Memory-wise

by Anne Unkenstein

  Why is it that I can remember things from my past in so much detail, but I can’t remember where I parked my car half an hour ago? It’s not just the car. For several months now I’ve noticed that I forget things. I’ll go into a room at home, and think, ‘What was I supposed to be doing?’, or I’ll be talking to someone, and lose the word that I want to say. I feel like I’m always forgetting where I put my reading glasses. I panic when I forget something—I’m scared that I’ve got early signs of Alzheimer’s. I feel so disorganised and stupid and I keep telling myself how bad my memory is.

  I find myself saying ‘no’ more and more when I’m asked to go out with friends and family. I’m worried that I’ll forget something in their company; it’s easier to just stay at home. I feel better doing things that I can still do well, like sewing my patchwork quilts and baking treats for the grandchildren. I’m going to have to get in the car again tomorrow though—I need to go to the doctor to get a script for medication for my back. I’ve had pain in my back for many years now, but the pain always seems worse when I worry more, and yesterday it felt overwhelming.

  Barbara’s situation is all too common. There are many factors that influence how her memory works for her.

  Age

  Barbara is 72, and she describes some of the changes in remembering that many older people experience. Barbara has trouble getting new things into memory storage, and getting stored information—like particular words—out quickly. She also says her memory for the past and for procedures like sewing and baking is okay. This pattern of strengths and inefficiencies in memory fits well with what is known about age-related memory change.

  Health (anxiety, chronic pain)

  Barbara describes feelings of worry and fear, and she notices her heart beating in her chest and her hands starting to shake when she panics. These are all common features of anxiety and panic. A sense of panic can also be accompanied by breathing difficulties, such as very rapid breathing or feeling breathless without exertion. Other anxiety symptoms include feeling restless, irritable and becoming easily tired. Muscular tension and problems with concentration and sleep are also common. Severe anxiety can have a negative effect on attention and memory.1 If feelings of anxiety, worry and/ or fear persist over several weeks and start to affect your ability to function, it is important to see your doctor to discuss appropriate treatment. This may involve referral to a psychiatrist or psychologist to work on ways to manage the symptoms of anxiety.

  Anxiety about memory loss can lead to an actual worsening of memory function, which can be thought of as a memory–anxiety spiral. Barbara is anxious about her memory, so she notices every time she has a memory lapse. Each time she ‘forgets’ something, it gives her more support for her theory about losing her memory due to early Alzheimer’s disease, so she gets more anxious; anxiety probably lowers her ability to concentrate and pay attention, so she seems to be getting more forgetful, and so more anxious.

  Barbara’s difficulty with remembering may be further exaggerated at the moment because of chronic pain in her back. When someone has constant pain, it often affects their ability to concentrate and pay attention. This may be directly related to the pain, but could also be due to possible side-effects of particular pain medications, or associated disturbance to sleep and/or mood. Barbara may not, in fact, be ‘forgetting’ information—it may not be getting into her memory storage in the first place, because she has not paid adequate attention to it.

  Attitude (negative expectation, poor self-confidence)

  Barbara has developed negative expectations about her memory. After some months of difficulty with remembering, she now does not expect to remember well, and says she feels ‘stupid’. She has little self-confidence when it comes to remembering, and subsequently little motivation to remember. She has started to avoid situations where she will have to use her memory. She withdraws from social interactions, and spends more time alone at home. She now believes that her memory is poor. Sometimes, people’s beliefs about themselves can become self-fulfilling prophecies. ‘I think therefore I am’ is a well-known quote, and applied to memory, it could be rephrased as, ‘I think I will forget, so I do forget.’

  Researchers have shown that whether we assess ourselves as competent, or not, is one of the most important aspects of memory functioning in older adults. Feeling under-confident about memory can lead to a worsening in performance on memory tests.2 If you doubt your memory ability, you most likely tend to avoid situations where you will need to use your memory. You can then easily lose confidence and make your memory worse than it actually is. You don’t lack ability—you lack self-confidence in using it!

  If Barbara continues to believe that she does not have a good memory, then she will feel her memory is worse than it actually is. It won’t help her to ‘catastrophise’ and tell herself that she is ‘always forgetting’ things and that her memory is bad.

  Lifestyle (social connections, supportive memory strategies, new learning activities)

  Barbara has been less likely to socialise with friends and family recently, but maintaining her social connections could help her to feel more positive about herself and her capabilities. Feeling good about oneself is definitely a good thing for memory function. When Barbara values herself, she will achieve a personal affirmation of her ability.

  If Barbara uses specific strategies to support her memory, she may feel more confident about attending social activities. She can use reminder notes to remember the details of any upcoming events, such as the time and date, location, directions for how to get there and things she needs to take with her. See Chapter 6 for more information about everyday memory strategies.

  Barbara says she has been spending most of her time doing familiar activities such as baking and sewing. She has been avoiding doing anything that might lead to a memory failure, which means she is less likely to challenge herself with new experiences. Researchers have shown that if we take part in activities that involve new learning, changes can occur in parts of the brain that support the learning process.3 In addition, when we experience success with learning something new, we often start to feel more confident about our memory.

  Barbara could introduce some social activities into her routine that involve new learning, such as asking an older grandchild to teach her how to use a new phone app or learning a new craft technique with a group of friends. These activities would provide the benefits of both socialising and mental stimulation. Of course, Barbara could still complete many pastimes that involve new learning on her own, such as listening to a complex discussion on the radio, or mastering a new cooking technique.

  Barbara will need to work out how she can fit these activities into her life. It will be best if she spends time on new activities when her back pain is manageable and she feels most energised and less anxious. She may need to make a conscious effort to reduce any possible distractions when learning new information, and work in short bursts with regular relaxation breaks.

  Barbara would benefit from:

  • knowing about expected memory changes that can occur with normal ageing

  • receiving reassurance that in her case she does not have the type of memory difficulties that are suggestive of the early stages of Alzheimer’s disease (see Chapter 8)

  • identifying some of the factors that she can control which may be exaggerating her memory problem at the moment

  • discussing her feelings of anxiety and panic with her doctor; this may lead to referral to a psychiatrist or psychologist for further assessment and treatment

  • identifying and using appropriate pain management strategies, with assistance from her doctor and possible referral to a multi-disciplinary pain clinic, where she could see specialists in pain medicine and other health professionals including psychologists and physiotherapists

  • staying socially connected

  • taking part in regular new learning activities.

  STORY 2 Martin, 41

  ‘I feel like I’
m in a fog and I can’t remember information when I need it.’

  After our son was born, we bought a bigger house and over-extended ourselves financially. It was getting harder and harder to find the money for the mortgage, so a few months ago I took on a new role at work with better pay. I expected the job to be demanding, but I didn’t realise how overwhelmed and tired I would feel. I’m now working 12-hour days and I often do work at home in the evenings or on the weekend. I’m working on several new challenging projects. I have to learn new work procedures and I’m meeting new people each week. I keep forgetting the names of my work colleagues, even though I’ve been told their names several times. Information just doesn’t seem to get in and I start to panic. I used to be able to remember things that we discussed in team meetings without taking notes, but now my head feels heavy and I get distracted easily. I’ve forgotten what my manager has asked me to do twice now. I feel like I’m in a fog and I can’t recall information when I need it.

  My memory is unreliable at home, too. Last week I forgot to go to my son’s music concert at school. I felt so bad and he was so upset. My family life is suffering and so is my relationship with my wife. I’m hardly ever home for dinner—instead I grab take-away food and eat it in the car on the way home. My wife goes to bed before me, and I end up hitting the alcohol pretty hard at night. I feel so ‘on edge’ all the time I drink alcohol to help me unwind. My wife complains that she hardly ever sees me now. I’m missing seeing friends and exercising too. I used to train at the gym three times a week and ride my bike with some mates on Sunday mornings, but that all stopped when I started the new job. This lack of exercise is getting to me, because I know that when I’m fit, my energy levels are better, and I get less tired.

  Many people in Martin’s situation would begin to notice that their memory is not as reliable as it usually is. There are several aspects of Martin’s life that he can alter if he wants to get more out of his memory.

  Lifestyle (stress, workload, fatigue, relationship problems)

  Martin has noticed significant changes in his memory since he started his new job. His heavy workload seems to be leading to stress and fatigue. Prolonged stress and elevations in stress hormones have been shown to have an adverse effect on memory performance.4 Everyday memory lapses are often related to doing too much, especially doing too many things at once. Add exhaustion and stress to this, and you’ve got a pretty mean combination as far as memory goes! This combination could have a direct effect on Martin’s ability to concentrate and pay attention. He has probably not ‘forgotten’ his work colleagues’ names or that he was meant to go to his son’s school concert—he probably never got these bits of information into his memory filing cabinet in the first place, because he wasn’t paying attention to them at the time.

  Martin is concerned about his relationship with his wife. This concern could also be reducing his ability to concentrate. The stress of relationship difficulties can often occupy our minds, and mean that it is difficult to take new information in.

  Health (physical exercise, diet, alcohol)

  The healthier you are, the better your memory will function. Martin says that when he is physically fit and participating in regular exercise, his energy level improves. If his energy level is higher, then he may be able to handle his workload and social commitments more easily. Physical exercise has been shown to have a positive effect on stress, and also on anxiety and depression.5 With less stress and fatigue, Martin should be able to concentrate and pay attention to things around him more easily. Of course this will have a positive effect on his memory.

  At the moment, Martin is not getting any regular physical exercise. He has given up training at the gym and cycling because of work commitments. He also seems to have given up on the idea of healthy eating, which of course is critical to good health. His diet would certainly not be described as ‘balanced’.

  Martin will need to watch his alcohol consumption. The current Australian National Health and Medical Research Council (NHMRC) guidelines recommend that drinking no more than two standard drinks a day reduces the lifetime risk of harm from alcohol-related disease or injury. An additional recommendation is to consume no more than four standard drinks on a single occasion to reduce the risk of alcohol-related injury arising from that occasion. A ‘standard drink’ is defined as a drink containing 10 grams of alcohol—for example, a small glass of wine (100 ml), a 375 ml can of mid-strength beer, or a 30 ml nip of spirits.

  Our community is becoming increasingly aware of the effect of alcohol on health and on memory. It is now a legal requirement in Australia for the labels of all bottles, cans and casks of alcoholic drinks to state the approximate number of standard drinks they contain.

  If alcohol consumption regularly exceeds the NHMRC guidelines, it can cause damage to areas of the brain that are needed for memory function. The direct effect of alcohol on the memory processes of heavy drinkers may be compounded by nutritional deficiencies, psychiatric disorders, traumatic brain injury, vascular disease of the brain, cirrhosis of the liver, other diseases and other drug use. Research shows that there is potential for improvement in memory abilities when people who have been dependent on alcohol cease drinking alcohol.6

  Attitude (negative expectation and self-fulfilling prophecies)

  Martin appears to have given up on his memory. He now calls himself someone with an ‘unreliable’ memory. He is close to telling himself that it will always be so. If he expects to have memory lapses, then he might stop trying to remember, and so get into a self-perpetuating cycle.

  Martin would benefit from:

  • realising that his memory ability is largely in his control, and that he can take action

  • not labelling himself as someone whose memory is permanently ‘unreliable’, but rather as someone whose memory is being affected by the situation he is currently in

  • using memory strategies as a back-up system, so that he believes his memory will be reliable. If he doesn’t already use a reminder system, he would be well advised to start doing so. Whenever he is asked to attend a function or is directed to do something, he could add this information to his reminder system.

  Martin should also focus on reducing his stress at work, with good time management. If he can do this, his ability to concentrate and pay attention should improve, which could have a direct effect on his ability to remember. At work he will need to prioritise jobs, and work on one at a time. He will need to make a real effort to focus on the task at hand, not to let his mind wander on to other things, to reduce any obvious distractions, and if he is interrupted while doing something, to go back to it as soon as possible afterwards.

  Finally, Martin’s goals should include:

  • having regular relaxation breaks at work, even if they only last for 5 minutes

  • focusing on his health—improving his diet, limiting his alcohol intake, and making about 30 minutes of regular daily exercise part of his life

  • scheduling time with his wife and family

  • taking steps to discuss his relationship concerns with his wife, and working on the damaging conflicts that are emerging between them.

  STORY 3 Voula, 55

  ‘I just can’t concentrate … my memory is hopeless.’

  Since Mum died last year everything has changed for me. I’ve gone from working in a fantastic part-time job to spending most of my time making sure Dad is okay. I didn’t realise how much Mum did for him, and it’s so sad that we are now facing the reality of moving Dad into residential care.

  I feel like a part of me died when Mum died. The fun, happy Voula seems to have disappeared now. I don’t feel like doing anything anymore. I used to enjoy going to work, but I had to give that up to be there for Mum when she was sick, and now I’m visiting Dad a few times a day to help him with his meals and running the house. I don’t think I’ll be able to get back into working again. My two brothers have never really helped out when it comes to our parents, and someone has t
o be there for Dad.

  My sleep was already a problem before I lost Mum, and I was going through menopause. I kept waking up on and off during the night dripping with sweat from hot flushes. I used to be able to drop back off to sleep fairly easily then, but now I have trouble getting off to sleep, and when I wake up during the night I tend to lie awake for hours. I probably only get about three or four hours sleep a night now.

  I’m tired all the time, but I have to push myself to do things for the family. My husband works full time and my son and daughter are both studying at university and still living at home, as they can’t afford to move out yet. I feel like all I do is look after other people—cleaning, washing clothes, and cooking meals that I don’t even feel like eating. I’ve been trying to fill out all the paperwork for Dad’s move into the aged-care facility, but I just can’t concentrate when I try. I was meant to call Dad’s accountant yesterday morning, but I completely forgot. When I was at work, I was making important decisions every day, but deciding which care facility will be best for Dad is just too much for me at the moment.

  I’m having trouble keeping track of everyone’s movements. Yesterday my daughter snapped at me after I’d asked her for the third time whether she’d be home for dinner. My memory is hopeless and I wonder if this is related to menopause. I keep losing things. I go to use my phone, and I can’t find it. I’m having mental blanks and it’s like my mind won’t grab information. We have a new neighbour, and I keep forgetting her name. I’ve almost given up on trying to learn her name. If I see her in the street, I tend to avoid talking to her now. I wouldn’t have much to say to her anyway—I’m so boring these days.

  Voula wonders whether her memory problem is related to menopause. While it is possible that menopause may be contributing to her difficulties, there are other aspects of Voula’s current situation that are likely to be affecting her memory.