The Aging Intellect

Cognitive aging and how to manage it.

Words of Encouragement for Tennessee Women’s Basketball Coach Pat Summitt

Not everyone diagnosed with mild cognitive impairment progresses to dementia

Last week the great Tennessee women's basketball coach, Pat Summitt, reported that she has early onset dementia of the Alzheimer's type. This diagnosis was made by Mayo Clinic experts whom Summitt consulted because of increasing problems with attention and memory. 

Pat Summitt is the most prominent person still in the prime of life that I can recall who has gone public with the news that she is afflicted with cognitive impairment. For those among you who don't know her, Pat Summitt has been head coach of the University of Tennessee women's basketball team for 37 years. During this span her teams have won 1,071 games-more than any other major college coach in history, male or female-as well as eight national titles and two Olympic medals.

The Mayo Clinic team that made the diagnosis of early onset dementia are recognized experts in their field and surely got it right. That said, it is also well known that a great deal of overlap occurs in the symptoms of mental conditions very close to early onset dementia such as "mild Alzheimer's disease," "limited dementia," and "mild cognitive impairment (MCI)." People diagnosed with MCI, for example, resemble people with early onset dementia. They have memory and other cognitive problems that are more severe than others of their age and educational background, but still function well above threshold for dementia.  MCI is considered a transitional state between normal cognitive aging and dementia. 

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My own review of nine longitudinal studies that followed people with MCI for 3-5 years found that about half of these men and women progressed as expected to dementia during this period. But just over third remained stable. Even more surprising was that one in six were no longer impaired at the end of the study. Nearly all of us who have worked with individuals with MCI have known individuals who have remained free of dementia during the time we knew them.  

What distinguishes those who are able to resist the decline into dementia? Genes surely lay a role, but two other factors are likely to play an equal part. First are healthy lifestyle habits. For instance, we might speculate that some of these newly diagnosed patients with mild impairment like Pat Summitt begin to practice healthy lifestyle habits known to enhance the mind along with the body-e.g., regular exercise, eating healthily, taking medication as prescribed, maintaining social networks, and minimizing stress.

Second, there is a whole array of evidence-based practices that maximize mental ability of older individuals. (Sorry, Pat, but your age puts you on the doorstep of the next stage of life called the "young-old" years.)  Here are four examples: 

Avoid being rushed: Our research with older and younger individuals found that 40 year olds were twice a quick as those 55-64 in solving reasoning problems or changing strategies.  When we eliminated the time component, most of the differences disappeared. 

Beware of distractions: The   ability to stay focused is greatly eroded by age. And sometimes we unfairly blame our memory for letting us down, when in fact the culprit is a distracting thought that disrupted our train of thought. Try to focus on one task at a time until it is completed, and ignore disruptive thoughts or feelings.

Engage in attention restoration activities: The work of suppressing distracting thoughts in order to concentrate on mental tasks that must be done is tiring. An antidote to this problem is engaging in attention restoration activities. A walk in the woods, strolling through a museum of art, or listening to music all have been demonstrated to refresh attention and memory by as much as 10%.

Apply the strategy of selection, optimization, and compensation: This is one of the most thoroughly researched strategies for maximizing mental ability as we age. Concentrate your powers by selecting those activities that most important to you and give up the others. Optimize your skills by spending more time in preparation for your work.  Compensate for not being as sharp as you once were by scheduling the most difficult problems during that part of the day when you are at your best (most older people are best in the AM), taking short naps, and relying more on co-workers.

There is no guarantee that any of these suggestions will be effective with Pat Summitt, or others with similar cognitive problems. But all of them have been demonstrated to slow the rate of cognitive decline.  They do not, however, restore prime of life mental quickness, flexibility, and judgment.  

Coaches like Pat Summitt know better than most of us when the dreams for this year have been realized or not, and when it is time to start thinking about next season. When Summitt steps down as head coach of the Vols, what might her next season be? Here's an idea inspired by Tara VanDerveer, the Stanford coach. She was quoted as saying, "I give her a lot of credit for being so open in sharing this. She's bringing visibility to something that a lot of people have a hard time talking about and dealing with." 

Of course Pat Summitt has already done this for women's basketball. She attracted widespread attention to her superb teams and to the growth of women's sports generally to an indifferent and sometimes antagonistic audience unused to watching females compete. If she chooses to talk about her experiences with cognitive impairment, as she did so well on a video I saw recently, she could have the same power to bring people's attention to early dementia and Alzheimer's disease as Betty Ford did with breast cancer and substance abuse. This could be Pat Summitt's next season. 

Douglas Hyde Powell, Ed.D., A.B.P.P., is a Clinical Instructor in Psychology at Harvard Medical School, and a Consultant in Psychology at McLean Hospital.

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