One Brain's journey

A friend asked me for a phone number a day or two ago and I said I didn’t have it but I knew someone who did and gave him that phone number. He called the mutual friend who declared, “I gave that number to him last week.” The first friend called me back to tell me this and I suppose expected some measure of guild from me in that I had lost the number or, more likely, had written it down and forgotten where I had put it. He got no satisfaction on the guilt front. I learned that lesson not long after I was diagnosed with ADHD. Soon after I heard one of the top experts on ADHD in Canada talk about the difference in treating adults with ADHD and treating children. “The main difference,” he said, “is that with the adults you have to deal with the self-esteem issues that have built up over a lifetime and if you don’t do this, you never get anywhere with treatment. With the kids they haven’t had time to suffer all the knocks and disappointments that lead to low self-esteem.”

I have never forgotten this and although I can still do a number on myself over some mistake or misplaced object, I rarely let someone else get away with it. My reply to the mutual friend was simply, “Whether I got it from him before or not is irrelevant. What I said was that I don’t have it now.”

My close friends know that this sort of statement means the issue is closed, certainly as far as I’m concerned but the odd one, usually someone who doesn’t know me well will persist. It happened to me a few weeks ago. Someone whom I have known for a long time but not well asked me to ask another mutual friend to call him when I saw him next. I stated that I would not remember. He persisted, more-or-less along the referred guilt path with a statement like, “What do you mean you won’t remember?”

I replied, “I don’t know how I can make it any clearer. I wont remember.”

He still wasn’t buying it and said, “Okay I’ll call you and remind you.”

Now I had him and I knew as sure as I knew I wouldn’t remember the first message that he wouldn’t remember to call to remind me and sure enough he didn’t.

I don’t really get angry in these circumstances…unless pressed. At least I have stopped getting angry, for the most part, at myself. Oh it does happen occasionally but it passes quickly but not nearly as quickly as any referred guilt from someone else. I guess you could say this is my contribution to my own self esteem and when I am diligent about it, it works.

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.

As anyone who reads this blog will know by now, you can change your brain and you can improve your working memory and this begs the question, “By how much?” In an interview conducted for Science Magazine last February, Dr. Torkel Klingberg of the Karolinska Institutet in Stockholm commented on a study he had conducted that demonstrated that working memory training actually changes the structure of the brain, Dr. Klingberg said that the training was associated with changes in the brain’s dopamine system.

I jumped to what I thought was the logical conclusion, when I first heard about the study–that the training increased the number of dopamine receptors (actually D1 receptors) and that this meant there might not be any limit on how great that improvement might be. Like most things involving the brain, it is not that simple. Dr. Klingberg made it clear in the interview that the training changed the density of D1 receptors. He went on to say that either too much or too little is not good and that for most subjects in the study, there was actually a decrease in receptor density and that for some of them there was a very small increase.

From my own experience I know that stimulants such as Ritalin (or its many varients such as Concerta or Biphentin) increase the amount of the neurotransmitter dopamine available to the brain. But it would seem that there is something much more complicated and refined going on with working memory training.

Why is this important? In the interview Dr. Klingberg points out that working memory deficits occur in ADHD, but also in schizophrenia and even the normal aging process. So improving working memory may have a beneficial effect on some of these disorders. Finding the optimal dose of a medication is a tricky issue, especially with stimulants. But it would appear from what Dr. Torkel says that working memory training is self regulating, that, put quite simply, you can’t over do it. It would seem that working memory training is a safe, effective and efficient way of improving working memory and, hopefully having an effect on disorders where deficits in working memory is a factor.

Beyond all this, another study conducted at the Karolinska Institutet, constructed a mathematical model of the brain and using this model discovered a mechanism that restricts the number of items held in working memory to seven.

I recently came across an article in the Los Angeles Times on time management describing the role of working memory and the body’s internal clock in time awareness.  It was of interest to me because being on time is usually a failing for people with ADHD, however, I am quite punctual and a few years back I worked with a partner who was also ADHD and punctual.  ADHD and punctuality are not words that are normally in the same sentence.  My former partner and I are unusual.  He and I came at punctuality from different directions. The article relates the problems with the estimation of the passage of time at the level of hours and minutes that characterizes ADHD and schizophrenia and suggests that the common element with these two disorders is problems with working memory.   Problems with working memory could cause problems with time management.  My former partner relied on a gadget–a Timex watch which replicated his calendar from Microsoft Entourage and would beep loudly ten minutes before appointments.  I relied on my internal body clock and my sense and estimation of the passage of time.  Regardless, the article describes how  you can improve your perception of time by improving working memory as well as assisting your body’s internal clock.  Cogmed Working Memory Training is being employed by some clinicians as a treatment for stroke damage but it is being positioned more now as a way of improving working memory in individuals who have problems with it but in all other ways may be quite normal.  Working memory problems exist in about 10% of the general population according to Tracy Alloway and more about her research at her university’s website.  One of the recommendations that really hit home with me in the LA Times piece was the recommendation to use an analogue watch or clock rather than digital.  The article quotes Dr Martin L. Kutscher, author of an upcoming book entitledOrganizing the Disorganized Child, “Time is a very ethereal, abstract issue especially for people with attention problems.”  He goes on to say, “For these people, the visual image of, say 15 minutes on an analogue clock or watch is much more concrete than a static display of numbers on the face of a cellphone.”  I am a gadget freak and was one of the first to own a digital watch decades ago.  I went back to analogue because I could never tell what time it was.  Oh sure, I knew it was 12:23:37 or whatever.  But what time is that? A quarter after two does no register in my brain the same as 2:15.  I did a little experiment way back then.  I would ask someone with a digital watch what time it was just after I noticed they had looked at their watch.  Invariably they would have to check their watch again to respond.  I also asked people with analogue watches the same question again after they have just looked at their watches and almost never did they have to look at their watches a second time.  I know the reason I am usually on time is not as simple as just using an analogue watch to assist my internal clock.  But making time visual could be part of the reason why.  Something else that I stumbled across some years ago that seems to help with staying on task at my desk is a metronome set at 60 beats a minute.  Now whether marking the passage of time, as the metronome would, at the rate of one beat per second can actually assist the body’s internal clock and therefore also support working memory I have no idea but both these ideas have helped me with the management of my time an, to some degree, with staying on task.