Manage Your Memory with Dr. Andrew Budson
Everyone’s memory slows down with age. Who hasn’t struggled to retrieve someone’s name that hovers on the tip of the tongue? Maybe you tend to forget where you put your wallet, keys, phone, or sunglasses. Maybe, at times, you even forget where you parked the car. Many worry that memory lapses could be an indication of early Alzheimer’s disease.
I am incredibly pleased to introduce you to Dr. Andrew Budson, a neurologist and memory expert from Boston University and Harvard Medical School. Dr. Budson has a plan to help you manage your memory. His real-life, practical tips and tools will help keep your memory strong. And, his background as an Alzheimer’s expert will help you discern which memory issues you can work on, and which ones you really need to worry about.
Meet Dr. Andrew Budson, neurologist and memory expert
Dr. Budson is the co-author, with neuropsychologist Maureen O’Connor, of Seven Steps to Managing Your Memory: What’s Normal, What’s Not, and What to Do About It (Oxford University Press, 2017.) He recently presented two talks at the St. John’s Hospital Cognitive Health Speaker Series in my community of Jackson, Wyoming.
After hearing Dr. Budson’s first talk, I went home and read most of his book. I immediately purchased 5 copies for people I know who are worried about their memory. By the time he had finished his second presentation, I had formulated a plan to collaborate a cooking event with him in Boston. His mission aligns with mine: To help people age well, take care of their brains, and learn all the science-based ways to fend off Alzheimer’s and other dementias.
Here, Dr. Budson answers my questions about memory management and the future of Alzheimer’s treatment and prevention.
BHK: The first of 7 steps in your book is to learn what normal memory is. You describe the memory center of our brain as a filing cabinet. And that filing cabinet has a clerk who is slower with age. She doesn’t move as fast, taking longer to retrieve the files she put in long term storage. What happens to her?
AB: First off, to use an analogy, that clerk is hard of hearing—you have to tell her more than once to find what you are looking for. Also, she doesn’t see as well as she used. She may need a hint or a cue to retrieve the memories. And the file clerk has to get enough sleep. When you are tired it is hard to pay attention. While you sleep the new memories that formed during the day get put into another cabinet for long-term storage. The good news is that if you filed memories into long-term storage, you can still get to it even if the new memory file cabinet gets damaged by a disease such as Alzheimer’s.
False memory and emotionally impacted memory
BHK: What is a false memory and why do they happen?
AB: False memories are incredibly common. We used to think our memories evolved to help us remember things. But we now believe that the real reason they evolved is not to remember how things happened in the past but to help us imagine new possibilities. That is why when we are given suggestive or leading questions, we can end up with a false memory. For example, memories can be corrupted by suggestions by an attorney leading a witness in the courtroom.
There are also false memories based on the things we do every day. Maybe you can’t remember if you locked the front door this morning? Every day, you latch the door before you leave the house. When we do the same thing again and again, it’s hard to remember the memory for any one specific day.
BHK: What about the emotional impact of memories? Can that change how we remember things?
AB: We remember things in the past the way we currently think about them. Every single time we retrieve a memory, we lay that memory down anew. So, we can actually change a memory based on our current thinking. For example, our memories of someone can change if we aren’t currently getting along with them well.
Every single time we retrieve a memory, we lay that memory down anew. — Andrew Budson, MD
Normal memory lapses vs. early Alzheimer’s
BHK: So now we know our file clerk is getting slower as we get older. We know we can misremember things or have an emotional reaction that changes how we remember things. But how do we know if our memory lapses are a normal part of aging or an indication of Alzheimer’s disease?
AB: The file cabinet, in our analogy, is the hippocampus, that part of our brain where all our new memories are stored. Alzheimer’s damages and ultimately destroys the hippocampus. It’s like there is a hole in the bottom of the file cabinet. There are a few ways you will know if you have a big hole in your hippocampus.
First, Rapid Forgetting. This is never normal. Even when information has been learned well, it is quickly forgotten, often leading to repeating questions and leaving important items unattended, such as leaving the stove on.
Second, Getting Lost. Anybody can get lost. But what do we do? We pull out our phone, call a friend, use google maps, a paper map, or stop and ask for directions. Then we are back on our way. With Alzheimer’s none of these things help. Either they don’t occur to us or they are too complicated to access.
Third: Losing Things. If you are someone who was always very organized and now it takes 15 or 20 minutes, maybe even an hour to find things, that is concerning. Especially when it represents a change from the way it used to be.
Number 4: Repeating Questions and Stories. Anyone can forget the answer to a question or retell a story. But a pattern of repeatedly asking the same question or retelling the same story — that’s not normal. It is due to rapid forgetting.
Rapid forgetting…is never normal. — Andrew Budson, MD
Fifth: Finding Words. With normal aging, it is considered normal to forget proper nouns, such as the names of people and places. But if you forget the words for common objects, like door, cup or phone, it is not normal.
Medication and your memory
BHK: If you are experiencing memory problems that are not in the normal realm of aging, what can you do about it?
AB: First, it’s good to know if you are taking a medication that is making your memory worse. Sleep aids, over the counter cold medication (especially anti-histamines), incontinence drugs, anxiety meds, muscle relaxants, narcotic pain relievers — all can make your memory worse. If you are taking any of these medications it is worth speaking with your doctor about possibly reducing or eliminating them. (Please don’t stop medications prescribed by your doctor without speaking with them first! Seizures are just one possible side effect if you stop a prescribed medication suddenly.) You can treat your memory problems with medication — the drug donepezil (brand name Aricept) is one cholinesterase inhibitor that can ‘turn back the clock’ on your memory by 6 to 12 months. These drugs are best used early in the course of Alzheimer’s, as soon as it is diagnosed.
BHK: What can we do to protect memory?
AB: The good news is that everything you do to prevent Alzheimer’s and dementia will also protect your memory. There are many studies that show the Mediterranean diet, and some of its cousins like the MIND diet, will protect you from getting Alzheimer’s, or at least delay its onset. Exercise is also critically important for our brains to improve thinking, memory and emotional health. Studies have looked at people in their 80s who were sedentary their entire life and found that in just 6 months, these individuals were showing the physiologic benefits of exercise. So, you are never too old to start exercising. But the earlier you start the better. There was a paper published in the last 3 months {in the journal Neurology} that showed that individuals who started exercising in their 40s were able delay the onset of Alzheimer’s disease by 11 years, from age 79 to age 90!
Memory tools and tricks
BHK: In your book you write about how to strengthen memory with tools and tricks useful for everyday situations. Could you give us an example?
AB: Names are typically the hardest thing to remember. But there are some simple things that everyone can do to remember names better. First, we need to pay attention when the individual is telling us their name. We can train ourselves to pay attention better using techniques such as mindfulness. Second, repeat the name aloud back to the person, “It’s nice to meet you, Annie.” Third, make an association between the name and something that has meaning to you, whether it is a personal connection (such as your sister) or something popular (such as the musical, Annie). Fourth, make an image in your mind using the association (picture the Annie you’ve just met in the red dress of the girl in the musical, maybe singing “Tomorrow.”) Last, repeat the name to yourself at least once during your conversation, then again at the end of the day, then a week later, a month later, and 6 months later. Now you’ll remember her name is Annie for a very long time.
BHK: Two-thirds of Alzheimer’s victims are female, yet we still don’t know why women are more vulnerable to this disease than men. What do you think puts women at increased risk?
AB: It has been known for many years that Alzheimer’s is an inflammatory disorder of the brain. There is new evidence that suggests the normal function of beta-amyloid, the protein that builds up in Alzheimer’s disease, is to protect the brain from infections, so it is part of the brain’s immune system. So, we can think about Alzheimer’s disease as an auto-immune disease that causes inflammation. If Alzheimer’s is an auto-immune disease, women are going to be more likely to develop it because women develop more auto-immune diseases than men. Why do women develop more auto-immune diseases? One speculation is that they have a stronger immune system to protect a fetus from infections.
It has been known for many years that Alzheimer’s is an inflammatory disorder of the brain. — Andrew Budson, MD
The future of Alzheimer’s prevention
BHK: What do you see happening in the treatment of Alzheimer’s in the next few years?
AB: Again, speculation. But I am optimistic that in the next 8 years, we will have a treatment shown to be effective against either the plaques or the tangles to slow down the brain’s degeneration. I don’t think it’s realistic to say it will stop it completely. But if we have a medication that can slow down the disease process by double, triple or quadruple then this is what I see will happen: When people are age 50, just like screening mammogram, PSA test, or colonoscopy, everyone will get a screening amyloid or tau PET scan. If positive, it will go like this: Mr. Jones, I see you are developing Alzheimer’s. The good news is we are going to give you this medication. You’re going to take it every day. And I can make sure that you will be above 90 years of age before the disease will affect you. That’s how I see the future.
I am optimistic that in the next 8 years, we will have a treatment…effective against plaques or tangles. — Andrew Budson, MD
BHK: Thank you Dr. Budson.
Learn more about Dr. Budson’s work on his website AndrewBudsonMD. Read his articles at Psychology Today and Harvard Health. Get the book Seven Steps to Managing Your Memory: What’s Normal, What’s Not, and What to Do About It wherever books are sold.
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