A Harvard Medical School Special Health Report

Improving Memory
Understanding age-related memory loss

In this report:
How memory
changes with age
17 ways to promote
memory health
Seven flaws of
normal memory
Is it normal aging
or dementia?
SPECIAL BONUS SECTION
Improve your everyday
memory

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IMPROVING MEMORY
SPECIAL HEALTH REPORT
Medical Editor
Contents
Kirk R. Daffner, MD, FAAN
J. David and Virginia Wimberly Professor of Understanding memory . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Neurology, Harvard Medical School What is memory? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Director, Center for Brain/Mind Medicine and
Chief Division of Cognitive and Behavioral
Neurology, Brigham & Women’s Hospital How memory works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Executive Editor Where are memories stored? . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Anne Underwood
Stage 1: Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Writer
Lynne Christensen Stage 2: Consolidation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Copy Editor Stage 3: Retrieval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Robin Netherton Seven flaws of normal memory . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Creative Director
Judi Crouse
How memory changes with age . . . . . . . . . . . . . . . . . . . . 13
Production Manager
Lori Wendin Age-related changes in the brain . . . . . . . . . . . . . . . . . . . . . . . . 13
Illustrators Reasons for encouragement . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Scott Leighton, Michael Linkinhoker
Published by Harvard Medical School SPECIAL SECTION
Gregory D. Curfman, MD, Editor in Chief Improving everyday memory . . . . . . . . . . . . . . . . . . . . . . . 16
Patrick J. Skerrett, Executive Editor
In association with 17 ways to promote memory health . . . . . . . . . . . . . . . . . 24
Belvoir Media Group, LLC, 535 Connecticut Avenue, Nor-
walk, CT 06854-1713. Robert Englander, Chairman and
CEO; Timothy H. Cole, Executive Vice President, Editorial
Memory problems: Normal aging or brain disease? . . . . . 39
Director; Philip L. Penny, Chief Operating Officer; Greg Mild cognitive impairment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
King, Executive Vice President, Marketing Director; Ron Goldberg,
Chief Financial Officer; Tom Canfield, Vice President, Circulation. Dementia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Copyright © 2015 by Harvard University. Permission is required Head trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
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Other neurological disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
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 Dear Reader,
Years ago, I saw a patient in the early stages of dementia. She still had moments of great clarity,
and in one of those times she lamented, “I’m vanishing as a person.” Her words have stuck with
me because they seemed like such a lucid description of the impact of dementia on an individual.
In many ways, our memories shape who we are. They make up our internal biographies—the
stories we tell ourselves about what we’ve done with our lives, the people we’ve loved, and those
who have mattered to us. In short, our memories are crucial to our essence as human beings.
Memory also facilitates the practical side of life. Remembering how to get from your house to
the grocery store or how to do the tasks that make up your job allows you to take care of your
needs and the needs of the people you love. That’s what makes memory loss so scary and one
of the most common fears of people as they grow older. In my work as a neurologist, I care for
patients with cognitive impairment, many of whom have disorders like Alzheimer’s disease.
To balance this activity, my research has focused on studying healthy cognitive aging. I have
been investigating the differences in brain activity between older individuals with very well-
preserved thinking and memory and those with more typical age-related difficulties. I also have
been leading studies aimed at promoting brain health and enhancing memory function. My
interest in these issues led me to accept the invitation to edit this Special Health Report.
There’s no getting around the fact that the ability to remember does change with age. Reassur-
ingly, many of these changes are signs of normal aging, not dementia. However, now is a good
time to commit to enhancing your brain and protecting it as much as possible from decline. One
key is continually challenging the brain with new tasks that build what the experts call cogni-
tive reserve—a reflection of the brain’s capacity to resist damage from disease or injury. Staying
mentally active and learning new skills are good ways to do this. Although the connection may
not seem obvious at first, keeping the rest of your body healthy is another fundamental way to
preserve your memory. For example, exercise turns out to be among the best prescriptions for
maintaining not only a healthy body, but also a healthy brain and a resilient memory.
In short, there are important measures you can take to protect your brain as you age. This report
will show you 17 concrete steps for enhancing and preserving your memory, as well as numer-
ous practical strategies for improving everyday recall. It will also answer common questions
about memory, and it will provide you with important ways to help distinguish between normal
memory changes and those due to disease. It will also help you understand why memory, at any
age, is imperfect. Now, let’s get started.
Sincerely,

Dr. Daffner would like to acknowledge Dr. Marilyn Albert and Dr. Aaron Nelson,
the previous editors of this Special Health Report, who provided the foundation
Kirk R. Daffner, M.D. for the current presentation, and to thank the Wimberly family, the Muss family,
and the Mortimer/Grubman family for their generous support.
Medical Editor

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 Understanding memory

ll your life, you’ve probably of abnormal proteins in the

A experienced times when
your memory failed you—
brain) can rob people of the abil-
ity to remember and think well
whether on a high school history enough to function indepen-
test or an examination for a driv- dently. How can you tell whether
er’s license. (Exactly how many your memory lapses are caused
feet away from a fire hydrant do by normal aging or something
you have to park, anyway?) Even more serious? There are some
as a teenager, could you remem- key differences, as noted later in
ber all the verses of a song, or this report (see “Memory prob-
was it only the chorus that stuck? lems: Normal aging or brain dis-
Memory is not perfect, no ease?” on page 39).

Thinkstock
matter how old you are. True, Unfortunately, there is no
some people have amazing mem- cure for dementia. However,
ories. They recall details of events that have long since there are many steps you can take to improve nor-
escaped you. But nature did not design the human mal memory and promote a healthy brain—including
brain—even theirs—for perfect recall of every detail in steps that will help you reduce your risk for developing
daily life. Just as you delete old emails on your com- dementia in the first place or at least delay its onset. This
puter to make way for new ones, the brain routinely report will serve as your road map. But first, you need
prunes out unneeded information, making way for to understand just what memory is and how it works.
newer, more relevant memories.
Moreover, memories are not like snapshots that
are taken and then stored in their entirety in one place What is memory?
in the brain. Rather, memories are encoded in a frag- Memory refers to all that you remember, as well as
mented manner and distributed throughout different your capacity for remembering. But not all memo-
parts of the brain; these different pieces must be reas- ries are created equal. Some memories are meant to
sembled when you remember something, creating be retained for a short period and then discarded. For
the possibility that you may reconstruct the memory example, you remember the telephone number of the
imperfectly. Adding to all this uncertainty, memories local pizza place only long enough to make the call.
of an event—even one you witnessed—can be heavily By contrast, memories that are more important—for
influenced by what other people tell you happened or by example, the names of close friends and relatives, the
your own biases (see “Seven flaws of normal memory,” multiplication tables, your phone number, and other
page 9). That’s why eyewitness testimony is unreliable. information you use regularly—are kept in the brain’s
In short, it’s normal to forget things. It’s also nor- equivalent of long-term storage and can be retrieved
mal to become somewhat more forgetful as you grow at will. Certain kinds of information can be memo-
older. However, for some people, memory problems go rized only if you concentrate, whereas other kinds of
beyond what is normal. Dementia (a serious decline in memories, such as the faces of people you see regularly
memory and thinking caused by Alzheimer’s disease, and the steps of simple everyday routines like brushing
damage to blood vessels that feed the brain, or a buildup your teeth, are absorbed without conscious effort.

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 Researchers and neuroscientists have devised
several classification systems to describe the various Flashbulb memory
forms of memory. One major system relies on dura-
tion, making a distinction between short-term mem- M emory researchers use the term “flashbulb memory”
to describe a vivid memory of an unexpected, emo-
tionally charged public event. The assassination of Presi-
ories, which are fleeting, and long-term memories,
dent Kennedy and the destruction of the World Trade Cen-
which can persist for a lifetime. ter are examples of compelling public events that became
ingrained in the memories of many who witnessed them,
Short-term memory either directly or through television. Flashbulb memories
This is information that the mind stores temporar- tend to include numerous minute details associated with
your experience of the event—where you were standing,
ily, encompassing what you need to remember in the what you were doing, who was around you, and so on. It
next few seconds or minutes. Short-term memories is likely that the combination of profound meaningfulness
include, for example, the name of the person you just and emotional impact surrounding the event serves to
met fleetingly at a cocktail party (as well as what that inscribe it intensively in long-term memory.
person said), and the date and time of the appoint- Experts used to assume that flashbulb memories remained
ment you just made and must remember only until more accurate over time than ordinary memories, but
research has shown that they are vulnerable to the same
you write it down.
biases and distortions as memories of less dramatic events.
One form of short-term memory is working
This theory has been corroborated in studies of different
memory, which enables you to manipulate infor- groups of people in the aftermath of the Sept. 11, 2001,
mation while holding it in short-term storage. For terrorist attack. In a study in The Journal of Experimental
example, working memory comes into play when you Psychology, researchers questioned more than 3,000
remember prices at the supermarket while at the same people from seven U.S. cities about their memories of the
event one week, 11 months, and 35 months after the as-
time performing a computation with them so you can
sault. Participants answered questions about where they
compare costs between different brands or quantities. were, what they were doing, and how they felt when they
Short-term memories are supposed to be fleeting. first heard the news, as well as specific facts about the
They turn over at a high rate because new ones are con- attack, such as the number of planes involved (referred
tinually replacing them, and there are only so many to as event memory). The researchers found that the rate
of forgetting was about 20% or more the first year and
short-term memories you can keep in mind. Research between 5% and 10% thereafter—a rate that’s similar to
shows that the average person can hold only about seven ordinary autobiographical memories.
(plus or minus two) unrelated “bits” of information in
mind at one time. That’s why it’s easier to remember a
seven-digit phone number than a longer number such trying to remember a phone number and someone
as the identification number on a driver’s license. walks into the room and asks you a question, chances
The relatively transient nature of your short-term are you’ll forget the number and have to look it up
memory is actually beneficial because it allows you to again. Shifting your focus of attention to answer the
discard unnecessary information. Imagine what life question overwrites the phone number, which was
would be like if you kept every short-term memory— being held in short-term memory.
the price of each dish you ordered from a Chinese
restaurant, or what color tie your friend wore every Long-term memory
day last week. Your mind would be so overloaded with Although most unimportant short-term memories
trivia that you’d have trouble focusing on the things quickly decay, the brain stores the important ones—
that really are important. It would be as if you kept all those that are emotionally compelling or personally
your junk mail and let it bury your personal letters, meaningful. That stored information is long-term
bank statements, and other important documents. memory. It is the total of what you know: a compen-
Short-term memory has another limitation. It is dium of data ranging from your name, address, and
fragile and easily disturbed by interruptions. If you’re phone number to more complex information, such as

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the sounds and images of important events that hap- fied punishment they received, a fifth-grade science
pened decades ago. It also includes the routine infor- project, their first date. These events probably made a
mation you use every day, like how to make coffee, deep emotional impression at the time.
operate your computer, and carry out all of the intri- Interestingly, research demonstrates that although
cate sequences involved in performing your job or long-term memory is more durable than short-term
running your household. memory, it is also changeable. For example, the way
Your long-term memory and short-term memory you remember your first romance can evolve over
are not distinguished merely by how long the memo- time in response to experiences and information you
ries last. Another difference is the amount of infor- acquire years later.
mation each memory system and its associated brain
regions can handle. Although the brain can juggle only Declarative (explicit) memory
a relatively small number of short-term memories Long-term memory can be divided into two catego-
at a time, it can store an enormous number of long- ries—declarative memory and implicit memory.
term memories. Barring disease or injury, you can Declarative memory, also known as explicit mem-
always learn and retain something new. Furthermore, ory, is information that requires a conscious effort to
long-term memories are less fragile than short-term recall. It is further divided into two subtypes—seman-
memories, which means they’re not lost when some- tic memory and episodic memory.
thing interrupts your train of thought. Some types of Semantic memory is factual knowledge, such
previously learned long-term memories even tend to as the names of the continents, the color of your
remain intact in the early stages of dementia, when spouse’s eyes, or what winter is. Much of the basic
people have trouble learning new information. This information you acquired during your school days
applies especially to procedural memory (see page 5). falls into this category. In addition to being factual,
Maintaining a long-term memory often requires semantic memory has another key characteristic: it is
that you periodically “revisit” it. Some memories that not bound to a specific point in time. You can’t point
go unused for a long time fade or become distorted. to the exact moment when you learned that George
Have you ever read a book that you loved, but years Washington led the Revolutionary War, for example.
later found yourself unable to recall much more than And even if you can remember the specific day when
the title? That’s probably because you hadn’t thought you learned the multiplication tables or other facts in
of the plot and characters in a long time. On the other school, the timing isn’t important to your knowledge
hand, certain long-term memories are amazingly per- of them.
sistent, no matter how infrequently you use them. For Episodic memory contains the images and
example, many adults are surprised by their ability to details of experiences you have had. Episodic mem-
remember minute details of their youth—an unjusti- ories are personal memories tied to specific times
and places. The party you attended last weekend, the
vacation you took last summer, and your children’s
Types of long-term memory birthday celebrations are all episodic memories. An
DECLARATIVE, Semantic: General or factual information episodic memory is more fragile than a semantic
or EXPLICIT „ (Examples: The year World War II started,
names of colors, state capitals, the contents
memory because it is more specific; it has a smaller
Requires
conscious effort of this report) network of associated connections in the brain.
to recall Episodic: Personal memories Throughout your lifetime, you’ve probably thought
(Examples: Your wedding, your vacation, about George Washington being the first president of
what you did yesterday)
the United States a hundred or more times, in many
IMPLICIT „ Procedural: Skills and procedures different contexts—maybe during social studies class,
Outside of conscious (Examples: How to type, play golf, ride a
bicycle, drive a car, brush your teeth)
then during a trip to see his historic house at Mount
awareness
Vernon, or when you saw his head on a quarter or a

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 QUICK QUIZ: WHICH MEMORIES WILL YOU FORGET?
You are 65 years old. You get in your car to drive to your sister’s house in another town for Thanksgiving. The last time
she made Thanksgiving dinner was five years ago, and it was your Uncle Ed’s last holiday with the family. He died three
months later. His new caregiver, Pat, had brought him to the dinner. That was also the Thanksgiving that your niece an-
nounced she was pregnant.
On this trip to your sister’s, while thinking about your last visit, which of the following are you most likely to forget?
A. To release the parking brake before setting the D. The family’s reaction to your niece’s news
car in motion E. The route to your sister’s house
B. Your uncle’s name F. To put the pumpkin pie you promised to bring
C. The name of your uncle’s caregiver in the car

Answer: If you have normal age-related memory problems, the of events that provoke emotion tend to endure. You may
correct answers are C and F. have more trouble remembering a mundane conversation
you had with your cousin than the joyous news about your
Let’s review:
niece.
A. The steps involved in driving a car are procedural memory,
which holds up quite well with age. E. You could have answered E to the question and been right.
This was a trick because there’s not enough information in
B. If you have trouble remembering your uncle’s name, this is a the question. If you visit your sister often, then you should
sign that something more serious may be wrong. You should remember how to get to her house. If you visit your sister
consider having your memory checked by a doctor. often, yet get lost on the way to her house, this is a sign of
C. The name of someone you met only once several years ago a memory problem outside the realm of normal, and you
is the type of memory that is less likely to be remembered. should consider having your memory checked by a physician.
When you met Pat, you may have put the name into short- If it’s been five years since you drove there, you will likely
term memory, but it never made it into long-term storage. So need directions or a GPS. As you drive, though, you may find
you will not remember it five years later. Even if you did store that you don’t need as much prompting as you thought. You
the name, you haven’t used it for so long that the memory may see landmarks that jog your memory.
of it has faded. If you saw Pat on the street, you would most F. How could you possibly have forgotten the pie? There are
likely recognize her but not remember her name. If she in- several possible reasons for this lapse that have nothing to
troduced herself, it would likely spark the memory and allow do with dementia. Distraction is an example. You may have
you to connect the name to the face. been thinking about other concerns while packing for the
D. Recollection of the interaction among the family members trip. Perhaps the phone rang while you were loading the car.
at the dinner is an example of episodic memory. Some types You chatted with a friend for a few minutes and then forgot
of episodic memory diminish with aging. But memories that you hadn’t put the pie in the car.

dollar bill. Episodic memories, on the other hand, are sciously recalling previous experiences with the same
probably brought up in fewer contexts and less often. tasks. How to ride a bicycle, write in cursive, tie your
shoes, drive a car—each of these skills required effort
Implicit memory and practice at one time, but once you mastered it, you
In contrast to declarative memory, implicit memory were able to perform it without remembering how you
relies on information that is stored at the subconscious learned it or the separate steps involved. When you
level. Though there are a couple of types of implicit take out your bike for a ride, for example, you don’t
memory, the only one that matters in this context is think, “Okay, first I straddle the seat, then I put my left
procedural memory. foot on the left pedal, and then I push off the ground
Procedural memory allows you to hone skills and with my right foot….” You just get on and go. It’s as if
do routine things like getting dressed, without con- your body does the remembering for you.

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 How memory works

ou just saw a new movie, and you stored the mem-

Y ory of it in your brain, along with other informa-
tion and events that you encountered today. But where,
Figure 1: Anatomy of memory processing

exactly, did it go? Is your brain’s system for storing

memories a “memory bank”—a single repository of all
CEREBRAL CORTEX
the sights, sounds, and facts that have made a strong
Hippocampus
enough impression for you to remember them?
The short answer is no. The memory of an event
is not a single entity, like a book on a shelf. Instead, it
is the aggregation of multiple streams of information Frontal Amygdala
lobe
from the various senses (sight, hearing, smell), filtered
through your perceptions. Moreover, multiple regions
of the brain are involved in the process of recording
and preserving a memory (see Figure 1, at right).
• The hippocampus. Deep within the brain, a struc-
ture known as the hippocampus plays a key role in
acquiring and consolidating new memories. The
information that will constitute a memory is sent
first to the hippocampus and surrounding struc- Memories are not encoded like a photograph, but rather in
tures. One of these structures creates what is called fragmented, distributed pieces, which need to be reassembled to
a hippocampal index, which catalogs the compo- remember. The hippocampus, a crescent-shaped structure deep in
nents of a memory so it can be re-collected and the brain, and surrounding structures play crucial roles in memory
storage. The amygdala reacts to emotionally powerful informa-
reconstructed later. The hippocampus is crucial
tion. The frontal lobes enable you to focus attention long enough
for retrieving memories until they are put in long- to encode new information. Long-term memory storage occurs
term storage in other brain regions. in the cerebral cortex.
• The amygdala. Situated close to the hippocampus,
the amygdala is the part of the brain that reacts to
emotionally powerful information, tagging this Where are memories stored?
information as important, so the brain retains it. For years, people believed that memories were kept in
• The cerebral cortex. Once a memory is established, a single place in the brain. But over many decades of
it is not stored in a single part of the brain, but dis- research, scientists realized that this assumption was
tributed among pertinent areas of the cerebral cor- wrong. In the 1980s, the development of functional
tex—the large, domed outer layer of the brain. brain-imaging technology gave scientists the tools to
• The frontal lobes. These are essential for focus- scan people’s brains as they performed a variety of
ing attention (and ignoring distractions). Focused tasks, including remembering things. This enabled
attention is important for acquiring new informa- researchers to confirm that long-term memories are
tion, activating and retrieving stored memories, not stored in a single location that functions as a
recollecting the source of information, and keeping repository of information, but rather are widely dis-
track of the timing and order of specific events. tributed in networks throughout the brain, primarily

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in the cerebral cortex—the outer covering of the two ticular aspect of a memory will most likely be stored
large hemispheres of the brain. in a region of the cortex that specializes in processing
It might sound odd at first that memory storage is similar information.
widely distributed, but this actually makes sense. The Therefore, the words of “The Star-Spangled Ban-
cortex is the most highly developed part of the human ner” would be stored in the language regions of the left
nervous system, containing about 20 billion neurons temporal lobe, but the melody would be stored in the
(nerve cells) that collectively function to integrate sen- brain’s auditory cortex. And each memory is connected
sory information, control voluntary movements, and to many related memories. For instance, if you associ-
mediate thought processes. Different areas of the cere- ate “The Star-Spangled Banner” with the American flag,
bral cortex process different kinds of information. For that image might be stored in your occipital lobe, which
example, auditory information, including speech and processes visual information. Your memories are thus
other sounds, is processed initially in the temporal intricately broken down and cross-referenced, making
lobes, while the registration of visual images occurs in your brain less like the shelves of a library and more
the occipital lobe at the back of the brain (see Figure like the Internet. Calling up memories is like search-
2, below). What these findings suggest is that a par- ing the Web, with one or two words activating many
hyperlinks.
But just how does the information that you
Figure 2: Brain map encounter on a daily basis get filed away? Memory
Sensation of touch, researchers have used a three-stage model to describe
Motor control of temperature, pressure,
voluntary muscles and pain from skin
how the brain learns and remembers each bit of
information:
• Stage 1: acquisition
Spatial • Stage 2: consolidation
FRONTAL PARIETAL
processing • Stage 3: retrieval.
OCCIPITAL
Impairment in any one of these three stages can
TEMPORAL
result in a failure of memory.
How smoothly the process goes—which is to say,
how well you remember—depends on many things.
Genetics plays a major role. Studies of human intel-
ligence suggest that approximately 50% of mental
Sight and ability is genetically determined. It may be that some
recognition of
visual images people are simply better at remembering than oth-
ers because of a genetic predisposition for an excel-
Executive function,
concentration, lent memory. But factors within your control are
planning, Use of words,
also important. Overall physical health, emotional
problem-solving understanding
skills speech, language, well-being, stress level, and sleep quality exert a huge
hearing influence on how well you learn and remember.

Different parts of the cerebral cortex of the brain specialize

in different functions. Memories are stored in many parts of the
brain, but some areas are more critical than others. To retrieve
Stage 1 | Acquisition
It’s common sense: for you to remember anything,
a memory, these areas of the brain must work in coordina-
tion with others. For example, the frontal lobes (important for your brain must first encode it. When new infor-
planning and organization) work together with several brain mation is learned or acquired, it first takes the form
regions in acquiring and retrieving visual, auditory, spatial, and of temporary pathways of nerve cell activity in the
other information. brain, as one neuron communicates with the next.

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The location of these neuronal pathways depends on
the nature of the information. For example, in most Figure 3: Remember grandma’s cookies?
people, activities such as speaking and writing acti- An experience that stimulates many parts of the brain is more likely
vate neurons in the left temporal lobe, which pro- to be remembered, particularly if it has an emotional component.
cesses language, whereas studying a map activates
Emotion: Feelings of
neurons in the right parietal lobe, which processes pleasure are processed
spatial information. by the brain’s reward sys-
When you’ve just learned something new, the tem, which includes the
amygdala.
neuronal activity that represents this newly acquired
Sight: The eyes relay
information is temporary, and the knowledge is part the image of chocolate
of your short-term memory. Most of this information chip cookies to the pri-
will quickly fade away. The memories that endure will mary visual cortex in the
occipital lobe.
be those that were encoded most completely in the first
place—the information that you paid the closest atten- Smell: Sensors in the
nose pick up the sweet
tion to when you learned it. When you have trouble scent and convey it to
remembering a piece of information, it’s often because the olfactory region of
the cortex.
you weren’t paying close attention when you initially
encountered it. Memories that involve multiple senses Taste: Sensory receptors
as well as emotions are more likely to be retained. on the tongue deliver the
flavor of chocolate to the
brain’s gustatory area.

Stage 2 | Consolidation
Let’s say that you were paying close attention to the more likely to recall objects or events that affected
information you just heard and that it was effectively you emotionally (see Figure 3, above). You can prob-
encoded in your brain. How does it become stored as ably remember the images of the World Trade Cen-
a memory that you can recall in the future? For the ter falling far more vividly than you can recall, say,
information to become a long-term memory, its ini- a photo of a hotel where someone in the news hap-
tial neuronal pathways must be strengthened. The pened to stay.
strengthening process, typically referred to as consoli-
dation, occurs over a period of time. Consolidation of procedural memories
In contrast to declarative memory, the consolidation
Consolidation of declarative memories of procedural memories is not dependent on the hip-
Several factors influence whether the hippocam- pocampus. Even people with amnesia, who have dam-
pus responds to the newly acquired information and age to the hippocampus, can form new procedural
gives the signal to store it as long-term memory. For memories—that is to say, they can learn new skills
example, you’re more likely to retain new information through practice. Procedural memories, such as how
if it relates to long-term memories you already have to play a musical instrument, also tend to remain
because the richer associations help you to store the intact with aging. They even persist during the early
information more deeply. You are much more likely stages of Alzheimer’s disease. However, acquiring new
to remember the names of the players on your local procedural memories becomes more difficult with age
football team if you know something about football because we process information more slowly.
than if you don’t follow the game at all. Procedural memory is stored throughout the
Your brain also has systems for detecting things brain in regions that are important for coordinating
or events that are new or unusual and remembering movement or sequential processing, such as the fron-
them for future reference. Similarly, you are much tal lobes, the cerebellum, and the basal ganglia.

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Stage 3 | Retrieval memories two to four times a week. Frustratingly, you
Retrieval is the act of recalling something. A memory may recall the first letters of the name or just the first
is stored in the brain as a unique pattern of nerve or last name before you remember the whole name.
cell activation. When you’re not thinking about the
memory, its neuronal pattern is inactive. To retrieve
the information, your brain must reactivate the pat- Seven flaws of normal memory
tern. Similar memories have partially overlapping pat- Regardless of age, you’re unlikely to have a flawless
terns of neuronal activation. Sometimes when you try memory. People who can remember very long lists of
to retrieve one bit of information, a similar memory numbers or recall the minutiae of their daily lives—
comes to mind and blocks out the information you right down to what they ate for lunch every day last
want (see “Blocking,” page 10). For example, you may year—are exceedingly rare. And frankly, such a mem-
be trying to recall the name of Tom Hanks’ first movie, ory can be a burden rather than a blessing. Memory,
but instead you keep thinking of the name of his most it seems, is inherently flawed—and in more ways than
recent film. you might think.
Researchers have determined that it takes less Daniel Schacter, a professor of psychology at Har-
than a second to reactivate a neuronal pathway hold- vard University, described the most common ways
ing simple, familiar information. They’ve found, for that normal memory fails us in his book The Seven
example, that when a young person sees a photograph Sins of Memory. Some of these memory flaws become
and is asked whether it’s familiar, it takes about a fifth more pronounced with age, but unless they are
of a second for the image to reach the visual system in extreme and persistent, they are not considered indi-
the brain, a fifth of a second for the person to decide cators of Alzheimer’s or other memory-impairing ill-
whether it’s familiar, and another fifth of a second for nesses. They are simply the way that our brains work.
the person to begin to nod. The following is a brief summary of Schacter’s seven
If it always took just a fraction of a second to memory “sins.”
remember something, you wouldn’t worry about your
memory. But, of course, it often takes considerably lon- Transience
ger. Even if your memory is perfect, it can take several
1 This is the tendency to forget facts or events over
seconds or more to recall complicated information. time. You are most likely to forget information soon
How long the process takes depends on how famil- after you learn it. However, memory has a use-it-or-
iar you are with the information you’re looking for. If lose-it quality: memories that are called up and used
someone asks you to name the third president of the frequently are less likely to be forgotten. Although
United States, for example, and you’re an American transience might seem like a sign of memory weak-
history teacher, you may be able to recall in an instant ness, brain scientists regard it as beneficial because it
that the answer is Thomas Jefferson. Otherwise, your clears the brain of unused memories, making way for
brain will activate neuronal pathways that process newer, more useful ones. In this sense, transience is
information related to the chronology of the presi- akin to cleaning the junk out of your closets or clearing
dents—the year when the United States was founded the temporary files from your computer’s hard drive.
and the names of any early presidents that come to Although everyone experiences transience of
mind, for instance. In the process, you may feel that memory, it is extreme and debilitating in people with
the answer is “on the tip of your tongue.” If the neuro- certain kinds of brain damage. For instance, people
nal pathway in your brain leading to the answer is still with amnesia that is caused by injury to the hippo-
intact, you’ll eventually retrieve it. campus have normal short-term memory, but they are
While this may be irritating, it is very common. unable to form new long-term memories. They forget
Research shows that it happens to younger people as information soon after they learn it. This is not the type
often as once a week and to older people with normal of transience that normally affects people’s memories.

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 Absentmindedness similar in sound or in meaning were given along with
2 This type of forgetting occurs when you don’t the accurate definition, more people had memory
pay close enough attention to the information you blocks than when unrelated ones were given.
want to remember. You forget where you just put your Brain-imaging studies suggest how blocking might
pen because you weren’t focusing on where you placed work in the brain. When a person is retrieving a mem-
it. You were thinking of something else (or, perhaps, ory, some regions of the brain become more active and
nothing in particular), so your brain didn’t encode the others become less active. Some of the increased acti-
information securely. Absentmindedness also involves vation reflects inhibition of other regions. When the
forgetting to do something at a prescribed time, like right regions are activated, this inhibition can work
taking your medicine or keeping an appointment. in your favor by keeping your brain from calling up
One way to avoid this problem is to identify things irrelevant information. But when you call up an ugly
that can serve as cues to remind you to do something. sister by mistake, the brain regions that encode it may
For example, if the doctor tells you to take your medi- suppress the regions needed to retrieve the memory
cine at bedtime, you might use another regular bed- you really want.
time activity as a reminder cue for medicine-taking. In Scientists think that memory blocks become
this situation, you could link it to rinsing after tooth- more common with age and that they account for the
brushing, and use the same water glass to sip water trouble older people have remembering other people’s
to take your pills. Similarly, if you need to take your names. But it remains unclear whether tip-of-the-
vitamins at breakfast, you could make a habit of put- tongue experiences are more common than other age-
ting the bottle beside your coffee cup at your place at related memory problems. Increases in blocking have
the table so it provides a cue when you sit down to eat. been linked to less efficient executive control mecha-
nisms that help keep competing memories or words
Blocking from interfering with the selection of the appropri-
3 Someone asks you a question and the answer is ate response. In any case, there’s encouraging news
right on the tip of your tongue—you know that you about blocking. Research shows that people are able
know it, but you just can’t think of it. This tip-of-the- to retrieve about half of the blocked memories within
tongue experience is perhaps the most familiar example just a minute.
of blocking, the temporary inability to retrieve a mem-
ory. Blocking doesn’t occur because you weren’t paying Misattribution
attention or because the memory you’re looking for
4 Consider the following scenario: you’re asked
has faded from your brain. On the contrary, blocking who “John Smith” is, and you remember quite clearly
occurs when a memory is properly stored in your brain, not only who he is, but also what he’s done lately
but something is keeping you from finding it. that’s been in the news. Then you’re asked where you
In many cases, the memory block is a memory learned these details. You think for a moment and
similar to the one you’re looking for, and you retrieve reply that it was on the evening TV news. However,
the wrong one. This competing memory is so intru- there was no report about John Smith on TV. Instead,
sive that you can’t think of the memory you want. A you got your information from the friend you had
common example is calling your older son by your lunch with yesterday.
younger son’s name, or vice versa. Scientists call block- Right memory, wrong source—that’s one example
ing memories “ugly sisters” because they’re domineer- of misattribution. Misattribution occurs when you
ing, like the stepsisters in Cinderella. Scientists have remember something accurately in part, but misat-
used ugly sisters experimentally to block memories. In tribute some detail, like the time, place, or person
one such experiment, people were asked to pick out involved. Another kind of misattribution occurs
the definitions of uncommon words from a selection when you believe a thought you had was totally origi-
of possible definitions. When definitions that were nal when, in fact, it came from something you had

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 Suggestibility is the vulnerability of your memory
to the power of suggestion—information that you
learn about an occurrence after the fact. Although lit-
tle is known about exactly how suggestibility works in
the brain, the suggestion fools your mind into think-
ing it’s a real memory. Suggestibility can be the cul-
prit in recollections that adults have of incidents from
their childhood that never really happened.

Bias
6 One of the enduring myths about memory is
Thinkstock

that it works like a camera, recording what you per-

It’s common to remember information, but forget exactly where ceive and experience with complete, objective accu-
you learned it. For example, you may think you heard it on TV, racy. But even the sharpest memory isn’t a flawless
when you actually learned it from a friend you ate lunch with. snapshot of reality. In your memory, your percep-
tions are filtered by your personal biases—experi-
previously read or heard but had forgotten about. ences, beliefs, prior knowledge, and even your mood
This sort of misattribution explains cases of uninten- at the moment. Your biases affect your perceptions
tional plagiarism, in which a writer passes off some and experiences when they’re being encoded in your
information as original when he or she actually read brain. And when you retrieve a memory, your mood
it somewhere before. and other biases at that moment can influence what
Misattribution happens to everyone. Usually it’s information you actually recall.
harmless, but it can have profound consequences, par- Bias can affect all sorts of memories, but among
ticularly in the criminal justice system. In some cases, the most interesting examples are people’s recollec-
misattribution on the part of eyewitnesses is respon- tions of their romantic relationships. In one study,
sible for the arrest and conviction of individuals for couples who were dating were asked to evaluate
crimes they didn’t commit. themselves, their partners, and their relationships—
As with several other kinds of memory lapses, initially and then two months later. During the sec-
misattribution becomes more common with age. ond session, participants were asked to recall what
Age matters in at least two ways. First, as you age, they had said initially. The people whose feelings for
you absorb fewer details when acquiring infor- their partners and their relationships had become
mation because you have somewhat more trouble more negative over time recalled their initial evalu-
concentrating and processing information rapidly. ations as more negative than they really were. On
Second, as you grow older, your memories grow older the other hand, people whose feelings for their part-
as well. And old memories are especially prone to ners and their relationships had become more loving
misattribution. recalled their initial evaluations as more positive than
they really were.
Suggestibility Although everyone’s attitudes and preconceived
5 Imagine that you saw someone fleeing from a notions color their memories, bias plays an especially
car as its antitheft alarm was blaring. You didn’t get a bitter role in people prone to depression. These people
good look at the thief, but another person on the street tend to have what’s called negative memory bias: they
insisted that it was a man wearing a green plaid jacket. remember negative information better than positive
Later, when the police show you photos of possible information. Negative memory bias is an important
suspects, you’re confused until you see a man dressed risk factor for depression, which makes sense—con-
in green plaid. Then you point to him. stantly remembering the sad things that happened to

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you more than the happy things is likely to sustain a wish they could forget, but can’t. The persistent mem-
depressed mood. ories of traumatic events, negative feelings, and ongo-
Researchers are looking into which parts of the ing fears is another form of memory problem. Some
brain are involved in negative memory bias and how of these memories accurately reflect horrifying events,
it arises. Some theories suggest a problem with the while others may be negative distortions of reality.
interaction between the amygdala (which processes Two groups of people are particularly prone to
emotional memories) and the hippocampus (which having persistent, disturbing memories. One group
processes factual ones). Another study implies that is individuals with depression. Research has shown
a small-sized hippocampus relative to the size of the that depressed people are given to ruminating over
amygdala might be to blame. These results make unpleasant events in their lives or mistakes that they
sense, implying that negative emotional memories believe they have made. Dwelling on such negatives
take precedence. also fuels a vicious cycle of increasing depression.
One area of research that still needs to be probed The other group with persistent, unwanted memories
is whether memory bias of any kind becomes more includes people with post-traumatic stress disorder
common with age. (PTSD). PTSD can result from many different forms
of traumatic exposure—for example, sexual abuse or
Persistence wartime experiences. Flashbacks, which are persistent,
7 Most people worry about forgetting things. But intrusive memories of the traumatic event, are a core
in some cases people are tormented by memories they feature of PTSD.

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 How memory changes with age

any people begin to notice changes in their pow-

M ers of recall around the age of 50. Some of these
changes are relatively predictable and differ from the
memory impairment caused by dementia or other
conditions that damage the brain. There are ways to
tell the difference (see “Memory problems: Normal
aging or brain disease?” on page 39).
But just because your memory seems to be get-
ting worse with age, that doesn’t necessarily mean
that age is directly responsible. Your memory can fal-
ter as a result of stress, fatigue, or being overloaded.
Thinkstock

Some memory difficulties may also be caused by

medications, poor vision or hearing, sleep distur-
bances, or depression—in other words, things you As you age, it may take longer to recall information, such
can take steps to correct (see “17 ways to promote as a name or a word that is familiar to you.
memory health,” page 24).
This chapter covers normal age-related changes. new memories. The loss of receptors and of neurons
may also make it harder to concentrate.
These changes can undermine the encoding, con-
Age-related changes in the brain solidation, and retrieval of new information. Differ-
As you get older, certain characteristic changes take ent kinds of memory can decline with age, including
place. You are likely to experience delays in your abil- episodic memory (for example, which stock you sold
ity to recall things, which explains why you have to last year from your retirement account), semantic
rack your brain to remember a name or word that memory (facts, such as the year World War I started),
is familiar to you. It also becomes more difficult to and spatial memory (such as the directions to a new
divide your attention among more than one activity location).
or source of information. You may find it difficult to It’s not just that you learn this sort of information
focus your attention, getting more easily distracted more slowly; you may have more trouble recalling it
than when you were younger. because you didn’t fully learn it in the first place. If you
Over time, changes take place in the brain that may and your child or grandchild learn a new computer
account for these difficulties. Brain regions involved game together, chances are that the next day the child
with memory processing, such as the hippocampus and will remember more of the details of how to play the
especially the frontal lobes, undergo age-related struc- game than you do.
tural and neurochemical changes. For example, the In addition, the ability to perform tasks involv-
hippocampus shrinks in size. Some receptors (the lock- ing attention and executive function declines with
and-key structures on the surface of neurons needed age. Executive function is a group of cognitive activi-
for them to communicate with other neurons) may ties that involve the overall regulation of thinking and
cease to function normally. The result is that as you age, behavior—the higher-order processes that enable us
it takes longer to absorb new information and to form to plan, sequence, initiate, and sustain our behavior

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 difficult. For example, try repeating the information
Still sharp after all these years? several times in your mind or discuss it with friends
Sometimes, what appears to be a memory problem may (see “Focus,” page 18). Willpower and effort can over-
simply reflect a slower processing speed. Comparisons of
come a fair amount of age-related difficulty. In many
younger and older people’s scores on memory, learning,
and intelligence tests suggest that mental sharpness instances, if you make the effort to learn something
declines slightly with age. But whether such compari- well, you’ll be able to recall it as well as a younger per-
sons are valid is questionable because timed tests may son can. And consider this: while processing speed
favor the younger person. The older person’s information
may become slower with age, the general amount of
processing is a little slower: in one study, elderly people
took 20 to 40 milliseconds longer than younger people knowledge a person has continues to increase.
to detect gaps in circles. Thus, the lower scores of older
persons may simply reflect a slowing of their responses. Not all memories slip
People may require more time and effort to learn new One of the myths surrounding the term “age-related
information as they age, but once they’ve learned it, memory loss” is that all forms of memory are equally
they retain it as well as younger people. In practical
affected. In fact, while some information may become
terms, slightly slower thinking is not necessarily a disad-
vantage. It may actually reflect more thorough reasoning harder to recall—and new memories may be harder to
and result in fewer mistakes. lay down in the brain—other memories will remain
as accessible as ever. There is truth in the old saying
that “you never forget how to ride a bicycle.” Proce-
toward some goal, incorporating feedback and mak- dural memory—by which you remember processes
ing adjustments along the way. and skills such as how to ride a bicycle, serve a ten-
When people of all ages encounter new informa- nis ball, or accomplish routine tasks—does not tend
tion, they may all take in the big picture, but those to fade with age.
who are older may not absorb as much detail. For
instance, after listening to a presentation, a 25-year- Brain plasticity
old and a 75-year-old may both remember the overall While certain brain regions may take a hit from the
subject and basic ideas, but the 25-year-old may be aging process, the brain is also quite adaptable. The
able to recall more of the specifics. complex network of interconnected neurons through
which it processes information is quite dynamic,
changing constantly throughout life in response
Reasons for encouragement to everyday experiences—a phenomenon called
These changes may sound disturbing, but they are plasticity.
relatively minor and may simply represent slower For years, the scientific view of an adult’s brain
processing speed (see “Still sharp after all these was anything but encouraging. Experts believed
years?” above). In other words, age-related changes that, unlike other cells in the body, neurons did not
in the brain may slow down your learning and your regenerate. They thought that the brain produced
recall, but they don’t impair your ability to function new brain cells only early in life and that once you
effectively. Your ability to make sense of what you reached adulthood, the growth of new neurons
know and to form reasonable arguments and judg- ceased and existing neurons began to die off. You
ments is well-preserved. Moreover, the wisdom that may have heard the oft-repeated “fact” that you
you’ve gained from experience over the years remains lose 10,000 brain cells a day. The idea was that your
unscathed. brain was shrinking, and that could mean only one
In addition, you can compensate for the slow- thing: as you lost neurons, you also lost some of your
down in information processing and diminished abil- capacity to learn, think, and remember. Researchers
ity to concentrate by working harder to pay attention now know that this neuron degradation is less pro-
to any new information you are trying to learn. It’s not nounced than previously thought.

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 Not only do brain cells not die as rapidly as sci-
Figure 4: A wide web of memories entists once thought, but it may even be possible to
grow a modest number of new neurons—a process
known as neurogenesis. Nearly two decades ago,
compelling evidence showed that human adults do
sprout new neurons, even in the hippocampus. The
significance of this is not entirely clear, and neu-
Neuron rogenesis may be less important for memory than
Synapse
maintaining the connections among neurons—the
neural pathways that are formed among brain cells
Axon as you learn new information or have experiences
(see Figure 4, at left). Revisiting the information
Axon Neuron
Neurotransmitters strengthens the pathways. In fact, any activities you
Signal engage in frequently—whether related to your job,
Axon
terminal your hobbies, or running a household—become
more sturdily encoded.
The brain also has some capability to reorganize
itself, shifting functions from one network to another,
if a particular process starts to weaken. For example,
some studies have found that the brains of older and
younger adults may engage different brain regions to
accomplish the same mental task. Scientists believe
Receptors
that this may be a mechanism of older brains to com-
pensate for diminished function in the area normally
In order to recall a memory, you must activate a vast network of used for that task.
interconnecting brain cells called neurons (nerve cells). These brain The bottom line is this: New connections between
cells deliver and permanently store messages along neural path-
neurons are formed as we learn information or take
ways, primarily in the cerebral cortex, the large, domed outer layer
of the brain. in visual images and other types of stimuli. The more
we use the information, the stronger the memory.
One brain cell communicates with another across a space called a
synapse, by way of chemicals known as neurotransmitters. These
Even if some brain regions weaken, the brain may
neurotransmitters activate the receptors on the neighboring cell. be able to compensate. For these reasons, stretching
Revisiting a memory strengthens the connections between brain your mind with mentally challenging activities can
cells that are responsible for maintaining that memory. improve your memory.

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 SPECIAL SECTION

Improving everyday memory

here are plenty of techniques that boost your ability to re-

T
electronic organizers, some experts
tain new information and skills. Doctors and other clini- recommend a “memory note-
cians who work with people on improving their cognitive book,” which is a binder that has a
weekly calendar and paper for writ-
performance and memory have found these strategies to be ef-
ing down important information.
fective. They aren’t difficult to master. Indeed, many are simple Develop the habit of checking your
things that you probably do already, but can benefit from do- organizer or notebook at least sev-
ing more systematically. By investing some time to learn these eral times each day.
Daily tasks. In addition to list-
skills, you can reap the rewards of a sharper, quicker mind.
ing your appointments, keep a list
These techniques fall into three It doesn’t matter which tool you of the miscellaneous things that
general categories: organizational choose; what matters is that you you have to do each day or week—
tools, behavioral strategies, and use it consistently. people to call, items you need to
memory-enhancing techniques Here’s a brief list of the types buy, routine maintenance on your
that make new information mean- of information that people often car or home, and so on. Keep those
ingful and relevant to you, thus forget and some organizational to-do lists in your electronic orga-
making it easier to remember. strategies to help you remember. nizer or memory notebook.
Table 1, page 17, also contains a Contact information. Keep
Organizational tools quick troubleshooting guide for your address book or electronic
Most people need to organize a ways to deal with common mem- organizer up to date with the names
multitude of facts each day: dates ory problems. and phone numbers of friends,
and locations of appointments, Belongings. Have a designated relatives, and professionals or com-
people’s names and phone num- spot for your most important per- panies with whom you do business
bers, even where they left the car sonal belongings (keys, glasses, (bank, doctors, mechanic, etc.).
keys. Information that is well orga- handbag) and always put them Vital information. Keep impor-
nized is much easier to learn and there when you’re not using them. tant documents like insurance
remember. There are many orga- Meetings and appointments. papers and medical records in a file
nizational tools, including time- Maintain a calendar (on paper cabinet or other designated loca-
honored ones such as address or on an electronic device like a tion. Record other vital informa-
books and calendars. You can also smartphone or tablet) in which you tion in your electronic organizer or
get apps for smartphones and other write appointments and impor- memory notebook. You may want
electronic devices that remind you tant dates, and keep it with you at to list the medications you are tak-
when it’s time to do something. all times. For people who don’t use ing and when to take them; your

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 Improving everyday memory | SPECIAL SECTION

Table 1: Common memory lapses and strategies to overcome them

WHAT YOU FORGET HOW TO REMEMBER BETTER

Names • When you meet someone for the first time, stop and take the time to register his or her name.
Many times you may forget a name simply because you didn’t notice it being said to you in the first place.
• Use a new acquaintance’s name in conversation.
• Think about whether you like the name.
• Think of people you know well who have the same name.
• Associate the name with an image, if one comes to mind. For example, link the name Sandy with the image
of a beach, and imagine Sandy on the beach. Use as much detail as possible—picture her in a bathing suit,
on a beach that’s familiar to you.
• Write the person’s name down in your memory notebook, personal organizer, or address book.

Where you put things • Always put things you use regularly, such as keys and eyeglasses, in the same place.
• For other objects, repeat aloud where you put them.
• As you put an object down, make a point of looking at the place where you put it.
• If you still don’t think you’ll remember, write down in your memory notebook or personal organizer where
you put the object.

What people tell you • Ask someone to repeat what he or she just said.
• Ask the person to speak slowly; that way, you’ll be able to concentrate better.
• Repeat to yourself what the person said and think about its meaning.
• If the information is lengthy or complicated (such as advice from your doctor), record it on your cellphone
or a small voice recorder, or take notes.

Appointments • Write them down in an appointment book, in a calendar that you look at daily, or in your personal organizer.

Things you must do • Write them down in your personal organizer or calendar.
• Write yourself a note and leave it in a place where you’ll see it (for instance, on the kitchen table or
by the front door).
• Ask a friend or relative to remind you.
• Put an object associated with the task you must do in a prominent place at home. For example, if you want
to order tickets to a play, leave a newspaper ad for the play near your telephone.
• If you must do something at a particular time (such as take medicine), set an alarm.

Adapted with permission from Winifred Sachs, Ed.D., Center for Cognitive Remediation and Treatment, Beth Israel Deaconess Medical Center.

medical history; names and phone alizing where you are going can Checklists. For procedures that
numbers of your doctors, health help reinforce your memory of the you may have difficulty remember-
insurance company, homeowner’s directions you may have written ing from one time to the next (like
insurance, and credit card compa- down. And just knowing that you using a digital camera), write the
nies; and work numbers of your have a map can help minimize any steps down and post them nearby.
closest relatives and friends. anxiety you may feel about getting
Locations. Keep maps of your lost. If you use a GPS, don’t become Behavioral strategies
area and other places you visit so reliant on it that you fail to pay Certain behavioral strategies can
regularly in your car or at home. attention to where you’re going. help improve your ability to learn
Before going somewhere new or Otherwise you’ll never memorize new information effectively and
unfamiliar, check the map. Visu- the routes. retain it over time.

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 SPECIAL SECTION | Improving everyday memory

Focus. Your ability to focus be able to focus on them without only the general concept but also
your attention and absorb infor- having your attention wander to the details. You can improve your
mation quickly declines with age other diners. comprehension by rereading mate-
and contributes to age-related You can improve your ability rial, asking questions about it, and
memory loss. The slowdown in to focus on a task and screen out discussing it.
processing causes a bottleneck distractions if you do one thing at a Make a note. How many times
of information entering your time. Try to avoid interruptions. Ifhave you had a brilliant idea while
short-term memory, reducing the someone asks you something while getting ready for bed or standing
amount of information that can be you’re in the middle of reading or in line and then forgotten it? Many
acquired and encoded into long- working, ask if the person can wait people assume that if a thought
term memory. You can enhance until you’re finished. Don’t answer is important enough, they will
your focus and attention by doing the phone until you’ve finished remember it. But this is unrealistic.
the following: what you’re doing—let voice mail When something significant occurs
• When someone is talking to you, take the call. to you, write it down as soon as
look at the person and listen Repeat. You will remember you can. The act of writing things
closely. If you missed something new factual information more down actually helps reinforce them
that was said, ask the person in your mind, so you may not even
effectively if you repeat it to yourself
to repeat it or to speak need to refer to your notes to
more slowly. help jog your memory.
• Paraphrase what is said Before going to the doc-
to make sure that you tor’s office, make a list of
understand it and to questions you want to ask or
reinforce the informa- things you want to mention.
tion. For example, if Jot down other thoughts as
someone says, “We can they come to mind: ideas
see the movie either at related to your job, possi-
Loews Theater at 7:30 bilities for birthday and holi-

Thinkstock
or at the Paramount day presents, the names of
at 7:50,” you might Writing things down can help you remember them. It pro- restaurants you’d like to try
respond, “Which would vides a written reminder and actually reinforces the memory. or books you’d like to read,
you prefer, 7:30 at Loews or movies that you didn’t
or 7:50 at the Paramount?” or say it out loud. If someone gives see when they were first released.
• If you find that you tend to you directions, for example, repeat These are the sorts of ideas that
become distracted during con- them to the person to make sure often fade with time, but that you
versations, try getting together that you got them right. Discuss- know you’ll want to remember.
with people in quiet environ- ing newly learned material with a Practice spaced rehearsal.
ments, such as homes instead friend or colleague is another way Research on learning has shown
of noisy restaurants. When you to help reinforce it in your mind. that “spaced rehearsal” is more
do meet people at a restaurant, Ensure comprehension. The effective for long-term recall than
sit at a table near a wall. If your more thoroughly you understand “cramming.” In other words, you
companions sit against the wall new information, the greater the will remember something more
and you sit facing them, you’ll odds that you will remember not effectively if you rehearse it once a

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 Improving everyday memory | SPECIAL SECTION

day for several days rather than all niques for remembering infor- Make associations to remem-
at once. mation. The name comes from ber numbers such as access codes
If you have trouble retain- Mnemosyne, the Greek goddess of or passwords that you need to use
ing complicated information— memory. One mnemonic device regularly but, for security reasons,
for instance, when you read an is to think of a word that rhymes don’t want to write down and keep
article, take a course, or start a with a person’s name so that you in your pocket. For example, if
new project at work—try using don’t forget the name. Another is to you need to remember the num-
spaced rehearsal. Write down the come up with a sentence or phrase ber 221035 to get your voice mail:
main points of what you have just to help you remember something, 22 could remind you of “catch-22,”
learned and then review your notes such as “Every Good Boy Does and 10 might be your house num-
once or twice. Read them again the Fine” for recalling E, G, B, D, and F, ber, while 35 was your age when
following day and then again the the notes that fall on the lines of the your oldest child was born.
day after. Spacing out these study treble-clef musical staff.
sessions gives your brain a chance “Chunking” information
to consolidate the information that Associations Another technique for remem-
you have learned and form a more When you learn something new, bering a long series of items is to
durable memory of it. immediately relate it to something regroup them—for example, so
Do small tasks first. It’s only you already know. Making connec- that a list of 15 things is organized
natural to turn your attention to tions is essential for building long- into three groups of five. For exam-
the large, important tasks at hand term memories. What you’re really ple, when you do grocery shopping,
and let the mundane tasks slide. doing is making the information think of the items you need by cat-
The problem with this approach meaningful, thus aiding your hip- egories, such as dairy, produce, des-
is that small tasks, like answering pocampus in consolidating it. Mak- serts, frozen foods, and so on.
email messages, tend to pile up ing connections between new and Chunking is also useful for
and then get forgotten. If you act old information also takes advan- remembering numbers. Phone
on them quickly, you don’t have to tage of the older pattern of synaptic numbers are naturally chunked
worry about remembering to do activation, piggybacking the new into the area code, local exchange,
them later. material onto an existing network. and remaining four digits. Let’s say
Be patient. One of the main Remember names by mak- your checking account number is
reasons memory declines with age ing associations with the first let- 379852654. Instead of memorizing
is that the brain processes informa- ters. For example, it’s fairly easy it as a string of nine single digits, try
tion more slowly. Give yourself the to remember the National Aero- grouping the digits into three triple-
time you need to absorb new infor- nautics and Space Administration digit numbers: 379, 852, and 654.
mation. Don’t consider it a sign of because it is familiar as the acro- That way, you’ll reduce the number
personal failure that you need to nym NASA. You might try this of chunks of information you need
slow down in order to learn some- technique with people’s names, to remember from nine to three.
thing new. too. Let’s say you meet someone
named Louise Anderson. Her ini- Method of loci
Memory-enhancing tials are L.A., an association that’s This technique originated in
techniques easy to remember because it’s ancient Greece and it is still one of
You may have heard the term already familiar as the abbrevia- the best ways to memorize complex
“mnemonics,” which refers to tech- tion for Los Angeles. or lengthy material, like speeches.

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 SPECIAL SECTION | Improving everyday memory

The idea is to link the main points step method is particularly effec- Professional memory
of the material to specific locations tive for mastering a large volume of training
so that thinking of those locations technical information from a text- You can go it alone and teach your-
triggers your recall. book or professional document. self techniques for strengthening
Here’s how it works: First, Survey the material by read- your memory. Or you can get pro-
think of a familiar route, such as ing through it quickly. Concentrate fessional memory training. Some
your commute to work, and imag- most on the chapter headings and medical centers offer memory
ine traveling that route, noting the subheadings, as well as the first sen- training programs in which peo-
stores and other landmarks along tence of each paragraph, to get an ple meet every week or so to learn
the way. Next, pick out the main overview. memory-enhancement techniques,
points in your speech or other Question yourself about the then practice them as homework.
information and relate each point main points of the text. The more Another alternative is to attend
in sequence to a landmark on your provocative and interesting your a series of individual sessions
route. When giving your speech (or questions, the better able you will with a clinician who specializes
recalling the information), think be to mentally organize the mate- in memory and other cognitive
about commuting to work and see- rial when you re-read it. problems, such as a psychologist,
ing the landmarks. The image of the Read the text carefully for occupational therapist, or speech
landmarks will help you remember comprehension, keeping in mind pathologist. Such a specialist can
the points of your speech. It helps your questions from the second recommend specific strategies for
if you vividly picture the images of step. Don’t take notes or under- the types of memory problems
your route, and also vividly picture line yet—doing so at this stage can that affect you (see “Phyllis’s story,”
something from your speech in that actually interfere with your com- page 21).
place. For example, if one of the prehension by interrupting the flow Do memory training programs
points in your speech deals with a of information. work? Studies on the effectiveness
publication your company just put Recite what you have just of memory-enhancement pro-
out, picture that publication—the read, either to yourself or to some- grams have found some benefit.
title page just as it looks in real one else. Speaking out loud helps One study demonstrated the
life—on the doorstep of the coffee deepen your understanding of the potentially enduring value of an
shop you pass every day. material. Now is also the time to organized training program for
The loci that you use can also take notes. cognitive enhancement. For this
be rooms in your home, which Review the text, as well as study—called Advanced Cognitive
you can imagine walking through your notes, a day or two later. Now, Training for Independent and Vital
sequentially, maybe starting at the think critically about the informa- Elderly, or ACTIVE—2,832 adults
front door and walking whatever tion: does it support or contra- ages 65 to 94 were divided into four
path you normally take through the dict other information you know groups. Participants in three of the
house. As you picture your path, about the subject? Go back to your groups attended 10 training ses-
mentally drop images from your questions from step two. Can you sions—one group received training
speech along this route. answer them? Do any questions in memory, another in reason-
remain? Review the text quickly ing ability, and the third in speed
The SQ3R Method several more times over the next of processing. The fourth group
SQ3R stands for Survey, Question, several days or weeks to help your received no training and served as
Read, Recite, and Review. This five- brain consolidate and store it. a comparison group. Each of the

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 Improving everyday memory | SPECIAL SECTION

PHYLLIS’S STORY: The benefits of memory coaching people living in retirement com-
munities, with an average age of
“I used to have a sharp memory,” says Phyllis, 58. But then she started having 81. The researchers tested the par-
trouble remembering all sorts of things. She’d forget where she left her glasses
and her keys. She’d forget the details of conversations. Formerly an avid reader,
ticipants’ memories at the begin-
she had trouble retaining information that she’d read. ning, middle, and end of the study,
Her doctor recommended that she see a therapist who specializes in helping and found that over all, the people’s
people devise strategies and systems to improve everyday memory function. memories had improved. The par-
At her first session, the therapist asked Phyllis to tell her specifically what she’d ticipants also felt their memories
been forgetting, then proposed a strategy for each type of memory lapse. Once were better. An important limita-
a month, Phyllis met with the therapist to discuss how well the strategies were
working and to fine-tune them as needed. tion of the study was that there
was no control group to which the
For example, the therapist suggested that Phyllis put her glasses and keys in the
same places whenever she came home. On the occasions when she had to leave researchers compared the subjects
them somewhere else, the therapist told her to say out loud where she was who received the memory training
putting them. For example, if the phone rang as she was coming in the door and and lifestyle intervention.
she rushed into the kitchen to answer it, she would say, “I’m putting my keys on
The four memory techniques
the kitchen table.”
used in the study were based on
To remember information from conversations, the therapist helped Phyllis learn
how to paraphrase during the course of the conversation. Restating the informa-
those found in the book The Mem-
tion in her own words would reinforce it in her mind. ory Bible: An Innovative Strategy
To improve concentration while reading, the therapist recommended creating For Keeping Your Brain Young by
a place in her home just for reading that was free of distractions. Phyllis also psychiatrist Gary Small, an author
learned how to make a brief written note summarizing the key aspect of each of the study. The techniques were
section of the material she was reading. taught sequentially, and partici-
Phyllis feels that most of the strategies have proved to be extremely helpful. pants were expected to practice
She still struggles to concentrate on what she’s reading, although she’s doing
each skill at home the week it was
better than before she started seeing the therapist. Now that her last memory-
coaching session is over, the most encouraging improvements are that she can taught, according to clinical neuro-
almost always find her keys and glasses and follow the details of conversations. psychologist Karen Miller, the lead
“I feel my memory is nearly back to normal,” she says. author of the study. These are the
four techniques they learned:
• Look, snap, connect is all about
training groups improved in the in their ability to engage in daily paying attention, since you can’t
cognitive area that was trained. activities (for example, preparing remember what you don’t notice
For example, the memory group meals, handling finances, shopping, in the first place, and then using
showed enhancement on tests of housework, driving) than those in visualization to solidify the
memory. Follow-up studies dem- the comparison group. memory. Look refers to slow-
onstrated that these improvements Another study found that ing down and noticing what you
lasted many years. However, no older adults improved their mem- want to remember, such as the
improvement was ever found in ories after a six-week program fact that you parked your car in
mental functions that were not that included memory training, section 3B of the parking garage.
specifically trained. Ten years after physical activity (daily walking or Snap means taking a mental
the study began, the participants in swimming), stress reduction, and snapshot of the item. That could
each of the three training groups a healthy diet high in antioxidants. be a literal image of the parking
reported that they had less decline The study participants were 94 garage sign, though you’ll prob-

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 SPECIAL SECTION | Improving everyday memory

Can computer brain-training games save your brain?

Y ou probably know teenagers

who spend large amounts of
time riveted to various electronic
became better multitaskers, and
they also had a boost in cognitive
skills that weren’t directly related to
devices playing games. In recent the game. Working memory (tempo-
years, a new crop of electronic rarily holding information in mind
games has come on the market. and manipulating it) and the ability
These are aimed at middle-aged to sustain attention also improved.
and older adults worried about The gains in memory remained six
their memory. Companies like Nin- months after the end of the study.
tendo, Posit Science, Lumosity, and
In a study of 23 adults (ages 60 to
even AARP have made computer
70), published in Neuroimage, the
brain-training games big business.

Thinkstock
But do they work? Cogmed Working Memory Training
program was shown to improve
The quick answer is this: be wary working memory and also positively
of outsized claims about computer- Brain-fitness programs can be fun, but beware affected episodic memory and the
ized brain-fitness programs. The of outsized claims. They may teach a specific task,
ability to sustain attention. In one
jury is still out on whether these but they don’t necessarily help overall memory.
part of the study, participants who
programs can live up to market- underwent training could carry out
ing promises. There is good evidence that these programs a working memory task more efficiently, relying on less brain
can improve your ability to perform the specific tasks in the activity to attain the same performance level.
program—for example, remembering a list of unrelated items.
But whether this translates to helping overall memory is still However, these studies have some limitations. None of them
under investigation. So, you’ll get good at playing the com- compare one program to another or to other types of mental
puter game, but this may not help you remember the name of challenges, such as learning a new language or taking up a
an acquaintance or find your car keys. musical instrument. Moreover, the competitive features of
a program and the person’s desire to get his or her money’s
That said, a couple of small studies have found that a few worth from buying the software (some of which costs nearly
specific computer programs may extend the improvement to $400) might influence the results. It is also worth noting
other domains of memory and thinking. Bear in mind that that so far there is no evidence that any of the commercially
these results are preliminary and must be replicated in larger available training programs prevents or delays the onset of
studies to be considered valid.
Alzheimer’s disease or any other form of dementia. So try a
A program called Project:EVO appears to help people improve computer program, if you like. It certainly won’t hurt (except
their ability to multitask, something that becomes more maybe in the wallet). But no single computer program can
difficult with age. A study published in Nature in 2013 found replace the benefits of staying physically, mentally, and
that the 46 older adults (ages 60 to 85) who played the game socially active throughout life.

ably be more likely to remember parked. So you could imagine expands on Look, Snap, Con-
a more elaborate image, such as the bees in your car. Then when nect. It is helpful when you need
that of three bumblebees (rep- you pause to remember where to remember many items, such
resenting the 3B section you you parked after coming back to as a list of things to do. In this
parked in). Connect involves the garage, you’ll likely draw up case, you assign each item a
connecting the image and the the image of the three bees buzz- visual image to represent it in
thing you want to remember— ing in your car. the story, and then you make up
in this case, the three bees and • The story method, used by a story with those images in it.
section of the garage where you many memory researchers, Say you have to buy a present for

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 Improving everyday memory | SPECIAL SECTION

your wife after work, then get objects and chunking them into if Christine has curly hair, you
your dog groomed, then pick categories so you can remember might think of Christmas orna-
up your daughter from dance them more easily. For example, ments hanging from her curls.
class, and then call your mother if you have a list of items to get If you are considering a mem-
in Florida. You might picture a at the grocery store, you can ory-enhancement program, choose
present buckled into the front remember them in groups such one that is run by a health profes-
seat of your car. Then, as you’re as bread, dairy, fruits, etc. When sional with specialized training in
driving the familiar route to the you get to the store, you can cognitive rehabilitation. Beware of
store, you picture your wet and shop for the items one category memory-enhancement programs
soapy dog running out in front at a time, since that’s how you that use computer games as a one-
of the car. Chasing after it is memorized them. size-fits-all means of strengthening
your daughter, dressed in a tutu. • Face/name association ad- your memory (see “Can computer
Next, a pile of Florida oranges dresses the common problem brain-training games save your
rains down on your car. When of forgetting the name of a new brain?” on page 22). People with
you go to remember what to acquaintance. This technique memory problems that are sub-
do, you tell yourself the story links the name with something stantial enough to interfere with
you created, remembering each prominent about the person’s their daily lives are most likely to
errand one by one. looks. For example, if Carlos benefit from individual treatment,
• The categorization technique has a big nose, you might think where their particular needs can be
consists of taking groups of of a car parked on his nose. Or identified and addressed.

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 17 ways to promote memory health

s you get older, certain aspects of memory nor- Of particular significance, exercise may actually
A mally slow down, but that does not mean you are
powerless to protect your brain as you age. In fact,
boost the size of the hippocampus, a brain structure
important for memory that typically shrinks as a per-
there is a lot you can do. son ages. For example, a study published in Proceedings
Certain lifestyle measures—such as exercising of the National Academy of Sciences found that people
regularly, reducing stress, and getting a good night’s who underwent exercise training for one year increased
sleep—can produce noticeable improvements in mem- the size of the hippocampus about 2%. By contrast,
ory and mental function or at least help you maintain study participants who were assigned to a stretching
your current abilities. Looking toward the future, how- program had a 1.4% shrinkage of this vital structure.
ever, it’s also a good idea to protect your brain from In part, these beneficial effects may be the result of
injury and other assaults that can damage your mem- increased levels of a compound called brain-derived
ory and increase your risk for dementia. This chapter neurotrophic factor (BDNF). BDNF promotes the
will cover both types of measures. growth of neurons (nerve cells) in the brain and
Unfortunately, there is no pill with true memory- strengthens the connections between brain cells. Exer-
enhancing qualities, though makers of various herbs, cise also encourages the formation of new blood ves-
vitamins, and other supplements would like you to sels in the brain. And it reduces your stress levels and
think there is (see “Ginkgo: A no-go for memory,” page improves your sleep—two measures that help mem-
30, and “What about vitamins?” on page 29). But if you ory in additional ways (see “Manage your stress,” page
follow the recommendations in this chapter, they will 26, and “Get a good night’s sleep,” page 27).
do more for you than any so-called memory pill. Perhaps less obvious, exercise also promotes
brain health by helping other parts of the body. For
Exercise example, it helps maintain a robust cardiovascular
1 Physical fitness and mental fitness go together. system, which ensures a good supply of oxygen-rich
In fact, engaging in regular aerobic exercise (mean- blood to the brain. It also helps reduce the risks for
ing any exercise that speeds up your heart rate and type 2 diabetes, high cholesterol, high blood pressure,
breathing) can help you achieve both of the goals and strokes—problems that can lead to brain-damag-
listed above—that is, improving your memory now ing cardiovascular problems, including strokes, and
and reducing your risk for dementia later. People who increase the odds of developing dementia. A six-year
exercise regularly have better mental function than study, published in Annals of Internal Medicine, of
those who do not exercise, and they experience less of 1,740 people ages 65 and older found that people who
a decline in memory over time. exercised more than three times a week had a lower
Exercise appears to help memory in numerous risk of dementia than their sedentary counterparts.
ways, enhancing the ability of the brain to adapt and What you can do: Researchers don’t know precisely
compensate for age-related decline. For example, physi- how much exercise is needed for good brain health, but
cal fitness seems to slow the normal age-related shrink- one thing is clear—you only reap benefits if you exercise
age of the brain. Studies have found that physically on a regular basis. You can’t exercise for a week or two
active older adults have greater brain volumes over all and consider it done. The available research suggests
than those who are less fit. This seems to translate to that the exercise needn’t be extreme, but should be
maintaining higher levels of mental function longer. moderately vigorous. (See “Exercise recommendations

24 Improving Memory w w w.h e a l th.ha r va r d.e du

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 Exercise recommendations for older adults
If you’re 65 years of age or older, are generally fit, and have no limiting health conditions, you
can follow the guidelines listed below, which will deliver benefits for your body as well as your
brain. If you have a health condition that limits your activity, do as much as you are able to do
comfortably and safely. Always check with your doctor before starting an exercise program.
The Physical Activity Guidelines for Americans from the U.S. Department of Health and Human
Services recommend this combination:
• Two hours and 30 minutes (150 minutes) minutes of moderate activity equal one min-
of moderate-intensity aerobic activity (e.g., ute of vigorous aerobic activity.
brisk walking) every week. If you’re very fit, • Muscle-strengthening activities on two
you can substitute one hour and 15 minutes or more days a week that work all major
(75 minutes) of vigorous-intensity aerobic muscle groups (legs, hips, back, abdomen,
activity (e.g., jogging or running). Or, try an chest, shoulders, and arms). Allow 48 hours
equivalent mix of the two. In general, two between sessions.

for older adults,” above, for the federal guidelines.) more connections. As a result, the “educated brain”
A formal exercise program is best. If you’re just may possess a greater reserve of cognitive ability—a
starting, you can find helpful guidance on build- deeper well, so to speak—and be able to sustain more
ing a well-rounded program in another Harvard loss of neurons. But if you failed to get an advanced
Special Health Report titled Starting to Exercise (see degree when you were in your 20s, that doesn’t mean
“Resources,” page 48). But any physical activity is bet- it’s too late for you. A lifelong habit of learning and
ter than none, so try to build more activity into your engaging in mentally challenging activities seems to
daily routine. Here are some examples: keep the brain in shape. A study published in JAMA
• When possible, walk instead of driving. Neurology in 2014 found that people maintained bet-
• Set aside time each day for exercise—for example, ter memory and thinking abilities in later life if they
a brisk half-hour walk around the neighborhood. had higher levels of formal education, had held men-
• Use the stairs instead of the elevator. tally stimulating jobs earlier in their lives, or engaged
• Exercise at home, possibly with an exercise DVD. in higher levels of non-work-related mental stimu-
• Plant and tend a garden. lation in mid- to late life. Additional studies have
• Take an exercise class or join a health club. found that people who regularly engage in mentally
• Swim regularly, if you have access to a pool or stimulating activities—such as reading, writing, play-
beach. ing board games, playing musical instruments, and
• Learn a sport that requires modest physical exer- gardening—in midlife have a lower risk of developing
tion, such as tennis. dementia later.
Researchers are still trying to unravel the ways that
Keep learning mental stimulation may help maintain a healthy brain.
2 Like exercise, continuing to challenge your But in animal studies, environmental enrichment has
mind throughout life can get you closer to both goals been shown to increase the expression (activity) of
of improving your memory and lowering risk for genes involved with memory.
later decline. Some studies have shown that people What you can do: Exercising your brain with chal-
who have more years of education preserve their lenging activities is believed to stimulate communica-
overall mental function longer and have a lower tion between brain cells. Some ways of stimulating
risk for developing dementia than those with fewer your mind are obvious—for example, doing crossword
years of education. Scientists believe that intellectual puzzles, reading, participating in a book discussion
enrichment and learning stimulate the brain to make group, playing chess, or taking classes. However, the

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most beneficial activities may be ones that challenge Manage your stress
your brain in entirely new ways—for example, learning
4 Stress can impair memory in more ways than
a new language or taking up a new musical instrument. one. Stresses of everyday life, like deadline pressures
You don’t have to go to great lengths or spend a lot or arguments with family members, can cause you to
of money to find mental stimulation. Mental challenges expend mental resources managing the anxiety and
also come from the unexpected occurrences that take distress. When you reduce and manage these stress-
you out of your daily routines and make you think. If ors, that frees your mind for other memory and men-
you’re still working, chances are that you get some of tal tasks.
these curveballs thrown at you from time to time. But In addition, stress can trigger the body’s natural
if you aren’t working and your time is largely unsched- “fight or flight” reaction, which occurs in response to
uled, you may need to actively seek out novel experi- a perceived threat. To protect itself, the body releases
ences and learning opportunities. Planning day trips or stress hormones, including cortisol and epinephrine
longer vacations, meeting regularly with friends, going (also known as adrenaline). These hormones prime
to the theater or to museums, or just making a point of your body to respond to a physical danger by either
varying your routine can help keep your mind active running or standing your ground. Energy-boosting
and engaged. You can also try cooking new recipes, glucose is released into your bloodstream to fuel your
joining a club, or learning a new art or craft. muscles. Your heart pounds and breathing quickens to
deliver oxygen and nutrients to those muscles. Sharp-
Stay socially active ened senses, such as vision and hearing, make you
3 Some research suggests that older adults who more alert. Platelets become stickier, so clots can form
are socially engaged have better memory and other more easily to minimize bleeding from potential inju-
cognitive abilities, and may even be at a lower risk for ries. Immune system activity picks up.
dementia, compared with those more socially isolated. This physical reaction can help us sprint out of the
A study of 3,610 people between the ages of 24 and 96 path of an oncoming bus or fight an assailant. But in
looked at the relationship between participants’ men- today’s world, the sources of perceived threats have
tal function and their level of social contact based on multiplied (financial problems, a heavy workload, a
how often they talked on the phone to friends, neigh- distressing medical diagnosis). In the short run, this
bors, and relatives. The researchers found that the reaction is helpful, giving you increased energy and
higher the individual’s level of social interaction, the focus. But when your cortisol level remains high for
better his or her mental function; this result was found too long, it can harm brain structures vital to memory,
across all age groups. including the hippocampus.
There are several ways social engagement may What you can do: There’s no one-size-fits-all strat-
benefit your memory. Social interaction often goes egy for reducing stress. You have to find strategies that
hand in hand with intellectual stimulation. Carrying work for you—whether taking a brisk walk, listening
on conversations not only exposes you to new infor- to music, talking to a friend, or engaging in a relax-
mation, but also forces you to frame your thoughts in ing activity, such as gardening, knitting, or meditat-
different ways. Social relationships can also provide ing (see “Try meditation,” page 28). A handful of small
support during stressful times, reducing the damaging studies have investigated the effects of yoga on mem-
effects that stress can have on the brain. ory. For example, a 2014 study found that participants
What you can do: Reach out to others. Social who did eight weeks of Hatha yoga improved on tests
support can come from relationships with friends, of working memory when compared with a group that
relatives, or caregivers, as well as from a religious engaged in an eight-week program of stretching and
community or other organized group. You can even strengthening exercises.
tackle two brain-boosting options at once by joining a Dr. Herbert Benson at Harvard Medical School
walking group or finding an exercise buddy. has been a leading figure in the field and coauthored

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 the Harvard Special Health Report Managing Stress, sleep can reverse sleep-related impacts on thinking
which includes dozens of strategies for tamping down and memory. But some people have difficulty getting
your stress levels (see “Resources,” page 48). enough sleep. With age, people become more prone to
If you can’t lower your stress level on your own, sleep disorders. These make it harder to get adequate
you might benefit from counseling. Some research sleep, and they can contribute to a general decline in
indicates that it may not be the actual stressors in your mental function.
life that cause problems so much as your perceived level The most common sleep disorder is insomnia.
of stress. Unfortunately, many medicines used in the treatment
of insomnia can also impair memory and general cog-
Get a good night’s sleep nitive function, so it’s best to avoid long-term use of
5 People who don’t sleep well at night tend to be sleep-inducing medications. Instead, try the sleep tips
more forgetful than people who sleep soundly. A good described below for reducing insomnia.
night’s sleep is essential for consolidating memories Another sleep disorder is obstructive sleep apnea
(see “Sleep, perchance to remember,” below). Sleep (OSA), which can lead to memory impairment if
may aid memory in another way as well—by lower- not treated. People with OSA have short pauses in
ing levels of stress hormones. Stress hormones decline breathing that can disrupt sleep with hundreds of
during the first few hours of sleep, which experts “mini-awakenings” each night. More than 18 million
believe may free up the hippocampus to consolidate American adults have sleep apnea, with more men
memories. Recent research has also suggested that the than women being affected by it. It becomes more
brain clears out toxins during sleep, and this may have common with age, affecting at least one in 10 people
implications for your risks of developing dementia. In older than 65. It is often associated with loud snor-
studies with animals, levels of a toxic protein called ing. If you have OSA, treating the problem appears to
beta-amyloid that is associated with Alzheimer’s dis- improve some aspects of cognitive function.
ease were found to rise during wakefulness and fall What you can do: The following practices can
during sleep. Changes in time spent sleeping alter the help reduce insomnia:
rates at which beta-amyloid accumulates. • Establish and maintain a consistent sleep schedule
Although people vary in their need for sleep, six and routine. Go to bed at the same time each night,
hours appears to be the minimum that most older and wake up at the same time each morning. A set
adults need to ensure adequate daytime alertness and sleep routine will “train” you to fall asleep and wake
memory function. Getting consistently good-quality up more easily.

Sleep, perchance to remember

Why does sleep make a difference to memory? information to strengthen the neuronal
One theory suggests that changes in brain ac- patterns that were activated during the
tivity during two phases of sleep—slow-wave acquisition phase. This replaying of the
sleep and rapid-eye-movement (REM) sleep— learning scenario is the key component of
are important for memory consolidation. the consolidation process.
Research with rodents showed that during Research has also revealed that during REM
slow-wave sleep, the pattern of activity in the sleep—the phase of sleep when dreaming
hippocampus was very similar to the pattern occurs—there is increased activity in the cor-
that appeared earlier when the animals were tex. Some scientists now think that dream-
engaged in learning something. This finding ing is one of the ways in which the brain
suggests that during slow-wave sleep, the strengthens the neuronal pathways
hippocampus “replays” the recently acquired that encode memories.
Thinkstock

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• Use the bed only for sleep and sex. you. Researchers at Massachusetts General Hospital
• Plan to do your most vigorous exercise early in the in Boston and the University of Massachusetts Medi-
day. Exercising in the hours immediately before cal School in Worcester have found that this practice
bedtime causes physiological changes that may alters regions of the brain associated with memory,
interfere with sleep. Exercising in the morning, on awareness of self, and compassion. A study of 48 col-
the other hand, enhances your alertness when you lege students, published in the journal Psychologi-
need it most—at the beginning of the day. cal Science in 2013, found that those who engaged
• Avoid coffee and other sources of caffeine (e.g., in mindfulness meditation four days a week for two
chocolate, many soft drinks, some brands of pain weeks improved working memory and reading com-
relievers, many types of tea) after midmorning. prehension and reduced mind wandering. Moreover,
• Avoid excessive napping during the daytime. Pro- they increased their score on the reading comprehen-
longed napping can disrupt your natural sleep cycle sion section of the Graduate Record Examination
and prevent you from feeling tired enough to fall (GRE) from 460 to 520, on average. Those in the com-
asleep at night. parison group had no increase in GRE score.
• Don’t take sleeping pills unless nothing else works. For some people, the benefits of meditation relate
If you do take a prescription sleep medicine, work to stress reduction. In one study of 34 adults ages 65
with your doctor on using it effectively, but only on and older with high anxiety-related stress, eight ses-
a short-term basis, because sleep medications can sions of a mindfulness-based stress reduction program
be habit-forming. In addition, like sleep depriva- lessened the severity of their anxiety and improved
tion itself, sleeping pills can cause memory loss. their performance on a memory test—they were bet-
• Try drinking warm milk before bedtime. Milk con- ter able to recall a paragraph when asked about it later.
tains tryptophan, a chemical that may help you The study was published in the International Journal of
relax. Some people find this helps them feel sleepy. Geriatric Psychiatry in 2014.
• Don’t try to sleep if you’re not tired; otherwise you’ll What you can do: Numerous books, videos, and
set yourself up for tossing and turning. If you’re still workshops are available to learn the techniques of
awake after about 20 minutes in bed, get up and meditation. In particular, Jon Kabat-Zinn, a longtime
read awhile to help yourself relax. scholar on the science of meditation, is well-known
for his books and guided mindfulness meditation pro-
Try meditation grams (see “Resources,” page 48).
6 Meditation can boost your memory in multiple If you experience persistent sleep problems, con-
ways. It improves your ability to focus, even when sult your physician so that you can identify the spe-
things around you are chaotic—thus improving atten- cific issues and get the necessary treatment.
tion, which is crucial for memory acquisition. It helps
reduce stress, counteracting the harm of chronic high Eat a Mediterranean-style diet
levels of stress hormones on your brain, including
7 The Mediterranean diet—which features whole
the hippocampus, which can shrink under a steady grains, fruits and vegetables, and healthy fats from
onslaught of cortisol. And there is a third way it may fish, nuts, and oils—is famously good for the heart and
help. According to a study of mindfulness meditation, circulatory system. That may be why it also appears
published in JAMA Internal Medicine in 2015, it can to lessen the risk of developing memory problems
improve your ability to get a restful night’s sleep. later in life. “What’s good for the heart is good for the
In mindfulness meditation, you pay attention to brain,” according to the Alzheimer’s Association.
what you’re experiencing from moment to moment, One study, published in the journal Neurology in
without drifting into thoughts about the past or con- 2013, looked at the eating habits of more than 17,000
cerns about the future, and without analyzing (or people with an average age of 64 and found that those
making judgments about) what is going on around who most closely followed a Mediterranean-style diet

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were 19% less likely to have impaired mental func- studies. In one study, which looked at a subset of the
tion. Other observational studies have suggested that famed Women’s Health Initiative, 482 women ages 60
people who adhere to Mediterranean-type diets have and older were observed for three years. The women
lower rates of both mild cognitive impairment (see who consumed the most monounsaturated fat (found
page 40) and full-blown dementia. in foods such as olive oil and avocados) showed sig-
One component of the Mediterranean diet—fish nificantly less memory decline than those who ate
(which contains omega-3 fatty acids)—may be particu- less monounsaturated fat. In the highest consumption
larly beneficial. Evidence that supports the connection group, monounsaturated fat made up more than 13%
between brain health and omega-3s includes data from of dietary calories.
the Framingham Heart Study. This study revealed that Eating a lot of fruits and vegetables can be especially
people with initially higher blood levels of the omega-3 beneficial because many are good sources of vitamins
fatty acid docosahexaenoic acid (DHA) had lower rates and other nutrients that may protect against diseases
of dementia over a period of nine years. and age-related deterioration throughout the body.
Other components of the diet have also been What you can do: If you want to try a Mediterra-
shown to reduce dementia risk. For example, eating nean-type diet, here are the basics:
unsaturated fat—which includes fish oil as well as • Increase your consumption of fresh fruits and veg-
most vegetable oils—reduces risk, according to some etables. Half your plate should contain produce.

What about vitamins?

C onsuming adequate amounts of vitamins and minerals

is essential for overall health, including brain health. But
there is no convincing evidence that taking vitamin supple-
In theory, you can meet most, if not all, of your vitamin D
requirement with exposure to the sun on the arms and legs
for about 10 to 15 minutes a day. (You should always wear
ments at doses higher than the Recommended Dietary Allow- sunblock on the face and hands to avoid the skin-aging
ance (RDA) improves memory in the short term or protects effects of ultraviolet radiation.) Sunlight penetrates the skin
against dementia in the long term. and converts a naturally occurring substance into the form
B vitamins. In the realm of memory and cognition, you want of vitamin D that can be used by the body as a nutrient.
to be sure you are getting the RDA of the B vitamins—espe- However, in the northern latitudes, it can be difficult to get
cially B6, B12, and folic acid. A vitamin B12 deficiency, in par- enough sun exposure, especially in the winter. Moreover, few
ticular, can cause disorientation and confusion. Vitamin B12 foods naturally contain vitamin D, the main exception being
is found in meat, poultry, seafood, dairy products, and eggs. fatty fish (salmon, mackerel, and tuna). Milk and some juices
You can prevent or treat a vitamin B12 deficiency by eating are fortified with vitamin D. That leaves supplementation as
these foods or taking supplements. About 6% of people ages the best route. Try to get 800 IU a day.
60 and older are deficient in vitamin B12, and nearly 20% are Vitamin E. Vitamin E has several beneficial properties that
borderline deficient. Older adults produce less stomach acid could theoretically promote brain health and reduce the risk
than younger people, which makes it harder for them to me- of dementia. Its antioxidant properties could protect against
tabolize this vitamin from food sources. People who complain
injury from the toxic byproducts of metabolic activity—
of memory or thinking difficulties should have a blood test to
namely, harmful molecules called “free radicals.” Vitamin E
rule out a vitamin B12 deficiency, since it is often treatable.
also may increase blood flow by preventing cells in the blood
Vitamin D. Some studies have found that low levels of vita- called platelets from sticking together. Vitamin E is found
min D can impair mental function. And vitamin D deficiency in nuts, olive and other oils, and fruits and vegetables like
is common. For example, a study published in the Journal of tomatoes, broccoli, and avocados.
the American Geriatrics Society in 2014 of over 2,700 adults
ages 70 to 79 found that 68% of them had vitamin D levels Unfortunately, no study has shown that taking vitamin E
less than 30 ng/mL (30 to 74 ng/mL is considered normal). improves cognitive abilities in healthy people or reduces the
Those with lower vitamin D levels had lower scores on tests risk of dementia in people who have mild cognitive impair-
of mental function than those with higher vitamin D levels. ment. Moreover, taking vitamin E supplements has not been
Other studies have found a possible connection between low shown to diminish the likelihood of heart disease and may
vitamin D levels and increased risk for dementia. even slightly increase the risk of death.

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 • Limit red meat and avoid processed meat entirely. whether you can derive the same benefits if you’re
Fish, poultry, and beans are better protein sources. overweight to start with and then lose weight.
• Choose whole grains—such as whole-grain bread A few small studies of people who are severely
and brown rice—over highly processed grains. obese and undergo weight-loss surgery have dem-
• Use olive oil or another type of vegetable oil in onstrated improved memory and cognition after the
cooking. procedure. In one study, published in The American
• Snack on nuts (such as walnuts or almonds) Journal of Surgery in 2014, 50 people who had weight-
instead of potato chips, ice cream, or candy bars. loss surgery showed improvements in attention, exec-
It may be tempting to continue eating a basically utive function, and memory that lasted up to three
unhealthy diet (full of saturated fats and containing years after the surgery. Whether people can achieve
few fruits and vegetables) and supplement this with these improvements with less dramatic, nonsurgical
vitamins and fish oil capsules. But that will not have weight loss—and whether this translates to decreased
the desired effect (see “What about vitamins?” on risk for dementia—are questions under study.
page 29). What you can do: You’ve heard it over and over—
consume fewer calories. That generally means eating
Maintain a healthy weight more vegetables and fruits and less processed food,
8 Maintaining a healthy weight, particularly especially processed food products that are high in
during middle age, can help reduce risks of demen- saturated fat and refined sugar and flour. Replacing
tia. However, roughly one-third of Americans are calorie-dense foods like cookies and donuts with
obese, meaning that they have a body mass index low-calorie foods like produce both fills you up and
(BMI) of 30 or higher. (To calculate your own BMI, reduces your caloric intake. The number of calories
go to www.health.harvard.edu/BMI.) Being obese you need each day depends on your sex, age, and level
leaves you more prone to a host of medical problems, of activity (see Table 2, page 31).
including dementia. Particularly risky is having so- You may be consuming too many calories, and
called central obesity—the classic “spare tire”—in from the wrong foods. But don’t try to make major
middle age. In addition, people who are obese face alterations too quickly. The foods you eat, how you
a higher risk of heart disease and diabetes—two prepare them, and how often you eat become habits.
conditions that have also been linked to memory And habits are very hard to change. You also prob-
impairment and a higher risk of dementia. Though ably like the foods you’re eating. If you replace foods
maintaining a healthy weight throughout middle you like with foods you don’t like, you will quickly go
age is clearly beneficial, researchers are investigating back to your old unhealthy habits. So, as you slowly

Ginkgo: A no-go for memory

Ginkgo biloba, an extract from the people and those with mild to severe Taking ginkgo has not been shown to
nuts and leaves of the maidenhair cognitive impairments. The findings reduce risk for Alzheimer’s disease or
tree, has been widely touted as a have been disappointing. A study other causes of dementia. And it is of
memory booster. But the popularity of published in Human Psychopharmacol- no help for people with dementia. A
this supplement is more of a testa- ogyy analyzed results from 28 studies review by the Cochrane Collaboration,
ment to the power of marketing than that looked at the effects of ginkgo an international group of independent
to any measurable brain benefits from on memory, executive function, and experts, evaluated 36 studies testing
ginkgo, according to a large body of attention in healthy adults without ginkgo biloba in people with cognitive
research. dementia. They found no measurable impairment or dementia and concluded
Ginkgo biloba has been tested in doz- positive effects on any of the three the evidence of any benefit for the ex-
ens of studies involving both healthy types of mental function. tract was “inconsistent and unreliable.”

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 Table 2: How many calories do you need each day?
This table shows roughly how many calories a person of average weight needs to consume each day to maintain his or her current weight. If
you want to lose weight, you will need to take in fewer calories. If you weigh considerably more, these give you targets to slowly work toward.

AGE RELATIVELY SEDENTARY MODERATELY ACTIVE ACTIVE

31 to 50 1,800 2,000 2,200

Women
51 and over 1,600 1,800 2,000–2,200
31 to 50 2,200 2,400–2,600 2,800–3,000
Men
51 and over 2,000 2,200–2,400 2,400–2,800
Source: Dietary Guidelines for Americans, 2010.

increase the amount of fruits and vegetables you eat, age—which is actually a tiny stroke—affects a small
be sure to pick ones that you enjoy. area of the brain, and symptoms may not be apparent
If you find it difficult to change your diet, con- until a critical amount of tissue has been destroyed.
sider consulting a dietitian or nutritionist. They This is a form of vascular dementia, which is a well-
can guide you to an overall healthier way of eating recognized cause of memory loss in older people.
and suggest foods and methods of preparation you High blood pressure is generally easy to treat with
haven’t thought of. You may find that healthy foods a healthy lifestyle and, if necessary, medication. Low-
you scrupulously avoided are actually not bad if pre-
pared in a different way.
Lessons from the Nun Study
Manage your medical conditions The Nun Study, an ongoing research project begun in
9 Conditions that have been linked with heart 1986, seeks to understand the hows and whys of aging
disease—including high blood pressure, high choles- and Alzheimer’s disease. It features a unique population
of 678 retired Catholic sisters, all of whom agreed to
terol, and type 2 diabetes—have also been linked to donate their brains at death. The unprecedented wealth
memory problems. Moreover, they can increase your of information available about the sisters’ personal and
risk of suffering brain-damaging strokes and dementia medical histories, combined with the relative uniformity
or cause memory problems to appear at an earlier age of their lifestyles, allowed researchers to tease out some
of the medical and social factors that put an individual at
(see “Lessons from the Nun Study,” at right).
risk for developing dementia.
High blood pressure. Adults with high blood
One of the most significant findings has been the un-
pressure (hypertension) are more prone to memory
derstanding of how cardiovascular factors interact with
impairment than people with normal blood pres- Alzheimer’s disease pathology. When an autopsy is done
sure. Moreover, people with hypertension experience on the brain of a person who had Alzheimer’s disease,
memory loss that is more severe than that suffered by two distinctive features are found—clumps of material
individuals who don’t have hypertension. These differ- called plaques between cells and twisted fibers called
neurofibrillary tangles inside cells. In the Nun Study, the
ences hold true regardless of age. women who seemed to fare the best cognitively were
High blood pressure also increases risk for those whose brains, when autopsied, showed little
dementia, especially when it is present in midlife. evidence of stroke, even if they had plaques and tangles
It likely does so by accelerating atherosclerosis, the consistent with moderate Alzheimer’s. From this, research-
ers conclude that a healthy brain has reserve capacity it
buildup of plaque in the arteries that impairs circula-
can draw on to maintain normal functions even when Al-
tion. A reduction in circulation can slow blood flow to zheimer’s disease is present. On the other hand, when the
the brain, which can harm the cells of the brain. Even brain is compromised by cardiovascular disease, dementia
worse, if blood flow to one area of the brain is stopped, symptoms appear at an earlier stage.
brain tissue in that area can die. Each episode of dam-

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ering blood pressure reduces your risk for heart attacks just one condition; it’s a combination of problems. You
and other forms of heart disease. It also appears to have it if you have three or more of the following:
reduce your chances of developing dementia. • high blood pressure
High cholesterol. Like high blood pressure, high • excess belly fat, meaning a waist size of 40 inches
cholesterol levels appear to increase risk for memory or more for men, or 35 inches or more for women
impairment and dementia years down the road. There’s • high triglycerides, a kind of blood fat often
more than one form of cholesterol. Low-density lipo- checked with cholesterol levels
protein (LDL) cholesterol is considered the “bad” • low HDL cholesterol
form of cholesterol because it can build up in the walls • high fasting blood sugar.
of arteries and lead eventually to heart attacks and Metabolic syndrome puts you at greater risk for
strokes. High-density lipoprotein (HDL) cholesterol a host of problems, including strokes, diabetes, and
helps to clear excess cholesterol from arteries, and is a fatal heart attack. A study published in the journal
therefore considered the “good” form of cholesterol. Neurology suggests that problems with memory and
Having high LDL cholesterol levels in midlife has thinking be added to that list. The observational study
been shown to raise risk for later developing mild cogni- found that of the 7,087 French people ages 65 and over
tive impairment (see page 40) or dementia. It’s not clear who took part in the study, about 16% had metabolic
whether high cholesterol leads to memory loss only syndrome. Over the four years of the study, those
through increasing the risk of stroke, or whether the cru- with metabolic syndrome were 20% more likely than
cial factor is excessive LDL or insufficient HDL. There is the other participants to experience a decline in over-
some evidence that the generation of harmful amyloid all cognition. When researchers analyzed the various
proteins in the brain (which are present in people with components of metabolic syndrome, they found that
Alzheimer’s disease) might depend on cholesterol. people with high triglycerides and those with low HDL
Diabetes. Several large studies have documented had the greatest declines in memory and thinking.
links between diabetes and decline in memory and Full-blown diabetes was also associated with declines.
thinking. People with diabetes are at greater risk for What you can do: Ideally, you want to keep your
mild cognitive impairment, vascular dementia, and blood pressure, cholesterol levels, blood sugar levels,
Alzheimer’s disease. Scientists think that many fac- and weight within the normal range throughout life.
tors link diabetes and dementia. People with diabetes That means blood pressure below 120/80 mm Hg,
have chronically high blood sugar levels, especially total cholesterol below 180 mg/dL, blood sugar levels
if the disease is not well controlled. This may dam- below 100 mg/dL before eating and below 140 mg/
age small blood vessels in the brain. In addition, high dL two hours after eating, and BMI between 18.5 and
blood sugar depresses the function of the hippocam- 24.9. Several lifestyle practices, including a number of
pus, which, as noted earlier, acquires and consolidates
new memories. A Mediterranean-
Many people with diabetes have high cholesterol style diet, with
levels, high blood pressure, or both. This too may con- plenty of fresh
vegetables and
tribute to the higher risk for dementia faced by people
fruits, may help
with diabetes. ward off Alzheim-
There is some evidence that better control over er’s disease. Fatty
levels of sugar in the blood is associated with improved fish such as tuna
cognitive functioning. that are high in
Metabolic syndrome. Some doctors call metabolic omega-3 fatty
acids (particularly
syndrome the “most common condition you’ve never
DHA) seem espe-
Thinkstock

heard of.” It affects almost 50 million Americans, yet

cially helpful.
many of them don’t know it. Metabolic syndrome isn’t

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measures already discussed, can help you. palate will adjust. You can also compensate for
• Exercise regularly. This helps to reduce blood pres- reduced salt by using salt substitutes or adding
sure, lower LDL (bad) cholesterol, and raise HDL herbs and spices.
(good) cholesterol, and it can help keep blood • Reduce stress to help keep your blood pressure
sugar levels under control. under control. Blood pressure fluctuates through-
• Eat a healthy diet that’s rich in vegetables and fruits out the day in response to a variety of factors,
to help control both your blood pressure and cho- including stress and anxiety. (See “Manage your
lesterol levels. One option is the Mediterranean stress,” page 26, for suggestions on coping with
diet (see “Eat a Mediterranean-style diet,” page 28). stress.)
Another is the DASH diet (named for the Dietary • Avoid cigarettes. This is important for many rea-
Approaches to Stop Hypertension trial). Like the sons. Among smoking’s many harmful effects,
Mediterranean diet, the DASH plan emphasizes it raises blood pressure and increases the risk of
fruits, vegetables, and whole grains. It includes low- heart disease and stroke. (See “Don’t smoke,” page
fat or nonfat dairy products, lean meats, fish, poul- 37, for tips on how to kick the habit.)
try, nuts, and beans. It is high in fiber and low to
moderate in fat (see Table 3, below). If you drink alcohol, do so moderately
• Limit salt intake to help control your blood pres-
10 Drinking too much alcohol on a regular basis
sure. Your body needs a small amount of sodium increases the risk for memory loss and cognitive
to function normally. But most of us consume decline. People with alcoholism have difficulty per-
too much, mostly in the form of salt. Most people forming short-term memory tasks, such as memo-
ages 2 to 50 should consume less than 2,300 mg of rizing lists. Another type of memory loss associated
sodium a day. But if you are over age 51, are Afri- with alcohol use is Korsakoff ’s syndrome, a form of
can American, or have high blood pressure, dia- dementia in which severe amnesia comes on suddenly
betes, or chronic kidney disease, the limit is less and dramatically as a result of long-term vitamin B1
than 1,500 mg. If you’re eating packaged foods, (thiamine) deficiency combined with the toxic effects
read food labels for sodium content and choose of alcohol on the brain. The memory loss of Korsa-
foods with lower amounts. If you’re cooking from koff ’s syndrome is permanent about a quarter of the
scratch, you can control the amount of sodium time, but it can be reversible to some degree in most
you add. Try reducing the amount, and soon your cases, especially if it is caught early. Other alcohol-
related memory problems may be reversible if the
person sharply cuts down on drinking and eats a
Table 3: The DASH diet healthy diet.
SERVINGS ON A Even moderate drinking can negatively affect
TYPE OF FOOD 2,000-CALORIE DIET
memory in the short term. Your ability to remember
Grains and grain products 7 to 8 per day and think clearly are impaired while under the influ-
(include at least three whole-
grain foods each day)
ence of alcohol. In addition, alcohol consumption can
disrupt sleep (which is important for consolidating
Fruits 4 to 5 per day
memories) and may contribute to depression.
Vegetables 4 to 5 per day That said, some studies have linked moderate
drinking with a reduced risk of dementia over the long
Low-fat or nonfat dairy foods 2 to 3 per day
term. Moderate consumption means no more than two
Lean meats, fish, poultry 2 or less per day drinks a day for men and one a day for women.
Nuts, seeds, and legumes 4 to 5 per week Some studies suggest that red wine in particular
(as opposed to other forms of alcohol) may have an
Fats and sweets limited
especially salutary effect, possibly because of resvera-

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trol, a compound found in the skin of red grapes that is normal. If the feelings last and are intense enough to
has garnered attention as an anti-aging compound. interfere with daily life, you probably have depression.
Alcohol may be memory-protective because of its There are several signs and symptoms of depression.
antioxidant properties and the fact that it decreases According to the National Institute of Mental Health,
the risk of non-hemorrhagic stroke. they include
What you can do: Many questions remain about • persistent sad, anxious, or “empty” feelings
the relationship between alcohol and memory. If you do • feelings of hopelessness or pessimism
not currently drink alcohol, the study findings should • feelings of guilt, worthlessness, or helplessness
not be interpreted as a reason to start. If you do enjoy • irritability, restlessness
a cocktail or glass of wine, keep it moderate. Clearly it’s • loss of interest in activities or hobbies once plea-
better to forgo alcohol altogether than to over-imbibe. surable, including sex
• fatigue and decreased energy
Treat depression • difficulty concentrating, remembering details, and
11 The relationship between depression and mem- making decisions
ory loss is complex. Depression can be a cause as well • insomnia, early-morning wakefulness, or excessive
as an effect of memory dysfunction. Severe, ongoing, sleeping
and untreated depression can make people forgetful • overeating, or appetite loss
by interfering with their ability to concentrate and • thoughts of suicide, suicide attempts
process information. This is particularly true in older • aches or pains, headaches, cramps, or digestive
adults. In fact, doctors coined the term “depressive problems that do not ease even with treatment.
pseudo-dementia” to describe older adults with severe If you have any of these symptoms, seek help from
memory impairment linked to depression. Once the a mental health professional, such as a social worker,
depression is treated, the person’s memory can often psychologist, or psychiatrist. These professionals can
return to the level of function that existed before he or provide counseling and possibly antidepressant med-
she was depressed. ication. Your primary care doctor can refer you to a
Depression that occurs for the first time in an mental health professional.
older adult may also be an early symptom of dementia.
Thus, older people who develop late-life depression Get your hearing tested
need to be closely watched. There are key differences
12 It makes sense: if you have trouble hearing
in the memory loss experienced by people suffer- something, you’re bound to have trouble remember-
ing from depression alone and people experiencing ing it. It’s not that you forgot, but rather, you never
depression in conjunction with Alzheimer’s. In people heard the information in the first place.
with depression alone, mental function usually fluc- In addition, the struggle to hear something that
tuates with mood. When mood improves—usually in sounds garbled requires the brain to work harder and
response to treatment with medication, psychother- possibly use resources at the expense of other func-
apy, or both—mental function generally improves as tions. One study found that adults with mild to mod-
well. By contrast, someone with Alzheimer’s disease erate hearing loss remembered fewer of the items from
will continue to have impaired cognitive functioning a list of 15 spoken words than did adults with good
even when the depression lifts. hearing. The researchers concluded that the extra
Depression has another possible effect on men- effort involved in trying to hear the words diverted
tal function: it seems to put people at risk for later brain resources from acquisition and consolidation of
dementia, particularly Alzheimer’s disease and vascular memory. Hearing loss is a remarkably common prob-
dementia. The reason for this is not entirely understood. lem, particularly in older adults.
What you can do: Depression goes beyond occa- What you can do: Periodic hearing tests should
sionally feeling sad or blue for a couple of days, which be part of routine medical care. Hearing loss is highly

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treatable. Hearing aid technology has improved levels of thyroid hormones, as well as thyroid-stimu-
greatly in recent years; if you tried a hearing aid in the lating hormone. Treatment can be as straightforward
past and didn’t find it helpful, consider trying again. as taking pills containing synthetic thyroid hormone.
Successful use of a hearing aid may require several Note that the role of other supplemental hormones is
follow-up visits to the hearing aid specialist, who will very much in question (see “Do estrogen and testos-
fine-tune and adjust the device for your needs. terone affect memory?” below).

Have your thyroid hormones checked Review your medications

13 The thyroid gland secretes hormones that con-
14 Many over-the-counter and prescription drugs
trol metabolism, the rate at which the body burns have side effects that can scramble thinking and dim
energy. When the thyroid doesn’t function properly, it memory. Older people tend to be more sensitive to
can release too much or too little of these hormones, these effects. Moreover, older people often take mul-
making the metabolism run too fast or too slow. Either tiple medications. Although one drug alone may not
problem can interfere with learning and memory, but cause problems, the cumulative effect of several drugs
in a different way. may impair memory and thinking.
• Hyperthyroidism, which causes an abnormally Popular over-the-counter drugs with these side
fast metabolism, can make people feel confused. effects—often listed on the label as dry mouth, blurred
• Hypothyroidism, which causes an abnormally vision, and confused thinking—include the antihista-
slow metabolism, can make people feel sluggish, mines brompheniramine (found in Dimetapp, among
sleepy, and depressed. others), chlorpheniramine (found in Chlor-Trimeton,
Research on animals shows that changes in thyroid Triaminic, and many others), and diphenhydramine
hormone levels cause physiological changes in the hip- (best known as Benadryl). Doctors sometimes recom-
pocampus. Research also shows that when thyroid dis- mend that people take diphenhydramine to help them
orders are treated, people’s memory problems diminish. fall asleep. (In fact, diphenhydramine is also the main
What you can do: If you suspect thyroid issues, ingredient in many over-the-counter sleep aids, such
ask your doctor for a simple blood test to check your as Compoz, Sominex, and Unisom, as well as Tylenol

Do estrogen and testosterone affect memory?

In addition to thyroid hormones, other naturally occurring hormones can affect memory and overall cognitive function.
In particular, research has focused on the sex hormones estrogen and testosterone.
Estrogen mone replacement therapy only at midlife (about age 48) had
Many women experience trouble with memory during meno- a 26% lower risk of developing dementia later, whereas those
pause, when their levels of estrogen fall sharply. Fluctuating who took the hormone supplements only later in life (about
and declining estrogen levels can cause hot flashes and sleep age 76) had a 48% higher risk. More research is needed
disturbances and may also be to blame for memory problems. before any recommendations regarding hormone replacement
Some studies suggest that estrogen protects neurons, which and memory can be made.
might explain a connection with memory. If that’s true, Testosterone
you would think that hormone supplements should protect Men with high levels of testosterone have better visual and
against age-related memory difficulties. However, a num- verbal memories than men with low levels. However, the value
ber of studies have revealed the opposite, casting doubt on of testosterone supplementation in older men is controversial.
estrogen’s promise for preserving memory. Ongoing research Testosterone supplements have drawbacks—they can increase
is looking into whether different forms of estrogen given at the risk of some kinds of cancer and may also raise the risk
different times may prove beneficial. One study of medical for stroke and for vascular dementia. In addition, the type of
records of female members of the Kaiser Permanente health testosterone and the amount (if any) that should be given as a
maintenance organization found that women who took hor- treatment for memory problems still needs to be established.

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 Table 4: Medications that may affect memory—and possible substitutes for them
IF YOU TAKE … … ASK ABOUT SWITCHING TO ONE OF THESE DRUGS
amitriptyline (Elavil) or doxepin (Sinequan) a wide range of alternatives, depending on your reason for taking a tricyclic
antidepressant (neuropathic pain, depression, etc.)
captopril (Capoten) a different ACE inhibitor
cimetidine (Tagamet) a proton-pump inhibitor, such as esomeprazole (Nexium), lansoprazole (Prevacid),
or omeprazole (Prilosec)
cold or allergy medication containing brompheniramine, loratadine (Claritin) or another non-sedating antihistamine
chlorpheniramine, or diphenhydramine
oxybutynin (Ditropan) or tolterodine darifenacin (Enablex), solifenacin (Vesicare), or trospium (Sanctura), which are
(Detrol, Detrusitol) anticholinergic but more selective for the bladder
paroxetine (Paxil) another SSRI, such as fluoxetine (Prozac) or sertraline (Zoloft), or a drug from
the SNRI class, such as duloxetine (Cymbalta) or venlafaxine (Effexor)

PM.) But if it causes you mental confusion, try non- even if you’ve taken these medications for a long time.
drug approaches to improving sleep instead (see the For some potential alternatives to drugs with anticho-
tips under “Get a good night’s sleep,” page 27). linergic actions, see Table 4, above.
Among prescription drugs, the prime culprits
include certain ones used to treat depression, such Say no to recreational drugs
as amitriptyline (Elavil) and nortriptyline (Aventyl,
15 People who use certain recreational drugs are
Pamelor); overactive bladder, such as oxybutynin likely to have problems with memory and related cog-
(Ditropan, Urotrol, and other brands); and heartburn, nitive functions—not only while they are under the
such as cimetidine (Tagamet). influence, but also for weeks after the drugs’ immedi-
These medications share a common mechanism: ate effects wear off.
blocking the neurotransmitter acetylcholine, which is There’s no question that recreational use of mari-
why they are known as anticholinergic drugs. Certain juana produces short-term problems with thinking,
drugs used to treat Alzheimer’s disease, such as done- working memory, and executive function. Marijuana’s
pezil (Aricept), have the opposite effect—they boost active chemical, THC, causes its psychoactive effect by
levels of acetylcholine in the brain—so it makes sense attaching to receptors in brain regions vital for mem-
to steer clear of anticholinergics when possible. One ory formation, including the hippocampus, amygdala,
study reported that the use of medications with anti- and cerebral cortex.
cholinergic activity was linked to a more rapid decline There’s debate about whether long-term use of
in the cognitive performance of older adults who had marijuana (either for medical or recreational purposes)
been studied an average of 7.8 years. produces persistent cognitive problems. Although early
What you can do: If you’ve noticed any kind of studies of recreational users reported such difficulties,
confusion or thinking problems since starting a new the studies had design problems. Typically they com-
medication, ask your doctor about a possible substi- pared long-term marijuana smokers with people who
tute, which is often (but not always) possible. For some had never used the drug, without controlling for char-
people, especially older adults, medications (both pre- acteristics such as education or cognitive functioning.
scribed and over-the-counter ones) can cause clouded These factors might play a part in determining who
thinking and memory, even if you’ve taken them for a chooses to smoke marijuana long-term and who never
long time without any problem. If you notice a marked tries it, as well as who might be most at risk for think-
deterioration in your memory, review your medica- ing and memory problems later on. That said, studies
tions with your physician to identify a possible culprit, suggest that although overall cognitive ability remains

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intact, long-term use of marijuana may cause subtle but
lasting impairments in executive function. Another reason to stay heart - and
Memory impairment is also a side effect of brain-healthy
habitual cocaine use. Cocaine users score lower than High blood pressure, high cholesterol, and smoking
nonusers on tests of working memory and recall of all make clogged arteries more likely. If the problem
becomes serious, a surgical procedure called coronary
long-term memories. Deficits are apparent on tests of
artery bypass may be needed. Some people who un-
verbal memory, even after users have abstained from dergo this type of surgery experience memory loss and
cocaine for 45 days. problems concentrating for a while after the operation.
What you can do: One of the worst things you can One study found that about half of the people who un-
derwent bypass surgery had trouble remembering things
do to your memory is to use recreational drugs. It is
or thinking clearly immediately afterward; approximately
unclear how much of the memory impairment can be six months later, about one in four people continued to
restored by quitting, but at the very least, quitting can experience such problems. Why this happens is not clear.
prevent further damage. Some research suggests that biological processes in-
volved in coronary artery disease also contribute to brain
Don’t smoke injury and cognitive decline—raising the possibility that
16 Current smokers have a higher risk of Alzheim- it is the underlying vascular disease, and not the bypass
procedure, that contributes to most cognitive problems.
er’s dementia than former smokers. In one large and
racially diverse study, researchers found that people Researchers continue to look into this issue. In the
meantime, if you are preparing for a bypass operation,
who had smoked more than two packs of cigarettes talk with your surgeon ahead of time about what strate-
a day at midlife had more than double the risk of gies are available to minimize the chances of post-sur-
developing dementia in old age when compared gery memory and thinking problems. After the operation,
with nonsmokers. But here’s the good news: people tell your doctor about any problems with attention or
concentration you may be having.
who had stopped smoking by midlife and those who
Source: National Heart, Lung, and Blood Institute.
had smoked less than half a pack a day had a risk of
dementia similar to that of people who had never
smoked.
Smokers also have a greater degree of age-related wanting to quit is often not enough. Many people need
memory loss and other memory problems. A meta- help. Cigarette smoking is both physically and psycho-
analysis of 19 studies involving a total of more than logically addicting, and both of these aspects must be
26,000 participants found that smokers showed a addressed. Quitting smoking usually requires a com-
greater yearly decline in cognitive scores compared bination of counseling, social support, and some sort
with nonsmokers. of nicotine replacement or other drug therapy. Start
No one knows whether smoking directly impairs by deciding to quit. Here are some specific strategies:
memory or is merely associated with memory loss • Set a firm quit date.
because it causes disorders that contribute to poorer • Remove all cigarettes and ashtrays from your
brain function. Smoking increases the risk for vascu- home, car, and place of work.
lar diseases, stroke, and high blood pressure, all poten- • Tell family and friends and ask for their support.
tial causes of memory impairment and dementia. • Use some form of nicotine replacement (patch,
What you can do: Regardless of the exact nature gum, or lozenge).
of the link between smoking and memory loss, if you • Talk to your doctor about other medicines that
smoke, it pays to quit. Research shows that people who may help you.
stop smoking have less mental decline than people • Call 800-QUIT-NOW (800-784-8669) to find the
who continue to smoke. Of course, quitting isn’t easy. quit line in your state.
Cigarette smoking is a very difficult habit to break. • Find counseling (individual, group, or telephone)
First and foremost, it requires motivation. But just that you are comfortable with.

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 To break the smoking habit, you’ll probably need poor concentration. Lead poisoning can result from
to come up with new approaches to handling stress. A drinking contaminated tap water and breathing in
counselor or fellow smokers who are quitting can help lead dust generated by the deterioration of lead paint
you come up with new coping skills that don’t involve in homes built before 1978, when it was outlawed.
smoking. At least at first, it’s best to minimize time Carbon monoxide fumes leak from malfunctioning
spent with smokers. household furnaces and are spewed from automobile
Addiction to the nicotine contained in cigarettes exhaust systems. Mercury and other toxic substances
can be very difficult to overcome. Several forms of nic- are found in some paints, dyes, and inks used in art-
otine replacement are available to help ease the transi- work. Still other sources of toxic exposure are pes-
tion. Nicotine products are available in skin patches, ticides used in home gardens and farms, darkroom
gums, and lozenges, which can be obtained without a chemicals, and chemicals used in metalwork and
prescription. Nicotine can also be delivered in inhal- woodwork.
ers and a nasal spray. To obtain these forms, you will What you can do: You can reduce the risk of head
need to have a prescription from your doctor. trauma by using the appropriate gear during high-speed
Aside from nicotine, a few other drugs have been activities and contact sports. Wear seat belts when you
shown to help people quit smoking. These include ride in motor vehicles. Car accidents are by far the most
bupropion (Zyban) and varenicline (Chantix). common cause of brain injury, and wearing seat belts
If you try to quit smoking and don’t succeed, don’t reduces the injury risk. Wear a helmet when bicycling,
be discouraged. Try again. Many people fail at their riding on a motorcycle, in-line skating, and skiing.
first attempt to quit smoking. Consider trying a differ- Reduce your exposure to toxic substances by tak-
ent technique to find what works for you. ing sensible precautions. Before using paints, sol-
vents, and pesticides, read the labels for safe handling.
Protect your brain from injury and toxins Test your home water supply and use a water filter to
17 Head trauma is a major cause of memory impair- eliminate lead, if necessary. Avoid sanding, scraping,
ment and appears to be a risk factor for future develop- and otherwise disrupting lead paint on older homes.
ment of dementia (see “Head trauma,” page 43). If you do plan to remove lead paint, hire a govern-
Physical force isn’t the only source of brain ment-approved contractor for this work. Have your
injury. Lead, mercury, and other chemicals present car and furnace serviced regularly to minimize car-
in homes and workplaces can cause memory loss and bon monoxide emissions.

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 Memory problems: Normal aging or
brain disease?
t’s common to become somewhat more forgetful as networks, and brain regions are damaged to the point
Iyou age. The question is, how can you tell whether
your memory lapses are within the scope of normal
that they fail to function effectively.
Neuroscientists and physicians have identified
aging or are a symptom of something more serious? some key differences between normal memory lapses
The changes associated with normal aging may and those that occur with dementia (see Table 5,
make life frustrating at times, such as when you can’t below). For example, word finding can become prob-
remember the name of someone you just met or have lematic for everyone. You know the word or person’s
difficulty concentrating. But they don’t interfere with name you want to recall; you just can’t quickly retrieve
your ability to go about your daily life. By contrast, it (it’s on the “tip of your tongue”). With normal for-
people with dementia have a loss of memory and getfulness, the information is not lost. It may require
other mental function severe enough to impede their some context, a reminder, or even time, but you
ability to function independently at home, socially, should remember it. For a person with dementia, the
and at work. The source of the dysfunction often is word is usually lost for good. People with Alzheimer’s
some type of injury to the brain that goes beyond nor- disease often can’t name common objects. They also
mal changes. For a variety of reasons, neurons, neural forget names, and not just the names of acquaintances.

Table 5: Normal aging or dementia?

Physicians often use information like that summarized in this table to help differentiate between normal aging and dementia.

q NORMAL AGING q DEMENTIA

• The person remains independent in daily activities. • The person is critically dependent on others for key daily living
activities.
• The person complains of memory loss but can provide
considerable detail regarding incidents of forgetfulness. • Theperson complains of memory problems only if specifically asked
and cannot recall instances when memory loss was noticeable.
• The individual is more concerned about perceived forgetfulness
than close family members are. • Closefamily members are much more concerned than the individual
is about incidents of memory loss.
• Recent memory for important events, affairs, and conversations
is not impaired. • Recent memory for events and ability to converse are both noticeably
impaired.
• The person has occasional difficulty finding words.
• The person makes frequent word-finding pauses and substitutions.
• The person does not get lost in familiar territory, but may
• The
person gets lost in familiar territory while walking or driving and
have to pause momentarily to remember the way.
may take hours to return home.
• The individual operates common appliances even if she or
• Theperson cannot operate common appliances and is unable to learn
he is unwilling to learn how to operate new devices.
to operate even simple new appliances.
• There is no decline in interpersonal social skills.
• Theperson may lose interest in social activities or exhibits socially
• Performance on mental status examinations is normal inappropriate behaviors.
relative to the individual’s age, education, and culture.
• Performanceon mental status examinations is below normal in ways
not accounted for by educational or cultural factors.

Source: Adapted from the American Medical Association’s Diagnosis, Management and Treatment of Dementia: A Practical Guide for Primary Care Physicians.

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They often can’t remember the names of their relatives other mental functions, such as their ability to keep
and other people they know well. Depending on the the details of routine activities straight, people with
severity of the disease, a person with dementia may be this type of MCI perform as well as healthy people and
unable not only to retrieve the names of people, but much better than people with Alzheimer’s. The criti-
also to recognize who they are. cal difference between someone with MCI and some-
Some causes of serious memory impairment are one with dementia is that in the person with MCI, the
reversible. For example, certain medications can cause impairment in mental function does not yet substan-
memory problems, and stopping the medication will tially interfere with day-to-day functioning.
restore mental function (see “Review your medica- MCI becomes more common with age, affecting
tions,” page 35). But many causes of dementia, like 14% to 18% of people over age 70. For some people
Alzheimer’s disease, are permanent. The following are with MCI, cognitive function continues to worsen.
some examples of conditions that prevent neurons In these cases, MCI is regarded as a transitional state
from functioning normally, causing a variety of men- between normal cognitive function and dementia.
tal impairments, including memory loss. However, not everyone with MCI progresses to full-
blown Alzheimer’s. Some even go back to having
normal cognitive function. If MCI remains stable or
Mild cognitive impairment reverts to normal, it most likely is because of a condi-
People with mild cognitive impairment (MCI) have tion such as depression, a sleep disorder (like obstruc-
either memory loss, decline of other mental func- tive sleep apnea), medications that interfere with
tions, or both, which are more persistent and severe cognition, or a medical condition. This means that
than what is considered normal for their age, but are MCI is a “nonspecific” diagnosis that is often, but not
less severe than what is found in people with demen- always, linked to Alzheimer’s.
tia. MCI has two major subtypes: amnestic (when To diagnose MCI, a physician will ask about your
memory is impaired) and nonamnestic (which affects medical history and will refer you for neuropsycho-
other types of cognitive functioning, such as lan- logical or cognitive testing (see “When to see a doc-
guage, attention, or spatial processing). If a person has tor,” page 45). The determination of whether a person’s
impairments in both categories, he or she would fall social and occupational functioning remains intact—
into a category known as multi-domain MCI. the crucial factor differentiating MCI from demen-
In addition to being more severe than normal age- tia—depends on a clinician’s judgment based on input
related memory loss, MCI is also different in terms of from the person and loved ones.
the kind of information a person forgets. With normal The symptoms of amnestic MCI include
memory loss, people tend to forget things that aren’t • a subjective sense of failing memory, preferably
terribly important to them—the name of a casual backed up by another person such as a family
acquaintance, for example, or to go to a dental clean- member (for example, the person reports being
ing. With MCI, a person may not be able to learn and very forgetful, or that his or her memory is much
retain important new information, such as the record worse than in the past)
of a favorite sports team, the outcome of important • memory impairment (for age and education) as
political events, or the plans of close friends or family determined by testing
members. • essentially normal general cognitive function
When taking memory tests, people with the • no substantial difficulties carrying out activities of
amnestic type of MCI have more trouble remember- daily living
ing the details of pictures they’ve seen or paragraphs • no dementia.
they’ve read just a few minutes earlier. Their memory Getting diagnosed with MCI can be frightening,
difficulty is comparable to that of someone with very especially because it is associated with a significant
mild Alzheimer’s disease. But on tests that measure increase in the risk of developing dementia, particu-

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 Amnesia: Memory loss caused by injury or trauma

A mnesia is the inability to form new memories or, in some

cases, to remember existing ones. Amnesia occurs when
key structures of the brain—such as the hippocampus, which
People with retrograde amnesia have difficulty retrieving pre-
viously learned information, memories that had been acquired
before the onset of the condition that caused the amnesia.
is essential for encoding memories—don’t function properly.
The duration of amnesia depends on the cause. If the disrup-
Some types of stroke, concussive injury, chronic alcoholism,
tion of brain function is temporary (as in a blow to the head
disruption of oxygen supply, or certain kinds of infections
that causes a concussion), most of the lost memory will be
such as viral encephalitis can cause amnesia. It is also a
restored, although memories formed just before and soon
common side effect of electroconvulsive therapy used to treat
after the injury occurred may be lost forever.
major depression, although the effect is typically temporary.
There is also a rare condition called transient global amnesia
People with amnesia don’t forget everything, and they can
(TGA). TGA refers to a brief period of time (usually hours)
retain their general level of intelligence. They have a normal
during which a person is unable to retain new information
attention span and can form short-term memories lasting
and tends to ask questions repetitively. After recovering, she
perhaps a few minutes, if not distracted. Their procedural
or he does not remember the events that occurred during that
memory—which covers well-established skills such as driv-
period. TGA is not related to later development of a more se-
ing a car or brushing their teeth—remains intact, because
rious memory disorder such as Alzheimer’s disease, although
retention of these skills doesn’t depend on the hippocampus
the precise cause of the condition is uncertain. Emotionally
and surrounding brain structures. The breakdown occurs with
or physically stressful events such as intense physical activity,
acquiring new long-term declarative memories, which often
sudden immersion in hot or cold water, sexual intercourse, or
depend on the hippocampus.
medical procedures can trigger an episode. TGA tends to be
People with anterograde amnesia are unable to form new more frequent in people who get migraines. Certain drugs
long-term memories after an injury or the onset of illness. and medications can also produce TGA-like episodes.

larly Alzheimer’s disease. About 1% to 2% of the gen- occur before age 60. The impairments in memory
eral population over age 65 develops dementia every and thinking of Alzheimer’s disease trace back to
year, but among those with MCI, it’s 10% to 15%. the production of two detrimental substances in the
brain—amyloid plaques and neurofibrillary tangles.
The plaques and tangles damage neurons, ultimately
Dementia causing neurons to die in brain regions essential to
Dementia is a brain disorder that results in a decline memory and thinking. Eventually, plaques and tan-
in memory and thinking that interferes with the abil- gles and the loss of neurons extend into other areas
ity to go about daily activities. There are several causes of the brain.
of dementia, including Alzheimer’s disease. Although For most people with Alzheimer’s disease, wors-
memory loss is a common symptom of dementia, ening problems with memory are the most promi-
memory loss by itself does not signify dementia. With nent early symptom, accompanied by impairments in
dementia, people lose their cognitive abilities to the judgment, problem-solving, language, interpretation
extent that they are unable to carry out normal activi- of visual images and spatial relationships, mood, and
ties and relationships. They may also experience per- personality. Behavioral and psychological problems
sonality and behavior changes such as agitation and can also occur.
delusions. Following are short summaries of the dif- The ability to form new memories usually goes
ferent causes of dementia. first with Alzheimer’s disease. Short-term memory is
impaired, but long-term memories remain for a while.
Alzheimer’s disease Although people with Alzheimer’s are frequently able
Alzheimer’s disease is the leading cause of demen- to recall events from many years ago, they have pro-
tia, accounting for 60% to 80% of all dementia cases. found difficulty acquiring new memories. That’s partly
It becomes more common with age, although it can because the hippocampus, which plays a central role

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in memory encoding, is particularly vulnerable to the dementia involves a combination of Alzheimer’s dis-
damage from Alzheimer’s. A person with dementia ease and vascular dementia. In fact, it has been esti-
may ask a question, get an answer, then ask the same mated that over 40% of people with Alzheimer’s disease
question a few minutes later. also have vascular dementia. But other mixed demen-
One type of memory that tends to hold up pretty tias, such as a combination of Alzheimer’s disease and
well in people with Alzheimer’s disease is procedural Lewy body dementia (see below), are also seen.
memory. They often can perform many routine tasks
(such as brushing their teeth). This is because proce- Other types of dementia
dural memory is supported by different brain systems Several other brain disorders may also lead to dementia.
than declarative memory (which, for example, is used Dementia with Lewy bodies. This progressive
to remember the name of an object). form of dementia stems from a buildup of abnormal
Many people who have a relative with Alzheimer’s proteins called Lewy bodies in brain cells that con-
disease worry about their own chances of developing trol cognitive functions and movement. According
it. The role of genetics in Alzheimer’s disease is com- to the Lewy Body Dementia Association, this type of
plex. For the most part, certain genes raise the risk that dementia affects 1.3 million Americans. The cogni-
you will get the disease, but this does not mean you tive symptoms include problems with executive func-
definitely will. Some combination of genes and envi-
ronmental factors likely must interact to initiate the
events that lead to Alzheimer’s. For a very small per- Figure 5: What happens during an ischemic
centage of people (those with early-onset Alzheimer’s stroke
disease), their genetic makeup does cause the disease. Cerebral Ischemic brain tissue
arteries
Vascular dementia
Another common cause of dementia, vascular demen-
tia refers to cognitive impairment that stems from
damage to blood vessels that feed the brain (see Fig-
ure 5, at right). These vessels may become narrowed or
blocked. Many factors, including high blood pressure
and high cholesterol, may contribute to this damage. Embolus
blocking
Brain cells, like tissues elsewhere in the body, flow
need a constant supply of oxygen to live; they get this
oxygen from the blood. When blood flow is inter-
rupted during a stroke, some brain cells die. Demen-
tia symptoms can develop after a stroke. Even “silent”
strokes—those that cause few or no obvious persist-
ing symptoms affecting movement or the senses—can
damage brain tissue and increase the risk for cognitive
decline and dementia. People who experience strokes
due to blockage of the small vessels in the brain also
exhibit a more rapid decline in memory test perfor-
mance as well as in overall intellectual functioning.
Ischemia refers to an insufficient supply of blood to an organ. Most
strokes—about 87%—are so-called ischemic strokes, which are
Mixed dementia caused by the blockage of an artery that feeds the brain. Many of
Dementia is very often the outcome of more than one these ischemic strokes are caused by emboli, blood clots that travel
underlying disease process. The most common mixed to the brain after forming elsewhere, typically in the heart or aorta.

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 Recognizing dementia

A lthough people in the earliest stages of dementia often

sense that something is wrong, the illness eventually
deprives them of the insight necessary to understand their
• trouble learning how to use a tool, appliance, or gadget
(such as a computer, microwave, or remote control)
• forgetting the month or year
problems. So it’s usually up to a family member or friend to
• trouble handling complicated financial affairs (such as
recognize the symptoms.
balancing a checkbook, income taxes, paying bills)
If you suspect that someone you know has dementia, • trouble remembering appointments
arrange for a medical evaluation. Making a diagnosis of
dementia requires a thorough examination by a physician. • daily problems with thinking, memory, or both.
A quick dementia screening instrument developed by If you or a loved one has experienced a change in two or
researchers from Washington University in St. Louis has been more of these, you should discuss this with your physician.
used to determine whether a person experiencing memory Many forms of dementia are not reversible, but early detection
problems should have a more extensive evaluation. It provides an opportunity to minimize other medical conditions
involves asking whether there has been a change in the last that may bring out severe dementia symptoms earlier than
several years in the following eight areas: they might otherwise show themselves. It also allows family
• problems with judgment (such as problems making members more time to come to terms with the illness and to
decisions, bad financial decisions, problems with thinking) plan for long-term care. While Alzheimer’s medications bring
only a moderate, temporary improvement in symptoms, they
• less interest in hobbies or activities
may be most helpful early on. And other symptoms commonly
• repeating the same things over and over (questions, associated with dementia, such as depression, can also be
stories, or statements) addressed.
Source: The Eight-Item Informant Interview to Differentiate Aging and Dementia, commonly known as the AD8, can be found in full at www.knightadrc.wustl.edu.
It is a copyrighted instrument of Washington University, St. Louis, Mo. All rights reserved. Used with permission.

tion, attention, processing speed, visuospatial abilities, such as inappropriate behavior, a lack of inhibition,
and memory. People with this form of dementia often euphoria, or—in contrast—apathy. Other forms may
experience varying levels of alertness, sleep distur- affect language or movement. It is sometimes misdiag-
bances, visual hallucinations, and mild motor symp- nosed as a psychiatric disorder or Alzheimer’s disease,
toms of Parkinson’s disease. but tends to occur at a younger age than is typically
Parkinson’s disease dementia (PDD). For seen with Alzheimer’s, usually from the mid-50s to the
dementia to be termed Parkinson’s disease demen- mid-60s. Of those with FTD, 20% to 40% have a fam-
tia, the person must have had Parkinson’s disease for ily history of dementia, suggesting the illness often has
one year or more before the dementia came on. In a genetic component.
PDD, like in Lewy body dementia, symptoms include
impaired attention, impaired visuospatial function,
problems retrieving information, and difficulties with Head trauma
executive function. Dementia is very common in peo- A blow to the head that is strong enough to cause a
ple with Parkinson’s disease, though just how common concussion—a brief alteration of consciousness—can
is hard to say. Studies suggest that close to one-third of also impair memory. The blow can damage brain cells,
people with Parkinson’s disease suffer from some form or it can stretch or tear the axons, the fine filament
of dementia. “tails” of the neurons. Most people who suffer mild
Frontotemporal dementia (FTD). This group of concussions recover their memories and other mental
diseases causes neurons in the frontal and temporal functions completely within a few hours or days.
lobes of the brain to die. The symptoms depend on the More severe head trauma, such as an injury sus-
part of the brain affected, but the most common signs tained in a high-speed collision, frequently destroys
include extreme changes in behavior and personality, brain tissue and injures nerve fibers throughout the

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brain. This type of damage is permanent. People who cussions. These include football, soccer, lacrosse, and
sustain multiple injuries from concussion—box- ice hockey. Many professional organizations, universi-
ers and football players, for example—appear to be ties, and secondary schools in the United States have
prone to later development of dementia and other put into place concussion prevention and manage-
brain disorders. There’s also evidence that repeated ment guidelines. Prevention is clearly the best med-
concussions raise the risk of chronic traumatic icine here, but if you or someone you love does get
encephalopathy, a serious and progressive condition. a concussion, it’s important to follow your doctor’s
Symptoms can include alterations in mood (depres- orders when it comes to rest and rehabilitation.
sion, suicidal thoughts, anxiety, apathy), cognition
(impairments in memory and executive function),
behavior (impulsivity, aggression), and motor func- Other neurological disorders
tion (gait, balance, tone). Among the many illnesses that interfere with brain
There is a growing awareness of reduced cogni- activities—including memory—are multiple scle-
tive function caused by sports activities that involve rosis, epilepsy, brain tumors, Huntington’s disease,
impacts to the head that can result in repetitive con- Creutzfeldt-Jakob disease, and late-stage AIDS.

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 When to see a doctor

f you’re concerned about your memory, or if people

I close to you have noticed some worrisome trends, see
your doctor for an evaluation. Because memory loss
can be a symptom of many different medical problems,
it’s important to identify the cause and begin treatment
as soon as possible. In some cases, addressing a medi-
cal disorder or treating an emotional problem can lead
to improvements in memory. For instance, people with
depression or sleep disorders often find that treating
Thinkstock

those conditions improves their memory function or

at least prevents further decline.

The first step medications that might have a known association with
Most often you would begin with a consultation memory impairment. If your memory loss came on
with your primary care physician. Because this doc- relatively quickly—and occurred shortly after taking a
tor knows you and your medical history, he or she is drug that is known to affect memory—then the diag-
in a good position to relate your memory symptoms nostic process may focus on that drug. Depending on
to medical conditions you have had or medications the medication, the doctor may ask you to stop tak-
you are taking. But don’t expect to walk out of your ing it or may prescribe a different drug to see whether
doctor’s office with a definitive diagnosis. There is no your memory improves.
single test that can pinpoint the cause of memory loss. Because certain emotional and medical conditions
The diagnostic process often requires a mental and can affect memory, the doctor will review your medi-
physical examination, a variety of tests, and, depend- cal history, ask you about new symptoms and illnesses,
ing on the results, monitoring over a period of several perform a physical exam, and possibly order blood
months or even longer. tests. The doctor will measure your blood pressure
Expect your doctor to ask you a lot of questions and blood sugar to look for hypertension or diabetes.
about your memory. For example: If you have one of these conditions, your doctor can
• How long have you been having problems? make sure that it is properly controlled, either with
• Did the trouble come on gradually or suddenly? medication or through lifestyle adjustments, such as a
• What sorts of things have become hard to modified diet. Your doctor may also check your blood
remember? and urine for signs of kidney or thyroid problems.
• Are your difficulties preventing you from doing The doctor may ask whether you’ve been under a lot
everyday activities like cooking or paying the bills? of stress lately or if you’ve been feeling blue, because
• Are you taking any prescription or over-the-coun- stress and depression can cause memory impairment
ter medications? as well as loss of interest in previously enjoyable activi-
These questions help the doctor narrow down the ties. If depression is an issue, your doctor may refer
possible causes of your memory loss. For example, the you to a psychologist or a psychiatrist for further eval-
doctor will need to know whether you are taking any uation and treatment.

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 To reach a clear diagnosis, the doctor may need afterward, and then again 10 to 30 minutes later. Some
you to track your symptoms for several months, and memory tests entail learning and remembering visual
so may ask you or your spouse to keep a record of information, such as a picture that you are asked to
your symptoms and then return to the office after that study or a design you are asked to copy. The neuropsy-
period. He or she can then determine if the symptoms chologist might also test your long-term memory by
are improving, staying the same, or getting worse. asking you questions about your personal history or
If your doctor suspects you may have dementia, factual information you may have learned in the past,
he or she may refer you to another health care pro- comparing it to information gathered from medical
vider who specializes in the assessment and care of records or other sources.
people with cognitive impairment and dementia. Spe- Testing executive function. Executive function is
cialists include neuropsychologists, cognitive neurol- the umbrella term for the high-level mental functions
ogists, geriatric psychiatrists, neuropsychiatrists, and that involve the overall regulation of thought and
geriatricians. behavior, such as control over multitasking, maintain-
ing focus on a task, inhibiting impulses, planning, ini-
tiation, reasoning, and problem solving. You use such
Neuropsychological testing functions even when doing simple things like follow-
If your symptoms warrant a more comprehensive ing a recipe. These abilities often become impaired
evaluation, your physician may refer you to a neu- early in the course of Alzheimer’s disease.
ropsychologist, a doctor with expertise in the rela- Executive function is also important in appreciat-
tionship between cognitive performance and brain ing the subtle, implicit rules that guide social interac-
function. Neuropsychologists typically use a battery tions—for example, exhibiting normal consideration
of paper-and-pencil tests of mental abilities to evalu- for others and the motivation to engage with them.
ate your cognitive function. The tests assess attention, People who are having difficulty in this area are often
memory, executive function, language, and spatial unaware of the problem; family members may be
ability. The doctor may also use tests or questionnaires the first to notice a personality change. These types
to gauge your mood. of problems with executive function are usually not
The neuropsychologist will interpret and analyze assessed through testing but rather through direct
the test results in light of your age, level of education, observation and discussion with family members.
and other variables that influence cognitive ability Testing language. Language functions include
and memory capacity, as well as in the context of your the abilities to express yourself through speaking and
medical history and other diagnostic studies. That writing and to understand what another person is
way, he or she can determine if the findings suggest a saying or what you are reading. The neuropsycholo-
specific type of disorder or if they reflect normal age- gist may ask you to name common objects or pictured
related changes in cognitive function. The following items. Problems with naming and word finding can
are the kinds of tests that are used: be early symptoms of Alzheimer’s disease. You may
Testing attention. Failure to pay close enough atten- be asked to follow instructions as a way of determin-
tion is one of the primary reasons people fail to learn ing if you understand what’s being said. You may also
new information—they never absorbed it completely in be asked to read a brief paragraph, repeat phrases, or
the first place. There are many tests that can be used to describe a picture in writing.
assess attention. As one example, the neuropsychologist Testing spatial ability. Spatial ability includes
might read you a sequence of numbers and then have analyzing visual information such as shapes, faces,
you repeat back as many as you can remember. and routes between locations on a map. Because the
Testing memory. Memory testing usually requires right side of the brain plays an important role in ana-
that you listen to or view some information and lyzing spatial information, people who are having
answer questions about it or reproduce it immediately difficulty with this type of function may have a condi-

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tion that has damaged the right hemisphere, such as a neurotransmitter that’s important for memory and
stroke. Spatial ability tests include drawing and copy- learning, in the brain. They are rivastigmine (Exelon),
ing designs, solving maze puzzles, and putting blocks galantamine (Razadyne), and donepezil (Aricept).
together to construct a specific pattern. The cholinesterase inhibitors work by blocking an
enzyme that destroys acetylcholine, which presum-
ably makes more acetylcholine available in the brain.
Brain-imaging tests All of these drugs show similar benefits in treat-
A magnetic resonance imaging (MRI) or computed ing the symptoms of Alzheimer’s disease, but they
tomography (CT) scan produces a structural image of are only moderately effective. People taking these
your brain. These imaging methods provide the most medications are less cognitively and function-
definitive method of identifying certain causes of mem- ally impaired, and the differences can be measured
ory problems, such as a stroke, brain tumor, or subdural over the course of several years. This slowing of the
hematoma (a collection of blood under the surface of progression of symptoms may enable people with
the skull). All of these conditions can injure the brain, Alzheimer’s disease to maintain independence for a
producing neurological and cognitive symptoms. Treat- longer period and reduce caregiver burden, among
ment for these conditions can lead to improvement, other benefits. A review of 29 studies found that
particularly if they are detected early. these drugs might also ease some of the neuropsy-
For people suspected of having dementia, an MRI chiatric symptoms of Alzheimer’s, such as depres-
or CT scan may be done to rule out other possible sion, anxiety, and apathy.
causes of memory and thinking problems or to look Side effects of these medications are primarily
for shrinkage in certain brain areas that would indi- gastrointestinal symptoms, including nausea and
cate the possibility of Alzheimer’s disease. A relatively diarrhea. They have also been known to cause slowed
new type of brain-imaging test known as amyloid PET heart rate, fainting, vivid dreams, and muscle dis-
scanning can detect amyloid plaques—one of two hall- comfort. Donepezil, an extended-release formulation
marks of Alzheimer’s disease in the brain—but by itself of galantamine (Razadyne ER), and the rivastigmine
it is not enough to diagnose Alzheimer’s. The FDA has patch are the most convenient of the drugs because
approved the use of amyloid PET scanning, but it is not they are taken just once a day, whereas standard
yet covered by Medicare or private health insurance. galantamine and rivastigmine are taken twice a day.
There is no evidence that any of the cholinesterase
inhibitors are effective for preventing the development
Treatment of dementia in people with MCI.
The treatment for memory loss depends on the cause. Memantine. Memantine (Namenda) is FDA-
Sometimes it’s as simple as treating an underlying approved for treating moderate to severe Alzheimer’s
disorder, such as depression or thyroid dysfunction, disease. It is an NMDA-receptor antagonist, which
or discontinuing a medication like diphenhydramine blocks glutamate, a neurotransmitter, from attaching
(Benadryl). There is currently no approved prescrip- to NMDA receptors in the brain. Too much glutamate
tion medication for treating normal age-related stimulating these receptors can damage neurons and
memory loss. synapses, leading to memory loss and problems with
There are some FDA-approved medications for other brain functions.
Alzheimer’s disease, but they are not cures. They are As with cholinesterase inhibitors, memantine
somewhat effective in temporarily reducing the symp- usually provides only a modest benefit that might be
toms. So far, no drug has been proven to prevent or apparent for six months or less. Research studies dis-
reverse the damage done by Alzheimer’s. agree about whether taking memantine with a cholin-
Cholinesterase inhibitors. The drugs in this esterase inhibitor provides additional benefit beyond
class work by raising the levels of acetylcholine, a taking each separately.

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 Resources
Organizations This book shows how to strengthen memory, avoid everyday
lapses, and reduce risk factors for dementia.
Alzheimer’s Association
225 N. Michigan Ave., 17th Floor Chicken Soup for the Soul: Boost Your Brainpower
Chicago, IL 60601 Marie Pasinski, M.D.
800-272-3900 (toll-free) (Chicken Soup for the Soul Publishing, 2012)
www.alz.org This book provides practical tips and medical advice for improving
This nonprofit organization supports research on treatments memory, along with motivation stories.
for Alzheimer’s disease and provides information and support
Harvard Medical School Guide to Achieving Optimal Memory
to families. The association has local chapters throughout the
Aaron P. Nelson, Ph.D, M.D., and Susan Gilbert
United States.
(McGraw-Hill, 2005)
Dana Foundation This easy-to-understand guide explains how to know if you
505 5th Ave., 6th Floor have a memory problem, discusses factors that can impair
New York, NY 10017 memory, and offers tips to optimize your memory.
212-223-4040
www.dana.org Keep Your Brain Young: The Complete Guide to Physical
and Emotional Health and Longevity
The Dana Foundation is a private organization that supports
Guy McKhann, M.D., and Marilyn Albert, Ph.D.
brain research and educates the public about neuroscience
(Wiley, 2002)
through free publications.
The book offers strategies for improving memory and maintaining
National Institute of Mental Health brain health.
6001 Executive Blvd., Room 8181, MSC 9663
Bethesda, MD 20892 Mindfulness for Beginners: Reclaiming the Present
866-615-6464 (toll-free) Moment—And Your Life
www.nimh.nih.gov Jon Kabat-Zinn, Ph.D.
(Sounds True, 2012)
This branch of the National Institutes of Health is a source
This book invites the reader to explore and experiment with
of information on depression, anxiety, and other mental illnesses
formal meditation practices and the cultivation of mindfulness in
that may contribute to memory loss.
everyday life.
National Institute of Neurological Disorders and Stroke
NIH Neurological Institute Harvard Special Health Reports
P.O. Box 5801 The following Special Health Reports elaborate on various
Bethesda, MD 20824 points that were mentioned briefly in the chapter “17 ways
800-352-9424 (toll-free) to promote memory health,” starting on page 24. They can
www.ninds.nih.gov be ordered online at www.health.harvard.edu or by calling
This branch of the National Institutes of Health posts information 877-649-9457 (toll-free).
on Alzheimer’s disease, mild cognitive impairment, and other
neurological disorders on its website, including the latest findings A Guide to Coping with Alzheimer’s Disease
on drug treatments. Scott M. McGinnis, M.D.
(Harvard Medical School, 2014)
National Institute on Aging
Building 31, Room 5C27 A Plan for Successful Aging
31 Center Drive, MSC 2292 Robert Schreiber, M.D.
Bethesda, MD 20892 (Harvard Medical School, 2014)
301-496-1752 Controlling Your Blood Pressure: What to do when your
www.nia.nih.gov doctor says you have hypertension
This branch of the National Institutes of Health conducts research Randall Zusman, M.D.
and publishes information on aging and health. (Harvard Medical School, 2014)

Diabetes: A plan for healthy living

Books David M. Nathan, M.D.
(Harvard Medical School, 2014)
The Alzheimer’s Prevention Program: Keep Your Brain
Healthy for the Rest of Your Life Hearing Loss: A guide to prevention and treatment
Gary Small, M.D., and Gigi Vorgan David Murray Vernick, M.D., and Ann Gentili-Stockwell, M.A.
(Workman Publishing Company, 2012) (Harvard Medical School, 2013)

48 Improving Memory w w w.h e a l th.ha r va r d.e du

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 Resources continued
Improving Sleep: A guide to a good night’s rest Starting to Exercise
Lawrence Epstein, M.D. Lauren Elson, M.D., and Michele Stanten
(Harvard Medical School, 2013) Harvard Medical School, 2015)

Managing Your Cholesterol Thyroid Disease: Understanding hypothyroidism and

Jorge Plutzky, M.D. hyperthyroidism
(Harvard Medical School, 2014) Jeffrey R. Garber, M.D.
(Harvard Medical School, 2015)
Reducing Sugar and Salt: Strategies for minimizing risks
to your health Understanding Depression
Teresa Fung, Sc.D., R.D. Michael Craig Miller, M.D.
(Harvard Medical School, 2012) (Harvard Medical School, 2013)

Glossary
acetylcholine: A chemical neurotransmitter that plays a role in the overall regulation of thinking and behavior; the higher-order
attention, learning, and memory by helping brain cells communi- processes that enable us to plan, sequence, initiate, and sustain our
cate with each other. behavior toward some goal, incorporating feedback and making
adjustments along the way.
acquisition: The first step in memory formation, in which the brain
absorbs new information. frontal lobes: Regions located in the front of the brain that play
a major role in executive function.
amnesia: A condition caused by brain injury or illness and charac-
terized by an inability to form new long-term memories or hippocampus: A seahorse-shaped structure situated within the
to remember earlier ones. limbic system deep in the brain that has a central role in memory
processing.
amygdala: A brain structure with strong connections to the hip-
pocampus and other structures of the limbic system that is vital to limbic system: A network of brain structures crucial for regulating
emotional arousal and the formation of long-term memories. emotions. The hippocampus, one of the structures that make up the
limbic system, is instrumental in memory formation.
axon: A long filament-like projection of a neuron that conducts elec-
trical signals away from the neuron cell body (nucleus) to other cells. magnetic resonance imaging (MRI): A noninvasive diagnostic
radiology procedure that uses magnetic fields to form images of the
cerebral cortex: The outer layer of gray matter surrounding the brain and other internal anatomical structures.
cerebrum that carries out all aspects of higher brain function
including thought, memory, sensation, and voluntary movement. mild cognitive impairment (MCI): A condition characterized
by the loss of cognitive function—usually memory—that is more
cognitive function: All of the brain mechanisms involved with severe than is normal for a person’s age, but without obvious
thinking, reasoning, learning, and remembering. impairment in activities of daily living.
cognitive reserve: The capacity of the brain to use alternative neuron: A nerve cell found in the brain, spinal cord, or nerves that
neural pathways or thinking strategies in response to neurological transmits information to and from other neurons.
injury from conditions such as Alzheimer’s disease.
neurotransmitter: A chemical substance that relays signals from
consolidation: A key phase in memory formation, in which one neuron to another.
the brain transforms newly acquired information into long-term
memories. positron emission tomography (PET): A nuclear medicine
imaging technique that uses differences in energy metabolism
cortisol: A hormone released by the body in response to physical in different areas of the body to produce an image of functional
or emotional stress. High levels of cortisol can damage the regions processes in the brain or other organs.
of the brain that are crucial to memory function.
procedural memory: The long-term memory of skills and
declarative memory: Memory for facts (semantic memory) and procedures, or “how-to” knowledge.
for events (episodic memory); also called explicit memory.
retrieval: The act of recalling previously learned information; it
dementia: A progressive decline across multiple cognitive involves the reactivation of particular nerve cell pathways that
domains, resulting in impairment of everyday function. encoded a given piece of information.
encoding: A multistage process by which sensation, perception, synapse: The junction between two neurons, across which
or thought is transformed into neural representations that can chemical neurotransmitters carry messages.
be stored in memory.
working memory: A type of short-term memory process that
executive function: A group of cognitive activities that involves involves temporarily storing and manipulating information.

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