Bill, a 70-year-old salesman with hypertension and high cholesterol, has noted difficulty in remembering the names of his clients. He used to remember them all, and is concerned that his work is suffering from worsening memory. He told his family doctor, who asked a few questions about whether he gets lost finding his way home (answer: No!) and if he has left the stove on allowing food to burn (answer: No!). Bill was surprised when told that there is nothing to worry about, and he is simply getting old. Still, he is worried and wants to know if there is something he can do about his poor memory.
What is Alzheimer’s disease?
Alzheimer’s disease is a degenerative neurological disease that affects 1 in 9 people over the age of 65. According to Marist poll, Americans rank Alzheimer’s as the most feared disease. So, lots of people are concerned in general, and many become very worried when they notice subtle signs that their memory is not as good as used to be. Many people even assume that they are developing Alzheimer’s based on the fact that they are forgetting things. However, Alzheimer’s is not just about getting older – it is an actual disease process that starts with the death of certain brain cells and build-up of abnormal protein complexes, and results over time in destruction of connections between nerve cells and ultimately in brain shrinkage. These pathological changes, which can be seen in the brain, are accompanied by progressive decline in memory and other cognitive abilities, resulting in greater dependence on others for help in performing activities of daily living, and ultimately death. So, a diagnosis of Alzheimer’s disease has specific meaning with regard to destruction of the brain and predicts a steady decline in function.
Age-related memory decline
We all start to forget things as we get older. In fact, research has shown that our ability to remember new facts, such as on memory games and puzzles, start to decline at age 25 and continues to decline throughout life. The decline may be subtle and is not to the degree that compromises daily function. Therefore, forgetting things a little bit is not a sure sign of Alzheimer’s.
What is “cognitive reserve”?
Because our brains are different from each other, we have different capacities to withstand damage before symptoms of cognitive decline start showing. This capacity is called by brain researchers, “Cognitive Reserve”. Someone with lots of cognitive reserve may appear normal for a period of time while his brain is actually undergoing changes of dementia. Someone with little cognitive reserve starts to show symptoms much earlier in the disease course, generally at a younger age. Certainly, even someone with a lot of cognitive reserve will eventually develop memory and cognitive decline if his disease progresses long enough – in fact, he may seem to decline much faster than someone whose disease had started earlier. Overall, having more cognitive reserve is thought to be better, since it results in more symptom-free years.
How do I build cognitive reserve?
That is a very good question that is not fully known. It seems that a large part has to do with your genetics, but it certainly helps to live a brain-healthy lifestyle and to be involved in learning. Things you could do include regular exercise, social activity, mental exercise, keep a healthy diet, and carefully managing vascular risk factors such as hypertension, diabetes, smoking, and obesity.
Should I get tested for Alzheimer’s?
It is a good idea to ask your doctor whether you should be tested. In all likelihood, you will be given a short screening test, and if suspicious for a problem, would be referred out for a longer cognitive testing session that could last 1 or more hours. The results of that test could provide objective evidence for a true abnormality in memory and other cognitive abilities. Some specialists also offer other tests that may be more specific for Alzheimer’s disease. These include brain MRI, PET, SPECT, and some genetic testing. In general, you should be sent for these tests only by specialists who are expert in dementia and only if your clinical data justify the need for these tests.
What can I do about my anxiety about getting Alzheimer’s?
So, your doctor told you that you don’t have to worry, but you are still anxious about getting Alzheimer’s.
First, remember that we all decline in memory ability as we get older.So, a little decline does not mean that you are getting Alzheimer’s.
Second, remember that there are things you can do to improve brain health:
Make an appointment for another evaluation by the same doctor in one year to see if there is a decline.
If you are really worried, ask to be referred to a memory specialist for a second opinion.
Make an appointment with your internist or family doctor to review management of your vascular risk factors, including lipids, blood pressure, body mass, and heart function.
Maintain a program of regular physical exercise.
Make an effort to remain active mentally with challenging work, games, or activities.
Try to lower your stress level by learning techniques such as relaxation or meditation.
Follow a healthy diet, such as the Mediterranean diet.
Summary: Tell your doctor and follow steps for good brain health
It makes sense that you are concerned about Alzheimer’s, but the best way to know if there is real reason to worry is to tell your doctor and, if needed, get checked out by a specialist – either a neurologist or a memory disorders specialist. In any case, it is worth following the recommendations for good brain health.
This ‘textbook’ case is based on collective clinical experience, and is not based on a specific patient.