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Dr. Gary Small’s The Naked Lady Who Stood on Her Head: Brain Fog

October 6, 2010 by SharpBrains

(Edi­tor’s Note: what fol­lows is an excerpt from Dr. Gary Small and Gigi Vor­gan’s new book, The Naked Lady Who Stood on Her Head: A Psy­chi­a­trist’s Sto­ries of His Most Bizarre Cas­es)

CHAPTER TEN

Brain Fog

Sum­mer 1990

Gigi and I had moved to Stu­dio City, about a forty-minute com­mute to UCLA. On week­ends, we often went to the movies at Uni­ver­sal City­Walk, a repli­ca­tion of Los Ange­les with­in Los Ange­les. Why peo­ple couldn’t just walk down the real streets of Los Ange­les made no sense to me, yet there we were, on a Fri­day evening, eat­ing ice cream and strolling down a sim­u­lat­ed street.

We had just seen Total Recall, Arnold Schwarzenegger’s new sci­encefic­tion film about a con­struc­tion work­er who under­goes a false mem­o­ry trans­plant that takes him on an imag­i­nary trip to Mars. But things go wrong, and when he comes out of it, he can’t tell what’s real and what’s imagined.

“When he first got back from Mars, there were so many signs that he was from the future that I believed it,” I said.
“But hon­ey, before he had that mem­o­ry implant done, he was per­fect­ly hap­py liv­ing in the present—on Earth. Then he got all paranoid.”
“Of course he did. How do you know what’s real­i­ty if you can’t trust your mem­o­ry?” I asked.
“I don’t know; you’re the mem­o­ry expert. I want to go into this shop for a minute.” Gigi dis­ap­peared into a record store.

As I ate my ice cream and watched the crowds, I kept think­ing about those ques­tions. If two real­i­ties seem equal­ly true, how would you know which ver­sion to believe? Many of my patients strug­gled with sim­i­lar issues, whether they were psy­chot­ic, dement­ed, or sim­ply hav­ing mem­o­ry problems.

Over the past few years, I had begun to con­cen­trate a large part of my prac­tice on mem­o­ry issues—not just in old­er patients with Alzheimer’s dis­ease but in mid­dle-aged peo­ple who were wor­ried about their increas­ing for­get­ful­ness. My research was also focus­ing on ear­ly detec­tion of demen­tia and age-relat­ed mem­o­ry decline, and I was devel­op­ing brain imag­ing as a diag­nos­tic tool.

Gigi came back with a bag of CDs and said, “Let’s get the car.” Thank­ful­ly, she remem­bered where we had parked.

The fol­low­ing Mon­day, I got to the office ear­ly and checked my phone machine as usu­al. There was a mes­sage from one of my UCLA men­tors, Dr. Lar­ry Klein. He want­ed me to see a VIP stu­dio exec­u­tive, Greg Wiley, who was com­plain­ing about his mem­o­ry. That name rang a bell—I had just read about him in the L.A. Times busi­ness sec­tion. He had been pro­mot­ed to head of pro­duc­tion at a major movie studio.

Two days lat­er he showed up at the office for his first appointment.

He was in his mid-fifties, lean and fit, and had an air of author­i­ty. He wore an expen­sive suit and car­ried a leather brief­case. As we shook hands, he looked me straight in the eyes, but then his gaze flit­ted about the room, as if he was siz­ing up my ter­ri­to­ry. I pulled up a chair across from the sofa, but rather than sit­ting on the sofa as most patients did, he posi­tioned the oth­er chair oppo­site mine—he wasn’t going to let me for­get who was head of production.

Greg crossed his legs, and I noticed his alli­ga­tor shoes—they prob­a­bly cost more than my month­ly mort­gage. Maybe I wasn’t charg­ing him enough, but as soon as that thought crossed my mind, I won­dered if I felt intim­i­dat­ed by him and was crack­ing jokes to myself to defend against the feeling.

I had just got­ten a new Mr. Cof­fee machine for the office. I went to pour myself a cup and asked Greg if he want­ed some. He declined and pulled an Evian bot­tle out of his brief­case. “Lar­ry Klein tells me you’re the go-to guy in your field. For a new­com­er, you’ve made quite a name for yourself.”

“Lar­ry tends to exag­ger­ate.” I sipped my coffee.
“Maybe I should hire you away from all this glam­our,” he said sar­cas­ti­cal­ly, ges­tur­ing around my sparse­ly fur­nished hos­pi­tal office.
I smiled and said, “Lar­ry tells me you’ve noticed some mem­o­ry changes.”
Greg leaned in, sud­den­ly seri­ous. “Now, this is com­plete­ly con­fi­den­tial, right?”
“Of course,” I answered.
“I haven’t told this to any­body, not even my wife, but there are moments when my mind doesn’t feel as sharp as it used to. And it tends to get worse lat­er in the day and evenings.”
“What do you think brings on these episodes?” I asked.
“It could be over­work or stress, I don’t know.” He took a swig of his water.
“Tell me more about what you’re experiencing.”
“It’s not so much my memory—in fact, most of the time my mem­o­ry is pret­ty good. But I have these moments of … not con­fu­sion nec­es­sar­i­ly, but my brain starts think­ing in slow motion. You know what it’s like when you dri­ve through a thick fog at night? That’s what it feels like.”
“Like a brain fog?” I asked.
“Exact­ly,” he said as he gulped down more water.
“Let me see if I under­stand this,” I said. “When you have these episodes toward the end of the day, your think­ing slows down and the
thoughts aren’t as clear.”
“Sort of … it takes more time to orga­nize what I want to say, and I sup­pose it’s hard­er to remem­ber things.”
“How often does this hap­pen?” I asked.
“A few times a week … maybe every oth­er day.”

My mind jumped to an inven­to­ry of pos­si­ble caus­es for Greg’s late­day brain fog. Hypo­glycemia was at the top of the list. It also could have been tran­sient ischemic attacks or TIAs, min­istrokes that don’t lead to last­ing brain dam­age. But when I asked him about his diet and med­ical his­to­ry, nei­ther fit. In fact, Greg had just had a com­plete med­ical check­up, and his blood pres­sure, cho­les­terol lev­el, and glu­cose tol­er­ance were all nor­mal. I did learn that he had a fam­i­ly his­to­ry of Alzheimer’s disease.

“We used to just call it get­ting senile,” he said. “My grand­moth­er was real­ly out of it, and so was her broth­er. Now my uncle is total­ly con­fused, and his doc­tor says it’s Alzheimer’s. I guess that’s anoth­er rea­son I want­ed to meet with you. Maybe I’ve inher­it­ed a pre­dis­po­si­tion for it, and it’s already starting.”

(Edi­tor’s Note: to learn more and order, you can click on The Naked Lady Who Stood on Her Head: A Psy­chi­a­trist’s Sto­ries of His Most Bizarre Cas­es)

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Filed Under: Brain/ Mental Health Tagged With: Alzheimers-disease, book, brain fog, Brain-Imaging, demented, excerpt, forgetfulness, Gary-Small, Gigi Vorgan, Hypoglycemia, memory issues, memory-decline, mini-strokes, Naked Lady, UCLA

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