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Dec 29, 2019 · To Medicate or Not to Medicate in MCI; That is the Question in Living with Mild Cognitive Impairment (MCI)

Hi again @helenfrances I also just replied to your other question. For this one, I'm not entirely sure what you are asking. My apologies.

Dec 29, 2019 · To Medicate or Not to Medicate in MCI; That is the Question in Living with Mild Cognitive Impairment (MCI)

Hello @helenfrances My apologies for the slow reply–I have been away for the holiday. The answer to your question is somewhat complicated. Mild Cognitive Impairment is a syndrome of cognitive decline in one area (most often memory). There can be many causes for MCI including early signs of Alzheimer's disease, Parkinson's disease, vascular disease, thyroid disease, and even depression. So, MCI can in fact BE depression. This is one of the reasons evaluation of cognitive changes/concerns is so important. So that we can treat anything that may be treatable, such as depression. There are times, however, when we think MCI is related to a neurologic problem like early Alzheimer's disease or Parkinson's disease but that person may ALSO be depressed. A comprehensive evaluation for cognitive changes that includes neuropsychological evaluation and neurologic evaluation will help sort our the pattern of impairment and what may be the cause or causes, as well as recommend any treatments. I hope this helps.

Dec 11, 2019 · Revisiting gratitude in Living with Mild Cognitive Impairment (MCI)

The holidays are always a good background for discussing gratitude, which we’ve done before. I encourage you to look back at those posts in 2018 by HABIT team members Andrea Francone and Michelle Graff-Radford. Both provide helpful hints about how to start a gratitude practice. Today, however, I wanted to highlight some research on gratitude. The reason I find this research important is that (1) many of us (myself included) are not naturally “good” at gratitude practice and this research shows us it can be helpful for us to create an intentional daily gratitude practice and (2) one sample in this research was specifically a medical population facing significant challenges and the intervention was helpful for them as well.

So what if you are not naturally “grateful” (welcome to the club)

When I’m leading the wellness health-behavior change discussions of the HABIT program for patients diagnosed with Mild Cognitive Impairment here in Arizona, I often admit that I don’t really have a temperament in which gratitude is natural perspective for me. I’m in awe of our team members and patients who naturally have a gratitude practice without even thinking about it. One patient once told me that her thoughts about potentially needing to stop driving and have her husband drive was, “That just means I get to spend that much more time with my husband!”  This is an example of the naturally grateful temperament I’m so envious of. I’m always able to find the frustrations in life and the things I wish were different. But so many things about life ARE frustrating and WILL NOT CHANGE.  So, I’m working on trying my own gratitude practice with these facts in mind and the research I’ll review tells me it is worth my effort.

The research was published in 2003 by Dr. Robert Emmons and Dr. Michael McCullough, psychologists at University of California and University of Miami. The key question of their research is –does gratitude cause improvement in well-being or is it just that people with high well-being also frequently experience gratitude with no causal link between them? More simply, does intentional gratitude practice actually cause improvement in well-being? If this link is found then our efforts to intentionally build our own sense of emotional gratitude will then result in improved emotional well-being. If the link is not causal then it is more about natural temperament and paying more attention to the emotion of gratitude wouldn’t improve well-being. The naturally joyful will remain more grateful and joyful (and us curmudgeons will just stay curmudgeons).

Study 1

The first experiment was completed with college students. They were randomly assigned to one of three assignments which involved:

  1. Thinking back over the last week and writing down up to 5 things in your life that you are grateful and thankful for (grateful condition).
  2. Thinking back over the last week and listing up to five hassles or irritants that occurred in your life (hassles condition).
  3. Thinking back over the last week and listing up to five events that had an impact on you in the last week (neutral condition).

The results showed that after 10 weeks of their assigned practice, those in the grateful condition rated their life more favorably overall and had higher optimism for the upcoming week than those in the hassles or neutral condition. They also reported fewer physical symptoms and exercised more than the other groups.

In addition, some students in the sample experienced a life challenge during the research and accepted some form of help for that challenge (such as accepting sympathy from someone, talking to someone about how they were feeling, or receiving concrete help or advice from someone). When they reported gratefulness in response to receiving that help (as opposed to feeling embarrassed, frustrated, or guilty) their overall emotional well-being was improved. This was true no matter what experimental condition they were assigned to.

Study 2

The second study was also with college students with similar gratitude and hassles conditions. This time, they completed their lists of things they were grateful for or hassles on a daily basis (rather than weekly). The third group in this study was a social comparison group instructed to think about ways in which they are better off than others or things they have that other’s don’t. This last condition was changed to give a more active comparison of a condition that, on the face of it, could be positive but not the same as gratitude.

The results showed that (1) the impact of the condition (gratitude or hassles) was stronger when completed on a daily basis than on a weekly basis and (2) gratitude practice again improved positive emotion.

Study 3

The third study is similar in terms of the experiment, but this time the participants in the study were patients from a neuromuscular disorder clinic. There are a number of neuromuscular disorders (NMDs) which impact the nerves and muscles in the body (see this link for more information). Even if you don’t know what NMDs are specifically, it doesn’t matter. The point is these are medical disorders that are chronic and often progressive and can involve significant physical disability for those who have them. In the context of this blog and Mayo Clinic Connect as a whole, this application to a significant medical population is such an important piece of this research. This group was randomly assigned to 21 days of reflection during which one group was assigned to reflect each day on things they were grateful for and complete measures of mood, well-being, and global outlook on life (gratitude group) or a group where they just complete measures of mood, well-being, and global outlook without any instruction about what to focus on about the day (control group).

The results showed that the gratitude assignment increased daily positive emotions AND reduced daily negative emotions. Those in the gratitude group were more satisfied with life as a whole, felt more optimistic about the coming week, felt more connected to others, and got more hours of sleep each night than those in the control group. Finally, in this study patients’ significant others were asked for their perceptions and they also rated those in the gratitude condition as happier and more satisfied with life.

What’s the take-away?

This research is important because it shows us that if we make an effort to establish a perspective that is more grateful, we are likely to improve our well-being, have fewer physical symptoms, take better care of ourselves better, and be more satisfied with life. This is obvious logic, but this research proves it. It also encourages us to accept help with gratitude when it is given–not only do we have the specific help but our gratefulness about it will help continue to improve our emotional well-being! These effects are occur even in patients struggling with very significant and chronic medical illnesses. Those patients with a gratitude practice slept better and were also noticed to be more happy and satisfied with life by their significant others as well. I really wish to emphasize this point because it is important not to ignore that medical illnesses of all types are stressful, may not be treatable, and may impact daily life. Mild Cognitive Impairment, our focus, is one such example. Gratitude is not about ignoring those facts–it is about recognizing that “every day may not be good, but there is something good in every day” and choosing that focus as much as possible.

With that, I hope you’ll try to join me as I fight my own tendency to focus on my hassles and instead focus on those things I’m grateful for.

Best wishes to all of you for the holiday season from the (grateful) HABIT team!

Talk with others discussing what they are grateful for in the gratitude discussion in the  Mayo Clinic Connect Just Want to Talk group.

Oct 8, 2019 · Way To Go Arizona! in Living with Mild Cognitive Impairment (MCI)

Thanks so much @drmelaniechandler ! We're excited to grow and appreciate being a part of the larger HABIT team!

Sep 10, 2019 · Top 10 tips for healthy sleep in Living with Mild Cognitive Impairment (MCI)



Quality sleep is so important for all of us for so many reasons: emotional health, immune system efficiency, daytime energy, just to name a few. But sleep is especially important for those of you living with Mild Cognitive Impairment (MCI) because bad sleep impacts your thinking efficiency during the day. Not to mention that it contributes to moodiness, fights with our spouses, low motivation, and generally feeling poorly during the day. About a year ago, I posted a two part story on sleep apnea. The first part reviewed the importance of treating sleep apnea–important for many of same reasons it is important to maximize quality sleep in general! The second part provided some tips for adjusting to a CPAP device, which can be tough.

Today, I wanted to provide some tips to maximize the chance of good quality sleep whether or not you have a sleep disorder like sleep apnea. This is sometimes referred to as “healthy sleep habits” or “sleep hygiene”. These are habits that essentially tell your brain reliably that it is time to sleep and allow you to naturally experience all phases of your sleep cycle most reliably so you get deep restorative sleep. We discuss these in our HABIT program as our top 10 behaviors for healthy sleep and I’d like to share them with you!

Build a good bedtime routine

These first habits are about building a good sleep routine. Basically the routine about how you get to bed and when:

1.Stick to a sleep schedule. Do your best. If you get to bed late one day–try to make yourself get up as the same time and get back to the schedule the next day.

2.Use the bedroom only for sleep and intimacy. Do you exercise in your bedroom?  Watch TV? Pay bills?  Try to do as many of these activities as possible in other rooms of your home. The goals is to have your brain pair your bedroom with sleep. That association, along with other good sleep habit routines, will help your brain release melatonin–the sleep hormone–at the right time.

3.No TV in the bedroom. In addition to the reason in #2 above, TV is stimulating and disruptive to the sleep cycle.

4.Have a relaxation activity as part of your bedtime routine. Try listening to relaxing music as you get ready for bed, a meditation activity, a breathing exercise, or saying your prayers (if that is your practice)–these relaxing activities help to lower your sympathetic nervous system (your fight or flight response) and activate your parasympathetic nervous system (your rest and digest system).

5.Discontinue screen time 1 hour before bed. Our brain interprets most light from electronics as sunlight which delays release of melatonin as our brains think it is still day time. However, I have recently seen research articles such as this one that suggest that using amber lenses to block the blue tone light may help.

6. Have a memory notebook handy at the bedside for those last minute thoughts of things that need to get done the next day that might keep you awake. Write them down so that you know you’ll be able to deal with them tomorrow. If you find that worrying about things you can’t control becomes an issue, you may benefit from seeing a psychologist to help you develop alternative thinking patterns for those times.

Daytime routines to help maximize quality sleep

These last habits are more about how you structure the rest of your day and environment and how that may help improve your sleep.

7. Get physical exercise daily, especially earlier in the day. This is always my #1 tip when my patients tell me they feel tired during the day. Getting exercise in the morning activates your brain and sets it off on the proper cycle. Your body is more ready for rest and sleep with activity in the day.

8. Sunshine in the morning. This is the companion recommendation to avoiding electronics in the evening. Get sunshine in the morning so your brain gets the message it is time to be awake!

9. Check your environment. How long have you had that mattress? Is your pet in the bed with you? Review that the mattress and pillows are comfortable, the temperature is cool enough, you have the right blankets, your beloved Fido or Tiger has their own sleeping space, you have curtains that block out light that might bother you, the TV is off, etc. Pets can certainly be reassuring, but they unfortunately do disrupt the sleep cycle in bed with you. Having them on their own bed in your room, may be a good solution.

10. Avoid alcohol, caffeine, and heavy meals before bed. These all disrupt your body’s ability to sleep soundly and move fluidly through all the phases of sleep as desired through the night.

Consider professional help if needed

It can be difficult to implement all of the above tips and you may feel like your sleep is worse before it gets better. There are psychologists who specialize in helping treat sleep problems using cognitive behavioral therapy for insomnia. They will help you implement many of the above routines and more to help you maximize your sleep quality.

I hope you can try out some of these tips—and give them a little time for your body to adjust. Please feel free to comment on your experiences or provide any other tips you’ve found helpful!






Aug 20, 2019 · When is memory loss a problem? When in doubt check it out! in Living with Mild Cognitive Impairment (MCI)




On this Living with Mild Cognitive Impairment (MCI) newsfeed, we’ve primarily focused on topics that might be of help or interest to individuals who have been diagnosed with MCI and find our page. However, when I saw this recent newsletter from Banner Alzheimer’s Institute, I realized that some of you may find us because you’ve searched terms such as “memory loss” or “short term memory problems.” The article, authored by Dr. David Weidman, a Neurologist at Banner, gives guidance for individuals who may be worried about memory changes. I’d encourage you to check it out as well as their 10 warning signs related to memory loss. I agree with their final advice–“when in doubt, check it out!” I assure you that your primary care doctor, neurologist, or neuropsychologist (or all three!) love nothing better than evaluating individuals and being able to say–“Nope, this is just normal forgetfulness. No worries!”  But, if you are evaluated and do receive a diagnosis of MCI, just know that there is support for you. Come back and check out our HABIT program information for starters!

At the same time I received this newsletter from Banner, I also received a newsletter from the Alzheimer’s Association. In that newsletter was a related article “Communicating with your doctor about memory loss.” If you are worried about your memory and know you want to bring it up with your doctor, their article can help you frame how you’d move forward–from advice about what to bring to the appointment to questions to ask. The article also provides information on the types of providers you may see in the evaluation process as well as helpful resources to help you prepare for your visit (such as a format for listing symptoms and questions or organizing medications).  There are also resources that may be helpful to you after your doctors visit.

I hope these resources help you move forward with getting those memory concerns evaluated!





Jun 8, 2019 · Revisiting Brain Exercises in Living with Mild Cognitive Impairment (MCI)

Hi @bonniep! I like your alternative plan. Sounds like you've found something that will give Denny a challenge that will adjust over time. And I like that you guys are planning to do this together. We've started playing around with some board games like Boggle, Scattegories, and Telestrastions in our HABIT class. I'm not convinced that these have the same brain exercise impact as the processing speed based adaptive computer games, but these games do have some time pressure involved and can be a challenge. So, if brain games just aren't feasible these may also be some other options, but I don't have official data on that. But something is likely better than nothing!

Jun 6, 2019 · Revisiting Brain Exercises in Living with Mild Cognitive Impairment (MCI)

At present, HABIT is only available at one of the Mayo campuses (Arizona, Florida, or Midwest) and the University of Florida. It is our goal to help support providers at other institutions also launch HABIT programs, but that has not happened yet.