This blog post was an article I originally wrote for appc.ca and is based on a workshop I delivered with my mentor Dr. Gail Eskes.
By now, we have all heard that we are an aging society. However, it is worth taking a moment to reflect on exactly how aged we are becoming. According to Statistics Canada 1 in 7 Canadians are over the age of 65.
By 2036, 1 in 4 Canadians will be over the age of 65 (“National Seniors Day… by the numbers”, 2015). According to the Population Reference Bureau, this is a global phenomenon, not a national one (Haub, 2011). So, attending to the needs and concerns of older adults is becoming a necessity, not a choice!
My experience as a researcher and a clinician has made it clear that one of the biggest cognitive issues on people’s minds as they age is memory loss. A quick Google search will also show you that memory loss (or some form of cognitive difficulty) is on many lists of “Top 15 concerns of the 65+ crowd”.
The reasoning behind this is pretty straightforward. We have all been made very aware that memory loss is the precursor to dementia. Alzheimer’s disease has been the most publicized form of dementia, and all dementias come with some form of memory loss. It is also true that the odds of being diagnosed with dementia increases as we age. The prospects for good quality of life once given a diagnosis of dementia is known to be poor and people are scared. So, they become very sensitive to the hallmarks of dementia – memory loss.
Is memory loss normal?
Memory loss is certainly something to be aware of and it is a key indicator of possible dementia.
However, it is important to understand that:
a) there are many different kinds of memory, and
b) some memory loss is a normal part of healthy aging
There is debate about some of the exact details of how our memory works and all the possible sub-divisions of memory, however what we do know is that we have memories for:
Episodes – both recent and remote specific events (e.g., what you did last night, what you did on your 18th birthday)
Facts and words – e.g., naming the Prime Mister of Canada, the word that describes the “white stuff” that falls from the sky (i.e., snow).
Procedures and skills – e.g., riding a bike, playing the piano, writing
Not all memories are negatively affected by aging
(Park & Reuter-Lorenz, 2009)
Episodic memory (events) is the most vulnerable, in part because it often requires rapid encoding of information, and speed of processing happens to be another cognitive process that declines with age
Procedural memory remains stable for already acquired skills (e.g., riding a bike). However, it becomes harder to acquire new skills.
Memory for facts and words (also known as Semantic memory), remains strong and can even improve as we age
How can we help?
To know how we can best help it is also important to understand at least some fundamentals about how memory works. Memory can be broken down into 3 stages – the Three R’s to a good memory:
1) Receiving – The brain receives too much information and has to filter most of it out. That means in order to receive the information we want to remember we have to pay attention and process the information. Processing the information involves organizing the incoming information and, ideally, connecting it with what you already know.
2) Recording – memories are laid down via structural (i.e., physical) changes between brain cells. These connections can take months or even years before they are fully realized. Relatively simple things such as a lack of sleep, poor nutrition, and stress can disrupt the recording process. Brain injuries (concussions, stroke) or treatments of other disorders (medications, electroconvulsive therapy) can have even more severe effects on the recording process.
3) Retrieving – many people think that memory retrieval is something akin to what happens when we use a video camera. All you need to do to pull up the right memory is to find the right spot on the memory card (or tape or DVD, depending on your generation). In fact, retrieval is a very active process and is much more like reassembling a puzzle that you hopefully have all the pieces for (and even if you don’t have all of them, if you have most of them, you will be able to fill in the blank spots).
The good news
There are actually a number of things that we can do to help bolster memory in healthy aging. Today I will focus on a few of the actions we can take as clinicians that might offer the “biggest bang for the buck”.
Sleep – this one cannot be overstated. Sleep quality can have a large effect on memory, other cognitive abilities (executive functioning, attention; Kilgore, 2010; Nebes, et al., 2009) and mood (which also independently affects cognition). One difficulty with sleep is that the root causes of the difficulty can be hard to pin down, especially as we get older. Sleep apnea is a disorder that affects your breathing when you sleep and results in a lack of oxygen to the brain. This sustained deprivation can have significant effects on alertness, attention, and concentration during the day. As we saw earlier good alertness and attention are critical to help filter out unwanted information at the receiving stage. Sleep also seems to form a critical part of helping us form the long lasting changes to the brain involved in the recording stage. Find out more about their sleep. If need be refer on to sleep specialists in your community. Here in Nova Scotia you can refer to the public system (though the wait list can be long) for a sleep assessment or you can refer people to The Snore Shop (thesnoreshop.ca), MedSleep (www.Medsleep.com) or go to the Sleep Well Nova Scotia website (www.sleepwellns.ca).
Physical Activity – is another big one and by no accident. When you think about it, our brain is just another part of your body. It makes sense that the health of your brain is dependent
to some extent on the health of the rest of your body. Physical activity reduces risk factors for stroke and vascular disease (associated with dementia), and there is some evidence that it reduces the risk of cognitive decline (Sofi et al, 2011). Exercise can take on many guises. There is evidence for both moderate aerobic and anaerobic exercise being effective for cognitive health. The reality is, if someone we are treating is able, it is best to help clients make regular exercise (ideally, 20 min, 3x/ week) a part of their weekly routines. You can brainstorm with them about what forms of exercise they can and want to start and help them create reminders and ways to hold themselves accountable until it becomes a part of their routine. Please note what exercises they choose may be limited by health issues which will need to be considered, however it can vary from going for walks, aquasize, chair exercises etc. Again, this is the kind of intervention that is likely to have effects at every memory stage.
Mental Agility – Recent litigation has shown that Lumosity may not be as good for our brain health as they said it would be (“Lumosity to Pay $2 Million to Settle FTC Deceptive Advertising Charges for Its “Brain
Training” Program”, 2016). That’s not to say all is lost though, programs such as Lumosity do hold some promise. Challenging games that keep your mind active are likely an important part of helping maintain memory and cognitive ability. If your older patients / clients are looking for a way to keep their minds sharp and agile, there seems to be something special about keeping ourselves challenged by many different activities. So rather than just doing the New York Times crossword, encourage clients to try multiple different activities: do crosswords and Sudoku and take up bridge, and learn to play an instrument or learn a new language using Rosetta Stone or a conversational Spanish meetup.com group (this is a social activities site, www.meetup.com). These kinds of mental workouts will hone skills to focus attention, enhance links with the knowledge you already have and increase the amount or organization and processing of the new information. Thus, this kind of exercise hopes to train your encoding and retrieving skills.
TAKE HOME MESSAGE
In our aging population, memory difficulties are a legitimate concern. While we should take care to be aware of memory difficulties, in the absence of other medical findings it is also important to understand that some memory loss is normal in healthy aging – memory for episodes or events is the most vulnerable to normal aging.
Some memory stays strong – our ability to remember facts and information remains strong and can continue to improve as we age.
Sleep, Physical Activity, and Mental Agility
are assessment and intervention targets that can have a big impact on memory functioning,
which can in turn enhance mood and satisfaction in activities of daily living as we get older.
OTHER RESOURCES
REFERENCES
Killgore, W. D. (2010). Effects of sleep deprivation on cognition. Progressive Brain Research, 185, 105-129. doi: 10.1016/B978-0-444-53702-7.00007-5
Haub, C. (2011). World Population Aging: Clocks Illustrate Growth in Population Under Age 5 and Over Age 65. Retrieved from http://www.prb.org/Publications/Articles/2011/agingpopulationclocks.aspx
Lumosity to Pay $2 Million to Settle FTC Deceptive Advertising Charges for Its “Brain Training” Program (2016). Retrieved from https://www.ftc.gov/news-events/press-releases/2016/01/lumosity-pay-2-million-settle-ftc-deceptive-advertising-charges
National Seniors Day… by the numbers (2015). Retrieved from http://www.statcan.gc.ca/eng/dai/smr08/2014/smr08_191_2014
Nebes, R. D., Buysse, D. J., Halligan, E. M., Houck, P. R., & Monk, T. H. (2009). Self-reported sleep quality predicts poor cognitive performance in healthy older adults. The Journals of gerontology.Series B, Psychological Sciences and Social Sciences, 64(2), 180–187. doi:10.1093/geronb/gbn037; 10.1093/geronb/gbn037
Park, D. C., & Reuter-Lorenz, P. (2009). The adaptive brain: aging and neurocognitive scaffolding. Annual Review of Psychology, 60(September), 173–96. doi:10.1146/annurev.psych.59.103006.093656
Sofi F et al. (2011) Physical activity and risk of cognitive decline: a meta-analysis of prospective studies. Journal of Internal Medicine, 269(1), 107-117.
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