Immediate answer: The newest research shows that your own impression of your memory–not anyone else’s, and not any particular test–could be the very first sign of mental decline as you age.
Longer answer: We all have episodes of forgetfulness no matter how old we are. Ask any high school senior confronted with the SAT vocabulary section (“I just looked that word up yesterday!”).
You’ve mislaid your keys again or you walk into a room and can’t remember why you’re there. If events like these occur rarely, it’s just part of being human. If they occur regularly, it’s probably time to see your doctor. It could be an easy fix–low vitamin B-12, underactive thyroid, diet changes, a review of your medications. But if all your tests pan out normal, it’s time for some preventive intervention.
Yes, there are significant steps you can take stop this.
Subjective cognitive impairment (SCI)
The term used by researchers is subjective cognitive impairment, which simply means you’ve noticed something’s not working right with your mind. It’s subjective because it’s your own perception. If you were to take a test for dementia as administered by a neurologist, you’d be told that everything is fine.
But if you answered yes to the question “Do you feel your memory or thinking has changed over the last five or 10 years?,” that’s SCI. If you answered no, you’d be classified as a person with no cognitive impairment.
Now, new research has confirmed what neurologists long suspected. Compared with people who have no cognitive impairment, if you have SCI you’re at increased risk of developing dementia as you age. The term “increased risk” doesn’t mean you’ll definitely have dementia in the future, especially if you take some steps now. It simply means that your SCI shouldn’t be brushed off as a feature of getting older.
Because the “S” of SCI is subjective as opposed to objective, there really aren’t any useful tests to help with diagnosis. It’s your personal observation taking the lead. SCI can occur in healthy people, with psychological testing showing absolutely no objective evidence of mental impairment. Not to confuse the issue, but totally reversible SCI can occur with physical illness, depression, anxiety, and hormonal changes, and as a drug side effect.
Global deterioration scale
Neurologists classify mental status using the Global Deterioration Scale (GDS), which rates you from GDS 1 (no subjective complaints or memory deficits) all the way to GDS 6 (advanced dementia).
GDS 2 (aka subjective cognitive impairment) was always tricky because the doctor didn’t know what to tell patients. To decide whether or not GDS 2 is present doctors will now ask about subjective complaints of memory deficit, including forgetting where one placed familiar objects and forgetting names one formerly knew well. There is no objective deficit in employment skills or in social situations. In other words, no one notices that there’s anything wrong with your thinking–it’s you and you alone who are concerned.
GDS 3 is more straightforward and is called mild cognitive impairment. To qualify (a) the person has gotten lost in a familiar area; (b) co-workers aware of poor performance; (c) word or name-finding deficit apparent to non-medical contacts; (d) can read a passage or book and retain little material; (e) cannot remember names of newly introduced people; and (f) may have lost objects of value.
GDS 4 through 6 are clear and obvious manifestations of dementia.
The new research shows that fully 20% of people in the GDS 2 category (remember, this includes those with subjective cognitive impairment) dropped to GDS 3 (mild cognitive impairment) within two years.
Everyone agrees more work is needed to discover ways either to halt or at least slow down this deterioration.
Here’s what we know about prevention
Regular intensive exercise is vital. This very impressive study published last week in the journal Neurology showed that individuals who exercised regularly and intensely had far fewer SCI issues than those who were inactive. Qualifying as intensive exercise were activities like running and swimming. Walking or biking were not intensive.
The American Heart Association showed that SCI occurs far less often among those practicing Life’s Simple Seven: avoid tobacco, exercise regularly, maintain an ideal weight, eat a healthful diet, and keep healthy levels of cholesterol, blood pressure, and blood glucose.
During your regular health checkup, be sure you’re screened for subtle chronic conditions like high blood pressure, underactive thyroid, and low levels of vitamins D and B-12. All are linked to SCI. If you’re taking prescription drugs, ask if any of them can cause SCI.
Nutritionally oriented neurologist David Perlmutter, MD, author of Grain Brain, places a lot of blame on unhealthy carbohydrates, including sugar, refined grains, and even touted-as-healthful whole grains. Virtually unknown a decade ago, a condition called non-celiac gluten sensitivity has been linked in some people to widespread inflammation that does not spare the brain. There are no tests for this except going completely gluten-free for a few weeks to see if you’re feeling better and then re-introducing gluten and monitoring your physical and mental responses.
Keep abreast of the latest research on the relationship between your gut microbiome and brain (there’s more here). New discoveries are showing people with healthy microbiomes have unusually low rates of mental illness and Alzheimer’s disease.
Uncorrected hearing loss is a well-established risk factor for developing early dementia. While you’re working to avoid SCI, make sure you get your hearing checked and don’t be embarrassed to wear hearing aids if you need them.
And finally, if you’re equivocating about how hard you should really work at protecting your brain from deteriorating, consider getting tested to see if you’re a carrier of the APOE gene. If you are, you’re at a greater risk for developing SCI than the general population. Being a carrier doesn’t mean you’ll inevitably develop dementia, but knowing your risk is greater might jump-start you into some kick-ass prevention.
David Edelberg, MD