Broken Connections, Missing Memories: JACOB FOX

Q. Many older people, noticing they have trouble remembering things, are petrified that they may be developing Alzheimer's. Are their fears warranted?

A. One of about every 20 patients I see at Rush-Presbyterian-St. Luke's Medical Center could be described as an Alzheimer's-phobic. My rule of thumb is that the person who thinks he or she has Alzheimer's doesn't. Almost invariably, the Alzheimer's patient is brought in by a family member. Either the patient is not aware of the problem or just can't get it together to make an appointment with a doctor.

Q. But why do so many older people seem to have trouble with memory lapses?

A. There's something known as age-associated memory impairment. It sometimes takes the form of absentmindedness, like misplacing things. The typical story is, you come into the house, you put your briefcase down, and you're distracted by something. Maybe the kids are having a fight. So you go break up the fight, and then you can't remember where you put your briefcase. Another common difficulty is thinking of names, particularly proper names. I myself have always had difficulty with names, and I've always been slightly absentminded. So when a person comes in with complaints about memory, I can say with a great deal of honesty that we both have the same problem, only I have it worse.

Q. Have you ever tried to train yourself to have a better memory?

A. Most memory tricks have to do with connecting words to visual images. When I've tried it, I couldn't remember the visual image I was supposed to recall!

Q. What is usually the first symptom of Alzheimer's disease?

A. The typical patient starts with memory problems and then deteriorates into more general confusion. A truck driver may keep delivering things to the wrong place, or a bookkeeper may not be keeping the books right anymore. Motor skills are usually retained longer, although certain patients will have difficulty early on with tasks like using a screwdriver or tying shoelaces.

Q. Why is memory the first to go?

A. In Alzheimer's disease one of the most profoundly affected areas of the brain is the hippocampus. Memories may not actually be stored in the hippocampus. Instead the area may act as a retrieval mechanism for reaching those memories.

Q. Why then do Alzheimer's patients often retain vivid memories of childhood events?

A. There is reason to believe that recently learned information is not dealt with in the same way as information learned a long time ago. So, even though the hippocampus may be involved in learning something initially, as time goes on, that information may be stored or processed in other areas of the brain. This may, in fact, be the explanation for why Alzheimer's patients initially have problems learning and remembering new things, but are better at remembering old things.

Q. What exactly does Alzheimer's disease do to the brain?