Health (menopause, sleep, depression)
Many women notice changes in their memory around the time of menopause, and the following chapter covers this topic in detail. While some studies have reported subtle changes in some aspects of memory during menopause, research has not revealed consistent evidence of significant memory loss directly related to menopause.7
Voula described difficulties with sleep over the past year, and disrupted sleep patterns are common during menopause and also with depression. During menopause, hot flushes and night-time sweats can interrupt sleep. With depression, it is common to have difficulty falling asleep and difficulty staying asleep. It is possible that Voula’s sleep difficulties are contributing to her memory difficulties.
The importance of sleep for memory function has been highlighted in recent research.8 Sleep has been shown to be crucial both before and after learning new information. Good-quality sleep is required to enhance the memory system’s processing of incoming information, and also to promote the formation of memories during sleep. Performance on tasks that involve attention and new learning has been shown to be affected by poor sleep. Sleep loss also leads to slower speed in thinking processes. Research has demonstrated that significant sleep loss can lead to changes in areas of the brain that are important to attention and memory, and that when sleep patterns are restored to normal, there is improvement in memory function.9
Voula could seek advice from her doctor for improving her sleep. In addition, she could see a psychologist to work on personalised strategies.
Strategies to enhance sleep include:
• going to bed at the same time each night, and rising at the same time each morning
• limiting day-time naps to 15–20 minutes
• exercising each day, keeping more energetic workouts for the mornings and more relaxing exercise for the evenings
• limiting caffeine intake, and not drinking too many liquids in the evening, including alcohol
• avoiding big meals at night, especially spicy and sugary foods
• avoiding television, computer, tablet and phone screens close to bedtime
• establishing a calming routine before bed, and doing something relaxing.
If Voula finds herself waking during the night and worrying about something, she should make a note of it, and tell herself she can deal with it in the morning. She should then distract herself by doing something mundane, like counting or muscle relaxation.
As well as her difficulty sleeping, Voula describes other symptoms of depression. She has felt unhappy since her mother died several months ago, and she describes a lack of enthusiasm and initiative, with not much to look forward to. Her self-esteem appears low, and she calls herself ‘boring’. She is constantly tired, her appetite has lessened, and she says she has trouble concentrating and making decisions. Voula’s negative feelings have started to have an effect on her life. For example, she is less likely to socialise now. Since these symptoms have persisted for more than two weeks, it is likely that she has depression.
People who have depression often remark that their memory is poor. Of course, not all people with depression experience memory difficulties. When they do, it is usually only some aspects of memory that are problematic. When people are depressed they are usually less motivated than usual and can feel ambivalent about things that would usually interest them. This can make it difficult to learn new things, as they find it hard to focus and concentrate on new information. This can, of course, affect their ability to get new information into memory storage—the initial acquisition phase. Problems with paying attention can lead to inefficient processing of incoming information. This may explain why Voula forgot what her daughter said to her about being home for dinner, and why she forgot where she put her phone and the name of her new neighbour. Effortful memory processes, such as prospective memory, which involve remembering to remember something, can also be difficult when someone has depression. An example of this for Voula was when she forgot to call her father’s accountant at a specific time. Researchers examining memory and depression have described these difficulties as memory problems associated with symptoms of depression, such as reduced motivation and inattention. Studies have also suggested that depression can affect parts of the brain that are important to memory, which can further compound memory issues during depression.10
If feelings of unhappiness make it difficult to function in everyday life, and these feelings persist for more than two weeks, it is important to seek medical advice. Treatment for depression can involve both medication and psychological care, and different types of depression need different approaches. With appropriate treatment, many people notice that their memory improves, along with their mood.
Lifestyle (overload)
Voula sounds exhausted. She is not sleeping well, and her days are full of family commitments. She seems to spend all of her time doing things for others—her father, her husband and her children—with little time to rest and take care of herself. Being so busy and tired would not be helping Voula’s memory.
Attitude (hopelessness)
Voula says, ‘My memory is hopeless.’ Every time she has a memory lapse, she uses that experience to strengthen her theory that her memory is hopeless. She blames the problem on menopause, and has given up on seeking ways to help her memory. With this attitude, her memory is not likely to get any better. She seems to think that she has no direct control over how well her memory can be made to work for her.
Voula could be encouraged to develop more realistic expectations of her memory. It would help if she was more patient with herself. When she forgets something, she could stay calm and say to herself, ‘There is a reason why I forgot that—I’m tired, overwhelmed and feeling flat’, rather than, ‘I am hopeless.’ The way we react to our memory lapses is important. We need to be kind to ourselves when we are experiencing difficult times in our lives.
We don’t need to remember everything, but for those important things that we do want to recall, we can use simple strategies to make us feel more confident in our memory. Voula mentioned that she keeps losing her phone. This is a common lapse related to not paying attention. Voula most likely puts her phone down while she is distracted and thinking about something else. There are several strategies that could help Voula be more mindful and pay more attention. When Voula puts her phone down, she could say in her head, or out loud: ‘I am putting my phone on the kitchen bench.’ She could make an effort to always put her phone in the same spot in her house or her handbag. To be totally confident that she will be able to find her phone, she could attach a location tracking device to it. Having a brightly coloured phone case could also help. Chapter 6 provides more information about useful everyday memory strategies to enhance confidence in remembering.
Voula would benefit from:
• acknowledging that there are some aspects of her life that she has the potential to control; if she works on these, she may find her memory improves
• seeing her doctor to talk about menopause, sleep and depression; this may involve referral to a psychiatrist and a psychologist for further treatment and support
• creating some time for herself by asking her brothers to help care for their father
• asking her husband and adult children to help out with household jobs such as cooking and cleaning
• making time for 30 minutes of moderate physical activity a day
• allowing time each day to do a small, simple activity that brings joy, such as a short walk in a natural setting outdoors
• being patient with herself and developing realistic expectations of her memory during this overwhelming time of her life
• using memory strategies as a ‘back-up system’ to get around her current difficulty with concentration and attention, which will also combat her feeling of ‘hopelessness’, and show her that she can and already does remember many things; Chapter 6 describes a variety of specific memory strategies.
STORY
4 Gordon, 64
‘I thought his memory would get better after the stroke, but lately it has started to get worse.’
My husband, Gordon, had a mild stroke three years ago, just after he retired from his work as a builder. Ever since, he has had a slight problem with his memory. The specialists at the rehabilitation centre told us that this was due to the memory areas of the brain being affected in a mild way by his stroke.
He’s okay when it comes to remembering things from the past. It’s just remembering more recent things that he has trouble with. It has been a very subtle change, so not many other people outside the family have noticed.
Over the last three months, I’ve noticed that the problem with his memory has gradually got worse. When I say this to him, he says, ‘It’s from the stroke, and there’s nothing I can do about it.’ Unfortunately the stroke seems to have left him with that ‘resigned to my fate’ attitude. He is quite apathetic. The doctors told me that people’s personalities can change in this way after a stroke.
We moved into a smaller unit about three months ago. The house that Gordon built for us as a family was getting too much for us to manage. The garden was large, and we just couldn’t keep it to the standard we wanted. It was sad to leave the house that we had been in since we were married, but we just had to be practical.
A few months ago he had trouble with his throat—needing to clear it all the time and feeling an ache in his neck muscles, yet he didn’t have a cold. A specialist thought his throat muscles were in strain and put him on Valium, to relax the muscles. It seems to be helping with the muscular problem, but I wonder if it has any side-effects on his memory? He seems to be less able to concentrate.
Lately, I’ve noticed that Gordon is asking me to repeat what I say to him quite often. I’m sure his hearing has got worse. When I think about it, it’s usually things people tell him that he forgets. He also often asks me to tell him where things are around the unit. Now that we’re in a smaller place, we’ve had to change where we keep most of our things.
I’ll have to do something about this. The specialists told me he would get better with time, not worse.
Lilian
Gordon’s wife has reason to feel concerned. He does have a real brain injury and a consequent memory problem due to the stroke, but the changes Lilian has observed in Gordon over the last three months are likely to be related to additional factors unrelated to his stroke. If Gordon and Lilian can be helped to identify and address these complicating factors, they will be likely to notice a positive effect on Gordon’s memory.
Health (brain injury, grief, hearing impairment, side-effects of medication)
Gordon has been told that he sustained mild damage to the brain from his stroke, particularly in the areas that are needed for some aspects of memory function. The stroke has most likely caused limitations in his ability to get new information into storage, and to be able to recall it later.
There are many other causes of change to the memory areas of the brain, apart from strokes. For example, serious head injuries, particular brain tumours, and certain forms of epilepsy can alter our ability to remember. Major operations can also sometimes affect memory function. We will discuss memory loss related to dementia and Alzheimer’s disease in Chapter 8. With any known brain condition, it is important to check continually for health, lifestyle and attitude factors that could be making the memory problem worse than it is.
Lilian also mentioned that Gordon’s personality changed after the stroke. He became more apathetic. A lack of motivation, no matter what the cause, can affect remembering in a negative way. If you are not motivated to remember something, you are less likely to get it into your memory filing cabinet.
Gordon may have some grief issues, which are not obvious to his wife. He has suffered some real losses due to his stroke. He has also recently retired and moved from the house that he built when he and Lilian married. His retirement and the house move could be additional major losses for Gordon. Grief and adjustment to loss can affect people’s ability to concentrate and pay attention, which in turn make it difficult to learn new information.
Gordon’s hearing may be another factor that is affecting his ability to get new information into storage. If you don’t hear something, then that information will not go into your temporary memory storage for processing—which means it will not get into your more enduring storage files. It is important to be aware of the effect of sensory loss on memory. Our senses of hearing, vision, smell, touch and taste are important to the processes of remembering.
When hearing is a problem, the following may help.
• Face the person when you are talking. Have enough light so that they can see your face, and do not cover your mouth when speaking. Avoid talking to the person from another room.
• Remove yourself to a quiet area to reduce the distraction of background noise. In a social situation, a one-to-one conversation away from the noise of the group may be easier than a group conversation.
• Keep your information short and simple, and allow pauses between pieces of information for the listener to process what is heard.
• Avoid shouting, as this can distort the sounds further, and confuse the listener. Raise your voice a little and speak more slowly.
• Check that the person has heard you and understood. Ask the listener for feedback: ‘Does that make sense?’ or ‘Was I clear in what I said?’
• Have hearing assessed regularly, as hearing acuity can change, especially with age or illness.
• If hearing aids have been recommended, ensure they are working properly and are being worn.
It is worth checking any medications that are being taken for their possible side-effects on memory. Valium (diazepam) is a commonly used drug that can have a negative effect on remembering.11
Lifestyle (unfamiliar environment)
Gordon’s memory started to get worse at about the same time as he and his wife moved into their new unit. Being in a new or unfamiliar environment can make remembering more difficult, especially for people who have had a brain injury, such as a stroke. When you move house, there is so much that is new to you. Learning where everything is kept can be a major undertaking, particularly when you have lived in your previous house for a very long time. People with memory difficulties can experience a similar sense of stress on their memory with any change of routine or new environment, such as moving home, going away on holiday or being admitted to hospital.
Attitude
Lilian has noticed that Gordon is not wanting to work on improving his situation, but rather blames all his problems on his stroke, and says, ‘There’s nothing I can do about it.’ While he holds a non-motivated attitude, he will probably not actively seek out any advice. It may be that Lilian will have to be the one who instigates change.
Lilian will benefit from discussing her feelings and attitudes towards Gordon with an experienced counsellor. This could help her to understand the changes she has noticed in Gordon. She may not have realised the extra load that moving house was going to place on Gordon’s memory, or the possible effect of his feelings of grief and loss on his motivation levels. She could work with the counsellor on introducing practical memory strategies to support the changes she has observed in Gordon’s everyday memory ability.
For example, she could set up a written reminder system on a wall calendar, so that she can reinforce what she tells Gordon by having it written down for him as well. She might also like to put labels in the cupboards and other storage areas to help Gordon get to know where items are stored in the new unit.
Lilian could also encourage Gordon to:
• see his doctor to check if any medical complications are making his memory worse, including possible grief and mood issues
• ask his doctor about possible side-effects of Valium (diazepam) on his memory
• arrange to have his hearing checked, to see if he would benefit from a hearing aid
• take part in regular activit
ies, such as attending the local ‘Men’s Shed’ group, or joining the bowls or golf club with friends.
See Chapters 6 and 9 for further information about supporting someone who has memory loss.
Possible reasons for memory change
The stories in this chapter have highlighted several reasons why our memory may not always function at its best. Take the time now to run through the following checklist, and mentally note any factors that might be having an adverse effect on your memory at the moment.
• Are you unwell?
• Are you taking any medication and, if so, do you know if it can affect your memory?
• Do you drink too much alcohol, or use other drugs to excess?
• Is your hearing or vision impaired in any way?
• Do you have pain?
• Are you eating and exercising well?
• Could your hormone levels be altered at the moment?
• Do you think you might be depressed, or do you often feel ‘down in the dumps’?
• Are you experiencing a high level of anxiety, fear or distress?
• Is your sleep disturbed?
• Is your workload too heavy?
• Is your current level of mental stimulation adequate for you?
• Do you have low expectations about how your memory will work for you?
To get the most out of your memory, you might need to take action. You may need to change your thoughts about yourself and your memory. Having realistic rather than negative expectations about memory functioning can help you be more relaxed about it. A change in what you think and what you say to yourself can actually enhance your memory.
Many factors can reduce your capacity to attend to what is going on around you. It may be this reduction in attention that is having an effect on your memory at the moment. You may need to find ways to increase your attention to what you want to get into your memory storage.
Memory-wise Page 5
