Page 89 - The Memory Program How to Prevent Memory Loss and Enhance Memory Power

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disrupting his sleep, and that he could no longer concentrate on his work or his personal life.

I was a little surprised to see someone like Jack in our Memory Disorders Center. The episodes
that he described could have happened to anyone, and most people wouldn't have rushed to seek help
from a specialist. When I probed further, the source of his anxiety became clearer. His father had
died of stroke, his mother from complications of Alzheimer's disease, and both conditions were
present in the extended family on both sides. Jack's fears now made a little more sense.

Based on my interview, I determined that he had a very mild level of anxiety that did not meet
diagnostic criteria for any psychiatric disorder. On neurologic examination, he had a generalized
increase in deep tendon reflexes that could have been due to the presence of multiple small strokes in
the brain. The MRI scan suggested the possibility of a very small stroke in the depths of the left
frontal lobe, but the finding was so unclear that the radiologist hedged his bets and refused to call it a
small stroke in his written report. I dredged up the scan from an obstinate medical records clerk and
couldn't see any abnormality either (the radiologist was obviously much better at this than I, but it's a
good idea for the patient's physician to also take a look). It seemed more likely that these abnormal
reflexes, because they were widespread and not localized, were caused by heightened anxiety.

Neuropsychological testing produced a profile of no memory loss with mild deficits in attention
and in the ability to change between ‘‘sets,” which means that the rules of the test are changed in
midstream and the subject is forced to readjust quickly and answer correctly according to the new
rules. These deficits in “executive function” can be caused by a disease of the frontal lobe, that huge
part of the brain sitting directly behind the forehead that is vital for intelligence and decision making,
as well as storage of long-term memories. Sometimes, these frontal deficits are associated with
specific neurological signs on physical examination, but these were totally absent in Jack's case. His
performance could also have been caused by a lack of focus while doing the tests.

I wondered if his symptoms were all due to anxiety or if he had early signs of frontal lobe
dementia, of which Pick's disease (microscopic structures called Pick's bodies are seen on brain
autopsy) is one of the more common types. Or was he having ministrokes, which could give rise to a
similar clinical picture, even though the MRI results did not clearly confirm this?