Every day in the United States, 16 million people live with a cognitive impairment of some kind, according to the Centers for Disease Control and Prevention. To put that into perspective, New York City has a population of eight and a half million people. How do you know if you are one of the 16 million?
To know if it’s time to see a doctor for a possible cognitive impairment, you need to understand exactly what is cognitive impairment, what the symptoms are, and what can be done to help.
What is a Cognitive Impairment?
The definition of cognition is “the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses.” Consistent difficulty in any of those processes can be a cognitive impairment.
Cognitive impairments happen when something in the brain isn’t functioning as it should. It can affect a person’s thinking, memory, vision, mood, and more. Essentially, cognitive impairment (CI) is the decline in a person’s ability to perform a task with his or her brain.
A cognitive impairment is not, however, occasionally being forgetful. Everyone forgets something now and then, and we all have days in which we just feel out of it. A cognitive impairment is more consistent and can disrupt a person’s everyday life.
Cognitive impairment is not the result of just one disease, nor is it a disease in and of itself. Instead, this condition is a symptom that may indicate one of many different illnesses. For example, someone with Alzheimer’s typically has one or more cognitive impairments.
Types of Cognitive Impairment
The human brain is complex, and as such, many things can go wrong. There is no one type of CI. A person can develop one or more kinds of CIs, depending on the underlying cause. Cognitive troubles can affect your brain’s many functions and cause problems in your daily life.
The first type of CI is aphasia or a problem with language. The brain must perform a lot of unique tasks to comprehend and respond to language. If any one of these processes stops working the way it ought to, the person can develop aphasia.
Within the aphasia category of CI, there are sub-categories as well. The first is anomia. An individual with anomia may have trouble naming everyday objects, even though they recognize the object. For example, a person may point to a salt shaker and say, “pass me that stuff,” rather than, “pass the salt.”
The second sub-category of aphasia is paraphasia. Like with anomia, a person with paraphasia has difficulty identifying the name of household objects. However, a person with paraphasia may only say the wrong word, even though he or she believes they said the right word.
For example, a patient may point to a potato and say “tomato.” However, he or she may feel certain that they were thinking “potato” when they said the wrong word. This type of aphasia can be particularly frustrating for many people.
The third type of aphasia is agrammatism or trouble with simple grammar. You shouldn’t worry about small slip-ups and typos. A person with agrammatism understands each of the individual words in a sentence, but not their relationship with one another.
For example, you may tell someone with agrammatism to “touch the paper with the pen.” He or she may understand that you are talking about touching, the paper, and the pen. However, the patient may not grasp the full meaning of the sentence.
Apraxia cognitive impairments put up a barrier between the commands the brain puts out and the functions the body carries out. The body struggles to follow the mind’s commands, and the patient often becomes frustrated.
If you think “take a sip of this water,” but your body struggles to do so or follows the command improperly, you may have apraxia. You may be the only person who can truly detect whether your body is listening to your brain, so it’s important to be honest with yourself.
This cognitive disorder is not what it appears to be in movies and soap operas. Amnesia is a cognitive memory disorder that keeps a person from forming new memories. This is the most common type of CI and is often associated with Alzheimer’s and dementia.
If a person has difficulty recognizing objects, people, or places, he or she may have agnosia. Unlike aphasia, which affects a person’s ability to name an object, agnosia keeps a patient from even understanding what the object is or how they relate to a person.
Sometimes a person with agnosia can understand and recognize things on one side of them but not the other. Although the patient can see both sides, he or she cannot comprehend what is on their left side. This mental impairment can cause the patient to be anxious and confused.
When the frontal lobe of a person’s brain sustains an injury, the person can develop executive dysfunction. This type of cognitive impairment keeps the patient from making decisions, plans, and goals. The person may get stuck on unimportant details and miss the big picture.
For example, someone with executive dysfunction may see the symbol for “no smoking” and get stuck on the circle with a slash through it. He or she may then see it as a “do not enter” sign instead.
Mild Cognitive Impairment
Even within each type of cognitive impairment, there are varying levels of severity. The most common level is a mild cognitive impairment or MCI. If you have an MCI, you and the people around you will notice the difficulties. However, the symptoms are not severe enough to put your life on pause.
Any of the other types of cognitive impairments can be MCIs. For example, a person with mild amnesia may have Amnestic Mild Cognitive Impairment. Keep in mind that only a trained professional can decide the severity of the disability.
Signs & Symptoms
The patient or a close loved one will typically be the first person to recognize the symptoms of an MCI. If you’re worried about yourself or someone in your family, look out for the signs of cognitive impairment.
Forgetting something every now and again is normal. However, being more forgetful than you used to be could be a sign of an MCI. If you continue to forget significant events or appointments, that could be a sign as well.
People with an MCI may also become more impulsive than before. As with your memory, it’s important to compare your impulsivity to how you have been in the past, not to someone else’s behavior. Change over time is a better indicator of an MCI.
If you notice that you often lose your train of thought while you talk or read, that could be an MCI. Similarly, you may have difficulty concentrating on movies, books, or conversations. You may also find it hard to navigate, even in your own home.
Due to the nature of MCIs, the patient sometimes does not recognize these symptoms in himself or herself. If your family or friends say they see these signs in you, be sure to take it seriously. They may notice things that you don’t.
People with MCIs may experience mood disorders as well. It can be frustrating to lose certain mental abilities. So, patients can develop depression, anxiety, and unfamiliar aggression. The individual may also feel uninterested in or apathetic toward things he or she used to love.
Unfortunately, there is no single cognitive impairment test that can help you determine if you have an MCI. Instead, you should see a specialist. A doctor can diagnose you based on a few important criteria.
First, the clinician will determine if you have trouble with your cognition. The doctor may simply ask you about your symptoms, or he or she may call in your loved ones to ask them. Next, the doctor will see if you’ve gotten worse over time or if you had a temporary problem.
Once the doctor has determined those things, he or she will work with you to determine the severity of the impairment. If your troubles do not significantly impact your life, it may be an MCI.
Next, your doctor may give you a Mini-Mental State Examination, or an MMSE. This quick test gives the doctor an idea of your current mental state. There are not wrong answers; this is a diagnostic tool. Depending on your test, your doctor may order further examinations of your cognitive abilities.
Finally, the doctor will try to rule out dementia and Alzheimer’s. These illnesses do cause cognition problems. However, they are severe enough that they do not qualify as an MCI. Treatments for dementia and Alzheimer’s are different than those for other cognitive impairments.
As part of the diagnosis process, your doctor may give you a basic neurological exam. This test just tells the doctor how your reflexes, eye movements, and balance are working. The results of the neurological exam can help your doctor find an underlying condition that may cause your symptoms.
For example, your doctor could find that a tumor has caused your cognition difficulties. They may also find Parkinson’s disease, stroke, or another condition that causes your symptoms. At the very least, this examination can rule out certain problems to help in the diagnosis.
If your doctor suspects a brain tumor, stroke, or brain bleeding, he or she may ask you to undergo an MRI or CT scan. These tests can help your doctor find and treat the underlying cause.
Sometimes, something as simple as a nutritional deficiency can cause MCIs. Your doctor may order blood tests to see if you have a vitamin B-12 deficiency or an underactive thyroid. Either of these problems could be the source of your memory problems.
If you receive an MCI diagnosis, you may feel hopeless and irritated. However, there are many treatments available to help MCI patients stop or live with their symptoms. Your doctor will use your symptoms, any primary problems, and your medical history to determine a plan of action.
If your medical team determines that Alzheimer’s disease is the cause of your mental decline, you may receive cholinesterase inhibitors. These drugs are the approved method for treating Alzheimer’s disease patients. However, these drugs are not typically prescribed to other MCI patients.
Sometimes, high blood pressure can cause an MCI because the pressure affects the blood vessels in the brain. Your doctor may prescribe blood pressure medication to lower your numbers. You will need consistent monitoring to be sure your BP stays in the right range.
Depression is quite common in MCI patients. If you or someone you love is depressed, seek medical attention. You may need therapy, medication, or a combination of both to overcome this symptom. Often, a patient’s memory improves when his or her depression clears.
Troubles with your sleep routine may cause memory problems and an MCI. If this is the case, your doctor may wish to treat the underlying sleep problem. Sleeping pills, sleep apnea masks, and changes in your routine can all help in your recovery.
Some people swear by certain alternative medications or supplements to treat their MCIs. These proponents say that vitamin E, ginkgo and other supplements can reverse your symptoms. However, it’s important to note that there is scant scientific evidence to back up these claims.
The Link Between Chronic Neck Pain & Cognitive Impairment
Your cognitive impairments may have an unlikely cause: neck pain. Recent studies have discovered that a person’s chronic neck pain and stiffness could be linked to cognitive troubles. In this case, the pain you experience changes your entire brain chemistry to create cognition problems.
In fact, neck pain can change the very wiring in your brain, which can certainly cause problems with your senses. This happens because the pain causes cells in your spinal cord to deteriorate faster than they otherwise would. It particularly affects the area of the brain that processes emotion.
This could explain why so many people with an MCI experience depression. Their pain has caused their brain to process emotions differently. The pain itself can also make it difficult for an individual to focus. After all, pain is incredibly distracting. Over time, this can lead to an MCI.
Getting your cognition back may be as simple as treating your underlying, chronic neck pain. For this reason, you may want to visit a neck specialist as soon as possible. The sooner you find an effective treatment for you, the sooner you will be back to your old self again.
When to See a Doctor
The earlier you see a doctor for potential cognitive impairments, the sooner he or she can diagnose the problem and recommend treatments. Although it can feel embarrassing to see your family doctor for cognition problems, you should know that your doctor just wants to help you.
Cognitive impairments are not usually a reason to run to the emergency room. As such, you often have time to prepare for a productive appointment. A little groundwork now can help your appointment go smoothly.
When you call to make the appointment, ask if the doctor will take any blood samples or run other tests. This way, you can appropriately manage your time.
In the days leading up to the appointment, write down every symptom you experience. The pressure of a doctor’s visit can make anyone forget a symptom, especially someone with memory loss. Keep a list in a common place in your house and write down issues you have as they come up.
If it is at all possible, bring a trusted friend or family member to your appointment. Your doctor may want to ask them some of the same questions he or she asks you, just to get the full picture. Make sure your companion is someone who has seen your symptoms in action.
Be sure to make lists of your other medical conditions and any medication you take. Include the date of diagnosis (or close to it) for any medical conditions. Also, be sure to write down the dosage of your medications. These details can help your doctor determine what caused your MCI.
Finally, make a list of questions you may have for your doctor. You may ask things like “What tests should I get?” and “What are the treatment plans?” Anything that concerns you is a legitimate question for your doctor.
If you think you may have an MCI, check the symptoms above. If you struggle with any of those, go ahead and make an appointment with a trusted doctor. He or she will run a few diagnostic tests to help determine the cause of your symptoms. Depending on the cause, there may be treatments available.
You are not alone in your battle with cognitive impairments. Be sure to build a solid support system to lean on when things get tough. The people you love can help you get through your treatments and even feel like your old self again.