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Senior moments or something more?

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Robert Sweet, professor of psychiatry and neurology at the University of Pittsburgh Medical Center

Posted: Monday, December 2, 2013 2:15 am | Updated: 12:43 pm, Mon Dec 2, 2013.

You walk into a room and forget why you entered in the first place. You can’t quite place a name with a face, or you fail to recall the name of an actor you’ve seen on television recently.

You’ve never had these problems before, but as you’ve gotten older, your thinking has grown fuzzier. Everyone experiences “senior moments,” those maddening lapses in memory or concentration that grow more common with age.

Trouble is, your risk of cognitive disorders also grows as the years tick by, and you worry that your memory woes mark your first steps on the path to one of the most feared diseases of older age: Alzheimer’s disease.

These incidental memory lapses aren’t necessarily cause for concern, but if they consistently affect your daily life, consider seeking an evaluation.

“Anything that represents a real change in how you’re remembering things or anything that’s interfering with your life or causing you to have to adapt substantially in terms of your daily function may be worth checking out,” says Dr. Robert Sweet, professor of psychiatry and neurology at the University of Pittsburgh Medical Center. “Certainly, anything that someone from the outside is really noticing is happening a lot in you should be a red flag that you should get checked.”

Your aging brain

Every day, your brain contends with a barrage of stimuli that affect your memory, from stress to daily distractions. For example, if you’re overworked or you multi-task, you might be less likely to process and store information correctly. Even the personal relevance, importance or complexity of the information your brain receives may contribute to forgetfulness.

Time is another enemy of the mind. Information stored in your long-term memory tends to deteriorate, especially if you do not retrieve it every now and then. And, to operate more efficiently, your brain naturally jettisons stored information you no longer need. Consequently, you might remember a phone number only long enough to dial it before your brain disposes of it.

Everyone experiences declines in memory, concentration and thinking speed. You might forget where you left your car keys, require more time to balance your checkbook or have a word get “stuck on the tip of your tongue.”

Typically, these changes begin in your 30s, but they’re so subtle that most people don’t notice them until they reach their 40s, 50s or even later.

And although frustrating, these complaints, in and of themselves, do not necessarily signal impending dementia. In a study published in October in the journal Psychological Science, researchers found that older people more often experienced “tip-of-the-tongue” moments compared to younger adults; however, the scientists found no association between the frequency of these moments and the study participants’ performance on memory tests used to detect dementia.

In fact, given enough time and allowing for slower cognitive processing, older adults often score equally as well as younger people on tests, Sweet says, and they may even outperform their younger counterparts in areas such as vocabulary and pragmatic knowledge. “There are some aspects of cognition that tend to improve with normal aging, so it’s not all bad news,” he adds.

Although they’re natural and to be expected, senior moments can be troubling, especially with increasing age. In your 20s, it’s easy to dismiss them as mere absent-mindedness. In your 30s, you might blame them on the pressures of work or family life. But in your 50s and 60s, you might entertain concerns about dementia, even if your cognitive changes are normal, Sweet says.

“Then we see the opposite,” he adds. “We see older individuals who are having more serious symptoms of forgetfulness but who dismiss them as part of normal aging when they ought to be paying attention to them.”

Oftentimes, people with early dementia fail to recognize the warning signs and seek help only after someone else points them out. These more severe symptoms can affect your daily life and may include difficulty managing your finances or remembering how to get to familiar places.

“It’s not uncommon for people to write more notes to keep track of things as they get older, but are you losing the notes?” Sweet says. “Have you missed appointments, missed paying bills or paid them twice? If you or a loved one think you’re having symptoms, it doesn’t hurt to bring it up with your doctor and ask to get checked.”

Identifying the problem

As part of a comprehensive evaluation of your cognitive health, you’ll take tests and answer questions about how you’re functioning in your home life and whether you’ve experienced any changes in how you do things, Sweet says. Your doctor should ask about your medical history, perform a physical exam (including a neurological exam) and review all of your medications, and he or she may order an imaging study of your brain.

Your physician also must rule out other medical ailments that might affect your cognition and, if treated, could solve your memory problems. These conditions include thyroid dysfunction, obstructive sleep apnea, anemia, depression, vitamin B12 deficiency, low blood sugar, kidney or liver disease, and alcohol abuse.

Correcting sensory deficits, such as hearing or vision impairments, also may result in cognitive improvements, Sweet says: “If you get bad information because you don’t hear something right or see it right, you’re not going to compute it very well in your brain. …Sensory input is the beginning of all of our effective thinking. If it’s bad, you have a crumbling foundation, and it makes it harder to think well.”

Additionally, a broad array of medications—ranging from over-the-counter sleep aids and antihistamines to prescription antidepressants, narcotic pain relievers and drugs for overactive bladder, among others—may cause memory problems as a side effect.

“There may be a medication that you’ve been taking for a long time and it never bothered you, but as you get older, your body’s metabolism changes,” Sweet says. “So what was a good dose for you before may now be a problematic dose for you, and having it adjusted may solve the side effect of memory loss.”

Preserve your memory

If you are diagnosed with Alzheimer’s disease or certain other forms of dementia, your doctor may prescribe one of several medications: donepezil (Aricept), galantamine (Razadyne), rivastigmine (Exelon) or memantine (Namenda).

Although the drugs may slow cognitive decline, their effects are modest, Sweet says. Additionally, evidence supporting the use herbal or vitamin supplements to prevent cognitive problems—such as acetyl-L-carnitine, antioxidant and B vitamins, ginkgo biloba, ginseng, huperzine, and vinpocetine—is generally inconclusive.

Given these limitations of medical and herbal therapy and the fact that no cure exists for Alzheimer’s and other dementias, experts recommend that older adults do all they can to boost their brain health, preserve their memory and potentially ward off cognitive impairment.

Prevention starts with a healthful lifestyle, particularly good cardiovascular health. An estimated 20 to 25 percent of the blood pumped with each heartbeat goes to nourish brain cells, so anything that negatively affects your heart and blood vessels can have adverse effects on your brain function.

High blood pressure, diabetes, high cholesterol, smoking and obesity all damage your heart and vascular system, contribute to heart attacks and strokes, and may increase your risk of Alzheimer’s disease and vascular dementia (caused by deficient blood supply to the brain). So, work with your physician to manage all of these risk factors through a heart-healthy diet, regular physical activity—experts recommend at least 30 to 45 minutes of daily moderate-intensity exercise, such as walking, biking and swimming, on at least five days a week—and, if necessary, medications.

“Things that are good for your heart tend to be good for your brain,” Sweet says. “There’s certainly some evidence that they improve brain function. The brain is the most demanding organ of your heart, so you can see why if your heart and vascular system aren’t delivering blood well, your brain is one of the first areas to suffer.”

Just as you exercise your body, you also should give your mind regular workouts. Research suggests that you might preserve your cognitive skills by taking part in mentally stimulating activities, such as solving crossword or sudoku puzzles, reading a book, learning to speak a foreign language or play a musical instrument, or playing one of several computer- or Internet-based brain-boosting games, such as Lumosity.

Some evidence also suggests that ballroom dancing and other sequential dances, which force you to engage your mind and focus on your footwork while being physically active, may be particularly beneficial for cognitive health. The key is to choose something you enjoy and will do regularly.

“Being physically and mentally active is good for a lot of things, and may be good for your memory and concentration, as well,” Sweet says. “Since we don’t know what’s going to ultimately help with these diseases, it’s reasonable to try anything that isn’t likely to cause harm.”

Sweet and other experts also recommend that older adults stay socially active. Humans are highly adaptive social creatures who depend on social interaction, Sweet says. Unfortunately, many older adults end up socially isolated: They find it more difficult to get out of the house, and their social network dwindles as their friends move away or die off.

When you converse with people, you engage your mind by finding the words to say while interpreting the words you hear. So, involve your friends in your activities.

“This creeping social isolation happens with progressive aging for many people, and most of us wouldn’t choose that. It’s good for us to fight against it and develop these other avenues of contact and interaction,” Sweet says. “Like any other aspect of aging, the best you can do is try to get out in front of cognitive decline. Prevention is better than treatment. Think about how to do things to keep yourself as mentally fit as possible.”

10 Alzheimer’s warning signs (for chart)

Forgetting a name or periodically having trouble finding the right word are typical of age-related cognitive changes, but other symptoms that are persistent or interfere with your daily life warrant an evaluation. The Alzheimer’s Association has identified these 10 warning signs of Alzheimer’s disease:

Memory loss that interferes with daily activities: forgetting recently learned information.

Challenges in planning or solving problems: difficulty following familiar instructions or keeping track of monthly bills.

Difficulty completing familiar tasks, such as driving to a familiar location or remembering the rules of a favorite game.

Confusion with time or place: forgetting where you are or how you got there.

Trouble understanding visual images and spatial relationships: difficulty reading or judging distances.

New problems with spoken or written words: repeating information or difficulty following conversations.

Misplacing things; losing the ability to retrace your steps to find things.

Decreased or poor judgment: poor grooming habits, mishandling of finances.

Withdrawal from work or social activities, such as hobbies, work projects, or sports.

Changes in mood and personality: becoming confused, anxious, suspicious, or easily upset.

Source: Alzheimer’s Association

Action points (for chart)

What’s good for your heart is good for your brain. Work with your doctor to manage your blood pressure, blood sugar, cholesterol, weight and other cardiovascular risk factors.

If you smoke, ask your physician about ways to quit.

Keep your mind active. Engage in mentally stimulating activities that you enjoy and that help with your daily functioning.

Stay socially active. Consider volunteering with local charities or joining a book or card club. Include friends and family in your leisure activities.

Maintain good vision and hearing, and seek help to address any sensory deficits. Good memory relies, in part, on recognizing and understanding visual and auditory cues.

Stay busy. Some research suggests that people who retire later reduce their risk of dementia. When you do retire, continue some of your work routine, but fill your day with enjoyable appointments and stimulating activities.

Turn off the TV. Some studies suggest that people who watch television for several hours a day face a greater risk of cognitive impairment later on.

Memory aids

To compensate for memory lapses, try these memory aids:

Take notes. Write down appointments, names of people you meet, instructions, etc.

Make a list. Write down frequently called telephone numbers, grocery lists, to-do lists, etc.

Put the camera on your cell phone to work. Snap a photo of a person, place or thing you need to remember.

Use a voice recorder to take audio notes of things you need recall.

Put things in assigned places so you know where to find them.

Mark up your calendar to remember important dates and appointments.

Set timers. Use alarm clocks, computer software or your cell phone to remind you to do what you need to do.

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