As a primary healthcare provider, one of the most frequent concerns residents of senior living communities ask is how to tell if memory issues are a normal part of aging or early signs of dementia. In many cases, patients want to maintain their independence in their own community for as long as possible and worry about dementia altering their lives. It’s a valid fear and concern. 

Cognition is not only a central part of our overall health, but an important piece of maintaining the lifestyle we enjoy. So, when optimizing brain health, we want more than to just preserve memory; we also want to promote independence, maintain quality of life, and support overall well-being.

Understanding your Community 

Your senior living community may already be designed to provide you with an environment that supports both physical and mental well-being. In some, you can access blood pressure checks, hearing screenings, low-sodium meal options, and join an exercise class or an engaging social activity. However, not all senior living communities have the same level of healthcare services. Important questions to ask whether you’re a new or existing resident include: 

• Does the community provide blood pressure checks? 
• Does the community offer hearing tests? 
• Does the kitchen offer a low sodium diet option or provide information about low sodium meal options? 
• Are there mentally stimulating and social activities for residents?
• Does the community offer dementia screenings or assessments? 
• Does the community offer onsite preventive healthcare services, including laboratory testing or neuroimaging, if I develop signs or symptoms of dementia?

Next, we’ll explore how primary care and preventive healthcare services in your community can play a role in maintaining your cognitive health.

Staying on Top of Blood Pressure  

One quick and easy way to help stay ahead of cognitive changes is your blood pressure. Regularly checking and managing blood pressure can minimize risk and help in early detection of potential issues. Here’s why: 

• Blood Pressure and Brain Health: Our brains rely on a healthy network of vessels to deliver oxygen-rich blood. Persistent high blood pressure, or hypertension, can damage these vessels, impairing the brain's functioning.
• Vascular Pressure and Cognition: Prolonged hypertension can lead to vascular pressure, causing small vessels in the brain to rupture or leak. This results in microbleeds, which may disrupt normal brain cell functioning and affect cognition over time.
• Vascular Issues and Dementia: Hypertension significantly increases the risk of vascular dementia, a condition resulting from reduced blood flow to the brain. Vascular issues are responsible for about 10% of all dementia cases.  

Getting Regular Hearing Tests  

As a healthcare provider, I strongly advocate for regular hearing screenings right in your community. Hearing is more than just one of our five senses. In fact, research suggests it has a deep connection with our cognitive health. In a recent Johns Hopkins University study, researchers found that older adults with hearing loss were up to five times more likely to develop dementia than those with normal hearing. In another study, the results showed that individuals with hearing loss had a 30-40% higher risk of developing cognitive impairment.

It’s okay if you feel self-conscious about hearing difficulties, but please know that it's a natural part of aging and nothing to be embarrassed or uncomfortable about. What's important is that we notice and act upon these signs quickly to maintain your overall health. 

Improving Nutrition and Sleep 

Nutrition and sleep both play a crucial role in maintaining cognitive health too. While a provider would personalize a care plan for you based on your unique needs, I might also consider the following: 

• Increase Vitamin B12 Intake: This vital nutrient plays a key role in maintaining nerve health and aiding in the production of DNA and red blood cells. Dietary sources of Vitamin B12 include fish, meat, poultry, eggs, milk, and milk products. For those unable to consume enough through their diet, Vitamin B12 supplements may be an option to consider.
• Increase Vitamin D Intake: Often known as the 'sunshine vitamin', Vitamin D is essential for brain health. It supports the growth and survival of neurons, the building blocks of the nervous system. You can obtain Vitamin D through exposure to sunlight, certain foods like fatty fish, and fortified dairy products. Supplements can also be used to maintain optimal Vitamin D levels.
• Reduce Salt Intake: While our bodies need some salt for proper function, excessive intake can lead to hypertension, which in turn affects cognitive health. A low-sodium diet can aid in maintaining a healthy blood pressure and by extension, promote better brain health.
• Get Enough Sleep: During sleep, our brains consolidate memories and remove harmful waste products. It's a restorative process that prepares us for the cognitive demands of the following day. Therefore, it’s recommended to aim for 7 to 9 hours of sleep each night to ensure optimal cognitive functioning.

Assessing Your Prescriptions for Anticholinergics  

Certain medications, while beneficial for some health conditions, could potentially affect cognitive health. For this reason, regular medication management with your provider is crucial. One class of medications to note are anticholinergics and often used to treat a variety of conditions, from allergies and colds to high blood pressure and some mental disorders. Anticholinergics work by blocking acetylcholine, a neurotransmitter that carries signals in your nervous system. 

However, the ACT study conducted in 2015 found a potential link between long-term use of anticholinergics and an increased risk of dementia. For example, the common allergy medication Benadryl is an anticholinergic drug. The study showed that long-term use of such a drug - even at a low dose like one pill a day - can increase the risk of dementia. This doesn't mean that every use of anticholinergics leads to cognitive problems. However, it's important to consider this information when discussing your medication with your primary care provider. Your PCP should always aim to find the best balance between managing your health conditions and preserving your cognitive health. 

Treating Reversible Conditions that Mimic Dementia 

Several conditions can mimic the symptoms of dementia but, unlike most forms of dementia, these conditions can be reversed with appropriate treatment. These include: 

• alcohol-related cognitive impairment,
• medication-induced cognitive impairment,
• metabolic and vitamin deficiencies, and
• untreated sexually transmitted diseases (STDs). 

If you or your loved ones notice cognitive changes, seek medical advice from your primary care provider promptly. Not all cognitive problems are a sign of irreversible dementia, but many causes can be treated. 

Increasing Cognitive Engagement and Physical Activity

Engaging the brain is much like exercising the body; the more we use it, the stronger and more resilient it becomes. A variety of activities can serve this purpose. Puzzles, for instance, can improve problem-solving abilities and enhance memory. Learning a new language can stimulate different areas of the brain and improve cognitive flexibility.

Acquiring a new skill, be it painting, cooking, or even playing a musical instrument, can also enrich neural pathways and stimulate brain health. These activities aren't just about passing the time; they facilitate what we call 'deep learning'. This type of learning goes beyond rote memorization, stimulating critical thinking and problem-solving skills. Such activities help build cognitive reserve, enhancing the brain's resilience to changes associated with aging or illness. 

Physical activity is another pillar of brain health. Engaging in regular exercise helps improve circulation, reducing the risk of vascular issues that can negatively impact cognitive function. Additionally, exercise stimulates the production of chemicals that enhance brain health and promote the growth of new neurons. For seniors, the recommendation is to aim for at least 30 minutes of moderate-intensity exercise daily. This level of exercise is defined as an activity where you can talk, but you can't sing. 

Remember, your brain is a remarkable organ, and it's never too late to start taking care of it. Keep active, stay engaged, prioritize your health check-ups, and always communicate openly with your healthcare team and your senior living community’s staff about any concerns you may have. By taking these proactive steps you will not only contribute to your brain health but also work towards a higher quality of life as you age.