Just as studies have shown that stress can have a negative effect on your memory, it’s pretty clear that anxiety can make it harder to remember things, too. We’ve probably all had the experience of trying to remember a name or a word and feeling frustrated about not being able to come up with it. Paradoxically, the harder you try to remember, the less you’ll be able to do so.

So far, that’s pretty normal. Younger people have the same kind of trouble with their memory occasionally, although it may happen more frequently as we get older. It’s what happens next that makes it different for older persons.

Many of my older patients may have a problem with remembering a word or a name, but they go one step further: When they can’t remember something, they start worrying about it. They may interpret the fact that they can’t remember means they have a memory problem, maybe even Alzheimer’s disease!

Sometimes, when people start worrying about a problem, they think of the absolutely worst thing that it could mean. A cloud in the sky, for example, may mean that a tornado is coming. We call that catastrophizing. It’s not good English, but it is pretty clear what it means. It means taking a real problem and magnifying it by exaggerating it to the worst possible outcome.

How do you avoid catastrophizing? When you begin to feel worried or anxious, try to stop and consider alternate explanations for whatever you’re worried about. Could that cloud just mean that there’s a cloud, not that a tornado is coming? Odds are that the answer is yes. Is having trouble remembering annoying. Yes. Does it mean that you have a serious memory disorder or neurological disease? Probably not.

As always, there’s no substitute for a thorough evaluation of your memory by a competent clinician. An evaluation ought to include assessment of your general ability, concentration, and memory. And never forget the importance of taking care of other medical problems, such as high blood pressure or diabetes.

Frailty may make you think about someone who is quite old and infirm, but at least some people think of frailty as a physical equivalent to developing cognitive problems. Pre-frailty (having just a few of the characteristics of frailty) may be like mild cognitive impairment, a milder form of memory or other cognitive problems that may lead to dementia.

From this point of view, preventing frailty may be a route to preventing decline. Although frailty is defined by things like slow walking and muscle weakness, research shows that frailty is associated with memory problems and depression.

It might seem odd that muscle strength and walking speed go along with memory and depression. But besides the research that show they are related, there’s a good reason why they are linked. Frailty has been linked to higher levels of markers of inflammation such as the pro-inflammatory substances called cytokines. There are substances in your body that are increased when you are sick, but they also increase as you get older.

Evidence suggests that low grade but chronic inflammation may be a key factor in aging. Researchers are still studying the best ways to reduce the effects of inflammation, but it’s likely that exercise reduces levels of inflammatory substances. It is also possible (but not proven) that antioxidant supplements and some diets may help to reduce inflammation. These same things may help prevent frailty. Exercise may be an important defense against developing frailty as well as helping with cognitive decline.

The second study, by Feart and her colleagues, looked at adherence to the Mediterranean diet and risk for having problems on certain mental ability tests. Here again, the study suggests that following the Mediterranean diet was associated with a reduced risk of developing certain kinds of cognitive problems.

The study was discussed by Dr. Nancy Snyderman on the Today Show. You can find a link to a page that will let you see the segment from the show here.  (Look for a link to “Study: Mediterranean diet cuts Alzheimer’s risk.” You also have to watch a commercial; that’s NBC, not me).  I think that she may overstate the case based on the research; there’s a very nice editorial in this same issue of the Journal by well-known neurologist David Knopman. He points out a number of possible reasons for these findings that might affect the conclusion that the Mediterranean diet and exercise reduce the risk of Alzheimer’s. He suggests we should “nibble and savor” the results of these studies, not “swallow them whole.”

It’s still premature to be sure that following the Mediterranean diet or being physically activity will prevent Alzheimer’s disease. Given what we know about the relation of cardiovascular health and risk for Alzheimer’s, and what we know about diet and exercise and cardiovascular health, though, I think it’s a good idea to pay close attention to your diet and to exercise safely.

The Mediterranean diet is an important part of any brain health program. A number of studies have shown that people who follow the Mediterranean diet have less chance of having a heart attack, and that changing to the diet can reduce risk for another heart attack. Consistent with our increasing appreciation of the relation of heart and brain risk factors, at least one study has shown that people who follow the Mediterranean diet more closely have a lower risk of being diagnosed with Alzheimer’s disease.

Just that may be enough to have you ready to try the diet, but you might wonder what it is and what you’re supposed to eat. That’s where Dr. Michael Ozner’s book comes in. Dr. Ozner is a cardiologist in Miami, Florida, and says that he has been using the diet to treat his patients for more than 25 years. The book includes clinical vignettes in which patients describe their experiences with the diet and how it has helped them. Although Dr. Ozner recommends the often-unpopular practice of counting calories, people who follow the diet may find that they can eat more and still lose weight because of the diet’s emphasis on low-glycemic index foods, fresh fruit and vegetables, and whole-grain breads and pastas.

In clear language Dr. Ozner lays out the reasons why you should be interested in the diet. He gives you an overview of the studies that have shown that people who follow the diet have lower risk for heart disease, and explains why. You may note that many of the elements of the Mediterranean diet have anti-inflammatory and anti-oxidant effects, making it similar in this respect to Dr. Andrew Weil’s anti-inflammatory diet.

But the book has lots more than just a description of the why the diet is important. It also has a complete 14-day diet plan and a wide selection of recipes that any cook can use to make the diet not just healthy but delicious. My favorite section of recipes is the one for pizzas. There is also a section with a number of recipes for desserts that are high in flavor and low in fat.

Overall, this is a very useful book that will help you understand the importance of the Mediterranean diet and will help you get started in following it.

The Miami Mediterranean Diet: Lose Weight and Lower Your Risk of Heart Disease with 300 Delicious Recipes

Hardcover, 432 pages, ISBN 978-1933771502, $25.95.

Click here to order the book from Amazon.

Cognitive Aging refers to how our mental capacities change over time. It may seem as though all of our abilities go downhill after age 30 or 40, but research shows that isn’t completely true. The truth is that some abilities decline over time, some stay about the same, and some actually improve as we get older. For example, psychomotor speed is an ability in which most people perform more poorly over time. The precise definition of psychomotor speed varies from study to study, but it’s often assessed by tests that ask you to do some kind of task that requires that you think and to something with your hands as quickly as you can. One task is called a pegboard. A piece of metal attached to a block of wood has rows of holes in it, a little like the kind of pegboard you might put up in your workshop to hold tools. The person being evaluated is asked to put small metal pegs in the board as quickly as he or she can. This is the sort of thing that younger persons in general do much better than older persons do.

Another ability that may decline over time is called working memory. This ability is usually assessed by asking someone to keep a couple of things in their minds and then do something with them. The person being evaluated might be given a series of numbers and then asked to repeat them backwards –  he or she has to remember the numbers and then somehow mentally read them backwards. Being asked to do mental arithmetic problems also taps working memory. Here, the person being assessed might have to remember some elements of the problem that are given, might have to access some existing knowledge (like how many quarts are in a gallon), and then do a calculation.

What abilities may actually get better over time? Things that don’t require speed or working memory, but may benefit from life experience. The most common example is vocabulary. Many older adults score better than their younger counterparts on tests of how many words they know. Older adults probably have had more opportunities to learn words, and once a word is in long-term memory, older adults can recall it pretty well. Some people have also suggested that because of the benefits of experience, older adults are better able to discern patterns in events around them. Finally, some research has shown that older adults are better than younger persons at certain kinds of problem solving, especially when it involves social skills or awareness of social issues.