BY ERIC B. LARSON, MD, MPH
Everyone knows the feeling of having walked into a room and not remembering why we went in there, or running into a longtime acquaintance but struggling to remember their name. Our brains are constant hives of activity, and sometimes the hive is stressed to the point of forgetting seemingly simple things. But age-related memory changes are common and expected, in the same way our physical abilities are expected to change as we get older. Most 80-year-olds can’t run as fast as someone in their 40s!
It’s worth remembering—no pun intended—that not all cognitive changes are created equal. Forgetting someone’s name or why you walked into a room is less serious than missing several mortgage payments. Even moderate memory problems can be offset with creating consistent routines, keeping lists, and planning for social situations, including having a handy, practiced response if you do forget a name so you can gracefully keep going, rather than becoming paralyzed with embarrassment or worry.
Age-related memory changes generally occur gradually, and may be heightened by life stressors, depression or anxiety, complex situations and competing demands, or general health including medications. People who were more highly functional in the past may not see any noticeable changes in their daily activities, but they may start feeling that something isn’t right long before others notice.
When should you consult your health care team?
Good question! The recent addition of cognitive testing in the Medicare annual wellness exam has been a welcome development. Clinicians are gaining experience in determining if everyday memory problems are early signals for Alzheimer’s or other dementias. If you’re concerned, tell your doctor. An ongoing primary care relationship is valuable in assessing whether change is cause for concern. Cognitive testing can sort out whether our brains are performing in a way that’s expected given our age and level of functioning. For those noticing a decline, testing can help identify ways to compensate by building on abilities that are still intact. Extensive cognitive testing is not always appropriate, and even following such testing, your doctor may say, “Come back next year and we’ll see what’s changed.”
What is helpful for anyone
While there are no “magic bullet” medications that prevent or reduce severity of cognitive decline, many lifestyle factors have been shown to affect dementia risk. Making positive lifestyle changes can support both heart health and brain health. Healthy lifestyle behaviors include exercise, diet, sleep, staying active mentally, maintaining social ties, and finding meaning in your life. Recognize that some degree of cognitive decline is to be expected. Tracking it over time can give you a sense of control, and help determine when to consult your doctor. Plus, it’s really challenging to predict an individual’s course of cognitive decline, we can only work with where we are today. Live with it like any health-related concern, and know that this is—as poet Mary Oliver describes it—“your one wild and precious life.” Even if it gets worse, today is a day to be lived.
Eric B. Larson, MD, MPH, is the author, with Joan DeClaire, of Enlightened Aging. He is the founding principal investigator of the Adult Changes in Thought (ACT) study, ongoing for about 30 years. ACT recently was awarded a $55.6 million expansion grant from the National Institutes of Health.