Recognize the Difference Between Normal Brain Aging and Cognitive Decline

Struggling to find the right word now and again is a normal part of aging; losing track of dates, seasons, or places is not. Differentiating between a normally aging brain and cognitive decline can offer peace of mind to those who recognize their memory blips as an expected part of the aging process. Those who think their memory problems fall outside of the bounds of what is considered normal should discuss their concerns with a doctor, and understand that early evaluation and treatment is the best way to slow progression of cognitive decline. Here’s a look at the differences.

Normally Aging Brain

“Most people don’t need an explanation as to why our bodies change as we get older. We accept that our hair turns gray and that we may not be able to run as fast or as far as we once could. The brain is changing too—structurally and physically. As a result, there are functional changes in our thinking abilities,” says Lisa D. Ravdin, PhD, associate professor and director of the Weill Cornell Medicine Neuropsychology Service.

A person with normal age-related functional brain changes may experience:

Slower processing speed: It may take more time to learn new things or react quickly in certain situations.

Mild forgetfulness: Perhaps you occasionally forget where you placed your keys or purse.

Word retrieval issues: You may have a problem pinpointing the precise word during discussions.

“For the most part, changes in the structure of the brain result in normal age-related changes in our thinking abilities, and they tend to be more of an annoyance, rather than a real problem,” says Dr. Ravdin. “It may take longer to recall a certain word, but in normal aging the word will come to you, and when it does, that word and its meaning are not forgotten.”

The Brain in Cognitive Decline

In Alzheimer’s disease (AD), or other states of cognitive decline, there can also be word-finding problems similar to those that occur in the normal aging brain, but there’s a distinct difference. “In the disease state, the ability to say that word and understand its meaning, or the ability to use the word appropriately may be impaired,” explains Dr. Ravdin.

A person whose brain is in a state of cognitive decline may experience:

Memory loss that impacts daily life: Forgetting important dates, events, or repeatedly asking for the same information.

Difficulty planning/problem solving: Struggling with tasks that involve complex thinking, like managing finances or following a recipe.

Trouble completing familiar tasks: Difficulty in completing routine activities such as driving to a familiar location.

Poor judgment: Making decisions that seem uncharacteristic or risky.

Evaluation Is the First Step

If you’re experiencing memory problems or confusion, report it to your physician. They may administer a test of thinking abilities to assess mental function. If your physician thinks further evaluation is necessary, they will refer you to a specialist in memory disorders; the specialist may be a neurologist, psychiatrist, or neuropsychologist. A neurologist will order blood tests and neuroimaging to identify the cause. A neuropsychologist will do a full cognitive evaluation and try to understand the symptoms and the potential origin of memory changes. “Even if a memory disorder is diagnosed, a person can continue to enjoy a good quality of life while taking FDA-approved medications that can potentially slow symptom progression. But it is best to get it addressed sooner rather than later,” says Dr. Ravdin.

Cognitive Decline Stages and Treatment

The earliest stage of cognitive decline is mild cognitive impairment (MCI). One-third of those with MCI will develop Alzheimer’s disease—which typically progresses slowly in three stages (mild, moderate and severe)— within five years.

Drugs are generally not prescribed unless someone reaches the stage identified as Alzheimer’s disease. Lecanemab (Leqembi) is the newest drug to receive FDA approval to slow disease progression in people with early AD. The drug is an anti-amyloid treatment that works by attaching to and removing beta-amyloid from the brain. AD is characterized by abnormal clumping of beta-amyloid and tau proteins in the brain. Other drugs that may help lessen or stabilize symptoms for a limited time include donepezil (Aricept), rivastigmine (Exelon), galantamine (Razadyne) and memantine (Namenda).

Stay Active

“There are things people can do if they have a true memory problem that will limit its impact on daily functioning, such as getting enough sleep, reducing stress, and paying attention to healthy lifestyle choices,” says Dr. Ravdin. Regular mental and physical activities, a balanced diet, and social engagement can contribute to healthy aging and potentially reduce the risk of cognitive decline. Experiencing occasional minor memory lapses is a normal part of aging. However, persistent or worsening cognitive difficulties should be discussed with a physician.

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