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December Newsletter )
The Power of Connection December 15, 2009
In this Issue
  • Aging and Cognitive Decline: What You Can Do to Keep Your Brain Thriving in a CrazyBusy World
  • Brain Training and ADHD
  • Different Types of Brain Training
  • 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

    Aging and Cognitive Decline: What You Can Do to Keep Your Brain Thriving in a CrazyBusy World
    Rebecca Shafir, Hallowell Center

    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:

    1. 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.
    2. 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."
    3. 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).
    4. 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.
    5. 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.
    6. 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).

    Brain Training and ADHD

    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:

    1. 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.
    2. Treat: Address underlying symptoms such as poor sleep, mood problems and anxiety via medication or a variety of non-medication approaches.
    3. Plan: Identify objectives and create an action plan.
    4. 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).
    5. 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.

    Different Types of Brain Training

    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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