Those ‘senior moments’ can be a reminder to take brain health seriously.
If you’ve spent any time around a golf course, you’ve probably heard about the golfer who arrives one morning boasting about how far he can hit the ball with his new driver and demanding that he be assigned a caddy with perfect vision. When the caddy master leads him to a frail, white-haired gent, he can barely contain his skepticism.
“Really?” he asks. “No offense, but this guy looks like he must be 80 years old.”
“Yessir, 85,” the caddy says.
“But he’s got perfect eyesight,” says the caddy master.
The golfer shrugs, puts his ball on the tee, and blasts a shot that slices slightly right and lands well beyond the 300-yard marker.
“Well, did you see that one?” the golfer demands.
“Yessir, saw it all the way,” the elderly caddy replies.
“Where did it go?”
“I forget.”
Serious memory loss is no joking matter, but most of us find enough giggle room to see the lighter side of “senior moments” as we adjust to getting older. But our chuckles often belie a vague unease that forgetfulness could be a warning sign of dementia, the devastating disorder marked by a loss of intellectual abilities, including memory, judgment, and abstract thinking.
Some people may find more cause for concern – but most should find their worries allayed – in the latest White Paper on Memory issued by the Johns Hopkins University School of Medicine. Written by Peter Rabins, director of geriatric psychiatry and neuropsychiatry at Johns Hopkins, the White Paper reports on the most current research related to memory and cognitive decline.
Rabins explains that the brain contains about 100 billion neurons, or brain cells. The common belief that thousands of neurons die each day is incorrect, but they do shrink as we get older. Around middle age, the brain’s production of neurotransmitters – the chemical messengers that relay information between nerve cells – starts to decline. The shrinkage of neurons along with the decrease in neurotransmitters may explain why our cognitive function slows during middle and old age.
According to Rabins, our understanding of memory is better than ever, largely because of brain imaging technology that allows us to see how the brain fires up during mental activity. Researchers identify four memory systems: episodic, which involves the recollection of personal experiences, such as a recent phone conversation; semantic, which manages general knowledge, such as the number of days in a month; procedural, which enables us to learn skills that will be performed automatically, such as riding a bike; and working memory, which controls our ability to concentrate and be attentive. Dementia can affect all of these, but its impact on our working memory is especially notable.
Rabins writes that one “reassuring difference between normal forgetfulness and dementia is that people who worry about memory loss are unlikely to suffer from a serious memory condition. By contrast, people who do have a serious memory impairment tend to be unaware of their lapses, do not worry about them, or attribute them to other causes.”
In an interview, he emphasizes that the forgetfulness that comes with normal aging is characterized by “a mild decrease in the ability to come up with names and words. Although that can be frustrating, it doesn’t really affect a person’s everyday functioning.” But, he cautions, “if there are activities that a person has always done but now has difficulty doing” – such as balancing a checkbook or planning meals – “then it’s time for a professional assessment.”
“If there are activities that a person has always done but now has difficulty doing, then it’s time for a professional assessment.”
Memory problems can stem from medical issues other than dementia, such as depression, thyroid dysfunction, cardiovascular conditions that affect blood flow to the brain, side effects of medications, vitamin deficiencies, and stress, all of which can be treated. So, if in doubt, get checked out.
In 1906, German physician Alois Alzheimer described a “peculiar disease” in a patient who had suffered profound memory loss and brain shrinkage. But it was not until 1976 that neurologist Robert Katzman identified Alzheimer’s as the most common cause of dementia.
Although there is no known cure for Alzheimer’s, Rabins says medications can relieve the symptoms and help people perform better. Given the many drugs in development, he is optimistic that treatments will continue to advance. “There is much greater scientific interest now, compared with 10 or 20 years ago,” he says.
According to the U.S. Centers for Disease Control, Alzheimer’s affects 5.4 million Americans and is the sixth-leading cause of death in the United States. But a recent study conducted at the Alzheimer’s Disease Center at Rush University Medical Center in Chicago ranks it third, behind only heart disease and cancer. The researchers contend that Alzheimer’s is responsible for nearly 500,000 deaths, not 84,000 as recognized by the CDC. The discrepancy results from the under-reporting of Alzheimer’s on death certificates, which list only the immediate cause of death.
“Physicians have known for a long time that the complications of Alzheimer’s – cognitive decline, change in physical function – can contribute to a person’s death,” says Neelum Aggarwal, a neurologist at the Rush Alzheimer’s Disease Center. “But the death certificate may identify the cause as pneumonia or heart attack.”
Our understanding of Alzheimer’s will improve from more research “at both ends of the spectrum,” she says – studying so-called “super-agers” who show no signs of cognitive issues well into their 80s, as well as those who experience early-onset cognitive decline. She also sees value in observing “personality and emotional traits that keep people young.”
As the research on Alzheimer’s continues, experts recommend some clear and sensible guidelines for promoting brain health and preventing cognitive decline. Jogging, for example, can do more than simply jog the memory.
“The risk factors that impact your heart health, such as high blood pressure and high cholesterol, can also impact cognitive function and are thought to be involved in developing dementia,” Aggarwal says. “I tell my patients that whatever is good for your heart is also good for your brain. That means that exercise – and especially walking – is the best way to keep your brain functioning at a high level.”
In the Johns Hopkins White Paper, Rabins reviews many findings related to the potential benefits of vitamins and dietary supplements, some of which show promise. But he reduces the regimen for cognitive health to four basic steps: exercise, lower stress, get a good night’s sleep, and follow the Mediterranean diet (fresh fruits and vegetables, unsaturated fats such as olive oil, fish and chicken rather than red meat, whole grains, low-fat dairy products, and a glass of red wine).
“There is reasonable evidence that staying socially and intellectually active might be beneficial to maintaining cognitive health,” Rabins says. “But it ought to be things that people enjoy doing. People who don’t like crossword puzzles or Sudoku are unlikely to gain any benefit from them. If you like them, though, it makes a lot of sense.”
“Staying socially and intellectually active might be beneficial. But it ought to be things that people enjoy doing.”
With regard to the multitude of supplements and substances that are marketed to prevent cognitive decline, Rabins says people should be wary of outlandish claims, especially if they’re based on a single study. “But to be totally cynical would be a mistake,” he says. “If you find an article about a breakthrough, take it to your doctor and ask.” — Paul Engleman