Dear Doctor: My brother-in-law, who recently retired from his job as a research scientist at age 68, has been diagnosed with mild cognitive impairment. I don't want to upset my sister with too many questions, so I wonder if you can explain what this means? Is he going to get Alzheimer's? Can anything be done?

Dear Reader: Mild cognitive impairment is a condition of decline in functions like memory, language and reasoning that is slight but still perceptible. People with MCI will have more trouble than others their age in finding the right words when speaking, and in remembering routine activities like events or appointments. They begin to lose track of things, like car keys or glasses. They may have lapses in logic or judgment and can sometimes have trouble following the thread of a conversation or the plot of a film or book. In some cases, MCI is also associated with a dulling of the sense of smell and difficulties with movement. When the condition affects memory, it's known as amnestic MCI. When motor skills and questions of judgment are involved, it's known as non-amnestic MCI.

These changes may take place gradually, but eventually they become significant enough that close friends and family members will notice. However, they do not approach the severity of symptoms of various types of dementia. For example, the disorientation, mood shifts, personality changes and aggression that are often part of Alzheimer's and other kinds of dementia are not present in MCI. The affected individual is often aware that something within him or her is changing, which can be frightening.

Diagnosis often entails a complete medical history, a neurological exam to evaluate the functioning of the nerves and reflexes as well as balance and coordination, brain imaging tests, blood tests, cognitive testing and input from individuals in the patient's daily life to assess mental status and independent function.

The causes of MCI are not yet understood, and thus far there are no drugs or medical treatments to address the condition. Although individuals diagnosed with MCI have been found to be more likely than others to go on to develop Alzheimer's disease, the progression is not a certainty.

When it comes to nontraditional treatments, the results are mixed. There is anecdotal evidence that gingko biloba or vitamin E can be helpful, but thus far they have not stood up to the rigors of a clinical trial. Some studies suggest that regular exercise can help with cognition. It is recommended that individuals with MCI take part in regular social activities and engagement, as well as mental challenges and stimulation. A diet of lean protein, healthful fats, and plenty of fruits, vegetables and leafy greens is good and plays a role in cognitive issues as well as cardiovascular health.

It's kind of you to not push for information at this time. But do let your sister know you're available when she needs you. This is a scary time for her as well as for her husband. Knowing you're close by can help pierce the isolation that a diagnosis like this can cause.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I am a woman in my early 70s who has been diagnosed with a bladder prolapse. I have no symptoms and was told I don't need surgery until symptoms appear. I have since learned that this condition is quite prevalent among women, but seldom discussed or written about. Should I seek surgery, which could lead to serious complications, even though my case is mild?

Dear Reader: You're correct that your condition -- and thus your worry -- is shared by many women. Before we explore the options, let's begin with an explainer: Bladder prolapse, or a cystocele, is one type of pelvic organ prolapse, which is a protrusion of pelvic organs into the vaginal region. In a cystocele, the front portion of the vaginal wall becomes weak, allowing the bladder to bulge down into the vaginal region.

The prevalence of pelvic organ prolapse is unclear. In 2003, about 200,000 women had surgery for symptomatic prolapse, with the majority of these surgeries due to a cystocele. However, many people go about their lives not even knowing they have a prolapse. A 2008 study described the symptoms of pelvic organ prolapse to 1,961 women over the age of 20 and asked whether they had those symptoms; 2.9 percent answered that they did.

The likelihood of a cystocele or other type of pelvic organ prolapse increases with age. A 2002 study assessed the presence of prolapse in 27,342 women, ages 50 to 79, based on vaginal exams. As you're aware, cystoceles were much more common than people realized. In women with a uterus, the prevalence of a cystocele was 34.3 percent; in those whose uterus had been removed, the prevalence was 32.9 percent.

One major risk factor for a cystocele is having had children. The more children a woman has, the greater the risk of a cystocele. Compared to the risk of women without children, the risk of pelvic organ prolapse is four-fold greater with the first child, eight-fold greater with the second, nine-fold greater with the third and 10-fold greater with the fourth. The theory is that pregnancy and delivery injure the muscles and nerves in the pelvic region, allowing for herniations in the vaginal area. The risk of pelvic organ prolapse also increases with prolonged labor, having a high-birthweight infant and having a first pregnancy before the age of 25.

Another risk factor for cystocele is increasing age. The majority of patients who seek treatment for symptomatic pelvic organ prolapse are in their 60s and 70s. Obesity also increases the risk of cystocele, with obese women having a 47 percent increased risk of prolapse.

Many patients with cystoceles feel the bulge of the bladder into the vaginal region, as if something has dropped into the vaginal area. In addition, women can have increased frequency, urgency and urinary incontinence with cystoceles. All of these symptoms may decrease the desire for sexual intercourse.

Women with urinary symptoms or pelvic discomfort can consider a pessary, a device inserted into the vagina to support the bladder, or surgery to lift the bladder and tighten the pelvic floor ligaments and muscles. But because you're not having any symptoms of cystocele, I wouldn't recommend surgical or medical treatment, which always poses some risk -- even if small.

For now, try pelvic floor muscle training exercises to prevent the cystocele from getting worse. Vaginal estrogen or the osteoporosis medication raloxifene might help as well. Although they haven't been studied extensively for this use, they have the potential to strengthen the vaginal tissues.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I'm not one for cosmetic surgery nor have I ever had money for such things, but now that I'm 61, I have more than the usual saggy breasts that come with age. Is corrective surgery unwise at my age? If I had thought forward to how the sagging would get progressively worse, I believe I would have tried something at an earlier age.

Dear Reader: It's unclear whether you're considering a breast reduction, a breast lift, breast augmentation or some combination of the three. Each is a major surgery that would, through different approaches, address the issue of sagging breasts. In a breast reduction, fat, tissue and skin are removed to achieve the desired breast size. If the reason for seeking breast reduction surgery is back or neck pain, insurance may cover some or all of the cost. In an augmentation, the size of the breasts is increased with implants made of saline or silicone. While all implants are made to be long-lasting, in reality they have finite life spans. It's possible that sometime in the future, implants may need to be replaced or removed. In a breast lift, underlying tissues are lifted and reshaped, and excess tissue and skin are removed. The specific surgical technique is determined by breast size and shape, the degree of sagging, skin elasticity and nipple position.

In general, people are considered to be candidates for elective surgery if they are in good health, are physically fit, don't smoke and -- this is equally important -- have realistic expectations. When it comes to age, there's a bit of nuance in the findings from various studies. Older age in and of itself is not considered to be a risk factor for physical complications during or after surgery. What matters more are frailty, cognitive impairment and, as we mentioned earlier, smoking. Both frailty and cognitive impairment are associated with being older, so in that regard age can be a factor.

A condition known as post-operative cognitive dysfunction, which we discussed in a previous column, has been linked to surgery and the use of general anesthesia in older individuals. In this condition, short- and long-term memory, mood and consciousness are negatively affected following surgery. Once again, research suggests that risk factors for this include poor physical health, as well as existing problems with memory or cognition.

Elective surgery is a personal decision that, in our opinion, is best made with input from your primary care physician, your surgeon and, if you wish, your closest friends or family members. This will help keep your own wishes and well-being front and center and will keep extraneous (and unhelpful) noise to a minimum.

If you do decide to move forward, start with research. Make a list of potential surgeons and learn about their backgrounds and ratings. Meet with your top candidates so you can ask every question you have. Request before-and-after photos of patients who are willing to speak with you. And check out the American College of Surgeons' program called Strong for Surgery, which focuses on how to prepare yourself physically and mentally for the best outcome.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)