Alzheimer Disease Sourcebook, 8th Ed.

By Omnigraphics

Provides consumer health information about symptoms, diagnosis, and treatment of Alzheimer disease and other dementias, along with tips for coping with memory loss and related complications and advice for caregivers. Includes index, glossary of related terms, directory of resources.

• Language: English
• Publisher: Omnigraphics
• Release date: Oct 1, 2021
• ISBN: 9780780819771

Book preview

Preface

About This Book

Approximately, 5.8 million Americans are estimated to be living with the progressive, incurable, fatal brain disorder known as Alzheimer disease (AD). By 2060, this number is projected to quadruple and affect 14 million U.S. adults aged 65 years of age or older. AD, which accounts for 60 to 80 percent of all dementia cases, damages brain cells, causes memory loss and dementia, and worsens over time until persons lose their ability to work, walk, and interact. Beyond the age of 65, the number of persons living with the condition doubles every five years.

Alzheimer Disease Sourcebook, Eighth Edition provides updated information about the brain’s structure, how it develops with age, and the cognitive loss and degeneration that occurs in dementia. It also covers the causes, symptoms, and indicators of AD and other dementias, such as mild cognitive impairment (MCI), corticobasal degeneration, dementia with Lewy bodies, and frontotemporal dementia (FTD), Huntington disease (HD), Parkinson disease (PD), and dementia caused by infections and other health conditions. It discusses the facts about genetic testing, cognitive and behavioral symptoms, AD clinical trials, and recent research efforts are also included, along with information about legal, financial, and medical planning and coping strategies for caregivers. The book concludes with a glossary of terms related to AD and a directory of resources for additional support and information.

How to Use This Book

This book is divided into parts and chapters. Parts focus on broad areas of interest. Chapters are devoted to single topics within a part.

Part 1: Facts about the Brain and Cognitive Decline provides information about healthy brain function and examines changes in cognitive functions and memory that occur during the typical aging process. Facts about the types, symptoms, causes, risk factors, and prevalence of dementia – a brain disorder that significantly impairs intellectual functions – are also included.

Part 2: Alzheimer Disease: The Most Common Type of Dementia discusses Alzheimer disease (AD), an irreversible and progressive brain disease, and identifies the signs, symptoms, and diagnostic stages of this disorder. Information about the role of genetics, brain injuries, and development of AD is also presented, along with facts about early-onset AD, a form of the disease that affects people under the age of 65 and deaths from Alzheimer disease. It also discusses the factors that influence AD risks, such as alcohol, nicotine, and sleep deprivation.

Part 3: Other Dementia Disorders identifies types, signs, and symptoms of dementia other than AD, including cognitive impairment, corticobasal degeneration, dementia with Lewy bodies, frontotemporal disorders (FTDs), Huntington disease (HD), Parkinson disease (PD), and vascular dementia. It details various causes of dementia, such as AIDS, cancer, delirium, and other diseases.

Part 4: Recognizing, Diagnosing, and Treating Alzheimer Disease and Dementias explains neurocognitive and imaging tools that are used to assess and diagnose dementia, such as positron emission tomography (PET), single photon emission computed tomography (SPECT), magnetic resonance imaging (MRI), and biomarker testing. Medications used to manage the AD and other dementias are identified, and information about participating in AD clinical trials and studies is included. An explanation of recent developments in AD research is also provided.

Part 5: Living with Alzheimer Disease and Dementias describes strategies for maintaining health and wellness after a dementia diagnosis. Patients and caregivers will find information about nutrition, exercises, and dental care for dementia patients, tips on telling someone about the diagnosis, strategies for slowing the rate of cognitive decline, and advice on pain, sleep problems, and sexuality in people with dementia. Information about Medicare and financial, legal, and healthcare planning is included.

Part 6: Caregiver Concerns offers advice to those who care for people with AD or dementia. Strategies for coping with challenging behaviors, communicating, and planning daily activities for someone with dementia are discussed, along with tips on creating a safe environment at home. Caregivers struggling to control frustration and cope with fatigue will find information about respite, home health, and nursing home care, as well as suggestions on evaluating difficult health decisions near the end of life.

Part 7: Additional Help and Information provides a glossary of terms related to AD and dementia and a directory of organizations that provide health information about AD and dementia.

Bibliographic Note

This volume contains documents and excerpts from publications issued by the following U.S. government agencies: Agency for Healthcare Research and Quality (AHRQ); Alzheimers.gov; Centers for Disease Control and Prevention (CDC); Centers for Medicare & Medicaid Services (CMS); Genetic and Rare Diseases Information Center (GARD); MedlinePlus; National Cancer Institute (NCI); National Center for Complementary and Integrative Health (NCCIH); National Institute of Biomedical Imaging and Bioengineering (NIBIB); National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); National Institute of Neurological Disorders and Stroke (NINDS); National Institute on Aging (NIA); National Institute on Alcohol Abuse and Alcoholism (NIAAA); National Institutes of Health (NIH); NIH News in Health; Office of the Assistant Secretary for Planning and Evaluation (ASPE); U.S. Department of Veterans Affairs (VA); and U.S. Social Security Administration (SSA).

About the Health Reference Series

The Health Reference Series is designed to provide basic medical information for patients, families, caregivers, and the general public. Each volume provides comprehensive coverage on a particular topic. This is especially important for people who may be dealing with a newly diagnosed disease or a chronic disorder in themselves or in a family member. People looking for preventive guidance, information about disease warning signs, medical statistics, and risk factors for health problems will also find answers to their questions in the Health Reference Series. The Series, however, is not intended to serve as a tool for diagnosing illness, in prescribing treatments, or as a substitute for the physician–patient relationship. All people concerned about medical symptoms or the possibility of disease are encouraged to seek professional care from an appropriate healthcare provider.

A Note about Spelling and Style

Health Reference Series editors use Stedman’s Medical Dictionary as an authority for questions related to the spelling of medical terms and The Chicago Manual of Style for questions related to grammatical structures, punctuation, and other editorial concerns. Consistent adherence is not always possible, however, because the individual volumes within the Series include many documents from a wide variety of different producers, and the editor’s primary goal is to present material from each source as accurately as is possible. This sometimes means that information in different chapters or sections may follow other guidelines and alternate spelling authorities. For example, occasionally a copyright holder may require that eponymous terms be shown in possessive forms (Crohn’s disease vs. Crohn disease) or that British spelling norms be retained (leukaemia vs. leukemia).

Medical Review

Omnigraphics contracts with a team of qualified, senior medical professionals who serve as medical consultants for the Health Reference Series. As necessary, medical consultants review reprinted and originally written material for currency and accuracy. Citations including the phrase Reviewed (month, year) indicate material reviewed by this team. Medical consultation services are provided to the Health Reference Series editors by:

Dr. Vijayalakshmi, MBBS, DGO, MD

Dr. Senthil Selvan, MBBS, DCH, MD

Dr. K. Sivanandham, MBBS, DCH, MS (Research), PhD

Health Reference Series Update Policy

The inaugural book in the Health Reference Series was the first edition of Cancer Sourcebook published in 1989. Since then, the Series has been enthusiastically received by librarians and in the medical community. In order to maintain the standard of providing high-quality health information for the layperson the editorial staff at Omnigraphics felt it was necessary to implement a policy of updating volumes when warranted.

Medical researchers have been making tremendous strides, and it is the purpose of the Health Reference Series to stay current with the most recent advances. Each decision to update a volume is made on an individual basis. Some of the considerations include how much new information is available and the feedback we receive from people who use the books. If there is a topic you would like to see added to the update list, or an area of medical concern you feel has not been adequately addressed, please write to:

Managing Editor

Health Reference Series

Omnigraphics

615 Griswold St., Ste. 520

Detroit, MI 48226

Part 1 | Facts about the Brain and Cognitive Decline

Chapter 1 | The Basics of a Healthy Brain

The brain is the most complex part of the human body. This three-pound organ is the seat of intelligence, interpreter of the senses, initiator of body movement, and controller of behavior. Lying in its bony shell and washed by protective fluid, the brain is the source of all the qualities that define our humanity. The brain is the crown jewel of the human body.

For centuries, scientists and philosophers have been fascinated by the brain, but until recently they viewed the brain as nearly incomprehensible. Now, however, the brain is beginning to relinquish its secrets. Scientists have learned more about the brain in the last 10 years than in all previous centuries because of the accelerating pace of research in neurological and behavioral science and the development of new research techniques.

This chapter is a basic introduction to the human brain. It may help you understand how the healthy brain works, how to keep it healthy, and what happens when the brain is diseased or dysfunctional.

The Architecture of the Brain

The brain is like a committee of experts. All the parts of the brain work together, but each part has its own special properties. The brain can be divided into three basic units: the forebrain, the midbrain, and the hindbrain.

Figure 1.1. Know Your Brain (Source: Brain – Cerebrum, Surveillance,

Epidemiology, and End Results (SEER) Program, National Cancer

Institute (NCI).)

The hindbrain includes the upper part of the spinal cord, the brain stem, and a wrinkled ball of tissue called the cerebellum. The hindbrain controls the body’s vital functions such as respiration and heart rate. The cerebellum coordinates movement and is involved in learned rote movements. When you play the piano or hit a tennis ball you are activating the cerebellum. The uppermost part of the brainstem is the midbrain, which controls some reflex actions and is part of the circuit involved in the control of eye movements and other voluntary movements. The forebrain is the largest and most highly developed part of the human brain: it consists primarily of the cerebrum and the structures hidden beneath it.

When people see pictures of the brain it is usually the cerebrum that they notice. The cerebrum sits at the topmost part of the brain and is the source of intellectual activities. It holds your memories, allows you to plan, enables you to imagine and think. It allows you to recognize friends, read books, and play games.

The cerebrum is split into two halves (hemispheres) by a deep fissure. Despite the split, the two cerebral hemispheres communicate with each other through a thick tract of nerve fibers that lies at the base of this fissure. Although the two hemispheres seem to

Figure 1.2. The Forebrain

Figure 1.3. The Midbrain

Figure 1.4. The Hindbrain

be mirror images of each other, they are different. For instance, the ability to form words seems to lie primarily in the left hemisphere, while the right hemisphere seems to control many abstract reasoning skills.

For some as-yet-unknown reason, nearly all of the signals from the brain to the body and vice-versa cross over on their way to and from the brain. This means that the right cerebral hemisphere primarily controls the left side of the body and the left hemisphere primarily controls the right side. When one side of the brain is damaged, the opposite side of the body is affected. For example, a stroke in the right hemisphere of the brain can leave the left arm and leg paralyzed.

The Geography of Thought

Each cerebral hemisphere can be divided into sections, or lobes, each of which specializes in different functions. To understand each lobe and its specialty we will take a tour of the cerebral hemispheres, starting with the two frontal lobes, which lie directly behind the forehead. When you plan a schedule, imagine the future, or use reasoned arguments, these two lobes do much of the work. One of the ways the frontal lobes seem to do these things is by acting as short-term storage sites, allowing one idea to be kept in mind while other ideas are considered. In the rearmost portion of each frontal lobe is a motor area, which helps control voluntary movement. A nearby place on the left frontal lobe called Broca’s area allows thoughts to be transformed into words.

When you enjoy a good meal – the taste, aroma, and texture of the food – two sections behind the frontal lobes called the parietal lobes are at work. The forward parts of these lobes, just behind the motor areas, are the primary sensory areas. These areas receive information about temperature, taste, touch, and movement from the rest of the body. Reading and arithmetic are also functions in the repertoire of each parietal lobe.

As you look at the words and pictures on this page, two areas at the back of the brain are at work. These lobes, called the occipital lobes, process images from the eyes and link that information with images stored in memory. Damage to the occipital lobes can cause blindness.

The last lobes on our tour of the cerebral hemispheres are the temporal lobes, which lie in front of the visual areas and nest under the parietal and frontal lobes. Whether you appreciate symphonies or rock music, your brain responds through the activity of these lobes. At the top of each temporal lobe is an area responsible for receiving information from the ears. The underside of each temporal lobe plays a crucial role in forming and retrieving memories, including those associated with music. Other parts of this lobe seem to integrate memories and sensations of taste, sound, sight, and touch.

The Cerebral Cortex

Coating the surface of the cerebrum and the cerebellum is a vital layer of tissue the thickness of a stack of two or three dimes. It is called the cortex, from the Latin word for bark. Most of the actual information processing in the brain takes place in the cerebral cortex. When people talk about gray matter in the brain they are talking about this thin rind. The cortex is gray because nerves in this area lack the insulation that makes most other parts of the brain appear to be white. The folds in the brain add to its surface area and therefore increase the amount of gray matter and the quantity of information that can be processed.

The Inner Brain

Deep within the brain, hidden from view, lie structures that are the gatekeepers between the spinal cord and the cerebral hemispheres. These structures not only determine our emotional state, they also modify our perceptions and responses depending on that state, and allow us to initiate movements that you make without thinking about them. Like the lobes in the cerebral hemispheres, the structures described below come in pairs: Each is duplicated in the opposite half of the brain.

The hypothalamus, about the size of a pearl, directs a multitude of important functions. It wakes you up in the morning, and gets the adrenaline flowing during a test or job interview. The hypothalamus is also an important emotional center, controlling the molecules that make you feel exhilarated, angry, or unhappy. Near the hypothalamus lies the thalamus, a major clearinghouse for information going to and from the spinal cord and the cerebrum.

Figure 1.5. Inner Brain

An arching tract of nerve cells leads from the hypothalamus and the thalamus to the hippocampus. This tiny nub acts as a memory indexer – sending memories out to the appropriate part of the cerebral hemisphere for long-term storage and retrieving them when necessary. The basal ganglia (not shown) are clusters of nerve cells surrounding the thalamus. They are responsible for initiating and integrating movements. Parkinson disease, which results in tremors, rigidity, and a stiff, shuffling walk, is a disease of nerve cells that lead into the basal ganglia.

Making Connections

The brain and the rest of the nervous system are composed of many different types of cells, but the primary functional unit is a cell called the neuron. All sensations, movements, thoughts, memories, and feelings are the result of signals that pass through neurons. Neurons consist of three parts. The cell body contains the nucleus, where most of the molecules that the neuron needs to survive and function are manufactured. Dendrites extend out from the cell body like the branches of a tree and receive messages from other nerve cells. Signals then pass from the dendrites through the cell body and may travel away from the cell body down an axon to another neuron, a muscle cell, or cells in some other organ. The neuron is usually surrounded by many support cells. Some types of cells wrap around the axon to form an insulating sheath. This sheath can include a fatty molecule called myelin, which provides

Figure 1.6. Nerve Cell

Figure 1.7. Synapse

insulation for the axon and helps nerve signals travel faster and farther. Axons may be very short, such as those that carry signals from one cell in the cortex to another cell less than a hair’s width away. Or axons may be very long, such as those that carry messages from the brain all the way down the spinal cord.

Scientists have learned a great deal about neurons by studying the synapse – the place where a signal passes from the neuron to another cell. When the signal reaches the end of the axon it stimulates the release of tiny sacs. These sacs release chemicals known as neurotransmitters into the synapse. The neurotransmitters cross the synapse and attach to receptors on the neighboring cell. These receptors can change the properties of the receiving cell. If the receiving cell is also a neuron, the signal can continue the transmission to the next cell.

Some Key Neurotransmitters at Work

Neurotransmitters are chemicals that brain cells use to talk to each other. Some neurotransmitters make cells more active (called excitatory) while others block or dampen a cell’s activity (called inhibitory).

Acetylcholine is an excitatory neurotransmitter because it generally makes cells more excitable. It governs muscle contractions and causes glands to secrete hormones. Alzheimer disease (AD), which initially affects memory formation, is associated with a shortage of acetylcholine.

Glutamate is a major excitatory neurotransmitter. Too much glutamate can kill or damage neurons and has been linked to disorders including Parkinson disease, stroke, seizures, and increased sensitivity to pain.

Gamma-aminobutyric acid (GABA) is an inhibitory neurotransmitter that helps control muscle activity and is an important part of the visual system. Drugs that increase GABA levels in the brain are used to treat epileptic seizures and tremors in patients with Huntington disease.

Serotonin is a neurotransmitter that constricts blood vessels and brings on sleep. It is also involved in temperature regulation. Low levels of serotonin may cause sleep problems and depression, while too much serotonin can lead to seizures.

Dopamine is an inhibitory neurotransmitter involved in mood and the control of complex movements. The loss of dopamine activity in some portions of the brain leads to the muscular rigidity of Parkinson disease. Many medications used to treat behavioral disorders work by modifying the action of dopamine in the brain.

Neurological Disorders

The brain is one of the hardest working organs in the body. When the brain is healthy it functions quickly and automatically. But when problems occur, the results can be devastating. Some 100 million Americans suffer from devastating brain disorders at some point in their lives. Some of the major types of disorders include: neurogenetic diseases (such as Huntington disease and muscular dystrophy), developmental disorders (such as cerebral palsy), degenerative diseases of adult life (such as Parkinson disease and AD), metabolic diseases (such as Gaucher disease), cerebrovascular diseases (such as stroke and vascular dementia), trauma (such as spinal cord and head injury), convulsive disorders (such as epilepsy), infectious diseases (such as AIDS and dementia), and brain tumors.

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This chapter includes text excerpted from Brain Basics: Know Your Brain, National Institute of Neurological Disorders and Stroke (NINDS), June 9, 2021.

Chapter 2 | The Changing Brain in Healthy Aging

The brain controls many aspects of thinking – remembering, planning and organizing, making decisions, and much more. These cognitive abilities affect how well we do everyday tasks and whether we can live independently.

Some changes in thinking are common as people get older. For example, older adults may:

Be slower to find words and recall names

Find they have more problems with multitasking

Experience mild decreases in the ability to pay attention

Aging may also bring positive cognitive changes. For example, many studies have shown that older adults have more extensive vocabularies and greater knowledge of the depth of meaning of words than younger adults. Older adults may also have learned from a lifetime of accumulated knowledge and experiences. Whether and how older adults apply this accumulated knowledge, and how the brain changes as a result, is an area of active exploration by researchers.

Despite the changes in cognition that may come with age, older adults can still do many of the things they have enjoyed their whole lives. Research shows that older adults can still:

Learn new things

Form new memories

Improve vocabulary and language skills

Changes in the Aging Brain

As a person gets older, changes occur in all parts of the body, including the brain.

Certain parts of the brain shrink, especially those important to learning and other complex mental activities.

In certain brain regions, communication between neurons (nerve cells) may not be as effective.

Blood flow in the brain may decrease.

Inflammation, which occurs when the body responds to an injury or disease, may increase.

These changes in the brain can affect mental function, even in healthy older people. For example, some older adults may find that they do not do as well as younger individuals on complex memory or learning tests. However, if given enough time to learn a new task, they usually perform just as well. Needing that extra time is normal as we age. There is growing evidence that the brain maintains the ability to change and adapt so that people can manage new challenges and tasks as they age.

Talk with your doctor if you are concerned about changes in your thinking and memory. She or he can help you determine whether the changes in your thinking and memory are normal, or whether it could be something else.

There are things you can do to help maintain your physical health and that may benefit your cognitive health, too.

Brain Cells That Influence Aging

You naturally lose brain cells with age. Certain regions of the brain have cells called neural stem cells that can regenerate. These stem cells serve as a sort of internal repair system, dividing to replenish other cells. They have only been found in a few brain regions, including the hypothalamus. The hypothalamus is critical for regulating the endocrine system – the glands and hormones throughout the body. The region is known to play a role in development, reproduction, and metabolism. It has also been implicated in aging.

To investigate whether stem cells in the hypothalamus influence the aging process, a team of scientists led by Dr. Dongsheng Cai at Albert Einstein College of Medicine examined these cells in mice. The study was funded by the National Institutes of Health’s (NIH) National Institute on Aging (NIA), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and National Heart, Lung, and Blood Institute (NHLBI).

The researchers first observed what happens to stem cells in the hypothalamus as healthy mice age. They found that the number of stem cells gradually diminished in early to middle-aged mice and were almost completely absent in older mice. They then experimentally disrupted these stem cells in middle-aged mice and examined the effects on aging over 3–4 months. Mice with the disrupted stem cells showed signs of cognitive impairment and other signs of aging earlier than control mice. Mice with the disrupted stem cells also had a shortened lifespan.

The researchers were able to slow these signs of aging by implanting hypothalamic stem cells harvested from newborn mice into the brains of middle-aged mice. The mice also lived longer than control mice. These antiaging effects could be replicated by injecting the tiny fluid-filled sacs, called exosomes, that are secreted by hypothalamic neural stem cells. Exosomes circulate in blood and carry genetic material called miRNA, which regulates genes in tissues throughout the body.

These results suggest that it is the endocrine function of the hypothalamic stem cells that essentially controls the aging process. It remains to be seen what role the cells’ regenerative properties play in the long-term control of aging.

Our research shows that the number of hypothalamic neural stem cells naturally declines over the life of the animal, and this decline accelerates aging, Cai says. But we also found that the effects of this loss are not irreversible. By replenishing these stem cells or the molecules they produce, it is possible to slow and even reverse various aspects of aging throughout the body.

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This chapter contains text excerpted from the following sources: Text in this chapter begins with excerpts from How the Aging Brain Affects Thinking, National Institute on Aging (NIA), National Institutes of Health (NIH), October 19, 2020; Text under the heading Brain Cells That Influence Aging is excerpted from Brain Cells That Influence Aging, News and Events, National Institutes of Health (NIH), August 15, 2017. Reviewed September 2021.

Chapter 3 | Cognitive Health and Older Adults

Cognitive health – the ability to clearly think, learn, and remember – is an important component of performing everyday activities. Cognitive health is just one aspect of overall brain health.

A growing body of scientific research suggests that the following steps are linked to cognitive health. Small changes may really add up: Making these part of your routine could help you function better.

Take Care of Your Physical Health

Taking care of your physical health may help your cognitive health. You can:

Get recommended health screenings

Manage chronic health problems such as diabetes, high blood pressure, depression, and high cholesterol

Consult with your health-care provider about the medicines you take and possible side effects on memory, sleep, and brain function

Reduce risk for brain injuries due to falls and other accidents

Limit use of alcohol (some medicines can be dangerous when mixed with alcohol)

Quit smoking, if you currently smoke. Also, avoid other nicotine products such as chewing tobacco

Get enough sleep, generally seven to eight hours each night

Manage High Blood Pressure

Preventing or controlling high blood pressure, not only helps your heart, but may help your brain too. Decades of observational studies have shown that having high blood pressure in midlife – the 40s to early 60s – increases the risk of cognitive decline later in life. In addition, the SPRINT-MIND study, a nationwide clinical trial, showed that intensive lowering of blood pressure (even below the previous standard target of 140 for systolic blood pressure) lowers the risk for mild cognitive impairment, which is a risk factor for dementia.

High blood pressure often does not cause signs of illness that you can see or feel. Routine visits to your doctor will help pick up changes in your blood pressure, even though you might feel fine. To control or lower high blood pressure, your doctor may suggest exercise, changes in your diet, and if needed – medications. These steps can help protect your brain and your heart.

Eat Healthy Foods

A healthy diet can help reduce the risk of many chronic diseases such as heart disease or diabetes. It may also help keep your brain healthy.

In general, a healthy diet consists of fruits and vegetables; whole grains; lean meats, fish, and poultry; and low-fat or nonfat dairy products. You should also limit solid fats, sugar, and salt. Be sure to control portion sizes and drink enough water and other fluids.

Researchers are looking at whether a healthy diet can help preserve cognitive function or reduce the risk of Alzheimer disease (AD). For example, there is some evidence that people who eat a Mediterranean diet have a lower risk of developing dementia.

While scientists are not sure yet why the Mediterranean diet might help the brain, its effect on improving cardiovascular health might in turn reduce dementia risk. In contrast, the typical Western diet often increases cardiovascular disease risk, possibly contributing to faster brain aging.

Researchers have developed and are testing another diet, called MIND, a combination of the Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets. According to observational studies of more than 900 dementia-free older adults, closely following the MIND diet was associated with a reduced risk of AD and a slower rate of cognitive decline.

Be Physically Active

Being physically active – through regular exercise, household chores, or other activities – has many benefits. It can help you:

Keep and improve your strength

Have more energy

Improve your balance

Prevent or delay heart disease, diabetes, and other concerns

Perk up your mood and reduce depression

Studies link ongoing physical activity with benefits for the brain and cognition as well, although a strong link between physical activity and AD prevention has not yet been documented.

In one study, exercise stimulated the human brain’s ability to maintain old network connections and make new ones that are vital to cognitive health. Other studies have shown that exercise increases the size of a brain structure important to memory and learning, resulting in better spatial memory. Aerobic exercise, such as brisk walking, is thought to be more beneficial to cognitive health than nonaerobic stretching and toning exercise. One study found that the more time spent doing a moderate levels of physical activity, the greater the increase in brain glucose metabolism – or how quickly the brain turns glucose into fuel – which may reduce the risk for developing AD.

Federal guidelines recommend that all adults get at least 150 minutes (2.5 hours) of physical activity each week. Walking is a good start. You can also join programs that teach you to move safely and prevent falls, which can lead to brain and other injuries. Check with your health-care provider if you have not been active and want to start a vigorous exercise program.

Keep Your Mind Active

Being intellectually engaged may benefit the brain. People who engage in personally meaningful activities, such as volunteering or hobbies, say they feel happier and healthier. Learning new skills may improve your thinking ability, too. For example, one study found that older adults who learned quilting or digital photography had more memory improvement than those who only socialized or did less cognitively demanding activities. Some of the research on engagement in activities such as music, theater, dance, and creative writing has shown promise for improving quality of life and well-being in older adults, from better memory and self-esteem to reduced stress and increased social interaction.

However, a comprehensive report reviewing the design and findings of these and other studies did not find strong evidence that these types of activities have a lasting, beneficial effect on cognition. Additional research is needed, and in large numbers of diverse older adults, to be able to say definitively whether these activities may help reduce decline or maintain healthy cognition.

Lots of activities can keep your mind active. For example, read books and magazines. Play games. Take or teach a class. Learn a new skill or hobby. Work or volunteer. These types of mentally stimulating activities have not been proven to prevent serious cognitive impairment or AD, but they can be fun! Plus, findings from observational studies suggest that some informal mentally stimulating activities, such as reading or playing games, may lower the risk of AD-related cognitive impairment and dementia.

Some scientists have argued that such activities may protect the brain by establishing cognitive reserve. They may help the brain become more adaptable in some mental functions so it can compensate for age-related brain changes and health conditions that affect the brain.

Some types of cognitive training conducted in a research setting also seem to have benefits. For the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial, healthy adults 65 and older participated in 10 sessions of memory training, reasoning training, or processing-speed training. The sessions improved participants’ mental skills in the area in which they were trained with evidence suggesting these benefits persisted for two years.

Be wary of claims that playing certain computer and online games can improve your memory and other types of thinking as evidence to back up such claims is evolving. There is not enough evidence available to suggest that computer-based brain training applications offered commercially have the same impact on cognitive abilities as the ACTIVE study training. NIA and other organizations are supporting research to determine whether different types of cognitive training have lasting effects.

Stay Connected with Social Activities

Connecting with other people through social activities and community programs can keep your brain active and help you feel less isolated and more engaged with the world around you. Participating in social activities may lower the risk for some health problems and improve well-being.

People who engage in personally meaningful and productive activities with others tend to live longer, boost their mood, and have a sense of purpose. Studies show that these activities seem to help maintain their well-being and may improve their cognitive function.

So, visit with family and friends. Consider volunteering for a local organization or join a group focused on a hobby you enjoy. Join a walking group with other older adults. Check out programs available through your Area Agency on Aging (AAA), senior center, or other community organizations. Increasingly, there are groups that meet online too, providing a way to connect from home with others who share your interests or to get support.

We do not know for sure yet if any of these actions can prevent or delay AD and age-related cognitive decline. Still, some of these have been associated with reduced risk of cognitive impairment and dementia.

Manage Stress

Stress is a natural part of life. Short-term stress can even focus our thoughts and motivate us to take action. However, over time, chronic stress can change the brain, affect memory, and increase the risk for AD and related dementias. To help manage stress and build the ability to bounce back from stressful situations, there are many things you can do:

Exercise regularly. Practicing tai chi or going for a walk, especially in nature, can restore a sense of well-being.

Write in a journal. Putting your thoughts or worries on paper can help you let go of an issue or see a new solution.

Try relaxation techniques. Practices such as mindfulness – which involves focusing awareness on the present moment without judgment – or breathing exercises can help your body relax. These can help lower blood pressure, lessen muscle tension, and reduce stress.

Stay positive. Release grudges or things beyond your control, practice gratitude, or pause to enjoy the simple things, such as the comfort of a cup of tea or the beauty of a sunrise.

Reduce Risks to Cognitive Health

Genetic, environmental, and lifestyle factors are all thought to influence cognitive health. Some of these factors may contribute to a decline in thinking skills and the ability to perform everyday tasks such as driving, paying bills, taking medicine, and cooking.

Genetic factors are passed down (inherited) from a parent to child and cannot be controlled. But, many environmental and lifestyle factors can be changed or managed to reduce your risk. These factors include:

Some physical and mental-health problems, such as high blood pressure or depression

Brain injuries, such as those due to falls or accidents

Some medicines, or improper use of medicines

Lack of physical activity

Poor diet

Smoking

Drinking too much alcohol

Sleep problems

Social isolation and loneliness

Physical and Mental-Health Problems

Many health conditions affect the brain and pose risks to cognitive function. These conditions include:

Heart disease and high blood pressure. Can lead to stroke and changes in blood vessels in the brain that can lead to dementia.

Diabetes. Damages blood vessels throughout the body, including in the brain; increases risk for stroke and heart attack; increases risk for AD.

AD and related dementias. Cause a buildup of harmful proteins and other changes in the brain that lead to memory loss and other thinking problems.

Stroke. Can damage blood vessels in the brain and increase risk for vascular dementia.

Depression. Can lead to confusion or attention problems and has been linked to dementia.

Delirium. Shows up as an acute state of confusion, often during a hospital stay, and is associated with subsequent cognitive decline.

It is important to prevent or seek treatment for these health problems. They affect your brain as well as your body and receiving treatment for other conditions may help prevent or delay cognitive decline or thinking problems.

Brain Injuries

Older adults are at higher risk of falls, car accidents, and other accidents that can cause brain injury. Alcohol and certain medicines can affect a person’s ability to drive safely and also increase the risk for accidents and brain injury. Learn about risks for falls and participate in fall prevention programs. Wear helmets and seat belts to help prevent head injuries as well. But do not let a fear of falling keep you from being active. Overcoming this fear can help you stay active, maintain your physical health, and prevent future falls.

Medicines

Some drugs and combinations of medicines can affect a person’s thinking and the way the brain works. For example, certain ones can cause confusion, memory loss, hallucinations, and delusions in older adults.

Medicines can also interact with food, dietary supplements, alcohol, and other substances. Some of these interactions can affect how your brain functions. Drugs that can harm older adults’ cognition include:

Antihistamines for allergy relief

Medicines for anxiety and depression

Sleep aids

Antipsychotics

Muscle relaxants

Some drugs that treat urinary incontinence

Medications for relief of cramps in the stomach, intestines, and bladder

Talk with your doctor if you are concerned that your medications may be causing cognitive problems. Do not stop taking any medications you have been prescribed without first talking with your health-care provider.

Lack of Physical Activity

Lack of exercise and other physical activity may increase your risk of diabetes, heart disease, depression, and stroke – all of which can harm the brain. In some studies, physical activity has been linked to improved cognitive performance and reduced risk for AD. In general, staying active is known to lower the risk of high blood pressure, stroke, and symptoms of depression, all of which in turn can improve cognitive health.

Poor Diet

A number of studies link eating certain foods with keeping the brain healthy and suggest that other foods can increase health risk. For example, high-fat and high-sodium foods can lead to health problems, such as heart disease and diabetes, that can harm the brain.

Smoking

Smoking is harmful to your body and your brain. It raises the risk of heart attack, stroke, and lung disease. Quitting smoking at any age can improve your health.

Alcohol

Drinking too much alcohol affects the brain by slowing or impairing communication among brain cells. This can lead to slurred speech, fuzzy memory, drowsiness, and dizziness. Long-term effects may include changes in balance, memory, emotions, coordination, and body temperature. Staying away from alcohol can reverse some of these changes.

As people age, they may become more sensitive to alcohol’s effects. The same amount of alcohol can have a greater effect on an older person than on someone who is younger. Also, some medicines can be dangerous when mixed with alcohol. Ask your doctor or pharmacist for more information.

Sleep Problems

At any age, getting a good night’s sleep supports brain health. Sleep problems – not getting enough sleep, sleeping poorly, and sleep disorders – can lead to trouble with memory, concentration, and other cognitive functions.

Social Isolation and Loneliness

Social isolation and feeling lonely may be bad for brain health. Loneliness has been linked to higher risk for dementia, and less social activity has been linked to poorer cognitive function.

By taking steps now to reduce your risks for cognitive decline, you will help to maintain your cognitive health for the future.

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This chapter includes text excerpted from Cognitive Health and Older Adults, National Institute on Aging (NIA), National Institutes of Health (NIH), October 1, 2020.

Chapter 4 | Understanding Memory Loss

Many older people worry about their memory and other thinking abilities. For example, they might be concerned about taking longer than before to learn new things, or they might sometimes forget to pay a bill. These changes are usually signs of mild forgetfulness – often a normal part of aging – not serious memory problems.

What Is Normal and What Is Not?

What is the difference between normal, age-related forgetfulness and a serious memory problem? It is normal to forget things once in a while as we age, but serious memory problems make it hard to do everyday things such as driving, using the phone, and finding your way home.

Talk with your doctor to determine whether memory and other cognitive problems, such as the ability to clearly think and learn, are normal and what may be causing them.

Differences between Mild Forgetfulness and More Serious Memory Problems

What Is Mild Forgetfulness?

It is true that some of us get more forgetful as we age. It may take longer to learn new things, remember certain words, or find our

Table 4.1. Differences between Normal Aging and Alzheimer Disease

glasses. These changes are often signs of mild forgetfulness, not serious memory problems.

See your doctor if you are worried about your forgetfulness. Tell her or him about your concerns. Be sure to make a follow-up appointment to check your memory in the next six months to a year. If you think you might forget, ask a family member, friend, or the doctor’s office to remind you.

What Can You Do about Mild Forgetfulness?

You can do many things to help your memory. Here are some