The Future of Treating Mild Cognitive Impairment
August 28, 2020
Looking at a face you know you should know… and failing to recall who it is.
Hearing or reading directions several times, because you can’t remember what they say by the time you get the end of the step you’re reading.
Getting in the car, driving away, and struggling to recall where you were going.
Some of this is normal aging, but sometimes, there’s a more serious current brewing in your brain. It’s called Mild Cognitive Impairment, and it can be treatable.
In this article, we’ll discuss:
- A thorough discussion of Mild Cognitive Impairment, including lack of medicines
- Current prevention and treatments
- How TMS is thought to treat Mild Cognitive Impairment
Understanding Mild Cognitive Impairment and Neuroplasticity
There is a natural decrease in cognitive abilities as we age, but sometimes that natural decrease starts slipping from normal into concerning territory. This is believed to be, in part, due to a lack of neuroplasticity, a term that essentially means the brain’s ability to repair, rewire, and build new neural pathways.
Those little synapses and nerve endings just don’t fire the way that they used to, and much like a congested street at rush hour, the remaining-- and sometimes dwindling-- brain traffic slows down, gets stuck, or worse, ends in a crash. The results can range from poor judgement and memory to lack of physical ability to balance. Hand-eye coordination is affected, as are planning abilities and other thinking skills.
This can be normal, or it can decline further and develop into Mild Cognitive Impairment (MCI). This increases the patient’s chances of developing severe cognitive impairments and diseases such as Alzheimer’s and dementia. Causes can include genetics, strokes, shrinkage of the hippocampus, brain damage, and more. Risk factors-- things that increase your chances but do not cause the MCI-- include medical conditions like diabetes, smoking, high blood pressure, and obesity, but also include other factors such as low education level and lack of physical exercise.
Approximately 15-20% of adults over the age of 65 develop MCI, and of those who do, a further 10-15% go on to develop actual dementia or Alzhiemer’s. Men appear to be at higher risk than women.
There are no current medicines for MCI that treat or cure the actual problem, and patients should be evaluated at least every six months. Medicines that are currently on the market for Alzhiemer’s, dementia, and MCI only treat the symptoms, not the issue that causes the symptoms.
Prevention and Current Treatment of Mild Cognitive Impairment
Before we discuss some promising new developments, let’s discuss whether preventing MCI is possible and current treatments available.
As it turns out, since we understand a lot of the factors that contribute to Mild Cognitive Impairment, it is possible to adopt prevention tactics fairly easily and early on in life. MCI is as much about genetics as it is about physical health and mental stimulation-- both things which are tied to lifestyle choices.
Since MCI is caused by the brain, it makes sense that powerful prevention lies in keeping your brain healthy with activities and stimulation. Engaging in crafts, games, and social activities increases your chances of NOT developing MCI by 25%, especially when it is part of regular life. Using a computer also contributes to preventing MCI. However, some studies suggest that it is only when these types of artsy or social activities are adopted earlier in life are they effective at preventing the development of MCI. Those who begin in midlife only may be starting too late for it to be effective-- studies are mixed on this.
It’s important to note that most of these activities-- arts and crafts, games, computers, and regular social interactions-- involve a need for constant thinking, learning, and problem-solving. You’re using areas of your brain that are vulnerable to decline in ways that makes them stronger. This is further supported by the fact that low education is often a risk factor for MCI, which means that constantly increasing education in various ways--like learning skills and reading, engaging in conversations and debates-- should be a factor in decreasing MCI’s likelihood of occurring.
It’s worth noting that studies are still mixed about the effectiveness of “brain training” exercises. Some show that they do not contribute to prevention, but others show that computer-based brain training exercises may be effective in treating MCI.
Physical fitness is also an effective prevention tactic, particularly muscle training that is rigorous. Passive exercises such as stretching did not appear to contribute to prevention in one Australian study. But since cardiovascular health, diabetes, alcoholism, and such are risk factors for MCI, maintaining a healthy body with nutrition and exercise is a powerful prevention tactic for MCI and other issues.
So far, science has not been able to verify any claims of preventing MCI or memory-boosting supplements. However, treating any depression, anxiety, and sleep disorders in a thorough and multi-pronged way help to remove those issues from the risk factor list. Talk to your doctor about all medicines, as some may carry risk factors for developing MCI, especially in regards to certain types of antidepressants.
Overall, there are no proven medicines to effectively treat MCI. The current course of treatment relies heavily on physical health, with methods such as physical therapy prescribed. Gait assessments and driving safety are a huge concern, as balance and coordination as well as thinking skills decline with MCI. Patients are more likely to fall, get lost, or forget how to follow directions-- therefore caretakers may need to take precautions to prevent these issues.
Decisions about care and the fright patients experience when they realize that they are mentally declining in health are not easy to cope with. There are therapists who can help both caretaker and patient with the mental and emotional burdens, as well as social workers who can help advise on difficult decisions and direct you towards resources. Take advantage of these support networks-- they are trained well and are often readily accessible, even to those who are experiencing financial hardship, through sliding scale clinics and non-profit organizations. Support can also be found for free online through specialized support groups.
Mild Cognitive Impairment and TMS
There is hope on the horizon though. A new application for a treatment developed in the 80’s may hold the key.
Transcranial Magnetic Stimulation (TMS) delivers magnetic pulse to the brain via an electrical coil that is placed against the patient’s head. It stimulates the brain’s natural electrical currents, which stimulates nerve cell growth and neurons to fire. It is possible to control how deep the electromagnetic waves penetrate the brain by controlling the amount of focus points for the delivery of the magnetic pulses.
The rapidity and repetition of the pulses stimulates the brain in different ways, making it possible to personalize the treatment. It’s currently used to treat depression, stroke rehabilitation, migraines, and more with relatively few and usually mild side effects.
Since TMS essentially rewires the brain, and helps it to keep rewiring itself, it only makes sense to develop a way of using it to treat Mild Cognitive Impairment, since a decline in neuroplasticity is a decline in that very element. But how to tell where to aim the electromagnetic pulses, and at what speed and strength?
Researcher Ying-hui Chou of the University of Arizona discovered that an MRI could be used to create a tailor-made approach to using TMS to treat Mild Cognitive Impairment, particularly in regards to developing Alzheimer's. She was recently granted $3.4 million dollars to develop this idea further.
Her idea is to use TMS, guided by MRI images, to plan and target specific areas like the hippocampus, to increase neuroplasticity and therefore reduce MCI. The hippocampus is central, and related to other brain areas, in the war against MCI. To be able to stimulate it using TMS would help modulate the communication between it and the brain bits connected to it. The problems with memory loss related to MCI are what Chou hopes to treat, as it is a subclass of MCI specifically related to the development of Alzhiemer’s disease called amnestic.
Chou’s idea to use MRI’s to guide the use of TMS to specifically target the hippocampus hasn’t been done before in amnestic MCI patients. The reason is because the hippocampus is roughly 25 centimeters into the brain, which is much deeper than traditional TMS has reached.
Since the hippocampus can’t be reached with TMS, Chou plans to use the MRI to see which areas of the brain are more directly connected to the hippocampus-- using it like a Google Maps directions-- and target them instead. She’s also hopeful that if she can produce enough evidence that TMS is beneficial to neurodegenerative diseases, the FDA will approve it as a treatment, and that eventually the combination of TMS and the MRI might also be able to be used to predict if the patient will benefit more from TMS or another treatment.
TMS’s brain-boosting stimulation has certainly benefited patients with mental illnesses such as depression, so it definitely has potential for other brain-related issues. Mild Cognitive Impairment is just the next item on the list, and we can’t wait to see how Dr. Chou’s study turns out.