Author sifts through the shifting sands of memory

Cathryn Jakobson Ramin

I was to some degree interested in memory because memory is such an important part of the Jewish faith,” said Cathryn Jakobson Ramin, author of “Carved In Sand: When Attention Fails and Memory Fades in Midlife.” “On the high holy days and at the Passover seder we experience the broader type of memory,” she said.

Ramin, who will speak at the Kaplen JCC on the Palisades on Wednesday, writes in her book that her concern about her own memory was a major incentive to pursuing the project.

“Over the course of a few years, as many of my friends and relatives moved into their forties and fifties, I began to realize that … I was part of a large group of middle-aged people who were struggling to keep up,” writes Ramin. “There was no way around it. Something was happening to my mind…. My mental calendar, once easily summoned, grew elusive and developed blank spots, as did my sense of direction.”

To be sure, children lose lunch boxes, college students forget their term papers, and young parents misplace the diaper bag. Most people at all stages of life experience some forgetfulness, losing keys, cell phones, and even their cars in a mall parking lot. But midlife seems to be a time where major life stresses, biological changes, and medical issues can contribute to and exacerbate memory loss.

Ramin set out to discover what could be done to sharpen her mind, restore her memory, and help her cope with the midlife changes she was experiencing. “It was about a three-year research and writing process,” she said in a telephone interview.

A journalist for 32 years, Ramin had written about many different topics in psychology, religion, and other areas. “I had never written about science per se until I took on this book,” said Ramin. “Carved In Sand,” Ramin’s first book, approaches memory issues from the perspective of neuroscience, pharmacology, sleep disorders, and endocrinology.

“I learned a great deal about cognition in general,” she said, explaining that “cognition is the science of thought, how we think, the physiological aspect of thinking.” She tried vitamins and other dietary supplements, pharmaceutical drugs, neurofeedback sessions, sleep therapy, hormones, and other approaches to memory enhancement.

“I refer to many, many studies,” said Ramin. “I really believe in combining anecdotal with peer-reviewed material.” Of her own experimentation, she writes, “I knew that the flaws in my ‘make myself a guinea pig’ methodology, which involved pursuing multiple, overlapping research protocols, would muddy my results.” There were instances when she was exposed to multiple interventions, or had not fully recovered from one treatment when she started another, making it difficult to discern which treatment was effective.

In scientific studies to assess the value of drugs, subjects are randomly assigned into treatment or control groups and are not privy to whether they are getting the drug or a placebo. Ramin always knew what treatment she was getting — and could have experienced the “placebo effect.” Her expectations for the treatment could have influenced her outcomes, performance, and her perception of her own memory skills.

Ramin took her guinea-pig role to the extreme, to the extent that some of the interventions and protocols may have exposed her to risks. “In terms of cognitive enhancement, there could be some hazard in some of the pharmaceuticals,” she said. “I took them for the book. I don’t think I would have taken them otherwise.”

For instance, Ramin was prescribed Adderall, a drug that has been used by millions of adults and children to treat ADHD, attention deficit hyperactivity disorder.

Given a very low dose of the medication, Ramin reports in her book, “the result: an increase in my level of attention and ability to resist distraction, which I appeared to have taken to extremes…. I felt wildly attentive…. At times, I felt like a nervous wreck…. By the end of the week, however, I started to see results. The gears in my brain were meshing.” Her cognitive test scores improved and it appeared that her attention and concentration would continue to improve. But, writes Ramin, “something nagged at me. I worked like a demon, but found myself disconnected from what I’d describe as ordinary human requirements.”

The psychiatrist who prescribed the drugs admitted that he never took them himself. “‘Stimulants make me hypervigilant. I just take coffee,’” he told her. When the Adderall wore off every evening she experienced withdrawal that made her “exhausted, tense, and often grouchy.” It got so bad that her children told her that she had lost her sense of humor. The clincher was a 2006 FDA report showing that Adderall could damage the heart. She suspended her treatment and went on to try other interventions.

Ramin strongly cautioned anyone taking drugs such as antidepressants or anti-anxiety drugs or considering drugs to treat memory problems. “There are many psychopharmacologists who are not competent,” she said. When she wrote an article about the side effects of such drugs, she received responses from all over the country. “People reported that they were given two or three psychiatric drugs, nervous system depressants together with stimulants, overlapping [treatments], ‘cocktails’ that could be immensely hazardous,” said Ramin.

“Carved In Sand” appears to recommend hormone replacement therapy as an approach to memory lapses in women. The chapter “Yearning for Estrogen” is subtitled “Rejecting hormone therapy could leave your neurons in the lurch.” Ramin said that she doesn’t address the risks of hormone replacement therapy in the book. HRT or hormone replacement therapy (estrogen plus progesterone) is associated with increased risks for breast cancer, coronary heart disease, and blood clots. ERT, estrogen replacement therapy, i.e., estrogen alone, can increase the risk for endometrial cancer.

“There are a lot of people who shouldn’t take it,” she said. But, she added, for those in the lower risk categories, “once you are through menopause there is a distinct benefit to the brain of a short course of estrogen.” Ramin claims that there is a short window of time when estrogen and progesterone treatment will improve cognitive function. “It’s a very personal choice,” she said. She reports that she is not menopausal yet, but already uses a small estrogen patch, and expects to take hormone replacement therapy for about a year and a half after menopause.

Ramin conveys the sense that memory lapses in midlife are a normal part of aging for men and women. “Men do experience the cognitive changes that women do…. The only reason men do better is that they have wives and secretaries [to keep them organized],” she said.

Still, she maintains that you don’t have to accept memory limitations; you can be proactive. “Carved In Sand” encourages readers to identify what may be causing memory problems. “It’s never just age,” said Ramin, citing in her book 80-year old Zvi Danenberg, whom she met jogging. The octogenarian Danenberg has interests and activities that eclipse many a 40-year-old’s.

“Are you sleep deprived?” asked Ramin. Sleep disorders can affect memory. Insomnia can have many causes, including menopause, and restoring normal sleep patterns can help improve memory.

“What are the drugs you are taking?” Ramin asked, explaining that many drugs can affect cognitive functioning and doctors are unlikely to mention those side effects. “Antidepressants have powerful effects on cognition and memory. Anti-anxiety drugs clear out your memory like nobody’s business. Sleeping pills, such as Tylenol PM, have a long half-life. [They can] stay in the body until well into the next day and make you foggy.”

“Figure out what’s pertinent to you,” she recommended. Then build what she calls a “scaffolding,” or a system of organization to keep you from “falling down the manhole.”

“Figure out where you fall down,” said Ramin. “There are people who lose their car in the parking lot all the time. There are people who lose their keys all the time. There are people who have three calendars. You can’t have three calendars.”

Her own “scaffolding” methods have helped her keep track of numerous obligations and responsibilities. “They are not always foolproof, she noted. “But there are systems that prevent things from falling through the cracks.”

Ramin also advised that if you have a family member with memory issues and begin to see progressive changes, it’s important to get an evaluation at a reputable medical center. “Maybe the changes are pathological. There are a lot of ways to intervene early,” she said. “The saddest thing is the resistance to treatment. Once there’s neuronal damage, they’re gone.”

She also put in a pitch for stem cell research with regard to regeneration of neurons, or brain cells. “When the day comes and we can supply growth factors … that will give us the opportunity to revive the neurons before they’re gone.”

In addressing the question of whether overuse of computers and the Internet change the way the brain works, Ramin is a strong advocate of “the triad: social interaction, physical activity, and mental activity.” She emphasized that “our brains are built to interact with people. Those growing up with computers … if their primary interaction is with screens, their brains are changed.” The best exercise for the brain is to “get out and be with people. Volunteer with something where you are interacting with real human beings.”

“Carved In Sand” was published by HarperCollins (2007, hardcover) and Harper Paperback (2008). More information on the book can be found at www.carvedinsand.com.