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I once came up with a metaphor I thought perfectly captured the sheer mass of material my classmates and I were expected to memorize in our first two years of medical school: it was like being asked to enter a grocery store and memorize the names of every product in the store, their number and location, every ingredient in every product in the order in which they appear on the food label, and then to do the same thing in every grocery store in the city.

When I look back now I can’t imagine how any of us were able to do it. And yet we did. The mind’s capacity to store and recall information is truly spectacular. Since I attended medical school we’ve learned a lot about memory and learning. Though much of what follows are techniques I used to survive my first two years of medical school, much of the science that proves they work is new.

STRATEGIES FOR REMEMBERING

1. Become interested in what you’re learning. We’re all better remembering what interests us. Few people, for example, have a difficult time remembering the names of people they find attractive. If you’re not intrinsically interested in what you’re learning or trying to remember, you must find a way to become so. I have to admit I wasn’t so good at this in medical school. The Krebs cycle (I provided the link only to prove how immensely boring it is) just didn’t excite me or relate to anything I found even remotely exciting (though I made myself learn it anyway).
2. Find a way to leverage your visual memory.You’ll be astounded by how much more this will enable you to remember. For example, imagine you’re at a party and are introduced to five people in quick succession. How can you quickly memorize their names? Pick out a single defining visual characteristic of each person and connect it to a visual representation of their name, preferably through an action of some kind. For example, you can remember Mike who has large ears by creating a mental picture of a microphone (a “mike”) clearing those big ears of wax (gross, I know, but all the more effective because of it). It requires mental effort to do this, but if you practice you’ll be surprised how quickly you can come up with creative ways to create these images. Here’s another example: how often do you forget where you left your keys, your sunglasses, or your wallet? The next time you put something down somewhere, pause a moment to notice where you’ve placed it, and then in your mind blow it up. If you visualize the explosion in enough detail, you won’t forget where you put it. Remember: memory is predominantly visual (unfortunately, I can’t think of a good image to help you remember this fact right at this moment).
3. Create a mental memory tree. If you’re trying to memorize a large number of facts, find a way to relate them in your mind visually with a memory tree. Construct big branches first, then leaves. Branches and leaves should carry labels that are personally meaningful to you in some way, and the organization of the facts (“leaves”) should be logical. It’s been well recognized since the 1950’s we remember “bits” of information better if we chunk them. For example, it’s easier to remember 467890 as “467” and “890” than as six individual digits.
4. Associate what you’re trying to learn with what you already know. It seems the more mental connections we have to a piece of information, the more successful we’ll be in remembering it. This is why using mnemonics actually improves recall.
5. Write out items to be memorized over and over and over. Among other things, this is how I learned the names of bacteria, what infections they cause, and what antibiotics treat them. Writing out facts in lists improves recall if you make yourself learn the lists actively instead of passively. In other words, don’t just copy the list of facts you’re trying to learn but actively recall each item you wish to learn and then write it down again and again and again. In doing this, you are, in effect, teaching yourself what you’re trying to learn (and as all teachers know, the best way to ensure you know something is to have to teach it). This method has the added benefit of immediately showing you exactly which facts haven’t made it into your long-term memory so you can focus more attention on learning them rather than wasting time reinforcing facts you already know.
6. When reading for retention, summarize each paragraph in the margin. This requires you to think about what you’re reading, recycle it, and teach it to yourself again. Take the concepts you’re learning and reason forward with them; apply them to imagined novel situations, which creates more neural connections to reinforce the memory.
7. Do most of your studying in the afternoon. Though you may identify yourself as a “morning person” or “evening person” at least one study suggests your ability to memorize isn’t influenced as much by what time of day you perceive yourself to be most alert but by the time of day you actually study—afternoon appearing to be the best.
8. Get adequate sleep to consolidate and retain memories. Not just at night after you’ve studied but the day before you study as well. Far better to do this than stay up cramming all night for an exam.

WHY MEMORY MALFUNCTIONS

One of the most common complaints I hear in clinical practice is about memory loss. Unfortunately, as a normal part of the aging process, many people start to find they can’t bring to mind names, places, and things as easily as they used to be able to do and worry they’re facing the beginning of dementia. “Benign forgetfulness” is the name we give to a process that occurs with normal aging in which a memory remains intact but our ability to retrieve it becomes temporarily impaired. Usually we try to describe the name or thing we can’t recall and when someone names it for us we instantly remember the word we wanted. As long as this is age-appropriate and doesn’t significantly interfere with normal functioning, there is no increased risk for progression to dementia. However, the trick lies in assessing what is and isn’t “age-appropriate.” Formal testing is sometimes necessary in ambiguous cases. Reassuringly, in one study, patients over the age of 50 who initially presented with what was considered to be benign forgetfulness had only a 9% chance of progressing to dementia. Unfortunately, cognitive impairments other than memory loss are correlated with a higher risk of progression to dementia.

Another reason people often have trouble remembering things is because memory is a function of attention. Which means when you multi-task you tend to forget more easily. Have you ever entered a room only to forget why you did so? More likely you’d remember if you weren’t simultaneously planning your dinner for that night and trying to remember the phone number of the person who just left you a message. This also explains why people who suffer from depression or anxiety have a harder time remembering things: both conditions interfere substantially with the ability to concentrate. The strength of a memory is also determined by the emotional state that accompanied the original event. Emotion, negative or positive, tends to embed events in our memory like a chisel carves lines in stone. A double-edged sword for people suffering from PTSD.

DECREASING THE RISK OF DEMENTIA

Here are three things you can do that have been shown in studies to decrease the risk of mental deterioration as you age:

1. Exercise your body. Evidence suggests this not only retards normal age-related memory deterioration but reduces the risk of developing dementia. It doesn’t even have to be vigorous exercise. Just 150 minutes of walking per week has been shown to be of benefit. Whether more intense exercise results in a greater risk reduction remains unknown.
2. Exercise your mind. Evidence also suggests that doing things that work the mind may delay or prevent memory loss. This research is just in its infancy, so here’s as good a guide as any to figuring out what activities will work: if an activity requires you to take breaks, it probably qualifies. We can watch television, for example, for hours on end without becoming mentally fatigued, but solving math problems, learning to knit, or even reading all require effort that tires the mind.
3. Take ibuprofen. Though one study suggests a daily dose of ibuprofen decreases the risk of developing dementia, the risk reduction appears too modest to justify the increased risk of stomach bleeding that accompanies ibuprofen’s daily use and I do NOT recommend this. However, if you’re already taking ibuprofen for some other condition, like arthritis, here might be an added benefit.

If the mind is indeed like a muscle (and research is validating that model more and more), memory may very well be like muscle tone: the more the mind is used, the more robust memory may become. As I’ve moved on from my medical school days to reach middle age, I’ve found myself experiencing benign forgetfulness far more than I like. As a result, I find myself comforted that the old adage “use it or lose it” is seeming more and more not just to apply to the body but to the mind as well.

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