(January 3, 2008 - Insidermedicine) Welcome to Insidermedicine's If I Had, where we get a chance to ask an expert what they would do if they had a medical condition.
On a recent trip to Baltimore, we caught up to Dr. Barry Gordon, MD, Ph.D, who is both a behavioural neurologist and cognitive neuroscientist at c. He is a founding member of the Mind/Brain Institute, and directs the Memory Clinic. Dr. Gordon has authored more than 100 scientific papers and book chapters, and is also the author of the book, "Memory: Remembering and Forgetting in Everyday Life."
We asked Dr. Gordon for his thoughts on what to do if you believe you have a memory problem.
If I had a memory problem…
Dr. Gordon: If I thought I had a memory problem, if I thought I was forgetting people’s names more than I should, if I thought I couldn’t remember names that I used to remember, if I was locking myself out of the car or forgetting even where I parked my car more often than I thought I should be, what I would do is go to either a psychologist, a neurologist, or a psychiatrist, ideally, but I’d go there with my spouse or someone else who knows me very well because I’d want them to be able to comment on their observations about my memory problems. And the reason I’d do that is because of something potentially very good, which is people are fairly bad judges of their own memory, and a lot of people complain about their memory who don’t have any problems at all, in fact some people with nearly perfect memories think their memories are below average. So I have to be very concerned if I think I have a memory problem that my judgment about the memory problem may not be good. Instead, it may be my standards are too high; I may be depressed or anxious, lots of things. And coming with a spouse or someone else who knows me well can help provide a perspective on that, which the doctor really needs.
What I then need to do to go to the doctor is think through and have my spouse or friend think through. “When did this begin?”, “What have I noticed?” or “What have they noticed?”, “How bad was it?”. For example, “Did I forget to pick up the kids?”, “Did I leave water boiling?”, “Did I forget to pay my taxes?” or was it something more ordinary? And actually, not even to be worried if I forgot to pay my taxes because that happens to people, too. So how bad were the episodes of forgetfulness? How serious were they? How often do they happen? Everybody’s entitled to forget something serious once in a while, but is it happening daily? Is it happening every five minutes? Has it been changing? Has it gotten worse or better? Are there days when things seem to be good? Are there days when things seem to be very bad? That’s important to know too. Have there been any other changes in me? Do I think my judgment is bad? Has my personality changed? Does my spouse or close friend think that’s happened, or not happened? Those are important things. And then, has there been any change in my medical condition at all? Either my general medical condition, medications I’m taking, or things I don’t even think are medications that I’m taking anyway, like I’ve just discovered a new health food and I’m eating it all the time. That’s what I’d go in armed to see the doctor with, that information, because he or she won’t be able to make a determination well without knowing that and without having another informant ideally.
I’d also, being a doctor, think to myself “I really should do this if I’m worried.” A lot of people say, “Well, jeez, if I have a memory problem, it’s going to be Alzheimer’s disease and why should I do anything at all? Nobody can treat that anyway. It’s a death sentence.” But actually, most memory complaints in the ordinary world are not Alzheimer’s disease. Some of them have very effective treatments, for example, handling depression. And regardless of what it is, people will be able to take care of it better and I’ll be able to manage it better the earlier it gets diagnosed. So I tend to encourage people, as I’d encourage myself, to go in earlier rather than later. There is an average of about 3 years from when people start to notice memory changes in the spouse to when they actually diagnose Alzheimer’s disease, and that’s 3 years that might be put to better use.
How is a memory problem managed?
Dr. Gordon: The management of a memory problem depends on what’s causing it. If it’s a memory problem related to aging, I try to reassure people. I suggest memory management techniques and there are several books available, including the ones I myself have written to try to discuss some of those. People can improve their memory a great deal, or improve their memory functioning a great deal, by just some simple techniques including paying attention, putting things you don’t have to strain yourself to remember in places where you can’t forget them. For example, instead of putting your car keys in some novel place every morning, put them in the same place by the door so you have to find them on your way out. Making lists, carrying little cards as many people do – that works for basic, simple memory things. The other thing that surprises people is being in good health is as important for memory as having good mental health, so physical conditioning, especially aerobic conditioning, is now known to be very important for maintaining mental and memory functioning. So I encourage people to get blood pressure treated, diabetes checked for, not to be overweight, and to be aerobically fit is very important. That boosts memory abilities and mental abilities. If you have a memory disease: Alzheimer’s, memory disorders due to high blood pressure, Lewy body dementia, etcetera, then in some cases there’s either more specific treatment possible, but that’s really a matter of judgment for each individual patient, individual doctor, and what they’re going to pick out of the armamentarium of disease-specific treatments to the extent we have them and how best they work for them. There are things that can help those conditions. They don’t help them as well as we’d like, but there are things people can do and there’s also things people can do to make their lives easier with those conditions. And there are any number of sources that talk about those, including Dr. Rabins’ 36 Hour Day for Alzheimer’s Disease and others. I have a section in my book discussing memory problems, basically for people with relatively mild memory deficits.