Episode 69 | Dr. Andrew Budson | Your Memory…What’s Normal and What’s Not
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In today’s Art of Living podcast, we’re diving into memory…what’s normal, what’s not, and what to do about it.
If you’re like most of us, you have some complaints about your memory. Perhaps you walked into a room and forgot why you were there, or you can’t think of a name of an acquaintance even though you met her half a dozen times…or you see a movie, and two weeks later you can’t remember the title, or parts of the plot. It can be a very frustrating experience!
With more than 41 million Americans over the age of 65 in the United States, the question becomes how much (or, perhaps, what type) of memory loss is to be expected as one gets older and what should trigger a visit to the doctor.
Today’s guest is Dr. Andrew Budson, the author of Seven Steps to Managing Your Memory…and he’s here to help us address key concerns about memory loss.
Dr. Budson is a professor of neurology at Boston University, and lecturer of neurology at Harvard Medical School. His career combines education, research, and clinical care for those with memory disorders.
In today’s show, you’ll discover…
• Signs that suggest your memory problems are more than just part of normal aging
• Specific markers of mild cognitive impairment, and how to know when it is time to start talking to your doctor about memory concerns
• Simple techniques to strengthen your memory…no matter what your age!
• Why exercise is a no-brainer when it comes to preserving your memory
• Hormonal differences in men and women and how they may cause your memory to be different
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Kathy Smith: Andrew, I’m so excited to have you on the show. Welcome.
Andrew Budson: Thank you. It’s a pleasure to chat with you.
Kathy Smith: I had the privilege of watching your presentation at the A4M conference in Las Vegas a few months ago, and that’s why I’m excited to have you on the show, because really memory loss is a topic that everyone I know is talking about now. So why don’t we just jump in and let’s talk about what are the signs that suggest your memory problems are more than let’s just say normal aging?
Andrew Budson: Sure. Let me actually start it with just talking about what types of problems can you see with normal aging. You mentioned, should we be concerned if we walk into a room and you can’t remember what you went in for? The first thing that I’ll tell your listeners is no, we don’t need to be worried about that. That is something that’s normal.
There are a few other things that also one can see with normal memory. It’s normal to need information repeated a couple of times in order to get a hold of it. It’s normal to take a little bit more time to retrieve the information that you’re interested in. And it’s also normal to, sometimes, need a hint or a queue to trigger you, “Oh! That’s right. That’s the name of that restaurant,” or, “That’s the movie that won the Oscar recently,” or something like that.
The types of things that are not normal is when information that has been brought into the memory stores when it cannot be retrieved. Some of the most common examples is when someone is getting lost, even when they’re going on a familiar route – particularly if this happens multiple times. The other thing that is a red flag is if someone is repeating questions and stories again and again and again.
It’s fine to forget an answer to a question and maybe ask it again. Everybody does that once or twice. But when there’s really a pattern of asking the same questions over and over, telling the same stories to the same people again and again, that’s one of the red flags that, “Gee. Maybe I should get my memory evaluated,” or, “Maybe I should take Mom and Dad in to see their doctor.”
Kathy Smith: Well, it’s interesting you say that, because in this era of multitasking and doing so much all the time– we’re driving the car, listening to Siri, listening to the radio, maybe a podcast, we’re doing this talking on the phone– have you found that just this lack of attention to what you’re doing impacts your memory?
Andrew Budson: Absolutely. In fact, it’s very common as normal aging or even people who are young, if you are multitasking and not paying attention, one can make a wrong turn or even more commonly, go a route one normally goes. Like you’re trying to go to the grocery store, you’ll find yourself heading home instead because you’re sort of driving your car on auto pilot, because you’re thinking about your conversation or what’s on the radio or something like that. So that would be normal.
The thing that’s not normal is if somebody is trying to drive to the supermarket, realizes they’re going the wrong way but cannot correct it, can’t sort of get back on track.
Kathy Smith: I know that with my annual physical now, I go in– it started last year– they have me do a memory test. I’m wondering about the memory test because to me, it seems so simple that I’m not sure it’s really testing if I am having decline. I’m having to go in, they gave me three words, then they ask me to draw a clock with a time on the clock, and then I have to come back give the three words again. To me, it was very simple.
At the same time, I see that I have other little signs. But to your point, they’re signs that with a little, “Oh, my gosh. What was that actor’s name again,” I can recall it but just isn’t quite as fast. So is that test enough? What should I be looking for? What are signs that maybe I do have to go to a healthcare provider and get some help?
Andrew Budson: I’m glad you brought that up. I will tell you. The test you had is called the mini cog. The mini cog was developed in an era when people thought there was just sort of too gradations of memory. There was either normal memory or people that actually had full-blown dementia, where dementia means that thinking and memory problems have gotten so severe that people can’t function in their day-to-day life.
We now know that memory loss can start in a very sort of gradual way, and the mini cog, with all due respect to your physician, is not adequate to be able to tell if somebody’s having the early stages of memory loss, which is in fact one of the reasons that we wrote this book, that we wanted to empower people to figure out themselves whether or not there having the beginnings of memory problems – that actually something should be done about it. When should they go see their doctor? And also, what should their doctor do in order to sort out whether or not there is a problem? The mini cog, unfortunately, is not a tough enough test, which you can tell as much as anybody. It’s just not difficult enough for all the complicated things that we do in everyday life.
Kathy Smith: The only thing that makes it difficult is you’re sitting there in a room with somebody looking at you, and you’re thinking, “Oh, my God. I hope I remember these,” and your blood pressure’s going up. “I hope I remember the three words.” It honestly is so simple, so what are some of the signs that we all should be looking for to trigger the visit?
Andrew Budson: If you’re worried about your memory, one thing to think about is, “Are there things that I used to be able to do just fine that I can’t do anymore?” For example, if you always prepared your taxes, which I think is a pretty complicated thing for people to do, and you cannot do it anymore – you’ve tried and you just get lost, you can’t get organized, you can’t find everything, file everything in the right place – that would be concerning. That would be a change from the activities you used to be able to do.
Another example, if you’re someone that always was able to balance your checkbook, and all of a sudden, you can’t balance your checkbook anymore, and maybe you start bouncing checks or you pay bills twice and some bills not at all, that would be something else that would be concerning.
If your friends are saying, “Hey! How come you didn’t meet me at the restaurant for lunch? We set a luncheon date, and you didn’t show up.” That would be another red flag if you’re missing important appointments.
The other thing that I think is helpful is getting input from your friends and your family. Sort of a funny thing about memory loss is that sometimes we can’t remember all the times that we forget things. So if one is concerned, it’s always good to run it by a friend or a family member. They will also be able to tell you whether they’ve noticed that you’re having any trouble with your memory.
Kathy Smith: I understand that the hormonal differences in men and women can cause our memories to be different. Can we maybe address that, but also, talk about besides age, what are some of the other factors that impact our memory?
Andrew Budson: There are absolutely hormonal factors that are very important to be having good and accurate memories. I would say that the largest number of individuals that I see in the clinic who end up having normal memory are perimenopausal women, because it just is somewhat more difficult to pay attention and remember things when the hormones are changing.
In fact, it can be true with men as well; although, typically men don’t have such a dramatic change in their hormone levels unless they are having some type of cancer. Like prostate cancer, for example, they might be put on an antiestrogen. Then men will have these same types of difficulties with their thinking and memory.
Now, you mentioned what are some of the other problems that can cause memory outside of normal aging? In my business as a neurologist, I worry most about Alzheimer’s disease being the most common cause of memory loss. But there are all sorts of other things that can also cause it, many of which are really quite treatable or even completely reversible. For example, one can have vitamin deficiencies. Particularly, vitamin B12 can cause trouble with thinking in memory. One can have thyroid abnormalities. Either the thyroid levels are too high or they’re too low. Either way, it can cause trouble with thinking in memory. There are a variety of different infections. I’ve seen people with Lyme disease, I’ve seen people with a weird type of mycoplasma – another infection that can cause trouble with thinking in memories.
So there are a lot of things that could be causing the memory problems. One of the reasons it’s worth highlighting trouble with infections or vitamin deficiencies or thyroid problems is these are things that are very real and very common. So some of your listeners out there may have noted that they had memory problems but were worried it was going to be Alzheimer’s disease, so they didn’t want to tell anyone or say see anyone about it. But it could be that it’s something as simple as a vitamin deficiency that can be totally cured with a pill. The worrisome thing is some of these types of problems – and B12 is one of them – that if it goes untreated too long, it is not able to be completely fixed. So if one is having memory problems, you really do want to face it, you want to address it. There are things you can do to help and sort it out.
Kathy Smith: So don’t ignore the problem, and to your point, even with thyroid medication. That’s interesting. To get a simple little pill could actually shift your whole experience.
Andrew Budson: Absolutely.
Kathy Smith: Let’s talk about forgetting. I want to move on to some lifestyle changes, but before we do that, let’s talk about forgetting, and is forgetting bad all the time? You talk about this in your book. We know that we all have had things in life we don’t want to necessarily remember. They might be bad experiences. They might be traumatic experiences. So is that the way that the brain helps heal the body by helping to maybe the lessen the impact of some of those experiences?
Andrew Budson: Yes. It’s a very important point that you’re making. The first thing I’ll just say is as you say, it is one of the things that we mentioned in the book that there is some sort of a myth out there that you’re supposed to remember every single thing that ever happened to you your entire life. And somehow, if you can’t remember what your birthday party was like in third grade that there must be something wrong with your memory.
But the fact of the matter is, for things that we don’t think about very much, it’s totally normal to forget them even if it’s something big – like you had a trip somewhere, you were away in some part of the world for a week. If you haven’t thought about that memory in 20, 30, 40 years, it may be totally gone. That’s just the way that memory works. It is, like you say, a normal thing that the brain does in order, really, to make room for new memories that are being formed.
I will say that working in a veteran’s hospital, I know all too well that people can have traumatic memories that they do want to try to avoid. And there are a number of ways that people can work on reducing the impact of these traumatic memories. There are things that people can do with desensitization therapies and cognitive behavioral therapies and a number of different approached that people can use to, if not completely forget about a traumatic memory, to at least make its impact less harmful, less powerful.
Kathy Smith: I’ve read about the forgetting curve and that we tend to forget a certain amount of information within the first 24 hours. I remember, I interviewed Stephen Covey once, and he had a little trick. His trick was within 24 hours of learning some new information, if you repeat it and have to teach somebody else or repeat to somebody else, you’re more likely to retain it.
So if you leave the movie and within 24 hours, you go, “Oh, my gosh. I saw Bohemian Rhapsody last night. It was all about such and such,” and you go through the story, then you’re more likely to remember it. Is that a true or a false?
Andrew Budson: That’s totally true. You may recall that it’s something we talked about in the book when we talk about how do you remember names. Let’s say you want to remember somebody’s name at a cocktail party. The forgetting curve actually starts much earlier than 24 hours. It starts in just minutes. When you meet someone at a cocktail party, after you pay attention and you hear their name and you repeat it back to them and maybe you try and sneak it into the conversation, it’s important to say that name back to yourself another five or 10 minutes later. Then another hour or two later as you’re driving home from the party, say that name back to you. Then the next morning, think about, “Okay. Let me think about all the different people that I met at the party.” Then if you say that again next week and next month, then it will really help to stick. But it’s absolutely critical to repeat that information.
In fact, that’s a good tip for any students who are listening. Because that’s good to remember anything like that French vocabulary that you need to learn. Repetition is really key.
Kathy Smith: There’s a famous approach to memory. Is it Proust [proust]. Who is it that where you walk into the house and then you imagine in the hallway?
Andrew Budson: Yes, Marcel Proust, [proost] was very famous. His whole book begins that he had these petite madeleines that his grandmother used to give him, soaked in a little bit of tea. And he had a similar cake and the smell and the flavors that it brought him back to his early days, and then his extremely long novel went on from there. But what you’re talking about is the method of loci, is how it’s often referred to, or the method of location. This is something that we believe that Ancient Greeks developed.
The idea is that you can picture some type of location that you know well like your house, and you can remember a very large number of items by simply walking through your house and thinking about placing an item in each room, or even better, to increase the number of locations in each part of each room. So people who participate in memory competitions and things like that, that’s one of the reasons that they’re able to remember large numbers of items and in a particular order, because they’re placing those items in the room as they’re going through the house.
Kathy Smith: So, I walk into my front entryway, and if I look at my grocery list and I see in the corner, there’s a banana and I look to the right and there’s an apple orchard. You try to define it and as you define it in that room, it tends to stick.
I’m going to have to try that. I’ll give it a try.
Andrew Budson: Yeah. Exactly. When you make a visual image, things that are visual are better remembered than simply lists in word. And if you make the image very rich and maybe a little bit funny and maybe you connect them together, then it really helps you to remember it. So instead of just a banana, think about a monkey eating a banana. And then the way that you can help to link it together, the monkey’s eating a banana, and in its other hand, it’s holding an apple. And maybe there is a donkey that’s trying to get at the apple, but instead, it’s only eating oats. And that will help you to remember to get the oatmeal at the supermarket. You can link all these things together with outrageous images. And the more outrageous the images are, the more likely that you’ll remember them.
Kathy Smith: That’s brilliant. Okay. I know a lot of people take medications when they’re suffering from memory loss, but I want to actually focus today not so much on the medications, but more on what kind of lifestyle changes should people be thinking about that might impact their memory?
Andrew Budson: The number one, two, and three things that people should do is they should engage in aerobic exercise. There’s actually so much evidence for aerobic exercise. You and I were talking earlier about a conference that I often attend in Park City, Utah where we have some of the basic scientists along with some of the clinical folks. The evidence is as strong in people as it is in mice.
The most exciting thing that I can say about aerobic exercise is it actually produces growth factors in the brain. And these growth factors actually help to grow new brain cells. There are actually studies that looked not only at young adults but also healthy older adults and found that even people in the ages between 55 and 80 were able to grow so many new brain cells that you could actually see an enlargement of the part of the brain that forms new memories on an MRI scan.
So, it’s just astounding what aerobic exercise can do. It really is the wonder drug for one’s memory.
Kathy Smith: Obviously, that’s music to my ears. I know what’s been fascinating for me is that when you also combine aerobic exercise and movement patterns. One of the things throughout my entire career is putting together exercise modalities, strategies, whatever, but we really did whether it was step aerobics or high-impact or low-impact, there was a lot of movement changes, memorization. So not only are you doing the aerobic exercise, but then you’re also having to learn new things as you go. I have to tell you, I would shoot one of my videos and it would take weeks to put one of these things together, and I would come out feeling so smart afterwards because of all the things you have to remember while you’re exercising.
So, I know there’s been a few studies that I’ve read on that, but I don’t know if that’s also a direction of some of the research that’s going, which is trying to create a pattern or do some kind of academic or intellectual work while you’re trying to do some movement. I’ve read some studies of how this also creates– I don’t know if it’s new synapsis or new neurons– but it stimulates the brain.
Andrew Budson: Yeah. It’s totally true. The thing that is most important about what you talked about is the fact that it’s new. So when we are learning to do something new with our mind, there is actually a lot of evidence that we are also making a new synapsis. So when you combine the aerobic exercise, which gives you growth factors to help to grow new brain cells and then you combine that with doing some new novel intellectual activity that’s sort of using those brain cells to form new synapses, that really is very helpful.
The thing that has not been proven to be effective is doing the same intellectual activity day after day after day, year after year after year. So if you have never done crossword puzzles before and you tackle them and you master them or get proficient in them in a month or two, that’s awesome. But when you continue to do the crossword puzzles for the next 30 years, that’s a really fun activity, but it’s not going to enhance your brain as much as would if you then moved on to another type of intellectual activity. Move on to Sudoku or even better, move on to a card game like bridge or something like that that’s a social activity. Because that’s the other thing that study after study after study has shown, that’s really good for thinking in memory, is to do things with other people.
So if you’re exercising with a group of people, whether it’s an aerobics class or a dance class or you’re going for a run with a friend, the social activity is actually super important as well.
Kathy Smith: What about sleep? I like the way you talked about what happens. All of us have heard we need sleep, we need that seven to eight hours, and how important it is and things we should do to get better sleep. But why is sleep so important for memory?
Andrew Budson: There are at least three reasons why sleep is critically important for memory. The first is the easy one. If we don’t get good sleep, what are we like the next day? We’re tired. And if you’re tired, you can’t pay attention to things well. If you can’t pay attention to them, you’re not going to be able to remember them. That’s the first reason.
The second reason is something that everybody probably doesn’t know. I remember it was startling to me when I learned about this. There’s a main part of our brain that learns new information. It’s called the hippocampus. That part of the brain holds onto information that we’ve just learned, but if we want to remember information for a lifetime, it has to get transferred to another part of the brain called the cortex. That transfer process actually occurs while we are sleeping. And so if we don’t get a good night’s rest, we won’t be able to remember what we’ve learned for a lifetime.
That is one of the reasons that if we cram for a test, we won’t remember that information for a lifetime, because there hasn’t been enough time for us to sleep each night and transfer bit by bit those memories into the long-term permanent storage.
I think it’s also a reason why we have difficulty remembering when our children were very young, because they kept us up all night and made it difficult to remember.
The last reason I’ll mention that sleep is important is there’s this abnormal protein called beta amyloid that we believe causes Alzheimer’s disease when it accumulates in too large amounts. We actually make a bit of beta amyloid every day, but we clear the beta amyloid each night as we sleep. So it’s important to get enough sleep for that reason, too, to clear away the beta amyloid.
Kathy Smith: I had Lisa Genova on the show. Do you know Lisa?
Andrew Budson: I don’t know her personally, but I certainly know of her work.
Kathy Smith: We talked about the XPRIZE and with Alzheimer’s and what they’re doing. I know I have to let you go. We have to wrap up. But what do you see on the horizon as next steps, what’s happening in the memory field, and what do you think is exciting that we haven’t heard about but we will be hearing about soon?
Andrew Budson: We’ve been hearing about new medications that are trying to remove this beta amyloid protein that I just mentioned. That is very exciting, but there has been now about 10 different studies trying that approach and it really hasn’t panned out, has not worked. There are new trials going on right now that are trying to remove another abnormal protein call tau.
I am very optimistic that this approach may actually be able to slow down the Alzheimer’s disease process. I don’t think it will cure it. But I think we can slow it down considerably, so I have my fingers crossed on that.
Then just a few other new things that people are working on, many people are actually using patterns of light and sometimes images for either to help diagnose Alzheimer’s when you put an EEG cap on someone’s head and you shine some light in their eyes in a certain pattern. One group is even trying different patterns of light to see if it could treat Alzheimer’s disease, which is a really novel idea. It may sound a little farfetched, but there are some very good scientists that are working on it, and those are also being tested in clinical trials.
So although right now Alzheimer’s remains an incurable and devastating disease, I am very hopeful that within the next five to ten years, we’re going to have some real effective treatments to hopefully dramatically slow down the disease.
Kathy Smith: That sounds hopeful. I thank you so much. For everybody listening, pick up a copy of 7 Steps to Managing Your Memory. It’s by Dr. Andrew Budson.
I have to say that it is a topic that we are all interested in, and when I read the book, there’s a lot that you can be doing that you think you might know already, and I learned so much from this book. I’m practicing little things every single day, because they’re strategies. They’re strategies to take you into the next decade and the next decade and the next decade.
It gets kind of exciting because it becomes like a game. And the game is how can you live life to the fullest and use every single tool you have to just keep everything intact?
Thank you. I really appreciate it, Andrew. The next time you come to Park City, we have to go skiing.
Andrew Budson: I’d love it. Sounds great.
Kathy Smith: Thank you.
Andrew Budson: Okay. Take care.