Strategies for Memory Improvement in Older Adults

Jane S. Saczynski, PhD; George W. Rebok, PhD

Disclosures

Topics in Advanced Practice Nursing eJournal. 2004;4(1) 

In This Article

Classification of Memory Decline

There is considerable research available on the course of memory development and decline in adulthood.[3,4] Normal aging is associated with changes in the ability to consciously learn and retain new information (ie, explicit memory). A number of age-associated diseases such as Alzheimer's disease (AD) also have a primary impact on explicit memory. Since cognitive decline associated with AD may appear many years before the dementia develops, the boundary between normal aging and the early stages of AD is often unclear.[5]

Although different types of memory (semantic memory, episodic memory) show varying rates of normal age-related decline, memory ability is preserved into early or middle older age (ages 65-75 years). Memory performance in adulthood also shows large cohort effects,[6] with older generations performing more poorly at the same age as their younger counterparts. Generational or cohort effects can reflect differences in formal education, healthcare, and nutrition with more recent cohorts receiving, on average, more years of education and better healthcare and nutrition. Education and lifestyle also appear to affect memory as one gets older. Education and engagement in social, educational, and physical activities are protective against decline.[7] The salience of cohort, educational, and lifestyle factors in memory performance across the adult years makes generalizing memory performance and providing specific norms difficult.

Memory impairment can be graded from normal performance to dementia. Low levels of impairment are often early indicators of a vulnerability to dementia. Mild cognitive impairment (MCI) and, more recently, cognitive impairment without dementia (CIND) are 2 commonly used grades of decline and may represent the appropriate classification of impairment for most elderly individuals who live independently and who may be seen by APNs in outpatient settings.

As relatively new subtypes of cognitive function, the classifications of MCI and CIND are less specific than that of dementia. MCI is characterized by poor performance on memory assessments and one other cognitive domain (eg, speed of processing) as well as self-reported cognitive decline.[8] Diagnosis of CIND is based on the exclusion of dementia and impairment on clinical exams or neuropsychological tests. CIND encompasses a wider etiology of impairment with subcategories for alcohol and drug use, depression, psychiatric illness, and age-associated memory impairment. The prevalence of MCI is between 3% and 5%,[9,10] and that of CIND is 11% to 17%.[11,12] The classification of CIND is more common and less specific than that of MCI. The clinical implications of these grades of impairment are significant, with conversion from MCI to dementia at a rate of 10% per year,[13,14] highlighting the public health significance of early identification and intervention.

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