brain health

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Why To Exercise Today: To Promote Cognitive Health (It’s Official)

(Diabetes Care/Flickr)

(Diabetes Care/Flickr)

The venerable Institute of Medicine came out with a report this week on cognitive aging (yes, that means you…) and a few things that can help avert the inevitable. The panel’s No. 1 recommendation? “Be physically active.” Enough said.

To be clear, “cognitive aging is not a disease,” the report notes. “Instead, it is a process that occurs in every individual, beginning at birth and continuing throughout the life span.”

That process impacts the brain like no other body part, the authors say. And while the extent and quality of cognitive aging (read: decline) varies greatly, many older men and women will experience problems related to the speed at which they process information, the ability to problem-solve and make decisions and, of course, memory. (Lost keys, anyone?)

Putting a little silver lining on things, the IOM news release quotes the chairman of the committee, Dan G. Blazer, the J.P. Gibbons Professor of Psychiatry Emeritus at Duke University Medical Center, saying that “…wisdom and knowledge can increase with age, while memory and attention can decline.”

So what should we do about our aging brains? The report is clear:

· Be physically active.

· Reduce and manage cardiovascular disease risk factors, including high blood pressure, diabetes, and smoking.

· Regularly discuss and review health conditions and medications that might influence cognitive health with a health care professional. A number of medications can have a negative effect — temporary or long term –on cognitive function when used alone or in combination with other medication.

The committee also identifies additional actions for which there is some scientific evidence to suggest positive effects on cognitive health:

· Be socially and intellectually active, and continually seek opportunities to learn.

· Get adequate sleep and seek professional treatment for sleep disorders, if needed.

· Take steps to avoid a sudden acute decline in cognitive function, known as delirium, associated with medications or hospitalizations.

· Carefully evaluate products advertised to consumers to improve cognitive health, such as medications, nutritional supplements, and cognitive training.

Continue reading

When Teens Talk Of Suicide: What You Need To Know

By Gene Beresin, MD and Steve Schlozman, MD
Guest Contributors

Here’s the kind of call we get all too frequently:

“Doctor, my son said he just doesn’t care about living anymore. He’s been really upset for a while, and when his girlfriend broke things off, he just shut down.”

Needless to say, situations like this are terribly frightening for parents. Kids break up with girlfriends and boyfriends all the time; how, parents wonder, could it be so bad that life might not be worth living? How could anything be so awful?

For clinicians like us who work with kids, these moments are at once common and anxiety-provoking. We know that teenagers suffer all sorts of challenges as they navigate the murky waters of growing up. We also know that rarely do these kids take their own lives. Nevertheless, some of them do, and parents and providers alike must share the burden of the inexact science of determining where the greatest risks lie.

Suicide has been in the news lately with a flurry of new research and reports and, of course, the high profile death earlier this summer of Robin Williams.

But suicidal behavior among teenagers and kids in their early 20s is different and unique.

So let’s look at a couple of fictional — yet highly representative — scenarios.

depressed

Charlie, a 16-year-old high school junior was not acting like himself. In fact, those were his parents’ very words. Previously a great student and popular kid, Charlie gradually started behaving like a different person. He became more irritable, more isolated and seemed to stop caring about or even completing his homework. Then one morning, just before before school, he told his mother that he wished he were dead.

Myths: Common But Distorted 

There are countless other examples. Sometimes kids say something. Sometimes they post a frightening array of hopeless lyrics on Facebook. And most of the time — and this is important — kids don’t do anything to hurt themselves. Morbid lyrics and even suicidal sentiments are surprisingly common in adolescence. Still, this does not mean for a second that we take these warning signs lightly. In fact, there is a common myth that asking about suicide perpetuates suicide. There is not a shred of evidence in support of this concern, and in the studies that have been done, the opposite appears to be true. Kids are glad to be asked.

We have to ask. It’s really that simple. But, we ask with some very basic facts in mind. Suicidal thinking, and even serious contemplation of suicide, is, as we mentioned, very common among high school students. In the Center for Disease Control Youth Risk Behavior Surveillance Survey distributed every two years to about 14,000 high school kids in grades 9-12, students are queried about a range of high-risk behaviors, including suicide.

The Underlying Mood Disorder

In 2013, 17% of teens reported seriously considering suicide, and 8% made actual attempts. Each year in the United States, about 15 in 100,000 kids will die by suicide, making suicide the third leading cause of death in this age group. Additionally, we have no idea how many deaths by accidents (the leading cause of death) were, in fact, the product of latent or active suicide.

The greatest risk factors for a teenager to die by suicide include the presence of some mood disorder (most commonly depression), coupled with the use of drugs, or other substances, and previous attempts.

Although research suggests that girls attempt suicide more often, boys more often die from suicide. Add these risk factors together, and it turns out that Caucasian boys are at highest risk.

Some of this is also driven by a still immature brain. Impulsive behavior is notoriously common in teens, and in many cases, it looks as if the act of suicide was the result of a rash and sudden decision. Continue reading

Study: Head-Blows In Single Sports Season May Impact Brain Health, Test Scores

When it comes to potential head injuries, I’m feeling pretty good about my daughters’ sports choices these days: Taekwondo, track, yoga, African dance.

Of course, injuries — head and otherwise — can occur anytime, anywhere. But I have to say, with the wave of new data emerging about the the scary long-term effects of repeated head blows, I’m pleased that they have, so far, shown no interest in hardcore contact sports like football or ice hockey, where head injuries are more common.

But I probably shouldn’t be feeling so puffed-up on this issue quite yet: even sports not typically associated with repeated head bonks are being reevaluated. (See, also: cheerleading.)

One local grandmother told me how concerned she is about her 11-year-old grandson, a soccer fanatic who dreams of playing professionally, and has already had a concussion and other injuries. “He tells me how much he loves soccer,” the grandmother says. “And when I asked him, ‘What about the injuries?’ he says, ‘Oh, that’s just part of the game.’ This certainly takes some of the joy out of watching him play. I’m very worried about what all this is doing to his brain.”

And a Newton mom, who had steered her son away from football and hockey, now has new worries: her 9-year-old just got a concussion skiing. “I think we’ll continue to let him ski, but we just hope he’ll be smarter, more aware — we tell him ‘It’s your head!’ Maybe we should have him wear a helmet all the time.”

The latest study by researchers at Dartmouth published online in the journal Neurology focused on the most notorious contact sports, but found that even one short season of play may change the brain in ways that negatively impact learning, memory and cognition.

Here’s more from the news release:

New research suggests that even in the absence of a concussion, blows to the head during a single season of football or ice hockey may affect the brain’s white matter and cognition, or memory and thinking abilities. The study is published in the December 11, 2013, online issue of Neurology®, the medical journal of the American Academy of Neurology. White matter is brain tissue that plays an important role in the speed of nerve signals.

“We found differences in the white matter of the brain in these college contact sport athletes compared to non-contact sport varsity athletes,” said study author Thomas W. McAllister, MD, of Indiana University School of Medicine in Indianapolis. “The degree of white matter change in the contact sport athletes was greater in those who performed more poorly than expected on tests of memory and learning, suggesting a possible link in some athletes between how hard/often they are hit, white matter changes, and cognition, or memory and thinking abilities.”

The work was completed while McAllister was with the Geisel School of Medicine at Dartmouth in Hanover, NH.

The study involved 80 concussion-free Division I NCAA Dartmouth College varsity football and ice hockey players who wore helmets that recorded the acceleration-time of the head following impact. They were compared to 79 non-contact sport athletes in activities such as track, crew and Nordic skiing. The players were assessed before and shortly after the season with brain scans and learning and memory tests. Continue reading