Memory, as Oscar Wilde wrote, is the diary that we all carry about with us. Open one volume, and you recall a summer picnic from childhood. Open another and there's a grocery list from last week. But what happens when the journal pages get stuck together? Or, even worse, tear loose and vanish entirely?
Thanks to advances in medicine and ever-lengthening life expectancies, most of us will live to find out just how ephemeral memory can be, says Cathryn Jakobson Ramin, author of the new book "Carved in Sand: When Attention Fails and Memory Fades in Midlife." Beginning in our 40s or 50s, we may begin to misplace words -- not to mention our house keys -- with greater frequency. And for some, that forgetfulness will turn pathological, leading gradually down the path toward dementia: According to the Alzheimer's Association, adults who survive past the age of 85 currently have a 42 percent chance of suffering from Alzheimer's disease.
Ramin, now 50, embarked on an investigation of the causes and possible cures for middle-aged absent-mindedness after she began having her own brushes with forgetfulness. "My mental calendar, once easily summoned, grew elusive and developed blank spots," she recalls. "Life became billowy, amorphous, as if someone had removed the support poles from my tent."
Determined to beat back the fog, Ramin turned into a human guinea pig, experimenting with everything from memory-enhancing tests to cutting-edge pharmaceuticals and sleep research. She altered her diet, cut back on multitasking, reduced her stress levels and visited experts who study how memories are formed and retained. Her conclusion: We can't stop time, but we can hinder its effects by taking better care of both our bodies and minds.
Salon sat down with Ramin in San Francisco, where she talked about the nature of memory, the curative powers of ballroom dancing, and why so many of us are scared to even say the word "Alzheimer's."
When did you realize you were losing your memory?
I noticed I'd started to forget things that I should have been able to remember. Once I went to a movie with my husband and five minutes out of the movie theater, I realized I did not know the name of the movie or the name of the main character. It was just gone, a blank.
Suddenly there were sinkholes, as if the information had just been sucked down the drain. And I started to notice a tremendous amount of what I called "content-less conversation." I would exchange information, decide on a plan and then it would be as if nobody remembered what had been said. People were relating these stories over and over to me.
Do you think age-related memory loss is more shocking now because we view people in their 40s and 50s as relatively youthful?
Sure. Twenty-five years ago, someone in their mid-50s was entering a slower, more relaxed time of life. That is not the case now. Our concept of middle age has changed totally. It's a boomer thing. We've never been willing to accept what comes along with any age.
Yet even though we do all these things to keep ourselves physically in shape -- diet, exercise, you name it -- no one has really dealt with the brain. People haven't thought about keeping their brains in shape. To people, brains are not organs. But it's not that different than your heart. You need to build up your cognitive reserve.
So along with aerobics, we should be doing crossword puzzles?
As long as you're not too good at it! To keep your brain at top notch, you have to be challenged. You need to get out of your field and do something that works different parts of your brain. Ballroom dancing is fantastic for your mind. You need to remember all the steps. You need to deal with yourself in space, you are propelling yourself around a room in the hands of a partner, you can't crash into other people. You can always add new and challenging steps. We're not just talking about putting yourself in an armchair with crossword puzzles.
You write that one of the first things we lose with age is the ability to multitask, yet that skill seems to be more important to us than ever.
Multitasking is quite a complicated neurological process, but generally it has a great deal to do with the frontal lobe's ability to switch from one task to another. And your frontal lobes are in far better shape when you're 20 than 40.
But aren't there reports that people in their 20s have begun experiencing problems multitasking, too?
Yes, there's a Japanese researcher who studies people who use various technologies to aid memory. And apparently, the more people use those technologies, the less they're able to actually retrieve from their own brains. It's as if memory is moving off-line. High school students are not called upon to memorize in the way that we did. All you need is a keyboard or a hand-held if you want to know what year the French and Indian War ended.
What were some of the techniques you used to improve your memory and focus?
I saw a psychopharmacologist who said, "I don't know if you have adult ADHD [attention deficit hyperactivity disorder] but I think you should give Adderall a try." It made me a lot faster and a lot sharper. I was able to juggle more. But I found I was thinking of work, work, work all the time and I simply wasn't able to enjoy my life. It was as if I had been possessed.
In the course of my research, one of the drugs that surprised me was Provigil. Provigil was invented to treat narcolepsy. Then some scientists started to look at it in terms of improving attention. When I took it, I found what I call "the clear windshield effect." It had a lot of the benefits of Adderall without the side effects. It worked very well with my word-loss issue. It also allowed me to do a little more multitasking. I had more working memory available.
But you don't seem to think all drugs are a magic cure; in fact, you have a lot of unflattering things to say about antidepressants and their potential impact on memory.
Depression itself can have an effect on memory but I found that there is an uncorroborated and unscientific anecdotal relationship between specific antidepressants and memory loss. It's not based on studies. And it will not be corroborated and I will tell you why. It is because the drug companies will never do those studies. They're not pressured to. It's not required of them by the FDA and it is to their extreme disadvantage.
How does what we eat affect the brain?
Well, we don't eat very well. It's very hard for us to absorb the nutrients that we need. Magnesium, for example, is critically important to midlife memory and cognitive ability. You must take it as a supplement because you would have to be a horse in an organic field to get enough. Magnesium has been leached out of the soil.
Then there is complex versus simple carbs. People don't quite get that the brain runs on glucose. Without sufficient glucose delivered at the right rate, your brain runs out of fuel like your car runs out of gas. When you consume simple sugars -- white bread, cookies, candy, potatoes -- you get a glucose spike. It will make you sharp briefly. But it drops like a ton of bricks. With age, it becomes harder to recover from a plummeting glucose level. As you get older, the mechanism is slower, and you just simply don't have the recovery time. What you need are foods that deliver glucose slowly, over a long period of time. That's seven-grain bread, and nuts, and quite a few other things.
You also write about a psychiatrist -- Daniel Siegel at UCLA -- who is studying a possible connection between parent-child attachment and infant brain development. Siegel claims that moms who are emotionally unavailable to their young children are setting them up for problems with memory in adulthood. As a mother, I found this to be both intriguing and scary stuff. Can you explain why we should take his theory seriously?
It's a very complex idea but I'll try. Siegel is looking at the possibility that mothers who are unable to attach to their infants fail to provide them with a basic brain structure that allows for the consolidation of memory. It's not about abusive parents at all. It's about parents -- particularly mothers -- who are unable to build a connection with a child, possibly because they have their own problems to deal with. If a parent and child are unable to attach appropriately, this child is going to lack the scaffolding on which to post the events of his or her life. Adults who did not have that kind of attachment as infants often don't remember their childhoods. But a lot of people get irritable about that theory.
I can see why.
Basically, the simple answer is that we need to look at brain health the way we look at maintaining other parts of our body. You don't sit there and eat a stick of butter; you don't smoke three packs of cigarettes. And if you do, you will have heart or lung problems. I think if you sit around and watch television, you don't read, you don't interact with other people -- well, social interaction is very important. The more isolated you are the more likely you are to have your brain and memory start to fade.
But in America we isolate our old people.
We certainly do. It's a terrible thing and it contributes heavily to the degree of Alzheimer's disease we see. More than 70 percent of seniors over the age of 65 live alone. The brain needs social interaction and without it begins to fail. I don't blame anyone -- I don't want that to be the idea.
In fact, I devote a big chunk of the book to the assessment and the intervention in Alzheimer's disease. But people almost never ask me about it. It's as if it is not in the book. People are very afraid to even address this. When I did the interviews and surveys, almost everyone insisted on being anonymous. Memory is such an essential part of you, of who you are, people can't bring themselves to go public with their fears.
OK, I'll take the bait. When does Alzheimer's disease begin to develop?
Middle age. There is a time where forgetfulness either turns into something pathological or remains pretty steady. It's very subtle, and this is where it's typically not been diagnosed. I profile a judge in the book. He went to his physician and said, "I'm dropping sentences in my briefs. Things are not right." The doctor says, "You've separated from your wife, you're overworked, go take a vacation." The judge comes back and says the same thing. The doctor says, "I think you're a little depressed, we'll give you some antidepressants." Six months later he's starting to get lost in the car and that's when they sent him for a work-up.
So there is this gray area: It can be as early as your early 50s and go into your mid-60s. That's when people are starting to get diagnosed. And that's going to be an increasing trend, because the technology is starting to be available for early intervention.
Can doctors do anything?
Yes. There are clinical trials. And if you know that things are not looking good you have a choice to make. You can let it go or you can start on various interventions and trials. Now you're going to have to have balls to go into some of these. Some of these trials, vaccine trials, especially, there's risk involved. And a lot of people will not want to take that risk.
Does anything about our brains improve with age?
Vocabulary. You keep learning new words and you don't forget them. But that does not mean that you can produce them! As we get older we blank and we block. We can't retrieve the word in the middle of a conversation.
I remember hearing that older people are better at predicting outcomes?
That's true. We can make certain valid assumptions based on previous experience, that younger people cannot. You can look at your daughter's boyfriend and realize in about 20 seconds that this is not going to work. But it will take her about two years.
So what is memory to us?
Memory is everything. Memory is who we are. When it goes, there is nothing left there. It's what we know about our lives. When it goes -- as it does in Alzheimer's disease -- people don't necessarily lose the ability to get up or eat a meal or go for a walk or sit in a chair. They lose themselves.