DR ANNE UNKENSTEIN, PhD, is a clinical neuropsychologist who has focused on working with people who experience change in their memory. For over 25 years, Anne worked in a memory clinic at a large public hospital in Melbourne. She has also worked in public and private inpatient and community-based psychiatric health services, and consults in private practice. Her clinical work involves identifying the nature and extent of people’s memory issues, assisting with the diagnosis of memory illnesses such as dementia, and providing supportive strategies for people with memory difficulties and their families. She holds an honorary position within the Department of Psychiatry at the University of Melbourne, and has been involved in the education of graduate neuropsychologists and psychiatrists. Anne’s recent research, based at the Royal Women’s Hospital in Melbourne, focused on women’s experience of memory during the menopause transition, and enhancing women’s memory self-confidence through the provision of group memory-strategies programs. Anne has presented her research at Australian and international scientific conferences and published her work in international journals and books. She has made educating the community about memory a priority throughout her career, contributing written information about memory and dementia to newsletters, websites and ‘help sheets’, and giving regular presentations through Dementia Australia, Council on the Ageing, community organisations, television and talk-back radio.
First published in 2019
Copyright © Anne Unkenstein 2019
All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without prior permission in writing from the publisher. The Australian Copyright Act 1968 (the Act) allows a maximum of one chapter or 10 per cent of this book, whichever is the greater, to be photocopied by any educational institution for its educational purposes provided that the educational institution (or body that administers it) has given a remuneration notice to the Copyright Agency (Australia) under the Act.
Allen & Unwin
83 Alexander Street
Crows Nest NSW 2065
Australia
Phone: (61 2) 8425 0100
Email: [email protected]
Web: www.allenandunwin.com
ISBN 978 1 76029 638 4
eISBN 978 1 76087 248 9
Set by Bookhouse, Sydney
Cover design: Christabella Designs
Cover photograh: Canan Özkahraman
In memory of Delys Sargeant AM
18 November 1927 – 19 September 2017
Contents
Introduction
1 How memory works
2 How memory changes as we get older
3 What else affects memory? Health, attitude, lifestyle
4 Memory during menopause
5 What can we do to reduce the risk of developing dementia?
6 Strategies for everyday memory
7 Working and learning
8 What if it’s dementia?
9 Changes in someone else’s memory—what can we do?
10 Towards a memory-wise community
Acknowledgements
Resources
Notes
Index
Introduction
At a particularly busy time in my life, when I was in my early thirties, I was working from home in the company of my four-year-old daughter. I had one day left to put the finishing touches on a project, and I was trying to squeeze in some writing in the morning. I put the kettle on to make a cup of tea, settled my daughter in front of her favourite television show, and went to my desk. After a little while I started to smell smoke. Suddenly I remembered the kettle! Oh no! I rushed into the kitchen and found the kettle boiled dry and burning on the gas stovetop. Later, after my shock had subsided, I bought a new electric kettle that turned itself off after it had boiled the water!
We all have memory lapses, at any age. When I boiled the kettle dry I was upset to think that I could have started a house fire, but I wasn’t concerned about my memory. I knew that I had forgotten about the kettle because I was distracted by my inner ‘to do’ list and work deadline stress, and by my daughter in the adjacent room. But if I was older, say 65, then maybe I might start to worry about my memory, especially if I had forgotten a few other things that week too. Or if I was living on my own at 75, and I told my adult daughter about what happened, she might become concerned about me, and wonder if I had early signs of dementia.
It is common to feel worried about memory, but how do you know if memory difficulties are normal, or the beginnings of dementia? Does your ability to remember change as you get older? Can dementia be prevented? Where do you go if you have concerns about memory? What can we do to get the most out of our memory abilities?
This book was written to answer these sorts of questions. In fact, two previous versions of this book (originally named Remembering Well) were written about twenty years ago by a much younger me, together with my friend and mentor Delys Sargeant. Without Delys, this book would not exist. Sadly, in 2017 Delys died, aged 89. Delys was a health promotion activist, dedicated to educating health professionals and the community, and providing advice to government and health agencies on ageing, women’s health and public health.
When Delys was in her late sixties, she became concerned about her memory and consulted me to have her memory assessed. The results were reassuring, and Delys decided to use her experience to help others who had similar concerns. Delys and I went on to provide regular community seminars on memory and ageing. After attendees asked what books they could read on the topic, we decided to write our own, and the first edition of Remembering Well was published in 1998, followed by a second edition in 2001. Remembering Well won the Australasian Journal on Ageing’s book award in 1999, was published in Spanish in Mexico, and an audio version was produced.
Delys and I were delighted to know that our book had been so warmly received, and had given emotional and practical help to readers who were concerned about their memory, or the memory abilities of a family member or friend. The main response from people who read the book was typically: ‘I feel so much better now. I recognise that I do have strategies I can draw on as needed.’ We heard with delight of one woman who had started to give the book to all her friends when they turned 50!
I have now worked as a clinical neuropsychologist, focusing on memory loss, for 30 years. For most of my career I have worked in memory clinics, seeing people who have memory issues that range from mild to severe, and working together with family members to foster personalised support. I have conducted research into memory, particularly for women during menopause. I have run memory courses for groups of people, helping them to identify aspects of life that make memory fluctuate, and taught practical techniques for managing memory change. My work has crossed over into my personal life. Now in my fifties, I am experiencing normal glitches in my own memory, and members of my family have experienced more significant memory loss, related to memory illnesses. Through both my work and my personal life, I have learned that we can wisen up to memory and manage it more efficiently.
Memory-wise focuses primarily on the everyday remembering that is such an important part of our lives. School children have to remember names, places, timetables, formulae, and words of songs. In the world of work, we rely on our memory for specific information and names of contacts. At leisure, we may need to remember cards at bridge, recall words for crossword puzzles, or names of old films or pieces of music. We remember technical procedures like how to drive a car, fix a fuse or set up a spreadsheet. At home, we need to know addresses, birthday dates and where we left the car keys. The list goes on. Every hour of the day we’re calling on memory. Our capacity to
respond to these demands depends on our state of mind at the time, on our health and, to some extent, on our age. We live in a busy, multi-tasking society, we work long hours, and we work to an older age. We deal with stress, overload, mental and physical health issues, and we don’t get enough sleep. It’s no wonder we notice changes in our memory!
Whenever I talk about memory in the community, large numbers of people come to listen and to discuss their concerns. This need to know about memory is increasing as the proportion of older people in our society continues to rise rapidly. Not only do we have more people around us who experience normal age-related memory change, we also have more people among us who have significant memory loss related to memory illnesses, such as dementia. As more people have first-hand experiences with relatives and friends who have dementia, and as dementia becomes an increasingly high-profile issue in the media, it is more likely that those who experience everyday memory lapses will become concerned that they have dementia.
The broad aim of this book is to provide practical information and advice for anyone who is concerned about their own memory, or the memory abilities of someone close to them. The book uses real-life stories (names and identifying details changed, except for mine) for illustration and is based on the original Remembering Well, with updated versions of all previous chapters and two new chapters.
Chapter 1 provides a framework for understanding how memory works. Chapter 2 describes changes that can occur in memory as we get older, along with continued strengths in some aspects of remembering. Health, attitude and lifestyle factors that can lead to fluctuations in memory are described in Chapter 3, together with practical tips to minimise the effect of these aspects of our lives on our memory. Chapter 4 focuses on memory during menopause, including recent research on women’s memory performance at midlife. Researchers are continuing to update our knowledge on potential ways that we can reduce our risk of developing dementia, and Chapter 5 outlines practical suggestions for maintaining brain health based on current research.
We can all become more skilled in managing memory and more confident that we will remember. Chapter 6 describes practical everyday strategies to help get the most out of our memory. Working and Learning (Chapter 7) is for those who want to enhance their memory at work, or learn new tricks, as part of a new job, voluntary work or new interests.
Fortunately, the majority of older people do not develop dementia, but as a community we need to be aware of more significant memory loss that occurs with memory illnesses such as dementia. Chapter 8 discusses the emotional reactions involved in a diagnosis of dementia and provides practical strategies for the person who has the illness in its early stages. Chapter 9 is written for friends and relatives who want to understand this early stage and how they might help. The book concludes with the proposal that we develop a memory-wise community (Chapter 10), in which we acknowledge and support memory change.
All of the chapters are designed to stand on their own, as well as offer cumulative understanding, so some repetition is inevitable, but hopefully this in itself will be a useful memory-wise strategy! Places you might go to for further advice about memory issues are suggested—but remember that health systems are not all the same, and memory clinics, or the role of doctor and neuropsychologist, for example, will vary according to where you live.
Memory change is a reality over the whole of our lives. This book explains how memory works—and what to do when it doesn’t. Use it as a starting point to understand and nurture your own memory, and to help us all to live in a memory-wise community.
CHAPTER 1
How memory works
It is tempting to make all-or-none statements about memory as if it were a single concept. You might say, ‘My memory is letting me down’, for example—but is it a problem with remembering what you did yesterday, or what you did when you were a child? If a person is said to have a ‘fantastic memory’, is it for remembering names, or for recalling faces? Is the same process at work when we recall facts and figures, as when we register a familiar aroma—the salty sea air, gum trees, a roast in the oven—and it triggers a burst of feelings and memories we thought we had forgotten? What about community memory, represented in things like commemorative stamps, statues and symbols, in oral history, and in language itself?
Memory is mediated by culture: in some societies much more value is assigned to, say, musical memory skills, visualisation or the ability to remember complex dance movements than in others. Memory is individual: some of us remember the feelings and sense of events rather than the specific details; others have strong recall for facts and figures and are great to have on your team in a trivia quiz! Memory teamwork can work well, with an excellent memory for names complementing a strength in recognition of people’s faces.
I’m not good at remembering jokes and trivia, but I can usually rely on my visual memory. This comes in handy when my children are rushing out the door saying, ‘Has anyone seen my shoes?’ I can often drum up a distinct memory of the shoes under the couch, where they were left the night before!
Maria, 44
My sister has a fantastic memory for facts and details. She is a lawyer and needs to be able to recall this type of information for her work. I’m different. I remember the feeling of things. I will go to a party, and forget what was said in the speeches or the name of the venue where the party was held, but I will remember the emotions that I felt whilst I was there and that it was a joyous occasion. I have always been like this.
Lucy, 62
Memory is, in fact, a very complex phenomenon: a whole book could be written outlining the current theories and debate about how memory works and its neurophysiological basis. The words that are used to describe various memory processes can be confusing, with terms like ‘short-term memory’ and ‘long-term memory’ meaning different things for different people. Without getting too technical, let’s run though a simple model of memory to clarify memory terminology and to help understand which parts of the ‘works’ could need special care and attention.
The starting point is to think of memory as a storage system. Storage facilities are all around us: the refrigerator, the pantry, wardrobes, computers, smartphones, libraries, even department stores. Of course, some systems are more streamlined than others—locating a particular item in a library is usually much easier than finding the thing you want in your junk room!—but the procedures for using them are the same. Think of your good old filing cabinet: you put your selected work-related documents, family budgeting information or recipes into labelled folders, you store them in the cabinet, and you get them out when you want them. In other words, you acquire information, you store information and you recall information. In principle, these same processes are also a part of memory.
Getting things you want to remember into the files (acquiring)
Temporary memory
So we have our filing cabinet ready to be filled up with more new memories. How do we get them in there? There are a few steps in this process.
First we pay attention to the information—we need to be awake and alert here—and it goes into a small temporary store, often referred to as working memory. You could think of this temporary memory as your in-tray, which you keep on top of your filing cabinet. The working memory system temporarily holds and processes small amounts of information. Later the information goes into more enduring storage.
When temporary memory is used to repeat information for immediate use, this is how it works:
• You do not process or manipulate the information that goes into it. The information gets in and sits in your in-tray without being checked over or organised in any way.
• It can only hold a small amount of information at one time. Your in-tray is small and has a very limited capacity. It can hold five to eight items at one time.
• The next information that you put into this temporary store will wipe out what was in it before. Each time new items are placed in your in-tray, the previous items are moved ou
t to make more room.
Now, have a go at using this temporary memory process so that you can test out what we’re talking about.
Read the following telephone number slowly. When you have finished reading it, stop, and say the telephone number to yourself: 9412 5738.
Now, here’s some more information to put into your in-tray. You are at a meeting and someone introduces himself to you. He says, ‘Hi, I’m Anton Pillay.’ Now repeat the name to yourself.
After you put the name ‘Anton Pillay’ into your in-tray, you probably found it hard to remember the phone number that you’ve just repeated. If so, it was moved out, to make more room. This type of memory is good for remembering a phone number long enough to dial it, but doesn’t last long enough for you to dial the same number again half an hour later (or even five minutes later!).
Enduring memory
Let’s say that you want to save that phone number for later use, but you don’t have a pen and paper handy to write it down or your phone at hand to type it straight in. Or perhaps you want to remember Anton Pillay’s name because you are likely to meet him again. To remember these bits of information later, you will have to move them from your in-tray into more durable storage, inside your filing cabinet.
To make the information more durable you will have to process or manipulate it in some way. These manipulations can happen without you being aware of it, but more often you do them intentionally. For example, you might repeat a number a few times or divide it into two or more sections to be remembered separately; you might repeat a name a few times, concentrate on its spelling or think how it is similar to the name of a person that you know very well. People sometimes use quite complex reminders which have personal significance.
I will always remember the phone number for our local take-away pizza shop. The first digits are the local dialling code, and the last four digits are 1956, the year that the Olympics were in my home town—Melbourne!
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