By Victor S. Sierpina

Once upon a time, people didn’t live so long. Elders, if they survived into old age, were revered in society for their long term memories. They could tell the village or tribe when to plant and when to reap, when the buffalo would return or the salmon run, predict the cycle of the seasons, and anticipate a hard winter when extra wood must be cut and stored. In short, they served as kind of a living Farmer’s Almanac for their community. It was their long term memories, their recollections of history and tradition that were most valuable and helped the people survive and thrive. Short term memory didn’t matter as much then.

Times have changed. People are living longer. Society is faster and ever changing. These factors accentuate the problems with loss of function in the aging person. Perhaps no other condition is so feared in our minds as dementia, which includes Alzheimer’s and other types. It is estimated that over five million Americans over 65 suffer from Alzheimer’s and more than 60 percent are women. Short term memory is affected early and most severely though, while long term memory may be preserved a surprisingly long time.

Many age-related changes in memory and cognition can be entirely normal and benign. In my practice, patients often come in alone or with a loved one highly concerned about a sense of “slipping.” They can’t remember words, names, why they went into a room, find the keys and other minor inconveniences. They worry excessively that these occurrences are part of an inevitable slide into Alzheimer’s.

Certainly, if you or a family member has such concerns, have your physician or another health care professional administer a screening test for dementia. The most common one is the Mini-Mental Status Exam. There are several others including the Montreal Cognitive Assessment, and the Saint Louis University Mental Status Examination for Detecting Mild Cognitive Impairment and Dementia. Scores below 25 suggest cognitive impairment and lower scores than 20 increasing degrees of dementia.

A scale called Functional Assessment Staging of Alzheimer’s disease, or FAST, is useful, as it grades several stages of function. This might give you an idea where someone in your acquaintance falls on the spectrum of function:
• No difficulties, either subjectively or objectively — Normal Adult.

• Complains of forgetting location of objects. Subjective word finding difficulties — Normal Older Adult.
• Decreased job function evident to co-workers; difficulty in traveling to new locations; decreased organizational capacity — Early Dementia.

• Decreased ability to perform complex tasks (e.g., planning dinner for guests), handling personal finances (forgetting to pay bills), difficulty shopping, etc. — Mild Dementia.

• Requires assistance in choosing proper clothing to wear for day, season, occasion — Moderate Dementia.

• Difficulty putting clothing on properly without assistance, unable to bathe properly (e.g. difficulty adjusting bath water temperature), occasionally or more frequently over the past weeks; inability to handle mechanics of toileting (e.g. forgets to flush the toilet, does not wipe properly or properly dispose of toilet tissue), occasionally or more frequently over the past weeks; urinary incontinence, occasional or more frequent; fecal incontinence, (occasional or more frequently over the past week) — Moderately Severe Dementia.

• Ability to speak limited to approximately a half dozen different words or fewer, in the course of an average day or in the course of an intensive interview; speech ability limited to the use of a single intelligible word in an average day or in the course of an interview (the person may repeat the word over and over), ambulatory ability lost (cannot walk without personal assistance), ability to sit up without assistance lost — e.g. the individual will fall over if there are no lateral rests (arms on the chair), loss of the ability to smile — Severe Dementia.


Unfortunately, there are few medications that are available and these are largely ineffective in reversing the condition of dementia. Ginkgo biloba may slow progress of dementia, as can prescriptions such as donepezil and memantine, although their effects are rarely dramatic. My colleagues and I published a review paper in the Southern Medical Journal called “Complementary and Integrative Approaches to Dementia” (Southern Medical Journal. 2005. 98;6:636-645). Though, at that time, there were many promising studies in such areas as mind-body therapies, meditation, nutrition, and supplements, scientific support for most of these was and remains weak.

Some cases seem genetically linked, though lifestyle may also play a large factor, even in families with a dementia history. I reflect soberly that my mother and three of her siblings suffered from and ultimately died from dementia. Important lifestyle changes that can provide epigenetic protection are listed below:

Light alcohol consumption can be helpful in forestalling dementias recently reported by researchers at UTMB. Plant-based flavonoids like those in cacao (chocolate) and blueberries are especially recommended, as is fish oil. Eating a diet with at least five to seven servings of fruits and vegetables a day is strongly recommended.

As usual, prevention is the preferred path. It is pretty simple. If you think of what it takes to foster good heart health, similar measures that promote healthy circulation to the brain can delay or even prevent dementia. Here is a Brain Health program adapted from the Mayo Clinic that has stood the test of time and multiple studies:

• Stay physically active, exercising at least 150 minutes a week.

• Eat a Mediterranean-type or anti-inflammatory diet.

• Stay mentally challenged through lifelong learning, games, hobbies or other mind-stimulating activities.
• Maintain active social engagement.

• Be sure to treat depression, if it is present, as it can mimic dementia or worsen it.

So though treatments are limited for dementia, following these simple measures clearly improve your chances of preventing or slowing the suffering from this increasingly common, often tragic, contemporary condition.

Dr. Victor S. Sierpina is the WD and Laura Nell Nicholson Family Professor of Integrative Medicine and Professor of Family Medicine at UTMB.