News at NCH
"How to Assess and Improve Your Memory" by Allen Weiss, MD, MBA, President & CEO


How to Assess and Improve Your Memory


April 1, 2012 - Ever had a “senior moment”—even if you’re not a senior?  Ever forgotten where you parked your car, after you hurried to park or got distracted by something else?  Ever have a word or name on the tip of your tongue—but not have the thought develop until later when you were relaxed, which was too late to use it?

Relax.  You are not alone, according to Naples Psychologist Dr. Bill Beckwith.  I heard Dr. Beckwith lecture recently to a group of very interested and healthy folks who immediately empathized but didn’t want to acknowledge their fear of being labeled as “losing it.”  All these behaviors are normal.  We have so much going on in our brains that it is surprising that more doesn’t go “missing.”  

Our brains start shrinking at about age 20.  That was not a problem when the average life expectancy was half of our current 80+ years.  (Collier County has the longest life expectancy for women and second longest for men in the country.)  Add to that longevity the huge amount of knowledge available and the constantly-increasing the speed of communication, and you’ve got a snapshot of a mentally stressful environment.  

The structure of the aging brain includes neurofibular tangles and amyloid plaques—both of which are associated with aging and dysfunction.  Some other diseases of the brain are characterized by an excess of these anatomical changes, but not all degeneration of the brain is caused by either tangles or plaques.  The bottom line, structurally, is there are many different causes for decreased memory—some of which can be observed and others that don’t change the appearance of the brain.  

Forgetting is a normal physiological process characterized by reduced memory efficiency, different defects in memory, and other causes—but all having the common outcome of decreased mental agility.  

Long-term memory is a “use it or lose it” skill which is the sum of knowledge, habits, skills, personal history, and self-confidence.  The more we use our brain for learning, the better.  

Short-term memory is a specific process anchored in the base of the brain called the hippocampus.  Unfortunately, this area of the brain cannot be exercised and is often the most obvious functional defect as we age.  Losing the ability to learn new names, decreased creativity, and not remembering recent pleasurable activities are all symptoms of short-term memory loss.  

What helps mental functioning?  Exercise, good diet, and social involvement—which also impact our general health.  Learning another language as an adult is an excellent way to keep the brain sharp.  People who are involved, volunteer, and are optimistic in general do better than those folks who isolate themselves, become selfish, and are pessimistic.  

Good mental hygiene in the geriatric age group (or for anyone who is concerned about his or her thought process) starts early with a memory evaluation.  This can be reassuring, even though initiating the process can be daunting.  Who wants to know how they are doing if they already seem OK?  Who really understands how they are doing if they have a problem?  Obtaining a real memory evaluation is as smart as any other screening tests recommended today (such as a colonoscopy every 10 years if there are not risk factors).

Recent studies by psychometrists (scientists who are concerned with psychological metrics) show that a simple 21-question screening quiz can help predict the difference between normal aging memory loss and “amnesic mild cognitive impairment,” a condition that can be an early stage of progressive memory problems such as Alzheimer’s disease.

People with amnesic mild cognitive impairment often realize they are having new problems such as balancing the check book, having trouble knowing the date or time or getting lost.  Understanding if there is a problem early on will help with planning, treatment and ultimately the prognosis for the individual and their supporters.  

The 21 questions are designed to be easy to administer in a primary care setting.  They include recall after 20 minutes of 15 words read aloud five times.  The more words recalled, the better.  A short fictional story is read to the person being assessed and after a 20-minute delay the examinee is asked to repeat as much of the story as he can.  Connecting lines in a logical manner based on a specific instruction is another part of the assessment which is combined with a similar test connecting numbers and letters.  

Other assessment exercises include being asked to name as many animals as possible in a minute; naming words which start with a common letter; recalling words printed in different colors; and matching line length and angles of two lines.

The questions include six which are “double weighted” because they are known to be predictive of clinical Alzheimer’s disease.  Although the tests are clearly not perfect, scores above 15 predicted Alzheimer’s disease; five to 15 were consistent with mild impairment; and below four, normal function.  

Quickly and easily identifying where we are on the scale of getting older—normal and benign vs. serious and progressive—is beneficial to all.  If you have a problem, you can make plans while you still have the ability to make good decisions.  If you have nothing more than normal aging behavior, then relax and keep active by contributing to society.  

None of us want to “lose our minds.”  Spending more time and effort early on, directed to getting an accurate assessment, is an excellent investment.  The folks around us who pay attention and care for themselves will do better than those who ignore a problem until it is too late to learn coping skills for decreased short term memory.  

One thing we should all remember: Practice good habits and keep mentally fit.  No time like the present to start.



 
Past Health Advice Articles

Dr. Allen Weiss is CEO & President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.