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Memory Upgrade
Despite a wealth of brain boosters on the market, a psychiatrist remains a frugal shopper.
by Elissa ELy

Whenever I visit my doctor, after we have finished with the usual blood-pressure and weight-loss scripts, I ask him what he’s doing to keep his mind sharp. Inquiring on this topic is like asking someone to show a couple of snapshots from his last vacation. The rest of the world then waits for as long as it takes.

Dr. Q., my specialist, has a desk littered with pill bottles. He pops supplements between patient appointments, one to two dozen pills a day, but the particulars change each time we meet. The most recent combination (as far as I can recall) included high-dose fish oil, several amino acids, coenzyme Q10, thyroid hormone, testosterone, and vitamins C and D. He is off vitamin E and beta-carotene, disappointed in ginkgo, and reconsidering Zocor since he read a study linking statins to memory loss. He lifts weights and carries index cards with facts he commits to memory. To improve praxis, he likes to draw his patients’ blood himself in the office. He is a marvel.

After each consultation, I rush home, take out my seven-day pill dispenser (fastidiously packed with my own supplements) and stir the contents with a forefinger. Royal jelly goes out, curcumin powder goes in. The recipe for a perfect brain is always in flux. But I don’t really need my doctor for this advice—there are dozens of other doctors out there willing to give it, in lists with such decisive titles as “Eight Essential Strategies for Keeping Your Mind Sharp and Body Young,” “Nine Strategies to Improve Memory,” and “Ten Steps to Better Memory in Your Seventies.” Each author is dead sure. But you see the dimensions of the problem already: no one can agree on a number.

One could begin with “smart drugs.” They may enhance cognition, and pharmaceutical companies are sprouting up everywhere to compete for them. It’s like an Iron Chef smackdown, with contestants grabbing dishes from the hot stove and racing them to the patent office for judges to taste.

Smart drugs are supposed to increase brain metabolism, improve cerebral circulation, and quash free radicals. There are calcium-channel modulators, nicotinic-receptor partial agonists, pyrrolidone derivatives. Don’t forget the “building blocks of life”—the amino acids, especially tyrosine and phenylalanine. We can take lecithin and L-carnitine, inositol, vasopressin, and lipid-lowering statins. The selective serotonin-reuptake inhibitors may cause hippocampal neurogenesis—though they also cause frontal apathy, or “Prozac poopout.”

Years ago, a nurse in a hospital where I used to work ran a thriving underground business in grape pip extract. Now you can buy it online, purified and ten times as costly. For those who can’t swallow pills, the aroma of peppermint has been shown to improve performance on a Cognitive Research Computerized Assessment Battery.

Dietary factors are earthier than nootropics, and you don’t have to order them from specialty stores. The well-stocked pantry carries everything. You’ve got your fruits and vegetables, your whole grains, your omega-3s. Red wine with resveratrol is recommended nightly. Take one to two glasses, but not more; this could qualify as alcohol abuse—which would damage the very memory you’re trying to preserve.

Then there are the many varieties of exercise. Physical exercise, of course, has been popular since the Socratic academy. It is cheap and healthful, with only a few caveats, such as avoid football, boxing, and skiing without a helmet. Aerobics are supposed to increase brain-derived neurotrophic factor and hippocampal neurogenesis and to decrease prefrontal shrinkage. The devil lurks in the details, though. Panting non-athletes, checking their pedometers, want to know: exactly how many laps, how many sets, how many summits? Here experts are back to their disagreeing numbers—half an hour, three times a week; sixty minutes, six times a week; daily, for as long as you can bear. This much is vaguely clear: more is likely better.

Social exercise may be effective, too. In one study, ten minutes of pleasant personal interaction each day increased Mini-Mental State Exam scores as much as the same amount of intellectual study. I find this heartening. It speaks well of our species to think that a dozen friends are worth a dozen logic problems.

There is also exercise for the brain itself: In 2007, more than $225 million was spent by the hopeful and the despairing on brain-fitness software such as My Brain Trainer and Mind Spa. The theory is that math, logic, and memorization problems lay down additional neural pathways. Six months after enrolling in one memory enhancement program, a group of 60- to 90-year-olds without dementia tested no better than their non-enrolled peers. But they were much less worried about themselves, which is worth the price of admission. Some of us will always prefer friends to brain exercises, but that is a matter of taste. I won’t denigrate computer games if you respect the gossip I live for.

If you are inclined to invasive techniques—fatty-cheek–pad implants instead of moisturizer—there is deep brain stimulation. If you are less inclined, there is poetry. Alliteration and repetitive consonant sounds cause easier retrieval of similar sounding phrases. So do mnemonics, associations, and chunking information into smaller categories. Greek orators memorized long speeches by visualizing themselves walking a familiar road, linking sequential landmarks with sequential points they wanted to make. Recall was as simple as a mental walk home.

Finally, for those who prefer no effort, there is the absence of exercise altogether. Ninety-minute daytime naps have been found to increase long-term memory consolidation. Unfortunately, they also make it harder to sleep at night, which will decrease long-term memory consolidation. On this topic, there is no god.

To what end all these efforts? What comes from supplemental, nutritional, aerobic, neurosurgical, Grecian, sociable, slow-wave strategies? Not better memory, at least not in a simple way. First of all, the brain is more complicated than our efforts to master it; there are a multitude of memories to worry about losing. We need short-term working memory, but we also need long-term declarative and procedural memory. Second, the act of remembering follows several stages: acquisition, consolidation, and retrieval. Each memory type and each stage is differentially sensitive to age and insult. Therefore one fix cannot fix all. You need to spend the rest of your life in repair.

When my doctor and I are sitting across his pill-addled desk, there is a question I have never brought up. It may be too plaintive for a specialist. Why do we take memory to be the most important measurement of human worth? It’s as if we judge the value of our minds to be the sum value of our selves, and no other measurements count. Dementia is tragic, but there is more to people than acquisition, consolidation, and retrieval. In my dotage—when I may no longer be able to learn what I should, and when I cannot recall what I want to—this is what I hope for: that someone I love will lead me by the hand to a place outdoors with flowing water and a waiting dog. We will sit together, listen to the water, and stroke the dog. In that place, I like to think, we will be happy—whether we remember it or not.

Elissa Ely ’88 is a psychiatrist at the Massachusetts Mental Health Center.

Photo: ©iStockPhotocom/Andrzej Burak