Cognitive Impairment

There are normal changes in brain function that come with age. It is normal, for example, to experience mild forgetfulness and difficulty with multitasking. “Normal aging” may cause the brain to slow in calculations and retrieval of information. These normal brain changes don’t interfere with everyday life. In fact, in normal aging, life can be enriched by learning new things and challenging the brain with stimulating conversation, thoughts and activities.

There are several terms that can be used to refer to a decline in brain function. “Dementia” and “cognitive impairment” are terms that refer to a set of symptoms that interfere with daily life, safety and independence.

Symptoms

Symptoms of dementia range from mild to severe and include:

• Problems with memory
• Difficulty with planning, initiating and carrying out tasks
• Difficulty with language and communication
• Disorientation to time and place
• Confusion
• Difficulty with decision making and reasoning
• Problems with focus, concentration and attention
• Poor judgment
• Difficulty understanding, interpreting and navigating the environment
• Changes in perception
• Difficulty recognizing once familiar things, places and people
• Inability to make new memories or learn new information
• Difficulty solving problems
• Decline in self-care
• Changes in personality, mood and behavior
• Fear, frustration and agitation
• Changes in the coordination and control of body movements.

Dementia is not a normal part of aging. Dementia symptoms indicate the presence of a problem that needs attention. Whenever there is a suspected change in an older person’s cognitive function, a health provider with knowledge of cognitive function should be quickly consulted. There are dozens of conditions that can cause dementia symptoms including sleep apnea, depression, stroke, vitamin B12 deficiency, infection, medication toxicity, alcohol use, thyroid disorders, nutritional deficiencies, head injuries, and other neurological disorders.

Because some causes of dementia symptoms are treatable, it is extremely important that a person gets a thorough evaluation by a health care professional as soon as possible to make an accurate diagnosis. Knowing the cause of dementia is important as it helps with treatment decisions, symptom management and future planning. Most people call their primary care provider when they have concern about changes in memory and other brain functions. It is important for the primary care provider to check for physical causes for the changes. Good health professionals will refer to a specialist if the health problem is beyond their scope of expertise, and people should feel justified in seeing a dementia specialist when there are growing concerns of cognitive impairment.

Delirium

Delirium is a serious medical condition that includes dementia – like symptoms such as confusion and disorientation. Delirium usually develops over a short period of time (hours or days) and the severity of the symptoms will change throughout the day. The hallmark symptoms of delirium are an inability to stay focused and changes in consciousness. Delirium can indicate a dangerous physical condition and it requires immediate attention. It is most often reversible when quickly treated. Common causes of delirium include dehydration, infection, anesthesia and medication side effects.

Mild Cognitive Impairment (MCI)

There is a syndrome in which people experience a decline in brain function that is troubling but does not yet meet the criteria for dementia. The problem is often with memory, but other cognitive functions, such as language, judgment and reasoning might also be in decline. This syndrome is called Mild Cognitive Impairment (MCI).

Generally speaking, people with MCI are able to perform everyday tasks of living and their cognitive impairment may not be noticed by those outside of a close circle of friends and family. MCI can be a pre-dementia condition for some people. Careful monitoring of MCI progression is key in helping to identify the potential onset of dementia. Research shows that memory medications work more effectively in early MCI stages than they do when a person has more advanced dementia – another reason to detect MCI as soon as possible.

Instrumental Activities of Daily Living (IADLs) are the tasks we perform every day that come easy to people who do not have cognitive impairment. Examples of IADLs include grocery shopping, banking, housekeeping and planning a family gathering. These are the tasks that first become difficult with a person developing MCI though the difficulties may not be obvious to others. Activities of Daily Living (ADLs) are the tasks we do that are more oriented to self-care e.g., dressing, grooming, eating and personal hygiene. People with Mild Cognitive Impairment are able to accomplish ADLs without much difficulty. There are assessments that can determine a person’s ability to function that may give a picture of that person’s cognitive health. Experts agree that functional assessment is important and helpful. People can ask health providers for a “functional assessment.”

Alzheimer’s Disease

Alzheimer’s disease (AD) is a brain disease that involves the death of brain cells in a predictable and progressive pattern, slowly destroying memory and thinking skills and, eventually even the ability to carry out tasks of daily living. In most people with Alzheimer’s, symptoms first appear after age 65. It is likely that the disease process starts as early as ten years before the onset of symptoms.

Alzheimer’s disease is the most common form of irreversible and progressive dementia, accounting for approximately 70 percent of dementia cases. While scientists are getting closer to the answers every day, they still don’t have full understanding of the cause which is likely to involve a mix of genetic, environmental and lifestyle factors.

Risk factors include older age (chances of having the disease doubles every five years after age 65), family history (mostly sibling or parental history), presence of Mild Cognitive Impairment and a history of head trauma. The early symptoms of Alzheimer’s disease include a very gradual change in the person’s ability to remember normal things, such as appointments, names of objects, or things that happened within the recent past.

Symptoms

As the disease evolves memory worsens, but memory is only one aspect of brain function that is impacted. People with Alzheimer’s disease commonly experience:

• Changes in personality, mood and behavior
• Decreased ability to plan and carry out complex tasks
• Difficulty interpreting the environment
• Frustration and agitation as everyday things become more challenging
• Struggles with verbal communication – both expressing and understanding information
• Challenges with physical movements
• Increasing difficulty with short-term and then long-term memory
• Fear and depression associated with cognitive losses
• Suspicion and false beliefs about loved ones

People with Alzheimer’s disease pass through stages that are predictable. It is very important for caregivers and loved ones to understand these stages so that they can best support the person experiencing the disease, maximize positive interactions and prepare for future needs and issues.

Most importantly, people need to understand that with Alzheimer’s disease and other forms of dementia, the individual with the disease has strengths and gifts to give to others. They need support as this disease is particularly isolating, but they can also maintain a pleasurable life.

Vascular dementia

Vascular dementia (also called multi-infarct dementia) is the second most common form of dementia after Alzheimer’s disease. It results when there is a disruption in blood supply to the brain. High blood pressure, heart problems, high cholesterol and diabetes are conditions that can cause or increase damage to the vascular system, resulting in vascular dementia. Strokes and transient ischemic attacks (also known as “mini-strokes” or TIAs) are common causes of vascular dementia.

Vascular dementia can occur suddenly. A person may not be able to think clearly, may become confused and have difficulty functioning. When this situation is observed, immediate medical attention should be sought. People with vascular dementia may experience: periods of extreme confusion; weakness or paralysis in a part of the body; memory and communication problems.

The progression of vascular dementia is “step-like” in that symptoms may stay stable for a length of time and then suddenly deteriorate. The symptoms vary according to the region of the brain that is affected. It is important to determine if a vascular problem is causing dementia because there are treatments that may help a person regain some functioning and reduce future episodes.

If you are concerned about memory loss in yourself or a loved one, the Alzheimer’s Association offers resources on assessing memory loss and accessing help. Visit https://alz.org/alzheimers-dementia/memory-loss-concerns.