I Think I Am Losing My Mind
Many people, as they age, become increasingly concerned with their memory and their cognitive dysfunction. What is normal and not normal is a fine line. But let’s be clear – cognitive impairment and dementia, while on a spectrum, are not the same thing.
The definition of dementia is a decline in one’s cognition that affects either one or more of a person’s memory, perception, executive function, language function, complex attention, creativity. and social aptitude. Importantly, as this was updated recently, these changes must reflect a significant and recognizable difference in previous level of functioning in these domains. A complaint concerning for dementia is more often suggested by a spouse or partner than the patient itself. The diagnosis of dementia has fairly specific criteria.
There are some diseases in the adult population that cause or contribute to dementia and include Alzheimer disease (AD), Dementia with Lewy bodies (DLB), Frontotemporal dementia (FTD), Vascular (multi-infarct) dementia (VaD), and Parkinson disease with dementia (PDD). Other diseases that may be associated with dementia are Progressive Supranuclear Palsy (PSP) and Huntington disease (HD). In addition, alcohol, trauma, certain medication use, prolonged depression, and systemic disease can cause a dementia process.
On the flip side, mild cognitive impairment (MCI) does not interfere in one’s activities of daily living, other than causing anxiety and worry. These feelings can certainly interfere in one’s daily functions and can have adverse effects of their own. At Center for Healing Neurology, we understand the worry of loss of cognition and memory many people have.
As we gain years, there may be age-associated cognitive decline, which has been fairly well documented and causes variable levels of interference in an individual life. Clinical acumen and judgment certainly play a role in the distinction between the cognitive changes of aging and MCI and early dementia. Early on, this distinction can be difficult and somewhat subjective.
To diagnose MCI on more objective terms, in addition to a comprehensive physical examination and diagnostic workup, a patient may undergo cognitive testing using the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment Test (MOCA). We review cognitive functions such as memory, calculation, orientation, recall, drawing ability, and language. Occasionally, for a more in-depth analysis on the function of a patient’s brain, or sometimes because the patient requests it, we refer for a neuropsychological assessment.
We believe neuropsych testing can be useful because of an important functional association between the gastrointestinal microbiome and brain function. The brain and the GI tract have known to be in communication via hormones and neurotransmitters. Now we are learning more of the role of the microbiota, or the gut organisms.
Neuropsych testing is one tool to better understand how the function of our brains differs over the course of a lifetime with regard to mood and cognition. Indeed, processes that we know affect cognition, such as autism, depression, irritable bowel syndrome, and even Parkinson’s disease, have been found to have altered populations of gut species. This is important because it may prove to be a critical target for treatment.
Maintaining optimal cognitive health can be done with important lifestyle choices. Exercise, connecting with nature, meditation, good sleep hygiene, and regular change in your surroundings are great for brain health. Avoid smoking, excess amounts of stress, unnecessary medications, alcohol, and environmental exposures. Avoid inflammatory foods and increase consumption of anti-inflammatory foods and anti-oxidants in your regular diet.
Research has shown the use of soy and soy isoflavones, for those who are not intolerant, results in improvements in memory and mental flexibility, Other supplements that are known to be beneficial include B vitamins, zinc, L-tyrosine, choline, and lecithin. Ginkgo biloba extract, has shown efficacy in treatment of age-related cognitive decline as well as benefits for those with early dementia processes. In addition to herbal and nutritional guidance, we offer neurofeedback and acupuncture as ways to “train your brain.” At times, judicious use of pharmaceuticals may be recommended. Finally, the “use it or lose it” philosophy applies to the brain as well. Brain fitness games and regular testing of memory, also employed here at CHN, are great ways of keeping your brain in top shape!
If you are concerned about your cognitive function or are interested in brain health, fitness, and testing, please schedule an appointment to see our team at Center for Healing Neurology for evaluation, guidance, and information.