The author's medical account of his illness is followed by helpful strategies to cope with episodal memory lapses. Many hysterically funny tales are included to keep the spirits up. An amazing combination of self help essential tips for memory lapses with delightfully amusing anecdotes.
To Jocelyn my wife. I apologies for calling you Joan.
To Joan, my sister, I frequently call Jocelyn.
To Fiona, my first daughter, for calling her Laura and, of course, to Laura, my second daughter, for calling her Fiona.
To Bruce, I regularly forget to call.
To Tache, whose name and bark, I will never forget.
Have you seen my…umm….. Memory?
All of us have memory lapses. We justify such occurrences as the consequence of living increasingly busy lives compounded by the gradual ageing process. The clinical extremes of Alzheimer’s disease and Dementia attract justified medical and media attention. Some positive medical news surrounds these ailments and there are optimistic sounds being heard for their case management. But what of the intermediate memory loss phase? The phase that demands early retirement from work, causes family bewilderment and personal self-doubt. The realisation of being in possession of an increasingly suspect memory dawns slowly.
This is not a textbook on mental health, although the author’s MCI (Mild Cognitive Impairment) is the background to this book. It is not written in a technical language. It is written for the person in the street because none of us knows what is round the corner in life. For those who have turned that corner and found confusion, memory lapses and depression, this book is for you too because you are not alone. The future is not permanently bleak and there are opportunities to reflect on experiences and to enjoy life more.
I do not talk of ‘cure’ but of finding in a multitude of experiences, some bizarre, some funny, some thought provoking, ways to recapture a quality of life to be lived with more pleasure and satisfaction. I gladly share this part of my life in which memory can be brought to heel, laughed at, reviewed and placed in context. It provides a personal pastiche of the power and the failings of the human memory. A much-needed self help guide to assist you to manage your memory is woven into this book. Accordingly, the mind can relax while the tips are absorbed.
Let Confucius set us on our way:
"I hear and I forget. I see and I remember!"
Netherholm Dumfries Scotland.
The author is greatly indebted to general practitioner Dr R Sabur and nurse Helen Bryden, occupational health physician Dr C Jamieson, consultant psychiatrist Dr D. Hall and consultant clinical neuropsychologist Dr J Moore, all of Dumfries. They have brought me through my illness to a greater understanding of the mind and given me encouragement to live life to the full.
Professor Narinder Kapur, formerly at the Department of Neuropsychology, University of Southampton and now at Addenbrookes hospital, Cambridge, gave permission for me to quote extensively from his booklet "Managing your Memory." Dr Olwen Wilson, consultant psychologist and long time friend, gave constructive criticism of the draft copy. My profound thanks go to both these distinguished psychologists.
Thanks to Alan, Margaret, Joyce, Stuart, Sean, Rachel, Jocelyn, Fred, Joy, Katrina and Kim – The Kirkpatrick Durham badminton team. I leave them wondering whether my shots stem from the mind or the body. And special additional thanks go to Joyce for her graphic artwork on the cover of this book as well as her work on Operation Oboe.
Remembering Richard and Wendy at Authorsonline.co.uk Adam of Research International, Bernard and Rosemary at Kleeneze and the production teams of Fifteen-to-One and Anne Robinson of the Weakest Link, all eager to assist. Thanks too to Derek Coates of Healthspan for permission to quote from the Healthspan booklet.
To Hans and Jutta in Germany, Peter and Elaine in Lancashire, Duke, Betty and Julie in Ghana. To Tom and Abbey, John and Huerta and all the four-legged friends I meet regularly with Tache. Because, like Mr. Dibdin,……
In every mess, I find a friend. Charles Dibdin 1745-1814
C O N T E N T S
Sticks and stones may break my bones 10
Words are, of course, the most powerful drugs
used by mankind 20
‘I forgot’, Lennie said softly, ‘I tried not to forget. 33
Honest I did, George’.
When I was young I could remember anything 41
……whether it happened or not.
Happiness is good health and a poor memory. 47
Studying and Memorising for Exams 56
One touch of nature makes the whole world kin. 65
Memory aids 71
Frequently asked questions 76
Final Thoughts 80
Sticks and stones may break my bones
But names will never hurt me.he empty lunchbox lay on the passenger’s seat as I left the picturesque lay-by in rural south-west Scotland and a thought occurred to me. I could not remember the names of the children I had taken to the Sheriff Court that morning.
I had conducted the case of two children whose parents denied the grounds for referral and the Sheriff had found the cases established but all of a sudden, I could not remember the names of the children concerned. I turned off the car radio, concentrated hard but the names just would not come. I drove on to the next lay-by, switched off the car engine and gave it one last effort. Defeated, I took my case from the back seat and opened it. The names on the files stared at me. How could this have happened? I put it down to over work …well…. yes… I suppose stress but so what? Were we not all stressed in this frantic new millennium?
The following month, driving back from the supermarket, somehow the road did not seem familiar. I drove on and turned left at the lights hoping to find more familiar territory. I must have driven for a further three minutes before I realised where I was in the town where I had lived in for the past twelve years.
Once more I justified the confusion in my mind. After all, apart from being the head of department, I was the chair of two other organisations and had just been appointed to chair the child protection committee in the area in which I worked.
I made an appointment with my general practitioner who would be bound to see the stress symptoms of my self diagnosis and give me a period of time to recover on sick leave. The garden would benefit. The dog would have an additional afternoon walk. I could read all the books I had put aside for a wet day and the piano and the oboe would have more regular practice. It was really a question of how long I would be given. Colleagues with similar symptoms had often been given three or four months. Four months would take me to early summer. Perhaps the house would really have a spring clean on time this year. It was time to get things back in order. The unnecessary stigma of stress was diminishing. I was beginning to welcome my self- diagnosis because I knew its medication was simply rest.
In reality, my diagnosis was wide of the mark! My doctor wished me to undergo a series of medical examinations. First came the clinical psychiatrist whose questions seemed so mundane that it was like a social meeting rather than a consultation until he concluded the appointment with a referral to a clinical psychologist and an appointment was also made for a brain scan.
The photographic slices of my brain and its apparent dormant activity were sent to the psychologist and an appointment was made for an hour’s testing.
Fifteen unconnected words were recited to me and repeated before I attempted to recall the list. Somehow after considerable concentration, only two words surfaced. I could not remember any more. The list was read out again and this time I focussed on the middle of the list but could only recall four words and neither of the original two that I had got correctly after the first round, reappeared. A different list was recited and I fared no better. I was simply unable to recollect these lists despite conducting a two-way conversation ably with the psychologist.
‘Count down from 93 in 7’s please.’ Now whose brain at the best of times works like that? I can recite any of the multiplication tables and divide or add but leave subtraction in multiples of 7 to the pocket calculator. I struggled here with the subtraction. Wouldn’t you?
‘Give me 15 unrelated words and no proper names, beginning with the letter ‘F’. Oh F--- why F? I momentarily mused at the psychologist’s choice of letter. Yet the words fell frequently from a flowing mind. ‘Failure, fraud, faded, faults, facts, figures, frigidity, fortune, fables, fixtures, fractures, football, furniture, freeze and frost’. I felt satisfied that I had not only found enough words but was able to count the right number required. I had used my fingers under the table!
‘Umm some negative thoughts predominating there. Try the same with the letter ‘S’’
I go full steam ahead again making his point redundant. ‘Sex, satisfaction, success, siblings, savoury, sailing, sunshine, snow, silver, sumptuous, seafood, shade, sunbeams, softness and to finish with, star!’ Other tests followed. Which floor was I on in the building? Then a game of placing difficult shapes into a sequenced order. The going got tougher. I found it an increasing challenge.
The conclusion of this appointment resulted in the diagnosis of Mild Cognitive Impairment (MCI), a condition I had never heard of. I had to write it down on a piece of paper. There were apparently two sources of my condition and neither could be adequately isolated.
The first was that I had been prescribed for high blood pressure medication two years previously and the HBP may have led to a short-term memory default. The other source was confirmed as the consequences of a near fatal operation some four years ago when, one Sunday evening, I was taken to hospital suffering an appendix pain. This operation which is not uncommon in youth, results in surgery which usually leaves a scar of little significance. Unfortunately by the time the surgeon operated on me that evening, peritonitis had set in and the penetrating surgical knife was met by bacterial infection spread throughout the abdominal cavity. Significant levels of anaesthesia were administered as the operation progressed. The increased amount of anaesthetic undoubtedly saved my life as the surgeon informed me the next day while inspecting the twenty two metal staple stitches on my stomach but the additional anaesthetic may also have caused damage to my short- term memory. Without it however, I would have died.
The implications for my work were stark. I could not afford to place a child’s life at risk if my memory was sufficiently damaged or if I forgot case law or if a child’s warrant lapsed due to my failing memory. The psychologist agreed, retiral on ill health grounds was deemed necessary. He would make a further appointment with an occupational physician and assess me every six months to see how my memory was responding.
By the time I had seen the occupational physician, I knew that my professional working life was over. It was nevertheless a valuable meeting at which the arrangements for adaptation to early retirement financially, emotionally and medically were addressed.
So, at the age of 52, after a working life which had encompassed five years in West Africa as a missionary, four years in Stirling as an educational social worker, and twenty years as a reporter to the children’s panels in Kilmarnock, Ayr and latterly Dumfries, I had retired. I had retired due to a diagnosis of ill health. Retired with MCI. I looked up this medical term on the internet. I was not familiar with it.
Mayo Clinic Abstract, Archives of Neurology, March 1999:
"Mild Cognitive Impairment (MCI) is a recently recognised condition describing a state of memory impairment that frequently (but not necessarily) precedes Alzheimer’s Disease. MCI is being viewed as a boundary or traditional state between normal ageing and dementia"
Researchers are attempting to clarify the boundaries between the memory effects of normal ageing and the onset of Alzheimer’s disease. Cognitive function, abilities such as language, critical thinking, reading and writing, is measured on a continuum between normal and early signs of the disease. This transitional area in the continuum has been labelled mild cognitive impairment – a memory disorder that is a strong early predictor of Alzheimer’s disease. It is estimated that there are nearly four million Americans who have Alzheimer’s disease. But the number of people who have mild cognitive impairment is still unknown. Studies to determine its prevalence are just beginning. What’s more, doctors often use varying criteria when making their diagnosis. Therefore, reliable numbers aren’t yet available to determine how common MCI may be.
MCI refers to a specific type of memory loss. People with this disorder have sharp thinking and reasoning skills, but their short-term memory declines. Typically, people with the disorder have the most trouble remembering recently acquired information and knowledge, while their recall of
long ago events may remain intact.
The area of the brain responsible for processing storing and recalling new knowledge and information is the hippocampus. You have one at each side of the brain. It is located toward the middle in each of the temporal lobes – portions of your brain that extend from beneath your temples to just behind your ears.
The hippocampus plays a crucial role in your memory system by sorting new information and sending it to other sections of your brain for storage. The hippocampus then recalls information when it’s needed. It also connects your new memories with other related memories. Just like my Google searches and entering my favourite links!
So in a nutshell, as it were, my condition of MCI is summed up as being a Sharp Mind, Shaky Memory. Useful signposts but where would this lead me? But first, what really is Memory?
What is Memory?
Memory is all about retaining information and being able to use it. Having a good memory or a poor memory does not necessarily mean that other skills or abilities will be affected likewise.
Different Types of Memory.
There are different types of memory skills rather than a single memory ability. For example, remembering a name that you have heard for the first time is different from remembering the name of your primary school. Also, remembering how to drive a car is different from recalling an event from your childhood. Memory for skills such as driving a car may often be unaffected in people with everyday memory difficulties. Remembering things which happened many years ago is usually easier than remembering something that happened yesterday, partly because older memories may be especially meaningful and tend to be rehearsed over and over again.
Trying to find the right word while having a conversation, such as remembering what something is called, is also a form of memory difficulty, but one which can not be easily improved and is not covered in detail here. If you are in such a position – and if it is possible- wait for a moment, since the word may come back to you. Going through letters of the alphabet or thinking of other associations may also help to bring the word to mind.
The advice I offer will mainly be concerned with shorter-term memory difficulties, such as remembering messages, people’s names, etc. Longer-term memory difficulties- such as remembering events from many years ago – are less common. If you have such difficulties, you may find that keeping a diary or looking at photographs will help to make such events easier to keep in mind.
Different Stages of Remembering
When we remember something for the first time, there are usually three stages involved. The learning stage - what happens when we concentrate on something for the very first time. The storage stage – when things we’ve learned are stored in the brain. The recall stage – when we try to bring to mind what we’ve learned. If any of these stages is affected, then a memory lapse may occur. While there is usually little we can do to improve the storage stage of memory, we can usually do something about the learning and recall stages. Much of this book is about offering advice and suggestions as to how you may try to improve your learning and recall skills.
Things to Bear in Mind
Firstly, no one’s memory is perfect! We all tend to forget things from time to time. You may find it useful to keep a diary for a few days of your memory lapses – this will help you see that your memory may not in fact be all that bad and it will also help pinpoint those areas of your memory that you need to work on. What stays in our memory will often depend on how keen we are on remembering the matter in question, how interesting it is, etc. As you are now reading this book, you may well find you are now more aware of memory lapses, compared to a few years ago. However let me stress, it is important to realise that your brain was never perfect. You shouldn’t say things to yourself such as ‘My memory is hopeless’ or I’m stupid, I’m always forgetting things.’ Because this may make you feel that your memory is worse than it actually is. If you really are forgetful lots of times, try to keep a sense of humour about it. Coping with memory failures, by staying calm and patient, and being open about any memory difficulties, is as important a skill to develop as improving memory in the first place. In fact these lessons helped to create this entire book!
Secondly, try to be well organised in your everyday routine. This may mean only doing certain things at certain times of the day or on certain days of the week, putting things away or filing things carefully in their own place, not allowing the place where you work or live to get cluttered, etc.
Thirdly, a poor memory is sometimes the result of poor concentration or trying to do too many things at once. When you are doing one thing, try to concentrate on it and don’t let your mind wander on to other things. You will learn best in a setting that is mostly free of distractions. When you find such a place, get into the habit of using it regularly. If you are motivated to remember or learn something, it will help your concentration enormously, so try to think of ways to improve your motivation if something initially appears to be rather boring.
Fourthly, if you are under stress or anxiety then this is likely to have a harmful effect on your memory. You may find that if you are more relaxed about things and make your life-style more easy-going, this itself may help improve your memory.
Finally, it is important to remember that being more forgetful is a normal part of growing older; that alcohol and drugs may have a harmful effect on memory; and that you are more likely to be forgetful when you are not feeling well. For example, when you are exhausted after a hard day’s work, when you are tired due to poor sleep, when you have headaches or are in any sort of pain.
So we now turn to ways of improving memory. Note that this is not a ‘cure’ for memory problems. At the moment there are no drugs or treatments that will result in a permanently improved memory. Instead I concentrate on the three main ways in which you can help to improve your memory. They are:
u Using Memory Aids
u Learning in Better ways
u Recalling in Better Ways.
It is impossible to cover all memory problems but some of the ideas can be adapted to suit different situations. You might even have your own methods that are every bit as valid as the ones that follow.
Have someone slowly read out loud the list of words beneath to you. If you don’t have anyone handy, read the list to yourself, then close the page. Take three minutes to write down all the words you remember.
Tyre Cloud Egg Gate
Chair River Apple Pen
Ball Hill Train Frame
Tree Book Shop Road
End of Chapter TIP: Try not to do too many things at once.
Site: Memory lapses made Manageable
Miller H Caldwell