NEUROLOGY: How to help your memory
July 10th 2009 15:50
Signature Tune
From: Johannesburg BusinessDay comes the following:
YOU strode purposefully into your PA’s office today only to stop dead, because you couldn’t remember what you wanted to say . You drove to work this morning, and realised you had no recollection of the journey between home and work. Senior moments? Perhaps. Secretly, you fear it may be the early onset of something more serious: Alzheimer’s.
Sadly, memory slowing is a normal part of ageing, but on the Alzheimer’s front there’s good news — if not for this generation, then possibly the next, says Johannesburg physician and geriatrician Dr Stanley Lipschitz. Current research into Alzheimer’s is investigating treatments to prevent damage to the brain, and potentially prevent the disease itself.
“At present, there’s little that can prevent the brain damage; by the time we diagnose the disease, the damage is usually done,” Lipschitz says.
Research that aims to prevent Alzheimer’s is focusing on two brain proteins: tau and amyloid. A microscopic look at the brain of a dead person with Alzheimer’s shows two things: tangles and plaques. The tangles are caused by deposition of tau protein and the plaques by amyloid protein; both are abnormally deposited in the brain, Lipschitz says.
These appear to be involved causing Alzheimer’s .
“In fact, placing amyloid protein in proximity to nerve cells in the laboratory results in direct damage to the brain,” he says.
“There is also a direct correlation between this protein and disease severity. Theoretically, if doctors can get rid of those proteins, they should be able to prevent the onset of Alzheimer’s.”
It’s an appealing thought for those at risk, and a potential cure, Lipschitz says.
Till then, the question is : were your lapses in the office or on the way to work something sinister, or just normal memory loss? Should you rush off to your nearest specialist for a battery of tests?
Lipschitz says memory changes occur with ageing. In your 20s, you’re at the peak of your rote learning abilities. It’s easy to remember birthdays, shopping lists, phone numbers. As you age, that type of memory decreases, but your ability to globalise, to comprehend the broader picture, improves.
“The brain is better able to multi-task as we age, but because it’s doing many things at the same time, one might experience the odd lapse in memory,” says Lipschitz. “But you are able to backtrack — to retrace your steps if you can’t find your car in the mall parking lot, for example.”
The problem is where memory loss interferes with daily life.
Johannesburg physician and geriatrician Dr Brent Tipping weighs in: “Naturally, with ageing there are diseases that people become predisposed to — hypertension, diabetes, strokes, Alzheimer’s, etc — that may damage the brain structures associated with memory and accelerate decline. It is important to recognise that normal brain ageing should not cause any functional impairment.
“Memory problems that impair the ability to perform daily activities are due to disease and not ‘normal’ old age.”
Abnormal memory problems are divided into two main groups: The first is isolated short-term memory loss, which results in mild cognitive impairment (MCI). It’s enough to impact on your daily life, is measurable, isolated to your memory, and static — it doesn’t worsen.
The second is dementia syndrome — a generic term for a cluster of diseases, the commonest of which is Alzheimer’s disease. It is progressive, and comes with other cognitive deficits — personality change, concentration problems, problems with executive function, orientation to time and space, practical ability, speech and language.
These are common diseases, which are commonly missed, says Lipschitz. “Especially in the case of a major memory problem, it’s often accompanied by a lack of insight — patients don’t think they have a problem. When people tell me they’re having memory problems, generally they’re okay. When their families tell me they have a memory problem, that’s usually an indication there’s something serious going on.”
As with many diseases, early diagnosis is always preferable, says Lipschitz: “We don’t have cures yet, and there no tests we can do to make a diagnosis, like blood tests or scans, but we can manage the illness. ”
That requires a clinical assessment by someone who understands the disease and can do a series of cognitive assessments, he says.
As people live longer, dementias are increasing.
“Both Alzheimer’s and vascular dementias ( caused by strokes) increase with ageing,” says Lipschitz. “In Alzheimer’s, about 1% of the population under 60 has it. The incidence doubles with every five years of age.”
Assuming your memory lapses are just a normal side-effect of ageing, is there anything you can do about it?
“It is important to maintain cognitive activity. The ‘use it or lose it’ principle applies. Keeping cognitively active through social activity, work, board games, musical instruments, reading, writing and calculation tasks results in a bigger reserve for the brain. Age- related memory slowing will be less noticeable if one has a big memory reserve,” says Tipping.
Managing chronic diseases you might have minimises the risk of added brain “insults”, which could damage memory systems, he says
Lipschitz agrees: “Enhancing your vascular protection may have some effect. That means controlling blood pressure, cholesterol and glucose levels, and looking after your cardiovascular system. Those at risk of cardiovascular events should also be on low-dose aspirin — but be guided by their doctor, as aspirin therapy is not appropriate for everyone. There is also evidence that folic acid and vitamins B6 and B12 may offer some vascular protection.”
Managing stress is a vital part of protecting memory.
“Stress is strongly associated with mood disorders such as depression and anxiety that impair concentration,” says Tipping. “Impaired concentration impairs working memory/attention. If you can’t concentrate long enough to store memory, you will have a memory problem.”
These mood disorders generally account for many memory problems in younger persons ( younger than age 60), he says. Dementias account for the bulk of memory problems in older persons (above age 65 ).
“There are some (not fully substantiated) thoughts that chronic stress hormones such as cortisol accelerate the ageing of certain brain areas,” Tipping says
Lipschitz says while stress and depression affect memory loss, they don’t cause it. However, depression in particular can severely affect memory, and can mimic Alzheimer’s: treat the depression and the memory loss goes. But those patients ultimately tend to progress to Alzheimer’s at a later stage, he says.
Tipping says a healthier, balanced lifestyle is presently the best way to offset stress.
“We need to recognise our own limitations. Get enough physical activity (example, walking 10km to 15km a week), eat a balanced diet, screen for and control any diseases you may collect as you get older. If you drink alcohol, do so in moderation (one drink or less for non- pregnant women and two or less for men), don’t smoke and keep as cognitively busy as possible.”
Memory problems that impair the ability to perform daily activities are due to disease and not old age
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