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Tue, Oct 1 3:40pm · Executive Dysfunction and MCI in Living with Mild Cognitive Impairment (MCI)

Executive FunctionA diagnosis of Mild Cognitive Impairment (MCI) usually involves significant issues with a patient’s memory. However, this is not always the case. MCI can involve issues with other cognitive areas like language, visuospatial skills or executive functioning. Any of these “domains” of cognitive impairment can occur in addition to memory loss, or even without memory loss. Today we’ll focus on executive function.

So, What are Executive Functions?

They are the mental processes needed to execute purposeful, goal-directed behavior. They refer to things like paying attention, concentrating, planning, self-monitoring, and adapting when needed.

Executive function skills can affect daily life in many ways, but let’s focus on 3 key areas: Working Memory, Flexible Thinking, and Inhibition.

  • Working Memory is different from short-term memory. In fact, we generally think of this term more as attention/concentration rather than “memory.” Working memory is about keeping track of information that is needed to work with. For example, remembering that you had spaghetti for dinner would be short-term memory. Keeping in mind that you have 5 minutes left on the timer for boiling your pasta, while chopping the onions and stirring the sauce, is working memory. People will also sometimes call the skill in this last example “multi-tasking.” Working memory or concentration is needed to make sense of anything that happens over time or in a particular order, such as following a story, working math in your head, or seeing task all the way through without getting distracted and moving on to something else.
  • Flexible Thinking refers to the ability to adjust to changes in demands, priorities, plans, or opportunities. Think of being able to “roll with the punches” when things go wrong, take another perspective, and adapt in order to accomplish the goal. This is the opposite of being cognitively rigid. People who are weak in this area have difficulty changing course.
  • Inhibition refers to being able to control (and stop) one’s attention, behavior, thoughts, and/or emotions. Examples of weak Inhibition skills include being distracted by background noise in the environment, blurting out the first thing that comes to mind even if it isn’t socially appropriate, impulsively thinking of the worst-case scenario when worried, or overreacting with anger. Inhibition is like a mental “brake pedal” that allows one time to think before acting.

Take a moment to take this self-quiz! It should give you an idea of how deficits in the three areas of EF can lead to practical problems in your daily life.

Executive Functioning Skills – Self-Quiz

For each statement below, please answer mostly Agree or mostly Disagree.

  1. I have trouble getting started on tasks.
  2. I find it hard to do things that aren’t interesting or fun.
  3. I am easily distracted.
  4. I am often late.
  5. When in conversation, I often forget what I wanted to say.
  6. I understand what I require before starting a new task.
  7. I have trouble completing multiple step-tasks.
  8. My personal space is usually messy and disorganized.
  9. I lose or misplace things almost every day.
  10. I become frustrated when things don’t go as planned and can quickly become angry.

(adapted from a similar quiz at http://www.additudemag.com)

The more “Agree” answers you have, the weaker your executive functioning skills are. If you “Disagree” with the statements, the less likely you have executive dysfunction. Regardless of the quiz score, in general, the executive function skills can decline with older age. So let’s discuss what one can do to improve/maintain one’s executive functioning.

Tips for improving Executive Functioning

  • Take care of yourself. Poorer executive functioning is associated with stress, obesity, not getting enough sleep, and substance abuse.
  • Consider computerized brain games. If you participated in our HABIT program, you were introduced to BrainHQ. Playing challenging games that involve fast processing speed, concentration, and switching between tasks can possibly improve executive function skills.
  • Break down tasks into steps and sub-steps. Create “recipes” for complex tasks: Make a list of ingredients (e.g., the equipment, supplies, and labor), and list each step in the process. Estimate the time it would take to procure the things you need and complete each step. Then double that estimate and make a timeline.
  • Take notes and keep a record of what you’ve done. This way if you stop, switch tasks, or get distracted, you’ll easily know where you left off.
  • Speaking of distractions, keep them to a minimum in your working environment and when you are communicating with others when possible. Don’t have the TV or radio on, and don’t have important conversations in loud, noisy environments where there is a lot of other stuff going on.
  • Don’t try to do effortful tasks when you’re tired. For example, if you’re a morning person, do the important/difficult stuff in the morning.
  • When communicating with your loved ones, try not to shout from another room. Instead, try to talk when it’s possible to make eye contact with good lighting, and make a habit of paraphrasing what you think you heard. Avoid long drawn out explanations.

People often think MCI is only about memory loss, but the diagnosis can instead result from deficits in executive functioning and/or memory loss. If you have weak executive function skills, they can affect your ability to complete tasks and activities of daily living. To ensure that you are functioning at your optimal level, live a brain healthy lifestyle, break down complex tasks into smaller tasks, consider using something like a day planner to keep track of what you’re doing, and work and communicate in an environment free of distractions.

Tue, May 21 3:24pm · Technologies That Can Help, Part 2 (Finances & Locating Misplaced Items) in Living with Mild Cognitive Impairment (MCI)

Locations App

This topic of how technology can help in Mild Cognitive Impairment (MCI) was broken up into two parts. Last week we covered technology and services that could help with medication and driving safety . In this week’s blog, we discuss technologies that can help with financial responsibilities and the locating of important items. You will be invited to share in the comments section any other tips or technologies that you found to be helpful!

For those who are not comfortable with technology, consider enlisting the help of a tech-savvy friend or relative – or just about anyone under the age of 30 – for a tutorial or to set up everything for you. Professional services are also available.

 Safety with MCI can become a serious concern. Individuals may find themselves asking questions such as:

  • Is it prudent to take trips and travel in foreign places?
  • Can I still manage the finances?
  • What can we do when keys, wallet, or phone is misplaced?

The “Big Three” safety topics we like to address are medication safety, driving safety, and financial safety. These involve high stakes situations in which we need to be very careful. In addition to improving overall safety, technologies can enable our loved ones to function more independently for longer. Let’s talk about ways technology can help.

 Financial Safety

Automatic Bill Pay. Most companies and agencies now offer automatic bill pay service. Using it can reduce the risk of missing a payment or paying a bill twice. You still can opt to receive the paper bill (which your loved one can continue to review) and request to be notified if the bill exceeds an amount you specify. Signing up can be done online or by filling out a form.

Online Banking.   One of the conveniences of online banking is fewer trips driving to the bank! New features are being added all the time, such as the ability to deposit paper checks online, the ability to set limits on transaction amounts, and immediate text notifications for suspicious activity or even every single charge made to your debit/credit card. If you’re worried about security, some experts argue that online payments are more secure and less subject to fraud than paper checks and physical credit cards.

A Warning about Social Media and Financial Scams.  Unfortunately, financial schemes are getting more sophisticated than ever. Scam artists have reportedly been able to use advanced data mining techniques to identify their targets on-line.   For example, they could determine who is likely to be an elderly, rich, away on vacation, lonely, sick, vulnerable, etc. All this information can be used to develop very plausible-sounding scams.  Be careful what you post!

 Locating Misplaced Items

Tracking devices. Tired of misplacing the wallet, keys, phone, day planner, remote control, eyeglasses? Tracking devices have gotten smaller over the years and can be attached to the item and then made to “ring” when you can’t find it. Enough said.

Location Tracking Apps. These are smartphone apps that allow you to see the location of another smartphone on a map, as long as it is turned on and has reception. What this means is that you can track the phone and the person who has the phone, regardless of whether the person knows how to operate the smartphone. These apps allow you to have an idea of where they might be with varying degrees of accuracy (I use one that is somewhere in the range of 250 feet).

Smart home devices. Smart home hubs have become more budget-friendly, and new capabilities are added every day that can add to our safety, convenience, and quality of life. These smartphone or voice-activated hubs allow you to verbally set timers and alarms (helpful when cooking!), and to call any number in your smartphone’s contact list – including your own phone, if you need help locating it. These hubs can control other smart devices by voice or using a smartphone.  They can, as examples, let you lock the doors to your home, turn off/on all the lights, or control the thermostat. My kids also love to asking ours to tell them a joke!

 

The information is this two-part blog was not meant to cover an exhaustive list of what new technologies are available. New products, apps, and features are developed every day. They were designed to make everyday life more convenient, but in some cases these advances could allow individuals to maintain a higher level of independence for longer and improve overall safety.

We invite you to share any experiences you have had with a technology or product that you recommend (or don’t recommend) for living with MCI, in the comments below! Have you found a way to use a technology that really helps your loved one? Is there a new product or service that you want to tell us about? We suggest you use this format in the comments:

  • Technology/Product Name:
  • What it’s supposed to do:
  • Your experience:

 

Tue, May 14 3:09pm · Technologies That Can Help, Part 1 (Medication & Driving) in Living with Mild Cognitive Impairment (MCI)

PillboxIn this week’s blog, we discuss some available technologies that can help improve the safety of individuals with Mild Cognitive Impairment. This topic of how technology can help the caregiver will be broken up into two parts. You will be invited to share in the comments section any other tips or technologies that you found to be helpful!

The primary audience for this blog is the a partner or caregiver. However, individuals with MCI are encouraged to read this and discuss any ideas that interest them with their partner. And, it is better to try to learn something new now, just in case the cognitive impairment worsens in the future.

For those who are not comfortable with technology, consider enlisting the help of a tech-savvy friend or relative – or just about anyone under the age of 30 – for a tutorial or to set up everything for you. Professional services are also available.

The safety of our loved ones with MCI can become a serious concern. A partner may find themselves asking questions such as:

  • Is my loved one able to independently manage their medications?
  • Should my loved one refrain from driving on the road?

The “Big Three” safety topics we like to address are medication safety, driving safety, and financial safety. These involve high stakes situations in which we need to be very careful. In addition to improving overall safety, technologies can enable our loved ones to function more independently for longer. Let’s talk about ways technology can help.

Medication Safety

Pillboxes. If your loved one is currently managing their medications and doesn’t yet have a pillbox for their multiple medicines, consider getting one. Pillboxes can have multiple compartments and accommodate taking pills 2 or 3 times a day. If your loved one doesn’t use a smartphone, consider a pillbox that has a built-in alarm to remind when to take the pills. If your loved one uses a smartphone, consider setting reminders (in their day planner or on their phone) to use in conjunction with their pillbox.

Full-service mail order pharmacies. Once you provide your current prescriptions, they will send you all your pills each month sorted by day and time in little packets. Sometimes they can also include your over-the-counter supplements and vitamins.

Online Patient Portals. Consider registering for an online patient account if this is available to your loved one. These “patient portals” typically allow patients to see a comprehensive list of current medications, dosages, refills, upcoming and past appointments, bills, test results, and visit summaries. If you communicate with your physician’s office through this portal, you then also have a written record of the messages. If you loved one isn’t comfortable with computers, you can print out the information on paper for them. They Mayo Patient Portal can be accessed here.

 Driving Safety

GPS. Using a GPS navigation system while driving can free up the cognitive resources that you otherwise would have spent on finding your way. This allows the driver to devote more energy to things like visual attention and reacting on the road.   If your loved one is driving and not using GPS, reconsider. GPS is widely available and has become much more user-friendly over the last few years. Set up their GPS to give voice instructions, make sure that the system has a stable place in the car in the driver’s view, and save common driving destinations into the system (e.g., home, work, doctor’s office) to make everything easy for your loved one to utilize. And, you and your loved one should promise to only fiddle with the GPS when the car is parked!

App-based ride services. These smartphone-based transport services are essentially taxi services, but less expensive than traditional taxis. Here’s how it works: Download the app, open an account, link a credit card, and enter where you want to go. You will then get an estimate on how long it would take for the driver to get to you and how much the ride will cost. If you confirm the order, you’ll receive the driver’s first name, their picture, make/model of their car, license plate, and an alert when your driver is almost there.

Did you know you can order app-based ride services for others (such as your loved one) to get a ride? And, you can track the location of the driver (and your loved one) in real time? You also can pay/tip the driver from your phone – so money never exchanges hands. Just remember to be always be safe – don’t ever get in a car before confirming the car’s license plate!

 

In next week’s blog we will discuss how technology can help with financial responsibilities, and how tracking devices, smartphone apps, and “smart home” hubs can help make life easier by, for example, helping with finding misplaced important items.

 

We invite you to share any experiences you have had with a technology or product that you recommend (or don’t recommend) for helping with medication or driving safety, in the comments below! Have you found a way to use a technology that really helps your loved one? Is there a new product or service that you want to tell us about? We suggest you use this format in the comments:

  • Technology/Product Name:
  • What it’s supposed to do:
  • Your experience:

 

 

Oct 9, 2018 · I Tried a Mediterranean Diet Meal Delivery Kit for a Week, and This is What Happened in Living with Mild Cognitive Impairment (MCI)

Have you heard about meal planning kits delivered to your front door? Some examples include Blue Apron, Hello Fresh, Plated, Marley Spoon, HomeChef, just to name a few!  The idea is that each week, the company sends you a box of recipes and fresh ingredients so that you can easily cook healthy dinners.  I’ve been wanting to try one of these services out for a while, and when I learned that one of them was now offering a Mediterranean meal plan, I knew it was time.

Ever since I learned about the brain-healthy Mediterranean diet, I’ve been trying to eat more fish and veggies. But I was stuck in a rut when cooking at home.  I was balking at the idea of picking a recipe, going to the store and finding the ingredients, and then preparing all the ingredients.  I don’t hate to cook, but I don’t love to cook either – and I only like the fun part, which is the actual cooking and eating part.  There are a couple other things you should know about me, when considering this review:  I love good food, and I’ll try anything, shellfish and beef are my favorite proteins, and I am an efficient (i.e., lazy) cook.

STEP 1. Picking a company.                                                                                                                                    

There are many different ones, and they seem to brag about different things. Organic!  Sustainable!  Vegetarian , Paleo, and Keto )!  Diabetes-friendly!  Gluten-free options! Lowest cost!  Hassle-free, easy, and quick!  Many meal options!  And so on.

Since SunBasket was the only one that advertised specifically a Mediterranean meal plan, I chose it.  But really, all the companies offer brain-healthy options – for example, pescatarian (fish) or vegetarian plans, or the ability for you to go online and pick each particular recipe each week. Nutrition information is always available for each recipe.

Price- wise, each meal portion costs roughly $12-13 for almost all the companies. And almost all offer a special introductory discount for your first order.

STEP 2. Going online and signing up.

Ok so this wasn’t too bad. I selected the 4-person Mediterranean Plan to include 3 dinners for the week.  It showed me the 3 default recipes, and I opted to replace one of them with one that sounded tastier to me.  There were a lot of meals to choose from, but only a handful were marked as “Mediterranean”.

STEP 3. Receiving my box.

The meals were delivered while I was at work on a Monday (you can pick the delivery day). Since I live in Florida, I was dismayed to see the boxes on my doorstep on 90+ degree heat! However, the box had cooler packs that kept everythingcold.  And, full disclosure, I promptly just put it all in the refrigerator, as I was too tired to cook that night.

The recipes came in a color booklet and were clear and easy, and cooking time ranged from 15-45 minutes for the 3 different recipes. Everything was clearly labeled and all ingredients were great quality and in good condition. The final meal portions were actually a very good size.

STEP 5. Cooking and Eating.

Recipe 1. One-Pan Mediterranean Stuffed Sole, with sautéed kale, tomatoes, olives, and white beans.

Stuffed Sole

I sometimes order fish in restaurants, but I usually hate to cook fish at home – it’s just so stinky. Well, this time… was no different.  The wild sole fillets fell apart a little in the pan, so stuffing it was a little tricky.  The recipe called for zesting a lemon, and I don’t own a zester so I skipped that step.

I thought the fish tasted boring and fishy. My husband, however, liked it!  So, he will eat the leftovers, and I will never cook it again.  The whole dish also felt like it was missing a starch, like brown rice.

On the bright side, we both thought the easy-to-cook vegetable side dish was delicious, and I could’ve eaten this for dinner alone. This recipe inspired me to  start adding olives and white beans to my veggies for flavoring and protein every now and then, so this was a win for the Mediterranean diet!

Recipe 2: Fast Honey-Harissa Pork Chops with spiced chickpeas and chard.

Porked Chop

Pan frying the pork chops was easy overall, but one of the pork chops was a much thicker and darker cut than the other one, resulting in one perfectly juicy pork chop and one slightly dry and tough pork chop. The honey glaze had a little spicy kick to it, and the flavor was very nice.  I modified the glaze just for the kids, replacing the harissa spice with garlic powder.

Sun Basket substituted the chard with red cabbage instead – they will occasionally make substitutions for a variety of reasons. We like cabbage, but the final plating felt like it was missing something green.  And this time I microwaved a bag of brown rice (ready in 90 seconds), just in case it felt like a starch was missing…

The Moroccan-spiced cabbage (coriander, cumin, allspice) and chickpeas were a wonderful compliment to the pork, and the meal really came together well. I ended up putting some brown rice on each plate to make it feel complete.  The African flavor profile was a gentle and pleasant change from our usual.  My husband and I agreed that this recipe is going into the rotation.

Recipe 3: Chicken Cacciatore with cauliflower mash.

Chicken

Ok, by this day the produce was not looking as fresh, so I knew I had to cook that night. Cacciatore is a rich tomato-based chicken stew, and I was looking forward to cooking stew on a 90+ degree day. (NOT.)

With the air conditioning cranked up, I tackled the recipe. It required me to chop cauliflower, olives, mushrooms, and parsley, which I found annoying – couldn’t they have done this for me?  I suppose the produce stays fresher longer this way, but I was still annoyed.  This better be good.

The cauliflower mash was little labor-intensive as well, maybe because I thought it was supposed to be the consistency of mashed potatoes. I gave up and renamed it cauliflower rice.  Whenever the recipe called for water, I substituted with my secret weapon: chicken broth. (I find that this gives my food that je ne sais quoi, umami depth of flavor that takes things up a notch.)

The final result was a hearty stew that the whole family (even the kids) enjoyed. The cauliflower mash/rice was tasty, and there was no need to add a proper starch to the dish.  Even the kids thought it was actual rice and ate it!  This meal is also going into the rotation in the winter, if winter ever comes here to Florida.

Overall

PROS

Doing this service forced me to cook fresh food, try out new things, and reminded me of healthy foods that I love. For example, I don’t think I would have ever tried cooking with white beans or chickpeas otherwise, and eating cabbage again reminded me how much I love it.  I will definitely add all the vegetable sides to my cooking repertoire.  It was very convenient, and we ate less take-out than usual.

CONS

If you are environmentally conscious, the packaging that the meal kits come in will be painful to deal with – all the cardboard, heavy cooler packs, and plastic containers each week. I actually needed these things and will be re-using them, but I know not everyone will re-use and recycle.

Not every recipe was a winner. Like going to a restaurant, there can be some trial and error, hits and misses until you find your favorites.

COST

The cost can seem high at $10 a portion, but when I factor in the time I saved by not going to the store or prepping the ingredients, and the fresh groceries I maybe would’ve thrown away when I didn’t use it all for the recipe, it’s not too bad. And considering that I could’ve resorted to ordering take-out instead, it may have saved me money.  But then again, if I cook at home, someone has to clean up…

The Final Verdict

I plan to continue meal delivery service, but with some changes. First of all, I will order two meals per week instead of three, so the ingredients stay fresh, and I have more flexibility.  I will filter out meals that include fish (unless my husband is willing to cook it).  We will eat our fish when we eat out!

I’ll take advantage of the introductory offers and try out a couple other services. Even though the others may not advertise Mediterranean meal plans, I can pick out plans and recipes that look brain-healthy, and use olive oil as my primary oil. For example, I’ll look for chicken, shellfish, or vegetarian recipes that are low in bad fats and high in green leafy vegetables and nuts, beans, and seeds.

Overall, I think these services can be useful and inspire folks like me to get in the HABIT of cooking again, and help folks discover new foods and food preparations to add to their routines.

 

Jun 25, 2018 · Repost: How "de-cluttering" can help you in Living with Mild Cognitive Impairment (MCI)

In general, we recommend a day planner that is small enough that you can carry it around with you everywhere. It should be simple but have 3 essential sections: The day's schedule, a task list for to-do's, and a notes section. We encourage you to write in it and review it consistently, so that it becomes a HABIT!

Jun 25, 2018 · Repost: How "de-cluttering" can help you in Living with Mild Cognitive Impairment (MCI)

If you are interested, here are a few websites that have more resources :

For a summary of the steps I outlined above — https://thecrazycraftlady.com/konmari-method-checklist-journey/
For a short simple checklist of items to work on, and the order in which to de-clutter — https://www.lavendaire.com/tidy-konmari/
For a a more thorough and comprehensive checklist of items — https://www.neatlittlenest.com/single-post/2017/11/03/ULTIMATE-KONMARI-CHECKLIST

Dr. An Oskarsson

Jun 25, 2018 · Repost: How "de-cluttering" can help you in Living with Mild Cognitive Impairment (MCI)

Hello Dr. Rubenzer,

If you are asking about a simple checklist or plan for your de-cluttering process, here are a few websites that have good ones :

For a summary of the steps I outlined above — https://thecrazycraftlady.com/konmari-method-checklist-journey/
For a short simple checklist of items to work on, and the order in which to de-clutter — https://www.lavendaire.com/tidy-konmari/
For a a more thorough and comprehensive checklist of items — https://www.neatlittlenest.com/single-post/2017/11/03/ULTIMATE-KONMARI-CHECKLIST

Thanks for reading!

Dr. An Oskarsson

May 1, 2018 · Our HABIT Team: Meet Miranda Morris in Living with Mild Cognitive Impairment (MCI)

Miranda Morris

I first met Miranda Morris last summer in 2017, when she was the coordinator and a therapist for the Jacksonville HABIT program. Since then, she has become the Master Program Coordinator for HABIT – supporting operations for Jacksonville, Phoenix, and Rochester.  This week I got the chance to interview her and learn more about this vibrant, funny, larger-than-life lady.

An Oskarsson: When you were a kid, what did you want to be when you grew up?

Miranda Morris: I told people that I wanted to be a mermaid until I was in Kindergarten. Then I said I wanted to be a scientist.

 

AO: How did you end up being a Master Program Coordinator?

MM: I originally started as a psychometrist AND a coordinator. I did that for a while until the program grew and demanded more time, so I slowly moved toward only doing HABIT stuff. Then, after being a full-time HABIT Coordinator for HABIT for a year or two, my husband got a promotion and was asked to move to Alabama. I truly love what I do, so I was heartbroken about the possibility of having to leave Mayo Clinic and HABIT. I jokingly asked Dr. Chandler if I could just work remotely from Alabama, and she supported the idea. Once we got permission for that, we discussed it with the HABIT Directors at the Arizona and Rochester sites. They supported the idea and asked me to come on board as a Master Program Coordinator so we could be more efficient and helpful to our patients.

 

AO: What is your favorite thing about the HABIT Program?

MM: There are so many parts that I love! I think my favorite is when I work with someone to get back to doing a hobby that they used to love, or when I can encourage someone to seek out creative activities. I now know several talented visual artists, writers and musicians.

 

AO: What do you usually use the “Notes” section of your calendar/planner for?

MM: I use the Notes section of my calendar to write one thing that made me laugh that day, one thing for which I am grateful and one goal for the next day.

 

AO: What is your favorite thing about living in Alabama?

MM:  So many different types of wildlife!

 

AO: What do you miss most/least about Jacksonville FL?

MM: The thing I miss the least is definitely the traffic—UGH! The thing I miss the most is the ocean.

 

AO: If you could only eat 5 foods for the rest of your life, what would they be?  (Don’t worry about whether it’s healthy)

MM: Tomatoes, strawberries, Moon Pies (it’s a southern thing), fresh mozzarella cheese, and pecans.

 

AO: Do you have a hidden talent or special skill?

MM: I paint a little. It’s one of those things that clears my mind, and I can lose myself in for hours on end.

Miranda's Painting

(Reference picture is on the left, and painting by Miranda Morris is on the right. She likes to take a little freedom with vivid colors.)

AO: What is one of your goals for 2018?

MM: To have more adventures. Even if that only means driving an hour north to go on a hike to find a waterfall that I saw on Instagram.

 

In addition to her multi-site program coordinator role, Miranda continues to work as a therapist for some of the HABIT sessions. We are thankful for all that she does!