August 10, 2011
People with Alzheimer’s disease often have trouble remembering things like important dates or whether they took their medications, a problem that can disrupt day-to-day activities and planning. The same problems are also common in those with mild cognitive impairment, or MCI, which often precedes Alzheimer’s disease, even though problems with daily tasks, work or social activities are not generally part of the definition of the condition, according to a new report. The findings appeared in the Archives of General Psychiatry, a journal from the American Medical Association.
For the study, researchers from the New York State Psychiatric Institute surveyed nearly 400 men and women with mild cognitive impairment, and nearly 200 with early Alzheimer’s disease. Another 229 people served as healthy controls.
They asked participants about two main areas of daily concern that are difficult for someone with Alzheimer’s disease. The first involved remembering appointments, family occasions like birthdays and anniversaries, holidays and taking medications. The other set of questions centered around gathering paperwork like assembling tax records or other business records.
Almost three fourths of patients with mild cognitive impairment had problems with these areas of daily functioning. Those who had the most problems were most likely to progress to full-blown Alzheimer’s disease; almost all of those with Alzheimer’s have problems with these activities. In comparison, fewer than 10 percent of the healthy controls had problems with remembering appointments or handling paperwork.
Mild cognitive impairment causes a range of problems, often but not exclusively related to memory. But according to criteria to diagnose the condition, it does not involve “substantial interference with work, usual social activities, or other activities of daily living.” But as this study makes clear, many people with MCI do have problems with day-to-day tasks.
Understanding the level of impairment a patient has is important, note the authors: “Identifying the extent and severity of functional deficits that typically occur in each disorder can aid in early diagnosis, help in estimating prognosis, and improve treatment strategies.”
The results, the researchers note, may help physicians better recognize whether patients with MCI are likely to advance to dementia. “These findings show that even mild disruptions in daily functioning may be an important clinical indicator of disease and represent the latter phases of disease progression within the MCI classification system for cognitive impairment.” They note that additional research is needed to understand when and how trouble with functioning occurs, and what might be done to treat it.
Not all people with mild cognitive impairment go on to develop Alzheimer’s disease. But finding a way to recognize who will progress to Alzheimer’s could be important. Doctors increasingly recognize that treatment for the disease may be more effective in the very earliest stages, when symptoms are minimal and damage to the brain has not become extensive.
Current Alzheimer’s medications are not effective against the downward progression of disease, though they may ease symptoms for a time. As research continues and new treatments are developed, though, it will be important to assess conditions like mild cognitive impairment at its earliest stages, to determine who might benefit from new treatments.
Source: Patrick J. Brown; D. P. Devanand; Xinhua Liu; Elise Caccappolo; for the Alzheimer’s Disease Neuroimaging Initiative: “Functional Impairment in Elderly Patients With Mild Cognitive Impairment and Mild Alzheimer Disease.” Archives of General Psychiatry. Vol. 68(6), June 2011, pages 617-626.