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CHECK UP
Thursday 24 August 2006, 3.00-3.30pm
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BRITISH BROADCASTING CORPORATION


RADIO SCIENCE UNIT



CHECK UP

Programme 4. - Cognitive Impairment



RADIO 4



THURSDAY 24/08/06 1500-1530



PRESENTER:

BARBARA MYERS



CONTRIBUTORS:

ROY JONES



PRODUCER:
ERIKA WRIGHT


NOT CHECKED AS BROADCAST





MYERS

Hello. Yes if you've been listening to Radio 4's memory season you may well have been struck yesterday, as I was, by Roy's story. Roy's been diagnosed with mild cognitive impairment and that's our subject on today's Check Up. Here Roy and his wife Dorothy describe how it's affecting their lives.



ROY
The first time I realised that there was something wrong was when I was going somewhere and I just couldn't remember where I was going.



DOROTHY
When he drives over to our daughter's - she lives in a little village at Upton Scudamore - I'll always phone up and see if he's got there. It's not very far, it's only about five minutes, but in my mind I'm thinking is he coming home or is he going somewhere else.



ROY
Sometimes I've gone in the car park not thinking and walking round the car park trying to look for my car like you know.



DOROTHY

You did come home without it one day.



MYERS
Well I do wonder if you were left thinking that this condition - mild cognitive impairment - could explain your poor memory. Well if so this is your chance to your questions to one of this country's leading experts on the subject, he's Professor Roy Jones from the Research Institute for the Care of the Elderly, where he's been running a memory clinic for the past 20 years, he's with me now.



Give us a call: 08700 100 444 or you can e-mail checkup@bbc.co.uk.



Roy, the other Roy, are his symptoms really typical of what you see when you see a patient with MCI?



JONES
Yes they are. It's very common for people with MCI to be aware themselves of problems and also for someone in the family to be aware. For the memory problems to be a nuisance but not serious, so, for example, he forgets certain things but, for example, he knows he's driven the car somewhere, he knows he's been out for the day if he can't remember the exact name of the place. So they're troublesome things but they're not sufficient at that point to say that he has a severe problem like - something like Alzheimer's Disease.



MYERS
Right we've got Lea Parkin on the line from Hastings, whose mum has symptoms of MCI - mild cognitive impairment. Has she had a diagnosis or where is she up to with this Lea?



PARKIN
Hello. No she hasn't had a diagnosis, I did mention it to her GP earlier this year but she kind of waved it away and said - Oh well at her age what can you expect? And didn't seem very keen to take it any further or do any tests for her.



MYERS
And what age is she?



PARKIN
She's 79.



MYERS
And what would be her main symptom then, does it connect with what we've just been hearing from Roy and the inability to find his car but still to drive it?



PARKIN
Yes keys, that sort of thing, purse, variable short term memory loss, can sometimes remember everything that's happened in the day, sometimes can't remember that I phoned earlier - that sort of thing.



MYERS
Okay Professor Jones, what would you say about Lea's mum and how can she get some help - the GP doesn't seem to have been particularly concerned?



JONES
Yes I think that's unfortunate in many ways, although obviously the GP may know your mum quite well and may have known her over the years and therefore may not be that concerned. But I think what you've described are predominantly memory related things and one of the factors that makes me more concerned is, is she still managing to do everyday activities on her own, for example, does she look after herself, I don't know, for example, whether she lives on her own?



PARKIN
She does live on her own and it is a concern that she lives on her own and gets fairly little sort of contact with other people and she seems to be less willing now to go out and do things like shopping by herself, will go to the local shop but doesn't really want to venture as far as the big supermarket. But is looking after herself, is still doing laundry and washing and dressing and everything yes.



JONES
Okay, well in fact that's really - what you've just said is really quite a good description of mild cognitive impairment. It's someone who's got a memory problem that's a change from before, it's mainly just memory related and conditions like Alzheimer's Disease, for example, affect other areas of thinking - not just memory. But she's still going about her everyday activities and looking after herself reasonably well and that's the difference between more serious problems. Obviously the fact that she's a little bit less willing to do things may be slightly that she's trying to protect herself because she's lost a bit of confidence. So you could certainly try and deal with some of those things. You could look at strategies, for example, that might help her remember - a notice board, writing things down - those sort of things. But I think it is important if you're worried and even more if she's worried it is important to go back to the GP and ask that she is given an assessment because it is worth establishing what the level of her problem is and I'm afraid it is still relatively common for many people just to say oh well it's age what do you expect and I don't think that's really an acceptable attitude in this day and age now.



MYERS
So you'd be happy to see Lea's mum in your memory clinic and do some assessments?



JONES
Absolutely. What I would hope though is that her GP would do some assessments - not necessarily the doctor himself, there are some quite easy assessments now that give an idea whether someone has got significant problems, there are a range of tests that most family practitioners have available to them that often take about 10 or 15 minutes, that measure things like whether the person knows what day it is, a simple test of memory and things like that, so you can get an idea. And certainly in our area - I live in Bath, which is where our clinic is - and in our area many of our doctors will do that sort of test and if they found a problem on that test then they would refer them to someone like myself and say could we see if we thought it was more severe or even just to get a baseline so that we can then follow her and see how she's doing.



MYERS
Lea, I hope that's been helpful. If I can move on because we've got a lot of callers and we've got a lot of e-mailers today, this is something obviously a lot of people are having difficulties with. But I just wanted to pick up an e-mail from Pavla who says that her mum has recently been diagnosed with MCI, so at least she's got a diagnosis. In fact she seems to think that it's been brought on by depression and grief following her father's death some time ago. But the questions that are asked are: Are there any therapies or exercises or nutrition or any support groups - anything that might help to prevent any further deterioration? Perhaps you can first comment whether there might be a connection between the onset of MCI and grief and depression.



JONES
Yes I think there are two things. The first thing is that it's not uncommon when one of a pair of a couple actually dies or becomes seriously ill and can't then be in the house with the other person to in a sense expose the fact that actually the person that's left already had problems that weren't noticed and that you're therefore more aware of them. But quite clearly depression and bereavement, grief - those kind of things - clearly affect us for one, two years, perhaps even more, particularly in older people. It's wrong to feel that they may get over it more quickly. So I think the first issue would be to see if she actually is depressed and needs treatment, either with counselling or with help or possibly with drugs. Then there are everyday things - everyday strategies that you can use but looking perhaps a bit more at her general health as well. It's important, for example, to get a general check up to make sure her blood pressure's okay, to look at things like whether her cholesterol's high. Sometimes older people may have problems with their thyroid gland. So there are a number of things that are general medical things that I would be looking for. There is no specific drug treatment at present that has been shown to be that effective in people with MCI. We have looked at some of the treatments for conditions like Alzheimer's Disease to see if they work in milder problems but at the moment the jury's still out on that and so there's nothing specific apart from really things that are for general good health.



MYERS
Okay, let's go to another caller - Jackie's waiting patiently, she's in Islington, having trouble with names. What sort of names are you having trouble with?



JACKIE
Basically I'm very interested in both cinema and contemporary literature and I can never remember the names of the directors whom I'm fond of and of authors. For example, I recently read The Sea which won the Booker Prize last year and I can't now remember for the life of me who the author is.



MYERS
Well perhaps it doesn't matter that much but of course it's frustrating isn't it.



JACKIE
It is - it is frustrating, this is what drives me crazy. I sometimes feel as though my head is emptying when I'm trying to recall a name.



MYERS
Alright, well let's see if we can get some advice from Professor Jones, what would you say to Jackie on this?



JONES
Well Jackie first of all your head definitely isn't emptying and the good news is that actually our knowledge base can actually increase as we get older, so remembering facts, for example, is something that stays with us. But what you've described is really the commonest thing that I think practically all of us notice to some degree as we get older and that is recalling a name. Because I suspect if we mentioned the author that you're talking about or a director you wouldn't actually say oh no, I've never heard of them ...



JACKIE
I'm sure I wouldn't say that at all.



JONES
Right, so you would recognise the name, it's just that you can't get it and it's what we call a tip of the tongue problem and I think the only way of dealing with that - and I get them and most of my colleagues get them to some degree. First of all I wouldn't be too worried if that's the only problem that you have ...



JACKIE
It is, yes.



JONES
And you can look at things like strategies, like writing things down, trying to give yourself clues, trying to make more of an effort to remember the first time. But sometimes you'll just have to wait for an hour or so to pass and then it'll pop into your head and you can't think why it's done that.



JACKIE
Exactly. I was wondering whether I should make lists of people of whom I know I may want to mention in a conversation ...



MYERS
That's a very good strategy.



JACKIE
... and stick the list up on the wall or something.



MYERS
I mean I guess the idea about a strategy there is actually writing it down gets it into your brain in the first place a little bit more doesn't it, and then of course it's there as an aide memoire if you need to look at it, so is it a useful thing to do?



JONES
Absolutely, lists are very good ideas - any kind of strategy. The other thing is that if you use both sides of the brain, the left side's more logical, the right side's sort of more visual, so for instance if you try and associate a picture or writing it down, looking at the word as well as saying the word, those are all very good strategies. Also trying, if you can, to link it to some other thing - so if you try and link the book, for example, with I don't know the author actually swimming in the sea or something like that, so that - and the more bizarre the link sometimes the better you can actually link it together.



MYERS
What do you think of this e-mail we've just had from Arthur? He says that he too cannot remember names, he can remember lyrics, by the way but his point is that his wife thinks that he doesn't want to remember, so he's got selective memory - at least according to his wife.



JONES
I thought all wives thought that husbands had selective memory for certain things. But no I think that is - if he is aware, which it sounds as if he is aware of his problem, then I think it probably is a real problem. Although having said that if we don't concentrate when we're trying to take in information - and that's certainly true if you're at a party and you're introduced to 10 people in a row many of us don't even listen to the names because we know we're not going to remember them. So part of the initiative, if you like, is to concentrate and then repeat the name back, use the name, because that also reinforces it. But occasionally I guess all of us may be in a situation where we don't want to remember something. But I think it's wrong generally - and most people with memory problems aren't actually doing it because they're being difficult or because they don't want to remember it.



MYERS

So you don't like to hear people saying that then - he doesn't want to be bothered - it's often clearly people would want to remember if they could, generally speaking?



JONES
Generally speaking, unless someone, for example, is depressed or there are other issues, one of the issues is that these problems tend to occur more as we reach retirement and get to our 60s and sometimes people say oh well since the person retired they've not done anything, they've actually switched off and whatever. Occasionally that's true but usually it's coincidence, it's because that's around the time that we tend to get these problems and so people link them together. Having said that keeping active, keeping an active brain, is really important.



MYERS
Okay, if you don't use it you lose it. Okay. We'll move to Shropshire, Malcolm McIntyre who had a heart attack some time ago and since which time - well your memory's been affected you feel do you Malcolm?



MCINTYRE
Yes, certainly it seems take the - the situation with me is I'll be having a conversation with someone and suddenly the word I want to use next disappears in a cloud of smoke and completely breaks up what I was saying. But the thing that more than that worries me - because I was told by my GP and my cardiologist that's very likely to have happened because of the heart attack, which was last December, and it would get better over a period of time because I'm fairly active in what I do anyway, but then I had another heart attack two weeks ago and it suddenly occurred to me whether in fact I'll be back to square one or whether it would make it permanently worse or what, I just was wondering what the situation could be.



MYERS
So after your first heart attack you sort of began to build back again but now you've been - not as much as you would like to ...



MCINTYRE
I was told it was likely to but I must admit I still felt, even before the second heart attack, that I certainly wasn't back to where I was prior to the first heart attack.



MYERS
And now you've got another one. But you sound pretty hail and hearty, so that's good news at least.



MCINTYRE
Oh thank you.



MYERS
Let's get some advice for you from the professor. Roy.



JONES
Hello Malcolm. In fact I don't necessarily recognise it as that common that a heart attack per se will cause a memory problem, unless it was a very severe heart attack and obviously I don't know the details. I think any severe or serious physical illness may have an effect on your confidence and various other things, so it may be that that's what your GP and your cardiologist were referring to. I think the other thing that's true is that the things that cause heart attacks are also not usually good news for your brain as well, so that things like high blood pressure or high cholesterol - all of those things we know are risk factors for memory problems as well. So that you certainly need to make sure and I suspect that if you've had two heart attacks you'll already be on things like a small dose of aspirin and those sorts of things and probably a statin, which will be controlling the cholesterol, so you're probably on the treatments for that. And then I think it is a question of building back your confidence because I think actually a heart attack is quite - we can't tell your age from what we can hear but you sound quite young and active still...



MCINTYRE
Well that's sweet of you - I'm 61.



JONES
Sixty one, well there you are, that's young and active by many of the people that I see. And I think that it is quite a blow to you when that happens and it takes a while, in a sense your morale was a bit affected, it frightens you and all of those things have an effect on your confidence and in that sense I would hope that they would build back. But going back to what we said earlier - forgetting names, forgetting words is the commonest problem that people notice. So some of that may just be coincidental as well and hopefully some of it will go back, particularly if you follow some of the strategies that we've already started to talk about.



MCINTYRE
Right.



MYERS
Thanks for phoning us Malcolm, good luck with your recovery. We'll go to Kath, who's got chronic fatigue syndrome and has had this for a number of years. What's that doing in terms of your memory Kath?



KATH
I'd say that I have a third of the memory that I used to have. I'm struggling to learn algebra, I can't remember the formula, it's like the real nuts and bolts of things I can't remember.



MYERS
So you've forgotten things that you earlier learned and were quite familiar with?



KATH
Absolutely.



MYERS
And so are you managing, I mean perhaps it doesn't matter too much if you can't remember your algebra from school, are you forgetting other things that are perhaps more relevant to your day to day life?



KATH
If I meet people I don't know who they are. I met a receptionist that I worked with for many years and I didn't know who she was, yesterday, and it took about five minutes for me to work out from what she was saying who she was and how I knew her.



MYERS
Well let's see if we can get some advice for you, perhaps you could tell us first Roy whether chronic fatigue syndrome is something that's well known to perhaps lead to memory impairment, is that something you've come across?



JONES
Absolutely, it seems to be. Now chronic fatigue syndrome is something that doesn't affect that many older people and in my memory clinic I certainly see mainly people over 60 but quite often younger people but not children with chronic fatigue syndrome or younger adults. And so I don't see it as often. But having said that it's well recognised that it's part of the condition. So I think there is a reason why you've got that. I think it would still be good for you to try and develop strategies, to try and - with the things you're trying to learn write them down, try and chunk things - what you may find is if you're trying to learn something like algebra, which is particularly hard, to go back to it, so that when you've looked at it the first time try and go back an hour later, a day later, a week later, so that you reinforce the memory ...



KATH
Definitely, I'm at college, I'm actually studying algebra but I just can't take it in.



JONES
Okay, well if you try that with the repeated things you may find that it's going in but it's just taking you longer. And I'm afraid we still don't, as you well know, fully understand what causes chronic fatigue syndrome or how to manage it but it clearly is an issue that affects people and as I say memory is one of the things which really is quite debilitating if you're trying to study at college.



MYERS
Okay, thanks for that. You're listening to Check Up with me Barbara Myers and today with my guest Professor Roy Jones. And we're getting not just phones - phone calls and e-mails but tips are coming through from our listeners too and some of the strategies that Roy's been talking about and people have found their own ways forward with sharpening up their memory and if you'd like to check some of those out they're up on our website, you can go to bbc.co.uk/memory. We'll go to another e-mail question though. This comes from Brian who's only 30 years old, so he finds that he's - well he once had a great pride in his memory, he says, but I've noticed a decline, this has become so acute that I am finding myself stressed and he's worried, of course, that this is going to persist or get worse. He says there's no - to his knowledge - no history of mental illness, including MCI, in my family. I guess we should clarify that MCI is not a mental illness, that's for sure, but he is worried and at the age of 30 whereas he once he felt he was good he's now feeling that he's actually pretty poor and is getting worse. What would you say to Brian?



JONES
Well it's a difficult question with the information that we've got but clearly the first thing to say is it's extraordinarily unlikely that anyone at 30 will have something like Alzheimer's Disease or one of those much more serious conditions and in fact it would be very uncommon for someone like myself to even give the label of mild cognitive impairment - MCI - to someone in their 30s. What is much more common is that people in their 30s with these sort of issues very often it's the stress, a level of anxiety, possibly even depression that actually affects concentration and you develop a vicious circle, as it were. And so certainly Brian if that is something that you've noticed you really do need to go and see your family doctor and discuss it with them. They need to check the situation because that's not normal. But as I say stress and depression clearly affect concentration, clearly affect memory and it's one of the first things that we will look at when we're seeing older people in our clinics because there is something we can do about stress and depression and if we manage that for some people their memory problem begins to disappear and they realise that actually it was due to the stress and the depression. So I would certainly go and see your doctor.



MYERS
So in fact that's one of the advantages of getting checked out - that you may very well get the reassurance that will relieve the stress that you've got perhaps a worsening condition and then you kind of get back up with the game somehow?



JONES
Absolutely, and I think one of the problems is that there's so much more information and knowledge and discussion about things like Alzheimer's Disease and that it affects you as you get older that I think many people, as soon as they develop a memory problem, start to say oh well I've got Alzheimer's Disease and then they start to worry and then of course that then makes the problem worse. And as I say very often what we're able to do in our clinics, what a GP can do through GPs surgeries, they can reassure you that actually it isn't a problem. And in general if it's a mild problem and it isn't getting worse and it doesn't interfere with how you perform everyday activities, in other words how you deal with daily life, dealing with things like driving the car, cooking, those sort of things, then it probably isn't a serious problem.



MYERS
Do you think we're a bit hard on ourselves sometimes when it comes to memory, there's an awful lot we could remember if we have the time but our brains do get rather full up of information and are we expecting too much of ourselves?



JONES
I think that's true and as we move into middle life, certainly, we're often trying to multi-task, which we know is harder, it's also harder to multi-task as you get older, stress is a factor. So yes I think that there is that. And the other side is I think, for example, many of us accept that our eyes get worse as we get older and we take on reading glasses but we're less sort of keen, if you like, to accept that memory also changes a bit as we get older and in a sense build that in to how we deal with issues. And I think many people, particularly those who had a what they say is very good problem when they were - a good memory when they were younger, they often sort of feel even more cheated almost when it gets a bit worse as they get older.



MYERS
I hope our listeners will find that reassuring. Angela in Somerset is concerned, she is taking prescription drugs, affecting your memory you think?



ANGELA
Well I've certainly noticed that I have to concentrate a lot harder now but then also I've just turned 60. But my concern is what are going to be the longer term effects, I've had them for the past 10 to 15 years and the dose gets higher and higher as I need more and more analgesics. And where is this leading me?



JONES
Well Angela I think the first issue is that you said the doses are getting higher and higher and that must mean that you obviously need more relief from the pain for which it's been given and obviously if that's the case that will have an effect on your concentration and memory. The drugs themselves - some drugs - some strong analgesics - can affect memory, as can other drugs. But in general I would be surprised if the [name] itself is causing a problem, it's more likely to be due to the conditions around which you're receiving it and those things.



ANGELA
Alright, so yes my big concern is if I keep on taking it over the next God knows how many years am I going to go round the bend?



JONES
No, I don't think you are but I think what needs to be controlled of course is the pain that you're being given it for and of course pain is one of the commonest things that interferes with concentration and memory.



MYERS
Okay, I hope that's been helpful. We'll take a final call, if we may, from Susan Quick who's in Hebden Bridge. Hello Susan.



QUICK
Hello, hello.



MYERS
Yes your question please.



QUICK
No I was just going to say that I've got a form of brain damage called head injury, it was caused in a near fatal car accident 10 years ago and it took me about three or four years of psychotherapy to actually come to terms with who I am. But what I've learnt to do is actually to relax and if I can't remember something just relax and it'll come when the time is right. And it does. But it was so often, so if I was getting all het up about it there was no way that I would remember it.



MYERS
That's really helpful and quite reassuring - whatever the cause of your memory loss just to try and relax into it and the words or the memories you need will come to you.



We'll have to stop there, that's - our time, as usual, has beaten us but thank you very much for that call Susan. And thank you of course to my guest today - Professor Roy Jones - for all his expertise. Thanks to everyone who phoned in. You can listen to this whole programme again if you go to our website, that's bbc.co.uk. You can get some advice that's been offered by our listeners, that's the same address /memory. You can get information by calling our free and confidential helpline, that's 0800 044 044. Join me again if you will next Thursday afternoon at the same time, we'll be taking your questions on varicose veins.


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