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Where Did I Put My Car Keys?

Panelists advise on navigating changes of natural aging and age-related disorders

 

His grandmother lived to 109. His mother is doing well at 91. When James A. Ferrendelli, M.D., thinks about aging, he knows that genetics are on his side.

Ferrendelli was one of four panelists speaking at the 10th Annual Brain Awareness Public Forum March 19 at The University of Texas Medical School at Houston. An overflow crowd of more than 400 heard about a variety of issues, including Alzheimer's and Parkinson's diseases, stem cell therapy, dementia, and other topics related to the aging brain.

Two processes occur as you get older: natural aging and increased susceptibility to many diseases and disorders.

"Naturally as you get older, there are fewer nerve cells, but you've got 40 billion, so it doesn't hurt to lose a few," said Ferrendelli, the Kraft W. Eidman Professor in the Medical Sciences and chairman of the Department of Neurology at the Medical School. "Communication between nerve cells is still quite adequate to carry on most functions, but it does degenerate a little as you get older.

"If you look at the sort of things that are important to you, they are most of the things you can do just fine as you get older - reading, vocabulary, long-term factual memory," he said. "There are a few things that are not as good as at a younger age because you have visual- motor skills impairment - you can't go as fast."

Maintain intellectual activity. All those who don’t have computers,
buy one. The aggravation alone will keep you alert.”

– James A. Ferrendelli, M.D.

Biochemical changes that occur in the brain as you get older lead to structural changes, which affect abilities. "A simple one that we all know about is that we lose our hearing a little bit as we get older," said Joshua I. Breier, Ph.D., associate professor of clinical neurosciences in the Department of Neurosurgery and the Vivian L. Smith Center for Neurologic Research.

"There are also changes that occur in the central nervous system that affect higher level functioning," Breier said "It's not atypical for folks as they get older - mid- 60s or later - to complain of short-term memory problems. They are able to have new information but the area of the brain that consolidates the information, that makes it more permanent, is not working quite as well, and they may forget where their car keys are.

"Normal attention usually is pretty good, but the ability to attend to a specific set of information in a field of information gets a little bit less," Breier said. "For example, in a cocktail party you may be less able to attend to one person when there's a lot of talking going on."

Just as natural aging affects the brain, it also affects psychology. "Some of the challenges of aging are to deal with the inevitable role changing that takes place during this time," said Robert W. Guynn, M.D., professor and chairman of the Department of Psychiatry and Behavioral Sciences at the Medical School, executive director of the UT Harris County Psychiatric Center and a faculty member of the UT Graduate School of Biomedical Sciences (GSBS).

"For example," he said, "one is no longer a mother; one is now a grandmother. One retires. One has to have resilience to stand up to the various losses and the inevitable medical problems that begin to intervene.

"Sometimes the idea of somebody being able to live alone and by themselves is seen as a good thing because it implies that they're able to function," Guynn said. "On the other hand, there's a down side. People who live alone tend to get depressed more, tend not to take care of nutrition. And frankly they tend to drink more."

Depression is a particular concern in people who have dementia. When people hear the term "dementia," they often think of Alzheimer's disease. However, there's at least a 30 percent chance that the dementia has another cause, explained Stephen C. Waring, D.V.M., Ph.D., assistant professor of epidemiology and environmental science and associate director of the Center for Public Health Preparedness at the UT School of Public Health at Houston.

Waring emphasized the need for a thorough workup by specialists whenever Alzheimer's is suspected. "To get a diagnosis of Alzheimer's disease, you have to be sure that the dementia, the memory loss and the impaired cognitive function are really due to Alzheimer's disease and not to some other cause that can be treated."

So far, Waring said, three genes have been associated with early onset (before age 60) Alzheimer's disease. While all three genes put together account for less than 5 percent of cases, when you consider that roughly 4.5 million people in the United States have Alzheimer's, the potential for preventing even a small proportion could have "a major public health impact."

Treatment for Alzheimer's currently focuses on relieving the symptoms and possibly slowing the progression of the disease.

Much more can be done to deal with the challenges of natural aging. "One of the things that one must do is to have other interests," Guynn said. "It has to be meaningful for you - something you really enjoy, something you really find worthwhile. I personally think that it has to involve other people.

"One of the things that is positive in the aging process is that you're free to give; you're free to volunteer," he said. "Other people find meaning and satisfaction in things they haven't been able to do, such as travel.

"And add to my list of things that keep you young - a sense of humor."

To reduce the risk of stroke and dementia, Waring said, "look at things that have to do with cardiovascular risk factors and control those - exercise, diet, moderate alcohol intake."

Ferrendelli added to the recipe for successful aging: "Maintain physical activity. Of course you have arthritis - we all have arthritis after age 60. But the best treatment for it is exercise.

"Maintain intellectual activity. All those who don't have computers, buy one. The aggravation alone will keep you alert.

"The recipe is not hard," Ferrendelli said, "but it requires devotion and dedication on your part."

The panel discussion was moderated by James "Red" Duke Jr., M.D., the John B. Holmes Professor of Clinical Sciences and professor of surgery at the Medical School.

In addition to the public forum, almost 700 children and their families attended Brain Night, March 24 at the John P. McGovern Museum of Health & Medical Science. Both events were hosted by the Neuroscience Research Center (NRC) in conjunction with national Brain Awareness Week.

"I am gratified by the amount of interest Houstonians show in the program year after year," said John H. Byrne, Ph.D., director of the NRC, the June and Virgil Waggoner Distinguished Professor, chair of the Department of Neurobiology and Anatomy at the Medical School, and a GSBS faculty member. "It illustrates that people are very interested in their health and the health of people they know and care for."

Partial support for the forum came from The Ellwood Foundation, Linda Finger, Dee S. and Patricia Osborne, Roberta M. and Jean M. Worsham, Eisai Inc., and Cyberonics Inc.

By Ina Fried, Public Affairs