How To Remember Things

memory

Photo: quapan

I once came up with a metaphor I thought perfectly captured the sheer mass of material my classmates and I were expected to memorize in our first two years of medical school:  it was like being asked to enter a grocery store and memorize the names of every product in the store, their number and location, every ingredient in every product in the order in which they appear on the food label, and then to do the same thing in every grocery store in the city.

When I look back now I can’t imagine how any of us were able to do it.  And yet we did.  The mind’s capacity to store and recall information is truly wondrous.  Since I attended medical school we’ve learned a lot about memory and learning.  Though much of what follows are techniques I used to survive my first two years of medical school, much of the science that proves they work is new.

STRATEGIES FOR REMEMBERING
  1. Become interested in what you’re learning.  We’re all better remembering what interests us.  Few people, for example, have a difficult time remembering the names of people they find attractive.  If you’re not intrinsically interested in what you’re learning or trying to remember, you must find a way to become so.  I have to admit I wasn’t so good at this in medical school.  The Krebs cycle (I provided the link only to prove how immensely boring it is) just didn’t excite me or relate to anything I found even remotely exciting (though I made myself learn it anyway).
  2. Find a way to leverage your visual memory. You’ll be astounded by how much more this will enable you to remember.  For example, imagine you’re at a party and are introduced to five people in quick succession.  How can you quickly memorize their names?  Pick out a single defining visual characteristic of each person and connect it to a visual representation of their name, preferably through an action of some kind.  For example, you can remember Mike who has large ears by creating a mental picture of a microphone (a “mike”) clearing those big ears of wax (gross, I know—sorry—but all the more effective because of it).  It requires mental effort to do this, but if you practice you’ll be surprised how quickly you can come up with creative ways to create these images.  Here’s another example:  how often do you forget where you left your keys, your sunglasses, or your wallet?  The next time you put something down somewhere, pause a moment to notice where you’ve placed it, and then in your mind blow it up.  If you visualize the explosion in enough detail, you won’t forget where you put it.  Remember:  memory is predominantly visual (unfortunately, I can’t think of a good image to help you remember this fact right at this moment).
  3. Create a mental memory tree.  If you’re trying to memorize a large number of facts, find a way to relate them in your mind visually with a memory tree.  Construct big branches first, then leaves.  Branches and leaves should carry labels that are personally meaningful to you in some way, and the organization of the facts (“leaves”) should be logical.  It’s been well recognized since the 1950′s we remember “bits” of information better if we chunk them.  For example, it’s easier to remember 467890 as “467″ and “890″ than as six individual digits.
  4. Associate what you’re trying to learn with what you already know.  It seems the more mental connections we have to a piece of information, the more successful we’ll be in remembering it.  This is why using mnemonics actually improves recall.
  5. Write out items to be memorized over and over and over.  Among other things, this is how I learned the names of bacteria, what infections they cause, and what antibiotics treat them.  Writing out facts in lists improves recall if you make yourself learn the lists actively instead of passively.  In other words, don’t just copy the list of facts you’re trying to learn but actively recall each item you wish to learn and then write it down again and again and again.  In doing this, you are, in effect, teaching yourself what you’re trying to learn (and as all teachers know, the best way to ensure you know something is to have to teach it).  This method has the added benefit of immediately showing you exactly which facts haven’t made it into your long-term memory so you can focus more attention on learning them rather than wasting time reinforcing facts you already know.
  6. When reading for retention, summarize each paragraph in the margin.  This requires you to think about what you’re reading, recycle it, and teach it to yourself again.  Even take the concepts you’re learning and reason forward with them; apply them to imagined novel situations, which creates more neural connections to reinforce the memory.
  7. Do most of your studying in the afternoon.  Though you may identify yourself as a “morning person” or “evening person” at least one study suggests your ability to memorize isn’t influenced as much by what time of day you perceive yourself to be most alert but by the time of day you actually study—afternoon appearing to be the best.
  8. Get adequate sleep to consolidate and retain memories.  Not just at night after you’ve studied but the day before you study as well.  Far better to do this than stay up cramming all night for an exam.
WHY MEMORY MALFUNCTIONS

One of the most common complaints I hear in clinical practice is about memory loss.  Unfortunately, as a normal part of the aging process, many people start to find they can’t bring to mind names, places, and things as easily as they used to be able to do and worry they’re facing the beginning of dementia.  “Benign forgetfulness” is the name we give to a process that occurs with normal aging in which a memory remains intact but our ability to retrieve it becomes temporarily impaired.  Usually we try to describe the name or thing we can’t recall and when someone names it for us we instantly remember the word we wanted.  As long as this is age-appropriate and doesn’t significantly interfere with normal functioning, there is no increased risk for progression to dementia.  However, the trick lies in assessing what is and isn’t “age-appropriate.”  Formal testing is sometimes necessary in ambiguous cases.  Reassuringly, in one study, patients over the age of 50 who initially presented with what was considered to be benign forgetfulness had only a 9% chance of progressing to dementia.  Unfortunately, cognitive impairments other than memory loss are correlated with a higher risk of progression to dementia.

Another reason people often have trouble remembering things is because memory is a function of concentration.  Which means when you multi-task you tend to forget more easily.  Have you ever entered a room only to forget why you did so?  More likely you’d remember if you weren’t simultaneously planning your dinner for that night and trying to remember the phone number of the person who just left you a message.  This also explains why people who suffer from depression or anxiety have a harder time remembering things:  both conditions interfere substantially with the ability to concentrate.  The strength of a memory is also determined by the emotional state that accompanied the original event.  Emotion, negative or positive, tends to embed events in our memory like a chisel carves lines in stone.  A double-edged sword for people suffering from PTSD.

DECREASING THE RISK OF DEMENTIA

Here are three things you can do that have been shown in studies to decrease the risk of mental deterioration as you age:

  1. Exercise your body.  Evidence suggests this not only retards normal age-related memory deterioration but reduces the risk of developing dementia.  It doesn’t even have to be vigorous exercise.  Just 150 minutes of walking per week has been shown to be of benefit.  Whether more intense exercise results in a greater risk reduction remains unknown.
  2. Exercise your mindEvidence also suggests that doing things that work the mind may delay or prevent memory loss.  This research is just in its infancy, so here’s as good a guide as any to figuring out what activities will work:  if an activity requires you to take breaks, it probably qualifies.  We can watch television, for example, for hours on end without becoming mentally fatigued, but solving math problems, learning to knit, or even reading all require effort that tires the mind.
  3. Take ibuprofen.  Though one study suggests a daily dose of ibuprofen decreases the risk of developing dementia, the risk reduction appears too modest to justify the increased risk of stomach bleeding that accompanies ibuprofen’s daily use and I do NOT recommend this.  However, if you’re already taking ibuprofen for some other condition, like arthritis, here might be an added benefit.

If the mind is indeed like a muscle (and research is validating that model more and more) then memory may very well be like muscle tone:  the more the mind is used, the more robust memory may become.  As I’ve moved on from my medical school days to reach early (very early) middle age, I’ve found myself experiencing benign forgetfulness far more than I like.  As a result, I find myself comforted that the old adage “use it or lose it” is seeming more and more not just to apply to the body but to the mind as well.

NEXT WEEK: The Double-Edged Sword Of Attachment

18 comments to How To Remember Things

  • At 74 I have a few of those problems. Remembering names happens quite frequently and seems fairly common amongst seniors. If I can fluff over saying the name it will pop up shortly, I guess because the pressure is off.

    Keys: which is which? I have the colored plastic rings on them associated with the destination. Pink for the garbage room (pink-stink), Green for the bike storage (go Green, sort of) and so on. Works well.

  • Some helpful advice, as I’m considering returning to school. Thanks.

    Looking forward to your ideas on attachment. I am conflicted on the whole idea of non-attachment in the personal realm, and I am not sure how well it accords with the impulse to bond, etc.

  • pete

    Alex, why did you think I would find this posting particularly interesting? It is—like most of yours—but why highlight this one for me, or am I forgetting something?

    Pete

    PS—Leaving Kelowna in a couple of hours after great week with delightful Nancy.

    Pete: Nope, you’re not forgetting anything. Just thought you’d appreciate all the exercise you do is helping to keep your mind as healthy as your body!

    Alex

  • russds

    Great advice, and tips. Memorization is one of those cornerstones that effects so many other areas of our lives. It’s great leverage. Get good at that, and you’re good at a lot of stuff. Great encouragement, thanks!

  • Andrea

    I wish I could believe these three tips would work. The two men I first encountered with classic Alzheimer’s were brilliant physicians and first rate athletes. One took ibuprofen for osteoarthritis. They were both hit in their seventies.

    I taught remedial reading for fifteen years to sixth, seventh, and eighth graders. I did not think my job was all that justified because most of these students had had remedial reading since second grade, and I knew the caliber of their teachers. I used to say “they got a graduate degree in it but still had reading problems.” However, I quickly found that when there was a problem, sometimes it was because of a lopsided learning style that hadn’t been tapped into. I tutored a ten year old privately who could barely read. His parents had pulled him out of school and had spent a fortune hiring a tutor who used a very complex, totally phonetic approach. I knew the system and hated it. I quickly picked up that he was a totally visual learner; his memory did ALL the heavy lifting. Within a year he was reading on grade level and back in school. The brain is so complex.

    My mother had a stroke at eighty-eight and had little memory and language impairment, but more subtle cognitive difficulties. I had always been fascinated by the way so many people remembered plots of movies they’d seen years before and wondered if it was because so many senses were involved and concentration heightened by the minimal distraction of the movie theater. I started taking my mother to the movies as often as I could. She would remember the plot and it gave her confidence as well as pleasure. TV movies didn’t do it. I mentioned that before her stroke she was a “winner take all” poker player. But after, she refused to pick up a deck of cards; she told me she knew she didn’t have it anymore. I always wondered if she “knew” or if her confidence was shattered. (She was REALLY GOOD: when I was hospitalized and critically ill she found some doctors playing and asked if she could sit in to take her mind off things. She cleaned them out.)

  • Forseti9

    Great article, but where are the mnemonics and other memory helpers? ;)
    Most people mention them as soon as they can in their articles. Your method is very natural, but the total memory improvement effect can be easily doubled or tripled if combined with memorization principles and/or holistic learning techniques.

  • As someone who has gone through a severe depression and has been diagnosed with PTSD, I can completely testify to the lack of concentration experienced while working through both of these conditions. It’s maddening, especially considering I had a sharp memory up until my trauma event occured.

    What’s helped me is living in the moment, as much as I possibly can. I’ve had to slow my brain down and focus not on the past or the future (re-hashing, worrying, blaming, etc.) but really tap into what is happening in the NOW. It’s helped tremendously with my concentration and memory.

    Thank you for the insight.

    Veronica
    Moment-to-Moment Optimism
    http://www.drrussbuss.com

  • Anne

    As a second year medical student about to commence studying for boards, I appreciate this article. I really struggled my first year trying to manage the amazing amount of info we are expected to cram into our brains. I do a lot of talking to myself—repeating terms over and over and over. Consequently I spend a lot of time studying at home and not at the library or coffee shop.

    Thanks for sharing your words of wisdom.

  • Keith Beatty

    I agree with all those helpful suggestions. Yet, I caution that memory is the province of the hippocampus and it is a physical organ. If and when the hippocampus is damaged by stroke or starvation the memories are lost forever, and some times the ability to form memories is lost forever.

    The brain requires several nutrients that are rare in the American diet. When starved for nutrients some organ or portion of the brain must be scavenged to keep the essential machinery operating. Apparently the hippocampus is first in order of expendable.

    One nutrient essential for brain function is choline for production of phospholipid membranes and neurotransmitters. Minimal daily requirement of choline is in two egg yolks or quarter pound of liver. Other rare foods like brains and organ meats are unlikely in our diets. A supplement of lecithin is advised.

    Long chain omega 3 vitamin oils are plentiful only in the synapse/nerve endings. Unless you eat brains and eyeballs you best eat fish or take your cod liver oil.

    Brain function requires a lot of DNA modification. Methyl group transfer and acetylation vitamins are essential. Take your Vitamin A, B6, B12, folic acid supplements.

    Linus Pauling pointed out that vascular health depends upon Vitamin C. We are one of few species who in proportion to our size do not produce ten grams of vitamin C per day. Without the C you must ultimately suffer heart disease or stroke.

    The brain is energy intense. The aged brain cannot produce ATP energy without a ubiquinol supplement.

    Exercise and training are to muscle as to brain. You cannot grow and keep musculature and physical skills without excellent nutrition in addition to the exercise and training. The brain is the same.

  • Charles Eckenroed

    re: Post by Keith Beatty

    Keith, great post. Well written and seems authoritative. I did some quick online research using authoritative sources (JAMA, NIH, etc) for some of your claims (hippocampus, choline, lecithin) and found backing evidence.

    I’m just wondering, are you a physician or health care professional?

  • Keith Beatty

    I am a protein chemist with experience in the manufacture of human blood proteins for injection. I have keen interests in nutraceutical foods, nutrition, and memory.

  • Judy

    Thank you, Alex. Thanks all, especially Keith Beatty. I’d like to add to the emphasis on studying mindfully and paying attention. People who are hard of hearing often hear less than they are able to because they forget to listen. I am one of these people, and I find I must really concentrate when I listen, but that when I do, conversations are much clearer. Likewise, when my mother was ill with Alzheimer’s, we found that helping her to narrow her focus, along with drinking enough water, helped her most of all.

    When we have difficulty concentrating, we tend to stop concentrating, and it becomes a habit. “Gathering our wits” won’t compensate for injury or disease, but making it a habit can really help.

  • Serra

    I studied for Air Traffic Control in Canada and as part of our training we had to memorize the Manual of Operations. We had these really awful tests where we literally had to write out, word for word, huge paragraphs from the manual including knowing the article numbers. Because they are basically like laws, legal stuff, we had to know them word for word. Even one word, or one missing comma could change the meaning.

    I have never been very good with my memory and so while some students simply read the manual a couple times and remembered, I spent many many hours every single day re-writing the articles until I could do it without looking at the book. I had an average of about 96% in the course (there were a couple students at 99%) so the method does work.

    However after I was out of the course and not using it anymore the memory was gone. And I have had this problem before…constantly in University I would get to the next course in a progression of topics and although I got a B+ in the previous course all that information was gone and I would struggle with then having to learn twice as much in the 2nd course. Even when I am really really interested (like with a hobby) I often can remember WHERE the information is, even sometimes seeing the page of the book visually, but I can not actually remember the information itself.

    My brain likes to figure things out and sometimes I wonder if it forgets on purpose so that it can figure it out again. That is all fine for doing mechanical type things where I will do something that will trigger a memory of what I did before (let’s say I’m fixing a sink) but it REALLY does not work when it comes to remembering facts or having a discussion with someone about something. I just don’t know how to fix this, it’s really starting to bother me.

    If you know of any links or have any ideas I would really appreciate hearing them :)
    Thanks!

    Serra: Sometimes connecting information to other senses (particularly sound and smell) helps to reinforce long-term recall. This is why, for example, when people hear certain songs on the radio they haven’t heard for a long time memories associated with it often pop into their minds that they haven’t thought about literally for years. You might find it helpful to creatively connect the information you need to retain to sounds or music. Certainly, even information contained in long term memory will decay without reinforcement, so periodically rewriting the information you need to remember should help as well. I hope this helps!

    Alex

  • Anne

    Do you know anything about poor memories? I sense that I have only foggy memory of my childhood. Without photos I wouldn’t remember the houses where I lived growing up. My later memories are sketchy, not specific. For example, I couldn’t offer close memories of holidays or birthdays or vacations. I am in my mid-60s and healthy. The one shadow is alcoholism, from which I am in long-term recovery. I worry that teenage drinking may have affected my ability to remember. Do you know people who have this blurry sense in their lives? It is disturbing, although it prompts one to live very much in the moment.

    Anne: I’ve seen nothing in the medical literature that talks about what you’re describing. However, anecdotally, I do know of recovered alcoholics whose memories from different periods of their lives remain fuzzy or even non-existent, especially during periods in which they were drinking heavily, so I don’t think you’re alone.

    Alex

  • mike

    What Anne describes is similar to what I experience. My visual memory seems very poor. I have a very difficult time imaging things with my “minds eye.” If I close my eyes and try to imagine the inside of my house for example, I can tell you what pieces of furniture are where, but I can’t “see” them. I have no concrete picture in my mind…more like a fuzzy representation. I can tell you some of the features of my child’s face or my wife’s, but I can’t seem to see them clearly in my imagination. If I look at something and close my eyes, I can’t really picture it too well (detailed that is). Most of my childhood memories are in third person, which leads me to believe that I am actually using my imagination to create an image of what was going on rather than seeing the event itself.

    I have 2 small children and feel like I’m being robbed every day since if you asked me what we did yesterday, I can provide a rough narrative, but can’t really see it or in any way re-live the experience.

  • Med Student

    Your tips are very useful! I’m a second year med student studying for Boards step 1, and the amount of information we are expected to know is daunting. I don’t even know if my mind can hold all that information at one time!

    Med Student: It is daunting. But you can do it!

    Alex

  • Florence

    Your article is lively and useful. Its suggestions for how to acquire new information will definitely be useful for my 12-year-old in developing study habits. However, I question whether these techniques actually help slow the onset of Alzheimer’s. My own mother, diagnosed last year with Alzheimer’s at the relatively young age of 72, devoted her life to the mind and the body, as you advise—she was a writer, kept in good physical shape through swimming twice weekly and, by living in the city center with no car and therefore going everywhere on foot or by subway, and ate a diet very low in fat and high in vegetables. She was thin, smart, and active and has still lost her mind.

    Florence: I’m so sorry to hear about your mother. Devastating. Unfortunately, the techniques thus far studied are no panacea. They only decrease the risk of Alzheimer’s, which, of course, means many who practice them will still get it.

    Alex

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