People who think positively about aging are more likely to recover memory

A new study has found that older persons with mild cognitive impairment (MCI), a common type of memory loss, were 30% more likely to regain normal cognition if they had taken in positive beliefs about aging from their culture, compared to those who had taken in negative beliefs.

Yale School of Public Health. “People who think positively about aging are more likely to recover memory.” ScienceDaily. http://www.sciencedaily.com/releases/2023/04/230412131116.htm (accessed April 18, 2023).

Journal Reference – Becca R. Levy, Martin D. Slade. Role of Positive Age Beliefs in Recovery From Mild Cognitive Impairment Among Older Persons. JAMA Network Open, 2023; 6 (4): e237707 DOI: 10.1001/jamanetworkopen.2023.7707

I cannot believe how wonderful the aging process is said no one ever.

NEJM Teaching Topic – MCI

The NEJM Resident e-Bulletin is one of the ways I keep up with medical information.  While it will not be possible for me to reproduce every email that comes from this service, on occasion I will post topics of interest.  Copyright remains vested with the NEJM so don’t try and steal this to make money.

Teaching Topic

Mild Cognitive Impairment

Clinical Practice

Mild Cognitive Impairment

R.C. Petersen

CME Exam   Full Text Audio  Comments

MCI represents an intermediate state of cognitive function between the changes seen in aging and those fulfilling criteria for dementia, often Alzheimer’s disease (AD).

Clinical Pearls

Clinical Pearl  What is the estimated prevalence of MCI?

The estimated prevalence of MCI in population-based studies ranges from 10 to 20%. In the Mayo Clinic Study of Aging, a prospective, population-based study of non-demented persons ages 70 to 89 years at enrollment, the prevalence of amnestic MCI was 11.1% and of nonamnestic MCI, 4.9%.

Clinical Pearl  How can the “worried well” be differentiated from patients with MCI?

Neuropsychological testing may be necessary to corroborate a history of decline in cognition, usually memory. At times, the “worried well” can give a convincing history for memory loss, but neuropsychological testing reveals normal performance.

Figure 1. Diagnostic Algorithm for Amnestic and Nonamnestic Mild Cognitive Impairment.

Morning Report Questions

Q. What factors predict a more rapid progression of cognitive impairment among patients with MCI?

A. As compared with the incidence rate for dementia in the general population of 1 to 2% per year, the incidence of dementia in patients with MCI is significantly increased, with an annual rate of 5 to 10% in community-based populations and 10 to 15% in clinic-based populations. The degree of cognitive impairment at presentation is a clinical predictor of progression; those with greater baseline impairment appear more likely to progress more rapidly. The presence of the apolipoprotein E ε4 allele is also predictive of progression rate. Several MRI measures have also been reported to predict a faster rate of progression, including atrophic hippocampi, dilated ventricles, reduced total brain volume, and the presence of white matter hyperintensities.

Q. How can patients with MCI be managed?

A. Limited data support the potential benefit of cognitive rehabilitation approaches. Several clinical trials that treated persons with MCI with cholinesterase inhibitors used for AD (donepezil, galantamine, and rivastigmine) at standard AD treatment doses for 2 to 4 years have shown no significant reduction in the rates of progression to dementia.

MCI More Common in Older Men Than Older Women

I got this news release in an email the other day.  I have reproduced the release in its entirety for your reading enjoyment

NIA NEWS
For Immediate Release

Tuesday, September 7, 2010

Mild Cognitive Impairment More Common in Older Men Than Older Women

NIH-supported study suggests gender differences in cognition problems

Older men may be at risk of developing mild cognitive impairment (MCI), often a precursor to Alzheimer’s disease, earlier in life than older women, according to a study appearing today in Neurology.

Primarily funded by the National Institute on Aging (NIA), part of the National Institutes of Health, the study raises the question of whether there may be a gender difference in the development and progression of MCI.

Scientists evaluated the cognitive health of 1,969 dementia-free older people and found 16 percent showed signs of MCI, a condition usually marked by memory problems or other cognitive problems greater than those expected for their age. Prevalence was greater among the older participants, and it was consistently higher in men than women across all age ranges.

Ronald C. Petersen, Ph.D., M.D., and his team at the Mayo Clinic, Rochester, Minn., conducted the research, which was also supported by the National Institute of Mental Health (NIMH), also part of the NIH. Additional funding was provided by the Robert H. and Clarice Smith and Abigail van Buren Alzheimer’s Disease Research Program and the Rochester Epidemiology Project, also supported by NIA.

“Because evidence indicates that Alzheimer’s disease may cause changes in the brain one or two decades before the first symptoms appear, there is intense interest in investigating MCI and the earliest stages of cognitive decline,” said NIA Director Richard J. Hodes, M.D. “While more research is needed, these findings indicate that we may want to investigate differences in the way men and women develop MCI, similar to the way stroke and cardiovascular disease risk factors and outcomes vary between the sexes.”

The researchers conducted in-person evaluations of 1,969 randomly selected people from all 70- to 89-year-olds living in Olmsted County, Minn. The group was evenly split between men and women. Each individual received a neurological evaluation and neuropsychological testing. A panel then reviewed those data plus other information, such as health history and occupation/education levels, to reach a diagnosis. Sixteen percent were diagnosed with MCI; these individuals displayed either amnestic MCI, where memory is impaired, or non-amnestic MCI, where different cognitive problems arise, such as with language.

Results of the study indicated that:

  • Overall, MCI was more prevalent in men (19 percent) than in women (14 percent), even after adjusting for several demographic variables and clinical factors, such as hypertension and coronary artery disease.
  • Of the 16 percent affected with MCI, over twice as many people had the amnestic form that usually progresses to Alzheimer’s disease and the prevalence rate was higher in men than in women.
  • MCI prevalence was higher among people with the APOE e4 gene, a known risk factor for late-onset Alzheimer’s, a form of the disease that usually occurs at age 65 or older.
  • A greater number of years spent in school was significantly associated with decreased MCI prevalence, from 30 percent among participants with less than nine years of education to just 11 percent in those with more than 16 years of education.
  • MCI prevalence was higher in participants who never married, as opposed to those currently or previously married.

The researchers noted that estimates of MCI prevalence vary in studies conducted around the world but generally fall into a range of 11 to 20 percent. The Mayo team’s evaluation of participants included detailed in-person assessments that helped to capture the subtle changes in daily function that may mark the onset of MCI, Petersen said. The researchers also noted that the study’s limitations include a relatively low participation rate by Olmstead County residents and the fact that the population is predominantly white. Thus, these findings may not apply to other ethnic groups.

The NIA leads the federal government effort conducting and supporting research on the biomedical, social and behavioral issues of older people. For more information on aging-related research and the NIA, go to www.nia.nih.gov. The NIA provides information on age-related cognitive change and neurodegenerative disease specifically at its Alzheimer’s Disease Education and Referral (ADEAR) Center site at www.nia.nih.gov/Alzheimers. To sign up for e-mail alerts about new findings or publications, please visit either website.

The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure. For more information, visit www.nimh.nih.gov.

The NIH—The Nation’s Medical Research Agency—includes 27 institutes and centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

Low Vitamin D = Cognitive Decline

Medical News: Vitamin D Deficiency May Be Linked to Cognitive Decline – in Neurology, General Neurology from MedPage Today

Low levels of vitamin D appear to be associated with an increased risk of cognitive decline among older people, according to researchers.

In an observational study conducted among more than 800 Italians ages 65 and older, severe vitamin D deficiency was associated with a 60% increase in the risk of substantial cognitive decline (by a standard measure), according to David Llewellyn, PhD, of the University of Exeter in Exeter, England, and colleagues.

The findings — if confirmed by further studies and randomized clinical trials — “open up important new possibilities for treatment and prevention,” Llewellyn and colleagues wrote in the July 12 issue of the Archives of Internal Medicine.