Is Cognitive Impairment Preventable or Treatable?

Dr. Straus recently presented a talk about Cognitive Impairment in Toronto. Here is a summary of her lecture.

Dr. Sharon Straus, MD, MSc, FRCPC
Dept of Medicine
Director of Geriatric Medicine
University of Toronto

Types of Cognitive Impairment

Mild Cognitive Impairment
If you have mild cognitive impairment, your memory or mental function has “slipped.” Your family and close friends also may notice a change. But these changes aren’t severe enough to significantly interfere with your daily life and usual activities.

There is loss of executive functions with dementia: Memory loss, which is usually noticed by a spouse or someone else, difficulty communicating or finding words, difficulty with visual and spatial abilities, such as getting lost while driving, difficulty reasoning or problem-solving, difficulty handling complex tasks, difficulty with planning and organizing, difficulty with coordination and motor functions, confusion and disorientation.

a serious disturbance in mental abilities that results in confused thinking and reduced awareness of the environment. It is often be traced to severe or chronic illness, changes in metabolic balance (such as low sodium), medication, infection, surgery, or alcohol or drug intoxication or withdrawal.

Because symptoms of delirium and dementia can be similar, input from a family member or caregiver may be important for a doctor to make an accurate diagnosis: an inability to stay focused on a topic or to switch topics, getting stuck on an idea rather than responding to questions or conversation, being easily distracted by unimportant things, being withdrawn, with little or no activity or little response to the environment

Case studies
Mr. Y, 78 years old, is beginning to forget little things, names, appointments. He has some back pain.

Ms. L, 9o years old forgets to take her medications, has gotten lost in returning home from the bank, is forgetting to pay her bills. Her daughter fears dementia.

At present, there are no medications to prevent Cognitive Impairment. Treatment entails exercise and physiotherapy but these treatments have not been proven to be effective clinical treatments. Dr. Straus recommends good health habits, proper diet and nutrition, and regular exercise. Patients may be helped by such a routine but there is no preventative cure.

Dementia patients may receive pharmaceutical medications such as Donepezil but again there is no clinical confirmation that it is effective. Patients may experience symptoms of nausea and headaches.

Delerium patients may receive a variety of treatment strategies: pain control, sleep hygiene, nutrition and hydration advice, bowel routine consultation. The ratio of success is quite limited, 10%.

Cases follow-ups
Mr. Y was given an exercise program and assisted with developing routine strategies for the work that he does.

Ms. L was prescribed cholinesterase inhibitors.

In summation, according to Dr. Straus, the best people can do is to diet and eat properly and to adopt a regular exercise program.

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