Central  South  Dakota  Medical News
The Clinical View
  by P.E. Hoffsten, M.D.
24 September 2003

STEPS TO MAINTAIN YOUR MEMORY

     Last week’s column discussed the various degrees of memory impairment.  Medically recognized diagnoses now include:  1.  Age associated memory impairment   2.  Mild cognitive impairment   3.  Dementia.  There are suggestions from medical research that the conditions may be sequentially progressive.  Many patients ask if their problem remembering names now means that they won’t be able to think at all in years to come.  Indeed for some people this is true although there are steps a person can take to preserve memory and other higher mental functions.  Some of these steps are outlined below.

     Step #1:  Avoid becoming diabetic.  If diabetes has already developed, control of the blood sugar is critical.  Studies are available to show that uncontrolled diabetes is associated with a substantial decrease in function and memory.

     A recent study measured memory and mental function in a number of diabetics while they were in the fasting state.  These same diabetics were tested after they had taken in 200 calories of fast sugar in grape juice and a bagel.  As their blood sugars rose in the next half hour, they were again tested with the same memory and mental function test.  The fast sugar had a significant detectable impairment on the mental function of these diabetics.  Control of blood sugars and avoiding fast sugar meals helps preserve memory and mental function.

     Step #2:  Keep blood pressure in the normal range of 120/70 or less.  Just as for the blood sugar test mentioned above, tests have been done in which a person’s blood pressure was artificially raised by giving them natural blood pressure-raising hormones.  Arithmetic speed tests were done before and after the blood pressure had been raised.  Higher blood pressures were associated with significantly decreased ability to perform arithmetic calculations.  The message is that blood pressure control allows for better mental function.

     Step #3:  Avoid alcohol access.  There are innumerable medical studies showing that the consumption of more than two alcoholic beverages per day is associated with a long-term deterioration of mental function.  Those that average more than four alcoholic beverages per day are in a very high-risk group for development of dementia.

     Step #4:  Avoid smoking tobacco products.  Cigarette smoking is the worst health habit an individual can have.  It is associated with a substantial decrease in blood flow to the brain and other parts of the body.  The lung and heart disease that accompany cigarette smoking further decreases blood flow to the brain.  The long-term effect is a huge risk for mental impairment beyond the mental mistake of smoking in the first place.

     Step #5:  Maintain mental challenges and activity.  In the past three years, there have been no fewer than eight separate articles in major medical journals that analyzed a person’s leisure time activity and the relationship to subsequent development of dementia.  The findings have been consistent.  Those individuals who maintain reading, crossword puzzles, games such as checkers, or chess, card games such as bridge or poker, or even solitaire, are associated with a decreased risk of subsequent development of dementia.  The articles don’t indicate that there is one game or another that is better at maintaining mental function.  Rather, the articles clearly show that there is a difference between doing something and doing nothing.  Those that do nothing have a substantially greater risk of developing dementia.

     This observation is troubling in regard to the appropriate conclusion one might draw.  One might say that those people who can play the games do play but their tendency to develop dementia was less to begin with.  Alternatively, one might conclude that the active playing of games, reading, etc. prevents dementia.  At this point, the conclusions are speculative but to me favor the idea that playing games preserves mental function just like exercise maintains physical function.

     Everyone knows from personal experience that you don’t get stronger doing nothing.  Exercise, weight lifting, walking, or any physical exercise within reason leads to improved exercise and physical capacity.  Everone knows that when you quit exercising you get weaker.  To me, the same thing applies to a person’s brain.  When you quit using it, capability is lost.  It is my opinion that the weight of evidence favors a person staying active mentally as a preventive or, at least, a delaying factor for the development of dementia.

     Step #6:  Get at least 1 mg of folic acid daily.  I previously mentioned that the use of a multivitamin in adults is a good clinical practice.  Recent studies have strongly suggested that the use of a milligram a day of folic acid prevents the accumulation of a material called homocystine.  Homocystine build up in the blood has been associated with the early development of heart attacks and also progressive and early development of Alzheimer’s disease.  A milligram a day of folic acid completely reverses this problem.  Most vitamin pills have less than this and a special supplement is a useful step in care.