Archive of ‘Cognitive Functioning’ category

The Aging Brain: What’s Normal and What’s Not?

In 2014, there were 46.2 million Americans over the age of 65, which represents about 14.5% of the U.S. population. By 2040, this number is expected to rise to over 81 million, and by 2060, almost 100 million. With this significant increase in the aging population comes a growing concern about the prevention and treatment of age-related diseases. One, if not the most, notable of these diseases is dementia, due to the impact it has not only on the person with the disease, but also to their spouses, children, and to the healthcare system as a whole.

By: Shannon Haragan, LPC

By: Shannon Haragan, LPC

How Do I Know if it’s Normal Aging or Early Signs of Dementia?

In the not-too-distant past, researchers believed that the brain only developed and built connections during our early years, after which, development stopped, and the rest of our lives were spent losing brain cells. Now we know that the brain can continue to generate cells and build connections throughout our life span–we call this neuroplasticity. If we keep our bodies and our minds engaged and active, we can have a healthy brain throughout our lifetime. Here is an example of truly healthy aging, at age 106, who got to dance with the President and the First Lady

Similar to any muscle in our body, however, we can apply the age-old “use it or lose it” principle to the brain, as well. As we age, we tend to naturally slow down both physically and mentally. We tend to engage less with things that are mentally and cognitively challenging. Our minds follow suit, and as a result, we may naturally experience memory lapses from time to time. So some memory loss is considered normal. But how much? What if you forget where you left your keys? Call your granddaughter by your sister’s name? Walk into a room and forget why you walked in there in the first place? Here are a few guidelines for what’s normal and what’s not:

             Normal Aging                      Signs of Dementia
Preserved independence in daily activitiesCritical dependence on others for key daily living activities
The individual is more concerned about alleged forgetfulness than close family members areClose family members are much more concerned about incidents of memory loss than the individual
The person complains of memory loss but can provide considerable detail regarding incidents of forgetfulnessThe person complains of memory problems only if specifically asked; cannot recall instances where memory loss was noticeable
Recent memory for important events, affairs, and conversations is not impairedRecent memory for events and ability to converse are both noticeably impaired
Occasional word-finding difficultiesFrequent word-finding pauses and substitutions
Person does not get lost in familiar territory; may have to pause momentarily to remember wayPerson gets lost in familiar territory while walking or driving; may take hours to return home
Individual operates common appliances even if unwilling to learn how to operate new devicesPerson cannot operate common appliances; unable to learn to operate even simple new appliances
No decline in interpersonal social skillsLoss of interest in social activities; socially inappropriate behaviors
Normal performance on mental status examinations, relative to the individual’s education and cultureBelow-normal performance on mental status examinations in ways not accounted for by educational or cultural factors

 

There are many different causes of dementia (Alzheimer’s is the most common), but the way the symptoms present is different for everybody. If you have a concern for yourself or a family member, talk with your primary care doctor or a neurologist. If you’re struggling with anxiety, worry or grief around a potential diagnosis, a therapist can be helpful. Though the funding is currently lacking compared to other diseases such as cancer and heart disease, important research is currently ongoing, and there is great hope for finding effective treatments to combat Alzheimer’s and other forms of dementia in the not-too-distant future. For more information, check out the Alzheimer’s Association or more info about dementia.


Caring for the Caregiver: An Introduction

Let’s start with a few sobering facts about dementia and Alzheimer’s disease: 
By: Shannon Haragan, LPC-Intern Supervised by Lora Ferguson, LPC-S

By: Shannon Haragan, LPC-Intern
Supervised by Lora Ferguson, LPC-S

— As I type these words, there are currently 5.1 million Americans living with dementia and 60-70% of those individuals have Alzheimer’s (the most common cause of dementia).

— Every 67 seconds, someone new develops the disease–and that’s just in our own country.

— By 2025 (that’s just ten years from now!), the overall number of Americans living with the disease is expected to jump 40%, to 7.1 million. By 2050, perhaps around the time you or someone you love turns 65, that number is projected to be nearly 14 million.

— For unknown reasons, two-thirds of these people are women.

— Alzheimer’s is the sixth leading cause of death in the United States, and it is also the ONLY cause of death in the top 10 that cannot be prevented, slowed or cured.

If you have a brain, you are at risk of developing the disease.

If anybody you love has a brain, you run an even higher risk of becoming a caregiver.

So here’s where the rubber hits the road. A couple of stats from caregiver.org:

— Up to 70% of family caregivers have clinically significant symptoms of depression, and up to half of those caregivers meet the diagnostic criteria for major depression.

— Caring for persons with dementia reportedly impacts a person’s immune system for up to 3 years after their caregiving experience ends, thus increasing their chances of developing a chronic illness themselves.

Caregiving for someone diagnosed with dementia takes a significant toll, physically, mentally and emotionally. This is the first in a series written about the world of dementia caregiving, and ways that caregivers can cope with a variety of common issues, from the practical to the emotional to the existential. Though I will be focusing on dementia, primarily Alzheimer’s, much of this is applicable for caregivers for any chronic illness. The term caregiver certainly applies to those individuals living in the home and helping to provide ongoing daily care of their loved one (typically spouses or adult children), but it also refers to other family members and friends who spend time and energy invested in the health and well-being of the care receiver.

ACUTE vs. CHRONIC

Acute illnesses are short-term, with available cures. Caregivers and families typically operate in a world of certainty, knowing their loved one’s health will ultimately improve. Chronic illnesses, like Alzheimer’s disease, offer no cures. They are long-term, and are marked by unpredictability and a future negotiating change.

CHANGE vs. TRANSITION

Generally speaking, there are three broad stages that all Alzheimer’s patients and their families go through: early, middle and late. Each stage brings its own set of changes and transitions, varying between periods of encountering new symptoms, behaviors and emotions, and adjusting to the “new normal.” Though much of the journey of caregiving involves components you can’t control, it is crucial to discover and focus on those parts you CAN control:

Change is external and generally involves things you CANNOT control, such as:

— Roles
— Situations
— Abilities
— Care needs
— Events

Transition is internal, and generally involves things you CAN control, such as:

— Emotions/feelings
— Thoughts/cognitions
— Attitudes
— Learning
— Acceptance

Future blogs will address how to transition well, and will offer practical solutions the changes that your family encounters. Ultimately, the goal of the Caring for the Caregiver blog series is to learn how to better take care of YOU. By making yourself a priority, you will ultimately be able to better care for your loved one. Like the flight attendants tell us, we must first put the oxygen masks on ourselves before helping to put the oxygen masks on those we care for.


Dissociation and Dissociative Disorders

Now that we have explored the various experiences of dissociation and dissociative disorders, how do dissociative disorders develop? The short answer is trauma. There is about a zero percent likelihood that dissociative tendencies are genetic. Dissociative disorders are most commonly associated with repetitive childhood physical and/or sexual abuse and other forms of trauma. These other forms include severe neglect or emotional abuse. Children may become dissociative in families in which the parents are unpredictable, frightening, or are dissociative themselves and do not have their own methods of coping in a healthy way with dissociation.

By: Susanna Wetherington, LPC-Intern Supervised by Lora Ferguson, LPC-S

By: Susanna Wetherington, LPC-Intern
Supervised by Lora Ferguson, LPC-S

To reiterate from before, dissociation is considered adaptive because it reduces the overwhelming distress that is created by trauma. The trauma is just too much to handle, and so in a protective response, parts of the brain shut down and others become activated so the experience does not overwhelm the individual. This is survival at its best. It’s truly amazing that our minds can protect us in these ways. Difficulty arises when dissociation continues to be used in adulthood, when the original threat no longer exists, and it can then be seen as maladaptive. A dissociative adult may disconnect in situations that are perceived as threatening, because aspects of the situation trigger the former trauma(s), without determining whether or not there is any real danger. This can leave the person “tuned out” in various ordinary situations and unable to adequately protect themselves in times of real danger. When we think of the fear responses produced by the amygdala, “fight, flight and freeze,” this is a version of the “freeze” response.

Dissociative disorders can also develop in adulthood. This tends to be related to the intensity of dissociation during a traumatic event experienced as an adult. The more severe the dissociation experienced at the time of the event, the greater likelihood that these dissociative mechanisms will generalize to subsequent events. And again, if trauma is frequently experienced, such as abuse experienced in adulthood, there is a greater likelihood that a dissociative disorder may develop. The experience of ongoing trauma in childhood also greatly increases the likelihood of developing dissociative disorders in adulthood.

Treatment

Before seeking treatment, it is important to find a licensed professional who is well versed in treating dissociative disorders. There are various ways to treat dissociative disorders and treatment will be specific to the type of dissociative disorder that is diagnosed. However, there are key components that are central to these treatments. The first is stabilization. This is important in all areas of therapy, with the focus being creating safety and stability in the individual’s life. This includes creating coping skills specific to the individual in order to help them cope with their symptoms, ranging from anxiety to depression. Sometimes this includes safety planning, which pertains to coming up with a plan with the individual if the individual believes they may be in danger of harming themselves or others or if the individual is engaging in risky or dangerous behaviors. Stabilization also involves normalizing the individual’s experience, helping them understand that dissociation is a common response and that more severe dissociation is actually an adaptive response that helped them cope with overwhelming distress. This is extremely important. Many people assume that because someone suffers from a mental health disorder that there is something “wrong” with them. I reiterate to my clients this is not the case. Our brains are amazing and complicated organs. Sometimes they ways in which our brain protects us can also lead to problems in day-to-day functioning down the road. The primary function of therapy is to help individuals get back to a balance that works for them.

Since trauma is the most common cause of dissociative disorders, part of the treatment involves trauma work. This means processing through the memories of the trauma experienced by the individual. This takes time and it is imperative this is done at the pace of the individual. Continued stabilization and development of coping skills may continue throughout treatment.

This concludes my discussion on dissociation. I hope you have gained insight into dissociation and all its facets. Please visit the International Society for the study of Trauma and Dissociation for more information.

 

 

 

References:

http://www.isst-d.org

Haddock, Deborah Bray (2001) The Dissociative Identity Disorder Sourcebook, McGraw-Hill.


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