How to Stay Sharp in Old Age

Of all the common consequences of aging, there is nothing more frightening than memory loss . Even if you’ve never watched your loved one die of Alzheimer’s – which I promise is worse than it sounds – it’s natural to wonder if something like this could happen to you.

Our collective fear of aging has long been used for profit; cognitive decline is no exception. Most people are afraid of losing their mental faculties as they age, and corporations know this – brain-building games and apps are big business these days. Their claims are bold : Lumosity promises to help users “improve memory, improve focus, and find peace.” The 2013 Apple App of the Year winner Elevate bills itself as “a brain training program designed to improve attention, speaking, processing speed, memory, math skills, and more.” Using fear to sell products can be an effective marketing strategy, but these products rarely solve any real problem.

There is so much about dementia that we still don’t know, but one thing is for sure: it is caused by a complex combination of many, many factors. In other words, any prevention-focused strategy – like playing on the phone for a few minutes a day – probably won’t make any difference, but a multi-pronged approach can. While most risk factors are out of our control, some of them we can change, and knowing the difference is your best defense.

What is dementia and what causes it?

There are three main types of memory loss: age-related cognitive decline, mild cognitive impairment (MCI), and dementia. While the symptoms overlap to some extent, they are different conditions and it is important to know the difference between them.

Age-related cognitive decline

Age-related cognitive decline is what we call a somewhat normal level of memory loss. Just like our hair, skin and muscles, brain cells age with us, which can cause impaired cell function and communication. Everyone loses some neurons as a result of the normal aging process, so mild memory problems can be attributed to aging.

Mild cognitive impairment

The MCI falls between normal aging and dementia on a scale of severity. People with MCI have more memory problems than is normal for their age group, but they can still function on their own. (As always, it is up to the qualified healthcare professional to determine what is “normal”.) It makes it difficult to perform daily tasks such as remembering prescriptions and medications, but, unlike dementia, MCI does not usually induce behavioral changes. …

Dementia

Dementia, according to the National Institute of Aging , is “a loss of cognitive functions – thinking, remembering, and reasoning – and behavioral abilities to the extent that it interferes with a person’s daily life and activities.” People with dementia forget about prescriptions and medications, but they can also experience impairments in vision, language skills, spatial reasoning, and decision-making. They can wander or get lost. Dementia can ultimately cause personality changes: irritability, paranoia, hallucinations, aggression, unusual sexual behavior, and even physical abuse.

The most common cause of dementia is Alzheimer’s disease, which can be either early or late onset. With late onset Alzheimer’s, the most common type, dementia symptoms begin in the mid to late 60s. Early-onset Alzheimer’s disease is less common, accounts for about 10 percent of all cases, and occurs anytime between the ages of 30 and 60.

Scientists don’t fully understand why dementia develops, but in general, cognitive problems arise when neurons stop communicating with other brain cells and eventually die. In Alzheimer’s disease in particular, amyloid proteins and neurofibrillary (or tau) fibers clump together into abnormal structures, interrupting neuronal connections and killing previously healthy tissue. These masses, called amyloid plaques and tau tangles, are thought to at least partially explain the cognitive and behavioral changes seen in Alzheimer’s patients. Areas of the brain associated with memory are usually the first to be damaged, causing forgetfulness and wider memory loss; as the disease spreads to other parts of the brain, the patient gradually loses the ability to reason, speak, and behave normally. Eventually, the damage becomes so widespread that it affects basic physical functions such as breathing and swallowing.

Who is in danger?

The exact physiological causes of dementia are largely unknown, making early detection nearly impossible; if there is a predecessor that shows up on routine blood tests or imaging, we haven’t found it yet. For most people, dementia symptoms are the only warning, so knowing your risk is important.

The biggest risk factor for dementia is age . Whether it’s Alzheimer’s or something else, dementia is much more common in older people; The NIH estimates that half of people over the age of 85 have some form of dementia. Family history also plays a role. Some people with no family history develop dementia, but as with many other conditions, the more people in your family have the condition, the higher your risk. In addition, mental illness, especially depression, is associated with an increased risk of dementia .

Both early and late forms of Alzheimer’s disease have a genetic component , but this does not mean that you are assessing your risk with a DNA test – it simply means that researchers have identified some of the chromosomes and genetic mutations involved in Alzheimer’s development. Your genes are just a few of the many factors involved in a complex, decades-long process; Many Alzheimer’s patients do not have the corresponding mutations at all. It is worth noting, however, that most people with Down syndrome will develop Alzheimer’s disease . This may be because the gene that makes amyloid proteins is located on chromosome 21, of which people with Down syndrome have an extra copy.

What can we do about it?

This is not embellishing: dementia cannot be prevented at this time, and there is no way to stop, reverse, or slow its progression. Finding a cure is a top priority, but the ultimate goal of dementia research is to prevent it entirely, ideally through adaptable lifestyle changes. Scientists have investigated several interventions that may delay the onset of cognitive decline, but only a few are truly promising.

Exercise may help, but we’re not sure

Of all the possible interventions, none has been studied more than exercise. The results are mostly inconclusive . While some research suggests that increased physical activity can slow normal age-related cognitive decline, there is no evidence that this is true for MCI or dementia. However, staying physically active has enough general health benefits that it is worth the time that it is not the only thing that can keep you from developing dementia.

Brain Training Games Can’t Improve Your Brain in Real Life

Another increasingly popular activity is “cognitive training,” or playing increasingly complex games that challenge different parts of your brain. It’s an attractive idea: play enough games and solve enough puzzles, and you, too, can improve your general cognition. Unfortunately, research doesn’t quite support this. Some games look more promising than others , but for the most part, brain training seems to mostly improve your ability to play this particular game.

For cognitive training to work, any benefits gained from play must be transferred to related tasks in a so-called “transfer effect.” Proving this is far more difficult than it sounds: Scientists disagree about which aspects of cognition correspond to brain training games , and how to meaningfully test improvements. As a result, very few researchers have observed carry-over effects. That hasn’t stopped corporations like Lumosity from saying otherwise, although there is no evidence that these games can prevent cognitive decline . (In 2016, Lumosity was fined $ 2 million by the FTC for “fraudulent advertising.”)

Treating high blood pressure may help

Something that could be more helpful is aggressive treatment for hypertension, which simply means bringing your blood pressure back into the normal range of 120/80 mmHg. or less. A recent randomized clinical trial of over 9,000 hypertensive adults found an association between intense blood pressure control and the risk of MCI and probable dementia: in people who had their systolic blood pressure lowered to 120 mmHg. systolic pressure was below 140 mm Hg. Art. (14.6 versus 18.3 cases per 1000 person-years, respectively). The intense lowering of blood pressure also significantly reduced the combined risk of MCI and dementia. In terms of probable dementia per se, the researchers observed a measurable decrease of 7.2 versus 8.6 cases per 1000 person-years for the 120 mmHg groups. Art. And 140 mm Hg. Art. Accordingly – but it was not statistically significant.

This does not mean that this research is nonsense; just the opposite. This is the first large-scale randomized clinical trial to find a statistically significant association between an overall curable physical condition and the risk of MCI. In addition, the study was so successful in reducing cardiovascular events and overall mortality that the blood pressure management program ended 3.3 years later – more than a year and a half earlier. The MCI and dementia assessments continued for a full five years. Given the relative youth of the participants (about 68 on average), the short observation window, and the fact that MCI tends to manifest earlier than dementia, it makes sense that significant results were only observed with respect to MCI – and so interestingly enough, any dementia outcome is not was observed. It is always possible that future research will contradict these findings, but until then it seems as compelling reason as any other for keeping your blood pressure under control.

Social interaction is our most promising strategy at the moment.

Finally, and perhaps most promising, there is mounting evidence that social isolation is a major risk factor for cognitive decline and dementia. A 2017 Lancet Commission report estimated that social isolation accounts for up to 2 percent of the lifetime risk of dementia – the same as hypertension. Although this is a relatively new area of ​​research, more and more research is exploring the possibilities of intervention by enhancing socialization. To find out more, I spoke with the author of one of these studies: Dr. Hiroko Dodge, Principal Investigator for the I-CONECT project at Oregon University of Health and Science.

In a June 2015 article on Alzheimer’s and dementia , Dr. Dodge et al. developed a clinical trial to test the effect of “natural human contact” on cognitive function in older (average 80 years) adults. About half of the participants had video link with trained interviewers for 30 minutes a day for six weeks; others did not. Compared to baseline and control groups, video chat participants showed improvements in semantic fluency (the ability to find and pronounce words in a specific category) and psychomotor speed (reaction time). The only statistically significant results were observed in subjects with normal cognition, i.e., no impairment or dementia, but subjects with MCI still showed improvement over the control group. The study was found to be successful and large-scale follow-up research is ongoing .

Dr. Dodge believes that human factors in video chat are the key to the observed results. During the interview sessions, interviewers were trained to prioritize eye contact and two-way communication, two important facets of personal contact that socially excluded people lack. Additionally, video chat is available to the people who benefit the most from it: physically and socially isolated adults. I asked Dr. Dodge if FaceTiming or video chatting with isolated elderly relatives could be done regularly. “Definitely,” she said, explaining that regular face-to-face conversations can improve cognitive compensation mechanisms – the brain’s ability to work with cognitive impairments.

Of course, there is still a long way to go before curing or preventing dementia. The NIH calls clinical trials the “gold standard” of medical evidence, but it is extremely difficult to get statistically significant results from them. As Dr. Dodge explained to me, this is due to the very high variability of research on dementia, especially when it comes to humans:

“If you ask [subjects] to do tests in the morning and then do tests in the afternoon, even within an individual, the fluctuations will be so significant. … When they feel good, or if they slept well last night, they feel much better. If they slept badly or caught a little cold, it really changes the grade. “

She also mentioned that cognitive compensation further complicates the situation: people with the same degree of cognitive impairment may perform differently on tests depending on how (or if) they have learned to cope with it.

Studies on social isolation are promising, but they are just beginning – and until they study more people of different ages, nationalities, nationalities, genders, and socioeconomic classes, we will not know for sure how much they can help.

Taken together, results from dementia intervention studies show that staying socially and physically active is the best way to ensure a long, healthy life. However, as Dr. Dodge reminded me, you can do everything “right” and still have dementia, so we must stop blaming people for not being able to prevent an incurable disease. “If someone gets dementia, others may say, ‘Oh, she didn’t communicate with people or did no cognitive stimulation’ … unfortunately, some people will get this condition, and it is not their fault.”