Ask HN: At 45, I can't seem to read as well anymore | Hacker News Reader

Ask HN: At 45, I can't seem to read as well anymore

85 pointsmeifun136 comments

Howdy HN Friends,

I've gone back to school into a medical degree.

However, I am realizing that I have trouble reading well. I used to not have trouble with any topic, but now I have to re-read text several times, I have to take a ton of notes (40+ pages per chapter), I am skipping lines and transposing characters.

I went to a specialist for academic learning and they did a battery of tests and told me my reading level is very low and were surprised I am even in a medical program.

I went to a development/behavioral ophthalmologist and they prescribed new lenses and cognitive eye therapy. The lenses seem to help but the eye therapy isn't.

I am at risk of needing to withdrawal. Perhaps pausing this education is the best thing while I get this under control, but I don't see a path to start on.

Any advice?

Edit: I have talked with my advisor and instructors and they don't have advice except to seek more help, ask even more questions.

Edit 2: Taking no meds for the last 9 months, never had Covid, my PCP referred me to the development/behavioral ophthalmologist.

Edit 3: no alcohol, no drugs, no ADHD medications.

View on HN

I'm older than you and also have trouble reading but I figured out the problem. I've spent so many years skimming articles on the web that I'm having a hard time breaking the habit. I'm reading "Spare" today by Prince Harry and it's a struggle, but I'm managing to slow down and comprehend each sentence and each word if necessary before moving on. I'm doing this because I want to start reading books again in my retirement.

You case sounds different though, like it might be something organic. Are you taking a medication that makes you less sharp? Bipolar meds certainly do that. Do you have headaches that might indicate some problem? Have you had Covid so maybe have brain fog from long Covid? Are you depressed and anxious? Do you drink a lot? Etc... Good luck figuring it out.

Agree with this. Seems like there could be many confounding factors in this case. Others: How much do you sleep? How active are you? What is your diet like?

Taking no meds for the last 9 months, never had Covid, my PCP referred me to the development/behavioral ophthalmologist.

updated the main post as well to reflect this..

But do you have a reading habit? That is, outside of reading the non-fiction texts you now need, do you read fiction for leisure?

Yes, I read a lot for enjoyment. This has also gone down hill.

This x1,000. The only time I'm able to effortlessly get in a lot of long-form reading done is if I go on vacation somewhere with no goddamn Internet at all. It's wonderful.

I swear, if a genie gave me three wishes, concern about being able to properly craft the wish would be the only thing that'd keep me from burning one of them to permanently eliminate the Internet.

[EDIT] That is, in addition to weakening my reading ability through use of it, the presence of the Internet is so damn distracting that it's hard to read more than a few pages at a time. Consider how, say, pop-culture trivia questions used to come and go from one's mind with hardly any conscious notice taken—no relevant book on hand, no friend or family member present who might know, well, even calling someone's too much effort for something so unimportant, and off goes that idle thought, probably never to come up again—now, though, those sorts of questions reach one's conscious mind all the time, and they itch until you take the 5-second break to answer them; repeat for everything else, like how's so-and-so doing, wonder if anyone's posted anything interesting, et c.

They said, on the internet, using a device likely paid for by a job that depends on the internet, likely alive due to medical knowledge that could only exist through the internet, ... and so on....

> They said, on the internet, using a device likely paid for by a job that depends on the internet

Yet you participate in society. Curious!

> likely alive due to medical knowledge that could only exist through the internet

Definitely not true yet. Maybe some day. Maybe never.

> Yet you participate in society. Curious!

You didn't say "the internet sucks", you said "I'd get rid of it if I could".

> Definitely not true yet. Maybe some day. Maybe never

Medicine has come further since the internet than it did in 50 years prior, imagine the hit COVID would have had if nobody fucking knew about it until someone they knew got it.

So many things depend on global information sharing, saying "blow it all up" because you don't like TikTok or Instagram is so ignorant it's unreal. The internet isn't just cat videos and short form content, it's the backbone of the last 50 years of innovation.

Yep. What can I say, the years have turned me from a "plug me in ASAP!" future-loving optimist to a bit of a luddite. I truly think I'd be happier in a world without the 'net.

I want to say I completely agree with this. I think, even more, we've lost sight of what is real. People think that the internet is real, and we're losing sight that life is something in the physical world. Heads are being stuck more and more into phones, and nobody is just out there talking and interacting in the physical world. It's a huge problem, not to mention the screen addiction I saw among teens when I was teaching.

I'd be much happier if I could have an internet free room or two near my family. In fact, if I ever move back, I might seriously work on that. Bedroom and a study/library if I can afford the place, no internet.

I much preferred the Internet when it was a place you had to go. A room with a computer. And maybe you had to wait for the dial-up connection, and you couldn't use the phone while it was on. And then it was slow.

I think it was actually better with a fair bit more friction. Most of the good stuff was still possible. It couldn't be as big a distraction as it is now. You had to decide to use it, then go to the place where you can use it, then wait a bit.

[EDIT] "So why don't you just live like that?" unfortunately, the entire world now assumes you have fast Internet available everywhere, at all times. Schools, employers, banks, everyone. Living like that today would be far more inconvenient and come at a higher cost than living like that back when it was the norm (or, before it was the norm, even—most households in the US weren't "online" at all until 2000 or so) due to changing expectations.

> Medicine has come further since the internet than it did in 50 years prior, imagine the hit COVID would have had if nobody fucking knew about it until someone they knew got it.

PCR goes back to the mid-80s before the internet became common at all. The news of a novel virus in China was all over the mainstream media outlets back in Jan 2020. Publication of the identification of the viral sequence happened in Nature, that could have still all happened over phone calls and fax machines.

The internet makes that all decentralized and faster, and now anyone can look up that information without going down to the medical library, and there's videos on youtube about virology where the average person can find good information (although you have to run the gauntlet of a plague of bad information without any training as well, so its kind of 50/50).

We still would have responded to the virus and developed the vaccines, and people still would have been able to be informed by the media. The ability of the average person to find out better information is also somewhat balanced by the ability of the average person to find out worse information.

It wasn't entirely the dark ages back in the 80s though and medical science still progressed.

> I swear, if a genie gave me three wishes, concern about being able to properly craft the wish would be the only thing that'd keep me from burning one of them to permanently eliminate the Internet.

In a "3 wishes" scenario, use the first wish to wish for additional wishes, then for each concrete wish in a 2 part process wish for a written quote that includes a no-harm rollback clause and a penalty clause granting more wishes describing how the genie will execute the wish, then wish for the genie to execute the steps described in the quote.

Any genie must be treated as a hostile counter-party.

Oh, I wouldn't even try a single wish with a genie I wasn't very, very sure wasn't hostile. It's hopeless.

That's a good observation. It's not just the neurological changes as a result of frequent exposure to clip-style internet content, but also simply adjacency to these things, as a consequence of their simply existing in ones environment.

In order to read like I read as a teenager, I now need to be on a beach and have detoxed from work/responsibility for a day or so.

I suspect the two are strongly linked. I.e. my subconscious at most times is actually continually running "normal adult life/parent shit" in the background, versus teenager-me had those cycles free.

I wonder how much strain on our ability to read long form is also caused by constantly reading badly proofread comments on the Internet, particularly ones involving autocorrect typos producing sentences that read almost-but-not-entirely correctly.

This really resonates with me. Thank you for sharing. I never really considered the fact that skimming articles on the web can have such an impact on me as well, especially when I don’t read long form content or books as often as I did in college.

Just another one vote for this. In my case, I find myself reading extremely fast online, but when I read a book (fiction or textbook) I'm really slow, have to go back lots of times, sometimes I have to read a sentence 5 times.

My suggestion is to try to relax. I find it gets worst when I'm stressed because "I have to finish this chapter today". Pressure is my worst enemy. Also what helps me, is going to a park, or a place where I feel very good, that stimulates my good mood to read.

I didn't even finish reading your comment, so touché.

(That's not sarcasm. I'm genuinely agreeing with you and mocking my short attention span.)

Ever try using a sheet of paper to force yourself to slow down while reading a book? You use the sheet of paper to cover the unread portion of the page (aside from the current line, obviously) to prevent your eyes from skimming ahead.

I remember seeing kids with reading problems doing this in grade school.

Much to my chagrin (and amusement!) I now find it very useful for myself. Prevents me from reading so quickly that I absorb nothing.

I suspect that this is true for a number of people and you're being honest with yourself. I find that frequently skimming social media, mostly twitter and IG, makes deeper reading harder. If you do that even 30 min a day, you're untraining reading and training skimming. the rapid cognitive switching involved with skimming a wide range of topics that fly by on a timeline also trains the neural grooves for rapid context switching over attending to something for a while.

Good luck - might take a few months, but with good sleep and restricting phone use, I would imagine you'll see improvements. Med school is also very hard - my wife's a doctor so I see this up close. Don't be too hard on yourself.

my screen time on my phone is less than 45 mins each day.

I use an iPad also but I don't have any social media apps, etc loaded. Its very strictly used for classwork, research, assignments, etc.

I've found that I cannot use an iPad, even though I spend a lot of time writing code on a MacBook and use an iPhone. So, even though the font rendering system is the same (yes, I get headaches for a few days when I switch between font rendering systems - Windows, Linux, macOS), there is something about the iPad display -- even in environments where the phone is fine -- that hurts my eyes.

I'm not sure Ipads are particularly good bulk reading devices. Something with an Eink display (i.e. non-light-emitting) might be a better option.

I use a Kobo ereader a lot. It has integration with Pocket[1] which makes it handy for reading a lot of web pages. Then there is Calibre[2] for converting and managing any other documents I may need to deal with.

Good luck!

[1] https://getpocket.com/

[2] https://calibre-ebook.com/

I use a reMarkable e-ink device for a lot too.

You almost have to learn to read again. I regrettably stopped reading for years (other than web articles, email, skimming, etc). In the last few years I started reading novels for pleasure again, and I swear if I stop for a couple of weeks when I get back to it I have to take my time and be slow. Something that has helped is reading books in my native language (Spanish). Since I'm not as strong as I used to be in Spanish, I find that reading in Spanish really forces me to take my time reading every single word. Resist the urge of your brain / eye saccades to skip ahead a bit. Keep reading and soon you'll realize you can do this for many pages.

Edit: I saw that you read plenty for pleasure, so it's probably not this :/

Thank you for taking the time to write a response :-)

I had a similar experience when I joined grad school in 2007. I couldn't get through, or even really understand papers, even though I thought I was a good reader. I also had to "learn to read" again. For me, it was about 1 semester of focused effort to rebuild the skill. I was in my 20's then.

That said, if you don't see (or haven't seen) noticeable improvement over 3-5 months, that is probably a signal to pay attention to.

can you share what you did that semester to help?

I realized in my 50s that I had been reading less and less for many years. I didn't know why, and it bothered me. Then, one day in the drug store, they had these reading glasses on one of those wire displays. On a whim, I tried one on. My gawd! I could see! My vision had declined so gradually I didn't notice it, but the reason I wasn't reading anymore was because of the effort to make out the letters.

The reading glasses solved that problem, and I was reading again. I also had been in denial and finally got progressive lenses for my glasses.

I know this is not your particular issue, what's happening to you sounds awful.

Thank you for writing a reply.

I had a similar situation/concern a few years back… went to Dr and Optician got glasses, light therapy etc. No improvement and became exasperated.

What solved the mental focus for me was light movement while reading (walking on treadmill etc) and/or laying down to relax most core muscles. Second, shockingly NOT chewing gum or doing too much downward facing iPhone reading made a massive difference to my vision.

Causality? The impact of posture and/or movement on breathing has a big impact on brain focus. If you have a blood O2 meter you can test this while your are reading. Ironically the more worried you become about not focusing the more you hold your breath and the more clenched your posture. It’s a vicious cycle.

Gum was the shocker, I would habitually chew in the morning for an hour or two (mindlessly) and it turns out it was over taxing the jaw and neck muscles. This caused the eye muscles to be impacted and resulted in blurry strained vision. Cutting out gum for a week almost entirely removed my need for glasses. Lastly, I would still get blurry vision occasionally and finally narrowed it down to iPhone “texting neck”.

I’ll post a couple of refs in a minute. May be unrelated but if there’s a thread to pull on here I hope it helps.

Link to comment about phone and gum: https://news.ycombinator.com/item?id=23363566

Link to post about breathing:

https://news.ycombinator.com/item?id=24102829

I've found this too, even at 30. Walking on a treadmill (or using a stationary bike) while reading makes it so much easier, though I am starting to find it easy enough to read in bed without moving again. It took some time to build back up to it though.

This is super interesting, thanks for reporting.

Thanks. Let me digest this.

Do you live in North America? Have you possibly been exposed to Lyme disease? These are all common symptoms of early Lyme and possibly even long term exposure.

I do live in an area where ticks are prevalent. Thanks for mentioning.

Ticks carrying Lyme's disease are not limited to North America. In fact, the whole northern hemisphere is affected.

Good to know, thanks.

Dumb question: have you had your eyes checked? I had serious reading issues, massive headaches and whole pile of other assorted symptoms and someone on HN suggested I go to an eye exam. A set of +2 reading glasses later and everything was fine again for many more years. 45 is roughly the age at which you can start to expect that kind of thing.

Yes, 3 times since July and just got new glasses 2 months ago. I have everyday glasses and also glasses for reading/screens. They help to enlarge the text and make it more crisp. They are an improvement.

Ok, so you can rule that out. I felt it was weird to ask because it's such an obvious thing but better safe than sorry. Best of luck with this, it is super tricky. Next step: neurologist, and hope for the best. Hang in there!

edit: ah, and only now I noticed you had mentioned that, who needs glasses here ;)

TY. I value your feedback.

I heard somewhere that moving along the metabolic disease path from pre-diabetic to diabetic can cause structural deformation of the eye lens rather dramatically due to increased blood sugar content and can be the cause of a symptom like, "I woke up one morning and couldn't read." Anyways, worth looking at diabetic markers in that age range even if my previous sentence is bunk.

Have you had a brain scan? I don't want to scare you but that sounds like it may be a tumor. Or at least I know two people who had brain tumors that had similar symptoms.

Actually, I do feel a slight lump (about the size of a nickel) above my right ear and it changes in size, sensitivity, etc. My PCP wrote it off, but sometimes it feels very warm too.

Push on them harder for a head MRI. Point out that you have the lump and that you can't find other causes. Keep pushing. Eventually they will get tired of you asking. Good luck!

Maybe a pilar cyst? Does it move around at all or is it attached to bone?

It stays in the same location, I believe it is attached because I can't really move it, but it does seem to change size, etc.

If you can feel it on the outside of your head, it's not a brain tumor. Jedberg is freaking you out.

It seems to be between my skull and my skin.

I should mention that I have had some auditory hallucinations within the last few weeks.

There are tons of reasons that lumps happen under the skin. If your doctor has looked at it and concluded it's not serious, then you should take their word for it. It's not an area where you expect catastrophic medical misjudgment.

FWIW, this entire thread is really something you should bring up with your doctor(s), and not rely on people on the internet for anything more than empathy.

I was trying my best not to freak them out, given how rare brain tumors are. I just wanted to make sure they were considering it.

you are fine. I am not freaked out by your thoughts. I truly appreciate you replied at all.

Just as a counterpoint - I have several lumps in my neck and head area that have all been fully checked out. One is a benign lymph node in my neck. The other is a very hard fixed structure to the front of my left ear. Both have been there for decades. CT scan and MRI show it's all benign.

Nobody can diagnose you with a brain tumor over the Internet and primary brain tumors are in fact rare - about 1.3% of all cancers.

OP, please take jedberg's advice. It may seem like "Well, if it could be a tumor, why wouldn't the specialists have mentioned that possibility?" but it turns out that doctors often overlook corner cases. It was surprising.

Hell, it's not even always corner cases they overlook.

There's stigma about self-diagnosing, but if you've got a little sense it's a very good idea to do so. You may well google your exact signs, symptoms, and circumstances and find the doctor's (multiple doctors, even!) failed to rule out the #1 most likely cause, let alone more obscure possibilities.

Agreed. One member of my family was "misdiagnosed" and they didn't catch the cancer until it was Stage 4. My beloved grandfather died within months of the diagnosis once it was finally made. He was my "person".

A blood clot creating a small stroke could also do similar damage to specific parts of your brain. I suspect they happen a lot and never get diagnosed. Like your peripheral vision going, it's hard to notice what just is no longer there one day.

The good news is, the brain can remap and relearn.

interesting, there was a day where I was mixing words, slurring speech, etc. My Dr. said it was a reaction to medication and the medication was changed. But I have been off all meds since July.

My dad used to work with all kinds of people who had brain damage through strokes and accidents. I earned my first money programming software to help these people to improve their cognitive abilities like calculating and reading.

The best reading training was a kind of side scroller which scrolled a text from right to left. You could adjust speed, font, fontsize and the actual text.

This was in the 90s, so I don’t know if there is a program like this now, but it should be easy to build something with JavaScript in the browser.

Slurring speech, mixing words and characters jumping around when you're reading. Does it also feel like you get into reading mechanically where you read each word but don't actually connect the words into sentences?

This happens to me a lot. It's stress related. If I'm really under pressure or burnt out I put 110% effort in and get stuck. That builds impatience with myself and that burns me out even more.

I go through periods when I can't learn a thing I'm just too wired on stress hormones. It normally takes a few months of doing mindless things to come back to normal. Physical work or basic repetitive admin tasks seem to be the best for clearing the burn out. Anything that doesn't require mental clarity or learning but still provides a sense of achievement.

I went from a period where I seriously struggled to learn things like one new git command to picking up functional programming in F# with ease.

+1 to this. Decades ago, my mother complained that her vision was "dim" in one eye. It did turn out to be very bad, terminal news thereafter.

You should definitely be able to read freely and fine at 45, and definitely see a doctor.

Something you can do in the in between time is order a full blood panel, kidney, liver, thyroid, hormones, etc, online or through your doctor's office. Then get a copy of this (you can often download a PDF from the lab company that does your panel, or doctor's office) and visit a natural path (ND). You might be able to find one through your school. Bring up what foods you eat, your lifestyle, exercise, sleep habits. Then, try and see if any adjustments work.

When you finally do get an appointment for a medical doctor (you said in 9 months) bring this information, so your doctor has something to go on. Your MD will probably just re-order the labs again, but now you will have some previous data, and some experience tweaking your lifestyle with what worked and didn't.

Thank you. My panels are good.

Do you have experience with an ND?

For line skipping and visual tracking more generally, try BeeLine Reader. [1] It is used as a speed reading tool by some, but is also used as an assistive technology by people with visual tracking issues, attention issues, and dyslexia. The Chrome extension has a 2-week free trial, and the iOS extension is completely free. It's also now available on textbooks, though may not be available on medical textbooks.

Disclosure: I am the founder (and am happy to send you a free pass to our Chrome extension, if you find it helpful).

1: http://www.beelinereader.com

Thank you. I will check this out today.

Questions: If you could read well during your undergrad, but decades later now cannot, what happened in between those times? Did you read regularly? Is this simply a bad case of skill fade masquerading as a medical issue?

Are there types of reading that are not so difficult? Can you read articles on your phone or screen without these issues? Do you remember material that you don't directly read such as an audio lectures?

If you are reading in a new field, you might not be used to actually reading every letter of a word. If you only read in a narrow subject matter then your mind can memorize word shapes rather than reading through every letter. When you then switch to a new field with unfamiliar words things slow down as you downshift into letter-by-letter reading. But they will speed up again once you get a grip on those new words. (This is a common law student complaint. The children of lawyers who grew up around words like "constitutionality", "relevancy" or "admissibility" temporarily seem to be faster readers because their brains have already memorized those word shapes. By second year this advantage disappears.)

I don't have much to add on the reading issue, but huge respect for "I've gone back to school into a medical degree." at 45

Oldest person in my group.

Coincidentally, they call me "boomer" and have adopted me as group "mom".

That’s actually really funny. Good luck with figuring this out!

Ha, you are gen-x or millennial if anything!

They call me boomer, I call them whippersnappers.

You could have an attention deficit brought on by spreading your attention too thin for a long period of time. You're reading fine, but you aren't absorbing/comprehending the information because that requires singular focus. Today's world with all of its distractions trains us to do the opposite - multitask with our attention on multiple things at once.

The solution? It seems to me that the opposite of spreading your attention in every direction is meditation. Sitting quietly and silencing your mind. Perhaps if you can learn and become comfortable in that state of mind, you can evoke it to some degree while you're reading to help achieve focus.

I'm in my 50s. The cognitive decline in my mid to late 40s was very, very real. I'm hanging on hard because I work at a FAANG and I have to keep my job, but I'm literally dumber than I was 10 years ago.

I don't know if there's anything you can do about it. I did start drinking those energy drinks with nootropics, at least the caffeine helps.

Some other suggestions are: get a lot of sleep, cognitively I declined tremendously when I got sleep deprivation. I would also get an MRI. I just read your comment about slurring words and I would spend the money and get an MRI on your own money just to be sure.

Well this is terrifying (especially as someone who barely sleeps).

I’m asking my PCP to order one.

This is the second time today that an HN front page post about some perceived decline has started the headline with their 40+ age.

Even when the problem might have nothing to do with their age.

I suspect that an effect of headlines like this is that it reinforces ageism in tech.

Ageism has been a problem in tech since the the modern flavor of Internet startups started. (AFAICT, with the "drop out of college to be a founder, because you have fewer commitments, and will work harder" essays.) And we're still seeing mutated versions of that.

Are you burned out? Depressed? Anxious? All of these also lead to an inability to focus and reduced comprehension.

Have you tried a concentration based meditation such as vipassana?

I meditate for 3-4 hours every day. I am no stranger to 10, 20, 30 days of a vipassana silent meditation experience.

3-4 hours every day?! How do you find the time to do that, in addition to medical school? That's 1/4 of the waking hours in a day.

yup, I make it my priority. I live very simply, I eat only raw produce.

Sometimes it is 2-3 hours if I am feeling cramped for time, but 3-4 hours 4-5 days a week.

Have had done metabolic panels? A raw vegan diet can be very difficult and for some people unsustainable.

But still, are you burned out? Depressed? Anxious?

My panels are good.

I will think about being depressed, anxious, etc. it could be a real possibility.

My experience with burnout is exactly like you described FYI. It was like my mind just couldn’t process properly. I couldn’t read, or engage in thought on anything with any depth or acumen. Coupled with the burnout was a depression and deep anxiety. If you meditate a lot then I’d suggest examining with your awareness what is happening when you’re reading. If you’ve coupled some Buddhism with your practice then you can examine whether you are resisting / reacting. With burn out it happens at a subconscious level, but you should be able to sense a resistance when trying to engage in things you have trouble with. Do you feel joy? Interest in things? Can you remember what music you like? These sorts of things are useful to ask yourself.

Finally, I assume you’re male. Have you had your testosterone levels checked?

Thank you for the reply. My T levels are where they re supposed to be.

I do feel joy.

I have an interest in a lot of things and notebooks full of ideas.

I love and listen to music daily.

I am Buddhist and have a daily practice along with prostrations and reading texts, meditation, etc.

I would definitely back off the restricted diet. It's not hard to imagine how you could be missing an important nutrient by eating only raw produce.

I am 50. I was telling my wife last week, the thing I miss the most about being young(er) is the ability to sit in a corner and be lost in the pages of a book - really entrenched.

Now, it is hard. I am constantly writing my comments at the end of each page, and pausing to re-read a line.

One thing that helps is to read important content right after working our or meditating, when the mind is at it's most focused. I live close to a park and a river, and leaving my phone behind and reading at either of these places, brings that boy in me back now and then. I also keep a small notepad where I mark down all the distractions that assume fake urgency, and I get back to reading.

However it is not all negative though. I am able to make sense of what I read in a _different_ way than I did when I was in my 20s. I am able question what I read, toss it around, swirl it in my mind more and reflect on what I read. Years ago, what would have appeared as a stand-alone fountain of new knowledge, now gets bunched to an vestibule of other knowledge I have accumulated over years about a field I am reading about. I learn more by contrasting with what I know, than de novo.

All the best.

Thank you for the reply. Helpful.

Sorry to hear, thanks for reporting. Am in my 50s. I did notice a drop off in deep reading and attention capacity in my early 40s, including seemingly physical issues like line skipping, transposing and other weirdnesses that I never had before.

I definitely feel like I am back to higher functionality in my 50s, though the reading process is definitely different.

If you are familiar with Kahneman metaphors of System 1/System 2, my reading when I was younger used to be System 1 (quick, ingestion for memory rather than concept, etc) and now it is almost entirely System 2 (slow, conscious, model building). So it is slower, but definitely deeper, and maybe on balance more efficient.

In terms of what helped- I recall noticing this reading issue and being unhappy about it, and making a conscious effort to practice...which means what exactly? Not sure.

I don't experience those seemingly physical issues anymore of transposing or skipping. And while I have had distance glasses since my teens, I still don't require reading glasses. Am sure at some point I will.

One odd association here fwiw is that I am very careful these days about staying fully hydrated when doing intellectual work. I drink very large quantities of water- up to and over a gallon some days. I never feel thirsty but when I start to notice subtle intellectual deficiencies, or my attention is sagging, I go and drink 16 or 32 ounces of water, and then often performance improves. Sometimes I take a bit of salt as well. Seems bizarre to me, I don't understand the biochemistry. But it works like a charm. This is a recent practice for me- last 5-10 years. After sleep, staying very hydrated is the top of the maintenance list.

Good luck to you.

What I see most often, there are 3 main causes that I was able to identify, probably a lot more than I am not aware of.

1. Eye glasses. At this age (~ 42-43, more precise) most people start to have degrade vision that requires some correction, mostly for reading. Even if you can read without glasses, it is not really efficient.

2. Information overload in the Internet age made us learn to skim instead of read. This is involuntary and it is very difficult to correct, but at least you can do something about it.

3. Age shows for your brain, this is why we do school very young. There is nothing you can do about this particular point, just learn to live with it and handle the consequences. This applies also to coding, there was a question yesterday about coding and focus at 40 years old.

So visual therapy takes years. It took me 3+ years before I noticed improvement. You are likely rebuilding neural pathways which takes time and effort. It's a process and it's awful.

It sounds like you have a "tracking" problem?

in part, yes, I believe that I do and I believe the visual therapy and new glasses every few months seem to be helping.

I'd really like to encourage you to trust that process. I spent years dealing with the repercussions of a traumatic brain injury (weekly visual rehab). I remember feeling like it only made the migraines worse and more frequent. In my case, it actually helped. The results just weren't obvious at the time.

Good luck.

Thank you. I do continue with the therapy every day.

I’m 45 as well. I’ve read aloud to my daughter regularly for the last 9 years. I started reading novels to her 5ish years ago. It was a challenge at first to say every word and not to skim the text. I’m able to put myself into “read aloud mode” now (without actually speaking) and it helps me with dense text. I’m probably subvocalizing when I read this way, and it’s definitely slower than my “normal” reading, but I get more out of text. (I’ve gotten more out of novels that I read when I was younger just reading them aloud to her. It was kind of shocking to read mindfully and see what I was missing.)

Thank you for the response.

Coming up to 37 and for the last few weeks I’ve had the same sort of realisation - reading novels seems to take more concentration than it should, and I’ve become lazy with maths.

I’ve had an eye check, a few months back a general medical. Both were fine/no significant changes. I rarely drink, no drugs. I feared a series of migraines might been response but I’ve been assured otherwise.

I so far figured it’s too much skim reading, a lot of very poor sleep, being on the edge of burn out and maybe a touch of post COVID brain fog.

Your post is encouraging me to start doing something about it.

I don’t have much to add but it’s reassuring to know that I’m not alone

If the issue is visual tracking and comprehension, consider seeking an audio version of the textbook. These are often prepared as part of accessibility for the blind or visually impaired, but can also be a great help to people with other issues like dyslexia. It’s not ideal, because medical terms and dense topics tend to be harder in that form, but it could really help with ensuring that you can ingest all the content, possibly with access to the physical text for cross referencing.

One thing you might try is reading aloud. Ref: https://www.bbc.com/future/article/20200917-the-surprising-p...

I find this really helps me both focus and retain what I'm reading, even though it takes a bit longer. It also helps tremendously when reading ancient texts, the Bible, etc.

I've noticed my reading ability has been impaired as I've gotten older, but I think it's just a concentration thing. Have you thought about ADHD drugs?

I was on ADHD medications for 2 years and stopped this past July. I felt like the medications kept me withdrawn and my spouse said I wasn't the same person. Also, they didn't seem to help even on a large dose of Vyvanse.

If you have ADHD isn’t that the answer to the question you’re asking? When I don’t take my meds I can’t retain or focus on anything.

I realize that doesn’t solve your problem if the meds give you undesirable side effects.

As an aside, one thing I have noticed is that focusing on print vs screen is way easier for me.

I'm 44, too sedentary, out-of-shape, and wasting time on video games lately. I'm ADHD-PI with timeblindness, tangents, procrast, and overfocus. I have monofixation syndrome (MFS) that I never knew I had until my new old-timer opth found incidentally.

Stress maybe? How's your Maslow's sleep, diet, exercise, and mood?

Also, consider that age comparing now with peak performance of say 15-20's is unfair. Give yourself a break.

Maybe a sabbatical is in order.

Perhaps some time away would be a good idea. Thanks for mentioning it.

I would definitely seek medical advice. Start with your PCP. They’ll be able to refer you to a relevant physician, maybe a neurologist or psychiatrist. Anecdotal, but your experience sounds similar to a friend of mine who’s dyslexic + ADHD. AFAIK that would have have shown earlier but I’m not a doctor!

On another note, have you tried any text to speech software? I used to do that in school when my eyes were tired or I just felt like listening.

Were you ever considered to be a strong reader? You mention you used not have trouble with any topic, but were you academically 'excellent'? Depending on where you are, your curriculum may not have been all that rigorous in reading.

Not asking in a facetious way, but is this medical program a level up from what you've done in the past?

Yes. I’ve always been an excellent student

If I were you I'd get a neurological test and try to rule out all serious possibilities. Not because they are likely but because its good to catch many of those possibilities early and the fact that you are posting here suggests it is at least a possibility. IANAD

Consult a neurologist, specifically.

I am on a 9 month waiting list and that was the shortest wait list for top drs in my state.

I don't think you need a top tier doctor to do a basic exam and order a scan. You can always go that route if something abnormal shows up, the waiting time will likely be a lot shorter in that case.

Probably not related, but just to be sure: check the quality of your display/monitor. Recently I experienced a lot of improvement in investing in a much better monitor (an Eizo in my case, which isn't cheap, but made quite the difference).

Maybe the reading material is just not engaging? I know I can be selective about what topics I can concentrate on and which require me to reread every other paragraph again and again because I start daydreaming. Never going to be a chemist.

It might be a good idea to check your sleep - there are apps like SnoreLab that can tell you if you're snoring heavily, and if you are, you should get a sleep study done to see if you have apnea.

I use an Oura ring currently.

How much were you reading before you had this realization?

Have you been a lifelong reader? Or did you read a lot, and then stop for a few years, and are now getting back into it and having trouble...?

Yes, lifelong reader, I own almost 700 books and have read a very large percentage of them.

Do you read for fun? I had declined in the amount I read purely for pleasure over the years, and recently re-upped my time spent in it, and subjectively I think it improved my reading in general. There are some studies that seem to support that: https://neurosciencenews.com/reading-aging-memory-22011/

On a more active path, you might also consider consulting a neurologist and describe to them your the differences between past and current reading performance as well as observations of the problems you're having now.

Mental illness is a possibility. You may think that’s impossible, but anosognosia is a common symptom. Adult onset ADD is possible and can be diagnosed with a brain scan.

Thank you. I can explore this.

What about setting a very large font and read on the phone? This way there is at most 1 line at a time

Learning some speed reading improved my focus when reading. Google it and look into the different methods available, see if any work for you.

To add to the pile of random medical advice, finally getting my wisdom teeth removed helped my thinking and attention a bit.

curious, does something like https://www.spreeder.com/app.php?intro=1 make it easier to read for you? click the Spreed button if it doesnt start automatically

I bought a gadget to magnify and backlight the text.

Small hardcopy print just gives me a headache.

I'm starting to think everything we do has a use it or lose it quality. I remember reading how people who haven't spoken in their native language in awhile (for example because of a study abroad) have difficulty speaking their language when they come back. They also end up using simpler vocabulary as well.

So it wouldn't surprise me if skills like reading also fall under this. But to be fair the stuff you are probably reading is probably really dense and full of lots of medical terminology so it might not be surprising that you have to reread it.

What's your exercise regimen?

This is an important question. Speaking from experience, when you're 20 you can get away without exercising. 45 is about the time when lack of exercise starts to have a significant effect on your life.

I don't exercise really, but I do tend to walk 10,000 steps every day.

You can also try asking reddit medical group for advice. r/diagnoseme

Interesting idea, wisdom of the crowd....TY.

Also it just occurred to me that lots of medical students are probably on there and can relate to reading medical texts.

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