Improving Everyday Memory in At-Risk Elderly-- the SeniorWISE Study

Improving Everyday Memory
in At-Risk Elderly
Media

Stretching your brain: Mental activity
may help fend off Alzheimer's

By LAURA BEIL

DATE: 3-25-2002
PUBLICATION:
The Dallas Morning News
PAGE: 1C, 2C

Read this story and feel the burn. To stay fit, one line of thinking goes, the body may need just as much exercise above the neck as it does below.

Ancient writers such as Cicero believed in a "use it or lose it" philosophy for the brain, and recent studies have described tantalizing evidence that
mentally challenging tasks can, in fact, lower the risk of Alzheimer's disease, the most common type of dementia. Brain-stimulating activities may even
be able to slow the inevitable mental erosion that comes with old age."I think people would like it to be true," says Dr. David Bennett of the Rush
Alzheimer's Disease Center in Chicago, who published some of the newest research on the topic last month. Imagine keeping all your faculties with no
need for expensive drugs. This approach "would be available to everybody, regardless of their socioeconomic resources," he says.

So far, though, the idea is still a hypothesis with a lot of unanswered questions. Although studies have found that people who regularly visit
museums or work crossword puzzles are more likely to stay sharp as they age, the studies can't yet tell which comes first. Will working crosswords
keep you mentally fit, or do you work crosswords because you are mentally fit to begin with?

"It's still a chicken-and-egg kind of question," says Elisabeth Koss of the National Institute on Aging. The issue may not be use it or lose it. Maybe
you don't use it because it's already going.

And, though ab crunches today could still tone your tummy, the workout your brain gets now might not be as important as the workout it got during
childhood and adolescence. "It's important to develop those [thought-using] skills in early life and keep them," says David Snowdon of the
University of Kentucky, who has tracked a group of 678 older Catholic nuns for more than 10 years. After young adulthood, he says, the brain may
already be relatively hardwired for life. If you want to build a cushion against dementia, Dr. Snowdon says, try to do it before age 20.

While scientists say that it's still too early to know whether reading or playing games will protect the brain, experts can say with some confidence that
you won't lose much by trying. "You're not going to hurt yourself," Dr. Koss says, "so why not do it?"

"And in addition," she says, "you might enjoy yourself."

Scientific evidence in the field started to build during the 1990s, when researchers began to notice that people with more education appeared to be
less likely to have dementia in old age. But the studies couldn't exactly pinpoint what "education" was measuring. For example, better-educated
people might receive better social support and medical care.

More clues to the relationship began to emerge in the late 1990s. In 1996, Dr. Snowdon and his colleagues published a study in The Journal of the
American Medical Association reporting that the nuns in his study who died with Alzheimer's disease showed differences in linguistic ability even in
their early 20s. Dr. Snowdon analyzed the autobiographies the women wrote just before taking their vows and rated them according to the complexity
of writing and density of ideas.

The researchers then examined the brains of 25 nuns who had died. Ninety percent of the sisters who had Alzheimer's disease (which can be
confirmed only with an autopsy) had a low "idea density" in their early writing. Among the women with a high idea density, about 15 percent had
Alzheimer's.

A follow-up study published in 2000, after 74 nuns had died, found similar results.

Still, the research can't say whether early sparks of Alzheimer's hampered the women's linguistic skills when they were young, or whether the women
who had developed a high complexity of thought had some protection from the disease in old age. No one knows how long Alzheimer's disease
smolders before a person has noticeable symptoms.

"The reality is, this is a tough area to study," Dr. Snowdon says.

He believes that in later life, physical exercise may be more important than mental exercise for keeping the brain healthy. Sister Esther, who at 107 is
the oldest nun in his study, rides an exercise bike five days a week.

"If you have a choice between doing New York Times crossword puzzles for a half-hour or walking for a half-hour, get out the door and walk for a
half-hour," he says. Many scientists strongly believe that physical activity is as important to the mind as it is to the body, perhaps because exercise
helps the brain cope with chemicals that interfere with learning and memory.

Though the studies of nuns suggest that mental development early in life is a key to dementia, other research has suggested that even an older brain
needs to stretch its legs once in a while. In 1999, scientists reported in the journal Psychology and Aging that people who prefer intellectually
engaging activities - such as learning a new language - maintained a better mental edge than those who preferred more passive ways to pass the time
(say, watching a ballgame on television). The results are based on a study of 250 adults age 55 and older in Victoria, British Columbia.

Which comes first?

But this research is also dogged by the chicken-and-egg problem. Maybe, says David Hultsch of the University of Victoria, people give up mentally
demanding acts because they are already sensing some decline. "If you can't remember the cards, then you're not going to want to play bridge," he
says.

Or both scenarios could be true. "It could be that engaging in a lot of cognitively demanding activities does maintain your skills," Dr. Hultsch says.
"It's also possible that when your cognitive function begins to drop, you actually begin to give up this activity because you can't do it anymore."

And he and others caution that no study has found any activity that guarantees a person won't get dementia. "It's not like some kind of magic pill,"
he says. Even a person with doctoral degrees can get Alzheimer's. But if someone wants to do some heavy thinking, "the evidence is certainly quite
suggestive that it's a positive influence."

More recent studies have tried to address the question of which comes first. In February, Dr. Bennett of the Rush Alzheimer's Center published
research as part of a project studying not just nuns, but older Catholic priests and brothers. Dr. Bennett and his colleagues interviewed the clergy
members at the start of the study, which began in 1994, asking how they occupied their days. Their activities, which included reading, playing games
and listening to the radio, were then rated on a scale of 1 to 5, based on their frequency. A high variety of activities also raised the scores. But people
were excluded if they had dementia before the study began.

Writing last month in the The Journal of the American Medical Association, Dr. Bennett reported that more than four years later, 111 of more than
700 people had developed Alzheimer's disease. However, every 1-point increase in the cognitive activity score was associated with a 33 percent
reduction in the risk of Alzheimer's disease. The higher the score, the lower the risk of dementia.

The strength of Dr. Bennett's study is that people were interviewed before they had dementia. What's needed, he says, are more studies started
before people have the disease, as well as research in which one group of people is prescribed certain brain-stimulating activities and another is not.

Animal research

Researchers have done experiments like these in animals, says Molly Wagster of the National Institute on Aging. Older rats that are put in more
intellectually stimulating environments - with fancier toys and such - perform better on memory and learning tasks than rats left in bare cages. And
studies with rats and mice have found changes in the brains of these animals, including an increase in brain weight and connections among nerve
cells.

No one knows, however, whether the phenomenon can happen in humans, Dr. Wagster says.

Some cause-and-effect studies are under way, though. One $2.5 million project just began at the University of Texas School of Nursing in Austin.
Graham McDougall and his colleagues are enrolling 350 older volunteers who will take classroom courses designed to improve their memories.

Other participants will take courses on health and aging without the memory-stimulating component.

Mental training can be a delicate undertaking, Dr. McDougall says. If people attempt a task and have difficulty, they may become overly anxious or
depressed and avoid challenging themselves in the future. Older people also get bombarded with cultural messages saying they are supposed to
weaken as they age. This may discourage people from pushing themselves, he says.

His research has found that people lose confidence in their memories. Improving that confidence, he says, may be a key to getting people to pursue
more mentally demanding pastimes.

Although his research doesn't examine Alzheimer's disease, it does include people considered at risk for memory loss. And he believes that people
can protect themselves from the kind of general decline that may interfere with daily living, no matter what their age.

"I don't think it's ever too late," he says. "I have people in their 90s enrolling in my study."

E-mail lbeil@dallasnews.com