Newest BrainBeat podcast offers tips for dementia caregivers

November is National Family Caregivers Month. It’s also Alzheimer’s Awareness Month. It’s fitting that the latest episode of the BrainBeat podcast from the National Academy of Neuropsychology (NAN) offers tips for dementia caregivers.

During the 18-minute episode, Dr. Maureen O’Connor, a board-certified neuropsychologist who serves as director of neuropsychology at the Bedford Veterans Hospital and assistant professor of neurology at Boston University, illuminates the emotional, mental, and physical challenges that caregivers confront, as well as some of the invaluable resources at their disposal.

Her insights offer a profound understanding of the world of dementia caregiving, a role predominantly shouldered by older adults, often family members who find themselves navigating their own health-related concerns. The episode also explores the emotional toll on these caregivers, characterized by elevated rates of depression and stress, all while shedding light on the social and financial implications of this pivotal role.

(A recent study published in JAMA Internal Medicine indicated that dementia patients lost more than 60 percent of their median wealth over an eight-year period, and a recent article in The New York Times suggested that caregivers experience concomitant financial hardships as well.)

Throughout the episode, a resounding message emerges—the paramount importance of caregivers prioritizing self-care.

“Often our dementia caregivers are so involved in caring for their loved one that they’re not caring for themselves,” Dr. O’Connor says at one point.

As usual, this episode of BrainBeat unfolds as a conversation between Dr. O’Connor and host Dr. Peter Arnett, professor of psychology at Penn State University and a past president of the National Academy of Neuropsychology. The conversation underscores the significance of constructing a robust care team that comprises healthcare providers, friends, family, and support groups, all of whom are indispensable for caregivers to deliver optimal care.

Dr. O’Connor and Dr. Arnett navigate other topics, including driving cessation and end-of-life care.

Again, the podcast—Episode 16 of BrainBeat—is available now and can be accessed on demand by clicking here.

All BrainBeat podcasts can be accessed here.

7 tips for navigating holidays with a loved one who has dementia

The holidays are upon us, and whether your loved one is experiencing cognitive impairment due to Alzheimer’s disease, Parkinson’s disease, stroke, or any other cause, special planning and considering key changes to family traditions can help make the season more enjoyable for everyone. 

Amelia Anderson-Mooney, clinical neuropsychologist with private practice in Glasgow, Kentucky, and assistant professor of neurology and graduate medical education for the University of Kentucky College of Medicine, said a few small tweaks to annual rituals can go a long way toward making everyone more comfortable.

“Adjusting holiday plans appropriately often begins with a good understanding of what disease stage our loved one is experiencing now,” she said. “If symptoms are mild, small adjustments can make a world of difference.  If symptoms are moderate to severe, it’s likely that we will need to make more substantial changes. In mild stages, many elders with cognitive decline may be able to have a more active role in planning and preparing for family activities. In more advanced stages, their role will very likely be smaller but no less valuable.”

Here are seven tips for making the holiday season more comfortable for your loved one with dementia and everyone else.

Tip 1: Ask and learn

Sometimes we haven’t been fully aware of what our loved ones have been doing behind the scenes of our traditional holiday gatherings. When a loved one receives a diagnosis of dementia, it’s up to us to educate ourselves about the full extent of the responsibilities they have taken on over the years, and then have an open, direct discussion about what that loved one feels comfortable doing for this year’s holiday celebrations.

Anderson-Mooney said it’s important to make sure your loved one with dementia is involved in holiday preparation in a way that is meaningful to them. She said sometimes this can be accomplished by asking, simply, “What can we do to make the holidays easier for you?” Anderson-Mooney added that it’s critical to have this conversation with the understanding that elders with cognitive change may need additional time to gather their thoughts and respond.

“It is also important to remember some elders with cognitive change may not fully understand their limitations, which means a more substantial change in approach for us,” said Anderson-Mooney, who is a National Academy of Neuropsychology (NAN) board member and chair of NAN’s publications committee.

Tip 2: Delegate, delegate, delegate

If the person in your family with dementia is the person who has hosted holiday traditions, it might be necessary to rethink the entire celebration. Perhaps your loved one no longer feels able to prepare their home in a way that makes them feel ready. Perhaps they feel they can do it, but they need help. Anderson-Mooney said it’s always a good idea to offer to help make a list and gather volunteers to pitch in.

She added: If your loved one with dementia no longer feels comfortable handling the family meal solo, delegating tasks could be a golden opportunity to learn family recipes and traditions straight from the source so they can be passed down to future generations. 

Tip 3: Keep tabs on overload

Anderson-Mooney noted that it’s also important to consider how much holiday cheer loved ones can handle at one time.

People with cognitive change often talk about how overwhelming it is to be in large groups of people, even people they love, because they feel like they can’t follow the conversations well.  Because of this, they tend to withdraw, and that withdrawal can be hard for other family members to understand. If you have noticed your loved one having difficulty interacting in family gatherings during the year, your family may want to plan to have smaller gatherings more often. 

Her advice: Make sure you build the day around what your loved one’s body needs  Plan activities at a time of day when your loved one feels the sharpest and most energetic. Do your shopping outings before lunch. If your loved one feels and operates best in the morning hours, maybe a Thanksgiving breakfast is in order, with smaller visiting groups later in the day.

“The holidays are about being together,” Anderson-Mooney said. “That’s what matters most.”

Tip 4: Make travel easier

Cognitive decline often adds a layer of complexity if your family has traditionally traveled for the holidays. People with cognitive impairment often lean heavily on their daily routine to help them get by from day to day. Travel, by its nature, can disrupt that routine completely.

Anderson-Mooney said this means that travel might be out of the question for some people with cognitive impairment. She added that if a loved one has had trouble adjusting to relatively small changes in their daily routine at home, you can anticipate that they may not adjust well to the larger demands of traveling.

In extreme cases, or cases where a loved one is experiencing significant cognitive decline, it may be wisest to eliminate travel of any kind.

Tip 5: Build in time to rest

Sleep disruption can be very problematic for people with dementia. Anderson-Mooney said in practice, she often sees an increase in confusion and emotional upset from disrupted sleep. Again, if you have seen your loved one struggle to adjust to an earlier wake up time for a doctor’s appointment, or struggle to adjust to time changes or new time zones, for example, unusual holiday schedules or on quick trips can be doubly hard. 

Consider also that traveling itself—whether it’s a one-hour car trip or a six-hour plane flight—can be exhausting.

Most people are familiar with the fatigue we feel after reaching our destination when we travel, even though we’ve just been sitting in a car all day or waiting for a plane. This fatigue happens, at least in part, because our brains are very busy processing all the novel scenery, keeping us safe in traffic, making sure we make our flight connections, helping us remember where we put our carry on bags, and so on. Anderson-Mooney said this fatigue can multiply in a serious way in people with cognitive impairment.

“If travel is in the plans for your loved one with cognitive impairment, consider breaking up the trip into smaller legs or adding a day before and/or after to allow your loved one to recover energy-wise,” she said.

Tip 6: Line up support

If you’re planning to travel for the holidays by car, be very realistic about whether your loved one can handle any of the driving. If you’re flying, airlines help vulnerable elders just as they do for unaccompanied minors. Most of this assistance is available in part because of the federal Air Carrier Access Act and the Americans with Disabilities Act. Airlines are required to offer assistance for seniors such as help in boarding and making connecting flights, and many airlines go above and beyond the basic requirements to ensure that their elderly passengers are well cared for in their travels. (This, this, and this are great websites for more information on the subject.)

Anderson-Mooney suggested that family members may want to consider adding an extra layer of support for loved ones with dementia.

Specifically, she advised that someone in the family (or a hired caregiver) accompany your loved one as the person’s personal “travel coordinator.” This person becomes responsible for carrying your loved one’s medications, keeping track of their valuables, and tracking the itinerary. The person also can be responsible for making sure that your loved one takes their medications on time while traveling and while on the ground at the destination. (Setting alarm reminders on the coordinator’s phone is a helpful way to make sure your loved one never misses a dose.)

Anderson-Mooney said the coordinator should travel with a full, printed list of medications, dose amounts, and dosage times, as well as names and phone numbers of your loved one’s doctors. She added that it’s important to keep the list and the medication in a carry-on bag so it’s not lost and separated from your loved one.

“It’s so important to consciously and deliberately appoint someone to ensure these things are done,” Anderson-Mooney said. “With some medications, missing doses can be dangerous. Replacing medications in lost baggage can be done, but it’s better to avoid the hassle in the first place.”

Tip 7: Providing physical care

Finally, Anderson-Mooney said it’s important to be mindful to maintain our loved ones’ physical needs in the hustle and bustle of the holidays.

Make sure your loved one is eating good quality food on a regular schedule. Make sure they stay hydrated while out and about in town and during busy family gatherings. Be very careful and limited with alcohol consumption. Deliberately add in more time for rest and recovery in your schedule. Set medication alarms to make sure we remember to take medicines during our activities (taking water with us is often necessary for this).

Again, it can be very helpful to have a dedicated person or group of people to watch over these needs for your loved one. If this is too big of a job for one person, designate a different coordinator for each day of the holiday, and switch throughout the celebration. 

Closing thoughts

Of course, all these suggestions assume that your loved one is going to be an active, agreeable participant in adjusting to their own needs. Unfortunately, sometimes this is just not the case.

“Cognitive change is cruel and unforgiving, and it can completely change our loved ones’ personalities and ways of doing things,” Anderson-Mooney said. “Our loved ones may no longer be capable of understanding their own changes and adapting to their own needs. Our loved ones may no longer recognize us when we visit.  We might deal with more agitation and anger, more upset, lashing out behavior. In these cases, our traditional plans just don’t make sense anymore.”

In these worse-case scenarios, Anderson-Mooney said we must adapt to a much heavier degree.

Specifically, if visits usually leave your loved one agitated and upset, it may be best to delay the holiday all together.

If visits leave your loved one confused, it may still be worth making the effort to celebrate together. Anderson-Mooney added that even if your loved one no longer recognizes you, they are very likely to recognize and understand that you are someone who loves and cares about them. They will appreciate your gesture of time and company, small gifts and comforts, favorite foods, and chatting about family photos. Spend time listening to their favorite music. Talk about their favorite memories from the past. Take the time to write down the family stories they tell before they fade away.

“This time can be a gift, even while you mourn the changes your family is experiencing,” Anderson-Mooney said.  “Give the best love and honor that you can, and know that it matters, whether or not your loved one can appreciate it.”

This essay has been factchecked by members of NAN’s Publications Committee. For more about that process, click here.

The connection between nutrition and brain health

You’ve probably heard the saying, “You are what you eat.”

Some brain scientists like to riff on this trope with a more brain-specific version: “Your brain is what you eat.” It’s not so far-fetched; there are serious connections between nutrition and brain health.

We’ve compiled some of these connections in a quick tips video on the subject. The video can be found on the new Brain Health Hub section of the NAN website.

In a nutshell (see what we did there?), healthy nutrition habits can help us to stay fit, and certain diets are especially good for brain health.  These include the Mediterranean, MIND, and DASH diets. All three diets include whole grains, olive oil, beans, nuts, vegetables, and fruits, and moderate amounts of fish and dairy products.

In contrast, diets that are high in unhealthy oils and fats, refined sugar, and processed foods could lead to excessive weight, inflammation, and declining brain health.

You might wonder how consistent you need to be about your eating habits, but you can get brain health benefits by following these diets even part of the time. Some research has shown that people who followed the Mediterranean and MIND diets at least moderately well could lower their risk of Alzheimer’s disease.

The best protection comes from continuing to follow these diets regularly over time.

New research into the intersection of nutrition and brain health has focused on gut microbes—tiny organisms in the digestive system which can possibly be helpful or harmful for brain health. While future studies may find medications or supplements that might be helpful here, we don’t know enough yet to make strong recommendations.

As you consider how you can embrace better nutrition to spark better brain health, remember to be careful; it’s always important to discuss any significant dietary changes with your healthcare team.

How TMS treats depression

Transcranial Magnetic Stimulation (TMS) is a procedure that generates magnetic fields to stimulate nerve cells in the brain. The goal: to improve symptoms of major depression. The approach is considered a “noninvasive” procedure because it’s done without surgery. In research, TMS has shown promise in treating multiple conditions when symptoms don’t respond to other treatments, including migraines, smoking cessation, PTSD, OCD, Tourette’s Generalized Anxiety Disorder, and movement disorders such as Parkinson’s. TMS, which is notably different from Electroconvulsive Therapy (ECT), is now used most often as a treatment for depression when other treatments haven’t been effective. Dr. Zafiris “Jeff” Daskalakis knows all about TMS. Dr. Daskalakis is chair of the University of California San Diego Psychiatry Department and director of the University of California San Diego Health’s Interventional Psychiatry Clinic. He has become an internationally recognized expert in treating severe psychiatric disorders with TMS. As a sidebar to this essay about a patient’s experience with TMS, BrainWise Managing Editor Matt Villano recently sat down with Dr. Daskalakis to understand more about the science behind the treatment. What follows is an edited transcript of their interview.

BrainWise: What is happening during a TMS treatment?

Dr. Zafiris “Jeff” Daskalakis: Basically, we’re causing millions of neurons to fire together, all at once. And when those neurons fire in synchronicity, it results in neuroplasticity. Of course, it’s much more complicated than that. To do TMS, an electric pulse generator, or stimulator, is connected to a magnetic coil connected to the scalp. The coil is about two laptops thick and about half a laptop in width. The machine takes electrical charge from the wall and stores that electrical charge in a large capacitor. When that capacitor triggers, it sends the electrical current through the coil for an instant. It’s less than 50 microseconds in duration. That very brief instant of time translates into a magnetic field, which travels through the coil, across the skull, and activates neurons in the brain. There’s no actual electrical conduction; it’s a magnetic field. The magnetic field is much less painful, much better in terms of tolerance. And the magnetic field generates neuronal change. We’re able to get neurons to fire in a certain rhythmic pattern. Why is this important? The old expression is, ‘When neurons fire together, they wire together.’ These neurons firing together and wiring together creates neuroplasticity. Which leads to change.

BrainWise: To be clear, TMS does not involve an electrical charge going into the brain? It’s only a magnetic charge?

Dr. Daskalakis: That’s correct.

BrainWise: How finely targeted is the directionality of this magnetic charge?

Dr. Daskalakis: The area of activation depends on the size of the coil. The larger coil size, the higher the area of activation, the larger the area of activation. The smaller the coil size, the smaller the area of activation. By and large, the coils’ area of activation is elliptical, around three centimeters in diameter. The depth of the impact also depends on the amount of stimulation charge, but at standard stimulation charges, on average, they get about 2 to 2.5 centimeters deep. It’s really that top layer of the brain that is most affected.

BrainWise: Why is this such a big deal?

Dr. Daskalakis: Whenever we look at the brain, there’s always an outer and an inner shell. The inner shell tends to be a lot paler, and the outer shell tends to be a little darker. That’s because the inner shell is associated with lots of neuronal output connections, and the outer shell is really the cell body; it’s where all the action happens. The outer shell allows us to think and function and navigate and interact with our world, think logically, be future minded, and play instruments. And the outer shell just so happens to be that same area that we target with TMS. By stimulating that outer shell repetitively with magnetic fields, we are causing neurons to align. And when those neurons align, that neuroplastic effect takes place. It doesn’t happen right away, and it doesn’t happen with just one treatment, but it happens when you bring people in repeatedly over the course of days to weeks and aim to improve their symptoms.

BrainWise: Can this work for everyone?

Dr. Daskalakis: Not exactly. A certain proportion respond to psychotherapy and a certain proportion don’t. We think that up to a third, perhaps as many as 40% of patients do not respond to conventional treatments, conventional meaning medications or psychotherapy. Of those, about two or three patients out of 100 not only have depression, but also have the type of depression that doesn’t respond to conventional treatment. [Editor’s note: For more on this, click here or here.] This proportion of the population tends to be labored with suicidal thinking oftentimes, because the longer it takes for you to get better, the worse you are. That’s where TMS comes in. TMS is singularly used for that patient population. And we believe that roughly out of those patients who choose to receive TMS, one out of every two or three will achieve a significant clinical benefit.

BrainWise: To what extent are there negative impacts of this treatment? What are the side effects?

Dr. Daskalakis: Lots of groups have looked at this very closely. We have learned that TMS represents one of the safest treatments that we have. There’s an extremely remote risk of seizures. In fact, the only population that we do not have TMS available to is patients who’ve had a seizure disorder. [Editor’s note: Some sources also point out that TMS can be a bad idea in patients who have metallic implants in the brain or skull.] Outside of that, the major side effect associated with TMS is a bit of a headache and some discomfort at the stimulation site, which isn’t profound. And usually, it’s very well-tolerated.

BrainWise: What’s the next frontier of TMS? What questions will you be asking next?

Dr. Daskalakis: There are several areas that we can advance. One of them is how do we make the treatment more efficient? It’s already an extremely efficient treatment, but the treatment requires people to drive into a clinic to get treatment a certain amount of time for a certain number of days. Can we make people better within a week? Can we make people better within a day? These are all hot topics that we need to continue to explore.

The second piece, which goes hand in hand with the first piece, is how do we make the treatment more effective? How do we enhance the efficacy? That leads to the third piece, which is understanding the brain. We have a treatment, and we are narrowing in on the ways that this treatment works in the brain.

I’ve mentioned one mechanism called neuroplasticity, but there’s other mechanisms that are also being considered. One of those mechanisms is connectivity—how different parts of the brain connect to one another. That’s really about the threads of connections between different parts of the brain that may be responsible for inducing depression. Understanding those brain mechanisms is the third piece of the puzzle.

Finally, the fourth piece of the puzzle, I think, is how do we maintain people’s wellness? What do we need to do to continue to treat people so that once they respond, they stay better for longer periods of time? Relapse rates are high. When you go on a medication, you’re not out of the woods just yet. The chances that you’re going to get depressed again could come up down the road. And, similarly with TMS, if you respond, how do we maintain your wellness so that you don’t relapse? Understanding how it works, understanding how we can make it work better, understanding how to make it more efficient, and understanding how we can make the effects more durable are all key pieces of this treatment that we need to continue to pursue.

For more about TMS, read this essay by a patient who recently completed 37 sessions of the treatment for depression.

This essay has been factchecked by members of NAN’s Publications Committee. For more about that process, click here.

How social connections can improve brain health

Social connection is a fundamental human need, as essential to survival as food, water, and shelter. It’s also critical to brain health.

One of the missions of the National Academy of Neuropsychology (NAN) is to make facts about brain health available to as many people as possible. Our recent quick tips video spotlights the importance of social connection to brain health and healthy living.

The video can be found on the new Brain Health Hub section of the NAN website.

The video opens with some sobering facts. Loneliness and social isolation are considered epidemics by the US Surgeon General. Some surveys have found that one in two American adults—especially younger adults—report experiencing loneliness. A lack of social connection has been considered as dangerous as smoking up to 15 cigarettes a day.

The good news? We humans can change and increase our social activity over time. Three aspects of social connectedness seem to matter most: 1) the number and variety of relationships in our lives, 2) how often we interact with others, and 3) how satisfying our relationships and interactions with others are. In addition, science has shown us that developing meaningful friendships, nurturing them, and maintaining regular contact with friends and family members can stimulate our brain, reduce stress, and slow decline in our thinking skills.

Put differently, having meaningful connections, including having supportive listeners in our lives, matters.

Not only does it feel good to share a difficult day with a supportive friend, but it also helps preserve our thinking abilities. If you’re not very socially active, it’s a good idea to consider ways to become more active, such as reaching out to a friend for a coffee meet-up, joining a hiking or walking club, joining a book club, or volunteering in your community.

Having a socially active lifestyle has physical benefits too, such as a lower risk of heart disease and a better chance of living longer.

We all need positive social relationships for our brain health. Remember that a little kindness, a friendly chat, staying connected with those we already know, and embracing new connections can do wonders for our brains.

Former NAN President quoted in Reader’s Digest story about intelligence

While most members of the National Academy of Neuropsychology (NAN) are at the annual conference in Philadelphia this week, former NAN President Dr. John DeLuca is proving that, figuratively speaking, the organization is everywhere.

DeLuca, a neuropsychologist and senior vice president for research at the Kessler Foundation, was quoted extensively in a recent Reader’s Digest article about intelligence. The story, titled, “What is IQ and how well does it predict success?” appeared in the print edition of the magazine, and also was published on the Reader’s Digest website earlier this month.

In the story, DeLuca said each IQ test measures a slightly different set of cognitive skills. Some of these skills include verbal reasoning, math, visual-spatial reasoning, processing speed and working memory. DeLuca noted that IQ also measures verbal and nonverbal aspects of intelligence.

Specifically, he noted that IQ tests measure an overall intellectual factor, which has been referred to as a “g.” DeLuca said, “A lot of things go into that factor, but ‘g’ is the idea of this overall intelligence.”

From here, the story provided a bit of history about Intelligence Quotient, or IQ, tests.

Author Laurie Budgar quoted an expert from MENSA International, which is an organization created by and for those individuals who score in the top 2 percent of all administered IQ tests. (Essentially, it’s a high-IQ society.)

The story also explained that when IQ tests were first developed in 1912, the IQ score was meant to reflect the ratio (or quotient) of a person’s “mental age” divided by their chronological age and then multiplied by 100. To provide an example of how this might work, a person whose chronological age was 10 and who also tested at a mental age of 10 would have an intelligence quotient of 100.

But IQ is about much more than intelligence. DeLuca, who is based in New Jersey, went so far as to say that, contrary to popular belief, IQ tests actually do not determine how smart you are.

“An IQ test will tell you if you have some level of overall intellectual ability,” DeLuca said. “Does it mean you have common sense? No. It means you have an ability to process information at a high level. It doesn’t mean you’re smart in everything you do. Einstein [may have] had a high IQ, but it doesn’t mean he was able to, for example, make good decisions about his financial life.”

The article also provided information about how traditional IQ tests are scored—on a bell curve, with that same score of 100 reflecting average intelligence.

DeLuca was the source who explained how IQ takes age into account. He said it’s normal for certain aspects of intelligence to change over time, and noted that cognitive processing speed at age 20 is likely to be a lot faster than it will be at age 50.

He also took the opportunity to discuss the intersection of intelligence and neuropsychology.

Specifically, in reference to the concept of cognitive reserve, DeLuca told the author: “People with a lifetime of highly intellectual stimulation will create a brain that’s more resistant to disease—not necessarily resistant to getting the disease or progressing in that disease, but resistant to the outcome of it. A person may be less likely to become demented even if they develop Alzheimer’s.”

To see if you can pass the world’s shortest IQ test, click here. For more on DeLuca’s work at the Kessler Foundation, click here.

What not to miss at the 43rd annual NAN Conference

The National Academy of Neuropsychology (NAN) is set to celebrate its 43rd annual conference this week in Philadelphia, and the event is shaping up to be interesting, informative, and integral to understanding where brain science is headed.

NAN has lined up dozens of speakers to present an eclectic program. These neuropsychologists and other researchers will opine on everything from concussions to the Mediterranean Diet.

NAN Executive Director Dr. Bill Perry said he is looking forward to the breadth and depth of expertise.

“Neuropsychologists are always the busiest people I know,” he said. “This is the one time all year when we stop what we’re doing, get together and listen to each other to get a sense of what we’re all doing and where the field is heading next. Year after year, NAN is excited to be able to facilitate this confluence of minds.”

There are 52 sessions over three-and-a-half days of programming at the Philadelphia Marriott Downtown. Here are just some of the sessions about which attendees undoubtedly will be talking:

Wednesday, October 25

First, in a welcome plenary titled, “Three Lessons About the Brain (or Stuff I’ve Learned From Studying Emotion),” Dr. Lisa Feldman Barrett will describe three insights about brain architecture and the corresponding computational affordances from the science of emotion. The welcome session begins promptly at 1:15 p.m.

Later in the afternoon, Dr. Michelle C. Carlson will deliver a talk titled, “Promoting Cognitive and Brain Health through Social Engagement and Neighborhood Factors.” This talk will summarize work increasingly focused on multi-domain dementia prevention interventions and describe work that incorporates social and productive engagement. Dr. Carlson also will describe the rationale for research examining the intersection of individuals and their environment or neighborhood, when examining cognition, function, and brain health.

Toward the end of the day, Dr. Paul Thomas Maruff will discuss the intersection of cognitive dysfunction and preclinical Alzheimer’s Disease. Dr. Maruff will highlight how attempting to understand this disease stage with both conventional and computerized cognitive tests provide new challenges and lessons for the field of neuropsychology. The talk is titled, “The Nature and Magnitude of Cognitive Dysfunction in Preclinical Alzheimer’s Disease: What The Disease Tells Us About Neuropsychology and What Neuropsychology Tells Us About The Disease.”

Thursday, October 26

Day 2 of the conference kicks off with a symposium titled, “The SuperAging Research Initiative: Identifying Protective Factors to Promote Healthspan.” Because the initiative spans three sites, this particular talk will comprise three speakers. Dr. Emily J. Rogalski will provide an overview of the initiative including rationale, known features, current progress, and new directions. Dr. Amanda Cook Maher will provide insights on outreach, recruitment, and engagement approaches. Dr. Angela C. Roberts will describe the innovative remote data collection protocol and initial observations from the wearable technology used in the study, which is designed to quantify measurements of daily life including sleep, physical activity, autonomic responsivity, and social engagement.

Next, Dr. Gayathri J. Dowling will deliver a talk titled, “The Adolescent Brain Cognitive Development (ABCD): Opportunities for Scientific Discovery.” In this session, Dr. Dowling will describe the comprehensive nature of this longitudinal study (including the many different types of data being collected), and discuss emerging findings from the ABCD study and describe its potential value for understanding risk and resilience factors that influence adolescent development.

NAN Executive Director Dr. Bill Perry will deliver a talk on Thursday, as well—a session titled, “The Role of Neuropsychology in Evaluating Physician and Pilot Fitness for Duty: Ethical, Legal, and Clinical Considerations.” In this presentation, Dr. Perry will summarize the various types of physician assessments and the legal and ethical issues associated with each type. His co-presenter, Dr. Robert Elliott, president of Aerospace Health Institute—LAX, will describe the aviation evaluation process and the qualifications required to conduct mental health and neurocognitive evaluations required by the Federal Aviation Administration.

Finally, in a talk titled ” Positive Emotions in the Regulation of Stress: A Neuroaffective Model with Applications for Resilience,” Dr. Christian Waugh will introduce a neuroaffective model of how people use positive emotions to regulate their stress. This model contributes to the stress/emotion regulation and neuroscience literatures by outlining multiple psychological mechanisms through which positive appraisal helps promote resilient responses.

Friday, October 27

The third day of the conference is by far the busiest, with several talks happening simultaneously during the morning session.

One from Dr. Robert Motl, titled, “Effects of Exercise on Cognition and Other Variables in Multiple Sclerosis,” will review the evidence regarding the effects of exercise training on cognition, mobility, and quality of life in people with multiple sclerosis (MS); another. In another talk titled, “Neuropsychological Outcomes in Pediatric Cancer Survivors: Clinical Management and Emerging Research,” Dr. Peter Stavinoha and Dr. Marsha Gragert will provide an overview of the current understanding of factors associated with cognitive and educational outcomes for pediatric cancer survivors.

After lunch, Dr. Gabriel de Erausquin will deliver findings from recent research into cognitive impairment profiles of older adults after SARS-CoV-2 infection as part of a talk titled, “Alzheimer’s Association Consortium on Chronic Neuropsychiatric Sequelae of SARS-CoV-2.” (BrainWise published a Q&A with Dr. de Erausquin earlier this year.)

To end the day, Dr. Maria T. Schultheis will drive (see what we did there?) a discussion about how technology can help patients drive after neurological compromise. Titled “Technology, Cognition and Driving: What Have We Learned and Where Are We Going?” the talk will summarize current research in this area and highlight emerging technologies that can further contribute to understanding of brain-behavior functioning.

Saturday, October 28

The final day of the conference is a short one, and several early-morning talks are compelling.

A workshop titled, “Social Justice and Brain Health Science Futures: Testing, Training and Research Applications,” will offer offers professional development though a lens of social justice that builds upon available empirical evidence and historic records to establish foundational understanding of the current scientific landscape of brain health disparities. Led by Dr. Desiree A. Byrd, the talk also will inform practice enhancements for clinical and research evaluations that yield equitable assessment experiences for populations most susceptible to brain health disparities.

In another morning session titled “Technology Strategies that Support Cognition to Improve Health and Everyday Function,” Dr. Maureen Schmitter Edgecombe and Dr. Tania Giovannetti will discuss and share findings from clinical studies that use personal technologies, including smartphones, smart watches, tablets, and laptops to scale and deliver cognitive interventions that support cognitive abilities and improve everyday function.

The conference will conclude with a plenary session delivered by Dr. Antonio Damasio during which he will explore the biology and psychology of human consciousness. The closing plenary will begin promptly at 9:30 a.m.

BrainWise Managing Editor Matt Villano will be on site publishing daily reports from the conference. Also be sure to follow the official BrainWise Instagram account for more.

Finally, if you’re a neuropsychologist and you’re attending the conference this week, be sure to check out this article, from The New York Times, about the best 25 restaurants in Philadelphia right now.

Physical activity a key to brain health

One of the missions of the National Academy of Neuropsychology (NAN) is to make facts about brain health available to as many people as possible.  That’s precisely why NAN recently released a quick tips video with information related to the connection between physical activity and brain health.

The video, part of NAN’s new Brain Health Hub, features NAN President, Dr. John Randolph, who also is a clinical assistant professor of psychiatry at Dartmouth University.

While we’ve known for many years that being physically active is important for general health, heart health, and our mood, we now know that being active through exercise and daily movement can do many things for the brain too.

Being physically active on a regular basis is linked to a stronger ability to focus, learn, remember, and solve problems in daily life.  Benefits from exercise workouts, in particular, can happen after individual sessions, and can also happen if we exercise and stay active day to day, and week to week.

What types of physical activity count? Going on walks, hiking, dancing, cycling, doing yardwork, swimming, and many others are all good for the brain—anything that gets your heart beating a little faster than usual for at least 20-30 minutes at a time seems to be the sweet spot for improving brain health.

In this process, we can even form new neurons, or brain cells, in the memory center of the brain. 

One other thing: Exercising on a regular basis is associated with a significantly reduced risk of developing Alzheimer’s disease.  Even if you’re not very physically active much right now, by starting to move and exercise more often, you’ll be helping your brain stay healthy, and you may avoid problems many years from now.  

Leaning into a new exercise regimen isn’t easy. If you’re having trouble building a new exercise habit, consider taking small steps first, such as going on short walks once or twice per day.  Exercising with a friend might help improve your motivation to work out, and there’s evidence that exercising with someone else might be even better for brain health than exercising by yourself.

For more information about the connection between physical activity and brain health, or for information about other aspects of brain health, please visit NAN’s Brain Health Hub, a growing library of resources on the NAN website.

Hemsworth raises awareness about genetic testing and dementia

It turns out Thor might be mortal after all.

More than anything else, that was the takeaway from a recent episode of “Limitless with Chris Hemsworth,” the NatGeo documentary series on longevity.

In the show, the Australian actor who plays Thor took a genetic test that revealed he has two copies of the gene APOE ε4, which is linked to an increased risk of Alzheimer’s disease. A recent Men’s Health magazine article thrust the issue like a hammer (see what we did there?) into the national zeitgeist.

This article, published October 3, noted that Dr. Peter Attia, who specializes in longevity and is the consulting doctor on “Limitless,” explained to Hemsworth that while this gene increases the risk of Alzheimer’s—making it somewhere between three and 10 times higher than everyone else’s—it’s doesn’t mean Alzheimer’s is a sure bet.

In other words, according to Dr. Attia, a patient can have the high-risk gene without ever developing the disease. Conversely, the same patient may not have the gene and can still develop Alzheimer’s.

Ten years ago, researchers knew of only 10 genes linked with Alzheimer’s. Today, scientists have identified more than 70 genetic regions associated with Alzheimer’s. The APOE gene is involved in making a protein that helps carry cholesterol and other types of fat in the bloodstream. Problems in this process are thought to contribute to the development of Alzheimer’s.

APOE ε4 increases risk for Alzheimer’s and is associated with an earlier age of disease onset in certain populations. A 2015 JAMA report indicates that with an allele frequency of 14 percent, APOE-ε4 is present in approximately 25 percent of the US population and associated with increased risk of Alzheimer’s Disease.

What’s more, a separate report from 2021 indicates that roughly 2 to 3 percent of those who carry APOE-ε4 actually carry two copies like Hemsworth does.

(We all always knew that Thor was an extraordinary specimen; for more on the research, click here.)

Risks associated with having APOE ε4 are manageable. On the “Limitless” show, Dr. Attia said he believes that with aggressive lifestyle adjustments one can reduce risk.

Specifically, Dr. Attia told the 40-year-old Hemsworth he considers Thor’s test result a blessing. “This will motivate you to take steps today that most people [in their 40s] would never think about until they’re in their 50s or 60s,” he told the star.

Hemsworth, in turn, responded with signature panache.

“It was a good kick in the arse and a reminder to do whatever is in my power to give myself the best fighting chance,” said Hemsworth. “Whatever work I’m doing for my brain health benefits the rest of my body—we turned it into a positive.”

In the article, Hemsworth added that he hopes sharing his news will inspire other people in similar situations to take better care of themselves.

Specifically, he told Men’s Health Executive Editor Ben Court that people in similar situations should “either go and get checked or to understand more about brain health and see what they have within their power to change.”

Hemsworth also cited impacts of focusing on certain areas of brain health, including diet and sleep.

To be clear, in most cases Alzheimer’s does not have a single genetic cause. Instead, it can be influenced by multiple genes in combination with lifestyle and environmental factors. According to the National Institutes of Health, a person may carry more than one gene or group of genes that can either increase or reduce the risk of Alzheimer’s.

Importantly, people who develop Alzheimer’s do not always have a history of the disease in their families. Still, those who have a parent or sibling diagnosed with the disease have a higher risk of developing Alzheimer’s than those without that association.

(Additional studies by NAN’s own Archives of Clinical Neuropsychology journal have established that APOE ε4 is connected with an increased likelihood of neurocognitive impairment following sports-related concussion, and that the presence of APOE ε4 can be a predictor of heterogeneity in cognitive function.)

It’s also worth noting that genetic tests are not routinely used in clinical settings to diagnose or predict the risk of developing Alzheimer’s or a related dementia. In some cases, if a person has symptoms at an early age with a strong family history of Alzheimer’s, a neurologist or other medical specialist may order a genetic test for rare single-gene variants known to cause the disease.

As mentioned earlier, although APOE testing is also available, the results cannot fully predict who will or won’t develop Alzheimer’s. Rather, this type of testing is used primarily in research settings to identify study participants who may have an increased risk of developing Alzheimer’s. This approach helps scientists look for early brain changes and compare the effectiveness of possible treatments for people with different APOE profiles.

In Hemsworth’s case, it also makes for great TV, and an impetus for change.

This essay has been factchecked by members of NAN’s Publications Committee. For more about that process, click here.

New Brain Beat podcast features Dr. Tresa Roebuck Spencer

The Brain Beat podcast, which is published by the National Academy of Neuropsychology (NAN) Foundation, has shared its latest episode: A gut-wrenching interview with neuropsychologist and former NAN President Dr. Tresa Roebuck Spencer.

As BrainWise wrote in a Q&A feature article earlier this year, Dr. Roebuck Spencer has a glioblastoma multiforme (GBM), a fast-growing and aggressive cancerous brain tumor.

Since her diagnosis in October 2020, Dr. Roebuck Spencer has managed the roller coaster of treatment (including four brain surgeries, three clinical trials, two rounds of radiation and chemotherapy), as well as the ups and downs that have come with transitioning from expert to patient.

Earlier this fall, she did some public service announcements for the National Brain Tumor Society (NBTS).

(As an aside, the NBTS provided statistics and data that informed this blog post, which ran as a companion piece to the BrainWise Q&A.)

In the podcast, Episode 15, Dr. Roebuck Spencer talks more about her new life as a patient, and about some of the challenges she is facing today. She also looks back on her journey—sometimes even with humor.

Dr. Roebuck Spencer has had an incredibly accomplished career in neuropsychology. The Houston-based doctor is a board-certified clinical neuropsychologist who has worked in Texas, Louisiana, Florida, and Washington, D.C. She has published more than 70 peer-reviewed publications and book chapters in the areas of traumatic brain injury, rehabilitation, and computerized neuropsychological testing.

All episodes of Brain Beat can be accessed here.