Dr. Tom Kaluzynski on “Brain Aging and Memory: What’s Normal?”
Dr. Tom Kaluzynski of MemoryCare led a discussion on “Brain Aging and Memory: What’s Normal,” on October 9 at Higgins United Methodist Church in Burnsville. MY Neighbors co-sponsored the event with MemoryCare. A summary of Dr. Kaluzynski’s presentation follows:
Our memories are not an accurate and objective record of the immediate or distant past. For most of us, our memories are far from perfect. Our memories tend to be highly selective and fickle.
Confidence in our memory and recall is not a good indicator of how accurate our memory is. For instance, we now know of numerous cases where confident and accurate eye witness accounts resulted in the wrongful conviction of innocent individuals. Today we also have numerous studies in the field of neuropsychology that also dispel the myth that our memories are highly accurate and objective.
The normal aging individual--
- May misplace an item at times
- May forget names on occasion
- Will experience more difficulty with multi-tasking
- May have difficulty remembering details
- Will experience blocking or “tip of the tongue phenomenon.” (This is routinely for low frequency word. For example, trying to recall the words “nimbus” or “halo” to describe the light drawn around the head of saints in artwork. The more we try to recall such words, the less likely we are to do so. An effective strategy when this happens is to think of something else. Then it’s more likely that you recall the word you’re blocking sooner.)
- Our most recently learned knowledge is most subject to age-related decline.
The above changes--however frustrating or embarrassing-- do not disrupt our ability to function. Nor do they change our prior social or occupational abilities. We continue to retain the ability to learn new things.
In the world of dementia research—regardless of our age-- the normally aging individual is classified as having Normal Cognitive Aging– or what is now being referred to as ARCD – Age Related Cognitive Decline. Once most of us reach the age of 30, we will begin to experience a) a decrease in “working memory; and b) a decrease in our brain’s processing speed.
What is “working memory”? Think of working memory as the brain’s temporary work space. It’s where we hold onto some information on a short term basis, long enough to manipulate the information to accomplish a task. A common example would be when someone asks you to dial a phone number for them--without a pencil and paper-- and you go to your phone and dial the number.
An example of processing speed would be how long it takes to give a dollar in change from some coins. In a common screening test called the “Time and Change Test” we may lay out on the table 3 quarters, 7 dimes and 7 nickels and ask someone to make a dollar in change from the coins. Where it once took a person five seconds, it might now take nearly a minute.
Cheer up, however, because as we age-- over most of our life span-- two brain functions improve. Our word knowledge (vocabulary) improves. And what neurocognitive scientists call Crystallized Intelligence (Wisdom).
Our semantic long-term memory ability doesn’t really change at all. For example, once we’ve learned something like who was the first president of the US or that the color of a ripe banana is yellow, it stays with us. It’s rare for any of us to remember when we first learned such information that cognitive scientists call declarative memory.
Two types of memory that do change with age are episodic memory- primarily with regards to the accuracy of details of an event we’ve personally experienced. (It’s common to misattribute to one event, something that was said or that happened to another time or to another person that may not actually have been at the activity we’re recalling.)
Prospective memory--the ability to remember to carry out some plan or action at a specific time-- weakens as we age. As we age, refocusing becomes more challenging-- especially when there are distractions along the way in performing a task. We experience more difficulty in moving from one task to the next. Because we become increasingly aware of these glitches in staying focused-- and because we don’t like these changes!—in some cases they can snowball and make things worse.
Age-related cognitive decline is not dementia. The jargon free definition of dementia is when an individual’s thinking and memory abilities decline to the degree that such impairment disrupts daily living and when that happens, one is no longer able to independently function safely.
Alzheimer’s Disease is the most common type of dementia in adults over the age of 65. Often Alzheimer’s Disease overlaps with another form of dementia. In autopsies this overlap has been found in as many as 70 % of cases, even though during the patients’ lives the history, testing and behavioral pattern was most consistent with only one type of dementia. The most common types of neurodegenerative disorders are Alzheimer ’s disease, Vascular Dementia, Dementia with Lewy Bodies and Frontotemporal Dementias. All four types are relentlessly progressive disorders and we currently have no evidence-based treatment that slows down or cures the degenerative process.
Dementia is not delirium. In some people, day to day memory and performance on memory tasks remain relatively well preserved early on, while other cognitive areas are already impaired. These may include learning, orientation, comprehension, judgment, language and problem solving.
Most people who end up with a diagnosis of Dementia go through a transition phase called Mild Cognitive Impairment where either they themselves (or someone who knows them well) can recognize that compared to a prior level of ability they are having inefficiencies in completing activities. On formal testing they show some areas of objective cognitive decline. This transition phase to Mild Cognitive Impairment and how it’s defined is a moving target, and how it’s defined or diagnosed will continue to be modified as brain aging science and technology advances.
However, Mild Cognitive Impairment is not normal. About 15 out of every 100 individuals in this group each year end up with some further decline and eventually meet the criteria for dementia.
The human brain is one of the most complex organ systems of the body since it is made up of billions of cells called neurons. Think of the brain as the power plant for how the human body processes and uses sensory and emotional information to adapt to and survive in the world.
Aging is an uneven biological process of wear and tear. Some tissues remain healthy all of our lives, while others wear out, some more quickly than others, and the brain is no different.
And just like a power plant, the brain needs fuel and a system of maintenance to handle day to day wear and tear, as well as some ability to repair damage when it occurs. The science of how the brain does its job in normal conditions and what goes wrong in disorders such as neurodegenerative dementias is relatively new field in medicine called Cognitive Neuroscience. One of its cofounders—Dr. Michael S. Gazzaniga-- is still living and active today.
Modern technology has enhanced our growing appreciation that the brain is a complex system of nerve cells spread out as grids that are interconnected. “Neurons that fire together wire together,” is a better way to explain how our brain does the amazing things it can. Unfortunately, as we age some parts of our brain work less effectively. Dopamine is the widespread neurotransmitter in brain, which is involved in many functions-- reward and pleasure, physical movement and general motivation. As we age our dopamine levels drop about 10% per decade. Dopamine is also linked to our socializing experience. Older adults report increased feelings of social loneliness. It’s possible that declining dopamine levels may play a role.
Dr. John Medina, a professor of Bioengineering at the Univ. of Washington School of Medicine, says this about the benefits of SOCIALIZATION: “It’s good for our brains when we are young, good for our brains moving through middle life. It’s great for our brains as we age. Having a strong social support system -- wholesome and sustained shared interactions with a wide variety of people regularly --- is good for both physical and mental health.”
Keeping the above in mind, following are some ideas on how best to stay in the Normal Cognitive Aging category (consider this as a “Ten Thoughts to Help You From Losing Your Mind” list):
- Stay PHYSICALLY ACTIVE
- Stay SOCIALLY ENGAGED
- Eat a WELL BALANCED DIET (I like the seven word summary you find in Michael Pollan’s book “Food Rules, An Eater’s Manual”— “Eat Food, mostly plants, not too much.” Do most of your grocery shopping around the edges of the traditional supermarket.)
- It may help to keep B-12/Folate and Vitamin D in optimal ranges. Check with your personal physician about and individualized recommendations for you.
- Avoid drugs which are known to impair nervous system functioning. (Anticholinergics, benzodiazepines, alcohol. For some, even low to modest amounts may not be the best for one’s brain, balance and motor coordination.)
- SLEEP well. (If appropriate - find out if you have a sleep apnea syndrome or REM sleep behavior disorder)
- Be wary of Brain Training Promotions. Exercise does more to boost thinking than thinking does. There is evidence that you can improve performance on the brain training task itself, at least in short term. But there is honest debate on whether there is any evidence for long-term benefit of training in one domain (such as processing speed) resulting in a benefit in another area (such as memory or reasoning) or whether it can translate into areas such as remembering to take medications or maintain safe driving skills.
- Beware of Pills or Supplements that claim to extend your life, or claim to make you smarter or “end forgetfulness.” Neurocognitive scientists theorize that forgetting is adaptive and normal.
- A Comment on Genetics and Alzheimer’ disease: In 2017, routine screening of family members or the general population for such genetic markers as the APOE 4 allele is not recommended. There are now over 20 “genetic risk markers” – these are common variations in genes and to some degree influence the risk of developing Alzheimer’s or a related dementia. These variations are not the same as the uncommon inherited genetic mutations that to date have been identified as a cause of Early Age Onset Dementia. Do consider genetic counseling for the individual with a diagnosis of Early Age Onset Dementia (younger than age 65) or with a family history of the same.
- This last point speaks to the importance of discussing Advanced Care Plans with trusted family and friends now, while we can think clearly and process information on our own behalf. Designate a proxy for both health care and personal affairs (also known as a “Health Care Power of Attorney”). It is crucial to regularly review your values and goals as they relate to life-sustaining treatment in the event you suffer serious decline in your health.
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We are so fortunate to have someone with Dr. Kaluzynski’s incredible expertise in our local community. If you or someone you know is struggling with memory issues, please contact MemoryCare at (828) 771-2219 or visit their web site memorycare.org
Thanks to Higgins UMC and to Teri Beth Darnall, a nursing educator who serves as a Faith Community Nurse for hosting us at Higgins!