Mild cognitive impairment is the stage of cognitive impairment with noticeable symptoms, but the problems are not severe enough to interfere with daily life or independent function. For a more detailed introductory information of mild cognitive impairment, see post “Three Phases of Age-Related Cognitive Impairments” and “Causes of Mild Cognitive Impairment And How To Reverse It”. This post is part of the series of posts describing how to identify MCI with symptoms in the areas of mood, memory, and attention – Manifestations of Mild Cognitive Impairment:
- Manifestations of Mild Cognitive Impairment: Personality And Mood
- Manifestations of Mild Cognitive Impairment: Memory
- Manifestations of Mild Cognitive Impairment: Attention
The earliest symptoms of mild cognitive impairment are often also associated with personality and temperament problems (e.g. anxiety, depression). Anxiety typically becomes an issue which can lead to a number of mental health problems. Insomnia is one of them that exacerbates anxiety and depression. Increased anxiety and/or other mental health issues are almost always linked to the brain chemical imbalance which also have their roles in cognition function. Increased personality and mood problems create damage to the brain and brain chemical imbalance or deficiency, thus causing various symptoms of cognitive impairments. It is very hard to concentrate or remember when anxious or depressed feelings become dominant.
Anxiety initially produces an increase in brain speed, though. This may come from pending final exam or has to get a job done, for example. Anxiety and stress often make an individual better able to focus initially. This type of positive effect is due to the increased dopamine related chemicals – stress hormone adrenaline and cortisol. Afterward, exhaustion ensues, resulting form a decrease in the calming neurotransmitter GABA caused by increased stress hormone. (see post “Brain Waves, Brain Chemical Systems and Memory”). After a while, the stress induced extra energy faded and eventually leading to a loss of dopamine energy (dopamine is the neurotransmitter for active cognitive tasks -working memory, attention and beta brain waves). A vicious stress loop is created , rewiring the brain and interfering neurogenesis. Long term exposure to stress hormone such as cortisol (see post “How Stress Affect Memory”) has been found to damage neurons in the hippocampus involved with memory, learning.
When the brain is deficient in GABA (the inhibitory neurotransmission system that has the role to balance excitatory neurotransmission, GABA is the brain stabilizer), the brain wave or brain electricity is generated in bursts. This is known as brain arrhythmia. (The term “arrhythmia” refers to any change from the normal sequence of electrical impulses.) The electrical impulses may become too fast, too slow, or erratic when a dysrhythmia (a disturbance or irregularity in the rhythm of the brain waves as recorded by electroencephalography) occurs. Restless, anxious, nervous and irritable feeling become prevalent. Once the brain loses its balance, its stability is lost. Various personality and mood problems may develop or the cognitive thinking displays this or that symptoms: difficulty concentrating, inconsistent attention patterns, blurred thinking, verbal memory and working memory impairments. GABA is also involved in the production of endorphins – the feel good hormones that are produced in the brain during physical and mental relaxation.
Scientists have discovered that roughly 80% of the signaling in the brain is carried out by two brain chemicals (glutamate and GABA) that balance each other. (see this post for a detailed scientific review of “The Role of Glutamatergic Neurotransmission System In Aging Brain”). Glutamate is the excitatory neurotransmission system and GABA is the inhibitory neurotransmission system. These 2 systems interact and balance each other to ensure cognitive tasks can be completed without excitotoxicity. Glutamate excites neurons, increasing neurogenesis and facilitating learning and memory. Glutamate is released every time new information is learned. GABA is also present to guarantee neuron were not over shooting. However, under stress, GABA is imbalanced, leading to too much glutamate, causing excitotoxicity. Instead of increasing learning, excess uncontrolled release of glutamate actually kills neurons, hinders the neurogenesis. During times of excess stress or anxiety, this neuronal loss make one feel rigid instead of being able to think clearly. Coping skills are interfered. Before an individual can even realize the problem, the stress cycle begins again. For stress reduction, see “A 7- Step Action Plan For Preventing And Treating Memory Loss”.
When GABA is imbalanced and when anxiety is prevailing , insomnia may trouble an individual. Decreasing serotonin level (aging is a factor that decreases serotonin) can also cause insomnia. When serotonin level begin to wane, brain can not modulate the energy created by the dopamine system. The brain is overloaded all day long and at the same time the delta wave (deep rest brain waves associated with serotonin system) signal increases, blocking alertness (dopamine), creativity (acetylcholine), and relaxation (GABA) and leading to depression (decreased serotonin). Disrupted sleep further hinders the REM (rapid eye movement) sleep (the deepest most restorative phase) which is one of the biggest age accelerator. Not only the brain energy can not be restored, but it also creates its own stress loop that is hard to break. Insomnia associated with serotonin imbalance affect cognition in a variety of different ways: slowed reaction time, less efficiency in learning new information or retrieving memories, frequent overwhelming confusion and impaired decision making. There is correlation between a lack of REM sleep and the onset of depression and psychomotor retardation (the slowing of thought, speech, affect and reduction of physical movements). The resulting fatigue and depression affect both physical and cognitive functions as well as mood stability. Insomnia can be treated by enhancing the brain chemicals GABA and serotonin. Treatment of insomnia also bring other diminishing brain chemicals into balance. Sleep apnea is a common medical condition that is not easy for people to realize. The condition is characterized by dozens or even hundreds of “mini awakenings” that fragment the sleep duration. The result is the constantly roused consciousness which cause an individual tired in the morning. During sleep apnea, the person momentarily stops breathing. When the brain did not get enough oxygen, if forces the “mini-awakenings” in order to breathe, creating multiple sleep interruptions. The brain’s constant vigilance causes lack of REM energy restoration sleep, resulting in a slow brain in the day. Lack of oxygen also damage existing neurons that may further exacerbate cognitive impairments. Insomnia also disrupt memory consolidation. Scientists have discovered that brain needs to be fully rested to maximize information consolidation. Memory are consolidated and moved into long-term storage and this process is continued and enhanced during sleep.
The effect of depression on cognitive impairment and their associations have long been discovered. Both dementia and depression are associated with atrophy of the hippocampus – the part of brain for long-term memory creation. Neurons are found to be damaged gradually in both medical conditions. The natural consequence of depression is the neuron loss and brain electrical loss which in turn cause significant problems in personality, temperament and thinking (cognition). Untreated depression could lead to Alzheimer’s while untreated memory loss in turn leads to more severe depression. Neurogenesis can be recreated through treating depression with anti-depressant, therefore reversing MCI and stopping dementia.
Anxiety and depression are not the only mood problems with MCI. Other personality and mood issues associated with MCI include: tendency to become easily upset or rattled; increased suspiciousness, diminished initiative, growing apathy, focusing exclusively on self, inappropriate behavior or comments, increased stubbornness, lack of emotional control, withdrawal from friends and family and others.
Mood instability are among the easiest brain reversals that is possible because they appear during the mildest brain chemical deficits. The importance of mood to learning and cognition can not be emphasized enough. Studies have demonstrated that people with psychological distress have increased risk of developing Alzheimer’s disease than those who had better coping skills. The “A 7- Step Action Plan For Preventing And Treating Memory Loss” provides a comprehensive protocol for reversing MCI , preventing cognitive impairments in a systematic way.
Reference: book by Eric R. Braverman, MD.