Real Simple November 2023How to Do Things

HEALTH
Dude, Where’s My Car? For the (ahem) mature set, this may be a familiar refrain, right along with “Did I lock the door?” and “Why did I walk into this room again?” In case you’re feeling more forgetful these days, one health writer of a certain age takes a look at what’s normal, what’s not, and how you can shore up your wayward memory. BY AMY CONWA
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RECENTLY A MIDDLE-AGED friend of mine joked that he doesn’t need to buy any more novels—he barely remembers the ones he’s already read, so he can just pick one off his shelf and start fresh. Another friend had to do calculations to figure out whether she was turning 52 or 53 (or maybe 54?). We’re at that stage where we’re forgetting names and looking for the reading glasses that are on top of our heads. While we’re laughing, we’re also wondering: Is this something I need to worry about? After more than a few of these discussions, I started to dig into the research and talk to some experts. I am a health editor, after all, and at this point in my life, a lot of my work starts with my own aches and pain points (physical and mental).

The most reassuring thing I learned: Some forgetting is normal at any age. When you were in your 20s, you occasionally lost an actor’s name and where you put your rain boots—you just didn’t stress about it, because aging and Alzheimer’s disease weren’t on your radar. We’re not meant to remember every little thing, says Lisa Genova, PhD, a neuroscientist and the author of Remember: The Science of Memory and the Art of Forgetting. “Think of the sheer amount of data that comes in through our eyes, ears, nose, and emotions. If you picture that on a whiteboard, by the end of the day it would just be too cluttered.” For the sake of efficiency, our brains are more likely to remember what’s meaningful, moving, surprising, or new—the things that grab our attention —as opposed to mundanities like whether we washed the lights or the darks first last week. And it’s normal to have memory blips more often as the years tick by because, like every other part of our bodies, the brain changes with age, says neuropsychologist Jessica Caldwell, PhD, director of the Women’s Alzheimer’s Movement Prevention Center at Cleveland Clinic in Las Vegas. “Around midlife and as we age into our 60s, 70s, and beyond, most of us lose a bit of cognitive sharpness,” she says.
To understand what’s happening (and worry a tad less), it helps to know a little about how our brains store and retrieve information. Imagine that memories are made out of building blocks, says Andrew Budson, MD, chief of cognitive and behavioral neurology at VA Boston Healthcare and coauthor of Why We Forget and How to Remember Better. When you meet someone new, you don’t take a mental video of the entire interaction to access at a later date. Instead, your frontal lobe breaks the experience down into those building blocks—what the person looks like, what you’re thinking at the time, the sounds and smells around you. Then your hippocampus (a part of the brain associated with memory, learning, and emotions) makes a “sketch” of all those pieces together. When you want to retrieve the memory, your brain uses the sketch to reassemble the necessary building blocks.

Now imagine there’s an older construction worker in your brain who can’t build as easily as they used to. “They can still do it, but it’s going to take longer,” Budson says. “And it’s easy for errors to creep in, when blocks get omitted or misplaced.” So if you’re heading into middle age or already solidly there and you occasionally call the food processor “that choppy thing” or forget your flu shot appointment, it’s normal.

But while it’s fine to misplace your keys once in a while, it’s more troubling if you can’t find your way to a familiar destination, or if you have a hard time following a TV show or conversation, paying bills, completing simple tasks (like setting the table), or remembering skills you’ve already learned. People with cognitive disorders often have problems using devices they’ve previously mastered, like the TV remote or their phone. Behavioral changes are also something to note: If someone who’s always been hyperorganized starts to regularly spend 15 minutes hunting for their wallet, that could be a red flag.
If you experience these issues or notice them in a loved one, see a health care professional for an assessment. One possible diagnosis is mild cognitive impairment (MCI), which means there’s a slight deterioration in a person’s memory and thinking but they’re still able to perform day-to-day functions on their own. Dementia is a more severe form of cognitive decline, in which the ability to remember, reason, think clearly, and interact socially is so impaired that a person’s daily functioning suffers. Note that   dementia is not a diagnosis but a group of symptoms or conditions. Alzheimer’s disease is a diagnosis, and the most common cause of dementia.
MCI can progress, stay about the same, or improve. According to Budson, studies show that half of people with MCI will develop Alzheimer’s or another cause of dementia. The other half may remain stable or get better, especially if a root cause can be identified and treated. Some things that can cause MCI? Stroke, depression, Covid, a head injury, thyroid problems, and nutrient deficiencies.

As with most health-related situations, there are some tools you can put in your tool kit. They’re called neuroprotective habits, and you can boost your brainpower by incorporating them into your life at every stage, even if you have MCI or Alzheimer’s. They won’t stop the progression of disease, but they can at least help stave off the symptoms. Dividing Rule

If you’re heading into middle age or already solidly there and you occasionally call the food processor “that choppy thing,” it’s normal.
  Be a Lifelong Learner The old school of thought was that humans were born with nearly all the brain cells we’d ever have. In recent decades, research has shown that we have the gifts of possible neurogenesis (the creation of new brain cells) and neuroplasticity (the formation of new neural connections) as we age. “Neuroplasticity is really good for our memory today, and for building what’s called a cognitive reserve,” Genova says. “We build neural pathways every time we learn. So, if something happened in your brain, like a head injury or a mild stroke, you’d have extra neural connections that could detour any roadblocks.” Learn a language, try a new instrument, play word games, or pick up a hobby. “It has to be something that pushes you past your comfort zone, and that you like enough to keep at,” Caldwell says. If you include friends, even better: Social connections can be protective, says Michael Rosenbloom, MD, associate professor of neurology at the University of Washington. “In groups, you have to pay attention and follow conversations,” he says, “which forces you to keep your brain active.”

Get MovingRegular exercise fuels the physical and mental fountains of youth. Studies have shown that aerobic activity can improve memory and cognition and reduce the risk of dementia. Research shows that exercise increases our levels of a protein called brain-derived   neurotrophic factor, which helps support the survival of existing brain cells and encourages the growth of new brain cells and their connections. Aerobic exercise can also lower blood pressure and reduce the risk of diabetes, further benefiting the brain. Genova recommends brisk walking for at least 30 minutes, four or five times a week. Swimming, cycling, or dancing can do the trick too.

Don’t Skimp on Sleep Sufficient sleep—at least seven hours a night for most adults—is essential. During sleep, the brain locks in memories of the day’s events and clears toxins, such as beta-amyloid proteins, which can accumulate and form the plaques associated with Alzheimer’s. Plus, sleep deprivation makes it difficult to focus, which means it’s harder to take in information or clearly remember events later.

Feed Your Mind Loaded with leafy greens, berries, whole grains, nuts, olive oil, and fish, both the Mediterranean diet and the Mind (Mediterranean-Dash Intervention for Neurodegenerative Delay) diet   are thought to slow cognitive decline and reduce the risk of Alzheimer’s. One recent study from the National Institute on Aging suggested that for those who already have Alzheimer’s, these diets may help protect the brain from further damage.

As for alcohol, having one drink a day isn’t necessarily harmful, Budson says, but two or more can be. And, he adds, “if you have even a single drink, you’re not going to remember things as well.”

Pay Attention! If you’re forever losing your phone or bag, it’s possible you’re just preoccupied and you aren’t giving your brain a chance to make the connections in the first place. Next time you put an important item down, Genova suggests, visually note where you’re placing it. You can even say out loud, “I’m putting my glasses on the counter!” Odds are much better you’ll zero in on it when you need it.

Another scenario that’s probably familiar: walking into a room and forgetting why you’re there. You went to the bedroom to read, say, but realized you left your glasses in the kitchen. You go back to the kitchen and…hmm, did you want a cup of tea? A snack? You return to the bedroom and boom— you remember the glasses! That’s because, in the bedroom, you see glasses-related cues, like the book and bedside lamp. The kitchen setting sent you down a food-and-drink path, outside the “neural neighborhood” of glasses, so you couldn’t retrieve the thought. When you forget why you’re in a room, Genova advises, think, Where was I before? Then go back, physically or mentally, and look around. The cues you see should bring back that fleeting memory.

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MEMORY & MENOPAUSE

Estrogen affects not just our bodies but also our brains, offering a number of neuroprotective benefits. “It influences brain areas responsible for memory, mood, and cognitive function,” says Lisa Mosconi, PhD, director of the Weill Cornell Women’s Brain Initiative at Weill Cornell Medicine in New York City and author of the upcoming book The Menopause Brain (out next March). That means, yep, thanks to fluctuating or declining hormone levels, both perimenopause and menopause can impair memory. “Brain fog, characterized by forgetfulness or difficulty concentrating, is a very common complaint,” Mosconi says. “For some women, this can be so unnerving that they fear it may be an early sign of dementia.” Take heart: It usually improves over time as the brain adjusts to the hormonal changes.

You can help mitigate the effects with the usual roundup of healthy habits—regular exercise, good sleep hygiene, stress management, avoiding smoking and excessive alcohol, and filling your grocery cart with fruits and vegetables. “One of my top tips is to eat more plants,” Mosconi says. “Plant foods are packed with nutrients beneficial for both brain and hormonal health.” Salad tonight?
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