‘On the Tip of My Tongue’: Is It Just Aging—Or Something Else?

America’s aging population continues to grow, with nearly 1 in 5 Americans aged 65 or older. In fact, older adults now outnumber children in half of all U.S. counties. 

Research also shows that nearly 1 in 10 adults over 65 has dementia, according to a study published in the journal JAMA Neurology. Another 22% have mild cognitive impairment, a stage between normal cognitive aging and dementia.

Black Americans are about twice as likely as older white Americans to have Alzheimer’s or another form of dementia, according to the Alzheimer’s Association. Yet a roughly equal number of Black and white adults report experiencing milder cognitive impairment. 

What increases risk among Black Americans are the social determinants of health that are linked to socioeconomic status. This includes access to doctors, affordable medication, healthy food, and safe, walkable neighborhoods, according to noted geriatrician Dr. Sharon Brangman.

Brangman is director of the Center of Excellence for Alzheimer’s Disease at The State University of New York Upstate University Hospital. Word In Black asked Brangman for pointers on understanding the differences between normal cognitive aging and the onset of actual diseases such as dementia and Alzheimer’s. The following has been edited for length and clarity. If you notice persistent changes in memory, talk with a licensed healthcare provider.

Word In Black: What, in general, is normal aging, and can we know if we are noticing that things drift into areas of concern?

Dr. Sharon Brangman: Cognitive aging is just the fancy word for what our brains go through as we get older, and it’s a normal process. Many people think aging is a disease, but it’s actually a normal process. Our brains change just like the rest of our body. For example, you might find it takes longer to process new information or new details, but your brain can still process it. 

So, you may be talking, and a word is on the tip of your tongue, or you see someone coming toward you and you just can’t remember their name. It takes a little longer to pull it out of the deep recesses of your brain, but you can do it.

WIB: What’s the average onset of these changes? 

Brangman: Most people begin noticing [these changes] in their 50s or 60s, but it is highly individual and should be judged against a person’s own lifelong baseline. That’s when people start to say, “Oh, I must be getting dementia because I can’t remember that person’s name.” Or, if you’re talking about a movie, you can remember the movie, but you just can’t remember that actor’s name.

WIB: How does multitasking affect these changes? 

Brangman: ‘Multitasking makes you stupid.’ I read that once and it stuck with me. Our culture really values multitasking, but it’s not good for our brains because our brains were designed to do one thing at a time. And when you’re multitasking, you’re not paying enough attention to all those different things that you’re trying to do at once. So you’re going to make mistakes. 

But some things also get better, or stay stable, as we get older. Everything you’ve accumulated over your lifetime doesn’t decline. Our experiences, our general knowledge, and wisdom either stay stable or might even improve over time. 

Our vocabulary and our language don’t change either, so we should still be able to comprehend information and words. And our visual and verbal abilities don’t really change. 

Then there’s our procedural memory—the things we know how to do, like ride a bike or play an instrument—that doesn’t decline as we get older, and we can still learn. 

You’ve heard that expression, “You can’t teach an old dog new tricks?” Well, that’s not true. We can always learn. It may take us a little longer [as we age]. We might have to try different techniques, like talking out loud, writing it down, or seeing it a few times, but you can keep learning.

WIB: Does reading more, doing crossword puzzles, playing word games help with memory?

Brangman: Those haven’t been shown to really improve your memory or reduce your risk of Alzheimer’s disease. You want to keep making all those little nerve connections in your brain by reading, listening to music and socializing in person to keep your brain building those nerve connections.  

WIB: Would a change in procedural memory indicate some deeper problem?

Brangman: It’s possible, yes. But I’ve had patients with dementia who can still play the piano. I’ve also had patients who were never good at remembering names. As they get older, if they’re having trouble with that, I would not consider that a problem because it’s not new. It has to be an individual thing.

WIB: When should people really start saying, “Hey, something’s wrong”?

Brangman: If someone is starting to have trouble getting through the day because of their memory, that’s when to get concerned. 

For example, if you’re taking a lot of pills, you might forget a pill here and there. But if you forget your pills for a period of time, or you forget to get them refilled, then I’d be concerned. Also, having trouble figuring out how to get to a location they’ve been to before, or inability to solve a problem in the middle of a new situation. 

I had a patient who encountered some road construction and a detour, and that totally threw her off. She could not get back on track. That would be something to be concerned about. 

Also, if someone’s hygiene starts to change. They may have trouble selecting clothes, so they wear the same thing every day. When you start to see the memory problem cause a change in everyday function, that’s a concern.

WIB: What role does technology use play in these scenarios?

Brangman: We live in a society now where everything is on a phone or a quick lookup, and sometimes that’s such a big shortcut. We don’t give our brains a chance to really exercise and do the work that it’s meant to do. 

WIB: What is often overlooked when we think of the social determinants of health?

Brangman: There’s not a racial predisposition to getting dementia. It has to do with questions like, ‘Can you get to the doctor? Can you get fresh groceries?’

Probably the biggest thing you can do to age well—not just for your brain but for your whole body—is walk every day for about 30 minutes, or get 150 minutes a week of walking. But in some neighborhoods, that’s not safe or possible. Stress is also emerging as a big risk factor, and stress has become so normal that people may not even realize they’re experiencing it.

WIB: So that’s how weathering and all those other effects come into the picture.

Brangman: Yes, that’s a real thing. Under stress, our bodies make more cortisol, which puts you at risk for getting hypertension and diabetes. And that stress wears on you over time. The stress can be related to your job, experiencing racism, being able to figure out if your kids are safe, what your kids are doing, if you can afford your rent and groceries and gas. All of those little things add up over time and have a detrimental effect on our health.

WIB: And all it takes is 30 minutes a day or 150 minutes a week to counteract stress?

Brangman: Yes. You don’t have to run a marathon, you don’t have to bench press 500 pounds, and you don’t have to do it all at once. Walk for 15 minutes in the morning and 15 minutes in the evening.

WIB: How can people maintain their physical fitness during the winter?

Brangman: I say go to one of those big-box stores and walk around in the store.

WIB: How about YouTube? It has lots of exercise programs?

Brangman: Exactly, and they’re free. That’s better than sitting on the couch pushing the remote.

WIB: You’ve mentioned the role stress plays in cognition. What do you suggest for handling stress during our stressful times?

Brangman: I had a patient who sat all day watching breaking news, and his anxiety and depression level was so high. I essentially told him to turn off his TV. I said, “Turn on some music that you enjoy. Get a book.’ Limit your exposure to very negative news, and make sure you vote, because that’s one way to maintain control.

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