Fly Well: Memory loss

Now where did I put my...

August 1, 2012

 

Sackier

At 11:30 a.m. in Potomac Park, Washington, D.C., on May 14, 1918, President Wilson, amid large crowds, waited for the Curtis Jenny engine to start for the inaugural airmail flight. And waited. Mechanics checked. And checked. And then they remembered to check the fuel tank. Empty. Oops.

Neglecting to fuel, pull a chock, or remove a gust lock is usually poor discipline rather than dementia. Forgetting flight procedures or your call sign may suggest failing memory, our topic for today. With aging, some memory degradation is expected, but if it’s progressive or permanent, it may reflect a serious problem.

Ever entered a room, stop, and wonder why am I here? Have you forgotten a common object or person’s name? Everyone does. But if regularly forgetting faces, names, repeating yourself, or why you are doing a task or how to do something familiar, something is wrong. Although it can happen temporarily, exhaustion, fever, or stress might impair memory.

Short- or long-term memories form when brain cells link and communicate. Diseases or damage to discrete areas affect different types of memory acquisition, storage, retention, and recovery. Unremitting loss drives patients to seek medical help, but in transient global amnesia, scary episodes lasting five to six hours are, as the name suggests, total—but temporary. Prosopagnosia, a splendid word, means the inability to recognize faces.

Head trauma may cause memory problems years later from cell damage or expanding blood clots. Emotional trauma may induce antegrade amnesia, remembering nothing since—or retrograde, nothing before—an event. Chronic oxygen deprivation damages memory—one reason I encourage liberal aviation oxygen use. “Recreational” drugs may damage memory centers, and therapeutic medications such as sleeping or blood pressure tablets, antihistamines, painkillers, and antidepressants can impact memory. Always check if a newly prescribed drug is FAA acceptable and for any side effects threatening to pilots.

Reactive depression (family death, retirement, social isolation) or true psychotic illness can impact memory and merits immediate medical attention. Prior meningitis episodes may explain impaired brain function, as may West Nile virus or other infections. Epilepsy can present with major seizures or absences impacting how we think and remember. Memory issues together with seizures or headaches might imply a brain tumor.

Alcoholism can cause vitamin B1 deficiency and Wernicke-Korsakoff syndrome. These folks lose short-term memory, confabulating fantastical stories to substitute missing parts of their life. Other vitamin or hormone imbalances can similarly impact brain function. Certain toxic substances induce brain damage from environmental poisoning, conditions such as Wilson’s disease. Remember the Mad Hatter? This character was based on harm caused to workers using mercury during felt hat manufacture. High blood pressure may cause strokes—not always in the form of a massive paralysis. These brain attacks can kill neurons, subtly damaging higher mental functions.

No memory loss discussion is complete without referring to dementia, conditions where many aspects of mental capacity decay including social skills, reasoning, judgment, and memory. Dementia occurs with age, from Parkinson’s and Lewy Body disease, and strokes. Most often, however, the cause is Alzheimer’s, which can strike as early as the third decade. Other rare culprits are Niemann-Pick or Creutzfeldt-Jakob where minuscule misshapen protein bugs called prions are to blame. Normal pressure hydrocephalus imitates Alzheimer’s and symptoms include memory loss, urinary incontinence, and altered gait. Unlike Alzheimer’s however, treatment with a shunt reduces brain pressure with often dramatic results. Current drugs for Alzheimer’s slow disease progression. There are many support groups and technologies to help those living with Alzheimer’s.

Worrying memory loss should inspire medical consultation; this will commence with a detailed history and examination. Various investigations may be ordered including blood tests; specialized psychological evaluation; brainwave analysis (EEG); and MRI, PET, or CAT scans. Treating underlying conditions may help and using checklists and routines can be as helpful outside as inside the cockpit.

Protecting your brain should include a balanced, nutritious diet; proper exercise and sleep; stress avoidance, and regular medical checkups. Social interaction and stimulating mental tasks may preserve intellectual acuity, and some people believe various supplements are beneficial (e.g., gingko, garlic, and bioflavoids).

Email the author at jonathan.sackier@aopa.org.

Jonathan Sackier