Memories Are Made of This : Lose Your Keys? Can’t Recall Key Names and Dates? A Clinic at UCI Experimentally Treats the Problem
Bob Lansing started noticing his memory problem after he landed a job as an engineer at one of the county’s largest aerospace firms. During presentations to his superiors, he forgot words, sentences and sometimes his whole speech. At one point, he heard someone in the audience try to complete his sentences for him.
Then he noticed a broader memory gap. Lansing, who asked that his real name not be used, would spend a month reading a Tom Clancy novel, then find immediately afterward that he couldn’t remember the main character’s name. In conversations, he would often forget the point that he was trying to make and have to ramble for a while until it came to him.
The more Lansing worried about forgetting, the more he forgot. The memory problems, along with the routine stress of job and family responsibilities, made him so anxious that one day he experienced a panic attack returning from a business trip and had to find a quiet corner of the airport to calm himself.
That’s when the middle-aged executive’s doctor referred him to the Memory Disorders Clinic at UC Irvine.
The 5-year-old clinic is one of only about half a dozen diagnostic centers in the country that experimentally treat people with memory problems. Each year, its physicians see about 100 patients referred by doctors who have not been able to diagnose or treat certain neurological problems. When the normal medical channels are exhausted, it’s time for the experimental approach of the clinic.
With state-of-the-art diagnostic equipment and the UCI College of Medicine’s staff at its disposal, the clinic helps people with memory problems big and small, from the woman who keeps losing her car keys to the man with Alzheimer’s disease who can’t remember his wife’s name.
“The clinic has helped people who have debilitating memory problems show significant recovery,” says Dr. Curt Sandman, assistant director.
Nelson Butters, who as chief of psychology services at the Veterans Administration Hospital in San Diego often refers patients to the clinic, says it has been effective in finding causes of problems that have puzzled both patients and physicians.
“The clinic can determine the source of the problem, which is important because most physicians are not trained to diagnose the cause of memory disorders,” Butters says.
“We pin down exactly what process in the brain is awry,” Sandman says. “It’s a very difficult diagnostic challenge.”
Dr. Arnold Starr, director of the clinic and chairman of UCI’s department of neurology, estimates that perhaps 20% of the population has some form of memory loss.
But many people who think they have a memory problem or even Alzheimer’s disease may instead have a temporary condition triggered by drugs, stress or a head injury. Some patients who have trouble processing information turn out to have Parkinson’s disease. And others are just losing their memory as a natural part of aging.
Therapy usually involves weaning patients off drugs known to impair memory, encouraging them to keep written reminders, teaching them “memory tricks,” such as word associations, and taking them through some highly individualized therapies for specific disorders.
“Most memory problems can be treated simply,” Starr says. “Even those with Alzheimer’s disease may be helped by paying attention to the small things. Most patients are very embarrassed and sometimes become angry rather than working around their difficulties.”
Joseph Allen, a retired lawyer living with his wife in an oceanfront Laguna Beach home, is one of the many Alzheimer’s patients following Starr’s simple approach. Shortly after retiring a few years ago, Allen (not his real name) found his memory faltering. He forgot appointments, simple financial transactions, phone numbers and dates. Soon he was forgetting the names of friends and family and losing keys and important papers.
After seeing several doctors, Allen was diagnosed with Alzheimer’s disease and referred to the Memory Disorders Clinic for therapy.
“The doctors there told me the best thing for me to do to live with my problem was to keep lists and notebooks and write everything down,” says Allen, who is in his late 60s. “That’s what I’ve been doing ever since, and I can keep track of everything now with the lists. I do all my own banking, write my own checks and make my own appointments. But I don’t know what will happen in the future.”
Starr says treatment during later stages of Alzheimer’s disease often shifts away from the patient, who may be less able to take care of himself, and toward the family, which is instructed on how to help.
Memory is the process of receiving, storing and retrieving information. Humans and some animals have the power to remember and tuck away the information in the neurochemical stew of cells and proteins of the brain. Scientists believe human memory is a process involving millions of chemical communications relayed among brain cells. What they don’t know is how or where the information is stored and how it is retrieved.
“The more I study memory, the more humbled I am by its complexity,” Sandman says. “I don’t think I can even define it anymore. It’s too many things.”
The nation’s leading memory researchers, including scientists at UCI’s Center for the Neurobiology of Learning and Memory (which shares research information with the Memory Disorders Clinic), believe they are on the threshold of discovering how the brain receives and stores information. They hope that once a biochemical model of memory is provided, neurologists and pharmacologists will be able to come up with medicines and other treatments to cure memory problems.
Meanwhile, the clinic has found ways to help people suffering from memory problems--including a memory-enhancing technique developed by Sandman.
Sandman’s so-called “significant events” memory-retraining technique calls for patients to replace mundane routines with exciting events. Patients are told to vary their routines as much as possible and avoid getting stuck in a rut.
Sometimes called “flashbulb memory,” Sandman’s method stimulates receptors in the brain, triggering a flood of neurochemicals so that part of the brain can be enhanced and rejuvenated, he says. He cites the public’s ability to remember minute details of the day President John F. Kennedy was assassinated as an example of an emotionally charged incident aiding memory.
Sandman, who is a professor of psychiatry at UCI, says his “significant events” therapy can help up to 20% of patients suffering from memory loss because of age. He theorizes that memory may worsen with age because people tend to slow down and lead more routine lives as they get older. The neurochemicals may get stirred up less and less.
Other researchers are studying substances (caffeine, strychnine and anti-depressants, for example) for use as memory enhancers, although many of these have been found to have too many negative side effects to be practical.
On the other hand, patients on medications known to diminish memory--beta blockers, diazepam (Valium), barbiturates, alcohol and almost any medication that affects the central nervous system--are usually eased off the drug, if possible. And most patients experience a dramatic change once they quit taking the drug, Starr says, adding, “When they stop taking it, they say, ‘Oh, I can think again.’ ”
The clinic also uses biofeedback, along with concentration exercises, to help anxious patients relax so they’re better able to retrieve memory, Starr says.
“We don’t know why our therapy seems to work,” Sandman says. “But we do a number of things that require a lot of work from the patient and changes in the patient’s environment, and this seems to help. I think the critical difference between what we do and what has been done in the past is we ask people to take responsibility for their condition and treatment.”
Lansing, the aerospace engineer, was given a wide range of suggestions and exercises to help him live with his condition, a disorder that doctors theorize is caused by acute stress.
A patient at the clinic for nearly two years, Lansing says that when he first started to notice his memory problem, he didn’t know whether it was psychological or physical.
When tests at the clinic ruled out physiological reasons for his lapses, Lansing discussed psychological problems he had experienced shortly before starting his job as a middle-management engineer. He had undergone difficulties trying to rescue a failed business venture, followed shortly by anxieties connected with his new position.
“I always did have problems talking in front of a group,” Lansing says. “But at that time, I had also suffered a lot of psychological problems from my failed business, and then I had to remember a lot of technical information in a short period of time.”
In effect, Lansing had developed a severe case of stage fright that has hampered his professional efforts by hindering his ability to communicate.
“That’s my biggest complaint, the inability to verbalize what I’m trying to say and having trouble remembering the essence of what I’m trying to say,” Lansing says. “I go blank.”
Lansing said after a few discussions with Starr and Sandman at the clinic, he and the doctors realized that stress might be causing his problems.
“At first, I just hoped they had a miracle pill that I could take to improve my memory and that would be that,” he says. “But the doctor said I probably had a memory block stemming from a fear of looking foolish in front of people.”
“All the tests Lansing did were fine until we started to really push him,” asking him difficult questions and urging him to perform, Starr says. Then he started to falter. “It was my clinical impression that it was not a dementing illness, and at the end of a two-week testing period, we were able to present him with the evidence: that it was more a situational condition, triggered by stress, that was giving him problems.
“He was so relieved because this is a tangible thing you can deal with, rather than dementia, which is much harder to help.”
Lansing has been practicing relaxation techniques, using word associations that help trigger thoughts while he is giving presentations, rehearsing talks in front of his family and taking public speaking classes. He has noticed some improvement but admits that he has a way to go.
Sometimes people arrive at the clinic after bouncing from doctor to doctor for several months or years in an effort to find out what’s wrong with them. That’s what happened to Larry Jones (not his real name), a respected educator who sought Starr’s help to steer him out of his mid-life turbulence.
The nightmare that drove Jones out of his job and community began about seven years ago. The 55-year-old former teacher began taking pain medication immediately after a back operation. The operation didn’t relieve his back pain, so his doctor kept him on the medication, even though he had recuperated from the surgery.
Within weeks of the operation, Jones’ friends and family noticed subtle changes in his behavior: He started forgetting things, his speech became slurred and he started walking with a limp. He met with more doctors, who prescribed more and more medication.
Jones’ life gradually deteriorated. He started hallucinating at work, getting lost on the way to the supermarket and forgetting details. It got so bad that one rainy day he got in the car and drove to Long Beach for no reason. He parked the car and started wandering around in the rain. Soon he was diagnosed as having Alzheimer’s disease.
“I don’t recall a lot of it,” Jones said. “I was really out of it. The doctors told my family they were in for a miserable time and that they didn’t know how long I had to live. My children all came home and talked to psychologists about what to expect in the coming years. They said I had three years (to live), maybe more.”
Shortly after that, in the mid-1980s, Jones’ wife read about Starr’s work at the Memory Disorders Clinic. She made an appointment.
Like most patients who come to the clinic, Jones began with an initial visit with Starr, who took his case history, examined his medical records and scheduled a series of neuropsychological tests with various specialists. Most patients are given about a half-dozen tests with about the same number of specialists to zero in on neurological quirks or disturbances.
The clinic can also call upon the big guns--the latest in modern medical technology that provides detailed, colorful pictures of the brain so minute that small strokes and even schizophrenia can be detected.
This multimillion-dollar equipment--the MRI (magnetic resonance imaging), CAT (computerized axial tomography) scan, computerized topographic EEG (electroencephalogram) mapping and PET (positron emission tomography) scanner--is all available to clinic doctors to help rule out physiological reasons for memory disorders.
Finally, Jones’ luck changed. Starr was able to determine from tests that he was not suffering from Alzheimer’s disease but, rather, was experiencing a severe reaction to his prescription drugs.
“I was suspicious from the beginning (that he might be reacting to medication),” Starr says. “First, I had to wean him from the medicine, and he kept improving, so then I knew.
“He then had to come back to the living because he lost many months when he just didn’t remember anything.”
“Starr was the one who brought me out of all this,” says Jones, who is now retired and has moved to a different part of the county to start a new life. “He was a lifesaver. It had been a long nightmare. If I wasn’t hallucinating, I was losing the car or forgetting where I was going. At one point, I thought I was one of the hostages held in Beirut.”
While a “memory pill” may still be years away, Sandman and Starr are optimistic about the future. They believe that once a model of memory is reproduced in the laboratories, restorative treatment is sure to follow.
“I think we have to have a better understanding of memory before we can talk about a cure,” Sandman says. “But once the process is understood, the thing is to find a drug that works.”
“When you lose your memory, you lose something in the brain,” Starr says. “When we identify what these substances are that are missing, we can begin to work on replacing them.”
