Am I losing my mind? Managing your memory in an age of rising dementia and forgetfulness

Key Points:

You've lost your keys, your wallet, your glasses ... but are you losing your mind, too?

Maybe you've lost your keys for the second time this week, or forgot what someone told you five minutes ago, or you can't recall an acquaintance's name until hours after you've seen her. Are you losing your mind due to stress, illness, sleep deprivation ... or could this be something more disturbing, like dementia? Reasons for memory problems are complicated, but today we know more about how the brain works - about what's normal forgetfulness and what's not. Weekend reporter Dawn Picken spoke to locals and experts about what they're forgetting, why, and when it's time to seek help.

Terri's Story

Terri Bessa says she used to feel she was losing her mind.

"I would just be mid-conversation and for the life of me I couldn't grasp a really simple word and even something I said pretty regularly, it would be on the tip of my tongue and I couldn't for the life of me pull it up."

The Welcome Bay mum says the lapses happened more often at the end of the day when she was tired. She also started forgetting things like people's birthdays and battled to keep up with her daily schedule.

Bessa and her husband have three girls under 8. She says some people attributed her forgetfulness to "mummy brain", but she thought that was derogatory and simplistic.

"People sometimes assume that once you have children, your brain doesn't run like it used to. It doesn't, but that's not always a bad thing."

The 33-year-old visited her GP, who suggested anti-depressants.

"It was the quickest and easiest solution for them. It's necessary sometimes, but not all the time."

Bessa was eventually diagnosed with Hashimoto's, an autoimmune disorder that can cause under active thyroid and memory issues. She went on medication but says it made her shaky, sweaty and anxious.

"I manage through diet and exercise and being very particular about what we clean the house with and body products. I've never had to go back on meds since."

The Bessas saw a need for a service to help other stressed families - those dealing with serious illness or other big life changes. They started a business called Helping Hands that provides cleaning, organising and decluttering using chemical-free products.

"I felt strongly about the fact if my home was clean and tidy and organised, my brain felt more organised, as well."

Besides having a tidy home, meditating and walking, Bessa uses other techniques to manage forgetfulness. She'll repeat a new customer's name several times, then write it down as soon as possible. She's also learning new skills, like her husband's native language, Portuguese.

"I try to train my brain a bit ... teach myself something new like learning to crochet, even crossword puzzles or something to try to work my brain."

Causes of Memory Problems

Experts say some degree of memory issues and other cognitive problems are normal as we age. But there's a difference between normal changes and those associated with Alzheimer's disease and other dementias.

Mayoclinic.org lists other possible reversible causes of memory problems such as: medications; minor head trauma or injury; emotional disorders (like depression, stress and anxiety); alcoholism; Vitamin B-12 deficiency and hypothyroidism and brain diseases (tumours and infections).

Bay of Plenty District Health Board neurologist Dr James Cleland says patients often question whether memory lapses are normal.

"There's no single test that tells us whether someone has normal age-related forgetfulness, or beginnings of dementia."

Cleland says he can take an assessment of how recurrent the memory problem has been, how it impacts day-to-day functioning, and whether forgetfulness is a one-off event or an emerging theme. Often, he says a spouse or partner helps fill in information.

Cleland says other signs of dementia can be persistently forgetting appointments, getting lost navigating familiar places, losing a vehicle in a car park frequently; pulling back from conversations because you can't follow; and repeating the same questions. He recommends website alz.org which lists other early signs and symptoms of Alzheimer's (see graphic, 10 Early Signs).

What about hormones? Cleland says though dementia typically doesn't arise around menopause, sleep problems do.

"Sleep disruption has a really negative effect on memory. We don't know the exact relationship between hormones and memory loss; there's no dramatic difference in dementia rates between males and females ... but as people become aware, we see a lot of patients in that age group worried about their memory."

Cleland says most younger people he sees who are worried about their minds do not have dementia.

"If a person themselves is particularly concerned about their memory, they often don't have a demonstrable memory problem, whereas the person who's unaware of a memory problem and a spouse or GP is forcing them to come along, those we worry about."

He says people unaware they have a memory issue are usually older.

Rotorua Lakes District Health Board psychiatrist Dr Martin Van Zyl says if someone's forgetful, they should ask their GP to rule out medical problems. After that, he recommends a brain scan to investigate significant forgetfulness.

"It can help in terms of diagnosis, but it doesn't always happen. I've worked in the UK where most people did have brain scans. Over here, GPs often don't refer for one unless they suspect a stroke."

A stroke happens when a blockage such as a clot blocks blood flow to the brain, or when a burst blood vessel bleeds into the brain.

Te Puke resident Lynn suffered a stroke but waited two days to see her doctor. She didn't want us to use her real name when relating her forgetfulness.

The 80-year-old says her foot gave way as she was getting out of bed last November. She landed on the floor but thought she was okay until she saw the GP.

"He said yes, it was a stroke. I had to go to the hospital. I was wobbly, but I didn't think it was a stroke because my face was fine. I could walk, though my leg was funny."

Since the stroke, Lynn says she sometimes blanks on people's names and forgets where she's going or that she had an appointment.

"I was at a funeral the other day and said the daughter-in-law's name. Half a minute later, I went to say it again and it went, it was gone. I have to write everything down but if I haven't got a piece of paper right there, I'm likely to forget the minute I've hung up - why was I talking on the phone?"

Effects of stroke on memory can last years - or a lifetime. Harvard-trained neuro anatomist Jill Bolte Taylor suffered a stroke at 37 in 1996. Initially, she couldn't recall any of her life. It took her eight years to recover - a process that included relearning the alphabet and retraining in her profession as a scientist studying the structure and organisation of the nervous system. She went on to write a bestselling memoir called My Stroke of Insight.

MCI and Cranium Care

There's a grey area between normal age-related memory decline and dementia called mild cognitive impairment, or MCI. It can involve problems with memory, language, thinking and judgment that are greater than normal age-related changes.

Van Zyl says often the difference between whether someone has mild memory problems or a disease process is whether recall affects daily life.

"If it has an impact on everyday functioning it's more likely a disease process. If it doesn't, it's often diagnosed as mild cognitive impairment, because they're forgetful but their functioning is still intact."

Van Zyl says Alzheimer's medications are not recommended for people with MCI, but techniques such as keeping notes, a calendar and doing puzzles can help.

"If you have dementia, it will progress no matter what you do, there's no stopping it. People with high IQs and very good vocabularies can sometimes cope better with memory problems; they don't decompensate as quickly as people who have a lack of education."

Van Zyl says keeping the brain stimulated offers early protection but won't stop dementia from eventually taking over.

Cleland says about 15 per cent of people with MCI will go on to develop Alzheimer's.

"We can't identify those 15 per cent who are going to transition to Alzheimer's disease ... we can't necessarily offer treatment, but we're encouraging them to get involved in research."

Cleland says trials are happening worldwide and at Auckland University, where researchers are working to identify bio-markers for dementia.

While it seems a breakthrough treatment for Alzheimer's makes news each week, Van Zyl says new medications haven't proven themselves yet, so patients rely on decades-old drugs such as cholinesterase inhibitors.

"Research shows they're cost-effective in that they may delay people going into care homes. I don't think they slow down the disease process, but they might help people cope better."

What we can do to protect brain function, says Cleland, is exercise our bodies, minds and social lives.

"Physical exercise multiple times per week we believe reduces the risk of developing dementia 40 to 50 per cent."

He says mental exercise and regular social interaction are thought to be good preventative strategies, too.

"It's the complex interaction between genes and environment as is often the case in neurology. We can't say if you exercise, don't have high cholesterol and do crosswords, it doesn't mean you won't develop Alzheimer's. It's all about trying to reduce the risk as much as you can."

Why Get Checked?
Neurologists say getting a prompt diagnosis when someone has memory loss affecting daily life is important. Identifying a reversible cause of memory impairment enables you to get appropriate treatment. Mayoclinic.org and alz.org say early diagnosis of mild cognitive impairment, Alzheimer's disease or a related disorder is beneficial because you can:
-Begin treatments to manage symptoms
-Educate yourself and loved ones about the disease
-Determine future care preferences
-Identify care facilities or at-home care options
-Settle financial or legal matters
-Have an opportunity to take part in clinical trials
-Prioritise health by making lifestyle changes such as participating in exercise
-Save money: Early diagnosis saves costs of medical and long-term care for families and governments.
One US report shows among all Americans alive today, if those who will get Alzheimer's disease were diagnosed when they had mild cognitive impairment, before dementia, it would collectively save at least $7 trillion in health and long-term care costs.
alz.org/alzheimers-dementia/diagnosis/why-get-checked

Tech Memory vs Biological Memory: are we losing our ability to memorise?
An article earlier this year in PC Magazine with the headline, "Is Technology Destroying our Memory?" asks whether humans are losing their ability to memorise things such as phone numbers and maths times tables because we store information in devices rather than commit it to memory.

Cognitive scientist Dr Jason Finley says many researchers have been "asleep at the wheel" when it comes to this subject.

"With a handful of early exceptions, hardly any psychologists have done any research on the interplay between technology (external memory, stored outside your brain) and human memory (internal memory, stored inside your brain)."

Finley says technology is making memory different, not necessarily worse. But he says the idea storing information in the cloud instead of in your head is creating more space in the brain isn't true, either.

"The human brain doesn't fill up and run out of space like a hard drive; the capacity of human long-term memory is essentially unlimited. Rather, counterintuitively, the more knowledge you gain, the better your ability to learn even more ..."

Cleland says while phones have become "accessory brains", we still use our minds for complex tasks.

"Decision-making tasks, executive functioning, planning and making judgments ... Our brains are still getting plenty of exercise, just a different type of exercise, if you like."
au.pcmag.com/news/62373/is-technology-destroying-our-memory

Train Your Brain
Experts say techniques and tricks employed by memory champions can help you remember where you put your keys or recall someone's name.

An article on the American Psychological Association website says scholars throughout history have used a common metaphor to talk about memory:

"The mind is a vast storehouse or space; memories are objects stored in that space; and retrieving a memory is akin to searching for and finding an object in a physical space."

One way to store and retrieve items is through mnemonic (the study and development of systems for improving and assisting the memory) techniques like name mnemonics, where first letters of words within a phrase are used to form a name.

Many of us learned the colours of the rainbow using Roy G. Biv: red, orange, yellow, green, blue, indigo, and violet. One way to remember a list of items involves a trick called the "memory palace", where you place items throughout a familiar place, like your home.

And chunking helps us remember numbers by breaking them into smaller pieces (for things like your IRD number or credit card number).

Website CoCogno.com includes videos explaining memory compensation techniques, such as a tip for not losing important items like keys. They suggest treating everything like your toothbrush, meaning keep things in the same spot.

For remembering names, they suggest linking a new piece of information to an older, hardened memory. For example, you might be able to remember the name of a new acquaintance by linking it to the name of an old friend with the same name.

One memory champion suggests saying a new person's name immediately, then associating the name with a defining characteristic, like hair colour. So you might remember Karen because she has red hair and Karen sounds similar to carrot.

To recall something you intended to do in the future, such as buying an item at the store you forgot to write on your list, a technique called Stop/See it/Say it can help. Step one involves stopping and giving the task your full attention. Step two is picturing yourself completing all steps of the task. Step three is saying aloud what you plan to do.
gocogno.com/memory-compensation-part1/