We often focus on the cognitive changes such as memory that predict risk of decline and future dementia. But those who work or live with persons that ultimately obtain a diagnosis of Alzheimer’s disease know there is more to it than just memory. Equally as damaging are changes in what researchers at Rush University Medical Center are call “life space.” Life space is getting out and about. Those with restricted life space don’t venture far from home.

One of the studies recently coming out of Rush’s longitudinal study of aging demonstrated a link between restricted life space and latter development of Mild Cognitive Impairment and Alzheimer’s disease. There were 1294 participants who had no mental decline at the beginning of the study. Participants were assessed after 4 to 8 years with detailed tests of cognitive functioning. Life space was defined as how far they went beyond home during the past week (e.g., to their porch, to their yard, outside of their neighborhood, outside of their town). Those who restricted their life space to staying close to home were about twice as likely to be diagnosed with Alzheimer’s disease than those who traveled out of town.

These findings remind me of a study from several years ago that demonstrated that those who were couch potatoes in middle age were more likely to be diagnosed with Alzheimer’s disease latter in their life than those who were active. There are at least two interpretations of these findings. First, having a limited life space may increase the chances of developing Alzheimer’s disease. This is the preferred in interpretation as it suggests that if you get active you may slow down or prevent Alzheimer’s disease.

Alternatively, Alzheimer’s disease may first make its presence known by limiting life space. It is clear that as Alzheimer’s disease (as well as many other progressive dementias) advances, afflicted persons become increasingly disengaged. This is often referred to as apathy in the professional literature. There is a lack of lack of interest, emotion, and motivation. Indeed, apathy is often misdiagnosed as depression (beware that one can be both depressed and apathetic and forgetful) early in the course of Alzheimer’s disease.

The plan of action is the same by either interpretation. Get moving. Whether depressed or apathetic the key is to become engaged in life whether or not you are motivated. It’s like the old Listerine commercials. “It may taste bad but it’s good for you.” No matter what stage of cognitive decline or lack of cognitive decline, we all do better if we have things that expand our life space beyond our own back yard. Those with adequate memory can do their own activities. Those with Alzheimer’s disease usually need someone else to get them to activities that they are either willing or interested in doing. They need an understanding friend or companion to remember for them.