Seven Steps to Managing Your Memory What's Normal,
What's Not, and What to Do About It
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Contents
Preface
Acknowledgments
How to Use This Book
About the Stories
Introduction
STEP 1 LEARN WHAT IS NORMAL MEMORY
1 Which Memory Errors Can Happen to Anyone of Any Age?
2 How Does Memory Change in Normal Aging?
STEP 2 DETERMINE IF YOUR MEMORY IS NORMAL
3 What Kinds of Memory Problems Are Not Normal?
4 What Should the Doctor Do to Evaluate My Memory?
5 When Are Special Tests and Evaluations Needed?
STEP 3 UNDERSTAND YOUR MEMORY LOSS
6 Will My Memory Get Better? Which Causes of Memory Loss Are
Reversible?
7 What Are Dementia, Mild Cognitive Impairment, and Subjective
Cognitive Decline?
8 What Is Alzheimer’s Disease?
9 What Are Vascular Dementia and Vascular Cognitive Impairment?
10 What Else Could It Be? What Are Other Brain Disorders of Aging
Affecting Thinking and Memory?
STEP 4 TREAT YOUR MEMORY LOSS
11 Which Medications Can Help Memory Loss and Alzheimer’s Disease?
12 I’m Feeling a Bit Anxious and Depressed by My Memory Loss or My
Diagnosis: What Should I Do About These Feelings?
STEP 5 MODIFY YOUR LIFESTYLE
13 What Foods Should I Eat or Avoid to Help My Memory?
14 Can Physical Activity and Exercise Help My Memory?
STEP 6 STRENGTHEN YOUR MEMORY
15 What Can I Do to Strengthen My Memory?
16 What Strategies Can I Use to Help My Memory?
17 Which Memory Aids Are Helpful?
STEP 7 PLAN YOUR FUTURE
18 Will Changes in My Memory Change My Life?
19 Where Do I Go from Here?
Glossary
Further Reading
About the Authors
Index
Preface
• You walk into a room to get something and forget why
• You cannot think of the name of a friend at church even though you have
met her a half-dozen times
• You cannot remember as many details of important events of your life as
your spouse, including those such as your wedding and family vacations
• A week after seeing a movie you have trouble remembering the name of
the movie and parts of the plot
• When you are driving and not paying attention, you take one or more
wrong turns and end up somewhere you didn’t intend to be
• You cannot come back with the correct items from the store unless you
write them down and look at the list
• You spend too much time looking for your keys, glasses, wallet, or purse
• You find yourself having difficulty finding your car in a parking lot
• You find yourself looking at the calendar multiple times a day to
remember your schedule
• Your family tells you that you’ve asked that question before
Do some of these experiences sound familiar?
Do you find it difficult to know which of these experiences are likely due
to normal aging and which are likely due to a memory disorder?
Do you sometimes have these or other memory problems?
Do you joke that you have “senior moments” or suffer from “CRS”
(frequently translated as, “can’t remember stuff”)?
Have you ever wondered—or worried—whether a slip of memory could
indicate the start of Alzheimer’s disease?
Do you want to have your memory evaluated but are not sure how to go
about it?
Are you nervous about what the evaluation will consist of and what will
and will not be covered by Medicare or other insurance?
Would you be interested in taking a medication if it would actually
improve your memory?
Are you interested in helping your memory with healthy foods and diets
but confused by all the conflicting claims?
Would you like to know whether doing crossword puzzles or playing
computer games can improve your memory and stave off Alzheimer’s
disease?
Do you want to start exercising to help your memory but are not sure
what is the right type or amount of exercise to do?
Have you been diagnosed with mild cognitive impairment?
Have you been diagnosed with Alzheimer’s disease?
If you answered “yes” to any of these questions, this book was written
for you. We can help you with your memory. We can explain which lapses
of memory are normal and which are not. We can teach you diets and
exercises that can help. We can provide you with strategies and activities to
improve your memory and keep it strong. And we can help you know when
you should see your doctor and what your doctor should do about your
memory problems.
In our practices as a neurologist and a neuropsychologist, we have
evaluated several thousand individuals with concerns about their memories,
just like you. We help them understand when their memory difficulties are
due to normal aging, vitamin deficiencies, or depression and when they are
due to diseases such as Alzheimer’s. Depending upon the cause of the
problem, we then recommend particular medications, vitamins, diets,
exercises, or group activities, and sometimes even clinical trials of new
medications being developed.
So why now and why this book? When we are discussing the results of
these evaluations and our recommendations with individuals, we often wish
that we had more time—more time to explain our rationale as to why their
memory problems are likely due to normal aging versus a serious disorder,
more time to explain how and why a medication works, and more time to
explain the pros and cons of various treatments and recommendations. This
book provides us with the opportunity to tell you all of the information
about these and other topics, from which you can take in as little or as much
detail as you would like.
Although you may feel worried about having memory problems, today
there is more we can do to diagnose and treat memory problems than ever
before. In just the last few years there has been an explosion of new
diagnostic tests and criteria to help evaluate memory loss, as well as a huge
expansion in our knowledge of treatments, diets, and exercises to help
memory in individuals aging normally as well as in those with mild
cognitive impairment, dementia, and Alzheimer’s disease. (Yes, we can
even help those diagnosed with Alzheimer’s disease.) This book is our
opportunity to share these advances with you and help you manage your
memory in seven basic steps.
Acknowledgments
The genesis of this book began with the excellent questions posed to us by
individuals with memory concerns and their families. We would therefore
like to begin by thanking them for the inspiration and guidance they have
given us. Next, we would like to thank our friends and family members who
read various drafts of this book and provided their invaluable feedback:
Fred Dalzell, David Wolk, Jeanie Goddard, Amy Null, George Null,
Richard Budson, Sandra Budson, Leah Budson, Adnan Khan, Brigid
Dwyer, Kate Turk, Cecilia McVey, Peter Grinspoon, Suzanne Gordon,
Barbara Wojcik, Nan Pechenik, Susan Fink, and Barbara Mindel; we
couldn’t have done it without you. An additional special thanks goes out to
Dennis O’Connor and Todd Harrington for their support. We are also
grateful to our colleagues and mentors who have taught us so much about
caring for individuals with memory concerns, including Paul Solomon,
Elizabeth Vassey, Kirk Daffner, Dan Press, David LaPorte, Michael
Franzen, Keith Hawkins, Richard Delaney, Patricia Boyle, Malissa Kraft,
Lee Ashendorf, Helen Denison, and Edith Kaplan. Finally, a big thanks to
our editor, Craig Panner, who saw our vision, had the courage to encourage
us, and guided and supported us through the process.
The content of this book has been derived from the patients that the
authors have seen in their private practices along with literature reviews
conducted solely for the purpose of this book. These reviews and the
writing of this book have been conducted during early mornings, late
nights, weekends, and vacations. Their contribution to this book was
conducted outside of both their VA tours of duty and their Boston
University/NIH research time.
How to Use This Book
We set out to write this book to be as useful to as many people as possible.
If you are:
• An older individual with concerns about your memory, this book was
written with you in mind. We suggest that you read the book cover-to-
cover.
• A family member (or friend) of someone whom you are concerned about,
this book was also written for you. We suggest that you read the book
cover-to-cover as well.
• An older individual without any memory problems or concerns, but with a
desire to strengthen your memory, we suggest that you read Steps 1, 2, 5,
and 6. Other Steps can be read if you wish.
• An individual of any age who wishes to learn more about memory,
including late life memory disorders, their treatments, and the diets,
exercise, and strategies that can help, please read any Steps you wish.
• A healthcare professional, this book can be recommended to your patients
to help them better understand memory, memory disorders, their
treatments, and the diets, exercise, and strategies that they can do to
manage their memory.
• An educator, this book can be used as an easy-to-read text on memory and
memory disorders, full of case examples.
• A student who hopes to use this book to improve their performance on
exams, this is not the right book for you. We would suggest Make it Stick
by Brown, Roediger, and McDaniel.
About the Stories
To make this book more accessible, we have woven stories throughout the
text. As we mention below, we hope that these stories will make it easier to
understand the issues we are discussing and their implications. If, however,
you would prefer to read the text without the stories, please do so. You can
skip them altogether, or you can read specific stories when you want more
information on a particular topic. We’ve written the book so that the stories
are optional. To make it easier to jump into the stories in the middle, we’ve
included the cast of characters below.
Sue, an 80-year-old woman with concerns about her memory
John, Sue’s husband
Jack, a 72-year-old man with concerns about his memory
Sara, Jack’s daughter
Sam, a mutual friend of both Sue and Jack. Sam’s wife, Mary, has
Alzheimer’s disease.
Introduction
That could have been embarrassing, Sue thinks to herself. She was
halfway through lunch with one of her closest friends, before the name
of her friend’s husband came to her. How could I have forgotten? she
thinks again. She is able to remember everything about him—what he
looked like, his career as a surgeon, his retirement party—except his
name.
Sue was able to cover for this little memory lapse. In fact, she has
become quite good at covering for memory lapses, such as trouble
coming up with someone’s name, and laughing it off when the lapse
was noticed. Sue herself, however, isn’t laughing.
Sue is worried about her memory. Worried, in fact, is a bit of an
understatement. She is absolutely terrified that she is developing
Alzheimer’s disease. She just turned 80, the same age that one of her
friends, Mary, was diagnosed with this disease. Since that time Mary
has had to move out of her apartment and into a facility.
Sue hasn’t mentioned her concerns to her friends or her children. Her
children would only worry and overreact—wanting her to go into one
of those “retirement communities.” She doesn’t need that … after all,
she has no difficulty living in her home. She does her own shopping,
cooking, cleaning, and she has never been late with a bill payment. Her
friends wouldn’t be interested in hearing about her concerns. It would
only make them anxious about their own, similar memory difficulties
—or worse, they would start to treat her like an invalid and stop
including her in their social activities. She has mentioned her concerns
to her husband, John. He doesn’t think her memory is abnormal, and
she doesn’t want to worry him by bringing it up again.
Sue thinks about some of her other memory lapses. Just yesterday she
walked downstairs to the basement and could not remember for the life
of her what she was looking for. It was only when she walked back up
to the kitchen that she remembered the roll of paper towels that she
needed, which she then successfully walked down to get. She doesn’t
have trouble remembering things that happened yesterday or last week,
but she finds it quite difficult to recall some of the things from her
childhood, such as the name of her best friend in second grade. Is that
normal? Sue isn’t sure.
Sue is having trouble remembering names, walking into a room and not
knowing why she is there, and recalling some of the information from her
childhood. Yet she is completely independent with everything she does in
life—and she wants to stay that way. She is quite concerned about her
memory. Should Sue be worried?
Let’s consider another story. Jack has just come from his local
community lodge where Sam, one of his buddies, suggested that Jack get
his memory checked out because Sam thought Jack could be developing
Alzheimer’s disease or dementia.
Could he be right? Jack thinks about Sam’s words. He isn’t sure whether
he should thank Sam—or slug him. Part of him wants to do both. Deep
down he knows that Sam is trying to be helpful, but he has a lot of
nerve. Sure, Jack knows he has some trouble remembering, but who
his age doesn’t? Just because Sam’s wife has dementia, all of a sudden
he thinks he’s a goddamn doctor. Not that the doctors know very much
about memory problems, from what Jack could tell. Sam had to take
Mary to her doctor four times before the doctor actually did anything
about it.
Jack considers his memory. He didn’t think anything was wrong, at least,
not any more than with anyone his age. He is 72, after all. Sure, his
memory isn’t as good as when he was 32 (or 62, for that matter). At
least half his friends—maybe three-quarters of them—have similar
difficulties coming up with people’s names and remembering the
details of what they did yesterday or were going to do the next day.
The more he thinks about it, the more he thinks his memory is
probably normal … better than normal, in fact. How many people his
age can list off their buddies from high school and the make, model,
and year of the cars that they drove? Heck, he can even remember
some of his friends from grade school. Jack appreciates that he doesn’t
know very much about dementia or Alzheimer’s disease but he’d bet
that few people his age can remember details of their childhood like he
could.
Still, Jack feels unsettled. Sam stressed that the reason he was bringing it
up was because there were medications Jack could take that would
improve his memory. He doesn’t want to be stupid . . . he had seen his
neighbor ignore his high blood pressure and then suffer a stroke that
left him unable to talk . . . sticking his head in the sand is definitely not
the right thing to do. After all, he has never been one to run away from
a problem; he’d rather stand and confront it. Perhaps he should call his
doctor.
Do the stories of Sue or Jack sound familiar? We will be following Sue and
Jack throughout this book to illustrate the seven steps to managing your
memory. We will be with them as they gain a better understanding of
normal memory (Step 1) and, partnering with their doctor, get a thorough
evaluation (Step 2). We’ll watch as various disorders are considered and a
diagnosis is made (Step 3). We will see the medications they are prescribed
(Step 4), the diets, vitamins, and exercise regimes they explore (Step 5), and
the habits, strategies, and aids they use to improve their memories (Step 6).
We’ll also see them struggle with issues of mood, anxiety, and adjustments
in their lives that need to be made. Finally, we’ll see where they turn for
additional resources and how they plan their future (Step 7).
We hope that these stories—composites of real people we have worked
with—will make it easier to understand the issues we are discussing and
their implications. If, however, you would prefer to read the text without the
stories, please do so. We’ve written the book so that the stories are optional.
Without further ado, we now turn to Step 1 to understand normal
memory and the changes in thinking and memory associated with healthy
aging.
Seven Steps to Managing Your Memory
Step 1
LEARN WHAT IS NORMAL MEMORY
Is your memory normal? To answer that question we need to start with a
different question: What is normal memory?
In Step 1 we will learn about the problems that are part of normal
memory. One thing that makes memory loss tricky, however, is that the
difference between normal and abnormal memory isn’t necessarily the type
of problems that occur but rather the frequency and severity of those
problems. Nonetheless, in order for us to begin to help you know if your
memory is normal or not, we need to first tell you about the memory errors
that can happen to anyone of any age and then let you know what changes
occur to memory as we get older.
1
Which Memory Errors Can Happen to
Anyone of Any Age?
In this chapter we will take a look at a number of different ways that
memory often fails in healthy individuals of any age, leading to forgetting
or even distorted and false memories. We’ll also begin to explain how
memories are formed, stored, and retrieved.
MEMORIES FILL UP THE PAGES OF OUR
LIVES
Sue (whom we met in the Introduction) and her husband John are visiting
Washington, D.C., for the first time since they took their children there
about forty years ago. They are excited to see which parts of the city
have remained the same and which have changed. Although she hasn’t
mentioned it to John, Sue is also using this visit to test her memory—
to see what she can and cannot remember of their prior visit. They are
eating lunch at the Garden café in the National Gallery of Art.
When we speak about memory, in general we are referring to memory for
the episodes of our lives. Think about an episode of your life, such as the
last lunch you had with a friend. The episode would include the sights of
the restaurant and your friend, the sound of your friend’s voice, the smells
and tastes of the foods, as well as your thoughts and feelings at that time.
When you are creating a memory, the information from your senses,
thoughts, and emotions becomes drawn together in a coherent story, just as
if you were writing it down. Each separate sensation—say the sound of
your friend’s voice—would constitute an aspect of the memory. The
different aspects would come together to represent the several parts of the
episode. For example, one part could be your impressions of the waiter:
what he looked like, including his clothing, haircut, mannerisms, and voice.
Another part would be what drink you ordered, whether a glass of water,
diet soda, or cocktail with a little umbrella in it. There would be a part for
your lunch entrée, and a part for what your friend ordered. There would be
parts for your conversation—different parts for each topic you discussed.
THE HIPPOCAMPUS BINDS THE MEMORY
TOGETHER
When the episode is over (in this case when your lunch is over), the
different aspects of each part of the event and the different parts themselves
become bound together as a coherent whole: a memory. Once the episode is
bound it can then be stored so you can later retrieve it as a whole. In fact,
once bound together, thinking about any part of the memory, such as your
entrée—or even the smell of your entrée—can bring the entire episode to
mind. The binding is coordinated by the hippocampus, the memory center
of your brain. There’s one on each side, left and right. They are located deep
inside your brain on the inside and bottom of each temporal lobe, which are
next to your temples on each side of your head, just behind your eyes. The
left hippocampus is somewhat specialized for remembering verbal and
factual information, and the right for nonverbal and emotional information.
MEMORIES FADE WITH TIME
After lunch, Sue and John walk across the grassy National Mall to visit
the National Air and Space Museum.
