Memory and Aging:
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What Everyone Should Know
Brent P. Forester MD, MSc
Director, Mood Disorders Division,
Geriatric Psychiatry Research Program
McLean Hospital
Assistant Professor of Psychiatry,
Harvard Medical School
Outline
Title
Page and Normal Aging:
1. Cognition
Background
2. When Memory Loss becomes
Problematic: Mild Cognitive Impairment
(MCI) and Alzheimer’s Dementia
3. Healthy Brain Aging Tips
4. Unique Role of McLean Hospital in
addressing questions of the aging brain
The Graying of America
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WE ARE HERE
3
Successful Aging
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• 94 year old woman, widowed
• Living at a continuing care retirement
community
• History of depression
• Now with mild memory complaints
• PhD in psychology
• Trying to get her dissertation published on
Sigmund Freud’s introduction to America
Risk Factors for Memory Loss
• Age
Title
Page
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•
•
•
•
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Obesity
Sedentary Lifestyle
Hypertension
Hyperlipidemia
Diabetes
Alcohol and other Substance Abuse
Depression, Stress
Mechanisms For Memory Loss
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• Inflammation
• Heart Disease
• Genetics
Treatable Causes of
Cognitive Decline
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• Vitamin B12 or folate deficiency
• Underactive thyroid
• Unstable medical problems: diabetes,
heart failure
• Fluid accumulation in the brain
• Medication side effects: Tylenol PM
• Excessive alcohol consumption
Memory Changes with Middle
Age: 35-55
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• Brain becomes more efficient at processing
information
• Misplace keys and glasses BUT…
• Improved managerial skills, seeing big
picture, figure out novel ways to solve
complex problems
Small and Vorgan.
The Alzheimer’s Prevention Program. 2012.
Memory Changes with Aging:
Beyond age 55
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• Forgetfulness
• Slower processing of information
• Learning and recall is slowed down
Mild Cognitive Impairment
(MCI)
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• Memory decline on at least one standard
memory test
• Functioning is normal
• 10 million in US over the age of 65
• 10-15% per year convert to Alzheimer’s
Disease
Alzheimer’s Disease
• Alzheimer’s
Title
Page disease (AD) affects about 5.4
million Americans¹
•
Most are aged 65 years and older, with
prevalence reaching nearly 50% at age 85
and older1
•
New AD diagnosis every 70 seconds
•
AD patients typically live about 7 to 10
years after diagnosis2,3,4
1. Alzheimer’s Association. Alzheimer’s Disease Facts and Figures. 2007.
2. Taylor DH, et al. J Am Geriatr Soc. 2000;48:639-646.
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3. Bracco L, et al. Arch Neurol. 1994;51:1213-1219. 4. Walsh JS, et al. Ann Intern Med. 1990;113:429-434.
Normal
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Alzheimer's
Tim Wheelock
Brain Bank, McLean Hospital
Alzheimer’s Disease, Amyloid Plaques
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Tim Wheelock
Brain Bank, McLean Hospital
Neurofibrillary Tangles
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Tim Wheelock
Brain Bank, McLean Hospital
Risk for Alzheimer’s Disease
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• Age
• Family history
• Genetics – APOE 4
• Down’s Syndrome
• Depression
• Cerebrovascular factors – diabetes, high
cholesterol, hypertension
Alzheimer’s Disease:
the Criteria
Title Redefining
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• Pre-Clinical Alzheimer’s Disease
• MCI of Alzheimer’s Disease
• Dementia due to Alzheimer’s Disease
Steps to Improve Memory
as We Age
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• Memory Training
• Nutrition
• Exercise
Memory Training and
Brain Fitness
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• Practice memory techniques
• Games, puzzles, new approaches to
daily activities
• Education
Look, Snap, Connect
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• Look – actively observe/pay attention to
what you want to learn
• Snap – create a mental snapshot or
picture of the information (real or
imagined)
• Connect – bring two mental snaps
together
Small and Vorgan 2012
The Mediterranean Diet
Associated
Title
Pagewith improved cardiovascular
health, reduced risk of dementia and
depression (30%)
Healthy Brain Diet
• LimitPage
caloric intake, avoid processed foods
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• Moderate caffeine and alcohol intake
• Omega 3 fatty acids – reduce risk for heart
disease, stroke and cognitive decline
• Antioxidants – limiting damage from free
radicals
–Vitamin E – 400-800 IU/day
–Vitamin C – 500-1000 mg/day
Exercise
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• Exercise at mid-life reduces subsequent
risk of dementia1
• Increases brain cell growth in animals2
• Increases brain blood flow in humans3
1. Andel, 2008; 2. Gage 2002; 3. Rolland 2008
Tips for Successful Aging
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•Title
Healthy
brain and heart diet
• Minimize stress
• Mental and physical aerobics
• Plan for retirement
• Maintain social relationships
• Attitude is KEY
• Assess and treat memory problems early on
Geriatric Psychiatry Research at
McLean Hospital
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• Well situated to study common late life psychiatric
disorders (depression, anxiety, dementia)
• Large clinical population: inpatient, outpatient,
community
• Collaboration among clinical programs, McLean
Imaging Center and the Mailman Research Center
• Use advanced technologies to explore behavioral
symptoms and syndromes that reflect the effects of
aging and physical illness on brain function
Examples of Brain Imaging
Techniques at McLean Hospital
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For Further Questions
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For further questions or comments Dr. Forester
can be reached at:
McLean Hospital
Geriatric Psychiatry Program
115 Mill Street
Belmont, MA 02478
(617) 855-3622
bforester@partners.org