Remember: Book Review

 

Published
23 March 2021

I had the opportunity to read Lisa Genova's novel Still Alice prior to the release of the film based on her fictional account of a woman living with early onset Alzheimer's. Because she has a doctorate in neuroscience, Genova's novel was informed by science.  

I make an effort to read books about cognition -- fiction and nonfiction, expected age-related changes in cognition and disease-related changes. My octogenarian step-father is living with Normal Pressure Hydrocephalus, which includes dementia, and my octogenarian step-mother is living with dementia (vascular? Alzheimer's? mixed?). Consequently, when I saw that Genova wrote a nonfiction book about memory--Remember: The Science of Memory and the Art of Forgetting (2021)-- and then bought the hardback so that I could reread parts if not all of her description of how human memory works. 

The Brain's Way of Healing: Book Review

Published 27 January 2015.

I enjoy reading about neuroplasticity for a variety of reasons:

1.  I am very interested in learning more about cognitive development through the rest of the life span after spending decades focused on teaching critical thinking to first-year college students.

2. Neuroplasticity offers positive views of aging and hope for people who have age-correlated problems.

3. I enjoy looking at the birth of a new scientific discipline.

For these reasons and others, I was eager to read Norman Doidge's new book on neuroplasticity.  The Brain's Way of Healing: Remarkable Discoveries and Recoveries from the Frontiers of Neuroplasticity, pubished in January of 2015.

I find it contains some very intriguing case studies.  The book discusses well over a dozen cases in detail, but here are a few to serve as a quick preview:

We meet a midlife man who improved his walking despite a diagnosis of Parkinson's disease, a midlife woman who recovers from Traumatic Brain Injury,  a boy diagnosed with ADHD who becomes more focused, and a toddler girl who overcomes a sensory processing disorder.

Being Brain Healthy: Book Review

Published 11 March 2015.

Working on brain health is vital to every person, not just for those coming back from a traumatic brain injury (TBI).

Curran's Background

However, it was her own experience sustaining a brain injury in a car accident in November of 2003 that started Ruth Curran on her quest for greater knowledge and skill regarding brain health.

After having to look very closely at how her brain was relearning information, Curran accelerated her own recovery by earning a master's in psychology between 2004 and 2006 with an emphasis on cognition.

She had additional interest in how the brain functions, given that her parents developed cognitive challenges--her mother because of the side effects of chemotherapy and her father because of Parkinsonian dementia.

Truth be told, Curran had already earned a degree in psychology during the late 1980s and worked as an organizational behaviorist in the 1990s--both activities conducted well before her accident that show a heightened interest in how the brain functions.

Based on her education, work experience, family members' needs and her own needs, Curran developed visual exercises to improve brain function and then in 2011 started her blog and business, Cranium Crunches: Brain Based Solutions.

Cognitive Changes: The Usual Suspects

Photo by Mark B. Schlemmer. 

While teaching college English for 30 years, I thought I knew a great deal about the human mind. After all, I was teaching critical thinking.  Entering the field of gerontology at midlife has brought me to a greater awareness of how the brain works.   As people experience changes based on trauma, disease or even just the passing of time, we can see how the brain functions.  The contrast helps us see the efficiency of the brain that we usually take for granted.

Now that I am a gerontologist, I frequently have friends and acquaintances ask me if a parent’s changing cognition is a sign of dementia, specifically Alzheimer’s disease.  I am not a neurologist, so I am not qualified to assess. I ask them to schedule an appointment with their parent’s general practitioner.  Nevertheless, here is an overview of some of the many reasons why an aging parent might demonstrate a change in cognition. 

This list is no way exhaustive, but it contains the "usual suspects" when cognitive changes appear.  If you or someone you love shows cognitive changes, please consult with a licensed medical professional. 

An App that Supports Memory

Photo taken with my Droid Razr Maxx HD

Every once and a while, I have a little trouble with my memory.

I might lose my keys, forget an appointment or struggle to recall the name of someone I've recently met.

When I was younger, I attributed memory problems to being overcommited, tired, or stressed out.

I have even more demands competing for my attention now. 

To better manage all my responsibilities as a midlife woman, I'm learning about age-related changes to cognition.

Note that mature people have many strengths and other advantages when managing their cognition:

* greater stockpiles of information
* greater understanding of how to respond effectively based on context
* greater self-awareness of cognitive abilities
* greater awareness of means for compensating.

My maturity helps me manage challenges to my memory.  I have customized compensating strategies to my own needs.

Dystextia: Sign of Brain Trouble

Photo by David365.

Strokes all too often go undiagnosed despite efforts to increase awareness of the signs and risk factors.  Add to the signs the phenomenon of dystextia--the inability to text properly and the failure to recognize errors in one's own text messages.  It's interesting that for some of the case reports, dystextia is the only apparent sign of an abnormal cerebral function.

People should add dystextia to other communication failures that signal the possibility of a brain abnormality such as a stroke or a transient ischemic attack (TIA). Right now, the number or reported cases is very small:

• a 40 year old male in Ireland published in 2006
• a 20 year old male in New Zealand published in 2011
• a 40 year old male on business in Detroit published  in 2012
• a 25 year old pregnant woman published in 2013

The man in Detroit did not detect any errors in his text messages including the phrase “Tjhe Doctor nddds a new bb," which should have read "The doctor needs a new Blackberry."  He was experiencing a stroke in the Broca's area of his brain, a key language center. 

Mild Cognitive Impairment (MCI)

Photo by Flood. 

As people get older, they experience age-related changes to their memory: i.e., they take longer to store and retrieve information, their attention is compromised when multitasking, and they take longer to retrieve the desired name, date, place or specialized word.

Sometimes older adults too readily fear that they are in an early stage of Alzheimer's disease (AD). Usually, these changes to memory are just normal signs of aging.

But what if the memory problems seem more serious?  Is it Alzheimer's disease?  Maybe, maybe not.

Yes, as people age, their risk for AD and other forms of dementia does increase. About 5% of those ages 65 to 74 have AD; the rate increases to about 50% for those 85 plus. Yes, symptoms of AD can often mask as normal changes to memory. Some disregard atypical memory changes, which postpones a diagnosis until people move beyond the early stage and into the mid-stage of the disease.

(For a fuller overview of various stages of memory performance,
see this list at alz.org.)

However, older adults with memory problems should first consider the possibility they have Mild Cognitive Impairment (MCI).

EDITED TO ADD: A year after this post was published, the APA's 5th edition of DSM changed the name of this from MCI to mild neurocognitive disorder. Here is an article from 2015 that explains the science behind the name change. 

The Alz.org document 2012 Alzheimer's Disease Facts and Figures reports this prevalence: "Studies indicate that as many as 10 to 20 percent of people age 65 and older have MCI" (p. 9).  Furthermore, only a small percentage (15%) seek medical advice about MCI. Of those who do seek treatment, half will develop dementia in 3-4 years.

Clearly, older adults and their loved ones need a greater awareness of MCI as a distinct diagnosis.

Modify Conversation with Older Adults As Needed

Photo by McBeth

How do you talk with older adults?

Communicating with older adults may not require any adjustments on the part of the speaker.

Often people 65 plus have no problems maintaining good communication.

Here is an overview of some communication challenges that might be at play.

• Elderspeak on your part
• Delirium from a treatable medical problem, such as an infection or dehydration
• Dementia 
• Hearing Problems
• The Use of Touch to Communicate
• Depression
• Drug Interaction
• Hospital-induced Delirium

See the list of links below for more detail about many of these challenges. 

Most older adults only have mild communication challenges if any, so don't let this list and the links let your imagination run wild.   But cautiously and calmly consider whether the communication problems you perceive need some kind of intervention, including changes in your own communication choices. 

If you interact regularly with the same person, you will soon see his or her typical needs for clear communication. If you work with the general population and only the occasional older adult, it make take you a while to hit the mark correctly. Again, you do not want to treat people as feeble minded or childlike, but you do want to accommodate their communication needs if possible.

Related:
Talking with Older Adults in a Crisis  This is the most comprehensive post
Elderspeak: Babytalk Directed at Older Adults
Is It Dementia or Just Delirium?
Prevelance of Dementia and Diagnosis Tools
Hearing Loss Can Be Hard to Manage
The Importance of Touch Persists through the Lifespan
Hospital-Induced Delirium
Talking with Older Adults, Serving as a Witness

On the Tip of My Tongue

Photo by mademoiselle lavender

“Oh, she was in Gone with the Wind and Streetcar Named Desire. Don’t tell me. I’ll think of it. . . Vivien Leigh!”

People of all ages have trouble retrieving names at times. However, as we age, this phenomenon occurs more frequently. 

Neurologists and speech language pathologists have numerous explanations for memory problems.  Some are a result of injury or disease.  Others are merely the result of healthy aging.    Retrieving a name is just one small aspect of memory.

It’s usually part of healthy aging to sense that retrieval of a name is imminent but not forthcoming.  Numerous theories exist for explaining specifically what causes these mental blocks. 

Although described earlier by William James and other psychologists, it wasn’t until 1966 that the research team of Roger Brown and David McNeill published an empirically based study that dubbed this frustrating memory problem “Tip of the Tongue Syndrome” or TOT.

Bingo--More Than Meets the Eye

Photo by Kimberly Malvar

Attending Monday bingo in the skilled nursing center for fifteen months has shown me that this supposedly simple game requires the players to manage multiple skills.

Players must have adequate vision, hearing and the fine or gross motor skills to play. 

During a round, someone asks, "Did the caller say '50' or '60'?" They also need the cognition to retain the number in their mind while scanning each number on three cards.

For reasons having to do with vision or with cognition, sometimes a 3 will look like an 8, a 7 like a 1. They also have to perceive the winning patterns.

Almost each resident in skilled nursing has trouble with at least one of these tasks, but they find ways to accommodate age-related changes.

Laura sits at the front table so that she can see each ball as it comes out of the mixer. She relies on her vision since her hearing is impaired. Sam uses large-print cards. Bill places his cards on a non-stick mat and wears gloves that keep his fingers from forming a fist. These aids help him push the windows closed without the assistance of a staff member or volunteer.

A handful of residents have every skill set required to play bingo. They just have lower-body challenges to manage, so once they maneuver their wheelchair into place, they are ready to play without impediment.

Betty receives gentle reminders from a volunteer about when she can call bingo. Even though she struggles to remember that five numbers in a row is the desired pattern, she shows great accuracy each week over the course of 11 games in finding the called numbers on her cards. Even though she has memory problems, she still possesses enough skill with her hearing to help others at her table.

Residents at tables throughout the dining room take turns helping each other in this way: one might have the better hearing, her neighbor the better vision. This co-operation reinforces the importance of social skills required for bingo. They tease each other for winning too often or not at all.

Gladys wins the current round, so she receives a dollar in winnings. The caller shouts out, “If there are no others, this round is closed. Clear your cards.” An adult son walks into the dining room and pulls a chair next to his father. Another resident comes in from an appointment in the beauty parlor and tries her luck for the last two games.

The weather outside worsens. Everyone looks up to see the rain splashing heavily against the windows before turning to hail. The noise of the storm mixes with the sound of the bingo balls tumbling in the cage. One by one, the numbered balls escape down the shoot and line up to be called in the next game.

Related:

Is It Dementia or Only Delirium?
Age-related Changes to How We Write
Activities of Daily Living and Instrumental Activities of Daily Living
Don't Be a Boy Scout: Preserving the Independence of Older Adults

Age-Related Changes to How We Write

Photo by Marc Moss

With the boomers moving into late adulthood, many are posing questions about what constitutes healthy aging in a variety of areas such as cardiovascular health, respiratory health, and cognitive health.

Unfortunately, more research to date has been done with diseased older adults as opposed to healthy older adults. Older adults would benefit from learning what changes might be disease related and what changes are normal and expected as part of healthy aging. Gerontologists and other scholars are now starting research to rectify this ommission in the literature. Nevertheless, some research exists here and there that describes healthy aging.

For example, T. L. Mitzer and S. Kemper published a study in 2003 that analyzed the biographical statements of 118 older women (ages 78 to 91) in an effort to find an explanation for what contributed to stronger writing samples. Strong writing samples did not correlate to the writer's age. Instead, strong writing was produced by those who were in better physical condition, had higher educational levels and higher cognitive status. The high-level writing samples had the following characteristics: less-varied vocabulary, longer utterances, more clauses per utterance, more grammatically complex structures, fewer fragments.

Is It Dementia or Delirium?

Photo by Susan NYC

When I first started interacting with older adults with greater frequency as a student of gerontology, I was conflating a number of terms.

Senility, cognitive slowing, confusion, dementia, and Alzheimer’s are not interchangeable phenomena.

Senility is a dated term employed before contemporary medicine was able to diagnose more specific forms of cognitive changes.

Senility is a general term, one that lumps too many situations into one group. Using the label “senility” limits the observers’ understanding of the affected person’s limitations, capabilities and needs. Therefore, “senility” is a harmful term.

[Note: The purpose of this post is to raise awareness not to offer medical advice. If you have a concern about your health or the health of a loved one, please see a licensed medical professional.]

Cognitive slowing is a natural, age-related process. Everyone who ages will need more time and fewer distractions to perform various mental functions. If a person temporarily forgets the name of the lead actor in Gone with the Wind, this does not mean that person has Alzheimer’s Disease. In my 30s, I used to give three hour lectures in college literature courses without using lecture notes. Now I need to review names, dates and places that I used to recall immediately. This is especially true if I feel stress, if I am tired, or if I have distractions competing for my attention. Age-related cognitive changes include a degree of short-term memory problems, problems with word retrieval, word substitutions and slowing of executive planning and working memory.