A friend posed a thought-provoking question after reading last month’s edition of Connecting the Dots. The post was titled, “Understanding Brain Health”. She wondered, “What memory mistakes are ‘red flags’ that should be checked by a doctor, versus regular forgetfulness?” She explained the ongoing joke at her house, “I hear my husband almost daily mention his dementia—but of course, his symptoms are the same ones I’ve had for years, like walking into the garage to get something, and forgetting what I came there for; repeating myself because I forgot which child I told already; missing an appointment that didn’t quite make it to my calendar….should I worry about these mistakes my husband and I both make? If not, what does constitute alerting the doctor during my routine brain checkup?”
It’s not just my friend who questions her memory. I hear the concern in many of my consultation visits with family caregivers. Recently I was speaking with a 75-year-old woman who cares for her husband with dementia. Bless her heart, the woman thinks every time she loses her car keys, “This is contagious!” She’s afraid that she’s getting dementia, but she’s just forgetting—like we all do. I want her to focus on changes that signal a potential problem, not worry that her brain is shrinking dramatically as she ages.
I believe my friend’s curiosity about normal forgetfulness and proactive brain health monitoring is a perfect example of connecting the dots in dementia care. So, while I’m drafting future articles with more “nitty-gritty” dementia care tips, I paused to think about what my friend and the rest of us want and need to know—and do.
Distinguish between “red flags” and normal forgetfulness in healthy brains in order to address potential problems early and avoid sweating the small stuff.
My friend is correct in thinking that some memory mistakes do warrant further investigation with a doctor, and some mistakes are normal forgetfulness. After all, forgetting is a part of normal brain function. I find it easy to explain normal forgetfulness with a story.
Here’s How Normal Forgetting Works
Imagine you’re sitting in the living room watching TV when you see a commercial about coffee. You think to yourself, “Coffee sounds good. I’m going to make a pot of coffee.” Now, you’re using a type of memory called “working memory”.
Working memory holds the information you need for the task you’re doing right now. Working memory only holds 5–8 “chunks” of information at a time. You can think of it like what’s on the front of your mind.
OK, you’ve got 5–8 things about coffee on the front of your mind as you walk to the kitchen. But, before you get to the coffee pot, the telephone rings. It’s your sister calling to confirm plans for the upcoming birthday party. Oh good, you’re looking forward to the party. You receive updates and offer a few ideas for the menu. Do you notice what’s happening? As soon as 5–8 new things enter working memory, coffee gets kicked out. You can probably predict what happens when the call ends. You’re standing in the kitchen thinking, “Why did I come in here?”
Good news, folks! THAT’S NORMAL. Your brain has to move information out of working memory to constantly make room for new information.
Here’s how it works, you take coffee out of working memory and slide it over to short-term memory, so you can get it back shortly.
Here’s the bad news…the older you get, the longer it takes you to retrieve your files in short-term memory. Unfortunately, many of us are not as fast as we used to be. In fact, most of us are probably in the same boat, feeling the delay, because memory retrieval was the fastest when we were around 20 years old. Back me up, friends, there is life after 20! We just need a little more time to remember. And there are other advantages to having a more mature brain!
Those of you over age 20, see if this sounds familiar. You’re standing in the kitchen with no clue why you’re there, so you return to the living room. Then it hits you—like something falling from the sky! You say, “OH YEAH, I made it halfway to the coffee pot.” That’s your brain retrieving the file from short-term memory and pulling it back to working memory. The information was temporarily forgotten, not lost forever. The “OH YEAH” is the sign of your healthy brain remembering.
A “Red Flag” Memory Mistake
The difference between normal forgetting and a red flag mistake is subtle. A person in the earliest stage of dementia, not yet diagnosed, has many preserved skills. He could see the same commercial you did. He also thinks, “Coffee sounds good.” He could have the same conversation on the phone. After swapping 5–8 pieces of information, coffee gets kicked out—SO FAR, WE’RE THE SAME.
Here’s the difference, in early-stage dementia, cells in short-term memory are unreliable. The problem occurs on the transfer when the information doesn’t get filed. So, poof, coffee is gone completely.
Someone with early-stage dementia hangs up the phone and can’t figure out why he’s in the kitchen. Naturally, he goes back to the living room. You’d have to be watching closely to notice what happens next. He sees the commercial again and says, “Coffee sounds good, I think I’ll make a pot.”
Did you catch it? He’s headed to the kitchen like it’s the first time…there’s no OH YEAH.
The missing OH YEAH, no memory of something whatsoever—is not normal and should be further investigated. People will say, “Heather, why do I want to know if I’m losing my memory? Until there’s a cure for dementia, don’t tell me.” I get it…but consider this. There are many reasons that those brain cells could be operating at less than full capacity. Many of those reasons are not dementia and have relatively easy fixes. We want to help folks notice these early, subtle changes and help them get the formal evaluations they deserve because many people will discover it’s not dementia, and their whole brain function can be improved—who would pass that up?!
A Few Contributing Factors to Normal Forgetfulness
- Age. I’ve mentioned that normal, age-related forgetfulness generally means we need more time to find our files in short- and long-term memory as we get older. You may notice how often you’re riding down the road when the “OH YEAH” hits you.
- Stress. Putting it simply, when stress goes up, brain function goes down. Notice how many mistakes you make when you’re feeling stressed. You’re running late and trying to get out the door—where are those sunglasses? They’re on your head. Under pressure, looking for the car keys? Check your hands. Longer, unrelenting stress can lead to more severe thinking and memory problems, which should be investigated with a doctor. However, when it’s the regular low-grade stress of daily life causing your mistakes, a few simple breathing techniques might be the perfect reset button your brain needs.
- Divided Attention. My friend noticed one more common instance when normal forgetting happens. She said, “I tend to make more memory mistakes when I’m not fully tuned in to committing the information to memory.” Have you noticed that some information doesn’t get filed? For example, your child swears they told you that this week was your week to bring snacks for the class, but when given a last-minute reminder, it feels like the first time you’ve heard about it. When you notice this type of mistake (no memory of what happened), check yourself to see if you were paying full attention (tuned in, as my friend put it). As it turns out, our brains are not made for multi-tasking. It doesn’t stop us from trying to pay attention to everything at once (who else is cooking while texting and watching TV?). When your attention is divided, some information is bound to get lost. In your defense, your child announced the snack schedule while you were on the phone. In that case, your memory lapse is still a normal and predictable mistake.
In each blog, I will share success stories I’ve heard from others, related to the topic at hand. Here are two examples from this week. An audience member gave me a good tip during one of my presentations when the topic of regular forgetting arose. Like me, she found herself forgetting the name of a person immediately after their introduction. I’m the worst at introductions. I hear a name, and it instantly goes in one ear and out the other as my brain manages the micro-stressors of that routine social interaction. The woman in the audience noticed the same thing and developed a solution that helped her slightly slow the tempo of the introduction, reduce her stress, and focus her attention on the person’s name for better memory storage. She explained the memory strategy: when a person says their name, repeat it. For example, ‘It’s nice to meet you, Karen. I’m Heather.”
Another person called to say the story about coffee brought her so much relief and improved her
conversations with her doctor about memory loss typical of normal aging, including strategies to
maximize her healthy brain function.
Do you have at least one new idea to distinguish between normal forgetting and a “red flag” mistake? And do you feel more confident to talk about the difference with friends, family, and your doctor?
Have you noticed normal forgetfulness increasing with age? Please share any tips or tricks that could help the rest of us, as we’re all constantly trying to file, hold, and retrieve more information!
Caregivers, how might you use this information to support the older adults in your life (loved ones or clients)?
Additional Resources if You’d Like to Learn More
Tune in for the next CTD blog post titled “Dementia Care Communication: Top Four Tips for Answering Repeated Questions”