We are clearly a society that relies on the use medications and drugs. Look in your medicine cabinet. How many medications do you find? Aspirin? Acid blockers? Allergy medications? Blood pressure medications? Antidepressants? Anti-anxiety drugs? Do you drink coffee or caffeinated sodas? Do you drink alcohol? Drug use is pervasive. Indeed, we have become so enamored with drugs that we often forget that many human problems are better treated with nonpharmacological methods. Furthermore, aging increases drug accumulation over time and increases the risk of toxicity from medications and drugs. A single class of medications; psychotropics that are used to manage conditions like anxiety, depression, and lack of sleep; is used by as many as 40-50% of those who are aged, by some estimates. The use of psychotropics is greater among the aged than the young despite the fact that mental illness […]
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I am in the same boat as everyone else who is aging. I am trying to plan for the best outcome. My profession does not protect me from either the physical or mental changes that come with getting older. During my last physical, my physician, Kathleen Wilson, gently reminded me that I am not being aggressive enough with my personal wellness program. I have been managing hypertension since I was 35. I have Type II diabetes in my family and mildly elevated blood sugars. These factors and age increase my risk for cognitive decline (I hope that if I decline it will not be severe enough that I become demented) as I grow older. As part of my wellness, I take an aspirin each day, exercise, and stay engaged in professional and leisure activities. A couple of recent studies encourage […]
I have had a number of clients who have sought out advice after coronary artery by-pass surgery. They, their spouse, or their children often report that everything was fine mentally until after the surgery. I often see these clients within the first year after surgery. The concern is always the same. Mom, dad, my husband or my wife has physically recovered from the surgery but now has memory problems they did not have prior to the surgery. A recent study (Journal of Behavior Medicine, 2012, 35, 557-568) provided memory training to patients recovering from coronary artery by-pass surgery. They assessed cognition by neuropsychological evaluation one week, one month, three months, and four months after surgery. 65% of patients displayed memory deficits one month after surgery and 41% continued to have deficits after 4 weeks. Memory training focused on use of […]
Last July I discussed the differences between delirium and dementia. To review, by the dictionary a delirium is “an acute mental disturbance characterized by confused thinking and disrupted attention usually accompanied by disordered speech and hallucinations.” By the same dictionary dementia is “usually progressive condition marked by deteriorated cognitive functioning with emotional apathy.” The critical thing to know is that a delirium has a sudden onset and is reversible in time. A dementia often has a gradual onset and is irreversible. A new study (Archives of Internal Medicine, 2012, August 20 online) demonstrated that there are enduring effects of hospital-acquired delirium in patients with Alzheimer’s disease. The rate of decline is about two times faster in those who developed an in-hospital delirium when compared to those who do not. Delirium is thought of as a transient condition that clears and […]
I was talking with staff from the Alzheimer’s Support Network in Naples after Minder’s Keepers (a memory loss support group for families dealing with early signs of memory loss) about frequently asked questions. They often get asked how do I find out whether I have Alzheimer’s disease? Who do I see first? What should an evaluation consist of? First, diagnosis of Alzheimer’s disease can be done by either licensed medical personnel such as a physician or nurse practitioner or by a licensed psychologist, usually a neuropsychologist. Where you go first depends on both your insurance coverage and your comfort level. If you have government run Medicare you can see ether a physician or a neuropsychologist first at your own discretion. If you have Medicare replacement or other insurance, check with your carrier first to see what their requirements are. The […]
I was talking with staff from the Alzheimer’s Support Network in Naples after Minder’s Keepers (a memory loss support group for families dealing with early signs of memory loss) about frequently asked questions. They often get asked how do I find out whether I have Alzheimer’s disease? Who do I see first? What should an evaluation consist of? First, diagnosis of Alzheimer’s disease can be done by either licensed medical personnel such as a physician or nurse practitioner or by a licensed psychologist, usually a neuropsychologist. Where you go first depends on both your insurance coverage and your comfort level. If you have government run Medicare you can see ether a physician or a neuropsychologist first at your own discretion. If you have Medicare replacement or other insurance, check with your carrier first to see what their requirements are. The […]
There is a long standing debate in psychology and medicine regarding what defines our physical traits (e.g., height), skills (e.g., memory) and personality (e.g., temperament). Which is more important genes or environment? We usually think of the impact of this question for early experience. Do we place emphasis on genes (nature) or on parenting/schooling (nurture)? The most hotly debated topic in this arena is intelligence. Is intelligence inherited or is intelligence built from experience? Research estimates for heritability of intelligence range from 40% to 80% depending on factors such as socioeconomic class, age, and design of study. In other words, intelligence is determined by the interaction of genes and environment. Both are important. The practical implication of this is that ability is not fixed but rather is modifiable within limits. Early interventions (e.g., quality of teaching, decrease class size, memory […]
The foundation of any cognitive wellness program consists of evaluation, long-term planning, and goal setting. Cognitive wellness also requires a lifelong commitment to exercise. In addition, cognitive wellness is further enhanced by managing short-term memory, remaining cognitively stimulated, and social. Short-term memory failure is usually the culprit for senior moments as well as the first sign of diseases such as Alzheimer’s disease. Short-term memory is not a time but rather the process by which the brain learns new information such as a new name or a change of address. There are two basic causes of forgetting involving short-term memory. First, you will not remember if you don’t pay adequate attention. New information does not get attended to well enough in situations like multi-tasking or stress and fatigue. This is like attention deficit disorder. Second, the short-term memory system in the […]
To review from last week, Alzheimer’s disease unfolds over a very long time which gives us an opportunity to develop a comprehensive wellness plan before changes set in. Everyone’s life plan should address the four pillars of long term wellness: advanced directives, financial planning, physical health, and cognitive/memory health. We are fairly good at long term commitment to the first three but many ignore the fourth pillar of wellness: memory and cognitive health. The foundation of any wellness program is evaluation. Baseline evaluation allows measurement of strengths and weaknesses to allow for development of strategies for enhancing skills. Ongoing evaluations allow feedback on progress and needed refinements in long range goals. Finally, evaluation allows monitoring of changes. Memory evaluations should begin by at least age 50 for anyone with high risk for developing Alzheimer’s disease (e.g., family history, late life […]
