Mild Cognitive Impairment – AKA Early Dementia, Early Alzheimer’s

Why would you want to know if you are just having a “senior moment” or if you are on the path to Alzheimer’s disease? Conventional medicine tells you that there is no cure, there is only staving off symptoms for a little while before you become incapacitated. Our own government’s National Institutes of Health declares: “Alzheimer’s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks. It is the most common cause of dementia in older adults.” [They do, however, go on to say that] While dementia is more common as people grow older, it is not a normal part of aging.”

A report in the journal The Lancet discusses dementia prevention, intervention, and care. This report discusses potentially modifiable risk factors which could theoretically prevent 40% of diagnosed cases of dementia worldwide.

The mortality rate assigned to dementia alone in otherwise “healthy” individuals is estimated to be 1.55 million individuals worldwide.

An online newsletter called “Alzheimer’s News Today” estimates 44 million people worldwide living with Alzheimer’s disease, 5.5 million of whom live in the United States. About 200,000 of these are under the age of 65 and have so-called “early onset Alzheimer’s Disease”.

The Centers for Disease Control, on their “Alzheimer’s Disease and Healthy Aging” page, cites 5.8 million residents of the United States diagnosed with Alzheimer’s in 2020, with a projection of the numbers tripling to 14 million people by 2060.

If dementia is not a normal part of aging, then why are so many of our elders becoming demented, and end up living in nursing homes because they cannot take care of themselves, and no longer have the mental capacity to realize how badly dysfunctional they are?

Many causes have been proposed. We will review some of the literature on these proposed causes, and seek to determine whether any of them might have any effective treatment.

It will be important to determine whether the treatment needs to be prophylactic – i.e. start before the symptoms of dementia become manifest – or whether the treatment is effective once dementia is already diagnosed.

The following factors have been proposed to be associated with the diagnosis of Alzheimer’s disease:

• Age – the incidence of Alzheimer’s disease is estimated to double every 5 years beyond age 65. A friend (who died at the age of 99) sent me a birthday card that read “Age is a question of mind over matter. If you don’t mind, it doesn’t matter.” Nevertheless, age is not a modifiable factor, at least not in this Universe as we know it. But we certainly do have control over how the number of years we have been alive affects our mental and emotional well-being. We even have significant control over how rapidly our cells age and die – the term is “cellular senescence”.
• Mitochondrial dysfunction – the brain has the second highest number of mitochondria in the body, second only to the heart. Since mitochondria are the intracellular powerhouses that provide energy for metabolism, it makes sense that dysfunctional mitochondria would result in both cardiovascular disease and neurologic disease.
• Nutrition – do those who eat fast foods, drink sodas and alcohol, and lots of sugar have the same incidence of Alzheimer’s as those whose diets and habits are healthier? We will examine the literature.
• Exercise – do “couch potatoes” have the same incidence of Alzheimer’s as moderate exercisers or marathon runners?
• Fungal infections – yeast overgrowth – do these play a part?
• Lyme disease and other chronic infections – is the incidence higher in those with similar infections? We are already beginning to see signs of cognitive impairment in people diagnosed with “long COVID”. Is it possible that the issue is more the chronic infection and oxidative stress and less the specific infection?
• Heavy metal burden – does accumulation of mercury, lead, arsenic, cadmium, and even gadolinium play a part in the development of the disease?
• Pesticides, insecticides – we spray our crops religiously. We are in the process of decimating the bee population – as I can attest with regards to my own garden. Are we that different from the bees that we think we are not affected by these metabolic poisons?
• Pharmaceutical drugs – many are associated with “brain fog” and even cognitive decline. Others have been shown to improve cognitive function – at least in rats, if not yet in humans.

There appears to be debate about whether lifestyle interventions are worth the effort.

On the one hand, the Lancet 2020 study on aging states: “a growing body of evidence supports the nine potentially modifiable risk factors for dementia… less education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, and low social contact.” 

On the other hand, an article written apparently in response to that Lancet statement says: “evidence from large clinical trials is not conclusive to support that a third of dementia cases might be prevented.”

And there are always financial considerations, as this somewhat cynical article suggests.

So… prevention is possible.

So… it’s not worth trying to prevent because

• Prevention is a lot of trouble.
• Prevention has not been shown to be effective in a six-month period over a limited number of study subjects.
• Therefore we should wait for more studies to be carried out, before deciding whether prevention is “worth the effort” as a public health measure.

One paper actually looked at costs of intervention over time vs the cost of caring for demented patients, and concluded: “The results suggest that the multidomain approach of BBL-GP is highly likely to be cost-effective.”

We know that Alzheimer’s disease is diagnosed after death, on autopsy, by finding amyloid plaques in the brain, and by seeing the nerve cell tangles under a microscope.

So… if there is no way to diagnose the disease before death, and there is no treatment for it anyway, who in world would want to know if they are going to get it? That sounds like an exercise in masochism.

Maybe not so fast… we know that amyloid plaque in the brain can be seen without having to cut into the brain – that’s good news. We can test for elevated levels of amyloid plaque by seeing it on a PET scan of the brain. We can test by doing a spinal tap and pulling spinal fluid from the spinal cord and measuring specific proteins in the spinal fluid – that’s a pretty invasive procedure.

So let’s talk about risk factors – what you can do to minimize the chance of developing dementia.

It appears that there are several risk factors that would be susceptible to intervention BEFORE dementia (or even mild cognitive impairment) develops. These risk factors are present in all people, no matter their age, race, or socioeconomic status.

Dementia does NOT have to be a normal part of aging.