A conversation with the professor of psychiatry and aging at the UCLA School of Medicine

Gary Small: I’m Dr. Gary Small. I’m a professor of psychiatry and aging at UCLA School of Medicine. 

Question: Why does memory appear random?

Gary Small: It seems that memory is random. Some things we recall better than others. It’s probably not random. It’s just that we don’t always understand what makes one experience more memorable than another. One way to wrap your head around this is to think emotional memory. Anytime we experience something in a heightened emotional state we’re more likely to remember it. For example, most of us who are baby boomer remember exactly what was happening to them the day that President Kennedy was shot, but it’s unlikely that we remember what was going on the week before or the week after, so there are experiences that taint or exaggerate certain memories that make them fix into our memory stores better than others.

Question: Why do memories change over time?

Gary Small: Often our memories seem to be malleable, that is they seem to change over time and I’ve had the experience. I’m sure many of us have had the experience where we go back to a place and we’re convinced that It’s on the other side of the street or they’re something different about it and yet that hadn’t occurred and what happens is that memory is basically stored in little neurochemical packets in the brain and there are a lot of physiological processes that can affect those neurochemical packets, so they can be changed and our memories can deceive us very often.

Question: What steps can we take to improve our memories?

Gary Small: Our research group at UCLA has looked into ways to improve memory and our work and the work of other scientists have found that it’s actually possible to improve our memory ability with relatively simple strategies and techniques and my favorite and actually the building block of all memory techniques involves three things, look, snap, connect, so this is an easy way to remember the three major steps in improving memory performance. So look stands for focusing attention. The biggest reason that people don’t remember things is they’re simply not paying attention. You’re running outside the house and you can’t remember whether you did some minor task because you weren’t paying attention. Snap is a reminder to create a mental snapshot of information you want to recall later. Many of us find it easier to remember visual information than other types of information. And then the third step connect, is just a way of linking up those mental snapshots, so an example would be if I’m running out quickly and I have two errands, pick up eggs and go to the post office. I might visualize in my mind and egg with a stamp on it.

Question: Can we prevent everyday mental slips?

Gary Small: Many people complain about everyday memory slips. They misplace their keys, their glasses. They forget appointments and these problems are very annoying to most of us. There are simple things we can do to improve on that. I mean certainly using look, snap, connect can help, just the process of focusing attention will help us remember where we place objects. Another simple strategy is to use memory places. I like to hang my keys on a hook in the kitchen, so I remember where I place my keys. This can be problematic though when you’re traveling because you may be in a hotel and you have very thin glasses and you put them down distracted by something and then you’re in a panic, but you can always bring a pair, a set of glasses to help with that

Question: Why does memory decrease with age?

Gary Small: Memory tends to decrease with age because our brains like the rest of our body tends to age and function does not continue the way it does when we’re young, so we have shrinking of the brain, so brain cells actually start to function less efficiently and do die over time. The connections between the brain cells diminish in their capacity and the neurochemical transmitters seem to have problems as we age. So all those kinds of physiological changes seem to contribute to problems with memory as we age and the biggest problems are not so much with long term memories, but really the short term memories, so we can remember our first kiss when we were in high school, but we may not remember what we had for lunch.

Question: What steps can people take to preserve memory?

Gary Small: A lot of people recommend remaining active mentally and physically to protect the brain. As far as mental exercise to protect the brain there is circumstantial evidence to suggest that. For example people who finish college have a lower risk for getting Alzheimer’s disease, but we haven’t proven cause and effect. It may be that people with really good brain genes end up on the college trajectory, but there is still this idea of use it or lose it when it comes to brain health and memory and it’s fun to maintain mental activity. I often recommend that people find things that they prefer personally, things that are mentally challenging, but not too difficult. So the point is to train, but not strain the brain, whether it’s crossword puzzles, learning languages, playing musical instruments. It’s important to try out different things and do what works for you and what’s enjoyable

Question: What happens to the mind when we get used to paying partial attention?

Gary Small: We all know we multitask. I mean this is a common part of everyday life and you know I like to drink my coffee in the morning and read the newspaper, so that’s a form of multitasking. Now of course I don’t do that when I’m driving because that is dangerous, so we know of many dangers of multitasking. We know that middle age people who multitask don’t do as well as people who are focusing on one task and we also know that young people who multitask, they can complete the task more rapidly, but they make more errors, so we’re becoming faster, but sloppier when we multitask, but there is another mental process related to multitasking that’s often called partial continuous attention. Here we’re not just doing two or three tasks at the same time, we’re scanning the environment for new information at any point and this is a process that I think is becoming very popular now that we have all these new electronic communication gadgets, cell phones, PDAs, computers, the internet, so many people are at their workstation or at home in bed because we don’t have much demarcation these days between leisure, life and work life and they may be having a conversation on the phone or with someone next to them and they’re waiting for a little ding or a little sound or a new message that might be more interesting and exciting than whatever mental activity they’re engaged in at that time. Now there is dangers to that I think. Certainly there are social dangers. You can certainly insult someone if you answer your cell phone in the middle of a conversation, but I think it also may be a state of heightened mental stress because we’re constantly scanning the environment and we know from other studies that chronic stress is not good for the brain. In fact, laboratory animals under stress have smaller memory cells in the hippocampus. Human volunteers injected with stress hormones like Cortisol have temporary impairment in learning and recall, so I think partial continuous attention it’s hard to resist, probably our dopamine circuits that are involved in reward systems drive it because we want that exciting new bit of information, but we have to be aware of it and try to manage it better.

Question: How can we counteract the effects of partial continuous attention?

Gary Small: I think the first step to managing partial continuous attention or PCA if you want to give it an acronym is to be aware of it and to certainly be aware of how it affects our face-to-face communication skills, how it can affect somebody personally. Not long ago I said to my teenage daughter, “You know Rachel when I’m talking to you and you’re texting at the same time I just don’t get the sense that you’re paying attention to my conversation.” So she looked up at me and said, “Don’t worry Dad, I don’t do this with my teachers.” And then looked right down and continued her texting. Now I can laugh about that and she is an adolescent and it’s a different culture to some extent. It’s tolerated more in their age group, but I think there are still social gaffes that people get into as a result of partial continuous attention. I think another thing that’s important to do is to take breaks from the computer and if we’re having a face-to-face meeting maybe turn off some of the gadgets and not be tempted to be distracted by them.

Question: Can technology be addictive?

Gary Small: Human beings have the capacity to become addicted to many things. We often think of addiction as involving drugs or alcohol, but people get addicted to food. They get addicted to sex. They get addicted to technology. Now there is some debate as to whether you really can be addicted to the internet or to video games. In my mind you know that… we’re just dealing with semantics because it’s very clear there are many people, particularly young people who are unable to give up their technology of choice. In Asia they’re much more aware of this. There are in fact rehab centers for teenagers addicted to videogames and they work very hard to get them off of these video games. We know there are people playing these virtual life games 12, 14 hours a day. If you look at what drives any addiction it’s the primitive dopamine neurocircuitry in the brain, any kind of reward system, something that makes us feel good we have the prone to want it.

Gary Small: Anything that makes us feel good we’re prone to want it more and more and more and not give it up, so as the American Psychiatric Association continues to debate this we’re seeing a lot of people who are addicted to the technology and even if you’re not completely addicted where it’s not really causing a big problem in your life I think many of us can see the lure of it, how it’s often very difficult to leave it aside when we probably should be doing something else.

Gary Small: If you think of what defines an addiction it’s when you keep using something to the point where it’s hurting you in your life and often people who are addicted to technology or food or anything there tends to be a secretive nature about it. You isolate. You don’t tell people about it. You lie about it. If you can’t get it you crave it. You think about it. So all these patterns of addiction can show up with technology and it can range from eBay shopping to gambling, to virtual games, to video games. You name it.

Question: Is it possible for the sustained use of technology to alter the brain?

Gary Small: So the brain is a marvelous organ. It’s my favorite organ and it’s very sensitive to the environment, so from moment to moment our brains are bombarded by stimuli from our senses and whether I’m looking at a computer screen or reading a book or having a conversation the information comes in my ears, in my eyes. It’s translated into little neurochemical packets that are transmitted across little synapses or connection sites between the brain cells or neurons and all the information is understood, is compartmentalized and processed and it’s quite a remarkable thing that our brain is doing. Now one thing that is quite interesting is that if the brain spends a lot of time with a specific mental task over and over again the neurocircuits that control that task will strengthen, it will actually grow synapses. If we neglect certain tasks the neurocircuits that control those tasks will weaken and I think this is an issue we’re facing right now because young people, the digital natives are spending so much time with their technology that they’re technological circuits are great. They can use this technology. Communicate to their friends from moment… They can use the technology to communicate with their friends from moment to moment, search online. It’s marvelous what they can do, but they’re not spending enough time talking to each other face-to-face, so having eye contact, recognizing nonverbal cues the neurocircuits controlling those mental tasks I’m concerned that they are weakened.

Question: Are there any recent studies on this topic?

Gary Small: There is a recent study that involved about 200 young people ages 17 to 23 and the task involved watching a face morph from a neutral expression to either an angry expression or to a happy face and they found that when these young people played a violent videogame before the face recognition task it had a significant effect on their ability to recognize the emotional expression from the face. Now that’s some systematic scientific data, but many parents will notice in their kids if they play too many videogames, if they spend too much time with their technology that they’re not looking at them in the eye, that they become irritable, that there are personality changes and I think this is a whole area that is just beginning to emerge as an area of study.

Question: How does text messaging change the brain?

Gary Small: No one has directly studied how the brain affects of text messaging, but it’s an interesting phenomenon. I’m sure it’s increasing some neurocircuits, diminishing others. It has an interesting affect on people and in fact young people use it so much I found that college educators, professors are having trouble getting the kids to stop texting during class. They even take five minute text breaks half way through the class. It just it’s inconceivable to me that they’re doing this, but they’re doing it. Now it’s an interesting phenomenon how it’s affecting the way we think and the way we relate. I think there may be issues with creativity, thinking outside the box. I mean everybody is so connected. We’re like a colony of ants or bees checking ideas from moment to moment and not stopping to spend time and ponder thoughts. In fact, we have a staccato quality to our thinking. It’s just like we’re jumping from thought to thought as we do… We’re jumping from thought to thought just the way we jump from website to website. So there is a sacrifice of depth of thinking or breadth of thinking.

There is an upside and that is that the brain is malleable at any age. We found that in our older volunteers and we know that in young people as well, so we can understand what we’re doing to our brains and we can change our behavior and our brains will repair themselves. It will come back pretty quickly.

Question: How would the brain repair itself after years of bad habits?

Gary Small: Well just as we found with our brain on Google study that we could significantly activate neurocircuits in just a week we can change people’s behaviors which will alter their brain neurocircuitry. So it’s the same principle as how much time you spend on a task how that will determine those neurocircuits. Most of these changes are not permanent. Certainly very early in development there can be permanent damage if there is depravation or other kinds of insults to the brain, but most of the time we can change it. The problem is if these are long term habits people are often very resistant to change, especially if they’re addicted to a technology. It’s very hard to give up smoking and it’s very hard for some people to give you’re their technology.

Question: What effect do search engines have on the brain?

Gary Small: One thing that fascinates me is that we’re spending so much time with the internet and we’re searching online and when I wrote my book iBrain I was amazed that no one had studied directly what happens to the brain when it searches online, so we decided to do that. We did that study and we used functional MRI to measure brain function from moment to moment. Let me say that again. And we used functional MRI to measure the neurocircuits, how they were behaving from moment to moment while people searched online and it was quite an interesting study. We found that older people who searched online for the first time that they’re brains really didn’t activate that much. In fact, their brains looked very similar to how the brain looks when it reads a book page, but older people who had previous experience searching online had a much greater degree of activity in the brain when they searched online in the functional MRI scan. In fact, it was a twofold increase in activity, so that finding suggested to us that maybe the brain is exercising when it’s searching online. So to understand that better we did a part two of that study. We took these internet naïve people and we said to them, “Okay, we want you to practice searching online.” And they practiced doing it for a week, just an hour a day and we had a very interesting result and that was in a matter of just a week we saw significant increase in the neurocircuitry, not randomly throughout the brain, but in the frontal lobe, areas that control short term memory and control decision making, so the headline was “Google is Making us Smart”. I don’t know if it’s making us smart, but it is increasing our ability to search online more effectively and in fact tweaking those frontal circuits that control some of the mental tasks that we need to search online. Now whether it’s helping us with short term memory outside of the searching task or with decision making when we get offline we don’t know that and it would be interesting to study that.

Question: Are there any ways to prevent Alzheimer’s?

Gary Small: Right now, we don’t know the true cause for most cases of Alzheimer’s. There are some very rare cases where there is a genetic mutation, but for most people it’s not so clear cut. There are genetic risks, but there is also lifestyle issues that we’re beginning to learn about, so for example people who exercise regularly, get a lot of cardiovascular conditioning have a lower risk for getting Alzheimer’s disease. It’s probably that mental activity may protect us. Healthy diet, what’s good for your heart is also good for your brain, so a Mediterranean diet protects against Alzheimer’s disease. So there are many factors and there is probably drugs that people take that may protect against Alzheimer’s. Possible that anti-inflammatory drugs, maybe statins to lower cholesterol. We don’t know for sure so we don’t recommend these as preventive treatments. There is a lot we have to learn yet and the cause has not been pinpointed entirely, but there are a lot of interesting theories. There are little fibular protein deposits in the brain amyloid plaques and tangles that some people believe are causative. Oxidation may be an issue and so that’s why antioxidant foods as well as antioxidant vitamins may protect the brain and I think inflammation in the brain is also another key factor.

Question: Can you explain how inflammation is related to Alzheimer’s?

Gary Small: Basically inflammation is a process to correct problems in the body, so you know you get an inflammatory reaction if let’s say you get a splinter in your finger. It gets red. Cells attack the foreign body and this can go on anywhere in the body. What we find in Alzheimer’s disease there are these little amyloid plaques where there are elements of inflammation, little cells and debris that tells us that there in an inflammatory reaction. Now it’s possible that the abnormal insoluble plaque deposits create the inflammation, so the brain is trying to rid itself of the plaque or maybe there is something else going on, so we see that process in the brain and that’s why some of the strategies have involved using anti-inflammatory drugs to try to protect the brain.

Question: What are some of the biggest myths surrounding Alzheimer’s?

Gary Small: I think one of the biggest myths is that there are no effective treatments. Now we do have effective treatments, but they’re probably not as effective as people would like. They don’t cure the disease, but they do help temporarily. They can keep people out of the nursing home for a year or more and we’re finding that if we treat people very early that we can have an impact, so I think that’s probably one of the biggest myths I hear about.

Question: What are some of the most promising studies you have done?

Gary Small: Probably one of the most gratifying studies I’ve been involved in has to do with detecting Alzheimer’s very early. It always made sense to me that the brain doesn’t all of the sudden get Alzheimer’s disease, that this is something that begins very gradually and is a process and in developing new brain scanning technologies we found that definitely to be the case, that we can see very subtle evidence of Alzheimer’s disease decades before people obviously have the disease. Now that often scares people because they think my God, I’m in my forties or fifties and I’ve got the inklings of Alzheimer’s, isn’t that terrible? I think it’s cause for hope because it means that we will in the future be able to detect people at risk and work to protect to a healthy brain rather than try to repair one once the damage sets in.

Question: What are the unique challenges in treating Alzheimer’s Disease?

Gary Small: Well you know I think a big challenge with Alzheimer’s disease is that it’s so subtle and gradual and so how do you differentiate it from normal aging? We get this question all the time and it really comes down to the degree of the symptoms because all of us complain about memory slips. It’s very gradual an onset, but at some point we say you’ve got Alzheimer’s, you just don’t have normal aging and I think it’s a question of degree. So that’s a big challenge, but I think in the research we’re doing that that may be something eventually that we aren’t so concerned about because I think that we’ll get to a stage where we’ll have brain scans and blood tests and we’ll do brain checks so we’ll deal with Alzheimer’s disease the way we deal with high cholesterol where you’ll have some kind of a marker that will tell you, you know you’re at high risk for Alzheimer’s so you should take this drug or vaccine and so in the future it will lower your risk in the future. So that would be great because it would de-stigmatize the problem. Right now a lot of people don’t come in until very late because they’re afraid of what they’re going to find out and I think it’s really something that probably will affect us all if we live long enough, so it’s important to try to deal with it now.

I mean if you look at the risk… If you look at the risk of Alzheimer’s disease it just keeps going up with age and if you follow the statistics, by age 110 we might all have it, so I don’t think that’s true because I think that lifestyle is very important. It’s not all biological or genetics, but there are probably thing we can do to improve our brain health and lower our future risk for Alzheimer’s.

Question: What is the worst career advice you have received?

Gary Small: Well I think that I can’t recall one specific experience that’s worse than another, but I think there is a pattern of advice I’ve been given that is probably the worst and that is often to stick with something perhaps longer than I should have. I mean I tend to take projects to their completion, but I think some of them if I had abandoned them a little earlier rather than later I would have saved a lot of time and energy.

Recorded on: December 11, 2009