Stop drinking, keep reading, look after your hearing: a neurologists tips for fighting memory los

When does forgetfulness become something more serious? And how can we delay or even prevent that change? We talk to brain expert Richard Restak

You walk into a room, but can’t remember what you came in for. Or you bump into an old acquaintance at work, and forget their name. Most of us have had momentary memory lapses like this, but in middle age they can start to feel more ominous. Do they make us look unprofessional, or past it? Could this even be a sign of impending dementia? The good news for the increasingly forgetful, however, is that not only can memory be improved with practice, but that it looks increasingly as if some cases of Alzheimer’s may be preventable too.

Neuroscientist Dr Richard Restak is a past president of the American Neuropsychiatric Association, who has lectured on the brain and behaviour everywhere from the Pentagon to Nasa, and written more than 20 books on the human brain. His latest, The Complete Guide to Memory: The Science of Strengthening Your Mind, homes in on the great unspoken fear that every time you can’t remember where you put your reading glasses, it’s a sign of impending doom. “In America today,” he writes “anyone over 50 lives in dread of the big A.” Memory lapses are, he writes, the single most common complaint over-55s raise with their doctors, even though much of what they describe turns out to be nothing to worry about.

Coming out of a shop and not being able to remember where you left the car, for example, is perfectly normal: it’s likely you just weren’t concentrating when you parked, and therefore the car’s location wasn’t properly encoded in your brain. Forgetting what you came into a room for is probably just a sign you’re busy and preoccupied with other things, says Restak.

“Samuel Johnson said that the art of memory is the art of attention,” he says, down the line from his office in Washington DC (at 80, Restak is still a practising clinical professor at George Washington Hospital University School of Medicine and Health). “Most of these sins of ‘memory loss’ are sins of not paying attention. If you’re at a party and you’re not really listening to someone, because you are still thinking about some work-related matter, suddenly later you find you can’t remember their name. The first thing is you put the information in memory – that’s consolidating it – and then you have to be able to retrieve it. But if you’ve never consolidated it in the first place, it doesn’t exist.”

But what if you forget where you left your car keys, and eventually find them inside the fridge? “That’s often the first sign of something serious – you open up the refrigerator door, and it’s the newspaper, or your car keys, inside. That’s a little bit beyond forgetful.”

Memory does vary, he points out, and some people will always have been scatty. But the real red flag is a change that seems out of character. If you’re a keen card player who prides yourself on always keeping track of which cards have been played, and suddenly realise you can’t do that any more, it could be worth investigating. Similarly, Restak has noticed that many patients in the early stages of dementia stop reading fiction, because it’s too difficult to remember what the character said or did a few chapters earlier – which is unfortunate, he says, because reading complex novels can be a valuable mental workout in itself.

Restak and his wife are currently on Alexandre Dumas’s The Count of Monte Cristo, which has a complex sprawling cast: “It’s an exercise in being able to keep track of characters without going backwards from one page to another.” If that’s already difficult for you, he says, it’s fine to underline the first mention of a new character and then flip back to remind yourself later if necessary. “Do whatever you have to, to keep yourself reading.”

Like following a recipe, keeping track of fictional plots is an exercise of working memory – as distinct from short-term memory (temporarily storing something like a phone number that you can safely forget the minute you’ve dialed it) or episodic memory, which covers things like recollections of childhood. Working memory is what we use to “work with the information we have”, says Restak, and it’s the one we should all prioritise. Left to its own devices, he points out, memory naturally starts to decline from your 30s onwards, which is why he advocates practising it daily.

Restak’s book is full of games, tricks and ideas for honing recall, often involving creating vivid visual images for things you want to remember. He holds a mental map of his neighbourhood in his head, incorporating visually familiar landmarks – his house, the local library, a restaurant he often goes to – and for each item on a list he wants to remember, he will create a memorable visual image and attach it somewhere specific on the map. To remember to buy milk, bread and coffee later, for example, he might envisage his house transformed into a carton of milk, the library full of loaves rather than books, and a giant cup of coffee spilling out of the restaurant.

The book also touches on broader lifestyle advice. Recently, research from the Lancet’s commission on dementia suggested up to 40%of Alzheimer’s cases could be prevented or delayed – much like heart disease and many cancers – by limiting 12 risk factors, from smoking to obesity and heavy drinking.

Restak advises his patients to quit alcohol by 70 at the latest. Over 65, he writes, you typically have fewer brain neurons than when you were younger, so why risk them? “Alcohol is a very, very weak neurotoxin – it’s not good for nerve cells.”

He’s also an advocate of the short afternoon nap, since getting enough sleep helps brain function (which may help explain why sleep-deprived new mothers, and menopausal women suffering from night sweats and insomnia, often complain of brain fog).

More unexpectedly, he recommends tackling hearing or vision problems promptly, because they make it harder to engage in conversations and hobbies that keep the cogs turning. “You have to have a certain level of vision to read comfortably, and if that’s missing then you are going to read less. As a result of that, you’re going to learn less and be a less interesting person to other people. All of these things really come down to socialisation, which is the most important part of keeping away Alzheimer’s and dementia, and keeping your memory.”

Is he saying that honing your memory can stop you getting Alzheimer’s? “No one can guarantee that anybody else is not going to get dementia. Take somebody like Iris Murdoch (the late writer, who suffered from it) – there’s probably not a more brilliant woman in all of Europe, so it shows that it can happen. But I compare it to driving a car: you can’t guarantee you won’t get in an accident but by wearing your seatbelt and checking your speed and keeping the car maintained, you can lessen your chances.”

Not all memories, however, are ones people want to treasure. Many have mental images they’d rather forget, whether it’s of an embarrassing mistake or a painful failed relationship, or intrusive flashbacks from post-traumatic stress disorder.

The fantasy of wiping the slate clean is a pervasive one in popular culture, from the film Eternal Sunshine of the Spotless Mind (about a couple who break up, and use a futuristic machine to zap memories of each other) to the Men in Black franchise, where alien-fighting secret agents electronically erase the memories of anyone who sees them in action, thus protecting mere mortals from the truth about what’s out there.

These may be strictly fantasies but we already have the technology, Restak suggests, to inhibit people from laying down memories that might in future haunt them. Beta blockers, drugs sometimes used to treat high blood pressure, have been found to dull the emotional response triggered when something frightening is recalled, but Restak says there’s evidence they also interfere with the consolidation of events as memories.

“There are actually discussions about whether these drugs should be part of the armoury that would be used if we have got to send people into terrible scenarios, such as after a shooting – that must be a horrible experience, to go in there and clean these places up.” But it’s a blunt tool – the drugs can’t distinguish between memories that might be useful in future to emergency first responders, and ones that are simply distressing – and raises complex questions about the ethics of tampering with people’s minds.

Restak also highlights concerns about what he calls “memory wars”, or attempts to influence a nation’s collective memory by disputing what a particular event or period means. “The way we frame it in our memory is how we then perceive the world around us, and that’s what is encoded in the memory,” he says, pointing to recent political arguments in the US over whether the technical recession the country has entered – defined as two quarters of economic contraction – is actually a “real” recession. “It’s important because if you think you are in a recession you have certain beliefs and modes of action, and that’s how we are going to remember July 2022.”

And, as he argues, memory is intrinsic to who we are. It binds families and couples together, as we reminisce about our shared past. For individuals, meanwhile, past experience gives life meaning and texture. “We are what we can remember. The more things you can remember, the more clearly, the more full and enriched our personalities,” says Restak, who argues that the personalities of dementia sufferers can become flatter and more attenuated. “People say ‘Oh, they don’t seem to be the same person.’” Perhaps that’s why we fear Alzheimer’s so much: memory is so closely allied to a sense of self.

Yet even after memory loss has set in, it’s not necessarily too late to help people hold on to whatever’s left. One neurologist Restak knows had two patients who “weren’t sure where they were or what day it was”, but could still play a decent game of bridge. If someone you love has Alzheimer’s, Restak says, don’t upset them by constantly challenging mistakes or memory lapses; instead, meet them where they are now.

“What are they still interested in? Talk about that, work with that, because a lot of things stay within normal range even with a pattern of dementia,” he says. “You don’t just look on it as a hopeless situation, although it’s a very frustrating one and it’s very sad.” Where a flicker of memory remains, perhaps, there’s hope.

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