Now that 70 is in my rear-view mirror, I am increasingly attracted to articles with tittles like “A Plan For Successful Aging” (health.harvard.edu). I am officially one of those “geriatric” clients with whom I have worked for nearly three decades. I am one of the “young old.” I feel that the quality of the rest of my life requires that I don’t focus on the past – I can’t change it. I am the result of my genetics and cumulative experiences (the easy and the difficult, the mistakes and the successes). What follows is my general outline to protect my future as well as I can. 1) Be proactive. Don’t wait for the first fall to take action. I have been “thinking about” getting a medical alert device for my mother-in-law. She recently fell in the bathroom and was unable […]
Memory
Memory loss can result from a number of neurological conditions. Alzheimer’s disease is not the only cause of memory loss. There are at least three clinically important memory systems: 1) Episodic 2) Semantic 3) Working 4) Procedural Episodic memory is the most common clinical memory complaint and most thoroughly researched and assessed (e.g., recall of lists of words). Episodic memory involves the recall and recognition of personal episodes and experiences. What did you eat for breakfast? What was the most recent movie that you saw? Where did you go for vacation? Episodes are the scripts of your life that involve the sense of time and self. Episodic memory involves three steps: 1) Encoding. Awareness and attention are required for an event or episode to be recorded. 2) Consolidation. The brain process that actually lays down the memory “trace” for later […]
“Music is ubiquitous in our lives” (Turn off the music! Music impairs visual association memory performance in older adults, 2015, The Gerontologist). It’s present while we are driving, studying, working, shopping, and dining. I often feel that when I’m out and about, I am barraged by music and background TV. Further adding to my frustration is the fact that others are choosing what I have to hear as well as how loud it is. What is the impact of this noise on cognition and memory? Does it facilitate conversations at diner? Does background music help concentration? Does it help or impair memory? Does it release stress? There is evidence that background music enhances performance on simple tasks like naming as many animals as you can in one minute – called fluency. Then there is the controversial “Mozart Effect.” In the […]
What is a neuropsychological evaluation, what good is it, and how is it best done? Let’s start by making a distinction between testing and evaluation. Tests are rigid, standardized, formal measuring tools to determine things like mastery of information, placement in school programs, and outcomes for clinical trials of drugs. The test administrator needs to be consistent, neutral, not help, and not give feedback that may influence the results. Many neuropsychologists administer “tests.” On the other hand, an evaluation is more flexible. The interaction is less formal and can be modified to meet the needs and personalities of those needing evaluation. For example, memory evaluations start by observing whether the client is on time. Did he or she remember the paperwork? Can he or she find the office? Find their insurance cards? Know their birthdate? Remember a list of words? […]
It’s not just those who have memory disorders that want to remember better. In everyday life, at school, or at work we rely on memory to stay engaged, advance, and track information. Seems so simple. It is not. Ever try to remember which movies you have seen over the last 6 months? What books have you read (who wrote them? Details for discussion?)? What you have to do at 3:00? Here are some strategies that help. 1. Read physical books. Reading is reading, right? Apparently not. Turns out that reading a physical book leads to better memory than reading on an electronic reader. Also, taking written notes leads to better learning than transcribing notes on a computer or tablet. When I don’t care if I remember (like for reading just for fun novels), I read electronically. If I am reading […]
There are multiple memory systems in the brain. Each has its own organization and structure as well as unique role in our adaptively managing the world about us. I most often discuss short-term and long-term memory as these are so critical for our understanding of senior moments as well as common memory disorders. Short-term memory is the systems that allow new learning and is like the save command in a computer. Long-term memory is autobiographical information, knowledge, habits, sense of self and is like the hard drive of a computer. Working memory is the memory system that manages the complex inputs we are constantly bombarded with from within (thoughts, feelings) and without. It consists of awareness, near awareness, and rapid decision-making. It is constantly juggling multiple inputs and deciding what to attend to, what to process further, and what to […]
I was invited to participate in a panel discussion at Avow Hospice. The theme was “what are the three things that you want all of your clients to know.” This is an interesting challenge for two reasons. First, each panel member has only ten minutes to make their point, Second, as I have recently turned 70 and am rapidly approaching retirement, what do I need to know for myself as I am not immune to the complex cognitive and physical changes that accompany both normal, true senior moments, and abnormal aging, memory and physical loss. 1. We do not yet know what causes Alzheimer’s disease. A recent issue of the ARRP newsletter states that the problem is a lack of research funding. But the issue is more complex. Where do we put the money? Amyloid treatments are a bust despite […]
Alzheimer’s disease and other progressive dementias are not the only cause of cognitive impairment. It is commonly known that as the heart goes, so goes the brain. An estimated 5 million Americans suffer from heart failure and this number is expected to double over the next 40 years (“Heart failure and cognitive dysfunction,” International Journal of Cardiology, 2014, 178, 12-23, PMID 25464210). Cognitive impairment is common in those with heart failure with a prevalence ranging from 25% to 75% with greater degree of heart failure associated with higher levels of cognitive impairment. Those in heart failure with a left ventricular ejection fraction of less than 45% are especially prone to cognitive impairment that is at least mild. Cognitive impairment may involve any one or all of several brain functions. These include attention, memory, executive function, language, speed of thinking, and/or […]
Alzheimer’s disease does not develop suddenly. It emerges over the course of decades. There is a history of short-term memory loss that often dates back a decade before more obvious symptoms arise. Onset is subtle. How many of us have had senior moments? How do we know if they are benign or the hallmark of progressive cognitive decline? Changes are complex and differ across individuals depending on the region of the brain that is affected. One way to make sense of these complicated pathways is to have a category that reflects significant changes in memory that fall short of a dementia. The solution has been to create a category – diagnosis if you like – for individuals who have memory changes but are not demented. This is Mild Cognitive Impairment (MCI) (“Mild cognitive impairment and mild dementia: a clinical perspective,” […]
We often get so focused on Alzheimer’s disease that we neglect other causes of memory loss and cognitive dysfunction. Stroke is the second most likely cause of cognitive dysfunction after Alzheimer’s disease in the elderly. Furthermore, there is a complex interaction between cerebrovascular health and Alzheimer’s disease. Post-stroke cognitive impairment may affect several domains of cognitive abilities such as attention (tracking the moment), memory (recalling new information and/or details of personal history), language (expressive and/or receptive speech), orientation (for time, place, and/or person), and executive functions (planning. judgment, reasoning, and/or social graces). The effects of stroke may be temporary (e.g., TIA) or persisting depending on the size of the lesion and timing of treatment. The effects may be severe (e.g., cause dementia) or mild (e.g., cause mild cognitive impairment) and may affect single skills or multiple skills. There are three […]
