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If you’re over 60 and you’ve experienced a senior moment when you forget a word or a name, you’re not alone. Many people suffer some sort of decline in mental acuity as the years stack up.For some, the decline is steeper than others. In the worst cases, Alzheimer’s disease slowly and insidiously strips away memories and then life itself.

Diane Howieson, a neuropsychologist and associate professor emerita of neurology at Oregon Health & Science University, has spent a career studying the cognitive effects of aging and Alzheimer’s. We spoke to her about what happens after 60 in an interview that’s been edited for clarity and brevity.

Is cognitive decline inevitable for everyone after 60?

There are considerable individual differences. People who have stayed cognitively active, who have good education, a challenging work activity, they tend to do better when they get older. It’s called cognitive reserve. It’s as though you have stimulated the brain and it has some extra reserve in it.

It also helps to be in good physical shape without medical problems that can affect the brain (like) vascular disease. If people smoke, they have high blood pressure, high cholesterol, all of those things can put people at risk for developing vascular disease in the brain and then that shows up in people’s cognition as well.

How much decline can one expect or is it too difficult to quantify?

Some things decline more than others. People have more limited attention as they get older. They’re a little slower in their thinking. It’s more difficult to do multiple things as the same time as you get older.

Memory declines a little bit as people get older but it’s not so much that they’ve lost the memory of information that they know, but they have more trouble recalling it. If someone reads a newspaper article, (perhaps) they can’t remember specific information in the article but if someone else mentions it, they recognize it immediately.

One of the things that people complain about the most as they get older is that they can’t think of the words they want to use or can’t think of somebody’s name that they know well. It’s just that they can’t access it when they need it. It’s not that they don’t have the word or the name of the friend, they’re just slow to recall it up.

Is the cognitive decline a slow, steady worsening condition?

Overall, it’s mild, it’s subtle. It’s not something that will disrupt a person’s ability to do something as much as it’s just a little more difficult or a little slower.

Does that change with age?

Most of the changes that we notice are in people who are 80 years or older. People can notice some milder changes when they’re in their 60s or 70s but it does show up most in people who are 80 and older.

Are there things we can do to slow this decline?

Most importantly, keep active. There are many examples of people benefiting from keeping physically active, usually some kind of aerobic activity. It’s not just generally that it makes your whole body function better, but it also helps the brain.

Another thing to keep active with is mental and social activity. People who keep mentally stimulated and have good social engagements tend to do better as they do older.

What about supplements?

We do know that good nutrition is helpful to keep brain healthy. There’s a lot of mixed data about some of the supplements that people take as they get older. We did a study at Oregon Health & Science University looking at the nutritional profile of older people and seeing how it compared with their cognitive function. The nutritional profile was obtained by looking at blood samples. It wasn’t based on what people said they were eating. We found that people who had good levels of vitamins, particularly B vitamins, did well. People who had the worst cognitive outcome over time were those who had high levels of transfats in their blood. Those are things that are often found in donuts and cookies and various kinds of pastries.

Basically, eating a lot of good fruits and vegetables and limiting the amount of fat in the diet is good.

What about sugar?

Sugar can lead to obesity which increases your risk for vascular disease. That’s bad for the brain. People do benefit by restricting the amount of sugar that they eat and keeping their weight in a healthy range.

Do you recommend that people take B vitamins?

There is a lot of mixed data about the use of supplements. Every of month or year it seems like there is a report saying that supplements are not helping us. Then there are other data that suggests that supplements are good.

I would say that generally if people eat a good diet that supplements are not necessarily beneficial but if people don’t have access to a good diet, then supplements would be good. We’re looking at the levels of omega fatty acids and brain health at OHSU. Those are the ones found in salmon and some other fatty fish. We think they’re beneficial to the brain. You can get that in a supplement. What we’re doing is we’re studying whether taking it as a supplement benefits brain health. We’re in the middle of that study so we don’t have any results yet.

What are the risks for Alzheimer’s?

The biggest risk factor for Alzheimer’s disease is age. The prevalence of Alzheimer’s disease in people 65 years of age and older is about 13 percent. If you look at people who are 85 years of age and older it goes up to 45 percent.

What about genetics?

There is a form of Alzheimer’s disease that is genetically determined but it only accounts for about 5 percent of cases worldwide. Most people needn’t worry about that.

We’re just learning about the genetic influences on Alzheimer’s disease. We know one gene predisposes people to Alzheimer’s but it just slightly increases the risk. There are over 200 genes that are being studied.

Right now there’s not much people can do about their genetics. But they can keep themselves in good health.

What are some warning signs of Alzheimer’s?

The main warning sign for Alzheimer’s is if someone is having unusual trouble with their memory. Memory changes a little bit as we get older. Sometimes it’s hard to tell when you’ve gone past that to a more pathological form of memory problems. Usually, when people come to the aging and Alzheimer’s clinic at OHSU, they have history of couple of years of declining memory. Usually it’s a change in memory but it can be a change in memory and some other cognitive skills or even a change in behavior, like trouble understanding what people are saying to them, making mistakes in everyday activities. It begins so gradually that it is hard to tell when it started.

At what point should someone seek medical help?

If people are having trouble doing their daily activities, that would be a sign. If someone has trouble remembering information that they heard earlier in the day or the day before, that would be a sign.

The big question in Alzheimer’s disease is how do we identify exactly when the disease begins. We don’t know how to do that. That’s the big challenge in Alzheimer’s research right now.

But there’s no treatment, is there?

There’s no treatment that slows the progression of the disease or prevents someone getting the disease, but there is research in those areas. In order to do that research, you have to have a way of identifying when someone is getting the disease. Many researchers believe that the disease begins one or two decades before there are any symptoms. They’re working very hard on finding a way to identify people earlier. It’s possible that if you identify someone who’s developing the disease in the initial stages, the treatment may be effective. So far all the treatment trials have failed.

Are there social abilities that decline as you age?

People are slow to process information and they have trouble picking up as much information that comes at them fast, and sometimes that affects social skills. If you’re in a new social situation and you have to process a lot of information, an older person will be at a disadvantage because they’re only picking up part of the information that’s in their environment. But if they’re in a situation that’s familiar to them, they might do better than a young person because they know in this kind of situation what works and what doesn’t work.

Is wisdom also part of aging?

Wisdom is often the term that’s applied to when you benefit in a situation from having lots of prior experiences that lead you to make good decisions. That increases with age because as you get older, you’ve been in more social situations and you know how to handle them.

— Lynne Terry

Content shared from The Oregonian

Healthy over 60: Keep brain sharp with education, activity

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