There are steps one can take to protect and promote cognitive fitness as age catches up, writes Nizar Abdul Majeed Kutty
FORGETFULLNESS is intrinsically human and increases with age.
It is normal to sometimes forget a person’s name or miss an appointment. We may also misplace watches or keys occasionally.
But when such events become frequent, it is a warning sign. Similarly, frequent re-asking of questions is also likely to indicate substantial memory impairment.
Cognitive impairment has been shown to affect 22.2 per cent of the elderly population and this can have an impact on their everyday activities.
For example, the decline in cognitive abilities increases the risk that older adults will make errors in financial decisions, select options that offer less than optimal financial rewards or suffer financial fraud and abuse.
THOSE AT RISK
Mild Cognitive Impairment (MCI) causes a slight but noticeable and measurable decline in cognitive abilities, including memory and thinking skills. A person with the impairment is also at an increased risk of developing Alzheimer's or another type of dementia.
The causes of MCI are not yet completely understood. The risk factors most strongly linked to the condition are advancing age, family history of Alzheimer's disease or another type of dementia, and conditions that raise the risk for cardiovascular disease.
In persons over 65, Alzheimer's is the most common cause of MCI and mild dementia. Stroke and Parkinson’s can also lead to cognitive impairment.
Depression, multiple medical comorbidities and the adverse effects of drugs can sometimes produce cognitive impairment as well.
A thorough history from both the patient and someone who knows the patient well is essential. In the early stages of MCI, patients are aware of their cognitive difficulties and may themselves raise a concern with their physician. But generally, an informant who knows the patient well is necessary to corroborate the patient’s own observations. Finding such an individual and finding the time to interview an informant is one of the greatest challenges to diagnosis in the primary care setting.
Doctors use several tools for assessment of cognitive function. Mental status examinations are not perfect tools, but they are far more sensitive than casual conversations or ad hoc questions.
MCI is a clinical diagnosis representing a doctor's best professional judgment about the reason for a person's symptoms. Biomarker tests such as brain imaging and cerebrospinal fluid tests may be performed to determine if the individual has MCI due to Alzheimer's disease.
If the medical work-up doesn't create a clear clinical picture, your doctor may recommend neuropsychological testing, which involves a series of written or computerised tests to evaluate specific thinking skills.
No medications are currently approved by the US Food and Drug Administration to treat MCI.
Experts, however, recommend that a person diagnosed with the condition be re-evaluated every six months to determine if symptoms are staying the same, improving or growing worse.
DEALING WITH COGNITIVE AGEING
Not too long ago, medical research was focused on increasing our lifespan. Today, our goal isn't simply to reach our 80s or 90s, but to stay mentally sharp so we can be active and enjoy those extra years.
Certain strategies may help slow the decline in cognitive skills, although more research is needed to confirm their effect.
Sleep is essential for effective cognitive functioning. Losing even a few hours of sleep can have detrimental effects on a wide variety of cognitive processes such as attention, language, reasoning, decision making, learning and memory. Yet, does an impairment of cognition due to the loss of sleep in turn indicate that sleep enhances cognition? The answer is no.
Sleep is well known to facilitate memory consolidation, that is, the strengthening and stabilisation of new memories acquired before sleep.
Recent studies show that sleep enhances memory in the sense of less forgetfulness (to the point of no forgetfulness) and higher memory stability. We actually generate hundreds of new neurons each day, through a process called neurogenesis. Stress and lack of sleep can slow down neurogenesis.
Sleep deprivation can disrupt the ability to encode and consolidate new memories.
STRESS FACTOR
Stress management may reduce health problems linked to stress, which includes cognitive problems and a higher risk of Alzheimer's disease and dementia. When you are under stress, the brain is shunting its resources because it's in survival mode, not memory mode, says Dr Kerry Ressler, Professor of Psychiatry at Harvard Medical School.
Certain hormones, known as gonadal hormones; which are secreted in large amounts during foetal development, puberty, and pregnancy and depleted during menopause, may play a role in how stress affects an individual. For example, reductions in the gonadal hormone oestradiol during the menopausal transition may change how our brain responds to stress.
Scientists have reported that animals that experience prolonged stress have less activity in parts of their brain that handle higher-order tasks.
Throughout life, the brain is dynamic and constantly changing. It seems a good idea to involve in activities which challenge your brain for cognitive fitness. Cognitively stimulating activities like mind teasers, games and education and learning, is good for brain health to keep an active mind as the ageing process continues.
Incorporate enjoyable cognitively stimulating activities as part of a healthy lifestyle to help maintain brain health and reduce the risk of cognitive decline as you age. Don’t wait until later in life to try to maintain your brain health. Start today; the earlier you start challenging yourself with cognitively stimulating activities, the better your brain function will be as you age.
STAY SOCIALLY ACTIVE
Social engagement is also associated with reduced rates of disability and mortality, and may also reduce the risk of depression. Remaining socially active may support brain health and possibly delay the onset of dementia.
Participation in clubs, volunteer efforts and other community pursuits may be valuable in maintaining your overall health. Many of these social activities are low-cost or free, such as joining a walking group or book club in your neighbourhood. Staying socially active can also be as simple as engaging with friends and family on a regular basis.
A healthy diet has also been linked to overall brain health. Eat foods that are low in saturated fat, total fat and cholesterol, and high in fruits, vegetables and low-fat dairy.
Berry fruits high in polyphenols for example have been shown to contribute towards brain health and preserving cognitive function in ageing. Red beetroot as well as lettuce and spinach are also good for the brain.
One should consume whole grains, poultry, fish and nuts and decrease the intake of fats, red meats, sweets, sugared beverages and sodium.
Brain-boosting foods include blueberries, turmeric, broccoli, pumpkin seeds, dark chocolate, nuts, oranges, fatty fish — salmon, tuna and sardines.
GET FIT
Exercise can boost your memory and thinking skills both directly and indirectly. It acts directly on the body by stimulating physiological changes such as reductions in insulin resistance and inflammation, along with encouraging production of growth factors-chemicals that affect the growth of new blood vessels in the brain, and even the abundance, survival, and overall health of new brain cells.
It also acts directly on the brain itself. Many studies have suggested that the parts of the brain that control thinking and memory are larger in volume in people who exercise than in people who don't. It can increase levels of a protein called BDNF - brain-derived neurotrophic factor, which coaxes the creation of new brain cells. Brisk walking, dancing and tai chi are all beneficial.
It’s never too late to start. Consider physical activities that may also be mentally or socially engaging, such as walking with a friend, taking a dance class, joining an exercise group or golfing. Incorporate activities that you enjoy so you will continue to engage in them. For example, bike riding, gardening or walking the dog.
Adopting healthy exercise habits today will allow you to enjoy the lifelong benefits of regular physical activity.
On the other hand, being sedentary in later years can increase the risk of developing dementia, according to a recent study published in the Journal of Alzheimer’s Disease. The study, which analysed more than 1,600 older adults over five years, found that those who did not exercise were more likely to develop dementia than those who did.
Taking care of your general health is also important. Monitor and control bodyweight, blood sugar, blood pressure and cholesterol. Actively seek treatment to keep yourself healthy. Recent research has proven that controlling high blood pressure reduces the risk of MCI and dementia. Also, stop smoking and avoid excessive alcohol.
Brain injury can also raise your risk of cognitive decline and dementia so always wear a seat belt when travelling in a car, use a helmet when playing contact sports or riding a bike, and take steps to prevent falls.
You can be mentally sharp and maintain your ability to learn, reason, and remember well into old age by exercising, eating right, getting enough sleep, managing stress, connecting with others, and challenging your brain
TIPS TO ENHANCE YOUR COGNITIVE RESERVE
* Brush your teeth with the hand you don’t usually use.
* Take a different route to work or the store.
* Eat a bite or two of dinner with your eyes closed.
* Listen to a new kind of music.
* Sit in a different spot in your house or at a favourite restaurant.
* Learn to play a sport or game (tennis, ping pong, golf), dance or tai chi.
* Complete a jigsaw puzzle.
* Do something artistic.
* Play games, such as chess or bridge, that make you think strategically.
* The writer is a senior lecturer at the Faculty of Medicine & Health Sciences, Universiti Tunku Abdul Rahman. His research interest is in physical activity and mental health among older adults.