How We Remember
Air Date: August 16, 2021
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HEFFNER: I’m Alexander Heffner, your host on The Open Mind. I’m delighted to welcome today’s guest Lauren Aguirre. She is a science journalist and author of the new book, “The Memory Thief: And the Secrets Behind How We Remember – A Medical Mystery.” Lauren, a pleasure to be with you today. Thanks for your time.
AGUIRRE: Hi Alexander. Thanks for having me on.
HEFFNER: Our pleasure. Can you tell us about the origin of this project? What inspired you to write “The Memory Thief?”
AGUIRRE: So I have my own, fortunately very short-lived experience with severe memory loss that happened about a dozen years ago. And I was just working early one morning and suddenly everything I knew about myself disappeared. So, I didn’t know where I was. I mean, I knew I was in a room, but I couldn’t have told you what room. I didn’t know, kind of where in time I was, but most of all, I didn’t know who I was. I couldn’t have told you my name. And that lasted about two minutes and it was the most terrifying, nauseatingly frightening thing that you can imagine. And when you see someone with Alzheimer’s and how they don’t recognize people that they love, you know, you see how sad that is. But actually experiencing that complete loss of connection was really scary. So for me, it turned out to be a brain abnormality. I take medicine. It’s fine. It was a type of seizure. So really, fortunately for me, no big deal, but in the course of that, I also asked for a lot of second opinions. And one of them was from the neurologist friend named Jed Barash, who looked at my scan and I had been recommended to have surgery. And he said, that’s really not necessary. Just take medicine and you’ll be fine. So he was right. And he later turned out to be one of the first neurologists to see the first example of this new type of brain injury caused by fentanyl overdose. It’s called the opioid associated amnestic syndrome. So as that story evolved and I learned more about it, I thought, oh, that’s a great way to sort of talk about memory, how we know what we think we know about memory, what it’s like to experience memory loss and how, you know, what the efforts are to treat memory loss, especially Alzheimer’s disease. So that was the origin of my interest.
HEFFNER: Lauren, we’re so glad that you wrote this book and we’re glad most of all that you are taking medicine and you have recovered from that lapse of memory. So thank you for sharing those intimate details as you document for readers of “The Memory Thief.” Let, let me ask you this: when it comes to memory we’re told from a young age, you know, maybe you shouldn’t drink so much alcohol because it kills your brain cells. I mean, that’s sort of like the traditional conventional wisdom around this, and it is not clearly just with the act of alcohol that you might be risking your memory, but there are other activities or actions that might put your memory at risk. And I was wondering if we could start there for our viewers about what you found when it comes to activity in normal human life and, you know, attempting to protect your memory?
AGUIRRE: Well, to protect your memory, you need to protect your brain. It’s really, as basic as that. Memory is probably one of the trickiest jobs that your brain has to do because you’re pulling together information. That’s coming at you sensory information from sight, to sound, to smell, to emotions, to location. And it all has to be assembled on the fly by this tiny little structure in your brain called the hippocampus. And then it has to be somehow stored somewhere so that 30 years later you can remember it, or some version of it. So, when you think about that, that’s just a stunningly difficult job. So, so, but it depends on a healthy brain. So there’s any number of things you could do that would make it hard to form good memories, whether it’s sleep deprivation, whether it’s drinking too much, whether it’s maybe hitting your head repeatedly, whether it’s not having the right diet, which is why for now one of the best things, or really the only thing you can do to reduce your risk of Alzheimer’s is to try to live a healthy life and take care of your brain. So really, anything to protect your brain will help you with memory.
HEFFNER: What was revealed to you early on in your research and chronicling this connection between these overdoses and memory? And, and you document in the book what we can learn about that, both in terms of improving the conditions of those formerly addicted, but also what the science can reveal to us about how our brains or memory respond to those drugs.
AGUIRRE: So are talking about opioids in particular, right?
HEFFNER: Right, right. Opioids in particular.
AGUIRRE: Yes. So this was really the big surprise is that opioids beyond having the impact of suppressing breathing, which is you know, the main reason it’s possible to overdose so quickly, especially from potent opioids like fentanyl, that opioids actually can have a direct toxic effect on the hippocampus. And this was really unknown before this, there were actually hints of it from a whole series of experiments conducted in the eighties and nineties, mostly on rodents, but the idea that this drug could zero in on the hippocampus and really severely damage the whole thing, was unknown. So, you know, anytime you see a new piece of the puzzle, something previously unknown about how the brain works, that’s really an opportunity to turn it around and say, well, now that we know that opioids can injure the hippocampus, is there something about that that we can use to protect the hippocampus?
HEFFNER: And was there?
AGUIRRE: So there are a few kind of hypotheses that have come out of this work. One of them is okay, if fentanyl and other strong opioids can damage the hippocampus really acutely, what about lower dose opioids that are taken long-term as prescribed? So the brain biology is usually not just sort of an all or nothing on off switch. So is there some low-grade subtle memory loss that has been going on under the radar and people who are taking their opioids as prescribed, and I’m, I’m not talking about, you have a surgery and you go home with some Vicodin. That’s not the issue. It’s people with chronic pain who may be prescribed pretty high-dose opioids over the long-term. And this is especially a concern for older people whose memories are already at risk and who are prescribed opioids at a pretty high rate. So that’s one hypothesis. Another is, going back to what I said about a new piece of the puzzle, understanding that opioids can damage the hippocampus, which is the same part of the brain that’s damaged in Alzheimer’s disease early on in the disease. Could that be used as the basis for a new mouse model of Alzheimer’s disease. And mouse models are hard, how you test new drugs. And then the third is can we use a sort of anti-opioid in this case naltrexone, which is used to treat actually alcohol use disorder, as well as opioid use disorders, by blocking the opioid receptor, could that given at the right dose chronically help protect the brain. And I can get really nerdy on you and explain why that might work or move on to less nerdy things.
HEFFNER: No, I would like you to do that. If I’m understanding correctly, it’s a kind of reverse engineering, the problem that third way you’re approaching it and finding, well here we know is the enemy. Let’s look for the antidote, based on what kind of the enemy of this region of the brain is.
AGUIRRE: That’s right. And that, it makes sense though, in the context of what we already know about brain function, especially in older people and even more so in people in the earliest stages of Alzheimer’s, which is a little recognized phenomenon, that’s only more recently becoming sort of in the mainstream, which is a level of hyperactivity in the hippocampus. So too much activity. And this is sort of, this was seen for a long time in the field as, oh, that’s the brain’s way of making up for dying neurons. So that’s a good thing. We want that over activity so that those neurons can keep communicating. But in fact, the hippocampus is such a delicately tuned structure that adding extra activity is kind of like static in the background and it actually makes it harder for memories to work properly. So by blocking these opioid receptors, that would actually turn down that overactivity and theoretically make it easier to form good memories and retrieve memories.
HEFFNER: Over the course of writing this book, Lauren, understanding that we’re still in the midst of the pandemic and count me among those people who says, you know, anyone who, who frames the pandemic as over or nearly over as if during the pandemic I did X or when it was the pandemic, sorry to sound off on my soap box here, but we are in the midst of this pandemic, a global phenomenon in addition to an American phenomenon. There is no conclusion yet in sight, but opioid misuse and abuse have been subject to some speculation as to whether they have intensified during these periods of great isolation and what we are doing to our own brains during these periods of isolation. In writing your book and kind of researching and getting down to this must have been the final stage of producing the book, were there any insights you gleaned around this question of our brains and memory during times of pandemic, which in all honesty have been, have been rare in our lifetimes, likely in our parents’ or grandparents’ lifetimes, it didn’t happen. I mean, unless they were wrapped around in 1912.
AGUIRRE: Yeah. Well, it goes back to you know, how we started off this conversation in terms of what gets in the way of memory. I mean, I certainly found myself to be very distracted and having trouble remembering things. I know a lot of people felt that way. And so any time you have too much going on and you’re not able to pay attention, and I think that was part of the problem for people is paying attention. You can’t form strong memories if you’re not paying attention in the first place, it’s not even going to get stored. And then you’re tired because you’re stressed and you’re not sleeping well. So there’s a whole, whole slew of things that could have made people’s memories impaired.
HEFFNER: But in terms of just the conditions of our country during the pandemic, broad inequity, the disconnect between the way some folks were coping and the way other folks were able to cope during the pandemic. Were you able to get into any of that in conceiving of this subject for the book, if not in the book itself, just this question of how we will remember this time and how people have been either coping or not coping as a result of kind of excluding this from their past memory. I know personally, I think often about pre-pandemic life and photos are the strongest memory, and I’m sure some of our viewers might relate to that. And I wonder how that might intersect with what you hope to accomplish in the book.
AGUIRRE: So yes, I pretty much had wrapped it up. I sort of had to wrap it up when the pandemic hit because, you know, the focus was elsewhere and the research that I was following, you know, people had to, you know, deal with that and not continue on. So, but you know, I really just sort of thought about it in terms of what I had learned about memory, which is you pay attention to the things that are different from what you do every day. Like you’re not going to know what you ate last Wednesday for breakfast, unless it made you really sick or it was the best thing you ever had. So I’m sure we will all remember the pandemic because there’s so much emotion involved in it. And so many sad things happened to people and so much changed in our way of life that I’m sure it will always be a sort of before and after in a way that, you know, the Great War and the Second World War sort of our represents such an important place in people’s memories.
HEFFNER: Lauren, you often talk about medical conditions that might impair our memory, but there’s also this question of self-selection, what we choose to remember. And you’re getting at that with the, with the kind of strong visceral reactions to things, tastes or experiences, but what, in writing this book, what did you ultimately conclude about our own capacity, our own agency to, to be either keepers or thieves of our own memory?
AGUIRRE: Well, again, it’s about attention and it’s about sort of using your tools. I mean, you can, you can make a choice this, unless you have some serious, you know, brain impairment, you can make a choice about what you want to pay attention to and remember. You go to a party, and you want to remember someone’s name, you know, there’s a basic rule, say it three times within a short window, and you will remember it. The more kind of hooks into a memory that you create will help you. So, you know, write it down. I actually, if I am at a lecture and I want to remember something, I don’t use my laptop. I use a pencil because I can hear the noise. And there’s just so much more of your brain involved in creating that memory. And I think I actually read a study that people do remember better if they write it down. Or if they try to draw a picture of what that concept was. So that the more you, the more parts of your brain that you involve in making a memory, the more likely you are to remember it, which is why, for example, the person in my book, Owen Rivers who suffered this problem, he was interested in memory from, well, before he actually lost it. And he used all these kinds of tricks. He used this state-based memory, which is have something happening at the time when you’re learning something and then make sure that happens again. So for him, it was the smell of a particular cologne. So he would smell it while he was studying for an exam. And then he would go to the exam room and smell it again. And then that would help retrieve the memories.
HEFFNER: Dr. Barash now is using the insights from the opioid investigation, how, because you are actively a science journalist in addition to the author of “The Memory Thief” so what is ongoing now as it relates to the work around memory and his particular examination of this?
AGUIRRE: Well so it’s certainly not just him. It’s a number of different anesthesiologists and neurologists and radiologists working on this. So one is, will be a study at a pain clinic at UPenn, looking at this question of long-term, high dose, chronic, opioid use and comparing people who have been using opioids to control the pain as prescribed and people who’ve been using other methods. And is there a difference in their cognitive function? And is there a difference in the volume of the hippocampus? And then, another is still in discussion with potential collaborators abroad, would be looking at this question of using naltrexone to slow down memory loss in people in the earliest stages of Alzheimer’s disease. And then the animal models probably a little further out there. But also looking at, okay, if we give rodents or mice fentanyl, and then assess how does that affect their memory function? How does that affect their hippocampus? And really quantify that as the basis for moving forward with, okay, is there a sort of opioid-induced animal model for Alzheimer’s disease that we can use? There are tons of animal models for Alzheimer’s disease and none of them fully recapitulate the disease itself because mice don’t get Alzheimer’s. But the more different ways that you have of exploring and testing drugs in mice, the better.
HEFFNER: And were you most interested in getting into the stories of the book the individual episodes or how they were kind of correlated or if they had any predictive value in understanding kind of how this person and their, his, or her memory would operate in the future, based on these individual incidents or episodes, but I wanted to give you a chance to get into the experience of Rivers or others from the book that you could illuminate for our, for our viewers to have a greater sense of what most moved you in capturing the history of, you know, these individuals that you chronicle?
AGUIRRE: Well, really the bravery, because part of the problem with this injury is it’s invisible. One person talked about it as his invisible wheelchair. So, you know, they’ve only lost the memory function. There are still fully intelligent people who can carry on a great conversation as long as they’re not distracted. So it’s feeling like others think they’re stupid when they’re not, and feeling like they can’t say what’s wrong with them, because then they’ll be blamed for having caused it, for being responsible in some way. Cause obviously this is a very stigmatized population, and then there’s the personal cost in terms of their relationships with people. Because even though they still remember everything from their past, they can’t form new memories. So you know, their close friends might have lost their father last week and they wouldn’t remember. And so they might like ask, hey, how’s your dad doing? And then have to be told over and over again. So it’s this sort of disconnection and inability to move forward with your life. You’re kind of stuck. And yet at the same time, it’s really not all or nothing. So, so for Owen there is that. But he is so organized and has such great executive function. He makes lists of everything and journals everything. And he always did. He did it beforehand because he had sort of an obsession with memory loss. But he is still able to work take classes at a community college. And I asked five people who were in the book to write essays for the end of it. And he wrote a really beautiful essay. I didn’t, to be honest, understand how terrible his memory was because you talk to him and he’s very, very smart. You can have a great conversation, but he says, now he has a sense of gratitude that he really lacked before and gratitude for everything he learned before, which helps him survive now and gratitude for the love and support of the people in his life, you know, without whom he really couldn’t survive today.
HEFFNER: Were you able to get a sense quantifiably of what percent of cases of memory loss are due to conditions that are like in, in your case, a single episode that then reveals something that can be treated, versus something that can’t be controlled ultimately. Is that, is that really a question of which drugs work for which people or is there something kind of beyond the medical intervention, in terms of whether cases of memory loss, the majority of them, are single incidents from which folks recover, or there is an incremental case of loss separate of course from Alzheimer’s and sort of our normal conception of dementia.
AGUIRRE: Yeah, well, so to be clear, this is extremely rare. This condition only happens to a tiny fraction of people who overdose on fentanyl. The actual numbers are unknown because it’s pretty clear that many people don’t come to attention. But there are certainly other causes for sudden memory loss that resolve, you know, it could be a blow to the head. It could be something called transient global amnesia, which sometimes happens after a surgery and then resolved quickly. It could be a vitamin deficiency. So, you know, anyone who has sudden memory loss obviously needs to be evaluated by a physician.
HEFFNER: And of those cases though, separate from the opioid induced ones, are they concluded to be genetic, or they concluded to be random? I’m just trying to get a sense of the landscape here for our viewers in terms of, you know, brain injury in general, and then, you know, brain injury that causes memory loss, are those episodes more frequently a result of random disorders or the result of you know, physical activity that causes people to have those conditions?
AGUIRRE: So I didn’t look into this enough to really give you, you know, an intelligent answer. You know, my hunch would be most of the time it’s some sort of accident or something that happens environmentally. I’m not aware of a genetic condition that would suddenly reveal itself as an acute memory loss.
HEFFNER: Yeah. And what was your, you know, conclusion at, when you, when you finished the book about kind of the, the way in which memory is understood in our culture? Right? I mean, this idea that, that there are, there have been films and books about memory loss and sort of waking up one day and being a new person or someone who doesn’t have any recollection of what happened in his or her prior years. And, and so I just wonder, as we close here, how you think the culture can improve in reflecting the realities of these conditions; how they are probably more widespread in general than we realize in, in going forward.
AGUIRRE: So, I mean, I think we have always, we, humanity, have always been particularly interested in memory because it is who we are. It’s our identity. So it’s, it’s probably the most human of, of traits. But in terms of, you know, what it means today, I really don’t think it means anything any different. We’ve just learned more about how to protect it and more sophistication around what memory even means. I mean, there are different types of memories and you might lose the type of memory that people who suffer this injury from lose the, the ability to form new explicit memories, but still have other types of memories that that you can use, like procedural memory, memories of how to do things that don’t actually require this sort of learning. And then of course today we have all these tools that help people, even people with, with Alzheimer’s can do a lot more than they could have in the past because of iPhones, as long as they know how to use them and as long as they’re capable of that level of sophistication. So I don’t think the landscape has changed in terms of how important memory is to us. We just know more now, especially about protecting our brains, just being healthy. It’s not sort of the mag, it’s, it’s an amazing ability, but it’s not, it’s not magic, even though it looks like it.
HEFFNER: Just in the seconds we have left, there are certain things prescribed or recommended non-pharmaceutical interventions, vitamins, et cetera, that that are advertised as you know, really important for memory and protecting your memory. I asked you at the start this question, but just to close what are, if any, those interventions that are speculated to be profoundly impactful when it comes to vitamins or supplements?
AGUIRRE: Well, you know, I’m going to be a little bit of a curmudgeon here and say, you know, I’m sure there are some studies that suggest that various vitamins or extracts are good for you. I don’t think there’s super solid evidence for those that I’m aware of. I mean, I just really go back to, you know, have a good diet, exercise sleep. I don’t think there’s a magic bullet. We would all love that.
HEFFNER: That’s true. We’re out of time, Lauren. Thank you so much for the book that you wrote and for sharing your story and the books findings, appreciate your time.
AGUIRRE: Thank you. Great to be here.
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