Nisha Pandey

Alzheimer's Day: Why Can A Patient Remember An Event From Decades Ago But Forget What Happened This Morning?

Why Can An Alzheimer’s Patient Remember An Event From Decades Ago But Forget What Happened This Morning?

An Alzheimer’s patient may vividly remember their wedding day from 40 years ago, remember the house they grew up in or sing a song they learned in childhood, but still struggle to remember what they ate for breakfast or a question they were asked just an hour ago. 

So if Alzheimer’s is a memory loss disease, why do some old memories appear to remain intact while recent ones disappear so quickly? 

According to leading experts, the answer lies in the way different memories are formed, stored and retrieved in the brain. It is also in the fact that Alzheimer’s does not damage every memory system at the same speed. This means that the ability to form and retain new memories can become impaired before older memories are affected. 

“In Alzheimer’s, memory loss does not always happen evenly. The brain regions responsible for forming and storing new memories, particularly the hippocampus and surrounding areas, are often affected early,” <strong>Dr K K Jindal, Director, Neurology, CK Birla Hospital, Delhi</strong>, told <strong><em>HealthandMe</em></strong>. 

<h2>Recent Memories Disappear First </h2>

A person with <a href="https://www.healthandme.com/health-wellness/beyond-memory-loss-understanding-the-early-symptoms-of-alzheimers-article-156183289" data-type="tilCustomLink">Alzheimer's disease</a> may remember a marriage, childhood home or an event from 40 years ago, but not remember a meal or conversation from an hour earlier. To understand this, it helps to look at what happens when a new memory is formed. 

<strong>Dr Praveen Gupta, Chairman, <span rel="noindex">Marengo Asia International Institute for Neuro</span> and Spine, <span rel="noindex">Marengo Asia Hospitals</span>, Gurugram</strong>, told <strong><em>HealthandMe</em></strong>, “The memories that Alzheimer’s erodes do not deteriorate at equal rates. One of the first brain functions to be compromised is the creation of new memories. This is because the older memories have enough time to spread their representations in the brain while the newer memories rely on memory circuitry that is very vulnerable.” 

<strong>Dr Saurav Aggarwal, Consultant, Neurology, <span rel="noindex">Fortis Hospital</span>, Ludhiana</strong>, explained the process to <strong><em>HealthandMe</em></strong> through the concept of memory consolidation. He said when a person experiences something new, the memory initially depends heavily on the hippocampal network. 

Dr Aggarwal said, “Old memories go through consolidation, where the brain spreads a memory across the cortex, its outer layer, including the temporal and frontal lobes. Years of retelling strengthen those links.” 

By contrast, new memories remain heavily dependent on the <a href="https://www.healthandme.com/health-wellness/neuro-protection-how-your-30s-and-40s-determine-your-70s-and-80s-article-156157654" data-type="tilCustomLink">hippocampal network</a>. “Alzheimer's damages the hippocampus first, so the brain fails to consolidate new information, such as a memory from the morning or a few hours ago, causing it to fade” Dr Aggarwal says. 

Older memories have therefore had years, sometimes decades, to become more represented and strengthened through repetition and recall. New memories do not have that advantage.

Also read: <a href="https://www.healthandme.com/health-news/donald-trump-wants-childhood-vaccines-split-into-5-shots-to-prevent-autism-but-is-there-evidence-article-156191678" data-type="tilCustomLink">Donald Trump Wants Childhood Vaccines Split Into 5 Shots To Prevent Autism: But Is There Evidence?</a> 

<h2>The Hippocampus Is More Than The Brain's Memory Bank </h2>

The hippocampus is not just a storage box for memories. It plays a crucial role in organising and absorbing new experiences. Dr Aggarwal describes it as a “sorting desk”. 

He says, “The hippocampus works like a sorting desk. It takes in new experiences, a step called encoding, and passes them to the cortex for storage, meaning that proper memories cannot be formed if the hippocampus is damaged.” 

The hippocampus is particularly vulnerable in Alzheimer’s disease. According to Dr Aggarwal, two abnormal proteins are central to the disease process. 

“Two abnormal proteins drive this damage. <a href="https://www.healthandme.com/health-news/alzheimers-prevention-before-symptoms-appear-nhs-trial-tests-experimental-drug-in-high-risk-people-article-156096678" data-type="tilCustomLink">Amyloid</a> forms plaques between neurons, and tau twists into tangles inside them,” Dr Aggarwal says. “Tangles appear first in the entorhinal cortex, the hippocampus's gateway. They spread inward and, with amyloid plaques, damage the connections between neurons (synapses).” 

<strong>Dr Steve Paul Manjaly, Geriatric Medicine, <span rel="noindex">Apollo Hospitals</span>, Bangalore</strong>, told <strong><em>HealthandMe </em></strong>that the hippocampus has a high level of synaptic transmission, which makes it particularly vulnerable to toxic processes linked with Alzheimer’s disease. 

He explains, “The hippocampus is the seat of memory and has high synaptic transmissions, making it prone to toxicity,” he says. “Also the pathology is such that the affect the networking pathways that affect the hippocampus majorly.”

Also read: <a href="https://www.healthandme.com/health-wellness/world-patient-safety-day-with-2800-margin-costly-hospital-consumables-can-threaten-patient-safety-heres-how-article-156174778" data-type="tilCustomLink">World Patient Safety Day: With 2800% Margin, Costly Hospital Consumables Can Threaten Patient Safety; Here’s How</a>

One important misconception about Alzheimer’s is that there is one single type of memory that simply gets weaker over time. In reality, the brain uses several <a href="https://www.healthandme.com/health-news/lowering-cholesterol-may-protect-your-brain-as-study-links-statins-to-15-lower-dementia-risk-article-156014598" data-type="tilCustomLink">memory systems</a>, and they can be affected at different stages. 

“There is no single memory system; the three different types of memory systems are episodic memory, semantic memory, and procedural memory,” says Dr Gupta. 

Episodic memory refers to personal experiences. For example, what happened yesterday, where a person went, or what they discussed during a particular conversation. This is affected earlier. 

Semantic memory involves facts, information, words and their meanings. “Semantic memory is about names. E.g Delhi is the capital of India. This is affected much later in Alz,” Dr Manjaly explains. 

Procedural memory is the memory of how to perform learned skills. “<a href="https://www.healthandme.com/nutrition/gsk-investigates-whether-shingles-vaccine-could-lower-dementia-risk-article-151300810" data-type="tilCustomLink">Procedural memory</a> is about how something was learned. E. G driving a cycle etc. This is affected later in the disease,” he says. This is why someone with Alzheimer’s may forget what they had for lunch but still be able to tie their shoelaces or perform a familiar skill.

Also read: <a href="https://www.healthandme.com/health-news/scientists-grow-human-brain-tissue-inside-mice-could-this-help-cerebral-palsy-epilepsy-autism-research-article-156171838" data-type="tilCustomLink">Scientists Grow Human Brain Tissue Inside Mice: Could This Help Cerebral Palsy, Epilepsy &amp; Autism Research?</a> 

<h2>Why Can A Patient Sing An Old Song But Forget A Person's Name? </h2>

One of the most striking and fascinating examples of preserved memory in Alzheimer’s is music. Families of people with dementia often notice that a loved one who struggles to remember names or recent conversations may still be able to sing an old song almost perfectly. 

Songs are encoded through more than their words. Rhythm, melody, repetition, emotion and long-established associations all contribute to how they are represented in the brain. 

“The various types of memories involve different neural networks,” says Dr Gupta. “Songs we know are not just about words; songs have associations with rhythm, emotions, repetition, and neural links that have been created since ages.” 

Dr Aggarwal notes that procedural skills involve structures such as the basal ganglia and cerebellum, which tend to be affected later in Alzheimer’s disease. 

Musical processing also involves several networks beyond the <a href="https://www.healthandme.com/health-news/what-is-batten-disease-all-about-the-fatal-genetic-conditions-causing-waste-build-up-in-kids-brain-article-151205110" data-type="tilCustomLink">hippocampus</a>, some of which may remain relatively preserved. This helps explain why familiar routines, songs and well-practised skills can sometimes survive long after the ability to form new memories has deteriorated.

Also read: <a href="https://www.healthandme.com/health-news/1-in-4-doctors-near-retirement-age-by-2036-who-warns-of-global-health-workforce-crisis-article-156183629" data-type="tilCustomLink">1 In 4 Doctors Near Retirement Age By 2036: WHO Warns Of Global Health Workforce Crisis</a> 

<h2>When Is Forgetfulness More Than Normal Ageing? </h2>

Forgetting sometimes is not, by itself, evidence of Alzheimer’s disease. With normal ageing, people may take longer to retrieve a name, need more time to learn something new or occasionally forget something, and remember it later. The more important warning signs are progression, frequency and impact on everyday functioning. 

Dr. Gupta explains, “What matters most is not that they are forgetting but the frequency with which it occurs, that it is becoming progressively more problematic, and that it starts to interfere with daily functioning.” 

According to the experts, warning signs may include: 

<ul><li>Repeatedly asking the same question within a short period</li><li>Forgetting conversations or events that happened recently</li><li>Getting disoriented in familiar places</li><li>Misplacing objects and not being able to retrace one's steps</li><li>Struggling with familiar recipes </li><li>Having difficulty managing finances or medications</li><li>Developing problems with words or understanding conversations</li><li>Showing poorer judgement or decision-making</li><li>Becoming increasingly dependent on family members for tasks previously handled independently</li></ul>

<h2>How Do Doctors Determine Whether Memory Loss Is Due To Alzheimer’s? </h2>

Alzheimer’s Disease: Early Signs, Symptoms, Diagnosis & Prevention Tips

According to the doctors, <a href="https://www.healthandme.com/health-wellness/weight-training-could-reduce-risk-of-dementia-in-older-adults-article-151553199" data-type="tilCustomLink">Alzheimer’s diagnosis</a> begins with a detailed history, including when the symptoms started, how they have progressed and how they affect daily functioning. 

Information from family members can be particularly important because a person experiencing memory impairment may not recognise the extent of the changes. 

“Now, the diagnosis of Alzheimer's is not just about memory tests,” says Dr Gupta. “We utilize a comprehensive assessment along with high-tech investigation methods like serum markers and PET scanning to find out the presence of biological markers of <span><a href="https://www.healthandme.com/health/alzheimers-disease">Alzheimer's disease</a></span>.” 

Besides memory loss, several medical conditions can produce symptoms that resemble dementia. Vitamin B12 deficiency and thyroid disorders can contribute to cognitive problems and need to be considered. 

Experts say that blood tests can help identify such reversible contributors, while an MRI can look for strokes and patterns of brain shrinkage. 

“MRI scans and pet scans can help narrow it down further and help sometimes in ruling out other causes of cognitive impairment,” Dr Manjaly says. “Thyroid and vitamin b12 deficiencies are also conditions that may mimic dementia.” 

Modern diagnosis can also go beyond symptoms and structural imaging. Dr Aggarwal says amyloid PET imaging and cerebrospinal fluid testing can provide additional evidence of Alzheimer’s pathology by detecting abnormal protein changes associated with the disease. The exact combination of tests depends on the individual patient and overall clinical situation. 

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An Alzheimer’s patient may vividly remember their wedding day from 40 years ago, remember the house they grew up in or sing a song they learned in childhood, but still struggle to remember what they ate for breakfast or a question they were asked just an hour ago. So if Alzheimer’s is a memory loss disease, why do some old memories appear to remain intact while recent ones disappear so quickly? According to leading experts, the answer lies in the way different memories are formed, stored and retrieved in the brain. It is also in the fact that Alzheimer’s does not damage every memory system at the same speed. This means that the ability to form and retain new memories can become impaired before older memories are affected. “In Alzheimer’s, memory loss does not always happen evenly. The brain regions responsible for forming and storing new memories, particularly the hippocampus and surrounding areas, are often affected early,” Dr K K Jindal, Director, Neurology, CK Birla Hospital, Delhi, told HealthandMe. Recent Memories Disappear First A person with Alzheimer's disease may remember a marriage, childhood home or an event from 40 years ago, but not remember a meal or conversation from an hour earlier. To understand this, it helps to look at what happens when a new memory is formed. Dr Praveen Gupta, Chairman, Marengo Asia International Institute for Neuro and Spine, Marengo Asia Hospitals, Gurugram, told HealthandMe, “The memories that Alzheimer’s erodes do not deteriorate at equal rates. One of the first brain functions to be compromised is the creation of new memories. This is because the older memories have enough time to spread their representations in the brain while the newer memories rely on memory circuitry that is very vulnerable.” Dr Saurav Aggarwal, Consultant, Neurology, Fortis Hospital, Ludhiana, explained the process to HealthandMe through the concept of memory consolidation. He said when a person experiences something new, the memory initially depends heavily on the hippocampal network. Dr Aggarwal said, “Old memories go through consolidation, where the brain spreads a memory across the cortex, its outer layer, including the temporal and frontal lobes. Years of retelling strengthen those links.” By contrast, new memories remain heavily dependent on the hippocampal network. “Alzheimer's damages the hippocampus first, so the brain fails to consolidate new information, such as a memory from the morning or a few hours ago, causing it to fade” Dr Aggarwal says. Older memories have therefore had years, sometimes decades, to become more represented and strengthened through repetition and recall. New memories do not have that advantage.Also read: Donald Trump Wants Childhood Vaccines Split Into 5 Shots To Prevent Autism: But Is There Evidence? The Hippocampus Is More Than The Brain's Memory Bank The hippocampus is not just a storage box for memories. It plays a crucial role in organising and absorbing new experiences. Dr Aggarwal describes it as a “sorting desk”. He says, “The hippocampus works like a sorting desk. It takes in new experiences, a step called encoding, and passes them to the cortex for storage, meaning that proper memories cannot be formed if the hippocampus is damaged.” The hippocampus is particularly vulnerable in Alzheimer’s disease. According to Dr Aggarwal, two abnormal proteins are central to the disease process. “Two abnormal proteins drive this damage. Amyloid forms plaques between neurons, and tau twists into tangles inside them,” Dr Aggarwal says. “Tangles appear first in the entorhinal cortex, the hippocampus's gateway. They spread inward and, with amyloid plaques, damage the connections between neurons (synapses).” Dr Steve Paul Manjaly, Geriatric Medicine, Apollo Hospitals, Bangalore, told HealthandMe that the hippocampus has a high level of synaptic transmission, which makes it particularly vulnerable to toxic processes linked with Alzheimer’s disease. He explains, “The hippocampus is the seat of memory and has high synaptic transmissions, making it prone to toxicity,” he says. “Also the pathology is such that the affect the networking pathways that affect the hippocampus majorly.”Also read: World Patient Safety Day: With 2800% Margin, Costly Hospital Consumables Can Threaten Patient Safety; Here’s HowAll Memories Are Different One important misconception about Alzheimer’s is that there is one single type of memory that simply gets weaker over time. In reality, the brain uses several memory systems, and they can be affected at different stages. “There is no single memory system; the three different types of memory systems are episodic memory, semantic memory, and procedural memory,” says Dr Gupta. Episodic memory refers to personal experiences. For example, what happened yesterday, where a person went, or what they discussed during a particular conversation. This is affected earlier. Semantic memory involves facts, information, words and their meanings. “Semantic memory is about names. E.g Delhi is the capital of India. This is affected much later in Alz,” Dr Manjaly explains. Procedural memory is the memory of how to perform learned skills. “Procedural memory is about how something was learned. E. G driving a cycle etc. This is affected later in the disease,” he says. This is why someone with Alzheimer’s may forget what they had for lunch but still be able to tie their shoelaces or perform a familiar skill.Also read: Scientists Grow Human Brain Tissue Inside Mice: Could This Help Cerebral Palsy, Epilepsy & Autism Research? Why Can A Patient Sing An Old Song But Forget A Person's Name? One of the most striking and fascinating examples of preserved memory in Alzheimer’s is music. Families of people with dementia often notice that a loved one who struggles to remember names or recent conversations may still be able to sing an old song almost perfectly. Songs are encoded through more than their words. Rhythm, melody, repetition, emotion and long-established associations all contribute to how they are represented in the brain. “The various types of memories involve different neural networks,” says Dr Gupta. “Songs we know are not just about words; songs have associations with rhythm, emotions, repetition, and neural links that have been created since ages.” Dr Aggarwal notes that procedural skills involve structures such as the basal ganglia and cerebellum, which tend to be affected later in Alzheimer’s disease. Musical processing also involves several networks beyond the hippocampus, some of which may remain relatively preserved. This helps explain why familiar routines, songs and well-practised skills can sometimes survive long after the ability to form new memories has deteriorated.Also read: 1 In 4 Doctors Near Retirement Age By 2036: WHO Warns Of Global Health Workforce Crisis When Is Forgetfulness More Than Normal Ageing? Forgetting sometimes is not, by itself, evidence of Alzheimer’s disease. With normal ageing, people may take longer to retrieve a name, need more time to learn something new or occasionally forget something, and remember it later. The more important warning signs are progression, frequency and impact on everyday functioning. Dr. Gupta explains, “What matters most is not that they are forgetting but the frequency with which it occurs, that it is becoming progressively more problematic, and that it starts to interfere with daily functioning.” According to the experts, warning signs may include: Repeatedly asking the same question within a short periodForgetting conversations or events that happened recentlyGetting disoriented in familiar placesMisplacing objects and not being able to retrace one's stepsStruggling with familiar recipes Having difficulty managing finances or medicationsDeveloping problems with words or understanding conversationsShowing poorer judgement or decision-makingBecoming increasingly dependent on family members for tasks previously handled independentlyHow Do Doctors Determine Whether Memory Loss Is Due To Alzheimer’s?                   According to the doctors, Alzheimer’s diagnosis begins with a detailed history, including when the symptoms started, how they have progressed and how they affect daily functioning. Information from family members can be particularly important because a person experiencing memory impairment may not recognise the extent of the changes. “Now, the diagnosis of Alzheimer's is not just about memory tests,” says Dr Gupta. “We utilize a comprehensive assessment along with high-tech investigation methods like serum markers and PET scanning to find out the presence of biological markers of Alzheimer's disease.” Besides memory loss, several medical conditions can produce symptoms that resemble dementia. Vitamin B12 deficiency and thyroid disorders can contribute to cognitive problems and need to be considered. Experts say that blood tests can help identify such reversible contributors, while an MRI can look for strokes and patterns of brain shrinkage. “MRI scans and pet scans can help narrow it down further and help sometimes in ruling out other causes of cognitive impairment,” Dr Manjaly says. “Thyroid and vitamin b12 deficiencies are also conditions that may mimic dementia.” Modern diagnosis can also go beyond symptoms and structural imaging. Dr Aggarwal says amyloid PET imaging and cerebrospinal fluid testing can provide additional evidence of Alzheimer’s pathology by detecting abnormal protein changes associated with the disease. The exact combination of tests depends on the individual patient and overall clinical situation. 