Memories R Us
Chuck Ozug taught English his entire working career. He was in his classroom in Falmouth, on Cape Cod, when his heart suddenly stopped, and he collapsed. Paramedics rushed to the scene and literally brought Ozug back from the dead. Precious minutes had passed, and the lack of oxygen left Ozug with irreversible brain damage that destroyed most of his memories and prevented him from forming lasting new memories.
He now lives in a perpetual present, a frustrating, often depressing existence he counters with a quick sense of humor and a highlighter—so he can remember the passages in the newspaper he wants to show his wife, Mary Ann. He also writes poetry about his condition. One line particularly struck me: “My memory, like snowflakes, soft, faint, snowflakes soothing only for a while.”
Ozug considers himself lucky he survived. Doctors at the hospital told his wife he wasn’t going to make it. He says he finds joy in time spent with his wife and his two sons. Still, he lives in what he poetically describes as a never-ending blankness, often forgetting what someone has told him on the phone before he hangs up.
What is particularly frightening is that unless modern medicine intervenes, many of us will wind up with similar memory loss, though from a different cause—Alzheimer’s disease. When you’re sixty-five, there’s a one in ten chance you are affected by Alzheimer’s. By the time you’re over eighty-five, there’s almost a one in two chance you have the disease, according to the Alzheimer’s Association. Some medical researchers believe we would all get Alzheimer’s if we lived long enough.
Alzheimer’s is the most common cause of dementia among the 35 million Americans sixty-five and older (the greatest number of seniors in the nation’s history). An estimated 4.5 million Americans have Alzheimer’s, with 100,000 people a year dying of complications of the disease. As baby boomers age, that number will grow, and the number of Alzheimer’s sufferers will grow with it—unless a medical breakthrough intervenes. At the current rate, the number of Alzheimer’s cases is expected to almost triple by 2050, according to the National Institute on Aging.
Luckily for those of us who are under fifty, researchers gain a better understanding every year of how the brain works, how memories are formed, and how to stop the damaging plaques and tangles that form in the brains of Alzheimer’s sufferers and that result in memory loss and dementia.
It isn’t just Alzheimer’s that makes people entering their golden years nervous. Even in healthy seniors, declining memory is a fact of life. Some neurons shrink with age in areas important to learning, memory, and other higher-level functions. As a result, as we get older, we may have more trouble remembering names, the location of car keys, or the location of the car itself. These “senior moments” can be both frustrating and frightening. Of course, part of the fear comes from the uncertainty about whether the forgetfulness is just a harmless mental slip or the first sign of Alzheimer’s.
The prospect of memory loss is so unnerving because we are, in many ways, the sum of our memories. They define who we are. Memories tie us to our past, to our family and friends, and to the events that have shaped our lives—the weddings, births, deaths, successes, and failures along the way. Memories also instruct us, offering us lessons in the ways of the world. If we didn’t remember, we wouldn’t learn. The sum of our experiences—our memories—informs our worldview and sensibilities. You could say whatever wisdom we have is the product of our memories. In this way, they not only serve as a storehouse of information but also shape how we view the future. It should be no surprise, then, that the ability to hope and plan depends on memory.
REMEMBERING AND FORGETTING
What exactly is a memory? We tend to think our memories exist like some sort of neurological library or photo album. When we want to retrieve a memory of a specific event—a wedding or a birthday, for example—we retrieve the book or album that contains all the memories of that occasion. That is not the way memory works, though. The University of California professor James McGaugh, in many ways the father of memory research in the United States, told me our recollections are more like a net. When we want to call up the memory of an important event, we pull the various strands of the net. The images of the wedding come from one part of the brain, the smells from another, the sounds from another, the emotional memory from still another. The more strands or connections we have, the stronger the memory.
In a famous experiment that demonstrates this point, one group of test subjects was shown pictures of unfamiliar faces and the names that went with them. The second group was given the same faces and their occupations. In the experiment, the name and occupation given to each picture was the same. For example, one man was named Baker for one group and was a baker for the other group. Another was named Potter for one group and held a job as a potter for the other. When the separate groups were shown the faces later and asked to recall the name or the occupation, depending on the group, many more people remembered the occupation than the name. This is known as the Baker/baker experiment.
You may have had this experience yourself when you encountered a casual acquaintance you hadn’t seen for a while. You can remember everything about that person—his job, the number of children he has, where you saw him last—but you do not remember his name. Why is that?
In the Baker/baker experiment, test subjects were much more likely to remember a particular person was a baker rather than the name Baker because the job creates more connections in our brains. We are able to smell the bread baking, taste the bread, remember experiences we’ve had at bakeries. The name Baker does not create the same strong web of connections (unless, of course, we know someone else named Baker). It works the same way in the example of the casual acquaintance and in many aspects of our lives.
In fact, we filter out most of what we see every day. For the most part, these details don’t even register. We can see something unremarkable every day and not even notice. You could think of our brains as acting more as filters allowing almost all the incoming information to pass unremembered, rather than as sponges soaking it up. If you don’t believe me, think about the penny. You have no doubt seen a penny a thousand times. Probably more. Which way is Lincoln’s head facing? What else is on the front of the penny? Does it say “Liberty”? How about “In God We Trust”? You don’t remember because the penny is so ordinary. So unremarkable. So forgettable. This is just one of the thousands of details that wash over us every day of our lives. If we remembered everything—and there are some who do, with devastating consequences—we would be overwhelmed with details and would not be able to function in the world. We are experts at extracting the gist of an experience. This is how we learn. We may not remember what color shirt we were wearing or the day of the week, but we would likely retain a lifelong memory of getting stung by a bee as a child or the first time we rode a bike.
Our brains are constantly on the lookout for what is different—what is unusual—and emotional memories are stronger than unemotional ones. Memory is the act of storing information and then retrieving it when you need it. It sounds simple, but how many of us can say we’ve never forgotten where we parked the car at the mall or the airport? Usually, we weren’t paying attention. The first step to remembering something is to make sure you are really noticing it.
A MEMORY “WORKOUT”
Scott Hagwood was the U.S. memory champion for four years running. He flew to Atlanta to teach me some of his mnemonic tricks. For example, he is constantly being quizzed on the names of the four or six or eight people he just met. With unflagging good cheer, Hagwood always gets the names right. Here’s how he does it. When he is introduced to someone, he tries to think of someone else he knows with the same name and then one distinguishing physical characteristic about the person he just met. In that way, he is able to make the name something more than an abstraction. If he met someone named Baker, he would think of someone else he knew with the name. He would also pick out the cowlick or the crooked nose—some physical attribute that sets that person apart in order to add a visual memory. Hagwood’s recall in situations like this is flawless, but he hasn’t always had this ability.
Memory is something we need to work on, like a muscle, Hagwood says. Hagwood’s story is a case in point. Hagwood did not do particularly well is school, nor was he born with a photographic memory. He graduated from the University of Tennessee, Knoxville with a degree in chemical engineering, but was by no means a standout. He struggled to remember things in college and left school feeling inadequate about his mental abilities. “I wasn’t the sharpest tool in the shed,” he likes to say.
At age thirty-six, Hagwood was diagnosed with thyroid cancer. He learned that one of the side effects of chemotherapy was memory loss. Hagwood decided to fight against that by working on his memory. Hagwood read books by Tony Buzan, a Briton who has written a number of books on improving memory, and he began “working out” with decks of playing cards. For hours every day, Hagwood worked on his memory.
Cured of cancer, Hagwood decided in 2001 to enter the USA Memory Championship, an Olympics of the mind in which contestants are asked to remember impossibly long strings of numbers, names, faces, a poem, and other mnemonic challenges. Hagwood won, and he kept on winning. In fact, he won all four years he entered the USA Memory Championship. Hagwood now has a book of his own, Memory Power: You Can Develop a Great Memory—America’s Grand Master Shows You How.
I spent an hour with Hagwood for a documentary I did on memory. He gave me a quick explanation of the memory trick he and other top memory “athletes” use. Their technique involves converting names, numbers, cards, or whatever else they want to remember into moving images—experiences—that they place in their minds around their virtual homes or some other well-known place. The theory is that we are much more likely to remember a moving picture than the name of a card. For example, the four of hearts, to Hagwood, is a rabbit.
“I can feel the fur, and I can see the whiskers moving,” Hagwood told me. “Our physical eye is trained for movement. So is the mental eye.” Creating a mental picture of a rabbit creates many more connections in the brain than trying to remember “four of hearts” or even an image of the card. Research shows emotional memories are stronger than unemotional ones, and a rabbit certainly conjures up more emotion than a playing card.
If the four of hearts was the first card in a deck Hagwood was memorizing, he would place the rabbit, in his mind’s eye, in one corner of his living room. The next card he would place in the next corner. That way he can work his way around his house in his mind and never skip a card. He can also work backwards simply by reversing the order in which he makes his way through his house.
Hagwood can memorize an entire deck of cards in under three minutes and nine decks of cards, in order, in less than an hour. He can memorize a sequence of more than eight hundred numbers in an hour. To see Hagwood in action memorizing cards is to be amazed. I went through half a deck of cards, rapid fire, and he proceeded to list them back for me. He then put me through the paces, and in the space of about ten minutes, I was able to memorize ten cards. A modest accomplishment, but I find myself still using his memory techniques. The mind is like a muscle, Hagwood told me repeatedly. You should exercise your brain the way you would exercise your body. Hagwood insists his gifts are available to anyone who wants to hit the mental gym.
Interestingly, Hagwood says he forgets many of the mundane details of his life, just like the rest of us. He puts his car keys in the same drawer in his house every day so he doesn’t lose them. Hagwood jokes that when his wife is asked what it’s like to live with someone with a perfect memory, she answers, “I wouldn’t know.”
Incidentally, if you want to remember where you parked your car in a large parking lot, see where you are and make a mental picture. If you are parked in section 5B, you might create a mental picture of a giant hand sticking out of your car with a oversized bee on each finger. The more outlandish the image, the more likely you are to remember it.
PROTECTING THE MIND
Having the ability to remember names or other facts is one thing, but keeping our minds sharp and preserving our memories is much more basic to who we are and to living well in our senior years. What can we do to keep our brains sharp? After all, what good is a healthy body unless we are mentally “there” to enjoy it? Are we genetically predestined to succeed or fail mentally in old age? What, if anything, can we do on our own to protect our brains from the ravages of Alzheimer’s?
Alzheimer’s is named for Alois Alzheimer, a German physician who was dedicated to the study of the brain. He gave a lecture to the South-West German Society of Alienists in November 1906 that forever linked his name with the disease. At the meeting of alienists—an antiquated term for psychiatrists who are expert in the legal aspects of mental illness—Alzheimer described eine eigenartige Erkrankung der Hirnrinde, an unusual disease of the cerebral cortex in a mental patient who had died and whose brain had been sent to him. The patient, Frau Auguste D., died in her fifties at a Munich mental asylum after suffering from memory loss, disorientation, trouble reading and writing, and hallucinations. Alzheimer noticed that her cerebral cortex appeared to be thinner than normal. He also described what have become the hallmarks of the disease that took his name: the buildup of beta-amyloid plaques in the spaces between the brain’s nerve cells and the neurofibrillary tangles inside the nerve cells. A year later, Alzheimer’s second case entered a university psychiatric clinic in Munich, a demented fifty-six-year-old named Johann F.
Most people get some plaque in their brains as they get older, but in Alzheimer’s disease, the beta-amyloid plaques develop first in areas of the brain used for memory and other cognitive functions. Illustrations of these plaques generally depict them looking something like dust balls between the brain cells. Many researchers now believe the buildup of plaques between cells is a last-ditch effort by the brain to keep harmful beta-amyloid away from neurons. Increasingly, scientists think the plaques themselves do not cause harm, and that the real culprit may be something called oligomers. These are small, discrete clumps of a handful to a dozen or so beta-amyloid proteins. Researchers at Northwestern University suggest that these, not the plaques, may be the real vandals in the brain, attaching to a critical location on nerve synapses in the brain and disrupting communication between neurons. Unable to communicate, the neurons eventually die. When enough of these neurons die, our mental abilities dim.
The neurofibrillary tangles Alzheimer saw in the brain of Frau Auguste are twisted protein threads inside nerve cells. These don’t exist in healthy individuals. The bulk of these tangles are made up of the protein tau, which builds up in patients with Alzheimer’s disease after being pulled away from structures inside neurons. The end result of all this may be miscommunication between cells and, later, cell death.
A third physiological feature of Alzheimer’s—not noticed by Alzheimer himself—is the slow loss of connections between neurons. Eventually, they can’t function properly, and they die. As neurons die across areas of the brain, those regions atrophy—like the muscles of someone who is unable to move.
Genetic factors determine an estimated 40 to 80 percent of our cognitive abilities and also affect our risk of getting Alzheimer’s disease. In 1992, researchers found that certain forms of the apolipoprotein E gene, commonly referred to as the APOE gene, influences our risk of Alzheimer’s. The APOE ε4 gene appears to increase our risk. It is found in 40 percent of people with Alzheimer’s, although there are many people with the gene who never develop the disease. Conversely, 60 percent of people with Alzheimer’s do not have the gene. The rarely occurring APOE ε2 gene may provide some protection against Alzheimer’s, while the APOE ε3 gene appears to be neutral.
The FDA has approved a handful of drugs to treat Alzheimer’s. They do not work for everyone. Even in those people the drugs help, they do not stop the progression of the disease and are only mildly effective at slowing it for a period of months to a few years. But every year, scientists are making great strides in understanding both Alzheimer’s and how memories are formed, and they have developed compounds that radically improve the memories of fruit flies and mice. Pharmaceutical companies are now working hard, building on these breakthroughs to extend the results to humans.
Dozens of clinical trials are under way, testing the safety and efficacy of dozens of compounds designed to treat Alzheimer’s and mild cognitive impairment. Cholesterol-lowering statins are one class of drugs under investigation. They have shown some promise in clinical trials at slowing the progression of Alzheimer’s disease. The results are mixed, and doctors are cautioning against recommending statins to treat Alzheimer’s until more data is in. That data is on the way.
At this writing, two large, multicenter trials have begun, testing the effectiveness of two different statins in the prevention of Alzheimer’s. Another found a link between nonsteroidal anti-inflammatory drugs, like ibuprofen, and a lower risk of Alzheimer’s. Raloxifene (Evista), a drug used to promote bone growth in postmenopausal women, has also been associated with a lower risk of Alzheimer’s. Women taking the osteoporosis drug had a 33 percent lower risk of developing mild cognitive impairment, often a precursor to Alzheimer’s, compared to the placebo group. Still, it’s far too early to be taking any of these for the sole purpose of avoiding Alzheimer’s.
Alzheimer’s Vaccine?
In the future, we may be able to get immunized against Alzheimer’s. Nothing exists yet, but tests in which antibodies were injected into the brains of genetically engineered mice have succeeded in reducing amyloid deposits and reversing the development of neurofibrillary tangles.
The ultimate goal of all this research, of course, is nothing less than preventing or dramatically slowing Alzheimer’s, something science has thus far been unable to do. That means, for the time being anyway, it is up to us to do what we can to live in a way that lessens our chances of ever getting Alzheimer’s. If you have a family history of the disease, you need to be particularly mindful of behaviors that add to your risk and do what you can to lead a lifestyle that may actually reduce your chances of getting the disease.
HOLD THAT THOUGHT
Beginning in childhood, the way in which we live influences whether we are putting ourselves at greater or lesser risk for Alzheimer’s. Even delaying the onset of Alzheimer’s through healthy living is a worthwhile goal. Another year or two without the disease is another year or two of living life to the fullest. Remember our goal: to maximize our life span and remain mentally and physically fit for as long as possible. Incidentally, Alzheimer’s not only profoundly affects our quality of life, it is also associated with a dramatically reduced life span. If you are seventy years old and get Alzheimer’s, you can expect to live 8 more years if you are a woman and about 4.5 more years if you are a man. That’s half of what a woman that age without Alzheimer’s could expect to live and about a third of what a man that age could expect to live.
Dr. Gary Small is a professor of aging at the University of California, Los Angeles medical school, director of UCLA’s Memory and Aging Research Center, and the author of several books on keeping the brain healthy and our memories strong. Small, among others, argues that mental health and physical health are linked. In other words, a healthy body, to a large degree, means a healthy brain. Small advocates exercising, reducing stress through meditation and other means, performing stimulating mental activities, and eating a healthy diet. He recommends a Mediterranean diet, with fish, olive oil, nuts, vegetables, and fresh fruits, which together lower the risk for heart disease and Alzheimer’s.
“Eating fish once a week or just walking ten minutes a day. We looked at it over the next five years, and if everybody did that, and if our assumptions were true, we would reduce the number of cases in the United States by a million in just five years,” Small told me in an interview.
Cold-water fish, such as salmon, halibut, mackerel, sardines, and herring, all contain the omega-3 fatty acid docosahexaenoic acid (DHA). DHA is involved in a number of brain processes, including many related to nerve cell communication. Scientists believe DHA helps protect the brain against the cell damage caused by Alzheimer’s disease. In mice, DHA appeared to protect against beta-amyloid production, accumulation, and toxicity.
Because fish high in DHA can also contain mercury, dioxin, polychlorinated biphenyls (PCBs), and other harmful metals, eating them more than once a week can be dangerous. Another alternative is to take an omega-3 supplement made from algae. A third option is to eat eggs produced by chickens consuming DHA-rich feed, such as flaxseed. DHA-enriched eggs are more expensive than standard eggs but taste the same and offer an alternative source of omega-3 fatty acid.
Fruits and vegetables also appear to help. One study following more than thirteen thousand older women for more than a decade found those who ate the most green, leafy vegetables experienced slower cognitive decline than those who ate the fewest. Vitamins C and E and beta-carotene, found in carrots and other fruits and vegetables, may protect against cognitive decline, while deficiencies in vitamin B12 and folic acid may increase the risk. A note of caution: like fish, too much vitamin E can be dangerous.
Light to moderate alcohol use may reduce the risk of Alzheimer’s, while heavy alcohol use increases the risk.
Researchers are looking into whether the main chemical compound in the spice turmeric, which makes curry yellow, may be a valuable dietary tool for warding off Alzheimer’s. Turmeric has been used for thousands of years as an anti-inflammatory, and inflammation in the brain occurs during the neurodegenerative process that accompanies Alzheimer’s. So it would make sense that a substance with anti-inflammatory properties might help. A study with mice suggests the yellow pigment in turmeric, called curcumin, can suppress amyloid accumulation, which contributes to Alzheimer’s. Clinical trials in humans are under way. Because turmeric has been used in food for so long (it was around when Marco Polo visited Asia in the thirteenth century), side effects are less of a concern than they are in drug trials of compounds that are concocted in the lab. Researchers began looking into curcumin when they noticed that Indians experienced low rates of Alzheimer’s, heart disease, and several cancers. These low rates went away when Indians moved to western countries and abandoned their traditional diets. This suggested the Indians’ protection against these ailments was not genetic.
Much has been made of the brain-boosting powers of Ginkgo biloba, but there is little evidence the much-touted supplement does much to either improve our mental abilities or to ward off Alzheimer’s.
Aside from eating healthy foods, there appear to be a number of foods to avoid if we want to keep our brains healthy. They include trans-fatty acids, which are found in fried foods, processed baked goods, and some margarines; saturated fats, which are found in meat and full-fat dairy products; artificial sweeteners; and sugar. Cigarette smoking also heightens the risk for dementia.
Advice from the Experts
The Alzheimer’s Association of America recommends reducing the risk factors for dementia by treating depression and controlling hypertension, diabetes, and heart disease by quitting smoking, controlling blood pressure, lowering cholesterol, and avoiding obesity.
A diet containing a lot of fat, especially saturated and trans fats, has been linked to Alzheimer’s disease and other cognitive loss among the elderly. If you add a lot of copper to a high-fat diet, the Alzheimer’s risk skyrockets.
One study that followed Chicagoans sixty-five and older found a high-fat, high-copper diet resulted in the equivalent of nineteen years of mental aging in just six years, based on cognitive tests. Interestingly, those who ate a high-copper diet without a lot of fat did not show a higher than average mental decline during the course of the study.
In case you’re wondering, such organ meats as liver and shellfish are foods with the highest levels of copper. Other foods high in copper include nuts, seeds, legumes, whole grains, chocolate, and some fruits. The recommended daily allowance for copper is 0.9 milligrams. A single ounce of liver contains 4 milligrams of copper; a lobster tail contains 2.3 milligrams. If you eat 6 ounces of roasted peanuts, you would be right at the 0.9-milligram daily allowance.
If you want to adopt a lifestyle that lowers your risk of developing Alzheimer’s and dementia, exercise. Older adults who exercised at least three times a week were much less likely to develop dementia than those who were less active, according to a recent study published in the Archives of Internal Medicine. The types of exercise that appeared to help were walking, hiking, bicycling, aerobics, and weight training. The study did not show that exercise prevented dementia, but that those who exercised developed dementia a third less often. On the flip side, poor physical function may be associated with an increased risk of dementia and Alzheimer’s.
Leisure activities also appear to play a role in reducing the risk of Alzheimer’s, possibly because they are a source of ongoing intellectual and social stimulation. Remember the Okinawans? Alzheimer’s is far less common among elderly Okinawans, who engage in such leisure activities as gardening and tend to have strong social networks that keep them engaged with family and neighbors into very old age.
A longer education also is associated with better mental functioning in middle age and beyond. College graduates are less likely to get Alzheimer’s than high school graduates.
Also, people in jobs that are more mentally demanding appear less likely to get Alzheimer’s. Jobs were assessed on criteria such as the complexity of work with data, people, and things. Complexity of work with data considers whether the job involves mentally taxing activities, such as computing and analyzing. Complexity of work with people takes into consideration whether the job involves negotiating, supervising, or other challenging work relationships. Complexity of work with things looks at whether the job involves manipulating objects, operating machinery, or other precision work.
Ross Andel did research with James Mortimer at the University of South Florida in Tampa, using data from the Swedish Twin Registry. Among the more than ten thousand twins registered in the ongoing Swedish study, Andel and Mortimer found twenty-two same-sex pairs with occupations that differed with respect to complexity of work, and one of the twins developed some form of dementia. In twenty-one of those cases, the demented twin had the less-complicated job. For those engaged in complex work requiring people skills, the future risk of dementia seems to be relatively small, Andel says.
There are life circumstances that place you at greater risk of getting Alzheimer’s, most of them apparently because of the additional stress involved. If you have never been married, grew up in a single-parent home, or were born after three or more siblings, you are at greater risk for Alzheimer’s. Sustaining physical or emotional abuse during childhood or your teenage years or losing a parent also tip the odds against you.
In a French study, elderly people who were married had a significantly lower rate of Alzheimer’s disease in their mideighties and beyond than did those who were widowed, divorced, or never married. Growing up in the suburbs, as opposed to the city, also is associated with a lower risk for Alzheimer’s disease.
Scientists’ search for biochemical links to Alzheimer’s has looked at a number of possibilities. Research has found a high level of the amino acid homocysteine is associated with a greater risk for developing Alzheimer’s. Homocysteine has also been linked to heart disease. Levels of the amino acid can be reduced with folic acid and vitamins B6 and B12. There are also associations between Alzheimer’s and risk factors for stroke, such as high blood pressure, that begin in midlife. Researchers are also studying a potential link between Alzheimer’s and diabetes. Diabetes is associated with a greater incidence of several forms of dementia, including Alzheimer’s. One study of a large group of older priests, nuns, and brothers found that diabetics were 65 percent more likely to have Alzheimer’s. There is also a biochemical connection. In Alzheimer’s, an amyloid protein builds up in the brain. In type 2 diabetes, a different amyloid protein builds up—in the pancreas.
EXERCISE YOUR MIND
In addition to diet and exercise, the latest research suggests there is something else we can do to improve our odds of at least significantly delaying the onset of the dreaded disease. We can exercise our minds. This probably doesn’t come as a surprise, we are all familiar with the phrase “use it or lose it.”
Small serves as medical director for a private company called the Memory Fitness Institute, which is launching “brain boot camps” to help stimulate the minds of people in their golden years. In addition to exercising, improving diet, and reducing stress, participants engage in word games and other mental exercises. For example, they write with their opposite hand or practice remembering a list of words by creating zany stories to link them together.
In what amounted to a test run of the two-week brain boot camp, Small and his colleagues at UCLA took positron-emission tomography (PET) scans measuring blood flow in the brains of seventeen individuals. At the end of the fourteen days, the researchers took another brain scan. They found less brain metabolism in the region of the brain linked to memory and other cognitive functions. Small told me in an interview that this showed how these test subjects were able to use their brains more efficiently in just two weeks. The individuals also reported having better memory and performed better on a test. Admittedly, this is a very small study over a very short amount of time, but large-scale, population-based studies show time and again that education and mentally stimulating lives appear to protect us from age-related mental decline.
Even when the characteristic plaques and tangles in the brain that comprise Alzheimer’s are present, education appears to help fight against their effects. More educated people are able to live longer without showing symptoms of Alzheimer’s. They also show fewer symptoms than others with the same number of plaques and tangles in the brain. That means the symptoms will not appear until the disease is physiologically far more advanced than it is in those with less education. The more educated brains are somehow able to compensate for the damage, possibly because the initial connections in the brain are stronger or because their brains have adopted alternative pathways that avoid the damaged areas.
Autopsies back up these clinical observations. Researchers at Rush University Medical Center Alzheimer’s Disease Center in Chicago, in an ongoing study of aging among members of forty religious communities, found people with more formal education were able to sustain a greater buildup of plaques in the brain tissue.
PET scan studies have found the same thing. Damage from Alzheimer’s reduces the flow of blood in the brain. The more serious the Alzheimer’s damage in the brain, the lower the blood flow. You would expect the symptoms to follow suit, and they do in many Alzheimer’s sufferers. But in well-educated patients, that doesn’t happen. If you are well educated or had a high IQ before you were diagnosed, or if you had a mentally challenging job, then your symptoms would be much less severe than those in a person with the same blood flow minus the education, IQ, or job. Life activities such as reading, traveling, going for walks, gardening, and playing cards also seem to help give you the kind of brain that can better deal with Alzheimer’s.
This ability has prompted researchers to come up with the theory of cognitive reserve. A person with cognitive reserve essentially has extra capacity, which would have to be used up before symptoms started appearing. Someone with cognitive reserve would be able to tolerate more brain damage before showing a decline in mental functioning because his or her brain networks are either more efficient or more flexible (or both) than those in a less-educated person who does not have cognitive reserve. Not everyone agrees with this theory, but proponents point to mounting evidence that those who have used their brains more throughout their lives are better protected.
Evidence suggests almost any type of mental or social activity is beneficial, and the more you do, the better. Researchers have yet to figure out if one particular mental activity is superior to the rest in terms of warding off the symptoms of Alzheimer’s or compensating for the brain damage associated with the disease.
If the Alzheimer’s research wasn’t enough to get you to break out the Scrabble game, consider this: Cognitive reserve seems to do more than ward off Alzheimer’s. It also appears to help patients who have suffered from traumatic brain injuries. Shelli R. Kesler, a senior research scientist at Stanford University’s Center for Interdisciplinary Brain Sciences Research, has looked at magnetic resonance imaging (MRI) scans of twenty-five patients with traumatic brain injuries. Kesler and colleagues at Stanford and Brigham Young University found that brain size and education were good predictors of postinjury IQ, regardless of the severity of the injury. That suggests more education means less vulnerability to brain injury.
Kesler says more education means more neuroplasticity. Neuroplasticity is the brain’s ability to change. Neuroplasticity is stronger when we are younger. Anyone who has seen how quickly a child can master a foreign language knows that. But Kesler says neuroplasticity never ends. You can, in fact, teach an old dog new tricks. It just might take a little longer.
If you are an “old dog” reading this, you should be trying to learn new tricks on a continuing basis. Challenge your mind. Pick up an instrument. Learn a language. Read books. Do word games or math puzzles. Learning actually changes the shape, size, and number of neurons in our brains. The more you learn, the more protection your brain appears to have against damage later on.
“You can always learn,” Kesler says. “The more you learn, the bigger reserve you are going to have.” That’s the good news. The bad news is we need to keep challenging ourselves in different ways, she says. Don’t do the same type of mental exercise every day. Do a variety of challenging verbal and visual-spatial exercises. If you have mastered the crossword puzzle in your local newspaper, try sudoku. As you master one level of difficulty, go to the next level.
“Challenge yourself. Move up and progress to the harder ones,” she advises. “When you’re getting good at one thing, you want to do something you’re not very good at.”
It comes back to the analogy the memory champion Scott Hagwood likes to make: exercising the brain is like exercising the body. If you went to the gym, you would not use only the bench press every day, nor would you use the same amount of weight every day. You would use different machines and, if you were really working at it, you would probably start lifting heavier weights. You want to build strength in your brain in the same way. Make sure you are exercising your brain every day—in new and challenging ways. Chasing life is as much about keeping your mind sharp and functional as it is your body. Getting older doesn’t mean you have to forget your past or your present.
Paging Dr. Gupta
• Exercise your brain in different ways. Find problems that you have difficulty solving. The more you challenge your mind the better.
• Exercise your body; it helps your brain.
• Stay social and enjoy spirited discussions.
• Even if you’re an old dog, learn a new trick—the more you learn, the more you protect your mind.
• Make sure you get enough “brain food,” including fish oil, vitamins E and B, and folic acid.
• Add the spice turmeric to your diet—it may ward off Alzheimer’s.