Finding yourself forgetting things you promised the kids or your boss you would do later in the day? Got it on your to do list but still dropping the ball because you forget to check the list? Noticing that you are not taking your medication until your PD screams at you that you missed your scheduled time? Being called forgetful by friends and family even though you can read something in the paper or engage in a lengthy conversation then recall it in great detail weeks later?
Blame it on changes in your prospective memory, your memory to perform a planned act of some kind in the future. Not only does prospective memory
frequently change in individuals with PD, it is the epitome of what most of us think of as memory problems. And like many other aspects of the human condition, it appears to get worse with age.
This is all quite ironic because, strictly speaking, prospective memory isn’t entirely a function of specific memory processes and it is rarely assessed in most clinical settings, including your neurologist’s office. This should be of more than passing interest to those of you reading this blog because deficits in prospective memory are linked to such important areas as medication compliance and quality of life.
When you have your memory evaluated, say with the “repeat these three items” Mini-Mental Status Exam or the “listen to this list of words and repeat them back to me when I finish reading them” verbal learning tests, the examiner is looking at whether information is effectively stored and retrieved. Prospective memory relies on these same mechanisms but also requires several aspects of executive function in order to be effective. For example to remember to remember, one must set up a cue of some kind. This could be the passing of several minutes, an hour or a day (time-based). The cue could also be event-based such as when a seat-belt alarm reminds you of your intention to drive safely or you place a cup upside down by your toothbrush to remind yourself to take a medication you don’t require every day.
Time or event-based prospective memory requires that you monitor yourself and your surroundings. To effectively remember to remember, you must initially pay appropriate attention, periodically establish some awareness that there is something you are to do, break off an ongoing activity to initiate the planned one as appropriate, and finally, initiate the action. Prospective memory can break down when any of these cognitive operations fail to occur.
Fortunately, this is one time that we may be able to do a little about a problem PD (and aging) brings on. As with some other aspects of cognition such as attention and working memory, problems in executive function including prospective memory can often be improved through appropriate cognitive rehabilitation techniques and strategic planning. I hope to discuss a few things that have worked well for some of my clients in future writings.
So, if you have every intention of doing something but fail to remember it at the appropriate time or circumstance, it does not mean you have dementia. It might just mean that remembering to remember has become another PD challenge.