<![CDATA[Neuropsychology For You - Blog]]>Tue, 11 Feb 2025 08:20:30 -0500Weebly<![CDATA[A Thanksgiving Habit (Thanksgiving, habits, and neuropsychological health)]]>Thu, 26 Nov 2020 22:44:51 GMThttp://www.neuropsychologyforyou.com/blog/a-thanksgiving-habit-thanksgiving-habits-and-neuropsychological-healthHappy Thanksgiving! What do Thanksgiving, habits, and neuropsychological health have in common? ...
Recently I have been listening to an audio book (free through the Hoopla app and the Free Library of Philadelphia) by Darren Hardy, titled “The Compound Effect.” While he shares a lot of very good and helpful information in his book, one of its benefits for me so far has been the reminder of the extreme importance of habits.

This is of course not a new idea. We all know this. I could probably research and generate a rather long list of books on the importance of habits. However, while I know habits are super important, I am not always good at harnessing the power of healthy habits.

As I listened to this audiobook and the discussion of habits I began to reflect on the benefits of habits from a neuropsychological perspective, for brain health and health of mood and memory.

One of Darren’s thoughts that I found helpful was the idea that we are all always living according to our habits, whether we choose to or not. Life is made up of our habits. One problem is that often we develop habits by default rather than purposefully, and these default habits tend to either keep us stuck in life, or make things worse rather than better. The key then is to work at being more purposeful in what habits we are creating, habits that help move us towards our goals and values rather than keep us stuck or moving backwards.

Our behavior impacts our brain - the mood parts, the memory parts, and all other parts of the brain. This is a necessary part of neuroplasticity: brain changes in reaction to our behaviors. Greater brain changes result from consistent, repetitive behavior: habits. This process is necessary for any skill and performance-related activity, like playing the piano or golfing or becoming fluent in a new language. Improvements in these skills happen because of changes in the brain as a result of habits played out over time (and the benefits of those habits increase/compound over time, which is the main point of Darren’s book).

While many different parts of the brain are necessary for benefiting from habits, one in particular is worth highlighting: the cerebellum. The cerebellum is particularly important for development and improvement of skills and habits. The cerebellum is like the automation expert of the Brain Office. It is responsible for taking tasks (both physical and cognitive tasks) that we do repeatedly and turning them into more automatic behaviors. The more we practice those behaviors, the more the cerebellum can automate them. The more the cerebellum automates these behaviors/skills, less and less brain power will be required to perform them and keep them going.

We can use the benefits of habits and the cerebellum’s automation to improve our mood and memory. There are many habits we can develop and nurture to help improve mood and memory. Other posts and pages of this website discuss mindfulness for strengthening attention and various memory improvement strategies. The more we can turn those skills into habits, the more effective they will be for us (the more the cerebellum can make them automatic, strengthen those brain regions, and improve Brain Office efficiency and performance).

What if we view Thanksgiving as not just a holiday, but also a skill? The skill of thanks giving. The skill of giving thanks. This is also not a new idea. This is just a re-wording of “adopting the attitude of gratitude.” There are many benefits to this. Developing a habit of thanksgiving is one very important and effective tool for re-training an unhelpful emotion employee (see the Brain Office. “Emotion employee” = limbic system = emotion/mood circuitry of the brain. Problems with depression, anxiety, or other stubborn and unhelpful moods involve this emotion employee/circuitry misbehaving and needing to be re-trained).

Instead of an emotion employee, we could view the brain as having different mood/emotion/attitude muscles: a happiness muscle, joy muscle, thankfulness muscle, sadness muscle, worry and anxiety muscles, etc. Muscles for worry and other negative emotions typically don’t require purposeful strengthening; they seem to be good at exercising themselves for most of us. On the other hand, the more pleasant emotion muscles often need purposeful exercise (especially in stressful times of life). Nurturing a habit of thankfulness can be thought of as a form of weight lifting for some of the more pleasant emotion muscles. By doing this thankfulness-strengthening consistently over time, the unpleasant emotion muscles will become less dominant and overpowering.

Because moods and emotions interact with and affect memory, attention, and thinking skills in general, then establishing and nurturing the habit of thanksgiving will help not just mood/emotion but also have downstream benefits for memory and cognition.

​With so much to be worried about this Thanksgiving (pandemics, politics, and such), it might take a little (or a lot?) more mental effort and purposefulness to identify reasons to be thankful. It is in these very times though that it is even more important to do just that.

I challenge you this holiday season to begin (or further improve on) a daily habit of thanksgiving. Your brain will thank you!


]]><![CDATA[Managing stress by strengthening resilience.]]>Sat, 05 Aug 2017 03:45:23 GMThttp://www.neuropsychologyforyou.com/blog/managing-stress-by-strengthening-resilienceby matt bridgman
Resilience is the ability to be made stronger by problems in life, rather than being worn down by them. Kids are often described as being so resilient. They fall down when learning to ride a bike, and then get back on and keep going, eventually mastering the skill. That is resilience.

What makes a person resilient?

Is resilience something we can improve? I think so. By learning how to improve our own resilience we can reduce the wear and tear of life's stresses on us. 

Check out these resources on resilience:

Psychology Today - About Resilience - A very brief description of resilience

American Psychological Association - The Road to Resilience - A very detailed and comprehensive resource about resilience and how to strengthen/improve our own degree of resilience. 

The 5 Best Ways to Build Resiliency - by Jessie Scholl - A long but good article about building resilience. 
​



]]><![CDATA[Going to the dentist as an exercise in stress management]]>Tue, 11 Apr 2017 04:00:00 GMThttp://www.neuropsychologyforyou.com/blog/going-to-the-dentist-as-an-exercise-in-stress-managementI went to the dentist the other day for a routine cleaning. I really don't like going to the dentist. It is painful! First they take those sharp metal tools that they use to scrape and pick at your teeth. They push and pull with rather concerning force at times, I worry they slip and put one of those things right through my cheek. Then they switch to polishing, with the sandy toothpaste.

The worst part, though ...
...I think, is the flossing. My teeth are so tight together in places that they really push down hard to get the floss between them. Once the floss gets beyond the bottleneck between my teeth, it snaps down onto the gums with painful force. It feels like a knife slicing through my gums! 

Not only is the whole event physically painful, but it can be emotionally painful too! They always ask me how often I have been flossing. I hate to answer, because it is never as often as it should be. I feel such shame. Like a little kid being scolded by a disapproving parent. 

I am picking a bit here. I don't mean to be disrespectful to dentist or hygienists. They don't mean to cause me pain. They are just doing their jobs. It is a very important job, and despite the pain, I am thankful for the work they do. Obviously the little bit of pain and discomfort they cause me now helps to prevent worse pain and suffering in the future. 

The point of my rambling, though, is to share the thought I had during my recent cleaning: going to the dentist can be used as an exercise in stress management. 

The pain and suffering I endured during my cleaning was stressful. My solution to dealing with this stress should not be to eliminate this stress by avoiding the dentist (though my wife will tell you that I do tend to avoid the dentist). I need to accept this stress as an unfortunate, but unavoidable aspect of the teeth cleaning, which is very important (the teeth cleaning is important, not the stress). Because the teeth cleaning is so important, I must be willing to accept the pain and suffering, the stress, that comes with it. 

Acceptance here does not mean that I must somehow come to enjoy the pain and stress. Acceptance just means that I tolerate it and I don't do anything to try and stop it. (Although, my wife has tried to explain to me that if I go to the dentist every 6 months like I am supposed to, then my teeth will be healthier in general, and so they won't have to scrape so hard every time; I guess that would technically be a way I could at least reduce the stress). 
Acceptance does not mean choosing to
like or enjoy the pain/stress,
but rather a conscious decision to do nothing to
stop the pain/stress;
​it means I allow myself to experience it.
Anyway, I am going to allow myself to experience the stress of the teeth cleaning in order obtain the more important benefit of having clean and healthy teeth and gums. This acceptance of stress that we cannot eliminate is a good part of a healthy stress management plan (look up Acceptance and Commitment Therapy, aka ACT, which talks all about this idea). 

What I really wanted to share here, though, was how sitting in a chair, not allowed to move, with your mouth open and full of sharp metal objects, is a great time to focus on muscle tension in the rest of your body. 

As I sat in the dentist chair, with my mouth open and full of sharp objects, anticipating the pain of a scraper slipping and catching my gums, I noticed that my arms, my hands, my legs, my feet, my hips, my back, and even my forehead and eyebrows, were all tense. 

This of course makes perfect sense. When my limbic system (the emotion center of the brain, responsible for triggering the disaster response plan, aka fight-or-flight reflex) is anticipating physical, bodily harm, it gets the entire body prepared to fight. Even though the frontal lobes (which control reason, rationality, etc.) know on an intellectual level that my hygienist is very skilled, compassionate, and careful, and will not harm me, my limbic system is still not so sure, and so is preparing the body for a fight anyway just in case. 

Because I have nowhere to go - I cannot get up and run away from the stress, and I am trying to be accepting of the stress for the purpose of the greater good of clean/healthy teeth - why not focus on relaxing my muscles? Focus on taking deep breaths (through the nose of course; not the mouth full of sharp objects or sand-filled toothpaste). Focus on each individual muscle group: your feet, your leg muscles, your hands, your arms, your neck, your shoulders, your forehead and other face muscles. 

The ability to experience a high level of stress (the pain of the cleaning and the anticipation and associated fear/anxiety of more pain) and yet maintain a relaxed body (control the level of tension in my muscles) is an extremely important skill. This is an extremely important component of a healthy stress management strategy. ​
The ability to experience a high level of stress
and yet maintain a relaxed body
​is an extremely important skill. 
This skill is very tricky, however, because the limbic system (that emotional circuitry in the brain) is so very powerful, and so very fast. The limbic system, when it anticipates danger or injury, triggers a whole host of physiological changes in an instant. Because of this, it takes much practice and purposefulness to strengthen this skill. 

Encouragingly, when you practice and strengthen this skill in situations like the stress of a teeth cleaning, you will improve your ability to use and practice this skill in other contexts too. Although something like making mistakes at work and the resulting comments/criticisms from a supervisor, or a heated disagreement with a co-worker, may not involve physical pain like the teeth cleaning, they both are stressful situations that result in increased muscle tension.

This increased muscle tension, if occurring frequently or intensely over long periods of time, causes significant wear and tear on our bodies, and can negatively affect both our physical and mental health. Increasing the skill of minimizing muscle tension in the midst of stress is important for reducing the wear and tear that stress has on our bodies. 
Minimizing muscle tension 
in the 
midst of stress.
So, the next time you visit your dentist for a teeth cleaning, focus on relaxing your body as much as possible. Begin by paying attention to your feet, and slowly shift your attention to different muscle groups making your way up towards your shoulders and face. See how relaxed and limp you can make each muscle group (with the exception of those keeping your mouth open, of course!). 

Assuming that the pain and discomfort of the cleaning is truly within the range of what you would normally expect, then as you focus on relaxing your muscles, also reassure your limbic system. Remind your limbic system that the pain in your mouth is normal and acceptable. Encourage your limbic system that the pain is "ok" and that you are not in danger. 
Reassure your limbic system,
​as if it is a little child going to the dentist for the very first time, needing reassurance from a comforting parent.
Seriously.
Try it. 
Unfortunately, if the only time you practice this is at the dentist office, you won't really strengthen this skill. Going to the gym to exercise doesn't do much good if we only go once every 6 months. Use your next teeth cleaning to practice this skill, but also look for other opportunities, other moments of "normal" pain or stress, in which to exercise this skill.

The more you practice it, the better you will become at minimizing muscle tension in the midst of stress. The better you become at minimizing muscle tension, the happier and healthier your body will be!
]]><![CDATA[ The Problem of Stress: The Car Metaphor]]>Fri, 30 Dec 2016 05:34:43 GMThttp://www.neuropsychologyforyou.com/blog/-the-problem-of-stress-the-car-metaphor​Imagine your body is like a car. Cars have stress. Every time you drive your car, you are putting stress on the vehicle. This stress results in wear and tear. Wear on the engine; wear on the tires, the seats, and the body of the vehicle....
​Imagine two cars, the same make and model, bought brand new the same year. Imagine both cars 5 years later. The first car, car A, has been driven only during the summer, on dry, smooth, paved roads. This car received oil changes every 3,000 miles, tires rotated according to factory specifications, and complete detailing (wash, wax, vacuuming) once a month. The second car, car B, has been driven only during the winter, on rough, pot-hole-filled, heavily salted, sand covered roads. This car received oil changes every 10,000 miles, no tire rotations, and thorough cleaning only once a year. Imagine that these cars miraculously drove the same exact number of miles. At the end of 5 years they are they same exact age, and have the same number of miles. However, are they in the same shape? Are they in the same condition? Do the look the same age? The answer is quite obvious. Which car looks younger? That answer is also quite obvious. Car A is certainly going to be in better shape.
Stress causes wear and tear.
There are two issues here: amount of stress, and the frequency and quality of maintenance. Car A had much less stress over those 5 years, and therefore much less wear and tear. Car B had much greater stress, and therefore much greater wear and tear. Car B also was not maintained nearly as well as car A, and so wear and tear occurred faster than it might have otherwise.
 
Do cars have “mental” or “emotional” sides to them? No. The stress and its effects are all physical.
 
Our bodies are in a similar situation. Many issues in life are sources of stress and pressure. Some degree of stress/pressure is good for us, healthy and necessary for growth, strengthening, and increasing our knowledge and wisdom. However, when the stress of life gets too high it results in wear and tear. Sometimes life is more like the driving of car A, and other times it is more like car B. Regardless, when life is stressful, it affects us physically. This is important to acknowledge. 
Stress affects us physically.
Now, we as human beings are of course quite a bit more complex than cars. We have mental and emotional sides of our being. Stress also affects us mentally and emotionally. Physical health affects mental and emotional health, and mental/emotional health affects our physical health. Unfortunately, it is easy to minimize stress and dismiss it. However, ignoring the physical effects of stress can be disastrous, leading to faster physical wear and tear on our bodies; faster aging of our bodies.
 
When the stresses in life are really intense and numerous or persistent, we must not brush them off, responding with “I am fine” or “I am dealing with it.” Just like car B, when life is more stressful, if we want the car (our bodies) to last longer and hold up under all of the stress, we need to spend more time and energy maintaining our vehicle.
 
Which car are you lately? Car A with mild and healthy levels of stress? Or car B, with stresses that are wearing you out?
 
What does your maintenance plan look like? Car A, with several strategies for maintaining your body’s health, and frequent use of those strategies? Or car B, with very few strategies, or strategies that are not used very often at all?
 
We don’t always have that much control over the sources of stress around us (sometimes we have about as much control over our stress level as we do over the seasons and the weather). However, we have much more control over how we maintain our cars (and bodies).
How are you maintaining your vehicle?
If you find you relate more to the maintenance plan of car B, what is one new maintenance strategy you could try today or tomorrow? What is one maintenance strategy that you have found helpful in the past that you have not used in a while? Could you use that today or tomorrow?
]]><![CDATA[“Sorry, I am just terrible with names.”]]>Fri, 30 Sep 2016 04:00:00 GMThttp://www.neuropsychologyforyou.com/blog/sorry-i-am-just-terrible-with-namesby matt bridgman
​“Hi! How are you doing?” is the line I typically use when I cannot remember someone’s name. I just jump right into conversation so I don’t have to use their name. I have friends who seem to memorize names after hearing them only once. I definitely do not have that skill. I study and test memory for a living, and yet I am really bad about remembering people’s names.
 
Fortunately, I have talked to quite a few people who experience a similar “name-finding” difficulty (not fortunate for them, of course, but it makes me feel less bad about myself).  However, I recently decided that I probably should not just accept my name-finding impairment, and so I decided to do something about it.
I have since come across a number of resources about improving memory for names. Rather than strictly following any of the strategies outlined in those resources, I ended up using bits and pieces here and there depending on the situation.
 
Some of the key concepts that I have begun to use:
  1. Adjusting my attitude and expectations: I am working to stop accepting that “I am just bad at names, and that is how it is going to be.” I began to tell myself “I can be good at remembering names. I will become good at remembering names.” (ummm…”I think I can. I think I can.”). I may never be as good as some of my friends, but I can certainly do better than I am right now. Some of the specific “improving memory for names” resources included positive expectations as an important step. Furthermore, scientific research in general has clearly supported the idea that expectations affect behavior, performance, and even recovery from illness and injury. If I expect to be bad at names, I will be bad at names. Just changing my expectations in a positive direction will start to improve my memory for names.
  2. Paying closer attention: expecting myself to do better with names helps me then to also pay closer attention to names and spend more time thinking about peoples’ names (if I don’t expect to remember it anyway, why would my brain put forth any effort to learn it?).
  3. Use names more often in general, in conversation and greetings. I found myself avoiding even using the names of friends in greeting or conversation. My name-finding impairment at times is bad enough that I get nervous about using a wrong name when talking to friends (that would be so embarrassing!). However, this avoidance has the very unfortunate effect of further weakening my brain’s “name retrieval muscle” (Use it or lose it!). So I therefore started to use even just my friends’ names more often (though being careful not to go overboard), in the hopes that this would harness some of the power of neuroplasticity (the brain’s ability to change itself; see neuroplasticity Resources/Links) and really strengthen my brain’s ability to learn and remember names.
  4. Association and visual imagery: I started associating peoples’ names with anything that came to mind: another person I already know that has the same name, an object whose name rhymes with the new person’s name, etc. I made these associations as visual as possible.
 
Improvement certainly did not happen quickly. The first few weeks were actually uncomfortable: before now, I was comfortable in accepting my name-finding impairment and avoidance of using people’s names. It was a comfortable habit. Now that I was challenging myself to stop avoiding people’s names, I was noticing a little more anxiety about using the wrong names. I think I did use a wrong name a time or two, but thankfully the sky did not fall as my anxiety was predicting.
 
Last weekend was the first time I noticed a significant improvement. I attended a small conference. In one of the first sessions, the speaker had all audience members introduce themselves. There were only about 30 people in attendance. I thought “what a great opportunity to test out my new and improved name-learning skills!”
 
I was actually pretty impressed with myself. I certainly did not learn all of their names, but I definitely learned and retained more than if I hadn’t been practicing the above strategies for the past few weeks.
 
Here are some of the names I learned, and the associations that helped them stick:
  1. Carol – I had a real estate agent named Carol, and she and the new Carol have similar hair.
  2. Raquel – this is an uncommon name, which already helps it stick better. But then I though of Shawshank Redemption and the voice of Morgan Freeman talking about the Raquel poster. That really made it stick.
  3. Wendy – I don’t have any friends named Wendy. Well, that’s not true. I did know a Wendy years ago, but she didn’t come to mind right away. What came to mind first was Wendy’s restaurant. I like their spicy chicken sandwich. Wendy didn’t have red hair, but her hairstyle was slightly similar to the Wendy’s girl.
  4. Charles – “Charles In Charge” the old TV show. This guy also was pleasant, but had a demeanor as if he was in charge of something.
  5. Jenny – Jenny from Forest Gump, recalling the sound of Tom Hanks saying “Jenny”
  6. Erin – I have a friend named Erin, and they both have similar looking noses.
  7. Mark – I have a family member named Mark, so that was easy.
There were a few more, but I won’t bore you with the details. I am sure you get the idea by now.
 
Below are links to two of the resources I found most helpful.
 
http://www.brainline.org/content/2008/11/id-you-meet-whats-her-face-strategies-remembering-names_pageall.html
This article on brainline.org is packed with ideas about how to improve our memory for names. Information in this article was reportedly taken from a publication by the National Resource Center for Traumatic Brain Injury, titled Memory Matters: Strategies for Managing Everyday Memory Problems.
 
Ron White also presents a very good strategy for remembering names.
https://www.youtube.com/watch?v=m2GI0huaV5s
(if the link doesn’t work, search youtube for “Ron White how to remember names”)
From a neuropsychological perspective, his strategy is spot on. Focus/attention is a necessary first step to remembering anything. Mental organization (filing) of new information is vital to efficient retrieval. He then uses a combination of associations, elaborative encoding, and visual imagery to assist further with the organization/filing and enhancement of retrieval.
 
Check out the resources and give a few of my suggestions a try. See what works for you. Drop me a note and share your favorite way to avoid using names or your favorite name memorization technique. Feel free to also share any problems or barriers you have as you work towards improving your memory for names. 
]]><![CDATA[Is it dementia or is it Alzheimer's?]]>Sat, 09 Jul 2016 04:59:42 GMThttp://www.neuropsychologyforyou.com/blog/is-it-dementia-or-is-it-alzheimersby matt bridgman
I have been asked this question many times. What is the difference between dementia and Alzheimer's disease? Read more to find out. 
Dementia is a syndrome. Alzheimer's is a disease. 

Dementia is the term used to refer to a condition where someone has a significant decline in at least two areas of cognitive ability (refer back to my post on cognition for a description of those areas), to the point that they are no longer capable of completing daily tasks independently.

Dementia involves basically two criteria:
1) a significant drop in at least two areas of cognition (such as memory, language, attention, or reasoning ability)
AND
2) that drop in cognition is severe enough that the person has to depend on other people for daily tasks or responsibilities. 

For example, if someone has a worsening of their memory and language skills, to the point that they are no longer capable of managing their own finances, or managing their own medications, then they would be considered to have dementia. 

(One exception would be if the worsening of cognition is determined to be reversible, such as because of medication side effects. That would then be considered a delirium - a sudden and temporary confusion - not dementia).

The term "dementia" therefore says nothing at all about what exactly is causing the change in cognition. 

Alzheimer's disease, then, is a disease that causes or leads to dementia. Alzheimer's disease starts (in most cases) by damaging the memory center of the brain (the hippocampus) and then progresses to damage other areas of the brain, causing impairments in memory and other areas of thinking, to the point that those individuals become unable to manage various daily activities. 

Alzheimer's disease is the most common cause of dementia, but numerous other diseases also lead to dementia. Cerebrovascular disease (caused by either a large stroke, multiple smaller strokes, or a long history of issues like uncontrolled diabetes, high blood pressure, and high cholesterol), Lewy body disease, frontotemporal degeneration, and Parkinson's disease are other causes of dementia.

I cannot stop there, however, as the term "dementia" has fairly recently been replaced/updated. What we used to refer to as dementia (that which I have described above) is now called Major Neurocognitive Disorder. 

Major Neurocognitive Disorder (formerly dementia) is distinguished from Mild Neurocognitive Disorder. Mild Neurocognitive Disorder is the midpoint between cognitive changes of healthy aging, and Major Neurocognitive Disorder. If changes in cognition are viewed on a scale, with one end of the scale representing the mild cognitive changes typical of healthy aging, and the other end of the scale representing cognitive changes severe enough to be causing loss of independence (that would be Major Neurocognitive Disorder), then Mild Neurocognitive Disorder is the middle of the scale. 

Mild Neurocognitive Disorder = changes in cognitive functioning that are more than what would be expected just from healthy aging, but the individual is still living and functioning independently. "Changes in cognitive functioning that are more than what would be expected just from healthy aging" is something that is determined by neuropsychological testing: an individual's current cognitive test scores are compared to those of healthy individuals in their age range (while also accounting for individual differences such as education history and work history). 

Although individuals with Mild Neurocognitive Disorder are, by definition, still living and functioning independently, they are typically making more mistakes than they used to, and they are usually having to work harder to compensate for the memory changes. 

This post is a very brief introduction to these conditions, and is certainly not enough information for anyone to self-diagnose. A comprehensive neuropsychological evaluation is the only way to accurately distinguish between cognitive changes of healthy aging versus Mild Neurocognitive Disorder versus Major Neurocognitive Disorder. Accurate diagnosis (through a neuropsychological evaluation) requires an assessment of many factors, such as developmental history, education history, family history, medical history, occupational history, and others. Objective measurement of cognition is also required, and the results of such measurement/testing must be interpreted in the context of an individual's age and the aforementioned factors. If you are concerned that you or a loved one may be showing signs of any of these conditions, talk with your family doctor to see if a neuropsychological evaluation would be appropriate. 

Check out the Resources/Links page for links to websites containing further information about dementia/Major and Minor Neurocognitive Disorder, and neurodegenerative diseases such as Alzheimer's and Lewy Body disease. 
]]><![CDATA[Chemo brain]]>Wed, 15 Jun 2016 02:40:02 GMThttp://www.neuropsychologyforyou.com/blog/chemo-brainby matt bridgman
Chemo brain, aka chemo fog, aka chemo-related cognitive dysfunction, aka cancer-related cognitive dysfunction.
What is it? What causes it? What can be done about it? Read More to see what I have been learning in my attempt to answer these questions.   
    
Chemo Brain/Chemo Fog/Cancer-related cognitive dysfunction

1.    What is it? - Symptoms (Mayo clinic; MD Anderson; Evens and Eschiti, 2009)
     a.    Feeling unusually disorganized
     b.    Having moments of confusion
     c.     Increased difficulty Concentrating
     d.    Trouble finding the right words
     e.    Difficulty learning new skills
     f.     Difficulty multitasking
     g.    Fatigue
     h.   Mental fogginess
     i.    Shortened attention span
     j.    Short term memory trouble
     k.   Taking longer to complete routine tasks
     l.    Reduced or slowed information processing/processing speed
     m.  Trouble with verbal memory (like remembering a conversation)
     n.   Trouble with visual memory (like recalling an image or a location)

2.    What causes it? - Physiology (Mayo Clinic; MD Anderson; Evans and Eschiti, 2009; Raffa, 2011; Cui, Kong, and Zhang, 2012; Ho, 2015)
     a.    This is not entirely clear, but is not simply the chemo or radiation itself. Cause of chemo-brain is multifactorial; many factors combining to contribute to the symptoms of chemo brain. 
     b.    Possible factors/contributors: 
          i.    Cancer itself – particularly cancers of the brain
          ii.   Cancer treatments
               1.    Chemotherapy
               2.    Hormone therapy
               3.    Immunotherapy
               4.    Radiation therapy
               5.    Stem cell transplant
               6.    Surgery (post-operative cognitive dysfunction)
          iii. Complications of cancer treatment
               1.    Anemia (which is thought to contribute possibly to ischemic injury)
               2.    Fatigue
               3.    Infection
               4.    Menopause or other hormonal changes 
               5.    Nutritional deficiencies
               6.    Sleep problems/insomnia
               7.    Pain 
          iv. Emotional reactions to cancer diagnosis and treatment
               1.    Anxiety
               2.    Depression
               3.    Stress – stress is not just emotional. Stress is a medical condition. Stress affects physiology – evidence of stress induced telomere shortening; hormone changes, blood flow changes, changes in heart rate, etc.
                    a.    Epel et al 2004, study found association between psychological stress and indicators of accelerated aging (oxidative stress, telomere length, and telomerase activity).  (Telomeres are the protective endcaps of our chromosomes.)
          v. Other causes
               1. Inherited susceptibility to chemo brain
                     a.    Some indication that individuals with APOE 4 allele (which is implicated in Alzheimer’s) also confers increase risk of chemobrain 
               2. Medications for other cancer-related signs and symptoms, such as: 
                    a.    Pain medications, 
                    b.    Antiemetic, 
                    c.    glucocorticosteroids – which are for nausea, vomiting, and hypersensitivity reactions; appetite stimulant; alleviate pain; anticancer effects. (Wooldridge et al 2001). 
               3. Recurrent cancer that has spread to brain
         vi.  Inflammation and oxidative stress – (Raffa 2011; Cui, Kong, and Zhang 2012)
               1.    Inflammation and oxidative stress caused by chemo (but potentially exacerbated by any number of the issues above – the cancer itself, radiation, infection).
               2.    Inflammation and oxidative stress disrupt normal mitochondrial functioning (therefore affecting mental energy and working memory!) and leads to cell death by various complicated pathways (stimulates FOXO3 transcription factor, and blocking neuroprotection by IGF-1 (insulin like growth factor-1) (Davila and Torres-Aleman 2008). 
          vii.    Alterations in Blood brain barrier (which leads to inflammation and increased oxidative injury)
          viii.    Vascular injury
          ix.    Myelination changes
          x.    Decreases in grey matter and demyelination of white matter fibers after systemic chemo

3.    Risk factors (Mayo Clinic; Gordon and Haut, 2014)
     a.    Brain cancer
     b.    Chemotherapy given directly to CNS (central nervous system, which is the brain and spinal cord)
     c.    Chemotherapy combined with whole-brain radiation
     d.    Higher doses of chemo or radiation
     e.    Combination chemotherapy (multiple chemotherapy agents)
     f.    Radiation to the brain
     g.    Younger age at time of cancer diagnosis and treatment
     h.    Increasing age
     i.    Pre-cancer heath issues, such as: head injuries, depression, learning disabilities, and other neurologic disorders. These probably increase risk of chemo/cancer-related cognitive dysfunction, but confirming this is challenging, as individuals with such histories are typically excluded from research studies. 

4.    Diagnosis 
     a.    No clear definition or criteria for diagnosing chemo brain, so therefore no definitive tests exist. Cancer survivors who do experience cognitive symptoms often score normally on memory tests, but not always (depending on the tests used) (Mayo Clinic). (Jim et al 2012 metaanalysis did find consistent post treatment effects on verbal abilities and visuospatial abilities). 
     b.    Comprehensive neuropsychological testing is more sensitive to deficits than screeners such as MMSE/MoCA. 
     c.    Objective deficits are often subtle (so easily missed by cognitive screenings), or the decline is from an above average or average level, to an average or low average level (so test results are still “normal” even though they are a decline from pre-treatment). Having a pre-treatment neuropsychological evaluation can be helpful in this regard, to therefore provide comparison of pre-treatment and post-treatment scores, which is a more sensitive way of measuring a cognitive change. 
     d.    May undergo tests to rule out other causes/reversible causes of cognitive difficulty (i.e. B12 deficiency, anemia, electrolyte issues, nutritional deficiencies, etc.) (Mayo Clinic)

5.    Treatment (Mayo Clinic; MD Anderson; Evans and Eschiti, 2009)
     a.    No standard treatment exists for chemo-brain. Because chemo brain is the result of many factors, no single treatment will be sufficient. Effective treatment will require addressing as many of the responsible factors as possible.
     b.    Addressing treatable factors
           i.    Insomnia – treatment using medications, sleep hygiene, guided imagery 
               1.    Collaborate with your family doctor or other providers regarding possible medications or alternative therapies (i.e. melatonin). 
               2.    Behavioral therapy for insomnia (such as Cognitive Behavioral Therapy for Insomnia, or CBT-i, which is a formalized psychotherapeutic approach to treating insomnia) see the following site for an introduction to CBT-I http://www.mayoclinic.org/diseases-conditions/insomnia/in-depth/insomnia-treatment/art-20046677 
               3.    This is a good resource discussing sleep and sleep hygiene: http://www.med.umich.edu/painresearch/patients/Sleep.pdf 
               4.    This is also a great page: http://healthysleep.med.harvard.edu/healthy/getting/overcoming/tips 
               5.    Guided imagery: search YouTube for various guided imagery for sleep exercises. They are not all of equal quality or effectiveness, so check out several to see which may be helpful for you.
               6.    www.marc.ucla.edu click on the link for Free Guided Meditations, on which you will find several mindfulness meditation audio files, one of which is a body scan meditation for sleep
          ii.    Anemia – if your medical provider has tested and discovered anemia, they will advise you on how to treat this. 
          iii.    Depression/anxiety – medications, individual psychotherapy
          iv.    Hormone changes (e.g. menopause); your medical provider will advise you on how to address this. 
          v.    Pain: this is tricky, as the pain itself interferes with cognition, but medications to treat pain can also interfere with cognition. Finding an appropriate balance is tricky, but important. Consider treating pain not just with medication, but also with behavioral strategies. Much has been written recently about the benefits of meditation (such as mindfulness meditation) for chronic pain management (research has been not just related to cancer/chemo, but especially related to conditions such as Fibromyalgia) (find information about mindfulness and pain management through links/websites elsewhere in this outline). Also see the information on Pacing, below. 
     c.    Cognitive exercises
           i.    Cognitive rehabilitation, such as with a speech therapist: a formalized approach to learning and practicing specific exercises for strengthening memory and other cognitive abilities. Obtaining speech therapy for cognitive rehabilitation usually requires an order or prescription from your family doctor or other medical provider. 
           ii.    Meditation for improving cognition (Biegler et al 2009).  (see section on meditation below). 
     d.    Learning to adapt and cope
           i.    Tracking and understanding what influences memory problems
               1.    i.e. if concentration/memory worsen when hungry, be more purposeful about eating regularly, or doing more mentally demanding tasks shortly after eating
               2.    If concentration/memory issues worsen when tired, schedule/plan to do more demanding tasks at times when energy is typically highest
          ii.    Compensatory strategies
               1.    Taking notes
               2.    Organization
               3.    Routines
               4.    Using calendar more
               5.    Using reminders/alarms on a phone or other device
               6.    Take frequent breaks – Pacing!
                    a.    A good overview/strategy for pacing (meant for fibromyalgia, but applies to any condition involving chronic fatigue and chronic pain issues) http://www.med.umich.edu/painresearch/patients/Pacing.pdf 
                    b.    If cognition, and particularly mental fatigue is a problem for us, we need to consider pacing not just for physical tasks, but also for mentally demanding tasks and situations (as well as for emotionally taxing tasks and situations). 
               7.    Reducing distractions/multitasking
               8.    Work accommodations (adjustments to environment and/or work demands)
          iii. Memorization strategies
               1.    Association
               2.    Visual imagery
               3.    Appointments/tasks: Elaborative encoding/adding meaning
               4.    Information or lists of things: Method of loci (aka Memory Palace) https://www.youtube.com/watch?v=s2zUIw1ESbE (YouTube video on Method of Loci/Memory Palace, by aceblade – a quick 6:45 minute intro to using this strategy)
               5.    Names: https://www.youtube.com/watch?v=m2GI0huaV5s 
(Ronnie White – “How to Memorize/How to Remember Names/Memory Speaker”)
          iv.    Stress relief strategies
               1.    Relaxation techniques
               2.    Guided imagery
               3.    (and other things listed elsewhere, like exercise and meditation)
     e.    Meditation
           i.    In almost any form, such as mindfulness meditation, yoga, or tai chi. This assists with stress management, but also evidence of cognitive benefits, and evidence of benefits for telomere length (meditation is good for our genes!) 
          ii.    Biegler et al 2009 – meditation is an important treatment for cancer-related cognitive dysfunction (evidence that it can help cognition and psychological effects of cancer and cancer treatments).
          iii.    Epel et al 2009 – meditation may promote cell longevity by decreasing stress hormones and oxidative stress, and by increasing hormones that may protect the telomere (telomere = the protective endcaps of our chromosomes). 
          iv.    MBSR – Mindfulness Based Stress Reduction – a formalized program of using mindfulness meditation for the purpose of managing stress 
          v.    Resources:
               1.    www.marc.ucla.edu - contains much, much information on mindfulness meditation – videos, podcasts, articles, etc. on the background research, how do learn it, how to practice it, and how to apply it for different purposes (such as for pain, sleep, mood, etc.)
               2.    www.palousemindfulness.com - All you need to learn and benefit from Mindfulness Based Stress Reduction
     f.    Medications
          i.    No medications have been approved specifically for Chemo brain, but others are used “off-label” 
          ii.    Methylphenidate (Concerta, Ritalin, etc.) used for ADHD
          iii.   Donepezil – for AD
          iv.   Modafinil (Provigil) sleep disorders
          v.    Memantine – memory/AD
     g.    Alternative medicine/Nutrition
          i.    Ginkgo – some promise, but more study needed
          ii.   Vitamin E – may be beneficial for brain cells, but more study is needed
          iii.  Anti-inflammatory interventions (Cui, Kong, and Zhang, 2012), such as an anti-inflammatory diet.
          iv.    Zuniga et al 2015 provides some indication that intake of fruits and vegetables is positively associated with cognitive control for more cognitively demanding tasks
          v.    I am sure there is much more to be included in this section, hopefully to be added in the future. 
     h.    Exercise – helps with stress, sleep, energy, memory, neuroplasticity, neurogenesis
          i.    Again, keep in mind the importance of pacing (see http://www.med.umich.edu/painresearch/patients/Pacing.pdf 
          ii.    What is meant by “exercise”?
               1.    Aerobic exercise – gets your heart rate up, but not too high; activity that warms you up, makes you breathe a little heavier, but you can still carry on a conversation
               2.    Such as walking, biking, swimming, elliptical, etc.
               3.    Ideal: 30 minutes a day, 5 days a week
               4.    As always "check with your doctor before starting a new exercise program", always being careful to engage in activities that will not exacerbate pre-existing conditions or put you at risk of injury. 
          iii.    Why?
               1.    Improves depression and facilitates neurogenesis (Ernst et al 2006). 
               2.    Reduces brain tissue loss in aging (Colcombe et al 2003). 
               3.    Neuroprotection, and brain growth (neurogenesis, neuroplasticity) through mechanisms such as increasing BDNF’s – brain derived neurotrophic factors (Cotman and Berchtold, 2002)
               4.    Mitochondrial biogenesis (Hood, 2009; Vina et al 2009) 
               5.    Reduced inflammation (Woods et al 2009)
               6.    And of course, well-documented improvements in learning, memory, sleep, and stress management.
     i.    Support – support groups and support from family and friends is of course extremely important for navigating the challenges and stresses of cancer and chemo related cognitive dysfunction. 


References

Mayo Clinic website: http://www.mayoclinic.org/diseases-conditions/chemo-brain/home/ovc-20170224 Retrieved 5/21/16.

MD Anderson website:  https://www.mdanderson.org/patients-family/diagnosis-treatment/emotional-physical-effects/chemobrain.html Retrieved 5/21/16.

Biegler, K. A., Alejandro Chaoul, M., & Cohen, L. (2009). Cancer, cognitive impairment, and meditation. Acta Oncologica, 48(1), 18–26. http://doi.org/10.1080/02841860802415535

Colcombe, S. J., Erickson, K. I., Raz, N., Webb, A. G., Cohen, N. J., McAuley, E., & Kramer, A. F. (2003). Aerobic Fitness Reduces Brain Tissue Loss in Aging Humans. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 58(2), M176–M180. http://doi.org/10.1093/gerona/58.2.M176

Cotman, C., & Berchtold, N. (2002). Exercise: a behavioral intervention to enhance brain health and plasticity. TRENDS in Neurosciences, 25(6), 295–301.

Cui, H., Kong, Y., & Zhang, H. (2012). Oxidative stress, mitochondrial dysfunction, and aging. Journal of Signal Transduction, 2012, 646354. http://doi.org/10.1155/2012/646354

Dávila, D., & Torres-Aleman, I. (2008). Neuronal death by oxidative stress involves activation of FOXO3 through a two-arm pathway that activates stress kinases and attenuates insulin-like growth factor I signaling. Molecular Biology of the Cell, 19(5), 2014–25. http://doi.org/10.1091/mbc.E07-08-0811

Epel, E. S., Blackburn, E. H., Lin, J., Dhabhar, F. S., Adler, N. E., Morrow, J. D., & Cawthon, R. M. (2004). Accelerated telomere shortening in response to life stress. Proceedings of the National Academy of Sciences of the United States of America, 101(49), 17312–5. http://doi.org/10.1073/pnas.0407162101

Epel, E., Daubenmier, J., Moskowitz, J. T., Folkman, S., & Blackburn, E. (2009). Can Meditation Slow Rate of Cellular Aging? Cognitive Stress, Mindfulness, and Telomeres. Annals of the New York Academy of Sciences, 1172(1), 34–53. http://doi.org/10.1111/j.1749-6632.2009.04414.x

Ernst, C., Olson, A., Pinel, J., & Lam, R. (2006). Antidepressant effects of exercise: evidence for an adult-neurogenesis hypothesis? Journal of Psychiatry. Retrieved from http://search.proquest.com/openview/0ab8ef4de3168b3aa059ccad3258505f/1?pq-origsite=gscholar

Evens, K., & Eschiti, V. (2009). Cognitive Effects of Cancer Treatment:“ Chemo Brain” Explained. Clinical Journal of Oncology Nursing. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=10921095&AN=48882221&h=3JgRcdTtsSxttdfLabaS96BOwjkN2hOZaZxl4TOaSYcvc5Gg%2FGqBAEu1uWlY7oH8%2BXqjld8SqWf%2B9jWcxO6Gsw%3D%3D&crl=c

Gordon, D., & Haut, M. W. (April/May 2014). Chemo Brain: Cognitive problems after cancer treatment are not imaginary. Neurology Now. Retrieved from: http://patients.aan.com/resources/neurologynow/index.cfm?event=home.articlePDF&id=ovid.com%3A%2Fbib%2Fovftdb%2F01222928-201410020-00013 on 6/12/2016. 

Ho, K. (2015). Insights into the mechanism of “chemobrain”: deriving a multi-factorial model of pathogenesis. Novel Oral Anticoagulants. Retrieved from http://www.amsj.org/wp-content/uploads/files/issue/amsj_v6_i1.pdf#page=26

Hood, D. (2009). Mechanisms of exercise-induced mitochondrial biogenesis in skeletal muscle This paper is one of a selection of papers published in this Special Issue, entitled 14th. Applied Physiology, Nutrition, and Metabolism. Retrieved from http://www.nrcresearchpress.com/doi/abs/10.1139/h09-045

Jim, H. S. L., Phillips, K. M., Chait, S., Faul, L. A., Popa, M. A., Lee, Y.-H., … Small, B. J. (2012). Meta-analysis of cognitive functioning in breast cancer survivors previously treated with standard-dose chemotherapy. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 30(29), 3578–87. http://doi.org/10.1200/JCO.2011.39.5640

Raffa, R. B. (2011). A proposed mechanism for chemotherapy-related cognitive impairment (’chemo-fog'). Journal of Clinical Pharmacy and Therapeutics, 36(3), 257–9. http://doi.org/10.1111/j.1365-2710.2010.01188.x

Viña, J., Gomez-Cabrera, M. C., Borras, C., Froio, T., Sanchis-Gomar, F., Martinez-Bello, V. E., & Pallardo, F. V. (2009). Mitochondrial biogenesis in exercise and in ageing. Advanced Drug Delivery Reviews, 61(14), 1369–1374. http://doi.org/10.1016/j.addr.2009.06.006

Woods, J., Vieira, V., & Keylock, K. (2009). Exercise, inflammation, and innate immunity. Immunology and Allergy Clinics of North. Retrieved from http://www.sciencedirect.com/science/article/pii/S0889856109000125

Wooldridge, J., Anderson, C., & Perry, M. (2001). Corticosteroids in Advanced Cancer. Oncology, 15(2), 225–236. Retrieved from http://www.cancernetwork.com/review-article/corticosteroids-advanced-cancer

Zuniga, K. E. ., Mackenzie, M. J. ., Roberts, S. A. ., Raine, L. B. ., Hillman, C. H. ., Kramer, A. F. ., & McAuley, E. . (2015). Relationship between fruit and vegetable intake and interference control in breast cancer survivors. European Journal of Nutrition, (May 2016). http://doi.org/10.1007/s00394-015-0973-3

Disclaimer: Information contained in this outline is intended for educational purposes only, and is not intended for the diagnosis or treatment of any individual, or to replace the services of a qualified medical professional. This information does not constitute medical advice. 





]]><![CDATA[Mindfulness exercise: picking the right weight.]]>Sat, 21 May 2016 19:04:18 GMThttp://www.neuropsychologyforyou.com/blog/mindfulness-exercise-picking-the-right-weightby matt bridgman
Have you ever tried a mindfulness meditation and accidentally fallen asleep? Or better, yet, tried a mindfulness exercise and became so frustrated with your mind wandering away that it was anything BUT relaxing? What do you do when it seems like "mindfulness meditation" is not working?
In a previous post I discussed three steps of mindfulness exercise:
Step 1: picking something to pay attention to,
Step 2: noticing your mind when it wanders away, and 
Step 3: shifting your attention back to what you picked.

Sometimes what you pick for step 1 (the "sidewalk", as we discussed it in the last post) has a big impact on the success (or failure) of your mindfulness practice. 

How do you pick what to pay attention to? You could pick almost anything. Let's call these mindfulness objects. 
(Ultimately, the goal of practicing mindfulness is not to just become good at "doing" mindfulness, but rather for mindfulness to become a way of "being". In this way, we end up being mindful in almost anything that we are doing - hopefully. In the meantime, however, as we are learning and cultivating this skill, how do we choose what to use for practice/exercise?)

One of the most common methods of practicing mindfulness is to pay attention to our breathing. A simple mindfulness exercise involves spending several minutes focusing on your breath, and everything about it: the sensation of our breathing, the sound of breathing, the smells, the movement of our body as we breath, etc. 

Other ideas for step 1 include the sensations associated with walking. Go for a slow stroll, and focus your attention on the sounds and other sensations associated with walking (such as the sensation of your feet against the floor). 

Mindfulness in the shower is popular: pay attention to the sensation of the water against your shoulders, the temperature of the water against your skin, the sounds of the shower, etc. Notice how your mind likes to wander away from the shower. Where does your mind like to go instead? Be careful not to judge your mind for wandering away (it is designed to wander to some degree), and then just gently guide your attention back to the present moment in the shower. 

Mindfulness with your morning coffee (or any other food/beverage) is another idea.

One of my own recent experiences: I have two office locations, and on Wednesdays I spend the morning at one, and the afternoon at the other. One particular Wednesday recently I was rushing through lunch and packing my bags as I was running late to get across town. Before I knew it I had eaten half of a really good brownie without even realizing it. I failed to enjoy half of that brownie. At that moment I chose to practice mindfulness with the remaining half of that brownie; I sat down and paid 100% attention to my remaining bites of brownie, and I enjoyed it thoroughly. Mindfulness with food can be a very enjoyable way of practicing.

I like mindfulness with food, and mindfulness with breathing. However, you may not find these exercises enjoyable or helpful. What works for me for step 1 will not necessarily work as well, or in the same way for you. For starters, find something enjoyable. 

If mindfulness meditation is like exercise for your brain, then the objects of your attention are like dumbbells, which can vary in weight.

Different mindfulness objects will be light weights, while others will be heavy weights. Mindfulness objects that are very enjoyable or exciting are naturally easier to pay attention to. Mindfulness practice with these objects is easier.

For example, video games as a mindfulness object for a 10 year old boy is a very light weight (or better yet a helium ballon, haha). His mind doesn't easily wander away from the video games. Therefore, practicing mindfulness with a video game is not really strengthening attention. It is too easy and will not be very effective for strengthening the skill of mindfulness.

In contrast, for that same 10 year old boy, to sit still and pay attention to  his breathing would be VERY difficult. This would be challenging because this is very BORING. Breathing, then, for this 10 y.o. boy, is a very heavy weight - a very challenging mindfulness object. We might then think that this would be much more effective in strengthening his skill of mindfulness. However, for this particular kid, this weight might actually be too heavy (at least initially). 

It is possible to practice mindfulness with objects that are either too light (like the video games, or anything that is very enjoyable, interesting, or exciting), or too heavy (too boring). Both of these will be rather unhelpful, or even discouraging. It is very important to find mindfulness objects that are lighter, but not too light, and then slowly challenge ourselves with heavier and heavier objects over time. 

We might consider creating for ourselves a mindfulness object hierarchy. For myself, this might look like the following (from lightest/easiest to heaviest/most difficult):
1. video games or a really good television show
2. playing any type of sport 
3. playing the drums
4. reading something interesting 
5. food (coffee, ice cream, brownies, fruit, etc.)
6. listening to an interesting lecture
7. listening to a not-so-interesting lecture
8. reading something not-so interesting
9. taking a shower
10. breathing and/or muscle relaxation

Now, other factors can interfere with how difficult it is to practice mindfulness with each of these things. For example, when I have slept well the night before, practicing with #6 goes fairly well. If I stayed up late and then didn't sleep well, then practicing with #6 may not go so well. When life is busier, or more stressful, #4 may feel more like #8. If you notice that mindfulness is more difficult some days than others, or some times of day compared to other times of day, don't worry - that is normal. 

Vary the objects of your mindfulness practice depending on the day, time, stress level, or just how you are feeling in the moment. In this way, you can find the right level of mindfulness exercise in order to get in a good workout without working too hard and becoming frustrated. 

What does a successful practice look like?
Our goal in this cannot be to ever stop our mind from wandering.  The mind likes to wander and a wandering mind does have some benefits. Instead, consider success to be: improvement in our ability to catch our mind more quickly when it does wander away, and to more easily shift it back to whatever is most important in the moment (the mindfulness object). 

Give it a try. Create a mindfulness object hierarchy for yourself (your own set of weights). Pick one of the lighter weights/objects to get started. Now that you have completed step one, keep going with steps 2 and 3 (see the three steps at the beginning of this post). Oh yes, and keep in mind the "non-judgmental attitude" that I referred to in the previous post. 
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