MCI--- NOT JUST A TELEPHONE COMPANY

Victor Bloom MD

Lots of folks in Grosse Pointe are over 60. A recent international research conference on Alzheimer's disease was the source of much media attention, which must have captured the interest of many old-timers. The reports said the incidence seemed to be growing to almost epidemic proportions, but that statistic may have more to do with the increased number of old people and an increased rate of detection. There is certainly an increased awareness of the problem. The apparent increased incidence may even be due to the development of new criteria.

When I went to med school back in the fifties, Alzheimer's was called 'pre-senile dementia.' It was a seemingly no-brainer (no pun intended) clinical (not laboratory) diagnosis when a relatively young person (in his 40's or 50's) showed obvious signs of the brain damage typical of old age (senile dementia), such as extreme forgetfulness and inappropriateness. The definition of dementia usually included a loss of cognitive ability, meaning such phenomena as incomplete sentences, loss of words and not recognizing people. Disorientation to time, place and person was part of the picture, not to mention the progressive loss of logical and rational thinking processes.

It is shocking for family members, friends, neighbors and associates not to be recognized or remembered. It is even more shocking when a habitually well groomed person develops unkempt hair and wears shabby clothes, and worse--- to be totally unaware of the change. The typical picture of an Alzheimer victim used to be the gravy-stained tie and mismatched socks on an ill-shaven man with long and dirty fingernails, staring into space. He may not know his name or the year or the place. It is a mind-boggling experience for the family of such a person, especially when the progressive deterioration is rapid.

Current thinking has expanded the concept of Alzheimer's disease to include older and older people with progressive dementia (loss of brain function). It is still a 'clinical' diagnosis, as there is no definite laboratory test for it, but telltale signs include a shrinking of the brain size as shown on a CAT scan, which is like an X-ray. It is also a diagnosis of exclusion, as stroke and tumor are ruled out. A definitive diagnosis can only be made postmortem, the brain showing typical changes characteristic of the disease under the microscope. The neuronal pathways which contain our memories and personalities are destroyed. We wonder what is happening to the soul. No answer to that question can be found on the microscope slide.

With the expanded diagnostic criteria, statistics show that the older people get, the greater the incidence of Alzheimer's, so that the disease seems to become the inevitable accompaniment of old age. It is a rare 90 year old who does not show some signs of dementia. At that age it is hard to distinguish mild Alzheimer's disease from 'normal' old age clinically, but microscopically there are distinct differences. The older a person gets the more he or she is liable to TIA's (transient ischemic attacks) or small strokes, due to arteriosclerosis of the cerebral vessels and the formation of blood clots.

The latest development in Alzheimer's research is the recognition of early signs of Alzheimer's, called MCI (minimal cognitive impairment), which may be the early signs of Alzheimer's, signaling possible rapid progression in a few years, as opposed to normal aging, in which loss of cognitive function is very gradual or minimal. Recognizing early cognitive loss is the current trend, because some studies are beginning to show that active and early intervention may slow the progress of the disease.

Many medical centers now have departments of geriatric psychiatry, which do comprehensive evaluations and clinical studies to detect this possibility. These workups include a (non-contrast) CAT scan of the head, a neurological exam by a neurologist, laboratory tests and psychometric exams, testing recent memory loss and abstract thinking, usually performed by a psychologist. The geriatric psychiatrist will want to review your entire medical history and interview a close relative for factual data and symptoms to help make comprehensive recommendations and answer questions. Active followup is the rule.

If the diagnosis of MCI is made, treatment recommendations might include, according to the individual, getting more sleep, taking an anti-depressant, large doses of vitamin E, and a relatively new drug, Aricept, which increases the brain level of acetyl choline, a chemical which facilitates and enables nerve transmission from one brain cell to another.

The reports of Alzheimer's researchers are hopeful and optimistic about the future, as recent findings suggest they are getting ever closer to more definitive diagnoses and effective treatments of brain disorders.

Dr Bloom is Clinical Associate Professor of Psychiatry, Wayne State University School of Medicine. He is a member of the American Academy of Psychoanalysis and on the editorial board of the Wayne County Medical Society. He welcomes comments at his email address--- vbloom@comcast.net.