On a recent Thursday morning, a group of eight sat around a table. Paired in twos, they pored over coins and matches, trying to figure out how to build a bridge out of them. A sheet of paper next to each person listed a set of rules on how the bridge was to be built.
"This is how I would do it, but I don't know what they mean by a bridge," said Pat Shilling to Jerry Jones.
Every Thursday, the eight attend a Brain Builders class. The class helps those suffering from early memory loss to keep their minds sharp.
Terri Whitmire, who has administered the program since 2008 at Hutchins Street Square, said the project's goal is to help get them thinking.
"We give them a variety of things to do throughout the day to help make the brain work," she said.
After 10 minutes, Whitmire draws the diagram of the correct answer on the board. As the students look at the board, many of them say, "Ah." One student said that when she looked at the diagram, she thought it made sense.
"You have to think out of the box," said Whitmire.
The Alzheimer's Association's term for early memory loss is "mild cognitive impairment." The association defines a person with MCI as someone who has problems with memory, language or another mental function severe enough to be noticeable to people and to show up on tests. MCI can affect anyone who has head injuries that impact a critical part of the brain. It can eventually lead to Alzheimer's disease or dementia, but doesn't specifically meet the criteria to be a diagnosis.
Edie Yau, the director of diversity for the Alzheimer's Association's headquarters for California in Mountain View, said physicians are getting better at understanding MCI.
"It's an actual diagnoses. It's not the same as, 'My mom is getting forgetful,'" she said.
The causes of memory loss
There could be many different causes of memory loss, said Yau. One of the major risk factors for Alzheimer's, which is untreatable, is age. Memory loss is also a major symptom of dementia. Some problems people may have are trouble paying bills, confusion with the time or place, or having trouble understanding spatial relationships.
One out of 10 times the cause of MCI is something other than dementia, she said. The treatable causes include depression, urinary tract infection and anemia. Other types of diseases, such as Parkinson's, vascular dementia or frontal temporal dementia, can also cause memory loss.
Kristin Einberger, of American Canyon, has been working as an early memory loss consultant for 12 years. She said that if a person has significant early memory loss that gets in the way of everyday life, it is most likely some form of dementia or Alzheimer's.
The National Institute on Aging states that mild forgetfulness can be a normal part of aging. Some may notice that it takes longer to learn new things, or they don't remember information as well as when they were younger. An example of this is the "tip of the tongue" syndrome, said Einberger.
Another problem might be trouble with multitasking. A person might be in the bathroom and be interrupted by the phone or the doorbell, and then may not remember why they went into the bathroom.
"Memory loss has to do with a neurological disease. Memory loss is not a normal part of aging," she said.
To determine memory loss and its causes, Yau said it is recommended that patients first see their primary care physician to talk about their concerns. Although there are 10 warning signs for Alzheimer's, Yau said that not every symptom shows up together. Memory loss seems to be what gets people to the doctor because it affects their whole being, she said.
During their visit, patients are asked to give specific concerns such as getting lost in their neighborhood, missing a doctor appointment or leaving the stove on. Doctors can do an initial screening that is now being offered for every wellness check for anyone over the age of 65. The screening determines whether cognitive testing is needed. If dementia is suspected, a neurologist will do a series of tests to find out the cause. Blood tests, brain scans and depression tests are usually administered.
Who is affected by Alzheimer's or dementia?
According to the Alzheimer's Association, research has shown that those with MCI have an increased risk of developing Alzheimer's disease over the next few years. The majority of those who are diagnosed with Alzheimer's are age 65 and older, although five percent of people can have early-onset. This can appear as early as their 40s or 50s.
Yau said there have been cases of people who are diagnosed as early as age 29, although it's pretty unusual. There are roughly 500,000 in the U.S. who have early-onset Alzheimer's, she said.
There are one in eight people who develop Alzheimer's after the age of 65, and the risk goes up to one in two over the age of 85, she said.
Einberger added that the numbers in the early age category are growing. Studies have not shown why the numbers are increasing, but it is known that there is a quicker deterioration for those diagnosed at an early age.
What can be done?
Although there is no treatment for MCI, Yau said physicians will often prescribe an Alzheimer's-type medicine for those who are in the early to middle stage. The medicine can slow symptoms and may enable the person to continue to live independently for anywhere from six more months to two years. The disease, though, continues to progress, so brain cells are still dying, she said. Since the medicines are designed to help people live independent lives, they may not help those who are beyond that point.
"If someone is beyond able to communicate in words, beyond the ability to live independently and dress or feed themselves, then those medicines may not be helpful," she said.
They may also not help those in a very early stage.
"It's a very subtle difference. Many people can function just fine," she said.
There are programs out there that cater to people with different stages of memory loss, said Einberger. She started the model upon which Brain Builders is based. She began a pilot program in Napa, where surveys were taken of the participants to see what they liked and what they thought didn't work. For the past eight years, Einberger has been administering the Brain Booster program in Fairfield. Research there shows that cognitive stimulation with very early memory loss does help, she said.
"You can build up the neural reserves by learning new and complex things," she said. The program she created helps those who are able to take part in a group process. First, the person needs to be aware of their memory loss and recognize that help is needed. Next, the person needs to be proactive.
Richard and Joanne DeAngelis, of Lodi, recently attended the Brain Builders class for the first time. Richard, 63, was diagnosed with Parkinson's 12 years ago. The two decided to start the class to try and stimulate his memory. Joanne, 68, has been dealing with memory overload, in which she has so much going on in her mind that she can't remember things. Both of them have been having problems remembering where they put things or walking into a room and not remembering what they went in there for.
"It's very easy to get to a place where you have everything to do and don't want to try to recall things," said Joanne.
Yau says that brain-booster programs such as the Brain Builder's class can be beneficial, as long as the person enjoys it and doesn't get frustrated.
"Any stimulation where you can challenge the mind can certainly help. People in their older years can still develop connections in their brain," she said.
The Brain Builders class
As Whitmire passed around a second handout to the class, she explained that their task was to compare six pictures and find the one that matches the silhouette. After a couple of minutes, she looked around to see who was getting the answer.
"Sometimes you have to give them the answer and sometimes they get it right off the bat," she explained.
Typically, the class will be given nine to 10 exercises in the 3-hour class, said Whitmire, but it usually depends on how complicated each one is and how fast the class gets through them.
After five minutes passed, she asked the class who had the answer. Two of them said that No. 5 matched the silhouette. She then explained the difference in each one and told them to pay attention to detail.
After a bad car accident in 2009 left Lorraine Crane with only diminished cognition, the 68-year-old said her life wasn't the same. She decided to move to Lodi to be closer to her daughter. She tried to live an independent life, but couldn't help feeling like she was all alone.
Three years ago, Crane began attending Brain Builders. For her, the class has been all about realizing that others are dealing with the same problems.
"You learn from others. People you meet are your friends. You listen to them and you learn how to get the answer," she said.
In many ways, the class helps people with self esteem and gives them a feeling of safety and camaraderie, said Einberger.
"They feel like no one is going to think less of them," she said. "It keeps them from feeling isolated, and they become more involved in the community."
For Delbert Johnson, the class is his chance to go out and do something around other people. A couple years ago, the 92-year-old noticed he would go out to the freezer and not remember what he went for. The class keeps him from sitting around. He says he has been able to remember more.
"It makes you feel like you have accomplished something," he said.
In the next exercise, Whitmire wrote the word "COST" on the board. The class was given a subject such as TV comedies. They were asked to give names of TV comedies that begin with each of the letters, such as "The Cosby Show" for the letter "C" and then "One Day at a Time" for the letter "O." She gave them little hints until someone would blurt out the answer. JoAnne DeAngelis said the class makes her feel like she is stimulating her memory.
"You kind of get a brighter feeling," she said. "It's more like a waking up feeling."
An individual exercise on egg trivia was given to the class before the first half of the session concluded with a game of "Jeopardy!"
Richard DeAngelis said the "Jeopardy!" game was hard. He explained that he has a difficult time getting something to come out.
"It's in there, but he can't pull it out," said Joanne DeAngelis.
The class doesn't follow a series, but Whitmire said it is easy for her to tell when someone skips a class. Their minds don't seem to be as clear as when they come every week. Typically, the class has one or two new participants each month, and since the first of the year, five of them have been regulars, she said. A couple of them have been attending for about 2 1/2 years. Whitmire enjoys watching their minds work during each class and seeing them have fun with it.
"You can almost see their minds working and you see them laughing," she said. "They see that everyone has the same issues and they can joke about it."