Is Age-Related Cognitive Decline Inevitable?

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Jennifer Silver, a dentist in Calgary, Canada, became alarmed after her 62-year-old father started getting forgetful and confused earlier this year. “He had trouble recalling recent

conversations and would often ask the same questions repeatedly,” she says. “There were also instances where he forgot where he had parked his car or struggled to remember the way home from

places he had visited regularly.”

Fearing the worst, Silver and her family had her father evaluated for cognitive decline. A neurologist discovered the real culprit: clonidine, a blood pressure medication that can trigger

dementia-like symptoms in rare cases. After a switch to a different hypertension drug, lisinopril, her father’s mental state quickly improved.

While the symptoms that plagued Silver’s father were particularly dramatic, minor memory lapses — forgetting a person’s name or why you walked into a room — can also lead to worry that

you or a loved one is sliding toward dementia. Thankfully most of the time these fears are unfounded. True, the older you get, the greater the risk that some cognitive abilities will

decline. In the Alzheimer’s Association's estimate, 1 in 9 Americans 65 and older is living with Alzheimer’s, the most common cause of dementia.

But flip that statistic on its head for an overlooked reality: “Most of us do not develop dementia,” said Robert Klitzman, M.D., professor of psychiatry at Columbia University, Irving

Medical Center at a September presentation, Well+Being: Brain Health & Aging, at The Washington Post, supported by AARP. And there are things we can do to improve our odds. ​

That's news to people worldwide, according to a 2024 survey of more than 40,000 people reported in the World Alzheimer Report 2024 by Alzheimer's Disease International. Eighty percent of

the general public think dementia is a normal part of aging. And 65 percent of health care professionals believe the same.

Accumulating evidence suggests that cognitive decline extensive enough to affect daily living is not inevitable. But that doesn’t mean your brain will always work as well as it did in your

20s.

Cognitive function improves through early adulthood, and then, over time, certain aspects of cognition begin to decline, says Thomas M. Holland, M.D., a physician scientist at the Rush

Institute for Healthy Aging at Rush University Medical Center in Chicago. Holland studies the impact of lifestyle modifications on aging and is an advisor on the U.S. POINTER study, which

stands for U.S. Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk in people 60 to 79.

Recovery may involve several types of therapy:

Declines: thinking speed, attention, multitasking, holding information in mind, word-finding

Remains the same or improves: vocabulary, reading, verbal reasoning

Source: University of California San Francisco Memory and Aging Center

“Certain abilities — processing speed, for example — slow down [around] the age of 20 or so, when processing speed peaks, to age 70 or 80, when processing speed can be down as much as 50

to 70 percent,” says Howard Fillit, M.D., clinical professor of geriatrics, medicine and neuroscience at Mount Sinai School of Medicine in New York City, and chief science officer of the

Alzheimer’s Drug Discovery Foundation. (On the plus side, vocabulary and decision-making improves with age.)

Not remembering where you put your keys or your glasses is usually no cause for concern, Holland says. “As we get older, [many people] get distracted more easily,” he says.

More worrisome is not being able to perform the activities of daily life, such as bathing yourself, doing the laundry, cooking and cleaning — “things that you were normally able to do but

now find challenging, but not because of a physical impairment,” Holland says. For instance, it might be worrying, “if you were able to balance a checkbook and now you’re having trouble

doing it, for instance. I get concerned when someone is not remembering how to get home.”