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Tue, Sep 11 8:12am · HABIT Returns to Rochester, MN! in Living with Mild Cognitive Impairment (MCI)

RST Team Photo 2018

After a hiatus of over 1 year, we are thrilled to announce that the HABIT Healthy Action to Benefit Independence & Thinking Program ® has returned to regularly scheduled sessions in Rochester, Minnesota. The team is a mix of staff who primarily work in the La Crosse, Wisconsin Mayo Clinic Health System location, and others who work in Rochester.

If you’re unfamiliar with the HABIT program for people with Mild Cognitive Impairment and their care partners, check out this page to learn all about it!

Our session included 8 wonderful couples/partnerships from around the country. The location was the scenic Assisi Heights conference center, and many patients and partners enjoyed being able to get outside for a stretch break and some fresh air. As is usually the case, patients and partners found a sense of community with one another, and left feeling motivated to continue working on their new HABITS!

Our next session will be in October, 2018, followed by 4 sessions in 2019. The goal is to make this “Rochester” HABIT a Midwest HABIT program, with offerings in La Crosse as well.

Thanks to the patients, partners, and staff who helped make this special session a success!

Photo of staff from left to right: Carolyn Isaak, M.S. (Yoga & Meditation Teacher), Jennifer Loepfe, B.A. (Cognitive Trainer), Angelina Polsinelli, Ph.D. (Neuropsychology Fellow), Anni Shandera-Ochsner, Ph.D., L.P. (HABIT MN Director), Joanne Nordeen, M.S. (Cognitive Trainer), Miranda Morris, M.S. (HABIT Enterprise-wide Coordinator), Alissa Butts, Ph.D., L.P. (Neuropsychologist).

 

Thu, Aug 2 9:43am · Planning for the Future: Advance Directives in Living with Mild Cognitive Impairment (MCI)

@bonniep, this is such a tough decision, and one I'm sure many others with a spouse diagnosed with MCI face. Often it does make sense to list someone other than your spouse as the surrogate decision-maker, given the uncertainty about what your spouse's cognitive capacity may be in the future. This can be a good topic to discuss as part of the larger "planning for the future" discussions you and your spouse have.

Tue, Jul 24 1:21pm · Planning for the Future: Advance Directives in Living with Mild Cognitive Impairment (MCI)

Hi Nancy, you certainly can start with an attorney. They should be knowledgeable about the requirements for such a document in your area. The other options listed above are alternatives that would not come with a legal fee. Nice to hear you are being proactive in getting this taken care of!

Tue, Jul 17 11:01am · Planning for the Future: Advance Directives in Living with Mild Cognitive Impairment (MCI)

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A diagnosis of mild cognitive impairment (MCI) comes with a lot of uncertainty. Shortly after your discussion with your doctor, you may have wondered what your diagnosis means for the future. Many people worry about being a “burden” on their loved ones in the future, especially if MCI turns into dementia.

While we cannot predict the future with certainty, we do know that having MCI increases the likelihood of dementia, which means that you may eventually need help making major decisions due to the thinking problems that come along with your condition.

This is tough to think about, and many people push this topic to the side, saving it for later. The problem is, families often find that “later” gets pushed out farther and farther away, right up until there is a crisis. By that point, the initial memory or other thinking problems may be much worse, and the person unable to fully participate in the decision making process. This is a stressful situation for other family members, who are left with the anxiety of not knowing exactly what their loved one would have wanted when faced with the issue at hand. No one wants to put their family in this position. Fortunately, there is a way to prevent this.

Advance Directives

An advance directive is a legal document that can be “activated” or put into effect in the event that you are unable to make your own healthcare decisions. A physician or psychologist must make this determination based on a thorough examination of you at the time your capacity (ability) to make decisions is in question. The document specifies:

  • Who you want to make decisions on your behalf. This is sometimes called a “surrogate decision maker” or “healthcare surrogate.” Usually you can designate a first choice and a second or even third choice.
  • Your wishes about the care you receive. For example, whether you want life support. Often, you can specify the situations in which you want certain interventions depending on your doctor’s opinion of whether you are expected to recover.
  • Essentially, this is your written “voice” to be used if there is a time when you cannot state your wishes or make your own decisions. This is a gift to your family in that they will not be put in the stressful situation of trying to guess what you would or would not want.

How to Get Started

You can fill out an advance directive well in advance of needing one. It’s a good idea for every adult to fill one out, regardless of whether you think you will need it in the future. Because the legal requirements for the document can vary from state to state, it’s important to use your local resources to help you get started.

  • Talk to your primary care provider/family doctor. He or she will likely be able to provide you with the form used in your area, and can talk with you about your wishes. At Mayo Clinic, your physician can help you meet with a social worker who can walk you through filling out the form and even witness your signature.
  • Or, you can contact your area agency on aging. Visit https://eldercare.acl.gov/Public/Index.aspx to find the agency in your zip code.

Once you’ve completed your advance directive form and had your signature witnessed, make time to do the following:

  • Give your healthcare facility or providers a copy of the completed form. It’s good for them to have a copy scanned into your medical record in the event it is needed.
  • Tell your family where the original document is filed at home.
  • Sit down and have a discussion with the person or people you have listed as your surrogate decision makers. Talk about your preferences for care in the future as outlined in your advance directives. It can help them to understand why you do or don’t want certain medical interventions.

Have you completed your advance directives yet? Any tips for others who are considering this?

 

 

 

Tue, May 8 9:22am · Can Computer Games Help My Memory? in Living with Mild Cognitive Impairment (MCI)

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Turn on the television or radio and chances are it won’t take long before you hear an advertisement for “brain training” computer game programs that are meant to give your brain a workout and prevent dementia. The claims made in the advertisements sound great – but can we really give our brains a workout by playing games on a computer or smartphone?

What does the research say?

    • There have only been a few randomized controlled studies (the gold standard in research) about the effects of specific computer based programs.
    • One such study, called the Improvement in Memory with Plasticity-based Adaptive Cognitive Training (IMPACT) Study  was as multi-site study (Los Angeles, San Francisco, Rochester) led by researchers at Mayo Clinic. The goal of the study was to see whether older adults without evidence of cognitive or memory impairment who used the Brain Fitness program by Posit Science would show improvements on formal tests of memory and attention and in how they perceived their cognitive abilities in daily life.
      1. Participants used the program for one hour per day, 5 days per week, for 8-10 weeks.
      2. Another group of participants (the “control” group) did not use the program, but spent the same amount of time watching educational DVDs and taking paper and pencil quizzes to see what they remembered.
      3. Before and after the training period, both groups were given neuropsychological tests and questionnaires to see whether the training had an effect on memory and other thinking abilities and their perception of cognitive abilities.
      4. RESULTS: The group that did the Brain Fitness training improved (compared to the control group) on a test of memory, a test of thinking speed, and in their report of how good their memory in everyday life was.
      5. The catch: the benefits went away when people stopped doing the exercise.
    • A review of all of the studies on this topic from 1970-2007 found that overall, cognitive interventions, such as computer brain training programs lead to improvements in memory, but there is not good evidence that this is the ONLY way to get these benefits. In other words, computer based games seem to help, but so do other kinds of mental exercise.
    • A more recent publication by researchers at the University of Southern California, which combined results from multiple published studies, found that cognitive training improved thinking skills to the same extent as regular aerobic exercise.
    • The National Academies of Sciences was tasked by the National Institutes of Aging, the primary funding agency in the United States for aging related research, to evaluate the current state of the knowledge on interventions for preventing cognitive decline and dementia. In 2017, it published its report and one intervention they determined has “encouraging but inconclusive evidence” is cognitive training (in addition to physical exercise and controlling high blood pressure). It is important to note that they define cognitive training much more broadly than computer games. Cognitive exercise could be computer brain games, but could be other non computerized, cognitively challenging activities as well. They conclude that more research is needed to determine definitely the impact of these interventions, but that it is reasonable to expect cognitive exercise may help and for health care providers to recommend it.
    • Finally, in a recent review specific to Mild Cognitive Impairment and specific to computerized brain games, they found that brain games may modestly benefit aspects of cognition as well as mood in patients with MCI.

So, what’s the bottom line?

    • Cognitive exercise is likely beneficial. If you like computer-type games, give one of the “brain training” programs a try. One advantage of these programs is that they adapt to your skill level and get harder as you get better, therefore providing a consistent challenge.
    • But, you don’t have to spend money every month on a subscription to a computer program to see results. You can just as easily do something else to challenge your mind. Some examples are: learning to play a musical instrument, learning a new language, take up a new hobby or doing anything that really challenges your brain.
    • If you are already an expert at something (e.g., playing the guitar, crossword puzzles) you may need to try something new or make it more challenging (e.g., learning a new musical piece, trying harder crossword puzzles) to keep getting the cognitive exercise benefit.
    • The important thing is that you get in the habit of consistently doing something to keep your brain engaged!
  • Chime in! How do you keep your mind active?

Tue, Feb 20 10:12am · Have You Heard About the Latest News About Treating MCI? Here’s How to Evaluate It. in Living with Mild Cognitive Impairment (MCI)

Man Looking In Microscope

The lack of available treatments for Mild Cognitive Impairment (MCI) is frustrating for patients, families, and providers. When a new study or possible treatment approach comes out, it often gets featured in the mainstream media, and it can be hard to remind yourself to hold your excitement until you know more about the quality of the evidence being presented. If you’re not a scientist or healthcare provider, this can feel easier said than done. However, you can weed out the bad apples and flimsy claims by doing a little extra digging.

Here are a few points to consider:

  1. How big was the study?
    • The article you see may not give an exact number, especially if it’s in the lay media (e.g., a magazine, internet, or newspaper article). But, you can look for clues such as the words “case study” or reference to one or two individuals to tip you off to the fact that this report is based on a very small number of people.
    • In general, the smaller the number of people in a study, the less you should trust that the results may apply to you. In research, the most convincing evidence comes from studies of big groups of people.
  2. Was the research independent and free of bias?
    • It’s important to know who is reporting the findings. Sometimes, supplements or cognitive training products (e.g., brain training) mention lots of research with impressive sounding findings. But, if you look carefully, you can see that the research has all been done by the company actually selling the product or supplement.
    • Along the same lines, be alert for flashy advertising and “research” claims that are part of an attempt to get you to spend money on something. Be especially careful about internet sites that want you to pay to find out about the latest way to prevent Alzheimer’s disease.
    • As a rule, supplements (vs prescription medications) are NOT evaluated or monitored by the FDA, and so companies can make strong claims that have not been proven.
  3. Have the findings been confirmed by another study?
    • The most convincing and compelling research findings have been “replicated” or reproduced by 2 or more independent groups of scientists. Showing the same result no matter who does the research is a great way to increase the likelihood that a finding is something to get excited about.
  4. What does your healthcare professional think?
    • If you’re really curious about a particular finding and think it might be worth trying out yourself, be sure to talk to your healthcare provider and get their opinion first. Healthcare professionals typically have access to research that is not available to the general public, and are in a good position to judge the quality of evidence. They can also be alert to any risks or side effects that might come from taking a supplement with your regular medications.

Learn more about how to be savvy about non-traditional treatments in this Mayo Clinic article https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/alternative-medicine/art-20046087

Chime in! How do you evaluate company or research claims? How do you guard against scams?

Dec 26, 2017 · How Big Was That Fish? When Memory Loss Changes the Story in Living with Mild Cognitive Impairment (MCI)

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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?