The prospect of developing dementia is many people’s worst nightmare. But with case numbers high and genetics playing a role, it can feel almost inevitable to some.
Affecting seven million Americans, the disease most often strikes after age 65, robbing patients of their memories, problem-solving abilities, personality and basic independence.
Recent estimates suggest the number of dementia patients in the US is expected to double by 2050, driven largely by genetic mutations and modifiable risk factors such as high blood pressure, obesity and environmental pollution.
Dementia itself is irreversible, though some medications and lifestyle interventions have been known to slow its progression.
Focusing on a precursor to the devastating illness, which several studies have dubbed ‘pre-dementia,’ could be the key to stopping the condition before it starts, experts have revealed.
This is called mild cognitive impairment (MCI), a noticeable lapse in memory or thinking that gives patients pause without completely taking over their lives.
The subtle changes that occur with MCI could be forgetting about a long-standing appointment, spacing out in the middle of a meeting or feeling increasingly irritated at the smallest annoyances.
Dementia, however, looks like more frequent and profound episodes of memory loss, difficulty managing day-to-day tasks and trouble speaking or forming sentences.
Diagnosing MCI relies on patient interviews, memory tests and measures such as brain imaging and blood tests to rule out other conditions. In addition to the tests, doctors make a diagnosis based on complaints from the patient and their loved ones as well as how much independence they still have.
MCI involves the same brain changes as dementia, in which toxic proteins called amyloid and tau build up and form tangles that kill off cells in the brain’s memory and personality centers. Over time, as more brain cells die, MCI advances to dementia.
The Alzheimer’s Association estimates people with MCI are three to five times more likely to develop dementia compared to those with normal cognition. However, not all dementia patients have MCI first, and MCI does not always progress to dementia.
Dementia is becoming more common in Americans under 65. Jenna Nelson of Idaho was just 50 years old when she was diagnosed with early-onset dementia after family noticed she would often repeat herself and have trouble balancing.
She was also exhibiting personality changes and a sharp cognitive decline that left her unable to solve simple math problems or name colors.
Rebecca Luna of Canada was just 46 when she learned she had Alzheimer’s, and wrote on her GoFundMe page that doctors have given her between five and seven years to live.
Jana Nelson was 50 when diagnosed with early onset dementia, following severe personality changes and a sharp cognitive decline that left her unable to solve simple math problems or name colors
But as a recent study found half of dementia cases are tied to six modifiable risk factors, such as blood pressure and diet, experts have told the Daily Mail that MCI can be reversed or prevented entirely.
The key, however, is detecting it early before ‘irreversible cell death occurs.’
‘Think of cognitive health as a spectrum,’ Dr Jordan Weiss, assistant professor at NYU’s Optimal Aging Institute, told the Daily Mail.
‘On one end you have healthy aging – we’re talking about forgetting where you put your keys, or drawing a blank on a name you’ve known for 20 years and then remembering it an hour later when you’re doing something else entirely.
‘On the other end is dementia, where decline has become severe enough to interfere with someone’s independence.’
The scientific advisor and aging expert at Assisted Living Magazine explained that MCI lives somewhere in between the two.
‘With MCI, something is measurably off,’ Weiss continued. ‘It shows up on neuropsychological testing, but the person is still functioning, still driving, still cooking dinner.’
What separates the two, he said, is that dementia ‘erodes independence. MCI hasn’t done that.’
Experts estimate between eight and ten million Americans have MCI, but a recent study from the University of Southern California (USC) found that as many as seven million don’t know they have it.
Additionally, figures from the Alzheimer’s Association suggest only 18 percent of Americans are familiar with MCI.
Like dementia, MCI becomes more common with age. About seven percent of those aged 60 to 64 have the condition, while 25 percent of those between 80 and 84 have it.
Much like dementia, women are more prone to MCI than men. While some experts suggest this is because women live longer, Weiss pointed to hormonal differences.
‘Estrogen appears to be neuroprotective, and its decline at menopause may increase vulnerability,’ he said. ‘Women also have higher lifetime rates of depression and thyroid disease, both real risk factors.
‘For Alzheimer’s-type dementia, the underlying brain changes may begin 15 to 20 years before any symptoms surface.’
He also noted that once MCI is noticeable, it can progress to dementia within three to five years, though the exact timeline varies from person to person.
Weiss noted that struggling to find the right word is one of the earliest signs of MCI, but it’s not the occasional slip of the tongue everyone has. Instead, it’s more often repeatedly missing words in the middle of a sentence.
‘More significant is forgetting that a conversation happened at all, not just what was said,’ Weiss added. ‘That points to encoding failure, where the hippocampus is no longer consolidating new experiences into lasting memory.’
Dr Jordan Weiss told the Daily Mail that while MCI is reversible, interventions must begin early
People in the early stages of MCI may also start relying on lists or notes more often than previously. ‘Families usually spot this before the person does,’ Weiss explained.
At work or at home, patients may have difficulty with once-easy tasks, a sign of changes in working memory and executive function, and over time, patients may notice themselves getting lost in familiar places.
Weiss explained that when ‘your own neighborhood starts feeling confusing, that’s the brain trying to get your attention.’
For some patients, those signs can also be an indication of the early stages of dementia.
‘Early dementia can look a lot like advanced MCI,’ he told the Daily Mail. ‘Moderate dementia is when daily life starts requiring real support. Late-stage is where full-time care becomes necessary. MCI sits just before that arc begins, which is exactly why catching it there matters.’
Over time, the later stages of MCI and early stages of dementia look like repeating the same question multiple times in the same conversation, getting disoriented in familiar places and having trouble managing medications or finances without help.
Personality changes, paranoia, agitation and generally withdrawing from life begin to take over as parts of the brain that control memory and personality waste away.
‘Declining hygiene often gets misread as depression, but it can indicate the person has lost the ability to sequence the steps involved,’ Weiss said.
Older age is the most common risk factor for MCI, but lifestyle factors such as diabetes, smoking, high blood pressure, obesity, depression, a sedentary lifestyle and high cholesterol have all been shown to raise the likelihood.
Rebecca Luna was diagnosed with early-onset Alzheimer’s at 46
‘And this is what tends to surprise people: Not all MCI progresses,’ Weiss added. ‘Some people stabilize. Some return to their prior level of function, particularly when underlying causes get found and addressed.’
Starting early, even before symptoms begin, is key to preventing MCI, Weiss explained. ‘You don’t need a symptom to exercise, to get your blood pressure under control, to fix your sleep, to eat better,’ he told the Daily Mail. ‘The best time to start is before anything feels off.’
Deep sleep, for example, is the time in which the brain clears out toxic amyloid and tau tangles that cause dementia, but it is hindered by conditions such as sleep apnea, which cause repeated waking.
‘Untreated sleep apnea is one of the biggest underappreciated drivers of cognitive decline, and treating it can make a real difference,’ Weiss said. ‘If you snore and have never been evaluated, that conversation with your doctor is worth having.’
In addition to high blood pressure, chronic high cortisol caused by stress ‘is directly toxic to the hippocampus,’ Weiss said. He also pointed toward recent research suggesting hearing loss may be associated with cognitive decline.
Presbycusis, or age-related hearing loss, is thought to reduce brain activity and the volume of gray matter – part of the brain’s neural tissues that control thinking, memory and decision making – in areas of the brain responsible for hearing, speech and cognition.
‘Treating hearing loss, which people put off for years, is associated with real reductions in dementia risk,’ Weiss said.
Along with focusing on reversible lifestyle factors, blood-based biomarker tests can also help identify patients at the greatest risk of MCI, if symptoms are early or have not yet started.
‘But once someone reaches moderate dementia, the structural damage is largely beyond what medicine can currently undo,’ Weiss warned. ‘Progression can be slowed, symptoms managed, quality of life supported – but generally what’s been lost cannot be rebuilt.’
