Self Help

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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Alterations in short-term memory are the hallmark of Alzheimer’s disease as well as a whole host of other brain changes that can, in time, erode our ability to make complex decisions such as handling finances or making legal documents.  The changes are subtle in onset and slow in progression.  Neither our own self-evaluation nor that of competent professionals can detect the changes by observation in the very early stages.  Despite our personal beliefs about our selves, most will not “know” when to give up the finances or when to stop driving.  Changes in memory are not the province of medicine.  Medical screenings are insensitive to early changes in memory and brain scans produce too many false positive results.  Verbal learning tests used to assess short-term memory are better at detecting risk than are biomarkers such as PET scans. We need […]

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Depression comes in many forms. Mild depression may range from the colloquial use of “I’m having a bad day” to depressive symptoms that are not severe or pervasive enough to meet current diagnostic standards for Major Depressive Disorder (which is more severe and has to persist for at least two weeks). Dysthymia is an enduring but comparatively mild form of depression. Sadly, recent surveys indicate that as many as 40% of community dwelling elders (by most standards those over 55) have some form of depression. This puts those afflicted at greater risk of mortality and suicide as well as poorer quality of life than those who are not depressed. Does having a diagnosis of dementia increase the prevalence of depression in the elderly? The answer depends on the cause of dementia. The prevalence of depression in dementia due to Alzheimer’s […]

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Improving your memory is deceptively simple. Don’t forget the “One Minute Rule.” Anything given less than one minute of thought will fade from your memory. We have known this for years but as we get busy we ignore the truth that we knew when we were in school. We took notes at lectures and from reading and we reviewed them often. Notes allow us to think longer (the One Minute Rule) about the point we feel is important and they focus our attention. Additionally, taking notes allows us to review the important facts which again give more time to learn and later remember what’s important. In a world filled with massive and multiple sources of information we often ignore the fact that we learn most things well by spending time with the skill or information we want to remember. Human […]

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We all confront the major myth of brain function which is that our brains work best in our youth. Even as early as middle age (40-69?) we are confronted by changes. Our brain slows as we get older. But we can’t run as fast or hit a ball as far either. The brain becomes more distractible as it ages. We can’t multitask as well and memorization takes more effort. As the brain ages (as early as 40), it has more difficulty with names and nouns. None of these changes compromises competency or the ability to learn. The truth is that the brain not only preserves its youthful skills but also develops new strengths well into middle age and beyond for many. The middle and old aged adult brain can rewire and elaborate itself. The catch phrase for this ability is […]

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What can I do for my memory? That’s a question that I am asked many times a week. Let’s assume that your memory is not declining. In other words, you have a normal memory. There are two types of exercises you can do to improve your memory. First, you can exercise by doing memory or cognitive training. There are two types of cognitive training. You can do challenging mental activities such as computer mental training programs, do crossword puzzles, memorize phone numbers, play bridge, or learn a new language. You will improve your ability to do any of the tasks that you choose. Your brain needs these types of stimulation and they add joy to your life. However, they do not help you find your car in the parking lot or help you recall your appointments. Cognitive training is also […]

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Ron Reagan reveals (My Father at 100) that his father was thrown from his horse six months after leaving office during July 1989. He sustained a closed head injury and needed neurosurgery to relieve the pressure in his brain. The surgeons discovered that he already had the neurological changes of Alzheimer’s disease. This raises two interesting issues about memory. First, there is a great deal of debate about whether President Reagan showed signs of Alzheimer’s disease while he was in office. Second, John McCain (aged 71) would have been the oldest elected president of the United States, if elected. First, consider age. Although we don’t have a standard of too old to be president of the United States, there are a number of prejudices about age and competence. Should there be an age for mandatory retirement? Should there be an […]

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