Once upon a time, there was a lovely woman named Harriet.   She adored her grown children, her young grandchildren, her Pomeranian and her potted petunias.   She went for walks in the neighborhood nearly every day, stopping to chat with neighbors.   An extensive book collection lined the walls of her house, and she claimed to have read every one of them. 

At sixty-four, she was educated, financially savvy, and active.

She was also scared.

When she woke up in the mornings, she didn’t always remember what day of the week it was.  Always proud of her intellect, she’d started struggling to follow the science programs she loved to watch. She’d been feeling moody, she’d lost her keys 3 times  in the last week, and more worrisome, just today, she’d put a casserole in the oven and forgotten about it entirely. 

“Thank gawd for smoke alarms!” she thought, as she opened the windows to air out the smoke, and fought back her fears.

It wasn’t the risk of fire that frightened her - she was afraid of the forgetfulness.  “What if it’s Alzheimer’s?”  She was terrified of her brain betraying her, leaving her dependant on her children and grandchildren, without even knowing who they were to thank them.   How could she even tell them? The words were just too scary to say out loud.

That night, as she tried to sleep, the fears would not stop.   “What if, what if, oh no!” they whispered.

The concerns kept her awake most of the night (as they had for most of the past few weeks) and she woke up to find her mind more muddled than ever.  Fixing herself a cup of coffee, her gaze fell on the mostly-ignored computer tucked into the corner of the breakfast room.  

She decided to face her fears - but anonymously,  online, where no one else would know.  She sat down in front of the dusty monitor, flipped the on switch, and while the computer booted, she wondered about her future.  How long did she have before she couldn’t be trusted to make her own coffee? How long until she became a burden?

Unsure where to start, she typed “Do I have Alzheimer’s?” into Google (her grandson had set it up as her homepage).  She started following links, taking notes and printing out relevant information to help her remember. 

What she discovered didn’t give her easy answers, but they were important answers, and they did calm her fears.  

Why was she forgetting?

First, she discovered that her forgetfulness could be just normal age-related changes in memory, and were not really a cause for concern unless they began to interfere with her quality of life. 

Then, she found that some medications could interfere with memory and overall mental function, including the blood pressure medications she took on a daily basis.  

Harriet noted other causes for poor mental function that didn’t seem to apply: head injury, diabetes, alcoholism, dehydration and depression  - but she was surprised to find sleep deprivation and anxiety listed.  Could her staying up late, and worrying over her memory actually be making the situation worse?  According to the information online, maybe so!

But the fears persisted -  it still could be the early stages  of Alzheimer’s. After all, two of her aunts and her father had died of the disease, a family link which  web-sites said increased her risks.   She was pretty sure there was no cure for the disease….  was there any benefit to actually getting a diagnosis?  Could it even be diagnosed this early?  Maybe she could just try and sleep more…

But with a few more mouse clicks…

Harriet was surprised to find that while there wasn’t a single test for Alzheimer’s,  it could be diagnosed with a 90% accuracy.  And although there was currently no cure for Alzheimer’s itself, there *were* treatments that could delay or reduce its symptoms.   Additionally, there were many promising research trials going on - and obviously, to be eligible for the trials, she would have to be diagnosed.  

Knowing about the disease now, when her mind was still (mostly!) intact would  mean she had the ability to plan for the future - she could set up her finances and make long term healthcare choices so her family wouldn’t have to figure it out for her, later on.   The more she thought about it, the more she thought it would be better to know.   

She could make a special point to be sure her family knew how much she loved them, so they’d remember her love for them, later on through the tougher times.    On one site, she read about how going over old photos could jog memories in Alzheimer’s patients -  if she knew *now*, she could make albums of those photos herself…  or with her grandson’s help, maybe she could make video collections of the photos, recording a soundtrack using the memories she had now.   Maybe it would help her remember, or maybe it would just mean something to her family.  Either way, she would do it.   

And she’d use the diagnosis as a motivation to do those things she’d always wanted to do, but put off ’till later…  “If I do have Alzheimer’s,” she decided, “I’ll start piano lessons next week!  Maybe I can even do a recital to raise awareness and research money…”

But what if she *didn’t* have Alzheimer’s?

Was  a muddled mind just part of getting older, dooming her to a future of frustrating forgetfulness?  (Harriet is a big fan of alliteration, if you haven’t noticed)

With a few more mouse clicks,  Harriet found top experts who believed there were multiple ways to combat “normal” effects of age on the brain. Amazingly, the same methods  seemed to offer protection against symptom’s of Alzheimer’s and other causes of dementia.   

Several well-regarded organizations had put together recommendations for maintaining what they called “Brain Fitness”, along the same lines as the American Heart Association’s “Hearth Health” guidelines.  

Some of the advice seemed common sense, general health things…   including the usual standards of physical exercise and a healthy diet.  She was interested to find that exercise had more than a “general health” benefit though - it seemed to improve mental function in a variety of ways.  Good thing she’d been going for those daily walks!

But some of the ideas were intriguing, and based on new advances in neuroscience. 

New Ideas

No one seemed to know exactly why physical exercise seemed quite so crucial to mental function, but the best guesses had to do with increased blood flow, the way that physical activity caused different sections of the mind to work together,  and the specific mental states created by physical activity.

Another set of studies suggested staying socially active was important to keeping a sharp mind throughout life - again, there was no proof as to why, but the assumptions were that it had to do with keeping the brain stimulated in a variety of ways, reducing the risk of depression, and increasing the likely hood of physical activity.  She wondered if even just playing with her little lap dog might have some of the same effects, and she decided she’d start taking him to the Senior center with her, to see if he would perk up some of the more isolated folks who went there.

Most intriguing was the information Harriet found on mental exercise.  In contrast to what she’d had learned in biology classes decades ago,  scientists now knew that the brain *did* continue to produce new cells throughout life, and it could change, grow and adapt to new challenges at any age. The changes were often triggered in response to use and need,  the same way muscles grew (or atrophied) in response to use.   And just like an atrophied muscle could be trained back into use, in many cases, the brain could be re-trained to improve functions that may have been failing.  Diseases of the brain complicated the task, but didn’t necessarily make it impossible.

Mental exercise was turning out to be equivalent to physical exercise - “thought-workouts” could change the physical structure of the brain.   Companies were even developing various types of  “trainers” for the brain,  programs that would step them through a variety of challenges,  in much the same way that fitness videos and programs led people through a series of physical exercises.  

She was especially intrigued by the idea of building a “cognitive reserve”.  She wasn’t sure sue understood it entirely,  but it seemed that the more someone  built up and maintained their brain function, the less severe the symptoms of age-related declines would be, even when they involved diseases of the brain.

And it made sense.  The way she understood it, Alzheimer’s caused parts of the neural network to gradually fall apart as individual  connections failed.  The smaller and less complex the network was, the more impact the failure of those connections had.  But if the network had multiple connections, the messages could be rerouted to avoid the “bad spots” and the brain could continue to work smoothly. 

How could she build a strong  cognitive reserve?  In part, by continuing to learn, take on new challenges, practice skills that challenged different functions in her brain.  Her education likely already provided her with a buffer, but she could increase it with continued learning and targeted mental exercises.   She’d already determined that if she had Alzheimer’s, she’d take piano lessons…  now, that seemed like a good idea no matter what her diagnosis might be.

Much Relieved…

Harriet looked up from the screen to find that the morning light had shifted into late afternoon, and the day had sped past.   But she was no longer afraid of her own “twilight years”.   Looking over her notes, she turned them into a to-do list.
  

1. Make a doctor’s appointment.
2. Make a list of things to talk to the doctor about- not just symptoms, but possible causes: her  current medications, her sleep problems and anxiety.
3. Call her kids, tell them about her concerns and what she’d learned.  Encourage them to keep their minds (and the minds of the grandkids!) challenged and fit to build that cognitive reserve.
4. Sign up for those piano lessons.
5. Go for a walk!

Somehow, she was sure that after her walk, she’d be able to fall soundly asleep, and stay that way through the night.  Relief was good that way. 

And so she, her grown children, her young grandchildren, her Pomeranian and her potted petunias lived happily ever after for many more years, their minds as sharp as ever.  (Except for the potted petunias, of course… who had never been all that sharp witted to begin with)

MindTweak: There are very few monsters who warrant the fear we have of them.                                                                            - André Gide.