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How to improve your memory now

What works—and what doesn't—to stop Alzheimer's and boost brainpower

Published: April 2014

You couldn’t find your keys this morning, blanked on the name of someone you met last week, and had to look up the instructions on how to record a TV show again. Though you may worry that these lapses are warning signs of a downhill slide into mental decline, the truth is that the occasional “senior moment” doesn’t mean you’re losing your memory. “No one runs as fast at age 80 as they did at 30," Lon ­Schneider, M.D., director of the Alzheimer’s Disease Research Center at the University of Southern California­, said. "Our brain ages just like the rest of our bodies. But the majority of people who grow old do not get Alzheimer’s disease or any other form of progressive dementia.”

Nonetheless, a whole industry has grown up around that worry, with supplements and software targeting people hoping to keep their brains buff. The good news, according to our consultants, is that you can protect your brain and reduce your risk of dementia, but the key isn’t necessarily found in a pill or on your computer.

The aging brain

Illustration: Stacy Janis
 

No one’s brain is immune to the effects of aging. Certain areas shrink, communications between nerve cells fizzle, and the arteries responsible for nourishing the brain with oxygen-­rich blood narrow. In practical terms, it could mean you find it a bit more difficult to learn a new skill or to remember the name of someone you met last week. Age-related changes particularly affect the brain’s prefrontal cortex (the front portion of the frontal lobe) and the hippocampus, areas that are responsible for learning, memory, planning, and other complex activities.

But even with all of those natural processes, most of us know people who remain sharp well into old age. In fact, research verifies that healthy 70- and 80-year-olds often perform similarly to younger people on complex tasks of attention, learning, and memory—they just need a bit more time. It helps that some things, such as vocabulary and other general knowledge, often get better with age. Plus, brain scans of older adults show that our brains appear to compensate for natural declines in some brain regions.

All told, as many as 10 percent to 20 percent of people 65 and older have what is called mild cognitive impairment, or MCI, mean­ing they have some problems with thinking abilities but are still able to go about their daily activities. Some people with MCI never worsen. Others get better, possibly because an underlying cause—medication side effects or an aialment such as thyroid disease, for example—is identified and treated. But research shows that about half of people who visit their doctor because of MCI symptoms progress to dementia after three or four years.

The truth about dementia

 

Dementia can be caused by a brain injury such as a blocked artery or a leaking blood vessel—the result of a stroke, for example—or by abnormal changes in the brain. In Alzheimer’s disease, the outer layer of the brain, which includes the prefrontal cortex and the hippocampus, shrivels while the fluid-filled spaces grow larger. Twisted protein fragments, or tangles, develop in nerve cells and clump between cells in clusters called plaques. Those abnormal growths are thought to cause nerve cells to stop working, lose connection with each other, and eventually die. The disease is progressive and eventually fatal.

Though it’s still unclear exactly what causes the disease, risk factors include genetics, lifestyle, and environmental elements. For example, very high blood levels of DDE, a chemical by­product of the now-banned pesticide DDT, have been linked to people with Alz­heimer’s disease.

Smoking, high cholesterol, high blood pressure, and diabetes can be risk factors as well. So can allowing your mind to languish. One intriguing finding comes from autopsy studies showing that some people who functioned quite well while alive nonetheless had brains riddled with plaque deposits that mark Alzheimer’s disease. Researchers think that a lifetime of learning and engagement allowed those people to build a “cognitive reserve”—a buffer of extra brain structures and neurological networks that compensated for the areas affected by disease.

Do drugs help memory?

 

The only drugs developed specifically to treat the cognitive symptoms associated with mental decline in aging are those used in treating Alzheimer’s disease. Three medications approved to treat mild to moderate Alzheimer’s—don­epezil (Aricept and generic), galantamine (Razadyne and generic), and rivastigmine (Exelon and generic)—reduce the breakdown of acetylcholine, a chemical that shuttles information between nerve cells. (Because Alzheimer’s eventually destroys the cells that make acetylcholine, the drugs technically have the best chance of working early in the course of the disease.)

A fourth drug, memantine (Namenda), blocks a chemical messenger called glutamate that builds up to toxic levels during the disease. Memantine is approved by the FDA only for moderate to severe Alzheimer’s.

But the reality is that the drugs don’t help much. “For most patients, these drugs appear to have only a small effect on slowing the progression of symptoms,” Steven Woloshin, M.D., professor of medicine at the Institute for Health Policy and Clinical Practice at Dartmouth’s Geisel School of Medicine, said. “They have not been shown to reverse the disease, reduce caregiver burden, or prolong independent living.” An analysis commissioned by Consumer Reports Best Buy Drugs from Informulary, a company founded by Woloshin and another Dartmouth professor, Lisa M. Schwartz, M.D., reveals that few patients taking Alz­heimer’s drugs benefit based on doctors’ assessments and tests of basic thinking, and even then the improvement is usually slight.

The drugs also can cause side effects, including insomnia, vomiting, diarrhea, and weight loss, that can be especially difficult for people with dementia.

Still, if you or someone you know has mild to moderate Alzheimer’s disease and wishes to try a drug, consider CR Best Buy Drugs’ recommendation of generic donepezil, which has a lower rate of side effects. If there’s no improvement in symptoms after three to six months, it’s unlikely that there will be, so it makes sense to consider tapering and stopping the drug.

For more information, read Consumer Reports Best Buy Drugs report on drugs used to treat Alzheimer's.

Protecting the brain

 

Can you pop a pill to get protection? It’s unlikely, according to a large review published in 2013 in the Canadian Medical Association Journal. Researchers analyzed studies of Alzheimer’s drugs, hormones, nonsteroidal anti-­inflammatory drugs such as naproxen (Aleve and generic), and supplements such as ginkgo biloba, folic acid, and omega-3 fatty acids. They found no consistent evidence that they helped prevent cognitive decline in healthy people.

So what can you do? Experts say the same steps you take to promote your overall health and well-being should help protect your brain.

• Be active. Research has shown a link between physical activity and a reduced risk of cognitive decline. Exercise might also benefit those with dementia. In a 2012 study, Alzheimer’s patients who walked 2 hours or more weekly for a year improved on tests of thinking skills while their sedentary counterparts’ scores declined.

• Guard your health. Don’t smoke. Drink alcohol in moderation. Strive for a healthy weight. Work with your doctor to ensure that your cholesterol, blood pressure, and blood sugar levels are within a healthy range.

• Eat Mediterranean-style. Some people have been found to stay sharp longer and have a lower incidence of dementia if their diet is rich in fruit, vegetables, whole grains, beans, nuts, and seeds; has low to moderate amounts of fish, poultry, low-fat dairy, and olive oil; and is low in red meat.

• Sleep. Sleep problems could account for some of the cognitive difficulties people chalk up to getting older. If you have trouble getting a full night’s rest, talk with your doctor.

• Socialize. Regularly seeing family and friends, attending events, or volunteering might also prevent or delay cognitive decline.

Memory loss: When to worry


Being forgetful from time to time is a normal part of life, not just aging. But what’s normal, and what isn’t? See below for examples; for a complete list, go to the Alzheimer’s Association at alz.org.


Example #1:


What’s normal Occasionally forgetting names of acquaintances, books, or movies (but remembering them later). 


What’s not Forgetting the names of close friends and relatives. Being unable to remember things you just learned. Being unaware of your memory loss.


Example #2:


What’s normal Sometimes having trouble finding the right word. 


What’s not Frequently forgetting common words or substituting unusual ones (calling a watch a “hand clock”).


Example #3:


What’s normal Occasionally forgetting where you are going. 


What’s not Getting lost in your neighborhood or forgetting how you got somewhere.


Example #4:


What’s normal Sometimes misplacing things. 


What’s not Putting objects in unusual places, such as your keys in the freezer.


Example #5:


What’s normal Occasional moodiness. Becoming irritated if your routine is disrupted. 


What’s not Rapid mood swings for no apparent reason. Becoming increasingly suspicious, fearful, or easily upset.


Example #6:


What’s normal Making a questionable decision, such as setting off on a rainy day without an umbrella or jacket.


What’s not Frequently making clearly inappropriate decisions, such as giving large sums of money to telemarketers.


Editor's Note:

This article also appeared in the May 2014 issue of  Consumer Reports on Health. This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).



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