12:01am

Mon April 11, 2011
Your Health

Sussing Out Senior Moments: A Sign Of Worse To Come?

Everybody over a certain age — say, around 50 — has these moments: The car keys go missing. They can't retrieve a once-familiar name. They stride into a room with purpose and then forget why.

Phyllis Hersch knows about those lapses.

"I go to the store and do five errands and miss the most important one because I've gotten distracted by something else," says Hersh, who just turned 70. Recently she alarmed herself by leaving her car in the garage with the motor running at her home in Massachusetts.

Hersch says she might have shrugged off these episodes as just "an ordinary annoyance of aging" except for one thing — her husband Charlie has early Alzheimer's disease.

"Because of the situation with him, I worry," she says. "Is this happening to me, too?"

So she consulted an expert: Dr. Kirk Daffner, who directs the Mind-Brain Center at Brigham and Women's Hospital in Boston. Daffner is editor of a just-published report on age-related memory loss.

Daffner put Phyllis Hersch through a series of memory tests: repeating back strings of words and numbers, some mental arithmetic, and so on. They're designed to see if a person can encode new memories, manipulate the information and recall it.

Hersch scored in the normal range, but Daffner checks up on her every six months or so to see if there's any change.

Faulty Memory Vs. Not Paying Attention

Daffner says much of the time, what people experience as a memory problem is really a not-paying-attention problem.

A memory is made up of a lot of different pieces, stored in different parts of the brain. When you shut a door, for instance, your brain registers the feeling of your push on the door, the sound of the slam, an image of what room you were in, what you did next. When you're paying attention to all those things, even on a subliminal level, these piece help you remember that you shut the door. When you're not, you may not retrieve that memory.

On top of that, there's a slowing down of the way the brain works.

"What's common as people age is that the speed at which information can be retrieved on demand is slowed," Daffner says. "Through much of our lives, it was this wonderful gift — we wanted some information and bang, it came to us."

There are lots of reasons why brains get sluggish.

High blood pressure damages the wiring that connects different parts of the brain. Poor sleep or excess alcohol are enemies of a nimble brain. And many medicines — including common drugs to reduce stomach acid, control asthma or treat depression — can slow the brain down.

These are things that can be changed, up to a point. But new research is uncovering something else — something that on the surface seems pretty scary.

Many Have 'A Little Bit Of Alzheimer's'

Nearly 40 percent of people who die without dementia, or any measurable cognitive problems, have definite signs of Alzheimer's disease in their brains, says Dr. David Bennett, who directs the Alzheimer's Disease Center at Rush University Medical Center in Chicago.

"If you look in the brains of older people, it's hard not to have at least a little bit of Alzheimer's pathology," Bennett says. "It's probably a much, much larger problem than we currently recognize."

Just as almost everybody has a little bit of heart disease after a certain age, Bennett says, a lot of people have "a little bit of Alzheimer's."

Bennett's findings come from 16 years of studying thousands of older people who volunteered for the research when they had no cognitive problems. All agreed to donate their brains after death for study.

Bennett acknowledges that the notion that many apparently healthy people are walking around with Alzheimer's-like damage in their brains "could frighten a lot of people."

But in fact, his studies also contain some really good news. Bennett says many people clearly are able to tolerate "a little bit of Alzheimer's" in their brains — or even more than a little bit.

Tapping Into the 'Cognitive Reserve'

Their secret is something scientists call "cognitive reserve" — extra brain capacity. It compensates for whatever damage is accumulating.

It's not like the reserve you have in your kidneys or lungs. You can remove a kidney or a lung and do perfectly well.

"I think of cognitive reserve like the side streets when there's an accident on the expressway," Bennett says. "Everything comes to a dead stop, and you get off and you meander through the side streets, and you can actually get to your destination."

It'll take longer –- but you'll get there.

Some people are lucky when it comes to cognitive reserve. They inherit more of it. Perhaps 50 percent of cognitive reserve is genetically determined. Education -– both the formal variety and rich life experiences -– also contribute.

But some people have bad luck. Their cognitive reserve gets depleted by loneliness, anxiety or depression.

Bennett says people who tolerate Alzheimer's-like brain damage have certain things in common.

"Having a purpose in life, conscientiousness, social networks, stimulating activities — all these things seem to be protective in terms of how your brain expresses whatever pathology it's accumulating," he says.

Bennett and his colleagues have found that having a lot of friends was clearly associated with maintaining good cognitive function, even after they statistically accounted for other factors — such as whether a person suffered from depression or other illnesses. In other words, there's something about being social that's good for the brain.

So the bottom line is, rather than worrying about memory lapses, maybe people would do better to invest their energy in stimulating activities and maintaining their social life.

There is one other thing people can do: physical exercise. "Some of the best converging data about successful memory or cognition is linked to exercise," says Kirk Daffner, the Harvard brain specialist. Copyright 2011 National Public Radio. To see more, visit http://www.npr.org/.

Transcript

RENEE MONTAGNE, host:

This is MORNING EDITION, from NPR News. Good morning. I'm Renee Montagne.

STEVE INSKEEP, host:

And I'm Steve Inskeep.

Today in Your Health, we learn one of the secrets of longevity: the ability to bounce back from life's setbacks. First, we look at the senior moments that bother people of a certain age, those lost keys or missing words or forgotten names. When are those memory lapses signs of something more serious?

Here's NPR's Richard Knox.

RICHARD KNOX: Phyllis Hersch is very precise about her age.

Ms. PHYLLIS HERSCH: I just turned 70 years old - just turned 70 years old.

KNOX: Well, happy birthday.

Ms. HERSCH: Thank you very much.

KNOX: Seems like she doesn't want me to think she's a day older than she is, but she talks freely about some problems she's been having with her memory.

Ms. HERSCH: I do five errands and miss the most important one because I've gotten distracted about something else.

KNOX: Twice, she's left her car in the garage with the motor running.

Ms. HERSCH: I was really scared - not just that I'd left the car going, but that it was an indication that there was something more significant going on with my mind.

KNOX: She's especially anxious because her husband Charlie has early Alzheimer's.

Ms. HERSCH: So she consulted Dr. Kirk Daffner. He directs the Mind-Brain Center at Brigham and Women's Hospital in Boston. Dr. Daffner put Phyllis Hersch through a series of memory tests. I was curious about them, so I asked him to run through the tests with me.

Dr. KIRK DAFFNER (Mind-Brain Center, Brigham and Women's Hospital): You ready?

KNOX: Sure.

Dr. DAFFNER: OK. Four, two, seven, three, one.

KNOX: Four, two, seven, three, one.

Dr. DAFFNER: Right.

KNOX: And it got harder.

Dr. DAFFNER: Now I'm going to ask you to start with the number 100, subtract seven in your head and give me the answer. Then take that number, subtract seven and continue the pattern of subtracting seven and giving me the answer as you go.

KNOX: In the end, I scored in the normal range. So did Phyllis Hersch. Daffner checks up on her every six months or so. He says much of the time, what people experience as a memory problem is really a not-paying-attention problem.

A memory is made up of a lot of different pieces, stored in different parts of the brain. When you shut a door, for instance, your brain registers your push on the door, the slam of the door, what room you were in, what you did next. When you're paying attention to all those things, they help you remember that you shut the door. When you're not, you may not retrieve that memory.

On top of that, there's a slowing of the way the brain works.

Dr. DAFFNER: What's common as people age is that the speed at which information can be retrieved on demand is slowed. And through much of our lives, it was this wonderful gift. We wanted some information, and bang, it came to us.

KNOX: There are lots of reasons why brains get sluggish. High blood pressure damages the wiring that connects different parts of the brain. Poor sleep or excess alcohol are bad. And many medicines can slow the brain down.

These are things that can be changed, up to a point. But new research is uncovering something else, something that on the surface seems pretty scary. Nearly 40 percent of people who die without dementia, or any noticeable cognitive problems, have definite signs of Alzheimer's in their brains.

Dr. David Bennett directs the Alzheimer's Disease Center at Rush University Medical Center in Chicago.

Dr. DAVID BENNETT (Alzheimer's Disease Center, Rush University Medical Center): If you look in the brains of older people, it's hard not to have at least a little bit of Alzheimer's pathology.

KNOX: Just as almost everybody has a little bit of heart disease after a certain age, even if they never suffer a heart attack.

Bennett's findings come from 16 years of studying thousands of older people who agreed to donate their brains after death. But those same studies contain some really good news. Bennett says many people are able to tolerate a little bit of Alzheimer's in their brain, or even more than a little bit. Their secret is something called cognitive reserve -extra brain capacity. It compensates for whatever damage is accumulating.

Dr. BENNETT: I think of reserve like the side streets when there's an accident on the expressway. Everything comes to a dead stop, and you get off and you meander through the side streets, and you can actually get to your destination.

KNOX: It'll take longer, but you'll get there.

Now, some people are just lucky when it comes to cognitive reserve. They inherit more of it. Others have bad luck. Their reserve gets depleted by loneliness, anxiety, depression. But Bennett says people who tolerate Alzheimer's-like brain damage have certain things in common.

Dr. BENNETT: Purpose in life, conscientiousness, social networks - all of these things seem to be protective in terms of how your brain expresses whatever pathology it's accumulating.

KNOX: So rather than worrying about whether your memory is slipping, maybe you'd do better to invest your energy in stimulating activities and maintaining your social life.

And here's one other thing you can do: physical exercise. There's lots of evidence that exercise maintains your brain power.

Richard Knox, NPR News. Transcript provided by NPR, Copyright National Public Radio.