IIsn’t it Sod’s law? Just at the point in our lives when we start to think seriously about our long-term health and mortality—perhaps after witnessing the onset of a disease like dementia—our responsibilities are piled so high that we can feel like we already have our mental capabilities. The names of our favorite animals and people become an interchangeable word soup. Our keys are becoming increasingly elusive. Alerts must be set for all calendar items.
But how can we know if this frustrating flaking reflects age-related cognitive decline; the first signs of our own impending dementia; or just an overly taxing phase from which we will recover? Could it even be just normal forgetfulness? After all, we are not robots.
It may be reassuring to hear from neurologist Richard Restak, 82, whose new book is How to Prevent Dementia: An Expert Guide to Long-Term Brain Health. He says there may be a more mundane reason for memory loss: “Throughout life, stress causes a decline in normal brain function: you have difficulty with memory; you can’t think of names.
Of course, it’s impossible to avoid stressful things completely, but one thing you can choose to avoid, he says, is the worry that you’ll develop Alzheimer’s from mild forgetfulness: “There are examples of people leaving shopping centers come and not be able to remember where they parked the car. Well, that’s just normal.’
A more troubling version of the story would be, Restak says: “You come out of the mall and you can’t remember, ‘Did I drive here, did I take a bus, or did someone drop me off?'”
Restak is clearly still mentally sharp: in addition to writing books, he is a clinical professor at George Washington University in Washington DC. But he calmly accepts a mild decline in his abilities that comes with age. He remembers a book tour dinner many years ago where he met a dozen new people. “I had no trouble remembering the names at all,” he says. “I’m not sure I could do that today.”
Problems with remembering names are easy to solve, or at least Restak tells me: “Memory is based on images, not words. So I could write down your name, Amy Fleming, and see a picture of you in flames – flaming – and so the next time I see you, your name will come to me.
Memory is also often more about paying attention than about cognitive deficits. Returning to the Restak shopping center analogy, he says that if you have something more interesting in mind than the coordinates of a parking lot upon arrival, you will not pay attention to the seemingly insignificant parking zone, and therefore you will have no memory of it. It’s much harder to pay attention to things that don’t excite us.
Signs of memory depleted by dementia are much more apparent, says Linda Clare, professor of clinical psychology of aging and dementia at the University of Exeter. “There really is a gap somewhere that shouldn’t be there,” she says. “My own experience of this was telling my mother I was making a big move from Cambridge to North Wales and that I had found a house. And the next morning she couldn’t remember anything about it. Then I knew for sure that this had not simply been forgotten.”
Clare remembers another example, of a man who got into the car and couldn’t remember what the controls were for. “It’s those crunch moments that send you to the doctor.” But she admits it’s difficult to draw precise markers because conditions other than dementia can cause dramatic short-lived symptoms – such as urinary tract infections, hormonal imbalances, mini-strokes, depression and anxiety.
If you experience dramatic memory loss, or cognitive changes that are not normal for you, the usual course of investigation is a visit to a memory clinic, via GP referral.
“We try to encourage people, if they notice a change in their functioning, to go to the doctor,” says Clare. This is partly because other health problems causing the cognitive symptoms, such as cardiovascular disease that affects blood flow to the brain, may be noticed, but also because medications can help slow the progression of dementia if taken early.
But let’s back up for a moment: If you’re panicking because you’re getting older and can’t name the actor in the movie you just saw, it’s worth channeling this mental energy into positive action. For example, you may want to start learning new ways to deal with stress. “Try to reduce stress, and cognitive function will improve,” says Restak.
Clare suggests breaking the cycle of worrying about your health by focusing on taking care of yourself. “It’s not always easy,” she says. “Responsibilities do not disappear. But is there a way to get a little more sleep, or have someone give you an hour or two break to do something you want to do? Little things that keep you going are worth doing.”
On the other hand, having a mentally demanding job can be helpful because it keeps the brain agile and strong and makes the diagnosis of dementia less likely. “Whatever someone can do to boost their mental functioning is a good thing,” says Clare. “We think that complex mental activities are protective.”
Not that having a mentally taxing job is a prerequisite for brain health. Restak’s key phrase in tackling dementia is ‘cognitive reserve’, something that you can build up like a muscle. He says: “The brain remains highly malleable throughout life, and cognitive reserve can be built up beginning in childhood and at any time over the next seventy years.”
Having a well-trained brain won’t necessarily prevent dementia, but it can keep you functional longer if you do develop the disease. Restak’s best tip is to find something that “deeply interests you” and indulge in it as a “great obsession: you keep building on it with books, you go to movies about it – that’s how the mind stays sharp.”
Getting your brain to do new things, he says, is a way to “form new networks in the brain.” This applies to learning new languages, to musical skills, and is also why you should keep up with new technology instead of letting others do it.
Reading novels is another cognitive reserve-building power move. “They are much more demanding in terms of cognitive functioning than a nonfiction book, which you can open to whatever chapter is of interest to you,” says Restak. “You can’t do that with a novel.” You have to keep in mind the story so far, who everyone is, follow the text and subtext, and use your imagination.
Novels and puzzles require working memory. “Working memory is associated with IQ,” he says. “If you have a strong working memory, there is no chance of you developing dementia.”
Some of the exercises he suggests (see panel) would “tax everyone,” he says. The medical definition of dementia is a loss of memory, language, problem solving, and other cognitive skills that is severe enough to affect daily life.
“So if you have enough working memory to, for example, learn and name all the prime ministers since the Second World War, you can categorically state that you do not have dementia,” says Restak. “If you don’t follow politics, you might as well rank the members of your football team by position or alphabetically.”
In addition to reducing stress and keeping you mentally flexible, sleep (especially naps) is your memory’s friend. “Laboratory studies confirm that naps reinforce information already learned,” Restak writes. “When we first learn something, that knowledge goes to the hippocampus, the brain region responsible for the initial formation of a memory. When we take a nap, the activity of the hippocampus matches the pattern of activity that occurred when we learned the new information. This is called neural repetition.”
However, sleep problems often increase with age. Restak says: “A daytime nap can be helpful in regulating your sleep.”
None of this advice offers guarantees. “You can’t take a specific person and predict whether or not they will develop Alzheimer’s based on their lifestyle,” says Restak. “A high percentage of it is genetic, but these steps will reduce the chances.”
Avoiding excessive drinking is another, he says. “Everyone recognizes that alcohol is harmful, but you have to live. If one drink a day makes you feel better about life, I’d say great. Make up for it with other ways to prevent dementia, such as getting enough exercise and eating a healthy diet.”
The evidence also continues to mount to take care of your cardiovascular health and hearing, and to socialize as much as possible.
Fortunately, just as it’s never too late to build your cognitive reserve, it’s never too late to improve your systemic health. “Making changes for the better of your health, at any stage, has an impact,” says Clare. “Even if you start exercising when you retire, it still has benefits. Do what you can do at the time – we are never a lost cause.
Who came after Wilson?
Five exercises to build cognitive reserve
Name all the Prime Ministers of Great Britain, from Winston Churchill to the present. Then do them backwards, then put them in alphabetical order – and then separate them by political party.
If you don’t follow politics, list all the players of your favorite football team (or famous teams from history, such as the World Cup winners England 1966 or France 1998) by the position played, or alphabetically.
Go around the supermarket without looking at your shopping list until the end.
Solve puzzles such as Wordle and Sudoku. Restak says it’s helpful to do anything “that can enable or force you to move bits of information around in your mind.”