In medical terms, dementia is an “umbrella” term that describes symptoms associated with a decline in memory that eventually results in the inability to perform everyday activities also known as activities of daily living (ADLs).
In common terms, dementia is a progressive disease that initially effects short term memory and in the later stages also effects long term memory. It is irreversible and no two individuals’ journey with dementia is the same.
MCI is having a condition characterized by a having difficulty with memory, thinking, language or judgment beyond what is considered “normal” for a person’s age. Over 50% of people with MCI will progress over time to a type of dementia. The other 50% of people with MCI will indefinitely remain in this stage. Keeping your mind challenged by learning new things, getting proper nutrition and adequate sleep, as well as staying socially and physically active are all recommended ways to reduce risk for cognitive decline.
There are numerous types of dementia; however, the most common is Alzheimer’s Disease. Approximately 2/3’s of all individuals with dementia will either have Alzheimer’s Disease (AD) or a mixed dementia with AD. According to the Alzheimer’s Association approximately 5.8 million people in the United States have AD. 1 out of 10 people 65 year of age or older will get AD and 2/3’s of them are women. This does not account for all the other types of dementias.
The best place to start the process for a dementia/MCI evaluation is your primary care provider. Sometimes cognitive impairment is obvious to your provider but sometimes, especially in the early stages it can go undetected during your brief wellness annual visit. Bring up any concerns you may be having. Ask to have an assessment done. Early detection allows for early intervention. There is treatment that can slow down the progression of dementia. There are also many dementia mimics that can cause a pseudo-dementia.
These are factors that can cause memory impairment. Unlike true dementia, with a dementia-mimic once the underlying issue is resolved or treated, memory is improved. Often a referral to a neurologist is suggested to help with the evaluation. Although some PCPs manage dementia, a neurologist specializes in this area.
The initial assessment typically involves a memory assessment. The one used in my practice is called a Montreal Cognitive Assessment Tool (MOCA). Others use a Mini-Mental State Exam (MMSE). They both are 30 question exams. They ask things like: what is the day/month/year? Can you draw a clock? Can you recite/recall words? Can you count backwards in increments of 7?
I tell my patients that if there is something unusual about their memory processing the MOCA/MMSE will detect it but these assessments are not powered to specifically say if the patient has a dementia or something else such as a dementia-mimic. Depression is a common seen dementia-mimic. A person with dementia and depression can score similarly on the assessment.
After the initial interview, physical exam and memory assessment, a thorough review of medications is done and blood work and brain imaging (MRI or CT) are commonly ordered. Often a referral to a neuropsychologist is also made for assistance with the diagnosis. Once all the information has been collected and reviewed, a diagnosis is made. With all of this information available, which specific type of dementia an individual has is more evident.
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