Carolyn Forwood, a retired salesclerk and beautician, believes in regular exercise for body and brain.
The 68-year-old Parkville resident does crossword puzzles every day. She took up yoga a few months ago, and she works out on the treadmills and stationary bikes in the new fitness room at the Parkville Senior Center three to four times a week.
She also volunteers part time as a senior center receptionist and spends as much time as possible with her three daughters and two stepdaughters.
"I get up every day, and I try to keep everything working," she said.
New research shows that when people like Forwood stay physically active and socially connected as they age, they can help keep their memory sharp, as well.
While forgetfulness once appeared to be an invisible but inevitable price of growing old, experts now say they believe that it doesn't have to be that way.
"I think we're finding more reasons to be optimistic about aging and our mental fitness," said George Rebok, a psychologist and researcher at the Johns Hopkins Bloomberg School of Public Health.
Rebok was part of a national research team that improved the memories of up to 700 volunteers ages 65 and older with 10 approximately hour-long training sessions during a five- to six-week period.
In some cases, just being an active reader can help. This summer, another Baltimore researcher reported that workers at a Canadian lead smelter with higher reading levels had better memory and decision-making skills than those who didn't read as well.
"Being a reader, you're always trying to explore new areas," said Dr. Margit L. Bleecker, a neurologist who published the findings in the journal Neurology.
With the elderly population expected to skyrocket from today's 36 million to 55 million by 2020, memory loss is becoming a critical public health issue, experts say. More people, they say, are asking what they can do to keep their mental abilities intact and whether there are clear warning signs to developing serious memory problems.
An estimated 4.5 million Americans have Alzheimer's disease, the most common cause of dementia and memory loss in people over 65, according to federal estimates.
As the population ages, the number of Alzheimer's cases in the U.S. is expected to reach 14 million by 2050 if treatments and cures are not found.
Memory exercises won't prevent Alzheimer's or dementia, but they may stave off the symptoms, said Dr. Barry Gordon, a Johns Hopkins neurologist who is writing his third book on memory.
"If you're Arnold Schwarzenegger and you develop a muscle disease, you're going to remain stronger longer than someone else with the disease. But you're still going to have the disease," he said. "It's the same idea with memory."
People might experience some memory decline as early as their 20s and 30s, Gordon said. But many people only begin to notice in their mid-40s to mid-60s, when they begin to misplace car keys or have trouble remembering a name, Gordon said.
Problems become more pronounced when people reach their 70s and 80s. Excessive alcohol use, depression and anxiety can make memory problems worse at any age, he says.
Still, occasional memory lapses are usually nothing to worry about, Gordon said.
"Everybody is entitled to leave the kids at soccer at least once a season. But if it happens repeatedly, that's a cause for concern," he said.
Don't test memory
One tip Gordon gives is to avoid testing your memory if you don't have to. If you have something important to remember, make a note, he says.
Gert Gossett, the 70-year-old kitchen supervisor at the Parkville Senior Center, agrees with that advice. "I do tend to write things down more," she said.
Like most people, Gossett can remember songs from childhood, and she encourages seniors at the Parkville center to sing along after lunch. But like the rest of us, she occasionally has trouble placing names with faces.
Her ability to remember things has faded over the years, she said, but "it hasn't gotten to a point where people say to me, 'How could you forget that?'"
How can people tell if memory problems do become serious? Usually, a spouse or close friend will pick up on it first, Hopkins' Gordon says.
"The question is, are you forgetting something important -- and how often are you forgetting something important?" he said.
Recent studies have linked reduced risks of dementia to leisure activities such as reading, playing board games, playing musical instruments and dancing.
A panel appointed by the National Institutes of Health issued recommendations last year for enhancing memory and cognitive health among the elderly. They included regular physical exercise, keeping up with social contacts, maintaining cardiovascular health to ensure a healthy blood flow and regularly teasing the brain.
"In general, what's good for your heart is also good for your brain," said Dr. Joseph Quinn, a neurologist and memory specialist at Oregon Health & Science University.
But opinions vary on the value of specific memory tools such as computer games and crossword puzzles. "What I recommend is that people do what they like to do, what interests them. Because that's what they'll actually do," Gordon said.
Others warn that mind games alone aren't enough. "If you're doing crosswords every day but not watching your health, or eating or sleeping right, that's not going to facilitate remembering things better," said the Bloomberg school's Rebok.
Of course, what jogs one person's brain might not work for someone else -- and genetics make some people just luckier than others, experts say.
George Carey, a retired electrician born and raised in Baltimore, doesn't exercise regularly or do crossword puzzles. But his memory gives him no problems, he says.
He's active in St. Ursula's Catholic Church in Parkville, plays cards once in a while with friends, has called bingo for years at Parkville Senior Center and is blessed with good cardiovascular health.
"I'm 76, and I'm in perfect shape," Carey said.
Much of the current research is aimed at allowing the elderly to live independently as long as possible, said Hugh Hendrie, an Indiana University researcher who chaired the NIH panel.
At least part of the motivation is lowering the nation's health care tab. Medicare spending on Alzheimer's patients reached $91 billion in 2005, mostly on nursing home care, according to federal estimates. By 2010, the cost could reach $160 billion, experts say.
"If you can keep your abilities longer as you get older, it would be tremendous," Hendrie said.
But research based on differences in the behavior, habits and health outcomes of large groups has its limitations, experts say.
"The problem is, there could be a host of unknown factors influencing the results," said Dr. Marilyn Albert, a researcher at the Hopkins School of Medicine who served with Hendrie on the NIH panel.
Even so, researchers who have conducted the few controlled experiments on aging and cognitive health are optimistic.
In Rebok's study at Bloomberg, volunteers learned strategies for remembering word lists, sequences of items, text, and story ideas and details. When they were tested on their ability to remember these specifics, they showed a 26 percent improvement after the five to six weeks of training. They continued to show at least some improvements in follow-up tests over the next five years.
"The effects don't evaporate any time soon after the training, which is good," Rebok said.
Arthur Kramer, a researcher at the University of Illinois, has been getting sedentary adults, 60 to 80 years old, to exercise three times a week. The volunteers start by walking for 15 minutes and progress to an hour. After six months to a year, "they're walking farther and faster than they ever did," he said.
Mental tests show the volunteers also experience a 15 percent to 20 percent improvement in cognitive abilities after six months, including improved abilities to plan ahead and focus on relevant information.
Brain scans of their prefrontal regions and temporal lobes -- key areas for memory and decision making -- show the exercisers have performed the equivalent of turning back the clock two to three years, he said.
The work is aimed at improving practical skills that will help seniors live independently for as long as possible, he said.
"It's everything from ignoring cell phones and billboards while you're driving so you can keep an eye out for pedestrians, to making and keeping medical appointments," Kramer said.
Preventing memory loss
Stay socially engaged with family, friends and community groups.
Engage in mental exercise and continued learning, whether it's crossword puzzles, computer games or taking a language class.
Get regular exercise or physical activity and follow a balanced diet.
Maintain a positive attitude. How we perceive ourselves and the world around us can have profound effects on our brains.