Tag Archive | depression

Antidepressant Use and the Increased Risk of Developing Dementia

The Link Between Antidepressants and Dementia is Becoming More EvidentSeveral studies released recently – here we will focus on two of them: one a two-year study with a large group of elderly (over 65 years of age) participants and the a broader study tracking neurological changes associated with dementia that included participants of all ages – have raised significant red flags about the use of antidepressants and the increased risk of dementia associated with that. Continue reading

Daylight Savings Time and Its Effects on Health, Sleep, and Our Loved Ones with Dementias and Alzheimer’s Disease

Daylight Savings Time Increases Health Risks Physically and NeurologicallyHere in the United States, most of the country ended Daylight Savings Time (DST) at 2:00 a.m. on Sunday, November 5, 2016, which moved our clocks back an hour.

Both the beginning and end of DST are tough changes on even the healthiest among us. For someone like me who has had hardwired sleep challenges all my life, both the beginning and end of DST are particularly hard for me for about a week until my body and brain adjust to the change. Continue reading

Profiles in Dementia: Norman Rockwell (1894 – 1978)

1945 Photo of Norman RockwellNormal Rockwell’s artistic creations are an entrenched part of Americana. He captured everyday life with a unique emotional component that seemed and seems to touch the American soul deeply.

Rockwell is best known for the 47 years that his iconic cover illustrations graced The Saturday Evening Post, but his body of work also included other magazines, several books, and prints for both the common man and collectors.

Norman Rockwell: Artist and Illustrator BookGrowing up, I remember frequently picking up the oversized, hardcover edition of Norman Rockwell: Artist and Illustrator that my parents had purchased and immersing myself in a thoughtful journey through the large body of his work. There were some that stand out in my mind still. A sampling of those include:

But the four-part Freedoms From… illustrations that Rockwell did in 1943 (during World War II to shore up and promote American involvement in the war) are probably the ones that tug, even today, at American heartstrings.

In part, I believe, the Norman Rockwell - Freedom from Want (1943)reason is they represent an ideal that we all wish existed, but which, in fact, never did and never will in our lifetimes.

They invoke a nostalgia for our imagined past as a nation, as families, as people. And I suppose that we want to be those people is a good thing, but the reality that we’re not is, for me, quite disheartening.

But I still love the pictures even in my discouragement at how far we all fall short of the ideals they portray. My hope lies in a better fulfillment in another life, while my despair comes from knowing it won’t be this one.

Rockwell struggled with severe depressive episodes, as it seems most creative people do, throughout his life, but it rarely, if at all, is seen in his art, which is, frankly, amazing and admirable.

In the last decade of his life, Rockwell developed dementia and for the last six years of his life lost the ability completely to do any artwork or illustrations at all.

Rockwell died in 1978 at the age of 84 from emphysema. 

Insights: How Temperament Factors Into Dementias and Alzheimer’s Disease

In previous posts, we’ve looked at how life experiences and personality, quirks, foibles, and flaws factor into dementias and Alzheimer’s Disease with our loved ones.

In this post, we’re going to discuss how temperament factors into these neurological diseases and how we as caregivers can respond effectively and lovingly to provide balance and still meet the basic needs that our loved ones’ temperaments require.

For the purpose of this discussion, we will look at the big picture of temperaments and the two most dominant categories that each of us falls into: extraversion and introversion.

Temperament Categories

There are 16 distinct variations of these two temperaments (eight in extraversion and eight in introversion). (You can take free temperament test online to see which variation your temperament is.)

Sixteen Temperament Types

All of us fall into one of those 16 variations (for example, I have always and continue to test out as an INTJ). How we fall into them is what makes each of us unique (for example, I range between 92% and 100% for introversion every time I take the test and I suspect that variation depends on the amount of recharging solitude I have immediately had when I take the tests).

Temperaments are, in my view, a function of genetics. In other words, it’s hardwired in us before birth by DNA (nature).

Unlike other things about humans that are more fluid and can change over time, there is little to no effect from external influences that alters our temperaments.

Extroverts in a family that is more introverted don’t become more introverted, no matter how much pressure, spoken or unspoken, is applied to make them less social and more quiet.

By the same token, introverts born into a family (and into the Western world that places a very high value on extraversion) that is more extroverted don’t become more extroverted.

If anything, extroverts and introverts become even more extroverted or introverted because of the pressure applied because it conflicts with who they are at a very core level.

Whether our loved ones with dementias and Alzheimer’s are introverts or extroverts will be a factor in both behavior and socialization as they go through the journey of dementias and Alzheimer’s Disease as well.

But equally important is whether we as caregivers are introverts or extroverts and how we may need to step outside our natural dominant temperament characteristic to ensure the needs of our loved ones are met.

Extroverts with dementias and Alzheimer’s Disease will continue to crave being social and being with and around people on a regular basis. However, because as neurological changes progress, it is not uncommon to see increased conflicts in social situations (arguing, verbal fighting, anger, etc.) or exaggerated – and sometimes inappropriate – efforts to be the center of attention.

Introverts with dementias and Alzheimer’s Disease will become even more introverted as neurological damage progresses. They will tend to isolate themselves as completely as possible, become completely withdrawn, even from loved ones, and often become completely uncommunicative before they actually lose the ability to speak and communicate.

Neither of these scenarios is good for our loved ones, so it is incumbent upon us as caregivers to try to achieve and maintain as much of a healthy balance for them to meet their needs as is feasible and possible.

In my opinion, this is one of the hardest areas to negotiate effectively and well, and it also requires the most finesse and empathy.

This is especially true if our loved ones and we have different temperaments.

My mom and I were good examples of almost diametrically opposite temperaments. Mama was an ENFP and I am an INTJ. We both had intuition (N) in common, but we were total opposites in every other way, temperamentally.

From day one of our lives together, these differences in our temperaments were a constant source of clashes and contention between us, especially in the early years. Mama would push me continually to be more extroverted and I would push back equally or more tenaciously against it.

Mama would cajole, threaten (and usually follow through because punishment was a better option for me than doing something I could not abide the thought of doing), plead, try to reason, and try to entice me to be more extroverted in a social and a public sense. It never made sense to her that it was agony for me and it literally drained me of all energy and patience.

Ironically, neither my mom and dad (who was also more extroverted than I was, but was an INFJ, so he understood me somewhat better) stopped me at home when I would go off by myself to be by myself, just to get away from everyone else when I was younger and to read, draw, or write when I was older.

But they were both concerned about my lack of desire and enthusiasm to engage in group social activities and to spend a lot of time with other people doing “fun” things. I’m sure there were many bedtime discussions between my parents about me and whether this was normal or was cause for concern.

But eventually, we all sort of adapted (Mama never completely quit trying to push me toward a more extroverted temperament, but when I would finally have a meltdown of yelling and tears in frustration – and sometimes from too little solitude too often – Daddy would intervene and persuade Mama to give me some breathing room and let me regroup, which always worked) and we figured out how to live with and love each other in spite of our differences.

As Mama’s cognitive impairment worsened over the last eight years of her life, she continued to be social and seek social activities and environments. However, as the neurological damage deepened with her, the level and number of conflicts with other people increased. 

In the year and a half before Mama was diagnosed with mid-to-late stage vascular dementia and Alzheimer’s Disease, Mama’s relationships with everybody – including me – were much more contentious and much less harmonious.

On a daily basis, Mama would tell me about some dust-up with somebody. Mama had always been a bit on the scrappy side – not in a negative way, but she wasn’t afraid to take people on if they were wrong or she was protecting herself or her loved ones – but she also, because of her intuition, was able to see even the orniest of people objectively and still manage to interact in a positive way, for the most part, with them.

However, as Mama’s paranoia increased, her objectivity decreased and she began to see just about everyone in a more sinister light and as potential enemies. As a result, her social interactions, which she craved, became increasingly tense and hostile.

Just before Mama’s diagnoses and the medications that would balance out the most extreme aspects of the behaviors associated with dementias, Mama exhibited the behavior of an introvert like me.

With a profound hearing loss, Mama depended on hearing aids to connect with the world. Mama would always put her hearing aids on very soon after waking up in the morning so she didn’t miss anything.

In the few months before the inevitable crash that landed her in a geriatric psychiatric hospital, Mama often wouldn’t put her hearing aids in until late in the morning or early in the afternoon.

Mama also started isolating herself, spending the majority of the day in her apartment alone except for the time I spent with her each day.

As I went through her desk and computer when I was trying to make sense of where we were and what I needed to do when she hospitalized, I found that she’d spent a lot of time trying to write, either longhand or on the computer, and as I went through everything, I could see evidence everywhere of steep neurological decline.

It alarmed me to see the rapid progression over a few short months. I can only imagine how much more it must have frightened Mama because she didn’t know what was happening and yet she was aware that everything seemed to be quickly slipping away.

The right combination of medications brought Mama back to her true temperament and it was a relief to me and, I suspect, a relief to her as well.

She was once again involved in a lot of social activities during the day and not only did Mama thoroughly enjoy them, but other people thoroughly enjoyed her (she’d always been the life of the party and a welcome addition to any social gathering).

I made sure to encourage as much social interaction as Mama was up to and I made sure that whatever she needed to be a part of those activities she had. I would often join her in some of them, in spite of my natural aversion to that, because I knew Mama liked having me there with her and I knew that my being there made Mama feel safe.

When Mama came home to live with me, I had to continue to go outside my comfort zone to make sure she had enough social activity and interaction to thrive with her temperament. And, while it was hard at times on me, I never regretted doing that for her.

As the end of Mama’s life was drawing near and she began not knowing who I was on a regular basis and was often unable to recognize people she had known for a long time, I began to cocoon us.

The reasons were because it bothered Mama when she didn’t know people and, because they were strangers, Mama would get fearful (except for me – even when she didn’t know me, she wasn’t afraid of me and she felt safe with me).

So I began keeping the number of people with whom Mama and I interacted small and consistent so that the odds were good that Mama would remember them and so that she would not be scared.

To this day, I struggle with whether I did the right thing by Mama by doing this.

Logically, I know it was the absolute right decision because I didn’t want Mama to feel unsafe or scared.

But emotionally I question whether I should have taken the chance that Mama might have a good day and be glad to see longtime friends.

I still don’t know the answer. That will be just one more of those lingering questions that I’ll probably revisit with no resolution until the day I die.

 

 

Lifestyle Dementia: Underdiscussed, Overlooked, But a Very Real and Present Danger

Today’s post will discuss lifestyle dementia. Many of the people, especially the elderly and very elderly, suffering from dementias and Alzheimer’s Disease today either have the genetic markers for it or – and this is my opinion, but I see strong evidence to support it with the precipitous explosion of dementias and Alzheimer’s Disease – are suffering from the effects of living on a toxic earth, eating toxic food, and breathing toxic air.

However, another group of dementia sufferers is emerging.

They are younger and have very different lifestyles than their elderly and very elderly counterparts with whom they share the same commonalities of dementia. This group of people has dementia that is directly related to lifestyle.

How we live our lives is a series of choices that we make consciously or unconsciously along the way. That is what becomes our lifestyle. Our lifestyle – all of those choices – has short-term effects and long-term effects. 

The long-term effects of those lifestyle choices are beginning to be seen in the growing number of people suffering with lifestyle dementia. One of the generations most noticeably – and disproportionate to the incidence in the expected populations of the elderly and very elderly – affected is the Baby Boomer generation (people born between 1943 and 1960, according to William Strauss and Neil Howe in their book The Fourth Turning, which I highly recommend that everyone read).

I strongly suspect that one of the lifestyle choices, which I’ll discuss later, that was prevalent with this generation during the 1960’s and early 1970’s is a key contributor to the development of the lifestyle dementia we see emerging among this age group today.

Before we proceed with describing lifestyle choices that could lead to lifestyle dementia, it’s important to understand what the word dementia describes. Any loss of function of and/or damage to the internal components of the brain (neurological, chemical, or physical) falls under the broad category of dementia when describing the brain’s condition.

(Inset note: Alzheimer’s Disease is the shrinkage of the size of the brain from the outside in, brought on by a specific condition that occurs in the nerve cells of the brain. Therefore, it’s important to remember that all people suffering from dementia don’t necessarily have Alzheimer’s Disease, while all people suffering from Alzheimer’s disease have a very specific kind of dementia, commonly called tangles and plaques.)

So dementia is a condition – or  state – of the brain. Like many nouns, this condition or state has adjectives that describe where the loss of function or damage is or specific identified abnormalities of the brain that affect function and cognition. Therefore, when we see the term vascular dementia, for example, the loss of function and/or damage to the brain is related to the blood vessels in the brain. 

So what kind of lifestyle choices can lead to lifestyle dementia?

diabetes-insulin-dementiaIn the last twenty to thirty years, the western world has adopted a supersized fast-food diet, a very sedentary lifestyle, and an “ignorance is bliss” attitude toward taking care of their health with regular medical checkups and changes in their lifestyles to address health issues like diabetes and high blood pressure.

Unchecked or uncontrolled, both high blood pressure and diabetes directly affect the health of the blood vessels in the brain, leading to widespread blood vessel damage and neurological cell death, which is the cause of vascular dementia. 

alcoholAnother lifestyle choice that can lead to lifestyle dementia is alcohol abuse. While it’s generally believed that alcohol doesn’t directly kill brain cells, alcohol abuse creates key vitamin deficiencies that adversely affect the brain and adversely affects the liver’s ability to remove toxins from the body. Research shows that women who abuse alcohol begin to exhibit the adverse effects in half the time that men who abuse alcohol do.  

This article from the National Institute of Health gives a very clear and understandable explanation of how alcohol abuse results in long-term damage to the brain. The specific type of dementia that occurs with alcohol abuse is Wernicke-Korsakoff syndrome, which occurs because of a thiamine (B1) deficiency.

A third lifestyle choice that can lead to lifestyle dementia is drug abuse. I noted earlier that one lifestyle choice seems to point to why there is such a high incidence of older Baby Boomers showing signs of dementia at earlier ages than their elderly and very elderly counterparts do. I believe that this phenomenon has a direct correlation to the pervasive and unabashed drug experimentation within this age group in the 1960’s and early 1970’s.

A few years ago, I watched a documentary entitled The Drug Years on the History Channel (it was originally produced by the Sundance Channel and VH1). If you have not seen it, you should (Netflix and Hulu subscribers will find it in the Documentaries section). It’s shocking in some ways, but very informative in others. If you’re like me, you’ll watch it shaking your head a lot. But there’s a lot of history that explains things before some of us (like me) were born or cognizant and it also explains our continuing prevalent and unabashed drug culture in the U.S. today.

The series had a lot of commentary by Martin Torgoff, who wrote 2005’s Can’t Find My Way Home: America in the Great Stoned Age 1945-2000. Intrigued by the title (the first part of the title is the mind-altering drugstitle of one of my favorite songs by the band Traffic), I read the book after watching the documentary. I don’t believe that any book I’ve ever read scared me as much as Torgoff’s book did. And as much head-shaking as I did during the documentary, I did even more reading this book.

As Torgoff described the drug abuse of the 1960’s and early 1970’s and quoted well-known and not-so-well-known people about their own drug use and abuse, it became evident that there was an uninhibited desire to find, use, and abuse any substance that substantially altered the brain. The more altered the brain was, the “better” the experience.

With the psychedelic agents in LSD, acid, psilocybin mushrooms, and peyote, perceptions became altered, hallucinations occurred, and illusions became real.  In short, this generation liberally sought every possible means of chemically inducing the manifestations of dementia. In the process, neurological damage occurred and now, with age, the effects of that damage are becoming more evident with the emergence of lifestyle dementia.

To be clear and to be fair, I’m not saying that every case of early-onset Alzheimer’s Disease and dementia or other types of dementia occurring at a younger-than-usual age is the result of drug abuse. That’s much too broad a brush stroke to paint with. But a recent study showed a pretty strong link between dementia and teenage/young adult lifestyle choices for people without a family history of the diseases.

And the neurological damage from this lifestyle choice continues with the use of more modern drugs like Ecstasy, Adderall, and “bath salts,” which are psychoactive and which stimulate the brain beyond its normal capacity and can produce hallucinations, seizures, and even death.

Bath salts, which have become popular in the last couple of years, permanently create irreversible neurological damage because of the simultaneous and voluminous suckerpunch all at once to the brain with the chemical effects of amphetamines and cocaine.

It remains to be seen, although it certainly will occur, what lifestyle dementias develop among the Millennials using these drugs today.

Some things happen to us in life through no fault of our own. However, we have choices in how we live our lives, and we can make positive lifestyle choices that, while they may not preclude any of us from developing Alzheimer’s Disease and dementias down the road, will ensure that we’ve done every within our power to ensure that our choices and actions haven’t contributed to it.