Aging is associated with a gradual decline in physiological and physical abilities, with an erosion in reserves. There is decline in cognition and functioning that comes with age and with disease. Should we be making the use of products indicated for Alzheimer’s Disease (AD) (colloquially termed cognitive enhancers) more routine to mitigate the burden of an ageing population?
Mild Cognitive Impairment (MCI) is a modest decline in cognition, which occurs in 20 – 30% of the elderly. Out of these, one third will develop dementia. A good indicator of later dementia is a major depressive episode occurring for the first time at age fifty. MCI is associated with a functional decline which can be seen in abilities relating to use of the telephone, use of transportation, medications and finances.
Earlier treatment leads to a better prognosis.
Treatments available locally only have an indication for Alzheimer’s Disease so it is important to remind patients that the diagnosis is not necessarily AD. At the stage of MCI, it is unknown which way the disease will go, and it may not progress to dementia.
This supports the rationale of starting treatment as early as possible, even on a hunch.
Treatment for MCI starts with a memory enhancer. These fall into two groups, namely acetylcholinesterase inhibitors and NMDA-receptor antagonists. Side effects for the first group may include initial sedation, vivid dreams, gastro-intestinal side effects and sexual dysfunction. With the NMDA-receptor antagonists, glomerular filtration rate needs to be monitored, and there may be fatigue, sedation and confusion.
Psychotropic agents may be given for residual symptoms, such as mood or behavioral disturbances. Finally, ensure the cardiovascular risk factors are controlled. There are also methods to possibly prevent or slow down illness progression. Medication may include anti-inflammatories, apolipoprotein E2 or E3, vitamins E and C and hormone replacement therapy. Moderate red wine consumption, physical exercise, intellectual stimulation and appropriate diet have all been shown to play a positive role.
Population aging and the global burden of dementia pose a major challenge for society and health care. Cognitive enhancement is currently receiving attention as an approach to potentially reduce, or at least slowdown, this burden.