The Cognitive disturbances and cognitive problems , Including mild cognitive impairment, are considered an intermediate stage between normal or expected cognitive impairment as a consequence of aging and the development of a more severe decline, dementia (Mayo Clinic, 2012).
Mild impairment of cognitive functions may involve deficits in memory, language, impairment of judgment or thinking. Both the person and his / her relatives can begin to notice those changes; However, do not reach a level of severity enough to interfere with routine activities or daily life (Mayo Clinic, 2012).
Cognitive problems can range from an almost barely perceptible presence to a more significant presence, sometimes cognitive abilities will gradually decline, while others may remain stable for years (Memory and Aging Center University of California, 2016 ).
In the last decades, the study of the cognitive functions related to the age and the different pathologies has become a central point, as much for the medical area as neuropsychological, due in great part to the increase of the longevity of the population.
Recently, the medical community has changed its perspective on memory loss in the elderly population. Previously, memory alterations were considered as an inevitable event that was presented in a way consistent with the progressive increase of age (Institute of Cognitive Neurology, 2016).
It is now known that there are multiple factors that will protect our mnesic ability even at very advanced ages and that, therefore, cognitive impairment in a mild stage can be considered as pathological or indicative of a dementia process rather than an evolutionary event Cognitive Neurology, 2016).
What is mild cognitive impairment (DCL)?
People with mild cognitive impairment may have more significant or severe impairment of memory, language, or executive function than is expected for their age, but these symptoms do not interfere with their daily lives (National Institute on Aging, 2016).
Some of the most common symptoms of mild cognitive impairment are difficulties in remembering people's names, losing the thread of a conversation or a significant tendency to lose things (Alzheimer's Australia, 2016).
Typically, people with mild cognitive impairment can perform all activities of their daily lives with varying degrees of effectiveness. They often try to compensate their memory deficits with some external system, such as agendas, notes or calendars (Alzheimer's Australia, 2016).
Mild cognitive impairment is not a type of dementia. In many cases the alterations can remain stable; However, are more likely to escalate into a dementia process (Alzheimer's Society, 2015)
How Many People Have Mild Cognitive Impairment (DCL)?
Different studies estimate that between 5-20% of people over 65 have mild cognitive impairment (Alzheimer's Society, 2015).
On the other hand, 10-15% of people diagnosed with leven cognitive impairment have a high probability of developing Alzheimer's dementia compared to 1-2% of healthy subjects in the same age range (Sánchez-Rodríguez, 2011) .
What are the Symptoms of Mild Cognitive Impairment (DCL)?
It is not surprising that as age increases, oblivion episodes occur, more time is needed to find a response or to perform a task. But it is possible that when these persistently present situations may indicate the presence of mild cognitive impairment (DCL) (Mayo Clinic, 2012).
You may experience some of the following conditions (Mayo Clinic, 2012):
- Frequent forgotten.
- Forget important events like appointments or appointments.
- Lose the thread of conversations, movies, books or the thought itself.
- Difficulty in decision making, planning and / or interpretation of instructions.
- Difficulty recognizing frequent or familiar roads.
- Increased impulsiveness or reduced judgment.
- Both the individual and those close to him may be aware of this type of change.
Symptoms depending on the cognitive area
The experts usually classify the symptoms according to the cognitive area that is affected or altered (Alzheimer?? s association, 2016):
Amnestic mild cognitive impairment
It fundamentally affects memory. The person can begin to show significant forgetfulness as appointments, conversations, events that normally remembered easily (Alzheimer's association, 2016). In addition this type can be classified in:
- Single domain amnesic DCL Or: the symptoms relate only to memory (Sánchez-Rodríguez and Torrellas-Morales, 2011).
- Amnestic DCL with involvement in multiple areas : The symptoms are mainly memoristic but complaints are filed in other areas?? Resolution of problems or naming of words (Sánchez-Rodríguez and Torrellas-Morales, 2011).
- Non-amnestic mild cognitive impairment?? : The patient does not report memory complaints, fundamentally affects the ability to make decisions, anticipate the time or sequence of steps necessary to perform a task, among others (Alzheimer's association, 2016). It can also be single domain or affected by multiple areas (Sánchez-Rodríguez and Torrellas-Morales, 2011).
Alterations will generally occur in the following areas (Alzheimer's Society, 2015):
- Memory : Forget recent facts, quotes, names or a recent question.
- Reasoning : Difficulty in planning, problem solving or loss of thought thread.
- Attention : Difficulty in maintaining attention and targeting, easy distraction.
- Language : It is usual that more time is needed to find the right words in the construction of a response.
- Visual perception : Difficulty interpreting distances, depths or walking a few stairs.
Although normally healthy people begin to experience some signs of decreased or minimal impairment of cognitive functions with age, all of these symptoms are going to present more severely than in normal aging (Alzheimer's Society, 2015).
It is common that with the increase of the age pauses are needed to recodar data or words; However, getting disoriented and lost in familiar places or forgetting family names can not be indicative of a slight deterioration (Alzheimer's Society, 2015).
What are the diagnostic criteria for Cognitive Impairment (CCD)?
There is currently no specific diagnostic test that indicates the presence or absence of mild cognitive impairment (Mayo Clinic, 2012).
The specialist will make a clinical diagnosis based on information obtained from both the patient and his / her relatives and from the application of some tests (Mayo Clinic, 2012).
Complaints regarding the memory area are usually present from the onset of symptoms of mild cognitive impairment. They can be manifested by both the patient and the person close to the patient.
In addition, they often describe other symptoms, difficulty finding correct words when speaking, loss of objects, disorientation in different environments, loss of thought continuity, conversations and / or daily activities (Sánchez-Rodríguez and Torrellas-Morales, 2011) .
In most cases the following considerations are taken into account (Mayo Clinic, 2012):
- Memory deficits and other cognitive function : Planning, follow-up instructions, decision making.
- Medical history shows that the person has a decreased cognitive level in relation to the ideal or expected.
- Generalized mental function and activities of daily living are not significantly affected, although the symptoms may cause concerns and / or discomfort.
- The use of standard neuropsychological tests shows a slight but below-expected level of cognitive functioning for their age and educational level.
- The signs and symptoms are not severe enough to consider the presence of dementia.
Several proposals have been discreet about the diagnostic criteria essential for the diagnosis of mild cognitive impairment, some of them are the following (Sánchez-Rodríguez and Torrellas-Morales, 2011):
Diagnostic criteria of the Spanish Society of Neurology for the diagnosis of mild cognitive impairment
1. Alteration of one or more of the following cognitive areas: attention / executive function, language, memory, visuopaspacial area.
2. This alteration must be: acquired; Referred by the patient or by a reliable informant; Of months or years of duration; Objectified in the neurological exploration; The alteration does not interfere or does it in a minimal way in the habitual activities; There is no neurobehavioral syndrome or frock and / or dementia.
May Clinic Criteria for Mild Amnestic Cognitive Impairment
1. Subjective symptoms of memory loss corroborated by a valid report.
2. The patient or informant refers to a decline in one or more cognitive domains in relation to the previous abilities during the last 12 months.
3. Significant evidence of mild or moderate impairment in memory and other cognitive functions.
4. Activities of daily living remain unchanged.
5. This situation can not be explained by dementia and other medical cause.
Diagnostic criteria according to the International Psychogeriatric Association-World Health Organization
- No age restrictions.
- Decreased cognitive ability affirmed by the patient or informant.
- Gradual decrease and minimum duration of six months.
- Any of the following areas may be affected: memory / learning, attention / concentration, thought, language and / or visuopespatial function.
- Decreased assessment of mental status or neuropsychological tests a standard deviation by the value of the control group.
- There are no systemic, cerebral or psychiatric processes that can explain the clinical picture.
What are the causes of Mild Cognitive Impairment (DCL)?
No single specific cause has been identified for mild cognitive impairment.
Current scientific evidence shows that on occasion, mild cognitive impairment may show some brain changes similar to those found in some types of dementia (Mayo Clinic, 2012).
These include (Mayo Clinic, 2012):
- Abnormal concentrations of beta-amyloid plaques and proteins characteristic of the Alzheimer disease .
- Presence of Lewy bodies, associated with Parkinson's disease , Lewy dementia And some cases of Alzheimer's.
- Small strokes or reduced blood flow in some brain areas.
- Reduction of total hippocampal volume.
- Enlargement or dilation of the cerebral ventricles.
- Reduced glucose metabolism in some brain regions.
Are there risk factors that increase the likelihood of mild cognitive impairment (MCI)?
In general, the factors most associated with mild cognitive impairment are the same as those identified in dementia (Alzheimer's Association, 2016):
- Advanced age
- Family history of Alzheimer's and other dementia.
- Medical conditions that increases the risk of suffering from cardiovascular or cerebrovascular diseases.
On the other hand the Mayo Clinic (2012) also highlights other risk factors:
- Present a specific form of a gene called APOE4, related to Alzheimer's.
- Diabetes.
- Depression.
- Hypertension.
- High cholesterol.
- Consumption of alcohol and tobacco.
- Absence of physical exercise.
- Absence of social or cognitively stimulating activities.
Is there treatment for Mild Cognitive Impairment (DCL)?
With regard to drugs, there is currently no specific treatment for mild cognitive impairment. Despite this, there is a wide variety of ongoing clinical and experimental studies attempting to investigate the effectiveness of different drugs: cholinesterase inhibitors used in Alzheimer's, non-steroidal anti-inflammatory drugs or statins (Alzheimer's Australia, 2016).
Apart from this, there is solid scientific evidence on the benefits of neuropsychological rehabilitation and cognitive training. Constantly working attention, memory, executive function and other cognitive functions will be essential to achieve the stability of the progress of symptoms and on the other hand to develop compensatory strategies that provide people with useful and efficient tools to compensate Their deficits.
On the other hand, maintaining a healthy diet, exercising on a regular basis, and maintaining an optimal health status avoiding the use of harmful substances or controlling for possible risk factors are variables that may influence the development of symptoms and the Progression of mild cognitive impairment.
CONCLUSIONS
Mild cognitive impairment is a clinical condition that can cause significant alterations in the cognitive sphere of people, and also cause significant discomfort in their daily lives. Despite this, an essential distinguishing feature with dementias is that these deficits will either not significantly alter both the routine activities and the daily life of the patient.
An early diagnosis is essential as the early use of cognitive intervention will provide the individual with better compensation strategies for their symptoms of impairment. In addition they should be monitored to detect more significant changes that indicate the development of an insane process.
References
- Alzheimer's Association. (2016). Mild Cognitive Impairment. Retrieved from the Alzheimer's Association: http://www.alz.org/dementia/
- Alzheimer's Australia. (2016). Mild Cognitive Impairment. Retrieved from Alzheimer's Australia: https://fightdementia.org.au/
- INECO. (2016). Cognitive Impairment. Retrieved from"Instituto de Neurología Cognitiva": http://www.ineco.org.ar/deterioro-cognitivo/.
- Mayo Clinic. (2012). Mild cognitive impairment (MCI). Retrieved from the May Clinic: http://www.mayoclinic.org/diseases-conditions/
- NIH. (2016). Mild Cognitive Impairment. Retrieved from National Institute on Aging: https://www.nia.nih.gov/alzheimers/
- Sánchez-Rodríguez, J., & Torrellas-Morales, C. (2011). Review of the constructu slight cognitive impairment: genral aspects. Rev Neurol, 52 (5), 300-305.
- Society, Alzheimer's. (2015). What is mild cognitive impairment (MCI)? Retrieved from the Alzheimer's Society.