Dr Douglas Powell

Report by Elodie O'Connor, Alzheimer's Australia Victoria.

Mild cognitive impairment (MCI) is a phase of cognitive decline between normal ageing and dementia. While not all people with MCI progress to dementia, MCI is often identifiable prior to development of dementia.

Dr Douglas Powell, from Harvard Medical School in the United States, has reviewed clinical and empirical data examining lifestyle factors associated with non-progressive MCI (MCI that does not progress to dementia), and found that some of the most important factors include healthy lifestyle habits and compensating for vulnerabilities.

The available research indicates that the following healthy lifestyle habits are significantly associated with non-progressive MCI: not smoking; moderate alcohol consumption; healthy diet; absence of obesity; proper use of prescription medication; physical activity; satisfaction with social networks; and management of stress.

Additionally, compensatory strategies – strategies used by an individual to help adjust to changes in their functional abilities – have also been found to be significantly related to non-progressive MCI. Effective strategies include the following: recognising vulnerabilities; selection, optimisation, and compensation; minimising distractions; engaging in attention restoration activities; and taking advantage of advances in medical technology. Some practical suggestions include:

  • Recognising vulnerabilities by observing that cognitive function is likely to be better in the morning than the evening, and understanding that there may be a loss of energy and concentration in the late afternoon
  • Selection, optimisation, and compensation by selecting fewer things to concentrate on, optimising performance in these selected activities, and compensating for age-related cognitive losses with specific strategies (e.g. taking naps or drinking caffeinated beverages)
  • Minimising distractions by using techniques such as writing down instructions and focusing on one task at a time
  • Engagement in attention restoration activities (ARAs), which are periods of undirected attention, giving fatigued attention the opportunity to be restored; ARAs are activities that are enjoyable, don’t require success, have a sense of being disconnected, and are compatible with interests or passions (e.g. reading a book of poetry or going for a walk)

The reliability of MCI diagnosis is an area of concern for Dr Powell. He reviewed nine longitudinal studies and reported that, after three to five years, only around 15% of participants with MCI converted to dementia, with younger people significantly more likely to return to normal cognitive functioning than older people.

Implications for knowledge translation:
Much more work is required to further understand non-progressive MCI. Identifying the differences between those people who progress from MCI to dementia and those who do not may indicate ways that can help halt or slow the progression from cognitive decline to dementia. This may pave the way for effective treatments capable of protecting cognition against early pathological decline.