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Many factors can affect middle-aged memory loss

By MIRIAM SHUCHMAN
Tuesday, March 5, 2002  Globe and Mail Page R8

Boost memory. Enhance cognitive capacity. It sounds like an ad for a speed-reading course, but preventing the memory problems brought on by aging is the stated aim of a growing area of medical research.

The research focuses on individuals over age 50 with "Mild Cognitive Impairment" or MCI. Their intellectual functioning is fine, but they have trouble remembering things. The symptoms are common: blocking on the name of a person you've known for years; spending half an hour in the parking lot trying to recall where you put the car. It's the normal forgetfulness that comes with getting older. But when those sorts of experiences begin to occur more frequently, psychological testing might reveal Mild Cognitive Impairment.

As we pass through middle age, as many as 40 per cent of us may develop it, according to Barbara Sherwin of the Psychology Department at McGill University. Yet there aren't a lot of studies of it. And the jury is still out on whether mild cognitive impairment is associated with later developing dementia.

Here are some points doctors do agree on. First, many things that aren't Mild Cognitive Impairment interfere with memory. Before jumping to the conclusion that your problem is MCI, check to see if you're taking a medication that can cause memory deficits.

Prescription drugs that make people forgetful include the antianxiety drugs Xanax and Klonopin; certain antidepressants including Elavil and Serzone; hormonal treatments such as Lupron; the antiseizure drugs Topamax and Zonegran; particular sleeping medications; and the class of drugs known as tranquilizers.

Watch out for over-the-counter pills that contain diphenhydramine, an antihistamine, since it's also been linked to difficulties with memory. It's found in some allergy pills including Benadryl and certain forms of Actifed, as well as the over-the-counter sleep aids Nytol, Simply Sleep and some forms of Unisom.

Moderate to heavy drinking can make it hard to remember things. So can a serious depression. In fact, a number of medical and psychological illnesses have memory problems as one of their symptoms, so don't be surprised if your doctor runs tests to check for depression, Cushing's disease or thyroid disease when you complain that you're increasingly forgetful.

Of course, Alzheimer's disease causes impaired memory, but dementia causes other problems too. People with dementia can't do simple things they used to do. They can have trouble participating in a conversation. And they can get lost easily, even in familiar places.

If you're worried about your memory and you don't have any other problem, try supplementing your diet with folate, the B vitamin that's found in spinach and added to fortified cereals and grains. Higher levels of folate are associated with improved memory. Folate seems to work on the brain by lowering the blood level of homocysteine, a natural substance that's known to have negative effects on memory.

For women, estrogen has a definite impact. Several large studies have found that older women who use estrogen perform better on tests of cognitive function than women the same age who don't. Dr. Sherwin says, "It seems to protect against the decline in memory that occurs with normal aging." Estrogen also protects against osteoporosis and may prevent heart disease. But the decision to take estrogen is an individual one that each woman over age 50 has to make with her doctor.

The newer drugs used to treat people with Alzheimer's disease -- Aricept, Exelon and Cognex -- are sometimes prescribed to patients with mild memory problems.

And vitamin E is often recommended. Serge Gauthier, a doctor at McGill's Centre for Studies in Aging, is treating mildly cognitively impaired people with Vitamin E in a randomized study. The results aren't in yet but in theory it could help, since high doses of Vitamin E in some studies seemed to delay the progression of dementia from mild to more severe.

If your aim is to prevent further memory problems, then concentrate less on the vitamins and pills and more on keeping yourself mentally occupied and challenged. A recent study confirms the importance of staying "cognitively active." The study, published last month in The Journal of the American Medical Association, followed a group of several hundred older Catholic nuns, priests and brothers. Those who reported frequent cognitive activity -- even something as simple as reading a newspaper -- were considerably less likely to develop Alzheimer's disease than those with infrequent cognitive activity.

"For older people, keeping mentally active is the most important thing," says Dr. Sherwin. And probably for the rest of us too.

Interested in knowing more? "Mild Cognitive Impairment: Potential Pharmacological Treatment Options" by Barbara B. Sherwin appears in the April, 2000, issue of The Journal of the American Geriatrics Society. "Participation in Cognitively Stimulating Activities and Risk of Incident Alzheimer Disease" is in the Feb. 13, 2002, issue of The Journal of the American Medical Association.


Miriam Shuchman, MD, teaches medical ethics at the State University of New York at Buffalo and the University of Toronto. She is also board certified in psychiatry.
mshuchman@globeandmail.ca