With the ageing process one’s body goes through natural changes and one loses some of our functionality. We naturally lose bone density; our eyes have more difficulty in focusing; we lose muscular flexibility; our heart has more trouble pumping blood, etc. The brain is no different from our other organs, and some loss of functionality occurs naturally with the ageing process.
In a normal ageing process we lose some memory ability, we have more difficulty in concentrating, our reasoning gets a little slower. But sometimes this process of cognitive decline is higher than expected and not always due to the ageing process alone.
The stage where the individual shows cognitive changes that are serious enough to be noticed by him or others, but not severe enough to interfere with autonomy in everyday living is called Mild Cognitive Impairment (MCI).
People with MCI do not meet the clinical criteria to be diagnosed with dementia, but show a much higher risk for the condition to progress into dementia (Alzheimer´s disease being the most common). About 10% to 15% of people with MCI progress to dementia within a year, opposed to 1% to 2% in other individuals without MCI.
MCI can be detected trough a clinical assessment and neuropsychological tests. A neuropsychological assessment, through the use of general and specific tests (memory, language, attention, etc.) defines the level of cognitive performance of the individual. These results are achieved by comparing each individual’s results with what is expected for his age and education. The tests detect signs and patterns of cognitive decline. These results then make it possible to define if the changes experienced by the individual are normal and due to the natural ageing process or if it is a case of MCI.
In the case of MCI, the assessment also helps to differentiate its origin (depression, medical conditions, neurological degeneration) and subsequently to plan the necessary medical and neuropsychological treatment. With this assessment it is possible to obtain the baseline data of the person’s cognitive ability, allowing to perform a direct comparison in the future, which is the most accurate way in helping to diagnose dementia.
When should I decide to consult with a neuropsychologist?
You should seek a consultation in neuropsychology when you or others close to you notice that:
▪ You are forgetting more things in comparison to other people your age;
▪ You are having added difficulty paying attention in comparison to other people your age;
▪ You keep forgetting small things (like going to the kitchen and forgetting what you were looking for) or frequently losing things around the house (not knowing where you left the keys, wallet, phone);
▪ You keep repeating the same thing or asking the same question several times in the course of a day;
▪ You forget recent events very easily, like what you had for dinner the day before or what you did two days ago. However, you can remember long ago past events easily;
▪ You are struggling with activities that you did well in the past;
▪ There is a noticeable decline of your cognitive abilities in a short time (1-2 years).
What if I have MCI?
With a neuropsychological assessment it is possible to identify the probable cause of the decline and plan an appropriate approach. Some cases might require a medical follow-up with other medical specialties, while others may need neuropsychological rehabilitation.
The neuropsychological rehabilitation process consists of cognitive training (“use it or lose it” theory for memory, reasoning, etc.); remediation and compensatory strategies for everyday use; and family counselling and psycho education. This allows for either the remission of MCI; the maintenance of good levels of autonomy for much longer; and a faster diagnosis in the case of disease (dementia).
A Neuropsychological Assessment and subsequent rehabilitation will result in a better prognosis as far as memory loss in the ageing process is concerned.
By Dr Filipe Fernandes and Dr Miguel Coutinho
Dr Filipe Fernandes and Dr Miguel Coutinho work in the Group Hospital Particular do Algarve
For appointments call 707 28 28 28