Now where did I put those keys?

Author: Mark Sockell, MD, specialist in internal medicine and geriatrics

When asked who played opposite Humphrey Bogart in Casablanca, do you draw a blank? Do you sometimes forget the exact date if you haven’t just read the newspaper? When these things happen, do you chalk it up as a minor frustration of getting older or do you worry it could be a symptom of something worse, like Alzheimer’s?

Certainly, there is some cause for worry. More than five million Americans are affected by neurodegenerative disorders such dementia. Alzheimer’s, the most common form of dementia, occurs in 10% percent of people over age 65, 33% of those over 85 and more than 50% of people over 90.

Age is the biggest risk factor for such disorders, but the good news is that all forgetfulness is not dementia. Occasional minor memory loss, trouble recalling specific words or names, and greater difficulty in multi-tasking are all part of the normal, lifelong process called “cognitive aging.” Much like muscles and muscle function, as we get older our brains undergo gradual structural and functional changes such as loss of volume, reductions in blood flow and changes in the brain’s neurotransmitters. Although the degree is different in every individual, this typically causes a modest decline in cognitive abilities such as language, memory, and reasoning.

How do we know what we are experiencing is the expected part of aging?

We can start by understanding the key feature of Alzheimer's disease -- the insidious onset over months to years of cognitive decline severe enough to be recognized by friends and family and which affects the ability to function in a work or social environment. Forgetting Bogart's counterpart is not Alzheimer’s, but forgetting your mother-in-law's or boss's name could be. Forgetting where you left your tie is not Alzheimer’s but using it as a belt instead of under the collar could be. Not being able manage all the functions of the TV remote is not dementia, but forgetting how to work the stove may be. And how about forgetting where you put your keys? This, too, is not indicative of Alzheimer’s, unless they end up in weird places, like the refrigerator. Most Alzheimer’s is characterized by a forgetfulness that impairs a person’s ability to learn and retain new information. With cognitive aging, however, it probably will be harder to learn Spanish, even at age 55, but you should be able to retain new information and slowly improve your skills.

Alzheimer’s also affects non-memory areas, such as decision making, judgment, reasoning and planning and organizing. You may take longer to mull over how to plan or monitor your finances­­­ – that’s normal cognitive aging (and commonsense). But turning such decisions over to someone you don't know might be the sign of a more serious impairment. You may not be able to master an Android, but if you forget how to use the telephone, see your doctor.

Age-related cognitive changes aren't necessarily all negative. With age, we see and often experience an increase in wisdom, breadth and depth of knowledge, and compassion. In addition, research shows that certain cognitive abilities stay stable as we age, including intelligence, long term memory, ability to focus, use of language and problem solving.

Can anything be done to slow down or compensate for age-related changes to our brain function? More good news: we can take certain steps to maintain our healthy brains as we age: the best evidence is for exercise, and I recommend at least 15-30 minutes twice daily of something you enjoy. Reducing stress managing sleep issues will improve learning and memory; a heart healthy diet such as the Mediterranean Diet is recommended by most experts. Finally, see your doctor regularly and ask her to review to your prescription and over the counter medications to see if any impair brain function.

Many older patients develop adaptive strategies to help memory such as always putting things in the same places, writing notes or keeping a calendar. Keep mentally stimulated and socially connected. Take a Tai Chi class, talk to friends, and keep doing that daily crossword puzzle!