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.
Be well,
David Edelberg, MD
Thank you, Dr. Edelberg for the recommendations. I’ll put in my order and let you know if there is improvement. How long would you say that the supplements will show any effect?
Thanks,
evie
evie
Enjoying your site very much, but for some reason have not been getting them for a few weeks.
Mery
Mery. I’ve just checked and you are active in our data base. Please check your spam file. Look for our next Health Tip that will be published early tomorrow morning.
Dr. R
Dear Dr. Edelberg:
There are doctors and then there are extraordinary doctors — you are the latter!
The current newsletter has my name all over it and I knew immediately that it was an answer to my prayer. Here is my story; I’ll keep it brief.
I am hearing impaired; it’s an inheritance from my mom. A couple of months ago, out of the blue, my ears shut down instantly and I couldn’t hear myself or anyone even with my hearing aids in my ears. It was as if I was in a soundproof chamber. When I went to the doctor he literally had to put his mouth to my ear for me to hear him. I didn’t want to leave the house for obvious reasons. The scary thing was, I finally got up enough nerve to go to the grocery store. When I tried to swipe my card my memory left me completely. I could NOT remember my passcode; I had to actually leave my groceries there and come home to get the right passcode. That fast! I was doing, or not doing things I was NOT aware of and I kept telling myself something is going wrong with my brain! I never said a word to my family but kept telling myself that I had a BIG problem! Sure, I occasionally forget. But doesn’t everyone? I’m 77 yrs. old and I’ve NEVER had a memory PROBLEM. I read aloud everything I could get my hands on re supplements and whatever, AND to hear myself and hopefully vibrate my “ear nerves.” But I did more praying than anything else, literally BEGGING God not to take my ears and my brain away from me!
Enter your newsletter and the SCI factor! I jumped to my feet because I KNEW it was an answered prayer…! You got me out of the pit and back on my feet. My health is my wealth. I eat healthy and exercise regularly. I haven’t had any prescription drugs to speak of in 40+ years. And I’m very selective about the supplements I take because there so many varying opinions. But after twice reading your article (and ongoing until the contents become second nature to me), I have made my list and I’m truly excited about my shopping spree! ?
I had dealt with a lot of stressful situations in a brief period of time and I’m sure that was a significant factor. When I had my hearing test, I was very happy I was sitting down…not much left. But I believe in miracles and will keep looking up to the ONE Power who has the first AND the last word about EVERYTHING! Dr. Edelberg, to date, that was the most traumatic experience I’ve ever had. But thanks to God for the generous sharing of your knowledge and skill in such a down to earth way that it is easy to understand and apply. You are truly a blessing to mankind and very appreciated by me. I’m sure your patients adore you — I know I do! Grace to you.
Anonymous
Also, the above description of the Neurology study has a number of inaccuracies. There is nothing in the study about regular physical activity. When the participants were asked about their physical activity, they were only asked about the prior 2 weeks, with nothing about how long they’d been doing it or how regularly they got this type and amount of exercise outside that two week period. Also, the neurological evaluations were not focused on SCI. Rather, cognitive performance was assessed directly using well-established tests that are far from subjective impressions. It should also be noted that the participants in the survey averaged 70 yrs in age. And lastly, there was no mention of biking, swimming, walking or running in the article itself. If done at a certain level of intensity, any of those exercises could make the cutoff used in the article (>6 METs) to qualify for the more intense category (which just under 10% fell into).
Roscoe
While the study referred to above may not have found walking or biking to be intensive and have an effect on SCI, many studies on the impact of physical activity on cognition for older adults use brisk walking as the type of aerobic activity studied. What is important appears to be an elevated heart rate. Think of brisk walking as the pace you’d take if hurrying to catch a bus. Another study of physical exercise’s impact on cognition showed that the cognitive benefit was almost entirely tied to cardiovascular improvement shown (rather than just the amount of time exercising). So if very intense exercise isn’t an option or isn’t of interest, maybe do more less intensive exercise to try to get an equivalent cardiovascular benefit.
Roscoe
Hi Evie
The best supplements shown effective for memory and possibly preventive for Alzheimer’s are:
Acetyl L Carnitine, one capsule twice a day
Citicholine, one twice a day
Turmeric-HP , twice a day.
All three are in our apothecary
Don’t give up on your current exercise program and don’t feel “doomed.” Although your Alzheimer risk is statistically higher than the general population, it is not considered an inheritance based disease
Dr E
Dear Dr. Edelberg,
Brilliant article! A bit overwhelming for me, as I must be GDS3 for I had to read it aloud three times before I could comprehend it all.
My mother had Alzheimer’s for 24 years, and she passed away 25 years ago. Her autopsy confirmed the diagnosis. So, of course I have concerns.
I am disappointed to read that walking and biking are not considered intensive; I walk five miles a day at 3.5 to 4 mph and bike 10 miles 5 days a week and play Pickleball for two hours a day, five days a week. Running is not an option for me, but water aerobics is, when the weather co operates.
I like the idea of prevention, but not a lot of mention of the benefit of brain games. Every day I do brain training with Lumosity and Sudoku, yet I still feel doomed. I agree that diet plays a big role. What are your thoughts on the product Prevagen (apoaequorin)?
Thank you Dr. Edelberg for always keeping me enlightened.
evie
Dr Edelberg,
Great post, but I have some questions for you.
Have you ever read Samuel Milham MD, MPH’s book “Dirty Electricity”?
Or Ann Louise Gettlemen’s book “Zapped”?
We know someone who is wifi sensitive. It has totally taken away their life.
Short term memory is zapped, which has led is on the path to learning all we can to help.
Our bodies are all electrical so ones memory, could be impaired with dehydration, malabsorption issues and hyper-electrical sensitivity sickness.
After googling and reading and studying, short term memory, brain fog and other memory issues have become apparent.
Physical issues also arise, and the term “sick building illness” come to mind.
And of course cancer is another issue linked to HESS, but that is a discussion for another day.
So appreciate every one of your posts.
Using ones brain and thinking processes is so important. Thanks for contributing to my brain health.
Happy Spring,
Calle
calle