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Fri, Jul 26 7:52am · Repost: The 1 Minute Breathing Meditation for Relaxation in Living with Mild Cognitive Impairment (MCI)

Relaxing Couple

Summer is a time for relaxing for many.  Or, a busy time of travel, holidays, and BBQs.  For me, the kids are on summer break, and we’ll be vacationing with the in-laws.  A perfect time to remember a blog from a while ago by our Yoga Instructor and Physical Therapist in Arizona, Pauline Lucas, on taking a minute and taking a breath! 🙂

Do you have just 1 minute?

Do you find yourself frequently worrying about the future, ruminating about past events, or simply having a hard time quieting your mind? Using a simple breathing practice for relaxation might help calm your overactive mind. Breathing practices have been used for thousands of years and have gained much popularity lately. They are easy to practice, free of charge, and don’t have negative side-effects.

Fight or Flight

When we are stressed, either because of difficult circumstances, or because of our stressful thoughts, our nervous system gets ready for action. You may have heard of the “fight/flight response”. When our brain perceives danger, the body gets ready to either fight or run away from the threat. This is a great nervous system survival response for short term stressors and when we need to act quickly. An example of this is when a car comes swerving into our lane on the freeway and is about to collide with our car. We quickly jerk our steering wheel, maybe honk the horn, and once the situation is over, we might feel our muscles tighten, feel our heart beat fast, and our breath may be shallow and rapid. After a few minutes however, these sensations resolve and the body is typically calm again. If our nervous system experiences chronic stress, either because of a difficult situation or our constant worry thoughts, the same response happens, only now it doesn’t just ease up. The result can be chronically tense muscles, faster heart beat, fast and shallow breathing, digestive problems, and insomnia, just to name only a few!

The power of breath

The breath is an interesting function of the body as it typically (thankfully!) happens automatically, but we can also control it –for example to energize or calm our system. By becoming mindful of our breathing, purposely breathing in a calm way, and by breathing out a little slower than our inbreath, we can calm our nervous system and lessen the “fight or flight” response and instead move the nervous system to a calmer state called the “rest/restore” response. The result is relaxation of the body and a calmer mind. Some of this happens immediately, but with regular practice, the results are even more significant.

Easy steps to practice a 1-minute breathing meditation:

  1. Find a comfortable seated position, feel your feet on the ground and keep your spine tall and straight. Relax your shoulders away from your ears, and relax the face. If appropriate, you can choose to close your eyes.
  2. Take a long, slow breath in through the nose, and then calmly, slowly, and without tension breathe all the air out through the nose.
  3. Resume regular breathing by allowing the next breath to come in automatically, without any effort, and notice the cool sensations at the nostrils.
  4. Keep your awareness with the sensations at the nostrils as you breathe out calmly, and notice warmer air leaving the nose. Ideally your outbreath is a bit longer than the inbreath.
  5. For 1 minute (longer if desired) keep your awareness with the breath gently entering and leaving the nostrils.
  6. If you find your mind wandering, simply return it to the breathing practice.

Regular practice

Once you have practiced this technique a few times you can try a “mantra” practice, which means you use a word or short phrase to keep your mind focused on the breathing practice. For example: as you breathe in you might mentally say, “I am”, and as you slowly breathe out say “calm”, and you repeat this with each breath.

This is a simple practice that can be used pretty much anytime and anywhere. Although we tend to initially practice sitting or lying down, it can be done in standing as well. So the next time you find yourself in a doctor’s waiting room, or in line at the grocery store, instead of getting frustrated about the wait, you might use the time as an opportunity to practice some relaxed breathing and de-stress your nervous system instead.

Tue, Jul 16 8:42am · Patient Spotlight: Debbra and Ernie in Living with Mild Cognitive Impairment (MCI)

Deb and Ernie

Thanks to our HABIT Alumni Debbra and Ernie for sharing their story with us this week!

Mayo asked if they could do an article about our experience with their program called Healthy Actions to Benefit Independent Thinking (HABIT).   I knew they wanted us to share what we learned in the HABIT program, and I knew they wanted a picture of us.  I decided to start with the easy part… searching for a picture.

It turned out to be not so simple.  I could NOT find a picture that didn’t have HABIT’s Mayo Calendar sticking out of Ernie’s front shirt pocket.  I’ll admit to having a large strain of perfectionism, and I wanted something that looked more like a studio shot.  I started to ask a friend to take a more “appropriate” picture since it was going to be online.  But then I re-thought.  This is our life.  Ernie has that HABIT calendar in his pocket all of the time – every time you see him.  If he is awake, he has the calendar, he is checking it, writing in it or sometimes using it to remind me of something I’m supposed to do!  So here is our picture and here is our story.

Ernie was diagnosed with Mild Cognitive Impairment (MCI) in late 2015.  The doctor that made the diagnosis referred us to Mayo’s HABIT program.  This was a 10-day program for people with Ernie’s very same diagnosis and their spouses or partners.  Although we were both reeling from the diagnosis, we knew this was a great opportunity.  There are very few programs available in the country for patients diagnosed with MCI.  The possibility of participating in HABIT gave us hope that there was a way for us to learn to navigate the journey we were facing.  We felt so fortunate to be accepted into HABIT in 2016.

There are five parts to the HABIT program:  Individual memory compensation training (the Calendar), Wellness Education, Brain Fitness, Yoga and Group Support.  Our session of the program was part of a study that randomly left out one of the five parts, so we missed the group therapy sessions, but we got all the others.  Even with just four parts of the program, it was a lot to take in.  It was informative, interesting, challenging, inspiring and some days totally exhausting.  We learned so much!

Some of the aspects of HABIT were better suited to our lifestyle than others.  For example, yoga was like a foreign language to Ernie, and even as much as I wish I would incorporate it into my life, it hasn’t worked yet.  Yoga just didn’t “take” with us.

On the other hand, Brain Fitness was another story.  I enjoyed doing the brain games.  Ernie found them a little more frustrating.  But once we finished the program and settled back into our daily routine, he found that he really enjoyed playing Sudoku on his tablet.  I love doing the Crossword Puzzle and Jumble in the newspaper.  Doing stimulating brain exercises soon developed into one of many healthy “habits” that we incorporated into daily life.

Likewise, the Wellness Education provided a lot of new information and a number of useful reminders and helpful tips.  We were already fairly healthy eaters, but the information on the Mediterranean diet and discussions around that way of eating helped me to focus on making our meals part of our healthy “habits.”  And, the wellness discussions around physical activities were extremely helpful.  We went from thinking of a long walk as something that was nice to do when we had time, into making a morning walk a part of our daily routine – another healthy habit.

But far and away, the part of the program that was most helpful for us was the Calendar.  It took some training.  In the first days of the HABIT program, it was a little frustrating for both of us.  Ernie was sometimes discouraged learning the Mayo HABIT procedure, and I was unhappy and dragging my feet about having to “give up” the calendar on my smartphone.  We laugh looking back on that time.  Before the 10-day program was over, Ernie was totally on top of the calendar process and I happily realized that sometimes in life, you get to have your cake and eat it too!  Keeping my smart phone calendar AND the Mayo calendar was no problem at all, and it allowed Ernie and me to be real partners in planning our days and tracking our activities.

Based on advice from our HABIT program neuropsychologist, I have two cardinal rules:

  • to never touch Ernie’s calendar, and
  • to always sit down together to plan our activities.

Ernie’s calendar is his – he keeps it himself.  He writes in it whatever he finds useful and important.  On the yearly calendar, he keeps event dates like birthdays or major medical appointments.  He also uses the back section of blank pages to record information he wants to refer to later, but sometimes draws a blank on – the name of our lemon tree (Meyer Lemon), the names of friends who only visit us once a year, and the difficult medical names of his prescription medicines so he can reference this when he talks to his doctor.

On the monthly calendar, he keeps all of his personal appointments on the hourly schedule page.   In the “To Do” section, he writes things he wants to accomplish or activities that don’t have a specific time frame.   In the Notes section, he keeps all of my activities for each day.  (Did I mention that he sometimes has to remind me to start hustling since I have an appointment coming up?  He ALWAYS gets a chuckle out of this!)  He keeps other relevant information in the notes section.  As an example, if he meets someone and wants to remember their name or what they discussed, it goes into “Notes.”  Sometimes, if we have a special evening with friends, and he wants to remember the specifics of what we did, he puts it his Note section.

I could say the Calendar has become a healthy “habit” but it is so much more than that.  It is the bedrock of our daily conversation. “ What’s happening today?” “ What do we have to do this week?” “ Are we free for dinner with friends the first Friday of next month?”   It is a tool that gives us both autonomy and independence and at the same time, a shared reference point.

Before the beginning of each month, we sit down at the kitchen table and fill out our calendars for the upcoming month.  Every Sunday evening, we sit down again and double check the pages for the week ahead to make sure we have incorporated any new plans.  And every day, Ernie opens his calendar in the morning and checks the days activities.  He almost always ends the day by opening the calendar, checking off accomplishments, and making notes about what happened during the day.  The Calendar has been a Godsend for us.

The journey of cognitive impairment is not an easy one – it’s a hard trek.  When you are starting out on a difficult and strenuous trek, you need the right tools.  And if you are lucky, you will have someone cheering you on along the way and asking how things are going.  We found all of that and more in the HABIT program.

Deb and Ernie 2

 

Tue, Jun 25 8:55am · Repost: How Big was that Fish? in Living with Mild Cognitive Impairment (MCI)

Big FishThis week I wanted to repost a great article Dr. Shandera did last year about confabulation with memory loss, or the brain “making up information” that is not true when the real memory is not there.  I think it is so important for our relationships with someone with memory loss to understand the difference between willful “lying” and neurologic confabulation.  Thanks Dr. Shandera!

The original link is here.

How Big was that Fish?  When Memory Loss Changes the Story

Mild Cognitive Impairment (MCI) often affects memory. When memory fails, the brain sometimes compensates by attempting to fill in the gaps on its own. The technical term for this is confabulation. Confabulation might be the creation of “memories” for discussions or events that never actually happened, or it might be a distortion or elaboration of things that did happen. Sometimes, the confabulated story sounds very reasonable, while other times the gaps get filled in with outlandish or bizarre content.

Isn’t that lying?

Confabulation is not the same as lying. The person with memory loss truly believes what he or she is saying, as it feels like a real memory. The process happens automatically. For those close to the person with MCI, confabulation can be surprising or even scary at first. Spouses or adult children may feel embarrassed when it is obvious to others that the person with MCI is saying something that is not true. The person with MCI, in turn, may feel angry or humiliated when a family member corrects his or her version of a story.

Some examples

Sometimes, confabulation is a mix of what the person with MCI has seen or heard in “real life.” It might be triggered by reading a story in the newspaper or watching a program on television. Imagine this scene: Gene has Mild Cognitive Impairment. Gene and his wife, Marge, are watching a television nature program about sharks, and shark attacks on humans. The next day, Marge overhears her husband on the telephone with their daughter, explaining that they cannot come to visit her in Florida as planned because last time they were there they were attacked by a shark.

Other times, confabulation happens when a situation does not make sense to the person with MCI due to memory difficulty. For example, Irene recently had to change the passcode for her cell phone. However, she forgot she did this, and now she keeps getting locked out of her phone for repeatedly typing in the wrong code. Her brain may try to help fill in the gap in her memory by coming up with the explanation that someone came into her apartment and changed the passcode for her cell phone. She may start to repeat this story to anyone who will listen, and will likely feel upset about it.

What helps

  • Don’t argue. This is unlikely to result in anything more than frustration on both sides. Remember, for the person with MCI, this feels like a real memory.
  • Try re-orienting to reality. If a confabulated story sticks around and seems upsetting to the person with MCI, loved ones may try to gently present another explanation. This is where a memory notebook system can really come in handy. In the case of Irene, her husband could show her where she made a note of her new passcode in her notebook – “maybe you changed it? Let’s look in your notebook together to see if that’s what happened.” Stay neutral and helpful, be an ally. Avoid statements that put the person with MCI on the defense, such as “I bet you forgot” or “That’s not what happened, how many times do I have to remind you?”
  • Wait and see. For example, when Gene told his daughter they’d have to cancel their trip to see her because of the shark attack, his wife and daughter might say “okay, good point, we can get together another time.” Then, a few days later, his wife might try bringing up the trip again, to see how Gene responds. Sometimes the confabulation is forgotten soon afterward, and there’s no need to do anything about it.
  • Just go with it. Sometimes, a confabulated story sticks around, and there’s not much you can do about it. If it’s upsetting to the person with MCI, just nod your head, and provide reassurance and validation of the feelings he or she is experiencing. “I know the situation with your cell phone is so frustrating, I’m sorry that happened.” Then change the subject and redirect the conversation.

Chime in! What tricks and tips have you used to help cope with confabulation?

 

Tue, Jun 18 7:56am · HABIT Directors Present in Chicago in Living with Mild Cognitive Impairment (MCI)

Chicago 2019

In a rare coming together, all four HABIT Directors met to give a 3 hour lecture to the American Academy of Clinical Neuropsychology at the annual meeting in Chicago, IL on June 6, 2019.  (From left to right: Dr. Glenn Smith, University of Florida; Dr. Dona Locke, Mayo Arizona; Dr. Anne Shandera-Ochsner, Mayo Midwest; and Dr. Melanie Chandler, Mayo Florida.)

The team was invited by the national organization for board-certified neuropsychologists to help give a “hands on” presentation about HABIT, in hopes of spreading the knowledge of this intervention to more providers across the United States and Canada.  Dr. Chandler discussed the state of knowledge in general about behavioral interventions in Mild Cognitive Impairment, setting the stage for why we do the interventions we do in the HABIT Program.  Dr. Shandera next gave a “how to” presentation going over how to do the components of the program in detail, particularly the memory support system calendar training.  Dr. Smith provided our research findings as they impact the patient, and Dr. Locke discussed how the program affects care partners and future HABIT directions.

The presentation had excellent attendance (between 150-200 neuropsychologists in the audience!), and we got great feedback, including several folks interested in referring patients or starting a HABIT program of their own.

Equally important, this gave us all time to sit down together for a few hours afterwards and discuss how to keep growing and improving the HABIT program.  It was a great get together!

 

 

Sun, Apr 28 8:16am · Repost: How "de-cluttering" can help you in Living with Mild Cognitive Impairment (MCI)

shutterstock_640339735

The staff at HABIT tend to be people who like organization (did you notice?), and this goes beyond calendaring.  Anyone else binge watched Tidying Up with Marie Kondo?

Well, at our most recent HABIT session, we were reminded of how helpful simplifying your space can be when  memory loss occurs. So, we thought we would repost this blog from Dr. Oskarsson last year.  Hope you are inspired to get organized!

-Melanie Chandler

Got stuff?

By Dr. An Oskarsson

Most of us have accumulated a lot of stuff over the years.  Think back to the last time you moved – were you surprised by how much you had?

If you do a search on the internet for keywords like “de-clutter”, “minimalist living”, or “Konmari method”, you will find that there is a recent hot trend in the housekeeping world. People such as Marie Kondo, author of the books “The Life-changing Magic of Tidying Up” and “Spark Joy”, suggest that we all should dedicate some time to organize and simplify our home environment (read: GET RID OF STUFF).  The rationale is that doing so would ultimately reduce our stress and make us happier being surrounded by only the things we need or love.

The Importance of Simplifying

Before I go on to describe a specific method for de-cluttering, let me explain why this is the topic of a blog designed to help those living with MCI blog.

During Mayo Clinic’s HABIT program for people with MCI, we teach participants how to effectively use a day planner to help increase independence and compensate for memory issues.  Participants learn strategies for writing the important information you need and want to remember, how to organize the information (i.e., where to write it down so that you can easily find it), and how to use the planner effectively. As it becomes a habit, participants’ worry less about whether something has been forgotten and gain confidence in their abilities.

It’s a similar concept when applied to our physical surroundings!  While just about everyone can benefit from a simplified and organized home environment, imagine how it could be helpful to persons with cognition and memory problems.  Let’s use the clothes closet as an example.

Example: The Overflowing Closet

Do you really need to hang on to the clothes that don’t fit anymore, or that you haven’t worn in a year?  Do you need 5 similar belts, 10 pairs of jeans, 20 handbags…?  Are you going to be invited to a 70’s party anytime soon? Now suppose you reduced the closet to only the clothes that you actually have worn in the last year and the clothes you love… imagine how much easier it would be to find the items of clothing you are looking for when you need them!  Would it be easier to pick out an outfit to wear, or find that favorite shirt?

I myself have a 6-year-old son who is very opinionated about what he will wear. I finally figured out that the fastest way to get him dressed is to go straight to the laundry basket of clean clothes to pick out his outfit for the day. The clean clothes laundry basket is filled with his favorite items and if he wore it recently, I know it’s something he will accept! I’m not suggesting that you live out of a laundry basket, but I am saying that reducing the amount of un-used and un-loved stuff in your home has its benefits!

A De-Cluttering HOW-TO

Organization experts often suggest a specific method for purging your things, believing that some ways are particularly effective. The following is a basic description of one de-cluttering process that is loosely based on the Konmari method.

STEP 1.  Pick a category of stuff to declutter: Clothes, Books, Papers, Personal care/Bathroom, Kitchen, Miscellaneous Household items (e.g., electronics, DVDs, medicines), Sentimental items.

Continuing with the clothes closet example, let’s suppose you’ve decided to work on your SHOE inventory.

STEP 2.  Lay it all out.  Now you can survey everything and get a good sense of how much you have of each item type.

For your shoes, find a space (e.g., table, floor) where you lay all your pairs of shoes out in front of you. Put your sport shoes next to each other, all your dressy shoes together, your sandals, loafers, boots, and so on. (Now it will be more obvious that you have half a dozen pairs of white tennis shoes!)

STEP 3. Pick up an item one at a time, and ask yourself whether the item is has been recently used. If not, does it bring you joy?  If the answer to either of these questions is yes, KEEP the item and designate a space for it.

Pick up a pair of tennis shoes – when was the last time you wore them? If it’s been a while, why is that? Will you be wearing it them anytime soon?   Perhaps they are your favorite most comfortable pair (KEEP), perhaps they are a too small, or utterly hideous (DON’T KEEP). Maybe you’re keeping them because you never really used them and they look brand new – but should you keep things that make you feel guilty (DON’T KEEP)!?

STEP 4. If it’s not a keeper, thank the item for its service and then decide to THROW AWAY or GIVE AWAY.

With the pair of tennis shoes still in your hands, you can think “I really enjoyed wearing you in the 1990’s. ” Now put them in the trash pile or the donation/give-to-a-friend pile.

Tips:

  • If you are having a hard time discarding things, try focusing on whether you can come up with reasons to keep something (rather than reasons to discard it). While it may be true that there is “nothing wrong with it”, if you cannot think of a good reason to hang on to it (e.g., this was a present from my beloved aunt, I need it for upcoming special occasions), it’s time to let go.
  • Don’t try to do too much all at once, or you risk getting overwhelmed! Break the project into smaller tasks, and pick a category or subcategory of items that you feel is do-able in the time you’ve allotted for it. For example, in our closet scenario, you might work through the following categories in separate sessions over the course of a week if you have time, or a month if you are very busy:
    • Tops & Bottoms
    • Dresses/Suits, Jackets
    • Handbags, Belts, Scarves
    • Shoes, Hats, Gloves
    • Socks & Underwear

The Bottom Line

The reason we keep utensils in the utensil drawer in the kitchen and our underwear in the underwear drawer in the bedroom is the same reason we put our doctor’s appointments in our day planner and our to-do’s on our to-do list – so we can form a habit of looking in the right place for important things and being sure to get those things BACK into the right place so we can find them later.  Furthermore, making the effort to reduce how much stuff we have in each designated place – to only the things we really need and love – makes it easier to find what we’re looking for when we need it. We at the HABIT team feel that persons with MCI may especially benefit from an organized and simplified home environment.

So, why don’t you schedule some time in your planner to start de-cluttering? Give it a try and let us know how it goes and more importantly, how you FEEL!

 

Tue, Apr 16 11:36am · Repost: Common Questions after a Diagnosis of Mild Cognitive Impairment in Living with Mild Cognitive Impairment (MCI)

Question Cards

 

We had a lot of good discussion after Dr. Shandera’s recent post on the difference between MCI and dementia.  So, we thought it would be a good time to repost an old blog written by Dr. Locke about some common questions that we hear after giving a diagnosis of MCI. Click below to read the post, and let us know what you think!

Common Questions After Being Diagnosed with MCI

Tue, Mar 5 2:53pm · Repost: Coping with Memory Loss in Social Situations in Living with Mild Cognitive Impairment (MCI)

Today we thought we’d highlight a post from over a year ago, as it is a popular topic every time we host a HABIT session.

Thanks again, Dr. Shandera, for this great post!

Coping with Memory Loss in Social Situations

Group Smiling Over Dinner

Mon, Mar 4 8:00am · Getting Tough on False Claims About Supplements in Living with Mild Cognitive Impairment (MCI)

Thanks @liv4now . I absolutely agree that more research is needed and more $$ to do it, so that we can have definitive answers on these potential treatments!