Mental lapses are a part of life. It is common for people to be forgetful or absent minded at times. For some individuals, it may be a part of their personality. That is the way they are wired. During the aging process, brain functions naturally decline. The brain actually shrinks (especially in the prefrontal cortex, our learning region of the brain), blood flow decreases, communication between neurons in our brain can be reduced, and other declines present themselves. For some, these are subtle changes and may even be unnoticeable to most people. For others, it could be the first signs of a Neurocognitive Disorder (NCD), formerly referred to as dementia.
There have been significant advancement in the science and the medical field over time. This has brought great benefits to society. New medications have been introduced. These medications have successfully treated and even cured diseases. Individuals are living much longer than in previous years. However, as our population ages, we still face great medical challenges. NCD are still conditions that remain prevalent.
The number of people living with dementia worldwide is currently estimated at 47.5 million and is projected to increase to 75.6 million by 2030. The number of cases of dementia are estimated to more than triple by 2050. World Health Organization
NCD is more of a classification or description of a condition. There are disorders that fall under the description of NCD. Not all of them are progressive. A few may they run their course and do not cause permanent effects. Individuals may recover and return to normal functioning. Most of the other NCD conditions are permanent and take on a progressive course. Alzheimer’s makes up a majority of the cases. According to Aging, Demographics, and Memory Study (ADAMS), a nationally representative sample of older adults, an estimated 5.3 million Americans of all ages have Alzheimer’s disease in 2015. If an individual has Alzheimer’s prior to age 65, it is considered early onset. For those over 65, it is just referred to as Alzheimer’s. Eighty-one percent of people who have Alzheimer’s disease are age 75 or older (World Health Organization).
The warning signs for Neurocognitive Disorders include:
- Memory loss, forgetting things more frequently
- Problems with getting information out and formulating word
- Change in presentation or personality
- Misplacing things
- Poor decision making
- Not being able to do routine tasks
- Uncertainty of time and place
- Isolating more/decline of activity level
- Repeating oneself
- Change of hygiene
- Lack of control over bladder or bowel
- Difficulties in abstract thinking
These signs and symptoms do not determine conclusively that someone has a neurocognitive disorder but would support further exploration of a diagnosis. To formulate a diagnosis, it would involve extensive testing which would include: complete medical history, blood work up, CT(CAT) Scan, Magnetic Resonance Imaging(MRI),SPECT or PET imaging, brain scans, and Neurological testing. For some disorders, we may not know for sure what the disorder was until an autopsy of the brain. For patients who are diagnosed with a NCD , these tests are important to establish a baseline of functioning. When this is done, we can monitor the decline and have empirical data to rely on. Medication and lifestyle adjustments could be made accordingly.
There is not a conclusive marker or factor that determines who will develop a NCD. The risk factors for NCD include:
- Family History
- If you have Down Syndrome
- Lifestyle (weight, cholesterol, diabetes, blood pressure)
At this writing, there is no cure for some of these disorders. Some forms of NCD (usually substance induced, medication reaction, or short term reaction to illness) may subside after time. However, a majority of others do not. They get progressively worse. Their decline may take on a slower course than others. There may even be brief times of clarity that may be encouraging. These moments, unfortunately, do not last. There is a descent in their cognitive abilities, which may take years to run its full course. Medications are available that may slow down the progression of the condition but at this writing there is no cure. Some of these medications have provided up to six months of improvement. However, the progression continues after that. Unfortunately, as the disease reaches its final stages, the body shuts down and death follows.
Preventative measures for Neurocognitive Disorders are not scientifically validated. This means there is some research that has been done to support evidence that this helps, but not eliminate the possibility of NCD. This would include: Diet, exercise, intellectual stimulation, and social stimulation. These preventative measures would not eliminate the possibility of having a NCD, but decrease the likelihood of having one, or at least delaying onset.
A diagnosis of a Neurocognitive Disorder is significant event for families to come to terms with. Significant adjustments need to be made for all individuals involved. Our next issue discusses resources available for families and individuals who are faced with NCD.