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We all suffer some hiccups in brain function as we get older, but we don't all develop dementia. Here's how to tell you're just getting older and you're not losing your mind.

By age 65, about 40 percent of people suffer some degree of age-related memory loss. In a relatively small number of cases, memory loss is a symptom of dementia. But for the majority of people over 65, forgetfulness is a sign of a much more benign condition known as age-related memory impairment.

What's the difference?

Age-related memory loss: The signs

In age-related memory impairment:

  • You may not be able to remember a conversation you had a year ago, but you will remember a conversation you had an hour ago.
  • You may not remember the name of someone who was in a class with you in high school, but you will remember the name of your husband or wife and children.
  • You occasionally have difficulty finding words, or you can remember the right word in the wrong language (if you are multi-lingual).
  • You forget appointments and anniversaries occasionally.
  • You don't hear as well as you used to. It's gotten worse as you got older.
  • You are worried about your memory but the people who see you every day are not.

Signs of dementia-related memory loss

In dementia:

  • You forget a conversation a few minutes or even a few seconds after you have it.
  • You forget the names of friends, family members, and your spouse.
  • You have difficulty naming objects or holding a conversation.
  • You cannot make or keep appointments, and you fail to remember important events in your past.
  • You don't hear well. You have had a problem with hearing for a long time. It's not just aging.
  • You are not worried about your memory, but the people around you are.

Beyond either dementia or normal aging: What is cognitive frailty?

There is also a third category for age-related memory loss, cognitive frailty. Frailty is a "preclinical" state that can be influenced by diet, stress, and other concurrent health conditions. This is a condition that is considered reversible or potentially reversible. 

To diagnose cognitive frailty, doctors don't look at indicators of memory abilities. They consider grip strength, weight loss, exhaustion, slow walking speed, and low calorie expenditure. The more of these indicators are present, the greater the likelihood of loss cognitive abilities in the near future. These symptoms are more important than whether you locked yourself out of your house last week or you forgot your wedding anniversary (to the doctor, at least). 

People who seem to be "losing it" who don't have symptoms of frailty are diagnosed with mild cognitive impairment. People who show the same mental symptoms but also have these physical symptoms are considered usually to have a reversible condition of impaired mental health. About 4 percent of people over 65 who are well enough to be living on their own have reversible or potentially reversible cognitive frailty. About 22 percent of people over 65 who are confined to a hospital or a nursing home have reversible or potentially reversible cognitive frailty. So how to you reverse it?

People who have a combination of age-related memory impairment and difficulties with walking have the highest risk of developing dementia, from 4 to 319 times the expected rate for their age. They have the greatest need for the changes in lifestyle listed below.
  • Food choices make a difference. The Mediterranean Diet (lots of fruits and vegetables, limited amounts of meat, olive oil as the main source of fat, small amounts of natural sugars) is associated with reversing fraility and also with slowing the speed of progression of mild cognitive impairment (MCI) to major cognitive impairment (dementia).
  • Making sure to eat enough is important. In people over 65, weight loss is associated with impaired muscle function, anemia, decreased bone mass, immune dysfunction, pressure ulcers, reduced cognitive function, poor wound healing, delayed recovery from surgery, functional decline, falls, and increased morbidity and mortality for all kinds of diseases.
  • Reducing stress stops the progression of cognitive frailty. Stress interferes with language, eye-hand coordination, the speed at which the brain processes information, judgment, learning new words, and visual memory l Constant stress may disrupt the pituitary-hypothalamus-adrenal axis and accelerate loss of mental functions.
  • The effects of a positive attitude are positive and real. Conscientiousness, sticking to principles and goals, is associated with lower rates of dementia and greater rates of survival from cardiovascular disease. Neuroticism, moodiness punctuated by the experience of anger, anxiety, worry, envy, fear, frustration, guilt, jealousy, depression, and loneliness, is associated with higher rates of dementia and death from cardiovascular disease.
  • It's important to continue to see people and stay connected with friends and family. Social isolation sets off a downward spiral. People withdrawal from their friends and social networks because they become aware of reduced mental abilities. The isolation in turns causes further deterioration in cognitive abilities. People get out less and become more sedentary. If it is not possible to get out to visit people, it is important to welcome and encourage visitors to stay mentally sharp and at least a little more physically fit.

  • Dent E, Lien C, Lim WS, Wong WC, Wong CH, Ng TP, Woo J, Dong B, de la Vega S, Hua Poi PJ, Kamaruzzaman SBB, Won C, Chen LK, Rockwood K, Arai H, Rodriguez-Mañas L, Cao L, Cesari M, Chan P, Leung E, Landi F, Fried LP, Morley JE, Vellas B, Flicker L. The Asia-Pacific clinical practice guidelines for the management of frailty. J Am Med Dir Assoc 18 (2017), 564–575.
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  • Photo courtesy of SteadyHealth

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