Sunday, March 3, 2013
Tuesday, February 19, 2013
Crying among Older Adults
There is a hint of disgrace associated with crying,
especially among older men. The stigma
is not surprising since most scientific studies attempt to associate crying
with depression. In fact, among older adults, depression is often not related
to feeling sad. What emerges is that we
know very little about crying. Not only is there no clear-cut association that
crying is a sign of depression, there are also very few studies reporting the
opposite—that crying has healing benefits, when crying is not a response to pain or anger.
A popular view is that crying can have a positive
psychological as well as a physical benefit, a view shared in popular
literature. In a review of 140 years of popular fiction, crying is promoted not
only as beneficial, but most warned readers that keeping back tears would harm
them. Even Hollywood knows this and makes money selling us tearjerkers.
Lauren Bylsma now with the University of Pittsburgh, and her
colleagues reported that when 4000 men and women in more than 30 countries were
asked about crying, most people—in retrospect—reported improved mood, reduced
tension and feelings of relief after crying. But this report of benefits from
crying is not repeated in a laboratory setting,. When adults are made to cry in
response to a sad film, report feeling worse—increased sadness and distress—than
those who did not cry. Of course it could be a matter of timing. Using another
example, people are more likely to report being relaxed an hour after jogging
than immediately after. And the same might be the case with crying. There might
be a time lag in reporting positive effects from crying.
And what about gender differences? Women cry more often and
more intensely than men, although both report equal benefits. Interestingly
what researchers have found is that people who suffer from alexithymia—the lack
of understanding of emotions—reported fewer episodes of crying and reported
less positive mood benefits as a result of crying.
What is missing from these analyses is the fact that crying
can be a social behavior. Many of us cry, some privately and infrequently, others
more consistently and publicly. In some
cultures there are criers who are paid to cry at funerals. There is a social
context as well as a psychological one. Crying is also a learned behavior. Men
are taught not to cry from an early age, while women elicit support and
compassion when they cry. Social crying might be a
form of social behavior in order to elicit empathy from others. And the cues of crying are so
strong that even dogs express empathy when strangers are crying.
Crying among older adults is complex. There is evidence of
benefits but it depends on who you are. If you are a happy person you gain more
from crying than if you are a sad person, if you empathize you are more likely to benefit. There is also a positive social
component to crying that women might have been exposed to more than men. The benefits of crying might reflect more who you are than what you are emotional about.
Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and can be reached at mariusgarrett@yahoo.com
Monday, November 26, 2012
We are all Becoming Demented
For the first time since 1984 there is a new
clinical diagnostic criteria for Alzheimer's disease dementia. Published
in April 19, 2011 in Alzheimer's & Dementia: The National Institute on
Aging working with the Alzheimer's Association have expanded what we now
consider dementia.
While the previous guidelines only
recognized one stage—Alzheimer’s dementia—the new guidelines propose that
Alzheimer’s disease progresses on a continuum with three stages—an early,
preclinical stage with no symptoms; a middle stage of mild cognitive impairment
(MCI); and a final stage of Alzheimer’s dementia.
These new guidelines forge a solid causal link. What
was before just a probability of association is now seen as a causal
progression from changes in the brain that have no symptoms, to
mild problems with thinking and memory and ending with dementia.
What made this possible is the introduction of
new tests that can measure the health of the brain while the person is still
alive. In the past, the only way to get a definitive prognosis of dementia was through
an autopsy. Nowadays, especially with functional magnetic resonance imagery,
the use of biomarkers makes it possible to measure changes in the brain before
any symptoms appear, hence the new guidelines.
This ushers in a new era of fatalism. Unintentionally, these new guidelines are stoking the fear of dementia. A MetLife Foundation study in 2010 reported that people over 55 dread getting Alzheimer’s more than any other disease--other then cancer. These new guidelines raises our sensitivity to subtler decline in thinking and memory. However it is important to stress that this linear connection is not as clear-cut as neuroscientists would have us admit.
This ushers in a new era of fatalism. Unintentionally, these new guidelines are stoking the fear of dementia. A MetLife Foundation study in 2010 reported that people over 55 dread getting Alzheimer’s more than any other disease--other then cancer. These new guidelines raises our sensitivity to subtler decline in thinking and memory. However it is important to stress that this linear connection is not as clear-cut as neuroscientists would have us admit.
MCI indicate difficulty
with memory and thinking that are not normal but still allow the individual to
function independently. Many--but not all--people with MCI progress to
Alzheimer’s dementia. However there are some important causes of MCI other than
dementia--which the guidelines do not address--including medications, stroke or depression.
There are other inconsistencies in the logic of this causal path. As far back as thirty years ago M Marcel Mesulam with Northwestern University, reported 6 patients with progressive word-finding and naming difficulties that worsened over the years, but who did not develop a more generalized dementia. Even if the connection between MCI and dementia is established, Mike Martin and his colleagues from Zurich, reported the results from their meta-analysis and concluded that cognitive interventions do lead to modest performance gains with older adults.
There are other inconsistencies in the logic of this causal path. As far back as thirty years ago M Marcel Mesulam with Northwestern University, reported 6 patients with progressive word-finding and naming difficulties that worsened over the years, but who did not develop a more generalized dementia. Even if the connection between MCI and dementia is established, Mike Martin and his colleagues from Zurich, reported the results from their meta-analysis and concluded that cognitive interventions do lead to modest performance gains with older adults.
Even if the brain starts has the neuropathology it does not dictate the behavior. In the famous "Nuns Study" David
Snowdon first reported this very strange anomaly. He found that a third of the
nuns who behaved and acted free from dementia, were found to have the disease of
Alzheimer’s during autopsy. Numerous studies have also found this lack of
correlation between the disease and the behavior. More recently, Archana Balasubramanian with
colleagues at UCLA reported that for 58 individuals, 90 years and
older--who did not have any signs of dementia during three years prior to their
death--at autopsy had evidence of the disease of dementia. All these studies erode
the direct linear link between the disease and the behavior. There seems to be other
mediating factors that the NIA guidelines need to address.
Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and can be reached at mariusgarrett@yahoo.com
Sunday, November 25, 2012
Smell and Dementia
The sense of smell is accomplished through our
olfactory system, which is an old system in our biological development. It is
also one of the most evocative.
Smell acts as a portal to our emotions. It transports us directly to another time, another place and the only other medium that does this so quickly is the auditory sense--through music. But unlike music-- which can be written down and transferred in what Karl Popper calls World 3--smell is ephemeral.
Smell is somewhat undefined. Good, bad, sweet, acrid, then we loose track of translating the subtle smells into language. Smell has its own language and it cannot comfortably be translated into words.
Smell has power, it is evocative and nuanced so that a particular smell can immediately transport us to our first kiss, or the fear of high school, or your first child being born. Visceral and strong emotions which are hidden in the recesses of your mind. Never lost but subdued until dementia starts to erase them.
Smell acts as a portal to our emotions. It transports us directly to another time, another place and the only other medium that does this so quickly is the auditory sense--through music. But unlike music-- which can be written down and transferred in what Karl Popper calls World 3--smell is ephemeral.
Smell is somewhat undefined. Good, bad, sweet, acrid, then we loose track of translating the subtle smells into language. Smell has its own language and it cannot comfortably be translated into words.
Smell has power, it is evocative and nuanced so that a particular smell can immediately transport us to our first kiss, or the fear of high school, or your first child being born. Visceral and strong emotions which are hidden in the recesses of your mind. Never lost but subdued until dementia starts to erase them.
The olfactory system has a direct path to the brain. With
humans, this system starts with the nose and ends a short distance away at the base of our
brain. Olfactory receptors, with very thin fibers, run from the roof of the nasal cavity through
perforations in the skull ending in the olfactory bulbs, which are a pair of
swellings underneath the frontal lobes. It is the only sense that has such a
direct physical connection to the brain. It is is also the first to be
affected with the onset of dementia or Alzheimer’s. When the brain is affected by dementia, the area that deteriorates first is the area that
is responsible for smell.
There is currently a patent, by researchers from
Columbia University lead by Davangere Devanand, for a test using scents
that include cheese, clove, fruit punch, leather, lemon, lilac, lime, menthol,
orange, pineapple, smoke and strawberry. Using this test, the clinicians can
predict that an individual who cannot recognize three of the ten scents are
five times more likely to develop Alzheimer’s. It has also been found to
predict Parkinson’s disease as well as certain types of schizophrenia and brain
tumors.
Many people who lose their sense of smell also complain that
they lose their sense of taste. Smell enhances the information we get from the
mouth; salty, sweet, sour, and bitter tastes. Loss of taste might explain why
weight loss is also an indication of dementia. It is not the weight loss on its
own, but rather the loss of smell, which brings about the loss of appetite and
consequently to diminished appetite.
There are some sixty seven medical conditions identified
as possibly causing loss of smell--dementia being one of them. Some of these causes are temporary, such as colds, and nasal allergies such as hay fever. It may also occur due to some medications and
localized nasal polyps and tumors. Such factors reduces the odds of making the patent smell test a very reliable indicator in predicting dementia. But for individuals, it is important to notice changes in how well we can smell. So
if you are having trouble with smell, check with your physician first to make
sure that this is not a temporary condition.
Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and can be reached at mariusgarrett@yahoo.com
Saturday, September 1, 2012
Super Brains and Dementia
We have a lot of evidence showing that the older you get the
more problems we start having with our brains. In healthy adults they tend to
shrink, and then they become prone to diseases, not excluding our nemesis of
Alzheimer’s disease. We always assumed that these changes are fixed. But then how do we explain exceptional older
adults.
Exceptional adults are examples of what is possible, and not
what is statistically likely.
When Emily Rogalski from Northwestern University looked at
two groups of Chicago-area older adults of 80 years and older with similar
education--12 who had exceptional memory, and ten normal older adults--she was
not ready for the findings. Her study
reported that the exceptional group not only had sharp memories--as sharp as
people 20 to 30 years younger--but she also found that their brains appear
younger. When compared to 50 to 65 year
olds, these exceptional older adults had a thicker outer layer of the brain
important for memory, attention and other thinking abilities. While in another
region deep in the brain, they had thicker anterior cingulate--which is
responsible for attention. Not only was there no shrinkage, these exceptional older
adults show youthful brains.
Henrikje van Andel-Schipper was the oldest woman in the
world when she died at age 115 in 2005. After Gert Holstege, from Groningen
University, undertook a post-mortem of her brain he found few signs of
Alzheimer's or other diseases. It seems that these exceptional people have
escaped the normal effects of aging.
Jessica Evert from Ohio State University and her colleagues
support this view. When examining death from heart disease, nonskin cancer, and
stroke, 87% of male and 83% of female centenarians that they studied delayed or
escaped these diseases.
If we apply the concept of escapers to the brain, then we
can say that exceptional older adults escape from damaging their brain. As far-fetched as this might seem, researchers
are now focusing on studying how we might be developing the brain in
detrimental ways. Known as negative plasticity—by
not exercising the brain, learning things the wrong way and responding to stress—could be causing the brain to shrink and develop inefficiently.
Although brain shrinkage is related to aging, we now know it
is not fixed and invariable. If the brain shrinks because of trauma that we
impose upon it, then we need to start taking better care of our brain. The
brain likes to be challenged, to be happy, stress free, fed well and exercised--just like a precious teen.
Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and can be reached at mariusgarrett@yahoo.com
Highway Brain and the Earthquake Dementia
Our brain changes as we grow older. Changes dictated by the
slow shrinking of the brain, creating a widening of the pockets inside the
brain. And there are also changes in parts of the brain used for certain tasks.
We are learning more about these changes because of a new
technique of seeing into the brain called functional Magnetic Resonance
Imaging. The functional part is that we can have people perform an activity
while we watch their brain’s activity.
On the whole we witness variable results when we compare
older and younger adults. Sometimes there is less activation among older
adults, sometimes more activation, and invariable older and younger adults
differ in which parts of the brain they use while undergoing the same activity
(eg reading.)
The brain is a wonderfully clever but lazy organ. It works
as hard as it has to and nothing more. Which is why sometimes it is hard to
learn, because we have to persuade it that it has to. Like any precocious
teenager, they will do enough to get by. The brain is like that teen.
David Snowdon studies 678 nuns—Catholic members of the
School Sisters of Notre Dame—who are 75 to 106 years of age. The nuns undergo
extensive testing and when they die, his team examines their brain. It was
Snowdon who first reported a very strange anomaly. He found that a third of the
nuns who for all intents and purposes acted normally throughout their life,
when they performed the autopsy, they found that their brain had the disease of
Alzheimer’s. This finding has since been found in other populations, notably in
Sweden where otherwise healthy and competent older adults were found to have
diseased brains.
The quick answer to this finding is that some people have
“cognitive reserve”. Basically they have more brains and so they can afford to
loose some to the disease. But this does
not explain why certain occupations—academic, research, engineering and art,
occupations that develop your brain—do not protect you from dementia. It seems
that the reserve is not just in size but that the reserve need to be in
quality—how you develop and grow your brain.
Like a precocious teen, the brain knows of ways of escaping
from its many duties. Doing things that we take for granted—like reading for
example—the brain develops an interstate of neural pathways that makes it easy
for it to accomplish that repetitive task.
What seems to work is when we trick our brain in developing new
pathways.
In a 21-year study of older adults, 75 years and older,
Robert Katzman and Joe Verghese, found that mental activities like reading
books, writing for pleasure, doing crossword puzzles, playing cards as well as
playing golf, swimming, bicycling, dancing, walking for exercise and doing
housework did not offer any protection against dementia with some important
exceptions: frequent dancing, playing an
instrument and playing board games.
Creating new pathways is what works. When disease interferes
with the flow of traffic, then having alternate pathways helps divert traffic.
This is what seems to be happening and why it is not just the size of the brain
but the networks that we develop that protect us from dementia.
Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and can be reached at mariusgarrett@yahoo.com
Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and can be reached at mariusgarrett@yahoo.com
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