October 22, 2014
   
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Managing Cognitive Dysfunction
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Managing Cognitive Dysfunction

 
Cognitive dysfunction includes conditions ranging in seriousness from the relatively benign mild cognitive impairment (MCI) to dementia, which can be extremely debilitating. Once grouped under the catch-all term senility, these conditions have different causes, different symptoms and different treatments.

Taken together, the various forms of cognitive dysfunction represent one of the greatest health problems affecting the elderly in the United States today. Approximately 8% of Americans over 65 years of age have dementia. If you add those suffering from milder cognitive dysfunctions, the numbers rise to nearly 16%. All types of cognitive dysfunction become more common and more serious with age. Studies indicate that as many as 47% of Americans 85 years old or older have dementia; and the disease has been estimated to cost the United States nearly $100 billion annually.(1)

Mild Cognitive Impairment (MCI)
A number of older persons have cognitive impairment that is worse than expected for their age and educational level but they are not "demented." Persons with mild cognitive impairment have, primarily, a decline in memory function, while early Alzheimer's Disease sufferers, for example, usually have impairments in several cognitive areas (e.g., memory and speech; speech and control of bodily movements).(2)

Recent studies show that hormone replacement therapy is a promising new treatment for MCI in both men (testosterone) and women (estrogen).

MCI sufferers bounce back more slowly than the average person of their age from physical problems such as a hip fracture. They have a lower life expectancy and are more likely to develop dementia.(3) Therefore, it is important to treat early mild cognitive impairment. Recent studies show that hormone replacement therapy is a promising new treatment for MCI in both men (testosterone) and women (estrogen).(8)

Table 1.
How Doctors Diagnose Mild Cognitive Impairment
  1. Complaints and objective evidence of memory problems
  2. Daily living skills are normal
  3. Thinking ability, other than memory, is normal
  4. Score on MMSE (more than 23 if high school education or more than 17 if less than high school education
  5. Not depressed


Alzheimer's and the Different Dementias
Alzheimer's is the major cause of dementia. If a doctor determines that the patient has deficits in at least two of the following (memory, language, control of bodily movement, perception, loss of ability to make decisions), as well as worsening of cognitive function, no alteration in consciousness, onset between 50 and 90 years and absence of other possible causes, then the patient most likely has Alzheimer's.(5)

Dementia is subtle. Family members fail to recognize it almost one-quarter of patients.(6)(7) A number of studies have shown that doctors are not much better.

The clinical features of the common dementias are outlined in the table below.

Table 2.
The Different Types of Dementia

Type Onset Progression Clinical Features
Alzheimer's Insidious Slow progressive with fluctuation Deficits in at least two areas of cognition. No disturbance of consciousness. Altered behavior

Illusions,delusions and hallucinations

Increased muscle tone

Seizures (late)

Gait disturbances (late)
Vascular Abrupt Stepwise Emotional incontinence

Focal neurological disease

Evidence of vascular disease

Patchy cognitive defects
Depression Insidious Progressive with remissions Subjective complaints exceed objective findings

Sad

Poor motivation
Lewy-Body Dementia Insidious Progressive and more rapid Interferes early with social functions

Memory impairment may be late

Prominent attention and visuospatial defects

Fluctuating levels of alertness

Recurrent visual hallucinations

Parkinsonism

Repeated falls

Systemized delusions
Fronto-Temporal (Pick's) Early age Progressive Apathy

Disinhibition

Antisocial behavior

Poor insight

Language deficits

Memory deficits late


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