MEM­ORY CHECK-UP

A na­tion­wide study of mem­ory loss and pre-de­men­tia has good news for one of its first re­cruits, Graeme New­ton. We pro­filed him in our April 2017 is­sue, and later sat in on his an­nual re­assess­ment. Donna Chisholm re­ports.

North & South - - Health - DONNA CHISHOLM IS NORTH & SOUTH’S EDITOR-AT-LARGE.

Three years after be­ing di­ag­nosed with mild cog­ni­tive im­pair­ment, Graeme New­ton was con­vinced his mem­ory was get­ting worse. Names of peo­ple he’d met and plants he tended in the gar­den were elud­ing him more, and he strug­gled with the men­tal arith­metic at which he’d once been so adept.

It wasn’t for want of try­ing to do what all the text­books ad­vise for peo­ple with pre- de­men­tia; as one of the first par­tic­i­pants in the coun­try’s new De­men­tia Pre­ven­tion Re­search Clin­ics, New­ton knows the im­por­tance of keep­ing phys­i­cally ac­tive, so­cially con­nected and men­tally ag­ile – and he works hard at all three.

So when he meets neu­ropsy­chol­o­gist Dr Christina Ilse at the Auck­land Univer­si­ty­based Cen­tre for Brain Re­search for his an­nual re­assess­ment, New­ton is blunt about his de­te­ri­o­ra­tion. “I feel that I’ve de­clined.”

His wife Jay agrees, he says, not­ing he’s be­come more ver­bally ag­gres­sive be­cause of his frus­tra­tion, when he is usu­ally very mild-man­nered.

“She has dif­fi­culty be­cause she doesn’t know what I might or might not re­mem­ber. Some­times I’ll re­mem­ber ev­ery­thing and some­times I won’t, so there’s an in­con­sis­tency that she finds dif­fi­cult to deal with.”

Things are worse when his mood is low; then “most of the day can dis­ap­pear” with­out him know­ing where ex­actly it went. But he re­alises it’s just an off day and his de­pres­sion is un­likely to last.

Ilse tells him that’s a big positive. “Some peo­ple who have an episode of de­pres­sion have a com­bi­na­tion of symp­toms, in­clud­ing re­duced drive, hav­ing re­ally sad thoughts about them­selves and the fu­ture, re­duced ap­petite and dis­rupted sleep. Then they feel tear­ful, shaky and up­set.

“It sounds like you have just one – not feel­ing the get up and go – so that’s re­ally re­as­sur­ing. It’s okay to have a day like that and be­ing able to say, to­day isn’t great, but to­mor­row might be dif­fer­ent.”

Big fam­ily oc­ca­sions are now a thing of the past for him – try­ing to keep up with a con­ver­sa­tion with mul­ti­ple peo­ple has be­come just too hard. To cel­e­brate his 75th birth­day in June, they went out to din­ners with a cou­ple of good friends at a time, rather than hav­ing ev­ery­one come to a party.

New­ton man­ages his mem­ory loss by keep­ing mul­ti­ple lists and diary notes. He says he’s be­come adept at not dwelling on it when he for­gets a name or task but feels less con­fi­dent driv­ing to places he doesn’t know well. “A year ago, I’d rate my­self 8/10. Now I’m get­ting down to a 6.5. I still think I’ll get there, but just think­ing about it is an is­sue.”

Ilse says she’s try­ing to work out whether New­ton’s mem­ory has in fact de­clined, or whether he’s just be­come more wor­ried about it. New­ton be­lieves there’s a bit of both, and that although the de­te­ri­o­ra­tion is hard to quan­tify, it’s def­i­nitely hap­pen­ing.

Self-as­sess­ments vary in ac­cu­racy, ex­plains Ilse. “We get some peo­ple who re­port no dif­fi­cul­ties but their part­ner re­ports them and the tests show dif­fi­cul­ties, so the per­son has re­duced aware­ness of the prob­lems. We also have sit­u­a­tions where a fam­ily mem­ber re­ports prob­lems, but the per­son doesn’t and the tests show no dif­fi­cul­ties, so per­haps the fam­ily mem­ber is pick­ing up stuff that is not even there.”

For New­ton, the re­sults, when they come in, are good news: the ob­jec­tive tests show no ev­i­dence of de­cline, de­spite his and his wife’s per­cep­tion of change. Although his mem­ory is im­paired, “at­ten­tion, pro­cess­ing speed, gen­eral ver­bal and vi­su­ospa­tial abil­i­ties and ex­ec­u­tive func­tion re­main in­tact”.

It’s en­cour­ag­ing news, says New­ton, who says he’s hop­ing to at least main­tain his cur­rent func­tion­ing, or even im­prove, ahead of the 2018 tests, which will in­clude a brain scan.

He’s cho­sen to share his progress to help raise aware­ness and un­der­stand­ing of mild cog­ni­tive im­pair­ment in the com­mu­nity.

Es­ti­mates vary as to how many peo­ple with MCI will go on to de­velop Alzheimer’s dis­ease or other forms of de­men­tia. Some stud­ies suggest 5-15 per cent a year, while one meta­anal­y­sis found more than 60 per cent had not de­vel­oped de­men­tia 10 years after be­ing di­ag­nosed. It’s es­ti­mated around 50,000 New Zealan­ders have de­men­tia and the fig­ure is pre­dicted to top 150,000 by 2050.

De­men­tia Pre­ven­tion Re­search Clin­ics are be­ing set up in Auck­land, Dunedin and Christchurch with the es­tab­lish­ment of Brain Re­search New Zealand, a Cen­tre of Re­search Ex­cel­lence, in 2015.

Graeme New­ton man­ages his mem­ory loss by keep­ing mul­ti­ple lists and diary notes.

Neu­ropsy­chol­o­gist Dr Christina Ilse at the Cen­tre for Brain Re­search in Auck­land. She told New­ton she had to work out whether his mem­ory had de­clined, or whether he’d just be­come more wor­ried about it.

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