Recognizing the Importance of Early Diagnosis for Mild Cognitive Impairment
Jonel Dershem, a 50-year-old obstetrician from Voorhees, N.J., first noticed problems with her memory in 2016 after her breast cancer surgery. Initially, she attributed the lapses to chemotherapy and her busy, stressful life. Her husband, friends, and even her doctor also dismissed her concerns. However, as her challenges progressed from leaving a faucet running to trouble finishing routine tasks, Dershem grew increasingly worried about her condition. In December 2022, nearly six years after her memory loss began, she was diagnosed with mild cognitive impairment (MCI). While her delayed diagnosis was not uncommon, experts emphasize the need for change in recognizing and addressing MCI.
MCI is characterized by problems that disrupt daily life but do not make it impossible to function. It is often a precursor to dementia but not always. Ronald Petersen, director of the Mayo Clinic Alzheimer’s Disease Research Center, describes MCI as a subtle condition that may manifest as occasional forgetfulness or inefficiency in completing tasks. However, if these issues occur frequently and cause concern among family members, it may be a sign of MCI.
According to a study published in the journal Alzheimer’s & Dementia, it is projected that 14.4 million people in the United States will have MCI by 2025, and 19.3 million by 2050. The American Academy of Neurology estimates that approximately 1 in 10 people aged 70 to 74 have MCI, increasing to 1 in 4 for those aged 80 to 84 in 2018.
Denial about worsening symptoms can be tempting but dangerous. Soeren Mattke, director of the Brain Health Observatory at the University of Southern California’s Dornsife Center for Economic and Social Research, emphasizes the importance of both patients and physicians being aware of the symptoms of cognitive decline. Waiting until someone is obviously symptomatic may be too late. Early detection is crucial.
If individuals notice a significant decline in memory, reduced ability to absorb new information, difficulty understanding social cues, or an increase in clumsiness, it may be time to consult a doctor. However, research suggests that approximately 92 percent of people with MCI are undiagnosed. This alarming statistic highlights the need for improved recognition and diagnosis of MCI.
Dershem’s delayed diagnosis led her to retire from her medical practice in January 2023. However, her current doctor, David Weisman, director of clinical research at Abington Neurological Associates, emphasizes the advantage of catching MCI early. Early intervention can help delay the progression of the condition. Since February 2023, Dershem has been receiving treatment with lecanemab, a medication approved by federal regulators to treat MCI and early Alzheimer’s disease. Lecanemab reduces the buildup of amyloid beta, a protein associated with Alzheimer’s. While the medication can modestly slow dementia’s progress, it cannot stop the decline or reverse lost ground.
Diagnosis is not only valuable for determining appropriate treatment but also for identifying potential causes other than Alzheimer’s disease or related disorders. Petersen explains that various factors, such as brain tumors or medication side effects, can cause MCI symptoms. Therefore, an accurate diagnosis is essential to ensure proper management and care.
The emergence of amyloid-fighting medications like lecanemab and donanemab has given hope to many doctors. However, these drugs are only effective when the disease is caught early. Additionally, they come with potential dangerous side effects. Lecanemab carries a warning of brain swelling and bleeding.
While some memory decline is a natural part of aging, more worrisome cognitive gaps should not be ignored. It is crucial to prioritize memory and seek answers from a doctor. Weisman advises patients to make it clear that memory loss is a priority during medical appointments. If doctors do not take concerns seriously, consulting a geriatric psychiatrist or neurologist may be necessary.
Preparing for an evaluation involves taking an online test before the appointment and bringing the results to the doctor. The Self-Administered Gerocognitive Exam (SAGE) is considered the gold standard. Additional tests, such as neuropsychological assays, blood tests, or an MRI, may be conducted to rule out other causes. PET scans or spinal taps may be used to search for signs of Alzheimer’s disease or Lewy body dementia. New blood tests are also promising for easier diagnosis in the future.
Having a personal “historian” present during appointments is crucial, as individuals experiencing cognitive decline may not be the first to notice. This person, such as a spouse or friend, can provide valuable insights into the onset and pace of decline.
Karen Sandone from Doylestown, Pa., learned the importance of having someone accompany her husband, Anthony, to medical appointments. She noticed his memory issues in spring
