Special section: 10 steps to an optimal memory

| May 1, 2008

Special section: 10 steps to an optimal memory

No matter what your age, it's not too late to take steps to prevent memory loss. A good place to start is with the strategies for improving your memory described in this special section. In addition, good health habits can reduce the risk of illnesses that might affect your memory as well as the likelihood that you'll need medications that could have adverse side effects. And preliminary studies have identified vitamins and at least one medication that may help ward off dementia.

Research shows that the following strategies may help preserve your memory.

1. Exercise

Physical fitness and mental fitness go together. People who engage in regular vigorous exercise also tend to stay mentally sharp into their 70s and 80s. A six-year study of 1,740 adults ages 65 and older, reported in the Annals of Internal Medicine in 2006, found that people who exercised more than three times a week had a lower risk of dementia than their sedentary counterparts (see Figure 8).

Exercise may help memory in several ways. First of all, it's good for the lungs, and people who have good lung function are sending a higher volume of oxygen through their blood vessels and into their brains. Second, exercise helps reduce the risk for diabetes, high cholesterol, high blood pressure, and stroke — diseases that can lead to memory loss. There is also some evidence that exercise leads to increased connections between brain cells and enhances neurotransmitter function. In one small study, 59 healthy individuals ages 60 to 79 took part in either aerobic training or stretching and toning sessions for six months. The group that received regular aerobic training had significant increases in brain volume in both gray and white matter. There were no changes in brain volume in the stretching and toning group. Finally, animal research has shown that exercise increases the level of neurotrophins, substances that nourish brain cells and help protect them against damage from stroke and other injuries.

Researchers don't know precisely how much exercise is needed for good brain health. The available research suggests that the exercise needn't be extreme, but should be moderately vigorous and regular. The people in the MacArthur aging study whose mental functions remained strong were active almost daily. A study from Case Western Reserve University School of Medicine concluded that individuals who exercised — by walking or by engaging in physically active hobbies, such as gardening — had a lower risk for Alzheimer's disease. The National Heart, Lung, and Blood Institute of the NIH recommends at least 30 minutes of moderately vigorous exercise most days of the week.

Experts recommend that you build physical activity into your daily routine. Here are some examples:

When possible, walk instead of driving.

Set aside time each day for exercise — for example, a brisk half-hour walk around the neighborhood. For motivation, ask your spouse or a friend to go with you.

Use the stairs instead of the elevator.

Exercise at home, possibly with an exercise video.

Plant a garden.

Take an exercise class or join a health club.

Swim regularly, if you have access to a pool or beach.

Learn a sport that requires modest physical exertion, such as tennis.

If you haven't been physically active recently, check with your doctor before starting any exercise program.

2. Keep learning

In the MacArthur study, the characteristic that correlated most strongly with good mental functioning in old age was a person's level of education. Experts think that advanced education may help keep memory strong by getting people into the habit of being mentally active. Regardless of your level of education, you, too, can be an active, lifelong learner.

Exercising your brain with challenging activities is believed to stimulate communication between brain cells. Some ways of challenging your mind are obvious — for example, doing crossword puzzles, reading, participating in a book discussion group, playing chess, or taking classes. But you don't have to go to great lengths to find mental stimulation. Mental challenges also come from the unexpected occurrences that take you out of your daily routines and make you think. If you're still working, chances are that you get some of these curveballs thrown at you from time to time. But if you aren't working and your time is largely unscheduled, you may need to actively seek novel experiences and learning opportunities. Planning day trips or longer vacations, meeting regularly with friends and acquaintances, going to the theater or to museums, or just making a point of varying your routine can help keep your mind active and engaged.

New challenges and learning experiences help your mind thrive. It's a good idea to try to develop new skills or relearn old ones that you may have set aside years ago. Consider challenges such as these:

Plan a do-it-yourself project that requires some design work, such as building a deck, creating a new tile pattern for your kitchen or bathroom, or designing a new garden layout.

At work, initiate or volunteer for a project that involves a skill you don't normally use.

Get on the Internet, if you aren't already. You will be challenging your mind by learning computer skills and by gaining access to a wealth of information on almost any conceivable topic. You may even find stimulating communication in the form of chat groups or electronic mailing lists that focus on your interests. And you'll be able to stay connected with friends and relatives via e-mail.

Try cooking new recipes. Experiment and change the recipes to improve them.

Figure out new driving routes to work or to other places that you go regularly.

Join a club to play chess, bridge, or poker.

Rediscover other challenging games that you can play alone or informally with friends. Scrabble, Boggle, many card games, and even many computer games really make you think.

Write essays — or even a book — about your life experiences. You may be able to publish your work in your local paper, on a Web site, or elsewhere.

Take a class in a new or old skill such as playing a musical instrument, music appreciation, or painting.

Do puzzles and brainteasers. In addition to the crossword puzzle in your newspaper, you can find math brainteasers and word problems in books and magazines and on the Internet. Try doing some instead of watching TV when you have a free evening. Jigsaw puzzles challenge the mind, too.

3. Don't smoke

As described earlier (see "Smoking"), smokers perform worse than nonsmokers in studies of memory and cognitive function. Smoking increases the risk for stroke and hypertension, two other causes of memory impairment. No one knows whether smoking directly impairs memory or is merely associated with memory loss because it causes illnesses that contribute to poorer brain function.

Regardless of the exact nature of the link between smoking and memory loss, if you smoke, it pays to quit. Research shows that people who stop smoking have less cognitive decline than people who continue to smoke.

4. Drink alcohol only in moderation

While heavy drinking can harm your memory, moderate consumption of alcoholic beverages may actually be beneficial (see "Alcohol use"). Research suggests that moderate drinking reduces the risk of dementia. But excessive consumption of alcohol is toxic to neurons and is the leading risk factor for Korsakoff's syndrome, a disorder that causes sudden and irreversible memory loss. If you have been a heavy drinker, cutting back can prevent further memory loss and will usually lead to some recovery of damaged memory function.

5. Maintain a healthy diet

A nutritious diet rich in fruits and vegetables as well as healthy fats from fish, nuts, and whole grains is vital to maintaining brain health. Avoiding saturated fats (in meat and dairy) and trans fats (in commercial products with partially hydrogenated oils) will help keep your arteries clear and cholesterol levels healthy, and that in turn will decrease your chances of heart disease and stroke, including the small "silent" strokes that can damage brain function. Avoid excess calories to maintain a normal weight; this lowers your risk for illnesses such as diabetes and hypertension, which can impair your memory.

Eating a lot of fruits and vegetables can be especially beneficial because many are good sources of vitamins and other nutrients that may protect against diseases and age-related deterioration throughout the body.

6. Consider taking vitamins

If you eat a healthy diet, chances are that you are already getting most if not all of the vitamins that you need. However, aging can make you vulnerable to vitamin deficiencies due to nutritional restrictions and malabsorption syndromes. Taking a high-quality multivitamin is a good start toward ensuring that you are getting what you need. Individual vitamin supplements can also play a role.

Certain B vitamins (B₆ , B₁₂ , and folic acid) are important for neuronal protection as well as facilitating the breakdown of homocysteine, an amino acid in the blood that, at high levels, is a risk factor for heart disease, stroke, and peripheral vascular disease (see "B vitamins"). Deficiencies of B vitamins tend to become more prevalent with age. Work with your doctor to monitor your homocysteine level, and correct B-vitamin deficiencies with supplementation when necessary.

And despite the uncertainties, it's reasonable to speculate that a diet rich in vitamin E may help delay or prevent the development of Alzheimer's disease. So include foods such as wheat germ, vegetable oils, whole grains, and leafy green vegetables in your diet. The benefits of vitamin E supplements are less clear. The Alzheimer's Association recommends that people already diagnosed with Alzheimer's take vitamin E only under the care of a physician. One reason for their concern is that high-dose vitamin E can interfere with the blood's clotting ability, raising the risk of hemorrhagic (bleeding) stroke. If you take blood-thinning medication such as warfarin (Coumadin) or aspirin, you should be especially cautious and talk with your doctor before taking vitamin E.

7. Get a good night's sleep

Sleep is essential for memory consolidation as well as overall health. Although people vary widely in their individual sleep needs, research suggests that six to eight hours of sleep a night is ideal. Perhaps even more important than the amount of sleep is the quality of sleep. People with breathing problems during sleep, such as obstructive sleep apnea, can sleep for 10 hours per night but still feel unrested in the morning. Of course, for some people, getting a good night's sleep is easier said than done, particularly because insomnia becomes more common with age. But certain habits can help. For example, try the following:

Establish and maintain a consistent sleep schedule and routine. Go to bed at the same time each night and wake up at the same time each morning. A set sleep routine will "train" you to fall asleep and wake up more easily.

Plan to do your most vigorous exercise early in the day. Exercising in the hours immediately before bedtime causes physiological changes that may interfere with sleep. Exercising in the morning, on the other hand, enhances your alertness when you need it most — at the beginning of the day.

Avoid coffee and other sources of caffeine (e.g., chocolate, many soft drinks, some brands of pain relievers, many types of tea) after midmorning, because caffeine is a stimulant that can keep you awake for hours afterward.

Avoid excessive napping during the daytime. Prolonged napping can disrupt your natural sleep cycle and prevent you from feeling tired enough to fall asleep at night.

Don't take sleeping pills unless nothing else works. If you do take a prescription sleep medicine, work with your doctor on using it effectively but only on a short-term basis, because sleeping medications can be habit-forming. In addition, like sleep deprivation, sleeping pills can cause memory loss.

Some people find that drinking warm milk before bedtime helps them feel sleepy. Milk contains tryptophan, a chemical that may help you relax.

Don't try to sleep if you're not tired; otherwise you'll set yourself up for tossing and turning. If you're still awake after about 20 minutes in bed, get up and read awhile to help yourself relax.

If you experience persistent sleep problems, consult your physician so that you can identify the specific issues and get the necessary treatment.

8. Be social

Social support — that is, close ties with others — can improve the cognitive performance of older people, according to the MacArthur study on aging and other research. Social support can come from relationships with friends, relatives, or caregivers.

A 2008 study of 3,610 people between the ages of 24 and 96 looked at the relationship between participants' mental function and their level of social contact based on how often they talked on the phone to friends, neighbors, and relatives. The researchers found that the higher the individual's level of social interaction, the better their mental function; this result was found across all age groups. A second study by the same team compared the cognitive effects of 10 minutes of group discussion against a similar amount of time spent in solitary intellectual activities such as silent reading or crossword puzzles. When tested on mental processing speed and working memory, the group that engaged in social interaction performed better.

There are several ways that social engagement may benefit your memory. Intellectually stimulating activities often go hand in hand with social interaction. Social relationships can also provide support during stressful times, reducing the damaging effects that stress can have on the brain.

9. Manage stress

When you're under a lot of stress, it's hard to concentrate. And not concentrating sufficiently is one of the main causes of poor learning and memory. Being under sustained stress for many weeks can impair your memory by altering brain chemistry and damaging the hippocampus. You can't control all the stressful events in your life, but you can control your reactions to those events to some degree.

One way to reduce stress is to work on gaining a greater sense of control over your life. The MacArthur Foundation's study on aging found that the people who reported the most "self-efficacy," or mastery, also had the best memory in old age. The researchers viewed self-efficacy as a buffer against the feeling of helplessness that often contributes to stress.

There's no one-size-fits-all strategy for reducing stress. You have to find strategies that work for you. For some people, taking a brisk walk or getting other kinds of regular exercise helps. Listening to music, meditating, talking to a friend, or engaging in a relaxing activity, such as gardening or knitting, can also help you cope with stressful situations. If you can't lower your stress level on your own, you might benefit from counseling.

10. Protect your brain from impacts and toxins

Head trauma is a major cause of memory impairment and a risk factor for future development of dementia. You can prevent head trauma by using the appropriate gear during high-speed activities and contact sports.

Wear seat belts when riding in motor vehicles. Car accidents are by far the most common cause of brain injury, and wearing seat belts greatly reduces the injury risk. Wear a helmet when bicycling, riding on a motorcycle, in-line skating, and skiing. Wear a mouth guard to lower the risk of a concussion by deflecting the force of a blow to the chin during contact sports such as football, ice hockey, soccer, basketball, rugby, and martial arts.

Reduce your exposure to toxic substances by taking sensible precautions. Before using paints, solvents, and pesticides, read the labels for safe handling. Test your home water supply and use a water filter to eliminate lead, if necessary. Avoid sanding, scraping, and otherwise disrupting lead paint on older homes. If you do plan to remove lead paint, hire a government-approved contractor for this work. Have your car and furnace serviced regularly to minimize carbon monoxide emissions.

Cognitive reserve: Engage your brain

For some time, scientists have pondered why Alzheimer's disease doesn't strike all people in the same way. In two people who have the same number of disease-related plaques and tangles — evidence of structural damage — one may continue to function normally while the other suffers severe memory impairment. The answer to this conundrum seems to lie in what experts are calling "cognitive reserve." Generally speaking, this term describes the capacity of the brain to withstand damage associated with disease or injury.

There are two aspects to this protective mechanism. The first, called brain reserve capacity, is the number of neurons and synapses a person's brain has. The theory is that a person who has more brain "hardware" to fall back on is able to maintain cognitive functions even when some of the structures are damaged. The other element, cognitive reserve, refers to the degree of efficiency and flexibility the brain has in processing information. People whose brains have alternate networks or cognitive strategies at their disposal are less likely to experience disruption in their mental processes in the face of disease.

While there's little you can do to improve your brain reserve capacity, scientists believe that cognitive reserve can be actively promoted. Although lifelong educational achievement is an important factor, virtually any activity that stretches your brain bolsters your cognitive reserve. In one 2004 study, mentally intact people in their 70s and 80s were asked how often they engaged in six activities that required active mental engagement — reading, writing, doing crossword puzzles, playing board or card games, group discussions, and playing music. In the following five years, those who placed in the highest third were half as likely to develop mild cognitive impairment than those in the lowest third. The take-away message is that the earlier you start stimulating your brain and the more activities you undertake, the greater protection you will afford your brain down the road. But building your cognitive reserve is an ongoing process that should be pursued throughout life — so it's never too late to start!

Review Date: 2008-05-01

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