The Book - Introduction
Many years ago, during my medical internship, the attending physician on the neurology service shared his advice to me in words I’ll never forget: “Ken, I’m going to tell you the only three words you’ll need to know in order to practice neurology.” I waited, holding my breath. Somehow, I knew these words would return to haunt me.
“I’m . . . so . . . sorry,” he concluded, with no hint of a smile.
Over forty years later, his words still echoing, I found myself wondering, Where can I turn for the information I need—and the optimism I desperately crave—for my own battles with memory and aging?
Well, what about Google? As I began searching for “dementia/memory books,” 17 million results popped up. Amazon.com lists over ninety thousand books with “memory” in the title. As I perused the first few candidates on the list, I saw that most offered memory-improvement strategies aimed at students wanting to strengthen their classroom recall. Also under that umbrella were forgetful people of all ages trying to keep track of their to-do lists.
I was stunned to learn that there were currently over than ten thousand books on Alzheimer’s disease. What about the National Library of Medicine? When queried in January 2023, the National Library of Medicine had cataloged 65,294 scientific papers with Alzheimer’s disease in the title. Clearly, aging has become a huge area for investigation encompassing both potential certainties: the “now” and “the forever.” Most adults are at least aware of what science and medicine advise to help them optimize their general and mental health (diet, regular medical and preventive care, exercise, moderation, social supports, etc.).
However, when seeking answers for failing memory and cognition, we have few readily available sources of unbiased information. 4 Instead, we are showered with opinions, hopeful predictions, statistics, pseudoscience, celebrity testimonials, and infomercials from sources both well meaning and of dubious value. With no agenda other than finding answers for myself and my family, I reviewed more than 1,200 scientific papers over nearly three years. The result is this book—a sometimes surprising, (usually) unbiased, fully referenced, and verifiable summary of the current knowledge of memory loss, cognitive aging, and dementia.
On the following pages, I will share evidence-based strategies to help you evaluate your situation and discover which solutions are available to you. Let’s be honest: we all suffer from the same terminal condition—life—and there are large numbers of us who can benefit from the latest information about our aging brains. As I’ve learned, both as a doctor and as a private human being, knowledge is the power from which wise decisions will flow.
Why Me, as the Author of This Book?
Consider the value of an author who has dedicated years to research, analyze, and then share life-changing information about a health concern of compelling interest to both himself and his readers. Most of us have no one with whom to share our intensely personal experiences of memory loss or confusion. Yet, we all have someone we have known whose path to cognitive decline we would very much like to avoid.
I offer myself, my journey, and (informed) personal observations to fill that gap. I couldn’t be more interested in this topic: now in my seventies, I find myself regularly misplacing my glasses, searching (sometimes endlessly) for a name, and deeply affected by the presence of Alzheimer’s disease in persons close to me.
After years of information gathering and analysis, I firmly believe that I have consolidated on these pages what we all need to know about the science of aging, memory loss, and cognitive decline. My goal is to open my readers’ eyes the same way I have opened mine.
The answers that matter to me, matter to you. Can we relax and slide into our “golden years,” or is it time to get our affairs in order? This book examines failing memory as both a natural aging process and a possible early symptom of a devastating disease. While full-blown dementia is often apparent, there are few reliable discussions about memory fluctuations and thoughts that develop as we move from the pathway of “normal” aging to a possible berth on the “memory care” Titanic, conveniently docked next to a nursing home.
My research process is nearly always the same: When looking for an answer to a medical question, I search long and hard for the relevant literature, read it, analyze, and synthesize what I read, and then record it in terms that I hope others will understand. For more than thirty-six years as an emergency physician, I have used the same approach to solve my individual patients’ problems. I also explore, research, and publish descriptions of tested, successful therapeutic techniques, many of which my colleagues were unaware.
It won’t come as a surprise when I say that the information that is readily available to the general public is—at its best—”informed opinion.” Its sources are science-focused journalists attuned to press releases and other “breaking news” from the pharmaceutical industry and medical blogs. Other sources include local or national physician “experts” offering a breathless couple of minutes on the evening news.
At its worst, the information available is based on wishful thinking, hucksterism, or fraud. In contrast, the underlying science I rely on is not hidden, although many of my references are restricted to paid subscribers, or in unfamiliar online government libraries. (See my instructions for accessing those papers for free in Appendix II.) Consider this book my gift: access to data most people will not see until, possibly, it’s too late.6
We 70 million baby boomers have been lumped together as a statistical body throughout our entire lives. It is to these sisters and brothers that I dedicate the results of my research. As we embark on life in the later years, fellow boomers, take a deep breath. Whatever lies ahead, we can gain strength from the words We’re all in this together.
Why This Book, Now?
Although there are reams of books on keeping—or losing— your mental agility, there are no up-to-date single resources available to anyone planning to live beyond age sixty-four (the medical profession’s definition of “elderly”). Like most people my age, I have friends and family members facing cognitive decline, plus my own “senior moments” to worry about. Being a doctor doesn’t counter the dark visions of future debility that come whenever I forget a name, misplace my keys, or find myself standing in a room wondering, “Why am I here?”
Some books are a labor of love. This one is a labor of personal urgency, alternatively titled Beat the Clock —with me and my readers as the “intended audience.” Ironically, information about memory decline continues to advance rapidly thanks to innovations across the full range of the biomedical sciences. A more urgent factor is the worldwide prevalence of dementia, with one new case occurring every three seconds. In fact, new information emerges so briskly that clinicians and researchers can barely keep up with it!
As I pursued my research, I learned that the most recent studies of Alzheimer’s disease (AD) and its precursors were published between 2015 and 2019. These reviews all described three distinct phases of cognitive decline culminating in Alzheimer’s dementia: (1) the undetectable preclinical stage, (2) mild cognitive impairment, and (3) Alzheimer’s disease. In fact, the information you read in this book today is the most cutting-edge news that even your doctor may not have reviewed! Within the next five or more years, the next batch of the last decade’s offerings will trickle into print.
In matters of mind and memory, it’s always best to have the latest data. Thus, this book is for all of us awaiting the next act in the continuing saga of aging and memory retention.
The most interesting data I found was new information on “subjective cognitive decline” (SCD), in chapter 2. This is now considered the earliest clinically identifiable set of symptoms with a risk for progression to dementia. SCD is the self-reported experience of worsening or more frequent episodes of confusion or memory loss.
When we are aware of SCD, we can benefit from earlier studies of at-risk individuals and the possibility of intervening—in some cases—before measurable decline. Right now, the specter of Alzheimer’s disease is just one more thing we aging boomers fret over. We are the “target demographic” for this possible burden, haunting those of us who live long enough.
Happily, this book offers a counter-narrative to the constant barrage of testimonials promoting “breakthrough” brain pills and dietary supplements. It also challenges the grim themes of TV dramas and movies that cause our children and grandchildren to view us as if we will soon be parented—by them!
“Knowledge is the antidote to fear,” the wise Ralph Waldo Emerson proclaimed. It’s a strength we can acquire even when other resources seem years down the road. The more current your information, the better decisions you can make. After reading this book you may have even more data than your doctor possesses about early cognitive decline!
Join me on my path to a solid understanding of the questions we seniors confront, the choices we have, and the knowledge we can safely infer from the science. Along the way, we will address the much larger and louder body of unsupported good and bad “news” vying for our attention, our hopes, and our money. Together we will explore “normal” aging of our brains, the differences between failing memory and dwindling understanding, and emerging insights into the significance of our subjective cognitive concerns. What I share from my exhaustive review of over five hundred scientific references clarifies the biological bases, associated behavioral changes, and natural history of many seniors’ number one fear, Alzheimer’s dementia. Topics will include risk factors for developing or progressing along the stages of cognitive decline, alternative diagnoses, the various tests and their advantages and disadvantages, plus available treatments (both longstanding and novel) and their potential for benefit. Realistic projections and practical coping suggestions for patients and families are offered.
When all is said and done, whatever the situation facing us today or tomorrow, there’s one resource of strength and comfort available to us all:
The Serenity Prayer
“God, grant me the serenity to accept the things I cannot change,
courage to change the things I can, and the wisdom to know the difference.”
This book brings you knowledge.
The wisdom is up to you!