By the year 2035, the 2018 U.S. Census Bureau has estimated that adults over the age of 65 will outnumber children under the age of 18. The trend, often referred to as “the graying of America,” has multiple mental healthcare implications. Foremost among them: meeting the care needs of a population that, at 65 years and older, inevitably suffers from much higher rates of memory loss and dementia.
Age is the #1 predictor of memory problems, after all, so as Americans live longer, their growing seniority makes them more prone to changes in the brain associated with Alzheimer’s and dementia (among still other mental health issues). For example, we know that mild cognitive impairment (MCI) occurs in 15 to 20 percent of Americans over the age of 65 (according to a widely cited statistic); and, that nearly 40 percent of people who have had MCI for five years or more will develop dementia (according to studies cited by the Alzheimer’s Association).
Early Intervention for Age-Related Memory Issues – What It Is and Why It’s Key
These statistics drive home how important it is to intervene quickly and as early as possible in response to signs of potential memory loss in you or a loved one. With early intervention, we can help slow down the progression of MCI or early dementia.
In addition to a consultation with a neurologist, early intervention should involve getting a detailed evaluation by a clinical psychologist who specializes in neuropsychology and is therefore qualified to diagnose you or your older loved one.
As a clinical psychologist specializing in neuropsychology, I am often asked to evaluate older patients with memory issues. Roughly half of these patients tend to come from a medical setting: a doctor may have referred them to me after a telling CT, MRI scan or other diagnostic intervention; in other cases, a patient’s loved one brings them to me, usually out of concern over certain behaviors that could suggest memory loss.
How a Neuropsychological Evaluation Assesses Different Memory-Related Skills
In every case, I administer certain tasks that help me assess the patient’s working memory. Working memory is the ability to retain new information and manipulate it. The ability to memorize a new phone number on the spot so that you can then dial the number is a perfect example of working memory.
By observing how patients complete certain activities, I am also able to evaluate patients’ verbal retention (a skill typically associated with the brain’s left hemisphere) and their non-verbal perceptual retention (a job assigned to the brain’s right hemisphere).
Another thing I’m looking for in my evaluations are signs of functional impairment in these two clinical categories: basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs). BADLs refer to activities like eating and brushing teeth. IADLs refer to activities like managing medications, writing checks or making doctor appointments (things that require a higher level of cognitive function and independence).
The Need for Better Treatments for Memory Loss and Early Stage Dementia
Early intervention and assessment, as critical as they are, are only one part of the answer to a graying America’s higher rates of memory impairment and dementia. The other part of the answer involves more and better treatments for these conditions— treatments that are effective, cause less side effects and can be introduced before a diagnosis of dementia, as preventative medicine at the first signs of MCI, for example.
Current treatments are limited. They involve cognitive-enhancing medications, which show mixed results, and behavioral prescriptions, such as getting more regular social interaction and exercise. More treatments are thus critically needed to meet the rising memory care needs of this growing older demographic.
How Neurostimulation Improves Working Memory in Older Adults
That’s why recent findings into “neurostimulation,” a non-invasive technique that applies magnetic or electrical currents to regions of the brain, are promising. Last month, a study in Neuroimage found that working memory in older adults improved “significantly” when a particular type of neurostimulation—”anodal transcranial direct current stimulation” (tDCS)—was applied to their prefrontal cortex while they performed certain cognitive tasks for rewards.
This finding reinforces the conclusions of earlier studies, such as research cited in April 2019 by the New England Journal of Medicine. There, on a computer-based task, older, non-demented adults exhibited worse working memory than younger adults. Strikingly, after only 25 minutes of targeted, high-definition transcranial alternating-current stimulation (HD-tACS), the older adults’ brains showed normalization patterns similar to those of younger adults, suggesting that even one short session of neurostimulation can substantially improve a senior’s working memory (at least in the short term).
Such findings beg for more research into neurostimulation as a potential treatment for early dementia and other memory issues. A 2015 Harvard Medical School report commented on studies evaluating the effect of transcranial magnetic stimulation (TMS) or tDCS on memory and learning: “Overall, the results indicate that the techniques are most likely to improve mental function when used in conjunction with other types of training, such as learning new systems for remembering names,” the report read, adding that “Afew small studies in people with mild Alzheimer’s disease suggest that TMS could be combined with cognitive exercises to improve function.”
This all should be good news for any senior, not just those with memory loss— and for those who love them.
By Dr. Antonio Rotondo
Dr. Antonio Rotondo is a licensed clinical psychologist, specializing in neuropsychology. He treats patients with addiction and other mental disorders at FHE Health, a Florida-based behavioral healthcare provider. Learn more about Neurorehabilitative Services at FHE Health.