What is mild cognitive impairment?
Mild cognitive impairment (MCI) is a condition in which people have more memory or other thinking problems than normal for their age, but their symptoms do not cause disability. Older people with MCI are at greater risk for developing dementia caused by Alzheimer’s, but not all of them do. Some may even go back to normal cognition. Studies are underway to learn why some people with MCI progress to Alzheimer’s dementia and others do not.
The problems associated with MCI may also be caused by certain medications, cerebrovascular disease (which affects blood vessels that supply the brain), and other factors, including depression or anxiety. Some of the problems brought on by these conditions can be managed or reversed through treatment at places like the Penn Memory Center.
The type of MCI with memory loss as the main symptom is called amnestic MCI. In another type, non-amnestic MCI, the main symptom is an impaired thinking skill other than memory loss, such as trouble planning and organizing or poor judgment.
What is dementia?
Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—and behavioral abilities to such an extent that it causes disability, meaning, it interferes with a person’s daily life and activities. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend completely on others for basic activities of daily living.
Many conditions and diseases cause dementia. The most common cause of dementia in older people is Alzheimer’s disease. Other causes include different kinds of brain changes that lead to vascular dementia, Lewy body dementia, and frontotemporal disorders.
In addition, some people have mixed dementia—a combination of two or more disorders, at least one of which is dementia. A number of combinations are possible. For example, some people have Alzheimer’s disease and vascular dementia at the same time.
What is Alzheimer’s disease?
Alzheimer’s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks. In most people with Alzheimer’s, symptoms first appear in their mid-60s. Alzheimer’s disease is the most common cause of dementia and MCI among older adults.
The disease is named after Dr. Alois Alzheimer. In 1906, Dr. Alzheimer noticed changes in the brain tissue of a woman who had died of an unusual mental illness. Her symptoms included memory loss, language problems, and unpredictable behavior. After she died, he examined her brain and found many abnormal clumps (now called amyloid plaques) and tangled bundles of fibers (now called neurofibrillary, or tau, tangles).
These plaques and tangles in the brain are still considered some of the main features of Alzheimer’s disease. Another feature is the loss of connections between nerve cells (neurons) in the brain. Neurons transmit messages between different parts of the brain, and from the brain to muscles and organs in the body.
Although treatment can help manage symptoms in some people, currently there is no cure for this devastating disease.
What is vascular dementia?
Vascular dementia, considered the second most common form of dementia after Alzheimer’s disease, results from injuries to the vessels supplying blood to the brain, often after a stroke or series of strokes. Vascular dementia and vascular cognitive impairment arise as a result of risk factors that similarly increase the risk for cerebrovascular disease (stroke), including atrial fibrillation, hypertension, diabetes, and high cholesterol. The symptoms of vascular dementia can be similar to those of Alzheimer’s, and both conditions can occur at the same time. Symptoms of vascular dementia can begin suddenly and worsen or improve during one’s lifetime.
Research has shown that Alzheimer’s and vascular disease-associated cognitive impairment are closely intertwined. For example, a large proportion of people diagnosed with Alzheimer’s also have brain damage caused by vascular disease. In addition, several studies have found that many of the major risk factors for vascular disease may also be risk factors for Alzheimer’s.
The overlap between these two types of dementia may be important because medications and lifestyle changes known to help prevent vascular disease, such as controlling high blood pressure, lowering cholesterol, and engaging in physical activity, may also help prevent Alzheimer’s disease.
What is Lewy body dementia?
Lewy body dementia (LBD) is another common brain disorder in older people. LBD is caused by abnormal deposits of a protein called alpha-synuclein in the brain. These deposits, called Lewy bodies, can lead to problems with thinking, movement, behavior, and mood. For example, symptoms may include changes in alertness and attention, hallucinations, tremor, muscle stiffness, sleep problems, and memory loss.
The two types of LBD are:
- Dementia with Lewy bodies, in which cognitive symptoms appear within a year of movement problems
- Parkinson’s disease dementia, in which cognitive problems develop more than a year after the onset of movement problems
Lewy body dementia can be hard to diagnose because Parkinson’s disease and Alzheimer’s disease cause similar symptoms. Scientists think that LBD might be related to these diseases, or that they sometimes happen together.
For Lewy body dementia research at the University of Pennsylvania, visit the Penn FTD Center.
What are frontotemporal disorders?
Frontotemporal disorders are a form of dementia caused by a family of brain diseases known as frontotemporal lobar degeneration (FTLD). These disorders are the result of damage to neurons (nerve cells) in parts of the brain called the frontal and temporal lobes. As neurons die in the frontal and temporal regions, these lobes atrophy, or shrink. Gradually, this damage causes difficulties in thinking and behaviors controlled by these parts of the brain. Many possible symptoms can result. They include strange behaviors, emotional problems, trouble communicating, or difficulty with walking and other basic movements.
Frontotemporal disorders can be grouped into three types, defined by the earliest symptoms physicians identify when they examine patients.
For FTD research at the University of Pennsylvania, visit the Penn FTD Center.
What is Parkinson’s disease?
Parkinson’s disease (PD) belongs to a group of conditions called motor system disorders, which are the result of the loss of dopamine-producing brain cells. The four primary symptoms of PD are tremor, or trembling in hands, arms, legs, jaw, and face; rigidity, or stiffness of the limbs and trunk; bradykinesia, or slowness of movement; and postural instability, or impaired balance and coordination. As these symptoms become more pronounced, patients may have difficulty walking, talking, or completing other simple tasks.
PD usually affects people over the age of 60. Early symptoms of PD are subtle and occur gradually. In some people the disease progresses more quickly than in others. As the disease progresses, the shaking, or tremor, which affects the majority of people with PD may begin to interfere with daily activities. Other symptoms may include depression and other emotional changes; difficulty in swallowing, chewing, and speaking; urinary problems or constipation; skin problems; and sleep disruptions.
There are currently no blood or laboratory tests that have been proven to help in diagnosing sporadic PD. Therefore the diagnosis is based on medical history and a neurological examination. The disease can be difficult to diagnose accurately. Doctors may sometimes request brain scans or laboratory tests in order to rule out other diseases.
For Parkinson’s disease research at the University of Pennsylvania, visit Penn’s Parkinson’s disease and Movement Disorders Center.
What is a lumbar puncture?
A lumbar puncture (LP/spinal tap) is a medical procedure during which a hollow needle is inserted between two lumbar bones (vertebrae in the lower back) to remove a sample of cerebrospinal fluid for diagnostic purposes, including the measurement of proteins associated with Alzheimer’s disease.
Cerebrospinal fluid (CSF) is a clear fluid that surrounds your brain and spinal cord to protect them from injury. Research suggests that Alzheimer’s disease in early stages may cause changes in CSF levels of tau and beta-amyloid, two proteins that can form abnormal brain deposits strongly linked to the AD. For this reason, an LP is used as a screening procedure in several research studies at the Penn Memory Center aimed at early detection of Alzheimer’s disease. To view how a lumbar puncture is done, click here.
What is Magnetic Resonance Imaging (MRI)?
Magnetic Resonance Imaging (MRI) is a common medical imaging procedure that uses a powerful magnetic field, radio frequency pulses, and a computer to produce detailed images of inside the body. An MRI is an important diagnostic tool for different types of dementia.
Currently, MRI is used to rule out conditions other than neurodegenerative disease that can cause similar symptoms but require different treatments such as stroke, tumors, or buildup of fluid in the brain. Additionally, MRI can detect brain abnormalities associated with mild cognitive impairment (MCI) and can be used to predict which patients with MCI have a higher probability of developing Alzheimer’s disease. The scan may show a loss of brain mass associated with Alzheimer’s disease and other causes of dementia, such as a shrunken hippocampus. MRI is used as a screening procedure in several research studies completed at the Penn Memory Center.
What is a Positron Emission Tomography (PET) Scan?
A positron emission tomography (PET) scan is an imaging test that allows a doctor to check for diseases in your body. The scan uses a special dye that has radioactive tracers which are injected into a vein in your arm. After your organs and tissues absorb the tracer, you enter a machine that scans your body, producing an image that identifies potential problems.
A chemical tracer called florbetapir F-18, approved by the U.S. Food and Drug Administration in 2010, binds specifically to beta-amyloid deposits in the brain, allowing plaques to show up clearly on brain scans. These beta-amyloid deposits are strongly associated with Alzheimer’s disease or other causes of cognitive decline. This technique is used for several research studies being conducted by Penn Memory Center.
More common terms:
- Affordable Care Act
- The Affordable Care Act, also known as the ACA or Obamacare, is a large law passed by President Obama in 2010 that transformed the healthcare and insurance industries by adding new incentives and regulations intended to improve health outcomes, lower costs, and improve access.
- Allele
- An allele is a specific variant of a gene that every person has that often results in a different phenotype, like blue eye color for example.
- Alzheimer’s disease (AD)
- Alzheimer’s disease is the most common form of dementia. Although it is not a typical part of aging, old age is a common risk factor associated with the disease. AD is a progressive disease, meaning it worsens over time and currently there is no available treatment to stop the effects of the disease.
- Alzheimer’s Disease Center (ADC)
- ADCs are found at major research institutions and they receive funding from the National Institute on Aging to help researchers turn advances in their work into improved treatments and diagnoses for people with Alzheimer’s disease.
- Amyloid beta
- Amyloid beta (Aβ or Abeta) denotes peptides of 36–43 amino acids that are crucially involved in Alzheimer’s disease as the main component of the amyloid plaques found in the brains of Alzheimer patients. In a healthy brain, these protein fragments are removed, but in Alzheimer’s disease the fragments accumulate to form difficult to break up plaques.
- Antibody
- An antibody is a large protein produced by the body that is used by the immune system to fight and control viruses and bacteria.
- Asymptomatic
- In medicine, a disease or a person is considered asymptomatic if there are no observed or experienced symptoms.
- BACE1
- Beta-secretase 1 (or BACE1) is an enzyme associated with Alzheimer’s disease. The enzyme involved cleaves cellular fragments associated with buildup of toxic cells. Several drug companies are developing products that inhibit BACE1 enzymes.
- Biomarkers
- Biomarkers, or biological markers, are a detectable and measureable substance in an organism whose presence indicates some biological condition. Biomarkers have become commonplace tools in basic and clinical to indicate the presence of a disease or the effectiveness of a drug or treatment.
- Brain donation
- After an individual passes away, he or she is eligible to donate their brain to researchers who will then study the brain, even if the donor was cognitively normal. Donations allow for a definitive neuropathological diagnosis beyond “AD probable,” “MCI,” or other assessments made through clinical observation and other testing while their loved one was alive. Brain donation from older adults with normal memory and thinking helps science better understand the physiology of lifelong brain health.
- Caregiver
- Caregivers, or care partners, take on a role that provides legal, financial, and medical support to a person who has Alzheimer’s disease, dementia, or another type of debilitating condition. This role is often filled by a loved one or a professional.
- Center for Medicare and Medicaid Innovation (CMMI)
- CMMI is an essential part of the ACA that develops and tests new ways to administer health care payments and service delivery models.
- Center for Medicare and Medicaid Services (CMS)
- The Center for Medicare and Medicaid Services is part of the Department of Health and Human Services in the federal government. The CMS manages Medicaid, Medicare, Children’s Health Insurance Program (CHIP), and the Health Insurance Marketplace.
- Clinical trials
- Clinical trials are experiments or observations conducted with human subjects over a period of time to test drugs, procedures, or to collect information about a group of people.
- Cognitive aging
- Is a normal part of aging and is not a part of Alzheimer’s disease or another form of dementia. It is likely due to neuronal loss or changes in the shape of certain neurons. While some brain functions like vocabulary and some math skills often remain intact with advanced age, some functions do inevitably decline like orientation in space.
- Cognitive testing
- Cognitive tests are assessments of the cognitive capabilities of humans and other animals. Tests administered to humans include various forms of IQ tests. These assessments are a critical diagnostic tool used for Alzheimer’s disease and dementia.
- Dementia
- Dementia is a broad term that refers to deficits in thinking or memory that impair a person’s ability to perform everyday functions. To receive a diagnosis of dementia, a person must experience deficits beyond what is expected from a normal course of aging. The most common form of dementia is Alzheimer’s disease, and dementia also includes diseases like vascular dementia, Lewy body dementia, and frontotemporal dementia.
- DNA
- DNA is the genetic material in humans and other organisms that is used to pass information from parent to offspring. Since the 1950s, the explicit study of DNA has been vital to countless scientific breakthroughs.
- Early onset Alzheimer’s disease
- Early onset Alzheimer’s disease refers to an AD diagnosis that occurs before the age of 65. It accounts for only 5-10% of all diagnoses of Alzheimer’s, and is highly linked to genetics. It is rare that a person would develop non-familial early onset AD.
- ECG
- Electrocardiography (ECG or EKG) is a procedure that measures the electrical activity of the heart by placing electrode sensors on the body. It is a common cardiology exam that detects small changes in conduction on the skin during heart beats. An ECG is often included in preliminary screening visits.
- Elder abuse
- Elder abuse has been defined by the World Health Organization as a single or repeated inappropriate action toward an elder in a relationship where there is an expectation of trust. There are common types of elder abuse that include financial or psychological abuse.
- Elder justice
- Elder justice advances the cause against elder abuse to promote the health and well-being of older adults.
- Enzyme
- Enzymes are types of proteins in the body which catalyze biological reactions like the digestion of food or the growth of hair. Enzymes are an essential component of human existence.
- Frontotemporal disorders
- Frontotemporal disorders are a form of dementia caused by brain diseases known as frontotemporal lobar degeneration (FTLD). These disorders are from damage to neurons in parts of the brain called the frontal and temporal lobes. As neurons die in these regions, these lobes atrophy, or shrink. This causes changes in thinking and behavior, including emotional problems, trouble communicating, or difficulty with walking and other basic movements.
- Gamete
- Sex cells (sperm or eggs)
- Genetic
- When something is genetic, it is of or relating to genes. When a disease is described as genetic, this means that there is some basis of the disease found in a person’s genes.
- Genome
- All of the genetic material in an organism
- Genotype
- Genotype, as opposed to phenotype, refers to a person’s genetic makeup. A person’s genotype is observed through genetic testing, not through observation.
- Geriatrician
- A geriatrician is a doctor who specializes in treating and diagnosing older patients.
- Healthy Brain Research Network
- The Healthy Brain Research Network (HRBN) was established under the direction of the CDC to include 6 major research institutions across the US to address public health problems of aging and cognitive health. UPenn is one member of the HBRN along with University of Washington, Oregon Health and Science University, University of Arizona, University of Illinois at Chicago, and the University of South Carolina.
- Informant
- Informants or knowledgeable informants are typically asked to accompany a patient to the Penn Memory Center and similar Alzheimer’s research institutions across the country. An informant is often someone who sees the patient regularly and can accurately report changes in mood or behavior to a researcher.
- Informed consent
- Informed consent is an important process wherein a doctor or healthcare professional explains clearly to a competent patient so that he or she can make thoughtful and voluntary decisions about the type of care he or she will receive.
- Lewy body disease
- Lewy body dementia (LBD) is another common brain disorder in older people. LBD is caused by abnormal deposits of a protein called alpha-synuclein in the brain. These deposits, called Lewy bodies, can lead to problems with thinking, movement, behavior, and mood. For example, symptoms may include changes in alertness and attention, hallucinations, tremor, muscle stiffness, sleep problems, and memory loss.
- Longitudinal
- Longitudinal studies span many years and involve researchers measuring one metric over a long period of time. Longitudinal studies are essential for the progress of many psychological studies and studies relating to aging, dementia, and Alzheimer’s disease.
- Lumbar puncture
- The procedure of taking fluid from the spine in the lower back through a hollow needle, usually done for diagnostic purposes, including the measurement of proteins associated with Alzheimer’s disease.
- Medicaid
- Medicaid is an American social health care program run by the federal government for citizens who cannot afford their own health care. Medicaid has been a large portion of the federal budget since its establishment in 1965. Currently, states have some leeway in deciding exactly who is eligible for enrolling in the program.
- Medicare
- Medicare is a federally run program established in 1965 that provides health insurance to Americans aged 65 and older.
- Mild cognitive impairment
- Mild Cognitive Impairment (MCI) is a broad term that refers to the slight, but still detectable deterioration of memory. MCI does not refer to deficits in awareness, language, or attention. There are no active treatment methods for MCI, but lifestyle changes are believed to help slow or even halt the progression of the disease.
- MRI
- Magnetic Resonance Imaging (MRI) is a common medical imaging procedure that can produce detailed images of the inside of the body that are different from X-Rays and CT scans. An MRI image is an important diagnostic tool for different types of dementia.
- Mutation
- A change in gene structure within the DNA of the sex cells (gametes); transmissible to following generations
- National Alzheimer’s Coordinating Center (NACC) study
- NACC collects ongoing individual data from volunteer participants at each of the 31 NIA-funded Alzheimer’s Disease Centers (ADCs) across the United States. NACC data is essential to Alzheimer’s researchers across the country.
- National Institute on Aging (NIA)
- NIA is federally funded institute that leads research on aging and the health of older adults in the US. There are 31 NIA funded Alzheimer’s disease research centers across the country, including the Penn Memory Center.
- Neurodegenerative
- Neurodegenerative is a broad term that refers to the progressive loss of the brain’s primary cells, neurons. Alzheimer’s disease is a common neurodegenerative disease, as is Parkinson’s, ALS, and Huntington’s. There are currently no treatment methods for neurodegeneration.
- Neurology
- Neurology is a specialty of medicine that treats and diagnoses conditions of the nervous system.
- Neuron
- A neuron is special type of cell that sends signals between the brain and the body. Neurons are the building block of the nervous system and the brain.
- Neurotransmitter
- Chemicals enabling transmission of neurological signals between two cells (usually two nerve cells).
- Palliative
- Palliative care is the cross discipline approach to medicine that focuses on relieving uncomfortable symptoms like pain, stress, or mental anguish regardless of the original diagnosis. The goal of this treatment is not to cure, but to improve quality of life for the patient and his or her family.
- Parkinson’s disease
- Parkinson’s is a neurodegenerative disease that affects movements in the body. There are genes associated with the onset of Parkinson’s disease. Lifestyle changes and certain surgical interventions can slow down or halt the progression of the disease. While Parkinson’s may seriously affect daily functioning, it is not life-threatening.
- Pathology
- Pathology is a specialty in medicine that studies the causes and effects of disease. Pathologists study body tissues for diagnostic and forensic purposes.
- PET scan
- A positron emission tomography (PET) scan is an imaging test that allows your doctor to check for diseases in your body. The scan uses a special dye that has radioactive tracers. These tracers are injected into a vein in your arm. Your organs and tissues then absorb the tracer
- Placebo
- A placebo is a fake treatment meant to mimic the appearance of a genuine treatment, but has no significant medical impact. Placebos are used in clinical trials to effectively evaluate the true effect of a treatment.
- Plaques
- Plaques are abnormal clusters of chemically “sticky” proteins called beta-amyloid that build up between nerve cells. Researchers are unsure, but believe that plaques are involved in Alzheimer’s disease.
- Pre-clinical
- Pre-clinical is a recently defined stage of Alzheimer’s disease where no clinical symptoms are observable, but biological processes related to Alzheimer’s disease may be underway.
- Prevention Research Center
- The Prevention Research Centers (PRC) is a network of 26 academic research centers in 24 states that study how people and their communities can avoid or counter the risks for chronic illnesses, such as heart disease, obesity, and cancer. They are funded by the CDC. UPenn is a PRC.
- Promodal Alzheimer’s disease
- The earliest stage of Alzheimer’s disease, in which memory has begun to decline, but the affected individual maintains functional independence
- Psychiatry
- The medical specialty devoted to the study, treatment, and prevention of mental disorders
- Public Health
- The science and study of promoting health, preventing disease, and prolonging life based in population health analysis and combined efforts of communities and individuals.
- Research
- The systematic investigation into a topic in order to establish a new or better conclusion. In biomedical research, large teams of professionals often work together to better understand diseases and treatments.
- Research Coordinator
- Research coordinators are responsible for conducting research trials under the supervision of a Principal Investigator (PI)
- Solanezumab
- Solanezumab, or sola, is a drug being investigated by Eli Lilly for its potential treatment effects on Alzheimer’s disease. It showed initial promise but in its phase III trial failed to show breakthrough potential.
- Study partner
- Study partners enroll with clinically affected Alzheimer’s patients in research trials to assist with logistics and consenting of the experiment. Study partners must regularly see the patient and are often spouses, adult children, or caregivers. They play an essential role in all research trials.
- Symptomatic
- Exhibiting visual symptoms for an associated condition. For Alzheimer’s disease, changes in cognition and behavior are symptomatic for advanced progression of Alzheimer’s disease.
- Synapse
- The junction between two nerve cells, by which a signal passes through the release of neurotransmitters.
- Tangles
- Tangles form inside dying cells. Tangles are twisted fibers of a protein called tau. The tangles often form a predictable pattern in the brain that disrupt essential processes that keep cells alive.
- Tau
- Tau is a protein found in the bodies of healthy humans. Excessive or abnormal amounts of tau, some scientists believe, may be associated with the cause of Alzheimer’s disease. Massive amounts of current research are in motion to better understand the role of tau in Alzheimer’s disease.
- Vascular dementia
- Vascular dementia, considered the second most common form of dementia after Alzheimer’s disease, results from injuries to the vessels supplying blood to the brain. Vascular dementia arises as a result of risk factors that similarly increase the risk for stroke, including atrial fibrillation, hypertension, diabetes, and high cholesterol. The symptoms of vascular dementia can be similar to those of Alzheimer’s, and both conditions can occur at the same time. Symptoms of vascular dementia can begin suddenly and worsen or improve during one’s lifetime.
- Verubecestat
- Verubecestat is an experimental drug currently being investigated for its potentially positive treatment effects for Alzheimer’s disease.
- Whealthcare
- A popular term coined by Dr. Jason Karlawish to describe the intersection of health and wealth to describe the interconnected nature of the two issues.