Straight Talk: Mild Cognitive Impairment

Contributed by: Dennis Fortier, President, Medical Care Corporation

Mild Cognitive Impairment (MCI) is a term we are seeing more and more frequently in the general press.  Unfortunately, efforts to clarify its meaning often serve to further confuse the issue.

Case in point is a lengthy discussion about MCI, with an associate professor of psychiatry, published recently in the New York Times "New Old Age" blog.  While lots of important ground is covered in the interview, most of the information is geared toward MCI caused by Alzheimer's disease, without proper emphasis and clarity about other, arguably more common causes of MCI.  Population-based studies suggest that prevalence of MCI cases caused by depression, poorly controlled diabetes, sleep-disorders, thyroid conditions, alcohol/drug abuse, medications, and cancer treatments, far exceed the number of cases caused by early stage Alzheimer's disease.

That oversight, that most MCI is caused by common, treatable, medical conditions and not early Alzheimer's disease, undermines the clarity of the piece.  Most of the discussion is geared toward understanding MCI caused by Alzheimer's disease, as opposed to MCI caused by the many other, more common, medical conditions that impair cognition.

This confusion about MCI and the proclivity to attribute MCI to Alzheimer's disease are not new phenomena.  I wrote about it more than three years ago in a post about MCI converting to Alzheimer's disease. In the years since, increased interest in cognitive health has brought increased coverage of these issues.  Unfortunately, much of the coverage is poorly presented and does not aid clarity.

Here is a constructive way to understand the term MCI: While some decline in cognitive function is normal with aging, MCI refers to changes that are more severe than would be expected at a given age, but not so severe as to prevent a self-reliant lifestyle. When cognitive decline is severe enough to prevent self-reliance, we use the term "dementia".  In this way, cognitive health can be viewed as a continuum from "normal aging" to "MCI" to "dementia". One crosses from MCI into dementia when the cognitive decline is severe enough to prevent effective self-care.

Alzheimer's Drugs in the Pipeline

Contributed by: Dennis Fortier, President, Medical Care Corporation

Recent history has not been kind to R&D efforts aimed at developing new Alzheimer's drugs.  While four approved drugs can help manage symptoms of the disease, and perhaps slow its progression to a small degree, the field has aggressively pursued new treatments that can significantly slow or stop progression.

These efforts have been hampered by the complexity of the disease and by, what most experts consider, a fairly rudimentary understanding of its pathology.  We understand that Alzheimer's disease manifests as a decline in cognitive function, and that the decline is caused by a loss of brain cells and the connections between them.  We also understand that an accumulation of amyloid proteins in the brain, and a chemical change in Tau proteins (phosphorylation) in the brain, are major factor contributing to that loss of brain cells.

However, the picture becomes less clear when we try to identify the many possible processes that start the pathology.  The answer may be related to cell metabolism, to brain chemistry, to inflammation, or trauma, just to name a few of the leading areas of scientific inquiry.  Probably, a host of these processes interact and lead to a cascade of biological responses along the way.

The questions to which we do not yet have solid answers are: which processes matter most, are they inter-related, and why do they lead to this disruptive outcome?  Without those answers, it is difficult to develop drugs that will target the right process, at an early stage.  It is a very complex problem involving the most complex of organs.

Nonetheless, research persists and scientific efforts are ongoing.  At this point, several promising agents are moving along the pathway in FDA clinical trials.  A good overview of the Alzheimer's pipeline was recently published by Fierce Biotech.  It is slightly technical, and geared toward financial analysts, but it is comprehensive and gives a good foundation of the theory behind each approach.

Depression and Aging

Contributed by: Dennis Fortier, President, Medical Care Corporation

This is a great overview on common triggers for depression as you age, including a few life-style choices that effectively keep depression at bay.

The link goes to a WebMD presentation of 21 slides that can be viewed and read in about 5 minutes.  For anyone over age 40, or with an interest in depression, I highly recommend clicking through and reading; it is very well done and informative.