LifeTwo's Interview With Cathryn Jakobson Ramin, Who Looks At Midlife Memory Problems in "Carved in Sand"

Can't remember where you put the keys ... or the car? Finding yourself standing at your dresser, blanking on what it was you came to look for? Forgetting names you just shouldn't forget?

What is going on with your once-reliable brain?

Journalist Cathryn Jakobson Ramin asked that same question of herself, and embarked on an exploration of what "goes wrong" with the brains of middle aged people. In the just published Carved in Sand: When Attention Fails and Memory Fades in Midlife she tells how she became a guinea pig for ten different treatments that seek to offset the effects of brain aging. She played brain training games, took prescription drugs, and danced the night away. At the end of it all, she had developed tools that won back much of the ground she had lost.

Publishers Weekly says "the variety of perspectives and the wealth of scientific information Ramin provides, as well as her warm personal style, will reward readers and may help them stay mentally sharp." Although the book is not prescriptive per se, Kirkus Review said that it is "A wholly encouraging plan for mental fitness."

Jakobson Ramin generously agree to an email interview with LifeTwo.

LifeTwo: There's a continuing debate in the research community over brain training: some (for instance, Gary Small, whose program you discuss) argue for its efficacy, while others (Timothy Salthouse at Virginia, for example) say the only thing that improves is your ability to do the training exercises -- not overall memory performance. Is it fair to say that you didn't see much overall benefit from brain training?

Cathryn Jakobson Ramin: I think there is ample evidence that specific types of brain training can work. Michael Merzenich, over at UCSF, is having great success with Posit, a computer-based program that takes advantage of the brain’s natural plasticity – the brain’s ability to reorganize itself by forming new synaptic connections, and putting newborn neurons (as a result of neurogenesis) to work. Merzenich’s hypothesis, with which I agree, is that most memory-training programs don’t work because you need an intact memory and intact frontal lobes to use them.

I found this to be true: When I set out to work on Gary Small’s mental aerobics, I failed miserably ... it was like asking someone with a broken leg to run a quarter-mile; easy for most, but impossible for me. Most programs are insufficiently customized to meet a person at his or her level. I found that MyBrainTrainer worked well for me; it was fun, fast, and instead of feeling like a dolt, I could see that I was slowly improving in these games. Posit, on the other hand, requires a lot of time and commitment, which like most busy middle-aged people, I don’t have available. Posit seems to work brilliantly for the older crowd, however.

I believe that the best thing you can do for memory and attention in midlife is to make sure that you find a mental challenge that really turns you on. Make sure it has a social component, because social interaction is probably the best way to keep your brain in trim as you age. Chess, Scrabble, bridge – all good, but unfortunately, sedentary. I know people who are playing pool very strategically – good! Ballroom dancing of all kinds (I like salsa) – all good!

You talk about the concerns you developed over the mild brain traumas that seem part of childhood -- once dismissed as harmless, you talk about research indicating that they could cause long-term trouble. As the mother of two boys -- is there anything you wish you'd done differently raising them?

I wish that I’d had the information I have now when my kids were younger. Not that would have strapped them to the sofa with seatbelts – they’re active boys – but I would have been more aware of the implications of each bump on the head, and more likely to acknowledge behavioral changes that occurred several months afterwards.

We went through an extremely difficult time when one of my sons entered a new private school in 6th grade, and on a class overnight trip, was beaten up by a boy who was recognized to have severe emotional problems. That boy was expelled, but little good it did us: Fortunately, my son has grown up to be a strapping six-footer with a 4.1 average – but the year that followed was brutal. At the time, I knew that he was scraped and bruised and that his head had been slammed repeatedly into a bunkhouse wall. The contusions healed, but in subsequent months, my son, who had been a stellar student in elementary school, experienced substantial academic and behavioral struggles. Eventually, the school asked us to foot the bill for neuropsychological testing. Four thousand dollars later, we learned that he had some learning disabilities. We removed our son from this competitive private school, mystified about what might have changed – never associating his problems with his head injury. If I’d known then what I know now, I would have sued the school and made them pay for everything – the neuropsych evaluation, the psychologist’s bills, and of course, the tutoring. Oh, and that year’s tuition…

On a different note, I am about to initiate a campaign to have the skate park behind our elementary school patrolled after school by a police officer, who will enforce the helmet law. The law is clearly posted, but I see kids out there every day, fifteen feet up in the air and upside down, with no helmets. This is pure negligence. And, as I put it in CARVED IN SAND, one day the EMTs will be called, and someone’s life will be changed forever.

In "Carved in Sand" you describe ten different "treatments" you underwent. You were clearly more enthused about the results of some over others. Do you feel that the mix of treatments you ultimately settled on is a combination that is specific to you, or is it more general?

In the book, I explain that I decided to pursue the ten interventions more or less simultaneously over a period of two and a half years, because I wanted to find a solution – and fast. If I were a scientist, rather than a journalist, combining protocols in this way would never be allowed; there would be far too many variables. I included all the interventions in the book because some things that did not work very well for me – meditation, for instance, because I tumbled off into dreamland every time I attempted it – actually do work exceptionally well for other people.

For me, the most valuable things were:
1) Getting the vitamin and supplement routine down,
2) getting my subclinical thyroid disorder diagnosed and treated,
3) learning how to use cognitively enhancing drugs, specifically Provigil, when required, and
4) taking on the gigantic mental challenge of writing CARVED IN SAND.
Subsequently, my insomnia issues have started to come under control, and that has been the icing on the cake.

I do not expect that any reader will pursue all ten interventions. Each reader will pick what seems most applicable, given what he knows about himself and his life patterns. It has been interesting to hear from readers about what they’re trying and what is working for them.
 


One of the steps you took was to establish a "no multitasking" rule. How hard has that been?

It hasn’t been easy, and I have lapses, but getting this under control is essential. I’m hearing a lot from readers who’ve asked me to create a sort of multi-tasker’s Twelve Step Program, with meetings, like they have in Alcoholics Anonymous. Alcoholism is nothing I joke about, but there are parallels; it’s incredibly difficult to quit multitasking, and the lure is always there. As recently as this morning, I had an unfortunate pancake incident. As soon as the batter hit the griddle, my elder son asked me to get him a document from my computer. I searched for it – and you can guess the results.

It’s fairly easy to control your own inclinations towards multitasking. What is difficult is refusing to let other people throw you off course.
 


As a consumer looking for health information, were you frustrated that you received so much incomplete, or in some cases contradictory, information?

Years ago, when I was actually just a consumer, rather than a pain in the rear, I swallowed everything doctors told me. I was amazingly agreeable and obedient. That has changed. I am now highly skeptical, and inclined to research everything and show up with my purse full of PDFs from peer-reviewed professional journals. This is extremely irritating to nearly all physicians, who are accustomed to playing God.

Repeatly, in my research, I learned that doctors – who do have patients’ best interests at heart – are often unaware of new research in a field. I am inherently a layperson – I do not have any degrees past the B.A. -- so I am no better equipped to understand this complex material than you are. But I learned that it is really important to go look up your drugs in the Physician’s Desk Reference, or online, so that you know what to expect. Understand that many physicians are in bed with pharmaceutical companies. Don’t smile appreciatively when your doctor hands you those free samples; instead ask why that drug, and not another that the pharmaceutical company is not dropping off at the office along with a fancy lunch.


At the conclusion of the book, you were still investigating other steps you could take -- for instance, working more on your sleep pattern. What else do you wish you had tried?

I am still working on sleep, with more success these days, now that my book is out and is doing well! When I wake up with a start at 3 am, my brain, instead of leaping into third gear to solve some pressing problem, sort of says to itself – “oh, gee, I guess now everything is basically okay.” And I go back to sleep. It makes a big difference in how I function.

I’d like to go back to meditation, now that I am not so sleep-deprived. I truly believe that meditation has a huge impact on attention and memory. For many people, that is where the solution lies.

There are a few other things I would have liked to have tried – magnetic transcranial brain stimulation, where electrodes are placed on your skull, and different parts of your brain are stimulated, with interesting results.

I also would have liked to participate in a study at NYU, where investigators are doing important work with electroencephalogram technology, evaluating cognitive changes that may lead to Alzheimer’s.

I would also like to check out some of the new cognitively-enhancing drugs as they emerge from the pipeline.


Where do you feel the field is headed? Based on what you've learned, which treatments look most promising?

In my chapter, “Do You Really Want to Know?” I run down the most promising methods of assessment, intervention and treatments for Alzheimer’s disease. Most of these are experimental, in one stage or another of clinical trials. It behooves anyone who is in the earliest stages of the disease (or more likely, that person’s caregiver) to get on the site called ClinicalTrials.gov and to use the search function to find trials in your region. Currently, it is only in the very early stages of this disease that there is hope for slowing down or halting the progression of the pathology. You may help yourself, but you will certainly help other people. Unless humans participate in these studies, progress will be painfully slow. These approaches to treatment evolve every day; what is promising today can quickly become old news.

But what about therapies for the rest of us – those whose changes in memory and attention are, as I say in CARVED IN SAND, “normal, but not acceptable?” Pay attention to the recommendations in my book: make sure you are getting enough antioxidants, Omega-3s and magnesium in your diet. Drop some weight if you’re obese – the cognitive improvement will be noticeable. Find out if you suffer from insulin resistance. If you have diabetes, hypertension or chronic depression, make sure it comes under control with the appropriate drugs and interventions. Be certain that your exercise routine includes aerobic workouts; climb the office stairs three times a day instead of taking the elevator, if you have to. Find yourself a mental challenge, preferably one that includes social interaction, and stick with it. Do not allow yourself to become isolated; the brain thrives on social interaction, and many aspects of cognition depend on it.

I believe that cognitively enhancing drugs will become increasingly common in the next two decades. The drugs I describe in CARVED IN SAND – Adderall and Provigil, both of which I used in the course of my research – definitely improve attention and focus. However, I know we’ll be seeing a host of new pharmaceuticals in the next several years, specifically targeted to different aspects of cognition. Will it be necessary to take them? That may well be determined by how long you want to stay in the workforce, and what you want to do there.

The study of midlife cognition is really very new. It might not have existed at all, unless baby boomers insisted on it. We’ll be seeing more interesting research over the next few years.

After reading "Carved in Sand," which provides a great overview of middle age memory loss and a range of possible treatments, where should someone who's concerned about their own midlife cognitive issues turn?

I can tell you this: If I believed that my memory was failing in a progressive fashion – which is to say that I knew it was getting worse – I would be sure to be evaluated at an Alzheimer’s disease research center. I have heard from many readers since the book was published that they would like to know where to go for such an evaluation. In response, I’ve developed a list of Alzheimer’s and memory centers, which you can find on my website. Go to http://www.carvedinsand.com and click on “The Experts’ Corner.” Contrary to what most people think, Alzheimer’s is NOT a disease of old age; it is a disease that plants its seeds in middle age, and it is at this point that you can make the changes that will determine how your cognitive life will end.

One thing that I recommend for anyone with these concerns is the establishment of a baseline. You can do this quite simply; one of the brain-training websites I talk about in CARVED IN SAND, mybraintrainer.com, allows you to test many different cognitive capacities. The man who designed it is a wildly competitive statistician, which is helpful. You can compare your performance to that of other people your own age, in your profession, etc.
Most handily, you can see how YOU are doing, day by day. As long as your scores are improving, you don’t have much to worry about. Declining scores – or a notable decrease in performance over six months or a year – would be enough to send me to “The Experts’ Corner” for a more thorough evaluation.

It is important, when getting a baseline, to be able to compare YOU to YOU. Comparing YOU to the average Joe tells us very little, especially if you were (at least at one time) in possession of an impressive IQ. 


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Cathryn Jakobson Ramin will be promoting "Carved in Sand" at San Francisco's Commonwealth Club on Tuesday, September 18 (2007). Other tour information is at HarperCollins' site here and Jakobson Ramin's site here.

There's a brief Quickttime format interview with Jakoson Ramin at her site that provides another look at what she learned about midlife memory problems.