That problems with working memory may have a role in schizophrenia has been touched on before in this blog and now a new study indicates what that role might be. Previously scientists thought that the one problem with the disorder could be with automation processing of ordinary tasks i.e. learning by repetition to do things on auto pilot. Dutch researcher Tamar Van Raalten studied the role of working memory in automation and established that it is not the automation process but the processing of new information that was the cause of problems.
Van Raalten, using an fMRI scanner, asked subjects to perform tasks in which they had to remember a series of letters, something that would be accompished in working memory, and discovered that the more the tasks were repeated, the lower the brain activity became in the areas of the brain associated with working memory. But this activity was not compensated for by other areas of the brain involved in long term memory. By automating the letter series the subjects were releasing working memory capacity allowing it to process new information. Van Raaltlen concluded that this restructuring of incoming information was another function of working memory, a process known as chunking. For example to remember 1232673445 you would clump numbers together as you might a phone number, 113 276 3445 . This allowed working memory to be freed up to process new information. Her initial conclusion, in observing schizophrenic patients performing the same tasks, was that their working memory was less efficient and automation did not proceed as well as with healthy subjects. Van Raalten went on to observe that schizophrenic patients process less information than healthy subjects. However, the testing revealed automation proceeded as well as with healthy subjects but subsequently, working memory was not released to deal with new tasks. Further testing revealed that the working memory in schizophrenic subjects struggled with the processing of information that continually changed, leading to the conclusion that Schizophrenics may have more of a tendency to adopt automatic strategies in circumstances that demand flexible behavior.
Over the last few months my path has crossed with several people who are troubled by the fact that they seem to be acquiring label after label from mental health practitioners. The complaint is usually expressed something like this, “I just got used to the idea that I have an attentional disorder and now I’m told I have bi-polar disorder and an anxiety disorder as well.”
I understand their discomfort as I believe everyone wants to think of themselves as normal, functional and worthy of their own self esteem. But just thinking of yourself as normal doesn’t make it so. Besides that, it really seems like sweeping the problem under the carpet. Decades ago a friend of mine began seeing a psychiatrist who told him in the first visit to pretend he was normal until he was normal. Of course the psychiatrist would analyze his actions and thoughts over a period of time and offer advice and direction that would lead him to being normal. Another friend, only a year ago, when I raised the issue of my ADHD, asked me, “Why can’t you just think of yourself as normal?” My reply astonished even me at the time when I said, “I don’t want to think of myself as normal. I want to be normal.” I went on to explain that I thought that my journey began with finding out what wasn’t working for me, such as focus and attention, and then I could do something about it. This is what I have tried to do with medication. I would go about it differently now that I know about neuroplasticity and that problems with working memory seem to be at the heart of ADHD and that you can improve working memory. In other words I would be looking for a more permanent kind of change than what medication provides. To me this represents the hope provided by the new research in neuroscience–that the brain can change and we can change it.
In addition, multiple disorders do not necessarily equate to multiple causes or underlying problems. In fact one job of the diagnostician, as I undertand it, is to find the primary disorder. In many cases treatment of this disorder will have a beneficial effect across the board. A few years ago I read a book entitled Shadow Syndromes written by John Ratey, who co-wrote Driven to Distraction with Edward Hollowell. Ratey’s thesis is that there are a number of disorders that seem to have a common underlying cause which he calls ‘noisy brain’. This spectrum of noisy brain disorders would include Bi-Polar, Tourettes Syndrome, Obsessive Compulsive Disorder, Anxiety Disorders, Mood Disorders. I know that ADHD, which would be included in the noisy brain spectrum, almost always occurs with co-morbidities as they are known, that would be in the ‘noisy brain’ spectrum. It seems a forgone conclusion that if you could alleviate the ‘noisy brain’ problem you would also alleviate symptoms of the co-occurring conditions or co-morbidities.
The idea of multiple diagnoses would then not really matter if you could just treat ‘noisy brain’. I don’t know that ‘noisy brain’ is related to problems with working memory but I would be willing to bet on it. If this is the case, improving working memory could have a positive effect on all of these ‘noisy brain’ disorders and that I find that encouraging and hopeful…
I was returning home from having lunch with a friend recently and saw a billboard for something called VIVIMIND™. One line read, “Test your memory at VIVIMIND™.com.” Since I am past 60 and also because I have the obvious interest in this field, when I got home I logged on to the website which said VIVIMIND™ is “a patented product based on the naturally occurring ingredient homotaurine, which binds to A-beta proteins and reduces the deposition and toxic effects of these proteins in the brain.” The site claims the product is supported by over 15 years of combined rigorous scientific research including clinical testing with over 2,000 individuals. The site also claims VIVIMIND™ helps prevent memory loss due to aging and that it is sold in drugstores and supermarkets as well as online. You take two tablets daily and a month’s supply costs $90. One of the drug store chains listed that stock the product was Shoppers’ Drug Mart and there is a store not five minutes away from where I live. I was going to walk there to check it out but then I got to thinking. To me, more than anything, this product is a sign of three trends. One is that this current crop of seniors will not be content to just make a long, slow slide into senility as previous generations might have. Another point is about the importance now of having a product backed by solid scientific research. Don’t get me wrong though, I have no idea whether VIVIMIND™ is backed by solid scientific research other than what they claim. Finally, the website says VIVIMIND™ is a “natural health product”. I am a recent convert to natural health products. I was diagnosed recently with high blood pressure. It was inevitable. My father had it from his mid-forties. I tried medication after medication and had side effects with every one of them. About the time that my doctor, in frustration, was about to prescribe what he referred to as “water pills”, a medication that my father would have been prescribed half a century ago, I tried omega-3 fatty acids at the suggestion of a friend. My blood pressure is now normal. Even so, given a choice between taking a supplement for the rest of my life versus the change brought about by a natural regulation of cognitive function as with Cogmed Working Memory Training…well you know where this is going. Just for the record again, I have a relationship with Cogmed Working Memory Training (which I described in my first post) but I have not done the training. Finally, consider VIVIMIND™ at $90 a month versus a one-time fee of $1,500 for the Cogmed Training? Well it seems a bit of a no-brainer unless you don’t plan on living very long.
Working memory was first explained to me by a psychologist friend as memory in which words, numbers or visual images and spatial relationships are stored for just a few seconds to be manipulated or recalled. I know from an neuro-psychological assessment I had in 2004 that I have a problem as described in the report as “Immediate and delayed recall of visual and non-verbal information.”
I was also tested in these three key areas by Dr. Atilla Turgay during a consultation in his office last summer. He does this test in just a few minutes asking you to remember and repeat back seven digit numbers, sentences forward and backward and then, the one I did terribly at, the positioning of his fingers, hands and legs which I had to replicate.
Lately I have come across references to working memory as fluid intelligence and the I started to get confused. This confusion increased just a few weeks ago when I was reading a blog that referred to a relationship between schizophrenia and problems in working memory. It would seem this is getting pretty far from remembering someone’s phone number or a street address. I accept that my knowledge in this area is limited. In addition, new knowledge in the area of neuroscience seems to be increasing daily.
I will come back to this subject when my own understanding has grown enough to explore it further…