November 24, 2013

On Memory

How Memory Works

Having a good memory is not the same thing as having perfect teeth, nice eyes or great hair. Memory doesn’t exist in the same way body parts do. When neurologists speak of memory they refer to the act of remembering, a process that’s spread throughout various areas of the brain as opposed to being concentrated in one single location. And rather than something that happens all at once, memory is a fluid, multifaceted and ongoing brain activity. Whenever a specialist evaluates a patient’s memory I ask them to repeat and remember these three words: ball, tree, shoe. Asking the patient to repeat the three words evaluates what we refer to in neurology as “immediate recall.” The same distracts them briefly by asking a couple of unrelated questions, and then ask them to repeat the three items again, testing short-term memory.

Memory formation is a sequential operation where information processing moves from the present (immediate recall) into short-term memory and then into long-term memory. This exercise tests immediate recall and short-term memory. In order to remember something it first has to appear on your radar screen. If it doesn’t, it never registered and it can’t possibly be remembered. Someone with significant memory or attentional difficulties will be unable to repeat the words immediately after saying to them, while someone who can’t recall these words a few minutes later may have short-term memory issues.

Every day your short-term memory is filled with new facts, names, events, concepts and impressions. Most of these short-term memories are not that important and decay over time. For example, a doctor don’t expect his patients to remember the three words which was given to them when they come for their follow up visit several weeks later; this information isn’t important enough to store in their long-term memory. Besides, it can easily be tested on their long-term memory by asking them to name the last three
presidents of the United States or what happened on September 11, 2001.

So how does the brain retain memories? Information streams into your brain through the five senses (sight, sound, smell, taste and touch.) When we describe sensory information or streams, what it really mean is that of describing a flood. You couldn’t possibly attend to every bit of data that comes at you from the outside world, so your brain is forced to prioritize. Immediate recall has a small storage capacity. Experts have determined it can only hold about seven independent items at one time. This is one of the reasons information like local phone numbers and zip codes are seven digits or less. It’s too difficult to hold longer strings of numbers in your head for the amount of time it takes to press the buttons on your phone or write on an envelope. It’s also why breaking up numbers like phone numbers and social security numbers into separate and distinct chunks of data makes them easier to remember.

Information from immediate recall is only sent into short-term memory under certain circumstances. Unless you purposefully make an effort to remember something, you’ll only retain a memory if it’s an attention grabber — like a parade of clowns marching up Main Street — something that’s emotionally meaningful — picking up a loved one at the train station — or any piece of intel that is personally important to you — for example, a job interview is much less likely to slip your mind than a routine dental cleaning.

Memories become permanent keepsakes and enter long-term memory when they are truly learned, emotionally significant, personally meaningful or especially memorable. The brain attaches newer memories to similar and related memories to enable you to consolidate new concepts and facts with older memories. However, just because something has been stored in your memory, doesn’t mean you can necessarily access it immediately.

We’ve all experienced “tip of the tongue syndrome,” that maddening memory malfunction where you try to call up some word, name or fact and you can almost see the information but can’t quite grab it from your memory bank. In effect, you remember that you remember something — though you can’t actually remember what it is you’re trying to remember! This is a problem with retrieval — the process that allows you to bring stored memories into conscious awareness when needed. Because similar information is often stored together, cues can be helpful in triggering that elusive word or memory.

Memory Hitches and Glitches

Those little memory lapses we’re all prone to, like misplacing keys and forgetting names, can be quite irritating and frightening if you worry about Alzheimer’s disease.

Ordinarily though, these memory glitches are usually the result of memory inefficiencies rather than an underlying memory disorder. A memory misfire we can all relate to sometimes happens when you take a trip to the mall. After a couple of hours of shopping you head back to the parking lot — but where did you park the car? Are you parked in the row parallel to a telephone pole or was it near the third shopping cart return? Did you park in the blue section or the red section? If you draw a complete blank, one of two things has happened.

In the first place, you may not have encoded or stored the information. Perhaps your cell phone buzzed just as you pulled into your parking space and you were so engrossed in conversation on your way into the mall, the information about your car’s location never made it past your sensory filters into short-term memory. If you were extremely distracted, it may not have even have made it into immediate recall. Other times, there is simply nothing particularly memorable about where you parked your car for your brain to latch on to. In either case, you didn’t forget the information — because you never really learned it in the first place.

A second possibility is that you’re having trouble retrieving the memory about your parking spot. The information is in your head somewhere; you just can’t get to it. When this happens, you can try searching for clues by re-tracing your steps. If you were fortunate enough to encounter something out of the ordinary on your way into the mall, like some construction taking place, this will often serve as an effective memory trigger. Locate that construction area and bingo — you’re all set. At other times, for reasons that are hard to explain, the car’s location will suddenly just pop into your head. This may occur after a long delay despite the fact that you’ve racked your brain trying to remember where you parked.

Whatever the reason you find yourself wandering the mall parking lot in search of your vehicle, as a neurologist would look at it, it doesn’t get too concerning about these minor but frustrating retrieval issues. However, when important information frequently doesn’t come back or when there are more serious memory issues such as someone forgetting they even drove to the mall in the first place, a medical evaluation is recommended.

Legitimate Concerns about Memory

In most cases of dementia, it’s usually the power to form new memories that goes first. This is because the brain structures involved in short-term memory processing tend to be affected early on in the course of Alzheimer’s disease and other dementias. Long-term memories, the ones that have been
embedded more diffusely in the brain’s memory, often hang on the longest and are the last to go. It’s not until the later stages of the disease, and damage to the brain becomes more extensive, that long term memories are affected. This is why someone with dementia may not be able to remember what he had for breakfast that day (short-term memory) but can recall in detail the prank he played on his teacher when he was 12 years old (long-term memory).

This phenomenon can be confusing for some patients and their loved ones. Especially in the early stages of dementia, memory difficulties can be misinterpreted as wilful inconsideration. For example, someone with memory loss may not remember to pick up a quart of milk from the store as requested, yet remembers to buy the newspaper he’s bought daily for the past 10 years. It’s also why a person with advancing dementia can speak fluently about the past but can have difficulty focusing on the here and now.
So when are memory glitches a cause for concern? Here are some early warning signs to watch out for:

• Repeatedly asking the same question
• Forgetting common words or mixing them up with each other
• Getting lost while walking or driving around familiar places
• Trouble following rote tasks such as making the bed or tying shoes
• Misplacing items in inappropriate places, such as putting a wallet in the freezer
• Difficulty following directions
• Undergoing sudden changes in mood or behavior for no apparent reason

Check Up on Your Memory

The thought of losing our powers of memory is terrifying. Memory is the essence of who we are, the culmination of all our experiences and everything we’ve learned over a lifetime. Oftentimes, people assume that memory problems automatically mean a diagnosis of Alzheimer’s disease and they avoid seeking help out of fear. They will try to keep their struggles a secret or a well-intentioned loved one will help them compensate or cover for any deficits. Neither is a good idea. If you notice any issues with memory loss in yourself or a loved one it is urged that you see a doctor for a proper diagnosis and treatment.

It’s important for you to know that many factors affect our ability to remember and numerous medical conditions can impair memory. In other words, there are many treatable and reversible causes of memory loss. For example, depression, sleep disorders, thyroid dysfunction, stress, and medication side effects are common conditions that can masquerade as dementia. And as Kim Hackett shared in her story “B My Hero,” vitamin B12 deficiency can do it too. We also know that underlying heart, lung, liver and kidney disease can affect memory. With appropriate diagnosis and treatment, memory can be improved and in some instances returned to normal.

This is why it’s so important to see your doctor if you do have memory problems. You may well have a treatable condition. For those diagnosed with Alzheimer’s or other forms of dementia, proper medical care is essential to ensure that any contributing medical issues are addressed. In addition, optimal supportive care will allow them to be as functional as possible for as long as possible.

You can also take comfort in knowing that some mild memory loss as the years pass is perfectly normal and is part of natural aging. As you get older, you may have more difficulty recalling names or words. You’re likely to become prone to misplacing things or need to make more lists than you used to in order to stay organized. So long as these changes in memory are generally manageable and don’t disrupt the ability to work, live independently or maintain a social life I don’t usually get too worried about them.

Memory Tips You Won’t Forget

Can you recall the three words from above that were asked to the patients to remember? Most likely they were only fleetingly retained in your short-term memory. Because the words are commonplace and have no particular personal or emotional context for you, there is no reason for them to stick. On the other hand, if were asked you to envision the three words — ball, tree and shoe — using an effective memory technique, you would have no problem recalling them.

Envision the following scenario with as much detail and feeling as possible: Imagine you are holding an enormous rubber ball. It’s three times your size and you have to stretch your arms out as far as they can go. The rubber feels slippery against your fingers and you must hold on tight — really visualize this and notice the rubbery scent as it presses up to your nose. All of a sudden, a gnarly tree with spike-like roots descends from above and punctures the ball so that it makes a loud pop. Feel the air brushing against your face as the ball deflates and you now find yourself hugging the rough surface of the tree. You then look up to see thousands upon thousands of dazzling shoes dangling from the branches. Watch them as they twirl by their straps and laces.

If you really visualized the above scenario in your mind’s eye, there’s a good chance those words are now locked in your memory. This is a common memory technique known as the link system. But what if you forget the first word? That’s easy. All you need to do is link the first word to the task. In other words, imagine you’re sitting in my office when I ask you to remember the three words. Picture me placing the huge rubber ball in your lap — it’s so big you can’t even see someone and together, are having this ridiculous interaction on opposite sides of this enormous ball. And of course, you now know what happens next.

Once you get the hang of the link method, you can remember countless items sequentially. If the next word was “whipped cream” you could picture those thousands of dazzling shoes flying off the tree and flinging themselves into a huge bowl of whipped cream. What makes this memory technique effective is that you are painting completely absurd pictures in your mind’s eye. The more outlandish and unique you can make your mental picture, the more deeply it will be etched into your mind. This is because your brain is programmed to take notice and recollect things that are out of the ordinary.
As I previously mentioned, you tend to remember things that are personally meaningful, emotionally charged or particularly memorable. By converting ordinary objects into ridiculous, one-of-a-kind scenarios, you can make the mundane profoundly memorable. The key is to make the context absurd, exaggerate proportions, incorporate action and embellish with a variety of senses, including touch, taste, smell and sound. This may seem like a crazy way to commit information to memory, but it really works.

Of course there are other ways to enhance memory. Mnemonics, rhyming, loci methods, and reinforcing the information by writing it down on paper (or even in the air) all serve to strengthen retention. Repeating a piece of information to yourself such as the name of someone you just met at a party is a straightforward yet effective way to retain the information. Each time you repeat the name you are essentially resetting the clock on how long the data is held in your short-term memory. The more you repeat something the more “stable” the memory. One of the most tried and true ways to improve your memory is to simply use it. In the story, “Capital of Delaware,” Shawnelle Eliasen gives us a perfect example of this when she decides to test her memory along with her children. You probably don’t challenge your memory skills on a regular basis the way you may have when you were in school and you were asked to memorize reams of information for your studies. Remember having to recite poems, memorize historical facts and commit mathematical theorems to memory? Stephen Rogers reminds us of this in his story “Partly Cloudy Pancakes.” In the process, your memory skills got quite a workout. Many of us have stopped flexing our memory muscles, especially since we’ve ceded a good portion of our memory skills to electronic devices in this digital age. We no longer memorize phone numbers, addresses or driving directions.

The good news is that by challenging your memory, no matter what its current condition, you can make improvements. Like any other brain function, practice makes perfect. Using whatever memory method you choose, try to memorize your grocery list, an inspirational poem or the names of some people you just met. For a real memory booster, take a course that tests you on what you have learned.

Exams and quizzes require you to truly stretch your memory skills. Now that you understand why you can’t find your car in the parking lot, here’s what to do the next time it happens. Try roaming around aimlessly while randomly clicking your remote car lock.

Eventually you’ll hear a beep. It’s worked like a charm for us on numerous occasions!