You're never too old.
Reviewed By Gary Vogin
For as long as house designer Mary Dulude can remember, she's been forgetful. Getting organized was as elusive as nailing Jell-O to a bulletin board.
She would arrive for a client meeting without the necessary paperwork. Walk away from a restaurant oblivious that she'd left her purse dangling over her chair. Lock herself out of the house not once, not twice, but five consecutive times.
Then there were those dreaded trips to the supermarket. She'd either neglect to make a list or lose it, and frantically roam the aisles unable to recall what she needed.
"My memory problems tended to revolve around errands," says Dulude, 57. "I felt just like those pictures you see after an airline crash -- I was treading water in the ocean, and all the things I needed to remember were like debris floating around me."
Then Dulude encountered Memory 101, a service at Beth Israel Deaconess Medical Center, a teaching hospital affiliated with Harvard Medical School. There, researchers custom-make solutions to maximize memory for people of all ages. Their key tool? An 8-by-10 memory notebook in which clients can carefully write everything they need to do each day, the amount of time it will take, and even post pictures and details about friends and grandchildren.
The seemingly simple technique has attracted some big-time attention -- it was featured in the summer 2000 issue of the Journal of Geriatric Psychiatry. And while there's no proof yet that memory notebooks help everybody, studies have shown they can relieve forgetfulness in patients recovering from severe head injuries.
"We were seeing people who had memory deficits and feelings of incompetence, and we had nobody to refer them to, no way of really helping them," said clinical neuropsychologist Cheryl Weinstein, PhD, who helped develop the program several years ago.
Since then, the program has worked with patients who have learning disorders, head injuries, dementia, bipolar disorder, or the garden-variety absentmindedness that often comes with older age. Its potential benefits are huge: Some 80% of people older than 35 complain they have lost some of their ability to remember things and to concentrate, according to a 1997 survey by the company Bruskin/Goldring Research. Given that the average American leads a life more frenetic than a pinball game, both the program's directors and its patients agree that Memory 101's techniques could be helpful to virtually everyone.
"Have you noticed that our society expects the woman of the family to be the glue that holds everyone's schedule together?" asks Dulude, a mother of two who was just diagnosed with attention deficit disorder. "I was extremely bad at that. I needed some glue just to hold myself together!"
To begin, Memory 101 specialists do an exhaustive workup and interview -- even collecting old school records if possible -- and administer a battery of tests to pinpoint where memory function jumps the tracks. Deep within our brains, memories are sorted in a section of the brain called the hippocampus, which acts as a gatekeeper, deciding whether data is significant enough to pass into long-term memory. Important memories are filed away in the cerebral cortex, the outer layer of the brain where a vine-like thicket of billions of nerve cells communicate via electrical and chemical impulses to retain information. Less important thoughts -- a chore you have to do today but will never think of again -- are filed into working memory, used, and then jettisoned.
Researchers believe that sometimes memories fail because the information never gets properly encoded by the hippocampus. Sometimes memories aren't filed properly. And sometimes the breakdown comes when the patient tries to retrieve the memory. When Memory 101 specialists nail down the problem, they have determined whether the patient suffers a true "memory disorder" -- an impairment such as that caused by Alzheimer's -- or a "memory complaint" such as forgetfulness, caused by a disorganized life.
Next, the prescribed remedy: Repeat and write it down. Memory 101's recommendations spring from a foundation of research (done at Harvard, Brown, the University of California at Los Angeles, and elsewhere) showing that repetition, reinforced by writing information down, is critical to a robust recall. For instance, a study in the July 1998 issue of Nature Neuroscience reported that teaching a skill repetitively strengthens horizontal connections in the brain's cortex, where the circuitry of long-term memory operates. Another study in the November 1999 issue of the Journal of Gerontology found that note-taking and repetition boost memory.
Neuropsychologist Winifred Sachs, EdD, co-creator of Memory 101, discovered the notebook idea after her mother suffered damaging strokes. She and her mother started a diary, of sorts, to serve as headquarters for all kinds of information about her life and her treatment -- a notebook her mother could check every day, and a place for doctors, caregivers, and relatives to swap data about her care.
"I was amazed at the difference it made for my mother,'' says Sachs. "And I've watched it help a lot of other people with different kinds of memory deficits.''
When Dulude first looked into Memory 101, she was skeptical: "I'd tried planners and calendars, but I always got impatient with them." Sachs persuaded her to try again, and so she did, constructing a "memory notebook" in a book already decorated with Renaissance paintings that appealed to her as an art aficionado. Most memory notebooks have organizing tabs, a calendar section, and an address book, but each person customizes the notebook with the help of a psychologist based on his or her own lifestyle and personality.
With Sachs' guidance, she transferred personal, medical, and miscellaneous information into the book and also used it to store the particulars she might need for the immediate future: birthdays or addresses, directions to an appointment, or instructions for programming the VCR. She began using it to plan her days hour by hour -- not merely noting, say, her doctor's appointment but boxing off the time it would take to get there, park, talk with the doctor, and return home.
"The night before, if I take five minutes to visualize my day with my book, I can prioritize in my mind," says Dulude. "It becomes like a piece of art I help create and then can see in my mind's eye all day long.''
She also learned to tighten her focus by talking aloud to herself. "Dr. Sachs taught me to ask myself as I'm going out the door, 'Do I have my coat? Yes. My gloves? Yes. Where am I putting my gloves? I'm putting them in my purse now.'
"I may be able to think of 10 things at the same time, but I certainly can't talk about 10 things at the same time. Talking forces me to slow down."
Occasionally Memory 101 specialists urge dramatic changes. One patient had a hard time remembering what he had read or heard. Yet he planned to become a social worker. "He'd picked a profession that's going to tap into his weakness,'' says Weinstein. "This kid has great visual-spatial ability. We said maybe doing physical rehab work with patients would be a better fit."
In Dulude's case, Weinstein told her she needed "structure, structure, structure" -- exactly the opposite of her work as a house designer, in which she must adapt her hours and her style to each client. Sometimes hiring a secretary or personal assistant will do the trick. But Dulude says at her age, neither a career change nor a secretary are practical.
Luckily, Memory 101's techniques seem to be working. "Before, I would flounder all week never accomplishing anything, and try to play catch-up by working odd hours and weekends," Dulude says.
"Now that I've started keeping my memory notebook, I find I can easily schedule in a couple of hours to relax and do gardening or whatever. I'm allowing myself free time for the first time. And I'm not so grouchy anymore."
Vicki Haddock is a reporter for The San Francisco Examiner who writes about health and family frequently for WebMD. She lives in Petaluma, Calif.
Originally published Oct. 9, 2000.
Updated and medically reviewed by Gary D. Vogin, MD, on Feb. 27, 2002.
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