Worry and Brain Fitness

An interesting article appeared in the New York Times over the weekend. The article by Katie Hafner is titled “Exercise Your Brain or Else You’ll . . .Uh . . .” You can find the original article here (registration is required, but is free).

The article recounts several incidents in which people over 50 had troubling memory problems. One man, for example, couldn’t remember his own address when he went to send a package, and a woman who couldn’t locate her cell phone later found it in the refrigerator. Do these kinds of memory lapses mean that these persons have serious memory problems? The answer is, “It depends.” One memory lapse doesn’t mean very much. But a pattern of memory problems over a period to time may mean that someone’s memory isn’t as good as it used to be. Even if that’s true, though, it doesn’t necessarily mean that a person has a serious brain illness such as Alzheimer’s disease. Only a complete evaluation by a well-trained clinician can make that decision.

One issue the article highlights is how people over 50 or so may be more concerned than younger people about memory lapses. Put simply, people over 50 are more likely to worry about brain fitness. I have the pleasure of working with several young people in the Center on Aging. I notice that they may have memory lapses, but they don’t worry about them nearly as much as some of the people who come to our Memory Disorders Clinic for evaluation of their memory. They’re young, and if they forget something they don’t automatically worry about it. For them, it’s just a lapse. For someone over 50, the same kind of lapse is ground for worry. I’m not suggesting that if you’re over 50 and you’re worried (or your spouse and family are worried) about your memory you shouldn’t do something about it. I am suggesting that people over 50 may worry more about their memories. The New York Times article goes on to talk about how worry about cognitive fitness and cognitive decline or memory problems is feeding interest in brain fitness software.

If you’re worried about your memory, the best thing to do is find a qualified clinician who can complete a screening evaluation. Tests of memory and other cognitive abilities can help you find out where you stand in relation to other persons who are similar to you. This can help you decide whether your memory problem needs to be treated. And if you have a memory problem, a knowledgeable clinician may help you find out what’s causing it. Some memory problems are caused by problems such as mood problems, stress, or other treatable conditions. Getting the treatment you need may help.

Mood and Memory

Back in 2006, a group us that included Drs. Amarilis Acevedo, Elizabeth Crocco, David Loewenstein, Vineeth John, and myself published an article that presented results of a type of study called a meta-analysis. In that kind of study, researchers try to find all available studies on a subject and then combine the data from them. The advantage of this kind of study is that helps us understand results from conflicting studies and may allow us to correct for how well or poorly studies were done.

The subject of our study was whether there is a relation between having a history of depression and getting Alzheimer’s disease later in life. We looked at data from more than 100,00 people who had had depression. Our study, published in the Archives of General Psychiatry, 2006, 63, 530-538, showed that the odds of getting Alzheimer’s were about two times greater in people who had depression as much long as 10-15 years before. A study in the April 8^th edition of the journal Neurology confirms this relation (Geerlings et al., Neurology, 70, 1258-1264).

A lingering controversy is whether depression is a risk for Alzheimer’s or whether it is simply an early symptom of it. In a well-known study, one group of researchers reported that people whose memory got better after being treated for depression still got Alzheimer’s later. Some people have argued that being depressed was one of the first sign that they were getting Alzheimer’s.

Other people have suggested that depression, even much earlier in life, may be part of the same process that results in Alzheimer’s disease.

Many researchers today speculate that the process in the brain that results in developing Alzheimer’s disease begins years and even decades before someone has the disease. Researchers are also interested in the connection between cardiovascular disease and Alzheimer’s disease. It turns out that some of the same risks that are related to cardiovascular disease and Alzheimer’s disease are also related to depression. For example, when some people have magnetic resonance imaging (MRI) scans of the brain, something called “white matter changes” are sometimes seen. Many people believe these are caused by vascular disease in the brain, and they are related to having depression.

What does this mean for your brain fitness? I think it shows the importance of keeping cardiovascular risks low, not just to keep your heart healthy but also to keep your brain healthy. If you don’t know about your blood cholesterol level (and associated lipids such as HDL, LDL, and triglycerides), find out. A simple blood test will let your doctor find out more about how your body is taking care of certain substances in your blood. You may want to ask your doctor about another simple blood test for a substance called C-reactive protein. C-reactive protein is a separate marker for cardiovascular risk. If your cholesterol or one of the other lipids needs treatment, your doctor may prescribe diet changes, increased exercise, and a medication from a group of drugs called statins. These medications can improve your lipid profile. People who take statins have reduced risk for Alzheimer’s disease.