Unlocking the science of memory: How to remember better and forget less [PODCAST]

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Join us as we sit down with neurologist Andrew Budson, co-author of the book Why We Forget and How To Remember Better: The Science Behind Memory. Andrew shares his personal journey into the field of neurology and his passion for understanding the inner workings of the brain. We delve into the different types of memory and how they are impacted by aging, disease, and trauma. Andrew shares his expertise on how we can improve our memory, including simple lifestyle changes and memory exercises. Tune in for an insightful and informative discussion on memory and the brain.

Andrew Budson is a neurologist.

He shares his story and discusses the book, Why We Forget and How To Remember Better: The Science Behind Memory.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Get CME for this episode by clicking on the CME links in the show notes. Today we welcome Andrew Budson. He’s a neurologist, and he’s the co-author of the book “Why We Forget and How To Remember Better: The Science Behind Memory.” Andrew, welcome to the show.

Andrew Budson: Thanks so much for having me.

Kevin Pho: So we’ll get into your book in a little bit, but first off, just briefly share your story and journey to where you are today.

Andrew Budson: Well, I actually started off in high school being interested in trying to understand how this lump of gray cells that we have inside our skull produces things like thinking, memory, thoughts, consciousness, and things like that. Then I actually pursued that in college. I was a double major in chemistry and philosophy, trying to get to both sides of the problem. When I entered medical school, I knew I was either going to do psychiatry, neurology, or neurosurgery, and neurology just seemed to be the best fit, both for the questions I was asking and also because they seemed to be my people, the people I enjoyed hanging out with.

So after my neurology residency, I did a fellowship in cognitive behavioral neurology, and at the same time did a postdoctoral research fellowship to really try and dive into those questions in a very specific way, doing cognitive neuroscience research, where you’re trying to put the cognitive things, like memory and thinking, into the neurons, the cells, and what activity is actually going on in the brain. I chose memory to study, both as a research and as a clinical topic, because it’s the most clinically relevant field. So that led me to have a dual career, being both a memory disorders clinician and also a memory researcher, and that is where I am today.

Kevin Pho: So in your clinic as a neurologist, in Alzheimer’s-specific clinics, tell us what’s the typical presentation patients would be referred to you for.

Andrew Budson: So either the patient themselves, the family member, or sometimes the clinician notices that there are some difficulties with memory. One common and important way that patients get to me is that the clinician is prescribing them an antihypertensive medication, and their medication doesn’t seem to be under any better control when they see them back in the clinic. They’re raising the dose, they’re adding a second agent, and then they realize, “Oh, the patient is not remembering to take their medication.” So then they would refer them to us.

We would be able to sort out what’s going on by doing a comprehensive history of the problems. We do some pencil-and-paper testing as part of our routine evaluation. We rule out things like thyroid disorders and vitamin deficiencies with blood tests. We get a structural brain imaging study, and usually by the time we have all of those pieces, we’re able to offer a diagnosis at that time and begin to talk about the treatment.

Kevin Pho: All right, let’s talk about your book that you co-wrote. It is titled “Why We Forget and How To Remember Better: The Science Behind Memory.” So tell us, how did this book come together?

Andrew Budson: Well, it really started a couple of years earlier, when I wrote my first book for the public, which took on the problem that I had noticed first and foremost in patients who were coming to my clinic. The problem that I noticed is that most people just don’t know what is to be expected as the memory problems that occur with normal aging, and how those differ from the memory problems that occur with Alzheimer’s. That book was called “Seven Steps to Managing Your Aging Memory: What’s Normal, What’s Not, and What to Do About It.”

That all went very well, and then I went to tackle the second most common problem which I saw, which is what family members can do to help manage all the problems that come up in the moderate-to-severe stage of dementia, because there’s so much knowledge that family members and other caregivers need to know to deal with all sorts of different behaviors. We dove into that in our book “Six Steps to Managing Alzheimer’s Disease and Dementia: A Guide for Families.”

But then what I realized is that there were all these other people out there who would often have neurologic problems, from seizures, from Parkinson’s, from multiple sclerosis, from a traumatic brain injury, who would like to better understand what the problem is with their memories. I also had the experience of watching my daughter go through high school and college, and realizing that we know a lot about the best way that we can help improve everybody’s memory: how to improve people’s memory if they had a traumatic brain injury, and how to improve memory if they’re just a normal high school or college student and they want to be able to study smarter for their tests and exams, and things like that.

So what my co-author and I decided is that we would work on designing and writing a book that would explain how memory works, how it breaks down in these different types of diseases, and how you can use this knowledge of how memory works to actually improve your memory in day-to-day life, whether you’re recovering from an illness, whether you have a chronic illness, or whether you’re just a healthy individual.

Kevin Pho: So without getting too much into the book, I would love to hear some of your tips in terms of translating how memory works into how we can remember better. What are some of your main ways to do that?

Andrew Budson: So one first principle that is very important and isn’t always intuitive is that the more effort that you put into remembering something, the better you will remember it. The way that this comes into play, and why it can be counterintuitive, is this: Let’s consider two different common ways of studying. One is that many people like to highlight and then reread portions of their textbook. I confess, when I was in medical school, that was my number-one method. I had four different colors of highlighters, and I would highlight all the different sections and reread them right before the test. I know other people, some of my friends, would take notes from the textbook, make flash cards, and test themselves on it.

It turns out that highlighting and rereading is not only not the best way to get it into your memory, because it’s not active, it actually gives you the illusion that you know it when you really don’t know it that well. When you reread the same section, it becomes easier and easier to read, and because it’s easier to read, it gives you an illusion that it feels like you know it. It turns out the harder, effortful task of writing things out on note cards and testing yourself is a far better method of studying. But if you ask college students which of these two methods is better, and the study has been done, they’re 50-50. So most people don’t know that when things seem harder, you remember them better.

This gets at this whole concept of learning styles. We often think, “Well, I’m a visual learner,” or “I’m an audio learner.” Well, it turns out that if the learning comes more easily to you, it’s not going to stick with you as well, and everybody learns best if they learn both audio and visual together. So that’s one basic principle. I’d love to tell you one more.

Kevin Pho: I would love to hear it.

Andrew Budson: This is an acronym that we have built into the book that covers a lot of different research, all combined into one, and the acronym is the word FOUR. There are four things that students in particular can do to really enhance their memories. You want to focus on the information that you’re trying to learn; that’s the F. The O is that you want to organize it in a way that makes logical sense. The U is to make sure you understand it as deeply and richly as you need to understand it; otherwise, you’re not going to be able to remember it well. And the R is to relate it to something that you already know. So between effort and the four principles, this in and of itself can change students from a C to an A.

Kevin Pho: How about outside the academic setting, in a real-world setting? Let’s say someone is out of school, and they just want to, on a day-to-day basis, maintain their memory and not let that deteriorate. What are some tips you have in that scenario?

Andrew Budson: Yeah, absolutely. One of the things that we talk about in the book is to work to understand some of the different components of memory and see if you’re having trouble with one of them. For example, let’s say somebody is having a little bit of trouble paying attention, and they might have trouble with paying attention because they have attention deficit disorder, or because they’re feeling anxious, or for whatever reason. We can actually all learn to pay attention better, which is the first principle to remember anything, like the names of people you meet at a cocktail party, or even just the experiences you’re having. You have to pay attention, and people can work on learning to pay attention better.

My favorite technique for this is actually practicing mindfulness. When we engage in mindfulness, we’re actually working on trying to control our thoughts, to pay attention to what we want to pay attention to, whether it’s focusing on paying attention to our breath or the environment or whatever it is. So that can be a helpful tip.

If we’re paying attention, but then the problem is that we don’t know what it was two or three days later, the helpful thing to do is, at the end of, say, meeting a person at a cocktail party, or at the end of the day, spend a minute and review whatever you have learned or whatever experiences you have had that you would like to remember better. Some people like to write things down in a journal or a diary, and that can be very helpful. Other people just like to review their day before they go to bed. I actually like to do that. I spend a minute and think about the different things that happened during the day.

And I do work on remembering names. I’m not good at names innately, but I know the tricks, so as long as I apply the tricks, I can actually remember them better. By reviewing names before you go to bed, and other things, your daily experiences, that will help bring them into long-term memory.

Kevin Pho: One of the things that you mentioned in your first book caught my attention: the differences between quote-unquote normal forgetting versus more pathological forgetting, which could be a sign of Alzheimer’s. So what are some key red flags to look out for there?

Andrew Budson: So in normal aging, there are generally three things that individuals have trouble with, and it all has to do with the fact that the frontal lobes don’t work quite as well as they used to in normal aging. Because of that, people often need to hear or read the information they’re trying to learn more than once. It may take a little bit longer for people to retrieve the information that they’re looking for, and they may need a hint or a cue in order to retrieve it. So those are all part of normal aging, but in normal aging, as long as the information got into the memory store, it should be able to be retrieved.

Now, in contrast, in Alzheimer’s disease, the problem is that even when information is repeated, even if you wait a bit of time or give a hint or a cue, the information is rapidly forgotten. So in that case, people end up asking the same questions again and again and again, because they’re given the answer multiple times, but they can’t hold on to it. The normal person is trying to come up with the name of a restaurant; you give them a hint, and they’ve got it. The person with Alzheimer’s, you can give them a hint, give them a cue, and they have no memory as to what restaurant it was.

Kevin Pho: We’re talking to Andrew Budson. He’s the co-author of the book “Why We Forget and How To Remember Better: The Science Behind Memory.” Andrew, tell us some of your take-home messages that you want to leave with the KevinMD audience.

Andrew Budson: Well, I’m hopeful that whether you’re listening to this podcast and you have a healthy memory and everything is working fine, but you’d just like to make your memory a little better or understand how memory works, or you’re a person who has one or another disorder that’s affecting your brain, you’ll learn things in this book that will be able to help you remember better.

Kevin Pho: Andrew, thank you so much for sharing your time and insight. Thanks again for being on the show.

Andrew Budson: My pleasure. Thanks for having me.

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