Can't remember what's its name? Senior moment or Alzheimer's?
Little yellow and blue flowers peeped out of melting snow, you snapped your fingers, trying to remember their name. Halfway to the gym, you turned around because you weren’t sure if you unplugged the iron. A trip to Aldi, you got three bags of groceries, everything except the one thing you actually needed: half-and-half.
How much forgetfulness is healthy? Given that I’ve just described my last week, let’s go there.
Alzheimer’s disease (AD) accounts for the majority of dementia cases. Luckily, the age-specific cases are on the decline, have been for decades. In a 2017 JAMA article, Americans over the age of 65 diagnosed with dementia had decreased from 11.6 percent in 2000 to 8.8 percent in 2012. But with more people living longer, total cases are increasing.
Hereditary AD is rare, but hits young: before 65. In the Rotterdam Study, the average age of dementia diagnosis is 82. But memory problems start 16 years earlier.
The kind of memory loss associated with AD is insidious, progressive. Grandpa tells his favorite story. Years ago, he bought a three-pronged, plastic cactus lamp for $2.75 from Goodwill (“a highway robbery!”). While cleaning it, he found a wad of cash, $362 to be exact, hidden in the stem. What he forgets – he just told that story 15 minutes ago. Other signs of cognitive decline may be loss of motivation, organization, insight.
To work up dementia, doctors do blood tests, brain scans and psychiatric evaluations. What they’re looking for are treatable causes of dementia: thyroid problems, nutritional deficiency, depression, strokes. AD, like Parkinson’s disease, is diagnosed based on characteristic clinical findings, not tests. Even an autopsy isn’t definitive; one-third of people over 85 without dementia have degenerative brain changes consistent with AD.
The risk factors for AD are everything doctors warn you about: smoking, diabetes, obesity, hypertension, pesticide exposure, sedentary lifestyle … getting old.
However, there isn’t a single intervention that’s been proven to prevent or slow AD. Exercise and a healthful diet are promising. Cognitive training, vitamins, gingko biloba, hormones, drugs don’t work.
In a New York Times interview, David Holtzman, a neurologist who’s studied AD genes for 25 years, was asked if he’d tested himself for AD. “Why do it,” he said, “when there is no drug or lifestyle strategy that is absolutely guaranteed to protect the brain?”
Here are my recommendations.
First, make lists. Get organized. Grocery list, to-do list, bucket list. Also update your will and advance directive – every grownup should.
Second, exercise, buy broccoli in three-pound bags, take naps, have a group of close friends to grow old with. Last week, Janet, my writer friend, reminded me these early spring flowers are crocuses. The blackish birds that shroud my neighborhood in late falls are starlings. She sent me a video of murmurations. It’s living poetry.
Still need a jolt of calm, reassurance? Click on the news. Somewhere, some dictator, politician or celebrity had just said or done something asinine that’s bound to make you feel like a beacon of common sense, genius.