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I'm sitting across from a white-coated woman, struggling to recall whether "apricots" is on a list of random items she's just read to me. I search for clues in her face, but she stares back blankly, just as she did a few minutes earlier as I attempted to recall what a boy had been eating in a picture she'd shown me. Was it salad? Spaghetti? A second glimpse reveals that he wasn't, in fact, eating. Oookaay. This is basically how my morning at a neurologist's office in New Jersey goes. And by the time the three-hour battery of tests I've paid $700 to undergo is finished, I stumble out utterly convinced that I am in the clutches of early-onset Alzheimer's or that, basically, I've become a complete idiot before I've even turned 50.
Not that I didn't already have my suspicions: After increasingly losing track of my cell phone, spacing out on appointments, and forgetting to follow up with friends regarding their recent biopsies, job interviews, and the like, I'd become convinced—actually frantic—that my memory was going and thus scurried off to see a doctor. It's an anxiety, apparently, that's hardly limited to myself and several of my 40- and 50-something friends: According to a recent international survey administered by the Harvard School of Public Health, people fear Alzheimer's second only to cancer.
One in five women who reach the age of 65 will ultimately develop Alzheimer's, but only 200,000 Americans have early-onset Alzheimer's, which usually appears around age 40 or 50. And believe it or not, middle-aged adults (in their 40s and 50s) worry more about their memory than people in their 70s and 80s do. "This may be because middle-aged adults tend to live complex lives with a lot of things hanging in the balance. It makes the anticipation of losses now or in the future very scary," says Constantine Lyketsos, M.D., chair of psychiatry at Johns Hopkins Bayview Medical Center in Baltimore. He adds another, more philosophical observation: "So much of who we are is defined by what we remember. Losing our memories can feel like we are losing ourselves."
When the results of my tests come in about a week later, I am somewhat surprised by the findings. I scored in the bottom 1 percent on one portion that assessed my attention level. I also didn't do well on a part that tested "auditory processing." In other words, I don't listen very well. Sounds like me in real life. On the other hand, I scored in the top 99th percentile in sections that hinged on language—for example, naming as many items as I could starting with a certain letter. Makes sense—I earn a living as a writer. In the end, the results confirmed what most people close to me suspected: I'm perfectly normal, although I rush a lot and could pay closer attention when people are talking to me. But as I scramble into my car and turn the ignition, my flush of relief is quickly replaced by two unsettling questions: What is normal for a woman my age? And if this is normal, how lame-brained will I be by the time I hit 55? Or 65?
Fielding such questions from nervous Nellies like myself is routine for the experts at New York University (NYU) Langone Medical Center's Center of Excellence on Brain Aging in New York City. "Five years ago, most of the people who came for testing were older, 70 and up. But as the baby boomer generation enters into its 50s and 60s, we've seen an increase in the number of people worried about their memory," says managing associate director Karyn Marsh. She escorts me through the enormous building, past a warren of labs, clinics, and offices, to sit down with Susan De Santi, Ph.D., an adjunct associate professor of psychiatry at NYU. De Santi has analyzed thousands of tests, like the ones I took with my neurologist in New Jersey, as part of her memory research.
"Normal testing range for a woman of 45 barely differs from what's considered normal for a person 20 years her junior," explains De Santi. She's even willing to bet that had I taken this test two decades ago, I'd have performed just about the same. Or worse, because I had less invested. "Very seldom does an adult under the age of 60 come in and we find there is something going on," she continues. "And even then, the problem tends to be related to depression or something other than dementia that can impair memory." (See "When It's Not Alzheimer's" on page 4 for a list of eight conditions and drugs that impact your ability to recall information.)
Then why, I ask, are so many of us middle-agers pfumpfering around in search of our keys? Primarily, says De Santi, because we have so much more to pay attention to now than we did at a younger age. "When I was 20 I'd study for a few hours and go out and party the rest of the night," says De Santi."I look at my own life today...I'm working 15 hours a day. My efforts as an adult have to be much more directed for longer periods of time. We don't realize how much we are demanding of ourselves and that we burn out after a certain number of hours."
Undoubtedly, the ongoing salvo of information catapulted into our consciousness by BlackBerries, Tweets, e-mails, and cell phones has only added to our distraction. Diverting our attention to interrupting cell phones not only causes memory loss, it decreases the accuracy of our memory altogether, according to some research. "We don't start seeing significant and meaningful changes in memory performance until the age of 60." And even then, in the absence of illness, that doesn't signify inferior overall ability.
But there's more to it. Much of the reason we start to worry about memory slip-ups after 40 is because, well, we start to give a hoot. "My daughters are in their 20s, and they sometimes lose their train of thought but think nothing of it. As adults, we notice this kind of thing because we are concerned about getting older and developing a dementia like Alzheimer's," Ralph Nixon, M.D., Ph.D., director of the Center, later tells me over the phone. He also points out that copious media coverage about Alzheimer's and memory problems has added to our generation's elevated anxiety levels. As Nixon talks, my mind wanders back in time to all the hours I spent locked out of my college dorm room because I'd forgotten my key. I recall that year in elementary school when I lost four winter coats. I realize it's true: To some extent, we do idealize what our memory might once have been.
Reassuring insights, for sure. But a short stroll down the hall to the office of Mony J. de Leon, Ed.D., quickly reveals that things aren't quite so straightforward. Surrounded by models of the brain and colorful pictures of the same, de Leon is a sort of counterpart to De Santi: While De Santi analyzes performance, de Leon uses high-tech imaging tools like PET scans and MRIs to study the actual structure of the brain. And what he tells me is disconcerting: Although tests like De Santi's are very good at detecting disease, they aren't necessarily designed to track how the healthy brain subtly—but definitely—changes as we age.
"You see these structures here," says de Leon, pointing to a pair of kidney-shaped red blobs on the scan of a 20-something adult. "And you see how much smaller they are in a scan of an adult in his 70s?" Those two red blobs, explains de Leon, make up the hippocampus, which acts as a sort of gateway for new memories. As that "gateway" shrinks with age, de Leon explains, it becomes less efficient at dispatching names, faces, smells, and more to other regions of the brain where they are stored as actual memories.
That's not all that slowly begins to shrivel when we hit the age of about 40 (mind you, we're still talking brain here). So, too, does the frontal lobe, says de Leon, as he waves his hand over a large region at the front of a rubbery model brain. "The frontal lobe acts like an index system. It's responsible for retrieving all the memories that are stored elsewhere in the brain," he says. When we find ourselves with a name or a word at the tip of our tongue, it's not because the memory isn't there, explains de Leon. "It's because the machinery that is supposed to find that word is becoming less efficient," he says.
De Leon goes on to explain that the frontal lobe is also responsible for something else: our ability to pay attention, that all-important piece of the memory puzzle that helps us actually notice where we put our coffee cup or truly hear what someone said her name was. At this point I'm imagining my frontal lobe being the size of a pine nut. "Tasks that demand attention are very vulnerable to age because as the frontal lobe shrinks it has less bandwidth, or capacity to manage information," says de Leon. This doesn't mean, however, that we're doomed to a lifetime of being locked out of our cars. It simply means that as we get older, we have to take an extra second or two to look at where we are putting those keys, so our brains have a chance to grasp the information. One more fascinating fact to consider: Men's brains begin to age earlier than women's, but we do, unfortunately, catch right up. "During and around the time of menopause, chemical and hormonal changes cause the brain to reduce in size. So by the time they are 60 to about 80, men and women are basically going downhill at the same rate," says de Leon.
With all this shrinking and shriveling, how is it, then, that De Santi's performance tests don't reflect such changes? "Because they don't ask the right questions," says de Leon, almost smiling. Sure, portions of standard evaluations touch on age-sensitive issues like attention. "But if you really want to see how a 45-year-old brain compares to a 20-year-old brain, ask your subjects to perform tests that are speed dependent or that require them to switch back and forth between two tasks. That's where the younger brain will dominate."
But de Leon is quick to emphasize the flip side of this story. Apparently, while we may become less efficient at things like rattling off phone numbers backward, a lifetime of experience gives us tools that our children may lack to cope with and compensate for memory weaknesses. Aware that we may not remember to call a friend after her doctor's appointment, we get to a place where we write ourselves a note on the calendar to do so. We're not surfing the Internet or watching TV while talking to her on the phone. And, if her news is bad, we know all the right things to say. "That's called wisdom. And in life," says de Leon, "wisdom can take you pretty far."
A tool using PET scan technology to detect Alzheimer's could be approved by the FDA this year. But experts debate whether it's definitive and who should be tested. For now, talk to your M.D. and check out this list of signs that nothing's wrong or something's amiss.
Normal: Misplacing car keys
Not So Normal: Not remembering what car keys are for or finding them in an odd place like the freezer
Normal: Worrying about your memory
Not So Normal: Others telling you they're worried about your memory
Normal: Periodically forgetting names of acquaintances
Not So Normal: Struggling to remember names of close friends and associates
Normal: Forgetting why you walked into a room
Not So Normal: Difficulty completing everyday tasks, like cooking a meal or making a call
Normal: Occasionally having trouble finding the right word
Not So Normal: Searching for names of everyday items, like a vase or a tea kettle
Normal: At times not remembering where you're going
Not So Normal: Getting lost in your own neighborhood and not being able to get home
Normal: Forgetting what you ate while recently out to dinner with friends
Not So Normal: Not recalling the entire experience
When It's Not Alzheimer's
Don't jump to the dark side just yet. Trouble remembering is most often attributable to a range of less serious—and reversible—causes. If you are concerned about your recall, ask your M.D. if it could be...
...Depression Considered a major cause of memory loss in middle age, the fog of this mental illness often makes people too unfocused and inattentive to file and recall passing events in and out of memory.
...Menopause Declining estrogen levels during and around menopause are associated with some decrease in recollection.
...Hypertension Untreated, this disease can chip away at your memory by cutting down on blood flow to the brain.
...Diabetes Poorly controlled glucose levels in patients with diabetes have been shown to impair recollection in the short and long term.
...Sleep Deprivation Being tired makes it more difficult to pay attention and visually process information, which are key to the creation and filing of memories in the brain. What's more, individuals with sleep apnea—a disorder in which a blocked airway repeatedly halts a sleeper's breathing—show tissue loss in brain regions that help store memories.
...Thyroid Dysfunction Both hypothyroidism and hyperthyroidism disrupt a number of key steps in the memory formation and retrieval process.
...A Vitamin Deficiency Vitamin B12 is crucial to brain health because it helps preserve myelin, the fatty sheath that protects brain cells or neurons. Left untreated, a B12 deficiency can cause permanent neuronal damage, including trouble remembering.
...Your Medication Memory loss is a side effect of several drugs, including some urinary incontinence drugs, over-the-counter sleep medications, certain antidepressants, and some steroidal drugs prescribed for chronic arthritis.
Is Alzheimer's preventable? Some experts say yes. Lifestyle changes could reduce the prevalence of the disease by 25 percent, according to research presented at last year's Alzheimer's Association International Conference. And even experts who disagree note that all these behavioral changes are still smart health bets.
Get head-to-toe healthy. Diabetes, depression, and heart disease have all been linked to increased risk of Alzheimer's. The very same cholesterol plaques and inflamed blood vessels that clog your heart, for example, also clog the arteries that carry blood and oxygen to your brain. "Reduced blood supply to the brain can be a huge determinant of who gets Alzheimer's disease and when they develop symptoms," says P. Murali Doraiswamy, M.D., professor of psychiatry and geriatrics at Duke University Institute for Brain Sciences and coauthor of The Alzheimer's Action Plan (St. Martin's Griffin). Now's the time to commit to keeping your weight down, your stress in check, and your cholesterol, glucose, and blood pressure at optimal levels by engaging in regular aerobic exercise. You should also embrace a heart-healthy diet that's heavy on fresh produce (like berries, which studies have shown promote brain health), fatty fish (rich in omega-3 fatty acids, which may protect against mental disorders), and whole grains, but light on saturated fats, red meat, and highly processed foods.
Protect your crown. Alzheimer's disease is believed to be caused by plaques and tangles of protein in the brain, which essentially interrupt brain circuitry and reduce memory function. Injuries to the brain—even microtraumas that may result in only a short loss of consciousness or state of confusion—add further "dead zones" to the brain and make it that much more vulnerable. Bottom line: You, your husband, and the kids should always wear your seat belt and use a helmet whenever you skate, bike, ski, or participate in an activity where head injury is a risk. Enforce those rules with the whole family.
Step out of your comfort zone. One of the major discoveries in the field of brain science is that even as we age, we can stimulate the growth of new brain cells and bolster our brain circuitry. Those extra connections act like a "cognitive reserve" that your brain can turn to when other cells die off or become deadened by injury or Alzheimer's plaques. "To most effectively stimulate and strengthen connections in the brain, you have to engage in activities that are challenging, new, and take you off automatic pilot," says Doraiswamy. If you're a numbers person, consider doing crosswords. If you're a word person, perhaps take up bridge. You might even pick up one of the many software programs, like Posit Science or Lumosity, that are designed to boost your memory and overall cognitive skills.
Socialize regularly. In a study of people over 50, those with larger social networks showed smaller declines in memory as they aged. Doraiswamy explains that this may be because social individuals tend to engage in more brain-boosting mental and physical activities and may have stronger brain circuitry, plus socializing may reduce the negative effect of stress on the brain. Even if you're not the belle-of-the-ball type, make an effort to get out with others. Join an exercise class or a book group, or pass up that solitary walk with Rufus for an hour with other pup lovers at your local dog park.
Find solutions. Writing lists, using a BlackBerry calendar, and slowing yourself down so you can pay attention aren't like wearing a girdle: They don't cause your memory to atrophy by providing support. "Even the best memory champions write things down when they don't want to take the chance of forgetting something," says Doraiswamy. Head to the bookstore to pick up a self-help book that offers memory-boosting strategies.
Go On, Get Involved
Considering the number of people Alzheimer's affects—every 69 seconds someone develops the disease—it is grossly underfunded in terms of research for better treatments and support for the millions who are caring for people with the disease. But you can help make a difference.
Be an agent for change. Visit ActionAlz.org, where you can learn about fundraising opportunities and urge your elected representatives to support and initiate important legislation that could brighten the future for Alzheimer's patients and their families.
Consider a clinical trial. The Alzheimer's Association's TrialMatch site has information on trials for people with Alzheimer's or related dementia and their caregivers, family members, and doctors (go to alz.org/trialmatch). The Alzheimer's Disease Neuroimaging Initiative is searching for individuals with normal and impaired cognition who may ultimately help uncover ways to prevent the disease (go to adni-info.org).
Lift someone up. Keeping their loved one safe is a primary goal of any caregiver. But so many other tasks fall on their to-do list that it can be overwhelming, to say the least. Offering to check in on someone suffering from dementia, bringing over a home-cooked meal, or just helping fold laundry could mean the world to a caregiver. You can also help them learn how to talk to their children about the disease or get their legal and financial planning in order with the Alzheimer's Association Caregiver Notebook. To order, call 800-678-5752 or visit fccatalog.com. Please specify code BKCAREGIVE. $12.95 plus shipping.
Originally published in the March 2012 issue of Family Circle magazine.
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