An article by Mar Mesa Reixach,
psychologist at the Font dels Capellans residential center ()
Cognitive impairment concept
He cognitive decline is a construct that has been used for many years to refer to deterioration that may appear during normal aging or constitute a intermediate stage between normal aging and dementia. In this last case we would be talking about the Mild Cognitive Impairment (DCL), which is the concept that we will deal with from now on and that it is a pathological condition that is associated with a higher probability of developing dementia.
The criteria to diagnose mild cognitive impairment are:
- Memory problems corroborated by an informant.
- Memory deficits objectified through a neuropsychological examination.
- Preservation of general cognitive function.
- Preservation of activities of daily living.
- Absence of dementia.
Cognitive decline may constitute an intermediate stage between normal aging and dementia.
Causes and risk factors
With aging, morphological, biochemical, metabolic and circulatory changes occur that can continue their normal function or lead to alterations or cognitive deficits. According to the World Health Organization (WHO), there are a number of risk factors that may favor the appearance of mild cognitive impairment and which are the following:
at the age of
b) certain health problems (hypertension, diabetes, hypercholesterolemia, obesity, depression, etc.)
c) lifestyle (sedentary lifestyle, tobacco and alcohol consumption, and unhealthy diet)
d) social isolation and cognitive inactivity
It should be noted that these risk factors are also valid for the development of dementia.
Prevention and Treatment
With the purpose of prevent cognitive decline WHO recommends the following:
- Perform physical exercise
- cognitive stimulation
- Maintain social relationships
- Lead a healthy lifestyle
- Control vascular risk factors and other pathologies.
As for the treatment of mild cognitive impairment, this aims to improve symptoms and also prevent or delay the onset of dementia. We can distinguish two types of treatment for MCI: Non-pharmacological treatment and Pharmacotherapy.
He non-drug treatment includes the same recommendations included in the MCI and dementia prevention framework:
- Lead an active life both intellectually and physically, that is, perform cognitive stimulation exercises or activities that stimulate the brain and physical exercise
- Maintain the network of social relationships and hobbies
- Have a healthy diet
- Keep track of vascular factors and other pathologies
- Avoid the consumption of drugs such as tobacco and alcohol.
These factors can prevent, initially improve, or delay the progression of MCI.
1. Physical and intellectual activity: Various studies have shown that exercise is related to brain health, and physically active people have a lower risk of developing MCI and dementia compared to sedentary people. As for cognitive stimulation, this refers to the practice of creative activities, such as painting and drawing, playing a musical instrument, playing board games, doing crossword puzzles and word searches, attending museums and plays, etc. . All of these activities contribute to improving cognitive and social functioning.
2. Social activity: It has been proven that older people who have fewer social interactions have a higher risk of cognitive decline and dementia.
3. Food: A healthy and balanced diet can prevent many diseases that increase the risk of developing dementia. Specifically, the Mediterranean diet is the one associated with a lower risk of mild cognitive impairment and Alzheimer’s.
4. Control of vascular risk factors and other pathologies: A review of several observational studies found that obesity in mid-adulthood increased the risk of dementia. In relation to other pathologies, the relationship between depression and cognitive impairment and dementia has been widely demonstrated.
5. Consumption of alcohol and tobacco: There is ample evidence that excessive alcohol consumption is a risk factor for MCI and dementia. Tobacco dependence has been linked as a factor that negatively influences the ability to work in older adults, which worsens the state of frailty and is also associated with a greater risk of Alzheimer’s disease.
Another therapeutic tool that has been shown to be effective both for the prevention and treatment of cognitive decline (including dementia as well) is virtual realityalthough more studies are needed to examine the real impact of this technology in improving the cognitive abilities of the elderly.
As for the Pharmacotherapy The following drugs and supplements have been proposed:
a) acetylcholinesterase inhibitors
b) NMDA glutamate receptor inhibitors
c) Nootropics
d) Neuroprotective
e) Vasodilators;
e) Vitamin E
g) Phosphatidylserine
h) Ginkgo biloba
i) Omega-3 Fats
The recommendation is the combined use of different supplements (DHA-EPA, phosphatidylserine and Ginkgo biloba), more than its individual application.