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Memory and Aging: What Everyone Should Know

Memory and Aging: What Everyone Should Know. Brent P. Forester MD, MSc Director, Mood Disorders Division, Geriatric Psychiatry Research Program McLean Hospital Assistant Professor of Psychiatry, Harvard Medical School. Outline. Cognition and Normal Aging: Background

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Memory and Aging: What Everyone Should Know

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  1. Memory and Aging:What Everyone Should Know Brent P. Forester MD, MSc Director, Mood Disorders Division, Geriatric Psychiatry Research Program McLean Hospital Assistant Professor of Psychiatry, Harvard Medical School

  2. Outline • Cognition and Normal Aging: Background • When Memory Loss becomes Problematic: Mild Cognitive Impairment (MCI) and Alzheimer’s Dementia 3. Healthy Brain Aging Tips 4. Unique Role of McLean Hospital in addressing questions of the aging brain

  3. The Graying of America WE ARE HERE

  4. Successful Aging • 94 year old woman, widowed • Living at a continuing care retirement community • History of depression • Now with mild memory complaints • PhD in psychology • Trying to get her dissertation published on Sigmund Freud’s introduction to America

  5. Risk Factors for Memory Loss • Age • Obesity • Sedentary Lifestyle • Hypertension • Hyperlipidemia • Diabetes • Alcohol and other Substance Abuse • Depression, Stress

  6. Mechanisms For Memory Loss • Inflammation • Heart Disease • Genetics

  7. Treatable Causes of Cognitive Decline • Vitamin B12 or folate deficiency • Underactive thyroid • Unstable medical problems: diabetes, heart failure • Fluid accumulation in the brain • Medication side effects: Tylenol PM • Excessive alcohol consumption

  8. Memory Changes with Middle Age: 35-55 • Brain becomes more efficient at processing information • Misplace keys and glasses BUT… • Improved managerial skills, seeing big picture, figure out novel ways to solve complex problems Small and Vorgan. The Alzheimer’s Prevention Program. 2012.

  9. Memory Changes with Aging: Beyond age 55 • Forgetfulness • Slower processing of information • Learning and recall is slowed down

  10. Mild Cognitive Impairment (MCI) • Memory decline on at least one standard memory test • Functioning is normal • 10 million in US over the age of 65 • 10-15% per year convert to Alzheimer’s Disease

  11. Alzheimer’s Disease • Alzheimer’s disease (AD) affects about 5.4 million Americans¹ • Most are aged 65 years and older, with prevalence reaching nearly 50% at age 85 and older1 • New AD diagnosis every 70 seconds • AD patients typically live about 7 to 10 years after diagnosis2,3,4 1. Alzheimer’s Association. Alzheimer’s Disease Facts and Figures. 2007. 2. Taylor DH, et al. J Am Geriatr Soc. 2000;48:639-646. 3. Bracco L, et al. Arch Neurol. 1994;51:1213-1219. 4. Walsh JS, et al. Ann Intern Med. 1990;113:429-434. 11

  12. Alzheimer's Normal Tim Wheelock Brain Bank, McLean Hospital

  13. Alzheimer’s Disease, Amyloid Plaques Tim Wheelock Brain Bank, McLean Hospital

  14. Neurofibrillary Tangles Tim Wheelock Brain Bank, McLean Hospital

  15. Risk for Alzheimer’s Disease • Age • Family history • Genetics – APOE 4 • Down’s Syndrome • Depression • Cerebrovascular factors – diabetes, high cholesterol, hypertension

  16. Alzheimer’s Disease: Redefining the Criteria • Pre-Clinical Alzheimer’s Disease • MCI of Alzheimer’s Disease • Dementia due to Alzheimer’s Disease

  17. Steps to Improve Memory as We Age • Memory Training • Nutrition • Exercise

  18. Memory Training and Brain Fitness • Practice memory techniques • Games, puzzles, new approaches to daily activities • Education

  19. Look, Snap, Connect • Look – actively observe/pay attention to what you want to learn • Snap – create a mental snapshot or picture of the information (real or imagined) • Connect – bring two mental snaps together Small and Vorgan 2012

  20. The Mediterranean Diet Associated with improved cardiovascular health, reduced risk of dementia and depression (30%)

  21. Healthy Brain Diet • Limit caloric intake, avoid processed foods • Moderate caffeine and alcohol intake • Omega 3 fatty acids – reduce risk for heart disease, stroke and cognitive decline • Antioxidants – limiting damage from free radicals • Vitamin E – 400-800 IU/day • Vitamin C – 500-1000 mg/day

  22. Exercise • Exercise at mid-life reduces subsequent risk of dementia1 • Increases brain cell growth in animals2 • Increases brain blood flow in humans3 1. Andel, 2008; 2. Gage 2002; 3. Rolland 2008

  23. Tips for Successful Aging • Healthy brain and heart diet • Minimize stress • Mental and physical aerobics • Plan for retirement • Maintain social relationships • Attitude is KEY • Assess and treat memory problems early on

  24. Geriatric Psychiatry Research at McLean Hospital • Well situated to study common late life psychiatric disorders (depression, anxiety, dementia) • Large clinical population: inpatient, outpatient, community • Collaboration among clinical programs, McLean Imaging Center and the Mailman Research Center • Use advanced technologies to explore behavioral symptoms and syndromes that reflect the effects of aging and physical illness on brain function

  25. Examples of Brain Imaging Techniques at McLean Hospital

  26. For Further Questions For further questions or comments Dr. Forester can be reached at: McLean Hospital Geriatric Psychiatry Program 115 Mill Street Belmont, MA 02478 (617) 855-3622 bforester@partners.org

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