I’ll Never Forget Whatshername

Kiera Knightley.  I was in my early twenties when I first thought I might suffer from name aphasia.  My wife and I were at an educational workshop and during lunch a woman sat down at our table and started talking to me as if she knew me.  After lunch my wife asked me who she was and I replied, “I haven’t the slightest idea.”  But in the moment, I was struggling to remember who she was and what her name might be.

Kiera Knightley.  It happened to me on several occasions.  Years later my wife and I were at a music venue to hear my son’s band perform.  I saw one of the psychologists I worked with but when I went to introduce him to my wife his name just would not pop up in my mind.  It was embarrassing, frustrating, and kind of scary.  It took me at least 15 minutes, going through every mental process I could think of before I remembered his name.

Kiera Knightley.  The most frustrating thing about name aphasia is being able to remember someone’s face but not being able to remember their name.  It’s like there is a deep dark box and when you reach into it, you come out empty handed.  And it gets really scary as we age, as forgetfulness is a sign of age related dementias such as Alzheimer’s disease.

Kiera Knightley.  The technical name for name aphasia is anomic aphasia or dysnomia and it isn’t restricted to having difficulty remembering names.  People with this form of language deficit also forget the name of objects; they know the word, but have difficulty retrieving it.  This form of aphasia is typically due to damage to part of the brain, such as from a head injury, stroke, brain tumor, or infection.[1]   Individuals with Alzheimer’s disease may present with Primary Progressive Aphasia.  This too results in difficulty naming people and objects, but it is due to progressive degeneration of parts of the brain that control speech and language.  In other words, we observe similar behavior, but the underlying cause is different.[2]

Kiera Knightley.  Difficulty remembering or saying the right words, is currently in the news because Donald Trump and Joe Biden, both in their 70s, display this behavior, which raises questions about their mental fitness.  Biden does falter when he speaks, particularly as he searches for the right word.  He may start to say one thing, stop, sputter, and then come out with the word he wants to use.  That is not uncommon with people who have a large vocabulary and certainly not uncommon among older adults.  Biden also acknowledges he has struggled with stuttering since childhood, which contributes to his faltering speech pattern.

Kiera Knightley.  Because Biden tends to stammer when he speaks, I decided to carefully observe him during a press conference.  A reporter asked him three questions and I thought that after he answered the first one, he’d have to ask the reporter to repeat the other questions.  Not at all.  And he provided a cogent response to each one.  Clearly, despite talking haltingly to search for the right word, Biden has a good memory and presence of mind.

Kiera Knightley.  Trump’s situation is different as he tends to slur and mangle his words when he speaks.  (For a good laugh check out https://www.youtube.com/watch?v=UE9BXkQ-SRc)  One reason may be that he lacks formal knowledge and thus has a limited vocabulary.  It’s been pointed out, for example, that Trump often starts a sentence with the phrase, “believe me” because he needs to reinforce for his audience that he is knowledgeable when in fact, he knows virtually nothing about the subject.  Some have also suggested that he wears dentures which slip causing him to slur his speech as if drunk.[3]  Trump’s recent bragging that he passed a simple cognitive screening test did not allay fears among mental health professionals that, among a number of mental health issues, Trump may be displaying early signs of cognitive decline due to age-related dementia.[4]  

Kiera Knightley.  Finally, part of the problem arises because Trump cannot shut-up.  Due to narcissism, Trump needs to be the center of attention and thus he has something to say about everything.  And because a lot of what he has to say is meaningless, it gets a lot of attention, such as when he said he wanted the U.S. to buy Greenland.  Thus, we have an excessive amount of verbal and written (tweets) communication, which is replete with numerous gaffes, verbal oddities, misspellings, malapropisms, and slurring of speech which suggests mental deterioration.

Kiera Knightley.  If you live to retirement age, as I have, you can’t ignore the risk of age-related dementias including Alzheimer’s disease.  That’s because the incidence of brain deteriorating/function declining diseases increase with age.  The thought of slowly drifting into oblivion, not recognizing family members, forgetting where you are, not knowing how to feed or dress yourself, in essences declining back into infancy, is horrifying.  According to the Alzheimer’s Association, about 5.6 million Americans have some degree of cognitive decline related to Alzheimer’s disease.  Not only does the prevalence of the disease increase with age, so does the level of impairment.  For example, it is estimated that nearly a third of elders age 85 or older have some level of Alzheimer’s dementia.  Alzheimer’s is also more prevalent among women, in part due to more women surviving into old age and living longer than men.[5] 

Kiera Knightley.  I’m a Baby Boomer and the U.S. population has more than doubled since I was born.  By 2050, when my daughter, a member of Generation X, will be 75, there will be about 30 million more Americans age 65 and older than there are now.  Unless we find a cure or more effective treatment, the increasing number of seniors with age-related dementia will create a significant demand, at great cost, on the American health care/long-term care system.

Kiera Knightley.  In a July 2020 interview, Trump touted his ability to pass a simple cognitive screening test, noting that he successfully remembered five words in the order they were told to him.  According to Trump, the doctor told him, “Nobody gets it in order.  It’s actually not that easy, but for me it was easy.  They say, that’s amazing.”[6]  Aside from the narcissistic boasting, the Montreal Cognitive Assessment Test, is a simple screening instrument that most seniors his age have no problem in passing and because the five words are presented in a specific order, it is rare for someone to repeat them back out of order.  The purpose of the test is to identify early symptoms of mental decline which might warrant further testing and/or treatment.  In health care, there really is meaning to the saying, “an ounce of prevention is worth a pound of cure.” 

Kiera Knightley.  Several years ago when my doctor gave me the cognitive screening test (it is a standard part of Medicare’s annual health examination) he asked me if I had any memory problems.  I told him it bothered me that I would walk into a room with the intent on doing something or getting something and then having to stop and think about what it was I was going to do or get.  My primary care physician, a man in his forties replied, “Don’t worry it happens to everyone at all ages.  Seniors just worry about it more because they’re afraid they’re getting Alzheimer’s.”

Kiera Knightley.  His comments were reassuring, and they made me wonder if I really have name aphasia.  Turns out that I’m actually pretty good with names.  My wife and I like to watch movies and she especially likes movie classics from the 1930s, 40s, and 50s.  I’ll walk by while she’s watching a movie and say, “Oh, there’s Thomas Mitchell, or Charles Coburn, or John McIntire” and she’ll be amazed by my recognition.

Kiera Knightley.  One of the ways I learn names is through repetition.  When I couldn’t remember actress Kiera Knightley’s name, I said it over and over again – 50 times or more.  Then, a couple of days later I repeated the process.  Now, whenever I see her in a movie, I don’t say, “Oh, there’s whatshername.”  I used a similar process when I was teaching and I quickly learned and retained the names of my students, even when I was teaching several different classes.

 Kiera Knightley.  Another way to remember things is through association.  Here’s a joke I told my long-term care administration students:  Two senior couples were having lunch together and one man asked the other the name of his doctor.  After thinking for a few minutes he says to the other man, “What’s the name of that flower that’s usually red, has thorns, and you give it to your wife on your anniversary?”  “A rose” the other man replies.  The first man turns to his wife and says, “Hey Rose, what’s the name of my doctor?”

Kiera Knightley.  I used to think that joke was funny until it happened to me.  I had gone to see Star Wars: The Force Awakens and my wife asked me who starred in the movie.  I was not familiar with the female lead, but through association, her name quickly came to me.  Like the above joke, I remembered her first name was a flower: Daisy.  And since it was a science fiction movie, I remembered her last name was similar to SF director Ridley Scott.  The actress’ name is Daisy Ridley.  And then my wife asked me “What does she look like.”  And the answer was simple: Kiera Knightly (she’s the one on the left). 

[1] https://www.aphasia.org/aphasia-definitions/

[2] https://memory.ucsf.edu/dementia/primary-progressive-aphasia

[3] https://www.newsweek.com/donald-trumps-teeth-become-topic-discussion-after-slurred-jerusalem-speech-740604

[4] https://www.usatoday.com/story/opinion/2019/04/09/does-donald-trump-have-dementia-we-need-know-psychologist-column/3404007002/

[5] Alzheimer’s Association.  2019 Alzheimer’s Disease Facts and Figures. https://www.alz.org/media/documents/alzheimers-facts-and-figures-2019-r.pdf

[6] https://www.foxnews.com/media/trump-says-biden-should-take-cognitive-test-because-us-requires-sharp-leader

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