S2E35. The Fog Of Memory

It was the spring of 1986. I had quit my job in Newark, NJ, and we had moved out to Tyler Hill, PA, where we were renovating an 1847 farmhouse with plans to open a B&B by the 4th of July weekend.

I was in one of the bedrooms on the 2nd floor where I was removing more than a century’s worth of floral print wallpapers. The work was slow and painstaking, first soaking small sections in a solution of vinegar and water and then scraping it carefully so as not to gouge the plaster beneath it.

It was also pretty mindless. After a while, I started to replay memories. I was 35 at the time, so my just-ended career in Newark, high school and college years, and growing up were not all that long ago.

I seemed to be watching the movie of my life playing in reverse. The farther back I went, the faster the reel seemed to spin, until I saw my baby pictures in my mind’s eye and the movie ended.

I felt inexplicably exhausted, so I lay down on the floor and closed my eyes…and a feeling of relief swept over me. Suddenly, I felt unburdened by my past and all the emotional baggage that came with it.

I soon realized that all those memories were no longer as close and vibrant as they had been just a few moments before. It was as if I had packed them all into boxes and moved them up to the attic. 

Whatever happened that day was not intentional on my part, but it seems to have repeated itself every 10 years when I switch careers. It’s as if I hold on to a ton of potentially relevant information in case I need it, but then put it into long-term storage as soon as I don’t.

It happened again last year when I ended my 10-year career volunteering for the Democratic Party. No sooner had I quit as chair of the local organization than my memories of a decade’s worth of campaigning became remote. They had joined the previous sixty years worth of boxes in the attic of my mind, in a place that I refer to as ‘ago’ to differentiate it from the here and now. 

I envy people who say they remember events as if they were yesterday. I have no such ability. When I rummage around in one of those boxes, my recollections appear as photographs, not movies. And they are definitely not high-def! Many have shifted perspective, so I have a bird’s eye view instead of my actual eye-witness perspective. 

Many memories have been replaced by memories of the photographs of those events which I’ve viewed over the years. It’s a poor substitute, but it’s all I’ve got at this point.

Although I can’t conjure up strong visual images, I have detailed memories of the stories I’ve told about those long-ago events. My semantic memory (i.e., the facts surrounding events) is much stronger than my visual recollections. Auditory memory is pretty much non-existent.

Occasionally, strong emotional memories will surface. A feeling—sometimes triggered by a smell—will overwhelm me. I can’t always place it, but it’s familiar…and usually warm and pleasant.

I remember myself through a fog. I can still make out the shapes of my past, but they’re distant. I know that all of these things are part of me, but I just can’t see them all that well, even though I can describe them in great detail.

I have no idea whether this is normal or not. I don’t think it’s gotten worse with age. I think I’ve always been like this…but I’m not sure because I don’t think I thought about it when I was younger.

Which makes me wonder where it goes from here. 

I’ve been watching a series of lectures on the ‘Joy of Mathematics’ from TheGreatCourses.com. I remember loving math classes in high school and being good at it. I remember the joy of solving equations. I graduated from Brown just 2 courses short of meeting the requirements for a degree in math.

Yet watching these lectures has shown me that the lion’s share of all that learning and studying is completely gone from my memory. I know: use it or lose it. But it still seems a shame. And it raises the specter of vast stores of memories falling into a black hole from which there is no recall.

That possibility makes even foggy memories look really good by comparison!

__________

S2E34. Uh-oh: Memory Failure!

(Theodore Ribot, in The Diseases of Memory published in 1881, pointed out that the first characteristic of amnesia in patients with dementia is the loss of memory for recently experienced events with relative preservation of remote events.)

I opened an email from Greg, a classmate at Brown some 50 years ago, that include a link to a recent article in The Guardian titled “Stop drinking, keep reading, look after your hearing: a neurologist’s tips for fighting memory loss and Alzheimer’s.”

I appreciated his thoughtfulness in sending it to me as I am always on the lookout for articles that might generate the inspiration for a blog episode. This article was an interview with Dr. Richard Restak and the occasion was the release of his new book The Complete Guide to Memory: The Science of Strengthening Your Mind.

I googled the book before I even finished reading the article, then downloaded the electronic version so I could scan its contents. A lot of the usual material was covered and I was struck by the fact that here was yet another neurologist covering a lot of the same material that is standard for this type of tome. It didn’t look like there was much that I hadn’t covered in prior posts.

 As I was moving it to the trash, though, I noticed that I had previously downloaded this very book!

Strange, I thought, that I hadn’t recognized the cover art. The name ‘Restak’ seemed familiar, but I couldn’t place it. Thinking logically, I realized that I must have read the book and, therefore, I must have blogged about it. So I scanned the titles of all my posts looking for one in which I might have written a review of the book. Since nothing jumped out at me, I began opening posts with potentially related titles and soon found it. It was S2E28: Working Memory Workout? published on July 15th.

That was only a month ago…and my memory of reading that book had all but evaporated!

What a kick in the pants! Here I was doing daily workouts to improve brain performance and I just had a major fail of episodic memory, the kind of memory malfunction that Ribot described back in 1881.

Episodic memory is our memory of what happens to us: what we do and what we experience. How could I not remember reading this book just a few weeks ago when I had obviously spent a lot of time reading it, thinking about it, and finally writing about it?

Forming an episodic memory has three stages. First you have to pay attention to the event. Basically, if it didn’t make much of an impression when you first experienced it, it’s unlikely that you will recall it later on. 

Second, you need to encode it into memory. You do this by thinking about it, processing it, replaying it, and linking it to other experiences so it fits into a framework for remembering. 

Finally, you need to be able to retrieve it. Recall memory is when you can retrieve it from your memory banks without any assistance. Recognition memory is when you need cues or hints in order to find it. Unsurprisingly, recognition is easier than recall. In either case, though, the memory must have been encoded for you to unearth it later on, with or without a little help from your friends.

So what had happened to cause my memory failure? I clearly had paid attention to the book and processed it more than enough to guarantee encoding. It would be easy to conclude that this was therefore a retrieval error…but maybe not. Why did it not come rushing back to me after seeing multiple cues, including the cover and table of contents? Alternatively, the breakdown could have been caused by a failure in any one or in any combination of the three functions.

I did a quick web search of articles about episodic memory and came across one that suggested you could improve it by watching a movie and then listing as many of the scenes as you could remember. It seemed to me that this could also serve as a reasonable test of your ability to recall episodic memories, so I tried it with a movie I had just watched the night before: ‘Hud’ starring Paul Newman.

I waited 5 days to give my brain a chance to consolidate the memory and, perhaps, even time enough to forget a little about it before attempting the task. 

Now, obviously, I don’t know how many scenes there were nor how many scenes a brain-healthy 71-year old would remember, but I came up with 43.

I’ve got to believe that that’s pretty good. I’m pretty sure I didn’t miss much, so I’m going to put off worrying about any possible episodic memory failures for the time being.

But it is a little scary to see how it might sneak up on you.

__________

S2E32. Still Making Mistakes

I’m doing all the right things. I’m eating right, exercising, staying mentally active, getting good sleep, and hanging with friends whenever possible…and I’m still making lots of mistakes. What’s up with that?

Well…actually…nothing. It’s perfectly normal. The brain research doesn’t promise that you’ll stop making errors. It doesn’t even say you will have significant improvements in your memory, language skills, motor or executive functions. All it says is that your decline will be slower than it would have been had you not done all the right things. 

It’s akin to trying to protect a sand castle you built on the beach. You can pile wet sand around it to keep out the incoming tide, and that will work for a little while. Your castle might last a little longer than the one 3 umbrellas over, but at some point, it will be lost. The idea, though, is to enjoy it as long as possible. And that’s about all we can ask and hope for.

Unfortunately, we only get to live life once, so we’ll never get to compare the two trajectories for ourselves. We just have to take it on faith that living a brain-healthy lifestyle gives us our best shot at preserving our mental faculties for as long as possible.

So what kind of screw-ups have I committed recently? Here are three that stand out:

1. We made an overnight visit to Virginia to help my niece Kay celebrate her 70th birthday. On the return trip, we detoured to Harper’s Ferry for some sightseeing, arriving home around 6pm. 

At our apartment building we need to put the garbage outside our doors between 6-8pm for pick-up later that evening, so I was glad we got home early enough for me to get it out on time.

It’s usually picked up by 9pm, but when I went to bring the receptacle back in at 9:15, it still hadn’t been picked up. And not at 10pm, either. I checked once more at 10:30 and it still hadn’t been picked up.

I wondered what was wrong, as this had never happened before. If there was going to be a disruption in trash collection services, we always got an email notice from management, but that hadn’t happened.

So I looked up and down the hall to see if our neighbors’ trash had been removed and immediately noticed that no one else had put their container out.

DOH!

I knew full well that garbage is picked up 5 nights each week, Sunday through Thursday…and it was SATURDAY!

2. I was making a grilled cheese sandwich for Sally and had just placed it into the frying pan to brown when she asked me to help her with a problem she was having ordering concert tickets online.

I walked over to her chair, picked up her computer, and quickly found the problem. I clicked my way through the various menus and got to the point where she could finalize payment…when I smelled something burning.

OMG!

I had completely forgotten about the grilled cheese sandwich! Fortunately, the living room where Sally was sitting and the kitchen bookend a single open area and so I was able to see, hear, and smell what was on the stove from where I was standing. I sprinted the length of the apartment in record time and was able to get the pan off the burner before the sandwich was completely ruined.

That might have been my worst mistake to date. It had the potential to be disastrous. And it’s the kind of thing we, unfortunately, hear about all too often. It frequently signals the beginning of the descent into a world where there is reason to question our ability to live independently. 

3. “What we’ve got here is failure to communicate.”

Remember that line from “Cool Hand Luke?” That scene had to do with Paul Newman’s resisting the authority of the prison boss…which has nothing at all to do with the misunderstanding that Sally and I had last week. I just love that line, which is why I quoted it. 😀

Our ‘failure to communicate’ was not at all passive aggressive on my part. Sally asked me if I would do something for her while she was visiting a friend in New Hampshire and I said that I would. The problem, though, is that what I thought she wanted me to do and what she actually wanted me to do bore no resemblance to each other!

So when the time came, I remembered full-well that I had an assignment, taking several actions to make certain that I could fulfill my responsibility. I was ready. The problem was that I was faithfully attempting to fulfill the wrong task.

Upon her return home the next night, Sally was not at all pleased to learn that I hadn’t done what she asked. We tried to recall the conversation where things went awry and both of us had solid recollections supporting our respective positions. 

There’s no doubt in my mind that Sally did, indeed, say what she intended to say and that I latched on to an errant phrase and ran with it in a different direction, leading to the snafu. Regrettably, other people were involved.

We all know that you can’t remember something if you don’t first pay attention to it, so I guess I need to work on my listening skills, as well.

__________

S2E27. And The Diagnosis Is…

For the last year and a half now, I’ve been attempting to faithfully record the types of cognitive errors I notice myself making. At the same time, I’ve been researching the differences between normal aging, mild cognitive impairment, and dementia. So it’s about time I made the call and diagnosed myself, don’t you think?

Making a diagnosis like this isn’t a 1-time thing nor is it an all-or-nothing thing. It’s a snapshot of where I stand today. It’s not predictive of where I will be a year from now, or ten years from now. It’s more like an annual check-up than it is a definitive conclusion.

Before the ‘big reveal,’ though, I thought I’d summarize the range of mistakes I’ve previously documented in this blog. Here you go:

S1E2. Short-Term Memory Peek-A-Boo: walking into a room and forgetting why I went there; being able to hold fewer items in short-term memory (e.g., a 10-digit telephone number) than before.

S1E4. Mistakes On The Journey: doing things without intending to; tip-of-the-tongue word-finding problems; saying a word that isn’t the one I intended; not checking things after I’ve completed them so I don’t catch the errors I’ve made.

S1E5. Testy & Edgy: irritability; lowered frustration tolerance.

S1E6. Did I Do That?: Not remembering doing something right after I did it.

S1E8. Splotchy Thinking: more examples of doing unintended things; more examples of not remembering recent events.

S1E15. Vivid Memories That Aren’t: clear recollections of past events that turn out to be false.

S1E16. The Name Game: Not remembering the names of people I knew well years ago.

S1E18. 2 Runs, 4 Hits, 1 Error: Errors made in social situations.

S1E20. Dear Diary…: Errors in completing complex tasks.

S1E22. Making Coffee Isn’t Hard…Is It?: More problems with complex tasks and routines.

S1E24. Scary & Scarier: Breakdowns in implementing well-learned routines.

S1E28. Potholes On Open Highways: a variety of mistakes including memory, word-finding, and getting distracted.

S1E33. Poor Judgment: exactly what the title says!

S1E35. Mini-Miscues: A collage of errors, including visuo-spatial challenges.

S1E43. No Comment: Talking less in social situations.

S2E7. More Mistakes On The Journey: a grab bag of recent errors.

S2E12. When Your Fact-Checker Doesn’t: problems with executive function and meta-cognition.

S2E18. Subtle Symptoms?: Things that aren’t really problems now, but could become problematic if they worsen. 

(You can read all of these episodes by going to the home page and scrolling down: www.MistakesOnTheJourneyToNowhere.com.)

Reviewing these episodes in order to write this post was pretty sobering. It seemed really bad at the time and I remember being nervous about all the ways I was failing. But I don’t feel that way anymore, even though I recognize that I am still committing most of these categories of errors. What changed?

For one thing, I realized that none of the mistakes that were dogging me had serious consequences. When playing schoolyard basketball, we used to say ‘No blood, no foul’ and these cognitive ‘fouls’ aren’t drawing any ‘blood.’

Secondly, I think I’ve become used to committing this range of errors. They were pretty shocking when I first focused my attention on them, but now, not so much. When I do a mental belly flop I’m more likely to react with a ‘Meh’ than an ‘OMG!’

Finally, I’ve gotten better at compensating for a wide variety of them. In most cases, the duration of a screw-up is very short (measured in just a few seconds) and quickly corrected.

So here’s my bottom line as of July 8, 2022 as I’m just a few days short of 71½:

I definitely don’t have dementia. This is primarily based on the fact that none of the errors I’m committing have serious consequences or affect my ability to live independently.

For the same reason, I don’t think I meet the criteria for a mild cognitive impairment, either: there are no noteworthy consequences to my miscues. Even Sally, who is uniquely adept at spotting my screw-ups, would agree that they are mainly trivial in nature.

By process of elimination, then, it would appear that what I’ve been documenting is normal aging. Not only do my errors fall within a harmless range, but I’m maintaining pretty good executive functioning (e.g., writing this blog every week) and I am still able to find creative solutions to problems. 

So that’s the diagnosis I’m going with for now: normal aging. And if I’m correct about that, then it’s both reassuring and terrifying to know that one’s brain circuits can misfire so frequently and you still get to call yourself ‘normal!’ 

__________

S2E26. Losing My Mind

“Every day is new now, with little remembrance of the day before, but with enough memory retained to know there was a yesterday. This is a new way to live and it takes getting used to.”

Thomas DeBaggio, author of the above quote, was diagnosed with early onset Alzheimer’s in 1997 at the age of 57. His book detailing the progression of the illness (Losing My Mind: An Intimate Look At Life With Alzheimer’s) was published in 2000. He went on to write another book in 2002 chronicling his life with dementia, and became a tireless advocate for Alzheimer’s research. He passed away in 2012.

Up until now, all of my posts have focused upon discerning the difference between normal age-related errors we all make and the more problematic mistakes associated with the onset of dementia, as well as preventative measures we can adopt to try to dodge the illness which affects about half of those who make it beyond the age of 85.

Reading this book last week, however, was my first road trip into the world of life with dementia…and it was sobering. 

The book is presented as a braid of three interwoven threads. Fortunately for us, DeBaggio’s first love was writing. He was a journalist before settling into his career growing and selling herbs, which also led to his writing about that experience.

The book is not written in chapters. Instead, paragraphs alternate between the three threads. It’s a surprisingly effective technique that captures the essence of the relentlessly vanishing world in which he lived.

The first thread is his biography. Reading it, I wondered if he wanted to leave a trail he could follow to find himself once his memory of his own personhood failed him. A noble effort, for certain, but doomed to failure as the disease progresses inexorably through its mind-sucking stages which would ultimately rob him of the ability to understand that the story he had penned years before was about him. 

The second thread is a description of his current status as it unfolds over the course of his first three years living with Alzheimer’s. At this point, he still has the introspective awareness to be able to recognize when he is making a mistake or losing a cognitive capacity or experiencing something new and unfamiliar. It is here that I am most thankful for his literary skills…which makes it all the more painful to travel with him as he loses access to his words and to the thoughts that he can’t pin down and retain:

“There is a dullness in my brain now to allow me to stare into silence without an idea or thought breaking the stillness.”

Juxtaposed against his past and his present (and looming future) is a summary of his research into Alzheimer’s disease circa 1999. He details the state of the research with excerpts from scholarly publications. It soon becomes frustratingly apparent that there has been very little progress in the past 22 years.

I’m glad I read this book as it helped better define for me the seamless spectrum that runs from the errors of normal aging to indications of cognitive decline to the early experience of dementia. It’s the transition from making errors that are irritating but readily resolved to awareness of problematic thinking that has real-time consequences to the loss of control of your inner dialogue.

Thankfully, I’m still in pretty good shape. When I woke up Thursday morning thinking about how I would end this episode, I was able to table my ideas and return to them after breakfast without any problem. 

My thoughts don’t simmer in a quantum soup where they live lives measured in nanoseconds and their very existence is always uncertain. 

My computer’s spell-check isn’t working overtime to try to figure out what it is I really meant to type.

I’m nowhere near traveling DeBaggio’s path, yet I am grateful to him for illuminating the way.

__________

S2E25. The 10 Warning Signs of Alzheimer’s

I’ve been blogging for a year and a half now and, surprisingly enough, have yet to delve into the early symptoms of dementia in their entirety. I’ll correct that oversight below, but before I do, I’d like to add a little perspective.

When you go through the list below, I think you’ll agree with me that there has already been a significant cognitive decline by the time you experience those kinds of problems. Given that we have no treatment that can reverse the effects of dementia, the primary value of diagnosis at that point would seem to be to initiate the transition to some form of assisted living, whether it be in a facility or via support provided by your family.

But there is another really good reason for getting checked out. It’s very possible that the cognitive mistakes you are making have a cause other than dementia. In particular, depression, sleep disturbance, stress and medication interactions can all generate symptoms that mimic dementia. There is great value, then, in ruling out these other causes before you start to fret over beginning your long goodbye.

Having said that, I hearken back to my original intent in writing this blog which was to try to identify indicators that you were slipping well before you get to the debilitated state described in the ‘warning signs’ below. My hope was that perhaps an extra year or two of awareness would give you time to make lifestyle changes that might slow the progression of the illness. What I’m searching for is cognitive errors (my ‘mistakes on the journey’) that are more worrisome than ‘normal aging’ yet not as debilitating as a ‘warning sign.’

As for now, it appears that dementia-related errors are (1) more frequent and (2) more disruptive than those found in normal aging. It’s a fine line, indeed.

With that in mind, I joined a webinar this past Tuesday presented by the Alzheimer’s Association (www.alz.org) titled ’10 Warning Signs of Alzheimer’s’ in hopes of hearing about more subtle indicators of an approaching dementia. 

Spoiler alert: I was disappointed. The material covered was no different than that already posted on their website and, in fact, utilized the same slides. So rather than provide a summary of what I learned, it makes more sense for me to just present the information directly from their website, as I really don’t have anything to add. These are the best guidelines we as laypeople have to differentiate normal aging from dementia. The take-home message is this: If someone you know is exhibiting one or more of these symptoms, it’s probably time for a full diagnostic evaluation.

Here are the 10 warning signs:

1. Memory loss that disrupts daily life.

One of the most common signs of Alzheimer’s disease, especially in the early stage, is forgetting recently learned information. Others include forgetting important dates or events, asking the same questions over and over, and increasingly needing to rely on memory aids (e.g., reminder notes or electronic devices) or family members for things they used to handle on their own.

What’s a typical age-related change?
Sometimes forgetting names or appointments, but remembering them later.

2. Challenges in planning or solving problems.

Some people living with dementia may experience changes in their ability to develop and follow a plan or work with numbers. They may have trouble following a familiar recipe or keeping track of monthly bills. They may have difficulty concentrating and take much longer to do things than they did before.

What’s a typical age-related change?
Making occasional errors when managing finances or household bills.

3. Difficulty completing familiar tasks.

People with Alzheimer’s often find it hard to complete daily tasks. Sometimes they may have trouble driving to a familiar location, organizing a grocery list or remembering the rules of a favorite game.

What’s a typical age-related change?
Occasionally needing help to use microwave settings or to record a TV show.

4. Confusion with time or place.

People living with Alzheimer’s can lose track of dates, seasons and the passage of time. They may have trouble understanding something if it is not happening immediately. Sometimes they may forget where they are or how they got there.

What’s a typical age-related change?
Getting confused about the day of the week but figuring it out later.

5. Trouble understanding visual images and spatial relationships.

For some people, having vision problems is a sign of Alzheimer’s. This may lead to difficulty with balance or trouble reading. They may also have problems judging distance and determining color or contrast, causing issues with driving.

What’s a typical age-related change?
Vision changes related to cataracts.

6. New problems with words in speaking or writing.

People living with Alzheimer’s may have trouble following or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves. They may struggle with vocabulary, have trouble naming a familiar object or use the wrong name (e.g., calling a “watch” a “hand-clock”).

What’s a typical age-related change?
Sometimes having trouble finding the right word.

7. Misplacing things and losing the ability to retrace steps.

A person living with Alzheimer’s disease may put things in unusual places. They may lose things and be unable to go back over their steps to find them again. He or she may accuse others of stealing, especially as the disease progresses.

What’s a typical age-related change?
Misplacing things from time to time and retracing steps to find them.

8. Decreased or poor judgment.

Individuals may experience changes in judgment or decision-making. For example, they may use poor judgment when dealing with money or pay less attention to grooming or keeping themselves clean.

What’s a typical age-related change?
Making a bad decision or mistake once in a while, like neglecting to change the oil in the car.

9. Withdrawal from work or social activities.

A person living with Alzheimer’s disease may experience changes in the ability to hold or follow a conversation. As a result, he or she may withdraw from hobbies, social activities or other engagements. They may have trouble keeping up with a favorite team or activity.

What’s a typical age-related change?
Sometimes feeling uninterested in family or social obligations.

10. Changes in mood and personality.

Individuals living with Alzheimer’s may experience mood and personality changes. They can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, with friends or when out of their comfort zone. 

What’s a typical age-related change?
Developing very specific ways of doing things and becoming irritable when a routine is disrupted.

If these are the 10 criteria by which we are to measure our cognitive health, then I passed my 71½-year check-up with flying colors!

The only item that is close to raising a warning flag is #9: Withdrawal from work or social activities. As Sally has pointed out, I’m not as talkative as I used to be and now have a tendency not to participate in conversations. But it’s not because I’m not following along or can’t find the words or put together a sentence. I would describe myself in those situations as being comfortable and attentive, albeit not actively engaged. To the extent that my silence might represent a precursor to the development of poverty of thought, though, it’s worth keeping on eye on.

So I’ll take my current mental status as a win…and continue to search for earlier warning signs of dementia.

__________

S2E19. Dementia Screening Exam #2

It was just about a year ago that I reported on a cognitive exam I took (S1E19) and passed with flying colors. This week, I had occasion to take another very brief screening test. I didn’t do as well.

Sally and I have an insurance policy that provides support should we need any form of assisted living. Our contact, Linda, came for her annual visit on Tuesday to check our apartment for safety and fall risks and to see, in general, how we were doing.

Her screening exam was very brief (it took less than 10 minutes to administer), but it hit all the important functions. 

First came the orientation questions: naming the year, day of the week, and our location. I actually had to think about the date for a little bit as, just before she arrived, I was making appointments for medical checkups that all turned out to be on Wednesdays. So when she asked me to name the day of the week, ‘Wednesday’ popped into my head, but I knew that wasn’t right. I had to think about it for a second before remembering that I had done The New York Times Crossword puzzle the night before and that it was Tuesday’s puzzle. Hell of a way to remember the day of the week, eh?

Then she gave me 5 unrelated words to remember. I repeated them out loud to create a stronger memory trace before I set about trying to conjure up an image that included all 5 items. While I was doing that, though, she moved on to a math word problem that required you to add two numbers and subtract them from 100.

I realized that since my attention was focused on remembering the 5 words, I wasn’t listening to her at all and didn’t catch the numbers, so I asked her to start again. This time, though, since I knew I wouldn’t have time to form an image, I figured I would just divide my attention between listening to her and rehearsing the five items.

Much to my chagrin (and surprise), that didn’t work either. I still wasn’t able to follow her words. So I apologized and asked her to start again. At that instant, I knew that I would only remember 3 of the 5 words when she got around to asking me to repeat them.

Now attentive to the math problem she was reading, I solved it without any problem.

She gave me 3 numbers and asked me to repeat them backwards. Then 4 numbers. I did it by visualizing the numbers and then reading them from right to left. 

Then she read me a brief story and asked me three questions about it. Again, no problem. 

The next item was to name as many animals as I could in 30 seconds. I started quickly with a rush of jungle animals. I noticed, though, that at one point I had an image of a tiger in my head but that it took me a few beats to name it. That surprised me. 

It wasn’t long before I ran out of jungle animals and, in my mind’s eye, all I could see was a vast savanna without any animals on it. I was surprised that I had hit a blank spot so quickly. 

It took me a few seconds before I realized I needed to change habitats if I was going to name more animals and so I thought of a farm and came up with another bunch. Then household pets. But then I blanked out again.

Time was up.

I’m pretty sure I scored above a level that would have signaled an impairment, but I should have done a lot better. There were two problems with my performance. First, I encountered word-finding difficulty which is generally infrequent for me. Second, I didn’t shift gears quickly; I wasn’t flexible; I stayed stuck on ‘jungle animals’ for way too long. To do better, I would have had to cue myself more frequently and more quickly to generate associations that would connect me to more animal names. As it was, I never got around to fish or birds at all.

I last discussed this more than a year ago in ‘When Words Hide.’ IMHO, my performance has deteriorated a bit since then.

It wasn’t easy for me to flounder like that. The test shone a spotlight on something I didn’t think was there. When you combine this performance with my reduced participation in conversations, it starts to make sense: I’m not generating content as quickly as I used to.

Linda then got around to asking me to name the 5 objects she had asked me to remember and, as expected, a rattled off 3 of them. There was a fourth that seemed very vague and distant and I wasn’t at all sure it should be included, so I didn’t say it. Turns out it was one of the five.

We moved on to visuospatial questions. I was able to draw a clock and set the hands at ten to eleven (I can’t help but wonder if young people born in the digital age can do this task), identify a triangle from among 3 shapes, and determine which was the biggest of those 3 shapes.

And that was pretty much it.

I’m writing this the day after I took the test and I’m a little impressed with how many of the questions I remember. Sally was sitting at the table with us during the exam and she didn’t recall any items that I hadn’t already come up with. I think that’s pretty good, don’t you?

Bottom line: Although my performance was still well within the ‘normal aging’ range, there was a discernible drop-off from my previous level of functioning.

As always…I’ll keep an eye on it.

__________

S2E18. Subtle Symptoms?

Those of you who have been with me from the beginning will recall that the initial purpose of this blog was to record changes in my cognitive status over the years in the hope that it might be useful to a future researcher in helping to understand the differences between normal aging and prodromal dementia. So here’s an update on a few things I’ve noticed over the course of the last month or so.

1. Reading font. 

Strange choice for a possible symptom, right? Bear with me on this one.

We encourage the use of technology to help us with our daily activities, things like calendars and reminders on our computers and smart phones. Technology is our friend.

One of those wonderful technological advances is the introduction of ebooks and the programs used to read them. I’ve now completely abandoned real books and switched to their electronic versions.

One of the nice things about reading a book on my computer is that I can control the font size to make it easier to read. Although my vision has been fine since I had my cataract surgery last year and I can read 12-point type with ease and without magnifiers, I discovered that I really like reading with a much bigger font. In fact, with an enormous font!

The normal setting in the ‘Books’ app on my MacBook Pro uses a font that shows 2 pages on the screen, just like a real book. But I found that to be intimidating. Just looking at it, I felt a little twinge of ‘this is too much work.’ It took me by surprise the first time I noticed it, but after a while, I realized that keeping my eyes focused on the line I was reading and moving to the next line would be effortful. So I tried a bigger font.

And then I tried an even bigger font.

And then I tried even bigger fonts until there were only about 2 paragraphs on the screen…about half of one page.

That was comfortable…and easy to read…and I had a sense of accomplishment when I turned the page every 15-20 seconds or so!

As I thought about why this might be, it occurred to me that it could be a matter of focused attention. Apparently, I was finding it harder to maintain attention over a sustained period of time.

The ability to keep one’s attention focused is housed in the prefrontal cortex, so this change in my preference might indicate a subtle change in the efficiency (i.e., a decline in performance) of that brain area. 

Reinforcing this notion that there might be a problem with focused attention, I’ve notice that I sometimes skip a line of music when I’m practicing the recorder. It’s right there in front of me on the computer screen, but my eye skips it.

I think the two problems are related. I’ll keep an eye on it.

2. Talking less.

I’ve mentioned this before. I seem to be talking less when we’re out with friends. I can’t really put my finger on why that might be. I follow the conversation just fine, I can hear myself thinking about what is being said, and I come up with things I might want to say. But then I don’t say them.

Could it be that my timing is off? That while I’m waiting for someone to finish their comment, I wait too long and someone else jumps in? It’s possible. I can think of several times when conversations moved on to other topics before I had my say.

At other times, though, I just don’t feel the imperative to talk. I’m more than happy just to listen…but that’s not very sociable, is it?

Sally has also reflected back to me that I’m not talking as much at home when it’s just the two of us. Again, I’m thinking all the time, but I neglect to express my thoughts out loud. Or maybe I don’t think what I’m thinking is worth mentioning?

Bottom line: although my intention is not to isolate, I might be coming across that way. And although I’m feeling very comfortable and at ease, my silence can be uncomfortable for others.

Another thing to watch.

3. Perseverance and frustration.

If you do The New York Times crossword puzzle every day, you know that they start out quite easy on Mondays and then get more difficult as the week goes on. I breeze through Monday, Tuesday and Wednesday, then find Thursday more interesting (you usually need to discover a trick to solve it), but I have to work hard to get the Friday and Saturday puzzles.

In solving these latter two, I find that I’m now losing patience when I can’t solve them in short order. There was a time when my patience was endless. I might walk away and come back an hour later, but I would stick with it. I would persevere until I solved it.

Not anymore. Now I find I’m quick to hit the ‘check’ button which tells you which of your answers are incorrect. 

I didn’t used to do that, but I have very little tolerance for frustration these days.

Like focused attention, perseverance and frustration management are functions of the prefrontal cortex.

Is it possible that there is a pattern here?

__________

S2E12. When Your Fact-Checker Doesn’t

We know that the prefrontal cortex is one of the areas most vulnerable to atrophy as we age and along with that comes problems with executive functions. That’s a big deal.

Executive functions include things like making plans, implementing strategies, following directions, monitoring progress and sustaining attention. It’s that ‘monitoring progress’ function I want to zoom in on today.

We constantly monitor ourselves to make sure we do things correctly. Is it ½ or ¼ teaspoon of turmeric in the recipe? Did I already put it in? For the most part, it’s an effortless process that keeps us moving in the direction we want to go, no matter what the task. We constantly monitor our actions to make sure that everything is ok. In essence, it’s our internal fact-checker.

Imagine, then, what it would be like if your fact-checker stopped working. You wouldn’t realize that you are putting the crackers in the freezer instead of the pantry where they belong, or that your doctor’s appointment is next week, not today.

I recently had two episodes where my fact-checker failed me.

The first came when I was preparing to drink my morning tea. My routine is to steep it (equal parts of mint and green tea leaves) the night before in a 1-pint pyrex measuring cup and then refrigerate it overnight.

(I suppose a little background would be helpful here. When I gave up drinking coffee with half & half and sugar about 10 months ago, I tried to switch to green tea because of its brain health effects. I didn’t like the taste, though, so I tried mixing it with mint tea leaves. That was better, but I was still craving sweetness. It occurred to me that it might taste better cold and so I tried refrigerating it overnight. That worked! Finally, to pump up the brain health benefits, I started adding ½ teaspoon of a combination of equal parts turmeric, ginger, cumin and cinnamon with a little black pepper. Delish!)

Back to that fact-checking failure…

While getting my tea ready, I also brew Sally’s coffee. She continues to use sugar and half & half, and so not only do I put my mug out on the counter, but I put out her mug, the half & half container and the sugar bowl, as well.

As I do every day, I placed the sieve across the rim of my mug and poured the cold tea into it. But something wasn’t right. I had only poured about half the liquid when I noticed that the mug was full. How could that be? My mug holds two cups and I steep a little less than that in my measuring cup. It was impossible for it to be full with only about 1 cup of tea in it. 

What the…???

When I stepped away from the counter to think about what might have happened, I immediately saw what the problem was. Instead of placing the sieve across the rim of my mug, I had placed it across the rim of the sugar bowl which had been half-full of sugar at the time. That is why it only took 1 cup of tea to fill it to the top.

Oh lord!

The second time my fact-checker failed me was after working out in our apartment building’s fitness center. My habit is to burn a few extra calories by walking up the three flights of stairs to the 4th floor instead of taking the elevator, which is what I did on this particular day.

Up the stairwell I went, exiting through the doorway to the hall, and making the left turn to get to our apartment which is just a few yards away. As I did so, I noticed on the right-hand wall a pair of large double doors with a sign that announced: Telecom Room.

“Huh,” I thought to myself, “I never noticed that before.”

I continued on down the hall to my apartment and inserted my key into the lock, but it didn’t open.

What the…?

That was when I realized that our grape vine peace sign wreath wasn’t hanging on the door…and that I was standing in front of apartment 341 instead of 441…and that I had exited the stairwell on the 3rd floor instead of the 4th!

Oy vey!

I could explain away both of these episodes. It would be easy to attribute my fact-checking error in the stairwell to being exhausted after a hard workout. I could argue that placing the sieve on the sugar bowl was the result of my still being half asleep early in the morning.

But I’m not going to explain them away. It’s true that in neither case was I at the top of my game nor was I hitting on all cylinders. But how you perform when you are not at your best can offer a glimpse of what is lurking below the surface. Although these might be isolated and infrequent incidents now, in another couple of years, with additional age-related prefrontal cortex atrophy, I might very well see a further decline in executive functioning and more fact-checking failures like these.

As always, it’s something to keep an eye on.

__________

S2E7. More Mistakes On The Journey

It’s been a while since I reported on the kinds of errors I’ve been making, so I thought I’d provide an update.

As I mentioned in ‘Another Year Older’ (S2E3), I’m still making errors, but they don’t bother me as much as they did a year ago. Perhaps I’ve just gotten used to them, or maybe I’m more confident that they are not harbingers of worse things to come and so I don’t dwell on them. In any event, here are a few that cropped up this week.

On Monday night, Sally and I watched “King Richard,” the Academy Award-nominated movie about Venus and Serena Williams’ father and his dreams for them, starring Will Smith. The next day when I asked Sally a question about it, I called it “King Lear.” 

It happens…right?

Although I’m recalling the names of many people in my past with greater ease, there are 2 classmates from the Ph.D. program at UConn whose last names, for the life of me, I just can’t remember. I’ve gone back to it days and weeks apart, but no luck. What makes this so bothersome to me is that there were only 8 of us in that class (including me) and we spent 4 years together. And it wasn’t even 25 years ago. You’d think I’d remember them, wouldn’t you?

I’ve never had any problems with word-finding, so it came as a real surprise when I stumbled on a word this week. I was trying to tell Sally how I discovered that a sponge was caught in the ___________, except I couldn’t find the word. So I said it was caught in that thing in the sink that chops up kitchen scraps. She immediately filled in the blank with ‘garbage disposal.’

The odd thing, though, is that ‘garbage disposal’ was in my head the entire time, but it didn’t seem like the right phrase. It’s meaning was detached from my vision of what I was describing.

Weird, huh?

My prospective memory seems rather porous and fluid. I’ll form the intention to do something and then get distracted by something else which banishes my original intent from awareness. But no sooner does it disappear than it reappears. It’s a case of easy go, easy come. Bottom line, it’s not such a bad thing because it all comes back to me pretty quickly. It gives the phrase ‘gone but not forgotten’ a whole new meaning!

For example, I have an evening routine where I prep our coffee and tea so it’s all set up for me to make the next morning. There are several steps, the last of which is to fill the coffee grinder with beans. I’ll remind myself to do that while I’m going through the earlier steps in the routine, but then near the end, I will have forgotten about it, but I’m sure there is something else I need to do. Right on cue, the memory of filling the grinder pops into view!

At this point, I’m pretty confident that I won’t forget things for too long, or, at least, not long enough for something bad to happen.

Sally asked me to pick up some cottage cheese at the super market and I flat-out forgot to put it on my marketing list. Once inside the store, though, I remembered that there was something else she asked for that wasn’t on the list. Even before I got to the dairy aisle, I knew it was cottage cheese.

Here’s a bad one:

I was making quinoa on our glass-top stove and the sauce pan was simmering on low heat. When the timer went off, I removed it from the burner and let it rest for 10 minutes so the seeds could absorb the rest of the water. We had a wonderful dinner.

About an hour later, when we were cleaning up, I noticed that the ‘hot cooktop’ indicator light was still on. The surface should have cooled down by then, so that struck me as strange. That is when I realized I had neglected to turn off the burner when the timer rang.

Oh lord!

And then there was Wednesday morning…

I make my own kefir. It’s pretty easy. You just purchase kefir stones and plop them in some milk and let it sit for a day or two at room temperature. (The stones are re-usable, so you strain them out of the kefir and store them in the refrigerator until you’re ready to make more.) Then I like to add pureed strawberries and bananas. Easy peasy!

On Wednesday morning, the kefir was done fermenting and so it was time to add the fruit. I sliced the strawberries and broke up the bananas and put them in the blender. Then I poured some of the kefir in so there would be enough liquid for it to puree. 

OMG! I started pouring the kefir in before I strained out the kefir stones!

My first reaction was panic. How would I ever recover the stones? As luck would have it, I had caught myself just as I started to pour the kefir into the blender and, fortunately, most of the stones had sunk to the bottom of the container that held them. So I strained the contents and discovered that most of the stones were there. 

I then picked through the strawberries to recover any stones I spotted. There were some, but not many. Whew!

It was bad enough to forget to strain the kefir before adding it to the blender, but to make matters worse, I specifically reminded myself the night before that I had to strain the stones out of the newly fermented kefir before using it. In the moment, though, I just didn’t remember that I had reminded myself!

Mercy…is this what it’s going to be like?  😀

________________

S2E6. Real-Life Wordle

A week ago Thursday, Sally tried to print the New York Times crossword puzzle. Unexpectedly, the page that came out was blank, so she asked me if I could do it.

First, I tried to print it from my computer in order to rule out that the problem was with Sally’s MacBook Pro, but I got a blank page, too. Then I tried printing a different page from my computer to rule out that the problem was with the Times website.

Same result.

Then I turned the printer off and waited a minute before re-starting it. Another blank page emerged, so I knew the problem wasn’t with the printer’s software.

Next I tried to copy a page directly from the printer’s flatbed.

Whoa! It printed the colors but the black was missing. At that point it dawned on me that I had been getting blank sheets because the pages I had been trying to print were in black-and-white and the black ink wasn’t printing.

I checked the ink level and and, unexplicably, it showed the black cartridge was more than half-full. Odd…

But I replaced the cartridge anyway and…it printed perfectly!

A few hours later, it occurred to me that the process I used to solve the problem was a lot like playing Wordle. If you haven’t tried it yet, here’s a link that explains it.

Basically, the Wordle program selects a 5-letter word each day at random and you have 6 guesses to figure out what it is. You receive feedback after each guess telling you which letters (if any) are in the target word and whether you’ve guessed the right locations for any of those letters. You solve the puzzle by using the information you learn from each guess in order to make your next guess. I’ve been able to solve them all since I started playing and it usually takes me four guesses…but it’s the thinking it through that’s fun!

Can you see why fixing the printer reminded me of Wordle? Each attempt I made to print the crossword provided me with new information that I used to create the next attempt. With each try, I learned what was not the problem, thereby narrowing my remaining choices until I hit upon the solution.

(Yes, yes…I know…If I started out by trying to print a picture in color, I would have solved the problem in 2 tries instead of 5!)

So why am I writing about fixing printers and playing word games? Because they both rely on executive functioning, in this case, the ability to develop and implement a strategy and to learn from new information.

In dementia, it’s not just memory that goes. It also hits your prefrontal cortex and impairs your reasoning and ability to execute complex tasks. Typical symptoms are having trouble balancing your checkbook or following a recipe correctly. 

Having played it for a month now, I’m thinking that Wordle might be a good measure of executive functioning that could be used as an early warning sign for mild cognitive impairment. Here’s why:

For a simple game, it’s actually a pretty challenging cognitive task. You have to learn from each trial and apply that information to your next guess. You have to focus on—not only the letters that are part of the solution—-but on those that you have been told are NOT part of the solution. And you have to pay attention to location, as well. 

Because all the information from each guess is available to you on your device all the time, short-term memory is not a major contributor to solving the puzzle. The game really isolates two factors: your executive functioning and your ability to recall words. Both are affected in dementia.

As I do the puzzle each day, I have to take my time because I make a lot of mistakes. (Fortunately, a guess is not recorded until you hit the ‘return’ key, so you have time to correct errors.) I’ll get excited about a guess and then realize it uses a letter that I already know is not part of the solution. Or I’ll place one of the letters in the solution in a position that I know it can not occupy. Or worse yet, I’ll come up with a word that does not use all the letters I already know are part of the answer. 

Can you see how easy it is to make mistakes? Can you see how critical it is to check and double check your guesses before submitting them? Can you see how the errors you make in Wordle might translate into the kinds of real-life errors you make around the house?

I hope there are neuropsychologists out there running experiments to test whether performance on Wordle is correlated with cognitive decline. If so, I can’t wait to see the results!

__________

S2E4. Memory Is Overrated

Lisa Genova is a neuroscientist and author. If you’ve heard of her, it’s probably because she wrote the book “Still Alice” which was made into a movie starring Julianne Moore (who won the Best Actress Oscar for her portrayal) and Alec Baldwin. It was the story of a linguistics professor who develops early onset Alzheimer’s.

Now she’s written another book titled: “Remember: The Science of Memory and the Art of Forgetting.” I read it last week and I recommend it to you. It’s an extremely helpful guide to understanding what memory is and what it is not. This, in turn, provides insight into what changes in memory are normal—and which are not—as we age.

She writes in a breezy, conversational style and makes even difficult topics readily digestible, resorting to jargon only when absolutely necessary. Here are some take-aways:

For starters, we don’t remember everything. We just remember important things. That’s why you probably don’t remember what you had for dinner a week ago Tuesday (unless it was your birthday or anniversary). Even with our brain’s enormous storage capacity, it wouldn’t take long to overwhelm it if we retained everything we experienced, every word we read or heard and every thought we ever had.

In order to remember something, we first have to pay attention to it. Let’s say a truck goes by but you don’t notice what is advertised on its side. You can’t possible remember it later because you never paid attention to it in the first place. As a result, many of the events we label as forgetting are more likely to be things that we never attended to in the first place.

But it’s not enough to just pay attention. You need to react to it, experience an emotion about it, think about it, and link it to previous memories. This is called ‘encoding.’ Fortunately, this process is largely automatic, unless, say, you’re trying to learn a lot of facts for a test. Then rehearsal and other memory tricks (like mnemonics) might be necessary to encode the information.

Attention and encoding alone are still not sufficient to form a memory. You also have to store it. This is where the hippocampus comes into play. It’s the part of the brain essential to lock-in the neural connections that are created when you experience something. This consolidation mostly happens during sleep when strong connections from the day (i.e., those that are in some way meaningful) are stored in memory and weak connections (i.e., incidental inputs that aren’t very relevant to your life) are dismantled and forgotten.

Finally, assuming you’ve paid attention, encoded and stored an event or fact, it doesn’t do you any good unless you can retrieve it from memory. Most of us know this one all too well. That tip-of-the-tongue experience where we know that we know the answer, but just can’t find it. The memory must be relatively strong for us to recall it without any additional cues or hints. That’s why it’s a lot easier to spot the answer when it’s presented in multiple choice format.

Those are the essentials of memory formation, but they don’t tell you anything about the quality or accuracy of those memories. It turns out that our brains do not work like cameras or tape recorders and do not store digitally precise representations. What we encode is unique to each of us as it is linked to our previous experiences and memories. That’s why you can get contradictory eye-witness reports of the same event.

To make matters worse, our memories tend to warp over time and to be changed by later experiences. In fact, each time you tell a story, your memory of it changes a little bit. After a while, your memory can shift from your visual point of view to that of one observing the entire event with you included in it. (I described this in S1E15: Vivid Memories That Aren’t).

There are also different kinds of memory, each with its own separate pathway. Episodic memory is the record of things you have experienced or done. Semantic memory records words and facts. Muscle memory stores physical routines like how to eat with a fork, walk and ride a bike. Muscle memories are among the last to leave us in late stages of dementia.

The type of memory I think we have the most trouble with is prospective memory. This is remembering to do something in the future, like going to the supermarket to buy milk. Haven’t we all thought about an errand we needed to run but then realized at the end of the day that we hadn’t done it? Or, in the example of going shopping above, bought everything else but the milk?

Knowing that memory is so fickle makes it a lot easier to understand and accept the memory mistakes we make as we get older…the kinds that are normal. I think we have a tendency to put memory on too high a pedestal and then beat up on ourselves when we fall short of the unwarranted ideal we’ve created. Don’t get me wrong: memories are very much who we are and I sure as hell don’t want to lose mine. But it’s ok not to remember things going forward because a lot of what happens is not new, novel, important or noteworthy. After all, we’ve seen and been through a lot! 

Or maybe we were distracted or otherwise occupied and just didn’t pay sufficient attention to it when it happened. I’m guilty of this one a lot. Sally will tell me something while I’m engrossed in a puzzle. The odds of my remembering it are not good.  😦

The last chapters of the book are devoted to explaining how memories can be eroded with normal aging and in dementia, along with techniques you can use to eliminate a number of memory errors. First and foremost: make lists. There is no shame in making a list, and just the act of writing the item down makes it more likely you’ll remember it without looking at the list!

The author is not a big fan of doing crossword puzzles which, she believes, only tap into stored knowledge. She much prefers that we allocate our cognitive challenge time to learning new skills because these will grow the most new brain cells and synapses. 

There’s a lot more in the book, but I’ll stop there. Here’s a link to a 14-minute TED Talk she gave which covers a lot of the same material.

Please don’t forget that you want to watch it!

__________

S1E45. Subtle Changes

Just like that…it’s gone! Now you think it; now you don’t. POOF!

It’s quite the magic trick…making thoughts disappear like that. If only I knew how I do it!

Following up on the second blog I posted last December, I’ve noticed that I no longer experience the phenomenon of walking into a room and forgetting why I went there. There’s been a subtle shift. It’s morphed into something a little different.

What happens now is that I completely forget my original intent. For a moment, I don’t even realize I’ve forgotten it. Instead, I’ll do something else that needs doing in that area just as if that had been my purpose. Only after I’ve started that task do I realize that I had another purpose…and then it comes back to me. For example, the other day, I walked into the kitchen and started to unload the dishwasher before I remembered that the reason I went into the kitchen in the first place was to make some tea.

It’s only a fleeting experience, so there is no real down-side to it, and there is the benefit that I get things done that I obviously had deferred. Clearly, though, something has changed.

It reminds me a little of a video I saw about a form of ADHD that is caused by cognitive decline and dementia. It documented the story of a woman who couldn’t get anything done around the house because she was constantly being distracted by other needs before she could complete the previous task…and this went on all day.

Fortunately, what I’m experiencing is nothing like that. I catch on to what’s happening pretty quickly and I complete all the intended tasks…both the original and the newly-discovered.

In a way, it’s an improvement from a year ago. I recall my purpose a lot faster than I used to and without having to sustain a focused effort. But it’s still bothersome that I forget it in the first place.

A more problematic variation of this occurred the other night when we were out to dinner with friends. We were at an Asian restaurant that had a unique style of serving your dinner. They didn’t serve everyone at once. Instead, they served each order as soon as the cooks finished preparing it. As a result, some of us got our main courses first and our appetizers last. Some of us were served quickly and some had a longer wait. If I had to guess, I would say that salads were served the fastest, then came fried foods, and finally noodle dishes that required boiling. And the delivery speed for each was determined by the volume of orders coming in from the other patrons.

We all ordered and soon the food began to arrive. Two of us received our salads first while the others waited. Gradually, more dishes appeared. I was still hungry after I finished my salad and so I tried one of Sally’s chicken wings. Some fried tofu was being passed around and I tried that, too. After a while, I wasn’t hungry anymore.

Finally, the last member of our group was served, but along with his order came a huge bowl of tom yum soup. Nobody claimed it as theirs…until it dawned on me that I had ordered it!

In the half hour between ordering it and its being served, I had completely forgotten all about it. If I had remembered, I never would have sampled all those other dishes.

So that’s the bad news.

The good news is that I’ve noticed an improvement in another domain: remembering names. You might recall that I was having difficulty with that task back in April (“The Name Game”). Now names of people from my past seem to be cropping up in my head without a lot of effort. And when I do try to come up with a name, it seems to be within easy reach.

So what does all this add up to? I’ll be damned if I know!

The promise of a brain-healthy lifestyle is that it will slow the progression of cognitive decline. Around 40% of dementias can be prevented in this way, or so the research suggests. Another way of looking at it is to say that your rate of cognitive atrophy is slowed to the point that you die from other causes before you qualify for a diagnosis of dementia. Don’t get me wrong…I’m not complaining. Dying before you dement is a good thing!

What’s more, the research doesn’t say how long you have to be implementing the 5 Pillars before you see tangible results. Some studies have a 6-month time frame while others measure the impact of lifetime habits. 

And since we don’t know what my cognitive status would have been had I not changed my habits six months ago, we can’t really measure the success/failure of the program.

And so my journey continues… 

____________________

S1E35. Mini-Miscues

After shaving, I put the razor and shaving soap back in the medicine chest but didn’t notice until the next morning that I hadn’t returned the brush.

Upon seeing a good friend for the first time since she became a grandmother, I forgot to congratulate her.

To help me learn my way around our new town, I decided to look at a map and forego GPS when traveling to a restaurant we had been to once before. I was derailed, though, by a detour, became lost after several attempts to get back on track, and finally asked Sally to pull up directions on her phone’s GPS. As I followed her instructions, I was convinced we were heading home (south) instead of towards the restaurant (north). I was wrong.

My memory of our first visit to that restaurant was that it was on the left-hand side of the road as we approached from that same direction. Turns out it’s on the right.

Waking up one morning, Sally asked me something as I walked around the bed towards the door. As a result, I forgot to put on my wedding ring.

Friends asked me what was in the marinade for the grilled shrimp I made. I told them lemon juice, lemon zest, olive oil, garlic and parsley…forgetting all about the white wine.

I changed my morning coffee brewing routine again…and forgot to put the ground beans in the coffee maker before hitting the ‘brew’ button.

It’s not unusual for the wrong word (although a semantically related word) to come out of my mouth. Sally catches it and alerts me when it happens.

If I get frustrated with a hard crossword puzzle, I’ll cheat instead of coming back to it the next day.

Before going to bed, I close the blinds and pull the curtains in our bedroom. One morning Sally asked me if only closing the blinds on one of the two windows was some kind of experiment. It wasn’t.

Sally remarked that my sister had given us a certain frying pan. It took me a couple of hours to realize she was right. I initially thought that the gift had been given to me years before I married Sally.

I went downstairs one day to pick up a package from Amazon that was delivered to the garage (the normal delivery location). Halfway there, I realized I was walking to our mailbox which is at the opposite end of the building.

And here’s one that happens a lot: I’ll decide I want to do something and then not do it…but remember later on in the day that I wanted to do it…and then I’ll do it.

Does all this add up to anything? Is this cognitive death by a thousand cuts? Is this what prodromal mild cognitive impairment looks like? Or is it just that I’m noticing my mistakes more?

I haven’t a clue.

I take some solace, though, in the fact that Sally is making her share of mini-miscues, too. So wherever we are going on this journey, it appears that we’re going to get there together!

_________________

S1E33. Poor Judgement

Sally went away last week to help a friend, leaving me alone at the apartment…an accident waiting to happen…and it did…twice!

Episode 1: Stinky Onion.

I’ve never lived anywhere with a garbage disposal and so I’m just learning how to use the one in our new apartment. I googled it to learn the basics about what you can and can’t put in it, but the whole idea is still pretty new to me.

Around the fifth day Sally was gone, I noticed an acrid smell coming from the pantry and discovered a thoroughly rotten onion. Oy! What to do?

I could have put it in a zip-loc bag and put it out with the rest of the garbage two nights from then or I could have put it in a bag and walked it to the garbage chute down the hall right then and there. Or I could have put it in the garbage disposal.

For reasons that are unknown to me as I write this, I decided to use the garbage disposal. If I had thought it through, I would have reflected on the fact that chopping an onion releases tear-inducing chemicals into the air along with a strong onion smell. It might have occurred to me that running it through a garbage disposal would probably be like dicing on steroids! But I didn’t think it through. I just went ahead and ground it up and flushed it away.

Within seconds the entire apartment was fouled with a putrid odor. Oh lord! I tried filling the sink with hot soapy water and letting it flush out the unit, but that did nothing. Then I poured some bleach in and let it sit for an hour, but with little effect. I pushed a lemon in and let the disposal grind that up, but it only provided relief for a few minutes. I turned on the apartment fan and opened the doors and windows. That worked as long as there was a breeze.

By the time Sally returned, the odor was faint but still noticeable. We’re lighting scented candles now and close to getting back to normal.

Episode 2: Blackout Curtains.

I was reading up on the connection between sleep and brain health (see last week’s post) and learned that sunlight in the morning triggers the wake cycle of our circadian rhythm. It was suggested that blackout curtains could help you sleep a little longer in the morning by delaying the interaction between sunlight and your brain.

So I went to Amazon and ordered a blackout curtain and curtain rod for our bedroom. There were a mind-boggling number of choices and so I decided to keep it simple. The curtain I chose was white linen so it wouldn’t clash with our bedspread and the curtain rod had a nickel finish to match the doorknob in the bedroom. My thinking was that we could use this set to test out the idea and return it if either it didn’t help us sleep or if it did help us sleep but we wanted a different look.

But before going any further, you need to understand how radical a move this was for me. 

Since I have no design talent or taste whatsoever, Sally has taken the lead in the nesting process. So for me to initiate something as monumental as selecting bedroom curtains was really beyond my pay grade. For some reason, though, I thought Sally would be happy that I was finally taking the initiative on something.

Secondly, we always talk about improvements we’d like to make before actually doing them. It’s true that she was an hour away and would be gone for several more days…but her cell phone was still working so there was no reason not to have a discussion. But then again, the curtains would arrive the day after she got home and it might be a fun surprise.

Wrong and wrong again!

My initiative was not appreciated and Sally was a little more than miffed by my failure to share my thoughts with her. How did I misread this so terribly?

Hopefully, I’ve learned something from both the onion and blackout curtain episodes as I’d hate to experience anything like either of them again! And hopefully, too, this is not a harbinger of things to come in the coming decade.

________________

S1E31. There’s Hope For The Next 30 Years

Those who have followed this blog from the first post know that it started out as an effort to document my changing mental status over time. But over the course of the last month, it morphed into an account of my efforts to delay and (hopefully) prevent significant cognitive decline in the coming years. 

How did that happen? 

When I began writing last December, I assumed that dementia was something you were destined to develop. Either you had the gene or not. You were either lucky or you weren’t. But I soon learned that that was not the case. It turns out that, although there is no treatment or cure for dementia, you can do things to reduce your risk of developing it by 40%.

Bottom line: genetics is not destiny. You can get dementia without the gene and, conversely, not everyone with the gene develops it. The odds are just higher for those with the gene. Overall, about half of us will develop dementia after age 85 if we live that long and if we do nothing to protect ourselves. Making all the recommended behavioral changes lowers your chances of dementing after 85 from 50% to 30%.

Allow me to digress here for a moment to note how amazing it is to even be having this conversation. When I was in my early 20s, the average life expectancy for an American male was around 72. Now it’s over 85. Many of our parents are living into their 90s. It’s no longer unusual to read newspaper obituaries of centenarians. I would not be surprised if the final longevity calculation for my generation of baby boomers turns out to be over 100.

If that’s the case, then at 70, I may have 30 years ahead of me. Thirty years! I find that mind-boggling, don’t you? But all that extra time will be hell on earth if I dement. That’s a pretty strong motivator for changing one’s behavior, don’t you think?

So back to my main point…

There are 3 biological processes that make it possible to influence your cognitive future:

1. Epigenetics. Although your genes set the broad parameters of your life, you can influence how they are expressed, most importantly by controlling what you eat, how often you exercise, and the quality of sleep you get. So although I might be genetically programmed to live to be somewhere between 70 and 120, where I actually wind up will depend upon the lifestyle I assume on the way there. The same goes for brain function and cognitive decline.

2. Neurogenesis. Not that long ago, the common wisdom was that your brain developed until your mid-twenties and after that there was a long, inevitable process of cell loss. I used to joke about not holding in a sneeze because the spike in pressure would kill brain cells. Research in the last few decades, though, has demonstrated that we continue to grow new brain cells right up until we die. We just need to motivate our brains to do so by constantly challenging ourselves.

3. Neuroplasticity. Our brain is a mass of circuits formed by individual neurons connecting with each other. If there is damage to one part of our brain, there is the capacity (within limits) to re-wire ourselves to compensate. So even if a short-circuit develops because of some micro-damage, it’s possible to physically get around it. There’s a built-in resilience, if we can only tap into it. That may be the best news of all!

Those three things give me hope. We’re fortunate in that, just as we are living longer and finding ourselves at greater risk to develop dementia, research is discovering how to manipulate our biology to offer some protection.

And that is why I am changing my diet, exercising regularly, improving my sleep hygiene, doing crosswords and jigsaw puzzles, keeping my stress levels low and trying to socialize more.

While I catalog my behavioral changes to protect against dementia, I’ll try not to ignore the cognitive errors that keep cropping up. This week, for example, it became painfully apparent that I have pretty limited visual memory.  

I notice it when I do my daily jigsaw puzzle. I’ll study the picture before starting and describe it to myself verbally: “There’s a blue sky with clouds in the center, then a horizon line of mountains and a wheat field along the bottom, with dark green foliage on the right and light green foliage on the left.”

No sooner do I begin the puzzle, though, than the image of the whole picture disappears. Try as I might, I can’t conjure it up in my mind. I can recall the verbal description, but I can’t see it. Consequently, I match colors and shapes to complete the puzzle without having a sense of what the image is I’m creating. I’m surprised at the end when I see how it all came together!

Once I noticed this was happening, I tested myself by seeing if I could visualize the wall hanging we have of a Renoir painting. Nope. Couldn’t do it. I could clearly see portions of the painting like faces, hands, a hat and a dress, but I couldn’t see the whole thing all at once. There were several large features I didn’t recollect at all…and I’ve been looking at this painting every day for over a month now.

The good news is that I’m pretty sure this is baseline for me and does not represent a recent decline. 

When I was in graduate school, we would take the psychological tests we were learning to administer in order to better understand them. I recall doing well on the verbal portions of the Wechsler Memory Scale, but not so well on the visual tasks where you had to remember the items in a picture or a group of faces. How this plays out at a practical level is that Sally will ask me to describe someone I just met and I won’t be able to tell her the color of the person’s hair or eyes, or pretty much any other feature, for that matter.

I suppose I should keep track of this to see where it goes over the next 30 years.

________________

S1E28. Potholes On Open Highways

It seems fitting that the road on the journey to nowhere should be riddled with potholes. Here are a few that I bounced over during the last few weeks. I’m guessing that you’ve hit a couple of these yourself!

  1. We were getting ready to leave the pool and Sally handed me my t-shirt. I put it on backwards.
  1. We changed pharmacies when we moved, but I keep saying ‘CVS’ instead of ‘RiteAid.’
  1. Sally wanted to attend a ZOOM event that she thought began at 7. I said it was from 5-7 and that she had missed it. It turns out I confused the time of her event with another activity. She was right, but because she listened to me, she missed it.
  1. I was talking with my sister and mentioned that I had attended Bertie’s book club earlier in the day. Startled, she asked, “What???” I repeated that I attended Bertie’s book club. It wasn’t until she asked me a third time that I realized what I was saying. Bertie was my first wife. It was Sally’s book club I had attended. It happened again a week later when I told the pharmacist I was picking up a prescription for my wife. He asked me her name and I said “Roberta Crane.” I was aware of the error even as I was saying it.
  1. In the morning, I start the coffee, take our mugs out of the dishwasher and put the rest of the dishes away. One day I was running late, so I took the mugs out with the intention of emptying the dishwasher after we had had our coffee. You guessed it: I never unloaded the dishwasher.
  1. Why do I make so many mistakes brewing coffee in the morning??? After starting the coffee maker, I retrieve the half-and-half from the refrigerator, measure it into our mugs and then warm it for 30 seconds in the microwave. On Wednesday, though, when I went to the refrigerator, I couldn’t find it. I searched a second time. Then I asked Sally if she had finished it when she made her second cup the day before. She hadn’t. I went back into the kitchen and immediately saw it sitting on the counter. Apparently, I had taken it out of the refrigerator at the beginning of my coffee-making routine instead of at the end…and totally forgotten I had done so in the interim.
  1. This one happens a lot: I ask Sally about something and she’ll say, “Don’t you remember when we…” and then I immediately remember it. It seems my recognition works but my recall memory shorts out on a regular basis.

Thankfully, my life isn’t all potholes. Sometimes it’s more like cruising on an open highway. Sometimes there are bursts of creativity. Sometimes it’s a matter of deep concentration on a task and doing it correctly. Sometimes it’s just figuring stuff out. To whit:

  1. I ordered a 71″x74″ shower curtain printed with the image of Renoir’s ‘Dance at Bougival.’  Neither Sallly nor I liked it in the bathroom…but we both love the image. Two days later, it occurred to me that it might work over the couch in the living room where we have a twenty-foot ceiling. Wow…just stunning…thereby confirming the old saw that there’s a fine line between creativity and insanity!
  1. When we moved, we made the decision to keep our LPs and 45s and try to hook up the old turntable I’d been carting around since the 70s. Getting it to work set off a furious flurry of overnight orders from Amazon: amplifier, pre-amp, speakers, speaker wire, adapters, and more adapters. But that was only the beginning. Then came the task of connecting all our electronics: smart tv, amp, turntable, dvd player and dual headphones. It generated a rat’s nest of tangled wires, but everything works. As I write this, I’m still waiting for delivery of a pair of bluetooth speakers.
  1. Once I had the electronics figured out, we needed a tv stand to house everything. Sally ordered one from Amazon and it fell to me to assemble it. I approached the task with great trepidation as I have never been able to make sense of do-it-yourself assembly instructions, no matter how well written and illustrated. I invariably put something in backwards or upside down, or use the wrong size screws. But this time was different. Everything I saw before me made sense and I had every confidence in what I was doing as I worked slowly and double-checked the diagram before proceeding to the next step. Two and a half hours later and voila: picture perfect assembly on the first try!

And so the journey continues…

__________________

S1E24. Scary & Scarier

Sally’s question hit me like a ton of bricks:

“When did you decide not to put cinnamon in the coffee anymore?”

I was too stunned to answer her.

Just a week earlier, I had posted a blog about making coffee and had spent a lot of time thinking about my brewing routine. In all that time, not once did the idea of putting cinnamon in with the ground coffee cross my mind. Not once.

Although that had been my routine for at least a year prior to posting the blog, it had been completely beyond my capacity for recall. It was locked in a room somewhere in my brain, emerging only after Sally’s question opened the door that facilitated its escape.

This wasn’t just simple momentary forgetting that yields to a few minutes of concentrated effort (or walking away from it and having it pop into your head an hour later). This was gone. It was the first time it had ever happened to me and it was scary.

Looking back, I have an idea about when it happened. During our recent move, there was a period of about 3 weeks when the coffee maker had been packed up and moved to the new apartment but we were still living back at the old house. Since I couldn’t brew our own coffee, we went out each morning to get our daily fix. When we did finally move into the apartment and unpack, I began brewing coffee again…but without the cinnamon.

It appears that, my routine having been broken, my brain unpacked my decades-long routine of making coffee instead of the more recent cinnamon-laced version.

This past Saturday morning, I put the cinnamon out with the other coffee paraphernalia and installed the 2.0 version of my personal coffee brewing app.

As for Sally’s question, she finally got the answer when she read this draft.  

As upsetting as that experience was, it got worse, because it happened again.

I bought this MacBook Pro about a year ago and was tickled to discover that it had a fingerprint recognition security feature called ‘Touch ID.’ Instead of typing in my password, I merely press a key with my right pointer finger and voila…I’m in! A related feature allows the computer to remember my user name and password for various sites and lets me use Touch ID to automatically enter all that information. Each time I use it, I hear Louis Armstrong singing: “And I say to myself, what a wonderful world!”

Of late, though, I found myself getting irritated because I was constantly typing in my computer’s password in order to access the auto-fill feature for user names and passwords. Somewhere along the way, I had completely forgotten about the Touch ID option. Thankfully, when I updated my operating system this week, a window popped up asking me to enter my computer’s password in order to activate the fingerprint ID feature. That prompt was all I needed to get back on track.

But why did I need that reminder? Why was I unable to recall that option on my own? Unlike the coffee episode, I was never separated from my computer, so that shoots down my hiatus theory of forgetting. 

Although I am once again appreciative of the fact that I can let my fingerprint do the typing for me, I’m having a hard time putting a positive spin on this. My best guess is that it’s not part of normal aging.

______________________

S1E22. Making Coffee Isn’t Hard…Is It?

One of the first lessons I learned when we opened our B&B on the 4th of July weekend in 1986 was that the coffee had to be good. It was a guest’s first culinary impression of the quality of our food and set expectations for the breakfast to follow.

I spent a good deal of time researching how to make good coffee, experimenting with various beans and brewing methods. I settled on dark French Roast beans that I grind fresh every morning. I learned that the strength of the coffee is determined by the amount of beans used, how long you grind them (grind them long enough and you get espresso!), and the volume of water you brew.

I buy my beans in a 5 pound bag, fill an air-tight glass container for use over the course of the next week or two, then put the rest in the freezer to preserve their flavor.

For 35 years now, my routine has been pretty much the same. I fill my coffee grinder with beans and then grind them for 15 seconds. Then I place a paper filter in the brewing basket and pour the ground beans into the basket, being oh so careful not to spill a speck. Next, from the tap, I fill the coffee maker’s carafe to the 8 cup line (which is really only 6 ½ cups), pour the water into the reservoir, set the empty carafe on the hot plate, press the ‘brew’ switch and wait.

It’s neither rocket science nor brain surgery nor difficult, yet this week, I found a way to screw it up.

Here in our new apartment, we noticed more chlorine in the water than we are used to, so we bought a Brita water filter to restore the taste. That introduced a very minor wrinkle into my coffee-making routine. Instead of filling the carafe from the tap, I take the Brita out of the refrigerator and use it to fill the carafe, returning it to the refrigerator before I continue making the coffee.

I went through my routine this past Monday morning, but to my disbelieving eyes, when I went to pour our coffee, the water was clear…not coffee at all!

I was baffled. How did the water pass through the ground beans and still remain clear? The ‘brew’ light was on, so I know I started the process. I lifted the lid to confirm the beans were there, and they were. I touched them and they were bone dry. I looked inside the reservoir to see if there was any possible alternative route for the water to travel. There was none.

Then I noticed that the water in the carafe was not hot. And I recalled that I had not heard the coffee maker percolating while it brewed, nor the gurgling, sputtering and steaming exhaust when it completed its cycle. Most importantly of all, I hadn’t smelled the glorious aroma of freshly brewing coffee.

And then it hit me:

“DOH! I never poured the water into the reservoir!” 

I had filled the carafe from the Brita and put it down on the counter while I returned the Brita to the refrigerator. That one distraction was enough to sabotage my routine. When I returned to the counter, I picked up the carafe and just set it on the hot plate, forgetting to first pour its contents into the reservoir.

Mystery solved. Explaining what happened to Sally and feeling incredibly foolish wasn’t the worst of it, though. I’m really bothered, not so much by my forgetting to pour the water into the reservoir, but by my thought process when I discovered the water was clear.

The second I saw that the coffee hadn’t brewed, my immediate reaction should have been, “Shit! I forgot to pour the water into the reservoir.” But it wasn’t. I had ignored clues (no aroma and no percolating sounds) that should have made things instantly obvious. Instead, I wrongly assumed that the fault rested with the coffee maker. That’s the bigger error here: assuming I am right and the world is wrong. It didn’t get me into trouble this time, but this kind of thinking is an accident waiting to happen.

On the brighter side, my sleuthing to discover what caused the failure was pretty well-organized and I did accept responsibility once the evidence identified me as the culprit.

Post script: Once the coffee was finally made, Sally and I thoroughly enjoyed it!

S1E20. Dear Diary…

Each week I wait for something to happen that will become the focus of my post on Friday. I pass on any number of smaller mistakes while I wait for something ‘big’ to happen. It occurred to me that perhaps those little errors deserve their time on stage, too, and so this week I tried to track the ‘little’ things.

Wednesday

This falls into the “can’t walk and chew gum at the same time” category.

I was on my way out the door to get our morning coffee when Sally handed me a cardboard carrier for the cups. I thanked her but hesitated before going out the back door to the car. I knew it  was already warm outside and so I decided to take off my quilted shirt and just wear my t-shirt.

Having left the shirt on the bench next to the back door, I continued to the car, got in, started the engine, and was on my way before I realized that I didn’t have the cardboard carrier with me. I did a u-turn at the stop sign a block from my house and scanned the road as I retraced my route, thinking perhaps I had left it on the roof when I got into the car and it had fallen off.

Nope. And it wasn’t in the driveway, either. I went back into the kitchen and saw it on the counter above the bench where I had left my quilted shirt. Obviously, I had put it there to take off the shirt and forgotten to pick it up again as I left.

Thursday

We are scheduled to move into our new apartment next Wednesday the 26th (see December 12 ‘Happy Box’ here https://tinyurl.com/jwz43sjk) and so I shopped on Amazon to find a non-slip bathtub/shower mat. I found two that Sally might like and emailed her the links so she could pick one. We talked about it for a few minutes and decided on the light gray pebble pattern.

After doing a few other things around the house, I returned to my computer and placed the order. It was less than a minute after I received the confirmation email that I realized I had forgotten to change the item in my cart from ‘dark gray’ to ‘light gray’ as Sally had wanted.  Fortunately, I was able to cancel the original order and get it right the second time around.

Friday

I have no sense of direction and I marvel at those who do. The invention of GPS changed my life for the better.

For me, it’s not a question of finding my way out of a paper bag, but more importantly of learning how to get from point A to point B in our new apartment building.

From the main office, you go down a long hall to reach an elevator. Take it to the 4th floor and our apartment is across the hall and a little to the left. Couldn’t be simpler, right?

When I visualize the location of the elevator on the ground level, I see it on the right-hand side because that is how I approached it when I first learned its location. But when I visualize the elevator on the 4th floor, I see it on the left, probably because it is on my left as I exit the elevator to open the door to our apartment on the right. Try as I might, it doesn’t make any sense to me at all when I try to reverse the 4th floor image in my mind. It just feels wrong.

Clearly, north and south have no meaning for me. It’s all about right and left…and that seems to be determined by my first impressions.

If I want to go from our apartment to the mail room, I need to take that elevator (which is easy enough to find!) and walk down the hall towards the office. If I visualize the ground floor elevator on the right, I will turn left when the door opens and reach my destination. If I visualize the elevator on the 4th floor, though, with the elevator on the left, I will turn right when I reach the ground floor and never reach my destination.

Can you guess which way I turned this morning?

Saturday

Sally: “At some point, I want to put these yard signs in my car so I can return them.”

Me (picking up the signs): “Do you have your keys? We can do it now.”

Sally: “Yes…but that’s not my car.”

Sally’s car is a blue. The car parked in front of us was silver. My car is silver but doesn’t look anything like this one.

I have no clue what made me think I was looking at Sally’s car.

Sunday

We’re moving from the house to the new apartment on Wednesday, so I went over today to install the new bidet we ordered. I got a little past the stop sign a block from our house when I realized I had forgotten to bring the screwdriver and pliers I needed, so I turned around and got them.

I took my time with the installation and only made one mistake when I put 2 holding brackets in upside down…but, seriously, you couldn’t tell it was supposed to be that way from the diagram.

I gathered a variety of things I was taking back to the house, went down the elevator, put them in the back seat…and realized I had forgotten my mask. So I went back up, got the mask, and headed home.

Seven miles later and halfway home, I realized I forgot to take the screwdriver and pliers.  😦

Monday

Well, this is embarrassing. 

We’re moving in two days and most of our stuff is already packed up or at the new apartment. As a result, I’ve been doing almost no cooking here at the house. We eat out a lot and I warm leftovers in a skillet.

This morning I found half a bagel and egg sandwich in the refrigerator. I thought about warming it up in the skillet, but that didn’t seem like it would work, and so I ate it cold…just before realizing that I could have put it in the toaster oven. DOH!

Tuesday

Tomorrow is moving day. We spent the morning at the apartment then came home for dinner and a high school lacrosse game.

I racked up errors throughout the day, turning the wrong way at the apartment, giving wrong answers to Sally’s questions and then realizing a minute later why they were wrong, and generally being irritable.

Welcome to Wayne’s world!

________________

You can join me on the journey to nowhere by providing your email address below. Once you do, you’ll receive each week’s post in your inbox every Friday morning at no cost or obligation. Thanks for being interested!

Wayne