Multitasking Video Games that Stimulate the Brain

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Back in 2006, I was sitting at a dinner table with my husband, a friend of ours (to whom my husband was also a consultant), and a Scientist.  The Scientist, who had been involved in creating a computer program to help children with learning disabilities (a program our friend was using in her Rehabilitation Center) was excitedly sharing with us that the same group that had created this program for children with learning disabilities had just come up with a new program to help re-stimulate the aging brain.

My maternal grandmother had succumbed to dementia.  She had been living alone for many years and although she had been living in a small French town where she knew many people and she had had a livelihood as an artist, arthritis had set in, impeding her ability to go out and paint.   My father, diagnosed with Parkinson’s disease, also developed memory loss.  My mother-in-law, a brilliant woman who was living with us at the time, in her 93rd year (albeit that is a nice old age) started to loose her mind.  It is not comfortable watching someone who was such a part of life fade into nothingness.  I suppose it will happen to many of us if something else does not get to us first, but…I digress.  Back to the dinner.

Needless to say, when I heard about this program, my ears pricked up and I recognized that this would be the next big step in extending the aging process.  I asked the Scientist how I could learn more about the program.  Our friend agreed that this program could be incorporated into her business, but that I would remain an independent representative of the company providing the Brain Fitness Program, Posit Science.

I loved the program and I loved introducing it to people.  Because it was the first of its kind, there were a lot of rough spots that the company kept tumbling over.  Some of it was proving the claims they were making, but most of it had to do with “meeting those profits.”  In the end, they never permitted their representatives to own a part of the company or even be a franchise, thus it could never develop into a business for me.  At around the same time that I recognized this, the company decided to only market via the internet.  Nevertheless, the concept is a sound one and since that time, other companies have developed their own programs.

Just recently, I came across an article that spoke about a Scientist who is using video games to the same effect.  In reading the article in The New York Times, I see that some of the same arguments are being put forth that were constantly surrounding the Brain Fitness Program: what are the positive effects; what are the negative effects; what are the long-term effects.  In spite of this, there seems to be positive responses for this new study:

The latest research was the product of a four-year $300,000 study done at the University of California, San Francisco. Neuroscientists there, led by Dr. Adam Gazzaley, worked with developers to create NeuroRacer,  a relatively simple video game in which players drive and try to identify specific road signs that pop up on the screen, while ignoring other signs deemed irrelevant.

Studies have shown that multi-tasking abilities diminish with age, starting in one’s ’20′s!  By the time people reach their ’60′s, the ability to multi-task has dropped by 64%.

But after the older adults trained at the game, they became more proficient than untrained people in their 20s. The performance levels were sustained for six months, even without additional training. Also, the older adults performed better at memory and attention tests outside the game.

“That is the most grabbing thing here,” Dr. Gazzaley said. “We transferred the benefits from inside the game to different cognitive abilities.”

In spite of these findings, the Scientists remain cautious.  It is not just playing video games that will re-stimulate one’s aging attention span and Dr. Gazzaley emphasizes the need to remain within the confines of scientific rigor. His study does include a further validation of the effectiveness of video games:

The researchers created a second layer of proof by monitoring the brain waves of participants using electroencephalography. What they found was that in older participants, in their 60s to 80s, there were increases in a brain wave called theta, a low-level frequency associated with attention. When older subjects trained on the game, they showed increased bursts of theta, the very types of bursts seen regularly in people in their 20s.

“We made the activity in older adults’ prefrontal cortex look like the activity in younger adults’ prefrontal cortex,” said Dr. Gazzaley, referring to a part of the brain heavily involved with attention.

All of this sounds very positive to me.  I still believe in the benefits of re-stimulating our neurons through interactive technology.  But I also appreciate that the brain is a sensitive organ which we are still in the process of understanding and, thus,  understand the Scientists’ caution.  In the meanwhile, just in case, I will buy myself some video games…..

 

© Yvonne Behrens, M.Ed  2013

 

Caring for Aging Parents is a Roller Coaster Ride

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I recently heard a lyric sung by Ronan Keating, which perfectly describes the emotions evoked when caring for aging parents: “Life is a rollercoaster/Just gotta ride it.” Not a Six Flags aficionado? Me neither. We don’t get to choose. Mom will break her hip at a time when we’re already stressed to the max.

The past eleven years caring for my 93 year-old dad have been like an extended stay amusement park and I still have a series of barrel rolls and corkscrew turns to go. I’m starting to think feline genes run in my family. Don’t get me wrong–I’m not complaining about Dad repeatedly pulling through after I’d given him up for dead, but this ride on Space Mountain is shortening my own life.

If you have a parent with Alzheimer’s disease or another form of dementia, you know that Sherlock Holmes skills are a must. My dad can’t tell me what’s wrong when he stops eating, if he’s in any pain or why he doesn’t want to get out of bed. Behavioral observations yield only educated guesses.

Last week I was sure my dad was about to transcend to the pearly gates. My dad’s doctors, hospice team and experienced facility staff were convinced he had pneumonia and was aspirating food. He looked terrible and refused all sustenance, save three glasses of orange juice per day. When my dad started behaving like a fickle feline, turning his nose up at chocolate ice cream, his favorite treat, I knew something is rotten in the state of Denmark.

My husband and I were on death watch, visiting Dad several times per day, scouring the answering machine for messages the moment we walked in the door, and emailing “Dad updates” to my brothers and sisters. We were so confident of our psychic powers that my brother contacted the pastor at the church where we’d buried my mom’s ashes to alert him to the fact that she would soon have company. We double-checked Dad’s cremation plans.  I googled “How long can a person live without food?”

As it turns out, our crystal balls had malfunctioned in unison. Five days after Dad was down for the count, he had a sudden reversal of fortunes. His health returned to baseline and his mood resumed its wild swings between perky and cantankerous. If Dad were still verbally adept, he would have scolded up with Mark Twain’s retort: “The reports of my death are greatly exaggerated.”

This is the second time Dad had played rope-a-dope with a virus, and like Ali, ultimately won the fight. These recurring resurrections throw me for a loop and evoke starkly conflicting emotions. On the one hand, I’m pleased that my dad is still with me so that I can continue to shower him with my love. Yet, I also wonder what’s in store for Dad. Will his resilient body persist and allow his dementia to progress to the point where he forgets how to swallow? I hope not.

All I know for certain is that I’d better get used to thrill rides. That’s the reality of elder care. I just hope I haven’t inadvertently stumbled into Ohio’s Cedar Point, home of 17 roller coaster rides. I don’t think my stomach could take it.

 

 

Lorie Eber, JD is a Gerontologist and Certified Personal Trainer, who teaches Gerontology at Coastline Community College. She is also a writer and a Keynote Speaker on Healthy Living, Healthy Aging and Elder Care issues. Lorie’s Dad is 93 years-old and suffers from vascular dementia. Visit her website: www.AgingBeatsTheAlternative.com. Read her eBook: www.amazon.com/author/lorieeber.

Health Care or Mis-Care

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[Although I know that most people prefer to watch inspirational videos rather than harsh ones like the one I am showing in the next frame, how our society treats the elderly needs to be looked at in all of its harsh realities.  So for the next few weeks to parallel the blogs I have been writing about the elderly, the video will remain.  Please do view it, because in order to change things, one has to confront square in the face what is or can be unpleasant.  Bear with me.  I promise the next video will be inspirational. ]

In my last two blogs,  I have been exploring anti-psychotic drugs and the elderly.  According to a research done by the University of Florida in 2010,  70% of those entering nursing homes end up on psycho-active drugs within three months of entering the home in spite of having no prior history of psychotic problems. Although dementia may occur in old age, more often than not, the delirious or dementia like behaviors are most likely caused by medication or the interactions of several medications the elderly person may be taking.  Benzodiazepines, opiates and tricycic anti-depressants are the main culprits.  These pills come in very many variations and are extremely prevalent in our society.  Today’s blog is exploring the effects that these drugs can have on older users.

AFFECTS ON OLDER PEOPLE

As one ages, The body’s ability to clear drugs decreases often because of a normal age-related decrease in kidney and liver function. This results in a greater accumulation of drugs in the body.

Secondly, Older patients are often prescribed multiple drugs at the same time. Due to complicated interactions between different drugs, side effects can become more prominent.

Last, Some research have demonstrated that neurotransmitters become naturally imbalanced as people age, increasing the brain’s sensitivity to drugs that have activity in the central nervous system.

With the regular use of anti-psychotic drugs in nursing homes, it is no wonder that the Rovner, et al study concluded that nursing homes were “de facto psychiatric institutions.”

Let’s look at the above facts in more detail:

Number 1.  When doctor’s prescribe medication, they often prescribe the full dose without recognizing that in an older patient, “the body’s ability to clear drugs decreases with age.” For example the equivalent dose of diazepam (a short-acting Benzodiazepine) in an elderly individual on lorazepam (a long-acting Benzodiazepine) should be up to half of what would be expected in a younger individual.  Giving full doses of these medications are sure to cause the side effects to increase in severity the more the drug accumulates in the system.

Paradoxically, an overdose of Benzodiazepines can cause the effects it has been prescribed to diminish, ie, anxiety, delirium, combativeness, hallucinations, and aggression.[ (Wikipedia)

Number 2: “Older patients are often prescribed multiple drugs” many patients do not realize that they are taking too many drugs or taking drugs that might interact with the other drugs in an adverse way. Sometimes they may have two prescriptions for the same drug under two different names, thus inadvertently increasing the dosage.

With the fact that “Some research suggest that neurotransmitters” change as we age affecting the brain’s sensitivity to drugs continues the argument that prescribing drugs to older patients has to be done with extreme care.

With all these factors at play, it becomes of utmost importance, then, that in-depth evaluations are done if and/or when an elderly person begins to manifest dementia-like symptoms.

Public Citizens points out:

“Because cognitive impairment caused by drugs is so frequently overlooked, it is important that when symptoms of confusion, altered concentration or difficulty thinking occur that you and your physician review any medications you are taking to determine if any of them might be the cause.

Fortunately, if the cause is a medication, your symptoms should go away or become less severe after stopping the drug, even if it takes weeks or months. (http://www.worstpills.org/includes/page.cfm?op_id=459)”

And Dr. Gary Oberlender, a Specialist in Geriatric medicines,  points out that

“Dementia as the cause of a senior’s cognitive decline should only be considered after a thoughtful and thorough medical evaluation has excluded a potentially reversible cause. The list of common causes of dementia in seniors is short. It includes Alzheimer’s disease, vascular dementia (stroke), Parkinson’s disease, Lewy body dementia, and alcoholic dementia.”

In recent months, the overuse of anti-psychotic drugs is beginning to be noticed.  In an article that appeared in The Telegraph, doctors can get up to five years jail time in the British Isles for prescribing these drugs to the elderly.  Here in the U.S., nursing homes are being forced to reduce their use of anti-psychotic drugs 

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Nursing Homes as De Facto Psychiatric Institutions

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[Continuation of blog on anti-psychotic drugs for the elderly 2011]

“….within three months of admission, 70 percent or more of nursing home residents are on at least one medication with psychoactive properties and 15 to 20 percent are on four or more,” according to a study that was done by the University of Florida in 2010 and reported by Aging Today.  The study also noted that most residents who are admitted to nursing homes come without a history of either psychiatric diagnoses or treatment.

Although dementia does strike some older individuals as a “side effect” of aging, there is more and more acknowledgement that a lot of dementia-like symptoms are caused by the interactions of drugs.

According to a study done by the citizen advocacy group, Public Citizens, Worstpills.org (http://www.worstpills.org/includes/page.cfm?op_id=459):

“As people age, they become more susceptible to delirium and dementia** caused by drugs. This is known as drug-induced cognitive impairment, and it is an important syndrome to recognize….

Both in the hospital and office settings, drug-induced cognitive impairment is often overlooked [emphasis added] and attributed to an underlying medical illness or merely to “old age,” when it is actually a side-effect of a drug. In many cases, the reason for prescribing the culprit drug is questionable, or the cognitive impairment is related to taking multiple drugs at once.”

A study done in 1990 by Barry Rovner, et al which appeared in an issue of International Psychogeriatrics found that there was a high prevalence of mental health problems in nursing homes, so much so, that they concluded that nursing homes “can be viewed as de facto psychiatric institutions.”

Dr. Gary Oberlender, a Specialist in Geriatric Medicine, has done many evaluations of older individuals who have been diagnosed with dementia.  He concludes that:

“…..cognitive decline in a senior does not necessarily mean that the person has Alzheimer’s disease, or even that the person has dementia. There are many potential causes for why a senior might have memory loss, disorientation, trouble concentrating, loss of interest, or any of the other common manifestations of cognitive decline.

It is important to recognize that for many seniors, the ability to think clearly and maintain normal cognitive function is a very fragile thing. For some seniors, cognitive performance is the weakest link in their chain. It is the first thing to become impaired when faced with a stressful situation. Any physical, emotional, or even environmental stress can tip the balance and push them over the cognitive cliff.”

One can easily imagine the stress that an elderly person might feel when being moved from their home into a strange situation with strange people manipulating them physically (helping them change and bathe, cleaning them, etc.), surrounded by strangers and eating unfamiliar foods, having to follow a whole schedule that might be different from the one that they had been living.

Dr. Oberlender continues:

“Drug side effects or the onset of depression manifesting as cognitive decline are very common in seniors — more common than the general public or even many health care providers appreciate.

Other potential causes for cognitive decline in seniors include impaired hearing or not listening (these are two different things!); anxiety; vitamin B-12 deficiency; stroke or poor blood flow to the brain; thyroid disease; anemia; poorly controlled diabetes, hypertension, or heart disease; and inadequate nutrition.

None of these are causes of dementia but any one of them can cause a senior to experience significant cognitive decline and look for all the world as if they have dementia! Furthermore, almost all of these potential causes has the potential to be reversed,(emphasis added) which in turn would improve or totally reverse the cognitive decline.”

PSYCHIATRIC PROFILE OF NURSING HOME RESIDENTS

The Rovner, et al study found that there were  “three main categories of residents with psychiatric problems in nursing homes: Those with serious mental illness, those with dementia and behavioral problems, and those who are anxious or depressed.”  The last category, according to the study, is caused by “reduced functioning caused by medical problems and difficulties adjusting to nursing home life.”  Interestingly, there does not seem to have been further exploration done to see whether the second category, ie dementia and behavioral problems, might not be caused by the same reasons.

CULPRITS

There are three drugs regularly prescribed that have side effects that can cause dementia like symptoms:

Benzodiazepines:  These are tranquilizers and sleeping pills which are often prescribed for anxiety, to sedate chronically ill patients, or patients that are planning to undergo surgery.  They are highly addictive and there is a withdrawal that does occur if stopped.

“People who take benzodiazepines chronically for anxiety, which is not recommended, can also develop more chronic cognitive impairment. Furthermore, because addiction to benzodiazepines is common, stopping them abruptly can result in a withdrawal syndrome similar to what is seen with alcohol withdrawal, including sweating, agitation, confusion, hallucinations and even seizures.”

One can see that these combinations are in and of themselves not great but if a patient does not recognize that certain symptoms they are experiencing are being caused by the medication or from withdrawals by stopping the medication, they end up being caught in a cycle of pills and counter-pills to try and alleviate the symptoms.

Opiates: We know that opiates can cause delirium and fogginess of thinking.  They are used quite regularly to alleviate pain of any kind — from a sports injury to cancer.  As with Benzodiazepines, their effectiveness diminishes with use.  The response is to increase the dosage, which increases the symptoms.   Opiates can cause delirium and the more chronic cognitive changes seen in dementia.

Tricyclic antidepressants:  Although an older version of anti-depressant, they continue to be used for severe depression and also for pain symptoms, particularly neuropathy.

Since cognitive impairment symptoms are generally attributable to these three drugs, we need to ask how these drugs might affect an older person.

[Continue on Health Care or Mis-Care to come out next week]

© Yvonne Behrens, M.Ed  2011

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$20 Billion Industry

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Diagram of how microtubules desintegrate with ...

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An August weekend copy of the Europe The Wall Street Journal carried an article entitled: “Research Points to ‘Silent Phase’ of Alzheimer’s.” The first paragraph stated that a new “explosion” of research has been bolstering “an emerging view” that Alzheimer’s disease can begin to ravage “the brain years or even decades before” enough symptoms appear to diagnose the disease.

These findings, presented at the Alzheimer’s Association International Conference, are apparently influencing how scientists are thinking about the disease “…and the pharmaceutical industry’s quest for effective drugs against the disease.”

The article continued: “The findings are prompting companies like Pfizer Inc., Johnson & Johnson and Bristol-Myers Squibb Col to increase their focus on patients with mild memory symptoms.”

The next paragraph contained a sentence, which was the one for why I share this information with you: “Some analysts estimate the market for a drug that could slow or reverse Alzheimer’s could be as large as $20 billion a year.“

I hold the personal belief that the Alzheimer’s Association (not the Alzheimer’s Foundation or other organizations that have been formed to fight Alzheimer’s) is using marketing to make mucho buckos.  Their aggressive marketing has succeeded in making people believe that Alzheimer’s is the only form of dementia out there.  Dementia is no longer the umbrella term for loss of memory and every day functions.  Alzheimer’s is.

Certainly there should be a concern with regard to Alzheimer’s disease.  But it really is not the only form of dementia out there.  Below are a few other causes of dementia and this list by no means cover all the causes:

  • Vascular dementia
  • Parkinson’s disease
  • Dementia with Lewy bodies
  • Huntington’s disease
  • Alcohol related dementia – Korsakoff’s syndrome
  • AIDS related dementia
  • Fronto Temporal Lobar Degeneration (FTLD)
  • Creutzfeldt-Jakob disease.

An article that speaks about findings that “may indicate” that the “ravages” of Alzheimer’s “may occur before symptoms do” seems to reflect more the rather aggressive means by which the Alzheimer’s Association is trying to corner the market than anything that could potentially alter the onset of Alzheimer’s.  But the Association does have the public’s attention and apparently the pharmaceutical Industry’s attention as well.  One could endlessly produce pills that might counter what might be the beginning stages of Alzheimer’s.  Whether these pills are successful or not seem, if one were to read the article as written [granted, for the Wall Street Journal], secondary to the fact that this endeavor could potentially be a $20 billion industry.

 

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