impairment.

Reports of neurological complications in COVID-19 patients and “long-hauler” patients whose symptoms persist after the infection clears are becoming more common, suggesting that SARS-CoV-2 (the virus that causes COVID-19) may have lasting effects on brain function. However, it is not yet well understood how the virus leads to neurological issues.

“While some studies suggest that SARS-CoV-2 infects brain cells directly, others found no evidence of the virus in the brain,” says Feixiong Cheng, Ph.D., assistant staff in Cleveland Clinic’s Genomic Medicine Institute and lead author on the study. “Identifying how COVID-19 and neurological problems are linked will be critical for developing effective preventive and therapeutic strategies to address the surge in neurocognitive impairments that we expect to see in the near future.”

In the study, the researchers harnessed artificial intelligence using existing datasets of patients with Alzheimer’s and COVID-19. They measured the proximity between SARS-CoV-2 host genes/proteins and those associated with several neurological diseases where closer proximity suggests related or shared disease pathways. The researchers also analyzed the genetic factors that enabled SARS-COV-2 to infect brain tissues and cells.

While researchers found little evidence that the virus targets the brain directly, they discovered close network relationships between the virus and genes/proteins associated with several neurological diseases, most notably Alzheimer’s, pointing to pathways by which COVID-19 could lead to Alzheimer’s disease-like dementia. To explore this further, they investigated potential associations between COVID-19 and neuroinflammation and brain microvascular injury, which are both hallmarks of Alzheimer’s.

“We discovered that SARS-CoV-2 infection significantly altered Alzheimer’s markers implicated in brain inflammation and that certain viral entry factors are highly expressed in cells in the blood-brain barrier,” explained Dr. Cheng. “These findings indicate that the virus may impact several genes or pathways involved in neuroinflammation and brain microvascular injury, which could lead to Alzehimer’s disease-like cognitive impairment.”

The researchers also found that individuals with the allele APOE E4/E4, the greatest genetic risk factor for Alzheimer’s, had decreased expression of antiviral defense genes, which could make these patients more susceptible to COVID-19.

“Ultimately, we hope to have paved the way for research that leads to testable and measurable biomarkers that can identify patients at the highest risk for neurological complications with COVID-19,” said Dr. Cheng.

Dr. Cheng and his team are now working to identify actionable biomarkers and new therapeutic targets for COVID-19-associated neurological issues in COVID long-haulers using cutting-edge network medicine and artificial intelligence technologies.

Source: Cleveland Clinic