Self Help

There are two main pathways for cognition as we age: normal aging and cognitive decline (abnormal aging). It is important to understand that aging is not a disease, Alzheimer’s is. It seems clear that there are things we can do to protect and enhance cognition during normal aging. What is not clear is whether there are things that we can do to protect against abnormal aging. Staying sharp cognitively is a goal for many seniors as evidenced by the popularity of “brain fitness” programs such as Lumosity. Lumosity alone has some 70 million members from 180 different counties. It’s marketing ads boast that it is “scientifically” developed. There is no clear evidence that mastering their 40 games makes any real world improvement in everyday cognitive functioning let alone protects against abnormal aging. A recent report from the Institute of Medicine […]

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There are many stressors that confront us such as divorce, dementia, death, illnesses, caregiving, injury, retirement, addictions, and/or neurological disease.  Managing the emotions and behavioral changes required to move forward requires effort, persistence, emotional support, and saying the “right” things to yourself.  This is the foundation of resilience. Self talk  (“psyching oneself up”) as psychotherapy and self-help was popularized by Albert Ellis as “rational emotive therapy” and is broadly discussed today as “cognitive behavioral therapy.”  The underlying assumption is that the dialogues you engage in with yourself are the foundation for behavioral change and managing difficult emotions. Consider the statement “I can’t do it.”  Or sometimes others will try to help by pointing to someone who made the change you are seeking but you say to yourself “He/she can do it but that doesn’t apply to me.”  For example, “I […]

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There is increasing empirical evidence that a life style that includes at least moderate, consistent exercise improves cognitive and health outcomes as we age.   It seems logical that exercise would be helpful to improve outcomes of those with neurodegenerative diseases such as Parkinson’s disease where there is progressive loss of neuromuscular abilities.  Fortunately there is an encouraging review that serves as the basis for this article: “An evidence based exercise regimen for patients with mild to moderate Parkinson’s disease” (Brain Sciences, 2013, 3, 87-100 http://qxmd.com/r/24961308) Parkinson’s disease is, by some accounts, the second most common neurodegenerative disorder and affects 4-5 million of those over 50.  The primary symptoms involve motor control: resting tremor, slow response initiation (called bradykinesia), muscular rigidity, and postural instability.  It is now clear that exercise improves physical function, self-reported quality of life, strength, and gait speed […]

The most frequent question I am asked is “What can I do to improve my memory?”  The answer depends upon which type of memory you want to improve.  Practice, repetition, study, modeling, and imitation can all improve long-term memory.  Long-term memory involves reinforcing what is already stored in the brain.  It works like a muscle and strengthens and endures from use. Short-term memory is a different issue.  Short-term memory is the process of storing new information.  It requires learning and is demonstrated by memory or skills that will be demonstrated at some future time.  This memory system does not work like a muscle.  It usually takes time and effort to learn new things.  You remember best those things when you slow down, attend to, think about something.  Hence anything given less than  one minute of thought will fade from your […]

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There is treatment for Alzheimer’s disease.  Realistically, Alzheimer’s gives ample time to be proactive.  It is a slowly progressive neurological disease that unfolds over the course of several decades. Treatment involves being proactive rather than reactive.  These are the steps we all need to take beginning now. Assessment.  We all have wellness plans that are managed through annual physicals with our physicians.  We need to include annual memory assessment by a memory expert as a part of this plan.  The assessment should, at the minimum, thoroughly assess short-term memory by means of a challenging, standardized memory test and be administered by a memory expert. Treat short-term memory before it changes.  We seem to lose track of the fact that we took notes in school to manage short-term memory.  It never worked like a muscle.  It takes time, focus, and effort […]

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As we age we need to constantly work toward managing healthy behaviors such as exercising, eating healthy, and being engaged in social/intellectual activities.  These are proven ways to mitigate the effects of aging on health, wellness, mood, and memory.  It is becoming increasingly clear that we need to start this lifestyle  earlier in life to maximize effectiveness. A new study (“Alcohol consumption and cognitive decline in early old age,” Neurology 2014, , in press)  adds our drinking behaviors to the formula of proactive lifestyle.  Drinking too much alcohol from at least middle age onward may accelerate cognitive decline.  The study reports the findings from the Whitehall longitudinal study of 7153 British civil servants 67% of who were male.  The study began in 1985-87 with cognitive tests administered in 1997-8 and administered twice during the next ten years.  Participants were aged […]

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Depression is not part of normal aging and is one of the most common, treatable problems in older adults.  Depression in older adults is under-recognized and undertreated.  It may impair independence and make health problems worse.  The symptoms of depression include: Depressed mood most of the time Loss of interest or pleasure Disturbed sleep (too much or too little) Weight loss or gain Fatigue or loss of energy Feelings of worthlessness or guilt Difficulty in concentration Difficulty in decision making Restlessness or agitation Frequent thoughts of death or suicide There are three basic types of depression.  Major depressive disorder is characterized by having 5 or more of the above symptoms nearly all the time for at least two weeks.  Often those with major depression feel hopeless, anxious, worry, and loss of pleasure.  Minor depression is characterized by having 2-4 of […]

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I have had a number of clients over the years that have come to me with concerns about their memory that seemed just fine.  For example, there was the 82-year-old woman who was a Smith College graduate in physics.  I evaluated her four times over the course of ten years.   On the first evaluation, she tested among the highest I have ever seen – including short-term memory.  However, on each of four subsequent evaluations, her short-term memory scores declined even though the word list was the same.  She obviously was aware of changes before testing could detect decline. Clients such as this are referred to as the “worried well.”  Professionals dismiss them as if they are not aware of their own bodies.  I find this particularly disturbing as progressive neurological conditions such as Multiple Sclerosis, Parkinson’s disease, and Alzheimer’s disease […]

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I just returned from a speaking engagement in Tampa where I discussed “Treating progressive memory loss.”  The thing to note in the title is that the focus is on treating memory –there’s something you can do – rather than treating a disease – there’s confusion about what to do.  The treatment for Alzheimer’s disease needs to be proactive rather than reactive.  The focus of treatment is to plan for a good life (everyone’s long-term goal regardless of memory) as you age even if your memory declines.  There are two requirements of a good treatment plan.  First, build memory supports before you need them – use the One Minute Rule.  Second, build a life of engagement.  The popular advice is to learn something new or buy a brain fitness program.  Indeed, I recently read a neurologist’s suggested treatment plan for a […]

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It has become increasingly clear that most progressive dementias slowly unfold over the course of several decades.  For example, Alzheimer’s disease forms decades before there are any signs or symptoms.  It doesn’t appear suddenly or show up as a “conversion” from Mild Cognitive Impairment.   This is good news.  We can be proactive by life style and planning years ahead instead of just reacting to changes after they occur.  Life style interventions must start decades before problems show themselves.  The issue to resolve is what life style changes is worth the effort.  Exercise is the one factor that is emerging as a clearly protective of the brain.  Many short-term studies have suggested that increasing levels of fitness now pays benefits for future brain health.  The Cooper Center Longitudinal Study, Cooper Clinic in Dallas, published a study that prospectively followed a large […]

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