By Dr. Jim Ferguson
One of the most iconic and intriguing works of modern art is Salvador Dali’s The Persistence of Memory. You may remember Dali’s visionary landscape of his native Catalonia festooned with melting clocks. One art critic described the surrealistic landscape as dreamlike, whereupon awaking the contents of the dream melts away.
Everyone north of fifty has lapses of memory, where content or names just can’t be recalled, and seem to have melted away. Actually, the memories are there, but they’ve been “misplaced,” like your car keys. I think of my memory like a large library, and when I look for a “book” or a memory I have to search the archives. The problem is my librarian (search engine) is slow in computer terms and has a lot of shelves to search. I used to be able to know lots of phone numbers, but this was when most began with 588, 577 or the “exotic” 687 (which I suspected was from Ooltewah). When I get a call these days, I’m clueless of the caller’s origin.
Many patients express to me their fears that memory lapses are due to dementia. I once read a paper which noted that intellectual quickness peaks when we’re about twenty-five years old. This might explain why many scientific advances originate in twenty-somethings. An example is Einstein’s Theory of Relativity, imagined one afternoon as he sat by a roadside intersection. However, lest you despair, the learned experiences from a lifetime more than make up the difference of losses in cognitive quickness. I can testify that I was a fact-filled fool when I was twenty-four. I’m much wiser now even though I’m challenged by phone numbers.
As an internist and geriatrician I have evaluated hundreds, if not thousands, of patients with memory loss or dementia. While it is true that virtually all patients with Alzheimer’s disease have memory loss, lots of patients have memory issues in the absence of dementia. A crucial point is that Alzheimer’s disease affects other areas of function besides memory. Losses in executive functioning are integral in the diagnosis of dementia. These include difficulties in problem solving, planning, self-control and decision making. Additionally, as dementia advances patients may be unaware of their problems, while loved ones see issues of progressive memory loss and impaired functioning. A patient once came to see me with his wife and said, “Doc, I’m fine. I don’t know why I’m here.” All the while his wife was shaking her head and rolling her eyes at his protestations.
A recent posting on Facebook caught my eye. Someone had compiled a list of twenty-five places everyone should visit before they die. I had experienced eleven of those twenty-five places, though I took issue with the list which did not include Crater Lake or rafting the Colorado River through the Grand Canyon. I believe travel broadens the mind, filling it with memories that can be replayed for a lifetime. A now departed relative also believed in travel. In her later years, as she struggled with dementia, she tragically told her travel companions to pay attention to help her remember what she saw.
A recent article in JAMA addressed the concept of cognitive aging, defined as a gradual and highly variable decline in reaction time, thinking and memory which occur over a lifetime. Cognitive aging is not a disease, nor is it a harbinger of dementia like Alzheimer’s disease. The brain ages just like every other part of the body, and some people maintain their physical or cognitive capabilities better than others. We recently attended the Greensboro Open golf tournament and watched fifty-one year old Davis Love III best other, younger golfers including Tiger Woods. Apparently, there’s hope for my golf game because I learned that Mr. Love now drives the golf ball even farther than he did as a younger man.
Studies show that the brains of animals age, just as human brains age. In normal aging it is thought that the ten billion neurons of the human brain don’t die off as they do in Alzheimer’s disease. Animal studies show that neural connections diminish in aged brains. Older human brains have been shown to have diminished levels of the neurotransmitter ACh (acetylcholine). This protein enables neurons to communicate with each other, which collectively we call thinking. We want our neurons to stay connected! Older brains are more sensitive to medications that inhibit already diminished ACh production. On a regular basis I advise older people to avoid agents like Benadryl which diminishes ACh production and can cause confusion – and difficulty urinating.
One of the great concerns of older people is the loss of independence. We’ve all seen older drivers whose reaction times are slower. However, in defense of older drivers, they usually don’t drive fast like teenagers, and there is less probability they are on a cell phone or texting. Older persons may also be at increased risk of fraud, though watching “man on the street” interviews, I’m not very impressed by the disconnected and “uninformed” millennials so often misinformed by the New York Times and other scurrilous news media.
We all want to maintain our physical and cognitive functional status. Therefore, it is imperative to do what we can to promote health. Mini-stokes cause repetitive injury to the brain. These can be lessened by controlling blood pressure and diabetes, and avoiding smoking. Furthermore, being physically active maintains muscle tone and flexibility, and lessens falls. Current science also supports the role of “brain exercises.” Apparently, the notion of “use it or lose it” applies to our brains as well.
There are a number of brain exercises available on the Internet that are superior to just working crossword puzzles. However, just interactive dialogue has been shown to stimulate more areas of the brain than any other activity. As it turns out, simple conversation with other human beings is a better brain tonic than just watching TV, the aptly named “idiot box.”
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