Iisn’t that sod’s law? Just at the point in our lives when we begin to seriously consider our long-term health and mortality—perhaps after watching older loved ones get an illness like dementia—our responsibilities are piled so high that we can feel like we’re losing us. mental abilities already. The names of our favorite animals and people become an interchangeable word soup. Our keys are becoming more and more elusive. Warnings must be set on all calendar entries.
But how can we tell if this frustrating flimsiness is a reflection of age-related cognitive decline; the early signs of our own approaching dementia; or simply an excessive tax phase from which we will recover? Could it even just be normal forgetfulness? We are not robots after all.
It may be reassuring to hear from neurologist Richard Restak (82), whose new book is How to Prevent Dementia: An Expert’s 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 struggle with memory; you can’t make up names.”
Of course, it’s impossible to completely avoid stressful things, but one you can choose to steer clear of, he says, is worrying about getting Alzheimer’s from mild forgetfulness: “There are examples of people coming out of shopping centers and not being able to remember where they parked the car. Well, it’s just normal forgetting.”
A more troubling version of the story would be, Restak says, “If 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 slight decline in his abilities that comes with age. He remembers a book tour dinner many years ago in which he was introduced to a dozen new people. “I had no trouble remembering the names at all,” he says. “I’m not sure if I could do it today.”
Trouble recalling names is easy to fix, anyway, Restak tells me, “Memory is based on images, not words. So I can take your name, Amy Fleming, and see a picture of you in flames – flame – and so when I see you next, your name will come to me.”
Memory is also often more about paying attention than cognitive deficits. Returning to Restak’s mall analogy, he says that if you have something more interesting than parking lot coordinates on your mind when you arrive, you won’t pay attention to the seemingly insignificant parking lot zone, and therefore won’t have a memory of it. It’s much harder to pay attention to things that don’t excite us.
Signs of a dementia-depleted memory are much more noticeable, says Linda Clare, professor of clinical psychology of aging and dementia at the University of Exeter. “It’s a real gap somewhere that shouldn’t be there,” she says. “My own experience of this was telling my mum that I was going to make 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 it was not just ordinary forgetting.”
Clare remembers another example, of a man who got into the car and couldn’t remember what the controls were for. “It’s those pinching moments that send you to the doctor.” But she admits it’s difficult to draw precise markers, as conditions other than dementia can cause dramatic short-term declines – such as urinary tract infections, hormone imbalances, mini-strokes, depression and anxiety.
If you are experiencing a dramatic memory decline, or cognitive changes that are not normal for you, the usual avenue of investigation would be a visit to a memory clinic, via GP referral.
“We try to encourage people, if they do notice a change in functioning, to go to the doctor,” says Clare. This is partly because other health problems that cause the cognitive symptoms, such as cardiovascular disease that affects blood flow to the brain, can be picked up, but also because drugs can help slow the progression of dementia if taken early.
But let’s backtrack a bit: 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 might want to start by learning new ways to cope with stress. “Try to reduce stress, and cognitive function will improve,” says Restak.
Clare suggests breaking the vicious cycle of worrying about your health by focusing on taking care of yourself. “It’s not always easy,” she says. “Responsibilities don’t go away. But is there a way to get a little more sleep, or have someone give you an hour or two 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 beneficial because it keeps the brain agile and strong, making a dementia diagnosis less likely. “Whatever a person can do to stimulate their mental functioning is a good thing,” says Clare. “We think complex mental activities are protective.”
Not that a mental job is a prerequisite for brain health. Restak’s key phrase for tackling dementia is “cognitive reserve”, which is something you can build like a muscle. He says: “The brain remains highly malleable throughout the lifespan, and cognitive reserve can be built up from childhood and at any time during the next 70 years.”
Having a well-trained brain won’t necessarily prevent dementia, but it can keep you functional longer if you do get the disease. Restak’s top tip is to find something that “interests you viscerally” and enjoy it like a “magnificent obsession: you build on it with books, you go to movies about it – that’s how the mind stays sharp”.
Keeping your brain doing new things, he says, is a way to “form new networks within 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 for you.
Reading novels is another cognitive reserve-building power shift. “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 the story so far in your mind, 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 not a chance in the world that you have dementia.”
Some of the exercises he suggests (see panel, ) will “overstretch anyone,” he says. The medical definition of dementia is a loss of memory, language, problem solving, and other cognitive abilities that is severe enough to affect daily life.
“So if you have enough working memory to learn and, for example, name all the prime ministers since the Second World War, it can be categorically stated that you do not have dementia,” says Restak. “If you don’t follow politics, listing the members of your football team by position, or alphabetically, will do just as well.”
Along with reducing stress and staying mentally active, sleep – especially naps – is your memory’s friend. “Laboratory studies confirm that naps consolidate already learned information,” 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 sleep, hippocampal activity matches the pattern of activity that occurred when we learned the new information .It is called neural repetition.”
However, sleep problems often increase with age. Restak says, “A daytime nap can be helpful in regulating your nighttime sleep.”
None of this advice comes with guarantees. “You can’t take a specific person and predict based on their lifestyle whether they’re going to get Alzheimer’s or not,” Restak says. “A high percentage of it is genetic, but these steps will lower the odds.”
Avoiding too much is another, he says. “Everyone admits that alcohol is harmful, but you have to live. If one drink a day makes you feel better about life, I’d say good. Make up for it with the other ways to prevent dementia – do lots of exercise and stick to a healthy diet, you name it.”
The evidence also continues to mount to look after your cardiovascular health and hearing, and to socialize as much as possible.
Cheers, just like it’s never too late to build up your cognitive reserve, it’s never too late to boost your systemic health. “Making changes to benefit your health, at any stage, has an impact,” says Clare. “Even if you start exercising when you retire, there will still be an advantage. Do whatever you can do at the time – we’re never a lost cause.”
Who came after Wilson?
Five exercises to help build cognitive reserve
Name all the UK Prime Ministers from Winston Churchill to the present day. Then do it backwards, then put it in alphabetical order – and then separate by political party.
If you don’t follow politics, list all the players in your favorite soccer team (or famous teams in history, like the England 1966 or France 1998 World Cup winners) by position played, or alphabetically.
Go around the supermarket without referring to your shopping list until the end.
Tackle puzzles like 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”.
