Memory loss: Training can prolong independence

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Sherrie Hanna
Memory loss is a fact of life for people with Alzheimer's disease. It's also quite common in people who've had traumatic brain injuries. Some of the memory training techniques used with brain-injured people are also proving helpful to people with mild cognitive impairment (MCI) — a disorder that often precedes Alzheimer's disease.

Sherrie Hanna is the program coordinator of an ongoing study at Mayo Clinic in Rochester, Minn., to examine potential benefits of memory training for people who have MCI. In this interview, Hanna discusses the study's premise and its preliminary findings.


What types of memory training techniques are you studying?

We're using monthly pocket calendars, small enough to fit in a man's pocket or a woman's purse. Each day on the calendar is divided into scheduled events, things to be done today but at no particular time, and then notes on anything — like the weather forecast or the fact that grapes are on sale at the supermarket.

This type of memory training system has been successful with people who have had memory loss from brain injuries. We're testing it with people who have mild cognitive impairment. While the physical causes of their memory problems are different, the practical outcome is the same. And the system seems to work for both.


What's the difference between mild cognitive impairment and Alzheimer's?

Mild cognitive impairment is a transition stage between the cognitive changes of normal aging and the more serious problems caused by Alzheimer's disease. It often includes the memory loss problems common to Alzheimer's, but doesn't meet the qualifications for full-blown dementia.

While many people who have mild cognitive impairment go on to develop Alzheimer's, others don't. So a diagnosis of mild cognitive impairment doesn't necessarily mean you will certainly develop Alzheimer's.

Because the cognitive problems are less severe in MCI, there is greater opportunity to use nonmemory skills to compensate for memory problems.


How do people with memory problems remember to use the calendar?

We work with them for six weeks, so that it becomes a habit. It's kind of like driving a stick shift or typing on a computer keyboard. You don't think about all the motions involved in the process. You don't say to yourself, "OK, now I'm going to depress the clutch with my left foot and move the shifter with my right hand." You just do it. One of our participants compared it to golfing. He doesn't think about how to position his head or his hips. He just does it.

In addition to writing things in the calendar, we also ask our participants to look at their calendars at least twice a day. Three times is even better. At breakfast, they can look over what they're supposed to do that day. They need to check the day before, too, to see if there are any unfinished tasks that need to be carried forward.

We also tell them to check things off right when they do it. So even if they don't remember doing something — if it's checked off, they must have done it.


Does just writing things down help people remember?

Writing it down helps it stick in your memory. Saying it out loud as you're writing it down also can help cement it in your memory. I tell people to use all their senses to help jog their memory. I had a big test to study for recently, and I said things out loud and had color-coded reminder notes. I even drew pictures. The good thing about this calendar is that it can encompass whatever works for you.


This sounds helpful even for people who don't have memory loss problems.

This can benefit all sorts of people. I personally never kept a calendar until this. I got a planner and followed right along with the study participants. Lots of people need something like this. For example, they'll get a phone call and then jot a phone number on the newspaper and then throw the paper away.

One of our participants came in with a big stack of Post-it notes and scraps of paper, all bound together with a rubber band. We've just translated that into one system, so people can find what they need easily when they need it.


Is it working for the people in your study?

Almost every person in the study has said that it has helped them. That has been very satisfying. Some people are still at it after more than a year. That's really something, to have people change the way they do things and have it stick.

Every person who participates in this study is accompanied by a support person, usually a spouse or child. And these support people often say, "It's so nice not to have to answer the same question over and over."


Are there other benefits?

It helps make our participants feel a little bit more independent — that they don't have to rely on other people to remember things for them.

This system also gives them a way of feeling they are doing something pro-active. Many people feel the control slipping out of their fingers. By giving them back some personal responsibility and control, it's really making a difference in that individual. It's hitting both needs at the same time.


How long does this technique hold off the types of memory lapses that lead to loss of independence?

We don't know yet. In my mind, it's a "use it or lose it" scenario. You need to keep your brain engaged in attending to these things, or they're gone.

This is basically a holding maneuver. Some people may think they don't need it now, that they're functioning OK. But it's like muscle memory. If they get it to become a habit, it will help them be prepared for that day when they really do need it.