Andrew Budson, MD

Seven Steps to Managing Your Memory

Aired on:July 12, 2019

Episode Description
Have you ever walked into a room and forgot why you walked into the room? Have you forgotten the name of a person? Are these normal? When do we need to worry about our memory? Some of the above are considered normal and can be explained by distraction. Dr. Budson has evaluate thousands of persons concerned with their memory and shares his expertise. Tune in and learn about memory, when to be concerned and how we can improve our memory.

Dr. Dale Bredeson’s work (previous interview)

  • Is reversing symptoms of cognitive decline with a multi-prong approach
  • He has 5 Alzheimer’s subtypes
    • Toxic form
    • Metabolic form (insulin/ blood sugar related)
    • Where catabolic (tearing apart) processes are faster than anabolic (building up) processes
  • By treating the major contributors, he has reversed the cognitive decline
  • If his treatment is stopped, cognitive decline returns at approximately six months

Why Dr Budson wrote his current book:

  • He wants people to understand their memory problems
    • Are they normal
    • What to do about memory problems
    • One problem is that people come to him when it was too late
      • They did not think there was a problem
      • Their doctors told them there was no issue
    • There is not enough time to educate patients in a short appointment time
      • , why is memory normal or not
      • why medication prescribed
      • how medication works
      • why exercise is recommended
      • why diet is recommended
    • people think memory loss is normal
    • this is not necessarily true

Memory is like a filing system

  • frontal lobe -the file clerk
    • First part of the memory creation
    • Brings information in from the outside world and put into the memory file cabinet
    • With normal aging, the file clerk might have difficulties
      • Can be hard of hearing so information needs to be repeated
      • May move more slowly so it might take longer to find the memory
      • Might not see as well in finding a memory, so might need a cue or clue
    • Hippocampus the file cabinet
      • Stores new memories
      • Is deep in the temporal lobes
      • Is one of the first brain structure that is affected by Alzheimer’s Disease
      • Hippocampus shrinkage can be seen on the MRI scan
        • Hippocampus shrinkage is one of diagnosis criteria
      • Storage to a longer-term memory location takes place during sleep

What is normal for memory

  • Not remembering why walking into a room because we get distracted
    • Normal to have a lapse in memory as get distracted
  • Forgetting a name because we get distracted
  • Forgetting a memory but it all comes back when someone reminds us
  • Forgetting name of a movie, people, places, restaurants
  • Whether we remember the plot of a movie depends on how much we cared about the movie
  • Driving by exit due to distraction
  • Forgetting to buy some items on a grocery list
  • Losing keys, glasses if this has been a long pattern
  • Can have trouble finding car in parking lot if not paying attention
  • Looking at calendar frequently depends on past history of this
    • Depends on how complicated the schedule is
  • It is OK if
    • it takes repetition of information to obtain a memory
    • it takes little time to retrieve information
    • it takes some cues to retrieve information

When should we be concerned about memory

  • Rapid Forgetting
    • All new memories are stored in file cabinet. Hippocampus
    • Alzheimer’s Disease destroys the hippocampus
      • This is like a big hole in the file cabinet
      • Information disappears down the hole never to be found again
      • One cannot retrieve recent or past information
    • A person cannot remember an event even with reminding
    • People will repeat the same question or same story over and over again.
    • Cannot remember an event even with reminders
  • Forgetting normal words such as table, chair
  • Taking time to find keys or glasses if this has not been a problem in the past
  • If there is a change in your memory
    • For example, people with a large cognitive reserve (college professor) he may test normal, but this is a reflection of a decline in memory

When to Get Memory Evaluated

  • If worried about memory as it might be normal
  • There are treatable causes of memory loss
    • Thyroid disorders (either high or low)
    • Vitamin B 12 deficiency
      • Can cause memory loss or permanent dysfunction if not treated early
    • Infections such as Lyme Disease and other tick-borne illnesses
    • Normal pressure hydrocephalus
      • Has gait problems, urinary incontinence and cognitive difficulties
    • He finds that people tend to feel better when they know why they are having memory problems
    • Medications help if started earlier

Medications for Alzheimer’s Disease

  • If the condition is Alzheimer’s Disease, there are FDA approved medications that can slow down memory loss
    • The earlier these medications are prescribed, the better these medications work
      • Because there are more functioning neurons
      • These medications can turn the clock back on memory loss
        • Can make memory like it was 6 to 12 months ago
        • For example Ariceft (doniprazil)
        • The memory will continue to decline at the same slope but the memory will always be at a point six – twelve months earlier
      • If medications are stopped, memory plummets within one to two weeks to what it would have been without the medications
        • For this reason, medications are recommended until the very end
      • British study 2012 in the New England Journal of Medicine
        • Patients who stayed on doniprazil did a lot better
      • Are new antibody medications directed against the amyloid plaque or neurofribillary tangles (pathologies in Alzheimer’s Disease)

A lot of people try to hide memory problems

  • People are afraid of having Alzheimer’s disease

Strategies for Remembering

  • Imagine walking through the house with a grocery item in each room
    • The ancient Greeks used this technique
  • Finding car in parking lot: for example if parked in :
    • C 2 imagine two cats walking on car
    • A3 remember 3 alligators on the car
    • Works better if it is an animal you don’t like

Alzheimer’s Disease Pathology

  • Amyloid plaque was considered a part of Alzheimer’s pathology
  • Medications against these plaques have failed
    • Earlier scientists thought these medications failed because they were started too late
  • New thinking is
    • that beta amyloid may be to fight infections and an attempt to defend the brain
    • Amyloid may be part of the brains immune system that has gone overboard
      • Maybe like an autoimmune diseases where the brains immune reaction
    • For example if the amyloid is in the brain because there is a virus in the brain
      • For example people with Alzheimer’s Disease are more likely to have had an infection with Herpes Simplex virus
    • This may explain why there is no concordance in identical twins
    • This explains why anti- amyloid drugs have not worked
    • No study has shown that removing amyloid plaques can help in Alzheimer’s Disease
  • Anti neurofribillary Tangle Drugs are being evaluated

Aerobic Exercise

  • Has best evidence of protection against Alzheimer’s Disease
    • Studies that people who started strenuous aerobic exercises in their forties, delayed Alzheimer’s disease by 11 years (from age 79 to age 90)
  • Helps cardiovascular health can reduce the risk of strokes
    • Important for brain health
  • Is a natural antidepressant
  • Releases brain growth factors 9BDNF
    • Helps grow new brain cells
  • In 6 months of aerobic exercise can measure
    • Directly proportional to physical fitness
    • Amount memory improved in day to day live
    • Directly related to amount of BDNF
  • Exercise is closest thing as magic bullet
  • Check with doctor before embarking on new exercise program
    • Cardiovascular health
    • Joint health


  • Hard to pay attention if tired so won’t be able to remember
  • Transfer process from recent memory file (hippocampus) to older storage area taes place during sleep
    • So without sleep won’t be able to store long term memories


  • Mediterranean diet


  • If new depression might be connecte to memory loss and should be evaluate

Multi infarct (vascular) dementia

  • Step wise loss of abilities
    • Blood pressure and cholesterl.

Frontal temporal dementia

  • Changes in behavior and difficulties controlling behaviour
  • Become self centered
  • Cont care about other’s feelings
  • Do inappropriate things
    • Seuxall inappropriate
    • Often very oral wanting to ut htings in mouth
    • Diets cn cange to wanting to eat. A lot of sweets
    • ¾ of frontal demntia are under age 65
    • Loss ability to control behaviour
  • Dementia with lewy bodies (robin w
    • Has Parkinson s
    • Visual hallucinations can be one of first signs
    • People can act out dreams while sleeping


  • We need sufficient cholesterol to make myelin and cell walls
  • Lowers Co Q 10, adiponectin and affect the myelin sheath
  • A large study showed that simvastatin did not reduce or worsen memory loss
  • He states that neurologists don’t affect memory
  • No studies done to differentiate between statins that cross the blood brain barrier and those that don’t


  • An over the counter supplement
  • He does not believe it is harmful
  • He states there is no evidence that it is helpful

Montreal Cognitive Assessment

  • Ask if they feel their memory has decreased
  • Then a neuropsychologist can do further tests