Comparing Cognitive Changes

Running head: COMPARING COGNITIVE CHANGES 1

Comparing Cognitive Changes

Debbie Fernando

HCS/551

February 3, 2014

Dr. Donna Fife

COMPARING COGNITIVE CHANGES 2

Comparing Cognitive Changes

There are significant differences in the cognitive changes noticeable in Mild Cognitive

Impairment (MCI), Alzheimer’s disease (AD), and Parkinson’s disease. This paper will describe

the 3 diseases and explain how they are evaluated. The progression of changes that occur with

each disease will be discussed. The effects each has on the patient, family and friends, and

society will be covered. Any preventative measures or treatments will be discussed as well as

how to manage the symptoms of the diseases and resources available for support. Please feel free

to ask any questions or voice any concerns that may come to mind as you review this handout

with your health care provider.

Mild Cognitive Impairment (MCI)

Mild memory problems falling between two poles of “normal” and “dementia” are

common in older people. The World Health Organization (WHO) has placed a widely used

common term to use for these people, Mild Cognitive Impairment (MCI) (Chertkow, 2002). Mild

cognitive impairment is a syndrome defined as cognitive decline greater than expected for an

individual's age and education level but that does not interfere notably with activities of daily life

(Gauthier et al., 2006). People with MCI may have some short or long term memory loss with

no loss in the ability to function with daily activities. MCI is a label for people who do not have

“normal” cognitive functioning but also do not have enough cognitive impairment to classify

them with “dementia”. People with depression, delirium, mental retardation and other

psychological conditions are not included in this group.

Criteria for MCI

There are certain criteria that must be met for each neurological condition. The criteria

for MCI include a subjective complaint of memory loss and an objective impairment of memory.


Other cognitive abilities remain intact, basic day-to-day functioning is normal, there are no other

neurological or psychiatric problems causing the memory impairment, and dementia criteria are

not met. There is a debate on the percentage, but changes are that many people with MCI will go

on to develop dementia, especially Alzheimer’s disease (Chertkow, 2002). Many people have

subjective memory impairment where they think they have memory problems but they do not

show any objective impairment. It has been shown that the people who have subjective memory

impairment have a good chance of going on to develop dementia within the next 7 years

(Gauthier et al., 2006).

Effects

MCI effects people only in a mildly. As long as the person tries his best to remember by

doing the exercises, it should be only a mild nuisance. Family and friends need to watch for the

beginning of an increase in the memory loss, personality changes, and other cognitive

impairments. These need to be reported to the physician immediately.

Treatment

There is no treatment for MCI. Many people do things to help them remember like

keeping notes, repeating people’s names, and studying. Other ways to keep MCI at bay are

crossword puzzles, reading, working math problems, or anything that “exercises the brain”. It is

possible that doing these things will delay the onset of more severe symptoms. Of people with

mild cognitive impairment, about 15% will progress to dementia each year; 90% of this will be

due to Alzheimer’s disease. ("Memory Loss and the Early Signs of Alzheimer’s", 2011).

Parkinson’s disease


“Parkinson’s disease is a disorder of the brain that leads to shaking (tremors) and

difficulty with walking, movement, and coordination” (Parkinson’s disease, 2013, para. 1).

Parkinson’s disease is one of the most common nervous system disorders of the elderly

(Parkinson’s and Alzheimer’s disease, 2012). There is no difference in occurrence between

women and men. It can sometimes run in families. Nerve cells need a brain chemical called

dopamine which helps control muscle movement. Parkinson’s disease can develop when the

brain stops producing dopamine. The disease gets worse with time.

Symptoms

Individuals with Parkinson’s disease may first notice a stiff leg or foot that they feel like

they are dragging. When asked to hold out a limb, that limb will tremor. The tremors stop when

movement begins. The person may have trouble starting movements, especially in the legs. They

may also have trouble stopping a movement. Other symptoms that may develop over time

include drooling, a stiff face (because of the inability to control facial muscles), difficulty

walking, difficulty swallowing, constipation, slow blinking, loss of fine motor skills (unable to

write and trouble feeding self), and stoop shoulders. Often a “pill rolling” movement will be

uncontrollable.

Treatment

There is no cure for Parkinson’s disease. Medications can be used to help the brain make

dopamine. The goal of treatment is to control the symptoms as long as possible. Some of the

medications may cause hallucinations. Also, the medication may wear off as the day progresses.

Discuss this with your doctor. He may be able to change the medication, the dosage, or the time


it is taken. Certain tests can be done to help diagnose Parkinson’s disease. A swallowing test may

be performed along with brain scans and other tests.

Effects

The main effect that Parkinson’s disease has is there needs to be an increase in safety

precautions. Since the person may have trouble swallowing, choking is a constant worry. The

food has to be prepared so that it can be easily swallowed. Also, there is risk of falling since the

person has trouble starting and stopping movements. He may be walking and try to stop to avoid

tripping on something and be unable to stop. His surroundings need to be adjusted accordingly.

Alzheimer’s disease

“Alzheimer's disease (AD) is an age-related, non-reversible brain disorder that develops

over a period of years. Initially, people experience memory loss and confusion… ("National

Institute of Neurological Disorders and Stroke", 2014, para. 1). However, with AD the memory

loss becomes so bad that the patient will not recognize family members or remember to do their

activities of daily living. Personality changes occur with AD. It is important for family to

remember that if the patient starts talking mean to them that it is the disease process and not the

person they remember. AD becomes a safety factor for the patient. He may wonder off

somewhere and not know where he is or how to get back home. AD is the most common of the

dementias in people over age 65. Cognitive abilities worsen over time until there is a severe loss

of mental function.

Treatment


There is no known cure for Alzheimer’s. There are medications that the physician may

prescribe to help with the symptoms. The goal in treating AD is to slow the symptoms as much

as possible. Aricept, Exelon, or Razadyne may be prescribed for mild to moderate symptoms

whereas Donepezil or Namenda may be prescribed for moderate to severe symptoms. The NIH is

conducting clinical trials and studies at the present time.

Effects

AD is a traumatic change in lifestyle for the family. They must keep a constant eye on

their loved one and finally make the decision of whether to place her in a long term care facility.

The patient very probably does not know she has the disease and has no idea on how bad it is for

the family. For society, taking care of Alzheimer’s patients is costly. In 2013, the nation spent

203 billion dollars caring for AD patients. The cost is expected to rise to $1.2 trillion by 2050.

The emotional effect on the family caregivers is enormous. At least one-third of them report

depression. Due to the toll of caregiving, an additional health care cost of $9.1 billion was spent

in 2012 on the caregivers (Alzheimer’s and dementia, 2014, para. 6).

Conclusion

Mild cognitive impairment, Parkinson’s disease, and Alzheimer’s disease are all

neurological diseases of the elderly. MCI is the least worrisome with only mild memory loss or

impairment involved. Parkinson’s disease is a brain disorder that involves movement and muscle

control. These people have tremors, problems speaking and swallowing, and trouble with

walking. Alzheimer’s disease is the most common of the dementias in the elderly. It usually is

first noticed by just mild memory loss progressing to total mental dysfunction. Alzheimer’s


patients cannot remember family members or events or to take care of themselves. There are

ample resources available that family members can reach out to for information and help.

“Meals on Wheels” delivers food to people who need a hot meal. There are associations that

provide help for each specific disease. These can be found on the Internet, your public health

department, or by asking your health care provider.


References

Alzheimer’s and dementia. (2014). Retrieved from

http://www.alz.org/alzheimers_disease_facts_and_figures.asp#cost

Chertkow, H. (2002). Mild cognitive impairment. Retrieved from

http://s3.amazonaws.com/academia.edu.documents/31006846/15.pdf?

AWSAccessKeyId=AKIAJ56TQJRTWSMTNPEA&Expires=1391331748&Signature=R

ZwLfgG14fq5cNPZhkTFkn7hTO0%3D&response-content-disposition=inline

Gauthier, S., Reisberg, B., Zaudig, M., Peterson, R. C., Ritchie, K., Broich, K., …Winblad, B.,

(2006, April). Mild cognitive impairment. The Lancet, 367(6), 1262-1270.

Memory loss and the early signs of Alzheimer’s. (2011). Retrieved from

http://www.earlysymptomsalzheimers.com/memory-loss

National institute of neurological disorders and stroke. (2014). Retrieved from

http://www.ninds.nih.gov/disorders/alzheimersdisease/alzheimersdisease.htm

Parkinson’s and Alzheimer’s Diseases: similar but very different. (2012). Retrieved from

http://www.alznyc.org/nyc/newsletter/fall2012/06.asp#.UuymmfnYeSk

Parkinson's disease. (2013). Retrieved from

http://www.nlm.nih.gov/medlineplus/ency/article/000755.htm


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Comparing Cognitive Changes