When writer Anna Holmes began to get forgetful, she wondered if it was middle age, menopause or dementia-inflected memory loss. The brain fog made her reflect on not just her health, but her mortality. Having watched her mother slip away from dementia, she wondered if it was now happening to her. We talk to a neurologist and Holmes about her recent piece in the New Yorker, “My Mother’s Memory Loss, and Mine.”
Guests:
Anna Holmes, writer and editor; her latest piece in the New Yorker is titled "My Mother's Memory Loss, and Mine"
Dr. Niyatee Samudra, clinical assistant professor of adult neurology, Stanford University Medical School
This partial transcript was computer-generated. While our team has reviewed it, there may be errors.
Alexis Madrigal: Welcome to Forum. I’m Alexis Madrigal. Over the last half decade, as I’ve eased into my forties, I’ve heard an increasing number of complaints from women in my age cohort about one big thing: brain fog.
According to one study, up to 62 percent of women in midlife report experiencing brain fog, which — as Anna Holmes writes in The New Yorker — is a nonmedical term used to describe reduced mental clarity, difficulty concentrating, forgetfulness, and trouble with word retrieval. While the more physical changes that come with aging can be destabilizing too, brain fog seems like a direct strike on the self — an erosion of who people thought they were.
So our team was excited to read this new piece by Anna. It’s a bruisingly honest essay about her own brain fog and its uncomfortable parallels with her mother’s cognitive decline. Anna, welcome to Forum. So nice to talk with you.
Anna Holmes: Hi. Thank you.
Alexis Madrigal: Yeah. So, you know, as a writer, words are your livelihood — but they’re also kind of everything. And there came a moment when the words started feeling like they were slipping from your mind. Can you talk about what that was like and how you came to recognize it?
Anna Holmes: Yeah. Usually it happened in the context of having a conversation with somebody — and it’s very possible it’ll happen during this interview — where I’d forget a word. Sometimes it happened when I was writing. I wouldn’t be able to think of a word, and I’d have to open up a source and remind myself what the word was, or what I wanted to use.
This started about — I don’t know — three to four years ago, maybe even five. It’s funny because it coincides, I’m pretty sure, with the beginning of COVID. And even though I didn’t have COVID for a very long time — at least not that I knew of — I still felt this sort of brain fog that people I knew were describing, just because of the chaos of what was going on in the world.
But it persisted even after the acute phase of COVID subsided. I was pretty sure it was hormonal — or related to perimenopause. My OB-GYN, who’s based in San Francisco even though I’m in L.A., didn’t seem particularly concerned. She put me on HRT, which—
Alexis Madrigal: Hormone replacement therapy.
Anna Holmes: Yes. Which helped with some symptoms, but didn’t make the brain fog go away. Unfortunately, it still hasn’t gone away — although it may have improved a little bit.
But, as you said, it really does strike at the heart of who I think I am, especially as someone who works with words. It can be embarrassing when I’m talking to someone — whether it’s a stranger or a friend — to start stumbling over words and then have to say, “You know, the word I’m looking for is…” followed by this long pause.
So it felt important for me to write about it. I was hoping other women would identify with what I was going through. And on top of that, my mother was declining and had dementia, which did not help my own paranoia about what might be happening to me.
Alexis Madrigal: Yeah. Can we stick with the experience of it for a second? When you went to recall a word, did it feel like there was a library of words and you reached for a book that just wasn’t there? Or was it more like a blank? What did it feel like on the inside?
Anna Holmes: It was kind of both. There’d be a blank, and then I’d reach for the book — trying to figure out what the word was — and I couldn’t recall it. Or it would take anywhere from three to five seconds, maybe more, to retrieve it.
When I was writing, I could open a thesaurus. But I can’t really do that in conversation. I guess the blank came first, and then the attempt to retrieve the word.
I mention in the piece — I actually start it this way — that I was looking at my cat, and she was sitting on something under my TV, and I couldn’t remember the word. I kept thinking “table,” “bookshelf,” and then it took me a while to remember that the word was “console.”
Now, maybe “console” isn’t a word we use that often, but it’s not something I would have struggled with six—
Alexis Madrigal: Plus, you’ve always been a very precise writer. Was it more than just words? Were there other things happening?
Anna Holmes: Yeah. There was forgetfulness more generally. Forgetting words, forgetting to do certain things — like forgetting to lock my car.
My car is new enough that it has an app that tells me if it’s unlocked. So I’d go shopping or go on a hike, and then 20 minutes later I’d get an alert that the car was unlocked. Luckily, I could lock it remotely, but it still felt like a little poke in the ribs every time.
There were a couple of times when I left my keys in the front door of my apartment — usually after bringing in a lot of packages. So that’s how I kind of consoled myself: I was distracted. But a lot of it had to do with locks — cars, doors — word retrieval, forgetting why I walked into a room, which I know people do pretty regularly.
Alexis Madrigal: Yeah. And when I hear you talk about this — and when I’ve talked with women in my life about brain fog — sometimes it feels like it’s within the normal range of human experience. I’ve forgotten to lock doors. I’m verbally fluent but forget things all the time.
And on the other hand, if your brain wasn’t working like that before, suddenly you’re in a new part of the distribution of human experience. That must be destabilizing.
Anna Holmes: Yeah. It was the frequency that spooked me. And the fact that I was often forgetting words — or forgetting things I’d already said to someone.
For example, I told my friend Nancy a funny anecdote, and then a couple days later I started telling her the same story again. She said, “Yeah, you already told me.” That element of having my difficulty witnessed felt humiliating.
None of my friends said they were worried about me. But even my dad once commented that I’d forgotten something I’d already said. Again, this wasn’t within 10 or 15 minutes — it was days later — but that just wouldn’t have happened before.
I prided myself on being sharp, on multitasking, on not needing lists. So it felt humiliating, and there was a certain shame that I kept to myself. Writing the piece was partly about talking about it publicly.
Alexis Madrigal: We want to hear from you, too. Does this sound relatable? We’ll bring on a doctor later in the show, but listeners — have you had these kinds of experiences?
You can call us at 866-733-6786. That’s 866-733-6786. You can email forum@kqed.org or find us on social media — KQED Forum.
One thing I found interesting in your essay is that you founded Jezebel, you’ve written extensively about women’s health and feminism — and yet perimenopause and menopause symptoms still felt like a surprise. Did they?
Anna Holmes: They did. I think a lot of Gen X women would say the same. We may have known intellectually that perimenopause and menopause were coming, but they weren’t talked about by our mothers, older women, or even doctors.
I wouldn’t have associated perimenopause with brain fog. I would have thought of hot flashes, changes in skin, the cessation of menstruation — not forgetfulness.
What’s changed over the past half decade is that these conversations are much more public. There was a New York Times Magazine piece a few years ago about menopause and how under-studied it is.
It feels like something is shifting because women in midlife are talking openly about it — not just to console ourselves, but so younger generations don’t have the same “Why didn’t anyone tell me this?” reaction.
Alexis Madrigal: I remember reading What Fresh Hell Is This? and being shocked to learn that perimenopause can last anywhere from one to ten years. That variance really surprised me.
We’ll be back with more on perimenopause, menopause, and brain fog. We’re joined by Anna Holmes, writer and editor. Her latest piece in The New Yorker is titled “My Mother’s Memory Loss and Mine.”
If you’re trying to call in, hang tight — the lines filled up immediately. You can also email forum@kqed.org or reach us on social media.
I’m Alexis Madrigal. Stay tuned.