1. Running head: COMPARING COGNITIVE CHANGES 1
Comparing Cognitive Changes
Debbie Fernando
HCS/551
February 3, 2014
Dr. Donna Fife
2. COMPARING COGNITIVE CHANGES 2
Comparing Cognitive Changes
There are significant differences in the cognitive changes noticeable in Mild Cognitive
Impairment (MCI), Alzheimer’s disease (AD), and Parkinson’s disease. This paper will describe
the 3 diseases and explain how they are evaluated. The progression of changes that occur with
each disease will be discussed. The effects each has on the patient, family and friends, and
society will be covered. Any preventative measures or treatments will be discussed as well as
how to manage the symptoms of the diseases and resources available for support. Please feel free
to ask any questions or voice any concerns that may come to mind as you review this handout
with your health care provider.
Mild Cognitive Impairment (MCI)
Mild memory problems falling between two poles of “normal” and “dementia” are
common in older people. The World Health Organization (WHO) has placed a widely used
common term to use for these people, Mild Cognitive Impairment (MCI) (Chertkow, 2002). Mild
cognitive impairment is a syndrome defined as cognitive decline greater than expected for an
individual's age and education level but that does not interfere notably with activities of daily life
(Gauthier et al., 2006). People with MCI may have some short or long term memory loss with
no loss in the ability to function with daily activities. MCI is a label for people who do not have
“normal” cognitive functioning but also do not have enough cognitive impairment to classify
them with “dementia”. People with depression, delirium, mental retardation and other
psychological conditions are not included in this group.
Criteria for MCI
There are certain criteria that must be met for each neurological condition. The criteria
for MCI include a subjective complaint of memory loss and an objective impairment of memory.
3. COMPARING COGNITIVE CHANGES 3
Other cognitive abilities remain intact, basic day-to-day functioning is normal, there are no other
neurological or psychiatric problems causing the memory impairment, and dementia criteria are
not met. There is a debate on the percentage, but changes are that many people with MCI will go
on to develop dementia, especially Alzheimer’s disease (Chertkow, 2002). Many people have
subjective memory impairment where they think they have memory problems but they do not
show any objective impairment. It has been shown that the people who have subjective memory
impairment have a good chance of going on to develop dementia within the next 7 years
(Gauthier et al., 2006).
Effects
MCI effects people only in a mildly. As long as the person tries his best to remember by
doing the exercises, it should be only a mild nuisance. Family and friends need to watch for the
beginning of an increase in the memory loss, personality changes, and other cognitive
impairments. These need to be reported to the physician immediately.
Treatment
There is no treatment for MCI. Many people do things to help them remember like
keeping notes, repeating people’s names, and studying. Other ways to keep MCI at bay are
crossword puzzles, reading, working math problems, or anything that “exercises the brain”. It is
possible that doing these things will delay the onset of more severe symptoms. Of people with
mild cognitive impairment, about 15% will progress to dementia each year; 90% of this will be
due to Alzheimer’s disease. ("Memory Loss and the Early Signs of Alzheimer’s", 2011).
Parkinson’s disease
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“Parkinson’s disease is a disorder of the brain that leads to shaking (tremors) and
difficulty with walking, movement, and coordination” (Parkinson’s disease, 2013, para. 1).
Parkinson’s disease is one of the most common nervous system disorders of the elderly
(Parkinson’s and Alzheimer’s disease, 2012). There is no difference in occurrence between
women and men. It can sometimes run in families. Nerve cells need a brain chemical called
dopamine which helps control muscle movement. Parkinson’s disease can develop when the
brain stops producing dopamine. The disease gets worse with time.
Symptoms
Individuals with Parkinson’s disease may first notice a stiff leg or foot that they feel like
they are dragging. When asked to hold out a limb, that limb will tremor. The tremors stop when
movement begins. The person may have trouble starting movements, especially in the legs. They
may also have trouble stopping a movement. Other symptoms that may develop over time
include drooling, a stiff face (because of the inability to control facial muscles), difficulty
walking, difficulty swallowing, constipation, slow blinking, loss of fine motor skills (unable to
write and trouble feeding self), and stoop shoulders. Often a “pill rolling” movement will be
uncontrollable.
Treatment
There is no cure for Parkinson’s disease. Medications can be used to help the brain make
dopamine. The goal of treatment is to control the symptoms as long as possible. Some of the
medications may cause hallucinations. Also, the medication may wear off as the day progresses.
Discuss this with your doctor. He may be able to change the medication, the dosage, or the time
5. COMPARING COGNITIVE CHANGES 5
it is taken. Certain tests can be done to help diagnose Parkinson’s disease. A swallowing test may
be performed along with brain scans and other tests.
Effects
The main effect that Parkinson’s disease has is there needs to be an increase in safety
precautions. Since the person may have trouble swallowing, choking is a constant worry. The
food has to be prepared so that it can be easily swallowed. Also, there is risk of falling since the
person has trouble starting and stopping movements. He may be walking and try to stop to avoid
tripping on something and be unable to stop. His surroundings need to be adjusted accordingly.
Alzheimer’s disease
“Alzheimer's disease (AD) is an age-related, non-reversible brain disorder that develops
over a period of years. Initially, people experience memory loss and confusion… ("National
Institute of Neurological Disorders and Stroke", 2014, para. 1). However, with AD the memory
loss becomes so bad that the patient will not recognize family members or remember to do their
activities of daily living. Personality changes occur with AD. It is important for family to
remember that if the patient starts talking mean to them that it is the disease process and not the
person they remember. AD becomes a safety factor for the patient. He may wonder off
somewhere and not know where he is or how to get back home. AD is the most common of the
dementias in people over age 65. Cognitive abilities worsen over time until there is a severe loss
of mental function.
Treatment
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There is no known cure for Alzheimer’s. There are medications that the physician may
prescribe to help with the symptoms. The goal in treating AD is to slow the symptoms as much
as possible. Aricept, Exelon, or Razadyne may be prescribed for mild to moderate symptoms
whereas Donepezil or Namenda may be prescribed for moderate to severe symptoms. The NIH is
conducting clinical trials and studies at the present time.
Effects
AD is a traumatic change in lifestyle for the family. They must keep a constant eye on
their loved one and finally make the decision of whether to place her in a long term care facility.
The patient very probably does not know she has the disease and has no idea on how bad it is for
the family. For society, taking care of Alzheimer’s patients is costly. In 2013, the nation spent
203 billion dollars caring for AD patients. The cost is expected to rise to $1.2 trillion by 2050.
The emotional effect on the family caregivers is enormous. At least one-third of them report
depression. Due to the toll of caregiving, an additional health care cost of $9.1 billion was spent
in 2012 on the caregivers (Alzheimer’s and dementia, 2014, para. 6).
Conclusion
Mild cognitive impairment, Parkinson’s disease, and Alzheimer’s disease are all
neurological diseases of the elderly. MCI is the least worrisome with only mild memory loss or
impairment involved. Parkinson’s disease is a brain disorder that involves movement and muscle
control. These people have tremors, problems speaking and swallowing, and trouble with
walking. Alzheimer’s disease is the most common of the dementias in the elderly. It usually is
first noticed by just mild memory loss progressing to total mental dysfunction. Alzheimer’s
7. COMPARING COGNITIVE CHANGES 7
patients cannot remember family members or events or to take care of themselves. There are
ample resources available that family members can reach out to for information and help.
“Meals on Wheels” delivers food to people who need a hot meal. There are associations that
provide help for each specific disease. These can be found on the Internet, your public health
department, or by asking your health care provider.
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References
Alzheimer’s and dementia. (2014). Retrieved from
http://www.alz.org/alzheimers_disease_facts_and_figures.asp#cost
Chertkow, H. (2002). Mild cognitive impairment. Retrieved from
http://s3.amazonaws.com/academia.edu.documents/31006846/15.pdf?AWSAccessKeyId
=AKIAJ56TQJRTWSMTNPEA&Expires=1391331748&Signature=RZwLfgG14fq5cNP
ZhkTFkn7hTO0%3D&response-content-disposition=inline
Gauthier, S., Reisberg, B., Zaudig, M., Peterson, R. C., Ritchie, K., Broich, K., …Winblad, B.,
(2006, April). Mild cognitive impairment. The Lancet, 367(6), 1262-1270.
Memory loss and the early signs of Alzheimer’s. (2011). Retrieved from
http://www.earlysymptomsalzheimers.com/memory-loss
National institute of neurological disorders and stroke. (2014). Retrieved from
http://www.ninds.nih.gov/disorders/alzheimersdisease/alzheimersdisease.htm
Parkinson’s and Alzheimer’s Diseases: similar but very different. (2012). Retrieved from
http://www.alznyc.org/nyc/newsletter/fall2012/06.asp#.UuymmfnYeSk
Parkinson's disease. (2013). Retrieved from
http://www.nlm.nih.gov/medlineplus/ency/article/000755.htm
