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18 hours ago · We're All in HABIT! in Living with Mild Cognitive Impairment (MCI)

Hunter Moon

A rare event, like Halley’s Comet or an orange Hunter’s moon rising over the ocean (which we had here in Jacksonville by the way over the weekend!), all three of our Mayo HABIT sites are currently in session!  Which means, this will be only a brief hello to all our visitors and followers and to wish you all well.

We are busy helping more folks who can then hopefully join us here and add to the conversation!

Check back next week for another story!

Tue, Sep 24 12:15pm · Way To Go Arizona! in Living with Mild Cognitive Impairment (MCI)

Arizona HABIT Team

I want to congratulate Arizona on completing today 5 out of 7 HABIT sessions so far this year!  Arizona has done such a wonderful job of getting the message of HABIT out in the Phoenix area that it has resulted in amazing demand for the program.  Such a demand, in fact, that they have almost doubled the number of sessions offered there! (Most HABIT sites offer the program 4 times a year.)

We understand how much work goes into making that happen, so hats off to you, Dr. Locke, and the whole Arizona team.  Way to set the bar!!!

Wed, Sep 18 2:56pm · Repost: What's a Driving Evaluation and Why Should I Take One? in Living with Mild Cognitive Impairment (MCI)

Driving Eval OK

Happy almost Fall!  Here in Jacksonville it doesn’t feel like fall at all, but I can look forward to cooler temperatures soon, right?

Well, that aside, I had a conversation about driving with a patient and his wife just today, and it is a common point of discussion. So, I thought it would be a good time to revisit this on the blog as well. Enjoy!

What’s a Driving Evaluation and Why Should I Take One?

 

Wed, Sep 4 8:37am · HABIT in the News: See the Story on Us in AARP Magazine! in Living with Mild Cognitive Impairment (MCI)

Unfortunately there is no HABIT program in Maine. We are training Gaylord Hospital in Connecticut, which is closer, but I understand still far away. It is our goal to train more and more centers in the upcoming years.

Tue, Aug 27 11:45am · HABIT in the News: See the Story on Us in AARP Magazine! in Living with Mild Cognitive Impairment (MCI)

AARP

During our hot, sticky Florida July, we had a delightful reporter from AARP come out (from her much nicer California climate) and observe our HABIT session. The result: this nice piece in the AARP Magazine!

Thank you to all of our participants in that session and our alumni for sharing their stories, and to our collaborators at other centers for your time to speak with her and help this story come together.  What a great job she does painting the picture of the program!

See what you think:

https://www.aarp.org/caregiving/health/info-2019/mild-cognitive-impairment-habit-program.html

And, pass it on to friends to help us get the word out!

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?