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Declining Mental Faculties

Normal Aging or Medical Condition?

Erno Daniel, MD, PhD
Dr. Erno Daniel practiced Internal Medicine at 215 Pesetas Lane and specialized in Geriatrics. Dr. Daniel received his medical degree from the University of California, Los Angeles and was with Sansum Clinic since 1978. During his lifetime Dr. Daniel wrote numerous texts on aging and Alzheimer's disease and held a number of professional distinctions. The Internal Medicine Department can be reached directly by calling (805) 681-7602.

by Erno S. Daniel, MD, Internal Medicine & Geriatrics

Most of us note some "memory loss" with aging – we are not quite as mentally sharp as we used to be. However, clearly this involves more than simply memory loss. What we loosely call human "mental faculties," or in medical terms "cognitive skills" involve memory, concentration, ability to problem solve, do calculations, understand humor, and other mental tasks. And there are two kinds of memory: immediate-recall and short-term memory, and recalling and retrieving information learned or recorded by the brain years ago.

What is normal aging, and what is a sign of pathology? This is very difficult to define, because it involves a change from baseline, rather than some absolute measurement. Persons who had photographic memory all their life and now have to deliberately memorize things are clearly developing a problem. Someone who has had to memorize things all their life and is still doing the same does not have a problem. Yet both may be at the same measurable mental state. So how do we tell who is developing a problem?

Interestingly, family members and friends have an uncanny ability to note changes from baseline in the mental condition of someone whom they know closely. Asking such persons for their observations can provide insight into the evaluation of the patient. In medical conditions which cause evolving "cognitive impairment" there is an accelerated decline as compared to normal age-related slowing. However, one year into a slowly progressive condition such as Alzheimer's disease, it may be virtually impossible to tell whether one is on the normal downward slope or at the beginning of the pathologic steeper rate of decline.

How is a person with cognitive concerns evaluated? Diagnosis is made based on history as corroborated by family or friends, physical examination of the patient, and some laboratory tests. Formal neuropsychological testing may be suggested in cases where the cognitive symptoms may be early or subtle, or where there may be legal considerations regarding the person's decision-making capacity. Recently certain tests have become available that help more accurately prove the presence of Alzheimer's disease, but these same tests do not prove or disprove other causes of dementia.

In terms of management, dementia of the Alzheimer type has rightfully received the greatest attention. However, while certain treatments may be applicable to various dementias, certain non- Alzheimer dementias may have different treatments. If a person is suspected to have a condition other than Alzheimer's disease, then information should be obtained that pertains specifically to that condition.

According to information available at this time, medicines and supplements do not reduce the chance of developing Alzheimer's disease. Vitamins, antioxidants and gingko have not been shown to be protective. Physical activity which preserves brain volume and reduces risk of developing Alzheimer 's disease appears to provide the greatest protection. Maintaining ideal body weight, and aggressively preventing and managing diabetes, cardiovascular disease, hypertension and cholesterol and following a good diet are important. Mental activity and brain-fitness games are useful, but may not provide substantial protection. Social engagement, early recognition and treatment of depression offer benefit. Avoiding sedatives and anticholinergic medicines (such as strong antihistamines) and other medicines that are known to impair cognitive functioning should be a priority.

A great challenge is how to treat someone with mild cognitive impairment (MCI), which may be the early stepping-stone toward evolving dementia. No medicine has been officially proven to help.

A couple of thousand years ago the Roman poet Juvenal (along with the Greek philosopher Thales) admonished: "Mens sana in corpore sano". (A sound mind in a healthy body.) In regard to mental faculties and aging, we still have mostly the same simple suggestions: Do healthy things, eat a healthy diet, stay at a healthy weight and get lots of vigorous activity. Seek specific advice from responsible agencies. On January 4, 2011 the National Alzheimer's Project Act was signed into law, mandating a national plan under the aegis of Department of Health and Human Services to overcome Alzheimer's disease. Aside from healthcare professionals, organizations such as the Alzheimer's Association and the local Cognitive Fitness and Innovative Therapies (CFIT) center are excellent resources for those with concerns about their aging brain.



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