Key warning signs, when and where to get checked, and how you can help those who live and work with various levels of cognitive impairment. Interview with a Cognitive Impairment Specialist, Dr. Krystal L. Culler.
Just 16% of seniors get tested regularly for cognitive impairments and diseases, compared to 91% who receive screening for high blood pressure, 83% for cholesterol, and 61% for cancer, according to the Alzheimer’s Association. Why such a small percentage? Mild cognitive impairments (MCIs) and cognitive degenerative diseases (CDDs) may be harder to diagnose, but fifty million people worldwide have dementia, with nearly six million in the U.S. Shouldn’t this mean even more attention and diligence when it comes to testing and brain health?
MCIs and CDDs present a wide range of unique challenges for patients and their families. There are doctor appointments, day-to-day life changes, and medical bills from multiple sources. It’s not easy, but with a little knowledge and know-how, understanding and living with an impairment doesn’t have to be filled with shock and stress. The following guide walks you through the different types of MCIs and CDDs, the measures you can take to prevent or minimize symptoms, and whether anything you’re experiencing is a sign of impairment or simply normal cognitive aging. When it comes to brain health, you never can be too prepared.
Types of Cognitive Impairment & Degeneration
The Centers for Disease Control and Prevention defines cognitive impairment as an issue that causes problems with memory, concentration, decision-making, and onboarding new information. Approximately 16 million Americans – double the population of New York City – currently live with a cognitive impairment, making it a significant health concern. Impairments range from mild to severe and causes are difficult to isolate because the impairments can behave differently based on the patient. A wide range of well- and lesser-known types of cognitive impairments and degenerative brain diseases exist.
Normal Cognitive Aging
As the brain ages, the frontoparietal and hippocampal regions often shrink, causing these areas to work harder to perform the same cognitive tasks performed throughout the lifespan. As the name implies, it’s normal for the brain and brain function to age over time.
Causes & risk factors:
Normal cognitive aging is an ordinary process that occurs as you move into your senior years. While some factors can perhaps accelerate cognitive aging, the main cause is simply growing older.
Occasionally struggling to remember a person’s name, additional time required to recall words not frequently used, trouble dividing attention between multiple tasks (e.g., talking and driving simultaneously), some fogginess around memories from long ago.
Many factors associated with normal cognitive aging relate to influences outside our control, such as genetics, access to healthcare, and education level. Aging individuals looking to improve functions such as recall or sustained focus can engage their brains in challenging activities, such as math equations, substantial reading, and journaling about their memories.
When & where to get help:
Normal cognitive aging is not something to fear; it is simply part of getting older. If you’re looking for ways to slow the effects, speak to your doctor or an occupational therapist about brain exercises that can help you stay sharp.
Mild Cognitive Impairment
Mild cognitive impairment sits between the normal cognitive aging expected in our later years and the severe decline associated with diseases such as Alzheimer’s or dementia. Problems linked with mild cognitive impairment are greater than normal cognitive aging but typically allow you to continue living a mostly normal life.
Causes & risk factors:
Scientists report that no single cause for mild cognitive impairment exists. Research is ongoing, but some data suggests that you may exhibit some of the same changes seen in dementia patients but to a lesser degree. People with mild cognitive impairment may be more susceptible to developing more severe forms of cognitive impairment as they age.
Often forgetting words, important dates, meetings, or specific memories; frequent loss of your train of thought when in conversation; feelings of being overwhelmed when making decisions or performing familiar tasks; impaired judgement and/or impulsive decision-making; trouble navigating spaces once seen as familiar.
The FDA does not currently offer any approved pharmaceutical treatment for mild cognitive impairment, though clinical studies are underway to find options. People who mainly experience memory loss may be given drugs also used with Alzheimer’s patients.
When & where to get help:
Family and friends commonly notice the symptoms of mild cognitive impairment prior to the person being affected, making it important for them to speak up in a loving and supportive way. If you suspect you or someone you love shows signs of cognitive impairment, find a neurologist in your area.
The most common form of dementia, Alzheimer’s is a degenerative disease resulting in brain cells wasting away in stages. The length of these stages varies by person, with some people living approximately four to eight years after receiving a diagnosis, and others living up to twenty.
Causes & risk factors:
No established cause exists, but many scientists believe Alzheimer’s is caused by a mix of environmental, genetic, and lifestyle factors that affect the brain across the lifespan. Some studies suggest issues around two types of brain proteins that begin functioning improperly over time, eventually causing the loss of neurons.
Early symptoms often mimic mild cognitive impairment but intensify over time. Middle stage symptoms may include trouble remembering life events, withdrawing from social situations, confusion on everyday information (e.g. the date, their address, etc.), and getting lost. Late stage symptoms can include an inability to care for themselves, difficulty with basic communication, and body systems beginning to shut down.
Alzheimer’s is irreversible and eventually fatal, but the FDA has approved two drugs that can help preserve memory and cognitive functions for a time: cholinesterase inhibitors (such as Aricept ®) and memantine (Manenda ®). Doctors also suggest implementing environmental support such as checklists, routines, and calendars that can provide clarity around everyday living.
When & where to get help:
Aside from reaching out to a medical doctor specialized in Alzheimer’s and other degenerative brain diseases as soon as you or a loved one recognize common symptoms, the Alzheimer’s Association provides support and services via local chapters throughout the country.
Vascular dementia is a broad term used to describe memory loss, impaired reasoning and/or judgment, and other symptoms due to impaired blood flow to the brain.
Causes & risk factors:
Vascular dementia is often associated with patients who recently experienced a stroke, but this is not the only possible cause. Some cases of the disease developed incrementally with no prior brain trauma. Common risk factors include increased age, damaged blood vessels, high cholesterol/blood pressure, and a genetic history of heart attacks and strokes.
Symptoms can vary significantly based on causation, but common issues revolve around confusion, memory loss, impaired decision-making skills, restlessness, depression, loss of control around bodily functions, and fogginess when trying to analyze or understand new information.
No approved medicine currently exists to treat vascular dementia, but doctors have identified several lifestyle changes that can help reduce symptoms and prevent other contributing health issues. These include lowering cholesterol levels, reducing blood pressure, keeping blood sugar levels stabilized, and engaging in moderate exercise.
When & where to get help:
As with many other brain disorders, seeking help early is critical in terms of minimizing and/or slowing the effects of the disease. Aside from having regular physicals as you age, stay aware of your mental functions and contact a doctor if any of the symptoms listed above apply to you or a loved one.
Lewy Body Dementia
Identified as the second most common form of dementia behind Alzheimer’s, Lewy Body are protein deposits that impact brain nerve cells and cognitive functions such as memory, processing, and motor control. Lewy body functions as a degenerative disease, causing greater mental decline over time.
Causes & risk factors:
Research suggests that people aged 60 or older are at an increased risk for Lewy body dementia, as are those who have a family history of this illness or Parkinson’s disease. Men are typically affected more frequently than women.
Visual hallucinations, Parkinson’s Disease-like movement issues, poor attention, difficulty sleeping, confusion, memory loss, inability to stay focused, trouble with visual-spatial recognition, dizziness, bowel issues, apathy, and unidentifiable speech/slurring.
No cure for Lewy body currently exists, but scientists have identified several drugs that can treat individual symptoms for a time. These medicines are also used to treat patients with Alzheimer’s and Parkinson’s given several shared symptoms. Suggested therapies include implementing routines, simplifying responsibilities, and creating a soothing environment.
When & where to get help:
Help should be sought as soon as you identify any of the symptoms listed above. When working to develop a diagnosis, doctors may test for signs related to Parkinson’s, strokes, and other conditions that contribute to shared symptoms. Brain scans, mental assessments, and blood tests are all common parts of the diagnosis phase.
Preventative Measures: Stopping (or Slowing) Impairment Before It Starts
After receiving a diagnosis of a degenerative disease or cognitive impairment, you likely have a million questions about how to proceed. Can you slow down or pause any of the symptoms outlined above? When physical trauma isn’t involved, is it possible to reverse the damage? If so, do solutions involve medication, nutrition, and other lifestyle changes? All these questions and more are valid. The following sections examine some of the things you can do to maximize brain health and keep yourself as mentally sharp as possible.Exercising Your Mind
Your brain may not be a muscle by definition, but you can definitely train it. The brain health industry, producers of games and apps designed to improve cognitive functions, surpassed $1 billion in revenue as of 2012, and shows no signs of slowing down. While cognitive decline is a normal and expected part of aging, there are several exercises that can be done to maintain brain fitness and fight against sluggishness. A few options to consider include:
Games such as chess, Othello, and Sudoku all help exercise the parts of our brains concerned with logical decision-making. These tools help us think ahead, consider how our moves affect opponents, and implement strategy. Aside from traditional games, check out Beautiful Mind Games and Happy Neuron for new games and updates on the classics.
Tools & tech
Every day a new app or website pops up that’s designed to make life just a bit easier. This is also true in the world of brain exercises. A few apps to look into include Lumosity, CogniFit Brain Games, and Elevate Brain Training. Websites worth knowing about include BrightFocus, Brain Metrix, and Eidetic Memory Games.
Degrees and careers in brain health
If you’d like to work with patients experiencing MCI or a CDD, numerous options exist. Brain health crosses a wide range of fields, making it possible to combine your skillset with professional interests. If you’re interested in diagnosing and treating issues affecting the brain, research degree options in neurology, and if you’re attracted to addressing some of the behavioral, emotional, and mental health issues associated with brain health, opt for psychology. If you know you want to work with elderly populations but do not yet know in which capacity, consider a gerontology degree, as this allows you to pursue a range of careers.
Going with Your Gut
More and more research continues to come out on the connection between diet and brain health. A study published in the Journal of Neuroscience reported on an experiment where scientists fed rodents equivalent in age to 63-year-old humans three separate diets over an eight-week period. Rats given a diet of foods high in antioxidants such as blueberries, spinach, and strawberries showed signs of reversed deficits in areas of cognitive and neuronal function. There are many actions you can take to improve brain function when it comes to the foods you eat. We take a look at a few things you should know below.
Healthy food, healthy mind
Did you know that the brain requires approximately 20% of the calories we consume on a daily basis? It’s important to provide your brain with healthy carbs, fats, and proteins. Top brain foods include oily fish, kale, peanuts, coffee, nuts and seeds, dark chocolate, avocado, eggs, broccoli, and whole grains.
The gut biome
The gut and brain seem pretty far away geographically, but these two interact a lot more than was previously known. Studies on the “gut-brain axis” are ongoing, but early reports suggest that a dysregulated gut microbiome has potential connections with mild cognitive impairment and dementia.
Tools & tech
Keeping up with our diets in the midst of busy schedules and never-ending commitments can seem impossible, but plenty of apps exist for both Apple and Google devices to make this process easier. A few of the best names to know include MyFitnessPal, MyPlate, Nutrients Nutrition Facts, and Food Intolerances.
Degrees & careers in nutrition & diet
Because the study of how foods and our brains interact is an emerging area of study, it’s an exciting time to begin a career in this field. The most common educational paths include nutrition and dietetics, with many programs providing specializations that help you concentrate your studies in a particular area. Specializations in areas of physiology, nutrition education, and public health nutrition and policy can all be used to pivot your career into this growing niche area. Some interdisciplinary graduate degrees also incorporate studies in neuroscience and nutrition.
The Body/Mind Connection
Studies have long shown that exercise – particularly aerobics – helps increase blood flow throughout the body, including the brain. New studies show that the benefits extend far beyond. A 2019 report in the academic journal Neurology highlighted a 20-year study on 454 older adults who agreed to donate their brains to medical research after passing. Individuals who participated in regular exercise achieved higher scores on memory and cognition tests while also presenting a 31% lower risk for dementia. Benefits of particular types of exercise are highlighted in this section.
Running, walking, swimming, and cycling all fall under the category of aerobic exercise. These types of activities are especially beneficial because they increase our heart rate, causing our lungs and hearts to work harder while also providing increased blood flow to important regions, including the brain. Governmental guidelines suggest individuals should engage in at least 150 minutes (2.5 hours) of activity per week to receive the full advantage.
Weight lifting, sprinting, high-intensity interval training (HIIT), and isometrics qualify as anaerobic exercises and typically feature short, intense bursts of energy rather than sustained movement. A recent study found that this type of exercise can improve neuron connections in the hippocampus, leading to improved memory and learning abilities.
Degrees & careers in physical health
The benefits of physical movement have long been known, but the connection between brain and body health is an ever-evolving field. Plenty of jobs exist in this arena for people who want to help individuals look and feel their best. Whether exercise science, health science, or physical therapy piques your interest most, a clear-cut path exists to marry personal interests with professional aspirations. Many individuals are drawn to physical therapy assistant degrees as they combine both exercise and therapeutics to create a well-rounded plan of study.
Q&A with a Cognitive Impairment Expert
Dr. Krystal L. Culler, DBH, M.A. is the Founder of Your Brain Health Matters, LLC and an Atlantic Senior Fellow with the GlobalBrain Health Institute. She holds a doctorate in behavioral health, a master’s in psychology of adult development in aging, a graduate certificate in gerontology, and a bachelor’s degree in gerontology and sociology with a minor in developmental psychology. She completed her residency training at Trinity College in Dublin, Ireland and is a certified BrainHealth Coach.
Q: What are some of the biggest misconceptions you hear around diseases such as Alzheimer’s, Lewy body, dementia, etc.?
A: There are so many, but here are the most common:
- Alzheimer’s disease is a normal part of aging. (False.)
- Supplements can help my memory or prevent dementia. (False.)
- Alzheimer’s disease medications will stop the progression of my disease. (False. Current medications approved by the U.S. Food and Drug Administration are used to treat the symptoms of Alzheimer’s Disease.)
- Alzheimer’s disease is in my family so I will get it, too. (False.)
- Dementia only affects older adults. (False, examples include early-onset Alzheimer’s disease, frontotemporal dementia, etc.)
Q: What are some of your trusted resources for staying abreast of emerging research and findings in cognitive function and treatment?
A: There are quite a few resources for this option depending on if you are seeking medical information, clinical trial information, or general information.
First, I would recommend HealthyBrains by the Cleveland Clinic. Individuals can take a free online brain health check-up, gain information on brain health including healthy recipes, and sign-up for additional emails.
Second, I would recommend AARP’s Staying Sharp program as this is open to individuals of all ages and AARP members. This program is a holistic approach to brain health with brain games, healthy recipes, activities, and the latest science.
The Global Council on Brain Health offered in collaboration with AARP and AGE UK gathers experts to come together to discuss specific lifestyle issue areas that may impact peoples’ brain health as they age, with the goal of providing evidence-based recommendations for people to consider incorporating into their lives.
The Alzheimer’s Association is a valuable resource. Individuals can search for resources in their area and sign-up for emails based on topics related to their interests.
Q: What should students thinking about a role in this field consider before specializing in this area?
A: I would suggest they recognize that if they have met or treated one person with dementia then they have met or treated one person with dementia. The field is advancing in dementia care and skilled professionals are needed to work in this area. There are also diverse career paths in the field that include direct care providers, care navigators, program directors, support group facilitators, health educators, and researchers to name a few. These positions are filled by individuals with a variety of backgrounds from the biological sciences, social sciences, and applied healthcare degree fields.
Q: How can individuals, loved ones, etc. stay attuned to common symptoms without living in fear of developing one of these diseases?
A: Knowledge is power and being able to notice some of your brain health risks, such as lack of physical exercise, can be motivating to some individuals. Currently, the modifiable risk factors that have been identified and studied include the following: genetics (ApoE e4allele), education (lower levels), hearing loss, hypertension, obesity, smoking, depression, physical inactivity, social isolation, and diabetes. Additional factors that have been emerging in the literature include hydration, sleep, meditation, diet/nutrition, and air pollution, to name a few. The field of brain health is rapidly evolving.
Q: If you could give advice to someone genetically or environmentally predisposed to developing a cognitive impairment, what would it be?
A: Taken as a whole, brain health is 30% genetics and 70% lifestyle; thus, many things are in our control! Currently genetics is used to predict the likelihood of someone’s chance to develop a disease and it is not a guarantee. At the end of the day, although it is your DNA, it is not a good predictor of your health and genetics contributes 5-10% for most major disease, including Alzheimer’s disease.