Wednesday, April 20, 2011
A recent article on the WSJ claims clinical practice won't change much after new guidelines for identifying early Alzheimer's were released. Mild Cognitive Impairment has been studied for years. The pharmaceutical, biotech, and vitamin industries have been researching medications, vaccinations, and herb compounds alone and in combination in their haste to find ways of minimizing cognitive decline. The new generations are living longer with the inevitable consequences of aging.
I was a clinical research fellow in Alzheimer's and Movement Disorders at the National Institutes of Health in the Experimental Therapeutics Branch twenty years ago. Early research compounds consisted of only numbers and letters, not even proper names, and we were mainly looking at Alzheimer's and other dementias back then. As researchers, we studied people and families that struggled with the disease. At the same time, some highly functioning individuals would request a visit, worried about their perceived memory loss. In these cases, nobody around them noticed anything was wrong with the individual's memory. Only the person could notice any difference. No standardized test could determine a noticeable decline, particularly when there was no pretest to compare. All we could do back then – as now – was to conduct a neuropsychological test and continue to track memory prospectively.
In our hectic world, though, a highly functioning executive or entrepreneur won't wait to see what the future unfolds. Even if there was a positive biomarker, as long as the person continued to function on a high level, life would continue as usual. But, would it? Successful middle-aged businessmen and women are already taking cognitive enhancers. There will continue to be increasing pressure to practitioners to prescribe medications that will maximize intellectual capacity. Even though there is no evidence that current medications improve the prognosis or reverse Alzheimer's, there will be increased use of medications to alleviate the symptoms of cognitive decline.
These are some outstanding issues to consider:
1. Consult a neurologist: If you are seriously considering taking medication to improve your memory, consult a qualified neurologist and have a full work-up for memory. This includes baseline neuropsychological testing to track your memory through time.
2. Discuss your concerns with your spouse and family: If you are experiencing the beginnings of mild cognitive impairment, you will want to discuss your needs and wants with those who can help you, anticipating roadblocks and challenges when you are well. Mild cognitive impairment – and dementia – impact upon the individual and the family.
3. Continue work as usual: "If you don't use it, you lose it." Stay active and exercise your brain. Find a good balance between continuing your work and finding ways to relax. Stress will negatively impact upon your memory over time so ensure you are not burning out.
4. Focus on succession planning: We would love to live forever. Even though we can't, many people shy away from creating a contingency plan until something has already happened. Give yourself plenty of time to prepare, as this will ease off your responsibility. If you are "the boss," ensure you have a contingency plan rather than agonize about whether or not it would be good to get ready.
5. Exercise regularly: Physical exercise may be our best tool against memory loss so far. Repetitive exercises improve your blood flow to the heart and brain. Walk, jog, or swim daily for as long as you can. This will both enhance your memory as well as keep you relaxed.
Gabriela Cora, MD, MBA. Dr. Gaby Cora is a leadership and well-being consultant to corporations in critical situations and to transitioning leaders of multi-million dollar family businesses. Some of her clients include the Coca-Cola Company, Pfizer Pharmaceuticals, Blue Bunny, Home Financing Center, and Universal Group. She's the author of ExecutiveHealth.com's Leading Under Pressure (Career Press, 2010).