Mild Cognitive Impairment

It is always amazing when one is working in the field of medicine to discover new additions that are useful and something that will change one's approach. That is one of the wonderful things about medicine; that there is so much room for creativity while maintaining the essence of good science and coupling it with humanity and care.

I have had the privilege and joy of working with the authors of a new very comprehensive book on mild cognitive impairment. It is written by three neuropsychologists that work at the Baycrest Geriatric Health Care System. Drs. Nicole Anderson, Kelly Murphy, and Angela Troyer's newly released book: Living with Mild Cognitive Impairment: A Guide to Maximizing Brain Health and Reducing Risk of Dementia published in July 2012 by Oxford University Press is a very fine addition to the useful books that physicians interested in eldercare and cognitive function can use for their patients and families. The lovely thing about this book is that with the challenge of providing information at a level that the lay reader can understand and use, the ideas and approaches expressed in the book, are also very useful to the professional in the field not only because of the scientific validity of its content, but also because of the user-friendly way that complex concepts are expressed.

For many of us in the field and for our patients, the concept of Mild Cognitive Impairment can not only be puzzling, but also for the professional a real diagnostic conundrum and for the person given this label a great and at times frightening mystery as to "what will be?" It is not such a benign designation and you can be sure that once provided by a physician those who can access the internet will search vigorously for anything that can be found that not only explains the concept but attempts to provide therapeutic interventions that range from sound and sensible to on the fringes of believability and credibility. As we all know in practice, the public is often grappling for answers and looking for hope when there is a potentially "black" future. Therefore the need for a sensible and reliable guide for all of us, professionals, patients and their families who struggle to come to terms with the diagnosis and take charge in what they can do to maximize what can be done to forestall the progress of the condition and recognize when there have been significant changes in their cognition or function.

When Nicole Anderson, one of the book's authors was interviewed about what motivated the group of academic neuropsychologists to write this book, primarily directed to the lay public, she had this to say, "When I was asked by some of my clients if there were material available for them to read on the subject of MCI and I looked for published lay books, but could not find any. When I searched the internet for other sources of written material it too came up with very little other than a few small "definitions" of MCI but nothing in depth. So I spoke to Angie and Kelly and the three of us decided to write this book." I enquired about the point of writing for the lay public by a group of highly academic neuropsychologists and she replied with, "We figured if we did a good job with addressing this rather complex issue with the lay public, the professionals who are front line staff will probably benefit from the book as well, and therefore, the content of the book would be suitable for all readers for whom the topic is of personal or professional interest."

I asked Nicole what was the ultimate goal in writing the book beyond giving information to those personally interested in the subject because of their own or a loved one's diagnosis. She replied, "We want to also raise the awareness of MCI for all people, lay and professionals as it is a topic for which there is little understanding. We want people to be aware of it so that they could take any steps to help decrease the risk of the condition and if possible its progression."

Kelly Murphy who runs an ongoing support and information group for those with MCI and their families called Learning the Ropes for MCI, asked some of the members of the group who read the book whether it was helpful and these are some of the comments she received:

MCI CLIENT: "I want to tell everybody about this book", "it fulfills an empty niche", "I find this to be an amazing resource; I look up key words in the index and go read about it in the book", "I like how the chapters refer to other sections and chapters in the book so you can then jump to that section and read about it if you want", "we keep it out on our coffee table and frequently refer to it."

FAMILY MEMBER: "very understandable and handy reference", "I really like the structure of the book and the sections at the end of the chapters that include questions to ask your doctor and extra readings", "we are just so grateful for it to be honest", "we had just finished Learning the Ropes and we did not want to lose anything and this fills in the gaps with reinforcement and ongoing guidance."

I think these types of comments reflect the kind of impact this book can have on a readership that is thirsting for information and knowledge. I am a big proponent of the health care professional's duty to not only help their own patients and families and to teach other health care professionals, but to also teach the lay public. Public education has to be a significant part of what physicians and other health care professionals like Drs. Anderson, Troyer and Murphy have done in their excellent book that addresses the many faces and challenges of Mild Cognitive Impairment. Their book is well written, well organized and very readable.

Michael Gordon, MD, MSc, FRCPC
Dementia Section Editor