Five ways to improve midlife brain fog – and Sudoku isn’t one of them

Georgina Fuller
Georgina: 'Finding Dory, the Disney film about a very forgetful fish, has never seemed more relatable' - John Lawrence

“Oh god, what did I come in here for again?” I say to my 10-year-old daughter as I walk into her bedroom. I run through my never-ending to-do list in my mind – washing, homework, sorting out that pile of books for the school fair. Oh no! I forgot to reply to that work email about the event next week. “Mum, have you booked me onto that school trip? It had to be done by 4pm today,” my eldest son asks. I slap my forehead. “Hang on, let me just check,” I say, knowing full well that I haven’t. I walk into the kitchen and open the fridge door. Damn, I forgot to get chicken. “What’s for dinner? I’m starving!” my middle one asks, at that very moment. “Ping!” goes my phone with a work email which needs responding to immediately.

Welcome to the chaotic world of my mind which has, over the last few years, gone from being a capable, multifaceted machine which fired on all cylinders to something resembling a barely functional and unreliable starter motor. It all seemed to coincide with the onset of the peri-menopause and even though I’ve been on hormone replacement therapy (HRT) for over two years, I still seem to have the memory of a goldfish. In fact, Finding Dory, the Disney film about a very forgetful fish, has never seemed more relatable.

What exactly is brain fog?

“Brain fog” is known to be a common symptom of the peri-menopause and, as a working mum with three children at three different schools, it’s also something which has, at best, become a running joke to my kids. At worst though, it has led to me missing an important work meeting and living in a constant state of low-level anxiety, wondering what I might forget next.

A recent study by the University College Cork in Ireland found that there can, in fact, be changes to the brain during midlife in men and women and that the hippocampus, which is responsible for memory and learning, could even shrink.

Two of the report authors, Yvonne Nolan, a professor of anatomy and neuroscience and Sebastian Dohm-Hansen, a PhD student, told Medical News Today: “Two robust findings concerning the “middle-ageing” brain is the accelerating shrinkage of the hippocampus (a brain area critical for memory) and reduction in the volume of white matter (the connections between brain cells and brain areas).”

The hormonal shifts in menopause in particular could impact verbal episodic memory (the ability to remember specific events paired with the context in which they occurred), and accelerate brain ageing, according to the study.

So when I was offered a cognitive health assessment to help measure and assess my cognitive abilities, including my short-term memory, I was intrigued to learn more.

Could the assessment, run by Natalie Mackenzie, a neuropsychologist and cognitive rehabilitation specialist (who works with people recovering from brain injuries alongside doing more regular cognitive assessments), provide a health check and insight into my brain?

I was hoping it could help me to identify areas which need work – memory, attention, decision-making and so on – and see what sort of practical measures I can take to try and improve things.

How healthy is my brain?

I was instructed to find an uninterrupted and quiet space for at least 40 minutes to do the test, which was a bit like a multiple choice quiz with different categories – reasoning, verbal skills, visual memory, etc – and quick-fire answers.

I was a bit distracted by my barking dog at the start and before I knew it, I was on the first test, something called Monkey Ladder where I had to try and remember which numbers were in different boxes, but before I’d really got the hang of things, we’d moved onto the next one. Not a good start.

The tests measured different aspects of my memory including episodic memory. These help assess recollection of the common everyday activities associated with episodic memory including, for example: remembering which cupboard you put your groceries in, learning what each button does in a new app or device and remembering who you talked to yesterday, and at what time.

Another test, called Rotation Measures, looked at the ability to mentally rotate and remember different visual representations of objects and then to put them back where they were before. This is meant to measure your ability to navigate common everyday activities such as using a map, finding your way around a new city or planning a new layout for a room. I was surprised, given my hopeless sense of direction, to score an average mark for that.

How did my memory score?

Overall, I scored quite poorly (below average) on my short-term memory but fared better on something called deductive reasoning and grammatical reasoning and above average on my verbal short-term memory (probably just as well, given my job as a journalist.)

So how, I asked Mackenzie, could I help improve my memory and why had I become so forgetful in midlife?

“I’ve seen lots of peri-menopausal women like you who are struggling with brain fog and remembering day-to-day stuff,” she tells me. “In your case, you’re probably suffering with  cognitive overload.”

Mackenzie explains that I struggle to remember small day-to-day things – like whether I turned the hair straighteners off or made that dental appointment – is because my brain is too busy prioritising the important things, such as work deadlines and which child needs picking up when. I find that quite reassuring to hear.

She also tells me that my test results, which are quite erratic, indicate I have strong ADHD tendencies (even though I’ve never been formally diagnosed) which could be a contributing factor in my cluttered mind.

So what sort of practical measures can I take to help improve my memory? Could doing a particular brain exercise, perhaps Sudoku or a crossword, help? A little, says Mackenzie but perhaps not as much as I would like.

“There is actually very little scientific evidence to suggest that doing a particular cognitive exercise over and over helps improve overall memory. They might be good for improving ‘maintenance learning’, but that’s probably about it.”

So what exactly is maintenance learning, I ask.

“When we repeatedly practise something, say, doing a puzzle or playing the piano, we strengthen the connections rather than form new ones, and this ‘maintenance’ keeps the skill ticking over, if you will, rather than boosting brain activity,” Mackenzie explains,

The solution to improving brain fog

Learning something new, on the other hand, helps create new connections between the neurons in our brain. “This formation of new connections is known as synaptogenesis and it occurs with new learning. When more than two neurons fire together, the skill is embedded and ‘utilised’ by the brain,” Mackenzie explains.

“We also know that the hippocampus is where neurogenesis (creation of new neurons) occurs and also that the hippocampus deals with memory, so there is evidence that this learning and memory formation is intrinsically linked. Any new learning aids memory, including short term.”

Mackenzie also recommends setting short-term dopamine rewards during the day to help improve concentration and memory and prevent emotional overwhelm. “These could include 10 minutes of scrolling, chatting to a friend or listening to a great song,” she says.

The Pomodoro method, where you do a short, timed burst of activity, can also help concentrate the mind and aid memory. “A focused period for each task reduces the likelihood of procrastination and distraction, and this focused time encourages better learning and improved output. Therefore there’s more likelihood of being able to transfer from one skill to another.”

Time blocking or apps which help delegate, offload or organise a list of tasks, such as project management boards like Trello, can also help. “It’s essentially chunking tasks into smaller bite-sized pieces, which is often a memory strategy too.”

Lifestyle factors also have a huge lasting impact on our brain health and memory, Mackenzie says.

The single most important thing you can do, says Mackenzie, is make sure you get enough sleep  – something I have struggled with for many years. “Sleep allows for neural repair, is the time when we process and file the memories and when we ‘flush’ out the bad stuff. This keeps our brain in better readiness for learning and attending to new things, to increase the outcome of learning and boost memory.”

So how many hours should I be aiming for?  That varies from person to person, Mackenzie says. “The whole eight hour thing doesn’t have much evidence behind it, some people are OK with six hours, others need nine. It also depends on whether you are a night owl or a lark and you can’t ‘push’ against your natural cycle. Logging how you feel after a good sleep is useful to find what is optimal for you,” she says.

And while having anything too mentally stimulating in the bedroom is not advised, keeping a notepad by the bed might help when it comes to writing down your worries or a list of what you have to remember the next day. “If you do a ‘brain dump’ before bed you might be less likely to wake up as you’ve offloaded the thoughts,” Mackenzie advises.

Sounds like yet another worry to keep me awake at night. But if it helps me remember what I walked into my daughter’s room for, it’s got to be worth a shot.