Separating Forgetfulness and Disease
A new book explores the difference between normal forgetting and loss of self.
By Greg O’Brien
“I could while away the hours, conferrin' with the flowers
Consultin' with the rain….
And my head I'd be scratchin' while
my thoughts were busy hatchin'
If I only had a brain….”
—Yip Harburg, lyrics, "If I only had a brain," Wizard of Oz, 1939
While we all have a brain, one not made of straw, memory itself can be deceptive.
“While memory is king, it is also a bit of a dunce,” says close friend Lisa Genova, Harvard-educated neuroscientist, author of yet another New York Times Bestseller, Remember: The Science of Remembering and The Art of Forgetting, published through Penguin Random House.
“Often,” she adds, “you can’t remember what you had for lunch on Tuesday, but in the long term you can remember the details of a family vacation… Memory is selective.”
Hold that thought…
“Your brain is amazing,” Genova writes in her introduction. “Every day, it performs a myriad of miracles—it sees, hears, tastes, smells, and senses touch. It also feels pain, pleasure, temperature, stress and a wide range of emotions… Memory allows you to have a sense of who you are and who you’ve been. If you’ve witnessed someone stripped bare of his or her personal history by Alzheimer’s disease, you know first-hand how essential memory is to the experience of being human.”
And that’s the rub with memory: the difference between normal forgetting and loss of self, the disparity between distractions and falling off a steep cliff in slow motion.
Genova, author of the New York Times Best-Selling Still Alice, draws distinction between the two, one that offers solace to those who can’t find keys or forgetting why they walked into a room. There’s a distinct difference between forgetting where you put your car keys – and not knowing what the keys are for. There’s a manifest difference between forgetting where you parked your car – and not knowing you have a car.
I know that difference…
Over the years, Alzheimer’s has taken several close family members, including my maternal grandfather and my mother. Now the disease has come for me—slowly but surely.
Case in point: Several years ago, when I was still driving, I took our trash to the Brewster landfill on Outer Cape Cod in my four-door, bright yellow Jeep Wrangler. After discarding the trash and recycling, I was confused about how to get home. I thought in the moment that I could call my wife for a ride, my kids, or look around for friends at the dump. I was working myself into a panic. Yet, my bright yellow jeep was directly in front of me, but in the moment, my brain would not tell me that it was my car. It wasn’t until a friend, discerning my anxiety, pointed it out.
The most disturbing symptoms in my private darkness are the visual misperceptions, the playful but sometimes disturbing hallucinations—seeing, hearing, smelling, tasting, and feeling things that aren’t there, as my mother once did. There was a time in Boston, after a late business meeting, when I retrieved my car on the third floor of a parking garage near Boston City Hall only to find that a thick, grated metal wall had been pulled down to block my path. I feared I was locked in for the night. Walking toward the obstruction, the wall suddenly disappeared. It wasn’t real.
Months later, I was driving back to Cape Cod from a night meeting outside Boston, a route as familiar to me as a Red Sox collapse in late season. I was lost heading home, but my brain kept telling me to keep driving. So I did, driving south, not east to Cape Cod. Finally, at about 1:45 a.m. I saw a sign for Providence, Rhode Island, which is about an hour south of Boston and an hour and a half from the Cape. My brain in the moment was telling me to drive home, but home to 25 Brookdale Place, in Rye, New York, outside Manhattan where I grew up. I changed course and arrived terrified back in Brewster at about 3:30 a.m.
Doctors don’t permit me to drive now, and the Massachusetts Department of Motor Vehicles has revoked my driver’s license. And that’s a good thing. Alzheimer’s is not a part of normal aging.
The brilliance of Lisa’s book, Remember, is separating forgetfulness from disease. She does so with great illumination, but with a spotlight about brain health. While she advises others to “give yourself a break when you can’t remember,” the neuroscientist in her urges brain health—protect your brain in all circumstances to combat, where possible, the demons that prowl.
“Your hippocampus is necessary for the formation of any new memories that you can later consciously retrieve,” Genova writes. “If your hippocampus is damaged, your ability to create new memories will be impaired. Alzheimer’s disease begins its rampage in the hippocampus. As a result, the first symptoms of this disease are typically forgetting what happened early today, or what someone said a few minutes ago and repeating the same story over and over again.”
So what if your hippocampus is healthy? "You want to keep it that way for as long as possible," Genova says.
To foster that, Genova adds, one must work hard to get adequate sleep, handle stress, interact with others, exercise, learn new things, and proper diet—the “SHIELD” strategy to protect your brain, as promoted by Genova’s good friend Dr. Rudy Tanzi of Harvard and MassGeneral Hospital, and a world-leading Alzheimer’s expert and chief researcher at the Cure Alzheimer’s Fund.
“Sleep helps consolidate new memories, and insufficient sleep interferes with consolidation,” Genova says. And unmanaged stress, she adds, can be a flame thrower for cognitive decline. “Plenty of scientific evidence demonstrates that relentless, unmanaged stress is toxic for your body and brain.”
But evidence is strong, Genova notes, that people can reduce risks with proper brain health as they age. Genova is an advocate with UsAgainstAlzheimer’s, who recently launched BrainGuide, a new platform that can help millions of Americans who worry about memory or brain health find their way to helpful resources and a path forward. Along with current and former care partners, UsAgainstAlzheimer's has formed a brain health partnership to promote brain health and created the A-LIST, an online research community of people with, or at risk, for Alzheimer’s disease, other dementias, and Mild Cognitive Impairment.
“Most of what we forget is not a failure of character, a symptom of disease, or even a reasonable cause for fear—places most of us tend to go when memory fails us,” writes Genova. “We feel worried, embarrassed, or plain scared every time we forget something we believe we should remember, or would have remembered, back when we were younger. We hold on to the assumption that memory will weaken with age, betray us, and eventually leave us.”
All the more reason for proper brain health and building up a cognitive reserve.
Please don’t forget that…