Dear Dr Ash,

I go to the gym three times a week and consider myself pretty fit for a 65-year-old. However, it’s my brain I’m worried about, and I wonder if you can suggest comparable mental exercises for fending off dreaded dementia (or, almost as bad, the impression of “daffiness”). It maddens me when I’m having an intelligent conversation with a friend and suddenly can’t remember the name of the book or film I want to reference. It doesn’t matter how hard I concentrate, if there’s a sudden mental blank, I just can’t access the words. It feels as though they’re lost in a swirling morass of vocabulary somewhere at the back of my head. A few minutes, hours or days later, they’ll suddenly come into my mind, but absolutely randomly, and no thanks to my own deductions. It’s this very randomness that alarms me. Can you explain what’s happening and suggest some process for accessing “lost” information? I do the cryptic crossword every day, I’m learning French online and I work in an industry where writing reports is part of my job, so it’s not as though I lack for linguistic practice. But this sudden word blindness makes me nervous of doing the team presentations I used to love in the past. Any suggestions would be gratefully received.

Brain Jim
Bolsover

Dear Brain Jim,

On the bookshelf above my desk sits a worn copy of Aphasiology, a weighty tome about language disorders written by the great neurologist MacDonald Critchley in 1970. Although I trained at Queen Square, where Critchley worked for the majority of his life, this particular volume seems to have found its way to me from the Queen’s University Medical Library in Belfast. It has acquired some rather annoying ink stains along the way, one of which obscures the end of a quote from the Gospel of John that now reads: “In the beginning was the …”.

I suspect that you, like my poor library book, are simply experiencing word-finding difficulty and not a more serious form of degeneration.

Word-finding difficulty is a normal quirk of brain function, and one that becomes more prominent as we age. We store vocabulary in what neuroscientists call semantic webs, and when we recall a word our brains must travel through this network from association to association until they find their target. Infrequent words and phrases are woven into the web tenuously, with only a few ways to get to them. In the right context, when the brain is already close to the right part of the web, finding those words will be easy. When the context is distant and the words are infrequent, the task is much harder. Research suggests that the most difficult words to remember are proper nouns and noun phrases such as the names of people, books and films. No surprise to you, I’m sure.

The curious thing about the sort of word-finding difficulty that you’re experiencing is its metacognitive implications. You know that you know something, but at that moment you don’t know what the something is. You may be able to say the first letter, or the sort of sound it makes, even the number of syllables, but you just can’t seem to get to the word itself. It’s astonishing that the brain is able to retrieve so much information about a word while failing to retrieve the word itself.

Be warned, these fragments of information might tempt you into adopting exactly the wrong strategy, which is to try harder to remember. The fact that you cannot recall a word means that your brain has attempted to navigate its semantic web and has got lost. If you push harder, you’ll simply retrace your steps over and over, ensuring that you will never find your way to the part of the web containing the target word. As you have observed yourself, these words pop into your mind with total clarity when you’ve stopped looking for them. My advice to you is therefore, when this happens, to ease off. If you can observe your mind dispassionately you are far more likely to make the most of its astonishing capabilities.

Best wishes,
Dr Ash

Dear Dr Ash,

I know it’s a cliché to complain about problems with teenagers, but that doesn’t make my suffering any the less! My lovely daughter, who was so open, chatty and adorable as a child, has become a grumpy and recalcitrant adolescent. I’ve read up on troubles with teens and know that I must stay calm and understanding at all times. I recognise that she needs to assert her independence, and to feel she has agency in her life rather than letting her parents organise everything for her. But does it have to be this painful? Every time I try to talk to her she acts as though I’m enemy number one. I’m worried she’s not happy at school, but she won’t open up to me and tells me to stop bothering her. I’ve tried everything – cross mum, understanding mum, read-the-riot-act mum etc etc, but nothing works. So, since you approach problems from a neurological point of view, I wonder if you could give me some help in how to approach her? I long to regain some of our closeness yet feel as though I’m banging my head against a wall. Can you tell me anything about the teenage brain that would give me a clue about how to engage with her?

Teen Talker
Totnes

Dear Teen Talker,

I read your letter shortly after receiving a telephone call from an old friend who is a Buddhist. I have always known him to be infinitely kind, compassionate and wise, an experienced meditator with a deep understanding of the human mind – and yet I’ve spent the last half-an-hour listening to an unhinged rant about his teenage son. Even enlightenment, it seems, has its limits.

My own son is just entering this phase of life, and the changes that I see in him on a daily basis are comically uneven. One day his feet became unreasonably big. Another day his arms appeared to dangle down past his knees. One day his shoulders suddenly broadened. It’s like watching one of those “magic grow” toys unfurl itself in the bath. And for all the changes I can see, I’m aware there are also invisible changes happening in his brain. One day his limbic system develops more white matter, another day there is synaptic pruning in the parietal lobe, and on yet another there is development in the cerebellum. Brain maturation is slow and regional, and the adolescent brain is gangly, awkward and unbalanced.

One of the last brain regions to complete development is the prefrontal cortex. This part of the brain is responsible for regulating our behaviours, putting in a pause before we take rash actions, helping us to reason and make decisions – what neuroscientists call “executive functions.” Network connectivity in the prefrontal cortex continues to develop well into the mid-twenties, so although adolescents certainly do rely on prefrontal functions, these are effortful and error-prone. In contrast, emotional parts of the brain like the limbic system develop much earlier, and for many years these networks are imbalanced. A strong emotional drive in the absence of prefrontal regulation is, as you’ve seen with your daughter, a potentially explosive combination.

When you ask your daughter to behave in a way that may not be her inclination, you are asking her to drive her prefrontal cortex powerfully enough to overcome her limbic system. Her brain is probably not capable of that yet, at least not easily, and the attempt will only frustrate both of you. You may as well ask a four-year-old to reach a high shelf in the kitchen; there is no parenting technique that will help, the kid needs a step-stool.

A metaphorical step-stool for your daughter may be to encourage her to speak to adults other than you. Remember that familiarity breeds contempt, and parental relationships are always charged. On the other hand, godparents, family members, and your friends can offer guidance and support with a little bit of distance. These relationships are less likely to create a strong limbic drive or to threaten your daughter’s need for independence and agency. Your trust in your friends and family will also help your daughter trust you.

Ultimately, though, you are correct when you call for patience. Your daughter’s brain will continue to develop and one day she will walk into the room full of grace and light and ask you what all the fuss was about. That day is likely closer than it seems.

Best wishes,
Dr Ash