Baby Boomers' Guide to Daily Money Management for Aging Parents

Reprinted with permission from the American Association of Daily Money Managers (AADMM). Copyright 2012. For more information about AADMM visit www.aadmm.com.

The Challenge – Caring For Your Aging Parents

Caring for an aging loved one is an emotional and stressful situation. Many baby boomers – anyone born between 1946 and 19641 – struggle to manage the needs of their own children and grandchildren, while assisting their aging parents. Also referred to as the sandwich generation, approximately 77.3 million Americans comprise the baby boomer population.

Trying to balance all the caregiving responsibilities of your family is a daunting task and can greatly
impact your own quality of life. Managing the financial affairs of an aging parent is a major component in the caregiving process. Today, many baby boomers are alleviating this financial stress through daily money management services.

What does a daily money manager do?

A daily money manager (DMM) brings clarity and order to an individual’s daily management of personal bills, budgets and record keeping. A DMM assists clients with activities such as bill paying, day-to-day banking, budgeting, insurance paperwork, and organizing records and receipts in preparation for income tax filing.

Who needs the help of a daily money manager (DMM)?

A research study Conducted by the Brookdale Center for Healthy Aging and Longevity of Hunter College states: “For vulnerable older adults, management of daily financial obligations can become an overwhelming burden, quickly spiraling into adverse behaviors and at-risk situations such as unpaid bills,un-deposited checks, and the terrifying consequences of cut-off utilities, bank foreclosures, evictions, and financial exploitation.”

An experienced daily money manager (DMM) can provide day-to-day personal financial services for elderly parents, giving peace of mind to children that their parents’ financial affairs are being taken care of properly and professionally.

Hiring a DMM may allow some seniors with health challenges to avoid guardianship and a complete loss of independence.

What sorts of tasks do DMMs typically handle?

In addition to bill paying, day-to-day banking, budgeting, and records organization, many DMMs are experienced with handling Medicare and other insurance paperwork. This service eliminates the stress and confusion that often comes with these tasks, offering seniors and their families increased peace of mind. Also, a DMM can be a vital link to help senior citizens access community resources they may not even have known existed. Many DMMs are very knowledgeable about social support services for seniors – from Medicare home health benefits to Meals on Wheels.

If I hire a DMM for myself or my parents, do I/we still need an accountant, financial advisor, lawyer, social worker, or geriatric care manager?

Daily money managers are not financial planners or advisers. Although some DMMs may be separately certified or licensed in these areas, they do not take the place of accountants, attorneys, investment advisors or social workers, but rather complement services provided by these professionals.

DMMs are often “team builders” for their clients, bringing to the client’s table the right professional financial services such as accountants, elder and trust attorneys, financial planners, geriatric care managers or social workers. Most often the DMMs have no exclusivity arrangements so the client can make clear choices.

How frequently do DMMs generally visit their clients?

Daily money managers understand that each client has different needs so visits are scheduled based on the tasks being performed, and the individual’s goals and availability. A client who needs help paying bills due to dementia issues may receive weekly visits from the DMM while another client may only see the DMM face-to-face occasionally because the statements and bills are managed online or because the type of work they are assisting with does not require as much time. When establishing a schedule, DMMs take into account the client’s needs, costs and time.

Does hiring a DMM involve giving up control of my or my parents’ money?

Absolutely not. A DMM’s role is to offer a "best of both worlds" scenario, where the clients retain control of
their money but are freed from the responsibility of executing daily financial tasks. In many instances, DMMs work closely with the client's financial advisor – assisting the advisor with the implementation of the client's financial plan at the hands-on level. In this sense, a DMM’s role is to help clients, with their advisors, maintain control.

Does hiring a DMM result in loss of independence in any way?

No. In fact, a DMM can help individuals keep their independence longer by assisting with all facets of personal financial affairs. Trouble staying on top of personal financial affairs is often the first sign that a senior may be becoming overwhelmed with the responsibilities of independent living. By removing that issue from the situation, DMMs are often instrumental in helping individuals remain independent for longer.

What should I expect the services of a DMM to cost?

Some DMMs offer a free initial consultation -- ask in advance for their policy on first meeting charges. Most DMMs charge for their services on an hourly basis, with rates ranging from $46 - $150 per hour; however, rates may vary greatly based on factors such as geographic location and type of service provided.

In addition to the hourly rates, most DMMs charge for their travel time and for out-of-pocket expenses such as postage stamps provided to their clients and long distance charges for calls made on a client’s behalf.

Be sure that you understand the billing arrangements before the work begins. Some DMMs request payment at the time of service and others bill on a monthly or bi-weekly basis. Some local governments have reduced fee or free services available for low-income clients. Visit the AADMM volunteer outreach page to learn more and view a listing of agencies by state.

How can I locate a DMM in my area, or near where my parents live?

You can find a DMM in your area by visiting www.aadmm.com and clicking on “Find A DMM,” which allows you to search by state, city or ZIP code. Individuals are also often able to find a DMM through a referral by a lawyer, accountant or social worker.

How do I know I can trust this person to whom I would be providing so much sensitive
information?

AADMM members are expected to adhere to a strict code of ethics and standards of practice. AADMM promotes excellence in services through a voluntary certification program that emphasizes both experience in the field and continuing education. Certified daily money managers, called Professional Daily Money Managers (PDMM), must also submit to criminal background checks.

What questions should I ask when I interview a prospective DMM?

The type of work DMMs handle for their clients is highly personal and confidential. Whereas your personal judgment and instincts are important in determining the honesty of any professional with whom you may do business, you can take additional steps to safeguard yourself against becoming involved with a dishonest person.

First, ask for a referral from someone you know and trust, such as a friend, relative, lawyer, accountant, or doctor. If none of these people can put you in touch with a DMM and you must hire a basically "unknown" person, be ready to address the following issues before hiring a DMM:


Top 10 Questions to Ask When Hiring a Daily Money Manager

1. What types of services do you provide? (Do you only do bookkeeping, or are there other ways that you can be of assistance?)
2. How long have you been working as a daily money manager?
3. What kinds of professional insurance do you have?
4. Are there industry standards and code of ethics to which you adhere?
5. Are you willing to work with other advisors, for example, my financial advisor, tax accountant or attorney?
6. What are the costs of your services and what are the common billing methods?
7. How often do you usually visit your clients and what do you charge for travel, if anything? Would it be possible for you to assist me remotely, if necessary?
8. Do you require and/or provide a contract?
9. What about confidentiality?
10. Can you provide a reference list?

**A reference list should include two or more clients or their family members and at least one
professional; it may include a personal reference. Take the time to call the references on the list,
asking them whether the DMM is: respectful, dependable, efficient, empathetic, and professional
in manner. Ask if there have been any conflicts, and if so, how they were resolved. Find out if
asking for explanations of things not understood has been a comfortable situation.

Prepare for the impact of alzheimers

Even in the early stages of dementia, financial skills can be diminished. These steps can help protect you or a loved one -- and a retirement nest egg.

By Susan B. Garland, Editor, Kiplinger's Retirement Report
February 29, 2012

In drawing up your financial plan for retirement, you may be setting aside money for new hobbies or extensive travel. But perhaps you also should prepare a financial contingency plan for Alzheimer's disease.

That may sound somewhat alarmist, but consider this: A decline in the ability to handle financial matters is one of the early signs of Alzheimer's. Seniors with mild symptoms -- forgetting to pay bills or struggling to balance a checkbook or calculate change -- are easy prey for fraudsters. And the cost of caring for someone with dementia can devastate even a healthy nest egg.

The risk of at least one spouse developing Alzheimer's disease is fairly significant, which makes creating a financial plan so important. According to the Alzheimer's Association, 13% of people 65 and older have Alzheimer's, and 43% of those 85 and older have the disease. Longer life expectancy among baby boomers will increase the prevalence of dementia.

As boomers age and the number of seniors grow, financial advisers and physicians are beginning to come to grips with the financial impact of dementia. AARP and the Financial Planning Association have released a guide for financial professionals on the special issues related to older clients. And in a study in the Journal of the American Medical Association in February 2011, researchers instructed physicians on recognizing signs of impaired financial capacity. The researchers also provided guidance to physicians on the legal help that patients and family members could seek to protect their nest eggs.

Daniel Marson, one of the study's co-authors and the director of the Alzheimer's Disease Center at the University of Alabama at Birmingham, notes that it's sometimes difficult for family members to know when a loved one has mild cognitive impairment (MCI). Those with mild cognitive impairment "don't have significant changes in everyday functioning," he says. But, Marson notes, "Ironically, people who have MCI may be the most vulnerable to making poor financial decisions because a lot of families are not yet willing to admit there are significant declines." About 15% of those with mild symptoms develop Alzheimer's each year, says Marson, a professor of neurology.

So how does a loved one identify the early stages of Alzheimer's? In one study funded by the National Institute on Aging, Marson and another researcher compared healthy seniors to those who had early-stage Alzheimer's. The patients with mild symptoms scored significantly below the healthy seniors on such tasks as obtaining change for vending machine use or making an investment decision. Patients with mild symptoms also were unable to explain the risks of mail and telephone solicitations.

Seniors in the early stages of dementia have difficulty understanding basic financial terms, such as loan and interest, Marson says. They also forget to pay bills or pay them more than once. And they are particularly vulnerable to get-rich-quick schemes, he says. As the baby boomers move into their sixties, securities regulators are accelerating efforts to crack down on scams aimed at seniors with failing mental capacity.

Of course, it's best to make plans while you're still healthy, but someone with early-stage Alzheimer's can sign documents and make decisions. Here are some steps you and your family can take to protect your finances, whether it's before you or a loved one is diagnosed, or just after. Many of these plans work well for anyone who is diagnosed with a chronic illness.

Draw up directives. The first step is to draw up an advance health care directive and a financial power of attorney. Together these documents will allow a spouse, adult child or close friend to make decisions about your finances and medical care if you're unable to make your wishes known.

If your spouse becomes incapacitated and has not appointed an agent to make legal, financial and health care decisions, you'll have to go to court to become a guardian. Typically, spouses will name each other as health care and financial agents. Make sure you each appoint a backup agent, perhaps an adult child or a trusted friend.

Select a team. A financial adviser can develop a long-term strategy to pay for care. The adviser should take an inventory of all of the couple's assets, income and insurance policies. A long-term plan is especially important if one spouse is showing signs of dementia while the other has an acute illness, such as heart disease.

An elder law attorney can set up a "special-needs trust" that would pay for the disabled relative's care and protect a family's assets if he or she seeks government benefits. A lawyer also could help mediate among family members who may have different opinions on how to care for Mom or Dad -- or manage the money.

Moreover, a lawyer and financial adviser could develop plans that will take into account the financial needs of the healthy spouse. Even a short time in a nursing home can drain a couple's savings. At that point, a person with Alzheimer's will likely qualify for care paid by Medicaid. Rules vary by state, but generally the healthy spouse can continue to live at home and is allowed to keep some assets that are not counted in determining Medicaid eligibility. If you take action soon after the diagnosis, there are certain strategies that could protect assets for the healthy spouse and heirs while preserving Medicaid eligibility.

You can hire a geriatric care manager to help the family come up with strategies to assume control of the finances. A care manager also will help with day-to-day tasks, such as hiring home-care aides and finding an adult day-care center. You can find a care manager at the National Association of Professional Geriatric Care Managers (www.caremanager.org).

Designate a money manager. Because money-management skills are among the first to slide, a family member or the designated financial agent should start keeping tabs on the household finances. James Sullivan, a certified public accountant for Core Capital Solutions in Naperville, Ill., suggests that a family select two people to watch over the finances. "The family needs to establish checks and balances," he says.

It's not just financial abuse you're watching for, but also negligence. Sullivan recalls one incident where a mother was in a nursing home for five months before the son got around to filing for benefits under her long-term-care insurance policy.

Taking over the finances can be a delicate task if the senior has been in charge of the money. If your husband, for example, does not want to give up control of the finances, Sullivan suggests setting up a small checking account and depositing perhaps $200 or $300 a month. This way, he can still write checks, but the damage would be limited if he were tempted by a questionable financial scheme. "You're not taking away everything at once," says Sullivan, who specializes in planning for clients with chronic illness.

Family members can hire a daily money manager to pay bills, sort through the mail, balance checkbooks and decipher medical bills. You can find a money manager at the American Association of Daily Money Managers (www.aadmm.com).

There may come a time when a physician will be able to conduct a simple brain scan that will show whether you're in danger of losing your financial decision-making capacity. Research funded by the National Institute on Aging suggests a relationship between changes in the brain and diminished financial abilities in patients with mild cognitive impairments. "Wouldn't it be nice if we can tell patients that we're seeing certain changes in the brain that puts them at risk for declining financial capacity?" says Marson, a co-author of the study, published in the Journal of the American Geriatrics Society, in February 2010. "Then they can take protective steps."

Marson says such a scan could be 20 years away. In the meantime, you can watch out for the warning signs and make moves to guard yourself or your loved one -- and the retirement nest egg -- from harm.


Read more: http://www.kiplinger.com/columns/retirement/archives/prepare-for-the-financial-impact-of-alzheimers.html#ixzz1pbL0lCJn

Exercise for the Elderly -- There are Tremendous Benefits

By Marlo Sollitto

Reprinted from agingcare.com

The benefits of exercise throughout life are often touted. But is it safe for seniors older than 65 years to exercise? Absolutely. According to the American Academy of Family Physicians almost all older people can benefit from additional physical activity. Regular exercise protects from chronic disease, improves mood and lowers chances of injury.

With age, the body does take a little longer to repair itself, but moderate physical activity is good for people of all ages and of all ability levels. In fact, the benefits of your elderly parents exercising regularly far outweigh the risks. Even elderly people with chronic illnesses can exercise safely. Many medical conditions are improved with exercise, including Alzheimer's and dementia, heart disease, diabetes, colon cancer, high blood pressure and obesity.

Regular exercise provides a myriad of health benefits in your mom and dad, including improvements in blood pressure, diabetes, lipid profile, osteoarthritis, osteoporosis, and neuro-cognitive function.

Regular exercise improves:

Immune Function – A healthy, strong body fights off infection and sickness more easily and more quickly. Rather than sapping energy reserves entirely, recovery from illness should be less strenuous.

Cardio-Respiratory and Cardiovascular Function – Regular physical activity lowers risk of heart disease and high blood pressure. If the elderly person has hypertension, exercise will lower blood pressure.

Bone Density/Osteoporosis – Exercise protects against loss in bone mass. Better bone density will reduce the risk of osteoporosis and lowers risk of falling and broken bones. Post-menopausal women can lose as much as 2 percent bone mass each year and men also lose bone mass as they age. Research done at Tufts University shows that strength training can dramatically reduce the loss of bone mass, help restore bones, and contribute to better balance and less fractures.

Gastrointestinal Function – Regular exercise promotes the efficient elimination of waste and encourages digestive health.

Chronic Conditions and Cancer – Regular physical activity lowers risk of Alzheimer's disease and dementia, diabetes, obesity, heart disease, osteoporosis and colon cancer, to name just a few. It also helps in the management of high cholesterol and arthritis pain.

Regular physical activity is also associated with decreased mortality and age-related morbidity in older adults. In addition, a study by the Journal of the American Geriatrics Society examined exercise in the elderly and found that exercise training led to improvement in functional reach, balance and fear of falling.

Often, frail elderly people are unable to tolerate aerobic exercise routines on a regular basis due to lack of endurance. But while age-related changes in the cardiovascular system have significant effects on cardiac performance, it has been estimated that 50% of endurance loss can be related to decreased muscle mass.

The ideal exercise prescription for the elderly consists of three components: aerobic exercise, strength training, and balance and flexibility.

Cardio/Endurance Exercises

Physicians recommend 30 minutes of cardio respiratory endurance exercise each day for your elderly mom or dad. This means getting the heart rate up and breathing faster. Walking, cycling and swimming are all examples of cardio/endurance exercises. If the elderly person tires easily and for those just starting to exercise, it is OK to do three 10-minute periods of exercise.
Cardio respiratory endurance exercise increases the body's ability to deliver oxygen and nutrients to tissues and to remove waste over sustained periods of time. After exercising consistently for a few weeks, there will likely be an improvement in the person's ability to exercise and ability to perform everyday tasks without getting winded and out of breath.

Strength/Resistance Training

Strength training uses and strengthens muscles with repetitive motion exercises. Your elderly parent can do strength training with weights, resistance bands, nautilus machines or by using walls, the floor and furniture for resistance. Two to three strength/resistance training workouts a week will provide the greatest benefits. Exercise all muscle groups by doing 1 to 2 sets of 10 to 15 repetitions at moderate intensity. Progressively increase size of weights used during workouts.

Strength training helps prevent loss of bone mass and improves balance. Both of these things will help avoid falls and broken bones among seniors.

Stretching/Flexibility Exercises

Stretching is vital to exercise. Stretching helps muscles warm up and cool down gradually. Stretching improves and maintains flexibility, prevents injury, and reduces muscle soreness and stiffness.

Stretching can also be a time of meditation and a time to appreciate how the body feels. Activities like yoga or Pilates can provide a good form of stretching as well as strength training because they focus on isolating and developing different muscle groups. A number of exercise programs, like yoga and Pilates, focus on developing a strong ‘core,' a term which refers to the set of muscles connecting the inner stomach to the lower back and spine. Because the core muscles provide the foundation for all movement and strength, having a strong core can help with all movement, encourage better posture and reduce allover muscle pain.

Of course, there are some people whose physical abilities are limited by medical conditions or frailty in the elderly. These seniors have to go about exercise more carefully than others, but don't have to dismiss it entirely. With proper instruction and guidance, the elderly can learn activities and exercises that improve mobility and reduce frailty. Especially for those who are frail, it is particularly important to be careful, but to find a way to move the body, because regular exercise greatly reduces the risk of falling and broken bones. Try exercise in a class setting with proper supervision and definitely consider swimming or another form or water exercise as it can be less jarring to the body – the local YMCA or YWCA are good places to start when looking for exercise programs that address special needs.

Reprinted from Senior Health

Alzheimer’s Disease is a form of dementia that most often strikes people over the age of 65, although it is possible to occur at an earlier stage in life. It is incurable, and while treatments do exist, they generally have little effect on the disease’s progression. The best hope may be to recognize Alzheimer’s at its earliest stages in order to make the daily challenges of the sufferer less burdensome. Here are six common signs of Alzheimer’s.


1.Memory loss: Trouble remembering simple things is perhaps the most commonly-known symptom of Alzheimer’s. While some difficulty with memory is normal as a person ages, the problem is much worse in a sufferer of Alzheimer’s. The trouble extends to simple tasks that are part of everyday life, including things like not remembering where one recently put the car keys, or repeatedly asking someone the same question.

2.Problems following a plan or completing a familiar task: A person with Alzheimer’s will likely lose cognitive skills, which can make it hard to “use their brain.” It may suddenly become more difficult to solve crossword puzzles or cook a familiar dish. They may have trouble finding the way home from a place they visit often, or following the rules of a favorite game. This cognitive deterioration will also lead to problems doing multiple things at once.

3.Losing track of location or time: Someone suffering from Alzheimer’s will often have trouble with the details of the time and place in which they exist. This can be as simple as forgetting where the kitchen garbage can is. Or they may lose track entirely of what day it is or where they are, and forget significant events in their own lives and the world around them. Often they will only understand what is occurring in their immediate presence, and sometimes not even that. These symptoms will vary, and memory can temporarily return as quickly as it disappears.

4.Difficulty speaking or writing: As the brain degrades, those with Alzheimer’s will often experience trouble with their words, both when writing and when speaking. They may have trouble remembering the name of a familiar person or thing, may use the wrong word for something or find previously familiar words difficult to pronounce. They may jumble many words up so that though they think they are communicating, they are actually speaking nonsense.

5.Moodiness or personality changes: While changes in mood are expected as one ages, those suffering from Alzheimer’s may have more drastic changes than normal that can disrupt their daily life. They may find themselves apathetic, no longer enjoying things they previously did, such as hobbies or favorite foods. However this can extend to relationships as well, as the sufferer becomes withdrawn from their social life, and even fearful or anxious towards the people around them.

6.Making poor decisions: A common symptom of Alzheimer’s is a decrease in one’s judgment. The sufferer may have difficulty recognizing danger in common situations, such as crossing a busy street or using tools. They may also exercise poor judgment with their money and become susceptible to scams, because they are unable to understand when someone is taking advantage of them.
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Happy Holidays From EMM

The Aging Brain

From Wikipedia

Age is a major risk factor for most common neurodegenerative diseases, including Alzheimer's disease, cerebrovascular disease, Parkinson's disease and Lou Gehrig's disease. While a plethora of research has focused on diseases of aging, there are few informative studies on the molecular biology of the aging brain in the absence of neurodegenerative disease or the neuropsychological profile of healthy older adults . However, research does suggest that the aging process is associated with several structural, chemical, and functional changes in the brain as well as a host of neurocognitive changes. This page is devoted to reviewing the changes associated with healthy aging.

 Structural Changes

As people age, there are a number of changes that take place, whether physical, chemical or biological. Therefore, it is logical to assume the brain is no exception to this phenomenon. Computed Tomography (CT) studies have found that the cerebral ventricles expand as a function of age, and this process is known as ventriculomegaly. More recent MRI studies have reported age-related regional decreases in cerebral volume.^[1][2] Regional volume reduction is not uniform; some brain regions shrink at a rate of up to 1% per year, whereas others remain relatively stable until the end of the life-span.^[3] The brain is very complex, and is composed of many different areas and types of tissue, or matter. Differing properties of different tissues in the brain may be more or less susceptible to age-induced changes.^[1] The brain matter can be classified as either grey matter, or white matter. Grey matter consists of cell bodies in the cortex and subcortical nuclei, whereas white matter consists of tightly packed myelinated axons connecting the neurons of the cerebral cortex to each other and with the periphery.^[1]

Loss of Neural Circuits and Brain Plasticity

Brain plasticity refers to the brain's ability to change structure and function.^[4] This ties in to that old phrase, “if you don’t use it, you lose it,” which is another way of saying, if you don’t use it, your brain will devote less somatotopic space for it. One proposed mechanism for the observed age-related plasticity deficits in animals is the result of age-induced alterations in calcium regulation.^[5] The changes in our abilities to handle calcium will ultimately influence neuronal firing and the ability to propagate action potentials, which in turn would affect the ability of the brain to alter its structure or function (i.e. its plastic nature). Due to the complexity of the brain, with all of its structures and functions, it is logical to assume that some areas would be more vulnerable to aging than others. Two circuits worth mentioning here are the hippocampal and neocortical circuits.^[6] It has been suggested that age-related cognitive decline is due in part not to neuronal death, but in fact, synaptic alterations. Evidence in support of this idea from animal work has also suggested that this cognitive deficit is due to functional and biochemical changes such as enzymatic activity, chemical messengers, or gene expression in cortical circuits.^[6]

Thinning of the Cortex

Advances in MRI technology have provided the ability to see the brain structure in great detail in an easy, non-invasive manor in vivo.^[7] Bartzokis et al., has noted that there is a decrease in grey matter volume between adulthood and old age, whereas white matter volume was found to increase from age 19-40, and decline after this age.^[7] Studies using Voxel-based morphometry have identified areas such as the insula and superior parietal gyri as being especially vulnerable to age-related losses in grey matter of older adults.^[7] Sowell et al., reported that the first 6 decades of an individual's life were correlated with the most rapid decreases in grey matter density, and this occurred over dorsal frontal, and parietal lobes on both interhemispheric and lateral brain surfaces. Also worth noting, that areas such as the cingulate gyrus, and occipital cortex surrounding the calcarine sulcus appear exempt from this decrease in grey matter density over time.^[7] Age effects on grey matter density in the posterior temporal cortex appear more predominantly in the left versus right hemisphere, and were confined to posterior language cortices. Certain language functions such as word retrieval and production were found to be located to more anterior language cortices, and deteriorate as a function of age. Sowell et al., also reported that these anterior language cortices were found to mature and decline earlier than the more posterior language cortices.^[7] It has also been found that the width of sulcus not only increases with age,^[8] but also with cognitive decline in the elderly.^[9]

Age-Related Neuronal Morphology

There is converging evidence from cognitive neuroscientists around the world that age-induced cognitive deficits may not due to neuronal loss or cell death, but rather may be the result of small region-specific morphology of neurons.^[5] Studies by Duan et al., have shown that dendritic arbors and dendritic spines of cortical pyramidal neurons decrease in size and/or number in specific regions and layers of human and non-human primate cortex as a result of age (Duan et al., 2003; morph). Interestingly, a 46% decrease in spine number and spine density has been reported in humans older than 50 compared with younger individuals.^[6] An electron microscopy study in monkeys reported a 50% loss in spines on the apical dendritic tufts of pyramidal cells in prefrontal cortex of old animals (27–32 years old) compared with young ones (6–9 years old).^[6]

Neurofibrillary Tangles

Age-related neuro-pathologies such as Alzheimer’s disease, Parkinson's disease, diabetes, hypertension and arteriosclerosis make it difficult to distinguish the normal patterns of aging.^[10] One of the important comparison aspects between normal aging and pathological aging are neurofibrillary tangles. Neurofibrillary tangles are composed of paired helical filaments (PHF).^[11] In normal, non-demented aging, the number of tangles in each affected cell body is relatively low^[11] and restricted to the olfactory nucleus, parahippocampal gyrus, amygdala and entorhinal cortex.^[12] As the non-demented individual ages, there is a general increase in the density of tangles, but no significant difference in WHERE tangles are found.^[12] The other main neurodegenerative contributor commonly found in the brain of patients with AD is amyloid plaques. However, unlike tangles, plaques have not been found to be a consistent feature of normal aging.^[12]

Role of Oxidative Stress

Cognitive impairments has been attributed to oxidative stress, inflammatory reactions and changes in the cerebral microvasculature.^[13] The exact intensity of each of these mechanisms in affecting cognitive aging is unknown. Oxidative stress is the most controllable risk factor and is the best understood. The online Merriam-Webster Medical Dictionary defines oxidative stress as, "physiological stress on the body that is caused by the cumulative damage done by free radicals inadequately neutralized by antioxidants and that is to be associated with aging."^[14] Hence, simply put, oxidative stress is the damage done to the cells by free radicals that have been released from the oxidation process.
Compared to other tissues in the body, the brain is deemed abnormally sensitive to oxidative damage.^[15] Increased oxidative damage has been associated with neurodegenerative diseases, mild cognitive impairment and individual differences in cognition in healthy elderly people. In ‘normal aging’, the brain is undergoing oxidative stress in a multitude of ways. The main contributors include, protein oxidation, lipid peroxidation and oxidative modifications in nuclear and mitochondrial DNA.^[15] Oxidative stress can damage DNA replication and inhibit repair through many complex processes. One of these processes includes telomere shortening in DNA components.^[16] Each time a somatic cell replicates, the telomeric DNA component shortens. As telomere length is partly inheritable,^[16] there is individual difference in the age of an individual and the onset of cognitive decline.

Chemical Changes

In addition to the structural changes that the brain incurs with age, the aging process also entails a broad range of biochemical changes. More specifically, neurons communicate with each other via specialized chemical messengers called neurotransmitters. Several studies have identified a number of these neurotransmitters, as well as their receptors, that exhibit a marked alteration in different regions of the brain as part of the normal aging process.

 Dopamine

An overwhelming number of studies have reported age-related changes in dopamine synthesis, binding sites, and number of receptors. Studies using positron emission tomography (PET) in living human subjects have shown a significant age-related decline in dopamine synthesis,^[17] notably in the striatum and extrastriatal regions (excluding the midbrain).^[18] Significant age-related decreases in dopamine receptors D₁, D₂, and D₃ have also been highly reported.^{[19][20][21][22][23]} A general decrease in D₁ and D₂ receptors has been shown,^[21] and more specifically a decrease of D₁ and D₂ receptor binding in the caudate nucleus and putamen.^[20][23] A general decrease in D₁ receptor density has also been shown to occur with age. Significant age-related declines in dopamine receptors, D₂ and D₃ were detected in the anterior cingulate cortex, frontal cortex, lateral temporal cortex, hippocampus, medial temporal cortex, amygdala, medial thalamus, and lateral thalamus^[19] One study also indicated a significant inverse correlation between dopamine binding in the occipital cortex and age.^[20] Postmortem studies as well show that the number of D₁ and D₂ receptors decline with age in both the caudate nucleus and the putamen, although the ratio of these receptors did not show age-related changes.^[22] The loss of dopamine with age is thought to be responsible for many neurological symptoms that increase in frequency with age, such as decreased arm swing and increased Rigidity (neurology).^[24] Changes in dopamine levels may also cause age-related changes in cognitive flexibility.^[24]

Serotonin

Decreasing levels of different serotonin receptors and the serotonin transporter, 5-HTT, have also been shown to occur with age. Studies conducted using PET methods on humans, in vivo, show that levels of the S₂ receptor in the caudate nucleus, putamen, and frontal cerebral cortex, decline with age.^[23] A decreased binding capacity of the 5-HT₂ receptor in the frontal cortex was also found,^[21] as well as a decreased binding capacity of the serotonin transporter, 5-HHT, in the thalamus and the midbrain.^[25] Postmortem studies on humans have indicated decreased binding capacities of serotonin and a decrease in the number of S₁ receptors in the frontal cortex and hippocampus as well as a decrease in affinity in the putamen.^[26]

Glutamate

Glutamate is another neurotransmitter that shows a trend to decrease with age.^[27][28][29] Studies have shown older subjects to have lower glutamate concentration in the motor cortex compared to younger subjects^[29] A significant age-related decline especially in the parietal gray matter, basal ganglia, and to a lesser degree, the frontal white matter, has also been noted.^[27][28] Although these levels were studied in the normal human brain, the parietal and basal ganglia regions are often affected in degenerating brian diseases associated with aging and it has therefore been suggested that brain glutamate may be useful as a marker of brain diseases that are affected by aging.^[27]

Neuropsychological Changes

Changes in Orientation

Orientation is defined as the awareness of self in relation to one’s surroundings ^[30] Often, orientation is examined by distinguishing whether a person has a sense of time, place, and person. Deficits in orientation are one of the most common symptoms of brain disease, hence tests of orientation are included in almost all medical and neuropsychological evaluations.^[31] While research has primarily focused on levels of orientation among clinical populations, a small number of studies have examined whether there is a normal decline in orientation among healthy aging adults. Results have been somewhat inconclusive. Some studies suggest that orientation does not decline over the lifespan. ^[32][33] For example, in one study 92% of normal elderly adults (65–84 years) presented with perfect or near perfect orientation. ^[34] However, there is also data that suggest that mild changes in orientation may be a normal part of aging. ^[35][36] For example, Sweet and colleagues concluded that “older persons with normal, healthy memory may have mild orientation difficulties. In contrast, younger people with normal memory have virtually no orientation problems” ^[36] (p. 505). Hence, research up to this point suggests that normal aging is not associated with significant declines in orientation to person, place, or time. But, mild difficulties may be a part of the aging process and are not necessarily a sign of pathology.

Changes in Attention

Many older adults notice a decline in their attentional abilities.^[37] Attention is a broad construct that refers to “the cognitive ability that allows us to deal with the inherent processing limitations of the human brain by selecting information for further processing” (p. 334).^[38] Since the human brain has limited resources, people use their attention to zone in on specific stimuli and block out others.
If older adults have fewer attentional resources than younger adults, we would expect that when two tasks must be carried out at the same time, older adults’ performance will decline more so than younger adults. However, a large review of studies on cognition and aging suggest that this hypothesis has not been wholly supported.^[39] While some studies have found that older adults have a more difficult time encoding and retrieving information in a divided attention situations than do younger adults, other studies have not found meaningful differences.Similarly, one might expect older adults to do poorer on tasks of sustained attention, which measure the ability to attend to and respond to stimuli for an extended period of time. However, studies suggest that sustained attention shows no decline with age. Results suggest that sustained attention increases in early adulthood and then remains relatively stable, at least through the seventh decade of life. ^[40] More research is needed on how normal aging impacts attention after age eighty.
It is worth noting that there are factors other than true attentional abilities that might relate to difficulty paying attention. For example, it is possible that sensory deficits impact older adults’ attentional abilities. In other words, impaired hearing or vision may make it more difficult for older adults to do well on tasks of visual and verbal attention. ^[37]

Changes in Memory

There have been many different types of memory identified in humans, such as episodic, semantic, strategic, working, source spatial, and non-declarative.^[1] Studies done by Rapp et al., have found that memory functions, more specifically those associated with the medial temporal lobe are especially vulnerable to age-related decline.^[6] A number of studies utilizing a variety of methods such as histological, structural imaging, functional imaging, and receptor binding have converging evidence that the frontal lobes and frontal-striatal dopaminergic pathways are especially affected by age-related processes resulting in memory.^[1]

 Genetic Changes

Variation in the effects of aging among individuals can be attributed to both genetic and environmental factors. As in so many other science disciplines, the nature versus nurture debate is an ongoing conflict in the field of cognitive neuroscience. ^{[10] [11]} The search for genetic factors has always been an important aspect in trying to understand neuro-pathological diseases. Research focused on discovering the genetic component in developing AD has also contributed greatly to the understanding the genetics behind normal or “non-pathological” aging.^[11]
The human brain shows a decline in function and a change in gene expression. This modulation in gene expression may be due to oxidative DNA damage at promoter regions in the genome. Genes that are down-regulated over the age of 40 include:

• GluR1 AMPA receptor subunit
• NMDA R2A receptor subunit (involved in learning)
• Subunits of the GABA-A receptor
• Genes involved in long-term potentiation e.g. calmodulin 1 and CAM kinase II alpha.
• Calcium signaling genes
• Synaptic plasticity genes
• Synaptic vesicle release & recycling genes

Genes that are upregulated include:

• Genes associated with stress response and DNA repair
• Antioxidant defence

Delaying the Effects of Aging

The process of aging may be inevitable, however, one may potentially delay the effects and severity of this progression. While there is no consensus of efficacy, the following are reported as delaying cognitive decline:

• High level of education ^{[11] [41]}
• Physical Exercise ^[42]
• Staying intellectually engaged i.e. Reading and mental activities (such as crossword puzzles) ^[43]
• Maintaining social and friendship networks ^[44]
• Maintaining a healthy diet i.e. Omega-3 fatty acids, and protective antioxidants ^[10]

 "Super Agers"

Longitudinal research studies have recently conducted genetic analyses of centenarians and their offspring to identify biomarkers as protective factors against the negative effects of aging. In particular, the cholesteryl ester transfer protein (CETP) gene is linked to prevention of cognitive decline and Alzheimer’s disease^[45]. Specifically, valine CETP homozygotes but not heterozygotes experienced a relative 51% less decline in memory compared to a reference group after adjusting for demographic factors and APOE status.

Cognitive Reserve

The ability of an individual to demonstrate no cognitive signs of aging within the context of an aging brain is called cognitive reserve.^{[41] [13]} This hypothesis comes into play when two patients have the same brain pathology, one leading to noticeable clinical symptoms, while the other continues to function relatively normally. Cognitive reserve explores the specific differences between these two individuals, biologically, genetically and environmentally which makes one more susceptible to an increased decline in cognitive functioning, and allows the other to age more gracefully.

 Nun Study

A study funded by the National Institute of Aging, studied a group of 678 Roman Catholic sisters and the effects of aging. The researchers used autobiographical essays that were collected as the nuns joined Sisterhood. Findings suggest that essays that early idea density, defined by number of ideas expressed per ten words and the use of complex prepositions, was a significant predictor of its author’s risk for developing Alzheimer’s disease in old age. Lower idea density was found to be significantly associated with lower brain weight, higher brain atrophy, and more neurofibrillary tangles ^[46]

 See also

• Aging
• Aging movement control
• Alzheimer's disease
• Dementia
• DNA damage theory of aging
• Life extension
• List of life extension related topics
• Memory and aging
• Neuropsychological test
• Nun Study
• Senescence
• Reliability theory of aging and longevity

Remember this? No? Memory Loss and You

Causes, Treatment, and Help for Memory Problems

Keeping Memory

For most people, memory lapses are a normal part of aging, not a warning of serious impairment. There are many ways you can improve your cognitive skills and keep memory loss from disrupting your daily life.

In This Article:

* How aging normally affects memory
* Degrees of memory loss
* When to see a doctor
* Compensating for memory impairment
* Preventing memory loss

Many of us, when we reach a certain age, get a little nervous when we misplace our keys or forget a phone number we’ve dialed a hundred times. But lapses in memory and slowing of mental responses are a normal part of the aging process for many people, not an ominous sign of mental deterioration.

Let’s start with good news:

* Not all forgetfulness, even dementia, is caused by Alzheimer’s disease.
* Not all memory impairment among seniors reaches the severity of dementia.
* What looks like significant memory loss can be caused by treatable, even reversible conditions.
* Significant memory loss is not an inevitable result of aging.
* The brain is capable of producing new brain cells at any age.
* Brain training and new learning can occur at any age.
* To a large extent, maintaining healthy memory is under your control.

How aging normally affects memory

Memory isn’t a single cognitive process, and it isn’t stored in a single area of the brain. It’s classified by time (short-term vs. long-term) and by type (information you have to recall, like the 13 original colonies or a party you attended, and information that becomes part of you, such as how to drive a car or get dressed). Because different areas of the brain govern different activities and sensory functions, the nature of the information you want to remember determines what part of your brain takes it in and stores it. There are three stages in the process of memory formation and maintenance:

For more information, see the section What is memory? in Helpguide’s Improving Your Memory: Tips and Techniques for Memory Enhancement.

Acquisition-

New information enters your brain along pathways between neurons (nerve cells) in the appropriate area of the brain. Unless you focus on the information intently, its residence in your brain is fleeting — the old “in one ear, out the other” phenomenon.

Consolidation

- If you’ve paid attention well enough to encode new information in your brain, the relevant neuronal pathways get a signal from the hippocampus,a primitive structure deep inside the brain, to store the information as long-term memory. This happens more easily if it’s related to something you already know, or if it stimulates an emotional response.

Retrieval-

When you need to recall information, your brain has to activate the same pattern of nerve cells it used to store it. The more frequently you need the information, the easier it is to retrieve it along healthy nerve cell connections.

Several factors cause aging brains to experience changes in the ability to retain and retrieve memories:

* The hippocampus is especially vulnerable to age-related deterioration, and that can affect how well you retain information.
* There’s a relative loss of neurons with age, which can affect the activity of brain chemicals called neurotransmitters and their receptors.
* An older person often experiences decreased blood flow to the brain and processes nutrients that enhance brain activity less efficiently than a younger person.

These physiological changes can cause glitches in brain functions you’ve always taken for granted. You might have trouble remembering details of a movie you saw recently or directions to a new restaurant. It might take you longer to recall names, faces, and locations, even if you’ve seen them before. You might get flustered if you have to pay attention to more than one thing at a time.

Keep in mind, though, that much of what seems like forgetfulness is more of a slowing in the ability to absorb, store, and retrieve new information, not a loss. You can make and recall new long-term memories; the process just takes a little longer.

And many brain functions are largely unaffected by normal aging, such as:

* How to do the things you’ve always done and do often
* The wisdom and knowledge you’ve acquired from life experience
* Your innate common sense
* The ability to form reasonable arguments and judgments
* The ability to learn new skills and make then routine (though it might take longer)

Degrees of memory loss as part of aging
Normal forgetfulness

The following types of memory lapses are normal among older adults and generally are not considered warning signs of dementia:

* forgetting where you left things you use regularly, such as glasses or keys
* forgetting names of acquaintances or figures in the news
* occasionally forgetting an appointment
* having trouble remembering what you just read
* walking into a room and forgetting why you entered
* forgetting the details of conversations
* becoming easily distracted
* not quite being able to retrieve information you have “on the tip of your tongue”
* blocking one memory with a similar one, such as calling a grandson by your son’s name

Although most people start to experience memory lapses like these by age 60, they have little impact on daily performance. Later, we’ll look at some ways of improving memory and compensating for memory loss.
Mild cognitive impairment

When the information you forget is no longer trivial and your forgetfulness begins to have consequences — you miss your weekly card game or blank on your daughter’s birthday — your memory loss is beyond that of “normal” memory loss due to aging and may be diagnosed as mild cognitive impairment (MCI). The hallmarks of MCI are being unable to remember details of something you saw or read just a few minutes ago and trouble pulling up information you’ve known for a long time.

The memory lapses are similar to those of someone in the earliest stage of Alzheimer’s, and some experts see it as a precursor to Alzheimer’s or other forms of dementia. People with MCI do develop Alzheimer’s at higher rates than the general population of older adults. But MCI is not the same as Alzheimer’s, nor does everyone with MCI develop Alzheimer’s. Its symptoms stop well short of dementia, and people with MCI manage to accomplish their routine tasks independently, though they may struggle to do so.
Alzheimer's disease and other forms of dementia

When memory loss becomes so pervasive and severe that it disrupts your work, hobbies, social activities, and family relationships, you may be experiencing the warning signs of Alzheimer’s disease, another disorder that causes dementia, or a condition that mimics dementia.

Helpguide’s article Alzheimer’s and Other Dementias: Understanding the Differences, along with other pages in its series on Alzheimer’s and dementia, explains the different forms of dementia, what causes them, and how they are diagnosed.

Conditions and lifestyle factors that can cause memory loss

The conditions below might cause memory loss or produce dementia-like symptoms, but they are treatable. Be aware of ways that your environment and lifestyle might be contributing to your memory loss.

Factors which might cause memory loss or dementia-like symptoms:

Exposure to environmental toxins

Substances you come in contact with in your home and workplace can cause memory loss or inability to concentrate. They include:

* lead in drinking water or paint in older homes
* mercury in paints, dyes and inks
* carbon monoxide leaking from home heaters
* chemicals in pesticides and hobby materials

Medications

Many prescribed and over-the-counter drugs or a combination of drugs can interfere with neurotransmitters essential to memory or simply make you drowsy.

Alcohol and drug abuse

Excessive alcohol intake is toxic to brain cells, and illicit drugs such as marijuana, ecstasy, and cocaine block the function of neurotransmitters needed for memory.

Depression

Especially in the elderly, persistent depression may actually cause a loss of neurons in brain areas responsible for memory, making depressed people less able to concentrate and process information.

Vitamin B12 deficiency

B12 protects neurons, and some older persons develop an inability to absorb it effectively.

Thyroid problems

The thyroid gland controls metabolism: if your metabolism is too fast, you may feel confused, and if it’s too slow, you can feel sluggish and depressed.

Hearing loss

If you can’t hear what people are saying, you can’t remember it!
When to see a doctor

It’s time to consult a doctor when memory lapses become frequent enough or sufficiently noticeable to concern you or a family member. If you get to that point, make an appointment to talk with your primary physician and have a thorough physical examination. The doctor will ask you a lot of question about your memory, including

* how long you or others have noticed a problem with your memory
* what kinds of things have been difficult to remember
* whether the difficulty came on gradually or suddenly
* if you’re having trouble doing ordinary things.

The doctor also will want to know what medications you’re taking, how you’ve been eating and sleeping, whether you’ve been depressed or stressed lately, and other questions about what’s been happening in your life. Chances are the doctor will ask you or your partner to keep track of your symptoms and check back in a few months.

If your memory problem needs more evaluation, your doctor may send you to a neuropsychologist, who will have you take some pencil-and-paper tests that gauge different aspects of mental ability. If those tests show abnormal results, the doctor will try to rule out causes of cognitive dysfunction based on conditions such as vascular disease, psychological problems, eating and drinking habits, and environmental factors.

A problematic showing on mental ability tests means you’ll probably go in for imaging studies of the brain, such as a CT or MRI scan, which can detect anything putting pressure on your brain, and, if that’s normal, a SPECT or PET scan, which track blood flow and metabolic activity in the brain, respectively, and are the most sensitive tools at present for revealing brain abnormalities.

If you are diagnosed with mild cognitive impairment or early Alzheimer’s disease, you may benefit from one of the medications which work by protecting acetylcholine, a brain chemical that facilitates memory and learning.
Compensating for memory loss

Even if you are experiencing a troublesome level of memory loss, there are many things you can do to learn new information and retain it.

Keeping track of dates, schedules, tasks, phone numbers

Write it down!

* Leave yourself notes or make checklists.
* Put appointments and important dates on calendars and in a day planner or electronic organizer.
* Ditto for phone numbers and other contact information.
* If you have trouble remembering how to do something, write down the steps.

Remembering where you put things

* Put the things you use regularly (keys, glasses, purse, watch) in the same spot when you’re not using them.
* If you have to put something down in a different place, look at the place when you put down the object and say the location out loud.
* If necessary, write down where things are.

Staying on top of times and places

* Set an alarm clock or timer to remind you when to leave for an appointment or do something in your home.
* Use a map to help you get from one place to another.
* Enlist friends and relatives to remind you of where you need to be and things you’re supposed to do.

Learning new information

Work on your ability to focus your attention and screen out distractions:

* Listen closely when someone talks to you.
* Repeat back the information.
* Try to talk with people in quiet places.
* Focus on one thing at a time.

Preventing memory loss

The same practices that contribute to healthy aging also contribute to healthy memory.

Regular exercise

* It gets more oxygen to your brain.
* It reduces the risk for disorders that lead to memory loss, such as diabetes and cardiovascular disease.
* It may enhance the effects of helpful brain chemicals and protect brain cells.

Healthy diet featuring fruits, vegetables, whole grains, and “healthy” fats

* Antioxidants literally keep your brain cells from “rusting.”
* B vitamins protect neurons and help reduce risk of cardiovascular diseases.
* Avoiding saturated fats and trans fats helps cholesterol levels and reduces risk of stroke.

Managing stress

* Cortisol, the stress hormone, can damage the hippocampus if stress is unrelieved.
* Stress makes it difficult to concentrate.

Good sleep and enough of it

* Sleep is necessary for memory consolidation.
* Sleep disorders like insomnia and sleep apnea leave you tired and unable to concentrate during the day.

Not smoking

* Smoking heightens the risk of vascular disorders that can cause stroke and constrict arteries that deliver oxygen to the brain.

In addition, two other lifestyle factors are crucial for maintaining healthy memory throughout life:
Lifelong learning and exercise of the brain

When it comes to memory, it’s “use it or lose it.” Just as physical exercise can make and keep your body stronger, mental exercise can make your brain work better and lower the risk of mental decline. Here are some ideas for brain exercise, from light workouts to heavy lifting:

* Play games that involve strategy, like chess or bridge, and word games like Scrabble.
* Work crossword and other word puzzles, or number puzzles such as Sudoku.
* Read newspapers, magazines, and books that challenge you.
* Get in the habit of learning new things: games, recipes, driving routes.
* Take a course in an unfamiliar subject.
* Take on a project that involves design and planning: a new garden, a quilt, a koi pond.

Developing and maintaining social relationships

People who don’t have social contact with family and friends are at higher risk for memory problems than people who have strong social ties. Social interaction helps brain function in several ways: it often involves activity that challenges the mind, and it helps ward off stress and depression. So join a book club, reconnect with old friends, visit the local senior center. Being with other people will help keep you sharp!

For more information on strategies for preventing memory loss, see Helpguide’s Improving Your Memory: Tips and Techniques for Memory Enhancement.