Use it or Lose it (contd)

Use it or lose it (contd)

by Fred Lane PhD.

“Use it or lose it,” has been a golden mantra for the elderly for years. Now, a couple of new studies at Columbia University in New York and the University of Illinois at Urbana-Champaign suggest that mild aerobic exercise not only preserves but also encourages the growth of new brain cells. This is in direct conflict with the age-old belief that, after a brief period in life, we were left with a certain number of brain cells and that all we could do was to lose them over time. Attempts to repair or replace damaged nerve cells and their dendrites through neurosurgery or medication have a history of a very low success rate.

neuron-growth

New brain cells develop when multipotent neural stem cells divide into either neurons or glial cells. Many die in their process towards maturity, but those that make connections with other neurons (above) tend to survive over this month-long period. Growth factors assist in generating new cells and a brain-derived neurotropic factor keeps the successful cells alive. Any one of the billion or so mature cells in an adult brain brain cell might make 1000 or more connections through their delicate spider-web dendrites.

Neurogenisis

“Neurogenesis,” or the creation of new neurons, now seems possible according to an expanding body of research. This was spurred by 1998 mouse studies by Fred Gage at the Salk Institute, La Jolla, CA, where animals given running wheels were found to create two to three times the number of fresh neurons right up to the point of death, compared with others denied this form of exercise. The “exercise” mice were also better at solving traditional maze problems.

mouse_treadmill

Mouse on a treadmill running wheel similar to that used by Fred Gage.

Columbia study

At Columbia University, men and women aged 21 to 45 were given moderate exercise for one hour, four times a week. The exercise group performed better on memory tests and those with the best oxygen intake improvement showed the best memory improvement. Magnetic Resonance Imaging (M.R.I.) analyses suggested increased blood flows in critical areas of the brain’s hippocampus, as well as increased oxygen intake. The hippocampus plays a large role in memory and learning. As we grow older, it typically shrinks. In Alzheimer’s disease the hippocampus is noticeably wasted.

At Urbana-Champaign, 59 sedentary elderly people aged 60 to 79 walked one hour three times a week in a series of experiments supervised by Art Kramer. After six months Kramer was particularly interested in the significant brain neuron growth shown by M.R.I. scans in the prefrontal and temporal cortices regions of the brain.

“Use it and grow”

No single theory explains these phenomena. Some scientists claim it is increased levels of serotonin, others say it is due to an insulin growth factor protein. It might well be both, or even a third variable. However, it is becoming increasingly clear that in addition to the old “use it or lose it” philosophy, there might well be a “use it and grow” corollary. Exercise, diet, and social and environmental stimulation seem even more important than ever for retirees.

References:

Jacobs B.L., H. van Praag, and F. H. Gage. Depression and the Birth and Death of Brain Cells. American Scientist. 88/4, pp.340-44, 2006.
Colcombe, S.J., K.I. Erickson, P.E. Scalf, J.S. Kim, R. Prakash, E. McAuley, S. Elavsky, D.X. Marquez, L. Hu, and A. F. Kramer. Aerobic Exercise Training Increases Brain Volume in Aging Humans. Journal of Gerontology. Series A: Biological Sciences and Medical Sciences. 61: pp. 1166-1170, 2006.
Colcombe, S.J., and A.F. Kramer. Fitness effects on the cognitive function of older adults: A meta-analytic study. Psychological Science 14/2, pp.125-130, 2003.

Changing careers after 50

Changing careers after 50

by Casey-Ann Seaniger.
Reprinted with permission, 50-something magazine, National Seniors Australia, October 2009, p. 32

With so many negative stories surrounding rising unemployment and a bleak outlook for jobs, it’s refreshing to hear inspirational accounts of people who have taken a chance on their career and won. Making the decision to plunge into a new career in later life takes true guts.Changing careers after the age of 50 involves risk, but if done right, the rewards can be massive.

Seven career changes

According to research from the Department of Education, Science and Training in 2005, most Australians will now change career seven times in their life. Reinvent Your Career managing director, Nicholas Ricciuti, says an increasing number of people are reconsidering their line of work in search for something new. “Reinventing your career is hard work but often worthwhile,’’ he said.
“Although financial issues are a reality, and to stay put may seem the most practicable way forward, the commitment to live your career dream is often the match that lights the fire within, developing opportunities and a sense of self fulfilment that most never experience.In my opinion, not to engage and discover a work life that you enjoy is the real risk.”
For Roy Stall, going from the four walls of a library to the high seas teaching maritime English, has certainly paid off. Roy has been able to travel extensively and now has a new lease on life.
After years of working the busy executive lifestyle, Helen Schofield was looking for a change. Little did she know that making dolls would be her new career direction.
Sandy Potter also recognised the perks of being your own boss and after more than 37 years working in superannuation at a life assurance company, Sandy went from white collar to blue singlet when he purchased his own lawn mowing business.

Sequence of events

Mr Ricciuti said for most people, it was not about having a ‘mid-life’ crisis, but rather a sequence of other events that trigger people to make a change.
“Career decision making is seen as a series of continuous choices across the life span, not a once-and-for-all event,’’ he said.
“Thus, careers may be viewed as a spiral sequence of all life roles, with changes triggered by factors ranging from the anticipated (marriage, empty nest) to unanticipated (illness, divorce, layoff, death) to ‘non-events’ (a marriage or promotion that did not occur).”
Other reasons people seek change are because their initial career was not their own choice, their original aspirations were not met, there is insufficient time for other life roles, or the present career is incongruent with changed values or interests.
Longer life expectancy, changing views of retirement and economic necessity are some of the other factors.

Roy Stall, RAN retired

In the late 1990s, Roy fell victim to ageism in the job market but instead of giving up, he decided to head in a new direction. After his job at a university was abolished, he started the tedious search of looking for a new job and soon discovered he could wallpaper his home office with the amount of rejection letters he’d collected. Roy, from Perth, decided to study a Certificate in English Language Teaching to Adults (CELTA) course at a local college at his own expense. In the months and years that followed, Roy picked up quite a few part-time, casual, and relief teaching jobs at a variety of English language colleges in Perth.
Because he had an ex-Royal Australian Navy background, as well as a modest marine ticket gained in Hong Kong, he started to specialise in what is called ‘Maritime English’.
In the same way international aviators have to speak ‘aviation English’ when travelling around the world, so do captains of ships over 500 tonnes, when they converse with vessel traffic services, ships’ pilots, or other vessels on the high seas.
Roy has worked at a Tokyo-based maritime university and has undertaken three voyages on its 93-metre training ship, the Umitaka Maru, teaching cadets while en route.
Roy says his decision to spend money to up-skill was certainly worth it. “In recent years I have travelled to both China and Japan, to teach Maritime English, in a number of interesting locations, including Shanghai, Qinhuangdao and Tokyo,’’ he said.

roy-stall

Naval Officers Club member Roy Stall (dark shirt) teaches “Maritime English” to attentive cadets aboard Umitaka Maru.

Helen Schofield

Three years ago, Helen Schofield had had enough of her job as an executive assistant and decided she wanted a change.
While Helen was looking to buy dolls for her granddaughters living in the US, she noticed there was a real gap in the market for age-appropriate Australian-made dolls.
“I found the trend of popular culture via marketing, TV shows and music was to sexualise children so I decided in some small way to try to make a difference by offering an alternative,’’ she said.
After extensive research, Helen began a manufacturing business in dolls. Her business, Australian Girl, now supplies to over 30 stores around Australia and sells online via the website www.australiangirldoll.com.au.

Toy of the year finalist

Helen is at the helm of some exciting times for the business. The fifth doll, being released in November, was a finalist in the Toy of the Year awards at the Australian Toy Fair in Melbourne. Helen is also planning to publish an adventure novel based on her dolls.
“We have our first adventure novel for girls being published next year. We are planning on bringing some Australian history and Australian role models into the books.”
Helen also makes donations to charities and supports the work of Kids Free 2B Kids, Women’s Forum Australia and Wishes of the West.
“I am 60 now and feel younger than I did when I finished my last job,’’ she said. “I wouldn’t say I work less hours now, but I can say I work when I want to and the adventure of a steep learning curve has been exhilarating.”

Sandy Potter

Sandy Potter, 70, from Hornsby Heights in NSW, worked for the same life assurance company for 37 years before deciding it was time to move on.
As the years went by, Sandy started to feel more pressure, stress and an increased lack of job satisfaction at his work. “My focus was superannuation and tax changes were occurring almost as quickly as you could blink,’’ he said.

Lawnmowing franchise

Sandy decided to turn his love for gardens and the outdoors into something more practical. At the age of 55, Sandy purchased a lawnmowing franchise which gave him initial business support but then he went out on his own.
“I really valued being able to pick and choose the jobs I wanted to do, and this outweighed the hard work and long hours,’’ he said.
Although he faced a total lack of understanding from his colleagues when he decided to make the switch, Sandy hasn’t looked back.

No regrets

“I have no regrets about this change of direction, although it was at first a challenge to adjust from being an employee to being my own boss,’’ he said.
“And it may sound simple, but there is nothing like receiving a phone call from a client to say how great it was to come home and see the back garden transformed.”
Another totally unimagined spin-off from the gardening and lawn-mowing has been the growing of plants and selling at local markets. “This has brought us into a new world of activities and friendships,” he said.

 


Chemo Brain

“Chemo brain”

by Fred Lane PhD

After years of resistance, “chemo brain” (aka post-chemotherapy cognitive impairment, chemotherapy-induced cognitive dysfunction, et al), is gaining recognition in mental health and allied professional fields. Nearly all cancer patients undergoing powerful chemotherapy report this disorder and many surgical patients experience some kind of memory problem. Maybe 15 or 20 per cent report chronic significant impairment (Silverman and Davidson, 2009). Additionally, some cholinesterase inhibiting drugs, ostensibly for the treatment of Alzheimer’s disease, have been linked to dangerous falls because of chemical interactions in the brain.

Symptoms

The symptoms are fairly consistent, particularly in high-functioning people who had a past history of successfully juggling complex and multiple demands: problems with memory, word retrieval, concentration, handling numbers, multi-tasking and setting priorities. Some of these signs are seen in early Alzheimer’s disease, except true Alzheimer’s patients might not be aware of the problem until someone draws their attention to it. Early intervention and prevention strategies are therefore important if we are to fully understand the problem and avoid the “do-nothing” misdiagnoses.

Equally important is the avoidance of unnecessary stress on the one hand and apathy on the other. Both can make the condition worse. It is very important to differentiate the potentially curable “chemo brain” disorder from one of the more malignant dementias, like Alzheimer’s disease.

But first, Alzheimer’s patients taking cholinesterase inhibiting drugs, such as Aricept (donepezil hydrochloride), Exelon (rivastigmine) and Reminyl (galantamine hydrobromide), might have yet another more serious chemotherapy-related problem. These specific drugs were all used in the treatment of mild to moderate dementia, but in July 2009 they were moved to the “do not use” category by Worst Pills Best Pills, a highly respected American pharmaceutical research group.

As well as the usual but comparatively less dangerous side effects like nausea, diarrhoea, muscle cramps and incontinence, these drugs might contribute to slow heart rhythms and particularly to sudden fainting (syncope) when sitting or standing,

Falls, bone fractures

Fainting spells are particularly dangerous. They lead to falls and bone fractures, according to a persuasive study involving 80,000 patients (Sudeep et al, 2009). Dangerous side effects might not be seen at first, but they can develop over time and many other drugs can interact to produce potentially dangerous behaviour. An increased proportion of these patients taking these drugs were hospitalised for pacemaker insertions. This low risk, but nevertheless invasive procedure might not be needed at all if the cholinesterase inhibiting medication is avoided in the first place.

The cholinesterase inhibitors’ efficacy is in doubt in that while they might seem to blunt some of the more florid symptoms of Alzheimer’s disease and briefly slow the progress of the disorder, these benefits, like nearly all of the other Alzheimer’s interventions over the past 50 years, disappear over time and make little or no difference to the ultimate outcome of the disease. On the other hand, the prestigious Mayo Clinic and some other respected groups are still recommending cholinesterase inhibitors for mild to moderate Alzheimer’s and suggest they may be taken even in conjunction with Namenda (memantine hydrochloride) for moderate to severe cases. “People with moderate Alzheimer’s may experience even better results by taking memantine along with a cholinesterase inhibitor,” said a July 2009 Mayo Clinic report.

Contrary data

Oddly, the medical researcher presenting the results of a 2003 investigation into Namenda data to the USA Federal Drug Administration (FDA) reported, “Only a small minority of patients treated with memantine showed even a minimal or moderate improvement, with no patients showing a marked improvement, and the most common response being no change,” (Mani, 2003).

Namenda, marketed in Europe since the 1980s and approved by the FDA in 2003, is claimed to moderate the activity of glutamate, a common brain messenger chemical linked to the over-activation of some brain receptors that contribute to the destruction of brain cells. At the time of its approval, it was the only drug approved by the FDA for use with severe Alzheimer’s patients. Nameda is also used at times in the treatment of acute pain and AIDS-related dementia.

Once more, however, Worst Pills Best Pills researchers allocate Nameda to the “do not use” category with Alzheimer’s disease because of its modest (if at all) proven efficacy and dangerous side effects. Further research seems warranted and we await eagerly the outcome of a study presently under way in Stanford University, California, testing the drug’s efficacy with Huntington’s disease patients.

Let’s return to the chemo brain question in cancer patients who have no other convincing dementia sign. Interestingly, the disorder may be most frequently seen during or after chemotherapy treatment for breast cancer, ovarian cancer, prostate cancer and other cancers of the reproductive system (Matsuda et al). If there has been no sign of cognitive impairment before chemotherapy, then confusion and difficulty completing a job, losing a car in a car park or difficulty adding numbers may be a first warning sign of a serious chemical reaction affecting the memory components of the brain.

Intervention

Sitting down and saying, “I’m getting old, I have to accept this,” is absolutely the worst thing to do for any kind of memory impairment. Start with a regular written daily log of memory problems to quantify their quality and quantity. This serves two purposes. It helps your GP understand your problem and serves to quantify positive changes frequently missed by simple ancedotal reminiscence. That log becomes important hard evidence for a post-treatment “Attaboy” self-talk pat on the back, an important component of all cognitive-behavioural therapy.

Consult GP

Stopping medication might be enough to control some disorders, but this might be too dangerous or too late for problems arising from cancer medication or anaesthesia.

Silverman and Davidson recommend a smorgasbord of systematic and thoroughly tested cognitive behavioural therapy techniques such as prioritising tasks, developing routines, rehearsing responses to expected difficult situations, employing mnemonics and rhymes, using multiple senses, using notebooks, posting checklists in strategic places, using day planners, leaving messages for yourself, monitoring sleeping patterns, getting adequate rest and using cues like a saucepan on the TV to remind you of cooking on the stove. They strongly support the “use it or lose it” strategy.

Control your life

On the one hand, learn how to say “No” to those who want to overload you with routine work. On the other hand, keep your brain active, for instance with reading, crosswords, number puzzles and learning new skills.

Memory impairment is real. It does react positively to cognitive-behavioural interventions. Check it out. Give it a try.

References:

Mani R.B. Food and Drug Administration – Final briefing document for advisory committee meeting – Efficacy review of memantine (Namenda), Aug 19, 2003: 15.
Matsuda T., T. Takayama, M. Tashiro, Y. Nakamura, Y. Ohashi, K. Shimozuma. Mild cognitive impairment after adjuvant chemotherapy in breast cancer patients – evaluation of appropriate research design and methodology to measure symptoms. Breast Cancer 12 (4), pp. 279–87. 2005.
Silverman D and I. Davidson. Your brain after chemo: A practical guide to lifting the fog and getting back your focus. Da Capo Press: Cambridge. 2009.
Sudeep S.G., G.M. Anderson, H.D. Fischer, C.M. Bell, P. Li, S.T. Normand and P.A. Rochon. Syncope and its consequences in patients with dementia receiving cholinesterase inhibitors: A population-based cohort study. Archives of Internal Medicine 169(9), pp. 867-873. 2009.
Websites:
Mayo Clinic. http://www.mayoclinic.com/healthj/alzheimers/AZ00015.
Worst Pills Best Pills. https://www.worstpills.org/public/page.cfm?op_id=49.