Hoping for quick fixes
By Dr. Michael Gordon
On a recent office visit, Alice, who was accompanied by her two daughters, asked me: “ What are you going to give me to improve my memory the pharmacists said only my doctor could prescribe something that will help me.”
This was after I had informed them all that what Alice had was likely classifiable as “mild cognitive impairment” (MCI). It’s a condition in which the person may forget recently learned items, resulting in some need for repetition. MCI doesn’t have the features of early Alzheimer’s disease, such as breakdowns in judgement and decision-making. Nor does it come with the failure to execute essential everyday tasks.
Unfortunately, there are no specific tests (such as blood tests or scans) that can confirm a diagnosis of MCI, and instead a clinical diagnosis must be offered. Like Alice, many individuals believe that drugs such as Aricept (donepezil) are “memory pills.” Although these drugs can improve the short-term memory of some individuals with mild to moderate dementia, they have not been shown to be effective in those with MCI.
What, then, is there to do? This is a question asked of me by virtually every family, and it is not lightly asked. If one undertakes the usual contemporary ritual of searching the Internet, it’s possible to find recommendations ranging from “the responsible” to what those of us in mainstream medicine might consider a plethora of self-serving, unsubstantiated claims.
So, what therapies or changes do appear to have some benefit in reducing symptoms, both in early and late cognitive impairment the general term used to describe dementia?
The main reasonable and attainable changes are all related to what we would call lifestyle interventions: Address conditions that compromise the blood vessels, such as cigarette smoking (one of the worst risk factors), diabetes, high blood pressure and high blood lipids (cholesterol). Many of these can be well controlled without excessive effort. Smoking cessation is not easy, but can be done.
Then there are the slightly more complex undertakings, such as taking sustained exercise at least three days a week but, if it can be done daily, all the better. Activities that improve one’s mood, such as social interactions that stimulate connectivity and mental activities that occupy the mind, do not have such compelling evidence of a benefit but are intrinsically satisfying, and have no side effects.
Unfortunately, however, a recent review of studies from the Minnesota Evidence-based Practice Center concluded that there is no proven intervention for preventing late-life dementia (medicalxpress.com/news/2017-12-interventions-proven-late-life-dementia.html).
So that was, sadly, my message to Alice there is no quick fix! Right now, there’s no pill that can help to improve memory or reduce mental decline in those with MCI. However, in the realm of medicine things evolve and, with lots of hard work on the part of researchers and a little luck, I’m hoping a future column will contain better news.
Dr. Michael Gordon is Medical Program Director of Palliative Care at Baycrest Geriatric Health Care System.