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Tag Archive for: Cognition

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How Anxiety and Depression Can Impact Cognition

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)
Co-written with Ashley Carnegie, Occupational Therapist

As a student working with an Occupational Therapist in the community, I realized early in my placement that many clients struggle with anxiety and depression in combination with cognitive challenges like decreased attention, concentration and focus, difficulties with memory, and slower information processing abilities. This spiked my interest, as I was unaware of the possible impact anxiety and depression could have on cognition and how these symptoms could be related.  I decided to look into this further, and am sharing my findings below.

Occupational Therapists work in a wide variety of settings including the community. As the hospitals become less and less able to accommodate people long-term, community-based occupational therapy services are becoming more and more common. Working in the community allows occupational therapists to reach a wide variety of clients, and therapists utilize a strength-based approach to build on the client’s current strengths to promote wellness and productivity.

Depression and anxiety are the most common types of mental illness throughout the world, including Canada. From my community placement experience as a student Occupational Therapist, I have found that the majority of the clients I have seen are experiencing depression and/or anxiety, often in combination with other primary diagnoses.

Interestingly, depression and anxiety can negatively impact the way the brain thinks, learns, and processes information and thus how it functions.  However, the relationship is complicated as a decrease in cognition may also lead to an increase in depression and/or anxiety which can then perpetuate the cycle.

Research has highlighted how anxiety and depression can negatively impact several aspects of cognition including:

  • Psychomotor speed
  • Attention
  • Executive functioning
  • Problem-solving
  • Attentional switching
  • Cognitive flexibility
  • Visual learning
  • Memory

The result for most people tends to be poor functional outcomes in their daily lives. Additionally, the brain regions believed to be responsible for these functions have been shown to be abnormal in people that also suffer from anxiety and depression  (e.g. hippocampus, amygdala, temporal lobes, and prefrontal cortex). Decreased memory, slowed information processing, and issues with verbal communication can negatively impact multiple areas of people’s lives. This information demonstrates the importance of the need to detect and treat anxiety and depression as early as possible as well as the need for early cognitive interventions for clients with anxiety and depression.

As a student Occupational Therapist, I wanted to further investigate how Occupational Therapists can help. I found evidence that Occupational Therapists can help clients in reducing functional decline, while also reducing the probability of relapse by treating cognitive deficits. Occupational Therapist’s target these areas by teaching client’s cognitive remediation and compensation strategies during their interventions and treatment monitoring.

Examples of remediation interventions may include:

  • Retraining higher-level cognitive skills (e.g. strategy use, self-monitoring, self-correction, problem-solving, self-evaluation)
  • Education
  • Relaxation and stress management techniques to regain control
  • Divided attention training (e.g. learn tasks separately and then combine tasks)
  • Imagery
  • Rehearsal strategies

Examples of compensatory interventions may include:

  • Modifying the environment (e.g. dim lights, reduce distractions)
  • Altering the task, (e.g. use of rest breaks, breaking the task into smaller components, repetition of instructions)
  • Use of both internal and external cueing/reminders (e.g. use of mnemonics, post-it notes, organizers, applications)

With both, often, a cognitive behavioural approach is taken.  Cognitive behavioural therapy (CBT) works to change clients thought structure to allow positive mood change, enhance coping strategies/problem solving, and help challenge faulty beliefs.

Anxiety and depression are common and are known to negatively impact a person’s cognition.  Worsening cognition then can deteriorate anxiety and depression further.  Early intervention is key to break this cycle and to promote function and wellness.   Occupational therapists play a vital role in providing interventions for those with anxiety and/or depression by implementing interventions for these issues, as well as treating the common resulting cognitive deficits.  Both remediation and compensatory techniques are used, often through cognitive behavioral therapy.  If you, or someone you know, is struggling with anxiety or depression this may present as cognitive difficulty, or if cognitive issues are present, anxiety and depression may also surface.  Consider occupational therapy if you would like support and strategies to improve these symptoms and to reduce their effect on your daily life.

 

References:

1. Carrier, A., & Raymond, M. H. Community occupational therapy practice in Canada: A diverse and evolving practice.

2. McRae, L., O’Donnell, S., Loukine, L., Rancourt, N., & Pelletier, C. (2016). Report summary-Mood and Anxiety Disorders in Canada, 2016. Health promotion and chronic disease prevention in Canada: research, policy and practice, 36(12), 314.

3. Statistics Canada (2014) Survey on Living with Chronic Diseases in Canada (SLCDC). Retrieved from http://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&SDDS=5160

4. Lee, R. S., Hermens, D. F., Porter, M. A., & Redoblado-Hodge, M. A. (2012). A meta-analysis of cognitive deficits in first-episode major depressive disorder. Journal of affective disorders, 140(2), 113-124.

5. Jaeger, J., Berns, S., Uzelac, S., & Davis-Conway, S. (2006). Neurocognitive deficits and disability in major depressive disorder. Psychiatry research, 145(1), 39-48.

6. Bora, E., Fornito, A., Pantelis, C., & Yücel, M. (2012). Gray matter abnormalities in major depressive disorder: a meta-analysis of voxel based morphometry studies. Journal of affective disorders, 138(1), 9-18.

7. Femenía, T., Gómez-Galán, M., Lindskog, M., & Magara, S. (2012). Dysfunctional hippocampal activity affects emotion and cognition in mood disorders. Brain research, 1476, 58-70.

8. Lorenzetti, V., Allen, N. B., Fornito, A., & Yücel, M. (2009). Structural brain abnormalities in major depressive disorder: a selective review of recent MRI studies. Journal of affective disorders, 117(1), 1-17.

9. Fleming, J. (2017). An occupational approach to cognitive rehabilitation. Workshop presented through the Canadian Association of Occupational Therapists, Toronto, ON.

10. Grieve, J. I., & Gnanasekaran, L. (2008). Intervention for Cognitive Impairments. Grieve, JI, & Gnanasekaran, L.(3rd ed. ed.). Neuropsychology for occupational therapists: cognition in occupational performance. Oxford. Malden, Mass.: Blackwell.

11. Haran, D. (2009). Cognitive-behavioral therapy for depression. The Israel journal of psychiatry and related sciences, 46, 269.

12. Knapp, P., & Beck, A. T. (2008). Cognitive therapy: foundations, conceptual models,  applications and research. Revista Brasileira de Psiquiatria, 30, s54-s64.

 

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Computerized Cognitive Training – Does it Help?

How do you stay “mentally fit?”  In our previous post, Working up a Cognitive Sweat, we suggested some online ways to provide a “workout” for your brain through computer “brain training” programs or computerized cognitive training.  The following care of the McMaster Optimal Aging Portal discusses research which confirms that these training programs do provide benefit, even to those who with mild cognitive impairment.   Learn more about this research below and take a look at our OT-V episode, Cognition and Aging — Keeping the Mind Sharp, for more ways to keep your brain cognitively fit!

The McMaster Optimal Aging Portal:  Computer brain games for treating cognitive impairment

 

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Your Best Brain: Use It or Lose It

The old cliché is true when we talk of cognition – “use it or lose it”.

Our brains are made of billions of neurons, which interact with each other to complete specific tasks. Signals are sent from one neuron to another along neural pathways, and these determine our thoughts, emotions, insights, and so much more. Each task relies on a different neural pathway, so the pathway for reading a book is different than the pathway for putting on our shirt. The more we use a pathway, the stronger the connection becomes.

These neurons have the ability to physically change themselves when faced with new and difficult experiences. This ability is called neuroplasticity. As we are exposed to new areas, tasks, information or experiences, neural pathways are formed and existing ones are reshaped. This will continue throughout our entire lives as we learn. As we have experienced through practicing a musical instrument, memorizing our shopping list or recalling a friend’s phone number, if we consciously focus and train our brains in a certain area, they will become faster and more efficient at performing those tasks.

Just as we need to exercise the muscles in our body, we also need to exercise our brain.

Some great ways to keep “work up a cognitive sweat” include:

  •         Online cognitive training programs and apps
  •         Playing board games
  •         Reading books
  •         Completing puzzles such as a daily crossword or Sudoku
  •         Learning a new language or skill
  •         Getting artistic

Try our 30 Day Healthy Brain Challenge to help you find other ways to boost your brain and prevent cognitive decline.

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Community Safety for Alzheimer’s Disease and Cognitive Impairment

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

In recognition of Alzheimer’s Awareness Month, I wanted to touch on the important topic of helping people with Alzheimer’s disease (or cognitive impairment) to be safe in the community.

A few months back I received an email from a friend. She wanted to “pick my brain” about a problem they were encountering with her father who has Alzheimer’s disease. She mentioned that he enjoys spending time in the community on his own, but the family was growing increasingly concerned about his safety. She was wondering if I had any suggestions on how they could monitor his community activities, and be able to locate him should he not return home when expected.

My experience working in brain injury has had me looking for such solutions in the past. Some people, with behavioral or cognitive impairment, are at risk in the community because they become disoriented, confused, lose track of time, or are not attentive to traffic. There is such a loss of independence for people to be told they cannot leave the home alone, and some become agitated or angry when people try to supervise their activities. Yet, even a familiar route can become a problem for people if their cognitive status changes or deteriorates, and what is manageable one day may become problematic the next. Part of my role as an occupational therapist when dealing with cognitive impairment is to problem solve with the client and family the ways we can help them to pursue their goal of independence outside the home, while also ensuring their safety and easing the mind of the care provider. There are several ways to do this, and the list below is not exhaustive by any means.

  1. Consider the local Police Departments. These often have programs and ways to track people at risk of wandering. It is also helpful to notify the police about a potential wanderer so this is in their records should their help be needed.
  2. The S-911 bracelet has multiple features that allows health care workers and families to GPS locate anyone that may have wandered off, or who is in the community unsupervised. There is a monthly and yearly fee for this device.
  3. The Loc8tor is another option and notifies a care giver (or parent of a child for that matter) if the person wearing the device has wandered up to a certain distance away. The Loc8tor is also useful for helping people to find those items that tend to get misplaced – such as keys, wallets and cell phones.
  4. Smartphones have GPS detection capabilities such as the “Find my Friends” application for the iPhone. With this, both users can locate the other person, but it does require the person to be carrying the phone, and the phone to be charged and on. This can be a problem for people with cognitive impairment as they may not always remember to take the phone with them when out, may not understand how to turn this on and / or to check and see if it is charged.
  5. There are home monitoring systems that can notify family when people are coming or going, or even bed alarms if people leave the bed at night. Motion sensors in the home can also help to notify family if someone is wandering or moving between locations indoors. While these don’t work to locate or ensure someone’s safety outside the home, they are a way to give family members piece of mind to go about business inside the home without always needing to provide the person with cognitive impairment constant supervision.

Remember that Occupational Therapy is about helping people to solve the problems that arise when physical, emotional or cognitive abilities change rendering daily activities to become a struggle. In all cases, because disability is experienced differently by everyone, the solution for one person may not be the solution for another – even when dealing with the same diagnosis. So, consult an OT if you have a functional problem to solve!

Previously Posted September 2014

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Solutions for Managing Passwords

Online security experts recommend creating strong passwords with a mix of special characters, numbers and letters which are different for each application you use.  However, remembering one simple password is often hard enough!  Especially for applications you don’t use often, it is recommended you keep a log of each password so you can easily retrieve it when needed.  This is particularly helpful for seniors, or anyone dealing with cognitive issues, who may have difficulty remembering passwords, or have trusted family members and/or caregivers who may need access to these.

Use our printable Password Keeper to record these important online passwords and user names, and keep it in a safe place for future use.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For more helpful tools please visit our Printable Resources Page.

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Want to Reduce Cognitive Decline? Get Physical!

At any age physical activity is an important part of your overall health.  As you age it’s important to keep active for both physical and mental health, but in most cases activities should become increasingly moderate.  The following from CTV News showcases some of the best forms of exercise to boost your brain power and reduce cognitive decline.

CTV News:  Boost your brain by working out: Best exercises to slow cognitive decline

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Forgot Where You Left Your Keys… Should You Be Concerned?

Do you have trouble remembering where you left your keys?  Is it hard for you to remember the name of the person you were just introduced to?  Many who experience these momentary memory lapses often feel it’s cause for concern, but that’s not always the case.  The following from WebMD discusses a study which looked at memory in young and older adults and explains why these forgetful moments sometimes occur.

If you are concerned about your cognition and memory as you age there are great ways to keep your mind sharp!  Read a book, do a Sudoku or crossword puzzle, learn a language, stay social, or try one of our weekly mind benders.  Frequently using your brain will help to keep you on the ball through the years!

WebMD:  Midlife Memory Lapses May Be Normal Part of Aging