Can you save your memory and stay sharp as you get older?

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Alzheimer's Disease: A guide to diagnosis, treatment, and caregiving
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Get your copy of Alzheimer's Disease: A guide to diagnosis, treatment, and caregiving

Have you noticed memory problems piling up in ways that affect daily life in yourself or someone you love? Do you find yourself struggling to follow a conversation or find the right word, becoming confused in new places, or botching tasks that once came easily? More than 5 million Americans have Alzheimer’s disease, and estimates suggest it will affect 13.8 million by 2050. Already, it is the sixth leading cause of death in the United States. This Special Health Report, Alzheimer's Disease: A guide to coping, treatment, and caregiving, includes in-depth information on diagnosing Alzheimer’s and treating its symptoms.

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As we age, most of us will find our short-term memory and ability to process new information "not what it used to be." This is the cognitive equivalent of creaky knees — an inconvenient reminder that we're getting older.

Dementia, though, is something different. With dementia, multiple areas of thinking are compromised and the deficits are likely to get worse. By definition, dementia means memory and other cognitive areas deteriorate to the point that everyday tasks and decisions become difficult, and sometimes impossible. The causes of dementia are many, but in this country, Alzheimer's disease is responsible for between 60% and 80% of dementia cases.

Are there ways to avoid Alzheimer's disease? Not according to the 2010 National Institutes of Health conference on preventing Alzheimer's disease and cognitive decline. The group's consensus statement said there is no evidence of "even moderate scientific quality" that nutritional supplements, herbal preparations, diet, or social and economic factors can reduce the chances of getting Alzheimer's. Interventions intended to delay the onset of Alzheimer's didn't fare much better.

But it's not all bad news: Physical activity and cognitive engagement may help keep cognitive decline at bay

In terms of staying sharp (versus developing dementia) as we get older, the outlook was a little better, according to the group. Diet and nutritional supplements still didn't pass muster, and no medication was billed as preventing cognitive decline, but physical activity and cognitive "engagement" seem to hold some promise.

Why the difference? For one thing, by the time people are diagnosed with Alzheimer's disease (even mild or moderate cases), there may already be too much brain damage for exercise and other interventions to do much good.

In some studies depression has been associated with mild cognitive impairment and cognitive decline. Successful treatment of depression may not alter Alzheimer's, but the aspects of a person's thinking clouded by depression may improve with treatment.

To stay at the top of your game, stay on top of your health

A healthy mind relies on a healthy body. Elevated blood pressure and cholesterol, diabetes, excess weight, smoking, and a sedentary lifestyle all contribute to cognitive declines. Working to stay healthy helps you stay sharp.

Stop smoking. In 2010, a National Institutes of Health panel noted that current smokers were 41% more likely to exhibit cognitive declines than former smokers or nonsmokers.

Challenge your mind. Engaging in challenging board games, reading, working crossword puzzles, playing a musical instrument, and acquiring new skills may help keep your mind fit. These activities seem to expand the web of neuronal connections in the brain and help keep neurons nimble and alive.

Challenge your body. Brain cells crave a steady diet of oxygen. Physically active people lower their risk for developing dementia and are more likely to stay mentally active.

Get your rest. Too little sleep can affect memory. Six hours may be the minimum needed, although researchers testing college students found those who had eight hours were better able to learn new skills.

Watch your weight. Staying within a normal weight range lowers your risk for illnesses such as diabetes, hypertension, metabolic syndrome, and stroke, which can compromise the brain to varying degrees.

Check with your doctor. Are there any factors — such as medication side effects, vitamin deficiencies, depression, or chronic conditions — that could be better managed to help you stay as mentally sharp as possible? Discuss these issues with your doctor.

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Knees and Hips: A troubleshooting guide to knee and hip pain
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Get your copy of Knees and Hips: A troubleshooting guide to knee and hip pain

Do your knees or hips hurt? Most people will at some point have knee or hip pain because these large joints have a demanding task: they must bear the full weight of your body while at the same time allowing for a wide range of motion. Wear and tear, injury, and simple genetic predisposition can all contribute to knee or hip pain. This Special Health Report, Knees and Hips: A troubleshooting guide to knee and hip pain, covers a wide range of knee and hip conditions and describes in detail treatments, preventive strategies, and surgeries.

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Is hip replacement surgery dangerous for my heart?

Q. I am a 72-year-old with diabetes, and I need to have a hip replaced. Does my diabetes make this surgery too dangerous for my heart?

A. While people with diabetes have a generally higher risk of cardiac problems than those without this condition, the increase in risk for cardiac complications with major surgery is quite low — and there may be no increase at all with good care. People with diabetes have higher rates of atherosclerosis, of course, and if you've already had a heart attack or kidney problems, those risk factors do increase your risk of heart problems with surgery. But after taking those factors into account, diabetes is not clearly linked to short-term complications with surgery.

Major orthopedic surgery procedures such as hip replacement have a pretty low rate of major cardiac complications when performed by experienced teams at good hospitals. In short, good care can mitigate whatever increased risk of complications that your diabetes may carry. If you are having considerable pain from your hip, such as pain at rest, then I would strongly consider moving ahead with the surgery.

— Thomas Lee, M.D.
Editor in Chief, Harvard Heart Letter

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