Losing My Mind

I may not remember much, but I'm still learning a lot about Alzheimer's.

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I have a poor memory for details. Just about everyone who knows me will say this is true. My husband loves to make me uncomfortable by quizzing me to name the band when a familiar song comes on the radio. He knows I almost never can recall it, even when the answer is ridiculously obvious. My family jokes that they don’t want to be on my team in Trivial Pursuit games. I often struggle to remember the names of books I’ve read, and their endings. The same goes for movies that I’ve watched, and the actors in them. I need a recipe just to make chocolate chip cookies I’ve made 100 times before. I have that constant tip-of-the-tongue problem remembering words.

It’s not that I don’t know anything or that I can’t learn — I know and learn lots, of course. I was a good student during my school days, and my job now is completely centered on information. I have easily absorbed data about the health care system in Denmark, suicide rates in Finland, and doctor shortages in the United States. On separate occasions, I have investigated advances in proteomics, lipidomics, and genomics. I wrote authoritative articles on all these subjects. But often, a few months later, I remembered little of anything I wrote, and that without much certainty.

It is sometimes really embarrassing. So I often chalk it up to being overloaded. Other times I think that I am simply too present-focused — I don’t dwell enough on the past, so my memories are not reinforced. But sometimes it happens enough that I wonder if I have a problem in my brain. I wonder, could I have early Alzheimer’s? Although I am only 37 years old, it is not impossible.

It doesn’t help that as a science and medical writer, I read about Alzheimer’s all the time. Along with other neurodegenerative disorders, it is one of the most active areas of research in the United States today, with multiple articles in the area published in journals everyday. Many of the findings are actually quite practical. For instance, here are some useful findings that have come out of major universities and research centers in just the past month or so:

• A daily dose of caffeine may block the disruptive effects of high cholesterol that scientists have linked to Alzheimer’s disease.
• Fruits like apples, bananas, and oranges may also prevent Alzheimer’s. But neither vitamin E or C supplements appear likely to do so.
• High blood pressure and diabetes type II, both lifestyle-related diseases, may cause small, unnoticed strokes that damage small vessels in the brain, which can lead to Alzheimer’s.
• People who have had depression are more likely to develop Alzheimer’s disease than people who have never had depression.
• People with two parents who have been diagnosed with Alzheimer’s disease face an increased risk of developing the disease when compared to the general population.

Based on this information, I should continue drinking my morning coffee and eating fruit, but I should not worry about taking vitamin supplements, at least not for my brain. I should take up healthy habits that keep me active and ward off weight gain and depression. And I should hope against hope that my parents don’t develop Alzheimer’s — for my sake as well as theirs. Other useful tips from earlier publications emphasize the importance of walking, reading, doing crossword puzzles, and being social to keeping my mind in shape.

But honestly, I know it’s got to be a lot more complicated than all that. A tantalizing hint of how true this is has emerged from molecular studies at the Buck Institute, an independent research facility focused solely on aging and age-related disease. Scientists there elucidated a normal human process that culls the brain of inconsequential information — the type of information that our brain records but absolutely does not need, like the order of the cereal boxes at your local grocery store, the exact line-up order of the school kids at morning drop-off, or the name of the sixth song you heard on the radio yesterday. It does this to keep room for the stuff we need to remember, like how to read the names on the cereal boxes, the directions for how to get your child’s school and what time you need to be there for pick-up, and, perhaps if you are lucky, the names of the bands that sing your favorite songs.

The researchers found that in people with Alzheimer’s, the housecleaning mode turns aberrant. They get stuck in the process of breaking memories, and the result is loss of important, consequential information. The researchers have hypothesized that this occurs when the older, diseased brains lose the supple, plastic ability that allows younger and healthier brains to switch back and forth between appropriately remembering and forgetting.

Just why this happens in some aging brains but not others remains a mystery. Nevertheless, lead author Dale Bredesen suggested that one day the molecular pathways that control this balancing act of remembering and forgetting could be targeted therapeutically. It’s a thrilling prospect, but unlikely to happen in my lifetime.

As luck would have it, I may have time on my side. The prevalence of cognitive impairment — including memory loss and Alzheimer’s — is on a significantly downward trend among America’s older population. According to the University of Michigan researchers who identified this trend, it is probably because today’s older people are likelier to have had more formal education; higher economic statuses; and better care for risk factors such as high blood pressure, high cholesterol, and smoking that can jeopardize their brains.

I am suddenly more grateful for all of my years of schooling, for my good health, and for my relatively comfortable life. My forgetfulness could be worse, apparently. Perhaps its time to stop worrying about how much I have forgotten, and simply focus more on remembering. As a safeguard, too, I’ll keep on drinking coffee, eating fruit, and exercising. • 16 April 2008

SOURCES: Banwait S, Galvan V, Zhang J, et al. C-Terminal Cleavage of the Amyloid-beta Protein Precursor at Asp664: A Switch Associated with Alzheimer’s Disease. J Alzheimers Dis. 2008;13:1-16. Langa KM, Larson EB, Karlawish JH, et al. Trends in the prevalence and mortality of cognitive impairment in the United States: Is there evidence of a compression of cognitive morbidity? Alzheimers & Dementia. 2008;4:134-44.

 

Jennifer Fisher Wilson is the science reporter for Annals of Internal Medicine. Her stories are available at www.annals.org.
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