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Mind slips

Researchers seek a way to tell routine ‘senior moments’ from early signs of dementia

By Kay Lazar
December 13, 2010

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If you’ve been worried about forgetting names or misplacing car keys, you’re not alone. You also are probably not losing your mind.

Family doctors say their baby boomer patients often worry that such forgetfulness portends a dementia-filled future.

The collective angst has proven fertile territory for hawkers of supplements and other products that, manufacturers promise, will clear the fog from aging brains. From 1999 through 2009, US sales of herbs and supplements marketed for mental acuity grew 49 percent, to $458 million last year, according to Nutrition Business Journal.

It should be so simple. Some of the country’s top brain researchers say they have yet to find mind preservation in a pill. They also don’t have a rigorous way to tell when a lapse is just part of normal brain aging, versus a signal of serious trouble ahead. Boston researchers are embarking on a new study that they hope will help distinguish between the two. That information may, one day, guide patients and caregivers in choosing the right treatments, when they become available.

Scientists at Brigham and Women’s and Massachusetts General hospitals will be tracking 300 adults, age 65 and older, for five years, and asking them to do a few tasks that tend to trigger so-called senior moments.

“We’ll show older folks pictures of faces they don’t know, paired with fictional first names, and ask them to explicitly remember which name goes with which face,’’ said the study’s principal investigator, Dr. Reisa Sperling, a Harvard Medical School associate professor of neurology and a physician at the Brigham.

Thirty minutes later, the participants will be asked to recall the information, while scientists scan their brains to see which areas light up. That will show them the brain activity that’s associated with successfully remembered information versus the names and faces that have been forgotten. By repeating the exercise over five years, the researchers hope to see how brain activity might change over time.

“We are trying to determine which parts of the brain are preserved (during aging) and which ones give you senior moments,’’ said Sperling who, at 51, admits to a few of those moments herself.

The scientists are focusing on men and women older than 65 because it will give them the best chance of predicting, over the five years, which ones are on track for healthy aging as opposed to a trajectory for Alzheimer’s disease. The risk for Alzheimer’s increases sharply after age 65. They’re hoping to attract participants from all walks of life because too often brain studies are filled with high-powered types, potentially giving researchers a skewed view of the average mind, Sperling said.

The fear of forgetting cuts across all paths.

Harvard Vanguard family physician Eliza Shulman said that every week, at least one patient walks into her Braintree office, usually in his or her 50s or early 60s and generally healthy, but worried because their memory seems to be slipping.

One of the first things Shulman tells the patient is that the warning signs for dementia are usually different than the forgetfulness they’ve been experiencing. Physicians get concerned, she said, when patients describe or display behavior that suggests they have forgotten how to do familiar tasks.

“It’s not about forgetting your keys, but forgetting what your keys are for,’’ Shulman said. “That’s far more worrisome.’’

Other warning signs, she said, are forgetfulness coupled with major personality changes, or having serious difficulties with higher-level tasks, such as decision-making and problem-solving.

She said that often, memory lapses can be traced to other health issues that are not linked to dementia, such as stress, a poorly-functioning thyroid, a deficiency of vitamins B1 or B12, or interactions with other medications, including anti-anxiety drugs or over-the-counter pain medications that contain sleep aids.

“If patients are concerned, they should bring it up with their doctor,’’ Shulman said, “because oftentimes, we can be really reassuring.’’

As we age, we slowly lose brain cells, and the ones we do retain get a bit creaky and don’t fire up as quickly as they used to. But scientists have learned that we don’t lose many cells in the area of the brain, known as the hippocampus, that is critical for learning and memory.

Some scientists believe older adults are capable of growing new brain cells, based in part on the findings of a 2007 study by researchers at Columbia University and the Salk Institute that found increased cell counts in older laboratory mice that received lots of physical activity.

Other scientists have shown that old dogs could learn new tricks — when they were fed diets rich in vegetables, fruits, and vitamins, exercised at least twice weekly, and given plenty of play time with other dogs and with toys.

A 2005 study by University of California researchers found that older beagles given the superior diet, exercise, and play performed substantially better than those given a standard diet and care.

The researchers chose dogs because they are able to engage in complex reasoning strategies and process dietary nutrients in ways similar to humans.

Molly Wagster, a senior brain scientist at the National Institute on Aging, said that despite intense research, scientists have yet to find a way to stave off dementia. And much of the research involving animals that used nutrients or activities to boost brain cell counts and performance has yet to be duplicated with humans, she said.

That hasn’t stopped supplement manufacturers from using snippets of sound science in their ads to promote memory-enhancement products, she said.

“In many, if not most, instances, the manufacturers have not taken their product and subjected it to the rigorous standards to see if it really works in humans and at what dose or activity do they need to engage in to have benefit and at what length,’’ Wagster said. “If you stop the activity, do you lose the gains you made? There are many, many unanswered questions.’’

Federal law does not require vitamins and supplements to undergo the same scrutiny as prescription medications.

“Dietary supplements can be marketed without prior approval by the FDA, so these products are not looked at by the FDA for safety or effectiveness,’’ said US Food and Drug Administration spokeswoman Siobhan DeLancey. “Instead, the manufacturer is responsible for marketing a safe product.’’

As researchers continue their quest to unlock the mysteries of the mind, doctors say they will continue to offer their anxious, aging patients the best advice science can provide, along with reassurance that their memory lapses are probably benign.

“Remain physically active, remain part of your community, have something stimulating to do,’’ said Dr. Alan Adelman, a professor of family and community medicine at Pennsylvania State College of Medicine.

Adelman noted that many studies have documented the heart health benefits for humans of staying physically active and the mental health benefits of not becoming isolated as we age.

“I don’t want to leave people hanging that there’s no hope’’ in holding mental decline at bay, Adelman said.

“In the next few years, something may come up that may be effective,’’ he said. “People need to lead active and healthy lives, but what is going to happen to them in 20 years I wouldn’t worry about. It’s what they are doing right now that can help right now.’’

Kay Lazar can be reached at klazar@globe.com.

Correction: Because of a reporting error, the phone number for the Harvard Aging Brain Study was incorrect in an earlier version of this story about mental lapses that might be early signs of dementia. People interested in participating in the study can call 617-643-0143.

What’s normal and what’s not
A memory problem is serious if it affects your daily life.

  • Sometimes forgetting names or not being able to recall a word.
  • Memory lapses that include walking into a room to retrieve something and then blanking on what that was.
  • Forgetting where you put the keys to your car. (Forgetting how to use the keys is not normal.)

    NOT NORMAL

  • Forgetting how to do things you’ve done many times before, such as cooking a dessert you’ve made for years.
  • Repeating phrases or stories in the same conversation.
  • Unusual trouble making choices or handling money.
  • Permanently forgetting the name of a close friend or relative.
  • Frequently misplacing something such as a purse and putting it in inappropriate places, such as the fridge.

    SOURCES: American Academy of Family Physicians, US Food and Drug Administration, Dr. Eliza Shulman

    Brain study: Participants wanted

    Researchers from Brigham and Women’s and Massachusetts General hospitals are studying how aging affects the brain. They aim to pinpoint changes that occur during normal aging, versus ones that may signal a risk for Alzheimer’s years down the road.

    The researchers are also interested in the relationship between lifestyle activities and healthy brain aging, so study participants will be given pedometers to see how much they are walking in one week, and also be asked questions about their leisure activities now and 20 years ago.

    The researchers are seeking participants, ages 65 to 90, from Greater Boston who are generally healthy, but who have not had a previous stroke and do not have metal in their bodies, such as a pacemaker.

    The five-year Harvard Aging Brain Study will include yearly brain scans and memory tests. Participants from all walks of life are sought. Contact study coordinator Lauren Wadsworth, 617-643-0143, or go to www.nmr.mgh.harvard.edu/harvardagingbrain.

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