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Introduction to Cognitive Impairment

Sherry Christiansen
By Sherry ChristiansenJanuary 3, 2018

Cognition refers to a brain activity such as awareness, perception, reasoning or thinking. Cognitive impairment ranges from mild to severe, but before delving into cognitive impairment, it’s important to understand its impact on Alzheimer’s disease.

Alzheimer’s Disease and Cognitive Impairment

Alzheimer’s involves various, distinct, phases or “stages” (including Stage 0, 1, 2 and 3). The disease is considered a spectrum of symptoms, starting in the brain 20-30 years before symptoms occur.

According to the Alzheimer’s Association and the National Institute on Aging and Alzheimer’s:

Stage 0 is when a person is considered Alzheimer’s free, because the disease has not yet started, and it is not known whether it will ever occur.

Stage 1 is when the Alzheimer’s disease process has started in the brain, but no noticeable symptoms (such as memory loss) have occurred yet. This stage could last 20-30 years. Hallmark abnormalities in the brain include abnormal protein accumulation called amyloid and tau proteins. It takes years for these abnormal plaques and tangles to accumulate to a level that interferes with normal nerve cell transmission in the brain.

Stage 2 (MCI) involves mild memory problems and deficits in other thinking processes (called Mild Cognitive Impairment or MCI). During this stage, a person may have trouble remembering the steps to balance a checkbook, or get confused about directions — even in places frequently visited, such as in one’s own neighborhood.

Common symptoms of MCI include:

  • Difficulty with reading retention
  • Forgetting the correct sequence in the steps to complete a task
  • Inability to access decision-making abilities
  • Increasing difficulty with organization
  • Memory problems (noticed by the person with MCI, a healthcare provider or family member)
  • Occasionally losing objects

What Is Cognitive Impairment?

Cognitive (or memory and thinking) skills are needed for just about everything a person does, including:

  • Focusing
  • Remembering things
  • Solving problems

In Stage 2 Alzheimer’s disease (also called MCI), cognitive impairment is mild. A person may have noticeable memory impairment, but can still perform activities of daily living (ADL’s), such as bathing, dressing, eating etc.

Stage 3 is considered Alzheimer’s and dementia. It can be categorized as mild or severe, but in both mild and severe dementia, a person’s cognitive impairment interferes with performing ADL’s independently. A person with mild dementia has memory loss (more related to recent events), but enough that it also interferes with ADL’s. With severe dementia, a person requires constant help with personal care, may be incontinent and may have an inability to recognize familiar faces or understand the meaning of things. Severe dementia may also involve a disruption in communication. In addition, there is oftentimes a change in personality. People may say, “she/he just isn’t the same person she/he used to be.”

Cognitive Impairment Case Study

Meet Juanita

Let’s consider a real case scenario of a 79-year-old woman named Juanita, who recently began having some mild memory problems. Juanita’s daughter, Emily, took her to see the family doctor, with complaints of her mom asking the same questions, repeatedly. Emily reported that Juanita could no longer remember things, like the steps in making family recipes that Juanita had prepared for decades (without using a recipe). Her mom was losing items daily, couldn’t seem to remember how to balance her checkbook, and she even got lost walking home in her own neighborhood once. When asked if Juanita could take care of her daily needs, such as dressing, eating and preparing simple meals (like sandwiches), Emily replied, “yes.”

Meet Emily

Emily is Juanita’s only daughter. She explained to Juanita’s primary doctor, Dr. Jacobs, that she and her mom were very close. Emily also told Dr. Jacobs that her mom used to enjoy getting together with friends to play bingo every week, but that she showed little to no interest in any hobbies or socializing these days.

Dr. Jacobs’ Diagnosis

Upon examination of Juanita, Dr. Jacobs considered Emily’s report of the symptoms she has recently been experiencing. Because Juanita’s memory problems were mild, and the fact that she can still care for herself (performing AD’L’s independently), Dr. Jacobs diagnosed Juanita with Stage 2 Alzheimer’s or Mild Cognitive Impairment.

Dr. Jacobs informed Emily that while there is currently no cure for AD, there are a variety of interventions found to potentially help slow down the progression of symptoms, for now. Emily asked if there was any chance that she would be at risk for getting AD. Dr. Jacobs replied that although there was no foolproof way of knowing for sure, there are lifestyle interventions that may help reduce the risk (and delay the onset) of AD.

Ways to Prevent Cognitive Impairment

Dr. Jacobs encouraged Emily and Juanita to attend an Alzheimer’s prevention consultation with Nurse Karen, who did some teaching. The nurse explained that some interventions were found in studies to help slow down the progression of cognitive decline (and possibly reduce the risk of AD). These prevention tools included engaging in activities to stimulate the brain. The nurse gave Emily a list of some suggestions from the ANU-ADRI rating scale (a list of activities found in studies conducted at The University of Australia, to improve cognitive functioning).

The list included working to:

  • Establish a regular exercise routine (with the physician’s permission)
  • Get involved in family support groups for caregivers
  • Go to live plays or concerts
  • Join a book club or engage in other group learning activities
  • Learn a new hobby-preferably one that is offered in a group setting
  • Learn a new language
  • Meet and socialize with new people every day
  • Participate as frequently as possible in social activities with family and friends
  • Read something stimulating every day
  • Take adult education classes
  • Take a group exercise class
  • Take a writing class
  • Travel as frequently as possible to new destinations
  • Write letters, engage in online forums and other writing activities

Activities such as daily socialization, joining clubs, reading and a regular workout routine have been found to slow down the rate of cognitive decline and possibly help protect against Alzheimer’s disease.

Keeping the brain (and the body) active is a key Alzheimer’s prevention tool, for optimal health throughout the lifespan.

What other activities have you participated in to prevent cognitive impairment? We’d like to hear your stories in the comments below.

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Sherry Christiansen

Sherry Christiansen

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