do shrink in overall size – by about 10 per cent during adulthood – that loss of volume isn’t the only culprit behind memory problems.
A combination of factors actually conspire to create the infamous ‘senior moments’. These include a reduction in the effectiveness of the communication between nerve cells that whizz information around the brain, an increase of inflammation in brain tissue in response to infection and disease, a reduction in blood supply, and the damage caused by a lifetime’s contact with free radical molecules such as oxygen and nitrogen in the atmosphere.
Add these factors to the shrinkage, and you have the recipe for the wear-and-tear type changes we see in the ageing brain as reflexes become slower and people take much longer to finish a crossword than they used to. It’s normal, although by no means universal, for people to notice these changes. Some people don’t experience even this level of deterioration and are as sharp as tacks well into their 90s (and even beyond).
The abnormally ageing brain
In a person with mild cognitive impairment, the symptoms are more significant than those just described for normal ageing. It’s not uncommon for people to notice the following:
✔ Forgetfulness
✔ Difficulty following conversations
✔ Declining ability to make sensible decisions
✔ Getting lost easily
✔ Poor concentration and attention span
The severity of mild cognitive impairment and its progression towards full-on dementia can be charted using the Global Deterioration Scale (GDS) developed by Dr Barry Reisberg in 1982. This score has seven stages:
✔ Stage 1: No problems identified by doctors or the patient.
✔ Stage 2: The patient recognises that he has a problem, perhaps with remembering names, but he scores normally on diagnostic tests.
✔ Stage 3: Subtle problems carrying out thought processes start to affect work and social activities. Tests may well begin to pick up problems (this is mild cognitive impairment).
✔ Stage 4: Clear-cut difficulties develop in terms of memory and carrying out tasks such as dealing with finances or travelling. Denial is common. Early dementia has set in.
✔ Stage 5: The person needs some assistance but is still quite capable of washing, dressing, eating, going to the toilet and choosing appropriate clothes. Forgetfulness in relation to names and places is becoming more severe.
✔ Stage 6: The person is largely unaware of anything that’s happened to him in the recent past. He needs help with most of the basic activities of daily living and may need to be looked after in a care home. Incontinence is common.
✔ Stage 7: By this stage the person is experiencing severe dementia. He’s completely dependent on others for everything, often including mobility. Verbal communication skills are extremely restricted.
Recognising the causes of mild cognitive impairment and taking steps to avoid it
Some cases of mild cognitive impairment are caused by the development of similar protein deposits to those found in Alzheimer’s disease. This finding is perhaps not surprising, considering that those people who go on to develop dementia mostly have Alzheimer’s disease. Other brain changes noted include worsening blood supply and shrinkage of the part of the brain called the hippocampus, which is involved with memory.
No specific treatment for mild cognitive impairment exists and, in particular, no evidence suggests that the drugs used to treat Alzheimer’s disease are any use. You can gain some mileage, however, by addressing risk factors for poor circulation, by controlling your blood pressure, eating a low-fat and high-fibre diet, quitting smoking, drinking alcohol within the limits of recommended guidelines and taking regular physical exercise.
A multi-million-pound industry has developed producing specially designed ‘brain-training’ games and puzzles in response to people’s increasing fear of developing dementia.
In 2009, the Alzheimer’s Society in the UK teamed up with the BBC science programme Bang Goes the Theory to carry out a large-scale experiment looking at the effect of brain training on planning, problem solving and memory. The experiment, ‘Brain Test Britain’, gathered results from 13,000 people, which were then published in Nature, the eminent science journal.
The results clearly showed that while the brain-training exercises made people better at the particularly tasks they were performing, these skills weren’t transferred to other brain skills such as memory and planning. And while the research is continuing for the over 60s, the advice for those worried about cognitive impairment is to save money on these specialised products, because they offer no more benefit than do simple crosswords and puzzles.
A whole host of medical conditions can trigger symptoms in people that are very similar to dementia but don’t fit the full diagnostic criteria for it. These conditions often cause confusion and can stop people functioning normally in daily life, but they’re largely reversible with correct treatment and thus, thankfully, aren’t progressive in the same way as dementia is.
When people visit their doctor with symptoms that could mean dementia is setting in, they undergo a number of initial investigations involving blood and urine tests. Such tests are performed to rule out any reversible causes – most frequently, conditions that either affect the brain and nervous system or result from derangements of various bodily hormones. Acute infections can also trigger confusional states, and long-term alcohol abuse can lead to problems with memory (alongside its more commonly seen propensity to render people confused and disorientated).
Neurological causes
Some of the most well-known medical conditions affecting the brain and nerves have symptoms that can mimic some of the features of dementia alongside their own, more specific features. So doctors may want to rule some of these diseases out of their enquiries before coming to a final diagnosis:
✔ Parkinson’s disease: This condition does have a genuine overlap with dementia, because people with Parkinson’s disease have a higher-than-average risk of also developing dementia. In fact, Parkinson’s disease-related dementia accounts for 2 per cent of all cases.
The symptoms of Parkinson’s disease-related dementia are very similar to those of Lewy body disease, and researchers think that a link may exist between the two. Thus, alongside problems with cognitive function and movement, people also experience visual hallucinations, mood swings and irritability. Medication to help treat the movement difficulties found in Parkinson’s disease, such as tremor and stiffness
