Improving Your Memory (8 page)

11
Could Your Mood Be the Problem?

Memories are contrary things; if you quit chasing them and turn your back, they often return on their own.

—Stephen King

You may be surprised to learn that your mood can affect your memory. If you are experiencing depression, grief, anxiety, or stress, you may not recognize the symptoms or realize that these conditions can create problems with memory. We hope this chapter and its examples will help you evaluate your mood and its effect on your memory.

Depression

Many people believe that depression is a normal part of aging, but depression is an illness—a treatable illness. We know that memory problems often accompany depression and that, if the depression is treated, the memory problems improve. The National Institute of Mental Health website (
www.nimh.nih.gov/health
) lists the following symptoms of depression:

• Persistent sad, anxious, or “empty” feelings

• Feelings of hopelessness or pessimism

• Feelings of guilt, worthlessness, or helplessness

• Irritability, restlessness

• Loss of interest in activities or hobbies once pleasurable, including sex

• Fatigue and decreased energy

• Difficulty concentrating, remembering details, and making decisions

• Insomnia, early-morning wakefulness, or excessive sleeping

• Overeating or appetite loss

• Thoughts of suicide, suicide attempts

• Aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment

How Does Depression Affect Memory?

Motivation:
When you are depressed you don’t care about remembering your new neighbor’s name, the time of your exercise class, or who’s running for city council. None of these things seems important.

Concentration:
Even if you want to read the book for the next book club meeting, depression can make you feel foggy and not able to focus on the task.

Perception:
If you are depressed you may view a few instances of forgetting as a sign that you can’t remember anything at all.

EXAMPLE

Ed has experienced episodes of depression for several years. His friends and family had noticed that, when he was feeling depressed, he forgot appointments, confused the names of his neighbors, and couldn’t remember what happened the day before. The first few times this occurred, his family wondered if he was getting Alzheimer’s disease. The family encouraged Ed to see his physician. After a full evaluation Dr. Garcia concluded that Ed’s memory problems might improve if his depression was treated by a combination of medication and counseling. He also recommended that, while Ed remained depressed, his family set up his pillbox, help him with paying bills, and remind him of appointments.

Loss and Grief

When we have experienced a significant loss, we are often overwhelmed with feelings of pain and sadness. It is difficult to focus on anything outside ourselves, and it is harder to concentrate. Memory problems frequently accompany grief and will decrease over time unless the person who is mourning develops depression.

Most people think primarily of death when we talk about loss and grief. In fact, a feeling of loss may accompany many different experiences, including a move, major surgery, retirement, vision or hearing problems, illness of a friend or family member, changes in financial circumstances, death of a pet, marriage of a child or friend, and changes in health. Even a change you choose to make, such as retiring or moving, can be accompanied by a feeling of loss. When two or more of these experiences occur at once, the effect is greatly increased.

EXAMPLES

Sean had been ready to retire for several years when the day finally arrived. He looked forward to sleeping late, having no boss to answer to, and spending time in his basement workshop. He was surprised to discover, however, that he often felt sad and at loose ends. He also noticed that he was forgetting things. With his wife’s encouragement, he volunteered to deliver Meals on Wheels to shut-ins and began a drawing class. As he felt more useful, his sadness diminished, along with much of his forgetfulness.

Jeff had been dating Kristin for a year and a half. He thought things were going well and planned on a future with her. After the holidays, Kristin told him that she hadn’t been happy in their relationship for a while and that she wanted to stop seeing him. Jeff initially was very angry and told himself he was better off without her. As days passed, he found himself tearful and overwhelmed. He couldn’t pay attention to his work and forgot his friend’s birthday party. He felt like his mind was deteriorating. He wondered whether he was losing his memory, and he didn’t know what to do about it. After several months passed, he realized that he was feeling better and that his memory was better, too. With the lessening of Jeff’s grief, his memory returned to normal.

Anxiety

Anxiety is characterized as inner distress accompanied by physical symptoms and vague fears. Many people who are highly anxious are unable to focus on anything outside of themselves. Their minds are so filled with worries that they cannot pay attention to external happenings, and their memory failures affect their daily functioning.

Some symptoms of anxiety are

• Nervousness, worry, or fear

• Apprehension or a sense of imminent doom

• Panic spells

• Difficulty concentrating

• Insomnia

• Fear of potential physical illnesses

• Heart pounding or racing

• Upset stomach or diarrhea

• Sweating

• Dizziness or light-headedness

• Restlessness or jumpiness

• Irritability

EXAMPLE

Diane describes herself as someone who has always been a worrier, but it has gotten worse as she has grown older. She worries about her unmarried son, her granddaughter’s thumb-sucking, her own high blood pressure, and her arthritis, which could affect her ability to take care of her home. She feels agitated, doesn’t sleep well, spends most of the day worrying, and is unable to remember things very well.

When she is in the clinic to get a blood pressure reading, Diane mentions her anxiety to the nurse, who suggests that she should discuss it with the doctor. Dr. Hall recommends a cognitive behavioral therapy group for people who are anxious or depressed, where Diane might learn new ways of dealing with her anxiety and benefit from the group support. In the group, Diane recognizes that she has no control over her son’s unmarried state and her granddaughter’s thumb-sucking. She vows to try to take them off her worry list. The group helps her consider options for the future in case she is unable to take care of her home.

Diane knows that she will continue to be a worrier; however, when she reminds herself of the uselessness of worrying about those things that she cannot control, some of her symptoms of anxiety are alleviated, including memory problems. As she worries less, she finds she can concentrate and remember better.

Stress

When we are feeling stressed, pressured, or rushed, it is often impossible to

• Pay adequate attention to learning new information

• Concentrate on the details we want to recall

• Relax long enough to let a memory surface

We are more likely to forget things when we are under major stress—due to factors such as moving, illness, loss, or retirement—or even when we are under minor stress caused by experiences such as being late to an appointment, misplacing the house keys, preparing for company, or getting ready for a trip. It is important to realize that we may forget more frequently at times like these and that memory usually improves as the stress is reduced.

EXAMPLE

You have been extremely busy all week getting ready for a visit from your son and his family, who live in California. The sink becomes clogged, and the plumber is available only during the time when you are picking up the family from the airport. You ask your neighbor if you can give her a house key when you leave for the airport, so she can let the plumber in. To your horror, you forget to leave the key. Because you were stressed, overloaded, and rushing, you forgot to do what you wanted to do most. In a case like this, it’s best to take action the moment you think of it.

12
Ask Your Doctor about Health Issues

God gave us memory so that we might have roses in December.

—J. M. Barrie

EXAMPLE

Ellen’s son is very concerned about her forgetfulness. He continually tells her that she should try harder and feels that she should learn some new memory techniques. He learns about a memory course from a neighbor and insists that his mother take the course, although she is not enthusiastic. He calls the instructor to enroll his mother in the class and describes her problems. She repeats herself frequently and sometimes forgets that he has called. She is having trouble keeping track of her bills and has dropped out of her card-playing group. As he paints the picture of his mother’s memory problems and expresses his conviction that she could remember if she really tried, the instructor wonders whether Ellen’s memory problems may be related to a health issue. She suggests to the son that he should go with his mother to her next medical appointment and discuss his concerns with her doctor.

Physical health and mental functioning are very closely linked. Factors such as physical illnesses, medications, vision and hearing problems, fatigue, alcohol, and nutrition may affect your memory. Ask your doctor whether your memory changes may be related to a health problem or medication.

Some Physical Illnesses

Even though many older people do not develop severe memory loss, memory problems can be a sign that the body is not functioning properly. Some physical illnesses can aggravate an already existing mild memory problem, or they can cause memory changes in a person who has not previously experienced memory loss.

On the one hand, conditions such as infection, fever, dehydration, and thyroid problems can cause temporary changes in memory that improve when the condition is treated. Urinary tract infections are notorious for causing memory problems and confusion in older people.

On the other hand, some types of diseases or injuries that cause damage to the brain may not be reversible. Alzheimer’s disease is the most common cause of irreversible memory loss. (For more information on Alzheimer’s disease and other causes of dementia, see the appendix.)

Strokes and traumatic injury to the head often cause memory problems that show improvement in the months after the trauma but frequently leave some irreversible changes.

If you are concerned about your memory and want to rule out a physical cause, the first step is to see your doctor, who is familiar with your medical history. Some physicians receive little training in assessing the mental status of older people. In that case it may be worthwhile to consult a physician with specific training in geriatrics or neurology, who has the diagnostic
skills to distinguish among a wide assortment of possible causes of memory loss. A medical assessment often includes

• A social and medical history taken from both the patient and a relative or friend

• A thorough physical exam

• A neuropsychological exam, which is a series of tests that provides information about the thought processes

• Blood tests, which are used to detect thyroid, kidney, and liver malfunctions; certain nutritional deficiencies, such as pernicious anemia or vitamin B
₁₂
deficiency; infections; and metabolic and chemical imbalances

• Urinalysis, which is used to detect infections in the urinary tract

   Other tests that may be indicated include

• A CT scan of the brain (computerized axial tomogram), which is a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce horizontal images (often called slices) of the brain

• An MRI of the brain (magnetic resonance imaging), which is a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body, including the brain

• A PET scan of the brain (positron emission tomogram), which is a nuclear medicine scan that shows how the brain and its tissues are working (Other imaging tests, such as MRI and CT scans, only reveal the structure of the brain.)

• An EEG (electroencephalogram), which is a measurement of electrical activity (brain waves) in the brain

• A lumbar puncture (spinal tap), which is an analysis of spinal fluid that can detect malignancies, neurosyphilis, and certain infections

EXAMPLE

When Meg, the housecleaner, arrived at Theresa’s apartment for her weekly visit, she found Theresa in bed and quite confused. When Meg asked Theresa whether she had had breakfast, Theresa said she wasn’t sure. Also, she could not remember Meg’s name or exactly why Meg was there. Since Theresa had never been confused in the past, Meg consulted with a neighbor, who agreed that Theresa should go to the emergency room. The physicians at the hospital discovered that she had a serious urinary tract infection and admitted her to the hospital. When Theresa’s infection cleared up, her confusion disappeared, and she returned home feeling mentally and physically well.