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Use It or Lose It; Ways to Cope With Memory Loss

No matter how “normal” memory lapses may be, let’s face it, that doesn’t make them any less frustrating. Experts agree that the best way to keep your brain fit is to keep using it.

“People should realize that they have more control than they think, that one-third [of memory loss] is genetics, that means we have the potential to influence a large component of our brain aging,” Gary Small, MD, author of The Memory Bible: An innovative Strategy for Keeping Your Brain Young, and director of the Memory and Aging Research Center at the UCLA psychiatric institute told WebMD.  “The sooner we get started, the sooner we’re going to benefit from it.”

Small emphasizes four things in his books to slow down brain aging: mental activity, physical fitness, stress reduction, and healthy diet. “People who eat too much are at risk for high blood pressure, high cholesterol, diabetes, and other conditions that increase their risk for small strokes in the brain. Secondly, you want to have a diet that’s rich in antioxidants.” Small says antioxidants help protect brain cells and exercise helps with overall health.

Staying intellectually and socially engaged are “probably the most important things you can do to help extend and maintain your cognitive abilities for a longer period of time in life,” Zola says. Challenging oneself by learning new things, reading, and taking up hobbies keep the brain active and strong for the long haul.

Some other things you can do to improve memory include:

• Focus your attention. Forgetfulness may indicate that you have too much on your mind. Slow down and focus on the task at hand. Small says multitasking and not paying attention are some of the biggest causes of forgetfulness, especially in younger people.
• Reduce stress. Stress can endanger the brain areas involved with memory processing and impair memory.
• Choose to snooze. Zola says sleep is important because fatigue can affect memory and concentration in any age group.
• Structure your environment. Use calendars and clocks, lists and notes, and write down daily activities on a planner or use an electric organizer. Store easy-to-lose items in the same place each time after using them. Park your car in the same place at the office each day.
• Try memory tricks. To remember a person’s name, repeat it several times after being introduced. Use the same personal identification number (PIN) for all of your accounts if necessary.

When to See a Doctor
Alzheimer’s disease is a progressive condition that damages areas of the brain involved in memory, intelligence, judgment, language, and behavior. While there is no definitive way to pinpoint an Alzheimer’s brain — short of autopsy — there are some diagnostic ways doctors distinguish normal memory loss from that which should raise concern. Normal forgetfulness includes:

• Forgetting parts of an experience
• Forgetting where you park the car
• Forgetting events from the distant past
• Forgetting a person’s name, but remembering it later

While research shows that up to half of people over age 50 have mild forgetfulness linked to age-associated memory impairment, there are signs when more serious memory conditions, such as Alzheimer’s disease, are happening, including:

• Forgetting an experience
• Forgetting how to drive a car or read a clock
• Forgetting recent events
• Forgetting ever having known a particular person
• Loss of function, confusion, or decreasing alertness
• Symptoms become more frequent or severe

Still confused? Zola sums it up. “The kind of rule of thumb that’s kind of whimsical in a sense but clinicians often use is, if you’re worried about [your memory], it’s probably not that serious, but if your friends and relatives are worried about it, then it probably is more serious.”

By Cherie Berkley, MS
Reviewed by Louise Chang, MD

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SOURCES: Stuart Zola, PhD, director, Yerkes National Primate Research Center, Atlanta; professor, psychiatry and behavioral sciences, Emory School of Medicine, Atlanta. Gary Small, MD, director, Memory and Aging Research Center, UCLA Neuropsychiatric Hospital & Institute; author, The Memory Bible: An innovative Strategy for Keeping Your Brain Youn. WebMD Medical Reference from Healthwise: “Alzheimer’s Disease.” WebMD Medical Reference from Healthwise: “Confusion, Memory Loss, and Altered Alertness.”
 

Before you diagnose yourself with Alzheimer’s disease, take heart: Experts say some memory lapses are actually normal.

They say that memory is the second thing to go as you get older. So what’s the first? Umm, I forgot! And actually, by the time you reach the end of this story, you may remember only a fraction of it.  Not to worry, you’re not alone.

Experts say that mild memory loss is perfectly normal — especially as we age. That’s right, if you sometimes forget simple things, you’re not necessarily developing Alzheimer’s disease. There is a gang of people walking around just like you who occasionally misplace their keys, have that deer-in-headlights look as they search for their cars in parking lots, and can’t recall the name of one new person they met at their last office party — yes, the one from last night. And there’s a reason for those character-themed floors coupled with the happy-go-lucky music in Disney amusement park parking garages.
 
“If we have forgotten an appointment, we begin thinking, ‘Uh oh, is this the first sign of Alzheimer’s disease?’ and we become much more conscious, and it gets kind of a disproportionate amount of attention when it really may be something quite benign,” Stuart Zola, PhD, professor of psychiatry and behavioral sciences at the Emory School of Medicine and director of Yerkes National Primate Facility in Atlanta tells WebMD.

Memory is the ability to normally recall the facts and events of our lives, and this takes place in three stages:

• Stage 1: Encoding. This is when a person takes information in.
• Stage 2: Consolidation. This is when the brain takes the information it encodes and processes it so that it gets stored in certain areas of the brain.
• Stage 3: Retrieval. When a person recalls stored information in the brain.

But differentiating between normal memory loss and Alzheimer’s disease can be puzzling for a layman; the kind of memory that is affected in day-to-day situations is also the kind affected in the early stages of Alzheimer’s disease.

Time: Memory’s Worst Enemy
Fear not, memory loss and brain aging are a natural part of getting older. “It is often the case that people will start to report in their 50s that they think their memories are slipping,” says Zola, a research career scientist who has dedicated his work to memory function. “They seem to be consciously aware of that because they have to use more kinds of reminders or more kinds of strategies to remember things.”

But memory loss can happen even before we hit our 50s. Many people even in their 20s and 30s have forgotten a name or an appointment date or some fact that was on the “tip of their tongue.” Memory is tricky, and time is its worst enemy, says Zola. In fact, shortly after taking in information, memory traces begin to deteriorate, he explains. “Some things begin to fade right away, other things fade less quickly, and they’re a bunch of different forgetting curves with different rates of forgetting depending the nature of the material, depending on how important it is for you, depending on your stress level, depending on … all of the things that can affect memory.”

If you’ve ever gotten into heated debate with someone about how a past event or experience transpired, there’s a likely reason. You may think you have a vivid memory of an experience, but studies show that after awhile, people probably don’t remember events as they actually happened. Memory distortion — also a side effect of father time — explains this. This is the phenomenon where as time passes our ability to accurately recall events becomes diminished — and the longer the period of time that passes between the event and trying to recall it, the greater the chance we’re going to have some memory distortions and forgetting. Sometimes time distortion causes us to forget the event totally, Zola explains.

Other Causes of Memory Loss
But even if you think your slips of the old noggin aren’t normal, there could be other reasons for it short of Alzheimer’s disease, including:

• Stress and anxiety
• ADHD
• Depression
• Metabolic diseases such as thyroid gland diseases, diabetes, and lung, liver, or kidney failure
• Alcoholism
• Vitamin B-12 deficiency
• Infections
• Drugs, both prescription and over-the-counter

The good news is, causes of memory loss from many of these conditions are normally reversible. Zola says depression and stress are the most common reasons for temporary memory problems.

“If your encoding isn’t good, you’re not going to get the information in properly, and so you’re going to have difficulty retrieving it because it isn’t there in good form to retrieve. So that’s the kind of memory problem associated with depression, or with attention deficit disorder, as its name implies, you have trouble paying attention and focusing.” Stress affects the way the brain processes memory, Zola tells WebMD. “So it’s not so surprising that you have memory problems often during very stressful states because part of the brain is not engaged in the way it needs to ordinarily be in order to have good memory.”

To be continued in our next article entitled, “Is Your Memory Normal?  Use it or Lose it!  Ways to Cope With Memory Loss”.

By Cherie Berkley, MS
Reviewed by Louise Chang, MD

Millions spend golden years making green

Cecil Lawrence’s friends tease him that he’s crazy to work at his age. The 90-year-old glass salesman just laughs and suggests that they’re even crazier to sit at home and watch soap operas. “I guess they’re content to be old folks,” he said.

Like Mr. Lawrence, about 2.7 million Americans are skipping retirement and working into their 70s, 80s and even 90s.  Most remain on the job, retirement experts say, not for the money but for the personal satisfaction.  The lifelong workers still account for only 10 percent of their generation, but the proportion of over-70 Americans who have “retired retirement” has edged up since the 1990s as people live longer, enjoy better health and hold less physically demanding jobs.  And the number will only increase with the baby boomers. Seventeen percent say they expect to work indefinitely, though financial necessity will be a bigger reason for their passing up Golden Pond, according to the MetLife Mature Market Institute.

Policy analysts who fear an “entitlement crisis” with the retirement of 78 million boomers welcome the trend toward longer working lives, saying it offers financial benefits for older individuals and the economy as a whole.

Postponing retirement by just five years would boost the average worker’s annual retirement income by 56 percent and add $1 trillion a year to tax coffers by 2045, enough to erase Social Security’s deficit, says the Urban Institute’s Retirement Policy Center.

Older workers bear the burden of convincing businesses that they can remain productive, said William Zinke, a human resources executive who’s created a nonprofit group, the Center for Productive Longevity, to change employer attitudes.

“Although age discrimination is illegal, it exists far more than we’d like to think,” he said.  Many employers view older workers as particularly expensive, either because they demand higher salaries or incur more health care costs than younger workers, said Gordon Mermin, a policy analyst with the Urban Institute.  But by the time workers reach their 70s, many aren’t looking for traditional health benefits, because they’re covered by Medicare.

Only 15 percent have employer-provided health insurance, and 14 percent have pension coverage, the institute says. Only 27 percent work full-time, while 38 percent put in fewer than 20 hours a week.

Many businesses also worry that older workers are harder to train and will retire too soon for the investment in them to pay off. But older employees’ loyalty, sound judgment and even temperament can make them good role models for younger workers, Mr. Mermin said.

“The key is an understanding employer who’s willing to make some accommodations,” said Cynthia Metzler, president and chief executive of Experience Works, a national group that provides training and employment services to older workers.

Tax, pension and age anti-discrimination laws have discouraged employers from establishing formal “phased retirement” programs that allow workers to reduce their hours but stay on the payroll, Mr. Zinke said. But some employers do it informally. And plenty of older workers don’t need a boss’s approval. Among workers 70 and older, 42 percent are in business for themselves, the Urban Institute says.

KNOW THE TAX LAWS BEFORE YOU WORK

Some seniors complain that income tax laws discourage them from working.  Once you’re past your full retirement age, you won’t lose any of your Social Security benefits just because you’re working.  But a portion of your Social Security benefits may become taxable.

To determine whether you owe any federal income taxes on your benefits, the Internal Revenue Service looks at your “combined income.” That consists of your adjusted gross income (including wages from your job, pension payments and withdrawals from a 401(k) or IRA), any nontaxable interest income, plus half of your Social Security benefits.  If this combined income is between $25,000 and $34,000 (or between $32,000 and $44,000 for a couple filing jointly), you may have to pay income taxes on 50 percent of your Social Security benefits. That doesn’t mean you’ll pay half of your benefits in taxes. What it does mean is that 50 percent of your Social Security benefits must be added as income when filing your tax form.
 
If your combined income exceeds $34,000 (or $44,000 for a couple filing jointly), you may owe income taxes on up to 85 percent of your Social Security benefits. A tax adviser may be able to help you avoid this maddening situation: Say that on Dec. 31, the final dollar of annual income you earn from your job triggers taxes on your Social Security benefits.  That last dollar not only would be taxed as income, it also would prompt the taxation of a lot more income.

No matter how much you enjoy working in your golden years, you may wish you had stayed home that day.

Alzheimer’s disease will strike one in eight U.S. baby boomers, meaning that 10 million boomers will develop the mind-wasting disease, according to a new report by the Alzheimer’s Association, the 2008 Alzheimer’s Disease Facts and Figures.

The report predicts by 2010, there will be almost a half million new cases of Alzheimer’s disease each year, and that by 2050, almost a million new cases will surface each year. Whereas today someone in America develops Alzheimer’s disease every 71 seconds, by mid-century someone will develop Alzheimer’s every 33 seconds. Women are nearly twice as likely as men to develop Alzheimer’s disease (17 percent vs. 9 percent). The likelihood of developing Alzheimer’s doubles every five years after age 65.

“Unchecked, this disease will impose staggering consequences on families, the economy and the nation’s health and long-term care infrastructure,”said Harry Johns, president and CEO of the Alzheimer’s Association. In 2007, there were nearly 10 million Americans age 18 and over providing 8.4 billion hours of unpaid care to people with Alzheimer’s disease valued at $89 billion, four times more than what Medicaid pays for nursing home care for people with Alzheimer’s disease and other dementias. In addition, a quarter million American children age 8 to 18 years old are providing care to loved ones with Alzheimer’s, according to the Association.

Nevertheless, most people with Alzheimer’s disease end up in a nursing home or an assisted living facility “and three-quarters of people with Alzheimer’s will die in such a facility,” said Stephen McConnell, the Association’s vice president for advocacy and public policy.

The U.S. government has cut spending on Alzheimer’s research, McConnell said. “Right now the government is spending about $640 million a year on Alzheimer’s research,” he said. “It seems like a lot, but we are spending over $5 billion a year on cancer, and more than $3 billion on heart disease each year. If we can just get that $640 million up to $1 billion a year, that would make a big difference.”

“There is real hope for a better future where Alzheimer’s is no longer a death sentence but how fast we get there depends on how much we are willing to invest today,” added Alzheimer’s Association president Johns.

Widows and widowers who don’t want to sell their house right away will get a tax break under a new law. The law gives surviving spouses two years to sell their house and receive the full $500,000 capital gains exclusion that married couples are entitled to.

Couples who are married and file taxes jointly can sell their main residence and exclude up to $500,000 of the gain from the sale from their gross income. Single individuals can exclude only $250,000. Under the previous law, if a spouse died, the surviving spouse could file jointly — and therefore get the full $500,000 exclusion — only for the year in which the spouse died. The new law allows surviving spouses to get the full $500,000 exclusion if they sell their house within two years of the date of the spouse’s death and other ownership and use requirements have been met. The result is that widows or widowers who sell within two years may not have to pay any capital gains tax on the sale of the home.

The change is contained in the Mortgage Forgiveness Debt Relief Act of 2007, signed into law Dec. 20, 2007. For more on the bill, go to: http://www.govtrack.us/congress/bill.xpd?bill=h110-3648

Once you’ve taken the step to create a will and get your estate plan in order, you need to figure out what to do with the will itself. It is important to keep track of the location of your current will as well as any old wills.

Where to keep a will
The safest place to keep the original copy of your will is in a bank safe deposit box. If you keep the will at home, even if it is in a safe–you run the risk of it being stolen or being destroyed in a fire. Some attorneys may keep the original copy of the will. But if you leave the will with your attorney, make sure the attorney receives updated contact information from you when you move. That way if the attorney moves offices or retires, he or she will know where to find you and you will know where your will is.

You may want to keep a copy of your will at home with your other financial documents. It is usually not a good idea to give a copy to family members or friends because you may want to change the distributions at some point and may need the will back.

What do you do with an old will?
Once you have written a new will, your inclination may be to destroy the old will, but this may not be a good idea. If, for some reason, your new will is invalidated, the court may be willing to reinstate an old will rather than allowing your estate to pass intestate (according to state law). It is likely that your old will adheres more closely to your wishes than an intestate distribution. If the will is destroyed, it cannot be reinstated.

Making changes to a will
If you want to make changes to a will, do not mark up the will by hand, even if you have only small changes to make. A court could take a marked-up will as a sign that you intended to revoke the will. If you want to make a change, contact an attorney who can draft an amendment to the will (called a codicil).

Looking for something you can give your children and grandchildren that can’t be swallowed, won’t be recalled and doesn’t contain excessive amounts of lead? Consider contributing to your children’s and grandchildren’s 529 college savings plan.

The gift of a 529 plan probably won’t make your children and grandchildren squeal with joy but years from now, when they graduate from college debt-free, they’ll thank you.

Every state offers at least one 529 college savings plan, and you don’t have to invest in your own state’s plan. Your contributions aren’t deductible on your federal tax return, but more than 30 states allow residents who contribute to their own state’s plan to deduct some or all of their contributions from their state taxes. Your investments grow tax-deferred, and withdrawals are tax-free, as long as the money is used for college expenses.

Parents and grandparents can set up their own 529 plan, naming the child or grandchild as a beneficiary, or contribute to an existing plan set up by the child’s parents.

Even if the account isn’t in your name, you might be eligible for a state tax break. Most states that provide tax deductions permit non-account owners who contribute to an existing account to deduct their contributions, says Chris Hunter, program manager for the National Association of State Treasurers.

Make sure you keep a copy of your canceled check for your state tax records. You can find the rules for your own state at www.collegesavings.org.

The biggest drawback to contributing to an existing account is that you relinquish control of the money. The plan’s account owners can do anything they want with money in the account, says Bill Raynor, vice president of 529 plan sales for OppenheimerFunds. Raynor says he generally advises grandparents who want to contribute to a 529 to set up a separate account and name themselves as owner, so they can retain control of the money. That’s particularly important if you plan to make a large contribution to a 529 plan, he says.

Otherwise, he says, your contribution “could become a red Porsche convertible instead of the kid’s college fund.”

In addition, keeping the account in your name means you’ll be able to withdraw the money for emergencies, such as catastrophic medical expenses. You can withdraw money in your 529 account at any time, for any reason, says Jeff Coghan, Director of College Savings Programs for Hartford Financial Services. If the money isn’t used for higher-education expenses, however, you’ll owe income taxes and a 10% penalty on the earnings.

Contributions to a 529 savings plan are removed from your taxable estate, even if the account is in your name. That feature makes 529 savings plans a powerful estate-planning tool for wealthy parents and grandparents who are concerned about inheritance taxes, Raynor says.

You can contribute up to $12,000 a year, per beneficiary, to 529 plans without filing a gift-tax return with the IRS. Better yet, you can “frontload” your 529 plans by contributing five years’ worth of annual contributions in one year.

That means you can contribute up to $60,000 to a grandchild’s 529 plan — or $120,000 if you’re married — without filing a gift-tax return. If you have several children or grandchildren, you can set up multiple accounts and shelter hundreds of thousands of dollars from estate taxes, Raynor says. And if a couple of your children or grandchildren eventually don’t go to college, you can always change beneficiaries — as long as the accounts are in your name.

There’s one major drawback to setting up a 529 plan — or several plans — in your name. If you need nursing home care in the future, your 529 plan could hurt your eligibility for Medicaid, a joint federal/state health insurance program for low-income people. Because you control the account, the government considers your 529 plan a “countable asset.” That means you’ll be required to use that money to pay for your long-term care expenses before you qualify for Medicaid. (Except if you live in Arkansas, which enacted a law this year exempting 529 plans from Medicaid eligibility.)

If you think you might need to apply for Medicaid in the future, consider contributing to an account in someone else’s name, says Joe Hurley, founder of Savingforcollege.com. That way, the plan won’t be considered a countable asset for purposes of Medicaid.

Yet even this strategy won’t get you off the hook entirely. When you apply for Medicaid, the state will review your finances during the previous 60 months. Financial gifts made during this period, including contributions to a 529 savings plan, could hurt your eligibility for Medicaid benefits.

For more information, call or e-mail me or a financial adviser who specializes in long-term care.

The Department of Veterans Affairs should overhaul its outdated system of compensating former military personnel for disabling injuries they suffered during their service, the Institute of Medicine recommended yesterday.

The current system dates, in part, to the World War II era. It is out of step with modern medical advances in diagnosing, understanding and treating conditions such as traumatic brain injury, the institute said in a report requested by the federal Veterans’ Disability Benefits Commission. The institute is a branch of the National Academies, an organization chartered by Congress to advise the government on scientific and technical issues. The disability benefits commission, created by Congress in 2003 to study the VA compensation system, is expected to issue a report this year.

For years, the VA rating system has been criticized for bureaucratic delays and disability ratings that many veterans say are lower than they should be, which means they get less compensation. The subject is getting renewed attention as veterans of the wars in Iraq and Afghanistan return home with post-traumatic stress disorder, brain damage, amputations and other serious injuries and conditions.

The Center for Medicare Advocacy has just issued a report discussing the circumstances in which Medicare may be liable for dental services. The report concludes: “The likelihood of obtaining Medicare coverage for non-routine dental care can be increased by taking certain steps. First, a treatment plan established at the outset by the primary physician providing covered medical services should include provision for ancillary dental care. As dental services are needed, the physician should record the fact that they are incident to and necessary for the patient’s primary treatment, and prescribe the specific dental services. This will take such dental services out of the exclusion for routine care, and show that they are “incident to and an integral part of” a covered course of treatment. In order to obtain a successful decision, it may be necessary for the beneficiary to go through a number of unsuccessful lower levels of administrative appeal before reaching the ALJ or federal court levels. At these higher levels of appeal, the beneficiary or her advocate will have an opportunity to overcome the presumption that Medicare never covers dental services. Testimony and medical records from the beneficiary’s physicians should be presented to show that the dental services were ordered and supervised by them as part of the claimant’s covered treatment. Legal arguments can be made that 1) the controlling Medicare statute, as shown by its legislative history, excludes only coverage of routine dental services; 2) the manual requirement that services be “incident to and an integral part of” covered services was met; or if not met, 3) the interpretations of the statute in the manual are too inconsistent and unreasonable to be given deference.”