Living With Amnesia

It’s normal to become a bit forgetful as you get older. However, memory loss could be a symptom of something more serious and should be checked by a GP.

Memory loss, also called amnesia, occurs when a person loses the ability to remember events and information they would normally be able to recall. This could be something that happened only seconds or minutes ago, or a memorable event that happened in the past. The memory loss may have started suddenly or may have been getting worse over the last year or so.

Memory loss can be distressing, for the person affected as well as for their family. Relatives may fear the worst and assume it's caused by dementia but this often isn't the case.

The following information will tell you:

• what to do if you're worried about memory loss 
• how to tell if it could be caused by dementia 
• the most common causes of memory loss (but don't rely on this to self-diagnose a condition) 
• how to cope with a poor memory 

What to do if you're worried about memory loss

If you're worried because you or someone you care for has lost their memory, see your GP. They'll do an initial assessment and ask questions about symptoms, family history and lifestyle. They may also order a blood test

Memory loss has a wide range of possible causes, depending on the type of memory loss.

Doctors classify memories as either:

• Immediate memories, such as sounds, which are only stored for a few seconds. 
• Short-term or recent memories, such as telephone numbers, which stay in your memory for 15-20 seconds. The brain can store about seven chunks of short-term information at any time. 
• Long-term or remote memories - more permanent memories, which have been reinforced because you've repeatedly gone over them in your mind. 

If your GP thinks that you or your relative needs an assessment for dementia or that there may be another more serious underlying condition, such as brain damage, they'll refer you to a specialist.

Could it be dementia?

If you're reading this because you think your memory problems may be a sign of dementia, rest assured that they probably aren't. A person with dementia will not usually be aware of their memory loss or may deny it.

Your memory loss is likely to be caused by something a lot more common and treatable, such as depression. 

You may be worried that someone you care for has dementia. However, bear in mind that around 40% of people aged over 65 have some kind of memory difficulty, and only 15% will develop dementia each year. 

If your instincts are correct, their denial or lack of awareness of their memory loss can make it hard to convince them to see a GP. 

Signs that someone has dementia

As a general guide:

• Dementia usually occurs in people over the age of 65. 
• Someone with dementia will struggle to remember immediate or recent events, but can still recall events that happened a long time ago. Therefore, if their long-term memory is affected, it probably isn't dementia. 
• The memory loss doesn't happen suddenly but gets gradually worse over time. 

Common causes of memory loss

Generally, GPs find that patients who see them about memory loss are most likely to have: 

• Stress
• Depression
• Anxiety 

Their memory loss is due to poor concentration and not noticing things in the first place because of a lack of interest. Sleeping problems make the memory loss worse.

Your GP may suggest trying antidepressant tablets, If their assumption is correct, these should improve the memory problems as the depression lifts.

An elderly person with memory loss is likely to have depression if they also experience changes in behaviour, such as hoarding or being bad tempered.

Other common causes of memory loss are:

• a head injury, for example after a car accident 
• a stroke that cuts off some of the blood supply to the brain and causes brain tissue to die 

These will cause sudden memory loss, where you either forget events that happened before the trauma (retrograde amnesia), or you forget everything that happened after the trauma (anterograde amnesia). 

Less common causes of memory loss

Less commonly, memory loss can be caused by:

• an underactive thyroid, which means your thyroid gland (found in the neck) does not produce enough hormones 
• certain types of medication, such as sedatives and some treatments for Parkinson's disease 
• long-term alcohol misuse 
• bleeding in the brain, known as subarachnoid haemorrhag
• Vitamin B1 deficiency 
• problems with blood flow to part of the brain, which cause sudden episodes of memory loss that a person cannot recall afterwards (known as transient global amnesia)  
• a stressful or traumatic event that causes someone to block out the memory, leaving them unable to remember important information (known as psychogenic amnesia) 
• a brain tumour. 

Living with amnesia focuses on building habits to follow rather than relying on medical remedies. To cope with his extreme amnesia, Clive Wearing began keeping a journal after the onset of illness in 1985. Since his memory lasts only a few seconds, writing allowed him to retain some record of the past, although he never explicitly remembers doing it. Most entries are brief, guided by his implicit, or habitual, memory of how to write and instinctual awareness of keeping the journal.

Although Wearing's knowledge of specific facts and recent events is nonexistent, his IQ has stayed close its pre-amnesia levels, as with other amnesia patients. For instance, if you ask Wearing for directions to the kitchen, he wouldn't be able to tell you. But if you ask him to make you a cup of tea,  he can walk to the kitchen and do it independently. Because the implicit and semantic memories, which control performance and motor skills, reside in different areas of the brain from episodic memory, intelligence isn't severely affected.

Unfortunately, there is no magic pill or surgery that can fully restore the lost memories of someone with persistent amnesia. Since neurotransmitters play a large role in memory creation, researchers are investigating the potential of isolating them for treatments. With amnesia caused by alcoholism, (Korsakoff's syndrome), vitamin B1 supplements can help stop brain deterioration. Psychotherapy can also aid people with dissociative amnesia by working through the traumatic event. However, most persistent amnesia cases that deal with disease or injury-related brain damage depend on coping, not cures.

Since the bulk of amnesia cases involve anterograde amnesia, treatment focuses on ways to retain new information and build habits through your implicit memory, as we see with Wearing. In this way, you can think of memories as expiring coupons -- either use them or lose them. By integrating memory tools into everyday life, amnesia patients can recall memories as often as possible to try to strengthen them. Amnesiacs manage to remember to use these memory tools by creating habits, or implicit memories, so they instinctively know to check their calendar in the morning for appointments, for instance.

Pocket calendars or PDA's, such as PalmPilots, Blackberries and iPhones, can be helpful since people with amnesia can program reminders, store large amounts of information and take it everywhere. Having simple data like this on hand can increase the patient's sense of independence and lighten the burden on caretakers. In addition, establishing patterns of living are integral for amnesia patients to get on with daily life.

What can I do to improve my memory?

Here are some simple techniques to enhance your memory:

• Give yourself time and keep calm.
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• Keep to a routine. Place everyday items such as car keys, money in the same place and do try to do things in the same order.
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• Write information down as possible, keep paper and pencil or stick it notes near the telephone.
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• If you need to remember to take something with you to an appointment or when you go out leave it somewhere obvious e.g., by the door, or write yourself a big note to remind you and leave it on the door.
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• Get organised. Although most people are used to keep a diary at work, you might find it helpful to have a diary at home to remind you to do something.
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• Use an alarm to help you to remember to do something in the future, for example to take something cooking out of the oven or to make a phone call.
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• Repeat back to someone important information that you need to remember. Not only will this check that you have heard the information correctly, it was also increase the chance that you will be able to recall it later.

Memory and aging: What's normal, what's not

Forgetfulness is a common complaint among older adults. You start to talk about a movie you saw recently when you realize you can’t remember the title. You’re giving directions to your house when you suddenly blank on a familiar street name. You find yourself standing in the middle of the kitchen wondering what you went in there for.

Memory lapses can be frustrating, but most of the time they aren’t cause for concern. Age-related memory changes are not the same thing as dementia.

As we grow older, we experience physiological changes that can cause glitches in brain functions we’ve always taken for granted. It takes longer to learn and recall information. We’re not as quick as we used to be. In fact, we often mistake this slowing of our mental processes for true memory loss. But in most cases, if we give ourselves time, the information will come to mind.

Memory loss is not an inevitable part of the aging process

The brain is capable of producing new brain cells at any age, so significant memory loss is notan inevitable result of aging. But just as it is with muscle strength, you have to use it or lose it. Your lifestyle, health habits, and daily activities have a huge impact on the health of your brain. Whatever your age, there are many ways you can improve your cognitive skills, prevent memory loss, and protect your grey matter.

Furthermore, many mental abilities are largely unaffected by normal aging, such as:

• Your ability to do the things you’ve always done and continue to do often
• The wisdom and knowledge you’ve acquired from life experience
• Your innate common sense
• Your ability to form reasonable arguments and judgments

Normal forgetfulness vs. dementia

For most people, occasional lapses in memory are a normal part of the aging process, not a warning sign of serious mental deterioration or the onset of dementia.

Normal age-related forgetfulness

The following types of memory lapses are normal among older adults and generally are notconsidered warning signs of dementia:

• Ocassionally forgetting where you left things you use regularly, such as glasses or keys.
• Forgetting names of acquaintances or blocking one memory with a similar one, such as calling a grandson by your son’s name.
• Occasionally forgetting an appointment.
• Having trouble remembering what you’ve just read, or the details of a conversation.
• Walking into a room and forgetting why you entered.
• Becoming easily distracted.
• Not quite being able to retrieve information you have “on the tip of your tongue.”

Does your memory loss affect your ability to function?

The primary difference between age-related memory loss and dementia is that the former isn’t disabling. The memory lapses have little impact on your daily performance and ability to do what you want to do.

When memory loss becomes so pervasive and severe that it disrupts your work, hobbies, social activities, and family relationships, you may be experiencing the warning signs of Alzheimer’s disease, or another disorder that causes dementia, or a condition that mimics dementia.

Normal Forgetfulness vs Mild Cognitive Impairment (MCI)

Mild cognitive impairment (MCI) is an intermediate stage between normal age-related cognitive changes and the more serious symptoms that indicate dementia. MCI can involve problems with memory, language, thinking, and judgment that are greater than normal age-related changes, but the line between MCI and normal memory problems is not always a clear one. The difference is often one of degrees. For example, it’s normal as you age to have some problems remembering the names of people. However, it’s not normal to forget the names of your close family and friends and then still be unable to recall them after a period of time.

If you have mild cognitive impairment, you and your family or close friends will likely be aware of the decline in your memory or mental function. But, unlike people with full-blown dementia, you are still able to function in your daily life without relying on others.

While many people with MCI eventually develop Alzheimer's disease or another type of dementia, that doesn’t mean it’s inevitable. Some people with MCI plateau at a relatively mild stage of decline while others even return to normal. The course is difficult to predict, but in general, the greater the degree of memory impairment, especially when accompanied by trouble moving your legs and feet, the greater your risk of developing dementia some time in the future.

Symptoms of mild cognitive impairment (MCI) include:

• Frequently losing or misplacing things
• Frequently forgetting conversations, appointments, or events
• Difficulty remembering the names of new acquaintances
• Difficulty following the flow of a conversation

The same practices that contribute to healthy aging and physical vitality also contribute toa healthy memory

Exercise regularly. Regular exercise boosts brain growth factors and encourages the development of new brain cells. Exercise also reduces the risk for disorders that lead to memory loss, such as diabetes and cardiovascular disease. Exercise also makes a huge difference in managing stress and alleviating anxiety and depression—all of which leads to a healthier brain.

• Stay social. People who don’t have social contact with family and friends are at higher risk for memory problems than people who have strong social ties. Social interaction helps brain function in several ways: it often involves activities that challenge the mind, and it helps ward off stress and depression. So join a book club, reconnect with old friends, or visit the local senior center. Being with other people will help keep you sharp
• Watch what you eat. Eat plenty of fruits and vegetables and drink green tea as these foods contain antioxidants in abundance, which can keep your brain cells from “rusting.” Foods rich in omega-3 fats (such as salmon, tuna, trout, walnuts, and flaxseed) are particularly good for your brain and memory. Eating too many calories, though, can increase your risk of developing memory loss or cognitive impairment.
• Manage stress. Cortisol, the stress hormone, damages the brain over time and can lead to memory problems. But even before that happens, stress or anxiety can cause memory difficulties in the moment. When you’re stressed out or anxious, you’re more likely to suffer memory lapses and have trouble learning or concentrating.
• Get plenty of sleep. Sleep is necessary for memory consolidation, the process of forming and storing new memories so you can retrieve them later. Sleep deprivation reduces the growth of new neurons in the hippocampus and causes problems with memory, concentration, and decision-making. It can even lead to depression—another memory killer.
• Don’t smoke. Smoking heightens the risk of vascular disorders that can cause stroke and constrict arteries that deliver oxygen to the brain.