Ask the Experts

The form of Alzheimer’s disease that runs in families is quite rare, and almost always affects individuals before their 60th birthday. The more common “sporadic” form of the disease is not inherited directly. Rather, it is caused by a complex interaction of genes, environment, and lifestyle. People like your daughters who have a first degree relative with Alzheimer’s disease may inherit an increased susceptibility to the disease, but this does not mean that they will get the disease. Genes related to sporadic Alzheimer’s disease simply increase the risk of developing the disease, and some people with the genes never develop the disease at all. The good news is that there is research showing you can reduce the risk of Alzheimer’s disease by keeping your heart and brain healthy. Exercising, keeping your mind active, and managing stress are important ways to maximize brain health.

The Alzheimer’s Society of Canada has more detailed information about the genetics of the disease on their website www.alzheimer.ca.

A transient ischemic attack, or TIA, is a temporary disruption of blood flow to the brain. TIAs are also called “mini-strokes” because they can cause the same types of symptoms as strokes, although they don’t result in permanent damage. Whether or not a TIA causes memory problems will depend on what part of the brain was affected. If the loss of blood flow occurred in a brain region important for memory – such as the temporal lobes – it may indeed be associated with memory problems. Although by definition TIAs cause only temporary symptoms, they are risk factors for strokes that can cause more serious and long-lasting brain damage. People who have had TIAs can reduce this risk by working closely with their physicians to control vascular risk factors like hypertension, high cholesterol, and obesity.

An MRI of the head can provide a very detailed picture of the structure of the brain. In the case of possible dementia, an MRI can be used to rule out problems like a brain tumor or stroke that could be causing cognitive decline. An MRI may also be able to detect atrophy (or shrinkage) that occurs in specific brain regions in people with dementia, but by itself, an MRI can’t be used to diagnose dementia. Rather, dementia is diagnosed clinically by assessing symptoms, such as the extent and variety of cognitive impairment and the impact of the impairment on the person’s day-to-day functioning.

Assuming that they had the typical late-onset variant of Alzheimer’s, where onset occurs in one’s late 60’s or in the 70’s, then your risk, and that of your sisters, is higher than it would be for someone with no family history. But, that doesn’t mean that you are definitely going to follow the same path.

Importantly, we now know that a host of healthy lifestyle behaviours help to improve cognitive functioning and lower dementia risk. Indeed, over 50% of Alzheimer’s risk can be attributable to modifiable lifestyle factors. These include aerobic exercise, staying cognitively and socially active, eating a healthy diet that is plant-based and where protein comes mainly from fish and legumes, keeping in good cardiovascular health (weight, blood pressure, cholesterol, blood sugars), and getting treatment for anxiety and depression.

Even people who live like saints sometimes get dementia, but if you follow this brain healthy lifestyle, the research tells us that you’ll have a lot better chance of staying in good cognitive health.

Research shows us that the best way to improve brain health and memory is through a healthy lifestyle. This includes things like getting enough physical exercise; eating well and getting adequate sleep. It’s also important to spend time participating in leisure activities that provide cognitive and social engagement. Managing stress is also important, and can be done in a number of formal and informal ways. 

We serve a different and important purpose from Lumosity. Lumosity is focused on brain training and tracking your performance. Cogniciti is aimed at helping adults who are worried about their memory changes decide if it is time to have a conversation with their doctor. After completing the Cogniciti brain health assessment, which takes about 20 minutes, users will receive feedback and a recommendation about whether to talk to their doctor about their memory concerns. If a score is below normal, the test taker will also be provided with a report to take to his or her doctor. All users are directed to the Cogniciti website with the latest information on cognitive aging and age-related brain function that will help adults interested in proactively managing their brain health. A Memory Centre and a Caregiver Centre provide science-based information and tools related to prevention and management of brain health issues. And, of course, this "Ask the Experts" section allows site visitors to get specific information from Cogniciti's panel of scientists, doctors, and other professionals.

Cogniciti’s approach to the development and sharing of the test is firmly based on scientific evidence. Our initial research indicated that the only score we can responsibly report to test users is the overall score. The evidence shows that this is a very reliable score – meaning that if you take the test more than once, you will likely get a similar score. The specific sections of the test are our next research focus. At this time, we have opted to provide the highest quality information rather than the maximum amount of information. Thank you for your question, and please check back soon for updates on the report scores!

With age, there are a number of cognitive changes that many people notice, and these vary from one person to another. Some of the more common problems are difficulty remembering names and faces, misplacing household items, having problems coming up with words in conversation, forgetting PIN numbers or dates and getting distracted. Given how common these problems are, it is nearly impossible to attribute them to any particular cause – such as normal aging, dementia, stress, or something else – without a thorough medical work up. Generally, if these problems are only happening from time to time and if they are not causing major negative consequences, then they can likely be chalked up to an aging brain. Cognitive problems that are of more concern include repeating oneself multiple times within a conversation, getting lost in a familiar place, leaving pots on the stove to burn, and forgetting important or meaningful events shortly after they happen. If you are having any of these problems, or if you are starting to have difficulty doing things that you used to do – such as managing your finances or your appointments – then it is time to talk to your doctor about your concerns.

For the most part, and especially in the early stages of Alzheimer's disease, it is difficult to tell the difference between memory mistakes that are caused by Alzheimer's and those that are a normal part of aging. That is, both can be associated with problems remembering where you have put things, difficulty recalling recent events that have happened, or forgetting to do something you meant to do. The main differences are that these mistakes happen more often for people with Alzheimer's disease and they tend to have more serious consequences. If you sometimes forget to pay a bill on time and have to pay the occasional late fee, this may be normal. If it happens frequently and your phone service or credit card is cancelled, or if someone starts taking over the household finances, this may be a sign of a more significant memory problem. For more examples of what's normal and what's not, read this posting by Baycrest clinicians and researchers at www.psychologytoday.com/blog/living-mild-cognitive-impairment/201301/memory-changes.

The answer to this question has several aspects. First, the young brain is simply more efficient, and so registers events in a richer and more vivid way than when we are 60, 70 or 80. But second, memories from 50 years ago are not random events; usually they are striking, emotional happenings – either happy or sad – that are important to us. Third, because of their interest, importance, or pleasurable nature, these memories have probably been thought of and re-told many times – so they are not really from 50 years ago! And finally, they may have been altered substantially because of the many re-tellings. They feel vivid and true but most likely have drifted quite a bit from the original happening.

Your belief is supported by research indicating that older adults who report regularly participating in thinking activities requiring active learning, problem solving, and decision making, often do better on tests of learning and memory as compared to peers who are less engaged in cognitively stimulating past-times. Maintaining a healthy diet and engaging in regular physical activity have each been similarly associated with such benefits. There are many thinking activities that are cognitively stimulating, such as playing chess or bridge, creating something (painting, gardening, quilting, woodworking), engaging in lively discussions with peers, doing crosswords, solving puzzles like Sudoku, learning how to play a musical instrument or new musical piece, and learning a language. These are just a few examples. The key features are that the activity should be enjoyable so you want to do it and challenging so that it gives you a bit of a mental work out. The brain game industry has a lot to offer with respect to cognitively engaging activities but at this time, there is no substantial proof any of these games is better than similarly challenging non-computer based options such as the kinds of examples previously mentioned. Whether or not you pay a fee to participate in such activities on your computer at home or within your community is a personal choice. As you can tell from the examples, many of the activities could be engaged in for free.

When someone lacks interest or motivation it can impact how well they perform memory tasks as well as many other thinking tasks. In this case you would expect the person to also have difficulty in other areas of thinking such as concentrating or making decisions, and in their ability to participate in usual activities such as socializing with friends, shopping, and other day-to-day activities. Experiencing a general lack of motivation can be caused by a number of things, such as poor mood, medications, lack of sleep and stress, to name a few. On the other hand, a person who lacks interest only (or mainly) in memory tasks may do so for a reason. The person may have worries about their memory that lead to a self-fulfilling prophecy, or they may have a true memory impairment. In short, if more than just performance of memory tasks is affected then it may be related to a general loss of interest, rather than competence. If only memory tasks are affected then it may be due to anxiety about memory or it may reflect memory decline. Consider consulting with your family doctor if you are experiencing a change in your level of motivation that is impacting your ability to follow through on your daily tasks, or if you, or those close to you, have significant concerns about your memory ability.

The goal of the Online Brain Health Assessment is to help adults from 20 to 94 years of age decide whether their cognitive abilities, such as memory and attention, are within the range expected for their age, or whether they should visit their doctor for further evaluation. It’s good to keep in mind that there are a number of reasons why everyday cognition, as well as performance on the online assessment, might be cause for concern. These range from normal aging to depression or thyroid disease, to early stages of dementia such as Alzheimer’s disease. Lack of sleep, stress, and anxiety can also significantly affect cognitive abilities. Although the aim of the online assessment is to indicate whether memory and attention are within the expected range, many other factors need to be considered by a health professional before an individual’s risk of developing dementia could be assessed.

We know that living an active and healthy lifestyle supports brain function as we age. Benefits are seen across many different aspects of lifestyle, including keeping physically active, eating a healthy diet, staying connected with family and friends, keeping our brains engaged through hobbies, lifelong learning, participating in cognitively engaging activities, and protecting our heads through the use of seat belts and helmets. Participating in any or all of these activities will benefit your brain and please your doctor as he/she sees you taking control of a positive lifestyle.

Thank you for this question. While there is recent research suggesting that a history of significant traumatic brain injury (i.e., a blow to the head followed by loss of consciousness) may be associated with elevated risk of dementia, we do not know enough about this association to say whether or not your concussion is related to your difficulties with finding names. Name finding difficulty is the common cognitive complaint with aging, even in people who are perfectly healthy with no evidence of neurological problems or history of traumatic brain injury. You mentioned that you are active and bilingual. Being physically and mentally active and being bilingual are known to protect against age-related cognitive decline. Furthermore, lifelong bilinguals perform better on cognitive tasks involving inhibition and switching of attention as compared to their monolingual peers. There is a flip side to your bilingual advantage: bilinguals can be slower at naming things than monolinguals. Although this effect may be related to your speed in naming, it is an expected effect of bilingualism and not a cause for concern.

Having trouble finding a word in conversation happens to all of us. Many people notice that, as they grow older, this happens even more often. Usually, it is a problem related to retrieving the word from memory – in particular you may remember part of the word you want to say (like the first letter) or the word comes to you eventually. If you have to wait too long for the word, you may find that you forget what you were going to say. When this happens, it may be helpful to allow yourself to use a synonym or description rather than continue to search for the "right" word. Although frustrating, some degree of word-finding difficulty is part of the normal aging process and is usually much more apparent to you as the speaker than it is to the listener. If it is interfering significantly with your ability to communicate – for example, if you find that you cannot express your thoughts in a way that others will understand – or you notice a significant change in your speech, you should speak to your doctor about your concerns.

The best advice is to eat a well-balanced diet rich in fruits, vegetables, whole grains and cereals, fish, poultry and low fat dairy foods. Rather than worrying about counting servings from each of these foods, concentrate on what the dinner plate looks like when you serve your family. It should be 50% fruits and vegetables, 20% protein (meat, fish, beans, nuts, etc.) and 30% grains or other carbohydrate food (be certain to use whole grains frequently) and include a serving of low fat dairy (milk, yogurt, cheese or dairy alternative such as soymilk).

First of all, you should know that you are not alone. A number of survey studies have shown that remembering names is the most common memory difficulty reported by adults of all ages, young and old. Regarding what can be done, there are fortunately many strategies that can be used to help us learn new names. One of the most important things is to make a point of paying attention to the name when first introduced to someone. Many of us find our attention wandering in these situations, and we are unlikely to remember information later if we were not paying attention to in the first place. Another strategy is to repeat the name, either to yourself or out loud as part of the conversation, several times after being introduced. The important thing is to space out the repetitions over time and not do them all at once. This helps you "practice" retrieving the name from your memory, in preparation for the next time that you want to recall the name. A final strategy you can try is making the name meaningful in some way. Recent research has shown that it is easier to remember a word like "Ruby" if it is the name of an object (like your birthstone) than if it is the name of a person (like your co-worker). So, if you think about what a name means, this will help you remember the name later when you need it.

Remembering a string of random words may seem very different from memory problems in real life, but in fact many studies have shown that people with real memory problems do badly on such tests, so it is one quick way to get at least an approximate measure of current memory ability. Two words of caution are- first, memory for the last few words in a list (ones you have just heard) tap a different form of short-term memory, and performance here is not very sensitive to age and disease; remembering words from the beginning or middle of the list is more diagnostic. Second, memory for words will be good for people who have good verbal abilities, so we need other tests (involving scenes, sounds, spatial information etc.) to get a full picture of a person’s memory abilities. 

At this time, there is no test, simple or otherwise, that will accurately diagnose Alzheimer's disease. Doctors use a variety of procedures to rule out other possible causes before making a diagnosis of potential or probable Alzheimer’s disease. There are, however, a few online tests claiming to assess an individual’s risk of developing Alzheimer’s disease. Some are still in development, and some require the involvement of a clinician at the time of testing.  Although not designed to diagnose Alzheimer’s disease, Cogniciti’s Online Brain Health Assessment is a cognitive screening tool that is currently being clinically researched.  Its purpose is to help adults from 20 to 94 years of age decide whether their thinking abilities, such as memory and attention, are within the range expected for their age, or whether they should visit their doctor for further evaluation. 

Results from many population based studies are telling us that the best dietary advice for brain health is to eat a well balanced diet that is rich in fruits, vegetables, whole grains and cereals, fish and poultry, and limit the intake of animal based fats, red meat and highly processed foods. You need to focus on eating the breadth of nutrients the brain relies on for optimal function and not simply single nutrients or foods. One way to accomplish this is to eat a Mediterranean style diet, but other styles of healthy eating will also accomplish this.  While you will read much in the press about individual foods or supplements, it is important to recognize that there currently is no human evidence to support these claims, that eating one healthy food, e.g. blueberries, is not sufficient to counteract a poor quality diet, and that the best way to increase your intake of fruits and vegetables is to concentrate on those that you like and gently explore eating those that you are not familiar with.  Be certain, however, to include fish in your diet and if you don’t eat fish, then consider foods naturally rich in omega-3 fats such as walnuts, flaxseeds, soya products, and omega-3 fortified foods.

Although older adults often worry that lapses in memory indicate a more serious problem, memory slips occur at any age. Have you ever walked into a room and forgotten why you’re there? Or misplaced your keys? These common complaints happen to both younger and older adults, but aren’t usually cause for concern. What’s interesting is that our perception of these slips alters with age; what was considered a normal memory slip in our 30s or 40s may be far more worrisome in our 60s and 70s. However, because our bodies, including our brains, do change with age, some age-related changes in memory can be expected. While it is true that memory can be affected by many other factors, such as nutrition and mental activity, the minor lapses you refer to are generally considered part of normal age-related changes in the brain, and, although frustrating, should not affect the regular activities of everyday life. Simple habits, such as making lists, recording appointments on a calendar, and paying a bit more attention to certain tasks (such as where we put our keys) can help reduce these disturbing, but normal, lapses in memory.

It's quite common to make mistakes when performing such everyday tasks, even when those tasks are familiar to us, and it doesn't necessarily mean we've forgotten where things belong. Often, the reason is that we're just not paying much attention to the task at hand, especially when doing more than one thing at a time, or thinking about something else. Lapses of attention happen to people of all ages, but do tend to be more frequent as we get older. You mention these slips only occur when tidying up. It's possible you're thinking about where to put multiple things at this time, compared to thinking about just one item when getting it from the cupboard or drawer. It might help to develop the habit of focusing on one task at a time when tidying up, for example, finish putting away the cereal before picking up the dog food. This will give you the chance to stop and think about where it belongs. You can also imagine yourself putting the item in the correct place. For example, if the cutlery belongs in the drawer next to the sink, visualize yourself putting it in that drawer and say to yourself "I'm going to put the cutlery in the drawer by the sink." Eventually, you might find that you automatically associate the cutlery with the correct drawer, or the cereal with the right cupboard.

Yes, a deficiency in vitamin B12, as well as many other vitamins and minerals, has been linked to poorer brain function.  Broadly speaking, these results are telling us that nutrient deficiencies are harmful to the brain in addition to other tissues and organs.  There are a couple of important issues related to this question.  The first is that it is very rare to see a deficiency in a single nutrient; generally when we have a nutrient deficiency it means that we are not eating a high quality diet and that we are likely to have other nutrient deficiencies as well.  So, improving your overall diet is a more prudent approach to correcting a nutrient deficiency relative to taking a single nutrient supplement.  The second issue is that nutrient deficiencies can be harmful to the body, including the brain; so correcting the deficiency is important.  However, eating over and above our nutrient requirements has no added benefit.  So, if you are eating a well balanced diet and meeting all of your nutrient needs, you are not likely to benefit from taking a supplement – this benefit would be confined to those with a poor quality diet.  Finally, there are some nutrients, including vitamin B12, that we can experience difficulty in absorbing as we age and develop a deficiency despite a high quality diet.  This is a medical issue, not experienced by all, that you need to consult with your family physician about.