Poor memory? You might have an encoding problem

Q: My short-term memory has started to slip, and it feels pretty scary. When should I be worried?

I understand the feeling. I’ve looked for my phone while talking on it. We all do those kinds of things. But often, the root of the problem has more to do with attention and focus than an actual cognitive deficiency.

There are a lot of steps that go into making a memory. It’s a process. The first step is encoding. To do that properly, you have to take in all the relevant data about the concept you want to remember. This means focusing on the information you want to retain — like where you put your keys or parked your car. Once you have encoded something, you need to store it and be able to recall it.

Problems with these last two stages are associated with conditions like dementia. But for most younger people, the problem lies in the encoding. Doing too many things at once means we’re not able to give proper attention to any one task. For instance, if you come home and are thinking about dinner as you speak to your kids and sending a text at the same time, you likely won’t remember where you put your keys, because you weren’t focusing on the act of putting them down.

Young onset dementia (YOD) is rare and affects only about one person in every 1,000 — and most of these people are in their 50s and early 60s. (There are rare genetic forms of dementia that present in the 30s and 40s, but in these cases there is usually a strong family history.)

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When a patient expresses concern about memory, I always dig a little deeper. Poor memory may be a symptom of other physical or mental health issues, such as adult attention deficit disorder, sleep apnea, thyroid problems, vitamin B12 deficiency or difficulties related to perimenopause. And when associated with poor appetite, trouble sleeping and low mood, a concern about memory becomes a concern about depression.

There is cause for medical worry if you are consistently having trouble remembering things across several environments, or if difficulty with recall is impairing day-to-day life — if a patient tells me that she is consistently late for work, for instance, because she has to search her home from top to bottom to find things that she uses daily. But if you can remember things when you focus on them and are well rested, instances of forgetfulness should more likely be attributed to system overload.

Focusing on the task at hand will help with the encoding process. Routines, such as having a consistent place to put your keys, also help. And when you know you’re moving too quickly, stop and write down whatever it is you’ll need to recall later on.

Dr. Danielle Martin is a family physician and vice-president, medical affairs and health system solutions, at Women’s College Hospital in Toronto. 

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