Health: I've lost my keys... I'm going mad

Memory loss amounts to the failure of a fallible filing system - but it can often be easily fixed.
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The Independent Culture
Increased forgetfulness as the years go by is disturbing, partly because it is easy to panic and imagine the symptoms are a sign of something more serious. Medical experts, however, are reassuring about the problem. "People worry about it far more than necessary," says Dr Christopher Martyn, of the MRC Environmental Epidemiology Unit, Southampton. "They think their memory lapses are pathological, when they are quite normal."

To improve your memory, it is important to analyse why you forget things. Memory consists of three functions: registering new information, filing it away, and retrieving it. Your memory can fail because of weaknesses in any or all of these functions and, in some cases, the condition is eminently treatable.

If you are not registering new information properly, it could be because you are anxious or depressed. "When you have a patient who might be demented, the first thing to ask yourself is, is this person depressed?" says Dr Martyn, who works part-time as a consultant neurologist at Southampton General Hospital. "Depression is as common as dementia in older people and can be treated."

In a pamphlet called Memory and Dementia produced by the Royal College of Psychiatrists, doctors provide helpful hints about taking things in. "You can't remember what you never heard or saw in the first place. So you need to keep yourself alert and make yourself notice the things that you need to. For instance, you may find it helpful to repeat the name of a person you have just met," it says.

Memory is all about paying attention, which can be a problem for people with short concentration spans. They can also suffer from what psychologists term "information overload" where they simply have too much information to process and file away. Some may fail to take things in because of alcohol, tranquillisers, chronic pain and head injuries, all of which can also affect retrieval.

Certain medical conditions also affect memory. An underactive thyroid gland slows down the whole body - including the brain - severe heart or lung disease starves the brain of oxygen, and both high and low levels of blood sugar in diabetes interfere with the way the brain works.

But by far the most common reason for memory loss is the normal process of ageing, which makes it harder for us to retrieve the information that we want from our filing systems. The best way to deal with it, says Dr Martyn, is to cheat: "Sometimes people confront these problems head on, instead of thinking of ways round the problem. The easiest way to deal with memory loss is to outflank it. If you cannot remember what you should be doing, for example, keep a diary."

Dr Martyn's booklet, Forgetfulness and Dementia (Family Doctor series) has a dozen different tips on how to sidestep the problem, from always keeping a notebook with you for writing down tasks, to labelling cupboards and drawers, and deciding on a particular place for articles that you frequently lose.

Unfortunately, there is no evidence to suggest that if you constantly exercise your brain with games and puzzles, it keeps your brain alert in every area. It will help you to remain good at the particular game or puzzle that you do, but it will not keep you as capable of learning a new language or musical instrument as you were when you were 30.

Patrick Rabbitt, professor of cognitive gerontology at the University of Manchester, has carried out extensive research in this area and claims that it is not all bad news. "We got two groups of people together, one group in their early 80s and the other in their 50s, who were equally fast in doing cryptic crosswords and compared them in various ways," he says. Although they were equally good at crosswords, the older group did not perform nearly as well in intelligence tests. "What we seem to have found is that, if you go on practising some particular skill, you can maintain your competence in that skill into old age, but it does not seem to generalise to other areas.

"The good news was that the rate at which the two groups improved with practice was comparable. Both groups improved enormously over 36 weeks and the difference between a practised elderly person and an unpractised younger person was enormous."

But although doing endless mental puzzles does not keep your brain in all-round tip-top condition, there are certain things you can do to try to keep your memory as good as possible. "Unfortunately, they are all the usual boring things, like keeping your weight down, taking regular exercise, not smoking and only drinking homeopathic amounts of alcohol," Professor Rabbit says.

Alzheimer's disease,however, is a different prospect. There appears to be little you can do to prevent it and the strong genetic component means that certain people seem destined to develop it. The only consolation is that it is still comparatively rare. One in five people over 80 suffers from dementia (of which Alzheimer's is the commonest cause), but that still means four out of five do not.

Professor Howard Jacobs, of the endocrinology department at Middlesex Hospital, says: "There is some evidence that taking hormone replacement therapy may delay the onset of Alzheimer's disease - four out of five recent studies showed it to be useful - but it is too early to recommend it as a proven preventive measure."

The disease can usually be distinguished from normal age- associated memory impairment (AAMI) because it is often accompanied by changes in personality (the victim becoming irritable, withdrawn, rude, scruffy, idle or suspicious) and by difficulty with skills learnt early in life, such as dressing and using a knife and fork.

Despite investing a huge amount of money in Alzheimer's research, the pharmaceutical industry has yet to find a cure. The new drug, Aricept, for example, which was launched in Britain last year, is only of limited use. The herb industry and the supplement manufacturers are making dramatic claims for the ginkgo leaf, but large-scale studies are still needed.

So if an elderly relative seems to be developing really serious memory loss and personality changes, the best course of action is to have them thoroughly investigated to rule out other causes, such as the presence of tumours, stroke or blood clots, some of which can be treated.

If your relative definitely has Alzheimer's, there are one or two practical techniques that can help, such as keeping them in familiar surroundings and practising "reality orientation", in which the helper constantly tells the sufferer the day, date, time and what is happening. According to the Royal College of Psychiatrists, "it is a bit tedious but, up to a point, it works".

Of course, there are certain advantages in not remembering everything. The philosopher Friedrich Nietzsche said that it meant he could enjoy many things over and over again, as if for the first time. Dr Christopher Martyn also says forgetting is a useful process to stop the brain getting too cluttered: "Your brain stores what it considers important and discards what it thinks is trivial."

`Memory and Dementia', available free (with an SAE) from Royal College of Psychiatrists, 17 Belgrave Square, London SW1X 8PG.

How Reliable

is Your Memory?

Circle the number (1-4)

1=Never or hardly ever (a few times a year or less)

2=Occasionally (a few times each month)

3=Often (a few times a week)

4=Very frequently (every day)

How often do you find yourself ...

1. Forgetting where you have put something around the house?

1 2 3 4

2. Failing to recognise places that you are told you have often been to before?

1 2 3 4

3. Having to go back to check whether you have done something that you meant to do?

1 2 3 4

4. Forgetting to take something with you when you go out?

1 2 3 4

5. Forgetting that you were told something yesterday or a few days ago, and maybe having to be reminded about it?

1 2 3 4

6. Failing to recognise, by sight, close relatives or friends that you meet frequently?

1 2 3 4

7. When reading a newspaper or magazine being unable to follow the thread of a story; losing track of what it is about?

1 2 3 4

8. Forgetting to tell somebody something important. Perhaps forgetting to pass on a message or remind someone of something?

1 2 3 4

9. Forgetting important details about yourself - for example, your date of birth or where you live?

1 2 3 4

10. Getting the details of what someone has told you mixed up and confused?

1 2 3 4

11. Forgetting where things are normally kept or looking for them in the wrong place?

1 2 3 4

12. Getting lost or turning in the wrong direction on a journey, a walk, or in a building where you have often been before?

1 2 3 4

13. Doing some routine thing twice by mistake. For example, putting two lots of tea in the teapot or going to brush your hair when you have just done so?

1 2 3 4

14. Repeating to someone what you have just told them or asking them the same question twice?

1 2 3 4

Score:

14-19 Your memory is excellent.

20-29 Your memory is average but you might find advice on memory aids useful.

30-39 Your memory is below average. This may simply mean that you lead a very busy life.

40-56 Your memory is very poor. Frequent memory lapses are likely to have a serious effect on the way you cope with daily life. There may be several reasons for this, but it would be sensible to discuss it with your GP.

Taken from: `Understanding Forgetfulness and Dementia' by Dr CN Martyn and Catharine Gale, Family Doctor series, pounds 2.49.

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