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Prevalence of Cognitive Impairment without Dementia in the United States - DementiaGuide.com
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Prevalence of Cognitive Impairment without Dementia in the United States

Posted on May 12, 2008 by DementiaGuide

Prevalence of Cognitive Impairment without Dementia in the United States

A recent article in an American Medical Journal entitled "Prevalence of Cognitive Impairment without Dementia in the United States"describes the results of the Aging, Demographics and Memory Study (ADAMS). The investigators led by Brenda L. Plassman of Duke University Medical Center concluded that "Cognitive impairment without dementia is more prevalent in the United States than dementia, and its subtypes vary in prevalence and outcomes." The abstract and the patient summary are available at the American Journal Annals of Internal Medicine .

What does this mean to the person or the family who is seeing a change in cognition? As the authors have indicated, there are few studies that have been done to investigate cognitive impairment without dementia. The first to describe the problem and compare it with how commonly dementia occurs was done in Canada, and published in the Lancet in 1997 . Cognitive Impairment, No Dementia (or CIND, as it is called) is common, especially after age 80. Sometimes it is seen with depression, or disease of the blood vessels to the brain. Sometimes it goes on to become Alzheimer's disease, or any other dementia, and sometimes it remains stable, or even improves. Who will have which course is hard to know, but the observation that it can get better, stay the same, or get worse has suggested to some people that it reflects dynamic changes within the brain (reference article). This is an important idea, because it suggests that brain change is not a one-way street to worsening. Under the right circumstances, the brain can somehow "fight back" to resist dementia, so that people who exercise, for example, have a lower risk of progression of their illness (reference article).

So what to do? As with all health matters, the better one can describe and communicate what is happening, the more likely the physician is able to pinpoint the cause and make accurate diagnosis and recommend treatment options. The dilemma facing families and often their physicians is the reluctance to talk about changes in cognition - mostly through fear of being told that they are experiencing a symptom of dementia.

Only two weeks ago, Dr. Brian Carpenter, Washington University's study concluded that instead of people responding to a diagnosis of dementia with depression, in most cases, they accepted the diagnosis and began to organize their lives and care planning around the disease. According to the authors, "This study confirms that most patients, regardless of their degree of impairment, tend to experience a sense of relief after getting their diagnosis.

Each time a new study is conducted about dementia, Alzheimer's disease or in the case of this study, about cognitive impairment without dementia, it resonates how much more we need to know and understand about these diseases and how much physicians rely on their patients and care partners to help them understand "what is happening". When a patient and their caregiver come to a doctor's appointment and can describe what, when and how often a symptom is occurring, the discussion and care planning is apt to target a diagnosis and treatment. SymptomGuideTM was designed to help patients and their caregivers understand and describe what is happening and to actively participate in disease treatment decision making.

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