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How good is your memory?

written by Thu Tran, MD,FACOG
on Wednesday, 5th June ,2013

Most of us do not worry about our forgetfulness until we are in our "middle age". We usually blame it on our busy schedules and how we remember only the "essential" things and thus forget the "little things" in our daily lives.

I have noticed how even "brilliant" people like my husband David, a physician-attorney, tend to forget "little things". I can't even tell you how many times David has to use our home phone to locate his cell phone, and how many times his "lost" cell phone would be ringing within a few steps of where he was standing. Sometimes it would be his sunglasses, other times it would be his running shoes or his polo shirts sent to the house from hotels all over the country where he had given his healthcare lectures.

Just several days ago, David told me how a woman got out of the car in front of him when he was at a traffic light in Washington D.C. David was on a hurry taking Sandy to his "SAT II" -- Biology exam at Sidwell Friends school. It turned out that David left a mug full of coffee on the roof of his car!

"See what good a driver I am? After eight miles, the mug didn't fall off the roof and the coffee didn't even spill!" David proudly said.

I shouldn't complain about David so much since I once got one of my bras back from the Fairmont Hotel in San Francisco. At first, I was shocked because I thought it was from one of David's trips.

"A woman's bra? Either David is getting weird with his sense of fashion, or he'll have to come up with some pretty good answers for why there was a woman's bra in his room" I said to myself, before I recognized that it indeed was my bra. I am not perfect, as imperfect as the time I put my favorite pair of black shoes on the roof of my car and drove away to the gym before work. I was still in my 30's then.

Forgetful incidences like these could be comical, as they can happen to any of us busy people. Alzheimer's Disease (AD) or its early manifestation of dementia, however, is a devastating medical condition that progresses with no cure. AD currently affects about 5.4 millions American and can reach 17 millions by 2050. Fortunately, most researchers have found that AD is not genetic. Any of us can be affected, but we should not fear for getting AD if one of our family members is affected by it.

Like many of you a few weeks ago, I read about Margaret Thatcher, one of England's former prime ministers and among the most powerful of all women in the 1980's. She was tall, regal and elegant. She was a stern and strong figure, and stood out as a woman among the male world leaders, in the era when most women were home tending to their families or their gardens.

I was surprised to hear how Margaret Thatcher had vanished from public life since 2002 because of her severe dementia. She was like her friend Ronald Reagan who, at the end of his life, couldn't feed himself or recognize his loved ones. Where did all their brilliance go to?

At the end of March, I read a moving article in the Washington Post about Dr David Hilfiker who has struggled with AD for several years. He was the valedictorian of his high school, and was a Yale graduate. He practiced as an internist and founded Joseph's house in Washington D.C, where he and his family lived for three years among the homeless men living with AIDS. Dr Hilfiker has a blog called " Watching the Lights Go Out" to chronicle his journey with Alzheimer's Disease. He told stories of how it has been getting harder to do the usually mundane tasks in his daily life such as keeping track of appointments or recognizing the people he already met.

Instead of being bitter about his condition, Dr Hilfiker learned that he better enjoy the moments and make the most out of the days when he still can remember. He has become more emotionally attached to his family and tried not to live in the future, a painful future where he most likely will be confined in a nursing home. Instead, he lives in the present. As he summarizes movingly at the end of the article:

"Perhaps this Alzheimer's is allowing me to enjoy my life for the first time, not because things are better, but because I'm more emotionally in touch with the goodness, I feel rooted, grounded, I'm where I'm supposed to be."

Wasn't it a remarkable view from a man whose life is less than optimal? Wisdom often emerges from the hard times. I have always believed that our body is the house of the spirit. Even in the darkest hours, the spirit can always shine.

Moreover, we tend to live blindly. We focus on what we are doing as if we are walking through a narrow passage. Only when hardship strikes do we remember that there are so many things around our path that we did not notice before. We suddenly notice the sound of the wood pecker, the bright yellow petals of the daffodils against the dead leaves left behind from the winter. We notice the children playing in the park, the sunset on the horizon, or the full moon above the Poplar trees. We hear even the softest rain drops or the rustling of the leaves on a windy day. We use all five senses and suddenly realize there is more to life than just going to the office in the morning and coming home in the evening, just in time for dinner and to go to bed, so that the cycle can start over in the morning. We realize that we are important not just to our patients, but to our family.

Several days after I read the article on the Washington Post about Dr. Hilfiker, one of my dear patients walked into my office with her loving husband. She has severe dementia and can no longer perform most daily tasks. Her husband has retired to devote his time into caring for her. He makes sure she eats healthy food and takes many daily walks. She can no longer cook, and he's now her chef. This patient was still so lively. She told me how she was trying "the best I can".

"What do you do every morning, honey?" Her husband asked lovingly.

"I wake up every morning and say to myself 'Today will be a good day!'" She responded, smiling.

Her husband went on to tell me stories of how, since his wife's illness, he has become more observant with his environment and how disappointed he is with many people's attitudes.

"I see so many miserable people. They are miserable over the smallest things. They complain and complain over everything in their lives. They have no idea how much good time they have wasted." He shook his head.

We are the maker of our feelings. Live and enjoy the moment, I would concur with Dr Hilfiker and my patient.

We have been bombarded with information about the mind and nutrition. There are many theories out there about Alzheimer's or other dementias and their treatment or prevention. To educate yourself more about this disease, its early symptoms, possible treatment and prevention, and its different stages, you can go to the Wikipedia link below:
en.wikipedia.org/wiki/Alzheimer's_disease

I will point out , in this limited blog,a few popular studies or scientific theories and possible treatment/prevention plans to hopefully help you and me improve our memory, or at least slow down its decline:

1. Medical conditions affecting the normal blood flow to the brain could be the precursors of Alzheimer's Disease or many other dementias: Reducing these conditions might be the major strategy in preventing Alzheimer's Disease, according to Dr Jack C. de la Torre, MD, PHD of the University of Texas, Austin, reported in the Journal of Alzheimer's Disease. By controlling the incidence of diabetes, hypertension, atherosclerosis, high cholesterol, and heart disease, for example, we might decrease the prevalence of Alzheimer's Disease.

The above scientific finding was supported by another study released in Feb 2013 in JAMA Neurology, by Dr. Adam Brickman, PhD and assistant professor of neuropsychology at Columbia University. Dr. Brickman reported that damage to the white matter of the brain can be found in the brain of Alzheimer's patients and appears to increase the risk of developing the disease. By preventing the formation of these white matter plaques, one might decrease the chances of developing Alzheimer's disease. Having a normal weight or not smoking, according to Dr. Brickman, are ways to prevent damaging the blood supply to our brain.

We have to be mindful that the above discussed risks could already be established by the time we reach "middle age". We have to be healthy during this time to prevent the dementia process as we become elderly!

The American Heart Association recommends 150 minutes of moderately intense exercise weekly to prevent Alzheimer's Disease. The risk reduction could be as much as 50%. This amounts to 30 minutes, five days weekly. Remember that most evening TV shows are longer than 30 minutes!

2. Hearing loss in older adults can increase the risk of dementia: a study reported in the Journal of the American Medical Association in January 2013, by Dr. Frank Lin, MD, PhD, of the Johns Hopkins School of Medicine. Dr. Lin noted a 25% increase in mental impairment over six years in older adults with hearing loss.

3. Food for the brain: Essentially eat the kind of diet that would prevent heart problems or obesity. For example, a Mediterranean diet with grains, fatty fish, nuts, olive oil, and many fruits and vegetable. Two to four cups of green tea a day has also been shown to be helpful for memory and to slow brain aging. Eat four to six small meals a day instead of three major meals to avoid the spiking of blood sugar which can cause inflammation and damage to our blood vessels. Ginko and Turmeric have not shown strong evidence in preventing memory loss.

4. Adequate sleep is important. Most adults should sleep about eight hours a day. Children up to college age, if possible, should sleep about nine to nine and a half hours a night. To sleep well, avoid intense activities or exercises shortly before going to bed. Dim light and low level of noises or sounds is be helpful. Avoid caffeinated products eight hours before bedtime (although some of my friends and family members claim they can drink warm strong caffeinated products and still fall right asleep and sleep well).

5. Mental Stimulation: Play a board or card game, learn a new language, play word games, read an hour a day of newspapers or books, play a music instrument, take a new route to work. Feed your mind with new information and pathways.

6. Active Social Life: Make friends and stay in contact, join a sport club, book club, play chess or card games with friends, take a cooking classes, there are so many ways to socialize. Keeping ourselves connected through Facebook is also an important process for many of us, although I have to admit that I am one of the few people who does not have a Facebook account!

7. Stress management: Take long walks, go to Yoga classes, learn to meditate, listen to music . Learn to BREATH!!! Breathing through our abdominal muscles is an important technique to nourish our brain with good oxygen! Many of us have different ways to manage our stress. Please let me hear what works for you since it might help many others to better manage their stress.

Several weeks ago, one of the biggest and saddest local news story was about a missing elderly woman who arrived at Reagan National Airport from Barbados. While her daughter was waiting for her at the gate, expecting to see her in a prearranged wheelchair, the security camera showed her wandering to the luggage area, walking out the airport door. She then disappeared. Her body was later discovered near a bike path not too far from the airport. Her dementia had led her away from her prearranged path to home. Her family never got the chance to say goodbye to her, or to protect her from dying alone in an unfamiliar area. This elderly woman could have been one of our mothers or any of our elderly parents. I couldn't imagine the final moments in this elderly woman's life. Was she longing for her children and grandchildren? Did she cry for help? Did she see her childhood flashing in front of her eyes? The part I did not like to think about was her fear. To die in fear is not a peaceful way to part from your loved ones. Fear would bring on loneliness, and to die alone feeling lonely is an unnecessary tragedy.

I read a few days later how devastated the family members of this woman were after her body was found. I am sure they couldn't help but blame themselves for not "protecting" her enough. To be caretakers to an AD patient could bring on a lot of stress and self blame, especially when something tragic happens to the patient while under their watch.

For your good memory, remember to exercise, eat healthy, sleep well and stay connected!

Until next time,


Thu

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