Jack St. Genis of Griffin noticed his memory faltering about two years ago.
The former Marine and semi-retired business executive would go to the refrigerator and forget why he was there. He couldn’t go to the grocery store without a list. He needed people to repeat phone numbers or email addresses. He’d try to knock out an email, but some of the words didn’t come to him. He forgot names of neighbors and even the name of a grandchild.
The words or thoughts came, just not right away.
“There’s a delay,” said St. Genis, who is 72 and lives in a golf course retirement community. “It comes, but it might take a minute or two.”
Two doctors dismissed his slipping memory as just aging.
But he knew this was different. A new doctor ordered an MRI to rule out a stroke, and eventually diagnosed St. Genis with mild cognitive impairment (MCI).
St. Genis is one of millions of Americans negotiating a gray area of mental acuity that exists between normal aging and Alzheimer’s disease.
In this intermediate state of cognitive function, people can have trouble remembering names and words, and paying bills. Most people with MCI can live independently and participate in their normal activities.
“I can cope with a lot of things,” St. Genis said. “I can cope with someone being nasty at me, but not remember what button to push on the computer and that makes me furious.”
These more subtle declines in acuity are more difficult for doctors and researchers to diagnose, in part because many other conditions can have a secondary impact on memory and brain function. Memory lapses and spells of confusion are often caused by an illness, depression and other treatable health woes.
Doctors generally have to exclude a host of conditions before they can be certain that a patient suffers from mild cognitive impairment.
Even then, there is no certainty that a person with MCI will develop the more serious condition of Alzheimer’s, which slowly destroys brain pathways.
Between 10 percent and 20 percent of people over 65 have mild cognitive impairment, according to experts.
About half of people diagnosed with MCI will be diagnosed with Alzheimer’s within three years. And close to 8 in 10 will be diagnosed with Alzheimer’s within 10 years.
Dr. Majid Fotuhi, an assistant professor in the Department of Neurology at Johns Hopkins University School of Medicine, said he’s seen patients with depression fail a memory test but do well after three months of treatment. He’s seen women experiencing memory lapses while approaching menopause eventually get their mental clarity back.
Staff members at Atherton Place in Marietta, a senior living facility that includes independent apartments and assisted living, never jump to conclusions when they see residents suddenly hallucinating or acting bizarre. Bladder infections, side effects from drugs and vitamin B12 deficiency, can all impair cognitive function.
With MCI, the changes are typically more gradual. Wearing the same clothes for several days in a row, having difficulty paying bills or keeping track of appointments are indicators of MCI.
There is no specific test to confirm a diagnosis of MCI. Doctors make this diagnosis after conducting mental status testing and by ruling out other causes for cognitive decline such as an underactive thyroid gland. An MRI or CT scan of the brain can detect evidence of a stroke or brain tumor, which can also cause deficits in brain function. And often, doctors have to make judgment calls.
Fotuhi said some memory lapses are an “acceptable” part of aging. For example, Fotuhi gives a 75-year-old patient four items to remember. If the patient can remember half of the items and the other two after receiving clues, the patient likely does not have MCI. But if a patient can only remember one of the items and can’t remember the other three, even after clues are provided, that’s a red flag. Other common tests for MCI include writing a sentence and naming 8 to 10 fruits in one minute.
Often, the biggest clues to cognitive decline come from family members. A person who repeats the same questions at least two to three times can be exhibiting mild cognitive impairment.
“For example, a loved one may ask, ‘What are we doing tomorrow?’ And you tell the person, ‘We are going to the dentist.’ And then a few minutes later they ask the same question again, and again and have no recollection of the previous conversation.” That could be reason for concern, Fotuhi said.
It’s also possible the person asking the question over and over is simply exhausted and needs a good night’s rest. That’s why Fotuhi looks for patterns of behavior.
Noticing early signs
Mildred DeCsaby, an 89-year-old retired nurse who lives independently at an apartment at Atherton Place, started noticing she was forgetting the names of friends and losing track of things in her apartment about a year ago. Regular routines and exercise seem to be helping her, she said.
She walks every morning shortly after breakfast for about one hour, the same route every day. She organizes her clothes the same way every time. And she puts sticky notes on her door to help remind her of appointments.
She reads every day, from histories of India to gardening books and her Catholic University alumni magazine.
And as DeCsaby smiled warmly and talked about her life, the staff pointed to something else that seems to be helping: her positive attitude.
On a recent afternoon, DeCsaby talked about how her mother died when she was a child. She said it wasn’t easy growing up without a mother, but she’s always tried to focus on the blessings in her life. She looks forward to her daily walks, which always include a break at a stone bench.
Necessary assistance
Claudia Fine, chief professional officer at SeniorBridge, a health care consulting company, said the diagnostic boundaries of brain decline have become “blurred.”
“I’ve been in this field close to 30 years and when I started, mild cognitive impairment didn’t really exist,” she said. “What we had was pseudo-dementia and that was not really dementia, it was depression.”
SeniorBridge is often called by an adult child worried about an elderly parent’s behavior.
Sometimes the senior has an illness or is suffering from “sensory depravation,” and simply needs a more engaging lifestyle that gets him or her out of the house more, according to Fine. SeniorBridge puts together customized plans for patients. The plans can include getting help to pay bills, putting together a daily schedule and labeling kitchen cabinets with signs that say, “dishes go here.”
As people live longer, the chances of someday facing cognitive decline go up, Fotuhi said.
“If we live long enough, we will all lose our marbles,” he said. “Once you pass 100, we don’t use this diagnosis [of mild cognitive impairment]. We just say ‘job well done.’”
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