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INTERESTING STUFF – 2 May 2015

Better Brain Health

I am not alone in my greatest fear of old age: losing my mind. Okay, these days the more polite terms are dementia and Alzheimer's but the words amount to the same thing.

”In 2013, a YouGov survey...found that Americans of age 60 years and older were more afraid of Alzheimer's disease or dementia than cancer, heart disease, stroke, or diabetes.”

That survey is noted on page 305 of a huge new study from the U.S. Institute of Medicine about ageing and the brain, that was released in April. The title provides us with a new-ish phrase we need to learn:

Cognitive Aging, subtitled Progress in Understanding and Opportunities for Action.

The Journal of the American Medical Association (JAMA) defines the phrase for us:

”Cognitive aging is a lifelong process of gradual, ongoing, yet highly variable changes in cognitive function that occur as people get older.

“Some cognitive functions decrease predictably, such as memory and reaction time, whereas some other functions are either maintained or may even increase, such as wisdom and knowledge.

“Cognitive aging is not a disease or a quantifiable level of dysfunction. It is distinct from Alzheimer disease and other neurocognitive and psychiatric disorders that affect older adults’ cognitive health, so it is best measured and studied longitudinally among adults who are free of these disorders.”

So cognitive aging is nowhere near the same thing as Alzheimer's disease. Here is a chart from the study comparing the two:

ALZHEIMER'S V. COGNITIVE AGING
Alzheimer's Cognitive Aging
Chronic neurodegenerative disease Part of aging
Extensive neuron loss Neuron number remains relatively stable but neuronal function may decline
Affects approximately 10% of older Americans Occurs in everyone but the extent and nature of changes varies widely
Declines are often severe and progressive Changes are variable and gradual

There is a handy box at the JAMA website with a list of key features of cognitive aging.

The full study [pdf], which you can download for free at The National Academies Press website, is nearly 400 pages. I've skimmed it, reading more carefully in some places but for this short report, I've mostly relied on others. One of them, from AARP, provides a good overview of the most salient points.

The long-time usual suspects for promoting and maintaining good physical health are equally important for cognitive health: get plenty of aerobic exercise, stay intellectually active, control blood pressure, get a good night's sleep. And this:

”...eating less meat and consuming more nuts and beans, whole grains, vegetables and olive oil. Omega-3 fatty acids, found in fatty fish such as salmon, have been shown to help cognition in some studies, yet not in others.”

You have probably heard, too, the list of things that are detrimental to brain health: depression, hearing and vision loss, stress and hospitalization, excessive use of alcohol. In addition,

”Adults between ages 65 and 69 use an average of 14 different prescription drugs per year, often leading to serious complications.

“The report singles out strong anticholinergic drugs (including antihistamines such as Benadryl and some antidepressants) as well as benzodiazepines (such as Valium and Xanax, used to treat anxiety and sleeplessness) as being linked to delirium, cognitive impairment and dementia.

“'We aren’t saying don’t take them ever,' [study author, Dan G.] Blazer said. 'But you need to watch out and be aware of the side effects.'”

The report includes an important list of widely-used products that have no proven effect in preserving cognitive function: dietary supplements including vitamins B6 and B12, vitamin D, vitamin E and ginkgo biloba. Not to mention (emphasis is mine):

”Although research shows that brain training on computers and video games can improve attention and memory as they relate to the games, few studies show that those skills transfer to real life.

“The report recommends that consumers carefully evaluate claims of companies selling brain games. 'People may fall prey to using products that have not been proven to be effective and think they will help them in all areas of their lives,' Blazer said.”

As we have discussed here many times, among our worries are that forgetting a name or the reason we have walked into the bedroom could be harbingers of dementia. We cling to “advice” that as long as we can remember what the can opener does, even if we can't find it, it's not incipient Alzheimer's.

What is important about this report for elders ourselves (as opposed to health care professionals and researchers and others who work in age-related fields) is to understand the difference between dementia and this new phrase, cognitive aging. It is good to finally have a name for it.

If you are not up for reading the entire book (it is written in layman's language so it is not difficult to get through), the links I have provided above to The Journal of the American Medical Association and AARP explain the study well.

Comments

Good information, Ronni.

Thanks.

Your blog is such a wonderful resource, Ronni. Thank you for pointing your readers to this study. I had to laugh about the can opener. The one I heard is that you don't have to worry until you find yourself measuring the inside of the refrigerator to see if the toaster will fit. (And I say this as someone who has found my keys in there!)

Of course, Alzheimer's and dementia are no laughing matter. But good old "cognitive aging" that's going to happen to all of us if we live long enough? Well, maybe not so bad when you consider the alternative.

I have allergies and use Benedryl and this report has made me evaluate using it. I am glad for these kind of reports they help to make changes which may help keeping healthy.

We used to refer to people with cognitive decline and Alzheimers as being "senile". Thankfully, that term is not used as much anymore. However, the general public may still not be that familiar with what these terms mean and may never have come in contact with anybody suffering from severe dementia or Alzheimer's.
Living here at the ALF, I am surrounded by people in various stages of this disease. I have seen residents go from active, bright and involved people to confused, depressed individuals who often need assistance finding the dining room.
It is heartening to see that some very serious research is being done in this field, mainly because baby boomers are now reaching that certain age where this could become a problem. And if I know my fellow boomers we will not stand by idly by and watch our minds turn to mush.

My mom was diagnosed with Mild Cognitive Impairment, "the 'middle group' between Normal Aging and Alzheimers," according to her physician. Now "Normal Aging" is "Cognitive Aging"... my brain is as worn as my jeans, it seems.

Thanks for this, Ronni. I can now stop feeling guilty about ignoring Lumosity!
a/b

Ronni dear
Thank you!
How we could live without your support?

Warm regards

Bia

Sugar and grains. Alzheimer's is now being called Diabetes Type 3...meaning sugars are the root.

It's reassuring to know that everyone will suffer cognitive aging and that I am not alone.

I found it interesting that brain games do not transfer to real life. I no longer have to feel guilty for not doing them.

My mom went into decline around 85 and died at 90. I've long felt that part of her decline (which began around age 83) was in large part due to her never "staking her claim." She didn't identify, nor seek, what she wanted for her life until late and even then she was the submissive one, if need be. She was comfortable in that self-negating, "giving" role. At some point, I do believe she acquiested to all those social mores of those times that asked, or rather demanded, so much of women to relinquish their desires, their natural inclinations.

Since the 60s(?), women have found their freedom, if chosen, and it will be interesting to see any studies done about this timeline and the relation to aging terminology and categorization. I guess I hope this would empower women and strengthen their inner resources to become what they wish, not accommodating someone else's nor society's definition of their worth .

And yes, perhaps this is very personal and immediate. While showing little cognitive change, I notice that I'm experiencing the finite of existence and cognition loss is certainly a scare.

This is an important, but always a difficult topic to follow here. Having lived around the clock with my mother-in-law, for the last two years of her life when she had severe dementia, the subject always elicits agitation for me. I watch for signs of cognitive change in my husband and myself and feel as though I am constantly on guard.

I began following this blog when I was just a few months into my care giving arrangement. During those years, I read extensively on the subject of Alzheimer's and other dementias, cognitive loss, and related topics. I am very familiar with the possible link between diabetes and Alzheimer's, and while I'm not dismissing reports of a strong correlation, I don't believe that it's caused by sugar. If that were so, it would seem that the incidence of diabetes would be a lot higher than 10% among the aging population.

Simone's comments regarding women of a submissive nature and increased incidence of dementia are interesting. My mother-in-law was a very thoughtful, kind, sweet person, but very submissive. However, she worked all her adult life, was very intelligent, read and engaged in various interests, including playing bridge and other card games, and I think that these activities may have helped keep her from declining even earlier. Like Simone's mother, my MIL was about 83 when it became evident that there was cognitive loss beyond that due to normal aging. By 93, she had lost recognition of almost everyone, and had very little normal function of any sort. Keeping her as comfortable and as stress-free as possible became the daily goal. It didn't work well every day, but most days it did, and caring for her in her own home made a huge difference. Her time in an ALF was a disaster.

I wish we could find another term for "dementia," too. Perhaps Moderate Cognitive Impairment, or MCI, may take hold.

Didn't they call it "hardening of the arteries" when we were young?

And now I'm wondering: if we can keep up with the changes/advances the "happiness engineers" continually create for our computers, mobile phones etc., shouldn't the mental gymnastics required benefit our cognitive aging?

Thanks for addressing brain health--great subject!

Simone, your first paragraph is smoking!

I love "never staking her claim."

Perfect.

Thanks so much for this Ronni. Important topic, pertinent information and I am instantly fond of the term "cognitive aging".

Personally I have always been far more concerned about the possibility of a stroke than of dementia or Alzheimer's disease. With the latter two, there is time. Time to decide what you might wish to do about the diagnosis. Time to choose how to spend what remains of your cognitively-aware life. But with stroke, all of that is instantly taken away. One minute you're walking down the street and the next, you can't move, can't speak, have lost control of your life and are totally dependent on the assistance of others.

On a more cheerful note, I don't know if everyone else has seen this study, but Australian researchers have recently reported preliminary, tantalizing success in treating Alzheimer's with ultrasound. So far results are only on mice, but have been highly positive. I gather the word "breakthrough" is being cautiously used. The principle behind the treatment is that the ultrasound waves, oscillating very quickly, break apart the amyoloid plaques that destroy brain synapses. I believe the research was done at the Queensland Brain Institute and can be found by typing in "Australian study Alzheimers"...or words to that effect. It remains to be seen of course whether the results of this study can be consistently replicated.

Oops, I misspelled "amyloid". Why is it that a person only spots their spelling mistakes and grammatical errors in the moment AFTER they've posted their comment? Maybe it's part of cognitive aging? :)

Adding my voice to those who have thanked you, Ronni, for your blog and the community that's grown around it.
A wonderful resource, indeed.

Great information--thanks. I needed it on the morning when my husband discovered my KEYS on top of a cabinet outside our storage shed, where they had been left by me overnight. "Welcome, Bad Guys, unlock the door and come right on in!" I'd better not do that very often.

Elizabeth: When I misplace something, I've learned to backtrack to the places where I temporarily set things down before I do a task. For example, there is a shelf by my deck door where I often find my coffee cup. I set it down to go water the plants and then forget it is there.

P.S. And yes, I'm afraid of dementia, but I'm afraid of those other things, too. Yikes!

Thank you Ronni for keeping us up to speed with the latest research on ageing. You have touched on a subject that resonates with us all.

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