About Cognitive Impairment
Cognitive impairment becomes noticeable when a person has troubles remembering, learning new things, concentrating, or making decisions that affect everyday life. With mild impairment, people may begin to notice changes in cognitive functions, but still be able to perform their everyday activities. This stage of cognitive impairment is also called Mild cognitive impairment (MCI). Diagnosis at this stage is often very difficult as patient has often a normal score in specific cognition tests like MMSE (Mini-Mental State Examination). Often, the early signs of dementia only become apparent when looking back in time. The tendency of physicians to dismiss memory complaints as normal aging should be replaced by an enhanced awareness of mild cognitive impairment!
Severe levels of impairment can lead to losing the ability to understand the meaning or importance of something and the ability to talk or write, resulting in the in-ability to live independently. This can be various types of dementia. The most common forms are:
Severe levels of impairment can lead to losing the ability to understand the meaning or importance of something and the ability to talk or write, resulting in the in-ability to live independently. This can be various types of dementia. The most common forms are:
- Alzheimer’s disease (AD)
- Vascular dementia (VaD)
- while both types often coexist (form of mixed dementia)
Alzheimer’s disease is the most common cause of dementia among people aged 65 and older. AD is characterized by extracellular plaques containing misfolded amyloid beta peptides (Aß), formed in the brain many years before clinical signs are observed. Intracellular neurofibrillary tangles together with these plaques form the pathological hallmarks of the disease. However, why and how the disease develops is under intense investigation and no satisfying answers have been found until now.
Vascular dementia, also known as vascular cognitive impairment (VCI), is caused by problems in the supply of blood to the brain, typically a series of micro strokes, leading to cognitive decline that occurs stepwise. The incidence of vascular dementia is nine times higher in patients who have had a stroke compared to healthy controls. 25% of stroke patients develop new-onset dementia within one year after stroke.
Treatment options
In the treatment of dementia, early and accurate diagnosis is one of the key issues.
All pharmacological attempts to treat dementia aim to preserve and improve cognitive function and to delay progression to the later stages of the disease. Appropriate management of the disease by currently available drugs aim to stabilize the condition for a certain period, to improve cognition, to reduce behavioral disturbances and thus to delay the need for institutionalization.
In spite of enormous efforts in academic and industrial research, there has still been no major breakthrough in therapies for neurodegenerative diseases.
The following agents are associated with similar degrees of short-term improvement (six to 12 months) in cognition and global functioning. The benefit to AD is a symptomatic improvement rather than a disease delaying or preventing effect.
All pharmacological attempts to treat dementia aim to preserve and improve cognitive function and to delay progression to the later stages of the disease. Appropriate management of the disease by currently available drugs aim to stabilize the condition for a certain period, to improve cognition, to reduce behavioral disturbances and thus to delay the need for institutionalization.
In spite of enormous efforts in academic and industrial research, there has still been no major breakthrough in therapies for neurodegenerative diseases.
The following agents are associated with similar degrees of short-term improvement (six to 12 months) in cognition and global functioning. The benefit to AD is a symptomatic improvement rather than a disease delaying or preventing effect.
- Cholinesterase inhibitors are indicated for the treatment of mild to moderate Alzheimer’s disease. However, these drugs often induce considerable side effects including typical peripheral cholinergic and gastrointestinal side effects, such as nausea, vomiting, diarrhoea, loss of weight, headache, vertigo and muscle seizures.
- Memantine is indicated for mild, moderate and severe dementia inhibiting the excessive stimulation of nMDA receptors. Controlled clinical trials in dementia have shown improvements of cognitive disturbances, drive, motivation and enhancement of motor functions in mild to severe dementia.
- Nootropic drugs, such as piracetam, antioxidants in general, anti-inflammatory drugs and oestrogens are all widely used in the treatment of dementia but the evidence to support their use is unclear.
An alternative treatment approach in Alzheimer’s disease is the use of multimodal drugs, like Cerebrolysin®, that mimic the action of endogenous neurotrophic factors. A sustained neurotrophic regulation is essential for counteracting neurodegenerative processes and to stimulate endogenous repair processes.
https://www.ninds.nih.gov/Disorders/All-Disorders/Alzheimers-Disease-Information-Page
Alvarez. X., et al. Combination treatment in Alzheimer’s disease: results of a randomized, controlled trial with cerebrolysin and donepezil. Current Alzheimer Research, 2011, 8. Jg., nr. 5, S. 583-591.
Alvarez. X., et al. Combination treatment in Alzheimer’s disease: results of a randomized, controlled trial with cerebrolysin and donepezil. Current Alzheimer Research, 2011, 8. Jg., nr. 5, S. 583-591.