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Before dementia begins: What helps?

Diet, exercise, and appropriate medical care can slow the decline in memory and mental skills.

As we age, concern over forgetfulness leaps quickly to fear. Is it the first touch of Alzheimer’s disease or some other form of dementia?

Sometimes it is. A transitional phase precedes full-blown dementia, marked by a noticeable decline in mental skills and memory. Doctors call it mild cognitive impairment, or MCI.

MCI is not a diagnosis anyone wants, but knowing about it has value. Although we don’t yet have a way to stop MCI in its tracks, there are ways to slow it down, including diet, exercise, and appropriate medical care. Seeking a clear-cut diagnosis of MCI can have other, less tangible benefits.

“It’s something you would want to know,” says Dr. Gad Marshall, an assistant professor of neurology at Harvard Medical School. “It gives you time to plan and to know what will happen. It allows you to take steps to maintain your quality of life. And we could have new treatments for individuals with early symptoms in the next few years.”

MCI is not a diagnosis anyone wants, but knowing about it has value.

“It gives you time to plan and to know what will happen. It allows you to take steps to maintain quality of life.”

—Dr. Gad Marshall, Neurologist, Brigham and Women’s Hospital

What is MCI?

Before being diagnosed with MCI, a person may experience changes in thinking (cognition) and memory that are hard to distinguish from normal aging. But in MCI, the type and severity of memory loss changes. The person’s cognitive powers begin to fall below what they were just a few years ago. “You start to have persistent daily impairments noticed by yourself or others,” Dr. Marshall says. You may need to take notes, make lists, or get more help managing finances.

If you’re concerned about …




  • You get distracted sometimes and it may take a bit longer to take in new information, but you understand conversations and instructions.

  • You may need to think harder to solve day-to-day problems, but you can do so without assistance or guidance.

  • You often get distracted to the point that you can only complete one task at a time, or you leave many tasks undone even if you have the ability or skills to complete them.

  • It takes you longer to take in new information, often requiring others to repeat what they say or talk slower.

  • You need some guidance or start deferring to others to solve problems.

Most but not all people with MCI eventually progress to dementia—usually Alzheimer’s disease, the most common form of dementia in older adults. About 40% of people with MCI “convert” to dementia within three years; within six years, 80% make the transition. Along the way, changes in cognition and memory worsen, and the person has greater difficulty managing daily activities. On the other hand, MCI does not always progress, and sometimes it even reverses.

The fact that MCI’s progression varies so much means there is a window of opportunity to slow down the cognitive decline. Here are some potentially helpful actions anyone with MCI can take. No single step is likely to have a dramatic effect, but each is backed by at least moderate evidence from clinical trials, and the likelihood of harm is low.

If you’re concerned about …



  • It takes more effort and time to complete challenging tasks, such as managing finances, taking medications on schedule, cooking meals, using a phone or computer, and getting around with a car or public transportation, but you are able to complete these tasks independently and usually on time.


  • You need prompting or guidance to complete challenging tasks.

  • You start to request help in completing some of these tasks.

Stay mentally active: One hedge against cognitive decline is leading a mentally active life. Activities that engage your core mental skills—memory, attention, concentration, planning, and solving problems—put more “cognitive reserve” in the bank for you to draw on.

The “use it or lose it” theory is well established, but a study published recently in Neurology provided encouraging new support. In a group of about 300 people ages 55 and older, the most mentally active individuals remained cognitively more fit for a longer period. Even those with brain changes from early dementia declined more slowly.

Lead a healthy lifestyle: The best way to stay mentally sharp early in MCI is to maintain a healthy lifestyle. “There is evidence that regular physical exercise can slow down the progression of existing cognitive impairment or prevent it from happening,” Dr. Marshall says. Nutrition, too, can play a role because whatever is good for the heart is also good for the brain. That means a diet with plenty of fruits, vegetables, and whole grains; small amounts of red and processed meat; moderate portions of dairy foods; and healthy vegetable oils for salads and cooking.

Optimize artery health: People with health problems that affect the arteries also are at higher risk of cognitive decline and dementia. The major risk factors are diabetes, high blood pressure, high cholesterol, and vascular disease as indicated by a past heart attack or stroke. Treating these conditions may help to slow mental decline or delay dementia. That means keeping blood sugar under control for people with diabetes and a combination of nutrition, exercise, and medications for those who have cardiovascular concerns.

Consider cognitive rehab: A special kind of training called cognitive rehabilitation is an option. The training helps people to relearn skills or compensate for impairments due to brain injury, stroke, and various other conditions that affect the mind. Cognitive rehab helps to develop strategies to work around any impairments. Therapists receive training to be certified to perform the service.

Beware dietary supplements: Many people with memory problems are tempted to try herbal or dietary supplements, including ginkgo biloba, antioxidant vitamins, fish oil capsules, and coconut oil. For those facing cognitive decline, it’s understandable that they would want to “try anything.” But there is no strong evidence these substances help, and especially in high doses they could cause harm.

If you’re concerned about …



  • You sometimes forget names or words, or it takes a little longer to recall them.

  • You sometimes misplace items,
    like your wallet or car keys.


  • You regularly forget names or words despite frequent reminders.

  • You have difficulties retaining information you recently read.

  • You regularly misplace items.

  • You forget entire conversations.

Drug therapy update

There is no FDA-approved drug to treat MCI. However, some physicians are willing to consider prescribing donepezil (Aricept), a drug that is used to treat dementia, if the drug’s risks and uncertain benefits are clear. In one large clinical trial, donepezil briefly slowed progression of MCI to dementia, but not enough to justify wide use. The drug has significant side effects, such as nausea, loss of appetite, and drowsiness.

On the hopeful side, large trials are starting up now to test new drugs that target the damage caused by dementia in its earliest stages. The studies will include older adults who are still within the normal limits in cognitive skills but are at higher risk of decline.

Posted by: Dr.Health

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