Mastering Memory
Maybe it’s a sign of a mature mind when some of life’s bigger questions -- about love, faith, ambition--suddenly seem more manageable than smaller ones, such as: Why did I just open the refrigerator? Where on earth did I park my car? Where did I write down that phone number?
Then again, maybe it’s a sign of something else.
“Some people can’t find their keys, others are forgetting everything. We see all kinds,” said Celeste Bocian, who runs a free memory screening program at Sherman Oaks Hospital. The program attracts adults of almost all ages, even people in their 30s.
Who can blame them? Starting around age 28, our scores on memory tests decline steadily, researchers say; by 55, our ability to associate names with faces or memorize new phone numbers has slipped by about 20%. Almost everyone older than 40 has had a whopping lapse or two.
Yet our capacity for storing and retrieving information does not sift away like sand through an hourglass, as neurologists once believed. On the contrary, new research suggests that, when stimulated in the right way, brains of almost any age can give birth to cells and forge fresh pathways to file away new information. This emerging picture has not only encouraged those who treat and care for the 5% of older adults who have dementia such as Alzheimer’s disease, but it has also generated a wave of optimism among those studying memory changes in the other 95%, as well as an increasing public fascination with “memory enhancement” dietary supplements, books and brain-boosting techniques.
“This is the hottest area there is right now: to identify the brain changes that occur in normal, age-related memory decline, so that we can do something about them,” said Molly Wagster, grants director of the neuropsychology program at the National Institute on Aging, in Bethesda, Md.
The lapses many of us attribute to a failing brain are often due to something entirely different: anxiety, sleep problems, depression, even heart disease. The biological nuts and bolts of learning and memory in fact change little over time in healthy people, researchers say. “There’s very little cell loss, and structurally all the machinery is there, even very late in life,” said Greg Cole, a neuroscientist with the VA Greater Los Angeles Health Care System. It’s the cells’ speed and ability to send and receive signals that taper off, which is what makes the mind go blank when trying to retrieve familiar words and names. Neurologists have several theories to explain why:
* Free-radical damage. Created by normal body functions, free radicals are unstable molecules that can damage cells and cell DNA. Doctors know from autopsy evidence that brain cells are particularly vulnerable. Researchers have tested the effect of a variety of so-called antioxidants--which neutralize free radicals--with mixed results. A substance called curcumin (from the herb turmeric) significantly improves brain function in animals with memory deficits, Cole said; so do preparations that include alpha-lipoic acid and vitamins C and E, to name a few.
The evidence in humans is probably best for vitamin E, researchers say. In a 1997 study, investigators at Columbia University College of Physicians and Surgeons showed that daily doses of vitamin E significantly slowed the progression of disease in people with advanced Alzheimer’s. Some doctors believe that doses of the vitamin could also preserve cognitive function in healthy older adults.
* Loss of chemical messengers. People with Alzheimer’s disease show reduced levels of a chemical in the brain called acetylcholine, which is involved in signal transmission. Using drugs that prevent the breakdown of this messenger, doctors can slow the progression of the disease. It’s not yet clear how well similar substances would improve memory in healthy people, doctors say. The National Institute on Aging, part of the National Institutes of Health, is helping fund a study of a moss extract called huperzine A, which also works on acetylcholine, in people with Alzheimer’s disease. Results aren’t yet in.
* Changes in membrane composition. Neural membranes contain a number of fatty substances critical to cell function that appear to become more scarce with advancing age, researchers say. One of these is phosphatidylserine, or PS. In a 1991 study, PS supplements derived from cow brains produced significant memory improvements in middle-aged and older adults who had normal age-related memory problems. In a 1992 trial among 51 people with Alzheimer’s symptoms, those taking PS also showed some memory improvement, doctors reported. Most researchers consider the evidence preliminary and in need of better testing.
* Reduced blood flow. In people with cardiovascular problems especially, the brain doesn’t get the same volume of blood flow it did in young adulthood. Blood flow is thought to be critical to neural function, which may be one reason why physical exercise can enhance mental performance, doctors say. It’s also one of the reasons why the Chinese herb ginkgo biloba, which increases circulation to the brain, is routinely prescribed in France and Germany for memory problems. Intrigued by the European experience, the National Institute on Aging is now helping fund a trial in which 2,000 older adults at risk of dementia will take daily doses of ginkgo biloba or a placebo. The great appeal of substances such as ginkgo biloba or vitamin E is that they are not prescription drugs. They’re also relatively cheap and easily available. “Baby boomers are much more likely than previous generations to try alternative therapies, and I think the research is respectable for some of these supplements,” such as vitamin E and curcumin, said Debra Cherry, associate director of the Alzheimer’s Assn. of Los Angeles, Riverside and San Bernardino County.
Still, many neuroscientists doubt that any one of these supplements will turn out to be an all-purpose memory pill. For one thing, memory includes a range of very different skills--from the motor programs used to brush our teeth to narrative techniques we use to tell a joke or story. It’s unlikely that a single substance would enhance them all.
Said the VA’s Cole, who is studying the antioxidant curcumin: “I think what we’ll find in the end is that a cocktail of some of these things is what works best.”
Millions of consumers, however, aren’t waiting for the research to come in. Margo Lyons, 51, of Chatsworth, began taking ginkgo about a year ago after a series of lapses in which she forgot directions and everyday tasks. The memory problems cleared up before she began taking the supplement. “I just want to keep myself sharp so I don’t forget something really important, like picking up my kid from school,” she said. “It can’t hurt, and it might help; you just never know.”
Many physicians tend to be more skeptical of supplements because of the lack of safety information about many products. Ginkgo can cause gastric bleeding, for instance, especially when taken with aspirin. And little is known about the side effects of supplements taken in large doses over a prolonged period of time. Because nutritional supplements are not closely regulated by the federal government, doctors have no good idea what’s in the pills and powders or how well the active ingredients are absorbed by the body. Many herbs can also interact with drugs to cause side effects. “At best you’re wasting money” with many of these products, said Dr. Gary Small, director of the UCLA Center on Aging, “and at worst you’re doing yourself harm.”
Like many doctors, Small favors a safer answer for age-related memory decline: mental workouts. This is what some call the “use it or lose it” approach.
For more than a decade, researchers have known that people who have active, intellectually challenging lives are less likely to develop dementia than those who do not. Part of this difference is attributable to intelligence, some doctors believe: The more you start with, the longer it takes to lose it. And new evidence suggests that the act of using your brain is in itself protective, no matter who you are.
In a study published this February in the Journal of the American Medical Assn., investigators followed 801 older Catholic nuns, priests and brothers for almost five years, tracking what they did during the day and what happened to their cognitive function. The researchers paid particular attention to everyday activities: reading the newspaper, listening to the radio, playing games such as chess and checkers, or watching TV. They found that those men and women who did three or more of these things at least several times a week were almost 50% less likely to develop Alzheimer’s disease than those who read, listened to the radio and played games only a few times a month. “The encouraging thing was that these were easy, accessible activities, available to just about anybody,” said lead author Robert Wilson, professor of neuropsychology at Rush Presbyterian St. Luke’s Medical Center in Chicago.
Many brain-booster books and tapes attempt to push people a little harder than that. In a book called “Stop Memory Loss,” now on store shelves, there’s a range of mental exercises that include “pegging” numbers to words for easier recall and visualizing pictures with numbers and words. Other common recommendations from authors of memory books include crossword puzzles; logic and graphic puzzles reminiscent of high school SAT problems; and simple practice trying to recalls grocery lists 10 or 20 minutes after seeing them.
All of these activities can improve people’s scores on standard tests measuring recall of numbers and names, experts say. They also acknowledge, however, that there’s a big difference between playing chess with a friend and doing a mental exercise, such as memorizing numbers. One is an organic part of a person’s life, the other a purely intellectual exercise, done in isolation. The first is fun; the second, often, is a chore. That’s why many doctors who treat memory problems are skeptical of programs that promise significant improvements from mental calisthenics alone. “You shouldn’t do mental gymnastics just for the heck of it,” said Dr. Barry Gordon, director of the memory clinic at Johns Hopkins Medical Institutions in Baltimore. “They are very specific. If you learn how to do crossword puzzles and do a lot of them, well, you get very good at doing crosswords. It doesn’t mean that much for any other part of your life.”
The crucial element for any new mental activity, then, is that the person find it interesting or fun, or both. Learn German, play poker, study baseball stats, make yourself a wine snob: anything that will fit into your life and stay awhile, doctors say.
Not long ago, Nancy Levitt, 53, of Beverly Hills, whose father died of complications from Alzheimer’s disease, bought a memory book full of tests and techniques and mental exercises. She flipped through it once or twice but quickly lost interest. “I tried, but you want to do something that’s fun, and that was work,” she said.
If such memory work makes people feel pressured or inadequate, it may even be detrimental because research has shown that anxiety can interfere with memory. Bocian, of the SAGE Center at Sherman Oaks Hospital, guesses that about 80% of the people who come to the center are the “worried well.” “Especially when it’s a younger person, in their 30s or 40s, I check to see if there’s something else going on,” she said. “Often it’s just stress ... and worrying about their memory getting worse is making it worse.”
