Is it normal brain aging or cognitive decline?

Younger people often assume we seniors and retired persons have a lot of time on our hands, but they aren’t taking into consideration the unexpected ways we occupy ourselves.

There’s the time spent puzzling for a minute as we walk into a room, muttering to ourselves, “Now what did I come in here for?”  

There are the lengthy backward identity searches, which involve a query about someone – their name or something about them – leading to a series of frustratingly incomplete sentences.

“Oh, you know, he was married to…”

“And she was in that show with…I can’t think of the name…”

“Yeah, and that other guy was married to her … with the big mustache… He got arrested for something creepy and had that crazy kid who was in that movie with what’s-her-name…” 

It all, sadly, leads to a sigh and a change of subject.

We also spend our time looking for eyeglasses, trying to recall if we took our medication and angering wait staff while deciding whether to have an appetizer. And we talk about our health. A lot. With anyone.

But those moments don’t just fill time – they can cause alarm and questions about whether we are having a blip that comes along naturally as our brains age, or if one of those other, scarier types of cognitive decline is underway.

This whole muddle about brain health can be confusing, but the National Institutes of Health explains a few things clearly.

First, “cognitive health” is just “the ability to think, learn and remember clearly,” NIH says, and it is determined by a bunch of factors, including your genes and health and lifestyle – things like diet and exercise and environment, or if your days are filled with social engagement and enough other stimulation and opportunity to exercise and stretch your brain. Or if you spend too much time watching Court TV.

We often then throw around the term “dementia” as if it’s a specific ailment, but it actually is a broad umbrella term that describes what Alzheimer’s Association calls “a collection of symptoms (cognitive, functional and behavioral) that are caused by specific disease.” So, you might think of dementia as a broad term like “indigestion,” another familiar ailment that could be caused by a number of factors.

Margaret Goodwin, PhD, has a practice called Henlopen Psychological Services at the Cedar Tree Medical Center in Long Neck/Millsboro, and she specializes in working with older clients. She explained that in about three out of four cases, dementia is caused by Alzheimer’s disease.

That happens when brain cells are attacked by a sticky plaque that builds up between them or by strands called tangles that grow within them – hindering those cells’ function and the ability to communicate through the networks in the brain. Other types of dementia include Lewy body dementia and vascular dementia, she notes, along with other rare forms.

There is no cure for Alzheimer’s, but Goodwin notes that there are treatments, and more research is being done every day, so anyone with concerns should talk to a professional and keep abreast of the latest news. The Alzheimer’s Association is a great source for research.

So, then, what about that issue of determining if that forgotten name or pair of glasses is a normal skip in the brain LP or a more significant problem?

The National Institute on Aging puts it this way: “Serious memory problems make it hard to do everyday things such as driving, using the phone and finding the way home. Signs that it might be time to talk with a doctor include asking the same question over and over, getting lost in familiar places, having trouble following directions or recipes, becoming confused about time, people and places, and not taking care of yourself – eating poorly or not bathing.”

Still a little vague, but you can sort of see the distinction.

Goodwin says it is concerning if the changes are obvious or alarming to another person. “I’d look for disorientation and a loss of awareness in space and time – significant changes in behavior,” she said.

There is one other level of decline called mild cognitive impairment, a label a panel of experts came up with not just to befuddle us, but to describe a state signaling that a person might be struggling enough to be in decline and progressing toward some type of dementia. Those people would benefit from a neurological test, Goodwin said, noting it can be 10 years before a person with those symptoms is diagnosed with Alzheimer’s, and they could benefit from treatment.

Whew.

The National Institute on Aging and National Institutes of Health have collaborated on an Alzheimers.gov page, and a useful chart that makes these distinctions can be found at alzheimers.gov/alzheimers-dementias/mild-cognitive-impairment.

There is a lot of chatter about how you can avoid cognitive decline – from gobbling blueberries and salmon to playing the bassoon or writing your memoir. But there are other easier, effective approaches and a lot of new research which we’ll deal with in a future column.

Harvard Health has a good fundamental list here if you want to get started: health.harvard.edu/mind-and-mood/12-ways-to-keep-your-brain-young.