An Overview of How Human Memory Works (dijifi.com)
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Doctors express concern about Biden’s apparent cognitive issues during debate: ‘Troubling indicators’ (msn.com) Dementia Symptoms, Stages, and Treatment
INTRODUCTION Many individuals—especially older adults—panic when they experience episodes of forgetfulness, wondering whether memory lapses such as forgetting names and losing track of house keys are early dementia symptoms. While it is true that the incidence of dementia increases with age, there are many factors that influence memory ability and cognition that have nothing to do with progressive neurodegenerative diseases such as Alzheimer’s disease and other dementias. Learning more about such issues as how memory works, how and why memory performance changes, and how to increase memory power can help you resist memory decline, and recognize symptoms of memory loss that call for medical assessment.
How the Memory Works – Search (bing.com)
Genetics accounts for about half of our memory ability—some people may be born with the capacity to easily retain what they learn, while others may have to work harder. The other half of memory is shaped by our environment. Factors such as diet, education, and medical care all combine to affect brain function. If you weren’t blessed with a strong memory, there is evidence that you may be able to improve your memory performance through changes in your lifestyle and behavior.
Memory has three distinct phases: encoding, storage, and retrieval.
Information from your sense organs is transmitted via neurons to the regions of your brain that are associated with vision, sound, smell, taste, and touch. The impulses speed from one nerve cell to another across tiny gaps called synapses. Each of the individual cues is combined into a single memory in a region of your brain called the hippocampus. This process is known as encoding. Next comes the storage phase of the process. Your hippocampus sends the memory to the cerebral cortex, a kind of permanent file cabinet.
There are two distinct mechanisms to memory storage: short-term (working) memory and long-term memory.
Short-term memory involves information your mind stores for immediate recall. Your short-term memory can hold small amounts of information for limited amounts of time, such as remembering a telephone number long enough to find a phone and dial the number. Long-term memory involves retaining information for days, months, or years. The brain can store almost limitless amounts of long-term memory, which is why we can learn so many new things and retain what we’ve learned for many years.
Recalling a Memory
When you remember information, your brain reactivates the same pathway that was originally triggered when you stored the memory. This process can be fast or slow, depending on how familiar you are with the information and how well you learned it in the first place. © Legger | Dreamstime.com Above: anatomy of the human brain.
Memories can be retrieved either through recall or recognition. Recall involves directly accessing a memory, such as remembering the name of a book you read a week ago. Recognition involves cues that help you retrieve a memory, such as the process used in school multiple-choice tests.
Studying How Normal Memory Works
Many scientists believe that a memory is formed when a brief pattern of electrical impulses moves through a network of neurons, strengthening connections between the affected brain cells. This leaves a “memory trace” in the brain, which is revived when the information is later recalled. The brain has many different areas, each of which specializes in different types of information. Researchers now know that certain attributes of a memory are grouped with other, similar recollections. For example, the smell of popcorn may be grouped together with remembrances of favorite films. When you recall information, your brain cross-references the many different attributes of that memory. Using techniques like functional magnetic resonance imaging (fMRI) scans, researchers have been able to map connectivity between different brain regions and capture brain activity that indicates where certain memories are created and what the likelihood is that someone will be able to recall that information.
How Memories Are Lost Most
Most memory problems are not related to dementia. In the majority of individuals, the problem stems from physical or emotional issues, or from the normal effects of aging. Dehydration, fever, head injury, low thyroid function, liver and kidney problems, high blood pressure, obesity, poor nutrition, low blood sugar, and reactions to medications all are physical factors that can cause temporary memory impairment. Fortunately, these conditions can be treated. Emotional distress also can have a devastating effect on memory. Repeated stress, sleeplessness, depression, and anxiety can interfere with the normal encoding and storage process, and can significantly affect your ability to remember even the simplest things.
Age-Associated Memory Impairment (AAMI)
In addition to the everyday memory loss caused by physical and emotional factors, aging itself can take a toll on memory. This natural process, called age-associated memory impairment (AAMI), may start as early as our late 20s and progress as we get older.
Changes related to AAMI include:
• Loss of brain cells (neurons). This process usually occurs gradually over time. People who remain healthy and are mentally, socially, and physically active are able to generate new cells to replace many of these lost neurons.
• Reduced levels of certain hormones and neurotransmitters that are involved in the transmission of signals among cells in the brain, and to and from the brain and other parts of the body.
• Brain atrophy. The brain loses both volume and weight with age. This shrinkage is the result of the gradual loss of neurons (the brain’s “gray matter”) and damage to the branch-like dendrites and nerve fibers called axons (the brain’s “white matter”) that extend from the neurons and connect them to other cells.
• Shrinkage of brain tissue on the brain’s surface (gyri), and the grooves on the surface of the brain (sulci) widen. • Increased volume of ventricles (the spaces in the brain that contain cerebrospinal fluid).
• Decreased blood flow to the brain.
• Buildup of toxic proteins. Twisted protein filaments, called neurofibrillary tangles, may form inside nerve cells, and clusters of damaged beta-amyloid proteins, called plaques, may build up in the brain’s gray matter.
The effects of age-associated changes become most apparent after age 50, when people may begin to experience an increase in memory lapses, However, declines in cognitive skills such as reasoning, memory, and vocabulary skills may begin as early as age 45. The older people are, the more difficulty they may have with short-term memory and mental organization. AAMI may cause people to misplace things more easily, occasionally forget a name or phone number, have more trouble multitasking, become easily distracted, or be unable to learn things as easily as they once did.
When Memory Impairment Becomes More Serious
Most people who live into their 70s, 80s, and beyond never experience memory problems more severe than normal age-associated memory impairment. But for some, forgetfulness may get progressively worse and begin to interfere with everyday functioning—important indications that there may be cause for concern. A medical assessment may reveal that the problem is related to a treatable condition. Even when no related health conditions are identified, medications can help improve memory in the early stages of impairment, and ease symptoms such as anxiety or restlessness.
I. WHAT IS DEMENTIA?
Dementia comes in two forms: Primary dementias—such as Alzheimer’s disease or Lewy body dementia (dementia with Lewy bodies, or DLB)—involve damage to or wasting away of the brain tissue. Secondary dementias are memory troubles caused by mental or physical disorders, such as depression or thyroid problems. Changes in brain function with dementia can alter virtually everything about you—including your personality and behavior. According to diagnostic criteria, serious memory lapses may indicate dementia if they are accompanied by at least one other symptom of cognitive decline.
Dementia signs may include:
• Asking the same questions over and over
• Losing the ability to accomplish complex tasks, such as cooking a meal
• Becoming lost in once-familiar places • Forgetting names of familiar people
• Having trouble using language, or putting words together
• Failing to remember regular appointments
• Neglecting personal hygiene—such as brushing your teeth or showering
• Showing signs of mental confusion
• Having difficulty recognizing common objects, like a toothbrush or TV set
• Having trouble coordinating movements
• Experiencing mood symptoms such as anxiety, unusual irritability, or depression.
Mild Cognitive Impairment (MCI)
Scientists are working on identifying dementia in its earliest stages so that treatments can be initiated before brain damage has occurred. They are looking beyond the symptoms of age-associated memory impairment to the next stage in memory impairment, which sometimes—but not always—leads to dementia. Called mild cognitive impairment, or MCI, this stage is characterized by memory loss that is worse than that expected for the person’s age group and forgetfulness that may become increasingly noticeable to others. Currently, as many as 10 to 20 percent of Americans aged 65 and older have MCI, up to 15 percent of whom may progress to dementia each year.
People with MCI have more trouble remembering names or words, performing complex tasks, and acquiring and retaining information. People with MCI also perform worse on cognitive tests than is normal for their age group. People with MCI have normal mental function and can still perform their daily activities. They are able to follow written or spoken instructions, and can take care of themselves—that is, get dressed by themselves, prepare their meals without assistance, and go on walks without getting lost. In Alzheimer’s disease and other dementias, these functions gradually disappear.
Managing MCI
Having MCI doesn’t necessarily condemn you to certain cognitive decline. Many people with MCI won’t progress to dementia, and there are ways to slow the progression of memory loss. You may be able to help reduce your risk for further decline and perhaps even improve your cognition by adopting the lifestyle and behavioral changes recommended later in this report (see Chapter VII).
If you believe you or a loved one may have MCI, consult a health care provider who can help determine whether the memory impairment may be associated with physical or mental issues that are reversible, and recommend treatment.
Reversible Dementia
Just as with age-associated memory impairment and some cases of MCI, dementia can be temporarily caused by medical or psychiatric conditions, such as a high fever, vitamin deficiency, head trauma, or depression. Because many causes of these secondary dementias are reversible with treatment, it’s important to see a doctor if you’re experiencing sudden memory-loss symptoms, especially if your health has recently changed. The following are among the more common reversible causes of memory loss:
Excess alcohol consumption
Beer, wine, and liquor contain ethyl alcohol, a central nervous system depressant that impairs thought processes, motor control, and memory, and slows overall brain activity. Heavy drinking (more than two alcoholic drinks per day), even without alcohol dependency, can be harmful, research shows.
Those who use tobacco and alcohol are at a substantially higher risk for dementia.
Smokers face a 45 percent greater risk for dementia than nonsmokers.
Smoking damages the heart and blood vessels, limiting crucial blood flow to the brain and increasing the risk for stroke. It increases levels of homocysteine—a damaging amino acid that contributes to stroke and dementia risk, and injures the lungs, reducing the supply of nourishing oxygen to the brain. Quitting smoking can significantly reduce the risk for problems with learning, memory processing speeds, and working memory.
Inflammation
Infections that cause brain inflammation, particularly meningitis (an infection of the membranes surrounding the brain and spinal cord) and encephalitis (an A infection affecting the brain tissue itself) can contribute to mental decline if they’re not treated quickly and effectively.
Depression
Long-term chronic depression alters levels of key brain chemicals such as serotonin and norepinephrine, slows activity in the parts of the brain associated with executive function and perception, and shrinks the hippocampus (the part of the brain where memory is processed). Untreated depression is associated with a higher risk for dementia. Seek professional advice if you experience symptoms of depression, which include feelings of sadness and hopelessness that last for two weeks or longer, changes in sleep and appetite, restlessness, fatigue, irritability, a loss of interest in activities you once enjoyed, confusion, impaired memory, and trouble focusing.
Drug effects and interactions
Certain classes of prescription and over-the-counter drugs, including antidepressants, sleeping pills, anti-anxiety drugs, anticholinergic drugs, and some antihistamines, are known to affect memory and brain function. Chemotherapy or radiation for cancer may also cause memory loss, confusion, and difficulty concentrating—a short-term phenomenon that has been termed “chemo brain.” Older adults are especially vulnerable to cognitive side effects of drugs because of age-associated changes in the brain that heighten sensitivity to medications, and changes in metabolism and reduced liver and kidney function linked to aging. Check with your doctor if you recently began taking a new medication or switched to a higher dose of an existing medication and are experiencing memory problems. Drug-related memory impairment is usually resolved by switching medications, changing the dose, or stopping the problem drug entirely.
Lung problems
Conditions that impair respiratory function—such as chronic obstructive pulmonary disease, fibrosis, asthma, and even allergies—can reduce the delivery of oxygen to the brain, impairing memory performance. Treatment can help reverse these effects and, in some cases, may also lower long-term risk of more serious memory impairment.
Metabolic disease or abnormalities
Certain metabolic diseases can wreak havoc on your memory, and require assessment and advice from medical professionals.
These include:
Abnormal thyroid function
An underactive (hypothyroidism) or overactive (hyperthyroidism) thyroid gland has been linked with impairments of memory, visuospatial organization, attention, and reaction time. Even subtle variations in thyroid function can cause significant cognitive effects.
Metabolic syndrome
This condition involves a cluster of risk factors that include abdominal obesity, low levels of HDL cholesterol, high triglyceride levels, high blood pressure and insulin resistance. In insulin resistance, the body doesn’t respond appropriately to insulin produced by the pancreas, impairing the ability of glucose to leave the blood and enter the cells as it should. The pancreas produces more insulin to compensate, and this excess insulin can lead to inflammation and damage to the brain.
Diabetes
Diabetes—a disease in which the body cannot use glucose (sugar) properly, resulting in higher-than-normal blood sugar levels—may hasten cognitive decline by contributing to hardening and narrowing of blood vessels (atherosclerosis), which can reduce or block blood flow to brain tissue and deprive brain cells of necessary oxygen and nutrients. Depending on where the blockage in the blood vessel occurs, memory can be affected. Some studies suggest that diabetes may be associated with atrophy in the brain’s frontal lobes (responsible for attention and long-term memory) and temporal lobes (responsible for language skills and memory of verbal and non-verbal information).
Sleep problems
Optimal memory performance requires about seven hours of sleep each night. Research suggests that chronic sleep deprivation is associated with memory loss and may increase the risk of developing dementia by as much as 30 percent. Older adults who wake up frequently during the night are more likely than sound sleepers to have amyloid markers in their spinal fluid and amyloid plaque buildup in their brains—both indicators of Alzheimer’s disease. Be sure to get treatment for reversible conditions that can disrupt sleep and may be linked to memory problems, which include:
• Anxiety and/or depression
• Obstructive sleep apnea (OSA), a condition sometimes associated with obesity in which the muscles in the upper airway that support the soft palate, tongue, and other structures relax and collapse, blocking the air passages and causing temporary cessation of breathing
• Restless legs syndrome (RLS), which interferes with sleep by causing unpleasant sensations in the legs that occur just before falling asleep or during the night.
Stress
Stress increases the brain’s release of the hormone cortisol, which can damage both the hippocampus and neurons, promoting memory problems. The brain effects of excessive levels of cortisol are reversible, but not if the stress continues for months or years. Learning how to manage your stress and anxiety is important for keeping your memory functioning at its peak.
Vitamin deficiency
As you age, your rate of nutrient absorption slows, making it harder for your system to get the essential vitamins it needs. Drinking and smoking exacerbate this problem by leaching nutrients from the body. Vitamin deficiencies that affect brain function include a lack of the B vitamins.
A deficiency of vitamin B12 is associated with pernicious anemia that can damage brain cells and lead to symptoms similar to those of dementia; B6 and folate, which help promote healthy nerves and red blood cells; and vitamin B1 (thiamine), a deficiency of which can, over time, interfere with the ability to create new memories.
People with a B vitamin deficiency often have elevated levels of the amino acid homocysteine, which is damaging to brain cells and blood vessels. The B vitamins are found naturally in animal-sourced foods (meat, fish, poultry, eggs, and dairy products) and in fortified cereals, beans, and dark green vegetables.
Good’ cholesterol may decrease risk of Alzheimer’s (medicalnewstoday.com)
Niacin is a vitamin that is involved in various cellular functions, such as antioxidant activity, DNA repair, and cell signaling 1. Niacin deficiency, also known as pellagra, can cause skin problems, diarrhea, and dementia 1. Niacin deficiency has been linked to Alzheimer’s disease and cognitive decline in older adults 2. On the other hand, higher intake of niacin from foods may help prevent dementia and slow down the age-related loss of cognitive function 2.
RELATED Niacin and Dementia – Search (bing.com)
Another vitamin deficiency with effects on the memory is lack of vitamin D.
Up to 70 to 80 percent of people older than 75 are thought to be deficient in this vitamin, a hormone produced by the action of ultraviolet light (UVB) on the skin that nurtures the development of the brain and nerve cells and protects them against injury. Low blood levels of vitamin D are associated with worse performance on cognitive tests and higher risk for Alzheimer’s disease. Spending as little as five to 30 minutes getting unprotected sun exposure a couple of days a week can help provide adequate vitamin D. The vitamin can also be consumed in supplement form or in foods such as fish liver oils, fatty fish, fortified dairy products, and cereals.
Irreversible Dementia
Some dementia types are associated with brain damage that is irreversible. These are known as primary dementias, the most common of which is Alzheimer’s disease (AD). Apart from AD (which will be covered at greater length in a separate section), the following are important causes of primary, progressive dementia: Vascular dementia (VaD)
Many conditions that adversely affect the heart can damage the brain and nervous system and increase the risk of memory decline. Cardiovascular and cerebrovascular diseases are the prime actors in VaD, the second most common form of dementia after AD.
Causes of VaD include:
Strokes and transient ischemic attacks
Strokes involve the blockage or rupture of the brain’s blood vessels, which starves brain cells of oxygen and nutrients.
Damage may occur from one large stroke, a milder stroke called a transient ischemic attack (TIAs, or “mini-strokes”) with symptoms that disappear within an hour or so, or over time, as the result of a series of imperceptible tiny mini-strokes that progressively destroy small sections of brain cells. Damage that affects regions of the brain involved in learning and memory can lead to vascular dementia.
Signs of stroke require immediate medical care, and include the following:
• Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble with vision in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause.
Although TIAs usually do not cause permanent damage, they require prompt attention to reduce the risk of another, more serious stroke. With multiple tiny mini-strokes, symptoms may appear gradually over time as the damage spreads, and can include memory loss, shuffling movements, inappropriate behavior, and loss of bladder or bowel control.
It’s not possible to reverse the damage caused by a stroke, TIA, or other forms of VaD; however, you may be able to avoid further injury to brain cells by lowering cardiovascular risk factors through simple lifestyle changes. Controlling blood pressure and cholesterol, losing weight, quitting smoking, and managing conditions such as diabetes, abnormal heart rhythm, and coronary artery disease can reduce the risk of vascular events.
Atrial fibrillation (Afib)
One in 20 people over age 65, and one in 10 over 80, has Afib, an abnormal heart rhythm in which chaotic pumping actions cause blood to pool, dramatically increasing the risk for brain-damaging strokes and AD. Treatment for Afib usually includes medication, such as drugs to slow the heart rate and blood thinners to reduce the risk of blood clots; cardioversion, which uses electrical pulses or drugs to restore an erratically beating heart to its normal rhythm; and more rarely, catheter ablation, which burns off heart cells that are producing the abnormal rhythm.
Lewy Body Dementia (or Dementia with Lewy bodies—DLB) DLB is the third most common form of dementia, after AD and vascular dementia, representing between 10 and 25 percent of dementia cases. This condition is characterized by the buildup of abnormal proteins called Lewy bodies inside neurons in areas of the brain responsible for memory, language, and consciousness. These same proteins are found in the brains of people with AD and Parkinson’s disease (PD). People with DLB often develop Parkinson’s-like symptoms—including rigid muscles and a shuffling walk—along with other symptoms, such as confusion, trouble thinking and reasoning, hallucinations, and delusions.
Although no cure exists for DLB, medications can help control Fronto-temporal dementias (FTD) This spectrum of disorders (also known as Pick’s disease) causes atrophy of parts of the frontal and temporal lobes of the brain, which control memory, personality, and language skills. FTD may account for up to 15 percent of all dementias, and up to 50 percent of dementias in people younger than 65. Symptoms of FTD tend to come on slowly, and typically involve inappropriate behavior, difficulty finding the right words, and personality changes. In its late stages, FTD resembles AD, with significant memory impairment. Although no treatment for FTD exists, antidepressants and antipsychotic drugs may help control the behavioral symptoms.
Parkinson’s disease dementia (PDD)
PDD is a dementia type associated specifically with the movement disorder Parkinson’s disease, which is characterized by muscle rigidity in the limbs, tremors and balance difficulties, abnormal deposits of proteins known as Lewy bodies, and the hallmark plaques and tangles of AD. An estimated 50 to 80 percent of people with Parkinson’s will eventually develop PDD. As with other forms of dementia, PDD gets worse over time. It’s important to note that many of the drugs used to treat PD, including anticholinergic drugs and L-dopa, can potentially cause or worsen cognitive, mood, and thought disorders (e.g., hallucinations and delusions). Working closely with a doctor can help people with PD find the drug with the highest benefit in proportion to risk.
When to Seek Help
Everyone has a mental slip from time to time, but negative mental changes that are recent, growing worse, and showing no signs of improvement over the course of weeks or months may be an indication of serious cognitive problems. Individuals who suspect that they may have dementia should seek a thorough assessment from a family doctor or internist, or arrange to see a specialist such as a neurologist, geriatric psychiatrist, geriatric psychologist or geriatrician. Even if an irreversible form of dementia is diagnosed, it is possible to treat the physical and behavioral problems associated with the condition, and to get help coping with it.
II. ALZHEIMER’S DISEASE
Despite years of research, scientists still don’t know exactly what factor or combination of factors sets the Alzheimer’s disease process in motion. Understanding this process could help lead to earlier diagnosis and treatment.
The Search for Causes of Alzheimer’s
Among the theories scientists are working on to explain the Alzheimer’s disease process are the following:
Amyloid Hypothesis
The amyloid hypothesis suggests that toxic beta-amyloid plaques (sticky clusters of the protein that accumulate between nerve cells) somehow initiate the brain cell destruction observed in AD. The brain normally produces and then eliminates amyloid protein fragments, but in AD, the removal process is impaired and the protein accumulates and forms sticky masses, or plaques, which destroy neurons and cause the gradual loss of brain tissue.
Much of the current research © Ian Allenden | Dreamstime.com Alzheimer’s disease usually begins with minor memory loss symptoms. Aimed at finding new treatments for AD is based on this hypothesis, and recent work that made it possible for the first time to replicate in a laboratory dish the entire series of events leading to AD development is lending support to the amyloid theory.
Tau Hypothesis
Twisted fibers of abnormal tau protein called neurofibrillary tangles that accumulate within neurons form the basis of the tau hypothesis, another important theory of AD causation. Normally, tau protein builds part of a cellular structure called a microtubule, which helps transport nutrients and other substances from one part of the nerve cell to another. When tangles form, the microtubules break down, leading to deterioration in this transport system and, eventually, to cell death.
Oligomers
Because treatments aimed at reducing the accumulation of plaque in the brain have not improved symptoms of dementia thus far, some scientists are focusing on clumps of beta-amyloid and tau in the brain called oligomers. Beta-amyloid oligomers are thought to disrupt neuronal communication by changing the structure of communication points between brain cells known as synapses, and by promoting the development of neurofibrillary tangles.
A research study using immunotherapy to target tau oligomers in an animal model of AD both reduced levels of tau oligomers and reversed memory declines. Surprisingly, the treatment also reduced levels of beta-amyloid oligomers, suggesting the two types of oligomers may work in concert to damage the brain.
Cholinergic Hypothesis
The cholinergic hypothesis, the foundation for one of the main Alzheimer’s drug treatments, suggests that AD symptoms result from a decrease in production of the neurotransmitter acetylcholine, which is essential for learning and memory formation. Acetylcholine production is known to decline with age, but AD is associated with a much more significant decline in acetylcholine levels.
Excitotoxicity
The excitotoxicity holds that an over-activation of receptors for the neurotransmitter glutamate causes AD nerve damage. Glutamate is normally responsible for making neurons “fire” as they relay messages through neuronal networks, and is involved in establishing long-term memories. When normal glutamate processes are disturbed, excessive amounts of this chemical messenger build up in the space between brain cells, attaching to the cells, overstimulating them, and eventually killing them.
Oxidative Stress
Oxidative stress occurs when unstable molecules called free radicals, generated by factors such as environmental toxins, stress, and aging, overwhelm the body’s natural antioxidant defense system. As a result, the body falls behind in its repair of cellular damage. Research suggests high levels of free radicals and oxidative stress are among the earliest changes that occur in AD, however oxidative stress may be a marker of AD rather than a cause.
Inflammation
Inflammation has also been proposed as a root cause of AD. The immune system relies on inflammation to combat viruses, cancers, and other dangerous invaders. But when inflammation persists, it can damage neurons and may trigger excessive production and accumulation of beta-amyloid in the brain. AD has been linked to strokes, head injury, and surgery, which can cause inflammation in the brain, as well as to infections that lead to body-wide inflammation. However, treating people with anti-inflammatory medications in the early stages of AD has thus far not been effective at slowing or preventing the disease.
Insulin Abnormalities
The hormone insulin ferries sugar from the bloodstream into the cells to be used as energy or stored for future needs. In people with diabetes, the body either doesn’t produce insulin, or can’t use it effectively, leading to a buildup of sugar in the bloodstream and resulting damage to organs such as the kidneys and eyes. Researchers have discovered that insulin levels drop significantly in the early stages of AD, and progressively decline as the disease advances. Cell death and neurofibrillary tangles appear to be linked to abnormalities in insulin signaling. The theory has led to suggestions that AD may be a type of diabetes. Recent investigations into whether giving insulin to people with early cognitive impairment might slow this decline have been promising.
Alzheimer’s Stages
People who have Alzheimer’s typically go through a series of stages characterized by gradually worsening symptoms, although not everyone will go through all of the stages nor progress through them at the same rate.
Early-Stage (mild) Alzheimer’s
As AD progresses, the individual may remain independent, but encounters greater difficulty handling multi-step tasks, such as following a complicated meal plan, and may need help paying household bills. Family and friends might notice signs like forgetting familiar words or trouble recalling current events. The person may become increasingly withdrawn in social situations, and exhibit personality changes, irritability, anxiety, or depression, putting a strain on relationships with others.
Mid-Stage (moderate) Alzheimer’s
This is the longest stage of AD, and it is the time when assisted care usually becomes necessary. The person will be unable to remember important information, such as his or her address or phone number. He or she will need help picking out clothes and remembering the date and time. The person may become confused or delusional at times and express irrational fears—for example, that someone is stealing from him or her.
Severe (late-stage) Alzheimer’s
Cognitive ability becomes seriously compromised at this stage, as the person becomes unable to communicate or interact with his or her environment. He or she will need help performing even the simplest tasks, such as using the bathroom or eating, and often loses the ability to recognize loved ones. Although medications may help slow the progress of AD, the disease is still incurable—and irreversible. However, treatments and support systems can significantly improve quality of life for people with the disease.
Risk Factors for Alzheimer’s
The overall risk for developing Alzheimer’s is 10 to 15 percent. Older age is a major factor in the disease, with risk doubling about every five years after the age of 65. By age 85, nearly half of all older adults have AD. There’s little you can do to hold back time, but you can reduce your AD risk by addressing a number of other factors that increase your odds of developing the disease (see chapter 7 of this report). These include:
High Blood Pressure
Uncontrolled high blood pressure (hypertension) increases risk for stroke—a blockage in the brain’s blood supply that can lead to disability, problems with thinking and memory, and dementia. Even smaller strokes (mini-strokes or “silent” strokes) that don’t cause symptoms can lead to memory deficits by creating small areas of dead brain cells that can have a significant and lasting impact on memory. By some estimates, one-quarter of people over age 70 have had a silent stroke. Managing stroke risk factors can help preserve brain function.
Cardiovascular Disease
People with cardiovascular disease and heart conditions such as atrial fibrillation and chronic heart failure may be at significantly higher risk for cognitive impairment. The brain relies on a steady stream of oxygen and nutrient-rich blood from the heart to keep it functioning optimally, and the greater the disruption in blood flow, the greater the decline in cognitive function. Preventing and treating cardiovascular disease and its risk factors can combat mental decline.
Insulin Resistance and Diabetes
Insulin resistance, in which the body’s cells become less sensitive to the effects of insulin and have trouble using sugar for energy, is associated with high insulin levels that are thought to be a major factor in the development of Alzheimer’s disease. About 40 percent of older Americans have insulin resistance. The same enzyme that breaks down insulin also breaks down the beta-amyloid protein. When insulin levels are high, the enzyme is occupied with breaking down insulin and can’t efficiently clear out beta-amyloid proteins, leading to the brain deposits that are a hallmark of Alzheimer’s disease.
High blood sugar from insulin resistance is a risk factor for metabolic syndrome—a cluster of conditions that includes an enlarged waistline, high triglyceride levels, low HDL (“good”) cholesterol levels, and high blood pressure—and a characteristic of diabetes, both of which can increase risk for memory loss in older people. It is important for people with diabetes to manage the disorder with diet and medications, and to have their cognitive abilities monitored for signs of decline.
Head Injury
A blow or jolt to the head can cause the brain to shift and bend inside the skull, injuring nerve cells. These traumatic brain injuries (TBIs), which include concussions, not only lead to impairment in the area where damage occurs, but might also lead to the formation of beta-amyloid deposits in the brain.
Head injury can increase risk for Alzheimer’s disease—particularly in older people.
Depression
Individuals with depression, which affects an estimated 6.5 million seniors in the U.S., are vulnerable to all types of mental decline, including vascular dementia and Alzheimer’s disease.
Symptoms of depression include feelings of hopelessness and helplessness, loss of appetite, lack of interest in activities once enjoyed, confusion, social withdrawal, sleep problems, and delusion. In older adults, these symptoms can mimic those of dementia. Depression at any age can be addressed with treatments such as antidepressant medicines and talk therapy.
Poor Diet
An unhealthy diet that is high in fat and low in important nutrients can lead to chemical changes in the brain, accumulation of excess abdominal fat, high blood pressure, and high insulin levels, among other effects. These risk factors may, in turn, contribute to health conditions such as diabetes and stroke, which have been directly associated with increased Alzheimer’s risk. Eating a diet that promotes both heart and brain health may have a protective effect, shielding against the cumulative damage that leads to dementia.
Smoking
Research suggests that current smoking impairs memory function and increases the risk for dementia by 50 percent. Nonsmokers who are exposed to secondhand smoke face a 44 percent increased risk of dementia. Smoking is thought to affect memory by contributing to cardiovascular disease, a known risk factor for dementia. The tobacco habit also can damage brain cells and stop new cells from forming. Smokers who quit lower their risk for these conditions significantly.
Mental Inactivity
A lack of mental stimulation can be detrimental to cognitive functioning, and may increase risk for dementia. Studies suggest that older adults who often engage in mentally stimulating activities, such as games, puzzles, classes, hobbies, social interactions, and language training, are more likely to stay sharp than those who are mentally inactive.
Stress
Excessive or chronic stress can heighten risk for memory problems, research suggests, most likely because of an association between increases in the hormone cortisol during stressful experiences and damage to synapses in the brain that relay messages among brain cells.
Genetics
Your genetic background plays a role in your AD risk profile. The more family members you have who are affected by Alzheimer’s, the more likely you are to develop the disease.
Researchers have linked a number of single-gene mutations with the early-onset (before age 60) form of Alzheimer’s, which affects fewer than 5 percent of people with the disease. But finding the genetic factors related to late-onset Alzheimer’s has been more challenging.
Researchers have identified one gene variant—apolipoprotein E4 (ApoE4)—that appears to increase a person’s risk for developing the disease. Although ApoE4 does not cause Alzheimer’s, it impairs the ability to degrade toxic beta-amyloid, and may lead to more rapid loss of nerve cell functioning in the frontal lobe of the brain, a region involved in higher mental functioning.
People who inherit two copies of ApoE4 have a greater risk of developing Alzheimer’s than those who have just one copy. However, because not all people with Alzheimer’s have this ApoE4 genetic variation, and not all people who have the variation will develop the disease, testing for it is not currently considered a useful predictive tool
III. DETECTING ALZHEIMER’S
Although no definitive test for Alzheimer’s yet exists, researchers have learned much more about how the disease begins and progresses. In recent years, scientists have found new ways to diagnose Alzheimer’s disease while it’s still in its early stages.
Diagnosing Alzheimer’s
Individuals who have developed signs of dementia usually begin by seeing a general practitioner for assessment. The physician may make a diagnosis, or refer the person to a neurologist, psychiatrist, psychologist, or other specialist.
An Alzheimer’s diagnosis is usually arrived at by eliminating other possible causes of dementia. Assessment typically involves a physical exam, along with a review of the patient’s symptoms, medical history, and current medications. Even if another cause for the dementia is not found, diagnosing and managing conditions such as infection, high blood pressure, cardiovascular disease, depression, and other problems that can compromise brain function are an important aspect of dementia treatment.
Usually, blood and urine tests are ordered to rule out medical conditions that cause memory loss, such as thyroid problems, kidney or liver dysfunction, or Your doctor may give you simple memory tests, such as the Memory Capacity Test or the Face Name Associative Memory Exam (FNAME).
One or more diagnostic and cognitive function tests may also be recommended, including such instruments as the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment test (MoCA), and the Mini-Cog. Neurological tests (which include assessing balance, coordination, eye movement and reflexes) may be used to look for possible brain disorders, such as stroke or Parkinson’s disease.
Brain scans using high-tech imaging with computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and functional MRI (FMRI) are often ordered to help identify strokes, bleeding, or deposits of toxic proteins in the brain, abnormalities in brain structure, or abnormal brain activity.
Alzheimer’s Test Options
A clinical diagnosis can pinpoint Alzheimer’s with more than 90 percent accuracy. But researchers are working to identify new ways of detecting this disease in its very initial stages and distinguishing it from other forms of dementia. Earlier diagnosis will help ensure that as new and better treatments become available, patients can benefit from them before their brain has been irreparably damaged.
Brain imaging is an increasingly important way to look for signs of AD in the living brain, and new neuroimaging techniques are under development that are steadily improving these processes. In addition to brain scanning, other new tests that show promise for detecting very early indications of AD include: Biomarkers in cerebrospinal fluid
Proteins released into the cerebrospinal fluid (CSF, the fluid that surrounds and protects the brain and spinal cord) can help doctors identify indicators of damage. For example, researchers have discovered that people with early-stage have increased levels of tau and beta-amyloid proteins in their CSF. Examination of the CFS is an invasive test, which is performed using lumbar puncture or spinal tap to obtain spinal fluid.
Biomarkers in blood or saliva
Certain proteins—including tau and beta-amyloid—may be present at higher levels in the blood and saliva of people with Alzheimer’s. A simple blood test can reveal these biomarkers in the bloodstream. In a recent study, researchers used a technology called liquid chromatography-mass spectrometry to identify unique substances present in the saliva of people with AD, but not in healthy adults.
Sensory changes
Abnormalities affecting sensory organs are often early signs of AD, and might be useful in making a diagnosis, but they must be clearly distinguished from other medical problems that can cause similar sensory changes before they can be fully relied upon as a diagnostic technique. For example, researchers have discovered that impaired smell is linked to elevated beta-amyloid levels, as well as to greater brain cell death. Other studies have found that, compared to healthy individuals, people with AD show signs of eye changes, such as reduced blood flow and cell loss in the retinas of the eyes, and alterations in the retinal nerve fiber. Problems with contrast sensitivity, visual field, depth, motion, and color perception can also indicate Alzheimer’s.
Alzheimer’s prediction methods
Researchers have developed an Alzheimer’s prediction method that involves assigning a score to each of the following risk factors: age, education, gender, systolic blood pressure, body mass index, blood cholesterol, and physical activity. Results suggest that people at high risk for developing dementia within the following 20 years can be identified by combining the scores, and can then implement lifestyle changes that will lower their risk.
IV. TREATING ALZHEIMER’S
To date, no treatment has been found that can halt the progress of Alzheimer’s disease or prevent its destructive effects. Yet treatments are available to relieve some of the most troubling symptoms of Alzheimer’s, and make life easier for both those with the condition and their caregivers.
Alzheimer’s Medications
Drugs used to treat Alzheimer’s can be divided into two categories. One category treats memory, language skills, and other cognitive symptoms of the disease, while the other addresses agitation and other behavioral issues.
Treating cognitive symptoms
Cholinesterase inhibitors and memantine (Namenda) both treat cognitive symptoms of Alzheimer’s.
Cholinesterase inhibitors
These drugs boost levels of a brain chemical called acetylcholine, a neurotransmitter essential for proper memory function that is reduced in people with Alzheimer’s disease. The drugs in this class appear to be about equally effective at improving cognition and ability to function and may also slow the progression of mild-to-moderate Alzheimer’s in about half the people who take them.
The most widely used cholinesterase inhibitors include Donepezil (Aricept), Rivastigmine (Exelon), and Galantamine (Razadyne). NMDA (N-methyl-D-aspartate) receptor antagonist Another drug, memantine (Namenda), is approved to help with memory, attention, reason, language, and other impairments related to Alzheimer’s. The drug regulates the action of a chemical messenger in the brain called glutamate, which in excess can damage nerve cells.
When used alone or with a cholinesterase inhibitor, memantine can delay Alzheimer’s progression and improve cognitive function in some patients. Treating behavioral symptoms Behavioral and psychiatric symptoms such as anxiety, agitation, hallucinations, delusions, aggression, hostility, and uncooperativeness are among the biggest reasons why people with Alzheimer’s are institutionalized.
No drug is FDA-approved for treating behavioral symptoms in people with AD, however, several are used off-label, including: Antidepressants and anxiolytics Antidepressants known as selective serotonin reuptake inhibitors (SSRIs) are the class of drug used to manage symptoms of depression, and they can also ease irritability and depression in people with Alzheimer’s.
These types of antidepressants include citalopram (Celexa), fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and trazodone (Desyrel). Although these medicines can sometimes contribute to memory loss, older adults with AD and symptoms of depression who are continuously treated with antidepressants may have less cognitive decline than those whose depression is not treated or is treated only intermittently.
Doctors also use a class of medicines called anxiolytics to address symptoms like anxiety, restlessness, and disruptive behavior.
These drugs include lorazepam (Ativan) and oxazepam (Serax). Some research associates higher mortality with the use of these drugs in dementia patients. Antipsychotic medications Among the most disturbing features of dementia are severe emotional symptoms, such as aggression, hostility, anger, hallucinations, and delusions. These symptoms are so distressing that many doctors prescribe antipsychotic medications—such as aripiprazole (Abilify), clozapine (Clozaril), haloperidol (Haldol), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon)—in an effort to alleviate them.
Yet recent research has called into question the value, and safety, of antipsychotic use in people with dementia. Studies have found that those taking antipsychotic drugs are significantly more likely to die than those not taking the drug and that the risk of death goes up as the drug dose increases. The FDA has issued a “black box” warning, advising of the increased mortality risk among dementia patients who use these medications. Other drugs have been used as alternatives to antipsychotics, and have been shown to help soothe some agitated individuals.
These might include cholinesterase inhibitors, antidepressants, anti-epileptic medications such as divalproex (Depakote), and lithium. If severe behavioral problems, such as hallucinations, delusions or aggression, don’t respond to other therapies, it may be necessary to prescribe antipsychotic drugs in the short term until other, less risky strategies can be found.
Non-Drug approaches In many cases, non-drug approaches to behavioral and psychiatric symptoms can be just as effective as drugs. These approaches involve calming the agitated person by such strategies as: avoiding potentially upsetting situations; allowing for some agitation, provided it does not pose a risk; or responding flexibly through changes in routine and environment.
Alternative Treatments Researchers have studied a number of possible therapies besides prescription medications for relieving AD symptoms, and have found indications that some may help people with AD. However, more research is needed to clearly establish the benefit of some of these treatments.
Cognitive stimulation therapy
Cognitive stimulation therapy (CST) involves a series of sessions in which the person participates in a variety of mentally stimulating activities designed to preserve cognitive function. Research finds that CST significantly improves cognitive functioning and quality of life among people with dementia, and it may work as effectively as medication.
Nutritional supplements
It’s important to be cautious and consult your doctor before using any type of supplement, since their benefits have not been clearly established. Supplements are not regulated by the FDA and can sometimes cause side effects. Moreover, the potency and purity of supplements are not guaranteed. Alternative therapies that have been looked at—but not definitively proven to be of benefit for treatment of AD—include:
Coenzyme Q10 (CoQ10)
Coenzyme Q10 (CoQ10) is an antioxidant made naturally by the body, that is essential for cellular energy production and for controlling cell-damaging free radicals created as a byproduct of that energy production;
Ginkgo biloba
Ginkgo biloba is an herbal supplement with antioxidant and anti-inflammatory properties commonly used in Europe to treat Alzheimer’s.
Huperzine A
Huperzine A is a natural cholinesterase inhibitor derived from moss that has been used for centuries in Chinese traditional medicine to treat memory problems. Omega-3 fatty acids Omega-3 fatty acids are found in food sources such as fatty fish, walnuts, and flaxseed—help modulate the structure of nerve cell membranes and are important to gene expression in the central nervous system.
Alzheimer’s disease is strongly correlated with a decrease in omega-3 levels in the brain and peripheral tissues. Although there are many reasons to include omega-3-rich foods in the diet, recent research suggests that supplements have no significant effect on cognitive function.
V. ON THE HORIZON: AN ALZHEIMER’S CURE?
In February 2015, the National Institutes of Health acknowledged the importance of finding new treatments for AD by releasing a landmark plan to transform the face of Alzheimer’s disease research. The plan is intended to provide increased support for efforts to learn more about the underlying causes of the disease, and explore ways to treat, prevent, and perhaps even reverse Alzheimer’s disease.
Drugs in the Pipeline
Scientists are incorporating recent advances in molecular biology, bioengineering, genetics, and other fields into research aimed at modifying the outcome of Alzheimer’s disease and finding new possibilities for the treatment of memory disorders and dementia.
Some intriguing examples: Immunotherapy—Alzheimer’s vaccines One of the most exciting, and best-studied new therapies for Alzheimer’s harnesses the body’s own immune system, using vaccines or antibodies to find and destroy beta-amyloid and clear out plaques in the brain, or eliminate the clumps of tau protein (neurofibrillary tangles) that kill neurons responsible for memory loss.
Two types of immunotherapy are under investigation:
• Active immunotherapies, which induce a response from the patient’s own immune system;
• Passive immunotherapies, which involve the administration of antibodies to create an immune response.
Scientists are targeting the accumulation of beta-amyloid proteins using both active and passive immunotherapies.
A few active therapies have produced antibody responses to beta-amyloid, including vaccines known as CAD106, ACC001, and AFFITOPE, all of which are in ongoing trials.
Passive immunotherapy research focuses on drugs called monoclonal antibodies to target beta-amyloid proteins.
These drugs, which are already used to treat cancer, are engineered in the laboratory to mimic the antibodies the immune system naturally produces when confronted by bacteria, viruses, and other foreign invaders.
Studies involving use of the experimental drugs solanezumab and gantenerumab, and crenezumab in people diagnosed with AD have been disappointing, so researchers are now testing whether administering monoclonal antibodies at the very earliest signs of AD, before symptoms are evident and serious damage has been done to the brain, might halt progress of the disease. © Lisa F. Young | Dreamstime.com A number of medications that can help relieve some of the most troubling symptoms of Alzheimer’s disease are available. © Lisa F. Young | Dreamstime.com A FREE GUIDE FROM UNIVERSITY HEALTH NEWS 40 | Dementia Symptoms, Stages, and Treatment
Gene therapy
Genes code for the production of proteins throughout the body. When genes work the way they should, the body functions optimally. But abnormal changes in genes can set in motion a cascade of cellular processes that leads to diseases like AD. Researchers are looking for ways to target these processes using gene therapy.
For example, in a recent study in mice, researchers injected a gene into a key memory region of the brain called the hippocampus.
The gene, which produces a protein involved in long-term memory, reversed memory loss in the animals.
In another study, gene therapy was used to increase nerve growth factor (NGF) production in the brain, which improves neuron survival.
Researchers are hopeful gene therapy will eventually lead to new therapeutic approaches to AD. Histone Deacetylase (HDAC) inhibitors Drugs called histone deacetylase (HDAC) inhibitors target a group of 11 HDAC enzyme expressions of key proteins in the brain. One enzyme in particular, HDAC2–which silences genes that are needed to form new memories–is overproduced in the brains of people with Alzheimer’s. When an inhibitor is used to shut off the gene in the hippocampi of mice genetically engineered to develop Alzheimer’s, it restores normal cognitive function.
Another HDAC inhibitor, used to target HDAC6, reduced brain tau levels and restored memory in mice with Alzheimer’s. Insulin Insulin, the hormone that helps the body convert dietary sugar to energy, is thought to have strong links to Alzheimer’s disease. Because the same enzyme breaks down both insulin and beta-amyloid, a disruption in insulin signaling in the brain can affect amyloid removal, cell survival, inflammation control, blood vessel function, and other factors involved in the development of AD. Researchers are testing an insulin nasal spray they hope might help with Alzheimer’s and other forms of dementia.
VI. HELPING YOURSELF: HOW TO INCREASE MEMORY POWER
Even for individuals who are showing signs of memory difficulties, dementia is not a foregone conclusion. There is good evidence that by being proactive, you lower your risk for dementia or slow the progress of mental decline.
Ways to Lower Your Dementia Risk
Both those risk for Alzheimer’s and those who already have the condition can benefit from adopting the following healthy lifestyle habits to aggressively address risk factors for the disease:
Eat a healthy diet
Brain cells need a rich and varied supply of vitamins and nutrients to grow and function properly, and to resist and repair damage. A healthy diet also helps lower your risk for cardiovascular disease and other conditions that can contribute to memory decline. One of the best-researched eating plans for heart and brain health is the Mediterranean diet, which limits meat and emphasizes fruits and vegetables, fish, and monounsaturated fats such as olive and canola oils. The Mediterranean style of eating may be particularly beneficial when it’s combined with the National A FREE GUIDE FROM UNIVERSITY HEALTH NEWS 43 | Dementia Symptoms, Stages, and Treatment Heart, Lung and Blood Institute’s Dietary Approaches to Stop Hypertension (DASH) diet used to lower high blood pressure. Together, the two diets can reduce Alzheimer’s risk by up to 53 percent, research suggests. © Monticelllo | Dreamstime.com Medical experts can’t stress the importance of diet enough—and fruits and vegetables are the place to start.
Certain food groups benefit health in general, and brain health in particular. These include:
• Fresh fruits and vegetables, such as green leafy vegetables, colorful fruits and berries, and carrots, which are high in brain-protective antioxidants;
• Whole grains, such as bread, cereal, pasta, and brown rice, which contain complex carbohydrates that provide the brain with glucose to increase energy and improve memory function;
• Lean protein from low-fat dairy foods, nuts, seeds, fish, and beans, and occasional servings of eggs, poultry, and lean meats to help keep your mind alert.
• Healthy fats, such as those found in canola and olive oils, which help lower levels of LDL (“bad”) cholesterol; polyunsaturated oils, such as those derived from corn and sunflower seeds, which help the body absorb vitamins, provide energy and heighten alertness; and omega-3 fatty acids, which are found in cold-water fish, as well as in flaxseed and dark-green leafy vegetables, which appear to play a key role in cognitive health and functioning and may reduce the risk of mild cognitive impairment or AD.
Caring for your brain requires not only adding nutritious foods to your diet, but avoiding these unhealthy foods as well.
• Saturated fats, such as butter and lard; is MCT Oil a saturated fat – Search (bing.com)
• Trans fats (hydrogenated or partially hydrogenated oils) found in many commercially prepared fried foods, processed foods, and snack foods; • Simple carbohydrates, such as processed white rice and flour, sweets, and refined sugars;
• Sugar-laden soft drinks. Quench your thirst instead with about eight glasses of water daily to avoid dehydration that can negatively affect cognition.
• Watch your waistline: A high body mass index (BMI, a ratio of height to weight used to measure obesity) is associated with poorer mental skills in older adults. In general, individuals with a BMI of 25 up to 30 are considered overweight, and those with a BMI of 30 and over are considered obese. In one study, overweight and obese participants had smaller, older-looking brains than people of normal weight, of “severe brain degeneration.”
The brain regions affected by obesity are the same as those involved in AD, but the good news is that some studies have found a connection between losing weight and improved memory.
Exercise
A sedentary lifestyle increases risk for cognitive decline, as well as conditions linked to Alzheimer’s, such as diabetes, high blood pressure, and obesity. Inactivity may also significantly increase risk for vascular dementia (VaD), another common form of dementia. Regular exercise is one of the most important strategies available to reduce risk for dementia, and a large body of evidence supports its benefits for the brain. A good aerobic workout increases the flow of oxygen-rich blood to areas of the brain responsible for learning and memory and increases levels of brain-derived neurotrophic factor (BDNF), a chemical that protects neurons and strengthens synapses in the brain.
Forms of exercise that work several different areas of the brain at once–such as the eye-hand coordination, decision-making, and rapid information processing called for in playing ping-pong or tennis–have been linked to enlargement of a part of the brain that typically shrinks in patients with dementia. The earlier you start getting fit, the better. If you’ve been inactive for a while, ask your doctor to suggest an exercise program that’s safe for you. Aim for at least 30 minutes of aerobic exercise at least five days a week. Include exercises to improve muscle strength, balance, and coordination. Vary your activities to stay engaged and avoid boredom. Remember that even household chores and gardening count as exercise.
Break bad habits
Studies suggest that changing such habits as smoking and heavy drinking can be beneficial in warding off Alzeihmers.
• Smoking is detrimental to physical health, and the deleterious effects of smoking on the brain include neuron damage in the midbrain and hippocampus. If you smoke, talk to your doctor about smoking-cessation aids and other ways to help you quit.
• Chronic heavy drinking has been linked to brain atrophy, impaired memory and learning, and disrupted communication between brain cells. Excessive alcohol consumption is of special concern in older adults, because with advancing age, people become increasingly vulnerable to the effects of alcohol. In an older brain, alcohol may accelerate normal aging, aggravating symptoms of cognitive decline and early dementia. If you drink, do so in moderation. Women should have no more than one glass of alcohol a day. Men should limit themselves to one or two glasses (confirm this amount with your doctor). Avoid illicit drug use entirely.
Manage your medications
A number of medications commonly prescribed to older adults have unwanted cognitive side effects. Because your sensitivity to the effects of drugs increases with age and medications tend to linger longer in your system, side effects can show up at lower doses than they did when you were younger. Any decrease in cognitive function that occurs soon after you start taking a new drug or change the dosage suggests that medication may be the cause of the cognitive difficulty. It’s also advisable to review with your medical care provider regularly an updated list of your medications—including any over-the-counter drugs and natural medications they are taking. This type of patient-doctor consultation can help prevent unwanted side effects, dangerous interactions among various medications, and unnecessary over-medication that can lead to memory problems in older adults.
Although many drugs can impair memory, some of the most common examples of include:
• Benzodiazepine-like hypnotics used to treat anxiety, insomnia, and sleep disorders: zolpidem (Ambien);
• Antidepressants used to treat depression: venlafaxine (Effexor), fluoxetine (Prozac), and paroxetine (Paxil, Pexeva);
• Newer anticonvulsants used to treat epileptic seizures, bipolar disorder, and nerve pain: gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), pregabalin (Lyrica), and topiramate (Topamax)
Reduce stress
Although an occasional stressful situation doesn’t have lasting consequences for the brain, excessive or prolonged feelings of pressure, tension, and distress—with associated increases in levels of the stress hormone cortisol—can negatively affect the networks of dendrites that connect neurons with one another, reducing communication among brain cells.
High levels of stress slow the creation of new neurons to replace injured or dying cells, resulting in the gradual shrinkage of a key memory area called the hippocampus and higher risk for Alzheimer’s disease. Long-term stress also interferes with the proper functioning of neurotransmitters–chemicals responsible for transmitting messages from one brain cell to another–and impairs the functioning of the prefrontal cortex, the decision-making center of the brain responsible for short-term memory.
You can protect your brain from the harmful effects of stress and reduce your risk for memory problems by learning relaxation techniques to help lower breathing rate, blood pressure, oxygen consumption, and oxidative stress on cells. Stress-reducing relaxation techniques include deep-breathing exercises, yoga, tai chi, progressive relaxation, visualization, meditation, and relaxing activities such as listening to soothing music or taking a warm bath. If you are feeling overwhelmed by stress, consider seeking help from a mental health professional.
Get enough sleep
During restful sleep, your brain consolidates newly acquired information and strengthens memories, which makes getting at least six to seven hours of sleep at night a prerequisite for good memory and cognitive function. A lack of sleep can harm short-term, or working, memory, make it more difficult for you to remember skills and procedures, and contribute to AD risk by increasing the buildup of beta-amyloid plaque in the brain. Sleep changes with age. Adults over 65 experience less Stage IV sleep—the deep, restorative stage of sleep—than younger people do. They also take longer to fall asleep, and awaken more easily. Sleep disorders, such as restless legs syndrome and sleep apnea, may also interrupt restful slumber. Sleep apnea, which involves the interruption of respiration and oxygen flow, may be especially harmful to the brains of older adults. People who experience chronic sleep problems should seek treatment. © Wavebreakmedia Ltd. Finding your way to regular and restful sleep is a key to keeping your memory fresh.
To get a better night’s sleep and bolster your memory, establish good sleep hygiene by adopting the following strategies:
• Go to bed at the same time each night and awaken at the same time each morning.
• Sleep in a cool, quiet, darkened room.
• Do something relaxing before bed, like reading a book or taking a bath.
• Avoid large meals or exercise within four hours of bedtime, and restrict liquids close to bedtime to avoid sleep interruptions for bathroom visits.
• Limit alcohol and avoid caffeine at least four to six hours before you go to bed.
Staying socially active.
Having close relationships and staying socially active requires paying attention to your surroundings, following a conversation, responding to the actions of others, and watching for verbal and non-verbal cues—all of which require a lot of brainpower. Research suggests that individuals who are least socially active experience a 75 percent greater rate of cognitive decline than those who are most socially active, even after other factors such as age, general health, and physical activity are considered. To keep your memory sharp, get out with friends as often as you can, and call, email, or Skype with friends and loved ones.
If you’re socially isolated, begin a campaign to win new friends.
Stay mentally active
A large body of evidence suggests that exercising your brain with stimulating and challenging activities, such as reading the newspaper, playing checkers, or taking dance lessons can keep you sharp and help prevent dementia. Activities that require concentration, use many senses at once, and involve new or unexpected experiences and approaches are especially stimulating to the brain.
Some research suggests that brain-stimulating activities help counteract the effects of aging by keeping the brain efficient and reducing the production of toxic beta-amyloid. Other studies suggest that mental activity may actually reshape the brain through the promotion of powerful growth hormones such as brain-derived neurotrophic factor (BDNF), which promotes the development of communication points between neurons, called synapses.
Protect your brain from injury
Traumatic brain injury (TBI), caused by a fall, blow to the head, or even violent jarring, can injure sensitive brain tissues in ways that might cause later declines in cognition. Symptoms of TBI vary depending on the area of the brain affected by the injury, and may not show up until hours, days, or even weeks later. Prompt medical treatment may help prevent further damage to vulnerable tissues.
Taking steps to avoid head injury is a wise precaution. Some common-sense suggestions include eliminating fall hazards in your home, using vehicle seat belts, wearing appropriate footwear, and wearing a helmet when engaging in activities with a risk of head injury, such as bike riding.
VII. HOW TO IMPROVE MEMORY
You can take steps to preserve your memory as you age. Try some of the suggestions in this chapter to organize information, cement it in your mind, and recall it more easily.
Learn Basic Memory Skills
These simple approaches will help make information easier to retain and recall:
• Concentrate. Focus on one memory task at a time.
• Make sure you understand the information you are trying to remember.
• Make an effort. To motivate yourself to remember, consider how the information will be useful to you.
• Use mnemonic strategies and other memory techniques. Rhymes, acronyms, or other forms are easier for your brain to encode and recall.
• Associate. Connect new bits of information with things you already know.
• Manage your memory. Break the information you want to remember into small chunks so that you don’t overload your memory. Take breaks during the process of remembering to give your brain a rest.
• Get organized. Keep frequently used belongings such as car keys in the same place, so you can find them readily. Use memory aids, such as calendars and automated medication dispensers. Make a weekly plan in which you note your goals, activities, appointments, and chores for each day of the week to help you stay on track without cluttering your mind with minutiae.
• Use cues and reminders. Put your empty medicine bottle by the door to remind yourself to refill your prescription. Use a timer to remember to turn off the oven.
Train Your Brain
Regularly engaging in training exercises that help you practice specific cognitive abilities (e.g., attention or processing speed) seem to protect against memory loss better than memory strategies alone. Examples of cognitive exercises you might try:
• Strengthen your powers of attention by concentrating on one subject or task for 10 minutes without letting your mind wander. The next day, increase your concentration time to 12 minutes. Play online brain-training games to boost your brain’s processing speed. Memorize your favorite poems, or learn to play a new piece on the piano.
• Boost information processing speed by playing online brain-training programs. Another option: examining a photograph you have not seen before for one minute. Then turn over the photo and jot down as many details from it as you can remember. As your processing speed improves, shorten the time you spend examining each new photo.
• Exercise your capacity to recall information by reading a medium-length article on any subject while making an effort to remember as many details as you can. Put the article aside and write or recite as much as you can of its contents. Then check the original article to see how you did. Make Information Stand Out To increase your ability to retain a memory, use one of the following imaginative techniques to endow it with unique elements or associations so that it stands apart from other information you may be exposed to at the same time:
• Take a snapshot: Create a mental “photograph”—a visual record of what you want to remember–noticing as many details as possible.
• Prepare a speech: Pretend you must describe or explain the information you want to remember to someone else.
• Sing it: Make up a song or jingle containing the information you’re trying to remember.
• Create a vivid mental image: For example, to remember the peanut butter, chicken, and olives on your grocery list, picture a chicken covered with peanut butter wearing a necklace of olives.
• Laughter is the Best Medicine, Shopping Cart Therapy, Rides in the Car And Solving Puzzles.
Mindfulness Meditation
Research suggests that the ability to pay attention—a key aspect of memory—declines with age. One excellent way to improve your ability to pay attention and remember is to practice mindfulness meditation. This form of meditation involves focusing your awareness on sensory stimuli in the present moment, while ignoring intrusive thoughts and inner chatter.
Research suggests that older individuals who meditate have better preserved cortical regions of the brain—regions responsible for attention, sensory processing, and integrating emotional and cognitive processes that normally thin with age. To meditate, follow these basic steps:
• Find a quiet place where you can meditate without being disturbed.
• Sit comfortably, close your eyes, and slow your breathing.
• Focus on your breathing, or on a simple word or syllable uttered as you exhale.
• Be aware of sensory perceptions, but remain detached.
• When your mind wanders, bring it gently back to your breathing or focus word.
• After 20 minutes or so, open your eyes and sit quietly for a moment, letting yourself gradually return to your normal state.
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