A You’re right that high blood pressure is a key risk factor for dementia as well as many other health problems. The connection between high LDL (“bad”) cholesterol and dementia is less clear. Research exploring the impact high cholesterol might have on dementia risk has been going on for many years and continues today. A review of several studies, published last year in the journal Current Aging Science, found that using cholesterol levels to predict cognitive decline is not reliable. However, because high cholesterol is a major risk factor for cardiovascular disease, which is in turn a risk factor for dementia, it can be assumed that controlling your cholesterol would be helpful in maintaining optimal health in the brain and the rest of your body.

Interestingly, despite concerns about statins affecting memory and clear thinking in the short term, the cholesterol-lowering drugs may actually provide protection against cognitive decline. A meta-analysis of 11 studies involving about 23,000 people found that individuals taking statins had a 29 percent reduced risk of developing dementia later in life.

Q The more I read about attention-deficit/hyperactivity disorder (ADHD), the more I feel I may have had this condition for a long time. Should I get tested or is ADHD something that affects only children?

A ADHD is typically associated with younger people, but studies suggest that one out of 20 adults has the condition. The hyperactivity and impulsiveness exhibited in many children with ADHD often diminishes over time, while trouble with attention, organization, and memory can linger into adulthood.

Because certain symptoms of ADHD mimic some of those associated with cognitive decline, ADHD is sometimes harder to be diagnosed in older adults. However, if you have always had trouble concentrating and staying focused, making decisions, and managing your time, ADHD may be the reason. Diagnosing ADHD in adults usually involves a physical exam to rule out other possible symptom causes and a review of your medical history and that of your family. The review will include a history of your symptoms, so before you meet with a doctor be sure you are able to describe your symptoms in some detail, including how long you have experienced them. There are also several types of psychological tests that rate your attention and other thinking skills.

Medication may be helpful, but you may also be able to learn various strategies to help you overcome your specific challenges. Mindfulness cognitive therapy may also improve your ability to cope with ADHD.

Q Like a lot of people, I became more anxious during the COVID-19 pandemic. My husband and I both received our vaccinations a couple of months ago, but I’m still feeling a lot of anxiety. Could this be a permanent change?

A Because the world has spent more than a year dealing with COVID-19 and its health, economic, and social consequences, it’s likely going to take a long time for people to feel comfortable again. The longer you deal with any trauma, the longer you can expect the recovery to take. In addition, there are still many lingering questions about the disease and how we will deal with it in the months and years ahead.

Give yourself time to adjust, but don’t ignore your feelings. Developing strategies to cope with your anxiety, whether it’s through meditation or other healthy activities, can make a big difference. Don’t hesitate to seek out counseling. Talking with a therapist about your anxiety may be the first step toward finding some peace and a perspective to get you through this or any other challenges ahead.

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Regardless of the reasons, the evidence that chronic short sleep contributes to brain health problems down the road is becoming clearer. In a recent study published in the journal Aging, researchers found that older adults who sleep less than five hours a night have double the risk of dementia compared with their peers who sleep at least seven to eight hours nightly.

“Our findings illuminate a connection between sleep sufficiency and risk of dementia and confirm the importance of efforts to help older individuals obtain sufficient sleep each night,” says lead author Rebecca Robbins, PhD, an instructor at Harvard Medical School and a researcher with the Division of Sleep and Circadian Disorders at Brigham and Women’s Hospital.

Sleep Quality and Quantity

In the study, 2,610 participants in the National Health and Aging Trends Study filled out sleep questionnaires in 2013 and 2014. Questions covered topics including sleep disturbance and deficiency, nap frequency, sleep quality (rated on a scale from very poor to very good), sleep duration, and snoring. The researchers collected information about outcomes including dementia and death from any cause during the five years following the survey. At the start of the study, the average age of the participants was 76.

Overall, the study revealed a strong connection between several sleep disturbances, sleep deficiency variables, and dementia. For example, taking 30 minutes or longer to fall asleep was associated with a 45 percent greater risk for incident dementia. Frequent problems maintaining alertness during the day, routinely napping, reporting poor sleep quality, and sleeping five or fewer hours per night was also associated with increased risk of death.

Researchers suggest that further study of the relationship between sleep and dementia is necessary to develop interventions to help older adults achieve the quality sleep they need.

Takeaway

Just as the reasons for poor sleep vary from one person to the next, so too do the solutions for an individual’s sleep challenges. And because insufficient sleep isn’t something revealed in your annual physical or routine blood work, it’s up to you to tell your physician about any sleep troubles you have. It doesn’t mean you’ll automatically be prescribed sleeping pills, but it could be the start of a journey toward better sleep. Lifestyle changes involving diet, exercise and your bedtime routine may be enough to help. If not, seeing a sleep specialist may help diagnose your challenges and devise strategies that will help you sleep better.

It’s also important not to try to convince yourself that you can get by just fine on a few hours of sleep every night. Very few people can thrive on limited sleep. Daytime sleepiness isn’t a normal part of aging, and it may be a condition that can be fixed if you’re willing to invest the time and effort.

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Think about family birthdays you know off the top of your head or stories you’ve repeated through the years. One of the ways you can recall this information so easily is because you retrieve it from your memory time and time again. Numerous studies in recent years have found that simply retrieving information multiple times helps you learn it and have it ready for recall when necessary. With new information, however, the key is to space out those retrievals. In a study of college students several years ago, participants were given a vocabulary list of foreign words and their definitions. In one testing format, the students were quizzed on the list after seeing the words and their meanings one time only. In another condition, the students were asked to provide definitions three times in a row. This is known as “massed retrieval practice,” and it’s not unlike repeating the name of someone you just met several times in hopes of remembering it in the future. The third testing condition also tasked students with remembering the definitions three times, but the retrievals were spaced out so that some time passed in between each question. The results showed that retrieving the newly learned words and definitions one time didn’t produce great results. Retrieving them in quick succession didn’t improve scores much. But when having to retrieve newly learned information repeatedly over a longer period of time, the study participants performed much better. In your own life, you can practice recalling any piece of information you hope to hold onto for a long time. Just make sure you retrieve it often, but with time in between each retrieval.

Avoid Depressive Thoughts to Help Protect Your Memory

Negative or depressive thoughts may do much more than lower your mood and zap your motivation and energy. A growing body of research in recent years points to the conclusion that depressive thinking is associated with declines in memory performance, especially in people with a depressed mood or who are unhappy due to worry, stress, grief, or a similar mental state. Studies suggest that ruminating over unhappy experiences, missed opportunities, sad news or other factors may interfere with the brain’s ability to focus and remember. The same is true if negative thought-loops are making it difficult for an individual to concentrate. Avoiding negative thoughts can certainly be a challenge, but researchers suggest that some of the following strategies may help: Identify your negative thoughts, especially ones that may be unrealistic or beyond your control, and try to replace them with more realistic and helpful thinking. Whenever possible, focus on the positives in your life, or seek out music, movies, friends and other things that make you feel better and take your mind off of saddening or depressive subjects. Keep a daily journal that includes at least one topic that makes you smile—a fond memory, good news in your life or the life of a loved one, or everyday wonders like a pretty sunset or birds singing by your window. Exercise every day if possible, and try to get at least seven hours of sleep each night. Seek the counsel of a mental health professional if your depressive thoughts and low mood linger for more than two weeks and are interfering with your daily functioning.

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It starts with a little detective work. “The first option is figuring out what’s causing your insomnia,” says John Winkelman, MD, PhD, chief of the Sleep Disorders Clinical Research Program at Massachusetts General Hospital. “Is it restless legs syndrome, chronic pain, shortness of breath, depression, or some other condition?”

Effective treatment of an underlying condition, if present, may make sleep easier to come by. If an associated condition cannot be identified, cognitive behavioral therapy for insomnia (CBT-I) is first-line therapy and can assist individuals in overcoming obstacles to better sleep. CBT-I helps people identify the thoughts, feelings, and behaviors that may cause or perpetuate their insomnia. CBT-I therapists are in short supply, but digital or remote CBT-I has also been shown to be effective. If these approaches don’t work, then medications may be an option, Dr. Winkelman says.

“Sleeping pills are the last option for people with chronic insomnia,” he explains. However, for acute insomnia, with occasional episodes triggered by periods of mental distress or physical discomfort associated with an illness or injury, sleeping pills may the first option.

Considering Sleep Medications?

Like any medications, sleep aids come with their own sets of benefits and risks. Problems with memory impairment and gait stability are common among older individuals using sleep medications.

“When you’re taking the medication, your memory is not as good, it’s harder to exercise good judgment, and you may be more likely to trip if you get up in the middle of the night,” he says, adding that the side effects are present while the medications are in your system but subside as the drug wears off.

Consolidating a memory of what you do in the hours after taking a sleep aid, such as a conversation you have before falling asleep, may not occur. However, Dr. Winkelman notes, the use of sleeping aids may be associated with improved overnight consolidation of earlier memories—a result of allowing the brain to function as it is supposed to when you’re asleep. Memory consolidation and the clearing out of toxins from brain tissue are two critical activities that occur when sleeping.

Types of Sleep Medications

There are several kinds of medications that treat insomnia, though not all of them are approved for that use by the Food and Drug Administration (FDA). As a result, doctors prescribe them “off label.” It’s a legal and widely used practice that simply means a doctor prescribes a medication approved for one condition to treat a different condition.

One of the most commonly used sleep aids these days is trazodone, which the FDA originally approved to treat depression. Though it is seldom prescribed for that purpose these days, its sedating effects make it an effective insomnia fighter. Trazodone is in a class of medications called serotonin modulators. Serotonin is a neurotransmitter that helps regulate mood, but is also involved with sleep, digestion and other bodily functions. Other types of antidepressants, including tricyclic antidepressants (TCAs), are also prescribed for insomnia (and one of them, doxepin, is FDA-approved for insomnia).

Another widely used class of drugs used to treat insomnia are benzodiazepine receptor agonists (BZRAs). These medications work by increasing the brain’s sensitivity to gamma-aminobutyric acid (GABA), the primary inhibitory neurotransmitter in the brain.

Some BZRAs are also effective for anxiety and other conditions, including alprazolam (Xanax) and diazepam (Valium). Other BZRAs, known as “Z-drugs” because of their names—zolpidem (Ambien), zaleplon (Sonata), and eszopiclone (Lunesta)—also are effective for insomnia and are generally shorter-acting than the benzodiazepines.

Despite well-publicized concerns that BZRA use raises the risk of Alzheimer’s disease, the scientific evidence for such a connection is weak, Dr. Winkelman says. An analysis by Harvard psychopharmacologist Carl Salzman, MD, published recently in the American Journal of Psychiatry, suggests that not only does appropriate BZRA use not lead to the development of Alzheimer’s disease, but that by helping to ensure sufficient sleep, the medications may actually reduce the effects of stress on older adults and therefore help protect against the disease.

Other types of prescription sleep medications include orexin receptor antagonists and melatonin receptor agonists. Over-the-counter (OTC) medications that are primarily antihistamines are also widely used, particularly for acute episodes of insomnia. They include diphenhydramine (Benadryl, Aleve PM) and doxylamine succinate (Unisom).

Dr. Winkelman cautions against assuming that OTC sleep aids are automatically safer because they don’t require a prescription. “They may have some efficacy, but the effects are short lived,” he says. “Plus, they have their own side effects, including dry mouth, constipation and memory disturbance. Some studies suggest they may actually increase the risk of dementia.”

Medication Management

Determining whether you are a good candidate for sleep aids involves an assessment of your medical history and current health, as well as a review of all the medications and supplements you currently take. The most serious potential drug interactions involve sleep aids and other medications that have sedating effects.

“The decision to prescribe medication for insomnia is individualized for each person,” Dr. Winkelman says. “How bad is their gait? Do they already have memory problems? On the other side, how much distress is their insomnia causing them or their family?”

Physicians generally try to start patients out on a low dose of a medication they think will be well tolerated and effective. But because there are so many available medications, your doctor may be able to try a few different sleep aids before you both find the right drug and the right dose to get the outcome you want. If possible, medication use should be limited and CBT-I and other sleep-enhancing behaviors explored.

 Dr. Winkelman adds that many people use sleep medications for years, getting welcome sleep each night and without any serious side effects.

It’s up to you, however, to bring your sleep concerns to the attention of your doctor. You may be referred to a sleep specialist or advised to try nonpharmacological strategies first to combat insomnia. 

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Recognizing the early symptoms of DLB and getting appropriate treatment can help preserve a person’s relative quality of life and prevent complications from treatment better suited to other illnesses.

“DLB has been historically underdiagnosed in part because many primary doctors have not been trained to detect the clinical constellation that arises in DLB,” says Stephen Gomperts, MD, PhD, director of the Lewy Body Dementia Unit at Massachusetts General Hospital. “Instead, patients with dementia have often been lumped together, earlier as ‘hardening of the arteries’, etc., and these days as ‘Alzheimer’s.’ Getting the diagnosis correct is important, however, as it provides an opportunity to optimizing patients’ function and to reduce the risk of exposure to dangerous medications.”

What Is DLB?

Dementia with Lewy bodies is actually one of two types of Lewy body dementia. The other is Parkinson’s disease dementia (PDD). DLB and PDD symptoms often differ at first, but the two conditions develop from the same biological changes in the brain.

Lewy bodies are abnormal protein deposits discovered by German neurologist Friederich Lewy in 1912. He identified the deposits as the cause of brain function impairment in people with Parkinson’s disease. Lewy bodies also can be present in people who don’t have Parkinson’s disease. In Lewy body dementia, a protein called alpha-synuclein forms clumps within neurons. The cells usually affected at first are those involved with memory and movement. Certain brain chemicals are also affected by Lewy body accumulation.

Signs of DLB

Dr. Gomperts explains that thinkingskills changes triggered by DLB can affect any or all of these three cognitive functions: executive function, short-term memory, and visuospatial function. Early AD symptoms, by contrast, are usually isolated to the domain of short-term memory, Dr. Gomperts says. “Fluctuations in attention or level of alertness are often, but not always, present,” he adds.

Changes in motor functions may also occur and are characterized by signs of Parkinsonism—a slowing of muscle movement, walking changes, and a tremor.

Another distinct characteristic of DLB is the development of hallucinations relatively early in the course of the disease. “The hallucinations are usually animated, such as adults, children, or animals,” Dr. Gomperts explains. “Some patients develop delusions. Anxiety and depression are common, but not unique to DLB.”

People with DLB often develop REM sleep behavioral disorder, in which they act out their dreams during REM sleep.

Diagnosis and Treatment

If you or a loved one exhibit symptoms of dementia with Lewy bodies, it’s best to see a dementia or movement disorder specialist. These types of doctors are usually well trained to make an accurate diagnosis, Dr. Gomperts says. He adds that the clinical diagnostic criteria simply require the presence of dementia and at least two non-cognitive features, such as impaired motor skills, psychiatric symptoms, or a sleep disorder.

A diagnosis may also be made if there is dementia, one non-cognitive symptom and one biomarker test, such as a DaTscan (an imaging test that measures the integrity of the dopamine system), or a sleep study showing evidence of REM sleep without atonia.

There is currently no cure for DLB. Treatment usually consists of medications to control symptoms and physical therapy to help maintain motor function and muscle strength. If Parkinsonism symptoms such as muscle freezing and tremor are present, the doctor may prescribe carbidopa/levodopa, a medication that helps control movement. Hallucinations and delusions may be treated with behavioral redirection and reassurance, but in some cases medications are appropriate.

Takeaway

Research is going on around the world to find ways to prevent or reverse DLB. While the task is daunting, there is reason for hope, as some medications being tested are showing promising results in clinical trials.

 “There are growing number of treatments in the pipeline for DLB and PDD,” Dr. Gomperts says. “The closest to FDA approval is probably pimavanserin, a medication that has been approved for management of psychosis in PDD. Some evidence suggests that it also works in DLB, and there is a good chance that it will be available relatively soon for this purpose.”

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Caffeine can help most people feel more alert, but it can also disrupt sleep, according to a study published recently in the journal Cerebral Cortex. Poor sleep, many studies have shown, may affect gray matter of the brain. With that in mind, researchers set out to explore whether caffeine intake may affect brain structure by reducing quality sleep. Interestingly, the researchers found that caffeine consumed as part of the study did not interfere with sleep quality or quantity, but gray matter changes were still observed in a group of study participants who consumed caffeine tablets every day for the two 10-day periods of the study. The group of volunteers who did not consume any caffeine during the study had greater gray matter volume than those who took the caffeine pills. The gray matter portion of the brain affected by the caffeine included the hippocampus, a key region of the brain responsible for memory consolidation. After 10 days of no caffeine, the gray matter regenerated in the caffeine group, and no cognitive problems were reported. But researchers suggest that daily use of caffeine over a long period of time is worthy of greater study to determine whether any caffeine-triggered brain changes may have longer-lasting impacts.

Robotic Dogs, Laughter Therapy May Help Older Adults Cope with Loneliness

The emotional and psychological effects of social isolation and loneliness have received considerable attention throughout the COVID-19 pandemic. But isolation was and will continue to be a health risk for many people, especially older adults living alone. To help address this concern, researchers from the United Kingdom analyzed 58 relevant studies of interventions aimed at reducing social isolation and tackling feelings of loneliness. Two studies found that robotic dogs could be as effective as real dogs in reducing loneliness, and they may be more feasible in living situations not conducive to the care and boarding of live pets. A study of robotic baby seals that respond to certain stimuli also found that they helped curb feelings of loneliness. Laughter therapy, which includes laughter exercises, games, songs, deep breathing exercises, and laughter meditation, also helped reduce loneliness. Mindfulness training and tai chi were other interventions that proved effective. Other interventions that led to positive results included gardening (both indoors and outdoors), video games (such as Wii Sports), as well as video chats and video conferences. The analysis was reported in the journal PLOS One. Researchers said they hoped that their findings can help local and national policy makers develop programs to reach out to seniors and equip them with a variety of tools to combat isolation.

More Exercise May Reduce Migraine Headache Triggers

More than two-thirds of people who experience migraine headaches do not get enough exercise, according to a study presented recently at the American Academy of Neurology’s annual meeting. The study found that people who get at least 2½ hours of moderate to vigorous exercise per week had a reduced rate of common migraine triggers, such as depression, stress, and sleep problems. Researchers noted that exercise releases endorphins, which are natural painkillers that also help people lower their stress levels and get better sleep. Migraine sufferers who get little exercise may not be reaping the benefits of a brisk walk, bicycle ride, or game of tennis. The study involved about 4,600 people diagnosed with migraine. About three-fourths of them had chronic migraine, meaning at least 15 migraine headaches a month. The others had episodic migraine, or fewer than 15 each month. Just 27 percent of the people in the study exercised at least 2½ hours weekly. About a quarter of them reported symptoms of depression, while 47 percent of the people who did little or no exercise regularly had depression. Rates of anxiety and poor sleep were also significantly higher in the “no exercise” group of participants compared with those who exercised the most. The frequency of migraines was, on average, much lower among the individuals who exercised regularly. Migraine can be extremely challenging to treat, so it is promising that a simple, inexpensive activity such as exercise may be an effective intervention to reduce both the triggers for migraine headaches and the number of such events.

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You may have noticed that in a loud and crowded restaurant, you’re more easily distracted. When you go online to shop, read the news, or catch up with family and friends on social media, pop-up ads and other visual stimuli easily steal your attention. These scenarios describe challenges to selective attention—the ability to tune out distractions to focus on a particular object or task. Conversely, divided attention is the ability to handle several tasks or subjects at once. It’s more commonly referred to as “multitasking,” and it, too, often suffers with age.

However, another aspect of attention—sustained attention, or the ability to concentrate on one thing in the absence of distractions—tends to remain unchanged over time. So if you can dive into a book or hobby when your home is quiet and linger there for hours, it’s because your sustained attention is still strong.

“Research shows that some aspects of attention may change as we age,” says neuropsychologist Clara Vila-Castelar, PhD, with the Massachusetts General Hospital Multicultural Assessment and Research Center (MARC). “For example, older individuals may be less efficient when searching visually, ignoring distractors, processing information rapidly, or quickly responding, while other aspects of attention tend to remain largely stable as we age.”

What Causes Attention Changes?

There is no shortage of explanations for age-related attention changes. It could be something as serious as mild cognitive impairment or the early stages of dementia. Or, you may have struggled with attention-deficit/hyperactivity disorder (ADHD) for most of your life, but it’s only now, in retirement and without the structure of work and family responsibilities to keep you focused, that symptoms of ADHD intensify.

For most older adults, however, greater difficulty with concentration isn’t a symptom of an underlying condition. Instead, it may have more to do with lifestyle or an age-related, but fairly benign change in brain function. Research published in 2018 pinpointed the region of the brain that may be at the root of attention impairment in some people. A part of the brain called the locus coeruleus helps the brain focus during stressful or emotional moments. The researchers found that the locus coeruleus’s ability to focus the brain’s attention may weaken with age. Impaired attention is made worse by the presence of distractions or emotional pressure.

But for people of any age, distractions of all kinds can interfere with the ability to concentrate. Responses to potential distractions are also individualized. For example, you may be able to focus better on certain tasks with music playing, while others may find the melody or lyrics too much to ignore. Many people dealing with chronic pain may have an especially difficult time paying attention to something else, while others may be able to zero in on a task that actually distracts them from the pain. Your physical, emotional, and psychological health have a lot to do with how well or how poorly you can maintain focus.

“Attention skills can be particularly vulnerable to internal and external distractors,” says neuropsychologist Paula Aduen, PhD, assistant director of MARC. “For example, most individuals find it harder to concentrate in a crowded or loud environment. Similarly, changes in mood, symptoms of anxiety, such as excessive worries and restlessness, along with pain, fatigue, or suboptimal sleep, among other factors, can interfere with attention function and overall cognitive efficiency.”

Tune Out the Distractions

Reducing the distractors that are especially troublesome is certainly a worthy goal. This is sometimes easier with external distractors. You can turn off the notifications on your smartphone and avoid crowded environments when you want to have a meaningful conversation with someone. Think about other ways you can turn down the volume, so to speak, on the external stimuli that make you lose your place when trying to complete a task.

Internal distractors are often more difficult to tune out. Whether you’re facing physical discomfort, worrisome thoughts, or emotional challenges, you may have a hard time concentrating on other matters. “If the problem is that our minds are not always focused enough on the task at hand, then it follows that strategies related to monitoring and raising awareness of absentmindedness will help bring our minds back to the present,” says neuropsychologist Yakeel T. Quiroz PhD, director of MARC at Massachusetts General Hospital. “An important first step is recognizing when you have been absentminded and tracking the frequency and circumstances surrounding these attention lapses. What kept you from being fully aware and present in what you were doing as you were doing it? Troubleshooting these moments of distractibility can often hold the key to decreasing the probability of an attention lapse in the future.”

Dr. Quiroz suggests thinking about your environment during especially distracted times—was it too noisy, crowded, or uncomfortable for any other reason? If you find yourself especially distracted while multitasking, what could you have done differently? Could you have put off a particular task? And when you experience a lack of focus, could stress, fatigue, or another factor be a distractor interfering with your plans?

“In these examples, helpful strategies would include decreasing environmental distractors, engaging in one task at a time before initiating another, working toward a goal in small chunks of time so to not become overwhelmed or overly fatigued, and prioritizing more complex, focus-intensive tasks for times during the day when you are feeling most alert and refreshed,” Dr. Quiroz adds. “In addition to monitoring and noticing when your mind wanders, mindful breathing exercises can be beneficial to focus your attention and ground to the present. These exercises can be brief and are easily accessed through smartphone applications or freely available online resources.”

Fortifying Your Focus

Other strategies to help improve attention and organization include the following:

• Structure activities to be engaged in one at a time to completion, with minimal requirements for switching or abrupt changes.

“This may involve making lists of activities and tasks to be completed one at a time, and using checklists to document when each task has been completed before moving on to the next,” Dr. Vila-Castelar says.

• Use organizational strategies, such as lists, written instructions, and calendars that minimize the need to remember and mentally organize large amounts of information.
• In conversation, repeat key bits of information back to the speaker.
• Schedule brief rest periods to self-monitor in between short periods of work or activity to avoid feeling overwhelmed or fatigued.
• Minimize distracting environmental stimuli, such as noises. “A quiet environment will help increase focus for remembering information,” Dr. Vila-Castelar adds.

Takeaway

Feeling distracted and scattered once in a while is normal. Everyone has moments when their thoughts are not on the task at hand or they find themselves distracted by their environment. But it’s important to understand that paying attention is the first step in making a memory. You have to focus on new information in order to encode it for storage and retrieval. Often memory lapses are the result of not learning the information in the first place. However, we tend to think we are paying closer attention than we really are in many situations.

Cognitive training and other interventions have been shown to improve attention skills. In contrast, significant and/or debilitating changes in attention may be a sign of cognitive decline and warrant follow-up, Dr. Aduen says.

“Attention and memory are two of the cognitive functions most affected by age,” she explains. “However, these functions do not change uniformly for everybody. Evidence suggests that some aspects of attention and memory hold up very well with age, while others may show declines. Healthy lifestyle behaviors should be encouraged for preventative purposes and for optimizing attention and future brain health, including eating a healthy and balanced diet, getting enough sleep, and regular physical activity.”

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A: There is a common misconception that traumatic memories, such as childhood abuse, are likely to be repressed—locked away somewhere an individual’s subconscious. It’s viewed as a means of survival in that the painful memory won’t get in the way of a person’s mental health and emotional development. However, research shows that most child abuse victims and other survivors of trauma actually remember those events very clearly.

Most mental health experts, including a consensus of the American Psychological Association, say that people who were abused as children or who endure other painful and traumatic situations usually remember all or part of what happened to them. But because they may not be able to understand or explain what happened, or because discussing the events is emotionally wrenching, these individuals often choose not to share those memories.

Q: Does depression usually stem from a specific cause or can someone become depressed for no apparent reason?

A: In many cases, depression can be connected to an experience such as the loss of a loved one or the onset of a chronic disease. At the same time, depression often has no obvious trigger. But it’s important to understand that there is always a “cause” for depression. Looking for a “reason” why a person might be depressed isn’t always helpful. In fact, when people can’t think of reasons that justify their feelings, they may be less likely to seek treatment or talk about what they’re going through. It’s not uncommon for an individual who has friends, a loving family, a good job, good health, and other markers of a happy and successful life to try to mask feelings of sadness and hopelessness.

The truth is that depression often develops due to a combination of causes. You may be genetically predisposed to the condition. There may be environmental factors or other contributors beyond your control. Though we are still learning much about the brain chemistry involved with depression, there are some established facts. An imbalance of certain chemicals called neurotransmitters can contribute to depression. No one is immune.

Q: My wife is in the early stages of Alzheimer’s disease and sometimes shows signs of agitation in the evenings. Her doctor called it “sundowning.” Is this common and can it be prevented?

A: Sundowning is very common in people with Alzheimer’s disease. It’s marked, as you say, by behavioral changes including agitation, increased confusion, impatience, and anxiety that begin in the late afternoon or evening. These changes, which can be troubling to loved ones, may be the result of fatigue at the end of the day or changes in a person’s circadian rhythms. Lower light levels later in the day may contribute to feelings of confusion and anxiety. We still don’t know exactly what causes sundowning, but there are some ways to address it.

Check for signs of physical discomfort. Are her bed and wheelchair comfortable? Is she getting up and moving during the day? Is she getting enough fluids during the day to keep her hydrated? You may also want to review her medications with her doctor. Could the dose or timing of certain medications be adjusted to see if that makes a difference? Other approaches may be helpful. Reducing bright lights and other stimuli may help. That may require fewer visitors at one time or changing her schedule so that stimulating activities, such as bathing or doctor visits, don’t occur late in the day.

Caring for a spouse with Alzheimer’s is a challenge. As much as possible try to be reassuring and patient during the difficult times.

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Fortunately, for many people, effective treatment can often turn things around and clear up the confusion, memory lapses, and other side effects, says neurologist Jonathan Rosand, MD, co-director of the Henry and Allison McCance Center for Brain Health at Massachusetts General Hospital.

The following is a partial list of health conditions that can trigger cognitive impairment, particularly in older adults. There are many others.

Vitamin B₁₂ Deficiency

The body’s healthy production of red blood cells, nerves, and DNA rely on optimal levels of vitamin B₁₂. The essential nutrient is also critical in avoiding megaloblastic anemia, which can make a person weak and tired. Vitamin B₁₂ can be found in meat, poultry, and dairy products but not in plants. That means vegans are at a higher risk for B₁₂ deficiency. And because healthy levels of stomach acid are needed for the absorption of B₁₂, older adults (who tend to make less stomach acid over time) or people with certain digestive conditions are also at an elevated risk.

If you don’t get adequate amounts of vitamin B₁₂ in your diet, you may need B₁₂ supplements, either taken orally or by injection if levels are especially low.  “I’ve seen people make remarkable recoveries with vitamin B₁₂ treatment,” Dr. Rosand says.

Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a condition in which tissue in the back of the throat relaxes while you’re sleeping and blocks your airway so there are pauses in your breathing. These pauses (or apneas) can occur dozens or hundreds of times each night, leading to complications such as hypertension, atherosclerosis, and other serious concerns. OSA can also lead to fatigue and cognitive problems, as it interferes with the steady flow of oxygenated blood to the brain.

Treatment options include special devices worn in the mouth to keep your airway open and continuous positive airway pressure (CPAP) therapy.

Thyroid Disease

The thyroid gland plays a key role in metabolism, and the steady supply of thyroid hormones helps maintain healthy function of the brain, heart, muscles, and more. But an overactive (hyperthyroidism) or underactive (hypothyroidism) thyroid gland can cause problems throughout the body.

“If you’re suffering frequent episodes of cognitive impairment, we would check your TSH (thyroid stimulating hormone—a marker of thyroid gland function) levels,” Dr. Rosand says. “I’ve picked up thyroid disease that way.” He adds, however, that by the time your thyroid disease is causing memory problems, it’s already manifested in other ways.

Hyperthyroidism is usually treated with anti-thyroid medications, to reduce thyroid hormone production. Radioactive iodine is used sometimes to injure thyroid gland cells so they won’t overproduce hormones. Surgery to remove the thyroid may be necessary in some cases, but you’ll need to take thyroid replacement hormones for the rest of your life. Hypothyroidism is usually treated with thyroid replacement medications.

Takeaway

Two other conditions linked to cognitive impairment include hydrocephalus—a buildup of cerebrospinal fluid in the brain—and diabetes—elevated levels of glucose in the bloodstream.

 While disease-triggered cognitive impairment is common, there are also many other causes of thinking-skills changes. Certain medications, poor sleep, alcohol or drug abuse, mental health disorders, and many other factors all can play a role.

And of course, moments of forgetfulness or confusion may be early signals of mild cognitive impairment or Alzheimer’s disease or other causes of dementia.

Because you don’t always know up front what’s causing your thinking skills-changes, don’t hesitate to talk with your primary care physician to start finding some answers.

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