Dear Doctor: I read that dementia rates are going down due to rising education levels, but I don't have a college degree. Should I be more worried than most?

Dear Reader: Dementia is a scary disease, causing not only loss of memory but also the inability to reason through problems and, for many, difficulty with even the daily tasks of living. One bright spot is that dementia rates are indeed declining. This was first noted in the United Kingdom in 2013, where researchers in the medical journal Lancet reported a 24 percent decline in dementia rates compared to 20 years previous. The question is: Why the decrease?

A recent study published in the Journal of the American Medical Association attempts to answer that question, assessing differences in dementia rates in the United States between the years of 2000 and 2012. The data were taken from the Health and Retirement Study, which is based on a questionnaire given to thousands of people over the age of 50. The study looked at 10,000 people in 2000 and another 10,000 people in 2012. In this study, researchers found a 24 percent decrease in the dementia rate between 2000 and 2012, and one difference noted by the authors of the study was that overall respondents in 2012 had one more year of education than those in 2000.

A logical question is whether the population in 2012 was simply healthier. That does not appear to be the case. In fact, the 2012 population generally had greater rates of high blood pressure and diabetes, both of which are risk factors for dementia. To that point, it's possible that the more modern and stricter treatments for diabetes and high blood pressure played a role. After all, statins, as well as medications for high blood pressure and diabetes, can reduce the effects of diabetes and high blood pressure on brain function.

But ultimately the authors concluded that the higher level of education was the primary contributor to the decline of both dementia and cognitive impairment. That benefit may come from the creation of greater amounts of brain reserve, so that when brain function decreases years in the future, the effect may not be as obvious.

My belief is that any form of education is important. Although the study above showed that an additional one year of education had benefit, there are other ways of getting an education, such as learning a language. Numerous studies have shown that people who are proficient in two languages have a significant decline in dementia. So if you have the time, learning another language would be a worthy investment.

Please note, however, that I have had patients with high education levels get dementia, so education is not a total preventive.

But I would encourage you to continue to use your mind -- challenging yourself with learning new material and continuing to educate yourself. You don't need to sit in a class for this. A lifelong process of learning and understanding may itself decrease your chances of dementia.

(Robert Ashley, M.D., is an internist and assistant professor of medicine at the University of California, Los Angeles.)

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095.)

Dear Doctor: I just turned 65, and even though I'm strong and healthy, my friends say I should be concerned about osteoporosis. What is it, and how do I know if I have it?

Dear Reader: Osteoporosis, which literally means "porous bones," is a progressive disease in which bone mass is lost. As a result, bones become thinner, more fragile and are at higher risk of fracture. People with osteoporosis most often break a bone in the hip, forearm or spine.

Although osteoporosis can occur in men and women of any age, post-menopausal women have the highest risk. This is due to the steep drop in the production of estrogen, a hormone produced by the ovaries, which protects against bone loss.

Risk of osteoporosis increases along with a person's age. A family history of the disease is an indicator of risk, as are alcoholism, cigarette smoking, anorexia and steroid therapy. Race also plays a role, with Caucasian and Asian women more likely to develop osteoporosis than other ethnicities.

To understand osteoporosis, let's first talk about bones:

Your skeleton, which supports and protects your body, is made up of living tissue. It's also a storehouse of essential minerals that are held within your bones. Throughout your life your bones go through a metabolic process called remodeling, in which old bone tissue is removed from the skeleton and new bone tissue is formed.

As we age, the formation of new bone tissue slows. In people with osteoporosis, the formation of new bone can't keep pace with the removal of old bone, which results in a net decrease in bone density. In addition to an increased risk of fracture, people with osteoporosis experience a loss of height, stooped posture and decreased mobility.

So how can you know if you have osteoporosis?

Since in its early stages osteoporosis typically does not have symptoms, a bone density test is needed for an accurate diagnosis. This is a painless scan in which low-level X-rays are used to reveal the proportion of minerals in your bones. During the test you lie on a padded table as the technician scans several areas, usually your hip, spinal column and wrist.

Treatment for osteoporosis ranges from lifestyle changes, such as adding an exercise plan and switching to a diet rich in calcium and vitamin D, to a range of medications that you would discuss with your doctor.

No matter your age, there are things you can do to keep your bones strong. Calcium is one of the building blocks of new bone, and to successfully absorb that calcium, your body needs vitamin D. Dairy foods, certain nuts and green leafy vegetables contain lots of calcium. Eggs, fatty fish and fortified milk contain vitamin D. Talk to your doctor about whether you need supplements of calcium and/or vitamin D.

Staying physically active strengthens both muscle and bone. Try weight-bearing exercises three to four times per week, and don't forget about balance and agility exercises, which can help prevent a fall.

Your bones hold you up, allow you to move and contain the marrow that produces about 230 billion red blood cells per day. We think your friends have a point here -- don't take your bones for granted.

(Eve Glazier, M.D., MBA, is an internist and assistant professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and primary care physician at UCLA Health.)

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095.)

Dear Doctor: My husband and I are trying to have a baby, but we're having problems conceiving. Could my stress be to blame?

Dear Reader: First, let's consider a couple of statistics, specifically as they relate to women. The federal Centers for Disease Control and Prevention estimates that 6.1 percent of married women between the ages of 18 and 44 are infertile, while 12.3 percent of women between the ages of 18 and 44 have difficulty getting pregnant. Infertility is known to be linked to alcohol use and smoking, and possibly caffeine, so in assessing your own risk factors, I would first look at those potential influencers -- as well as the fact that your husband's sperm may be the source of the infertility.

As for stress, psychological stress has been an everyday part of life for generations of people. Today, our stress comes from such things as driving, shopping for essentials, managing finances and, of course, work. A Dutch study found that women who worked more than 32 hours per week took longer to first become pregnant than those who worked between 16 and 32 hours, but that both groups did eventually become pregnant at the same rate.

The best study of stress and pregnancy was among 401 married couples in Michigan and Texas attempting to get pregnant. The women in this study were followed for 12 months. They filled out questionnaires to assess their stress levels and took part in a measurement of their saliva's amylase. Salivary amylase is an enzyme that has been shown to be a reliable marker of psychosocial stress. Levels of it rise with increased activity of the sympathetic ("flight or fight") nervous system.

This study found that the group of women with the highest level of amylase was 29 percent less likely to become pregnant than those with the lowest level of amylase. Further, the level of amylase correlated well to a woman's stress level based on the scores from the questionnaires that were filled out.

So it seems reasonable from this study, and from a similar study in the United Kingdom, that psychological stress can reduce the chance of getting pregnant.

Further, simply trying to become pregnant -- and being unable to do so -- can create stress, as many studies have shown. A Korean study found that the levels of psychological distress were significantly higher in women who had difficulty conceiving compared to women who were able to conceive. This level of distress was twice as high in women than in their male partners.

Even the stress of fertility treatments can affect a woman's ability to get pregnant. One study found that women who were undergoing fertility treatment and were part of a support or therapy group had a 54 percent conception rate, while those who were not in a support group had a 20 percent conception rate.

Note that men are not immune to the negative aspects of stress. Men who have experienced more than two stressful life events have been found to have lower sperm concentration, motility and morphology.

It would be easy for me to tell you: "Stress less." But no one knows your typical life stressors better than you. My advice is threefold. One, turn to your husband for support. The two of you are in this together, after all, and he's in the best position to understand what you're going through. Second, develop some coping skills through relaxation techniques, meditation or simply going for a walk within nature. Hearing the sounds of the waves as you walk along the beach, listening to the sounds of birds or enjoying the view from a mountain can provide a calming perspective to your everyday life.

And three, if you find yourself still unable to become pregnant, consult a fertility specialist. Having some answers can point you in the right direction -- and reduce your stress.

(Robert Ashley, M.D., is an internist and assistant professor of medicine at the University of California, Los Angeles.)

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095.)