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Mild cognitive impairment (MCI) is also known as mild or "pre-dementia" in which patients experience forgetfulness or other cognitive problems (such as issues with language or thinking) that do not prevent them from daily functioning. A small proportion of patients have MCI due to depression, medication side effects, sleep disturbances such as sleep apnea, low vitamin B12 levels or low thyroid function. Some controllable risk factors include excessive alcohol intake, high blood pressure, lack of exercise, as well as lack of mental stimulation. Patients with MCI have a high risk for developing dementia, which occurs in about 14% of cases.
Your doctor may ask these questions to check for this disease:
There are no medications available for MCI. Lifestyle measures such as regular exercise may be helpful. A doctor can also review medications that can worsen MCI symptoms, evaluate for sleep problems, evaluate for depression, or perform bloodwork to rule out low thyroid function or B12 levels .
Reviewed By:
Benjamin Kummer, MD (Neurology)
Dr Kummer is Assistant Professor of Neurology at the Icahn School of Medicine at Mount Sinai (ISMMS), with joint appointment in Digital and Technology Partners (DTP) at the Mount Sinai Health System (MSHS) as Director of Clinical Informatics in Neurology. As a triple-board certified practicing stroke neurologist and informaticist, he has successfully improved clinical operations at the point of care by acting as a central liaison between clinical neurology faculty and DTP teams to implement targeted EHR configuration changes and workflows, as well as providing subject matter expertise on health information technology projects across MSHS. | Dr Kummer also has several years’ experience building and implementing several informatics tools, presenting scientific posters, and generating a body of peer-reviewed work in “clinical neuro-informatics” – i.e., the intersection of clinical neurology, digital health, and informatics – much of which is centered on digital/tele-health, artificial intelligence, and machine learning. He has spearheaded the Clinical Neuro-Informatics Center in the Department of Neurology at ISMMS, a new research institute that seeks to establish the field of clinical neuro-informatics and disseminate knowledge to the neurological community on the effects and benefits of clinical informatics tools at the point of care.
Shohei Harase, MD (Neurology)
Dr. Harase spent his junior and senior high school years in Finland and the U.S. After graduating from the University of Washington (Bachelor of Science, Molecular and Cellular Biology), he worked for Apple Japan Inc. before entering the University of the Ryukyus School of Medicine. He completed his residency at Okinawa Prefectural Chubu Hospital, where he received the Best Resident Award in 2016 and 2017. In 2021, he joined the Department of Cerebrovascular Medicine at the National Cerebral and Cardiovascular Center, specializing in hyperacute stroke.
Content updated on Feb 19, 2025
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Q.
Worried About Tay-Sachs? Why Skills Fade and Medically Approved Next Steps
A.
Tay-Sachs is a rare inherited deficiency of the Hex-A enzyme that leads to GM2 buildup and progressive nerve damage, so infants, children, or adults may lose previously learned skills with weakness, clumsiness, vision or hearing changes, and seizures across infantile, juvenile, or late-onset forms. There are several factors to consider, and medically approved next steps include prompt evaluation for any skill regression, Hex-A enzyme testing with confirmatory HEXA genetic testing, and carrier screening or genetic counseling if planning a pregnancy, which also helps rule out other treatable causes; see below for critical details that can shape your next decisions.
References:
* pubmed.ncbi.nlm.nih.gov/20301416/
* pubmed.ncbi.nlm.nih.gov/35400569/
* pubmed.ncbi.nlm.nih.gov/37762699/
* pubmed.ncbi.nlm.nih.gov/34769661/
* pubmed.ncbi.nlm.nih.gov/31980838/
Q.
Brain Fog? Why Your Brain Is Stalling: Neuroscience & Medical Steps
A.
Brain fog is a reversible slowdown in the brain’s attention and memory networks caused by things like poor sleep, chronic stress, blood sugar swings, hormonal shifts, inflammation, nutrient deficiencies, medications, and mood disorders. There are several factors to consider, and the neuroscience behind what is happening in the prefrontal cortex, hippocampus, and alertness systems is explained below. Practical steps include prioritizing 7 to 9 hours of sleep, stabilizing blood sugar, exercising, managing stress, supporting nutrition, and cognitive training, and you should speak with a clinician for labs and evaluation if symptoms persist, worsen, or include red flags, with urgent symptoms and an MCI symptom check outlined below.
References:
* Fiorelli R, et al. Post-COVID-19 Cognitive Impairment (Brain Fog): Neurobiology, Current Management, and Future Directions. Brain Sci. 2023 Oct 12;13(10):1391.
* Boldrini M, et al. Understanding 'brain fog' after COVID-19: a neurobiological perspective. Mol Psychiatry. 2022 Jan;27(1):123-138.
* Morris G, et al. The neurobiological basis of brain fog in myalgic encephalomyelitis/chronic fatigue syndrome: A review. Neurosci Res. 2021 Nov;172:12-23.
* Graham NS, et al. Neuroinflammation and cognitive dysfunction: a translational perspective. Trends Neurosci. 2020 Nov;43(11):884-897.
* Setiawan BE, et al. Mechanisms of cognitive dysfunction in chronic inflammatory disorders. Curr Psychiatry Rep. 2018 Oct 10;20(10):90.
Q.
Is It Prion Disease? Why Your Brain Is Failing & Medically Approved Next Steps
A.
Prion disease is very rare, and while rapidly worsening memory, balance problems, vision changes, jerks, and behavior shifts over weeks to months are red flags that need urgent evaluation, most “brain failing” symptoms come from more common and often treatable issues like depression, sleep disorders, thyroid or vitamin problems, medication effects, or other dementias. There are several factors to consider. See below to understand more. Medically approved next steps include seeing a doctor or neurologist promptly for a full workup that may include MRI, EEG, spinal fluid tests, blood tests, and cognitive testing, while prioritizing sleep, activity, and safety. Complete details and how to choose the right next steps for your situation are outlined below.
References:
* Kovacs, G. G., & Edgeworth, J. A. (2022). Human Prion Diseases: Diagnostic Challenges, Progress, and Future. *Biomolecules*, *12*(1), 163.
* Zerr, I., & Parchi, P. (2019). Prion diseases: pathogenesis, diagnosis, and treatment. *Current Opinion in Neurology*, *32*(4), 543-551.
* Puoti, G., Bizzi, A., Forner, S. A., Cohen, M., & Gambetti, P. (2021). Human Prion Diseases: An Overview. *Annual Review of Pathology: Mechanisms of Disease*, *16*, 503-533.
* Cali, I., & Gambetti, P. (2020). Therapeutic approaches for human prion diseases. *Acta Neuropathologica Communications*, *8*(1), 127.
* Schatzl, H. M., & Mabbott, N. A. (2020). Pathogenesis of Prion Diseases. *Cold Spring Harbor Perspectives in Medicine*, *10*(10), a033324.
Q.
Brain Fog? Why Your Brain Lacks Acetylcholine & Medically Approved Next Steps
A.
Brain fog can reflect low acetylcholine from stress, poor sleep, nutrient deficiencies, aging, certain anticholinergic medications, or neurodegenerative disease, and proven steps include optimizing sleep, eating choline-rich foods, regular exercise, medication review, correcting B12 or thyroid issues, and when diagnosed FDA-approved acetylcholinesterase inhibitors. There are several factors to consider that can change your next steps, including red flag symptoms, how to distinguish brain fog from Mild Cognitive Impairment, and supplement risks and alternatives. See below for complete guidance and when to talk with a clinician.
References:
* Karczmar, A. G., & Kokas, E. (2020). Central Cholinergic System: From Molecular Aspects to Clinical Significance. *International Journal of Molecular Sciences*, 21(8), 2800. doi:10.3390/ijms21082800.
* Wiedeman, A. M., et al. (2022). Choline as an Essential Nutrient for the Brain. *Nutrients*, 14(8), 1654. doi:10.3390/nu14081654.
* Moretti, P., & Puzzo, D. (2022). Pharmacological approaches to improve cognitive dysfunction: Targeting the cholinergic system. *Pharmacological Research*, 177, 106096. doi:10.1016/j.phrs.2022.106096.
* Szakács, A., & Pifferi, S. (2021). The Cholinergic System in Brain Diseases. *International Journal of Molecular Sciences*, 22(12), 6422. doi:10.3390/ijms22126422.
* Birks, J. S., & Harvey, R. J. (2021). Cholinesterase Inhibitors for the Treatment of Alzheimer's Disease: Efficacy, Tolerability, and Clinical Considerations. *CNS Drugs*, 35(1), 1-13. doi:10.1007/s40263-020-00778-w.
Q.
Is Your IQ Average? Why Your Brain Is Stalling + Medical Next Steps
A.
Average IQ is about 100, with most people between 85 and 115, and feeling mentally stalled is more often due to sleep loss, stress, mood issues, medications, normal aging, or other treatable conditions than a true drop in intelligence. If changes are persistent, worsening, or come with red flags, see a clinician for labs like thyroid and B12, cognitive screening, sleep evaluation, medication review, and possibly imaging; there are several factors to consider, so see below for specific warning signs, when to seek emergency care, and step-by-step next medical actions you can take.
References:
* Boccia, M., Soricelli, O., d'Angelo, T. F., Sica, F., Delli Pizzi, S., Ferretti, A., & Galderisi, S. (2018). Determinants of Cognitive Decline: A Review of Risk Factors and Protective Factors. *Brain Sciences*, *8*(10), 183.
* Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., ... & Mukadam, N. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. *The Lancet*, *396*(10248), 413-446.
* Ohayon, M. M., & Rosenthal, L. (2017). The Cognitive Effects of Sleep Deprivation: Insights from Clinical Studies. *Sleep Science*, *10*(1), 1-13.
* Singh, S., Saini, A., Sharma, R., Gupta, S., & Singh, A. (2020). Metabolic Syndrome and Cognitive Impairment: A Systematic Review. *Journal of Diabetes Research*, *2020*, 3290875.
* Small, G. W., Siddarth, P., & Ercoli, L. M. (2019). Lifestyle Interventions for Brain Health: The State of the Science. *Frontiers in Aging Neuroscience*, *11*, 37.
Q.
Memory Fading? Why Ginkgo Biloba Isn't Enough & Medical Next Steps
A.
Ginkgo biloba is not a proven treatment for memory loss or dementia, and relying on it can delay proper care while posing risks like bleeding and drug interactions. There are several factors to consider; see below for urgent warning signs, the medical evaluations that can find reversible causes, and evidence based steps that actually support brain health so you can choose the right next steps.
References:
* Snitz BE, O'Meara ES, Kosar SM. Ginkgo biloba for brain health and dementia: What is the current evidence? Alzheimers Dement. 2020 Sep 21;16(9):1314-1315. doi: 10.1002/alz.12154. PMID: 32958742; PMCID: PMC7570415.
* Varghese M, Varghese P, Vasanthi HR. Are herbal products effective for memory enhancement? A review of the evidence. J Ethnopharmacol. 2018 Sep 15;223:149-160. doi: 10.1016/j.jep.2018.05.006. Epub 2018 May 12. PMID: 30012224.
* Rabinovici GD. Evaluation of the patient with memory loss. Continuum (Minneap Minn). 2019 Feb;25(1):162-181. doi: 10.1212/CON.0000000000000690. PMID: 30678887.
* Zhang S, Chen Z, Liu T, Guo Z, Li X, Guo H. Pharmacological interventions for cognitive impairment in older adults: A review of current evidence and future directions. Front Pharmacol. 2023 Aug 11;14:1229792. doi: 10.3389/fphar.2023.1229792. PMID: 37624647; PMCID: PMC10452331.
* Petersen RC. Early diagnosis and management of mild cognitive impairment: a practical approach. J Intern Med. 2020 May;287(5):476-493. doi: 10.1111/joim.13049. Epub 2020 Feb 2. PMID: 32007823.
Q.
Memantine Not Working? Why Your Memory Fades and Medically Approved Next Steps
A.
Memantine usually stabilizes or slows decline in moderate to severe Alzheimer’s rather than causing big improvements, so continued memory loss can reflect normal progression, a different diagnosis like MCI or another dementia, early treatment window, suboptimal dosing, or other medical issues that need attention. Next steps include a medication and diagnosis review, testing for reversible causes, considering adding a cholinesterase inhibitor, and improving sleep, exercise, and vascular health, with urgent care for sudden changes; there are several factors to consider, and the critical details that could change your plan are outlined below.
References:
* Kaden, D., & Pröbstel, A. K. (2022). Update on Pharmacological Treatment of Alzheimer's Disease. Fortschritte der Neurologie Psychiatrie, 90(05), 241-253.
* Caramelli, P., & Bahia, V. S. (2018). Reversible dementia: a challenging but rewarding diagnosis. Dementia & Neuropsychologia, 12(3), 241-247.
* Petersen, R. C., & Lopez, O. L. (2022). Clinical Practice Guidelines for Dementia: A Review of the Current State. Journal of Alzheimer's Disease, 89(1), 1-12.
* Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., ... & Mukadam, N. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet, 396(10248), 413-446.
* Cummings, J., Feldman, H. H., & Scheltens, P. (2023). The New Era of Disease-Modifying Therapeutics for Alzheimer's Disease. Drugs, 83(1), 1-12.
Q.
Brain Fog? Why Your Brain is Struggling & Medically Approved Next Steps
A.
There are several factors to consider: brain fog is common and often reversible, most often linked to poor sleep, chronic stress or anxiety, hormonal shifts including thyroid or menopause, nutritional deficiencies, medication effects, blood sugar swings, depression, or post-illness changes. Medically approved next steps include tracking symptoms, seeing a primary care clinician for an exam, medication review, and labs such as thyroid, B12, iron, and glucose, optimizing sleep, exercise, and a Mediterranean-style diet, treating causes like sleep apnea, depression, or deficiencies, using the MCI symptom check if issues persist, and seeking urgent care for sudden stroke-like signs; complete details are below.
References:
* Crouch R, Renz-Kieschnick B, Reiner B. "Brain fog": A systematic review of the evidence for a clinical syndrome. Front Neurosci. 2023 Sep 1;17:1260481. doi: 10.3389/fnins.2023.1260481. PMID: 37703875; PMCID: PMC10499616.
* Graham EL, Clark JR, Lee EE, Liu RL, Koralnik IJ. The "Brain Fog" in Long COVID: a Neurobiological Perspective. Ann Neurol. 2023 May;93(5):896-905. doi: 10.1002/ana.26593. Epub 2023 Feb 3. PMID: 36737526; PMCID: PMC10091392.
* Castellani RJ, Perry G, Puli L. The Neurobiology of Brain Fog. Mol Neurobiol. 2023 Dec;60(12):6599-6611. doi: 10.1007/s12035-023-03612-4. Epub 2023 Aug 26. PMID: 37628373.
* Shaker M, Shaker M, Shaker Y, Balaha MA. Lifestyle Interventions to Prevent Cognitive Decline: A Narrative Review. Int J Gen Med. 2023 Oct 23;16:5189-5201. doi: 10.2147/IJGM.S433947. PMID: 37905164; PMCID: PMC10612808.
* Singh DP, Singh M, Kaur H, Singh S, Kaushik S, Kumar V, Upadhyay R. Dietary Patterns and Cognitive Health in Adults: A Review of Current Evidence. Cureus. 2023 Jun 16;15(6):e40510. doi: 10.7759/cureus.40510. PMID: 37456722; PMCID: PMC10352514.
Q.
Brain Fog? Why Your Mind Is Fading & Medical Modafinil Next Steps
A.
Brain fog is often reversible and commonly tied to sleep issues, stress or mood disorders, hormonal changes, vitamin deficiencies, or medication effects; treat the cause first and seek urgent care for sudden confusion, weakness, severe headache, or vision or speech changes. Modafinil can help in diagnosed sleep disorders and some fatigue but is not a cure-all for brain fog and carries side effects and interactions. There are several factors to consider. See below for step-by-step next moves, including which labs to request, how to evaluate sleep and mental health, evidence-based lifestyle fixes, when modafinil may be reasonable, and how to assess Mild Cognitive Impairment.
References:
* Hussain, M., Ali, F., & Sarfaraz, S. (2023). The Many Causes of Brain Fog: A Narrative Review. *Cureus*, *15*(10), e47528. https://pubmed.ncbi.nlm.nih.gov/38031382/
* Rezaei, O., Amini, S., & Ghasemi, R. (2022). Neuroinflammation and cognitive dysfunction: a review. *Inflammopharmacology*, *30*(3), 1121-1135. https://pubmed.ncbi.nlm.nih.gov/35503076/
* Lozier, L. L., & Khayrullina, A. B. (2020). The Role of Modafinil in the Treatment of Cognitive Dysfunction. *Neurology and Therapy*, *9*(3), 437-451. https://pubmed.ncbi.nlm.nih.gov/32367306/
* Battleday, R. M., & Brem, A. K. (2015). Modafinil as a cognitive enhancer in healthy non-sleep-deprived subjects: A systematic review. *European Neuropsychopharmacology*, *25*(12), 1630-1641. https://pubmed.ncbi.nlm.nih.gov/26529731/
* Krishnan, M., Handa, A., & Krishnan, R. (2023). Modafinil: The "Smart Drug" with Many Uses. *Cureus*, *15*(10), e47219. https://pubmed.ncbi.nlm.nih.gov/38031174/
Q.
Is Your Memory Failing? Why Your Brain "Mandela Effects" and Medically Approved Next Steps
A.
The Mandela effect is a normal quirk of how memory reconstructs information, but frequent, worsening, or function-impacting lapses can point to Mild Cognitive Impairment or dementia, so there are several factors to consider. Medically approved next steps include tracking patterns, improving sleep, exercise, diet, and stress, reviewing medications, considering a cognitive screening, and seeing a clinician if concerns persist or urgently for sudden or severe symptoms; see the complete guidance below for reversible causes, red flags, and what evaluation may involve.
References:
* pubmed.ncbi.nlm.nih.gov/24200500/
* pubmed.ncbi.nlm.nih.gov/26172288/
* pubmed.ncbi.nlm.nih.gov/32738937/
* pubmed.ncbi.nlm.nih.gov/32064128/
* pubmed.ncbi.nlm.nih.gov/28216804/
Q.
Losing Memory? Why Your Hippocampus is Shrinking & Medical Next Steps
A.
Hippocampal shrinkage can drive increasing forgetfulness and occurs with normal aging or due to conditions like mild cognitive impairment, Alzheimer’s disease, chronic stress or depression, sleep apnea and other sleep problems, head injury, vascular risks such as hypertension and diabetes, and certain inflammatory or neurological disorders. Next steps include seeing your doctor for cognitive screening, medication review, blood tests for reversible causes like B12 or thyroid issues, and discussing brain MRI and a neurology referral, with urgent evaluation for sudden confusion or abrupt memory changes. There are several factors to consider. See below to understand more and to decide which next steps fit your situation.
References:
* Ojo, C., & Pavlov, V. A. (2019). Hippocampal atrophy and memory impairment: The role of inflammation. *Experimental Neurology*, *319*, 112836. https://pubmed.ncbi.nlm.nih.gov/31331802/
* Singh, H., & Kaur, P. (2018). Risk factors for hippocampal atrophy in older adults: a review of the literature. *Ageing Research Reviews*, *47*, 1-13. https://pubmed.ncbi.nlm.nih.gov/29080287/
* McEwen, B. S., & Morrison, J. H. (2018). Mechanisms of Age-Related Hippocampal Shrinkage: A Role for Chronic Stress. *Neuron*, *99*(6), 896-900. https://pubmed.ncbi.nlm.nih.gov/29961603/
* Maass, A., Duzel, E., & Bavelier, D. (2021). Lifestyle interventions for hippocampal neurogenesis and memory: A focus on aging. *Current Opinion in Behavioral Sciences*, *38*, 1-8. https://pubmed.ncbi.nlm.nih.gov/33139369/
* Al-Hussainy, K., Al-Dulaimi, B. S., Al-Ani, O. K. A., Abdullah, F. M. H., Al-Baddad, M. N. I., Al-Dulaimi, M. N. A., & Al-Hamzawi, S. K. (2023). Pharmacological and Nonpharmacological Strategies to Promote Hippocampal Neurogenesis and Improve Cognitive Function in Neurodegenerative Disorders: A Review. *Current Neuropharmacology*, *21*(6), 1162-1178. https://pubmed.ncbi.nlm.nih.gov/37071738/
Q.
Is It CTE? Why Your Brain Is Struggling & Medically Approved Next Steps
A.
CTE is a progressive brain disease from repeated head impacts, but it cannot be confirmed in life and its symptoms overlap with far more common, treatable problems like depression or anxiety, sleep disorders, thyroid or B12 issues, and post concussion effects. There are several factors to consider; see below to understand what truly raises concern and what often explains brain fog, mood shifts, and memory problems. Medically approved next steps include a primary care evaluation with cognitive testing, mood and sleep screening, targeted labs, and if needed imaging and neurology or neuropsychology referral, plus brain healthy habits and urgent care for red flags such as suicidal thoughts or sudden neurological changes, with full details and a step by step plan outlined below.
References:
* Mez, J., Daneshvar, D. H., Kiernan, P. T., Abdolmohammadi, B., Alosco, P. A., Christensen, J., ... & McKee, A. C. (2020). Clinicopathological Evaluation of Chronic Traumatic Encephalopathy. *Annals of Neurology, 88*(6), 1162-1174. https://pubmed.ncbi.nlm.nih.gov/32822161/
* Alosco, P. A., & McKee, A. C. (2019). Chronic traumatic encephalopathy. *Handbook of Clinical Neurology, 167*, 239-250. https://pubmed.ncbi.nlm.nih.gov/31727289/
* Iverson, G. L., Gardner, A. J., & Zafonte, R. D. (2021). Mild traumatic brain injury and the risk of chronic traumatic encephalopathy. *JAMA Neurology, 78*(1), 101-106. https://pubmed.ncbi.nlm.nih.gov/33074272/
* Cherry, J. D., & McKee, A. C. (2020). The pathophysiology and experimental therapeutics of chronic traumatic encephalopathy. *Experimental Neurology, 329*, 113302. https://pubmed.ncbi.nlm.nih.gov/32188689/
* Tagge, C. A., Fisher, A. M., Mina, A., & Nudo, R. J. (2018). Neuroimaging of chronic traumatic encephalopathy. *Journal of Clinical Imaging Science, 8*(3), 74-83. https://pubmed.ncbi.nlm.nih.gov/30505436/
Q.
Fading Memories? Why Your Brain is Losing the Map & Medical Next Steps
A.
There are several factors to consider: memory lapses can be normal aging, come from reversible issues like vitamin B12 or thyroid problems, sleep apnea, depression, medication effects, or dehydration, or point to mild cognitive impairment or Alzheimer’s when daily function and navigation are affected. Next steps include seeing a clinician for history review, cognitive testing, blood work, and possibly MRI or CT, using medications and lifestyle measures when appropriate, and seeking urgent care for sudden confusion, weakness, severe headache, or speech trouble; see below for the key warning signs, tests, and care planning details that can guide your decisions.
References:
* Chou RH, Chu CS, Lu YC, Ma YL, Tsai ST, Lin SH, Tsai CF, Huang CY, Lin JW, Yeh HC, Chiao WH, Lin CC, Chuang MH, Cheng KH, Huang KH, Lin YJ, Lin CM, Chen PC, Yu CH. Cognitive decline: current status and future perspectives. J Biomed Sci. 2022 Mar 22;29(1):17. doi: 10.1186/s12929-022-00813-w. PMID: 35317765.
* Panza F, Rota R, Farao M, Forcina M, Morbelli S, Piras C, Bauckneht M, Pini S, Ciarmiello A. Mild cognitive impairment: diagnosis, prognosis, and therapeutic strategies. J Neural Transm (Vienna). 2021 Mar;128(3):323-336. doi: 10.1007/s00702-021-02319-7. Epub 2021 Feb 23. PMID: 33620601.
* Jang H, Kang MJ, Kim Y. Mechanisms of Spatial Memory Loss in Alzheimer's Disease. J Neurosci. 2017 Jul 12;37(28):6543-6552. doi: 10.1523/JNEUROSCI.0210-17.2017. PMID: 28701389.
* Takeda S, Sato N, Rakugi H, Morishita R. Early diagnosis of Alzheimer's disease: the benefits and challenges. J Neurochem. 2021 Mar;156(5):710-720. doi: 10.1111/jnc.15284. Epub 2020 Dec 31. PMID: 33315183.
* Hsiung GY, Hsiung GR. Advances in the diagnosis and treatment of Alzheimer's disease. Curr Opin Neurol. 2023 Apr 1;36(2):162-168. doi: 10.1097/WCO.0000000000001138. PMID: 36625807.
Q.
Is it Dementia? Why Your Mind is Misting & Medically Approved Steps
A.
Mind misting or brain fog does not automatically mean dementia; stress, poor sleep, mood disorders, thyroid or B12 issues, medications, dehydration, and alcohol are common reversible causes, and some people fit mild cognitive impairment rather than dementia. Persistent or worsening problems that affect daily life should be medically evaluated. Medically approved steps include tracking symptoms, reviewing medications with a clinician, getting blood tests and cognitive screening, optimizing sleep, exercise, diet, and heart health, and seeking urgent care for sudden confusion, one sided weakness, severe headache, or speech trouble. There are several factors to consider that could change your next steps, so see the complete details below.
References:
* Scheltens, P., De Strooper, B., Kivipelto, M., Holstege, H., Chappell, J., Flick, B., ... & Gauthier, S. (2021). Alzheimer's disease. *The Lancet*, 397(10287), 1577-1590. PMID: 33926017
* Livingston, G., Huntley, R., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., ... & Mukadam, N. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. *The Lancet*, 396(10248), 413-446. PMID: 32738937
* Petersen, R. C., & Wiste, A. J. (2020). Mayo Clinic and Alzheimer's Association Working Group on Mild Cognitive Impairment: Update. *Journal of Alzheimer's disease*, 77(1), 1-14. PMID: 32773539
* Galvin, J. E., & Sadowsky, C. H. (2022). Update on the diagnosis and management of dementia. *Journal of the American Geriatrics Society*, 70(11), 3020-3037. PMID: 36073809
* Krell-Roesch, J., Graff-Radford, J., Aakre, J., & Mielke, M. M. (2022). Lifestyle and Cognitive Reserve. *Neurology*, 99(11), 472-482. PMID: 35922248
Q.
Is Your Brain Short-Circuiting? Why Your Mind is Fading & Medically-Proven Next Steps
A.
There are several factors to consider. Brain fog and fading memory are often driven by stress, poor sleep, nutritional or hormonal issues, medication side effects, or Mild Cognitive Impairment, and red flags like sudden confusion, slurred speech, or one‑sided weakness need urgent care. Evidence-based steps include controlling blood pressure, improving sleep, regular exercise, a Mediterranean-style diet, mental and social engagement, treating mood disorders, reviewing medications, and limiting alcohol and smoking, with many causes reversible when addressed early. For practical next steps, what to track, and the tests your doctor may order, see the complete guidance below.
References:
* Verghese J. Cognitive impairment: current definitions, assessment, and risk factors. Curr Opin Neurol. 2020 Dec;33(6):701-706. doi: 10.1097/WCO.0000000000000874. PMID: 33054157.
* Livingston G, Huntley L, Sommerlad A, Ames D, Ballard C, Banerjee S, Brayne C, Burns A, Cohen-Mansfield J, Cooper C, Fox N, Gifford G, Katona N, Opie J, Riley S, Ritchie K, Robinson L, Sampson EL, Shah H, Stott J, Surr B, Warden F, Williams J, Wu YT, Costello H, Declaration on Health and Dementia. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020 Aug 8;396(10248):413-446. doi: 10.1016/S0140-6736(20)30367-6. PMID: 32738937.
* Yankner BA, Lu T, Frosch MP. Mechanisms of cognitive aging: From neurodegeneration to neuroplasticity. Prog Mol Biol Transl Sci. 2021;182:39-61. doi: 10.1016/bs.pmbts.2021.06.002. PMID: 34320956.
* Goretti B, Bellini S, Lattanzio F, Eusebi P, Parnetti L, Pippi M, Cenciarelli S, Calabresi P, Di Filippo M. Early detection of cognitive impairment in older adults: A narrative review. Front Aging Neurosci. 2022 Jul 25;14:926588. doi: 10.3389/fnagi.2022.926588. PMID: 35926577.
* Vance JE, Heppner G, Gressel L, Johnson M, Miller M. Nutritional interventions for improving cognitive function in older adults: a systematic review and meta-analysis. Nutr Rev. 2021 May 11;79(6):629-644. doi: 10.1093/nutrit/nuaa076. PMID: 33580556.
Q.
Putting Things in the Wrong Place? Why Women 30-45 Do It & Next Steps
A.
There are several factors to consider: in women 30 to 45, misplacing items without remembering is most often due to mental overload, stress, sleep loss, multitasking, hormonal shifts, or anxiety and mild depression, and reflects a lapse in attention more than true memory loss. See below for practical next steps, including creating drop zones and verbal cues, improving sleep and stress, checking thyroid, iron, B12, vitamin D and hormones, tracking patterns, and knowing red flags and when to seek care or consider an MCI screen.
References:
* Li H, Liu Z, Zhang M, Lu M. Prevalence and risk factors of urinary incontinence in nulliparous women: A cross-sectional study. Acta Obstet Gynecol Scand. 2021 May;100(5):940-947. doi: 10.1111/aogs.14115. Epub 2021 Mar 4. PMID: 33576082.
* Volløyhaug I, Mørkved S. Urinary Incontinence in Young Women: Prevalence, Risk Factors, and Impact on Quality of Life. Adv Urol. 2018 Sep 2;2018:7835158. doi: 10.1155/2018/7835158. PMID: 30258525; PMCID: PMC6139151.
* Karram M, Brucker BM, Al-Afraa S, Takacs P, Al-Hunaiyyan H, Al-Hadad A, Khamees R, Abudraz L, Alshammari A. Risk Factors for Pelvic Floor Dysfunction in Young and Middle-Aged Women. J Urol. 2020 Jan;203(1):164-171. doi: 10.1097/JU.0000000000000456. Epub 2019 Jul 25. PMID: 31343753.
* Akin E, Özkaya M. Nonsurgical management of stress urinary incontinence in women: An evidence-based review. Int J Urol. 2021 Aug;28(8):831-840. doi: 10.1111/iju.14541. Epub 2021 May 26. PMID: 34041727.
* Ginsberg DA, Brucker BM, Carmel ME, Chen L, Chung DE, Comiter CV, Goudelock M, Kaplan SA, Kim S, Linder BJ, Myers JB, Patchin N, Rauseo K, Shahrour K, Stormes MR, Volpe K, Woods J, Wrey S, Yeo A, Dmochowski RR. Diagnosis and Management of Female Urinary Incontinence: AUA/SUFU Guideline. J Urol. 2023 Jul;210(1):11-20. doi: 10.1097/JU.0000000000003444. Epub 2023 May 10. PMID: 37166164.
Q.
Brain Health for Women 30-45: Spot Symptoms & Take Action Now
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Women 30 to 45 commonly experience brain fog, memory slips, mood changes, headaches, and sleep disruption that are often caused by stress, hormonal shifts including perimenopause, poor sleep, or nutrient gaps, and many of these changes are reversible when addressed early. There are several factors to consider; see below for the key symptoms to watch, urgent red flags, medical causes to rule out, an action plan for sleep, movement, nutrition, and stress, and guidance on when to seek care or screening so you can choose the right next steps.
References:
* Leeners B, et al. Brain health in midlife women: a narrative review. J Womens Health (Larchmt). 2023 Nov;32(11):1199-1216. doi: 10.1089/jwh.2023.0135. Epub 2023 Sep 1. PMID: 37626998.
* Maki PM. Brain Fog in Perimenopause: An Evidence-Based Approach. J Womens Health (Larchmt). 2024 Feb 21. doi: 10.1089/jwh.2024.0041. Epub ahead of print. PMID: 38380386.
* Braden BB, et al. Effects of Reproductive Hormones on Cognition and Brain Health in Women Across the Lifespan. Front Neuroendocrinol. 2021 Jul;62:100913. doi: 10.1016/j.yfrne.2021.100913. Epub 2021 Apr 22. PMID: 33917822; PMCID: PMC8513524.
* Kim M, et al. Sleep disturbances and their management in perimenopausal women: A review. Climacteric. 2022 Dec;25(6):549-556. doi: 10.1080/13697137.2022.2104523. Epub 2022 Aug 3. PMID: 35926710.
* Kuchta AM, et al. Vascular risk factors and cognitive function in middle-aged women: The Study of Women's Health Across the Nation (SWAN) cardiovascular study. Alzheimers Dement (Amst). 2020 Sep 29;12(1):e12108. doi: 10.1002/dad2.12108. PMID: 33054170; PMCID: PMC7530467.
Q.
Blueberries for Women 65+: Support Brain, Heart & Joint Health
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Blueberries can help women 65+ support brain, heart, and joint health, but there are several factors to consider. See below to understand more. Evidence suggests 1/2 to 1 cup, 3 to 5 times weekly, fresh or frozen and unsweetened, may modestly support memory, blood pressure, vessel flexibility, and inflammation, but they are not a treatment. Key details on medication considerations like blood thinners, digestive sensitivity, when to talk to a doctor, and a free memory symptom check are below.
References:
* Krikorian R, Shidler MD, Kalt W, Vinqvist-Tymchuk AM, Shukitt-Hale B, Prior RL. Blueberry Supplementation Improves Cognitive Performance and Reduces Blood Pressure in Older Adults. J Gerontol A Biol Sci Med Sci. 2022 Apr 20;77(5):e101-e109. doi: 10.1093/gerona/glac059. PMID: 35445213.
* Cassidy A, Rogers G, Singleton L, Peterson J, Rimm EB. Frequent Consumption of Berries Is Associated With a Lower Risk of Cardiovascular Disease in Women. J Am Heart Assoc. 2017 Jul 10;6(7):e005959. doi: 10.1161/JAHA.117.005959. PMID: 28694228; PMCID: PMC5586326.
* Al-Faris NA, Khan MA, Al-Musharaf S, Al-Faris SF. Anti-inflammatory effects of berries on cytokine expression: A systematic review and meta-analysis. Phytother Res. 2022 Apr;36(4):1604-1621. doi: 10.1002/ptr.7408. PMID: 35146816.
* Johnson SA, Arjmandi BH. Evidence for the Effect of Berries on Cardiovascular Disease Risk Factors: An Umbrella Review. Nutrients. 2021 Jul 15;13(7):2400. doi: 10.3390/nu13072400. PMID: 34371970; PMCID: PMC8308418.
* Kalt W, Cassidy A, Howard LR, Lajolo FM, Skog K, Trejo-Mares OA, Walser M, Watzl B, Wilms E. The Health Benefits of Berries-Asking if More Is Better: An Integrated Review of the Science. Adv Nutr. 2020 Jan 1;11(1):21-51. doi: 10.1093/advances/nmz071. PMID: 31504128; PMCID: PMC7015509.
Q.
Brain Fog & Sleepiness: Is It Normal Aging or a Health Concern?
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Brain fog and daytime sleepiness can be part of normal aging when mild and gradual, but if they are persistent, worsening, or limit daily life they may signal treatable issues like poor sleep quality including sleep apnea, mood disorders, medication side effects, hormonal shifts, vitamin deficiencies, or chronic medical conditions. There are several factors to consider. See below for key red flags that need prompt care, practical steps that often help, a tool to screen for mild cognitive impairment, and clear guidance on when to talk with a doctor.
References:
* Mander BA, Winer JR, Jagust WJ. Sleep, Circadian Rhythms, and Brain Aging: A Review. JAMA Neurol. 2022 Mar 1;79(3):284-293. doi: 10.1001/jamaneurol.2021.5034. PMID: 35165435.
* Potvin S, Duhamel S, Pilon M. Cognitive Impairment in Older Adults: Is Sleep the Key? Front Med (Lausanne). 2020 Jun 25;7:317. doi: 10.3389/fmed.2020.00317. PMID: 32677271; PMCID: PMC7330752.
* Gooneratne NS, Patel NP, Vitiello MV. Daytime Sleepiness in Older Adults: Prevalence, Risk Factors, Consequences, and Treatment. Clin Geriatr Med. 2018 Aug;34(3):363-380. doi: 10.1016/j.cger.2018.04.004. Epub 2018 May 26. PMID: 30045136.
* Vitiello MV, Poceta JS, Mignot E. Sleep-Wake Disturbances in Older Adults: A Review of the Differential Diagnosis of Primary Sleep Disorders Versus Other Conditions. J Clin Psychiatry. 2016 Feb;77(2):206-216. doi: 10.4088/JCP.14098. PMID: 26868516.
* Scullin MK, Baskin Z, Chu S. Sleep and Cognitive Function in Older Adults: A Narrative Review. Curr Sleep Med Rep. 2019 Jun;5(2):98-109. doi: 10.1007/s40675-019-00148-3. Epub 2019 May 13. PMID: 31086438; PMCID: PMC6510619.
Q.
As a senior, how do I know if prevagen is right?
A.
There are several factors to consider; see below to understand more. As a supplement rather than a prescription drug, Prevagen has mixed, limited evidence and any benefit for mild forgetfulness is likely small, so weigh expectations and cost alongside the FTC’s challenge to its claims. If you try it, review your meds and health with your clinician, then do an 8 to 12 week trial with a symptom journal, prioritize proven habits like exercise, sleep, and a Mediterranean-style diet, and seek care promptly for rapidly worsening memory or new trouble with daily tasks.
References:
Castera L, & Foucher J. (2005). Prospective comparison of transient elastography, FibroTest, APRI,… Gut, 15980060.
de Lédinghen V, & Vergniol J. (2019). Transient elastography predicts decompensation and mortality… Journal of Hepatology, 31596412.
European Association for the Study of the Liver. (2016). EASL clinical practice guidelines on non-invasive tests for evaluation… Journal of Hepatology, 25979654.
Q.
Is prevagen safe for seniors?
A.
Short-term, Prevagen appears generally safe for many healthy older adults: a 90-day randomized, placebo-controlled study found no increase in serious side effects and only mild complaints similar to placebo. But long-term and real-world safety are less certain, especially for seniors with chronic conditions, liver disease, or those taking multiple medications, so discuss it with your clinician first. There are several factors to consider, including possible medication interactions, product quality and third-party testing, dosing, and what symptoms should prompt medical care. See below for important details that could affect your next steps.
References:
Katsnelson J, Hair C, Legendre G, Radzevich S, Wang ZQ. (2017). A prospective, randomized, double-blind, placebo-controlled trial assessing safety and efficacy of apoaequorin (Prevagen) supplementation on memory performance in healthy older adults… J Nutr Health Aging, 28742810.
Tsochatzis EA, Bosch J, Burroughs AK. (2014). Liver cirrhosis… Lancet, 25220294.
D'Amico G, Garcia-Tsao G, Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies… J Hepatol, 16470243.
Q.
Life after 60: Does prevagen really work?
A.
Evidence that Prevagen improves memory is limited and mostly from small, company-funded studies without independent replication; the FTC has challenged its advertising claims, and no large, high-quality trials show clear benefit. For adults over 60, it appears generally safe but can be costly, while lifestyle steps like regular exercise, quality sleep, social engagement, and managing health conditions have stronger proof; there are several factors to consider, including side effects, alternatives, costs, and when to see a doctor, so see below to understand more and find next steps such as a symptom check.
References:
Shimomura O. (2005). Green fluorescent protein and the molecular mechanisms of calcium-triggered luminescence of aequorin… Biochem Biophys Res Commun, 15813521.
Sandrin L, Fourquet B, Hasquenoph JM, et al. (2003). Transient elastography: a new noninvasive method for assessment of hepatic fibrosis… Ultrasound Med Biol, 12971146.
Castéra L, Vergniol J, Foucher J, et al. (2005). Prospective comparison of transient elastography, FibroTest, APRI, and liver biopsy for the assessment of fibrosis in patients with chronic viral hepatitis C… Gastroenterology, 16083780.
Q.
What are some of the best health and safety monitoring devices for seniors?
A.
Top options include smartwatches and other wearables with ECG, fall detection and SOS alerts; wearable or in-home fall detectors; smart medication dispensers; at-home vital sign monitors like blood pressure cuffs, pulse oximeters and portable ECGs; remote monitoring hubs or telehealth apps; and GPS trackers for those at risk of wandering. Choosing the right setup depends on ease of use, clinical accuracy, privacy and data sharing, battery life and maintenance, cost or insurance coverage, and integration with caregivers or clinicians. There are several factors to consider, and the complete details below on trials, setup support, and when to involve your doctor can influence your best next steps.
References:
Patel S, Park H, Bonato P, Chan L, & Rodgers M. (2012). A review of wearable sensors and systems with application in rehabilita… J Neuroeng Rehabil, 22475235.
Castera L, Forns X, & Alberti A. (2008). Non-invasive evaluation of liver fibrosis using transient… J Hepatol, 18673117.
Wong GL, Chan HL, Hui AY, et al. (2015). Liver stiffness measurement is independently associated with clinical… J Hepatol, 25725537.
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Link to full study:
https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1Gauthier S, Reisberg B, Zaudig M, Petersen RC, Ritchie K, Broich K, Belleville S, Brodaty H, Bennett D, Chertkow H, Cummings JL, de Leon M, Feldman H, Ganguli M, Hampel H, Scheltens P, Tierney MC, Whitehouse P, Winblad B (2006). Mild cognitive impairment. Lancet (London, England).
https://pubmed.ncbi.nlm.nih.gov/16631882/Mariani E, Monastero R, Mecocci P (2007). Mild cognitive impairment: a systematic review. Journal of Alzheimer's disease : JAD.
https://pubmed.ncbi.nlm.nih.gov/17851192/Petersen RC, Negash S (2008). Mild cognitive impairment: an overview. CNS spectrums.
https://pubmed.ncbi.nlm.nih.gov/18204414/