What you call a poor memory may be your attention

T The medical and functional perspectives are on an equal footing. They need at least equal attention, to be examined in parallel and to be followed up with the same care. Medical conditions that may explain the difficulties need to be assessed and, where necessary, investigated, so that illness or injury is not mistakenly understood or treated as a functional problem. At the same time, the functional side needs to be examined on its own terms, rather than simply becoming what is left when medical explanations have been explored.

The functional perspective examines how attention and other psychological processes affect what is registered and becomes available to memory. It does not presuppose an illness, a brain injury or a different brain, and it does not mean the difficulties are imagined. Medical and functional processes can also be present at the same time.

How attention can affect memory

For something to be remembered later, it first needs to be attended to and registered. If attention is also occupied with something else, less of the information may be registered. What is later experienced as forgetfulness may then have begun, in part, when the information was taken in. This is a possible mechanism, not an answer to what is causing your difficulties.

In experiments on divided attention, a concurrent task has impaired performance more when information was being learnt than when it was being retrieved. Such studies show how attention can affect memory in an experimental setting. They cannot establish whether an individual’s difficulties are due to attention, illness, medication, brain injury or something else.

How anxiety and negative thinking patterns can affect attention

When anxiety arises, attention may turn towards bodily signals, possible threats or one’s own ability. Worrying, rumination and repeatedly checking one’s memory can also take up considerable mental capacity. Low mood and negative or depressive thinking patterns can affect both concentration and how one judges one’s own ability. These processes need not be consciously chosen and can, together or separately, contribute to difficulties with memory and concentration.

How memory is experienced and how a person performs on a memory test can sometimes give different pictures. The difficulties can be substantial even when a test result falls within the expected range. That does not mean they are imagined or less important. The difference needs to be understood alongside how the difficulties began, how they have developed and how daily life is affected.

Research on functional memory and concentration difficulties has found associations with anxiety, depression, sleep difficulties, negative self-appraisal and negative beliefs about one’s own health. These associations do not show what came first or make any one of the processes the sole cause. Nor do they rule out concurrent medical or neurological conditions.

If such processes are part of your situation, sessions can explore how they affect attention and daily life, and what might help to change or ease them. That does not mean that the memory difficulties are explained away as psychological or that a medical condition has been ruled out. Medical assessment continues in parallel when needed.

Easing the load on memory in everyday life

Whatever the cause, external memory aids can make daily life easier. These might be a calendar, a reminder on the phone, a list kept in a fixed place or a routine that links a task to a situation. The support needs to fit the person and the situation. There is no single system everyone should use.

A systematic review and meta-analysis of 73 studies involving middle-aged and older adults and clinical populations found promising results for external aids for prospective memory, meaning remembering things one intends to do later. Many of the studies of external aids were small, however, and the authors called for larger trials. The evidence therefore suggests that practical aids may be worth trying, not that a particular aid helps everyone.

Computer-based working-memory training can improve performance on the tasks being trained. There is, however, no convincing evidence that the improvement generally transfers to broader cognitive abilities or everyday skills. Such programmes can be used if they feel worthwhile, but they need not be a prerequisite and do not replace assessment or individually tailored support.

When memory difficulties need assessment by healthcare

Memory tests measure different aspects of memory, often over relatively short delays. A result within the expected range can therefore be valuable but does not, on its own, establish why the difficulties are present. In research on accelerated long-term forgetting, people have been able to learn material and perform well on early recall, yet forgotten more than expected after a longer delay. The research concerns specific clinical populations and the methods vary, so the phenomenon should not be used for self-diagnosis.

Contact a primary care centre if memory difficulties recur, increase, affect daily life or do not improve. It is also wise to seek care if someone close to you has noticed a clear change. A doctor can assess whether the difficulties need investigation and whether, for example, illness or medication may contribute. You do not need to know what is causing the difficulties before contacting healthcare.

Call 112 if you or someone close to you suddenly becomes very confused. Also call 112 for other sudden symptoms, such as difficulty speaking, understanding, seeing or moving an arm or a leg.

The functional perspective can be explored while medical causes are assessed. You do not need to choose between the perspectives yourself. Keeping them in parallel reduces the risk of a medical condition being treated as a functional problem, and of functional processes being left without attention.