Monday, August 1, 2011

Building Neural Roads

Whether you have Alzheimer’s or are of a certain age that you’ve started routinely forgetting where you put your keys, you’re probably hearing a lot about the benefits of “exercising your brain.” We hear this “use it or lose it” philosophy mentioned frequently in sound bytes from medical experts, but what are they really asking us to do? And why? Are they just trying to get us to do lots and lots of crossword puzzles?

Here’s what they mean. Let’s think of the neurons in your head as roads, and let’s say you’re trying to remember a piece of information. Let’s say you’re trying to remember my name: Lisa Genova. When you think, “What is her name?” your brain starts looking for the road that will take it to the answer. You might travel down the road “Author of STILL ALICE” to get to Lisa Genova.

If that’s the only piece of information you know about me, you might have a hard time at first finding that one and only road. And because it hasn’t been well-traveled, the road might be small, unlabelled, maybe not even paved. It might take you a few minutes (or all day!) to remember my name.

But if you loved the book, if it stays with you after you finish the last page, if you talk about the book with friends and at book club, if you travel this particular road over and over, or in other words, if you practice and rehearse this information, “Lisa Genova is the author of STILL ALICE,” then the road becomes stronger. It becomes simple to find with a nicely labeled street sign, and it’s now wider and paved. After many experiences with “Lisa Genova is the author of STILL ALICE,” this road becomes familiar territory, smooth and easy to travel on. You now know my name and can remember it easily.

But what happens if you are in the earliest stages of Alzheimer’s, and amyloid-beta is starting to clog some of your synapses? Imagine amyloid-beta as a roadblock, keeping you from traveling down that road that leads to the information you’re looking for. What if amyloid beta is blocking the “Author of STILL ALICE” road to Lisa Genova. If this is the one and only road to my name, and it is blocked, then you can’t retrieve my name. Now when you ask yourself, “Who is the author of STILL ALICE?” you cannot remember no matter how hard you think. The information is inaccessible. Forgotten.

But let’s say you paved more than one road to my name. Let’s say you also built “Author of LEFT NEGLECTED Street” and “Neuroscientist from Harvard Avenue.” Now you can have a roadblock on “Author of STILL ALICE Road” and still have two other ways to get to my name. These other roads may not be the most direct routes to my name if you haven’t traveled them as much, but they’ll still lead you to Lisa Genova. You can still remember me.

The more connections you make to a piece of information (the more roads you build) and the more you use or rehearse that information (the more you travel those roads), the more able you’ll be to detour clogged connections (amyloid beta road blocks), and remember what you’re trying to remember.

Say you learn ten things about me. You've built ten neural roads. And now let's say you have Alzheimer's. You can have nine roadblocks, a significant amount of memory loss. But you still have one road left. You can still remember my name.

Wednesday, June 1, 2011

When is it Normal and When is it Alzheimer's?

Since the release of Still Alice, I’ve had the privilege of talking to a lot of audiences about Alzheimer’s. One of the most common questions people ask me is:

“When I can’t find my keys, how do I know if that’s normal forgetting or a symptom of Alzheimer’s?”

My quick and dirty answers are usually something like:

“Well, when you find your keys, are they on the table or in the refrigerator?”


“We all have trouble finding where we put our keys. It’s worrisome if you find your keys and then can’t remember what you’re supposed to do with them.”

Forgetting keys, names, how to get somewhere, how to do something–How do we know when it’s normal and when it’s Alzheimer’s?

The Alzheimer’s Association has put together the 10 Warning Signs List.

They also provide this phone number if you’d like to talk to someone about your concerns: 877 IS IT ALZ

My friend Kris recently shared one of her early warning signs (warning sign #4) with me:

My biggest tell-tale sign was when I’d gone shopping with my husband, and we went to a Best Buy store. I was looking at some CDs, and my husband had gone off somewhere else, and I looked up from the CDs, and I didn’t know where I was or how I had gotten there. It’s kind of hard to be in a Best Buy store and not know you’re in a Best Buy store, you know, with all the Best Buy signs everywhere. The only way I can describe it, and it’s so funny because in your book it was like this, it’s like an out of body experience.

I remember going out of the store to look at my surroundings, and I looked at the sign, but I couldn’t read that it was Best Buy. I saw the sign, but I couldn’t put together that I was at the Best Buy store. So I remember sitting down on the steps in front of the store and thinking, ‘Well, I got here somehow, I’m just going to have to figure out how I got here.’

I sat there for a while and then went back in the store, and I recognized my husband. And I thought, ‘OK. I got here with him, I’m still not sure where I am, but I got here with him and I’m okay because I know I can get home with him.’ And I didn’t say anything to him. I just followed him out to the car, got in the car, went home, and that night I still could not remember where I had been.

I didn’t want to alarm my husband about it, so just jokingly I said to him, ‘You know, I know we went out today, but I can’t remember where we went.’

He said, ‘We went to Best Buy.’

And I said, ‘Oh, yeah.’

How old were you?


When I was diagnosed with Alzheimer’s, I was relieved because now I knew there was a name to it. I know there’s no cure, and it broke my heart, but by the same token, now I knew what I was dealing with and that I wasn’t crazy.