[100-Year Brain Health④] "Manage Subjective Cognitive Decline and Mild Cognitive Impairment, the Pre-Dementia Stages," Advice from Professor Kim Gi-woong

Professor Kim Ki-woong, Department of Psychiatry, Bundang Seoul National University Hospital

Dementia May Progress Gradually, Not Suddenly
Management Needed Before Advancement Stage
Diagnose Factors Causing Mild Cognitive Impairment
Exercise, Sleep, Activities... Basics Must Be Followed
Positive Mindset and Teamwork with Family

Professor Kim Ki-woong, Department of Psychiatry, Bundang Seoul National University Hospital.

[Asia Economy Reporter Lee Gwanju] In the recently popular drama "Extraordinary Attorney Woo," the protagonist is a lawyer on the autism spectrum. The term "spectrum" is used because the manifestations vary widely from person to person. In the drama, while the main character Woo Young-woo has exceptional abilities, there are also characters who exhibit much more severe autism symptoms, to the extent that communication with others is nearly impossible.

Dementia is not much different. It is commonly perceived as an "unexpected misfortune" that suddenly strikes. However, dementia can progress directly depending on the cause or develop gradually in stages. Symptoms also vary widely from mild to severe. Dementia is a disease for which the term "spectrum" is by no means inappropriate. Yet, many cases are diagnosed only after the disease has progressed to some extent, due to patients' lack of awareness or indifference from those around them, resulting in missed early detection.

Therefore, management is necessary from the subjective cognitive decline and mild cognitive impairment stages, which can be considered precursors to dementia. Not all subjective cognitive decline progresses to mild cognitive impairment, nor does all mild cognitive impairment develop into dementia. Professor Kim Ki-woong of the Department of Psychiatry at Bundang Seoul National University Hospital, who served as the director of the Central Dementia Center and is regarded as one of the top dementia experts in Korea, emphasized in an interview with Asia Economy on the 16th, "If treatment is delayed until the dementia stage in cases of gradual progression, it is too late and the damage is significant," adding, "Treatment should begin from the mild cognitive impairment stage."

The Differences Between Subjective Cognitive Decline, Mild Cognitive Impairment, and Dementia

Dementia involves cognitive decline, so patients in the dementia stage often find it difficult to recognize their own cognitive deterioration. However, there is a period before this when the individual or those around them notice a decline in memory or other cognitive functions. This is called subjective cognitive decline. This stage occurs before any formal testing.

If subjective cognitive decline is accompanied by objective cognitive decline confirmed through neuropsychological tests by a physician, it is considered mild cognitive impairment. This means test scores are lower compared to others of the same age, education, and gender. Mild cognitive impairment involves both subjective and objective cognitive decline but does not significantly interfere with daily life. Dementia, on the other hand, indicates cognitive decline severe enough to cause difficulties in daily living.

Of course, not all dementia cases go through these stages. Vascular dementia caused by stroke or traumatic dementia due to external injuries such as traffic accidents can manifest directly with dementia symptoms. However, most dementia cases progress through these stages. Professor Kim explained, "Most underlying diseases causing dementia progress slowly, with Alzheimer's disease being a prime example," adding, "There is a preclinical phase lasting 10 to 15 years during which subjective symptoms are not felt at all."

How to Manage Mild Cognitive Impairment

Mild cognitive impairment does not necessarily lead directly to dementia. Professor Kim said, "One-third progress to dementia, one-third remain at mild cognitive impairment, and one-third recover." This highlights the importance of managing the condition to prevent progression. First, the cause of mild cognitive impairment must be accurately diagnosed. Causes vary widely, including extreme stress, vitamin deficiency, thyroid dysfunction, and depression. In such cases, removing the cause can restore normal function.

If mild cognitive impairment is due to degenerative brain diseases such as Alzheimer's, appropriate medication and lifestyle modifications can significantly delay disease progression. Professor Kim recommended ▲quality sleep ▲aerobic exercise ▲consistent activity. Adequate sleep helps clear amyloid-beta (Aβ), a factor causing Alzheimer's. He noted, "Elderly people with memory impairment often lead monotonous lives and go to bed early in the evening, but as people age, sleep duration shortens, and going to bed early reduces sleep quality," adding, "Daytime sleepiness leads to less activity and less mental stimulation, creating a vicious cycle. Functions that weaken need to be exercised diligently."

Aerobic exercise fundamentally promotes the production and secretion of neuroregenerative substances in the brain. It can delay brain cell damage and improve cerebral blood flow, aiding brain function maintenance, according to Professor Kim. Additionally, 'zoning out' time in daily life should be reduced. He said, "Protecting the brain by using it is not effective if done for just one hour; it must be continuous and consistent," suggesting, "Maintaining long-term activities such as hobbies or exercise in daily life is the way to train the brain."

Rather than focusing on eating brain-healthy foods, avoiding unhealthy habits like drinking and smoking is more effective. He pointed out, "People with cognitive impairment often have lifestyle-related diseases such as hyperlipidemia and obesity," adding, "Because they do not feel immediate discomfort, they may neglect management, but poor management increases dementia risk by 1.5 times." He further emphasized, "If you have mild cognitive impairment, brain care is important, but overall physical health management is even more crucial for thorough dementia prevention."

Professor Kim Ki-woong, Department of Psychiatry, Bundang Seoul National University Hospital, in the consultation room.

"Be Positive... The Family's Role is Important"

Another important factor in dementia management is the family. In cases of degenerative brain diseases, patients often find it difficult to recognize their own cognitive impairment. Families may notice memory decline compared to before, but the patient may not worry and dismiss it. It is important for families to pay more attention and encourage early screening.

One thing to keep in mind is that dementia or mild cognitive impairment does not mean forgetting old memories. Families sometimes test memory by asking about past events, but dementia patients have difficulty acquiring new information. Professor Kim explained, "Remembering events from 10 years ago but not recalling what was just said is the problem," adding, "If memory decline is accompanied by personality changes, difficulty finding one's way, trouble understanding speech, or other cognitive impairments beyond simple memory loss, a hospital visit is essential."

There is no need to be overly fearful if diagnosed with mild cognitive impairment or dementia. No one ages without developing some illness. The key is how actively the disease is managed. Professor Kim said, "Patients and caregivers who manage successfully are fundamentally positive," adding, "They first think about how to manage the disease. Generally, such cases have better prognoses." Especially when the patient has a strong bond with family, detection is earlier and outcomes are better. Moreover, actively seeking related information and utilizing support from the surroundings is ideal. He advised, "Dementia management and care must be a 'team play.' It is important to share information with close family and relatives to ensure sustainable care."

Finally, Professor Kim identified the biggest misconception about dementia as the failure to properly distinguish between dementia and Alzheimer's disease. Dementia is a stage, while Alzheimer's is an underlying cause. Since there are various causes of dementia, if Alzheimer's has reached the dementia stage, treatment may already be too late. He reiterated, "Treatment must begin before the dementia stage, at the cause," explaining, "This is why I keep emphasizing the need for dementia screening starting from the mild cognitive impairment stage."

This content was produced with the assistance of AI translation services.