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Thu, Jun 11 9:57am · Meet Mayo Clinic Geriatrician, Dr. Thomas Loepfe! in Living with Mild Cognitive Impairment (MCI)

@neptune – the loss of those outside activities can be devastating. It is important to try and maintain some connections via telephone/video chat when possible, but that can be tough for someone with dementia. You may find it helpful to look back at the posts from this page in March, where we address some of the isolation associated with the pandemic.

Tue, Jun 9 7:00am · Meet Mayo Clinic Geriatrician, Dr. Thomas Loepfe! in Living with Mild Cognitive Impairment (MCI)

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This week, we’d like to introduce you to another type of team member you might see as someone diagnosed with Mild Cognitive Impairment, a geriatrician!  Thomas Loepfe, MD, M.Sc. attended medical school, residency, and fellowship training at the Mayo Medical School/Mayo Clinic Graduate School of Medical Education in Rochester, MN.  He is a Fellow of the American College of Physicians, and certified by the American Board of Internal Medicine/Geriatrics Hospice and Palliative Medicine.

I work closely with Dr. Loepfe, as many of the patients I see for neuropsychological evaluation also are patients of Dr. Loepfe. I sat down with him to learn more about the role of a geriatrician on the medical team of someone who has MCI.

Q: Tell me a little bit about what it means to be a geriatrician, for those who aren’t familiar with the specialty:

A: A geriatrician is a specialist in the medical care of the elderly. Geriatricians are experts in the processes of growing old. They are trained in the medical, physical, cognitive, psychosocial, and functional changes that come with aging. They assist those patients with multiple chronic and complex medical problems, those on multiple medications, patients needing help with environmental transitions, those that need help defining appropriate goals of care, helping with advance care plans and end of life issues. Geriatrics uses a multidisciplinary team approach to the care of the elderly, especially those elderly that find they are struggling to maintain health and independence.

Q: How did you decide to go into this area?

A: I find aging and the changes with aging, especially the aging brain, to be a fascinating field of science and medicine. During my medical training I found assisting the elderly and their multiple, interconnected complex problems was very challenging, both instinctually as well as psychosocially. I enjoy the multidisciplinary approach geriatric medicine has used since the field was founded many years ago. I found that geriatrics was a perfect fit for me, my interests, my skills, and my personality.

Q: If a patient already has a primary care doctor, what does it add to have them see a geriatrician as well? Would they still see their primary care doctor?

A: The patient needs to maintain a relationship with his/her primary care provider. Sometimes geriatricians will do primary care as well as consultative care. Here at Mayo Clinic Health System-La Crosse, the Dept. of Geriatrics is consultation-based. We assist the primary care team with our expertise on aging and the changes and challenges that come with aging, such as dementia, depression, physical and functional declines, needing more assistance at home, advance care planning, capacity to make their own decisions, connections with governmental services, and so on. We work closely with the primary care provider. The patient still needs a primary care provider. The primary care provider is critical part of the health care team.

Q: Tell me about the Dementia Care Program you run. How do people with Mild Cognitive Impairment (MCI) fit in?

A: As part of our department of geriatrics services, we evaluate memory loss concerns that the patient or their families/caregivers may have. Our Dementia Care Program is a comprehensive, multidisciplinary team approach to the care of our dementia patients. If the patient is diagnosed with dementia, they will become part of our Dementia Care Program. We will look at the whole situation the patient is in, including health status, cognitive abilities, functional abilities, psychosocial needs, quality of life of patient and caregivers, degree of stress in the environment, the need for increased services, and many other aspect of their situation that their dementia impacts.   We will follow and assist the patients, their caregivers, and their primary care providers long-term, many times from diagnosis to end of life.

Patients with mild cognitive impairment (MCI) are ideal for our program. The people with MCI have mild memory loss and can benefit from our education and support programs and offerings. The HABIT program offered through Neuropsychology/Behavioral Health has shown to be of significant benefit for the individuals with MCI. We also have a dementia support group on campus which includes both patients and their caregivers and participants find the group very valuable to them.

Q: What’s been the most rewarding part of your career in working with people with memory loss?

A: I think the most rewarding part of working with those with memory loss is extending a hand to help. Many times even the smallest act of helping or of kindness can go the longest way. Plus I truly enjoy the times when a patient with dementia smiles. That smile goes right to my heart.

Q: What advice do you have for caregivers that you wish they would follow?

A: I would say to them to take one day at a time, to ask for help (there is a lot available), and to always try to look at something positive in the situation. Finding humor in the moment can significantly lower the stress levels.

Q: If someone wants to find a geriatrician in their area, how would they go about doing that?

A: There is a significant shortage of geriatricians in the nation so it could be challenging to find a certified geriatrician in any particular region. I would suggest that they ask their primary care provider first. Many times large medical/health care systems will have a geriatrics department or service line. Their websites may be a good place to start. The American Geriatrics Society has a list of some geriatricians on their website. Word-of-mouth from friends and family might be helpful. And of course, there is always Google.

Join other members talking about health and wellbeing as we age at the Aging well support group.

Tue, Mar 17 7:00am · Where You Live Can Influence The Size Of Your Brain! in Living with Mild Cognitive Impairment (MCI)

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Your neighborhood is an important place – it’s where your home is, of course, but also likely a source of socialization opportunities and a factor in where you shop, dine out, get your healthcare, etc. A recent study published in JAMA Neurology in January, 2020 found that your neighborhood can also play a role in the actual size of your brain, as well as the size of a very important structure called the hippocampus. The hippocampus is essentially your memory storage center; without it, you would not be able to form new memories about things that happen, people you meet, and what you do in a given day. The hippocampus is also typically one of the first brain regions to be affected by the tau tangles in Alzheimer’s disease. This is why memory loss usually occurs as an early symptom for many people.

The study involved looking at about 950 cognitively normal individuals living in Wisconsin with a family history of dementia who were part of the Wisconsin Registry for Alzheimer’s Prevention (WRAP) or the Wisconsin Alzheimer’s Disease Research Center. The researchers created an index of how “disadvantaged” a neighborhood was (i.e. the poverty, educational level, income level, employment, and infrastructure within a geographic region), and also looked at cardiovascular disease risk. They then looked at magnetic resonance imaging (MRI) pictures of the brain for each individual to see if there was any relationship between the socioeconomic standing of people’s neighborhood and brain volumes.

The results found that people who lived in the most disadvantaged neighborhoods had approximately 4% lower hippocampal volume and 2% lower total brain tissue volume. This was true even after the researchers accounted for educational attainment, individual socioeconomic status, age, race/ethnicity, and sex. When cardiovascular risk factors were considered, these explained total brain volume differences, but could not account for the relationship between neighborhood and hippocampal volume.

Overall, the authors concluded that living in a very disadvantaged neighborhood is a separate risk factor for lower brain volumes. They speculated that there is an effect of the type of immediate community one lives in on overall brain volume during the aging process, especially on that critical memory storage area (the hippocampus). The broader implication of a study like this, that looks at how our environment affects our health, is to help to know where to target policies and interventions to try to improve overall health.

To talk with others about brain-related topics, join the discussions in the Connect Brain & Nervous System group. 

What sort of community interventions can you think of that might help improve the quality of disadvantaged neighborhoods?

 

Tue, Jan 7 7:00am · Making a New Year’s Resolution? Here’s How to Keep a Promise to You! in Living with Mild Cognitive Impairment (MCI)

 

Happy New Year! I hope 2020 is off to a peaceful start for you after the hustle and bustle of the holidays. An age old tradition at the start of a new year is to reflect on the previous year and consider any changes one would like to make in the coming months. The “New Year’s Resolution” is essentially a promise to yourself to make a change for the better, which often is a commitment to start a new habit in the name of wellness.

The HABIT© Healthy Action to Benefit Independence in Thinking program staff is experienced in helping people with Mild Cognitive Impairment (MCI) and their support partners make healthy lifestyle changes in a way that is likely to stick. We work with people to come up with ideas for how to get into the habit of getting regular physical exercise, cognitive exercise, coping with stress, incorporating aspects of the MIND or Mediterranean Diets (more on this below!), and get a better night’s sleep.

In embarking on ANY lifestyle change, your mantra should be “slow and steady makes the habit.” One of the most common pitfalls people looking to make a new year’s resolution make is changing too much, too fast. We wrote about how to use a slow and steady approach to getting physical exercise a few months ago. For other changes, you can follow a similar approach.

  • Identify the broad goal or change you want to make. For example, “eat healthier.”
  • Break this big idea down into specific, clear goals that are small and manageable. You can always build on these after establishing success with the initial changes. So, you could look at a Mediterranean Diet guide and choose 2 changes to make that seem reasonable and appealing. (For example, Eat nuts 3 times per week, eat fish 2 times per week).
  • Using a calendar/planner/journal, write down and schedule your goals for the coming months. (On Friday, January 10th, you might write – “make grilled salmon for dinner”, On Saturday, January 11th, you could pencil in “eat almonds for a snack”, and so on, making sure you hit the weekly targets you set)
  • Plan ahead for any preparatory tasks you need to do to be successful. In our nutrition example, you’d need to schedule in grocery shopping for the items you want to consume, and may need to schedule the task of looking up a recipe for that grilled salmon.
  • Check off the tasks you complete, and review your progress at the end of the month so you can remember what you’ve accomplished.
  • Set new goals or write in a continuation of the previous goals before the next month begins.
  • Be sure to give yourself credit (even just verbally acknowledging to yourself can help) for the progress you make!

If you’d like to connect with others looking to build new wellness habits, please check out the Mayo Clinic Connect Healthy Living group.

Comment below on your goals for the New Year!

 

Dec 3, 2019 · Patient Spotlight: Chris and Bill in Living with Mild Cognitive Impairment (MCI)

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Thanks to our HABIT Alumni Chris and Bill for sharing their story with us this week!

Our journey with Mild Cognitive Impairment (MCI) started in 2017. It began when I noticed that Bill would forget conversations or plans that we had made. My background is in nursing, specifically working with people with dementia. An assessment revealed that Bill had MCI. We were in shock. I was angry and frightened of the future. In my imagination Bill’s condition progressed instantly to a time when he would need to transfer to a supervised dementia unit. Bill’s reaction was a fear of loss of control. Bill is a very bright and independent guy.

The first feeling of hope came when Bill began to take the medicine Aricept. We hoped that the medicine could slow down the progress of the disease. We began watching closely. Bill realized that he was still himself.  The diagnosis did not change him.  He would say “I’m still me.”

We both began to realize that we needed to take one day at a time. We became grateful for what we have. We began joking about his forgetfulness. We were smart enough to realize that I needed to learn about our finances. We completed our estate planning.

With all this positive occurring, I still had, in the back of my mind, the fear of the future. Would Bill need to live somewhere to get special help? How much time did we have left?

In October of this year we attended Mayo Clinic’s HABIT Healthy Action to Benefit Independence in Thinking  program in the La Crosse, Wisconsin area. We weren’t sure what we had gotten into. We knew that it was long, lasting two weeks. What about dementia could take two weeks to learn?  There was even daily homework!

On the first day of HABIT, MCI was defined. MCI does not automatically go into dementia. I just started the HABIT program and this bit of information was the best information I could receive. I began to have hope in today and in the future.

During the two weeks session we reviewed our lifestyles. Since Bill had MCI, what did we need to add or change that would help us remain happy, independent and safe? In other words, what tools would help Bill maintain his dignity?  Regular physical exercise has always been part of Bill’s life. On the other hand, when he was introduced to Brain HQ, he didn’t want to exercise his brain with “computer games.” He has since become pretty good at Brain HQ. We modified our diet to include parts of the Mediterranean diet. We were advised to think about planning for the future and to talk to our sons about where our estate plan was physically located plus making sure the boys had a complete, updated password list. Basic, important pieces of information we had not thought of doing before the program. Bill realized that he had been isolating socially. After the program he signed up for support groups, joined a group that meets weekly to talk about current issues, and, my favorite, he joined a MCI choir. With all these activities, he’s happy and busy. Thank God for the calendar.

Speaking of the calendar, it has helped Bill remain independent because he can look at his calendar and see what’s going on each day without having to ask me. For me, looking at all the activities that are scheduled, I find that sometimes I have to “unschedule” some of the events so I have time for myself. We have to continue to use the Calendar daily. It provides structure and peacefulness in our lives.

Bill has adapted the calendar to meet his needs. There are projects that he wants to do but does not know when he wants to start them or how long the project will take. He plans to work on them gradually. He does not want to forget to do them.  In the back of each monthly section he has added to the notes a category entitled “Stuff to Be Done.” These projects can be forwarded to the next month if not completed during the current month.

Being part of the partner’s alumni group on Clinic Connect has become a place where I can vent, seek advice and know that Bill and I are not the only ones who are living with MCI. Bill and I hope that other families do not have to experience MCI. If you or someone you love is diagnosed, remember that the world is not coming to an end. There are ways to work with MCI and not against it.  Paraphrasing on of Mr. Rogers quotes, “If a problem can be mentioned, it can be managed.”

Bill and I continue our journey.  We are simplifying our lives and ask for help from others. We are blessed to have the HABIT Program and you as our friends walking along with us.

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While the partners’ alumni group on Mayo Clinic Connect is private to those who have completed the HABIT Program, a general dementia on-line support group can be found at Caregivers: Dementia.

 

Nov 19, 2019 · Recipe: Basil Pesto Orzo in Living with Mild Cognitive Impairment (MCI)

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As the weather turns cooler, many of us find ourselves gravitating toward warm, cozy dishes such as pasta. Pesto is a great topping for whole grain pasta, with lots of brain-healthy olive oil as the star ingredient.

This dish was served at one of our recent HABIT sessions. Chef John Kessler of the La Crosse Country Club in Onalaska, Wisconsin, was kind enough to share his recipe with us. boosts the nutritional profile with lots of yummy roasted veggies, making this a complete meal in one bowl.

Bon Appetite!

Basil Pesto Orzo Recipe

  • 1 cup orzo
  • 3 tbsp pesto, bought or homemade (recipe below)
  • 2 cups roasted vegetables: zucchini, yellow squash, sundried tomatoes, onions, all work great as well as many others (spinach, kale, or other leafy greens can also be added at the end)
  • 1 tbsp olive oil (or 2 tbsp)
  • salt and pepper to taste
  • splash of lemon from one lemon
  • Garnish: goat cheese, feta or Parmesan cheese

Instructions

  • ROAST VEGETABLES: Cut vegetables into bite size pieces and toss with oil, salt, and pepper. Roast in oven at 350 degrees for ten minutes or until tender.
  • BOIL ORZO: In a medium pot, bring water with a tablespoon of salt to a boil. Add orzo and boil for about 10 minutes until orzo is al dente. Drain and put into large bowl or pot.
  • Basil Pesto Recipe: Process in food processor until smooth: 1 cup packed Basil leaves, 1/4 grated Parmesan cheese, 2 tablespoons pine nuts or walnuts, 1 teaspoon minced garlic and 1/4 olive oil. (makes 1/2 cup)
  • In a large bowl or pot place the orzo and mix in pesto. Add vegetables and gently mix or place orzo on plate or bowl and top with vegetables. Grilled chicken breast or proteins can be added as well.

 

Oct 29, 2019 · Getting Started with Exercising: Slow and Steady Makes a Habit in Living with Mild Cognitive Impairment (MCI)

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Awhile back, we featured a post by HABIT staff member Maria Caselli (@mariacaselli), on the updated physical activity guidelines for older adults (check it out here if you missed it). Her post was a great reminder that we don’t have to do all of our daily exercise minutes all at the same time. Short bursts of activity count, too. This information is wonderful, especially, if you’re someone who is looking to increase your physical activity by several minutes per day. But what if you’re not doing ANY minutes of physical exercise at this point? Well, read on, because this post is for you!

When making a new habit, such as exercising for the first time (or the first time in a long time), many of us fall victim to doing too much, too fast. We say to ourselves, “today I’m going to go for a jog.” We go for that jog, gung ho, and feel proud. Unfortunately the next day we feel more sore than proud, and going for another run doesn’t sound so appealing. We feel like we have “failed” at starting an exercise routine. That sense of failure makes us less likely to try again. Sound familiar?

Psychologists know that the best way to make a change is often by doing so in a gradual fashion using clear goals. The goals should be EASY TO ACHIEVE. In the beginning, I mean really easy. So easy that it seems ridiculous to not meet the goal. For example, let’s say your goal is to walk briskly 150 minutes per week. You currently walk briskly 0 minutes per week. Of course, be sure to check with your primary care doctor and get their okay before starting a new exercise plan.

Here’s what a sample plan looks like:

Week 1: Walk (inside or outside) for 5 minutes M/W/F.

Week 2: Walk (inside or outside) for 7 minutes M/W/F.

Week 3: Add 3 minutes to each walk (10 minutes per day).

Week 4: Add 5 minutes to each walk (15 minutes per day).

Week 5: Add 5 minutes to each walk (20 minutes per day).

Week 6: Add one more day of walking, but only for 10 minutes (20 minutes per day/M/W/F and 10 minutes on Saturday)

Week 7: Increase your Saturday walk to 20 minutes (20 minutes per day/4 days per week)

Week 8: Add 5 minutes to each walk (25 minutes per day/ 4 days per week)

See how you went from 0 minutes per week to 15 minutes per week and ended up at 100 minutes per week?! If you keep adding a few minutes each week, before long, you’ll be at your target of 150 minutes per week. And you’ll have gotten there in a way that set you up to be successful and made it less likely that you’d get injured along the way.

This technique can be used to make other behavioral changes as well, such as adding new foods to your diet (or cutting back on those that are less healthy).

Connect with others who are making changes toward a healthier lifestyle in the Mayo Clinic Connect Healthy Living group.

Comment below if you’re feeling inspired to get started on an exercise routine of your own!

Oct 25, 2019 · Appreciation from (and to) A Recent Graduate in Living with Mild Cognitive Impairment (MCI)

Hi @leslon, I am the director for the Midwest HABIT program. I am afraid the person you spoke to did not have all of the information. The program is not cancelled in the Midwest, in fact today was the last day of our October session here in La Crosse, WI. We have not set dates for 2020 sessions yet, due to needing to identify a reliable space where we can hold the program. If you would like to be on our waiting list for 2020, please reach out to @mirandamorris. Thank you!