Mild Cognitive Impairment (MCI) is now recognized as diagnosis, representing a state of cognitive decline associated with negligible functional loss. MCI is important as it often precedes Alzheimer’s disease (AD). Recognizing MCI may lead to preventive strategies that can delay the onset of AD. Many patients who transition into andropause report problems with their memory. There is strong evidence from basic sciences and epidemiological studies that both estrogens and androgens play a protective role in neurodegeneration. The evidence from small prospective clinical trials lends support to the role of hormones in improving cognitive function. The improvement in cognitive function with hormones is subtle and often not measurable on standard neuropsychological batteries. Patients have reported memory improvements in both declarative and procedural domains after being on hormonal replacement. Functional changes and vascular changes can be detected after hormonal replacement with more sophisticated imaging of the brain like PET scans. We hypothesize androgens and perhaps selective androgen receptor modulators as future treatment options for MCI in aging males.
A patient having significant impairment of short-term memory, while remaining cognitively intact, characterizes mild cognitive impairment (MCI). An informant usually reports the memory loss and the patient has normal activities of daily living. This condition has often been referred to as “age associated memory loss”. Functional changes can be seen on P.E.T. scans. The prevalence of MCI ranges from 17%-34%. Follow up of these patients suggest a conversion rate of 10-15% per year to Alzheimer’s disease. The pathophysiology of MCI includes significant neuronal loss in the hippocampus and decreased blood flow in the subiculum. Neurofibrillary tangles and -amyloid were seen in individuals with MCI. Cerebrospinal fluid also shows disproportionate increase in tau protein levels relative to similar age group individuals. Patients having MCI usually have a fall in their gonadal steroids at the same time. Women in their perimenopausal years often report better memory after estrogen replacement.. Men, when they age beyond 50 years may suffer from androgen depletion, which occurs more gradually as compared to women. This entity has been referred to as Andropause or the Androgen Decline in Aging Males (A.D.A.M.) syndrome. It has been observed that older men who have undergone androgen replacement often report improved memory function. This suggests that both estrogens and androgens may have a role in improving memory in individuals entering into a transitional stage of lowered hormones. If you have memory loss and you want to be evaluated, contact us at the Opal Medical Clinic in Houston. You can also visit us at ww.opalmedical.com for further information. We assess patients with both memory loss and hormonal decline