Understanding Mild Cognitive Impairment

Our Consultant Psychologist GRAHAM FAWCETT looks at the phenomena of Mild Cognitive Impairment during the pandemic, and shares tips on what to do about it if it’s affecting you.

Have you noticed yourself being more forgetful lately? Have you struggled to find the right words? Have you been a bit clumsier than normal? If so, you’re not alone. The long-term stress of a pandemic and our considerably-reduced activity has an impact on our working memory, attention and muscle memory.

There are two things at play here – distraction and context.

Our memory is more like a web of associations than it is a filing cabinet. And that’s why context is a key component of memory. It’s why a particular smell may evoke a childhood memory. Or why a photo might remind you of a summer day a long time ago. 

This principle applies in everyday life as well. For example, when you’re in one room of the house, and realise you need to get a book from another room, the memory is set up in that first room. When you cross the threshold into the other room, you might lose the context of that memory, and forget why you went in there. 

All of this is made worse by stress, because stress means our working memory is continually distracted by the threat of our pandemic circumstances.

Thinking of a shopping list or simply leaving the house or apartment creates a variety of these ‘threshold effects’: when we look in the fridge we know what we need, but when we get to the shop we don’t have the fridge with us and so we forget.  

Over many years we have become adept at leaving home with our wallet (always on the table), phone (by the charger) and keys (on the hook). We remember these things through muscle memory, rather than through thinking. Yet now, our routines are disrupted and we have to find all the usual things, none of which are where they should be. Triumphant we finally leave the house only to return sheepishly after 100 meters to get our mask!

“Stress means our working memory is continually distracted by the threat of our pandemic circumstances.“

Other features of our memory also falter on a ‘use it or lose it’ basis. We have become clumsier in part because we are out of practice on how to move around. Commuters using public transport accomplished an entire fine and gross motor skill workout each morning – getting on and off buses, trains, into cars; standing upright on swaying vehicles and grabbing for handrails, getting on and off escalators – the list goes on. For those in lockdown the daily step count has plummeted to the hundreds and the most complicated thing we do is open a door. Those in lockdown have become less practiced at motor skills, less adept and… drop the jar, bump into the counter, miss the shelf when putting a mug away.  

We also become less adept at looking. For those driving after lockdown many report having near misses.  Muscle memory helps to drive the car fluently but they have spent months looking at stationery objects (screen, TV, couch) a few meters away and are now less fluent at interpreting a moving object 100 meters away.

Detailed work is compromised too. Excel spreadsheets, reports and accounts are all suffering. We think we have done something and haven’t, simply forgot or got in a muddle without noticing.

All of these skills will return, quite quickly, once our lockdowns end and as the pandemic eases. In the meantime, here are some practical tips for mitigating memory lapses and clumsiness. 

1. Post it notes – virtual or real. Make lists – by the front door (keys, purse, mask), on the fridge as a running list, to do lists, downstairs to remind you to change the bed upstairs.
2. As you leave the chair to go upstairs tell yourself why you are going upstairs. Use your name – this helps to ground you – as an instruction – ‘N, go upstairs and get such and such a book’.
3. If you can’t recall a name or a concept, look it up. Constantly trying the same approach to recall a name won’t work the fifth time if it hasn’t worked the previous four times. Try to recall it in its context – when you first heard it, what it reminds you of.
4. If you are upstairs and forget why, return to the place where you had the bright idea to go upstairs in the first place – sometimes you don’t have to go all the way back, it will come to you.  Crucially don’t stand still, the context won’t change and isn’t helping you.
5. The first time you drive a car after a few months take it slowly.  Your driving is fine, but you may not be as observant as you used to be.   Try a few practice runs if you can.
6. When you put something down which you will need later tell yourself where you are putting it.  Use your name – ‘N you are putting your sunglasses on the kitchen table by the salt’.
7. Remember that many are experiencing word finding difficulties, including names. Today I forgot the name of a famous NGO.   My colleague filled in without a blink and we moved on. A few moments later she had trouble with a word and it was my turn to fill in.
8. Have colleagues check your work, especially copy editing if at all possible.
9. If you forget what you came to the shop for, pause and visualise where you had the thought to come shopping.   The item may pop into your mind.
10. And remember……. No, you aren’t dementing, you’re temporarily stressed, out of practice with life and will get all these skills back.