Is dementia a normal part of aging?

Have you ever wondered whether your memory is normal, what is the difference between a normally aging brain and a brain that develops dementia? Am I at risk of developing dementia or is dementia inevitable?

Let’s look at the easy part first- dementia is NOT inevitable.  Dementia can arise from a number of different disease processes that negatively affect brain functioning such that the loss of thinking functions becomes obvious as time progresses.  In other words, because dementias generally result from progressive diseases, meaning it does not get better, the person will experience thinking difficulties that eventually interfere with successful everyday living.  It is an insidious disease process, meaning these difficulties are initially not as obvious.

The most common disease process that results in dementia is Alzheimer’s Disease, which is most often identified through obvious memory and orientation difficulties.

So, again, dementia is not part of normal aging.  Rather, aging refers to the physiological processes that we all experience. Normal aging changes are intrinsic and universal. In other words, normal aging changes are hard-wired into our bodies. Thus, our brain ages like any other body part.  But, because the brain is located inside our skull, the brain’s aging process is not as visible as other aging signs such as graying hair, increasing wrinkles, decrease in muscle mass, and so on, all of which are part of the normal aging process.  Yet, although aging is inevitable, we all have observed that the rate of aging seems different for different people.  The same is true for the brain.

To be clear, as we get older, also the risk of disease and death increases.  But not everyone experiences disease as their age increases!   And Aging itself is not a disease!  Therefore, a disease process such as Alzheimer’s Disease can be differentiated from the aging process. Not everyone develops Alzheimer’s disease.

While some people live longer without developing major diseases, some people’s brains will remain more viable as they age.

With regard to thinking, all humans experience some fluctuations in their thinking capacity- it is not always at the same level.  Rather, just like our mood fluctuates, so will our thinking ability fluctuate during the day, the month, and so on. In addition, temporary factors will impact thinking ability.  For example, when a person is sleep-deprived, independent of their age, it will show up in their thinking speed (it gets slower) and their error rate (more errors on tasks). This of course will change as the person gets appropriate sleep. Also, attentional fluctuations are part of normal aging, and you might have experienced these in form of sometimes misplacing your keys or other items, especially when you were distracted.

Coming back to normal aging, as we get older, thinking speed gets slower starting around age 30 (we just don’t notice at that time), and by around age 50, people generally note some additional thinking changes such as misplacing items more often, resulting from slower processing and its impact on attentional capacity. This is a normal part of aging and not a sign of dementia!

Again, dementia refers to a collection of symptoms, generally thinking difficulties such as memory, and decision-making difficulties, or behavioural difficulties (eg., an increase in aggression), that get worse over time, and eventually will interfere with a person’s independent life.

Also important to know, pseudo dementia.  This is called ‘pseudo’-dementia because it mimics dementia-like difficulties, but its underlying causes can easily be addressed once it is identified.  A person may appear to have dementia, but the reason that drives this apparent dementia (eg., memory difficulties) will dissipate, once it has been addressed and the driving factors have been rectified.  Reasons for pseudo dementia include poly medications that interact with each other, kidney disease, and so on.  It is important to check for pseudo dementia.

If you would like to read more about the difference between normal (primary) and disease-related aging processes (secondary aging), you can read here.

If you would like to know more about dementia, you could read an article on What is dementia?

If you are more interested in how you could prevent developing the most common type of dementia, that is Alzheimer’s Disease, you could read about how to support your brain health.

Click on the individual links for more resources and posts on aging, mental health, and caregiving.

And if you feel the need to talk to Heike, you could find my contact information here.

Healthy versus secondary Ageing: What’s the difference?

Ageing happens to all organisms, and to all body parts, including the brain. How we age can have an impact on a person’s quality of life. Whenever aging process includes disease processes, we call it secondary or pathological ageing. “Pathological” refers to a disease process. Importantly, pathological ageing is not inevitable. But how do we actually contrast healthy versus pathological aging? You can learn about the differences including different types of dementias in an overview provided below. You can find more information here.

Medical conditions that can become an issue as we age include the dementias; the most prevalent type of dementia is Alzheimer’s Disease.

You can read more about aging services and information on aging including dementia as well as brain therapy, using the embedded links. Alternatively, you can contact Heike to book a free consultation by emailing Heike at mindyourbrain1@gmail.com

Summary

Article Name

Healthy versus Pathological Aging

Description

Pathological” refers to a disease process. Pathological aging is thus not inevitable. But how do we actually contrast healthy versus pathological aging? You can learn about the differences including different types of dementias in an overview provided here.

Author

Heike Dumke

Publisher Name

Mind your Brain

Publisher Logo

Ageism and its consequences

What is ageism and why is it a problem?

Ageism is a form of stigmatization that results from our stereotypes (how we think about others that are different) and prejudices (how we feel about others because they are different). With regard to ageism, such stigmatization is due to our bias regarding age and aging. It stems from incorrect beliefs such as overestimating negative age-related changes. In short, we think more about the negative changes that occur with age and unconsciously discount the positive ones. This type of bias is the most prevalent type of discrimination. For example, in a survey, ageist attitudes have been reported by almost 35% of all survey participants over the age of 18 (https:/www.ncbi.nlm.nih.gov/pmc/articles/PMC5550624). More worrisome, ageism is prevalent at all levels of society: individual, organizational, and institutional, and it appears to be pretty resistant to elimination at present.

Part of the reinforcement of such bias in people is due to the consistent reporting of cognitive-related challenges that increase with age while positive changes that come with age are only minimally reported. Commonly reported age-related cognitive challenges include the myth of memory decline. Unfortunately, when people are exposed to such negative ageist attitudes, they report greater worries about developing dementia.

Notwithstanding, positive changes occur as people get older, including an increase in a) wisdom and knowledge base, b) vocabulary, and c) procedural memory to name a few age-related improvements. The purpose of studying cognitive decline is, for example, the identification of therapeutic techniques, as opposed to ‘shooting ourselves in the foot’- so to speak- by discriminating against ourselves and others as we get older, which in turn negatively impacts our own functioning (see below).

Another important point relates to the fact that there is a difference between dementia (a disease process) and normal aging processes. Strategy use, remaining physically and mentally active, using stress management strategies, and healthy diet can be helpful tools in combating functional decline.

How can we decrease our bias against older adults?

One helpful approach would be utilizing the principles of cognitive behavioural therapy (CBT), which includes challenging our thoughts by finding actual evidence. keep in mind that neither our thoughts nor our opinions or emotions are facts. Rather, our thoughts and opinions are based on assumptions and heuristics (thinking shortcuts). These assumptions need to be checked before we can be fully confident in our own opinions and beliefs (thoughts).

As humans (i.e., society as well as individuals including professionals), we can learn to identify and challenge our incorrect assumptions that drive our thoughts, and replace these assumptions and misconceptions with actual evidence, thereby creating a healthier outlook for society and ourselves as we age. As mentioned above, many positive changes happen as we age including an increase in wisdom, knowledge base (semantic memory), confidence and stability. Thus, although we all will eventually go the same way (i.e., death is inevitable), we can choose how we view the aging process. This change in attitude can in turn positively impact our own well-being throughout the aging process. Optimal aging or successful aging is possible. Most important, beyond physical health, is brain and cognitive health.

If you want to learn more about how to support your own cognitive health as you age, you can read more at the following links: https://mindyourbrain.com.co/healthycognitiveaging-inthe21st-centurythe2nd-puzzlepieceto-the-successfulaging-concept/ and https://mindyourbrain.com.co/aging/brain-health-and-cognitive-health/

Society and ageism

Our functional levels (how well we function in society) and how we can apply our individual abilities within society (e.g., our talents) depend on how society (i.e., friends, family, acquaintances, governmental agencies) views and implements policies. In other words, how we function is a result of interactions between society and the individual. This view thus opposes the incorrect belief that it’s all 100% personal or individual responsibility as to how we function in life. The interaction between individual and society can be supportive or detrimental. In the domain of aging, which is of course important to all of us, evidence has been published showing that people’s cognitive functioning is negatively impacted by ageist views. Moreover, more recent evidence has been provided that has connected negative ageist views to the development of Alzheimer’s disease (i.e. biomarkers of negative brain changes associated with the stress experienced due to negative ageist attitude: Levy et.al., 2016).

Thus, making an effort in changing our unconscious but detrimental belief systems and biases against aging is required to allow society to enter a healthier stage in terms of life development by allowing us to perceive and correctly interpret evidence that we might otherwise discount due to unconscious bias. In society, the myth about declining memory or cognitive decline with age can lead to an attitude of not using cognitive strategies, thereby unnecessarily decreasing the level of functioning.

How does research fare in the area of cognitive aging?

At the research level, these same cognitive errors express themselves in different ways (misinterpretation of data): For example, while completing a meta-analysis in cognitive aging, I found evidence that some older adults (>65 yrs old) performed better on cognitive tests than younger adult (< 30 years old). One thought that came up in the team was to discount this evidence as statistical outliers. However, it became clear with some searching/ investigation that one of the factors involved was the degree of familiarity with a task, which in turn decreased the required processing time (that is, the person processed the information faster). I would argue that familiarity with a task is not the only factor that allows older adults to outperform younger adults, however.

You can learn about efforts to combat ageism here: http:/notoageism.com/

Healthy Cognitive Aging in the 21st Century: The 2nd puzzle piece to the Successful Aging Concept

Given the fact that our aging population increases as we speak, the concept of successful aging has been a topic of interest not only to researchers but also to society at large. According to the World Health Organization (2012), the number of individuals aged 60 and above in the world will have doubled by approximately between 2000 and 2050. In translation, the group of individuals over 60 years will have grown from approximately 11% to making up 22% of the whole world population.

Most studies though (Yaffe, Fiocco, Lindquist, Vittinghoff, Simonsick, Newman, Satterfield, Rosano, Rubin, Ayonayon, & Harris, 2009) and, with it, most information available to society, have focussed on physical functioning. Yet, while physical well being is an important part to successful aging, cognitive aging has now come to the forefront of society’s consciousness with more and more people surpassing current life expectancy and many reaching the 100-year mark (Temple University, 2013). With it, worries about dementia are increasing as well, at an individual as well as societal level, because dementia is considered an “aging-dependent disease”. In other words, the risk of developing dementia (e.g. Alzheimer’s Disease) increases sharply as we age, with 25-35% of people aged 85 and older having dementia or experiencing cognitive decline (World Health Organization, 2012). Given the increasing proportion of older adults in the world population, this also means that people experiencing cognitive decline or dementia will become more prevalent.

In combination with the financial re-structuring of society, requiring people to remain in the workforce due to later and later retirement, dissemination of such knowledge can be easily misunderstood and thereby bolster ageism (see, for example, Mann, 2010). For example, the motivation to hire older adults may be curtailed by fears created by misconceptions about the aging process. The consequence of such misconceptions can lead to unwillingness to hire older workers due to fears that older adults may suffer dementia and therefore may not be able to perform when in actuality older adults can bring a wealth of information and wisdom to a job. Moreover, while health researchers have suggested that ageism results from misconceptions about the aging process, the consequences of such misconceptions can also be detrimental to the healthy aging process (Minichiello, Browne, & Kendig, 2012). Importantly, while Alzheimer’s Disease is a brain disease that is associated with aging, research has shown that it is NOT an inevitable result of aging. It is therefore worthwhile to understand the difference between normal and pathological aging and learn about potential preventative strategies to support successful (or optimal) cognitive aging and reduce the risk of developing dementia.

Healthy versus Disease-Driven Aging

Normal (or primary/ healthy) aging refers to age-related changes that are intrinsic, progressive, and universal (Krauss Whitbourne & Whitbourne, 2011). In other words, these changes include the inevitable deterioration of structure and function that are built into the hard-wiring of the organism, and include such changes as wrinkling of skin, graying of hair, decrease in muscle strength and bone mass. Of course, and as anyone can easily discern by observation, these changes can occur at different rates in different individuals.

In terms of cognition (thinking ability including for example attention, information processing, reasoning) research has shown that healthy aging includes a balance between stable cognitive abilities and cognitive decline throughout the lifespan (Cognitive Skills & Normal Aging, n.d.; Salthouse, 2004). For example, some functions such as information processing speed (i.e. the speed with which we can process information) as well as the ability to maintain and manipulate information in our mind decline while others such as our verbal ability and knowledge store will improve with age. These cognitive changes, mentioned above (e.g. slowing of information processing speed), translate into everyday life experiences such as ‘losing one’s train of thought’ more frequently and difficulties retrieving information (also called tip-of-the-tongue phenomenon) or remembering new information. However, while cognitive decline may be inevitable for some cognitive components (i.e. processing speed) as we age healthily, these suggested changes will not interfere with successful functioning in everyday life.

If such cognitive changes include greater difficulty than for others of the same age and level of education in domains such as short-term memory and reasoning, then a comprehensive clinical evaluation at a clinic specialized in aging or memory loss is indicated. Such evaluation will provide clarification as to the causal factors involved in the decline and help with prevention of further cognitive decline to a condition called Mild Cognitive Impairment (MCI).

Although estimates vary widely with regard to the rate of progression from MCI to dementia, research suggests that at least some people diagnosed with MCI will progress to Alzheimer’s Disease (AD). Importantly, however, a diagnosis of MCI does not necessarily lead to a diagnosis of AD down the road (Mitchell & Shiri-Feshki, 2009). When MCI does progress to a diagnosis of dementia, it is considered pathological aging.

Your can learn more about Dementia here: https://mindyourbrain.com.co/aging/what-is-dementia/

Pathological (or secondary) aging refers to age-related changes that are due to disease processes that will eventually interfere with successful daily functioning. Again, these changes are physiological changes that are NOT inevitable, and thus they do not occur in all individuals (Krauss Whitbourne & Whitebourne, 2010). As a consequence and in contrast to healthy aging processes, pathological aging processes do require therapeutic interventions. For this reason, it is important to differentiate between these two (healthy versus pathological aging) – not only to allow for therapeutic measures to be taken where appropriate but also for the development of preventative measures.

In fact, the Centers for Disease Control and Prevention (CDC) has called into action “The Healthy Brain Initiative: A National Map to Maintaining Cognitive Health” whose primary actions include an emphasis on primary prevention (http:/www.cdc.gov/aging/healthybrain/roadmap.htm).

Successful/ Optimal Brain Aging

In general, optimal or successful aging refers to the way an individual can alter people’s aging processes by engaging in preventative measures and compensatory strategies. Utilizing such techniques permits an individual to avoid the negative changes that occur with pathological aging and slow down the normal aging process. More than likely, you will have heard that regular physical activity (Booth, Laye, & Roberts, 2011) and a healthy diet are not only beneficial for physical health but also for cognitive health.

However, revolutionary to the study of lifespan development and cognition is the fact that the brain retains its plasticity – its malleability -, and thereby its ability to change itself throughout the lifespan (Thornton, 2011). As a result, we continue to have options throughout our lifespan to support our brain to change and thereby to support healthy and successful cognitive aging.

What can be done to support optimal cognitive aging beyond following a healthy lifestyle (e.g., physical activity, healthy diet, use of stress reduction techniques, ensuring enough sleep)?

Well, to keep your cognitive abilities such as memory, attention, and thinking speed at optimal levels, you can complete complex cognitive activities and exercises, or, in other words, exercises that will engage your brain and cognition actively. So, if you are doing cognitive activities where you have to really concentrate and think things through, then you are on the right track! Examples could include doing your taxes, planning a wedding or any other get- together, taking a course on a subject you love, learn a new language or to play an instrument, or playing bridge or other games that require strategy development- the possibilities are endless on how a person can ensure mental stimulation.

Likewise, to gain the most benefit from completing cognitive exercises such as Sudoku, puzzles, or utilizing websites such as Happy Neuron, Lumosity, PositScience, CogniFit or BrainSpade (if you like such brain/ cognitive exercises), these activities need to be challenging to you- they must be neither too easy nor too difficult for you to complete. As well, cognitive exercises and activities will provide you with the most benefit if you do them consistently and regularly.

In addition, utilizing cognitive strategies such as paying close attention and actively processing new information (e.g. taking additional time to remember someone’s name after being introduced or using mental associations to permit recalling that person’s name later) can support people in keeping their cognitive abilities at healthy levels.

More information on how to support your cognitive health here

In closing, research evidence (Coyle, 2003; Middleton & Yaffe, 2009; Mental activity, brain health, and dementia risk- What is the evidence, n.d.) to date suggests that people who regularly stimulate their mental faculties with complex mental activities will be on average

• More likely to maintain and improve their cognitive functioning
• Less likely to show aging decline in their mental abilities and
• Less likely to develop dementia

Remember: Your brain matters. Therefore, Mind your Brain by challenging it!

References

Albert, M.S., DeKosky, S.T., Dickson, D., Dubois, B., Feldman, H.H., Fox N.C. et al. (2011) The diagnosis of mild cognitive impairment due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimer’s & Dementia, 7 (3), 270–279.

Booth, F., Laye, M.J. & Roberts, M.D. (2011) Lifetime sedentary living accelerates some aspects of secondary aging. Journal of Applied Physiology, 111, 1497- 1504.

Centers for Disease Control and Prevention (2007) The Healthy Brain Initiative: A National Public Health Road Map to Maintaining Cognitive Health. Retrieved March 31, 2013, from http:/www.cdc.gov/aging/healthybrain/roadmap.htm

Cognitive Skills & Normal Aging (n.d.). Retrieved April 1, 2013, from http:/med.emory.edu/ADRC/healthy_aging/healthy_aging/index.html

Coyle, J.T. (2003) Use or Lose it- Do effortful mental activities protect against dementia? The New England Journal of Medicine, 348 (25), 2489/90.

Krauss Whitbourne, S. & Whitbourne, S.B. (2011) Adult Development and Aging-Biopsychosocial Perspectives (4th ed). Hoboken, N J: John Wiley & Sons, Inc.

Mann, D. (2010, November 12) Aging workforce means dementia on the job could rise. Health.com Retrieved March 30, 2013, from http:/www.cnn.com/2010/HEALTH/11/12/health.dementia.rise.job/index.html

MCI Fact Sheet: What is MCI?, (n.d.), retrieved June 1, 2013 from http:/med.emory.edu/ADRC/documents/fact_sheets/mci_fact_sheet.pdf

Mental activity, brain health, and dementia risk- What is the evidence (n.d.) Retrieved April 6, 2013, from http:/www.yourbrainmatters.org.au/brain-health-program/brain/mental-activity/what-is-the-evidence

Middleton, L.E. & Yaffe, K. (2009) Promising Strategies for the Prevention of Dementia. Archives of Neurology, 66 (10), 1210- 1215.

Minichiello, V., Browne, J., & Kendig, H. (2012). Perceptions of ageism: views of older people. In J. Katz, S. Peace, & S. Spurr (Eds.) Adult Lives: A Life Course Perspective (332- 338), Bristol, UK: The Policy Press.

Mitchell, A.J. & Shiri‐Feshki, M. (2009) Rate of progression of mild cognitive impairment to dementia – meta-analysis of 41 robust inception cohort studies. Acta psychiatrica Scandinavica, 119 (4), 252- 265.

Salthouse, T.A. (2004) What and When of Cognitive Aging. Current Directions in Psychological Science,13(4), 140-144.

Temple University (2013, February 27). Study explores distinctions in cognitive functioning for centenarians. Science Daily. Retrieved March 30, 2013, from http:/www.sciencedaily.com/releases/2013/02/130227165126.htm

World Health Organization (2012) Ageing and Life Course- Interesting facts about ageing. Retrieved April 23, 2019 from http:/www.who.int/ageing/about/facts/en/index.html

Yaffe, K., Fiocco, A.J., Lindquist, K., Vittinghoff, E., Simonsick, E.M., Newman, A.B., Satterfield, S., Rosano, C., Rubin, S.M., Ayonayon, H.N., & Harris, T.B. (2009) Predictors of maintaining cognitive function in older adults -The Health ABC Study, Neurology, 72, p.: 2029 – 2035