PHILADELPHIA – As the population ages, more patients are concerned about memory impairment, but only about 1% will have a progressive cognitive problem, a researcher said here.
The challenge for primary care doctors is how to handle this large segment of the population who are experiencing natural cognitive aging rather than dementia or Alzheimer’s disease, according to Tom Rosenthal, MD, chair of department of family medicine at the University of Buffalo, in Buffalo, N.Y.
“One of the most important things to know is that the brain has plasticity. The healthy, undiseased brain with adequate blood flow will change in form, but also in its ability to function, with exercises aimed at increasing brain power,” Rosenthal said at the annual meeting of the American Academy of Family Physicians.
Speaking to a standing-room-only crowd of several hundred people, with scores more watching remotely in adjacent rooms, Rosenthal detailed a few studies that demonstrated the flexibility of the brain.
There was the one of London cab drivers who after a year on the job were found to have larger hippocampi, as well as increased neuro-electrical activity. Another study showed how the left motor cortex of violinists expanded due to the demands put on the right hand.
“The healthy brain does change,” he said. But Rosenthal made it clear that he is not talking about people in the throes of dementia or Alzheimer’s disease. “At that point, it’s a structural disease and currently cannot be reversed.”
Rosenthal told MedPage Today that society tends to “focus too much on the unhealthy brain,” that “we’ve overcategorized many older people who face memory challenges from less severe sources such as depression.”
He emphasized the importance of the role of the primary care provider in helping these patients. “A patient over 70 generally has three chronic problems and a fourth one will be diminishing memory. We will see these people about six times over the course of the year and it is our opportunity to motivate them to deal with their memory challenge,” he said.
“We can suggest ways for them to improve, monitor them, recheck their Mini Mental State Examination score. That why it is so critically important for the healthcare system to have a strong primary care base,” he said during an interview.
The first thing a physician should do upon hearing a memory complaint is to check for depression. He suggested having patients take the clock test – a simple exercise where they must draw a clock and mark the hands at a specific time. If patients can do this, they are probably depressed and have normal memory skills. If they misplace the hands of the clock, they are probably at a greater risk for dementia.
Misplaced hands on the clock are also associated with auto crashes, Rosenthal pointed out. He said that elderly people with a Mini Mental State Examination score of about 19 will have a driving record equivalent to a 16-year-old. “But they are more likely to get lost then have an accident.”
Physicians should also take an inventory of the patient’s medication, since some medications are associated with decreases in reaction time, attention, and memory.
Now comes the hard part, Rosenthal said. “We have to challenge patients to change their behavior. They have to become more physically active and have a balanced diet. “Thirty percent of people who present to the clinic for cognitive impairment have evidence of malnutrition,” he noted.
Equally important, however, is having patients adopt specific behaviors to improve memory. “Writing something down is the single most effective memory strategy,” Rosenthal said to the crowd. “As patients remember more things because of their notes, they will gain confidence, which in and of itself is a memory booster.”
A daily diary is also a good memory tool.
Other things patients can do to improve their cognition include being active and social, gardening, owning a pet, volunteering, listening to their favorite music with friends, joining a book club, and getting lots of fresh air.
There also are many virtual cognitive training programs that focus on memory, reasoning, and speed. “Even Nintendo has a series of games for memory,” he said, adding that studies have shown there’s not much difference between cognitive training programs and Wii memory games.
How long does one need to work out for cognitive improvement? Studies have shown that the ideal duration is 1 hour per day, 5 days a week.
Other ways that primary care physicians can help their patients improve memory include keeping a watchful eye on cholesterol and blood pressure control and monitoring alcohol consumption.
Most importantly, he said, ask patients about their memory. “Most people will be fairly honest, which paves the way for more testing.”
Source: Chris Kaiser, Cardiology Editor, MedPage Today-October 17, 2012 at http://www.medpagetoday.com/MeetingCoverage/AAFP/35374?utm_source=share&utm_medium=mobile&utm_campaign=medpage%2Biphone%20app