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Principles of the Memory Program

1. You need to adopt a comprehensive memory program rather than hope for a quick fix against age-related memory loss.

2. No single approach will be sufficient to prevent memory loss due to aging, or to block or reverse age-related memory loss after it has set in. An integrated approach that includes sound general health measures (diet, exercise, memory training), identifying and reversing specific causes of memory loss for those who have such causes, and limited use of medications (vitamins, alternative therapies, and pharmaceuticals) will give you the maximum benefit.

3. The program requires consistency and long-term commitment, because given the nature of age-related memory loss, you may not see any results for many months or even years after you begin the program.

4. You don't need to follow every single suggestion or piece of advice; rather, you should tailor the program to your own needs. For example, while everyone should develop sound dietary and exercise habits, not everyone needs to take medications to prevent memory loss. The Memory Program itself is individualized and tailor-made for people in specific age and gender categories, with separate guidelines for those who wish to prevent memory loss versus those who already have mild memory loss and need to treat it and prevent further decline.

In this chapter, I introduce the basic outline of the Memory Program. In subsequent chapters, I go through the various elements that constitute the Memory Program, giving you a detailed description and explanation of the science and clinical basis behind the practical recommendations, and how you should go about making the decision to implement each component in your own life. I then bring all this information together in a chapter devoted to describing the Memory Program in detail. I urge you to read this book sequentially and not skip to the later chapter that describes the program itself, because much of what you need there won't be clear if you haven't read the earlier chapters.

If You're Not Sure

If your memory is sound and you have excellent general health habits, you might justifiably ask why you need to even bother about age-related memory loss. My answer is quite simple: if you are willing to suffer a gradual dwindling in your memory starting in your forties and fifties, and continuing into your sixties and seventies, then you should not waste any of your time or energy worrying about it. But you probably belong to the majority of people who look forward to their golden years with hope and a positive attitude. You want to function at your peak physical and mental capacity for the longest possible period of time, so that your later years will truly be golden. If you belong to this group, now is the right time to begin taking steps to prevent age-related memory loss.

Don't Wait Until It Is Too Late

Prevention is the best strategy against the aging process, but our society often prefers to ignore problems until they strike us in the face. In some cases, we can get away with it, as the United States government managed to do with the federal budget deficit in the 1990s, waiting for the other shoe to drop before swinging into a corrective action mode. But maintaining good health is a different matter altogether.

Taking preventive action in your forties and fifties is a whole lot better than waking up for the first time in your sixties or seventies to discover that you've developed memory loss, a condition that gradually crept up on you while you ignored it. After age-related memory loss has set in, taking action at a late stage is not very effective because the death of nerve cells in the brain is largely irreversible. All that can be done is to prevent further damage, not rescue what has already been lost.

The Lessons of Osteoporosis and High Blood Pressure

The majority of older people, especially most women, gradually develop osteoporosis, which is a thinning and weakening of bone structure. If everyone said that there was no point in trying to prevent osteoporosis by using medications (estrogen, calcitonin, Fosamax, Evista) because it was, after all, "normal aging," you can imagine how frail and stooped most elderly women would be and how many more falls and fractures would occur. Hypertension is another such example: a mild to moderate rise in blood pressure was usually left untreated on the grounds that it was quite "normal" for an older person. After doctors began to treat even mild hypertension routinely, using diet, exercise, and medications if necessary (this practice began barely two to three decades ago), the risk of heart disease, stroke, and death in these people diminished steadily over time. Mild hypertension is now considered a treatable, and not just normal, part of the aging process. The same holds true for high cholesterol levels. The next sea change: preventing memory loss due to the aging process.

Grandma Still Has a Great Memory

But what evidence is there to support the dim view that most people will suffer from memory loss as they grow older? As a matter of fact, there has been considerable research on this topic. While a few people retain a stellar memory into their eighties and nineties, studies of middle-aged and older people consistently demonstrate that the vast majority show a gradual decline in their memory over time. When someone says that his or her grandmother has an outstanding memory, it usually means that her memory is much better than that of other people of her age, but it may still represent a decline from when she was younger. This is what we have observed in the Memory Disorders Center at Columbia University. Therefore, since age-related memory loss is likely to affect most of you in the years to come, you should begin to implement preventive strategies at this stage. And if you already have mild memory loss, you should get started on the Memory Program immediately.

The Three Main Elements in the Memory Program

There are three broad components to the Memory Program that I will describe in detail in the rest of this book:

1. Proactive general health measures that include a proper diet with appropriate nutritional supplements, regular moderate physical exercise, and practical training aids and techniques to boost your ability to remember.

2. Identifying specific causes of memory loss, many of which can be completely reversed if treated correctly. These include depression, stress, alcohol, hormonal abnormalities, nutritional deficiencies, and brain toxicity resulting from specific over-the-counter and prescription medications. Preventing stroke, particularly ministrokes, is another important element in this part of the Memory Program.

3. Medications to improve your memory. These include a variety of promemory medications— alternative, over-the-counter, and prescription. Some of them are useful in preventing or treating mild memory loss, others have questionable utility, and still others either don't work or are too toxic to use on a daily basis. I will review the evidence for and against each of these medications to help provide a sound basis for their inclusion or exclusion from the Memory Program.

Reversible and Less Reversible Memory Loss

All three sections of the Memory Program are important. Most of you will accept the idea that a sound diet with moderate, regular physical exercise supplemented by memory training techniques will help pro-

tect against memory loss. Some of you may also recognize the value of taking medications of one sort or another. But those who have a specific, reversible cause of memory loss are of particular concern to me. Depression is an obvious example, because it is often unrecognized by both the person suffering from this problem and the physician. Another common, often unidentified, culprit is alcohol, because with age the brain becomes more sensitive to even small doses—for example, your regular two to three drinks every evening can gradually cause brain toxicity as you grow older. Therefore, although only a minority among you will have a reversible cause of memory loss, if you do belong to this category it is imperative that the specific cause be identified and tackled head-on. And if you suffer from memory loss due to a reversible cause, general health improvement or memory training techniques or memory-enhancing medications won't do you much good until the actual cause is treated appropriately—for example, no amount of diet or exercise or memory training or promemory medications will cure memory loss if it is caused by thyroid deficiency; thyroid hormone replacement therapy is required.

I am emphasizing potentially reversible causes of memory loss precisely because they can often be fully reversed. For the more common problem of age-related memory loss, neither general health measures nor specific medications provide a perfect solution. These approaches will help slow down or block further decline in your memory, but they are unlikely to bring your memory back to what it was when you were twenty years old. This key fact makes it all the more important that you consider adopting this Memory Program before you develop significant memory loss.

If You Already Have Mild Memory Loss

Some of you have already developed mild age-related memory loss, based on either your performance in the memory tests that I described in the first chapter, or your own awareness that your memory is significantly worse compared to how it used to be a few years ago. But even if you fall into the category of those with mild memory loss, you can still employ components of the Memory Program with good results. Although people in their forties and fifties will benefit the most by adopting all the elements in the Memory Program, those among you who are sixty-plus will also gain by using these approaches.

Customize Your Memory Program

You should tailor the Memory Program to your own needs. For example, it is too expensive and cumbersome, and doesn't make a whole lot of sense, to take a medication cocktail of ginkgo biloba, vitamins A, C, and E, donepezil (Aricept), phosphatidylserine, selegiline, a COX II inhibitor like Celebrex or Vioxx, melatonin, and estrogen. Rational, practical choices among these various options are required. I will discuss the pros and cons of these choices, taking into account differences among individuals that will include a careful analysis of the risk-benefit ratio for each one of you. In the chapter that describes the entire Memory Program in detail later in the book, the optimal strategies within the program are specifically targeted for different groups of people:

1. People with mild memory loss versus people with currently normal memory who wish to prevent future loss.

2. People in the age group forty to fifty-nine versus those who are sixty and older, each described separately for the above two groups.

3. Men and women, described separately for each of the above categories.

This classification will help you develop and implement an individualized program for yourself to fight age-related memory loss. Before you go through the rest of the book, you should be clear as to whether you have a normal memory or already suffer from mild memory loss. Base this judgment mainly on your memory test performance in chapter 1 and don't rely only on your own subjective evaluation or the opinions of family and friends. I frequently return to this distinction in the rest of the book, and knowing whether you have a normal memory or mild memory loss will help you decide which advice does and does not apply to you.

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