As people age, their working or short-term memory — the ability to take in information, manipulate it, and retrieve it — declines. "At 20 you can remember easily," says Debra Hain, ARNP, DNS, BC, gerontological nurse practitioner at the Louis and Anne Green Memory and Wellness Center in Palm Beach, Fla. "At 70, it takes more effort."
A new study published in the Nov. 19 Journal of the American Medical Association eliminates ginkgo biloba as a preventative treatment for dementia and Alzheimer's disease, but there are measures that have been proved to minimize the effects of age on memory.
Memory Preservation
Judith Petrin, RN, ARNP, Lee Memory Care, part of Lee Memorial Health System in Fort Myers, Fla., says the "big three" risk factors are diabetes, high cholesterol, and hypertension. This triad affects the cardiovascular system, essential for proper brain function.
Experts recommend exercising 20 to 30 minutes five days a week. "You don't have to do 30 minutes all at once," says Petrin. "The idea is to be moving."
Exercise stimulates neurotransmitters and contributes to overall cardiovascular health. As far as memory in patients with advanced Alzheimer's, Tappen says, "We have not found a powerful memory effect in exercise research, but have seen less depression. People who are depressed score poorly on memory tests."
It's also important to pay attention to diet. Food items, such as blueberries to green tea, have been shown to benefit the brain. Omega-3 fatty acids, found in flaxseed and certain kinds of fish such as black cod and salmon, have been shown to reduce the risk of dementia.
Petrin says it's better to simply maintain a balanced diet, eat whole grains, and get nutrients from fresh and minimally processed foods. "Get color in your diet," she adds. "Stick to fruits and vegetables with lots of color like strawberries, blueberries, broccoli, and red grapes." Limit daily alcohol intake to 5 ounces of wine, 2 ounces of liquor, or 12 ounces of beer. Petrin also recommends a daily intake of natural vitamin E, which can be found in a handful of walnuts or almonds.
Mental calisthenics such as crossword puzzles are helpful, but it's important to have a variety. "You want to keep your brain stimulated with a smorgasbord of activity," says Hain.
Computer programs, such as those developed by Posit Science and Nintendo, are popular for "brain training," but Tappen says keeping the mind fit can be much simpler, "You don't have to do the computer programs. You can go out and dance, walk, whatever you love to do — things that are physically active and keep you socially active, too.
Patient Assessment
Florida has 15 state-designated memory disorder clinics under its Alzheimer's Disease Initiative, including the Memory and Wellness Center and Lee Memorial Care.
Hain recommends an evaluation for anyone who complains of memory difficulties. "They deserve to be evaluated, even if to just get a baseline that can be used in the future," she says.
Memory evaluations may lead to early diagnosis of mild cognitive impairment or Alzheimer's disease. "The earlier people are diagnosed with Alzheimer's disease, the more brain we have the possibility of saving," says Petrin.
Hain says she often can detect a problem even before administering standardized tests. For example, a person may, "go from one thought to the next without any transition."
Scores on standardized tests for assessing cognitive function can be the first sign of memory impairment, but results should be placed in context. For example, the Mini-Mental State Examination is commonly used, but Hain notes, "The Mini-Mental is not a diagnostic tool; it just tells you something may be there."
Another assessment test is the Montreal Cognitive Assessment, which is used to detect mild cognitive impairment. Several tests, including assessments of anxiety and depression, are better than any single test.
In the hospital setting, Hain says nurses should watch for acute confusion or fluctuation in cognitive status. She suggests asking, "Have you or any of your family members experienced memory problems?"
Ruth Tappen, RN, EdD, FAAN, professor at the Florida Atlantic University Christine E. Lynn College of Nursing, suggests asking if the person was having memory problems before he or she was ill? She cautions against traditional orientation questions such as "What day is it?"
"When you're in the hospital, Tuesday looks the same as Sunday."
In a primary care setting, Hain says nurses should watch for changes in patterns such as missing appointments or forgetting to start a new medication.
Here are some other memory assessment techniques from those interviewed for this story:
"I'm going to give you one minute to think of all the words beginning with the letter T." A person with normal memory can usually come up with 11.
Ask someone to remember three disparate words, such as a flower, color, and an idea or thought: daisy, red, trust. Five minutes later, ask the person to remember the words.
Ask the patient to count backward from 100 by sevens.
Treatment Study
Researchers such as Tappen are investigating the role of cognitive retraining programs for patients with Alzheimer's. In Tappen's study, patients with early-stage Alzheimer's underwent a 12-week functionally oriented, in-home cognitive retraining program.
"We sent people into the homes for one hour twice a week," says Tappen. Participants practiced techniques such as ways to remember lists, ways to keep track of medications, money management, and face-name association (mentally attaching something memorable to the face of a person to improve memory). A memory notebook that contained key information such as appointments, names, and phone numbers was also helpful for many patients.
"I reinforce to families and patients that this is a slow moving process, so the combination of medication, physical activity, and socialization gives us more time for research to catch up with a cure," says Petrin. "It's all about trying to give hope."
Cynthia Saver, RN, MS, is president of CLS Development Inc.
To comment, e-mail editorFL@nursingspectrum.com.
A new study published in the Nov. 19 Journal of the American Medical Association eliminates ginkgo biloba as a preventative treatment for dementia and Alzheimer's disease, but there are measures that have been proved to minimize the effects of age on memory.
Memory Preservation
Judith Petrin, RN, ARNP, Lee Memory Care, part of Lee Memorial Health System in Fort Myers, Fla., says the "big three" risk factors are diabetes, high cholesterol, and hypertension. This triad affects the cardiovascular system, essential for proper brain function.
Experts recommend exercising 20 to 30 minutes five days a week. "You don't have to do 30 minutes all at once," says Petrin. "The idea is to be moving."
Exercise stimulates neurotransmitters and contributes to overall cardiovascular health. As far as memory in patients with advanced Alzheimer's, Tappen says, "We have not found a powerful memory effect in exercise research, but have seen less depression. People who are depressed score poorly on memory tests."
It's also important to pay attention to diet. Food items, such as blueberries to green tea, have been shown to benefit the brain. Omega-3 fatty acids, found in flaxseed and certain kinds of fish such as black cod and salmon, have been shown to reduce the risk of dementia.
Petrin says it's better to simply maintain a balanced diet, eat whole grains, and get nutrients from fresh and minimally processed foods. "Get color in your diet," she adds. "Stick to fruits and vegetables with lots of color like strawberries, blueberries, broccoli, and red grapes." Limit daily alcohol intake to 5 ounces of wine, 2 ounces of liquor, or 12 ounces of beer. Petrin also recommends a daily intake of natural vitamin E, which can be found in a handful of walnuts or almonds.
Mental calisthenics such as crossword puzzles are helpful, but it's important to have a variety. "You want to keep your brain stimulated with a smorgasbord of activity," says Hain.
Computer programs, such as those developed by Posit Science and Nintendo, are popular for "brain training," but Tappen says keeping the mind fit can be much simpler, "You don't have to do the computer programs. You can go out and dance, walk, whatever you love to do — things that are physically active and keep you socially active, too.
Patient Assessment
Florida has 15 state-designated memory disorder clinics under its Alzheimer's Disease Initiative, including the Memory and Wellness Center and Lee Memorial Care.
Hain recommends an evaluation for anyone who complains of memory difficulties. "They deserve to be evaluated, even if to just get a baseline that can be used in the future," she says.
Memory evaluations may lead to early diagnosis of mild cognitive impairment or Alzheimer's disease. "The earlier people are diagnosed with Alzheimer's disease, the more brain we have the possibility of saving," says Petrin.
Hain says she often can detect a problem even before administering standardized tests. For example, a person may, "go from one thought to the next without any transition."
Scores on standardized tests for assessing cognitive function can be the first sign of memory impairment, but results should be placed in context. For example, the Mini-Mental State Examination is commonly used, but Hain notes, "The Mini-Mental is not a diagnostic tool; it just tells you something may be there."
Another assessment test is the Montreal Cognitive Assessment, which is used to detect mild cognitive impairment. Several tests, including assessments of anxiety and depression, are better than any single test.
In the hospital setting, Hain says nurses should watch for acute confusion or fluctuation in cognitive status. She suggests asking, "Have you or any of your family members experienced memory problems?"
Ruth Tappen, RN, EdD, FAAN, professor at the Florida Atlantic University Christine E. Lynn College of Nursing, suggests asking if the person was having memory problems before he or she was ill? She cautions against traditional orientation questions such as "What day is it?"
"When you're in the hospital, Tuesday looks the same as Sunday."
In a primary care setting, Hain says nurses should watch for changes in patterns such as missing appointments or forgetting to start a new medication.
Here are some other memory assessment techniques from those interviewed for this story:
"I'm going to give you one minute to think of all the words beginning with the letter T." A person with normal memory can usually come up with 11.
Ask someone to remember three disparate words, such as a flower, color, and an idea or thought: daisy, red, trust. Five minutes later, ask the person to remember the words.
Ask the patient to count backward from 100 by sevens.
Treatment Study
Researchers such as Tappen are investigating the role of cognitive retraining programs for patients with Alzheimer's. In Tappen's study, patients with early-stage Alzheimer's underwent a 12-week functionally oriented, in-home cognitive retraining program.
"We sent people into the homes for one hour twice a week," says Tappen. Participants practiced techniques such as ways to remember lists, ways to keep track of medications, money management, and face-name association (mentally attaching something memorable to the face of a person to improve memory). A memory notebook that contained key information such as appointments, names, and phone numbers was also helpful for many patients.
"I reinforce to families and patients that this is a slow moving process, so the combination of medication, physical activity, and socialization gives us more time for research to catch up with a cure," says Petrin. "It's all about trying to give hope."
Cynthia Saver, RN, MS, is president of CLS Development Inc.
To comment, e-mail editorFL@nursingspectrum.com.
