Mental performance has become a societal obsession. What else would you expect given this competitive world driven by the information age?

There is now an epidemic of people taking medications on an off-label basis as well as supplements that promise to enhance intellectual acuity, stamina, focus and memory. On the flip side, increasing numbers of patients worry about declining cognitive function. While many queries are motivated simply by fear of natural aging, a high-stress modern lifestyle does actually put more wear on the nervous system than ever before.

The experience of poor memory and focus can result from a great host of factors. Too little or poor-quality sleep, whether from sleep apnea, insomnia or long work hours, is quite common. Quality sleep is also negatively impacted by pharmaceutical sleep aids and “self-medication” for sleep such as alcohol. Getting enough healthy sleep can do wonders to restore mental malaise.

Intellectual clarity is also often compromised by mental health challenges like depression and anxiety. When neurotransmitters such as serotonin and norepinephrine drop, so do energy levels and the ability to think clearly. Anxiety is another mental health issue that makes it hard to concentrate. Anxiety may be a primary problem or secondary to another illness such as attention deficit hyperactivity disorder.

Hormonal changes also will affect memory. Certainly, those undergoing menopause and manopause complain not only of mood changes and fatigue but also of brain fog. The concept of “adrenal fatigue” now appears quite often in the popular press. Chronic stress with associated ongoing elevated cortisol levels can result in a form of burnout in which cortisol levels drop and stay low. Abnormally low levels of thyroid hormone are found in roughly 10 percent of the population. In addition to fatigue and weight gain, hypothyroid is usually associated with mood and memory deficits.

Alzheimer’s disease is among the most publicized neurodegenerative disorders. It affects 5.3 million people in the United States today, 5.1 million of whom are 65 or older. It is the sixth-leading cause of death in the U.S. Early symptoms include having a hard time remembering recent events. As the disease advances, there can also be problems with language, mood swings, loss of motivation and disorientation.

Among the most common causes of cognitive degeneration is multi-infarct dementia. With chronic high blood pressure, elevated cholesterol, diabetes and obesity the brain gets progressively more blockages in the tiny blood vessels that feed it. Over time, the global function of the brain slows, with negative effects on memory and concentration.

Subjective complaints of persistent memory loss and poor concentration must be taken seriously, professionally evaluated and properly diagnosed. In the best case, lifestyle modifications will be enough to restore health through balance, but more substantial intervention may be in order.

It is important to understand that healthy aging does include a gradual reduction in brain size and a slowing of impulses along the nerves. Too often, however, when an elderly person takes extra time to respond to a question, it is interpreted as a sign of mental deficits. The truth is that when our kupuna age naturally, their wisdom from experience continues to deepen even though it takes a little longer to process information. Let’s be sure we don’t miss out on what they have to teach us.

Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrated Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Submit your questions to info@manakaiomalama.com.