Some time ago, we took my mother to your clinic when we were in Roanoke. He was starting to behave in a slightly unbalanced way. You and your staff passed it over with a narrow-toothed comb and said it didn't have Alzheimer's disease, but that it looked like it was working on it. You called something like "MCI". Then you told us what to do with his drugs, smoking and beer, and we even wrote everything to make sure we understood and were good with it. Well, we didn't do anything because we moved and because my sister wanted to try the holistic way. Now, the mom is definitely over the limit and goes south very quickly. We took her to a new doctor here, where we live, and wanted to know what you said. We still had a page of what you gave us then to show it, and he said he would take the rest. Then, he started talking about MCI things like you. What is it about again?
– Morgantown, West Virginia
Well, let's take a deep breath and get to work.
MCI stands for mild cognitive impairment. It may represent a transitional period between the moment when a patient – or those around him – notice a decline in the memory function that has not yet begun to have a complete impact on daily activities, such as repeating questions or statements.
It is important to know that up to about 20% of people over 65 have MCI. While it is true that those with MCI are more likely to develop Alzheimer's disease, MCI does not inevitably lead to dementia. I have seen many cases return to normal or stable brain function due to changes in medication and / or lifestyle.
Many are intimidated by this; however, I am encouraged by it. Why? Because it offers us the opportunity to intercede – if we take advantage of it.
I remember from your previous visit that your response to my care plan was that your mother would not change her ways when it came to smoking or using alcohol. In my experience, these two life habits are the most common associations with MCI that lead to dementia.
The way we live over the years often guides us along the path of dementia. Transforming our lifestyle can lead to significant improvements in the quality of our lives. However, it can be a daunting challenge due to the gradual damage of dementia, which can seem very subtle over the years until it completely takes our memory and lives far away.
Between 2014 and 2016, the mortality rate for Alzheimer's dementia increased by almost 20%. Again, if there is one thing I wish to stress after my years in the field, it is that the basis for Alzheimer's has been established for decades before the symptoms of memory loss begin.
The time to "pay him back" in the prevention of dementia, I think, starts in our teens years. I say this because smoking and drinking habit habits often start during those years and go on and on until the damage is done.
That said, when we consider MCI as a pathology model, we look at how the thinking process is influenced by two categories. The first is called an amnestic MCI, in which information points that were common everyday memories of recent events are forgotten. The second is MCI which is not unaesthetic, which influences, for example, decision-making, sequential thinking or interpretative symbology (as in not understanding what a stop sign means).
MCI begins as a clinical diagnosis based on a physician's judgment of patient presentation. This judgment comes after an accurate medical history and a physical examination in conjunction with a neurological examination; evaluation of the independent function and daily activities with the patient together with the family contribution; and mental state and mood analysis in the context of laboratory and imaging results. This impression can be confirmed with an additional evaluation in a specialized clinic that provides neuropsychological tests to assess the patient's cognitive abilities.
After the diagnosis, a multidisciplinary treatment plan for the care group with the patient and his family is created and discussed. It is important to note that this should be done in a clinic that has the facilities to provide such an assessment. Not all medical studies do it.
In closing, one more thing: please don't look back. Now is not the time for recriminations of what should have been done because, I promise you, there are no guarantees regarding dementia. This is the time to join the ranks and make the current situation the best it can be for your family and your mother.
Every year during this time, I remember the immortal words of basketball coach Jim Valvano facing a really daunting problem: "Don't give up. Never give up." Keep these words in your heart and do what you can to improve tomorrow.