Memory & Cognitive Disorders Program

Alzheimer's disease is a progressive neurological disorder that affects the brain, leading to memory loss, confusion, and changes in behavior. It is the most common cause of dementia, a general term for a decline in cognitive abilities severe enough to interfere with daily life.

In Alzheimer's disease, abnormal protein deposits, such as amyloid plaques and tau tangles, build up in the brain, disrupting the communication between nerve cells and ultimately causing their death. This leads to a gradual decline in cognitive functions, including memory, reasoning, and language skills.

The early symptoms often include forgetfulness, difficulty remembering recent events, or repeating questions. As the disease progresses, it can cause more severe symptoms like disorientation, difficulty recognizing loved ones, changes in mood or behavior, and loss of the ability to perform everyday tasks.

Although the exact cause of Alzheimer's isn't fully understood, genetic, environmental, and lifestyle factors are believed to contribute to its development. Currently, there is no cure, but treatments can help manage symptoms or slow the progression of the disease.

Frontotemporal dementia (FTD) is a group of brain disorders caused by the progressive degeneration of the frontal and temporal lobes of the brain. These areas of the brain are associated with important functions such as personality, behavior, decision-making, and language. FTD typically affects people at a younger age than other forms of dementia, often beginning in the 50s or 60s.

There are two main types of FTD, behavioral variant FTD (bvFTD) and primary progressive aphasia (PPA).

As the disease progresses, people with FTD may experience changes in motor skills, such as difficulty walking or controlling movements, especially in certain forms of FTD that overlap with motor neuron diseases like ALS (amyotrophic lateral sclerosis).

Lewy body dementia (LBD) is a type of progressive neurological condition that affects the brain. It is caused by the abnormal buildup of proteins called alpha-synuclein that form structures known as Lewy bodies within brain cells. These Lewy bodies disrupt the normal functioning of the brain, leading to a range of symptoms that can vary from person to person.

There are two main types of LBD:

1. Dementia with Lewy bodies (DLB)

   – This form primarily affects cognitive function, such as memory, thinking, and reasoning. People with DLB may also experience hallucinations, fluctuations in alertness, and motor symptoms similar to Parkinson's disease.

2. Parkinson's disease dementia (PDD)

   – This form typically develops in people who have been diagnosed with Parkinson's disease, with cognitive changes occurring later on in the disease.

Vascular dementia is a type of cognitive decline caused by reduced blood flow to the brain, often due to strokes or other blood vessel problems. When the brain's blood supply is disrupted, it can lead to brain cell damage, affecting memory, thinking, and behavior.

There are two main types of vascular dementia:

1. Multi-infarct dementia

   This is the most common form, where small strokes (or "infarcts") occur in various parts of the brain, leading to gradual cognitive decline.

2. Subcortical vascular dementia

   This form is typically linked to the narrowing of small blood vessels in the brain, affecting areas responsible for memory and executive functions like planning and decision-making.

MCI is also identified as the first clinical stage of Alzheimer’s disease (AD). The subtype of MCI associated with AD is called amnestic MCI and affects an individual’s memory. Approximately 80% of people with amnestic MCI develop AD within 6 years. According to the Mayo Clinic, 15-20% of MCI patients progress to dementia each year. In comparison, the progression rate for the general population is 1-2%. Since MCI is the first symptomatic stage of AD, accurately detecting MCI enables medical professionals to then take the steps necessary to determine if a patient has early stage AD and might benefit from timely intervention.

Symptoms of Mild Cognitive Impairment (MCI)

Your brain changes as you grow older just like the rest of your body. Many people notice gradually increasing forgetfulness as they age. It may take longer to think of a word or to recall a person’s name.

But consistent or increasing concern about your mental performance may suggest MCI. Cognitive issues may go beyond what’s expected and indicate possible MCI if you experience any or all of the following:

• You forget things more often.

• You forget important events such as appointments or social engagements.

• You lose your train of thought or the thread of conversations, books or movies.

• You feel increasingly overwhelmed by making decisions, planning steps to accomplish a task or interpreting instructions.

• You start to have trouble finding your way around familiar environments.

• You become more impulsive or show increasingly poor judgment.

• Your family and friends notice any of these changes.

• If you have MCI, you may also experience:

• Depression

• Irritability and aggression

• Anxiety

• Apathy

Individuals in the dementia stage have declined in ability to perform instrumental activities of daily living, which include well learned skills such as cooking, shopping for groceries, driving to familiar locations, paying bills, doing housework or home repairs, performing well learned hobbies or pastimes.

The dementia stage progresses to affect even more well learned skills, called basic activities of daily living, including bathing, dressing, operating a toilet, planning to urinate or defecate so that they get to the toilet on time. Dementia finally progresses to affect walking speech, swallowing and control of the trunk, neck and face. The dementia stage is not seen in normal aging individuals and is due to one or more cognitive disorders. In Alzheimer’s Disease, the dementia stage lasts an average of 7 years.

Examples of cognitive impairment often seen during the dementia stage are:

• Rapid forgetting of recent instructions, conversations, or events

• Difficulty recognizing or naming common objects, familiar persons, or places

• Difficulty communicating in one’s usual capacity

• Difficulty making decisions or judgments such as the proper clothing to wear

• Difficulty organizing, planning and executing tasks such as packing or planning a vacation

• Difficulty operating familiar instruments such as a remote control, telephone, or computer

This suggestion is not new but deserves repeating because it has been proven beyond a doubt that good cardiovascular health leads to better overall health and lower risks for heart disease, diabetes, and Alzheimer’s disease. What is new is certain evidence about how easy it may be to start moving the needle in the right direction. Improving cardio fitness need not involve strenuous exercise and really doesn’t even require that you sweat. Walking is one of the overall best and most underrated forms of exercise and can often be incorporated into daily errands.

Also, don’t think that because walking is easier than running or swimming that you must do it longer to gain a benefit; a daily 30-minute walk is immensely beneficial to a person with no current routine of physical exercise. Especially if the walk can be augmented with a few trips up and down the stairs in lieu of the usual elevator ride.

In terms of staying motivated to maintain a routine of physical exercise, try to find a quantitative measure that will reveal your progress and keep you looking for more gains. In the past, much emphasis has been placed on body weight, a measure that is easy to obtain but can be difficult to improve. As an alternative, check your pulse rate at the end of your workout and track it for one month of daily walks; you might be surprised to see it fall. When you consider how many beats of your heart you can save over the course of a year by keeping your heart rate low, it can be very motivating.

Also, whether or not you suffer from high blood pressure or high cholesterol, be sure to get these measures from your physician during your next check-up and keep track of them as you exercise. Even something as simple as a daily walk is good for your brain and can produce meaningful improvements in both of these bio-markers as you gain better fitness.

This suggestion might top the all-time list of things that are easy to suggest but difficult to achieve. However, it turns out that for many of us, a high percentage of the daily stresses we encounter are self-inflicted. That’s right; choices we make and attitudes we willingly assume end up creating stress that we could otherwise avoid.

Reducing stress is important because we know how detrimental stress can be to our health. Real physical processes are triggered by emotional reactions to stress and, as far as science can tell, none of those processes are beneficial while all have harmful side effects.

Here is a simple suggestion for reducing stress that, although it won’t work for everyone, must be tried before you can fully believe its effects. Put simply, you should make a conscious decision to drive with patience and courtesy. Look for other drivers trying to cut traffic and motion them in. Don’t speed up to close the gap when another car wishes to enter your lane; slow down and allow them in. Embrace yellow lights for the opportunity they foretell to pause for a moment – this is certainly less stressful than treating them as a threat to your rapid progress. Don’t tailgate or change lanes incessantly seeking opportunities to move one car length closer to the front of the crawling traffic; it is just not worth it. Instead, accept the pace, listen to some music, and keep an eye out for other drivers who might benefit from your courteous cooperation.

If you are not an aggressive driver and cannot benefit from that tip, perhaps you can benefit from becoming a less aggressive “parker.” When visiting an establishment with a large parking lot, rather than seeking the spot nearest to the entrance, subjecting yourself to the anxiety of passing up a mediocre spot for the possibility of finding a better one, all the while monitoring the flow of motorists who might be competing for the best spot, try driving to the far end of the lot and parking in the open expanse of remote spots. It is a stress-free approach with the added benefit of a short cardio workout as you walk to your final destination.

While this might seem silly, it’s a step toward avoiding self-inflicted stress that just might carry over into other realms of your life as well. Get the right attitude, reduce your stress, and enjoy a healthier brain and body.

While most of us are not in danger of becoming accidental hermits, making new friends and interacting socially are activities that have been documented to decline as we age. We are most prolifically social as young students, followed by fairly intense socialization in adulthood when our children are students, and we tend to be least active when we are older and our children have grown and moved on.

Much research on the benefits of intellectual stimulation, the act of using our brains in challenging ways, has shown a positive correlation with maintained cognitive health. I will write more on that below but will make a separate point here. Meeting people, learning about them, interacting and cooperating with groups, and cultivating relationships are all activities that require deep and comprehensive cognitive activity. In socializing, especially with persons we are still getting to know, we use memory, verbal skills, and judgment along with a poorly understood melding of emotions and executive function. In the opinion of many scientists, socializing may be the best mental activity we have.

Two great ideas for remaining socially active are club membership and volunteering. While you may or may not have interests that lend themselves easily to club membership, a regular card game or social activity with a committed group brings the same benefits. As for volunteering, hospitals, churches, and many non-profit organizations are begging for help in nearly every community. Incidentally, one of the most meaningful gifts you can offer through volunteering is friendship and interaction with a lonely, usually elderly, person. Doing so will yield a double benefit because every interaction will be a workout for both of your brains, not to mention the good it will do for your hearts.

You had to know this one was coming. You needn’t necessarily deny yourself the junk food you’ve grown to love nor worry too much about your daily intake of calories. You do need, however, to worry about getting proper nutrition first. While consuming empty calories is harmful because it leads to weight gain and poor vascular health, the more damaging impact is that it strips away your appetite and prevents consumption of necessary vitamins and nutrients. A fresh approach to diet might be to focus first on what you should eat and set, as a second goal, the elimination of foods that you should not.

The good news is that the diet shown to produce the best vascular health was also shown this year to also promote the best cognitive health. One should be sure to consume a diet rich in cruciferous and green leafy vegetables, nuts, fish, and tomatoes and low in red meat and high-fat dairy products. Ideally, you will eventually adopt a diet whereby you take in what you need and avoid what you do not, but an easy place to start is to ensure that you get enough fruits and vegetables prior to filling up on junk; this will offer the best opportunity to keep your brain functioning at a high level.

If you have pondered the health of your brain at all, you have likely read or heard about the importance of ongoing intellectual stimulation. While it is not yet completely understood, it does appear that active brains decline more slowly with age than those that are relatively unchallenged.

A potential red herring in the discussion is the value of crossword puzzles, sudoku, and the like. Yes, they are mentally challenging activities but they may not produce the rich neural rewards that other activities, such as socializing, might yield. The key seems to be related to the concept of “learning.” If you don’t know the rules of crossword or sudoku, then these may be great activities for your brain. However, if you know how the games are played, then merely working through new forms of each puzzle requires no new learning and may offer few benefits to brain health.

Among the most challenging yet rewarding intellectual activities that you pursue are learning to play a musical instrument and learning to speak a foreign language. Both of these have become much easier in the digital age with the advent of tools and software to aid in the learning process. While this might seem counterintuitive, it is actually quite well grounded. With better tools, the learning becomes easier so the process yields faster proficiency and remains interesting through time. Despite the ease, the learning is real and the brain builds new circuits in accordance with the new learning. The whole process can be great fun, deeply rewarding, and very good for your brain.

So there you have five solid suggestions that will promote optimal brain health. Work on that cardiovascular fitness, reduce your stress, stay socially active, eat well, and challenge your brain with new learning. If you do so, you can expect that 12 months from now you can look back with clarity and reflect on a year when you made a worthy commitment to the health of your brain.