Category Archives: Dementia: Therapeutic Activities

Circadian circuit may affect “Sundowning”

News Release
April 9, 2018 | Boston – Beth Israel Deaconess Medical Center

New Discovery May Calm ‘Sundowning’

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BOSTON – Patients with Alzheimer’s disease and other forms of dementia commonly experience the sundown syndrome – a sudden worsening of confusion, agitation and aggression at the end of the day. Its daily pattern suggested that “sundowning,” as the phenomenon is also known, may be governed by the body’s internal biological clock. Synchronized by light and darkness, the circadian clock exerts control over wake/sleep cycles, body temperature, digestion, hormonal cycles and other physiological and behavior patterns. But whether the circadian clock regulated aggressive behavior was unknown.

Now, for the first time, a team of neuroscientists at Beth Israel Deaconess Medical Center (BIDMC) has demonstrated circadian control of aggression in male mice and identified the specific neurons and circuitry regulating the daily pattern. The insight opens the door to potential opportunities for managing the evening-time agitation common in patients with degenerative neurological disorders. The study was published today in Nature Neuroscience.

“Sundowning is often the reason that patients have to be institutionalized, and if clinicians can control this circuit to minimize aggressiveness at the end of the day, patients may be able to live at home longer,” said senior author Clifford B. Saper, MD, Chair of the Department of Neurology at BIDMC. “We examined the biological clock’s brain circuitry and found a connection to a population of neurons known to cause violent attacks when stimulated in male mice. We wanted to know if this represented a propensity for violence at certain times of day.”

Saper and colleagues observed aggressive interactions between male mice – resident mice defending territory against intruders introduced to residents’ cages at different times throughout the day. Counting the intensity and frequency of residents’ attacks on intruders revealed for the first time that aggression in male mice exhibits a daily rhythm.

“The mice were more likely to be aggressive in the early evening around lights out, and least aggressive in the early morning, around lights on,” Saper said. “It looks like aggressiveness builds up in mice during the lights on period, and reaches a peak around the end of the light period.”

Next, the scientists used genetics-based tools to manipulate neurons known to regulate the central circadian clock. When Saper and colleagues inhibited these neurons by disabling their ability to produce a specific neurotransmitter, the mice lost the daily waxing and waning of their aggressive tendencies. These genetically manipulated mice were more aggressive overall, demonstrating a significant increase in total time attacking intruders.

Using optogenetics – a technique that uses light to activate or deactivate targeted brain cells – to map brain circuitry revealed two parallel pathways between the biological clock and a population of neurons in a sub-region of the hypothalamus (called the VMHvl) known to cause violent attacks when stimulated in male mice.

Taken together, the experiments showed that this circadian circuit kept aggressiveness in check in the early morning; stimulating it prevented attack, while inhibiting it promoted attack. Because stimulating the neurons in question cools off aggression, Saper suggests that controlling this circuit could potentially make animals – and perhaps people – less aggressive.

“Our results in mice mimic the patterns of increased aggression seen in patients during sundowning,” Saper said. “This new research suggests this pathway may be compromised in neurodegenerative diseases. Examining changes to this pathway in patients could provide insight into future interventions that could greatly improve the quality of life for patients and caregivers alike.”

In addition to Saper, investigators included co-first authors William D. Todd and Henning Fenselau, Joshua L. Wang, Natalia L. Machado, Anne Venner, Rebecca Broadhurst, Satvinder Kauer, Bradford B. Lowell, and Patrick M. Fuller, of BIDMC and Harvard Medical School; Rong Zhang, of Boston Children’s Hospital and Harvard Medical School; Timothy Lynagh of the University of Copenhagen; and David P. Olsen, of the University of Michigan, Ann Arbor.

This work was supported by the G. Harold and Leila Y. Mathers Foundation and the US National Institutes of Health (NIH) (grants NS072337, NS085477, AG09975, HL095491 NS073613, NS092652, NS103161, DK111401, DK075632, DK096010, DK089044, DK046200, DK057521, NS084582-01A1 and HL00701-15. Additional support came from the Alzheimer’s Association (AARF16-443613), CNPq (National Health Council for Scientific and Technological Development), and CAPES (Coordination for the Improvement of Higher Education Personnel).

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Just the two of us: Holding hands can ease pain, sync brainwaves

News Release
Februarypexels-photo-325884.jpeg 28, 2018 | COLORADO – Just the two of us: Holding hands can ease pain, sync brainwaves

Reach for the hand of a loved one in pain and not only will your breathing and heart rate synchronize with theirs, your brain wave patterns will couple up too, according to a new study.

The study, by researchers with CU Boulder and University of Haifa and published in the journal Proceedings of the National Academy of Sciences (PNAS) this week, also found that the more empathy a comforting partner feels for a partner in pain, the more their brainwaves fall into sync. And the more those brain waves sync, the more the pain goes away.

Key takeaways
  • Holding the hand of a loved one in pain can synchronize breathing, heart rate and brain wave patterns.
  • The more empathy a comforting partner feels for a partner in pain, the more their brainwaves fall into sync.
  • Increased brain synchronization is associated with less pain.

“We have developed a lot of ways to communicate in the modern world and we have fewer physical interactions,” said lead author Pavel Goldstein, a postdoctoral pain researcher in the Cognitive and Affective Neuroscience Lab at CU Boulder. “This paper illustrates the power and importance of human touch.”

The study is the latest in a growing body of research exploring a phenomenon known as “interpersonal synchronization,” in which people physiologically mirror the people they are with. It is the first to look at brain wave synchronization in the context of pain, and offers new insight into the role brain-to-brain coupling may play in touch-induced analgesia, or healing touch.

Goldstein came up with the experiment after, during the delivery of his daughter, he discovered that when he held his wife’s hand, it eased her pain.

“I wanted to test it out in the lab: Can one really decrease pain with touch, and if so, how?”

He and his colleagues at University of Haifa recruited 22 heterosexual couples, age 23 to 32 who had been together for at least one year and put them through several two-minute scenarios as electroencephalography (EEG) caps measured their brainwave activity. The scenarios included sitting together not touching; sitting together holding hands; and sitting in separate rooms. Then they repeated the scenarios as the woman was subjected to mild heat pain on her arm.

Merely being in each other’s presence, with or without touch, was associated with some brain wave synchronicity in the alpha mu band, a wavelength associated with focused attention. If they held hands while she was in pain, the coupling increased the most.

Researchers also found that when she was in pain and he couldn’t touch her, the coupling of their brain waves diminished. This matched the findings from a previously published paper from the same experiment which found that heart rate and respiratory synchronization disappeared when the male study participant couldn’t hold her hand to ease her pain.

“It appears that pain totally interrupts this interpersonal synchronization between couples and touch brings it back,” says Goldstein.

Subsequent tests of the male partner’s level of empathy revealed that the more empathetic he was to her pain the more their brain activity synced. The more synchronized their brains, the more her pain subsided.

How exactly could coupling of brain activity with an empathetic partner kill pain? More studies are needed to find out, stressed Goldstein. But he and his co-authors offer a few possible explanations. Empathetic touch can make a person feel understood, which in turn – according to previous studies – could activate pain-killing reward mechanisms in the brain.

“Interpersonal touch may blur the borders between self and other,” the researchers wrote.

The study did not explore whether the same effect would occur with same-sex couples, or what happens in other kinds of relationships. The takeaway for now, Pavel said: Don’t underestimate the power of a hand-hold.

“You may express empathy for a partner’s pain, but without touch it may not be fully communicated,” he said.

Irit Weissman-Fogel, of University of Haifa, and Guillaume Dumas and Simone Shamay-Tsoory, of Florida Atlantic University, contributed to this study. It was supported with a grant from the Binational Science Foundation.

Source: https://www.colorado.edu/today/2018/02/28/just-two-us-holding-hands-can-ease-pain-sync-brainwaves?utm_source=colorado.edu&utm_medium=Hold%20hands%20to%20ease%20a%20lover%27s%20pain%2C%20and%20your%20brains%20couple%20up%2C%20too&utm_campaign=Homepage&utm_

Written by Lisa Ann Marshall.

Bilingualism could offset brain changes in Alzheimer’s

A Concordia study sheds light on how language history relates to brain plasticity

News Release
February 6, 2018 | QUEBEC – Bilingualism could offset brain changes in Alzheimer’s

After more than a decade of research, this much we know: it’s good for your brain to know another language.

A new Concordia study goes further, however, focusing specifically on the effects of knowing a second language for patients with Alzheimer’s disease (AD) and mild cognitive impairment (MCI; a risk state for AD).

“Most of the previous research on brain structure was conducted with healthy younger or older adults,” says Natalie Phillips, a professor in the Department of Psychology.

“Our new study contributes to the hypothesis that having two languages exercises specific brain regions and can increase cortical thickness and grey matter density. And it extends these findings by demonstrating that these structural differences can be seen in the brains of multilingual AD and MCI patients.”

Phillips’s study, led by recent Concordia psychology grad Hilary D. Duncan (PhD 17), is soon to be published in Neuropsychologia(Jan, 2018).

New methods: Enter the MRI

Phillips and her team are the first to use high-resolution, whole-brain MRI data and sophisticated analysis techniques to measure cortical thickness and tissue density within specific brain areas.

Namely, they investigated language and cognition control areas in the frontal regions of the brain, and medial temporal lobe structures that are important for memory and are brain areas known to atrophy in MCI and AD patients.

“Previous studies used CT scans, which are a much less sensitive measure,” says Phillips, founding director of Concordia’s Cognition, Aging and Psychophysiology (CAP) Lab.

The study looked at MRIs from participating patients from the Jewish General Hospital Memory Clinic in Montreal.

Their sample included 34 monolingual MCI patients, 34 multilingual MCI patients, 13 monolingual AD patients and 13 multilingual AD patients.

Phillips believes their study is the first to assess the structure of MCI and AD patients’ language and cognition control regions. It is also the first to demonstrate an association between those regions of the brain and memory function in these groups, and the first to control for immigration status in these groups.

“Our results contribute to research that indicates that speaking more than one language is one of a number of lifestyle factors that contributes to cognitive reserve,” Phillips says.

“They support the notion that multilingualism and its associated cognitive and sociocultural benefits are associated with brain plasticity.”

What’s next?

Phillips and her team are already building on their findings.

“Our study seems to suggest that multilingual people are able to compensate for AD-related tissue loss by accessing alternative networks or other brain regions for memory processing. We’re actively investigating that hypothesis now.”

Read the cited study, “Structural brain differences between monolingual and multilingual patients with mild cognitive impairment and Alzheimer disease: Evidence for cognitive reserve.

Source: NEW RESEARCH: Bilingualism could offset brain changes in Alzheimer’s

Memory Garden in a Belfast Care Home

This care home has opened a ‘magical memory garden’, designed to rekindle the memories of those with dementia (SBS Australia).

Alarming amounts of noise demand ways to silence noisy hospital environments

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Spending a night in the hospital is not only stressful, but also loud. The constant beeps, whirrs and alarms ascend to a cacophony that produces anything but a relaxing, restful environment. Researchers will summarize the limited number of studies available on hospital noise and discuss the different approaches health care facilities are taking to bring restful repose to patients across the country during the 174th ASA Meeting, Dec. 4-8, 2017, in New Orleans, La.

Source: Alarming amounts of noise demand ways to silence noisy hospital environments

Hospital noise is a growing concern for patients, family and staff, but many facilities are looking for new approaches to reduce the din and bring peace back to their environment.

Public Release: ACOUSTICAL SOCIETY OF AMERICA

WASHINGTON, D.C. December 6, 2017– Spending a night in the hospital is not only stressful, but also loud. The constant beeps, whirrs and alarms ascend to a cacophony that produces anything but a relaxing, restful environment. Ilene Busch-Vishniac, of BeoGrin Consulting in Baltimore, Maryland, will summarize the limited number of studies available on hospital noise and discuss the different approaches health care facilities are taking to bring restful repose to patients across the country.

According to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, noise is the top complaint of patients, staff and visitors. “Nearly everyone has a stay in a hospital at some point,” Busch-Vishniac said. “Noise is a universal problem in hospitals around the world.”

Busch-Vishniac will explore these concepts during the 174th Meeting of the Acoustical Society of America, being held Dec. 4-8, 2017, in New Orleans, Louisiana. Noises emanate from a variety of sources at the bedside. Airflow and the noisy machines controlling it are kept on high to prevent pathogens from lingering near patients, and overhead pages alert staff of needs or announcements. Equipment alarms are the most egregious source, and although they are designed to alert staff of changes in the patient’s medical condition, many also sound when medication needs to be changed or when battery conditions are low.

“Alarms in hospitals are being horribly abused,” Busch-Vishniac said. “Most of the time, they don’t in fact indicate urgent situations.”

Previous studies showed that alarms at a patient’s bedside sound an average 133 times per day. With so many alarms, staff often face alarm fatigue as well.

“Most alarms are being responded to eventually, but not all in a timely fashion,” said Busch-Vishniac. “Staff also may not respond quickly because they recognize that the sound is not critical and the situation will right itself.”

Besides the obvious barrier to rest, high noise levels have been associated with changes in the patient’s heart rate, respiration and blood pressure. These changes increase stress levels and may impair healing. The noise can also impair communication between patients and staff.

With noise levels on the rise, the Centers for Medicare and Medicaid Services (CMS) initiated the HCAHPS survey in 2008 to assess consumer perception of health care providers and systems. Today, more than 5,500 hospitals contribute to the report, which consists of patients’ responses on seven composite measures, including questions focused on room cleanliness and quietness.

The survey has teeth. Hospital value-based purchasing links up to 30 percent of CMS payments to hospitals across the country to the results of the survey.

“Faced with a loss of money, many hospitals are looking for ways to address noise levels in a way that patients can see as an improvement,” said Busch-Vishniac.

Hospitals have been developing and implementing noise control programs that can be broken into two categories: engineering and administrative interventions.

Engineering interventions aim to find ways to quiet the room. The solutions can be as simple as closing the door to a patient’s room or as complex as installing acoustical absorption materials along the walls and ceiling to dampen the noise level. Administrative interventions focus on changing behaviors. Many hospitals have instituted quiet hours when doors are closed and voices are kept low.

One of the big changes during the past 10 years has shifted alarms from solely sounding at the patient’s bedside to also alerting a central monitor at the nursing station. This approach improves the ability of staff to identify and respond to alarms set at a reduced volume.

According to Busch-Vishniac, it may be possible in the future to remove alarms from the bedside. A quiet hospital may not be a pipedream for much longer.

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Presentation 3pIDa: “Hospital noise: how bad is it?” by Ilene Busch-Vishniac is at 1:45-2:05 p.m. CST, Wednesday, Dec. 6, 2017, in Salon E in the New Orleans Marriott. https://asa2017fall.abstractcentral.com/s/u/M8hKSrQu66E

Digital life stories spark joy in people with dementia

 

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Creating a ‘digital story’ of their memories using photos, music, text and video, can hep dementia patients open up to their fear and move into optimism.
(Shutterstock)

Elly Park, University of Alberta

I was sitting on the sofa across from Christine in her home. She offered me a cup of coffee. Each time I visited, she sat in the same spot — the place where she felt most comfortable and safe. She had shared stories from the past and decided to talk about the birth of her daughters, grandchildren and great grandchildren.

For Christine, a research participant in a multi-sited study into dementia and digital storytelling, the fear dementia brings is that she won’t be able to be a part of special moments such as the celebration of birth.

As we worked together in Edmonton, creating a multimedia story from her memory, Christina started to remember new things. She became emotional when she talked about her daughters becoming mothers themselves. She pointed out that the project was so much more powerful than looking through a photo album. Like many participants, she said she recalled stories she hadn’t thought about for years.

As a post-doctoral fellow in occupational therapy under the supervision of Dr. Lili Liu, at the University of Alberta I worked with several participants in this study. Funded by the Canadian Consortium on Neurodegeneration in Aging, one of our goals was to investigate quality of life and how technology affects the lived experiences of persons with dementia.

Technology and quality of life

In this research project we defined digital storytelling as using media technology — including photos, sound, music and videos — to create and present a story.

Most previous research on digital storytelling and dementia has focused on the use of digital media for reminiscence therapy, creating memory books, or enhancing conversation. Collaboratively creating personal digital stories with persons with dementia is an innovative approach, with only one similar study found in the United Kingdom.

During this project, I met with seven participants over eight weeks. Our weekly sessions included a preliminary interview to discuss demographics and past experiences with technology. Then we worked on sharing different meaningful stories, selecting one to focus on and building and shaping the story. This included writing a script, selecting music, images and photographs and editing the draft story.

“I was blessed with wonderful parents, and I was a mistake,” begins Myrna Caroline Jacques, 77, a grandmother of five.

Participants worked on a variety of topics. Some told stories about family and relationships, while others talked about a particular activity or event that was important to them. After all participants completed their digital stories, we had a viewing night and presented the stories to family members.

Happiness in the moment

It was an intense process. Eight sessions working one-on-one with persons with dementia required a significant amount of thinking, remembering and communicating for the participants. There were challenges, such as when participants found themselves unable to express their thoughts or remember details.

In this digital story, Christine Nelson talks of her love for her children and her fear of forgetting special moments.

Although many participants were tired after a session, they all felt that it was a beneficial and meaningful activity. Working in their homes on a personally gratifying activity with a tangible outcome seemed to keep them motivated and eager to continue. The process was also enjoyable and gave the participants something to look forward to each week.

There was a sense of happiness in the moment. And the way that participants responded to me, along with their ability to remember who I was and the purpose of our sessions, all indicated a deeper positive connection. The participants all felt a sense of accomplishment and family members were proud to see the end product at the viewing night.

Into the future

I have met with one of the research participants again recently, and she still remembers me. I would like to follow up with the others to get a sense of the long term impact of this digital storytelling project. I am also eager to see how the findings in Edmonton line up with those from the studies in Vancouver and Toronto.

The ConversationFor the participants, talking about memories helped them open up about having dementia. Getting past the fear and looking ahead with optimism was the message I heard, and one that I hope to keep hearing.

Elly Park, Assistant Clinical Lecturer in Occupational Therapy, University of Alberta

This article was originally published on The Conversation. Read the original article.

Trishaws anyone?

A beautiful intergenerational activity to celebrate the love of cycling, a spot of reminiscence, and the great outdoors.

 

How lovely is this? As a child, my mother and I use to jump on a trishaw after our trip to the wet market. I use to watch the spokes go round and round and I still can hear the “Tak tak tak” sound the wheels make as we head home. It’s always a magical experience no matter how short the trip was. Took less than 5 minutes to reach our home from the market on a trishaw and I’ve sat in it for years and years with my mum, but it never grows old. With the wind in my face, the clicky round of the rickshaw, and just cuddled beside my mum with all our groceries at my feet, the world was our oyster.

When Cycling Without Age it just brought back all these lovely memories of my childhood. I wondered how wonderful would this be for it to be reintroduced into the community. There would be so many older adults in Asia whose main form of transport was the bicycle or the trishaw at a point of their time in their youth. As we aged and our physical abilities deteriorate, we lose our abilities to cycle and with it, our memories of freedom, that wind in your hair, the road just beneath your feet, to go wherever you wanted to go and be wherever you wanted to be.

Such an intervention can only bring generations together, a real intergenerational project of adventure and bonds. To bring people closer through the love of freedom and the outdoors.

I’m so glad to see this in Singapore and I hope that more Singaporeans will jump on board to support this movement!

If you have time, have a read of these 21 inspirational stories from Cycling without Age http://cyclingwithoutage.org/book/