Understanding Memory Loss and Cognitive Health in Aging

Galluzzi: Occasional forgetfulness is a normal part of aging. We've all experienced moments when we can't remember where we parked our car or misplaced our keys. These are common examples of age-related forgetfulness and do not necessarily indicate a more serious cognitive problem.

However, it's important to distinguish between normal forgetfulness and two conditions that may signal more significant cognitive changes: mild cognitive impairment and dementia.

Mild cognitive impairment involves changes in memory or other cognitive abilities that go beyond what we would expect with normal aging. These changes can be measured and monitored over time but don't necessarily interfere with daily activities. Importantly, not everyone with mild cognitive impairment will develop dementia.

Dementia, on the other hand, involves cognitive impairment significant enough to interfere with a person's ability to carry out everyday activities independently. Dementia is not a normal part of aging.

Galluzzi: A common example is having difficulty recalling someone's name or a particular word, only to remember it later. This is an example of what we call benign senescent forgetfulness, a term used to describe the occasional memory lapses that can occur as we age without necessarily indicating a more serious cognitive problem.

Another important consideration is how memory loss affects a person's ability to function independently. We generally look at two categories: basic activities of daily living, such as dressing, bathing, and feeding yourself, and instrumental activities of daily living, such as shopping, cooking, managing finances, and keeping appointments.

Instrumental activities of daily living require higher executive functioning, which involves the brain's ability to plan, organize, and carry out tasks. The distinction rests upon whether we're experiencing occasional forgetfulness or whether cognitive changes are beginning to interfere with our ability to manage everyday activities.

Galluzzi: One of the things we hear a lot is that someone will be walking or driving and get lost in a neighborhood where they've lived all their life. This person may have more than just normal age-related forgetfulness. Other warning signs include persistent word-finding difficulty, failing to recognize familiar people, or having trouble managing everyday responsibilities. Many formerly high-functioning individuals are able to maintain a good “social facade”—that is, they appear to have it all together—until they are pushed to do something involving executive function, like making travel arrangements or balancing a checkbook.

Often, these changes are first noticed by family members or caregivers, which is why we involve them when evaluating their loved ones. Sometimes, a spouse or family member has taken over responsibilities such as managing finances or grocery shopping, unintentionally compensating for cognitive difficulties that have already developed. When that support is no longer there, those difficulties become much more apparent.

We do that for our loved ones because we don't want to think that somebody is losing their cognition. But here's the thing: The sooner we recognize that something is wrong, the sooner we can intervene.

Galluzzi: One of the most important things we can do is maintain good metabolic and cardiovascular health. Conditions such as obesity, type 2 diabetes, and high blood pressure are associated with an increased risk of cognitive decline, including vascular dementia.

I like to say that the fountain of youth is exercise. That includes weight-bearing exercise, resistance training, and cardiovascular activity—and the earlier we establish these habits, the better. We shouldn't wait until we're older to begin taking care of our physical health.

I would also emphasize the importance of staying up to date on recommended immunizations. Preventing infections through recommended vaccinations is another important aspect of protecting our overall health as we age.

Mental exercise is equally important. Research has consistently shown an association between higher levels of educational attainment and better cognitive health in older age. Continuing to learn, challenging ourselves intellectually, and practicing new skills can help keep our minds engaged. It's really about both physical and mental exercise. Those are two of the most important things we can do to support cognitive health as we age. I believe that the future of longevity lies in improving brain health.