My grandmother lost her memory—and ultimately her independence—over the course of almost two decades. Before she died of congestive heart failure at 89, she would routinely ask my dad if he was George, her husband (and my grandfather), who had died years earlier. "No, Mom, I'm Gregory, your son," he'd say, seeking a flicker of recognition. Grandma Sally would mull this over a few moments, size up my dad, then jab him in the arm, giggling, as if he'd tried to pull one over on her. Somehow, as her mind slipped away, she'd become docile, even silly—the near antithesis of the stern woman she was with cognition intact. Reflecting on this surreal shift and her memory's prolonged departure, I can't help but wonder if such a chapter might await my parents—or me.
According to a study published Monday in the Annals of Internal Medicine, the odds, unfortunately, are pretty good. Using neuropsychological testing and in-depth interviews of 856 elderly subjects and their families, researchers surmised that more than 1 in 3 people over 70 have some degree of cognitive impairment, though not necessarily the full-blown dementia that robbed my grandmother of the ability to live independently. That suggests nearly all of us will either know a cognitively impaired person or be that person. "It could be mild impairment in areas including memory, judgment, orientation, language, or problem solving," explains the lead study author, Brenda Plassman, a memory researcher at Duke University. (Such a description would certainly apply to my grandmother, who for years before her dementia became obvious would regularly forget to turn the stove off after cooking, causing my grandfather's refrain: "I'm afraid she'll burn the house down!") Twelve percent of impaired subjects progressed to dementia each year, Plassman found.
Waning mental agility can be especially dangerous if it occurs along with another chronic disease—and it often does. A diabetic, for example, could land in the emergency room just because she forgot to take her insulin and lost consciousness. Plassman found that nearly a quarter of people with cognitive impairment (but not dementia) had a chronic medical condition such as diabetes or heart disease. The fix could be as simple as adjusting medications that are collaborating to fog the brain, which requires asking the physician—or visiting a geriatric evaluation clinic or memory clinic, typically part of a community hospital or major university. Cognitive impairment may be underdiagnosed when it occurs in concert with a more immediately threatening condition, Plassman speculates. "The physician has to deal with the multiple complex health issues that obviously are at the forefront of their care," she says.
The good news, if there is any, is that steps taken against cognitive decline can double as steps against some of the most commonly associated conditions. Plassman's recent research shows that 16 percent of subjects with cognitive impairment but no dementia had experienced a stroke (which is known to nearly double the risk of Alzheimer's disease); an additional 10 percent had the cognitive impairment caused by vascular disease. "Paying attention to vascular risk factors now is going to pay big dividends later," says Laurel Coleman, geriatric physician in Augusta, Maine, and national board member for the Alzheimer's Association. She ticks off that familiar list: exercise regularly, keep trim, eat a healthful diet, don't smoke, and control blood sugar, blood pressure, and cholesterol. "You don't usually think that applies to dementia," she adds, but staying on top of overall health might help prevent it, or at least delay its onset.
As for brain-preserving diversions, "it's about a lot more than crossword puzzles," Coleman says. Mental calisthenics need to include something that truly challenges your brain. Studying a foreign language, traveling independently, taking a dance class, or even doing those crossword puzzles—as long as it's got you out of the comfort zone—will help you develop more connective pathways deep in the brain, or "reserve capacity," explains Coleman. For that matter, strong social and familial connections provide a mental boost, too.
On that note, I'm going jogging with my German textbook. Mom, Dad, wanna come with me?