Something happened to my memory…
K. UMANSKY, MD (Denver, USA)
"Science and Life" No. 9-2008
Is it possible to keep a good memory until old age? Professor K. G. Umansky talks about the causes leading to its deterioration, and, in particular, about Alzheimer's disease.
Often, especially from elderly people, you can hear: "I forgot again. Damn sclerosis!" Those who are younger usually say this in jest. Older people tend to be concerned about their forgetfulness. Where will you go!
Is memory deterioration an inevitable process? And what is sclerosis?
Who knows that over time the vessels undergo age-related changes. And not only the vessels of the brain, but also all other organs and tissues: their walls become rigid, lose elasticity. These changes are called sclerotic. However, none of us comes to mind to make such a diagnosis as vascular sclerosis of the liver, pancreas or other organs.
Age-related memory disorders in healthy people are often imaginary. They are almost always associated with the appearance of absent-mindedness, a decrease in the ability to concentrate for a long time. Of course, with age, various kinds of disorders may appear due to narrowing of the vessel lumen, or even in the form of small-point hemorrhages in different areas of the brain. The effect of such disorders on memory largely depends on localization. But most often, even such, sometimes quite rough, vascular lesions do not lead to memory impairment. There are many examples of this. Thus, the greatest scientist, the founder of microbiology, the author of the great discoveries of the late XIX century, Louis Pasteur, who lived 73 years filled with continuous creativity, at an early age, due to vascular damage, almost lost an entire hemisphere of the brain. However, his memory and performance did not suffer from this.
I happened to observe a young man with an excellent memory and intelligence who suddenly died from a brain hemorrhage. At the autopsy, it turned out that he had a very rare congenital disease of the cerebral vessels. They looked like fragile, like dry pasta, tubes that broke with a crunch when bent.
Various diseases often lead to a decrease in memory function, not only of the brain, but also of other organs, almost any. Many factors play a role here, due to both metabolic processes and constant preoccupation with some kind of suffering. But there are other memory destroyers. For example, the Israeli biologist M. Aranson in 2001 published research results indicating that hours of watching TV programs impair memory and increase the possibility of dementia. According to him, deafening music can also lead to the same effect.
It is not so rare to find specific diseases accompanied by amnesia – memory loss (from Greek a – denial, mneme – memory), partial or complete, temporary or permanent. I will not dwell on psychogenic conditions and diseases that sometimes lead to such disorders. This is the field of psychiatry, which observes similar disorders in schizophrenia, epilepsy and other diseases of various origins, as well as in some forms of senile dementia.
Amnesia is different in its manifestations. In some cases, a person remembers only what happened before the disease, in others he does not remember anything or partially remembers what preceded the disease, for example, trauma. The latter type of amnesia is called retrograde and is one of the frequent signs that determine the severity of a concussion, for example in a car accident. In other cases, well-known facts and information are distorted in memory. There is another severe type of amnesia, in which the patient suddenly forgets his entire past life and who he is, including passport data. Such conditions can occur after severe physical or mental injuries, intoxication, and even for no apparent reason, when a thorough examination of the brain does not reveal any abnormalities. The mechanism of such pathology is still unknown. Treatment in these cases rarely gives favorable results. But sometimes a spontaneous "enlightenment" suddenly comes, as it were, and the patient remembers almost everything.
There are diseases of a different kind, in which the loss of memory and intelligence is caused by special, specific processes due to systemic lesions of the brain. They are characterized by a condition designated by the generalized concept of "progressive dementia" (from Lat. dementia – madness).
In this, the eighth year of the XXI century, it is useful to look back, especially in the middle of the XIX, the beginning of the XX century, at the turning point of the creative existence of mankind. It was at this time, when the globe was diligently entangled with networks of railways and telephone lines, radio and airplanes, tanks and rapid-fire weapons were invented, people learned about the existence of bacteria, viruses and much more. At the same time, there was a rapid development of medicine, and in particular neuropathology, which improved research methods.
Over the past century and a half, the average life expectancy of a person has increased significantly. Perhaps it is worth dwelling on this in a little more detail.
The life span of a caveman did not exceed 20 years. In ancient Rome, people lived on average a little longer than 25 years. By the middle of the XIX century, the average life expectancy of people, estimated at 80% of the population, reached 37 years. Since then, until our time, in just a century and a half, it has increased in developed countries to 70 years, that is, it has almost doubled. And that is why until the second half of the XIX century, many diseases developing after 45-50 years were practically not observed. Their descriptions cannot be found not only in the great Greek physician Hippocrates, who lived 400 years before our era, but also in the equally great Avicenna, who lived about 1000 years ago, as well as in the European Paracelsus, who lived in the XVI century.
Only since the second half of the XIX century, doctors began to identify diseases that appear mainly in the elderly and elderly. Then, to the many already known lesions of the nervous system, researchers added a number of new ones that were very rare, in which, for reasons unknown until now, certain parts of the nervous system suddenly begin to spontaneously degenerate, that is, to collapse. On the border of the XIX–XX centuries, many similar clinically, but morphologically different, that is, in their structure, diseases of the nervous system with an inevitable tragic outcome are described. About two dozen of them are known: Schilder-Foix disease, Pierre Marie, Kaltenbach and others. They are very rare, about 1-10 patients per million inhabitants.
The most famous is Alzheimer's disease. It is she who is most "on hearing" right now. Let's recall the history of its first description. Almost a hundred years ago, in 1906, Alois Alzheimer first described the results of a study of the brain of a 55-year-old woman who died after five years of suffering from severe increasing dementia.
For a long time, this disease quietly coexisted with many other progressive lesions of the nervous system. Quantitatively, Alzheimer's disease is only a small percentage among such diseases. Qualitatively, they are all one of the main sources of growing medical and social problems. These patients with no prospect of recovery form an ever-increasing stratum of people oppressed by their condition and oppressing others by the doom and impotence of modern medicine. It is necessary to face the truth, as in the eyes of patients expressing constant pain and hope, and, without deceiving themselves, to look for new approaches to the prevention and treatment of this disease right now.
Alzheimer's disease is severe. Starting imperceptibly, more often after 55-60 years, it often manifests itself for the first time, as if by stealth, in elementary non-compliance with hygiene: a person stops washing, cutting nails, changing underwear. Rest is replaced by lengthening periods of inactivity. Memory is gradually getting worse. Soon the so–called aphasia appears - the patient ceases to understand the speech addressed to him, responds at random or even on another topic. He doesn't seem to hear the question. Gradually, reading and speech are increasingly disrupted, and handwriting is changing. There are multiple rhythmic repetitions of the last word of the phrase. A little later, the patient ceases to recognize others, the movements become inaccurate. Hallucinations, various kinds of convulsions, up to epileptic seizures, and even unstable paralysis can be observed. The disease usually progresses within two to four years, rarely more. But I must say that the appearance of the first external signs of the disease is far from the beginning, but the continuation of the process, which imperceptibly lasted at least several years before. And it is simply impossible to catch its beginning by any most modern methods.
I have given far from all, but many clinical details and symptoms of Alzheimer's disease, pronounced, so that readers have less speculation and anxiety about their own forgetfulness.
And so the rare Alzheimer's disease would remain inconspicuous, one among other infrequent lesions of the nervous system included in the group of neurodegenerations, if not for President Reagan's disease and his courageous, in fact farewell, address to the nation after diagnosis.
Most people only then found out about its existence. It is "on the ear" and among doctors who have become more alert, but not always knowledgeable enough. And hence the avalanche of excessive, often superficially made diagnoses that have fallen on society, essentially unjustified sentences. And yet – a wave of threats to all mankind! For example, Ukrainian professor Vladislav Mertsalov "calculated" that by 2050 the number of people suffering from Alzheimer's disease in the United States could increase as much as 10 million people, and worldwide, in his opinion, their number will reach 100 million!
From my point of view, such intimidating data are based on assumptions provoked more by emotions than by the essence of the phenomenon.
Now the diagnosis of Alzheimer's disease is made with amazing ease to many patients, including young ones. In fact, almost any gradual memory decline that appears is now often and unconditionally regarded as the initial manifestation of Alzheimer's disease. At least, I see a similar trend in the USA.
My personal experience, as well as the experience of the development of medical science in general, shows that in addition to real epidemics, infectious and other diseases, there are epidemics that have a psychogenic (inspired) origin (the so–called iatrogenies; this name comes from the Greek words iatros – doctor and genos - origin), coming not so much from the public perception of those or other events, such as, for example, occurred in connection with the illness of President Reagan, how many of the general tendency to acute perception of "sensations", especially in medicine. And also, probably, because any person, thinking about his old age, possible infirmity and some unpleasant prospect of senile changes in the psyche, as if "trying on" them for himself. Such "fitting rooms" are inevitable, however, in my deep conviction, there are no grounds for panic, as there is no sensational "silent epidemic" of Alzheimer's disease. I have enough fundamental grounds for this statement. Studying the issues of acute and chronic pathology of the nervous system of various origins for more than forty years, I have constantly worked on the problem of progressive lesions of the nervous system, where the so-called neurodegenerations were leading in the development of the pathological process. Alzheimer's disease occupies a very modest place among them.
What did these long-term, comprehensive studies that covered more than four hundred patients show? First of all, an exogenous, that is, an external, incoming, factor (viral, toxic, etc.) was completely excluded. It also turned out that any acute diseases – from colds and infections to trauma or intoxication – are just provoking moments that reveal external manifestations of an already existing latent form of the disease. In addition, it has been established that hereditary factors can play a significant role in most cases.
The most important thing is that there was a strict connectedness of a number of lesions of the nervous system in general caused by the primary pathology of various endocrine formations – the pituitary gland, thyroid and parathyroid glands, adrenal glands and other disorders of their functions, most of which are causally caused by hereditary factors that are variously realized at different stages of life. It is from here that the multiplicity of lesions of the nervous system results. Similar ideas have been expressed before, but had no clear evidence.
We found the answer in 1993, when for the first time it was clearly shown that neurodegeneration is a neuroendocrine pathology.
In recent decades, science has established that the human brain, in addition to 13 billion (!) nerve cells and the pathways connecting them in the form of the finest fibers, has its own intracerebral, very powerful neuroendocrine system. The latter consists of many nodes that ensure the normal activity of various parts of the nervous system. A violation of the function of any such nodule may be the cause of a certain nervous disease. In particular, the most famous of them are Parkinson's disease and Parkinsonism (their separation is very conditional). They are caused by a violation of the function of the black substance of the brain, which produces the neurohormone dopamine. In the works of American researchers of the late 70s of the last century, it was found that a violation of the activity of another endocrine nodule of the brain (the unpaired Maynart nucleus), as a rule, leads to the development of Alzheimer's disease, the death of cortical cells, amyloidosis. It's strange that many people have forgotten about it now.
Inevitably, the question arises about the nature of such diseases in general. Can they be the result of a hereditary predisposition to neuroendocrine disorders? Obviously, the vast majority can. Here it is necessary to make a small explanation so that there is no confusion. Well-known endocrine diseases, such as thyroid or parathyroid gland pathology, diabetes and some others, are in no way related to neurohormones. This is a completely different endocrine system – somatic ("bodily").
It has already been mentioned above that most often the appearance of diseases such as Alzheimer's disease and similar ones is caused and stimulated by various revealing factors – infections, intoxications, injuries, etc. And only now it becomes clear that the starting mechanism of the disease, its "fuse" has another reason. The leading contenders for this role are genetic, hormonal, or more precisely, neurohormonal disorders.
The first confirmation that the chosen direction of the research was correct was obtained more than fifteen years ago, when in some cases the use of certain neurohormones, and hormones in general in such diseases showed some effectiveness, in particular in the treatment of Alzheimer's disease and other neurodegenerations. Unfortunately, the hormonal system of the brain and its constituent elements are still poorly understood.
In the meantime, medical science has to patiently observe the appearance of the most fantastic proposals and conjectures in overcoming such ailments in general and Alzheimer's disease in particular.
Such attempts include, for example, the proposal to use the well–known adsorbent Unithiol (BAL - British antiluisite, invented during the First World War to treat the effects of gas attacks), made recently by Ukrainian doctors, who for some reason believe that this drug was created only in 1950 in Ukraine by a certain V. E. Petrunkin... Or a vaccine (it is unknown to which pathogen), as reported by the American media.
Unfortunately, it will not be possible to overcome the diseases associated with age–related memory loss soon, and it is unclear whether it will be possible at all, because, as was said, the external manifestations of such diseases are usually detected gradually, after a fairly long period after initiation, when what happened is already irreversible. So far, only hopes for prevention and, possibly, for the suspension of the painful process are promising.
But, again, we must understand that such diseases are very rare, as are cases of senile dementia. The causes of memory loss, in the vast majority of cases, are much more diverse and not so severe. They often respond well to modern, well-known methods of prevention and treatment.
It should also be said that in a significant part of cases when patients complain of memory loss, in fact, something completely different happens to them – most often there is a violation of attention, so characteristic of age-related changes. Attenuation leads to underestimation, a kind of fleeting perception of situations and quite familiar surroundings. Getting rid of this is sometimes quite difficult. The only means is training, constant creative work, repeating the most important points to yourself, fixing the necessary things with notes, and even better – keeping a diary. Isn't it true that an extreme situation is always remembered quite firmly at any age? But the main thing is not to forget to look at the records.
And do not be afraid of sudden forgetfulness, even jokingly calling it "sclerosis" or "Alzheimer's." As the famous humorist writer of the 20s of the last century Arkady Averchenko liked to say, repeating folk wisdom, "God forbid, you can call on your head!" But this, perhaps, is already from the field of superstition…
Simple memory training techniquesMemorization.
It has long been known that cramming does not develop memory. And 80-year-old scientists remember special information better than their young students. It's all about the structure of the perception of information, and not in its chaotic swallowing.
Read the text and try to understand its main points. You can emphasize them, write them out, repeat to yourself.
Read the text again, already paying attention to the subtleties. Try to connect them with the main ideas. Repeat the main thoughts to yourself and understand their connection with the secondary ones. To deepen the understanding of the text, it is important to put questions to the main provisions.
It is useless to read the same text many times without memorizing the main ideas. Repeat the text several times to yourself or tell someone. By the way, this is how professionals prepare for important speeches and presentations, repeating the main theses to themselves.
Even if you are going to talk about something important in the family with your loved ones, say your speech to yourself. The main thing is to establish the final thought that you want to convey. Do not get lost on trifles, then your opponents will be forced to speak to the point.
The method of associations. This is a very important method. Example. Names and surnames that you used to remember easily often "pop out" from memory. Try to associate a "stuck" surname with an object or image. For example, the famous diplomat Gorchakov – connect his surname with bitterness, mustard. The amazing Russian writer Leskov – a young forest will appear before his eyes (you can repeat the image several times).
When going to the store, do not write a list, but count how many items you need to buy. Can you associate each with a number: 1 – milk, 2 – bread, etc. When leaving the store, check the result. You went to buy 6 items – how many do you have in your bag?
Activate the oral account. Start counting in your mind again. Set aside the calculator for large numbers. Figure out in your mind how much money you need for the simplest purchases, divide the budget by expenses – and everything is in your mind.
Organize your life so as not to experience constant panic. Such a simple thing – locks in doors that close from the outside. And you will not find yourself in a stairwell with the only opportunity to enter the apartment by calling the Ministry of Emergency Situations (it seems that it costs several thousand rubles).
Before leaving the apartment or leaving the dacha, hang up a list of what you should have with you: money, a social card or travel card, glasses, medications that you always take, a pen. It is better to put the passport in a pocket that closes with a zipper. The mobile phone should always be kept in the same place. More than once I have seen a man, especially women, in a panic looking for a ringing phone in a bag. If there is no mobile phone, then you will need a notebook – suddenly you will have to call a pay phone.
Mnemonic techniques. It is better to remember several phones, say the husband's work phone, by heart; the numbers are now long – break them into parts – 8-495-926-15-33. Repeat it to yourself, and you will remember it. Use mnemonic techniques: for example, 926 – dad was born in 1926, 15 – a game of "tag", 33 – a film with Leonov about 33 teeth – long, but it helps.
Document storage. Usually documents, which are becoming more and more over the years, are kept in large boxes or old briefcases, and in search of one you shovel the whole box. Use transparent thin folders with buttons: they are sold in stationery stores; paper easily pops out of plastic folders-"corners", they are inconvenient. It would be nice to write with a marker (with a bold indelible pencil) on each folder: "Apartment", "Cottage", "Inheritance", "Taxes", "Medicine" – this will make life much easier when searching for the right paper.
Do not write anything down on scraps of paper unless you have a special board to which they are easily attached. An ordinary alphabet book or a daily planner will simplify your life. Write down recipes, birthdays, necessary things there, say: "In six months you need to go to the tax inspectorate," etc.
Portal "Eternal youth" www.vechnayamolodost.ru09.10.2008