Dr. Qaadri

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MEMORY
Alzheimer’s Disease
Upgrading Your Memory

By Dr. Shafiq Qaadri, MD

Memories are our soul's private collection, the store of experience and emotion, the defining element of our most personal selves. The modern world rewards a better memory, and many seek to enhance their recall. Others struggle to maintain their current memory, and are terrified of it fading away. Society itself is said to have a collective memory, and psychologists and scientists are researching techniques and medications to turbo-charge recollection. But can memory be improved?

"I wish I could install another hard drive in my brain," says a 43-year-old man who changed jobs and is undergoing skills-retraining. Unfortunately, for now, human memory can't be upgraded as easily as a computer's. And in our busy workaday world, there are so many things to remember: names, numbers, passwords, appointments, instructions, birthdays, directions. Where did you park your car? Did you shut the lights off? You didn't forget your anniversary again?

Certainly, some people are born with extraordinary gifts of recall. There are individuals, even whole families, with eidetic (photographic) memories: Such people can look at a painting or newspaper, close their eyes and retain a fully detailed image, with all its colour, nuance and text.

But most people are not so gifted, and many seek advice on bettering their recall. "Doc, isn't there some kind of memory pill you can give me?" asks a 25-year-old law student who is bewildered by her course load. While there are many products and programs that promise information mastery, social success and total recall, there is no ideal solution, despite the many marketing claims.

No single memory-enhancement approach will suffice, as there are many subsystems to memory: How well you learn information initially, how deeply you process it, will have an impact on how efficiently you can retrieve material later. Distractions, depression, alcohol and sleeping pills, for example, all dull concentration and interfere with learning. Fear and anxiety, on the other hand, are good memory-inducers, making certain life experiences difficult to forget.

"I can't bear the scent of cedar and pine," says a divorced woman whose husband informed her of his affair at their cottage. This is an example of cued recall, and smells -- whether of a lover's perfume or a favorite childhood meal -- also rivet memory, cutting through our filters and going straight into storage. The brain is hard-wired to respond to fragrances, and that's why particular odours are so transporting, something the cosmetics industry seeks to exploit.

Neuroscientists are still uncovering the unimaginable complexity of memory, and continue to map the anatomy of recollection. The brain is the original supercomputer, and its 100-billion nerve cells, which form trillions of interconnections, are the infrastructure of mind, the basis of the richness and texture of thought. When confronting the brain, even usually non-poetic scientists rhapsodize about its intricacy. Freud was so impressed by the cerebral cortex, the outer layer of the brain responsible for higher learning, he proclaimed, "Anatomy is destiny." To some extent, he may be right. Our attention-wiring can only handle about seven new items of information at once. Also, the brain stores different kinds of information in different sites: Memories of faces, numbers, skills, even first and second languages, reside in separate locations.

And functionality is distributed also: An injury to one part of the brain (say, Broca's speech area, about the size of a quarter, in the left hemisphere) prevents a person from speaking, yet they can still sing. Injury to the hippocampus -- a seahorse-shaped structure that is the brain's arrival's terminal -- prevents a person from forming new memories, yet long-held memories remain intact. With such labyrinthine complexity, no one memory-enhancement approach will work.

Nevertheless, there are several self-help books, Web sites and courses that teach memory-management skills. Chunking information into smaller bits is the most familiar, and makes a string of numbers such as 3759421 more easily remembered as 375-9421.

Another suggestion is to attach an image to information. "Visualization is a strong tool to use for some people," says Anne Unkenstein, a clinical neuropsychologist at the University of Melbourne, and author of Remembering Well: How Memory Works and What to do When it Doesn't. For example, if you park on level 4C, imagine "Four Cats" on your hood to remember your spot later.

Mnemonic devices are another approach, and add chained structure to otherwise disparate items. Want to remember the colours of the rainbow? Meet ROY G. BIV: Red, Orange, Yellow, Green, Blue, Indigo and Violet. Without dozens of such mnemonics, medical students would not survive their schooling, as their memory circuits are always overloaded. For example, to pass psychiatry oral exams, students must ask depressed patients about key symptoms, and many students have been saved by the mnemonic SIGECAPS: Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychological agitation, and Suicidal thoughts.

Other techniques carry this approach further, and describe how to chunk, chain and add story line for 25, even 100 items. It's a matter of processing time, concentration, rehearsal and how elaborate -- even bizarre -- your imagery can become. All these mental exercises are part of neurobics, brain workouts, which help to consolidate memory and learning.

With exercise comes nutrition, and there are several vitamins and herbs that are gaining reputations as "brain foods."

"Increasing levels of vitamin E were associated with better memory performance," concludes a study from the Indiana University Center for Aging Research. Vitamin E is an antioxidant found in vegetable oils and fruits, and keeps the brain rust-free, cleaning the blood by neutralizing damaging chemicals known as free radicals.

Folic acid is found in grains and uncooked vegetables, and is also a circulation protector, according to the Human Nutrition Research Center at Tuft University in Boston. Doctors now recommend folic-acid supplements to pregnant women to help prevent fetal brain malformations, so there is a general beneficial effect on nerve cells. Some studies are now hinting at a potential role for folic acid in the treatment of Alzheimer's disease.

Gingko biloba, the dried leaf of a tropical tree, is the much-publicized Oriental herb. Proponents feel it is a "universal brain tonic," that it promotes blood flow and prevents hardening of the arteries. Medically approved studies cautiously note using gingko biloba has an improving effect on alertness, mental clarity, reaction time, vision and memory. "But so little is known with certainty," says professor Robert Green, a neurologist at the Boston University School of Medicine Memory Assessment Clinic. Physician-supervised studies are under way, and more definitive conclusions are pending, despite the ambitious claims by the industry.

For some individuals, the problem with their memory is that they can't forget. "I want to move ahead with my life," says a 59-year-old woman who was widowed after 33 years of marriage. She is suffering from post-traumatic stress disorder: Two years after her husband's death, she still finds herself phoning him, or wearing clothes for him to admire. "Then it hits me -- he's gone." With psychotherapy and medications, she is making modest progress.

But what are the treatment options when memory truly goes wrong?
Alzheimer's disease, also known as aging dementia, is a medical catastrophe, a devastating illness in which people become shells of their former selves.

Interestingly, the patient who asks about Alzheimer's usually doesn't have it. But many do -- about 5 per cent of people over 65 -- with more expected as Canada ages.

Medications such as donepezil and its cousins help to restore levels of a messenger molecule in the brain, the neurotransmitter acetylcholine, which is important for memory circuits. But despite the intense research, these medications have only moderate benefits, helping to delay disease progression, with only mild cognitive improvement.

Even so, certain findings from Alzheimer's research have broader implications on how to maintain an agile memory: The more you use your brain, the more protected you are.

What activities qualify as brain exercises? Writing essays, learning a second language, earning a graduate degree, playing a musical instrument and regular reading.

What doesn't strengthen the brain? Passively watching television is not memory-enhancing.
Exercised brains have more juiced wiring, collateral circuitry and spare links. "You strengthen a particular series of connections, the way a heavily trodden pathway in the woods becomes more visible and easier to follow," says professor Guy McKhann, a neurologist at Johns Hopkins University in Baltimore, and author of Keep Your Brain Young: The Complete Guide to Physical and Emotional Health and Longevity. Exercised brains are more efficient and have multiple access points to memories.

But the hunt continues for a memory pill. Neurologist Eric Kandel, the Nobel laureate who founded Memory Pharmaceuticals in 1998, is searching for a "Viagra for the brain," as are dozens of biotech and drug companies and university laboratories. "If we continue making the kind of progress we are now," says Dr. Kandel, "we will have drugs for age-related memory loss in five years."

Dr. Shafiq Qaadri is a Toronto family physician and Continuing Medical Education lecturer. www.doctorQ.ca

Stimulating ideas

Write essays, learn another language, play an instrument, read regularly, take up ballroom dancing, play chess or bridge, do crossword puzzles, learn to paint, earn a graduate degree.

Concentrate and focus on new information to be learned.

Distribute learning over several sittings.

Use encouraging self-talk.

Use Post-It notes.

Use mnemonic devices.

Practise other-handedness. If you're right-handed, comb your hair or write with your left hand.

Add a visual or story line to your information.

Have restful sleep.

Relax and avoid anxiety.

-- Adapted from The Centre for Biomedical Informatics, Brazil

Vitamins, herbs and medications that may aid memory:

Vitamin E

Folic acid

Gingko biloba

Ayurvedic bacopa

Estrogen replacement therapy in post-menopausal women

Anti-inflammatory drugs (super-aspirins): Celebrex, Mobicox, Voltaren

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