Posts Tagged ‘mild cognitive impairment’

Secondary Dementias

Secondary dementias, for the most part, begin with disease outside the nervous system.  They are not associated with a degenerative process like Alzheimer’s disease in which the pathology usually involves the brain itself and no other parts of the body.  The secondary dementias usually involve some general systemic process which affects the brain secondarily.  I have divided these secondary dementias into groups: Infection, Metabolic, Brain Tumors, and Trauma, which I hope will be have some benefit.


One important issue to remember about secondary dementias is that in many cases they are treatable dementias.  For example, thyroid dysfunction or toxic states.


Infectious Disease:

The most difficult infectious disease is called Creutzfeldt-Jakob disease (CJD).  Creutzfeldt-Jakob is a disease caused not by a virus but by an infectious protein very similar to a virus.  In the past it was quite difficult to diagnosis CJD because we didn’t have adequate neuro-imaging studies.  We used to frequently biopsy the brain in Creutzfeldt-Jokob, but in association with this biopsy there was the potential for the spread of the disease itself.  Now as one recent article suggests an MRI scan with contrast shows abnormalities of the cortical ribbon in the frontal areas.  These findings represent a typical picture associated with CJD and assist greatly in the diagnosis of this condition.

AIDS dementia complex, which is the dementia associated with HIV/AIDS used to be very common.  It’s of particular interest because the brain is one of the few if not the only organ in the body which is actually invaded by the abnormal virus like particle associated with HIV/AIDS.  AIDS dementia complex has undergone a dramatic change as it has become much less common with the new and helpful treatments for HIV/AIDS.  Twenty years ago I saw 5 patients a year with AIDS dementia complex and in 2013 I saw zero.

Cryptococcal meningitis usually occurs in individuals who have immune suppression, for example, a patient with leukemia. In the past it was difficult to diagnosis but we now have antigen antibodies that can identify it relatively easy even from the peripheral blood.  The diagnosis of Cryptococcal meningitis has changed dramatically with advances in our diagnostic tools.


Metabolic states:  One of the most common metabolic states is thyroid disease particularly hypothyroidism. I saw an executive person recently who was complaining of a difficulty with memory, unsteadiness, and weight gain. Examination showed that the individual was markedly hypothyroid and improved dramatically with treatment.  The positive treatment outcome associated with treating hypothyroidism emphases the idea that many of these secondary dementias are indeed treatable.

Deficiency states:  The most common deficiency state is a B12 deficiency.  B12 deficiency is an uncommon diagnosis but in my experience it almost always involves the peripheral nerves even prior to involving the brain.  The name for B12 deficiency used to be “combined degeneration” and this is because it involved the brain, the nerves themselves as well as a cognitive impairment.

Toxins:  The specific toxins we will discuss are heavy metals and the abuse of alcohol and drugs. More specifically the heavy metals consist of mercury and possibly arsenic. There are also, reports of people having skin toxicity from mercury causing a multi symptom disease but also involving abnormalities of the brain and cognitive function.  Abuse of alcohol and drugs and I am referring more specifically to continuous long term heavy drinking or use of drugs possibly narcotic abuse has been shown to increase the possibility of cognitive impairment.  It is known however, that a relatively small amount of alcohol and this includes two glasses of wine in men and one glass for women actually may have some preventative effect for AD.

Brain Tumors:  We have seen a few patients that have presented with weakness and confusion associated with a brain tumor.  I saw one patient who was complaining of headaches and weakness and in retrospect had some unilateral symptoms whom I thought from a clinical perspective had AD. After an appropriate examination he very clearly had a lung cancer and рак печени which had metastasized to the brain.  This can happen particularly in patients who have unilateral frontal lesions.  When the lesion is more posterior one can have weakness in the arm or leg and the diagnosis is much more obvious.  When the lesion is anterior the diagnosis may be much more difficult.


In the case of a subdural hematoma (blood clot on the surface of the brain usually caused by trauma) particular in older adults, the clinical symptom is frequently new onset headaches.  It is very important to take that particular clinical syndrome (new onset headaches) and evaluate it carefully if they have not had a history of headaches.

Normal pressure hydrocephalus (NPH) commonly referred to as “water on the brain” is associated with an increase in spinal fluid within the brain cavities.  In the past the diagnosis of NPH was difficult because we did not have adequate tools to measure long term spinal fluid pressure.  We now have developed new techniques which can actually tell us the prognosis of inserting a shunt (a tubing that reduces brain spinal fluid pressure by draining the fluid into the abdominal cavity).  This allows us to identify patients that would improve with a shunt thus improving the long term outcomes of those with NPH.


Depression is a very important issue in regards to older adults.  Depression increases as one ages and the suicide rate can be substantial in older individuals.  The important thing is that we actually have rather good treatments for depression. There are a number of anti-depressant medications which are associated with few side effects and can improve depression significantly.  Depression can produce a cognitive abnormality but the pattern is usually very different from AD and involves more pronounced attention abnormalities.  In addition, symptoms of depression can result in an increase cognitive abnormality in patients with early AD.  Often severe depression and associated depressive thoughts can contribute to the lack of attention seen in AD.


It is said that approximately 20% of individuals who present with AD have an associated depression.  This is a very important concept because patients that have a dementia or AD actually can have a substantial superimposed depression and therefore the effects can be synergistic.  The depression may exacerbate the cognitive problem itself and treatment of depression can be very gratifying.

Dr. Monica Crane – Discusses Alzheimer’s Disease

Dr. Monica Crane, at the University of Tennessee Medical Center and Cole Neuroscience Center discusses Alzheimer’s Disease symptoms and treatment options in a short video produce by UT Medical Center.



Sports Illustrated – Finding a Cure

Medinteract Co-founder, Dr. John Dougherty, was quoted in the article “Finding A Cure” by Alexander Wolf in the December 12, 2011 issue.

Excerpt  – “Early diagnosis is so important,” says Dr. John Dougherty, who runs the Memory Clinic at the University of Tennessee’s Cole Neuroscience Center. “The goal is prevention through delay. If we can delay symptoms by five years with medication and exercise, we can reduce the number of sufferers by six- to eight million—[about] the population of metropolitan Atlanta.”

View the full article

The cover featured: Sportsman Of The Year: Mike Krzyzewski / Sportswoman Of The Year: Pat Summitt

The two winningest coaches in Division I college basketball history (907 for him, 1,075 for her) have more in common than just extraordinary success. For reaching far beyond their campuses and refusing to be defined by their genders, SI honors them together.

Medinteract Co-Founder – Speaks at Knoxville Event

KNOXVILLE (WATE) – Hundreds of people were at Sevier Heights Baptist Church Thursday to hear what a leading Alzheimer’s specialist had to say about the degenerative brain disease.

Dr. John Dougherty, with Cole Neuroscience Center at UT Medical Center, not only talked, he listened as people of all ages shared their stories about life with a loved one struggling with the mind-robbing disease.

Knoxville News Sentinel – Hundreds turn out to hear Alzheimer’s Expert

WATE TV Knoxville, TN – Alzheimer’s Expert Shares His Knowledge at Knoxville Event

Reports on Alzheimer’s Disease in Knoxville, TN

Below are number of recent news reports on Alzheimer’s disease from Knoxville, TN:

WBIR-TV’s Robin Wilhoit interviews Janice Wade-Whitehead & Board member Dr. Monica Crane

Knox News Sentinel interviews Programming Director Linda Johnson about early onset dementia

WBIR-TV (NBC) interviews local family who wants Pat to know she has a bigger team now

WATE-TV (ABC) interviews local woman about her mother’s fight with Alzheimer’s


  • News
  • November 5th, 2010

Medicare’s New Annual Wellness Visit Promotes Cognitive Screening

In what is both breaking and outstanding news for the future of Alzheimer’s disease, Medicare has announced that, beginning January 1, 2011, all beneficiaries must be screened for cognitive impairment as part of their annual wellness visit, another component that will now be mandatory for Medicare beneficiaries.

WASHINGTON, Nov. 4, 2010 /PRNewswire-USNewswire/ — Yesterday, the Centers for Medicare and Medicaid Services issued final regulations for implementation of an important provision of the Patient Protection and Affordable Care Act, which will include for the first time an annual wellness benefit for all Medicare beneficiaries beginning January 2011. This Medicare preventive service benefit is significant for the growing number of baby boomers who will soon be reaching the age of Medicare eligibility. It is also particularly important to the Alzheimer’s Association and the more than 5 million Americans it represents because an assessment for the detection of cognitive impairment will be a mandatory part of this annual wellness visit.

Medinteract has long been an advocate for the critical need for regular and early warning screening for Alzheimer’s and dementia. In July, 2010 Medicare began reimbursing physicians for using the Computerized Self Test for cognitive impairment screening in their offices, for those patients presenting with memory concerns. As part of the new regulation it appears that Medicare will not only reimburse for screening of each beneficiary annually, but will require this (or similar) test be performed by their physician.

The Computerized Self Test (CST), a groundbreaking online screen for Alzheimer’s disease and Mild Cognitive Impairment (MCI), is one of the only tests available today which screens all six of the cognitive domains, something we now know to be critical for understanding ones level of cognition. With over 98% accuracy (clinical trials to date) the CST distinguishes between impaired and non-impaired persons. The CST also provides a level of cognitive detail the primary care physicians (PCP) have not had available from other tests. Using the CST’s computer-generated results, the PCP can now assess exactly which cognitive domain(s) show impairment, as well as severity of the impairment. Patients can be quickly and accurately categorized according to one of 5 groups: normal, MCI, mild, moderate or severe AD.

Armed with this level of detail the PCP can offer an individualized plan of care to each patient, based on their unique level of cognitive function, and upon retest, can accurately assess the efficacy of the existing treatment and adjust interventions, as necessary. This is a tremendous step forward in changing the face of Alzheimer’s disease, a move Medinteract hopes will radically reduce the estimated 60% of persons with Alzheimer’s who are currently going undiagnosed in the primary care setting, during a pivotal time when existing treatments are most effective.

For more information on the CST, please read our validation study, published in the Journal of Alzheimer’s Disease in April, 2010. For questions or information on integrating the CST into your medical practice please contact us.

What Is Mild Cognitive Impairment?

As diagnostic criteria for Mild Cognitive Impairment (MCI) has become more widely embraced by the medical community, more and more patients are receiving a diagnosis and then asking the obvious question: what is it? This is generally followed by: does this mean I have (or will have) Alzheimer’s disease (AD)? Read More

Alzheimer’s ABC’s: Cognitive Changes II (Apathy, Delusion)

Cognitive Changes in AD: Apathy and Delusion

In the last post we considered the cognitive change of depression, and how it can affect those with Alzheimer’s disease (AD), as well as some tips to help discern between pure depression and AD.

Today we’ll consider other cognitive change often seen along with AD – apathy and delusion.

Some AD patients develop frustration, agitation or combativeness, which can be extremely difficult to treat and manage (if you are a caregiver for an AD patient with these symptoms, you are all too aware of the strain this can create). Sometimes change in personality with agitated features can be an early manifestation of AD so pay close attention to this. Read More

Alzheimer’s ABC’s: Cognitive Changes (Depression and AD)

Depression and Alzheimer’s
In the first three posts (1, 2, 3) of this series we explored how to identify and understand many symptoms of early Alzheimer’s disease (AD), as well as how to use them to build a historical timeline.  These posts provide a good foundation for moving forward in our basic understanding of AD.

In this post we move into the topic of cognitive changes associated with early AD, and include an exercise you can try with your loved ones at home. Read More

Mild Cognitive Impairment

Mild Cognitive Impairment, or MCI, has become better understood in recent years. It is broadly considered to be a transitional stage between normal, age-related cognitive changes and dementia. We have learned some key things about individuals with MCI that are very important to understand for long term quality of life. Believe it or not, if you have received a diagnosis of MCI, this is actually very good news. It means that you are one of the few people who have been brave enough to get yourself tested for memory concerns. And because of this, you have learned at the earliest possible stage of some potential future problems. It’s great news because at this stage we have a lot of options for treating you and others like you.

As a physician, I can tell you that almost 8% of people diagnosed with MCI convert to Alzheimer’s Disease (AD) within 1 year. However, 20% of people diagnosed with MCI revert to normal memory within 1 year. So a diagnosis of MCI is not a cause for panic so much as it is a call to action. Read More