Some forgetfulness is acceptable and is part of age-related disorders; other times fatigue and distraction actually come into play. Mild cognitive decline reversible by adjusting lifestyles
Should I go left or right? After having traveled the same road for years, it may actually be surprising to find oneself doubting the way forward and therefore the real extent of a forgetfulness: will be the sign of a age-related cognitive decline or the beginning of something more serious like the Alzheimer’s disease or other neurodegenerative diseases? As happens for the whole body, brain cells also age with age: with fewer connections between neurons, some memory failures could be due to physiological brain aging even if, it is worth emphasizing, not all memory lapses are due to changes related to the age of our neurons. In many cases other more mundane factors come into play such as the tiredness, anxiety, distraction.
Which oversights are acceptable and which are not
UA certain degree of forgetfulness can be judged normal: Too much unnecessary information risks slowing down or hindering the recovery of specific memories. We don’t decide what to remember (unfortunately) but the brain that does and usually prefers social information (such as the latest gossip) to abstract information (such as mathematical formulas). However, the memory leak becomes a problem when it begins to affect the course of daily life. It can happen that you are absent-minded and find yourself in the car, along a road that you travel automatically every day, and go to work instead of stopping at the station, a destination that you actually wanted to reach. A pervasive thought can interfere and make us mistake, but there is no need for alarm to clarify Alessandro Padovani, director of the Neurology Clinic at the University of Brescia. Rather it can feed into the idea that there is something wrong – forgetting why you are in the car or not being able to make your way back if there are road disruptions because they don’t ‘fix’ geographic coordinates.
Spatial memory and associative memory
Alzheimer’s disease, as well as other neurodegenerative diseases, is very insidious and it takes years before the disorder becomes so disabling to take the patient, often late, to the family doctor or specialist. The first disturbances affect the spatial memoryor the one we use to “navigate” in space and the so-called memoria binding, or the one we use to link two pieces of information, for example the face of a person to his name: they are in fact two types of memory that suffer deficits following neuropathological alterations affecting the hippocampus and the precuneus clarifies Padovani, who is also the new president elected of the Italian Society of Neurology (in office since October 2023). In most Alzheimer’s patients the first complaints concern the ability to learn new paths or new associations of names to people. As Padovani points out, some people reported having had problems orienting themselves for several days once they arrived at the beach house after a year’s absence. Learning a new itinerary in a new reality – explains the neurologist – requires a certain ability to link different aspects together in a new temporal dimension to create the so-called path. The same thing happens with people’s names: learning new names for new people is by no means easy and not automatic. Alzheimer’s patients recognize a person in the public domain, but are unable to say their name. When I ask for something that seems trivial like the pope’s name, many patients struggle to remember it or don’t remember it at all and this is not an acceptable disorder, but a sign that something is really wrong.
The confounding aspects
The difficulty of understanding if we are faced with a cognitive decline which could represent the prodrome of a neurodegenerative disease or age-related disorders represented by the fact that 2/3 of patients begin to experience memory impairment at an advanced age, starting from the age of 75, when other age-related problems can take over, such as sleep disturbances or taking drugs that can interfere with neurological abilities. Age, especially in the more advanced stages of life – underlines Padovani – determines a memory disorder which is apparently similar to cognitive decline but which concerns the ability to learn new procedures or new patterns such as, for example, learning to use a new mobile phone or using a SPID: in other words, to correctly use all the information that makes up a memory and the strategies useful for strengthening the trace. It is not entirely easy to distinguish the two disorders clinically, especially when they occur simultaneously in old age. We read a book almost automatically – Padovani gives another example – but we will remember it better if we pay more attention to the story, if we reflect on the plot or write down some detail. With age, this ability to register and implement strategies to better remember events becomes less effective and it may happen that you do not completely remember a book or film because you have not implemented any strategy to do so, but it is not a sign troubling because it is a problem closely related to aging and has nothing to do with Alzheimer’s.
Not all lost
Realizing that memory no longer works like it used to be an initial step, have one diagnosis of mild cognitive impairment one more element which however could be seen as adouble weapon cut because older people risk experiencing anxiety and worry about discovering that their memory failures are abnormal and could (but certainly not) turn into dementia. In fact, experiencing a mild cognitive decline correlates with an increased risk (three to five times) of developing neurodegenerative diseases such as Alzheimer’s in the future. Approximately every year 10-15% of people diagnosed with mild cognitive impairment will develop dementia; another 15% will do it after two years, another 15% after three: we observe a certain evolution of the disease that affects a growing number of people over time, points out Padovani. But it is not an inescapable destiny. In the early stages, much can still be done to slow down or even reverse the trend. We have convergent data on the fact that improving lifestyles helps slow down the evolution of the disease adds the neurologist. Treating hypertension better, diabetes, treating depression, improving diet, sleeping better, walking more, eliminating smoking and alcohol are all useful strategies to lengthen the decline phase without entering an aggravation phase which distance of time is compatible with dementia. Really 20% of patients with mild cognitive impairment regain lost skills by “fixing” incorrect lifestyles. For a proportion of patients, therefore, cognitive decline may be reversible. In people with gastric and pancreatic disorders, in particular if they make prolonged use of gastroprotectants – concludes Padovani – the cognitive impairment can be partly linked to a reduction in the absorption of vitamin B12: in these cases, when correctly ascertained, it can be useful a vitamin B12 supplementation, preferably in combination with folic acid and omega 3 with Omega 3.
January 12, 2023 (change January 12, 2023 | 1:17 pm)
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