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1 day ago · Cpap and sleep in Sleep Health

Thanks @colleenyoung

I would love to see some comments here! Also just a heads up that the article above is just the first in a two-part series. Next week’s post is more about how to adjust when the issues are not just equipment related. Suggestions for things like feeling claustrophobic or having trouble taking it off at night without knowing if. So I hope part two may be helpful to this group as well!

4 days ago · The Importance of Treating Sleeping Apnea in MCI: Getting Started

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Why are we talking about sleep apnea in MCI?

Sleep apnea is a very common sleep disorder in the general population and also a common sleep disorder in our patients with Mild Cognitive Impairment (MCI). Sleep apnea is a sleep disorder where individuals stop breathing at night (and then gasp themselves into breathing again). Take a look at this link if you want more information on sleep apnea. My husband actually has sleep apnea, finally diagnosed after we were married, and I discovered the extent of his snoring and gasping for breath at night (in between the scary silent pauses when he wasn’t breathing at all).

In our patients with MCI, sleep problems are a significant cause of “excess disability”—it makes a person’s memory or thinking problem worse. One of our major aims in the Mayo Clinic HABIT Healthy Action to Benefit Independence and Thinking © program is to identify and treat anything that could make MCI worse. Sleep apnea is one of those that is very common.

Using a CPAP machine, or continuous positive airway pressure machine, or a related device, is a very common treatment recommendation, and CPAPs are very effective treatment. The problem is many, many individuals, including my husband, have trouble adjusting to using a CPAP machine. But treating your sleep apnea goes beyond just helping your memory: treating sleep apnea also has a major impact on your physical health. Importantly, complications of sleep apnea also increase your risk of heart problems and heart disease…Not to mention sleep deprived bed partners!

First steps to adjusting to a CPAP

Some individuals take to a CPAP or related device right away. For others, it is a struggle. I will get to some behavioral strategies for helping yourself adapt next week, but first, it is important to be sure you’ve done all you can to be sure you have the equipment that is the right fit for you. Sometimes, all it takes is the right mask and voila! CPAP and (quiet) dreamland are all yours. The variety of device options is not my area of expertise, so first, be sure you’ve explored with your physician or device supplier the following:

  1. Have you tried a variety of different masks? For my husband, he finally needed to move from a mask that covered his nose to a “nasal pillow” type mask that fit at the bottom of his nose.
  2. Have you confirmed that the pressure is set optimally for your needs? This is typically done at your sleep study visit, but it never hurts to ask if you feel that the pressure is too much or too little (if you feel it is too much, but your physician has confirmed it is correct, I’ll be providing some behavioral options next week).
  3. Have you explored other device options that may help ease the adjustment? For example, does your device offer a humidifier? Do you even need a humidifier? Does your device offer a “ramp up” period so that the pressure gradually increases when you turn it on? Perhaps you could benefit from a BiPAP rather than CPAP. A CPAP has the same continuous air pressure all the time while a BiPAP has two levels of pressure—one that is harder when you breathe in but lower when you breath out. Do you need a chin strap to help keep the mask on through the night and your mouth closed?

These are just a few observations as a spouse of a loved one who had to explore lots of equipment before finding what was right for him. Turns out, he needed the pressure ramp up because he couldn’t tolerate the full pressure right away. He also really needed the humidifier. We live in Arizona, and his first machine didn’t have one. Talk about a dry mouth in the morning!

Now that you know why it is important, and some important first steps to try with your doctor, check back next week for more behavioral strategies if adjustment is still difficult.

Tue, Aug 7 10:28am · Summer Recipes!

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In the Mayo Clinic HABIT Healthy Action to Benefit Independence and Thinking © program, we typically recommend a balanced, Mediterranean style eating plan for brain health. One of the recommended food groups in that plan is BERRIES! This is my favorite food group on the plan, so I wanted to share a couple of refreshing summer recipes with you.

These treats come from the Mayo Clinic Dan Abrahams Healthy Living Center. The strawberry sorbet is so cool and refreshing in this summertime heat! The summer salad is light but full of flavor. I also include my favorite berry—the blueberry! I enjoy the milder and crunchy daikon radish rather then the red radish (which I find a little spicy!) Also, if you go for a leafy green like spinach as the base, you’re also getting in a second recommended food group on a Mediterranean style eating approach—GREEN LEAFY VEGETABLES.

Strawberry Balsamic Sorbet

Ingredients

-3⁄4 cup balsamic vinegar
-2 tablespoons basil, finely chopped
-4 cups strawberries, hulled and halved,
-plus 5 berries, coarsely chopped
-1 tablespoon dark honey

Fresh Summer Salad

Ingredients:

-12 oz baby greens
-2 oz goat cheese
-2 cups assorted fresh berries
-1/2 cup julienne red onion
-1/3 cup Balsamic vinegar
-1/2 cup julienne red or daikon radish

I hope you try these and enjoy! Also feel free to post your favorite healthy berry recipe to share with the readers!

Thu, Jun 21 12:30pm · Living alone with Mild Cognitive Impairment in Living with Mild Cognitive Impairment (MCI)

Hi @user_cha272278. I’m so glad you asked! Mayo Clinic has the HABIT program, which is solely designed as a treatment program for those just diagnosed with MCI. Please take a look at the Program Overview tab on the Living with Mild Cognitive Impairment page for more details on what we do. Feel free to ask more questions after that!

Thu, Jun 21 12:23pm · Living alone with Mild Cognitive Impairment in Living with Mild Cognitive Impairment (MCI)

Hi @1gusto. My recommendation is that if you have concerns about your memory or possible Mild Cognitive Impairment that you start with a conversation with your primary care physician. He or she can then arrange an evaluation which often includes medical evaluation, sometimes a consultation with a neurologist and ideally a comprehensive neuropsychological evaluation.

Tue, May 15 9:16am · Living alone with Mild Cognitive Impairment

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Some of our patients with MCI live alone, perhaps with just occasional “check-ins” from family members. For many people, this is not a problem and they continue to manage well independently despite short-term memory loss. However, we would like to recommend that if you live alone and have been diagnosed with MCI that you consider putting some “safety nets” in place, just in case you need more support. Here are some tips from us here at the HABIT Healthy Action to Benefit Independence & Thinking® team.

  1. Inform a group of people you trust of your diagnosis.

This can be a small group of family members, such as adult children or siblings, or even trusted friends and neighbors. For many people with MCI, their friends and family may not even notice the short term memory changes at first. So, informing them of your diagnosis can start you off in building your support team safety net. In other cases, close friends and family may have noticed some short term memory changes, and you informing them of your diagnosis may come as a relief to those who care about you that you are being proactive about your health and care. This also can open the door to helping them feel comfortable asking you if they can support you in some way. Maybe you don’t need more support now, but you can have people who care about you helping to maximize your independence and ready to step in and support you if you do need help down the road.

  1. Consider a plan for driving supervision.

Many patients with MCI continue driving and can do so safely. However, driving safety is often a concern in MCI and certainly a concern if MCI progresses. We encourage you to empower a trusted loved one or friend to give you feedback about driving and possibly help you stop driving if there are safety concerns. Then consider how you might get around if you cannot drive–Do you live somewhere that you can use public transportation? Perhaps begin looking into ride services or determining if your church or other faith community has a volunteer ride service available.

  1. Consider a plan for financial supervision.

Managing finances, from routine household bills to complex investment or estate trust plans, can be complicated. People with MCI often make good decisions about finances, but short term memory loss can sometimes interfere with implementation. Therefore, we encourage you to consider enlisting professional help with financial management and/or involve a trusted family member in your financial matters. You may not need their help in making financial decisions at this time, but they can be a “safety net” for helping be sure you’ve gotten that utility bill paid on time (and not double paid), helping you talk through larger financial decisions, and serve as a memory back-up for implementing a decided upon investment strategy.

  1. Consider a plan for medication supervision.

Many patients with MCI use supportive tools, such as a pillbox, to help ensure medication accuracy. If you are not yet using one, we strongly encourage you to start. There are a number of models on the market that include multiple times per day dosing if needed. In addition, however, we would encourage you to enlist a trusted friend or family member to occasionally check in on your medications or perhaps oversee when you fill your pillbox to ensure accuracy.

  1. Consider joining MCI support or engagement groups.

Living alone can be isolating for any of us. Unfortunately we often see our patients with MCI withdrawing from their social networks. We’d encourage you to fight against this tendency (perhaps by letting some trusted social connections know of your memory loss so that you don’t have to worry about having a memory slip with them). In addition, many local Alzheimer’s Association chapters have social groups or support groups for those with MCI (sometimes called early stage support groups or social groups). Take a look to see what is available in your area, as being able to connect with others also experiencing memory loss may help you stay socially connected and engaged in addition to helping you find a source of encouragement along the way.

  1. Plan for your future.

It is important for all of us, with or without memory impairment, that we’ve made decisions and communicated our wishes including medical treatment wishes, financial planning, and end-of–life care. However, a diagnosis of MCI, with the possibility of progression of cognitive impairment, increases the urgency of these decisions. If you have already established a power of attorney for health care and a power of attorney for finances, do those individuals know your wishes?  Do you need to update them on any changes?  Do you need to revise any your advanced directives or living will? Do you need to revise anything related to your estate planning? Now is the time to make any changes and be sure to inform those who care about you of your wishes. You can seek out an elder law attorney in your area for help with these issues. Again the Alzheimer’s Association can also help guide how to handle some of the above planning issues.

The above topics are those we see coming up most often in our patients with Mild Cognitive Impairment. We’re hoping to encourage you to make some plans now, not because you need help right now, but so that there is a plan in place.  We want to see you live as independently as possible, but also have a safety net should your short term memory loss cause some bumps in the road. For many, MCI progresses, but we don’t know how soon or how fast. So we encourage you to make plans now, before you need them.

Your local Area Agency on Aging and the Alzheimer’s Association have additional resources related to living your best life as you age and additional considerations for living alone if MCI progresses to dementia. We would encourage you to also view these resources. Our goal is to help you live a full life as independently as possible by pre-planning for common challenges in MCI.  We would like to see you in the driver’s seat about decisions for how you might accept additional help if it is needed, rather than one day possibly having it dictated for you.

Fri, Apr 6 4:34pm · Depression and MCI: Part 2, Treatment options in Living with Mild Cognitive Impairment (MCI)

@judymcd –Wonderful! Thank you for sharing your story.

Tue, Apr 3 10:18am · Depression and MCI: Part 2, Treatment options

shutterstock_605004770Part 1 of this blog topic was inspired by a recent large landmark study confirming the efficacy of antidepressant medications. We reviewed the symptoms of depression in part 1 of this topic, and today’s post is about treatment options.

Medications

As noted in the study, antidepressants are effective for depression. It is important to discuss this with your doctor who knows more about you, your MCI and other medical diagnoses, as antidepressant medications can have side effects. Determine with your primary care physician if a medication is right for you. Your physician may opt to seek a specialty opinion from a Psychiatrist, a physician with specialty in treating mental health disorders such as depression. Note that antidepressants take some time to work—perhaps 4-6 weeks–and you’ll need to check in with your doctor during that time.

Therapy

In addition to medication, however, there are other non-pharmacological treatment options for depression that your doctor may suggest. These therapeutic approaches maybe recommended rather than a medication or in addition to a medication. There are a number of “talk therapy” approaches used by mental health providers, but the one with the most supportive evidence for depression is cognitive behavioral therapy (CBT).

To find a therapist, you may need to first check with your insurance carrier to determine mental health providers available in your area. Your primary care physician may also be able to recommend someone. In addition, the Association for Behavioral and Cognitive Therapies has a “find a therapist” link. This link can help you search for providers in your area who specifically provide treatment with a CBT perspective.

When you contact a possible psychologist or therapist about CBT for depression, I would encourage you to determine if the provider has any knowledge of MCI or memory loss, as they may need to adjust some therapeutic techniques or homework assignments because of your memory loss. This may include providing more information in writing, having you complete homework assignments in written format, and increased repetition of some aspects of the treatment to solidify your understanding and skill building. Written information is quite common in CBT, so these adjustments should not be too difficult for your therapist.

Increase Activity

Finally, an important component of therapeutic treatment for depression in addition to “talk therapy” is “behavioral activation,” which is a therapeutic way of saying “getting out and getting active”. Moderate physical exercise and social engagement help release neurotransmitters in the brain that are important for reversing depression.

Bonus: In addition to helping depression, physical exercise also releases proteins in the brain important for helping keep brain cells healthy, and increased socialization reduces the risk of dementia, so you get double for your effort!

The bottom line is that depression is quite treatable with a number of techniques. So please talk to your doctor. Unfortunately, we often cannot reverse Mild Cognitive Impairment, but treating your depression will help you achieve your best “living with MCI” life possible.

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