Cognitive Decline

When you think of cognitive decline, memory loss is often the most common symptom that comes to mind. But forgetting things or people is just one sign. And it’s not the hallmark symptom of everyone’s condition. For some people, communicating, feeling confused or having trouble doing daily tasks are bigger hurdles. It’s important to understand that your brain is uniquely your own, which means that your experience may be completely different from someone else’s.

Mild cognitive impairment

Mild cognitive impairment (MCI) is what you might experience first when you can still compensate for the changes. Your friends and family might have noticed little changes. Your symptoms are more than just little moments but aren’t bad enough to impact your personal, social or professional life in a big way.

You might misplace things or repeat yourself. You might lose focus or get distracted more easily than you used to. Or you might miss an appointment or two. If your MCI is a little farther along, it might take you longer to shop or cook, and you might need some help paying the bills. But basically, you’re self-sufficient.

MCI doesn’t always get worse. Sometimes it stays the same or even gets better. Other times, it can lead to a condition called dementia.

Dementia

Dementia is an “umbrella category” of conditions that can permanently change the way you think, remember and reason. They can also affect your personality, mood and behavior and can often make it hard to do activities of daily living (like dressing, going to the bathroom, taking a shower or eating).

Alzheimer’s disease is the most common type of dementia. It’s a chronic (lifelong) disorder. Other nonreversible types of dementia include:

• Frontotemporal dementia.
• Lewy body dementia.
• Vascular dementia.
• Mixed dementia (a combo of two or more types of dementia).
• Primary progressive aphasia.

Sometimes dementia is caused by another health condition, like:

• Huntington’s disease.
• Parkinson’s disease.
• Creutzfeldt-Jakob disease (CJD).
• Wernicke-Korsakoff syndrome.
• Traumatic brain injury (TBI).
• Stroke.

Some medication side effects or other health conditions, like thyroid problems, vitamin deficiencies, infections or normal pressure hydrocephalus (NPH) can cause dementia-like symptoms, too. These symptoms are often reversible with the right treatment.

Diagnosing Cognitive Decline at Cleveland Clinic

As you get older, it’s not unusual to occasionally forget a person’s name, misplace your glasses or tell the same story once or twice. We often call these “senior moments.” And even though they’re a nuisance, they’re natural. And they don’t impact your daily life much.

It’s when those moments start happening more often or other things happen, too — like struggling to get through a conversation, having trouble following directions, getting lost, making poor financial decisions or not driving safely — that it’s time to get help. These things could mean your brain isn’t working like it should anymore and something more serious is going on.

If this happens, it’s important to make that first appointment with your healthcare provider. The sooner you know what’s going on (if anything), the sooner you can start getting help.

What to expect at your first visit

Your provider will begin your visit by getting to know you. They’ll want to understand what’s been going on from your point of view. So, they’ll ask a lot of questions about changes you’ve been noticing. It’s often helpful to bring a friend or family member along to help you share information and take notes.

During your visit, your provider will also do a physical exam to check your overall health. You can also expect to have some other tests.

• Neurological exam: This test looks at how well your brain, spinal cord and nerves are working and helps rule out other neurological conditions. Your provider will check things like your reflexes, how you walk (gait), your strength and muscle tone and more.
• Cognitive test: In this short test, your provider will ask you to answer questions or do simple tasks. This gives them a quick view of how your brain processes thoughts and information.

Then, based on your scores on these tests, they may order a neuropsychological assessment. This takes much longer (two to four hours is typical, with breaks) because it’s more in-depth. It tests a wide range of things, like reading and comprehension, how you use and understand language, reasoning, how fast you can process information, if you can solve problems, your attention span and ability to concentrate, your mood, personality and more.

It’s important to remember that this test is meant to be a snapshot of your brain health at that moment in time. It gives us a baseline to see how your brain is working now so we see if your thinking skills get worse (or in some cases, improve) in the future.  

Depending on the results of your neuropsychological assessment, our team may also order imaging tests, like:

• CT scan (computed tomography scan) or MRI (magnetic resonance imaging) to check for signs of brain injury from a stroke, bleeding, too much fluid or a tumor.
• Blood and urine tests help us rule out other conditions by looking for things related to infections or inflammation.
• Thyroid hormone tests and vitamin B12 levels to see if they’re where they need to be.
• Spinal tap (lumbar puncture) to see if you have a neurodegenerative or autoimmune condition.

Meet Our Cognitive Decline Team

Cognitive decline can impact many areas of your life, and your symptoms can change over time. So, to make sure your care focuses exactly on what you need and when you need it, you’ll have a team of experienced providers from different specialties. Your team may include:

• Neurologists.
• Neuropsychologists.
• Primary care providers (PCPs).
• Geriatricians.
• Nurse practitioners.
• Psychiatrists.
• Psychologists.
• Speech-language pathologists (SLPs).
• Physical therapists.
• Occupational therapists.
• Recreational therapists.

Your care team works together to confirm a diagnosis and plan your personalized care. And they meet regularly to go over your progress, making care plan adjustments as needed.

Your team will build your care plan based on the kind of cognitive decline you have and your specific needs. No two people have the same symptoms. And not everyone with cognitive decline has dementia or will develop it. So, care is highly personalized.

Care for mild cognitive impairment

If your MCI is caused by fixable (reversible) things like an infection, sleep problems, depression, anxiety or medication side effects, treating the underlying health condition can often make the MCI go away or at least lessen the symptoms.

If it’s caused by a neurodegenerative condition, autoimmune disorder or a brain injury, we’ll help you find ways to manage it. Again, treatment will depend on what’s causing the cognitive decline.

While there are no approved medications to directly treat MCI, our researchers are looking for new and better treatment options all the time. They’re also studying the health and mental changes that come with MCI in hopes of better understanding why some people move into dementia and others don’t. Clinical trials are sometimes available to test new therapies. Ask your provider if you qualify to participate in one.

Care for dementia

How we manage your symptoms depends on what’s causing them. If you have a nonreversible type of dementia, like Alzheimer’s disease, we can prescribe medications to manage symptoms and hopefully slow the progression of the disease.

We can also treat sleeping problems, dementia-related depression and agitation, and hallucinations. We may also recommend sessions with a psychiatrist or psychologist. And you may do recreational therapy to help you stay engaged in your normal activities as much as possible.

If you have a dementia that can be reversed, our team will work to treat the underlying causes to try and slow or stop the symptoms.

Living With Cognitive Decline

Once you’re diagnosed, it’s important to keep up with your appointments and remember to take your medications. Regular appointments help us track your progress and see what’s working or what’s not, and the drugs we prescribe are ones that can help lessen your symptoms. Taking good care of your body by exercising, eating well-balanced meals, drinking in moderation and not smoking is also important. So is spending time with family and friends and talking about your feelings, if you need to.

We can also work with you and your family to plan for your future care in a way that best meets your needs, now and down the road. And we’re always here to answer questions and listen to any concerns you and your loved ones have about your condition — and the future.

Taking the Next Step

Learning you have any kind of cognitive decline isn’t easy. It can make you feel frustrated and worry about what lies ahead. But finding out what’s going on inside your brain is the first important step toward learning to manage what’s happening. And that starts with finding the most experienced and compassionate healthcare team.

Cleveland Clinic’s expert neurology providers will work together and with you to uncover what’s going on. Then they’ll design a care plan that focuses on your unique needs. From medications to therapy to counseling, we’ll help you manage your condition and keep symptoms at bay so you can live your best possible life.