Yet cognitive symptoms are quite common. “[They] are actually significantly prominent in depression,” said Deborah Serani, Psy.D, a clinical psychologist and author of the book Living with Depression.

And these symptoms are incredibly debilitating. “In my opinion, when cognitive symptoms of depression hit, they are more of a pressing concern than physical symptoms.”

Cognitive symptoms can interfere with all areas of a person’s life, including work, school and their relationships. Problem-solving and higher thinking, according to Serani, are greatly diminished. “This can leave a person feeling helpless and without a plan of action to defeat depression.”

Poor concentration can cause problems with communication, and indecisiveness may strain relationships, according to William Marchand, M.D., a clinical associate professor of psychiatry at the University of Utah School of Medicine and author of the book Depression and Bipolar Disorder: Your Guide to Recovery.

The cognitive symptoms of depression also may get confused with other conditions, complicating diagnosis. Here’s a specific list of symptoms along with similar disorders.

Cognitive Symptoms of Depression

“Cognitive symptoms can be subtle and often go unrecognized,” according to Dr. Marchand. Fortunately, psychotherapy can help individuals become more aware of these symptoms, such as distorted thinking, he said.

Marchand and Serani shared these cognitive symptoms of depression:

• Negative or distorted thinking
• Difficulty concentrating
• Distractibility
• Forgetfulness
• Reduced reaction time
• Memory loss
• Indecisiveness

Disorders That Mimic Depression

“The cognitive aspects of depression usually involve a person’s thinking being sluggish, negative or distorted in quality,” Serani said. However, there are many other disorders that share these similar symptoms, because they, too, inhibit cognitive function. Unfortunately, this means that the “risk for misdiagnosis is high,” she said.

For instance, Serani mentioned attention deficit hyperactivity disorder (the inattentive type), post-traumatic stress disorder and substance abuse.

Co-occurring disorders can add to the confusion. “In many cases there are comorbid conditions such as dementia (in elderly individuals), adult ADHD and generalized anxiety disorder, and it can be difficult to sort out which condition is causing the cognitive symptoms,” Marchand said.

It’s critical to receive a proper and comprehensive evaluation to make sure that you have depression or another condition. Again, psychotherapy and medication can improve cognitive symptoms along with other symptoms of depression. Also, there are many strategies you can try on your own to reduce symptoms and feel better (which are explored in another article).

This is a fascinating book for those who want to think about and remember more useful information. It combines some common-sense advice with the author’s experience in the field of cognitive science. While I didn’t find every point helpful, there is much to like.

According to Markman, smart thinking is “the ability to solve problems using what you already know.” That sounds simple, but the book explains how we can put better information into our brains and then get better at recalling that information. As a result, we become better thinkers. That’s an appealing idea.

Markman’s formula goes something like this: We should develop a habit of acquiring high-quality knowledge which we then apply to problem solving. It doesn’t seem to be the author’s intent to present startling new methods, but rather to use his knowledge of how the mind works to give us basic ideas to improve our thinking. This can mean thinking outside the box, which is hardly a new approach. Or, applying what we know from one field to a totally different one to arrive at a solution.

Markman spends a chapter or more on the topic of habits. He suggests that if we develop good learning habits, we make it easier for our brain to think. This in turn relieves mental stress and preserves energy for more challenging tasks. We likely haven’t thought a lot about how much energy we use in thinking, but Markman wants us to understand that we use mental energy in much the way we consume physical energy. When we are in our comfort, or habitual, zones of working with familiar subjects, thinking seems to come easily and without much stress. So, he posits, our goal should be to make more subjects familiar ones.

For instance, are you able to move about a room in the dark? If so, that’s because you have made it a habit to maneuver around furniture and other objects by making a connection between an action (your movement) and an environment (the room). When we make that connection in other learning situations such as a classroom or meeting room, it helps our brain to retain the information.

That example works well. But much of Markman’s discussion of other types of habits, such as smoking or overeating, is belabored. They aren’t bad suggestions; it’s just that we have read these ideas in many places before. Still, a helpful tip from the book is that if we want to change or drop a negative habit it works better if we replace that habit with a good habit. Markman adds that keeping a diary can be effective for some people.

I felt the most helpful and interesting discussion was on the subject of memory. Markman suggests that because our memory has capacity limits, it is important to take in information in a smarter way in order to retain more valuable knowledge. He uses a concept called the “Role of 3” to make his point. Even though there may be a lot going on around us, we are capable of absorbing only about three aspects at a time. Further, what we retain in long-term memory is even less detailed. For example, can you remember an early childhood birthday? Being honest, you may recall that there was a party that likely was in a home you recall and likely included certain friends. But you can’t recall much detail with certainty, including how you felt about it. Markman’s bottom line is that if you are having trouble remembering something, you did something wrong on the intake end.

Being aware of the Role of 3 can also be used to our advantage when we are delivering information, as we might in making a presentation or while teaching. We may want to tell our audience or colleagues everything we know, but this could result in their retaining the less important information. It’s better to stick to three main points. In fact, the author repeats common speakers’ advice: Tell them what you are going to say; say it; then tell them what you said.

Markman also says that we miss much of what is right in front of us. He calls it “change blindness,” explaining that although our eyes may be constantly scanning our surroundings, we only notice a small part of what we are scanning. We see examples of this when witnesses to a crime have difficulty describing the perpetrator with much detail, or describing accurately.

The book also claims that it is easier for us to learn new information that is related to something we already know than when it is a totally new topic for us. We can accept this as likely and use this to make us work harder when we are in new learning territory.

Why do we even want to become smart thinkers in the first place? Why not! It can help us in school at any level; in work and careers; and in social interaction. In showing us why we think the way we do, Markman’s book is a useful one, even if not every point is fresh. And if some of his suggestions seem to take too much effort or seem too challenging, we can still learn how to be more alert to what we absorb—and hopefully become more interesting people as a result.

Smart Thinking: Three Essential Keys to Solve Problems, Innovate, and Get Things Done
Perigee, Penguin Group, December, 2012
Paperback, 272 pages
$15

“I really enjoyed playing with the idea of ‘who are we without our memories’? Do you make the same choices? Do the same things make you happy?” – Allison Winn Scotch

Imagine waking up one day without your memory. Your history is depleted, and the only stories that you hear about yourself and your past are strung together from others’ perceptions. How do you even begin to maneuver your way through that kind of maze? Allison Winn Scotch’s well-written novel, “The Song Remains The Same” explores those complexities, along with the significance of confronting where you came from.

Nell Slattery survives a tragic plane crash and awakes in the hospital with amnesia as a result. Her memory loss could be due to critical brain damage, or to her brain shutting down from the severe trauma, likened to a protective shield of sorts. Nell’s now on a quest to find out who she is and seek out the missing pieces of her life, without a foundation that she can remember and draw upon.

Before the accident, her marriage was treading on thin ice and layers of emotional pain were present within. She was 13 when her father died; he was a renowned artist who struggled with his mental health, ultimately becoming a recluse. With so many voices in her ear (including her mother, sister, husband and friends) about various events and relationships, Nell must sift through the information and uncover the real version of the truth.

“The book shifts perspective a few times so the reader can see just how unreliable her friends’ and family’s perspective is,” Scotch said in a 2012 interview on Rosie Molinary’s blog site. “You realize (I hope) that no one is malicious or has malicious intent, they’re just all trying to muck their way through a terrible situation.”

One of my favorite excerpts stems from the heart of Nell’s road to discovery. “Maybe I have gotten a hell of a lot better, and I’ve only been holding on to my amnesia because I’ve been working hard to avoid the alternative. The memories. The journey. But I am standing here now, strong, capable, and perhaps it’s time to accept where I’ve been, what I’ve gone through and what comes next.”

In the final stretches of The Song Remains The Same, it seems apparent that even before Nell lost her memory, she was so swallowed up and defined by her pain that she lost sight of what she was about. However, right before the crash, she had begun making particular choices to find a way back to herself, even if scars still remained. Furthermore, as she battles with amnesia, she learns new lessons as well, forgiveness topping the list.

The novel brings to the surface age-old questions, such as whether people can change. Based on descriptions from those around her, Nell doesn’t envision herself to be the person she was, but as she embraces a new, clean slate, she constantly wonders if people really can be different than who they were. Perhaps people will always hold onto their essence, while they continue to grow and evolve. Regardless of whichever camp you buy into, Nell is an introspective protagonist who will grab readers’ attention.

In addition, Scotch emphasizes the importance of the past. Nell is able to uphold a sense of emotional memory through listening to music (a favorite playlist was compiled that induced triggers or childhood recollections) and learning to free associate in therapy. Through these mechanisms, she’s able to hone in on intuition and conjure imagery that relays an honest portrayal of what previously occurred.

I find that the “live in the moment” motif is often preached, and while that’s valid and insightful, the past doesn’t cease to exist, for our histories are still relevant. It must be surreal to place yourself in Nell’s shoes (or someone like Nell in real life), who must press on without prior experiences, or wounds that aren’t understood.

When Rosie Molinary asked Scotch about her inspirations for this “fairly dark book,” she responded openly about what drives her storylines.

“There must be something about me that loves to examine the underbelly of what makes people tick – and what makes us both loyal and disloyal,” Scotch said. “Certainly in my own life, I’ve had experiences of betrayal – fortunately, nothing like what Nell has gone through – and I guess they must have stuck in my subconscious. Also, I always love exploring characters who go through something difficult and find a way to make it out the other side.”

The Song Remains The Same is absolutely worth your time; it showcases complex themes, while executing a thought-provoking narrative — Allison Winn Scotch knows what she’s doing.

Kindred fans of Sir Arthur Conan Doyle’s detective will find themselves deep inside the mind of their beloved protagonist.

Konnikova, a Harvard graduate, is also a doctoral candidate in psychology at Columbia University. She currently writes a column for Scientific American. In Mastermind, she provides a bounty of excerpts from Doyle’s stories along with her own analysis to illustrate the clever ways that Holmes approaches each mystery before him. Through examining Holmes’s thinking, she writes, we will learn “how to apply his methodology to our everyday lives, to be present and mindful and to treat each choice, each problem, each situation with the care it deserves.”

Throughout the book, Konnikova uses the terms “Holmesian” and “Watsonian” to describe two different ways of thinking. Whereas Watson — Holmes’s sidekick in Doyle’s stories — sees, Holmes observes. The former is naive, Konnikova tells us, while the latter is aspirational. Unlike Watson, Holmes pays attention to things that may have been right before Watson’s eyes but that he did not in fact realize because of his failure to look beyond the obvious. Because “our minds love nothing more than jumping to conclusions,” as Watson’s sometimes does, Konnikova says that the goal is to “move from passive absorption to active awareness.”

This transition we want to make from passive to active, the author states, is dependent on what Holmes calls our “brain attic” — its structure (how our minds work) and its contents (things we have absorbed from life, and our experiences). Holmes considers that “a man’s brain originally is like a little empty attic, and you have to stock it with such furniture as you choose.” And though we often think we know certain facts and not others, we can, through observation, imagination, creativity, and education, draw upon our attics when faced with any kind of situation, mystery or not. “At any given moment,” Konnikova explains, “you only think you know what you know. But what you really know is what you can recall.”

Konnikova tells us that mindfulness and meditation are fundamental to thoughtful deduction, which is accomplished through reflection, inhibiting your initial intuition, and editing it accordingly. By isolating facts that are crucial from those that are incidental, we can effectively deduce something, she says. As Holmes puts it, it such deduction is really just “systematized common sense.” This is essentially that last mental look around the attic, when we discover the fact we’re looking for. It’s easy to imagine Holmes having that aha! moment upon realizing he has solved the mystery.

Because Konnikova uses selections from Doyle’s Sherlock Holmes mysteries as the foundation for her book, she includes background information for those readers who are not familiar with the stories. At the end of each chapter of Mastermind, she provides the quotes from Holmes that she has used in that particular chapter, as well as the plot and specific location in the book from which they came. Whether you come to Mastermind with this background already or absorb it only through Konnikova, you might find yourself adapting the author’s terminology. If you’re a fan of TV crime dramas such as NCIS, Criminal Minds, SVU, or Elementary, you may start analyzing whether the show’s characters are using Watsonian or Holmesian thinking.

While reading Mastermind, I was reminded of another recent book: Shlomo Breznitz’s Maximum Brainpower. Specifically, the act of “satisfycing” caught my attention again—the term for when you stop looking for an answer upon arriving at one that is simply “good enough.” Like Breznitz, Konnikova posits that when we multitask, all of the various tasks we’re performing are not done to their full potential. But Konnikova has her own trove of tips worth reading.

“If you get only one thing out of this book, it should be this: the most powerful mind is the quiet mind,” she writes. Mastermind shows us that by quieting the mind, we are then freed to look through the attic’s contents in a way that is productive rather than haphazard. This method serves Holmes well, paving the way for him to correlate pieces of information that may have appeared at the outset to be unrelated, or that may never have been considered in the first place.

Konnikova does a splendid job of illuminating the importance of details and seemingly stray pieces of information. Although many readers of Mastermind may begin the book by finding that their thought process is more like Watson’s, they will come away with the tools to solve problems like Holmes.

Mastermind: How to Think Like Sherlock Holmes
Viking Adult, January, 2013
Hardcover: 288 pages
$26.95

As populations in low and middle-income countries are aging, rates of dementia are rising, say Dr. Robert Stewart of King’s College London, UK, and colleagues in the journal PLoS Medicine. Currently, more than 35 million people worldwide have dementia, the majority of which is Alzheimer’s disease. More than 115 million people may have dementia by the year 2050, with much of this rise occurring in low- and middle-income countries.

“Mild cognitive impairment is a construct frequently used to define groups of people who may be at risk of developing dementia,” explain Dr. Stewart and colleagues. “It can be seen as an intermediate state between normal cognitive aging and dementia.”

People with mild cognitive impairment have problems that are more severe than those normally seen in people of a similar age, such as misplacing things and forgetting appointments, but they have no other symptoms of dementia and are able to look after themselves. The condition is currently defined as “a syndrome with impairment of memory or another cognitive deficit that does not interfere substantially with personal affairs nor result in inability to live independently.”

Knowing a country’s rates of mild cognitive impairment is crucial for helping governments plan their future health care and social support needs, but the rates in low- and middle-income countries are largely unknown.

The research team analyzed survey findings on 15,376 people ages 65 years or older without dementia living in Cuba, Dominican Republic, Peru, Mexico, Venezuela, Puerto Rico, China, and India.

Mild cognitive impairment was associated with physical disability, anxiety, apathy, and irritability, but not depression. It was not linked to age or education. Men had a slightly higher rate of mild cognitive impairment than women. This finding contrasts with higher reported rates of dementia among women than to men, but could be explained by the exclusion of confirmed dementia cases. Experts from the Mayo Clinic, Rochester, Minn., say that women may move from normal cognition directly to dementia at a later age but more abruptly.

Rates of mild cognitive impairment varied more than five-fold between countries, from 0.8 percent in China to 4.3 percent in India, but the authors think this mainly reflect difference in the diagnostic tests used.

The authors conclude that mild cognitive impairment “was consistently associated with higher than expected disability and neuropsychiatric symptoms.” But they add that longer-term figures are needed to confirm the findings, in particular, to investigate the factors that may protect against progression to dementia.

“This is one of the first studies, to our knowledge, to investigate the prevalence of mild cognitive impairment with related memory problems in low- and middle-income countries, where the large majority of older people and people with dementia currently live,” they write.

They point out that the large numbers of individuals affected “will have significant implications with regard to social support and future health care costs, especially as systems are not in place to cope with increased neurodegenerative disease and health resources at present are already extremely limited.”

Findings such as these are helping “build an evidence base to inform the development and implementation of policies for improving the health and social welfare of older people in low- and middle-income countries.”

A review carried out in 2008 also found that mild cognitive impairment is associated with these symptoms, which the researchers believe are of “potential importance for defining subgroups at higher risk of developing dementia in the future.”

In the review, Liana G. Apostolova, MD, of the University of California-Los Angeles (UCLA), explains that “behavioral abnormalities may prove to be a valuable biomarker for impending dementia.” They looked at the published evidence and found that behavioral abnormalities are reported in 35 to 75 percent of mild cognitive impairment patients, with the most common being apathy, anxiety and irritability. In addition, the researchers found evidence of a link with depression.

“There is a compelling body of evidence that mild cognitive impairment patients with behavioral features are more prone to develop Alzheimer’s disease than patients without these features,” they write in the journal Dementia and Geriatric Cognitive Disorders.

“The behavioral changes observed in mild cognitive impairment are similar to those of Alzheimer’s disease, and may help identify the subgroup of mild cognitive impairment patients with early Alzheimer’s disease,” they conclude.

Some of the risk factors for mild cognitive impairment and dementia are: physical inactivity, infrequent participation in mentally or socially stimulating activities, high blood pressure, diabetes, and smoking.

References

Sosa, A. L. et al. Prevalence, Distribution, and Impact of Mild Cognitive Impairment in Latin America, China, and India: A 10/66 Population-Based Study. PLoS Medicine February 8, 2012 doi:10.1371/journal.pmed.1001170

Apostolova, L. G. and Cummings, J. L. Neuropsychiatric Manifestations in Mild Cognitive Impairment: A Systematic Review of the Literature. Dementia and Geriatric Cognitive Disorders Vol. 25, No. 2, February 2008, pp. 115-26. doi:10.1159/000112509

Breznitz, a renowned cognitive psychologist, is the founder of a method of brain training and development called Cognifit. Hemingway is a writer and technologist who has co-authored other books as well, most notably one with Microsoft’s late CEO, Bill Gates. Together, they show us the  role that experience plays in learning, as well as how it can set us up for cognitive failure.

While experience may very well be the best teacher in some cases, sometimes its very existence causes us to not even attempt to look for other perspectives or solutions, the authors state. They propose that much too often we use our brain as “nothing more than a huge storage bin of precedents.” This filing-cabinet approach results in our resorting to a process called “satisfycing,” which causes us to stop searching for solutions when we arrive at one that is “good enough.” We do this on a regular basis, especially with our daily routines. The speed at which satisfycing automaticity occurs leaves us with no opportunity to intervene and change the process. These “good enough” solutions, combined with inadequate or inconsistent reinforcement, lead to mental rigidity, which then causes our routines to become difficult to eliminate.

“Maximum Brainpower” touches upon many related topics, including Alzheimer’s disease, schizophrenia, dementia, cancer, depression, memory, education, experience, and technology. Perhaps most influential in our cognitive well-being, the authors tell us, is the role of stress. In itself, the process of stimulating our brains sometimes brings stress that falls into the beneficial category; a lack of stress can actually foster cognitive decline and rigidity (as in “good enough”). Research conducted by Breznitz demonstrates seven ways we typically deny stress and convince ourselves that it’s unnecessary to worry about its underlying cause. The authors challenge the reader to think about which of these behaviors they see in themselves:

• Denial of personal involvement (“It cannot happen to me.”)
• Denial of urgency (“It can happen, but not for a long time.”)
• Denial of vulnerability (“If and when it does happen, I can cope with it.”)
• Denial of anxiety itself (“I know something is happening, but I am not worried.”)
• Denial of emotion (“I acknowledge my emotion, but I deny its source.”)
• Denial of threatening information (“I filter the information so that I do not perceive any threat.”)
• Denial of all information (“When presented with the truth, I deny it exists.”)

This denial of stress, Breznitz and Hemmingway say, reveals how our brains can know something and not know it simultaneously—something referred to as “middle knowledge.” We can be aware of a suitable amount of information that causes us to put up our defenses, without even consciously being aware of doing so. The authors provide new approaches to take us out of the comfort zone of our routines and help us view the world in new ways, think differently, and build the brain.

While I was reading “Maximum Brainpower,” a news story aired on ABC World News that illustrated how we sometimes accept as truth that which we may never have investigated for validity—again, “good enough.” According to the news story, 47 percent of teachers and 66 percent of Americans believe we use only 10 percent of our brains. I am sure you recognize that “fact” just as I did. The truth is that we use 100 percent of our brains, but that the neuronal cells we don’t use, die, as in the adage “use it or lose it.” Breznitz and Hemmingway put it this way: “Neurons that fire together, wire together; neurons that fire apart, wire apart.”

While you could just go right to the end of each chapter for a summary of the book’s contents, doing so would cause you to skip an abundance of fascinating research and subsequent conclusions. Don’t “satisfyce”—instead, read the whole thing. It will be a no-risk investment with significant returns.

Maximum Brainpower: Challenging the Brain for Health and Wisdom
Ballantine Books, June, 2012
Hardcover, 288 pages
$27 

As heart failure has been linked to depression and cognitive impairment, Professor Osvaldo Almeida of the University of Western Australia, and colleagues investigated whether this is specifically due to the heart failure itself, or one of its causal factors.

They analysed data on 35 heart failure patients, 56 ischemic heart disease patients without heart failure, and 64 healthy people with neither condition. All were aged 45 years or above and had no obvious cognitive impairment. Magnetic resonance imaging (MRI) scans of the participants’ brains were assessed.

This is the first study of cognitive changes in heart failure to include patients with ischemic heart disease.

Participants with heart failure had a lower volume of grey matter in many areas of the brain than the other two groups. These patients also had lower scores on short- and long-term memory, had longer reaction speeds, and took longer to complete a reasoning task.

Professor Almeida explains, “What we found in this study is that both ischemic heart disease and heart failure are associated with a loss of cells in certain brain regions that are important for the modulation of emotions and mental activity. Such a loss is more pronounced in people with heart failure. Health professionals and patients need to be aware that problems caused by heart disease are not limited to the heart.”

In their paper, the researchers conclude, “Adults with heart failure have worse immediate and long-term memory and psychomotor speed than controls without ischemic heart disease.”

This could make it more difficult for patients to comply with complicated treatment regimes, they warn, stating, “Our findings are consistent with the possibility that patients with heart failure may have trouble following complex management strategies, and, therefore, treatment messages should be simple and clear.”

They add that further studies will have to be done to uncover the process by which heart failure leads to loss of brain cells, to see whether the problems become worse over time, and to discover whether patients could benefit from cognitive rehabilitation.

Natasha Stewart of the British Heart Foundation commented: “Heart failure can affect people in very different ways. More research is needed to confirm the effect on mental processes, so that treatment can be targeted to look after patients in the best possible way.

“The biggest implication of this research is that patients may find it difficult to stick to treatment regimes and forget to take their medication. It is important to speak to your doctor about what is best for you. Together you can find a way to make your meds a part of your daily routine so that they are less easily forgotten.”

Responding to the study, Dr. Christiane Angermann and colleagues at the University of Wurzburg, Germany, say that links between cardiovascular disease and dementia have been observed for decades. In fact, the label “cardiogenic dementia” was first used in 1977.

Smaller studies on humans have investigated the issue, with inconsistent results. A few animal studies have also been carried out, and these studies showed changes to the brain after a heart attack.

Another potential cognitive problem among heart failure patients is an inability to decide what to do if their condition changes. For example, a patient who has a cognitive problem and experiences sudden weight gain may not think to notify their physician. Their condition could worsen over time, resulting in an avoidable trip to the emergency room.

Richard S. Isaacson, MD, a neurologist at the University of Miami School of Medicine, recommends that patients bring a family member or caregiver to doctor appointments to help understand the treatment regime and the importance of taking medication consistently.

“People with heart failure are going to have trouble understanding because their thinking skills are not as strong as they used to be,” Isaacson says. “They often have multiple medical problems and difficulty understanding what they can do to help themselves.”

He supports the use of handouts to explain heart failure and its treatments, to help remind patients of what they need to do and why.

References

Cognitive and brain changes associated with ischaemic heart disease and heart failure. Almeida, O. P. et al. The European Heart Journal, February 1, 2012. doi:10.1093/eurheartj/ehr467

Cognition matters in cardiovascular disease and heart failure. Angermann, C. E., Frey, A.. and Ertl, G. The European Heart Journal May 29, 2012 doi:10.1093/eurheartj/ehs128

If, in the world of a person with Alzheimer’s Disease or a related dementia (ADRD), she is 8 years old (not 80), and waiting for Mother to pick her up after school to go home and milk the cows, then that is the world to which care partners must travel. It doesn’t matter a bit that Mother died 50 years ago because that is not true in the reality where the person with dementia is living.

There are millions of people with ADRD living in the world today. Most of them are not being cared for using Habilitation Therapy, the comprehensive approach that the Alzheimer’s Association now considers to be a best practice. Instead, many dementia patients are cared for using the outdated but still widespread “Reality Therapy.” Someone using Reality Therapy would tell the person with dementia that she is 80, not 8, and that her mother died decades ago. Reality Therapy says that we must insist that the patient accept these facts in order to pull them back into our world.

Reality Therapy is logical and instinctual. The thinking is that things would be all right if only the person with dementia could get the facts straight. However, for Reality Therapy to work, people with dementia need to have fully functioning memories — which is exactly what they have lost. (Moore, 2010, Alzheimer’s Association, 2011, n.d., Snow, n.d.)

Tell a dementia patient that her mother has died, and one of two paths will unfold, both with the same outcome. Either she will deny that Mother is dead (“I just saw her this morning before school, and she was fine!”), or she will believe it to be true, grieving and in shock as she takes in the news for the first time. In either case, there will be high emotional turmoil. Soon, she will entirely forget the incident, though she will still carry with her a feeling of great upset. Later, she will again be 8 years old, waiting for Mother to pick her up after school. Repeated applications of Reality Therapy end no differently. This is why it is now considered ineffective and unintentionally cruel to all involved.

So what should care partners do instead? Habilitation Therapy gives the highest value to the emotional well-being of the person with dementia. (Alzheimer’s Association, n.d., p. 66) HT also leads us to ask: is it really a problem that sometimes this woman with ADRD believes sometimes that she is 8 years old and that her mother is just about to arrive? (Alzheimer’s Association, 2011) What if we didn’t try to correct these errors? Wouldn’t that allow care partners to help preserve her emotional well-being, dignity and calm?

Not attempting to drag the dementia patient out of their reality can be the most difficult aspect of Habilitation Therapy for many care partners. It requires them to knowingly accept what is not “true,” and sometimes even to actively tell lies — which in HT are called “therapeutic fiblets.” (Alzheimer’s Association, 2011, Moore, 2010) To do so goes against all training to always tell the truth — especially to one’s elders.

Do they really need to fib and let untruths stand unchallenged? Yes. Sometimes this is truly the wisest path. Fiblets are not told to mock the person with dementia, hurt their feelings, or exploit their weaknesses. Fiblets are best understood to honor what might be considered higher truths. These truths are that it is most vital to give any person with dementia a high-quality life where they are safe, comfortable, and can live with intact dignity and positive experiences. (Alzheimer’s Association, 2011) Being constantly corrected causes people with ADRD to feel disrespected, stupid, angry, confused, frustrated, sad and hurt. If challenging their mistaken ideas is both ineffective and destroys their dignity, then this habit needs to be stopped. (Snow, n.d.)

Typically important information about unmet needs is buried in dementia patients’ mistaken information. (Moore, 2010, Alzheimer’s Association, 2011) Take our example of the 80-year-old woman who believes she is 8 and waiting for her mother after school: She is making an important communication about how she feels and what she needs. This is information that, when decoded and used strategically, can help prevent difficult behaviors, and allow her to function at her best.

To decode this information, care partners need to know something about her life. In this example, it turns out that going home after school at age 8 to milk the cows made her feel she was fulfilling an important, grown-up function in her family. Connecting with and living in that time in her life may be the only way she can still communicate today how she feels and what she needs.

Care partners should consider this “meaningless” information to be an important metaphor for her life today. She might be saying, “I want to feel useful again,” “I am afraid I don’t have a purpose anymore,” or “I miss the feeling of working with others toward a common goal.” It could be that focusing her on simple, repetitive tasks around the house and praising her for her helpfulness would work toward satisfying these emotions. This is vital, because if care partners do not find safe and possible ways for unmet needs to be satisfied, the needs do not simply go away. Instead, they continually re-emerge and may eventually assert themselves with force in the form of anxiety, depression, withdrawal, rage, or other painful and difficult behaviors. (Snow, n.d.)

Therefore, an appropriate response in this example might be to tell the woman something like: “I got a phone call from your mother a little while ago, and she said she was going to be late. Why don’t we go and have a cup of tea and wait for her together? And you can tell me all about your life on the farm. Was it hard to learn how to milk?….” As a result, the woman gets to revisit and feel proud of her usefulness on the family farm. She is received by a caring listener, and can enjoy sharing a time that is still fairly clear in her memory. In the process, her troubled feelings may pass as her immediate emotional needs are met. It is likely that soon she will forget that she is 8, and waiting for her mother to arrive.

However, unless her ongoing needs for feeling purposeful are met, soon she will reconnect to that time in her history when she most felt useful. But if her care partners understand and use Habilitation Therapy, they will already know the drill. They can quickly decode what she is feeling, and move right into addressing her emotional needs. They will meet her in her world, and help her experience the kind of positive emotional state that lives at the very heart of Habilitation Therapy.

References

Alzheimer’s Association, Massachusetts/New Hampshire Chapter. (n.d.) Caring for People with Alzheimer’s Disease: A Habilitation Training Curriculum. Watertown, MA: Alzheimer’s Association.

Alzheimer’s Association, Massachusetts/New Hampshire Chapter. (August 2, 2011) Caring for People with Alzheimer’s Disease: A Habilitation Training Curriculum [Training Course]. Lawrence, MA: Alzheimer’s Association.

Alzheimer’s Association. (2011b). 2011 Alzheimer’s Disease Facts and Figures. Alzheimer’s & Dementia, Volume 7, Issue 2.

Moore, B. L. (2009) Matters of the Mind and the Heart: Meeting the Challenges of Alzheimer Care. New York: Strategic Book Publishing.

Moore, B. L. (November 20, 2010) StilMee™ Certification for Professionals: Working respectfully and effectively with people with Memory Loss [Training Course] Burlington, MA.

Snow, T. (n.d.) The Art of Caregiving. [Video] Florida: Pines Education Institute of Southwest Florida.

But that’s not necessarily true if someone has Alzheimer’s Disease — they may only see the white table. Though it is not widely recognized, it is a fact that people with several types of dementia (but especially Alzheimer’s Disease) experience significant changes in the way their brains take in and interpret visual information, generally unconnected to eye health and function. These changes follow several predictable patterns that powerfully influence the behavior of people with dementia.

In this, Part 3 of a series of articles on Habilitation Therapy (HT) for Alzheimer’s Disease and other dementias (ADRD), we focus on how this loss of function in the visual cortex of the brain helps us better understand a person with dementia. HT focuses on helping dementia patients function at the best of their still-present abilities, instead of trying to return lost functioning to them. (It is Rehabilitation Therapy that returns lost functioning; regaining former abilities is not known to be possible with ADRD.) (Alzheimer’s Association, 2011) Habilitation Therapy can be applied with enormous effectiveness to the difficulties that arise from these changes in visual processing.

In HT, care partners do their best to enter into the dementia patient’s reality, and to see the world through their eyes. (Alzheimer’s Association, n.d., p. 138) When it comes to vision and dementia, this is quite literal: we must understand visual processing changes to help the patient’s functioning and reduce or eliminate difficult behaviors.

Seven Types of Major Visual Changes

1. Inability to perceive dimensionality. People with Alzheimer’s Disease lose the ability to see and judge depth correctly. A light fixture flush with a nine-foot-high ceiling may seem to them to be reachable while standing on the floor, no stepstool needed. A stripe of black linoleum visible around the edges of a light carpet can be interpreted to be a bottomless pit they must not fall into.
2. Shrinking peripheral vision. By mid-disease, Alzheimer’s patients have the equivalent of tunnel vision. Occupational therapist and dementia expert Teepa Snow suggests we can experience how limited a view this is by using “binoculars” like a child would create with his or her hands. Do this by loosely circling fingers to make two tunnels through which to peer. By putting the circled fingers to our eyes like binoculars, we get a good estimation of this limited view; the field of vision is about 12” in diameter in all directions. (Snow, n.d.) This means the Alzheimer’s patient cannot see something unless it is directly in front of them at just about eye level.
3. High color contrast. Go back to the example at the beginning of this article: a clear glass filled with milk on a white table. Alzheimer’s patients need high contrast to discern one object from another. They may not notice a glass of milk on a table unless the table and milk are distinctly different colors – for example, chocolate milk on a white table would be easier to see.
4. Need for brighter lighting. Normal aging brings about the need for brighter lighting for most people. Enhanced lighting is even more imperative for people with Alzheimer’s. Dr. Paul Raia, one of the founders of HT, recommends significantly increasing the intensity of normal household lighting from 30-foot-candle power, to 60- or 70-foot-candle power. (Raia, 2011, p. 2)
5. Trouble with glare and shadows. “Sundowning” – the exacerbation of difficult behaviors as sunset approaches – is not well understood, but is not uncommon in dementia. One theory is that glare and lengthening shadows caused by the sun’s lower angle might be confusing to people with dementia. Pulling shades or curtains and providing steady, bright lighting for some people can be helpful to avoid or diminish such episodes. (Raia, 2011, p. 2)
6. Need for greater simplicity. Visual complexity can be difficult for the dementia patient to interpret. For example, multiple overlapping visual patterns can become a swirl of confusion. The same goes for the normal clutter in so many homes. Such visual “noise” makes it difficult for the dementia patient to organize their thinking and activities, thereby reducing their ability to function.
7. Right eye preference. In some types of dementia, the brain may stop or reduce processing information taken in by the left eye. This is why some dementia patients may, for example, say that they are hungry when the left side of their dinner plate still contains more food. (Snow, n.d.)

Knowing now about these significant changes people with dementia experience in their ability to see and understand what they see, it is easy to understand how they struggle to get through each day. There is much confusing or missing information about their immediate environment – information they previously had. Because their cognition and judgement also are damaged, it may be impossible to teach dementia patients strategies for operating with confused and diminished vision. Their resulting difficult behavior might be considered a fully normal reaction to a highly abnormal situation.

People with dementia cannot leave the reality they live in; care partners must join them there. Yet, most family and caregivers do not know about the profound and sweeping changes in visual perception that happen in people with dementia. Even though Alzheimer’s is the most commonly diagnosed type of dementia, and its visual changes are highly common, they remain one of its biggest secrets. (Alzheimer’s Association, 2011b)

By understanding and anticipating the vision changes experienced by people with Alzheimer’s, Habilitation Therapy can help care partners make simple, effective adaptations to the physical environment. These changes are all intended to enhance the patient’s ability to function more independently, which has an enormous positive impact on everyone’s emotional well-being.

References

Alzheimer’s Association, Massachusetts/New Hampshire Chapter. (n.d.) Caring for People with Alzheimer’s Disease: A Habilitation Training Curriculum. Watertown, MA: Alzheimer’s Association.

Alzheimer’s Association, Massachusetts/New Hampshire Chapter. (August 2, 2011) Caring for People with Alzheimer’s Disease: A Habilitation Training Curriculum [Training Course]. Lawrence, MA: Alzheimer’s Association.

Alzheimer’s Association. (2011b). 2011 Alzheimer’s Disease Facts and Figures. Alzheimer’s & Dementia, Volume 7, Issue 2.

Raia, P. (Fall, 2011) Habilitation Therapy in Dementia Care. Age in Action. Vol. 25, No. 4.

Snow, T. (n.d) The Art of Caregiving. [Video] Florida: Pines Education Institute of Southwest Florida.

As long as these visual processing changes remain little known — coupled with the decaying judgment and cognitive abilities typical in dementia — navigating ADRD will remain unnecessarily painful and difficult for both care partners and patients alike. However, once understood through the lens of Habilitation Therapy, such knowledge becomes a powerful tool to improve safety, functioning, relationships, and general quality of life for everyone involved with a person with dementia.

Habilitation Therapy (HT) is a comprehensive behavioral approach to caring for people with dementia. It focuses not on what the person has lost due to their illness, but on their remaining abilities. HT creates and maintains positive emotional states in the person with dementia through the course of each day. It is considered by the Alzheimer’s Association to be a best practice for taking care of ADRD patients. (Alzheimer’s Association, 2011) Fairly simple to understand, HT can be profound in its positive impact on dementia patients and their care partners.

HT maintains that people with dementia cannot leave the reality they inhabit — care partners must meet them in that world. (Alzheimer’s Association, n.d., p. 139) This means that family and other caregivers must imagine what it is like to experience visual processing as a person with ADRD does. It is only then that the underlying causes of difficult behaviors can be understood, and methods to prevent or limit them can be developed. For example, these might include providing additional visual cues, or clarifying or eliminating confusing ones.

In general, “less is more” in the space occupied by an ADRD patient, allowing them to function better with less confusion and distraction. Organizing clutter and reducing the number of objects in a room can help them be more independent for longer. Feeling more self-sufficient improves the ADRD patient’s feelings about him- or herself, and makes life easier for care partners, too. (Alzheimer’s Association, 2011)

Changes to the Environment for Someone With Alzheimer’s

While vigilance must be maintained and approaches honed as the disease progresses, simple but vital changes to the dementia patient’s environment can make a real difference in quality of life, safety and ability to function more independently. Applying our understanding of what isn’t working right in the visual cortex of the ADRD brain is central to creating the right interventions.

Here follow some concrete examples.

Wandering. Wandering is when a person with dementia leaves a safe place where they are supposed to be, to strike out for… well, it’s sometimes hard to say where they believe they are going. They can quickly become lost and unable to return to safety; they can even die of dehydration or hypothermia. Due to confusion and panic, they may also assault someone who unwittingly frightens them. Wandering is a problem to be taken very seriously.

Due to their inability to perceive depth or dimensionality, Habilitation Therapy will use this knowledge to reduce or stop wandering behavior. When a large black floor mat is placed in front of every exit accessible to people with ADRD, often their brain interprets the mat as a bottomless pit that must be avoided. Of their own accord, they may lose interest in the doors.

People with dementia need highly contrasting colors to pick out different objects. Painting an exit door, doorknob and its surrounding wall and trim all the same color can make an exit disappear for a person with ADRD. Installing floor-to-doortop drapes on the windows – as well as over an exit door – and keeping the drapes shut can make the door seem like it’s just another window. This, too, can eliminate wandering. (Moore, 2010)

Where did I last lay down my car keys? What did I need at the grocery store, now that I’m standing in its aisles? What day is that important meeting scheduled? What did I need to bring to it? Did I remember to switch the clothes from the washer to the dryer before they got moldy? Did I pick up new printer cartridges, or did I just think about getting them?

We middle-aged people caring for parents, children, spouses, paid work, personal projects, volunteer work — and somehow squeezing in a little time for ourselves — often become forgetful and distracted. When this happens, many of us worry that we are acting a lot like elders we know who have been diagnosed with Alzheimer’s Disease and related dementias.

We wonder: do we have it, too? (Alzheimer’s Association, n.d.)

Well, maybe. There are early-onset cases of dementia involving people in their 40s, 50s and 60s. But this is not usually the cause of such forgetfulness. We likely have so much on our plates, as we spin ever faster through our lives, that we simply cannot retrieve all the information we want when we need it. But still, we wonder: are we experiencing “normal” forgetfulness?

We may also wonder about our elder parents, friends, co-workers, spouses or other aging loved ones. Should we be concerned about certain behaviors we notice? How do you tell the difference between symptoms of dementia and the forgetfulness that comes with everyday functioning as we age?

Below are seven signs that you’re just fine. Consult your physician if you’re still worried, or if you feel these signs point to something abnormal.

1. Remembering later. You’ve forgotten a name, a word, or part of experience. Fifteen minutes later — either spontaneously or after thinking it over — it comes back. That’s “normal” forgetfulness. Not being able to remember an experience, name or word — or even a person or place that should be familiar — is not “normal” forgetfulness. (Alzheimer’s Association, n.d.).
2. Reminders work. Being able to reconnect to a name, word or experience after someone or something reminds you points to “normal” forgetfulness. The reminder can be anything: it can be visual, a word or phrase, a story, and so on. Reminding might not help memory recall in cases where forgetfulness is not “normal;” the information may remain missing. (Alzheimer’s Association, 2011).
3. Using tools to remember. Being able to effectively use tools such as notes or a calendar to compensate for forgetting leans toward “normal” forgetfulness. Decaying or missing ability to accurately check a calendar or notes to aid memory is not “normal” forgetfulness. (Alzheimer’s Association, 2011).
4. Forgetting once or twice. After forgetting a piece of information, then remembering or being successfully reminded, it should be more easily retrievable again later in cases of “normal” forgetfulness. Forgetting again later, especially if it is complex, likely also is “normal.” But repeatedly forgetting the same thing, or never being able to recall anything about the subject is not an indication of “normal” forgetfulness. (Alzheimer’s Association, 2011).
5. Too many balls in the air. Memory problems that come about when trying to do too many things at once – or at times of high stress or great fatigue – is probably “normal” forgetfulness. Diminished ability to remember how to do normal tasks, or an inability to figure out the sequence used in normal, daily tasks, is not “normal” forgetfulness. (Alzheimer’s Association, n.d.).
6. Acting otherwise typically. Feeling frustrated with forgetting, but exhibiting the usual personality and behavior while responding to such challenges, points to “normal” forgetfulness. Uncharacteristic anger, defensiveness, denial, or changes in personality, reduced problem-solving ability or deteriorating judgment may indicate that the memory problem is not “normal.” (Moore, 2009)
7. Doing self-care. Being forgetful, but still able to consistently perform basic needs such as bathing, dressing, and eating is “normal” forgetfulness. Uncharacteristically poor hygiene, unchanged or soiled clothing, weight loss due to forgetting to eat – or weight gain due to eating a meal multiple times having forgotten previous one(s) just consumed – are not indications of “normal” forgetfulness. (Alzheimer’s Association, n.d.)

Abnormal forgetfulness isn’t only about failing to remember. It’s more complex than that. Be concerned when you see a pattern of deteriorating functioning, not just correctable incidents of forgetting. Loss of previous abilities or negative changes in long-established, characteristic behavior and personality patterns indicates a need to seek help.

Understanding normal forgetfulness can help us more gracefully adjust to the challenges of healthy aging. We need to give ourselves and our loved ones more time to recall events, names, and words as we age, because “normal” recall can take longer. Knowing that can help us plan to build in extra time for certain events or tasks.

Fatigue and stress are great memory stealers regardless of whether dementia is involved. Insomniac dementia patients or those exhausted by anxiety will function more poorly. Many younger people who care for aging loved ones exhibit memory slips that parallel their exhaustion level.

At that point caregivers often start worrying that they, too, are developing what their parent has. It seems so eerily familiar that they often say it’s as if dementia is contagious. Though there is a genetic component to some dementias, it’s more likely that anyone acting as a primary caregiver to a person with dementia is experiencing “normal,” overwhelmed, fatigued, stressed-out, not-enough-hours-in-the-day forgetfulness. Hopefully, this offers some solace to the weary.

References

Alzheimer’s Association, Massachusetts/New Hampshire Chapter. (n.d.) Caring for People with Alzheimer’s Disease: A Habilitation Training Curriculum. (Watertown, MA). p. 68

Alzheimer’s Association, Massachusetts/New Hampshire Chapter. (August 2, 2011) Caring for People with Alzheimer’s Disease: A Habilitation Training Curriculum [Training Course]. (Lawrence, MA)

Moore, B. L. (2009) Matters of the Mind and the Heart: Meeting the Challenges of Alzheimer Care. New York: Strategic Book Publishing.

According to Silverman, Flaherty and Tobin (2006), …”[I]t is a better understanding of the psychology of dementia – how a person thinks, feels, communicates, compensates, and responds to change, to emotion, to love – which may bring some of the biggest breakthroughs in treatment….”

A parent, sibling or spouse has been just diagnosed with Alzheimer’s Disease or a related dementia (ADRD). In a somewhat perfect world, family members would receive an orientation to the disease, and learn how it affects their loved one’s behavior. They would quickly begin to learn how to deliver daily care and maintain best function. They would find out how to prevent many common, difficult behaviors, and address those that arise with some consistently applied, fairly easy-to-use psychosocial interventions.

The entire family and all other members of the care team in this somewhat perfect world would receive training and ongoing support to learn and apply Habilitation Therapy (HT), accepted as the best standard of care and psychosocial intervention by the Alzheimer’s Association (Massachusetts/New Hampshire Chapter), where it was first developed in the 1990s. (Alzheimer’s Association, Massachusetts/New Hampshire Chapter, 2011.) HT is considered the best practice in ADRD day-to-day care, in creating good environments for ADRD patients, and within all their relationships and activities. Though powerful and effective, HT is fairly simple to learn; even a child can understand and apply aspects of it.

So, what is this seemingly magical thing called Habilitation Therapy? Well, it’s not magic, but a comprehensive behavioral approach to caring for people with dementia. It focuses not on what the person has lost due to the illness, but on his or her remaining abilities. HT creates and maintains positive emotional states through the course of each day. The dementia patient’s capabilities, independence and morale are consistently engaged to produce a state of psychological well-being. In this way, difficult symptoms can be reduced or eliminated, even as the illness progresses.

Habilitation Therapy also benefits the patient’s family, friends and professional caregivers. The ability to enjoy time together and to share a relationship, activities, and feelings with a person with dementia can be uplifting for everyone involved. HT can reduce much of the stress and workload involved in living with Alzheimer’s Disease and other related dementias.

Note that this is “Habilitation Therapy,” not “Rehabilitation Therapy” (Alzheimer’s Association, Massachusetts/New Hampshire Chapter.) Rehabilitation returns patients to earlier, higher levels of functioning. There is no known rehabilitation for ADRD. Habilitation focuses on optimizing and extending what is possible now, not what was possible in the past.

The very best natural caregivers tend to spontaneously develop similar approaches to HT. Usually, though, they are unable to articulate why they do what they do, teach others except through example, or discover by themselves the totality of what Habilitation could teach. It can take months or years for talented caregivers to uncover just some of the techniques that could have been taught to them in a few hours through Habilitation Therapy training. Though it makes logical sense to provide such training on a regular, widespread basis, it is far from the norm.

A deeper understanding of Habilitation Therapy starts by looking at the way the brain is affected through dementia, and how large a presence emotions represent. This will be explored further in Part 2.

In this somewhat perfect world, medications such as antipsychotics would not be needed to manage the illness’s behaviors. (An antidepressant might be prescribed to help support positive mood and functioning, however.) Special dementia-specific behavioral methods — plus interventions such as gentle massage, music and art therapy, and wellness activities — would help the dementia patient be peaceful and happy, functioning best with what abilities still remain even as they decline. Caregivers (called “care partners”) would be happier and more peaceful, too.

People with ADRD living in this somewhat perfect world would be able to maintain as much independence as they safely could through an appropriately organized physical environment. Daily, they would experience a variety of emotions, including feeling safe, cared about, respected, purposeful and valued. Such positive emotional experiences bring them pleasure, comfort, laughter, happiness and even joy.

Nearly to the very end, they would share positive relationships and emotional experiences with their care partners – both family and professional – who experience time spent together as a close and profound (though not necessarily easy) experience. Most ADRD patients would live their final days in their homes, or would be stay living at home significantly longer due to this type of compassionate daily care. (Mittleman, Ferris, Shulman, Steinberg, and Levin, XXXX.) If and when they found themselves living in a facility, the entire staff, from janitors to nurses to administrative staff, would be fluent in the use of Habilitation Therapy.

Even in this somewhat perfect world, there would still be many, many tasks for care partners to perform every day. There would still be an emotional, physical and financial cost to delivering all the care necessary. The disease would still remain progressive, and the patient would continue to decline. Family and friends would still grieve as their loved one with dementia became more and more dependent and eventually died. But grief and loss would not be the only feelings those left behind would hold in their hearts and memories. There would be the close, enjoyable times that existed through much of the course of the disease.

This somewhat perfect world already exists in small pockets. A good or better quality of life could exist right now for many, many ADRD patients, their families, friends, and professional caregivers. One of the huge missing factors for the further manifestation of this somewhat perfect world is a lack of widespread awareness, training and adoption of Habilitation Therapy.

References

Silverman, N. M., Flaherty, G., Tobin, T. S. (March 2006). Dementia And Wandering Behavior: Concern for the Lost Elder. New York: Springer, p. 24.

Alzheimer’s Association, Massachusetts/New Hampshire Chapter. (August 2, 2011.) Caring for People with Alzheimer’s Disease: A Habilitation Training Curriculum [Training Course]. (Lawrence, MA)

Mittelman M.S., Ferris S.H., Shulman E., Steinberg G., Levin B. (1996). “A family intervention to delay nursing home placement of patients with Alzheimer disease. A randomized controlled trial.” Journal of the American Medical Association. Dec 4; 276(21):1725-31.

Alzheimer’s Association, Massachusetts/New Hampshire Chapter. (n.d.) Caring for People with Alzheimer’s Disease: A Habilitation Training Curriculum. (Watertown, MA). p. 62.

Nina Sunday proposes an alternative strategy in her slim self-help guide, Brainpower Smart Study. She maps out a method of learning that enables students to absorb the material and retain it. Her organized system is designed to supercharge the brain so that students not only score well for their big test, but retain the information for years to come.

A chart with some eye-opening facts sets the stage for Sunday’s guide. It shows that students retain only five percent of lecture material and only ten percent of reading material. This begs the question, how do students really learn? Sunday shows it’s through demonstrating, practicing, and discussing the material. Teaching trumps all other activities. Tell a student to teach the subject to the class, and her memory shoots up to 90 percent.

All of these factors play into Sunday’s eight-step guide. It begins with a little speed reading (Sunday is a speed reading coach). The steps that follow involve note-taking, reading for comprehension, reading to grasp the main points, rereading those points, self-testing, more note-taking, and finally telling or teaching the material. As anyone can see, there’s no real magic here. It’s more or less a combination of techniques students have used for generations.

On the other hand, there’s real ingenuity to Sunday’s plan. This is a building block approach. Each step builds upon those previously taken. Skip a step, and the whole tower may crumble. For instance, self-testing and teaching may be impossible.

But that’s the point, isn’t it? Learning takes time. Skimming or speed reading works well to see the big picture, and that’s a great starting point. After that, the student needs to dig in, slow down, ruminate, draw connections, absorb and synthesize the material. Ultimately, he or she needs to know the material well enough to explain it to someone else. That’s a new level of understanding, which I, as a teacher, fail to see happening with the majority of today’s students. They’re smart enough to read the words, but they don’t want to spend the time to consider the meanings behind them, weigh the concepts, the context, and the ramifications. That takes time and effort that they don’t want to invest. So I applaud Sunday’s efforts, and I plan to implement some of her ideas into my own lesson plans to crete an atmosphere of better learning.

On the other hand, the eight-step program requires time, methodology, and organization–in other words, maturity. Having worked with hundreds of 18- and 19-year-old students, I’m afraid to say that you could buy this book for your teenager and it would end up in the back of the closet where it will stay until you donate it to the next library book sale. No teenager is going to read about studying, even if it’s only sixty pages and would likely boost his or her grades up a notch or two.

Ideally, this book should be used by parents or educators who will lead and monitor students’ study habits. It could be the basis of small study groups or learning center projects. Or it might help the student who’s exceptionally driven to excel.  Again, however, this process requires a level of self-motivation and maturity.

The other shortcoming I see in this book is the final and most critical step: retelling. Again, teaching is the most effective way of learning; thus, Sunday wants to maximize this opportunity by proposing that the student teach someone else (even the cat or dog) the subject on which she is to be tested. Let’s be real. That’s not going to happen. You can’t even get a teenager to talk to you, let alone teach you something. They’re too self-conscious to teach Mom or Dad or a college roommate a history lesson. Instead, I’d propose that step eight be a self-lecture. Perhaps the student could tell the story to herself in the mirror. This more or less achieves the same goal, but self-empowers the student.

All in all, I really like Brainpower Smart Study. I see a number of great applications for this book, such as preparing a lecture for the classroom or preparing for a job interview. Anyone who wants to know a topic thoroughly and be conversant on it in a short amount of time will find it helpful. This is going on my teaching bookshelf.

Brainpower Smart Study: How to Study Effectively Using a Tested and Proven 8-Step Method
By Nina Sunday
Brainpower Training Pty Ltd.: July 5, 2011
Paperback, 60 pages
$29.95

Dr. Chris Fox of the University of East Anglia, UK, and colleagues found that anticholinergic drugs — which block a key neurotransmitter called acetylcholine and include many drugs often taken by older adults — may cause cognitive impairment.

Drugs which have anticholinergic activity range from antidepressants to antihistamines. They include Benadryl, Dramamine, Excedrin PM, Nytol, Sominex, Tylenol PM, and Unisom. Others available only by prescription include Paxil, Detrol, Demerol and Elavil. Older people are more at risk because they tend to be greater users of these drugs.

Now, the research team has looked in detail at these drugs’ effects on people already suffering from dementia. They studied 224 people with established Alzheimer’s disease who were taking low levels of anticholinergic drugs. The majority (71 percent) were women, and their mean age was 81 years.

The participants’ cognitive function was remeasured six and 18 months into the study using the Mini-Mental State Exam, the Severe Impairment Battery (which assesses specific behavioral and cognitive deficits associated with severe dementia), and the cognitive section of the Alzheimer’s Disease Assessment Battery. Their exposure to anticholinergic drugs also was recorded.

No differences were seen in cognitive functioning for individuals with high or low exposure to anticholinergic drugs at either six or 18 months, once cognitive function at the start was taken into account.

“Medications with anticholinergic effect in patients with Alzheimer’s disease were not found to effect deterioration in cognition,” the researchers reported.

“Our study did not support a continuing effect of these medications on people with Alzheimer’s disease who are established on them.”

Dr. Fox commented: “We found that taking a low dose of medication with a low degree of anticholinergic activity does not appear to lead to more impaired cognition or a more rapid cognitive decline in people with dementia. We hope that this will provide some reassurance to families and carers of those with dementia.”

But he added that the team is still concerned about the impact on frail older people who have no signs or mild signs of impaired cognition before they start to take the drugs. “More work is needed in this area,” he states. “In addition, we need studies on mortality in the more advanced dementia with these medicines.”

Co-author Dr. Ian Maidment of Kent University, UK, added: “One possible explanation for the different results is that in people with dementia, their cholinergic system is already impaired and therefore introducing a further insult to the cholinergic system has little effect. These results do, however, highlight the complexity of the issue and the need for further in-depth research.”

Future research also needs to assess the impact of medication doses, say the experts. The study is published in the journal Age and Ageing.

In a 2012 review of the effect of anticholinergic drugs on cognitive decline, several of the same authors explain that Alzheimer’s disease “is characterized by a cholinergic deficit in the basal forebrain.” They write that there is increasing evidence that this brain area is already affected prior to dementia, early in the course of Alzheimer’s disease.

This loss of cholinergic activity may be a crucial component since it is associated with cognitive impairment and behavioral changes in many types of dementia, they explain. And anticholinergic drugs may exacerbate the process. For example, an increase in plaque density has been observed in Parkinson’s patients treated with anticholinergics.

“The most important clinical issue,” they warn, “is that a high proportion of the older population are exposed to multiple drugs with low anticholinergic activity, and the cumulative burden of these medications over many years may be associated with accelerated cognitive decline.”

Clinicians should consider, as part of every older person’s medication review, whether each medication is necessary and whether it could and should be stopped, recommend the experts.

“One caveat to this is that people with established Alzheimer’s disease may be stable on their current medication and not exhibit, paradoxically, any medication-related decline in cognition, as the damage to their cholinergic systems has already occurred,” explain the authors, referring to their previous study. “These patients may be able to tolerate a relatively large anticholinergic load.

References

Fox, C. et al. The impact of anticholinergic burden in Alzheimer’s Dementia – the Laser-AD study. Age and Ageing published online September 19, 2011 doi:10.1093/ageing/afr102

Fox, C. et al. Anticholinergic medication use and cognitive impairment in the older population: the medical research council cognitive function and ageing study. Journal of the American Geriatrics Society August 2011, Vol. 59, No. 8, pp. 1477-83. doi: 10.1111/j.1532-5415.2011.03491.x.

Smithard, D. G. et al. Do anticholinergic drugs contribute to functional and cognitive decline? Aging Health February 2012, Vol. 8, No. 1, pp. 57-60, doi: 10.2217/ahe.11.87

A set of specific nerve cells found in the brain called ‘mirror neurons’ allows these events to occur. Their discovery has revolutionized the understanding of how humans relate to each other and to the world.

Researchers from the University of Parma (Italy) stumbled upon these amazing neurons. They were studying planning movements in monkeys and were testing a particular neuron that made a specific sound whenever a monkey would grab for a peanut.

One day, while a monkey was sitting idly, one of the researchers came in and picked up a peanut. The monkey’s cell fired even though it had not moved — he was merely watching the human grasp the peanut. The same neuron fired both when the monkey observed something and when it was doing something (Gallese, Fadiga, Fogassi, & Rizzolatti, 1996).

What the study reveals is that this neuron seems to mirror the movement it sees. Although some researches may call them the ‘monkey see, monkey do’ neurons, the Italian scientists labeled them mirror neurons.

Subsequent studies have shown that mirror neurons are also found in the human brain (Rizolatti, 2005). Seeing someone do something is the same as doing it yourself. Therefore, when you watch your yoga instructor perform a new posture, you are sharing that experience with her because your neurons are firing as if you are doing the posture. If you just look at a picture of someone eating a lemon, you naturally scrunch up your face as if you are the one eating the sour fruit. These neurons enable us to relate to the internal state of others as well as to empathize and learn from them.

When people observe someone juggling several packages while walking down the street, those observers react because they can feel the other person’s predicament. They know what it is like to carry heavy packages because their neurons are mirroring the action. This enables them to empathize with the individual and may even inspire them to offer some help. This could also be why it is so easy to be a sports fan. Your neurons are firing just like you are the one playing the sport; that gives a completely new meaning to the saying ‘armchair quarterback.’

These powerful neurons tie us to other people’s actions as well as to their feelings. This system may be the brain’s method of translating and interpreting the way we relate to the world.

Humans are intensely social creatures. The mirror neuron system appears to be the most basic brain system in relating to other people. It is a place in our brains whose specific job is to live in other people’s minds and bodies — a truly amazing concept. Mirror neurons help us to adopt others’ perceptions as well as to connect us emotionally. Think of the last time you laughed hysterically or cried profusely while watching a movie. Those are your mirror neurons in action. Perhaps this suggests that deep in our architecture, down to our very cells, we are built to be together. There is something very reassuring about that.

References

Gallese, V., Fadiga, L., Fogassi, L. & Rizzolatti, G. (1996). Action recognition in the premotor cortex. Brain, 119, 593-609.

Rizzolatti, G. (2005). The mirror neuron system and its function in humans. Anatomy and Embryology, 210, 419-421.