Strategies to Maintain Your Brain Diana R Kerwin

Strategies to Maintain Your Brain Diana R. Kerwin, MD Board Member, Alzheimer’s Association-Dallas Director, Texas Alzheimer’s and Memory Disorders Chief, Section of Geriatric Medicine

Aging Population Increasing population over 65 years – 4% in 1900 – 14% in 1995 – 17% in 2020 Increasing population over 85 years – 3% currently – this will double in next 25 years

Dementia Risk AGE is the most significant risk factor Age 65 - 70: 1 in 50 Age 80+: 1 in 5

Memory Stages Stage one: ENCODING Ability to learn new information Requires attention Focus on important and tune out irrelevant info y l e d i W d e t u b distri rk o w t e n

Memory Stages Stage two: STORAGE New info must be stored in order to remember later

Memory Stages Stage three: Retrieve Finding the right memory when you want to

Memory Stages - Recap stage one: ENCODING stage two: STORAGE stage three: RETRIEVE

What Is Dementia? Dementia is a clinical syndrome. It may be defined as a loss of cognitive functions significant enough to cause functional disability in everyday life. It can be caused by Alzheimer’s disease, Frontotemporal dementia, Vascular infarcts etc. Primary Progressive Aphasia Alzheimer’s disease Vascular dementia Lewy Body disease Frontotemporal dementia Etc. Do not replicate or redistribute this material without permission

Signs of Alzheimer’s Disease • Memory Loss that affects daily life • Challenges in planning problem solving • Difficulty completing familiar tasks at home, at work or at leisure • Confusion with time or place • Trouble understanding visual images and spatial relationships • Problems with words in speaking or writing • Misplacing things and losing the ability to retrace steps • Decreased or poor judgment • Withdrawal from work or social activities • Changes in mood and personality • Alzheimer’s Association 2010

Facts and Figures As many as 5. 4 million people in the US are living with AD Every 69 seconds, someone develops AD. AD is the 6 th leading cause of death Age is the biggest risk factor At Age 85, almost 50% of the population has Alzheimer’s disease By 2030, 7. 7 million people over age 65 are projected to have Alzheimer’s disease *2010 Facts and Figures, Alzheimer’s Association

Dementia Stage One: Encoding Stage Two: STORAGE Stage Three: Retrieve

Preclinical Dementia Disease is confined to the memory areas in the temporal lobes Memory loss is the first symptom

Mild to Moderate Dementia Disease begins to spread throughout the brain Symptoms broaden and may include confusion, word finding, changes in judgment and mood

Disease Stages • EARLY STAGE: Refers to the beginning of the disease process. Individuals often remain independent in many aspects of their lives and care. • MIDDLE STAGE: Greater difficulty performing complex tasks and planning. Less aware of changes. Increased confusion. Need increased assistance and supervision. Become more withdrawn, especially in socially or mentally challenging situations • LATE STAGE: Needs assistance with all activities of daily life, eating, bathing, etc. In the final stage of this disease, individuals lose the ability to respond to their environment, to carry on a conversation and, eventually, to control movement.

If it’s not dementia, then what is the cause of my memory problems?

Good News… • Not all forgetfulness is caused by dementia • Not all forgetfulness among seniors reaches the severity of dementia • Significant memory loss is not an inevitable result of aging • Produce more brain cells • Brain training and new learning can occur at any age • Treatable, even reversible conditions

Other Considerations Medications Thyroid/metabolism (confusion or sluggish) Vitamin deficiency (B 12, folic acid) Alcoholism Environmental Poisons/toxins Other systemic illnesses (infections, diabetes, liver disease, cardiovascular, pulmonary) Psychiatric conditions Sleep Disorders Hearing loss

Forgetfulness Forgetting where you left things Trouble remembering what you just read Walking into a room and forgetting why you entered Not quite being able to retrieve info you have on the “tip of your tongue” (cues) Slower to process information (repetition) Slower to recall names, faces, and locations

Maintain Your Memory

• Laura feels great. She enjoys gardening, playing cards with friends on Tuesdays and Fridays at the senior center, and taking a water aerobics class at the city indoor pool. She turns 78 this year, but feels like she’s still in her thirties.

“STEPPIN” • • Sleep Think Exercise Psychological well-being Positive Attitude Interact Nutrition

SLEEP Your Personal habits Fix a bedtime and an awakening time Avoid napping during the day (30 minutes early afternoon) Avoid alcohol 4 -6 hours before bedtime Avoid caffeine 4 -6 hours before bedtime Exercise regularly, but not before bedtime Your Sleeping Environment Getting ready for bed

THINK USE IT OR LOSE IT!! Learn to play a musical instrument Play games that involve strategy (cards, scrabble, crosswords) Get in habit of learning new things (recipes, driving routes, tech. ) Start a new hobby (gardening, volunteering) Take a course in an unfamiliar subject (foreign language) Take on project that involves design and planning (quilt, garden)

EXERCISE Staying active can help you: Keep and improve your strength so you can stay independent Have more energy so that you can do the things you want to do Improve your endurance, strength, balance flexibility Reduced the risk for disorders that lead to memory loss Perk up your mood and reduce depression

Exercise may alter risk of dementia and improve cognitive function

Archives of Neurology 2001 • 4, 600 cognitively normal Canadians 65 years or older followed for 5 years • Physical activity measured from questionnaire 50% reduction! none low mod high

PSYCHOLOGICAL WELL-BEING Cortisol, the stress hormone, can damage the hippocampus Minimize stress / prayer and religious activity Relaxation techniques: yoga, deep breathing, imagery Pleasurable activities: listen to music, read Learn to say “NO” (work on one thing at a time)

POSITIVE ATTITUDE Thoughts and feelings affect memory “My memory stinks” “I always forget important information” Fear and lack of confidence to excel in learning new skill Be aware of your negative self-statements Can cause emotions that can be distracting “I must remember everything” Accept “senior moments” Stay motivated!

INTERACT People who don’t have social contact with family and friends are at higher risk for memory problems than people who have strong social ties Socialization helps brain function in several ways: often involves activity that challenges the mind minimizes stress and depression Senior center Book club Reconnect with old friends

NUTRITION Balanced Diet Carbohydrates from food high in fiber and low in refined sugar fruits, veggies, whole grains (NOT ice cream, candy, cake) Fruits and vegetables are high in antioxidants colorful fruits and vegetables Avoid saturated fats and trans fats helps control cholesterol levels and reduced risk of stroke (omega-3 fatty acids are good) Water prevents dehydration

NUTRITION • Specific Dietary Recommendations • Mediterranean diet • Foods rich in B vitamins – B 12 -clams, mackerel, beef liver, beef, eggs, swiss cheese, tofu, crab • Cold water fish as protein and omega 3 FA source • Choline from nuts • Coconut oil? What is the evidence • Vitamin E and C rich foods – Almonds, kale, pumpkin seeds, parsley, papaya

Optimize Memory General Tips • • Focus on diet and exercise Incorporate more physical activity into every day activities Reduce distractions in the environment Avoid multi-tasking; focus on one thing Take your time Ask for repetition (e. g. , names) Actively use all senses to aid in detail of memory

Optimize Memory General Tips Use external memory aides: date book/calendar/appointment book/address book make lists (“to-do”, grocery list) put a bulletin board in a centrally located area labels pill box alarms (e. g. , cooking, use automatic shut-off appliances) maps orientation center / structure environment (belongings) object cues (e. g. , letter to mail) Pick strategies that work or you!!

Fourth Tuesday of the Month Memory Care Partners Group Tuesday, April 22 nd 11: 00 -12: 00 THRU