Second Thoughts on Thinking Loss

The key to dementia is prevention. The simple guidelines I gave [link to last week] are a starting point. If you really want to nail this issue, then what further preventative steps can you take??

The changes we call dementia ie poor short term memory, reduced organisation of thoughts and actions [so called executive functions] and poor orientation in time and place are endpoints demonstrating extensive brain damage. The earliest signs of dementia are called MCI - Mild Cognitive Impairment. Everyone has MCI some years before they have dementia. So there is a window of opportunity to halt the damage and the prevent deterioration.

Aim to identify MCI early and take remedial action

You have increased risk with a strong family history of close relatives affected or have had repeated sporting challenges to the brain [football, rugby, boxing]. ‘Cognition’ means thinking processes. The 8 domains [separate functions] are Sustained Attention; Response choice/Inhibition; Speed of Information Processing; Cognitive Flexibility; Multiple Simultaneous Attention; Working [short term] Memory; Category Formation and Pattern Recognition. If there is any form of brain damage, then one or more of these may be affected depending on where the injury is. Important: MCI does not just show up as a memory problem, it must be diagnosed through a test that covers all domains.

1.????Be aware you may not be a reliable judge of yourself

People with MCI deny the problem; they take compensating action eg avoiding challenging situations, they declare that this is ‘just normal ageing’ and say that ‘all my friends have some memory problems’. If you are over 65 your friends and relatives should be keeping an eye out for functional changes such as problems with “object memory,” [forgetting what things are called], forgetting what you watched on television, forgetting to do things that are right in front of you and complaints with “spatial memory,” such as where you put things or recognising places. This all sounds very technical but the test I recommend [MoCA] to screen for potential issues covers this and I use this in my program. Many doctors use an alternative called the MMSE.

2.????So – over 60? Take a test of ‘cognition’.

This is mainly appropriate for the over 60’s. MCI represents a transitional stage between healthy ageing and dementia and affects 10-15% of the population over the age of 65. Not everyone who has an abnormal test has dementia or a dementia precursor. The next step is to see a neurologist for a precise diagnosis [more tests like scans are needed]

3.????Work a bit harder on the basics

The main risks for dementia such as metabolic syndrome, inflammation; couch-potatoism, high blood pressure, and diabetes are all controllable. The really good news is that optimising all of these to well below the limits of normality is the route to preventing MCI or halting the shift from MCI to dementia. There is good evidence that specific physical exercise and tailored mental exercise programmes make a noticeable difference.

4.????Consider carefully the role of sex hormones

The adverse role of sex hormone lack is clear in both experimental models and human studies. So men receiving testosterone suppression treatment and women on aromatise inhibitors for breast cancer or with premature menopause have higher dementia risk and reduced cognitive functions. Hormone treatment of men and women with MCI report a benefit in some domains but not in all. This means some Drs are sceptical: however MCI has multiple causes and fixing just one of the causes shouldn't be expected to fix all the problems and failure to do so is not an example of treatment failure. When dementia is established there is some irreparable damage [think ‘holes in the brain’] so all treatments will have limited effect: any benefit is a benefit. Given the high level of safety of current treatment in both sexes it is a worthy option for discussion.

I will return to this and to the ‘optimise everything else’ story for those who want more detail.

• MCI precedes dementia: you can prevent MCI and slow or halt progression form MCI to dementia
• MCI is detectable on a questionnaire
• Exercise, mental training, optimisation of diet, cholesterol, blood pressure, sugar metabolism and sex hormones are all beneficial

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