Tag Archive for: brain health

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.

Lifestyle changes for better brain health

Dr. Gary Small knows all about brain health. As professor and chair of psychiatry at Hackensack University Medical Center, he oversees all professional and administrative activities within the behavioral health care transformation service at Hackensack Meridian Health. Prior to this gig, Dr. Small was a professor of psychiatry and biobehavioral sciences and a Parlow-Solomon professor on aging at the David Geffen School of Medicine at UCLA, director of the Division of Geriatric Psychiatry at the Semel Institute for Neuroscience and Human Behavior, and director of the UCLA Longevity Center. Now 72, Dr. Small is known for his public work in promoting the practice of psychiatry and innovative research on brain health, aging, and Alzheimer’s disease. He is a co-inventor of the first positron emission tomography (PET) scanning method that provides images in living people with Alzheimer’s disease with abnormal brain proteins, amyloid plaques, and tau tangles. Dr. Small has authored more than 500 scientific works and received numerous honors, including the American Psychiatric Association Weinberg Award in Geriatric Psychiatry. What’s more, Scientific American magazine named him one of the world’s top 50 innovators in science and technology. He is the author of 14 popular books, including a bestseller titled, The Memory Bible. (Dr. Small also recently spoke at a NAN workshop; to access the archived event, click here.) Earlier this year, BrainWise Managing Editor Matt Villano sat down with Dr. Small to discuss the most important aspects of brain health, and how aging adults can take better care of themselves for the future. What follows is an edited transcript of their conversation.

BrainWise: If we had to categorize lifestyle activities, what are some of the top things people can do to improve their brain health?

Dr. Gary Small: I would say number one is physical exercise. Mental exercise and challenging the brain is very important, but the scientific evidence is even more compelling that regular aerobic or cardiovascular conditioning protects your brain too. You don’t have to become a triathlete to achieve that. Some studies show that just a half hour of brisk walking each day will lower a person’s risk for Alzheimer’s disease. And it’s not just cardiovascular conditioning, which improves circulation to the brain, it increases levels of endorphins which lift a person’s mood and improves issues with pain. Physical exercise also increases levels of brain-derived neurotrophic factor, which is a protein that helps our brain cells communicate more effectively. Strength training appears to provide additional benefits. It may be that when you’re lifting weights or using resistance bands, it provides an additional cognitive challenge to get your form correct, or it may be that other factors are involved. We know that as people age, they are at risk for developing a condition called sarcopenia, which is loss of lean muscle mass, which is a predictor of shorter life expectancy. So that’s another area that strength training helps us in. A third component of physical exercise would be balance training. Older people are at risk for falls, and if you fall, you can hit your head and head trauma is not good for your brain health. [Literature such as this article, this article, and this article suggest that] people who hit their heads and lose consciousness for an hour or more [may have] greater risk for developing dementia or cognitive decline that interferes with their ability to care for themselves.

Brainwise: How can PET scanning help patients become better acquainted with and better in control of their own health?

Dr. Small: It’s a complicated issue because any test or technology that you’re going to use, you have to ask the questions, ‘How is it going to be helpful? What is the potential harm? What is the potential benefit?’ I have worked in this area for a number of years. In 2004, [PET scans were] used to differentiate Alzheimer’s disease from Frontotemporal Dementia (FTD). Today, PET scans are used for all sorts of other things. A PET scanner is essentially like a Geiger counter, it measures radioactivity. When a patient gets one, we inject the patient with a radioactive chemical marker that is taken up by the brain. The marker enables us to see how the brain cells are using sugar, which gives you a measure of cellular function. Of course, there is the risk that if you get these scans, it’s going to cause anxiety in [some] patients. I’m not really a big fan of telling people to go out and get a scan or get genetic testing [unless it’s medically necessary], because it could have negative effects. I am a big fan of encouraging everyone to live a healthy lifestyle, to see their doctor if they have cognitive concerns and get tested and find out where they are and whether these scans are [necessary] or not.

BrainWise: You mentioned genetic risk. What role do genetics play in all of this?

Dr. Small: I always want to encourage people to not be discouraged by their family history. One thing to keep in mind is that the age at onset of a cognitive decline tends to be consistent within families. So if you have a grandparent who developed dementia at 95, the chances are that’s more age-related, and whatever forgetfulness you’re experiencing in your forties is likely unrelated. Another factor, and we’ve done these studies, others have done these studies, is you find that even if somebody has a genetic risk, even if you’re an identical twin to someone who has dementia, that doesn’t necessarily mean you’re going to develop it, that if you live a healthy lifestyle, you can do better. We’ve done studies of people with that genetic risk for Alzheimer’s disease, and we find that if they exercise more, if they don’t have too much overweight or obesity in midlife, that they have less Alzheimer’s disease in their brain when we do brain PET scans.

BrainWise: Can someone be too cautious about protecting their brain?

Dr. Small: It’s never too early and it’s never too late to start protecting your brain. We see very good results in older adults, and one of the advantages of starting early is that you don’t have to change habits so much. It’s one thing to educate people about what’s good for their brain health, it’s another to get them to change. And we’re not just talking about becoming a weekend warrior and playing basketball once a month on Sundays; we’re talking about daily habits that have an impact. And we know from other research [such as Dr. Wendy Wood’s work; see this and this] that to convert a behavior into a habit takes a bit of time and takes some motivation and some consistency. It’s also important to develop a program that is not overwhelming. Not long ago, my wife (Gigi Vorgan) and I wrote a book called, Two Weeks to a Younger Brain. If we called it, ‘Two Years to a Younger Brain,’ I doubt anyone would read it, but the point was, two weeks is enough time to take baby steps to begin to change your life habits, your lifestyle habits, so that it becomes easy to protect your brain every day.

BrainWise: So how can someone jump-start momentum to make a change?

Dr. Small: It’s incremental. It starts with what we’re doing right now, educating people. If you let people know that ordering broccoli as your side dish rather than French fries is going to be better for your brain, you’re more inclined to do that. And part of that education is not just about physical exercise and mental exercise and healthy diet, but it’s also about how to get enough sleep, how to manage stress better, how to avoid experiences like head trauma that will worsen your brain health. If you have high blood pressure or high cholesterol, just taking the medicines for those illnesses can extend your life expectancy and lower your risk for dementia. Many of the books I’ve written outline these programs in some detail. There are many ways to get there. Sometimes it’s reading a book, sometimes it’s checking out a website. Other times it’s meeting with a [trained] professional [such as a psychologist or a neuropsychologist, a dietician, or a nutritionist, as the case may be]. Also, there are apps. I remember reading an article several years ago, it’s much easier to break into training with an app than with a person who will kind of give you a hard time if you don’t show up.

BrainWise: How much exercise is too much?

Dr. Small: When I see patients, I not only go through the standard medical interview and assessment and find out about their history, medications, illnesses, etc., but I ask about their lifestyle. I specifically ask, ‘How much exercise are you getting? How are you doing it? What holds you back?’ And I work with them to try to design something that makes sense for them. Let’s say somebody’s a very busy executive and they don’t have time to go to the gym. Well, what about parking your car a little bit further from the building and walking briskly to the office? Maybe take a few flights of stairs. We always think of it in terms of starting low and going slow. You don’t want people to injure themselves, but you want them to be able to build up in a gradual way. And if you can get the program going so that they get these endorphin rushes, the so-called endorphin high that elevates your mood, that’s very helpful in solidifying those exercise habits because people look forward to it. They know they feel better after they exercise. They have less pain after they exercise. I had a trainer who would always say, ‘Motion is the lotion,’ because it lowers inflammation. Exercise is really something that’s individualized and tailored to the person’s lifestyle. If you make it too daunting, they’re not going to do it.

In the aerobic area, exercise could be almost anything that gets your heart to pump oxygen nutrients to your brain. It could be swimming, jogging, or walking. Part of what determines a specific type of exercise is what’s convenient for you, what you enjoy, what kind of injuries you’ve experienced. For example, if you have a bad ankle, jogging may not be good for you, but you could probably swim. If you have a bad shoulder, maybe a treadmill might be better for you. I think that those kinds of considerations will come into play as someone tries to evaluate what form of exercise is best.

BrainWise: What about social activity? How can that impact the brain, and how much of that should people be emphasizing?

Dr. Small: It really needs to be individualized. My wife and I wrote a book about that called, Snap! Change Your Personality in 30 Days, and it brings up a couple issues. First, despite the clinical lore, it is possible to change your personality traits in a positive way to improve your health and improve your life. Personality is also important when it comes to brain health. If somebody is an introvert, they are not so keen on being so social. They come home at the end of the day, and they like to wind down by curling up next to a fire and reading a good book. An extrovert wants to talk about their day and kind of deprogram all experiences in that way. And so, an introvert wouldn’t necessarily want to spend so much time or need to spend so much social time. But a certain amount of social interaction, I think, is important for everyone, whether they’re an extrovert or an introvert, and it has several aspects that will affect brain health. If you’re having conversations, that’s a form of mental exercise and mental challenge, and that’s going to be good for your neural circuits. If you have conversations with friends who are supportive, that will lower your stress levels and that’s going to help your brain health. Loners don’t do well as they age. We saw this really impact people during the pandemic, among people of all ages. Isolation can lead to depression, and depression is a risk factor for cognitive decline.

BrainWise: Finally, what about diet? Can that really affect brain health?

Dr. Small: Diet is significant. Watching your calories, particularly in midlife, is key. The fat around the abdomen is inflammatory. Many of us think that heightened inflammation drives brain disease as we age, so watching out for that is important. The average western diet includes too much Omega 6 fat compared to Omega 3, and we want the Omega 3. Consuming at least seven servings of fresh fruits and vegetables, which lower oxidative stress in the brain and the heart, is wise. Processed foods and refined sugars, which can increase the risk for diabetes, [also may increase] your risk for dementia [as outlined in this CNN article about a recent study on this point]. I was just reflecting about diet this morning when I woke up. I got a reasonable night’s sleep and I felt pretty good getting up. And I thought, ‘Well, what did I eat for dinner last night?’ I had Mediterranean food. We hear a lot about the Mediterranean diet, and I felt a lot better than I did the day before. On that day, I had just returned from a business trip to Chicago where a lot of the airplane food, all that salt and more of a Western diet didn’t help me sleep so well and didn’t make me feel so great. People can experience subjective differences depending on diet. And you can talk to a lot of people who have changed their diet and notice subjectively they feel better. I think that’s one of the things I’d like to emphasize about taking these baby steps to improve your lifestyle. If you do it, you’re going to notice it’s not just the long-term effects on your brain health, but you’re going to start feeling better right away, which reinforces the habits.

BrainWise: Five years from now, what do you think we’ll be talking about when we talk about everyday ways that we can improve brain health?

Dr. Small: Well, I’m hoping that we’ll have more incentives for people to live healthier, because I know how hard it is to get people to change. We don’t want to force them to change, but we need carrots, not sticks, to motivate them.

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

When age is really just a number

We all age. Some of us age better than others. This is an area of expertise for Dr. Emily Rogalski, professor of neurology at the University of Chicago. Dr. Rogalski heads the school’s brand-new Healthy Aging & Alzheimer’s Research Care (HAARC) Center, which will focus on building deep multidisciplinary expertise and bridging the gap between scientific disciplines to accelerate breakthroughs in cognitive resilience. This focus is increasingly important as the world’s population continues to age—the World Health Organization estimates that one in six people will be aged 60 years or older by 2030. Early in her career, while at Northwestern University, Rogalski operationalized the term “SuperAger” to describe people over the age of 80 whose memory still functions as well as that of someone in their 50s or 60s. That project has received considerable attention, including this piece from CNN. The project also received a $20 million from the National Institute on Aging and the McKnight Brain Research Foundation to establish an international multi-center SuperAging Consortium. BrainWise Managing Editor Matt Villano caught up with Dr. Rogalski before a talk at the recent NAN Conference in Philadelphia to discuss her work, its implications, and where SuperAger research goes from here. What follows is an edited transcript of their chat.

BrainWise: How did you get into this area of neuropsychology?

Dr. Emily Rogalski: I grew up the daughter of a schoolteacher who taught kids with learning challenges. From a very early age I was surrounded by brilliant kids that learned a little bit differently. That’s really where my interest in the brain came from. As a young kid, I had a very naive question: ‘If these kids are so brilliant but they can’t learn in the traditional way that our schools are set up, I wonder if there’s something different about their brains.’ I think I’ve been always attracted by things that are on the outskirts rather than in the main lane, and how those elements can inform both the mainstream, but also help those on the outside. When I was in graduate school, I learned about a really rare dementia called Primary Progressive Aphasia (PPA), where instead of losing memory like we lose in Alzheimer’s dementia, individuals lose language. And not only that, but they lose it at a really young age. They can be in their 50s and 60s, even [in their] 40s sometimes. When this is happening, nobody is thinking it’s dementia. It can take years to get a diagnosis. I was really struck by the lack of research that was going on 20 years ago in this space and thought, ‘This is a real opportunity to explore and help.’ This dementia can be caused by Alzheimer’s disease about 40 percent of the time. And so I found myself in an aging and Alzheimer’s center for my dissertation work.

In the trajectory of aging, you’re constantly told there’s nowhere to go but down. Normally, the first thing that’ll come out of the mouth of anyone who’s giving an aging talk is something like, ‘As we get older, we lose our memory.’ [We’re taught to know] that when you get older, your eyesight changes, your hair gets gray, your skin gets wrinkled, and your memory declines. And while that makes sense in general, I think if we all stop to think about that, it’s not in practice all of the time. We all know the Betty Whites of the world. We know these people who really stick out as being something different. We know them as our neighbors, we know them as our aunts and uncles in our daily lives. And so this thing that we talk about with aging and it being nothing but bad news doesn’t really fit with people’s lived experience of they know at least somebody in this other sphere.

The challenge was that 15 years ago, there were people already studying successful aging. I think that was a great change in something that really [John] Rowe and [Robert Louis] Kahn did a great job of getting that concept out there, that there could be another trajectory called successful aging. But that definition and that concept was general. There was a great review done by [Colin] Depp and [Dilip] Jeste [in 2006] and they looked at definitions of successful aging. What they found was that in 28 studies, there were 29 different definitions. In and of itself, that’s not a problem. They also found that in those studies, the percentage of people who met the criteria for successful aging ranged from 0.9 percent to something like 97 percent. So virtually nobody to virtually everybody. That proved the definitions for successful aging were all over the place. One was you’re over the age of 65, dementia free, and you have good physical health. Another definition was that if you’ve lived to age 90, you’re a successful ager. There also were definitions in between—sometimes requiring good cognition, sometimes requiring good physical health. I started looking into aging and what makes for ‘successful’ aging. That’s when I [coined the phrase], SuperAgers.

BrainWise: What characterizes a SuperAger?

Dr. Rogalski: I operationalized this term SuperAger so it would be very specific. [The paper that established the definition is here.] While it fits under the larger umbrella of a type of successful aging, the goal was really to say we wanted to have both a specific neuropsychological definition and an age criteria. SuperAgers are individuals who are over age 80 who have memory performance at least as good as individuals in their 50s and 60s. Why age 80? Again, kind of back to this idea is everything gets worse when you’re older. And it turns out that merely getting older is the biggest risk factor for Alzheimer’s dementia. It wins. It wins over all other factors right now. By age 80, you’ve reached a point where you’re at great risk for typical or average cognitive decline. You’re at greater risk for Alzheimer’s dementia. If you’ve reached this age and then you have memory performance that’s youthful, that’s unique. If you’ve gone through all of those lived experiences, all that wear and tear, and you’re able to really look like a 50- to 60-year-old, that is, neuropsychologically speaking, quite different.

BrainWise: So, neuropsychologically speaking, what do all SuperAgers have in common?

Dr. Rogalski: We require them to have this memory performance that’s at least as good as 50- to 60-year-olds. Then we say other cognitive domains have to be at least average, but we’re going to explore it and then we’re going to look at those as variables to say, well, how much does attention and executive function contribute? When Dr. Amanda Cook Mayer was a graduate student at Northwestern working with me (now she’s faculty at the University of Michigan), we did a study on that to say, what are their other strengths in cognitive function? What we found is there’s not one path to get there, but [SuperAgers] tend to have strengths in attention and executive function, and that there’s some variability that helps to explain some of their memory performance. Some SuperAgers, no matter which cognitive tests you give them, knock it out of the park. They perform like 50- to 60-year-olds or better across all the cognitive domains. In other instances, there’s people where memory is really their strength and other cognitive domains are average. There’s a third trajectory where people of course have great memory, and the other cognitive domains oscillate a little bit. I think this is important because it’s not that the SuperAgers had to get there all the same way. There can be different paths or trajectories that got them here. As we move more toward personalized medicine and precision health, we have an opportunity to understand the contributors to each of those pathways.

BrainWise: How does this translate to your current study?

Dr. Rogalski: Our goal in this study is not to just look at one domain. So some studies are like, ‘I’m a study of sleep.’ That’s very important, but that’s not what we are going for. We really wanted to cover as many domains as possible, do them well, and then look for that integration across the things. So we’re going to look at structural function, but how does that relate to cognitive function? We’re going to look at genetic factors. What’s the interplay between cognition, genetics, neuropathology, and brain structure? What can we detect during life, knowing that in a living person, we can only see with a certain resolution? I liken this to when we first got digital cameras and we were all excited, we didn’t need film anymore, and we could take a bunch of pictures and that seemed great and they looked great on the back of our cameras. And then we printed them out in our home printers, and everybody’s faces looked like little squares. They were pixelated. Well, that’s about the resolution we can see during life. And so this is where someone donating their brain at the time of death gives us that better resolution where we’re at with our iPhones now or better so that we can really look at contributors of cellular and molecular factors.

BrainWise: Can you give us specifics about one of your SuperAgers?

Dr. Rogalski: Our oldest SuperAger is 109. And I was at her house a couple of weeks before her birthday to bring her a present, and we did a little video shoot with her. The day before, she made us strawberry rhubarb jam. She’d never made strawberry rhubarb jam before. She’s still trying new recipes at age 109, and it was delicious. She enrolled [in the SuperAger study] when she was in her early 100s. At that time, she was driving, and I would’ve ridden in the car with her. She only stopped driving because she got gout, and the medicine she was taking messed with her grip strength. She’s sharp as a tack. We ended up doing a three-hour interview [with her]. Her best quotes were at the end of the interview. I mean, everybody was in tears as she was sharing aspects of her life. She was the first Black woman to graduate from Grinnell College in Iowa. She talked about the first time there was a radio in her house, the first time there was a phone. Think about what she’s lived through: two pandemics, World War I, [World War II]. That’s pretty remarkable. She’s seen a lot.

BrainWise: How many people over 100 are participating in the study?

Dr. Rogalski: Fewer than 10, out of about 300 total.

BrainWise: How do I know if I’m a SuperAger, and what can I do to increase my chances to become one?

Dr. Rogalski: We know that diet and exercise are important from [epidemiologic] studies and from other cohort studies. When we look at SuperAgers specifically, we see they have variable diet and exercise. The good news [there] is [that] it’s a good idea to pay attention to your diet and exercise, but all may not be lost if you’ve not paid the closest attention.

We know that SuperAgers range in education from 12 to 20 years. So it’s not just doctors and lawyers that we’ve enrolled. And every time we make a comparison in our study, the IQ of the control group is always in the same range. So that means it’s not just general intelligence or a measure of intelligence that’s differentiating the groups. I’ve worked with cohorts in South America where they have focused on enrolling or identifying SuperAgers that have little to no education, and they’ve been able to find them. We [too] are starting to enroll more diverse samples. It is possible to find SuperAgers who have lower education. We’re not just picking up on extreme levels of education that allow you to maintain good cognition over age 80.

I think one practical thing that we’ve seen, and now we’re trying to quantify it more objectively, is that SuperAgers report having stronger social relationships with others. We don’t know much about those relationships. We don’t know whether they have one best friend that’s a trusted partner, or if they are the social butterflies of their community. I know anecdotally many of them are the social butterflies of their communities.

Until recently all the data we collected on SuperAgers was self-reported. Then in 2020 we had this opportunity to write a grant that expanded the program to make it multi-site and to change the depth and breadth of science that we do. And one of the ways that we changed the depth and breadth of science was to add in wearable sensors. Now we ask the SuperAgers to wear these in their daily lives for about 14 days so we can get measurements of activity and social engagement. Objectively we can get measures of sleep and autonomic function. For all the survey data and the anecdotes that we have collected over the first 15 years, we’re now collecting those data objectively and quantitatively moving forward across five cities in the U.S. and Canada.

BrainWise: To what extent could a SuperAger potentially have issues with eyesight or have some physical disability, and where does that come into play with your research?

Dr. Rogalski: I was very intentional in not requiring super agers to have good physical health. We know from the larger body of research that good physical health tends to be associated with good cognitive health. And this makes sense for a lot of reasons. However, if you make that an entry barrier, now you’re kind of penalizing people who were able to maintain great cognitive health, but they might need a wheelchair or a walker. Their physical aging or their physical brain age may outpace their cognitive brain age, and I didn’t want to have that penalty. Instead, I wanted to be able to look and say, ‘How many people do we find that are using wheelchairs or walkers?’ So our SuperAgers vary. Some of them are riding their bikes hundreds of miles a week or in the pool doing exercises and weightlifting in the pool. Others are leading a chair stretching class. There also are several who are like, ‘I don’t exercise and I don’t plan to start exercising.’

What we do see in our super agers is that their brain integrity and brain structure looks different. They tend to look more like 50- to 60-year-olds in brain structure than they look like 80-year-olds. In this instance, we’re talking about cortical thickness. That’s the outer layer of your brain where your brain cells live—we can measure that thickness and it gives us a proxy measure of the health of the brain. Generally speaking, thinner is worse and thicker is better. When we compare our average 50-year olds to our average 80-year olds, we see that same thing that others have shown: cortical thinning across the cortex of the brain. When we compare our super agers to the average 50-year olds, we don’t see any significant cortical thinning. In fact, we see a region in the anterior cingulate cortex that’s thicker in super agers than it is in the 50-year olds. This has spurred some of our investigations pathologically to make sure we’re paying close attention to this anterior cingulate region.

BrainWise: Where do biomarkers fit into this research? At what point do you hope we can begin to apply some of these lessons you’ve learned to say 40- and 50-year-olds to maybe help them get a sense of whether or not they will become a SuperAger?

Dr. Rogalski: The larger body of research tells us social isolation and loneliness are bad. There are studies that have shown those who are socially engaged and have Alzheimer’s dementia tend to have slower trajectories of decline and tend to fare better cognitively. Our data fit with that. The practical implication is that if you’re going to go home today and on your commute home, you’re thinking about calling your best friend, call them, talk to them, stay socially engaged. Why might that be important from a brain health standpoint? Conversation is hard. I don’t know exactly what you’re going to say next, but you’re going to ask me a question. And then I have to think really quickly on my feet to say, ‘Okay, how am I going to answer that?’ Our brain likes new and challenging things, and social engagement creates that newness all the time to keep you on your toes, so to speak.

Finding the thicker anterior cingulate, that was serendipitous and it led us to other research questions. Under the microscope, it turns out we see a greater density of a special type of neuron called Von Economo neurons. These are neurons that have only been described in two regions of the brain, the anterior cingulate [cortex] and the frontal insular cortex. They seem to have something to do with social behaviors and social function, and they tend to be abnormal in Alzheimer’s dementia, frontotemporal dementia, autism, schizophrenia, bipolar disorder. They also tend to only be present in higher order species like [humans and] whales and elephants. We can now look cellularly, molecularly, genetically at these neurons to say, what role are they playing? This [part of our research] isn’t going to have an actionable endpoint tomorrow, but we need to be looking at all of these different levels. And so that’s kind of the beauty of the design that we have, is that some things kind of glean more actionable things to think about today, where others might lead to whole new directions and protective factors that might take a little bit longer to get there.

[To speak to the issue of biomarkers], we are looking at blood-based biomarkers. Some of the SuperAgers have been getting amyloid PET and tau PET scans so that we can measure aspects of Alzheimer’s disease during life, and then also measure it at the time of death when they pass away. As I’ve mentioned, one thing about SuperAgers is that they tend to be healthier, so I always joke that I do better in my side of the study that’s on the living side than my colleagues who have to wait until they pass away because they keep living.

BrainWise: Which questions will you be asking in your research next?

Dr. Rogalski: I lead what’s called the SuperAging Research Initiative, which now has five sites across the U.S. and Canada. My particular expertise is in the cognitive aspects, the neuroimaging aspects, and in some of the social function and other survey data that we give. My partners in this are geneticists, neuropathologists, neuroanatomists, [and others]. I’m kind of fluent in many of these things, but they’re the primary leaders, and that’s the goal, to bring together these scientists with these different expertise so that we can really dig a little bit deeper. And so now we’ve got these partners across the U.S. and Canada, and we’ve got the SuperAgers.

Another goal is to diversify our sample, make sure we’re identifying SuperAgers in different communities, both regionally across the U.S. and Canada, but also racially and ethnically. We’re working hard to make sure we’ve got strong community partnerships and trusted relationships, and we’re not just coming in and saying, ‘Sign up for research!’ We want to make sure we’re intentionally there and building partnerships because these folks are with us for life. When they sign up, they’re coming back year after year after year. It’s a relationship we’re starting with them. It’s not a study where they come in for one blood draw, and we never see them again. This is longer term.

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.

From neuropsychologist to young adult novelist

Northern California resident Katie Keridan spent the first 12 years of her professional career as a neuropsychologist. Following her schooling, she served as a predoctoral intern at the Kennedy Krieger Institute at Johns Hopkins University School of Medicine in Baltimore, then moved on to become a postdoctoral research fellow and licensed clinical psychologist at Children’s National Health System in Washington, D.C. In 2017, she moved to California and started a private practice. She also was a member of the National Academy of Neuropsychology (NAN); the first annual conference she attended was in Vancouver, B.C., in 2010. During the Covid-19 pandemic, Keridan made a major life change, setting aside psychology and psychometric analysis for a new career as a young adult novelist. Since the switch, Keridan has published two full-length fantasy books for young adult readers, and she has already finished her third book in the series. The books and characters in them benefit from Keridan’s knowledge of psychology and neuropsychology. BrainWise Managing Editor Matt Villano recently caught up with her to talk about her journey and what’s next. What follows is an edited transcript of their interview.

BrainWise: Making the leap from neuropsychology to YA fiction is not a very traditional path. What prompted this transition?

Katie Keridan: Yeah. Who would go from being a doctor to a young adult fantasy author? Oh wait, that would be me. I have always loved to write, always. I mean, some of my earliest memories are of me taking paper and folding it and stapling it and making little books. And I’d go through and I’d write about these wild adventures I had as a child growing up on a ranch in Texas. And then I would illustrate my own little written books. However, I was the first person in my family to go to college and thinking about a career that is going to be sustainable, writing was not really up there at the top of what my parents hoped to see me do. Since my parents were paying for me to go to college, they had a real vested interest in what I was going to major in and what I was going to do. Probably because I love creating characters and I love figuring out how people think, psychology was a natural fit for me. I loved figuring out what’s going on for someone and how I can meet them where they’re at and help them. Neuropsychology is even a further branch off that, figuring out what’s going on in this child’s brain so that we can meet them where they’re at and help them and connect them with the resources that they need to be as successful as they possibly can. I loved the career that I developed, it was fantastic. The best part was obviously working with kids and their families. The worst part was insurance and billing and figuring out how you are going to help these people who are coming into your office today. I was very fortunate—once I moved to California and got into private practice, I had time to delve more into the writing that I wanted to do. And I thought, ‘40 is approaching swiftly on the horizon, why am I sitting around here waiting, thinking someday it would be fun to try to write a book? Let’s go for it. Let’s just try and put it out there.’ I connected with a great writing team. My first book, Reign Returned: The Felserpent Chronicles, Book 1, came out last year in 2022 and then the sequel, Blood Divided: The Felserpent Chronicles, Book 2, just came out October 3rd 2023. The final book in the trilogy has a publication date of October 2024. So, it’ll be three books in three years.

BrainWise: How did the first book come to life?

Keridan: That book started while I was still on the East Coast. I’d have these little moments where I knew these characters, I knew this was a story I wanted to tell and so in my spare time I would write little snippets. Sometimes the only writing I would do would be from 11 p.m. to midnight or midnight to 1 a.m. during the week because you’re working all day long and you have to find these bits of times to write when you can. The more I started doing it and letting that part of myself come out and breathe, the harder it was to keep putting it back into the box. Because the story started taking on a life of its own. So, it has been with me for a few years.

I really wasn’t sure what COVID would mean for the publishing industry at all. Thankfully with my first book coming out last year, I was fortunate that [Covid-related] shipping issues didn’t really affect it. Most of the worst had passed, bookstores were back to doing in-person events. [Once the book came out,] I had to figure out some changes. Was I going to pursue [writing]? Was I going to stick with what I had gone to college for, what I had decided was going to be my chosen career?

It was scary to make the transition, but it was incredibly exciting. Now that I’m at a point where I have two books out and I’m connecting with readers and starting to get feedback, it’s such a privilege to know that people enjoy the work and enjoy what I’m putting out there.

BrainWise: To what extent does neuropsychology play a role in your books?

Keridan: I try hard to include accurate mental health representations in my writing because that’s my background. And I would be remiss if I didn’t bring that into creating characters that I want readers to see. Anxiety doesn’t just have to look one way, depression doesn’t just have to look one way, trauma and processing, it doesn’t have to just look one way. And that’s been so incredibly rewarding.

We’re in a position in publishing right now where despite all of the really horrible things going on with book bans and libraries closing and school libraries closing, there’s never been a greater interest in accurate mental health representation. Ware getting a lot of own voices coming out and talking about their experiences—not just, ‘Here’s what happened to me,’ but instead, ‘Here’s what happened to me through the lens of this character that I created so that other people can better understand what it was like to go through this.’ Just as one example, my main character, Sebastian, was a victim of abuse as a child and I pulled directly from my own life experiences with that, having grown up in a very abusive, chaotic home. I wanted to show a character who thinks they’ve worked through this when they’re just ignoring it. Now that they’re in this new relationship with someone they love, they have to figure out what it means to be vulnerable? How do I open up about this trauma that I’ve experienced? What is my partner going to think if I have a nightmare and I wake up screaming? I’m just going to die of embarrassment. All these things that young adults go through, new relationships, big life changes—but experiencing that through characters who have a neurological or a neuropsychological diagnosis has been incredibly fun for me. And I love that I can reach so many more people than I could [as a neuropsychologist]. It is always a trade-off when you do cognitive testing with families, there’s a part of me that feels like I become part of that family, and they never leave me. The nice thing about writing a book is I can reach more people, the downside is it’s less personal than what I did before.

BrainWise: What was the most challenging aspect of leaving behind a career you had worked so hard to achieve?

Keridan: I have a Ph.D. That’s usually anywhere from five to seven years, then you do an internship. I did a two-year research fellowship. So, we’re talking into the double digits of [years of] schooling and commitment to [neuropsychology]. I think the biggest part was that I was more worried what other people were going to think of me for making this change. Thinking about looking around the room at my professional colleagues who have all these letters after their name and saying, ‘Hello, I’m going to be working on a YA fantasy novel.’ Just being able to believe in myself that I could do this and that I was not less-than for making a change—that was a challenge.

I’ve had some people ask, ‘Do you think you chose the wrong career? Do you think you went into the wrong field?’ Never. I love the education I got, I love the experiences I had, and the people that I connected with. Honestly, I don’t think I’d be writing the books that I am if I hadn’t had those experiences. We never know how things are going to play out ever. I’ve become so much better about trusting my instinct, listening to myself, and just going for it. I’m trying to be a little less of a Type-A Capricorn and a little more just go with the flow.

BrainWise: Can you please tell us a little about the series and what the enduring storylines are all about?

Keridan: In the first book, Reign Returned, we have an enemies-to-lovers story, because I’m a huge fan of [stories where] there’s all this conflict and we hate each other, [and then,] surprise, we’re actually going to fall in love. I’m a big fan of tropes in general. Some people will say they’re cheesy, I also say there’s a reason why they sell, and if it ain’t broke, don’t fix it. So, in the first book, we have a former king and queen who, before they die, bind their souls together and promise to return when it’s time to retake their kingdom and find one another. Centuries pass, they’re both reborn, but they come back with no knowledge of who they used to be, and they come back on warring sides. The first book is really about remembering the past in order to change the future. The second book comes around and my main characters have remembered their past, they know who they used to be, they know that they’re back and they’re ready to reunite the realms, but it’s not going to be that easy because…well, what would be the fun in that? So, they are back, and their arch enemy is back as well. This is really a story of found family, of figuring out who you are and who you want to be and gathering the support that you need in your life to make that happen.

BrainWise: Have you written the third book yet?

Keridan: Yes. The third book is currently undergoing proofreading. Without going into all the details here, with book three, I’m a huge fan of happily ever after, so I can tell you there is going to be a happily-ever-after. Our characters learn, they grow, family secrets are discovered, betrayals are survived. But in the end, as we always hope it does, good wins out and triumphs. [The book is scheduled to come out in October 2024.]

BrainWise: Now that your first series is behind you, what’s next?

Keridan: I’m working with an organization called The Novelry, because my next project is a middle grade book. This one is near and dear to my heart because my main character in this book is an 11-year-old girl with high-functioning autism. It’s a contemporary book, so it’s set in the present day, but there is a little bit of a dash of magic in there. I am incredibly excited. I’ve loved the young adult, YA, fantasy world, after three books, I needed a break because that’s a lot of plot lines and characters and layers to work through. I’m about three-fourths of the way done with this next book, and it will be for younger readers, which I’m really excited about.

[Another one] of the things I’m really excited about for 2024 and beyond is to have the opportunity to do more teaching. I am very fortunate that I have some fun events lined up for 2024, such as the San Diego Writers Festival. There’s a couple of different things that I can’t mention yet because they’re still potentially in the works. Writing is such a solitary activity. I mean, in the midst of it, it’s me with my laptop just sitting here with all these characters in my head. So, when I can get out in the real world and start connecting with readers and seeing people face-to-face, that’s so much fun. And I love that chance to interact and to hear something that they enjoyed about a book or a character.

BrainWise: To what extent are you keeping up with what’s happening in the world of neuropsychology?

Keridan: I could never fully disconnect from the brain community, no matter what. Even if I hit No. 1 on The New York Times Best Seller list, I will still be reading what’s happening with neuropsychology and especially pediatric neuropsychology. Any kind of breakthroughs involving kids, anything specifically related to oncology or autism or intellectually gifted kids who also have clusters of other things going on, I’m always paying attention to that and reading what I can because we need breakthroughs now more than ever. Especially since the pandemic, what kids have been facing from a mental health perspective, I don’t think we’ll fully even begin to understand it for years to come. But kids need services and support more than ever.

BrainWise: Do you ever see yourself going back into neuropsychology full-time?

Keridan: You just never know. I never thought I’d be sitting here doing this right now. But I will say I’m not actively seeing patients, I’m not actively taking on any cases or doing any neuropsychological testing at this point. Who knows? I would love to find a way to combine [writing and neuropsychology], whether it’s at a college-level class, to be able to talk about books and reading and brains and how this all goes together. Or it might just be a workshop that I put out. I’m going to think about that.

BrainWise: In conclusion, what advice can you offer others who are contemplating a career change, whatever their current careers might be?

Keridan: There comes a point where we have to decide, who are we living for? Are we living this life to make other people happy and do what we think they think we should do, or are we living this life for ourselves and figuring out how can we make the greatest contribution and connect with people? For me, growing up, books were an escape, they helped me stay sane. When I couldn’t leave the situation I was in, at least I could mentally check out and I had friends in books. That’s what I want to offer people today. Like saying, ‘Here’s a safe place where you can see someone, they might not be just like you, but there’ll be similarities and you can see yourself reflected on that page.’ We need more of that, it’s priceless.

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

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.

My experience treating depression with magnetic waves

Editor’s note: Sandra Haney lives in Waynesboro, Virginia, and recently turned to Transcranial Magnetic Stimulation (TMS) to treat chronic depression. BrainWise Managing Editor Matt Villano wrote this story in her voice after an extensive interview with her about the experience. For more on the science of TMS, click here.

Depression is like an old friend at this point; I’m 41 years old, and I’ve been dealing with depressive episodes since I was about 15.

It was episodic early on. Things came and went. I had more prevalent anxiety than I did depression. Pretty severe panic attacks. Really frequent intrusive thoughts of death—not so much suicidal ideation but more thoughts about my eventual demise. Throughout my teens and twenties, I did therapy. I tried tons of different medications. Some worked a little. Most didn’t. There were a lot of side effects. I was about 28 when I found a combo of meds that worked: Paxil and Wellbutrin. I still had lots of side effects.

By the time I was 32, I said, “This is ridiculous.” I was tired all the time. I had gained about 30 pounds. Finally, I did a GeneSight test. It turned out I have a very rare triple copy of an enzyme called CYP2D6. That makes me an ultra-rapid metabolizer, which means roughly 80 percent of medications won’t work on me like they should. I metabolize them too quickly.

It’s not a great thing to have if you’re battling depression like I am.

When I learned about being an ultra-metabolizer, when I realized that meds basically weren’t going to work for me, I started thinking about Transcranial Magnetic Stimulation (TMS). From what providers had told me, this is a type of treatment that can work for people who can’t do meds—people like me. I didn’t know anybody who’d done it TMS. I did some research. I got a packet of literature. That was basically it—at the time, I was deeply depressed and could barely make it to my appointments, much less seriously consider something like that. So, I didn’t pursue it.

Fast-forward to 2022. I started sleeping extremely poorly. I was getting more and more depressed. I had a severe bout of anxiety that lasted for four months. As the anxiety subsided, I started experiencing suicidal ideation. It was becoming more and more severe. It reached a point where things were going south quickly. I talked to my psychiatrist. Together, we decided it was time to give TMS a try.

I started the treatment in August. I finished in October. All told, I did 37 sessions. And it helped. But more on that later.

Understanding the basics

When you get the treatment, a machine sends magnetic waves through your skull into your brain. The idea is to stimulate neurons to change the way they’ve handled things in the past—kind of like rewiring the brain. For more about the science behind it, check out the sidebar that BrainWise published in conjunction with my story.

My TMS sessions started out at 21 minutes long. By the end they were at 31 minutes. It’s kind of boring to sit there while the treatment is happening. The doctors told me I needed to stay fully conscious. They let me talk. There was a TV in the room so I could watch TV. They were clear that they wanted me to keep my brain active.

Every time I went it felt like an electric zap. Like a static shock. There was no sense of pain. It was like tapping against my head. This may just be my own imagination, but I could swear I felt it going through my skull. I know the brain has no pain receptors, so maybe that’s impossible.

During the sessions I didn’t really experience any kind of change in thought processes or perception. I also didn’t experience any emotional effects. Initially there were headaches and a sense of really deep fatigue. That lasted the first two weeks. After that the immediate effects were a little brightening. My mood improved a little bit each time. It wasn’t a long-term thing; I felt better for a little while, and as the day wanes, my mood dropped back down. For me, it was all about the cumulative effect.

Side effects

After 4 treatments I had some interesting effects occur. One night, after cooking an elaborate dinner, I was sitting on the couch and, suddenly, it felt like I could smell everything. It felt like my sense of smell had been dampened that whole time and, suddenly, it had come into focus. It was like until the TMS treatment, I was smelling things at about 25 percent of what they were. The super smell lasted for about an hour each time, and then things went back to baseline. They say a lot of your senses get dampened with depression. I now know that’s real.

Another thing that happened during treatment: I started experiencing these perception switches. I would go from one state of mind to another. The switches occurred every 15 to 30 minutes. The only way I can describe what it felt like was to compare it to when I did acid a few times and ate mushrooms as a kid. The perception shift you get when you’re under the influence of those chemicals—that’s what it felt like for me.

Later in the treatment cycle I started to get very irritable and very angry. I’d have these mini bouts of rage that would last for 30 seconds or so each time. That was disturbing. Everybody in the house was jumpy and avoiding me. The cats were like, “We’re out of here!” I was told by the lead TMS tech that that was a good sign, that my brain was creating new neural connections and that’s what was causing the irritation. Most people experience a depressive episode in the first three weeks, but some people experience anger. That was difficult to deal with.

The suicidal ideation faded in the first week and a half. It faded out quickly. I don’t know if that was what was happening in my brain—something the machine was doing—or if it was the fact that I was getting help and I was actively doing something to improve things. I was looking at living and improving my health and having hope instead of thinking about ending things. That alone was worth everything.

Charting progress

Over the course of my treatment, there were several markers I used to evaluate how it was going.

The first were the markers from the doctor’s notes. Every Friday I did one of the DSM questionnaires about depression and anxiety. The doctor kept those scores. Over the duration of the treatment, the doctor said my scores decreased depression-wise by about half and anxiety-wise by about a little more than half. The reduction in anxiety was the biggest thing I noticed. The other thing is that I found myself to be more motivated, more hopeful and a little more energized. The reduction in anxiety has been fantastic. Suicidal ideation disappearing has been fantastic. Depression has decreased, for sure. They said I would start sleeping better, but I didn’t. I’m a lifelong insomniac.

I have mixed emotions about this progress. I was hoping for more. At the same time, I know my expectations were unrealistically high and the whole time I fought to bring my expectations back to reality. I had to come to terms with the fact that this is something that will improve things so that I can further improve on my own. It’s like the treatment gave me a toehold so I could get moving in the right direction.

My doctor said things would continue to improve for about two months after the last treatment finished. I’ve also read that each TMS treatment cycle lasts about a year, and that after the year it really varies wildly. About a month later I’m still seeing improvement.

I also recognize that I’m lucky to have insurance. This treatment runs anywhere from $12,000 to $16,000. With my copay it was $980. This is what my specific insurance company and specific insurance plan required before approving TMS. I’m sure requirements are different from company to company, and even plan to plan within the same company.

After dealing with depression for most of my life, this feels like having a future. A lot of possibilities are now open that weren’t open before. My husband and I have been planning trips. We’re talking about going to Iceland and Finland. We talked about doing a bunch of different things. I feel much more excited and motivated to do that. I feel more excited to live.

Spreading the word

I kept a journal about my experiences. Once a week, I shared these journal entries with my friend list on Facebook. The entries were straightforward. Here’s what’s going on with me. Here’s what’s happening. Here’s what it’s been like. People were really interested. After my journal entries, I have been contacted by phone and through Facebook by people who are either interested in TMS for themselves or for loved ones.

I would recommend TMS. Even if TMS doesn’t work for someone at all, I encourage people to try something. Depression is not a way to live well, and it can end in your demise. For me, TMS felt like going to the moon, doing something totally unknown and super frightening.  At first, I felt like I was being a coward, but now I see the opposite is true. I can recognize it as being brave. The stigma around mental health is decreasing, which means more people are talking to each other about depression. Hopefully that means more and more people will start talking about TMS to help.

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.