Mild cognitive impairment an early intervention point in the fight against dementia

The World Health Organization has estimated that the number of people worldwide with the most severe form of memory loss–dementia–is expected to triple by 2050 to more than 100 million adults.

Neuropsychologists at Baycrest Health Sciences are working on getting ahead of this looming health crisis by identifying people most at risk of dementia and initiating treatments and interventions early on to delay or prevent further cognitive decline.

“The only way that we can proactively address the impact of dementia on society is to try and identify people who are at risk at the earliest possible point, when treatments are usually most effective,” says Dr. Kelly Murphy, clinical neuropsychologist at Baycrest.

Individuals diagnosed with Mild Cognitive Impairment (MCI), a condition considered to be a border zone between normal age-related cognitive changes and the more severe cognitive decline associated with dementia, represent an ideal target group for early interventions according to Dr. Murphy.

“We know that half a million Canadians  aged 65-and-older have MCI and that this places a  strain on the family member or friend  closest to them, so you could say one million Canadians,  are impacted,” she says.

Dr. Murphy and colleagues Drs. Nicole Anderson and Angela Troyer have just written a book, Living with Mild Cognitive Impairment: A Guide to Maximizing Brain Health and Reducing Risk of Dementia. The book is written for people living with MCI, and their loved ones and will also be helpful to doctors who may not be familiar with the diagnostic criteria for MCI and serve as a refresher for those who are.

Researchers estimate that about one in 10 adults over the age of 65 have MCI and about 50 per cent of these people will develop dementia within five years. But people living with the condition may be able to delay or even prevent further cognitive decline.

“Research is starting to identify that when people with MCI improve their exercise and diet habits, and cognitive and social engagement, they enjoy better levels of functioning and this helps delay progression to dementia,” says Dr. Anderson, a clinical neuropsychologist and senior scientist at Baycrest’s Rotman Research Institute.  “The economic and psychological benefits of this delay are enormous,” she adds.

Dr. Anderson encourages older adults who are experiencing memory changes that don’t seem normal for their age to make an appointment to talk with their doctor. It may be that they have nothing to worry about, or their doctor may decide it’s necessary for them to see a neurologist or neuropsychologist, or other specialist for further cognitive tests.

“The family doctor will look at the patient’s complaint, and rule out other factors, such as stress, depression or medical conditions that could be the underlying cause of the memory issues,” explains Dr. Murphy.

Unlike a diagnosis of Alzheimer’s disease, the prognosis for MCI is uncertain.“MCI can be an unsettling diagnosis because you don’t really know what it means. It might progress to dementia, it might not. It could get better,” says Dr. Troyer, professional practice chief, Psychology, and program director of Neuropsychology and Cognitive Health, at Baycrest.

Despite this uncertainty, a clinical diagnosis gives patients the opportunity to be proactive about their cognitive health. Ten years ago, Drs. Anderson, Murphy and Troyer developed a memory intervention program that brings together evidence-based strategies and memory techniques to help people with MCI maintain their cognitive health as long as possible.

“We wanted to provide individuals with MCI with what we know from research to be the best things that they can do to promote their brain health,” says Dr. Troyer.

The program helps people to develop and sustain good practices related to healthy diet, physical activities, maintaining leisure activities that are social and cognitively engaging as well as promoting development of good memory habits, such as keeping lists and putting car keys and reading glasses in the same spot so they can be easily found.

Peggy, 87, of Toronto, was diagnosed with MCI about 18 months ago. An active and energetic woman who worked well into her 70s, she pursued a diagnosis because changes in her memory were making her feel “out of control.” “It was getting too hard to live with. It was a constant companion, being out of control,” she says.

Peggy enrolled in Baycrest’s memory intervention program where she learned strategies to support her memory abilities and regain confidence in her abilities to manage her daily life. “I write things down. The other thing that I do now which I’ve been training myself to do since I started coming to this program is having specific places for putting things. I can only put my glasses down in one place in each room,” she says.

There are fewer than a dozen programs for people with MCI in the world, but Dr. Murphy says she hopes to change this.  “We believe that this program can make a real difference to the lives of individuals, based on our clinical experiences. We’re poised to share the program with other health care professionals and institutions,” she says.