Early diagnosis of memory problems key to treatment

Last night you went to see a movie with what's-his-name.

Then on the way out, you ran into old friends Joe Somebody and his lovely wife Jill or Judy.

To top the night off, you spent 10 minutes searching the garage for your car, which you were sure you parked on the yellow level, or was it orange?

Although disturbing, occasionally forgetting names or misplacing objects (even your car), are signs of normal forgetfulness and should not cause concern. However, continual forgetfulness may be a sign of a more serious memory problem, called amnestic mild cognitive impairment. People with mild cognitive impairment have memory problems greater than normal for their age but do not show other symptoms of dementia, such as impaired judgment or reasoning.

"People with amnestic mild cognitive impairment are usually aware that something is wrong with their memory, but they are able to compensate, so that it doesn't affect their daily functioning," said Rachelle Doody, MD, PhD, director of the Alzheimer's Disease and Memory Disorder Center at Baylor College of Medicine and a professor of neurology. "For example, they may start using a PDA, or they may designate memory tasks to someone else. Because they are so aware of it, they develop ways to check themselves."

Often, people with mild cognitive impairment develop coping mechanisms so sophisticated that only a thorough evaluation by a neurologist can detect a problem. Early detection by a doctor is important, because people with the condition are at higher risk for developing Alzheimer's disease within a few years of diagnosis. And while there is no cure for Alzheimer's, some drugs can help slow the patient's decline and help with symptoms, if taken in the early stages of the disease.

Do I have mild cognitive impairment?

Scientists are still working to agree on one definition of mild cognitive impairment, since so little is known about the condition. Following are some of the criteria doctors use to diagnose mild cognitive impairment, according to the Alzheimer's Association: An individual's report of his or her own memory problems, preferably confirmed by another person Measurable, greater-than-normal memory impairment detected with standard assessment tests Normal overall thinking and reasoning skills Ability to perform normal daily activities

One drug approved for patients with mild to moderate Alzheimer's has also shown promise in treating mild cognitive impairment. Donepezil, sold as Aricept, may slow down the time it takes for a person with mild cognitive impairment to develop Alzheimer's, according to a recent study presented at the Alzheimer Association's 9th International Conference on Research sponsored by the National Institutes of Aging.

The study compared donepezil, vitamin E or placebo in study participants who had mild cognitive impairment to see if the drugs might delay the onset of Alzheimer's disease or prevent it from developing altogether.
"Aricept delayed the conversion among the participants who developed Alzheimer's," said Doody, BCM's principal investigator of the national clinical trial. "For the first 18 months of the three-year study, fewer of the people on donepezil were likely to develop Alzheimer's. That doesn't mean that donepezil prevents Alzheimer's. It just slowed it down in one study."

Doody cautions that the study is just a first step.

"No one knows yet whether mild cognitive impairment patients should take donepezil or any other medication, and the FDA has not yet approved any drugs for this purpose," Doody added.

Study participants taking vitamin E didn't experience any significant benefit, according to the study.

Doody recently launched a shorter term, one-year study to investigate the effect that donepezil, compared to placebo, may have on the thinking abilities and symptoms of study participants with mild cognitive impairment. The Alzheimer's Disease and Memory Disorder Center is also participating in a national clinical trial sponsored by the National Institutes of Health, which will use magnetic resonance imaging and positron emission tomography scans to detect changes in the brain that may signify which mild cognitive impairment patients actually have Alzheimer's. Researchers will correlate the scans with clinical measures currently used to diagnose Alzheimer's.

"A better diagnostic tool could lead to earlier diagnosis of Alzheimer's," Doody said. "A scan could tell you who you have to worry about and who you don't. The goal is to develop therapies that will be effective for patients in the mild cognitive impairment stage."