Life and Memory Center

It’s never too early to start monitoring and measuring cardiovascular and brain/memory functioning. It’s never too early to start a life plan to protect your heart and your brain. Recent results from the Whitehall II study indicate that cardiovascular risk profile in midlife predicts later cognitive decline. Cardiovascular risk was calculated from the Framingham General Cardiovascular Risk Profile (which you can look up online). The Framingham profile includes age, sex, total cholesterol, HDL cholesterol, smoking status, systolic blood pressure, and medications for blood pressure.

The Whitehall II study was begun in 1985-1988 and recruited 10,308 civil servants in London. The participants were aged 35-55 at the time. The most recent findings were based on 3486 men and 1314 women who were free of cardiovascular disease at entry into the study and had an average age of 55. Cognitive function (i.e., reasoning, memory, etc.) was assessed upon entry into the study and again after 5 and 10 years. The results indicated that higher cardiovascular risk was associated with an overall decline in cognitive skills in both men and women. Furthermore, cognitive decline was less in those treated with anti-hypertensive medications. These findings continue to reinforce the fact that the brain is tied to the heart. What’s good for the heart is good for the brain.

The good news is that we can all reduce the rate of cognitive changes we experience by early life style interventions if we begin them at least as early as middle age (in our 40s and 50s). Cardiovascular disease has a number of risk factors such hypertension, diabetes, and hyperlipidemia. We can manage all of these risk factors by first monitoring them over time and secondly by life style – which we control. We don’t start saving for retirement when we are in our 80s. We start early in life. The same principle holds for protecting your memory. Manage your cardiovascular risk. Start today.

I have already put my memory and cardiovascular plan into effect years ago as I have a family history of diabetes and stroke. Rather than taking unproven supplements, I have put the following plan into effect:

• Put together a Durable Power of attorney and Living Will in my early 50s.
• Exercise vigorously at least four times a week and have done s since I was 40.
• Eat healthy foods 80% of the time.
• Monitor my blood sugars.
• Monitor my blood pressure and cholesterol.
• Take anti-hypertensive medications to manage my blood pressure.
• Monitor my short term memory regularly and use external memory aids liberally.
• Get lots of mental stimulation doing the things I enjoy.
• I am working on having better cardiovascular and memory function ten years from now by sticking to my plan.

Lewy Body Disease is the second most common cause of progressive dementia after Alzheimer’s disease affecting over 1 million in the U.S. Dr. Frederich discovered aggregates of proteins in the brain stem that deplete a neurotransmitter known as dopamine. This causes Parkinson’s symptoms and the abnormal proteins are known as Lewy Bodies. In some persons, Lewy bodies diffuse out of the core brain structures to other areas of the brain causing diffuse Lewy body disease.

Lewy Body disease is a progressive brain disorder characterized by decline in short-term memory (not as prominent as in Alzheimer’s disease), visual hallucinations (but other types of hallucinations may occur), movement disorders (e.g., slowness of movement or speaking, shuffling feet, walking stiffly, falls, blank stare), delusions (false ideas about another person such as partner having an affair), sleep disorders (e.g., movement, gesturing, speaking during sleep or confusion at awakening), and fluctuating cognition (episodes of acute confusion leading partners to think they are faking).

Like with Alzheimer’s disease, the cause of Lewy Body disease is unknown. Risk factors include being older than 60, being male, and having a family member with Lewy Body disease. A recent study published in the European Journal of Neurology suggests that having Attention Deficit Disorder may also increase the risk of developing Lewy Body disease. Nearly half of the study participants with Lewy Body disease had prior symptoms of Attention Deficit Disorder, whereas only 15% of either those with Alzheimer’s disease or healthy controls had preceding symptoms of Attention Deficit Disorder. This finding needs further exploration but does not mean that those with Attention Deficit Disorder will become demented but rather that they need to monitor their memory as they age.

The distinction between Alzheimer’s disease and Lewy Body disease is important for two reasons. First, persons with Lewy Body disease may respond better to medications such as Aricept, Exelon, and Razadyne than those with Alzheimer’s disease. Second, many with Lewy Body disease are especially sensitive to antipsychotic drugs used to treat hallucinations and delusions.

Assessment for Lewy Body disease is the same as for Alzheimer’s disease and should include both medical and neuropsychogical evaluation and should focus on early detection of changes especially in those at higher risk. The course of treatment needs to be proactive and use of antipsychotic drugs needs to be undertaken with great care. Lewy Body disease is often underdiagnosed and less familiar to professional and lay persons alike. Support services such as the Alzheimer’s Support Network of the Parkinson’s Association of Southwest Florida can offer help and support.

Alzheimer’s disease is characterized, first, by a slowly progressive decline in short-term memory and, later, a decline in other brain skills. Mild cognitive impairment is characterized by a milder decline in memory and is the precursor of more severe memory loss in some. A recent study from the Rush Alzheimer’s Disease Center was published in Archives of Neurology. The results demonstrated that by current diagnostic standards, mild cognitive impairment is preceded by a 7 year decline in short-term memory. As with any potentially progressive disorder (e.g., diabetes, cancer) treatments are more effective if started as early as possible.

The Rush study consists of more than 2000 elderly individuals who had their memory and other thinking skills assessed annually since 1994 and 1997. In other words, the study treated memory like we treat medical evaluation. Most of us have annual evaluations by our physicians during which we are interviewed, given a physical, and have lab work.

The Rush study did annual evaluations of memory for its participants. Memory was evaluated – not screened – by rigorous assessment that first produced a baseline measure of memory strength. Then each year memory was again measured and compared to the first assessment just as blood sugars can be compared during annual physicals. This allows you to be compared to yourself rather than group norms. This is a very sensitive method of measurement that allows you to detect changes in memory very early when you can do something about it.

I recall one lady who I assessed because her mother had Alzheimer’s disease and she wanted to be proactive about her future. On her first testing, she was able to recall all 16 words from the memory test – a rare occurrence in the several hundred memory evaluations that I have completed. Over the next ten years, she showed a progressive pattern of decline in short term memory to the point where she had an average memory for her age rather than a superior one. We would never have known if we hadn’t done multiple assessments. We developed a personalized treatment plan that included life planning and progressive shoring up of her short term memory. She was very pleased with both the process and the outcome.

The good news is that the earliest changes for those who will develop Alzheimer’s disease will occur in short term (new learning) and working memory (multi-tasking) and occur years before current medical methods can detect them. These memory skills can be measured and followed over time – just like with serial medical assessments for blood sugar, thyroid function, etc. Don’t fall into the trap of thinking there is nothing you can do for memory loss. There is so much you can do if you measure early and track your memory over time. My associates, Dr. Steve Saldukas and Dr. Karen Bilter, and I continue to be available for assessments. We are also developing treatment programs to help not only those with changes in memory but also for those who are their partners.

What can I do for my memory? That’s a question that I am asked many times a week. Let’s assume that your memory is not declining. In other words, you have a normal memory. There are two types of exercises you can do to improve your memory. First, you can exercise by doing memory or cognitive training. There are two types of cognitive training. You can do challenging mental activities such as computer mental training programs, do crossword puzzles, memorize phone numbers, play bridge, or learn a new language. You will improve your ability to do any of the tasks that you choose. Your brain needs these types of stimulation and they add joy to your life. However, they do not help you find your car in the parking lot or help you recall your appointments.

Cognitive training is also the use of memory supports. Learn to use your calendar effectively as a memory aid. Always put your keys, glasses, and wallet in the same place. Use strategic post-it notes. Take organized notes. Use timers to remind yourself of when you need too do things like take medications. Leave a message for yourself on your cell phone. Have a take-way spot for those things you want to remember to take with you like grocery lists. In short, plan on how you will remember.

Second, get moving. Moderate exercise improves memory in “older” adults. A recent study recruited “sedentary” adults aged 60 to 80 who exercised less than 30 minutes per week. Participants were randomly assigned to either a group that engaged in toning and stretching or a group who were given a program of walking. Persons in the exercise group started on a progressive walking program for 10 – 15 minutes at a time and progressed to brisk walking for about 40 minutes three times a week. The study lasted a year. Both groups had similar memory performance at the beginning of the study.

By the end of the year, the aerobic exercise group improved scores on memory testing. They also showed increased volume of the hippocampus (an essential brain structure for short term memory). The group who did stretching and toning for a year performed worse on the memory tests and displayed decreased volume of their hippocampus.

There is hope for all of us who are getting older. We can make our brain work better by exercising it. Exercise your long term memory skills be learning and being stimulated by activities that you enjoy and stretch you mind. Also, train yourself to use practical external memory supports that manage short term memory. Finally, help your memory by aerobic exercising on a regular basis for at least 40 minutes at a time three times per week.

Dr. Beckwith is a neuropsychologist, speaker, and author of Managing Your Memory: Practical Solutions for Forgetting. He has an office in Naples and can be reached at memoryseminars@aol.com or (239)851-1968. Visit Dr. Beckwith on Facebook at the Life and Memory Center or at www.lifeandmemorycenter.com. Join Dr Beckwith for breakfast at Arden Courts in Naples on March 24. Call 417-8511 for reservations.

Delirium is a frequently encountered form of confusion that is very frightening to family and friends as well as to the delirious person. Delirium presents as a sudden and often severe confusion as a result of severe medical illness, medication, surgery, hospitalization, or drug or alcohol abuse. Delirium occurs in 10-20% of hospitalized adults, 30-40% of hospitalized elderly, and up to 80% of those in ICU. Delirium is especially prevalent in persons who are demented.

Delirium and dementia are often confused. However, the differences are important to know. Dementia is an irreversible deterioration of mental skills and may be sudden in onset such as with stroke, head injury, or brain tumors. Dementia is more often a slow progressive decline over the course of months to years such as with Alzheimer’s disease. Delirium is sudden and reversible but may last for a few hours or as long as several weeks or months.

A major risk factor for developing a delirium is being demented. The dementia may be mild and/or undetected, which adds to the surprise when a delirium develops. Those who are demented need to be monitored more carefully for risk factors for delirium especially as they age. Potential triggers for delirium are visual or hearing impairment, poor nutrition, dehydration, terminal illness, multiple medical problems, medications, multiple medications, surgery, sudden severe illness, infection (especially watch for urinary tract infections in elderly and demented), hospitalization, being moved to a new living arrangement, being placed in an intensive care unit, and alcohol or medication withdrawal.

Medical treatment for delirium includes managing the underlying causes such as stopping suspect medication or treating an infection. It is helpful to make sure that fluids and nutrition are provided. Hospitals or moving to a new living arrangement can often trigger a delirium. Avoid or minimize room changes and use of restraints. Minimize use of psychotropic medications and discontinue as soon as the underlying condition improves. Provide adequate light and opportunities for natural light. If possible, keep the delirious person in a familiar environment with familiar caregivers. If they must be hospitalized, have them returned to their home environment as soon as possible.

When interacting with someone with a delirium be calm and reassuring. It is critical to approach the confused person from where they can see you coming, identify yourself, and address them by name. Avoid confrontation and arguments. Be reassuring and don’t deny their reality. Don’t try to use logic or long explanation, as the person is confused and will not understand. Keep noise and distraction to a minimum. Provide orientation such as referring to a clock or calendar often if needed.

If you are a partner or caregiver for a delirious person, the good news is that the delirium clears with time after the cause has been resolved. It is often helpful to get support for yourself during this traumatic time.

I was on “Sound Off With Sasha” (FGCU radio) and asked how Google influences memory. In order to answer this question, I need to describe some types of memory as memory is not a unified skill but rather a large number of skills and processes.

There are four basic types of memory. First, there is sensory memory which registers sound, touch, images, etc. It is very brief and cannot be trained. Second, there is working memory which briefly holds information and constantly decides what will be important and what moves on to longer storage. This is basically multitasking and is closely related to attention and works best when we are doing one thing at a time (our brains do not parallel process very well or driving while texting would not create problems). Third, is short-term memory which is not a time but rather a process. Short-term memory is the process whereby the brain learns or “consolidates” information into long-term memory. This is why we take notes, rehearse, and practice. Finally, long-term memory is the ability to have access to information at a later time than when it was originally encountered. Long-term memory works like a muscle, the more you use it the stronger in becomes.

Our memory systems and skills evolved long before computers and Google. We have a long and creative history of inventing tools to extend our limits. For example, we have telescopes and microscopes to extend sensory memory. We have books, Post-It notes, journals, recorders, timers, smart phones, and computers to augment our short term and working memory. The problem is that technology has vastly expanded our ability to create information and data. The maximum value for learning new information is set by a memory system that evolved thousands of years ago not by advances in technology.

The limitation is human memory. We can take in at best about seven new pieces or chunks of information at a time. Furthermore, there are limits on our attentional resources. We can only bring in new information at a fixed rate which may change as we tire or become bored. Multi-tasking distracts us. For example, we remember 10% few facts from a new story if there is a scrawl at the bottom of the screen. Finally, recall takes more effort than recognition. That’s why many prefer multiple choice tests to essay tests.

Google is a wonderful tool for finding massive amounts of information quickly and it is faster than thumbing through resource books. However, remembering information takes time and effort. Our ability to find information far exceeds our ability to review, understand, and recall information. As Nicholas Carr (The Shallows) put it: “The problem today is that we’re losing our ability to strike a balance between these two very different states of mind” that is finding information and pondering on it. Formation of memory needs time for understanding and reflecting. Has Google caused us to develop a technologically driven attention deficit disorder?