Page 186 - The Memory Program How to Prevent Memory Loss and Enhance Memory Power

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memory a little, to feel a bit low about getting old. My body doesn't function the way it should.
Many in my family have died, and some of my friends have passed away too. At my age, I don't see
how things are going to get better for me.”

She had come to our Memory Disorders Center at the insistence of her sister Myra, who had
become worried about the changes that she had observed. When Myra walked into the office a few
minutes later, the contrast between the two women was so striking that I momentarily wondered if
the two were even related. Myra was well built, bouncy on her feet, and had a jovial, lively manner
that lit up her face and was quite endearing.

“Your older sister was just telling me that she is no longer as interested in her hobbies,” I said.

Myra looked at her sister Cynthia, turned toward me with a puzzled expression, and then suddenly
laughed. ‘‘You kiddin' me? She's not older. Cynthia, my little sister? She's six years younger than I
am!”

I simply couldn't believe it. I had guessed that Myra was fifty, not seventy years old. And with my
earlier impression of Cynthia being eighty rather than sixty-four, the contrast between the two sisters
was even more striking to me. So I asked Myra about her own health habits. She went through the
usual litany: a sound diet, regular exercise, no smoking, low alcohol intake, and a mellow, low-stress
approach to life. Finally, she revealed that she was taking Premarin, a standard estrogen-replacement
therapy for postmenopausal women.

I turned to ask her sister Cynthia if she had thought of taking estrogen herself.

“My aunt died of breast cancer, so I won't take the risk,” she replied.

Myra explained that she had no problems on estrogen and that she had regular, frequent checkups
with her gynecologist, including regular mammograms and pelvic exams. But Cynthia remained
adamant that because there was a risk of cancer, she would not take estrogen.

Keeping this information in the front of my mind, I completed the diagnostic workup for Cynthia's
memory loss, and possible depression. There were no abnormalities on neurological examination or
any laboratory test, including MRI scan of the brain. Her neuropsychological testing showed only
minimal deficits, which may have been due to mild depression. A twelve-week treatment course with
the antidepressant medication paroxetine led to only slight improvement in