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If you're like me, once in a while you wonder whether or
not that phone number you just forgot is a sign of
normal memory decline, or something bigger. This
month we pull in Rebecca Shafir from the Hallowell
Center to talk with us about cognitive function, normal
memory issues, memory loss as we age, and memory
issues specific to people with ADHD. We wanted to
know - "What can one do to stave off memory decline?"
It's a question I hear lots of boomers asking these
days!
I sent her a number of questions - and her responses
were so interesting and straightforward that I decided
not to reformat and rewrite her information but to
present it to you "as is". She talks about memory
issues for people without ADHD and for people with.
Next month we'll be back with our normal format and
sections. We'll focus on parenting and schooling
issues as well as news and events.
"See" you in the New Year!
Melissa Orlov, editor
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Aging and Cognitive Decline: What You Can Do to Keep Your Brain Thriving in a CrazyBusy World |
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Editor's Note: This newsletter is dedicated to the
topic of keeping your brain active and strengthening
your memory. Rebecca Shafir, pictured at left, is our
expert.
Q: What would be a good description
of "normal cognitive decline"?
A: As
we age we all experience some forgetfulness, but we
each differ in our degree of memory change. Forgetting
names, important dates, location of objects, and
appointments is consistent with NCD or age-
associated memory impairment. We also tend to
become a bit more distractible and have trouble
processing and learning complex information (working
memory) as we age.
Q: What usually "goes first"?
A:
Verbal recall of information (names, movie titles,
etc.) and working memory (the ability to hold some
information 'online' while we do something else). Brain
scans show that the frontal cortex and temporal lobes
are the first to break down as we age.
Q: Are there specific signs to look out for that
might indicate faster than normal cognitive decline?
A: If the above problems start to
interfere with daily functioning to a point where it
causes you and others around you concern, this could
be a sign of a more severe condition - mild cognitive
impairment or MCI. An estimated 10 million Americans
over age 65 suffer from MCI. Someone with MCI has a
10-15 % chance of developing Alzheimer's.
Q: At what age does our brain power peak?
A: Early 20's.
Q: What are the best overall ways to keep our
minds healthy?
A: There are what I
consider
to be six "pillars" of brain health:
- Physical exercise particularly first thing in
the morning or before you sit down to do a project can
also help sharpen your brain: physical exercise
enhances neurogenesis or the growth of new brain
cells.
- Good sleep - falling asleep easily, staying
asleep and waking up refreshed are the essential
aspects of a healthy sleep. Your brain needs deep
sleep to process the days events, capture new
knowledge and produce "clear thinking."
- Balanced diet - A diet rich in Omega-3 oils,
seafood, dark green leafy vegetables, protein, dark
berries, spices( tumeric, rosemary and sage), coffee,
eggs, avocados, nuts, seeds and wine( in
moderation).
- Stress management is important since
stress has been shown to actually kill neurons and
reduce the rate of creation of new ones (see
www.Heartmath.com). Having a good sense of humor;
laughing is good for the brain. Spirituality, optimism, a
good attitude can help us put problems and turmoil in
perspective.
- Socializing with People - interactive
conversation (even if you just listen), participating in a
clubs, church/synagogue or choir satisfies the brain's
inherent need to belong to something and learn
something new.
- Brain training. This ranges from low-tech
(i.e. meditation, one-on-one brain training with a
qualified brain fitness therapist, reading and
discussion, piano lessons, chess etc.) to high-tech
(brain fitness software programs).
Q: Is there anything else you think is important
to communicate to boomers?
A: We
used to think that we were born with a finite # of brain
cells and once we started losing them there was no
getting them back. Current neuroscience research tells
us that we can not only rejuvenate cells
(neuroplasticity) but we can create new cells with the
right kind of activities (see "6 pillars" above).
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Brain Training and ADHD |
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Q: What are the most common cognitive
issues for people with ADHD and are they associated
with specific parts of the brain?
A:
People with ADHD struggle with varying degrees of
restlessness, impulsivity (difficulty inhibiting unwanted
behaviors) and distractibility.
The pre-frontal
lobe (the forehead and slightly behind the hairline) is
the CEO of the brain. ADHD is believed to interfere in
the CEO's executive functions: sustained attention,
working memory, inhibition, metacognition, time
management, goal-directed persistence, organization,
planning/prioritization, task initiation and
flexibility.
Depression or anxiety often co-exist
with ADHD. These issues can impinge upon learning
and worsen with aging. When I embark on a plan for
training executive functions or a brain fitness regimen,
the presence of mood issues and anxiety are key
considerations. Whether one has ADHD or not, a
person who is anxious or depressed is less apt to
think clearly and utilize their executive functions
adequately in the face of stress and depression. Sleep,
diet, exercise and environment also play major roles in
cognitive functioning.
Q: Do ADHD medications affect cognitive
functioning?
A: ADHD medications
can do a fine job at allowing the CEO in the brain to do
his/her job. However, many ADHDers may have
difficulty tolerating medications or find the medications
minimally helpful in this regard.
Q: What are the most common ways to
improve
cognitive function for ADHD?
A: You
can think
of it in steps:
- Assess: It is essential to assess
the nature
and extent of the cognitive dysfunction by a review of
one's medical/family history, neuropsychological
testing result or various self-rating scales, and by
identifying one's strengths.
- Treat: Address underlying
symptoms such
as poor sleep, mood problems and anxiety via
medication or a variety of non-medication
approaches.
- Plan: Identify objectives and create
an action
plan.
- Moderate: Introduce and monitor
use of
strategies to improve executive functions with particular
attention on working memory (considered by many
physicians to be the core deficit in AD/HD and one of
the first processes to decline as we age) in one-on-
one (executive function training) or group sessions
(see ADHD skill based support group starting in
January at the Sudbury Center).
- Brain training: (optional step) Add
on at
home brain-training via select software (depending on
the software chosen takes anywhere from 15-40
minutes 3-5x a week) to boost progress. Customized
software recommendations are also addressed in our
sessions.
Q: Can people do "brain training" at home, or
do they need a doc?
A: Brain training
at its best is done via one-on-one training with a
qualified brain fitness therapist 1-2x a week at a clinic,
but the software and strategy application is the
homework.
Q: What about Crossword puzzles, Suduko or
brain teasers?
A: Our brains benefit
best from training programs that emphasize variety;
and the right combination of exercises will be different
for each person. If you only do crossword puzzles, you'll
only get better at doing crossword puzzles. In brain
fitness training, exercises are tailored to each person's
unique situation.
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Different Types of Brain Training |
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Q: Are there different types of brain training?
A: All these kinds of brain training
programs are offered at the Hallowell Center. We think
they have the strongest data behind them:
- Cognitive-behavioral therapy (CBT) has been
around for many years. It is based on the notion that
the way people perceive their experience influences
their behavior and emotions.
- Brain-training, a newly emerging approach and
available at the Hallowell Center is a structured use of
cognitive exercises or techniques taught by a qualified
therapist. Its aim is to improve attention, thinking and
memory skills.
- Commercially available software applications.
- Meditation
- Biofeedback/neurofeedback
Q: What's the status of research around brain
training?
A: Each method of brain
training
above has been shown to be helpful in making
significant and positive brain changes across a wide
range of multi-subject controlled studies to actual
single or small group clinical reports. An up-to-date,
but laymen-friendly answer to this question can be
found in The new book The Sharp Brain's Guide to
Brain Fitness (2009) by Alvaro Fernandez and Dr.
Elkhonen Goldberg.
The software programs
are the best studied. There are only a handful of viable
software programs with good research claims behind
them. Buyer beware - some programs and gadgets
have research that is funded by the software company
instead of an independent research entity. Keep in
mind that "peer-reviewed" studies often mean "in-the-
club reviewed."
Q: How are the programs different?
A: All the above brain training
methods approach brain improvement in different
ways. Some people do better with personal guidance
than by working independently. Prices vary from $150
per one-on-one training to $2500 for a software
program. Some programs are very structured and
repetitive and others are more game-like and directly
applicable to everyday activities.
Q: How do you figure out which one is right for
you?
A: It is a time and money saver
to access a brain fitness therapist to skillfully assess
your cognitive needs and tailor a program well suited
for you. Several factors are taken into account when
planning a brain fitness program: Results of the initial
assessment; time and resources a client has
available; self guided or therapist guided preferences;
a client's personal objectives, etc. Some approaches
work better for specific needs than others, so it makes
sense to look at all the factors to derive the best
outcome in the shortest amount of time.
Demonstrations and trials of various approaches also
aid in the decision-making process.
Q: Can you do this in a group?
A: Yes, for some of the work. As an example, the
Hallowell Center in Sudbury is offering two brain
training groups starting in
January:
ADHD Skill Based Support
Group starts Monday, Jan 11, 6:30-8:00. This
is led by Theresa Garvin, LICSW. Call for a free 15
minute intake - 978-287-0810 x
105
Staying Sharp: Brain Fitness for
Boomers and Seniors starts Jan 9 (free intro
session) followed by 6 once-a week sessions on
Tuesday nights from 6:30-8:00. Rebecca Shafir, M.A.
CCC leads this one. Call 978-287-0810 x117 to
register.
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