By JUDD MATSUNAGA, ESQ.
Years ago, I was at a Las Vegas show when comedian George Wallace asked a mid-70-ish Nisei woman to stand up as he “worked the crowd.” She gladly stood up, and as he gently placed his hand on her shoulder, put the microphone up to her mouth, and asked, “Please tell us your name and where you’re from.”
She was so excited that what came out of her mouth was unrecognizable. So he asked, “Just how long has it been since you lost your mind?” She hit him.
Did you know that every three seconds, someone in the world develops dementia? According to Alzheimer’s Disease Research, a BrightFocus Foundation program, this disease changes the lives of thousands of American families each day. Alzheimer’s disease is an irreversible degeneration of the brain that causes disruptions in memory, cognition, personality, and other functions that interfere with everyday activities and eventually lead to death from complete brain failure.
Age is the greatest risk factor for Alzheimer’s disease. The percentage of people with Alzheimer’s increases with age: 5% of people aged 65 to 74, 13% of people aged 75-84, and 33% of people aged 85 and older have Alzheimer’s dementia. A 2025 study estimates a 42% lifetime risk of dementia after age 55, over double previous risk estimates for this age group.
It is estimated that over 900,000 people aged 65 or older develop Alzheimer’s each year.
According to the Alzheimer’s Association, early diagnosis of Alzheimer’s disease is important because it allows patients to start disease-modifying treatments (such as lecanemab or donanemab) and symptom-managing medications while brain function is best preserved. Early care helps stabilize daily function, manage behavioral changes, and reduce medical complications or emergency hospitalizations.
Early diagnosis can also rule out reversible conditions; i.e., memory issues can stem from treatable conditions like vitamin deficiencies, thyroid problems, or severe depression rather than Alzheimer’s. Just as importantly, early diagnosis allows people to adopt heart-healthy diets, exercise routines, and sleep habits that may help protect remaining brain function. Early detection gives individuals the chance to join clinical trials testing new treatments.
Basically, the doctor needs to evaluate whether your lapses in memory or worse-than-normal mental function are caused by reversible causes of cognitive impairment, such as delirium.
Older people are often mentally assessed during or after a hospitalization. But that’s not a good time to try to definitely diagnose dementia, because many elders develop delirium when they are sick, and it can take weeks or even months to return to their previous level of mental function.
Make a note that they may or may not have underlying dementia, and plan to follow up once the brain has had a chance to recover. After considering delirium, check to see if your senior might have another medical problem that interferes with thinking skills.
Common medical disorders that can affect thinking include depression, thyroid problems, electrolyte imbalances, B12 deficiency, and medication side effects. Many of these causes of cognitive impairment require laboratory testing and sometimes additional evaluation.
According to board-certified gerontologist Dr. Leslie Kernisan, MD, MPH (www.betterhealthwhileaging.net), the doctor should check for difficulty with mental functions and may administer an office-based cognitive test. But the results don’t tell the doctor much about what’s going on in the person’s actual life. So it’s important that family members inform the doctor if there seem to be any problems managing activities of daily living (ADLs) and instrumental activities of daily living (IADLs).
Driving and managing finances require a lot of mental coordination, so as dementia develops, these are often the life tasks that people struggle with first. In some cases — usually very early dementia — it can be quite hard to decide whether a person’s struggles have become enough to qualify as “impairment of daily life function.” If someone isn’t taking their medication, is that just regular forgetfulness? Ambivalent feelings about the medication? Or actual impairment due to brain changes?
The doctor should also check for other mental disorders. This step can be a challenge. Depression is the most common mental health problem that makes dementia diagnosis difficult. This is because depression is not uncommon in older adults, and it can cause symptoms similar to those of dementia (such as apathy and poor attention). It’s quite common for people to have both dementia and depression at the same time. In many cases, there may be no easy way to determine whether an older person’s symptoms are depression, early dementia, or both.
If you’re like me, whether or not the doctor says you have dementia or normal age-related forgetfulness, you’ll want to keep your mind sharp for as long as possible. So, according to Dr. Andrew E. Budson of Harvard Medical School, there are six strategies you can adopt to promote neuroplasticity and help strengthen cognitive function. “Neuroplasticity” (if you’re wondering) is your brain’s ability to learn, remember, and change when it is appropriate for the circumstances.
From a special health report from Harvard Medical School, “Understanding Age-Related Memory Loss,” the following six strategies are a combination of physical, mental, and social activities that support neuroplasticity:
(1) Move more, think better
Exercise boosts neuroplasticity by increasing brain-derived neurotrophic factor (BDNF), a protein essential for brain cell growth. Research suggests that lower levels of BDNF may contribute to cognitive decline, affecting memory, concentration, and learning ability.
Aerobic activity is especially effective. The U.S. Department of Health and Human Services recommends at least 150 minutes of aerobic exercise per week. I’ve done the math: 25 minutes per day, six days a week (rest on Sunday).
(2) Keep your brain active+
Mental challenges strengthen neural connections and build cognitive reserve. Lifelong learning is a powerful way to protect the brain. Try:
Learning a new skill, language, or instrument
Reading about new topics
Playing challenging games or doing puzzles
Attending cultural events
Traveling to unfamiliar places
Engaging in creative hobbies
(3) Prioritize quality sleep
Sleep consolidates memories, clears toxins, and repairs neural pathways. Adults over 70 still need 7 to 9 hours of sleep per night. Struggling to rest? Improve sleep by:
Keeping a consistent sleep schedule
Getting morning sunlight
Limiting caffeine and evening screen time
Creating a calm sleep environment
Exercising regularly (but not too close to bedtime)
(4) Fuel your brain with the right foods
The Mediterranean and MIND diets — rich in vegetables, berries, whole grains, fish, nuts, and healthy fats — are linked to better brain health and reduced cognitive decline. Avoiding processed foods and refined sugars can help preserve mental clarity.
(5) Stress less for a healthier brain
Chronic stress increases cortisol, which can damage neurons and inhibit neuroplasticity. Mindfulness meditation, deep breathing, music, and time in nature can all reduce stress and encourage neuroplasticity.
(6) Stay socially engaged
Social connections support memory and mental clarity. Conversation stimulates key brain functions and helps build cognitive reserve. Stay connected by:
Traveling or exploring new places
Attending concerts, plays, or museums
Joining community or hobby groups
Spending time with loved ones
In conclusion, as we grow older, staying mentally sharp becomes more important — and more possible — thanks to neuroplasticity, the brain’s ability to adapt, learn, and rewire itself throughout life. While there’s no surefire way to prevent or cure dementia, research shows that your daily habits can play a powerful role in protecting your brain.
By staying active — physically, mentally, and socially — you can leverage neuroplasticity to stay sharp and independent as you age. With the right habits, you can maintain or even enhance cognitive fitness. From staying active and eating well to getting quality sleep and fostering social connections, small lifestyle changes can help slow cognitive decline and promote mental sharpness.
Finally, you might say, “I was doing fine until the doctor took away my driver’s license. How am I supposed to stay socially active if I can’t drive myself to the local Japanese American community center, or to bowling, or to dancing, or to tai chi class?”
I’ll tell you the same thing the DMV instructor told me when she took away my uncle’s driver’s license after he failed the driving test at the age of 92.
“Look into ACCESS,” she said. ACCESS is a curb-to-curb shared-ride transportation program that is provided for elderly and disabled individuals within Los Angeles County.
Eligible individuals are required to schedule rides ahead of time. ACCESS does not provide emergency or same-day transportation services. Most ACCESS rides are shared with other ACCESS riders.
To qualify for ACCESS, you must schedule an eligibility appointment. ACCESS will schedule a pickup at the curbside of your home and transport you to ACCESS headquarters, where the intake and application process will take place. Once completed, the applicant will be taken back to their home. To learn more and schedule an appointment to apply for ACCESS, visit https://accessla.org/.
Judd Matsunaga, Esq., is the founding partner of the Elder Law Services of California, specializing in estate/Medi-Cal planning, probate, personal injury and real estate law. With offices in Torrance, Encino, Pasadena and Fountain Valley, he can be reached at (310) 318-2995. Opinions expressed in this column are not necessarily those of The Rafu Shimpo.