"Dementia"

TR was here yesterday. He has complaints about memory loss. He is doing very well, despite his inability to remember things. On his Neurtrax, which is the instrument I use to measure thinking, he scores 104 which is just above average. Average is 100. One standard deviation below normal is 85, which is considered "abnormal" on the test.
We have a classification called "Mild Cognitive Impairment". We have "Normal". We also have the famous "Dementia". "Mild Cognitive Impairment" means (as close as I can translate), in English: "There's definitely something wrong, but it isn't bad enough to say that it's Dementia. We have guidelines set up to determine that someone has dementia.
The reality is that people "slip". They don't generally go downhill in steps. The slide one point (a made up point of some sort of unknown unit) per month. The course is a linear one. Although different people decline with somewhat different slopes of the line, there isn't a huge variation. Almost all of dementia is "neurodegenerative" which means either Alzheimer's or Vascular Dementia (many tiny little strokes) or a combination of the two. According to our current standards each year 10% of people with mild cognitive impairment develop dementia.
TR has been a patient of mine for about two years. When we started with his thinking he was 102 on the Neurotrax. That means he's had no change in cognition (he has a better score, but since it's only a couple of points that's basically "unchanged"). I have another patient who has had a somewhat larger increase in his score.
Most of my patients with thinking problems are on some sort of Alzheimer's medication. Very few of them can maintain or increase their thinking, though. So it isn't a matter of just the medications we're using. (I do think that Turmeric and Barcopa are especially effective, though). I know that there are some people with MS who can repair broken brain cells better than others. I suppose that's also true with the dementia illnesses. Unfortunately, no one has really written anything about these people who aren't "sliding". No one even seems to acknowledge that there can be people who are "climbing" instead of "sliding". I don't do research anymore, so I'm certainly not in a position to tell anyone what to do research about. It seems to me that this small group would be very interesting to look at. I want to know why they're doing what they're doing and how I get all of my patients to do the same thing.

It's kind of frustrating sometimes that we don't seem to know anything. Then it seems to me that the most important questions aren't even being examined very carefully.