Garth Rattray | “I cannot recall”

When then government minister Dwight Nelson (God rest his soul) repeatedly said, “I cannot recall” during the probing and intensive 2011 Manatt-Dudus Enquiry into the events leading up to the extradition request for Christopher (Dudus) Coke and the engagement of the US lobbying firm Manatt, Phelps & Phillips, some citizens wondered if he was sincerely experiencing memory issues. However, most were convinced that he was feigning a failing memory to avoid responding to extremely sensitive issues.

Because of this, the phrase “I cannot recall” became very popular for several reasons, not the least of which was the genuine concern that we all have if we find it difficult to recall names, tasks, locations and/or events. As we get older, we increasingly ask ourselves the scary question: Is this dementia? The reassuring answer is that forgetfulness does not automatically mean dementia.

In fact, occasional lapses in memory occur at every age. Stress, fatigue, poor sleep, anxiety and distraction can all interfere with our ability to remember. Sometimes the problem is not that a memory has disappeared, but that the information was never properly stored in the first place because we were not paying sufficient attention.

Very simply put, for memory to become embedded, several things must occur. We must focus on the thing that we want to remember, and our brains will register it in short-term (working) memory. After that, we must repeat it and associate it with things that we already know. Then our brains will retain (embed) it so that we can recall it.

The problem is distraction. When distracted, if we put down keys, we may later have absolutely no memory of where we placed them. The memory did not necessarily “fail”; the brain may simply have been occupied with something else when the keys were put down.

Age can also affect the speed with which we retrieve information. An older person may take longer to remember a name or find the right word but eventually remember it. That, by itself, is not dementia. Dementia is something more serious.

The World Health Organization describes dementia as a syndrome involving deterioration in memory and other cognitive abilities sufficiently severe to affect a person’s ability to function. It is not a normal or inevitable part of growing older. Dementia may affect memory, but also reasoning, language, judgement, orientation, behaviour and the ability to carry out familiar everyday activities. Dementia is an umbrella term covering several conditions.

Alzheimer’s disease is the most common cause, accounting for an estimated 60 to 70 per cent of cases. Early symptoms commonly include difficulty remembering recently learned information, repeated questions and increasing difficulty managing everyday tasks.

Vascular dementia results from damage to the brain’s blood vessels or interruptions in blood flow, sometimes after strokes. Its symptoms can vary depending on the areas of the brain affected and may include difficulties with planning, judgement and attention.

Dementia with Lewy bodies is associated with abnormal deposits of a protein called alpha-synuclein. In addition to cognitive problems, people may experience fluctuations in alertness, visual hallucinations and Parkinson-like movement difficulties.

Then there is frontotemporal dementia, which affects the frontal and temporal areas of the brain. It can initially produce striking changes in personality, behaviour or language. Memory loss may not necessarily be the first or most obvious symptom. Sadly, it is not unusual to have mixed forms of dementia.

It is usually not alarming to forget an appointment and remember it later, occasionally struggle to find a word (or name), or misplace something and eventually locate it. However, repeatedly asking the same questions, becoming lost in familiar surroundings, being unable to follow familiar directions, losing track of dates and time, having increasing difficulty managing money or medication, or experiencing problems with language, judgement or everyday tasks that were previously routine warrant attention.

Changes in personality and behaviour are important; behavioural changes deserve medical intervention.

Depression and anxiety can affect concentration and memory. So can poor sleep and sleep disorders. Certain medications may interfere with thinking. Problems involving the thyroid, liver or kidneys, vitamin B12 deficiency, head injuries and other medical conditions can also affect memory and mimic dementia.

It is important to keep physically active. Sleep properly. Challenge your brain by learning something new. Read. Write. Take up a hobby. Stay socially connected. Conversation and meaningful relationships exercise the mind and may help protect against the effects of isolation and loneliness. Mental activity is not a magic shield against dementia, but keeping the mind engaged is part of healthy ageing.

Control medical risk factors. High blood pressure, diabetes and other chronic illnesses should be properly controlled. Hearing and vision problems should not be ignored because they are hard-wired into our brain circuitry and, without their stimulation, we will deteriorate mentally.

And, perhaps most practically, use memory aids without embarrassment. Calendars, notebooks, telephone reminders and routines are not signs of intellectual weakness. They are tools. Although cellular telephones have replaced many mental tasks that we used to do for ourselves, they can be useful in this regard.

So, the next time you forget a name or misplace your phone, resist the temptation to panic. Do not immediately assume that dementia is knocking at the door.

If memory fails you, ask yourself: Is this recent? Is this occasional? Am I tired? Am I stressed? Have I been sleeping properly? Is this interfering with my ability to live my normal life? If you are still concerned, seek medical help.

Garth Rattray is a medical doctor with a family practice and author of The Long and Short of Thick and Thin. Send feedback to columns@gleanerjm.com and garthrattray@gmail.com.