stress

Temporary cognitive impairment for many hospitalized seniors

May, 2011

Hospitalization can temporarily impair seniors’ cognitive function, and more support is needed. Discharge instructions should be given with this in mind.

A study involving 200 older adults (70+) experiencing a stay in hospital has found that at discharge nearly a third (31.5%) had previously unrecognized low cognitive function (scoring below 25 on the MMSE if high-school-educated, or below 18 if not). This impairment had disappeared a month later for more than half (58%).The findings are consistent with previous research showing a lack of comprehension of discharge instructions, often resulting in rehospitalization.

The findings demonstrate the effects of hospitalization on seniors, and point to the need for healthcare professionals and family to offer additional support. It’s suggested that patient self-management may be better taught as an outpatient following discharge rather than at the time of hospital discharge.

Sleep disruption and stress are presumed to be significant factors in why this occurs.

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Individual differences in learning motor skills reflect brain chemical

April, 2011

An imaging study demonstrates that people who are quicker at learning a sequence of finger movements have lower levels of the inhibitory chemical GABA.

What makes one person so much better than another in picking up a new motor skill, like playing the piano or driving or typing? Brain imaging research has now revealed that one of the reasons appears to lie in the production of a brain chemical called GABA, which inhibits neurons from responding.

The responsiveness of some brains to a procedure that decreases GABA levels (tDCS) correlated both with greater brain activity in the motor cortex and with faster learning of a sequence of finger movements. Additionally, those with higher GABA concentrations at the beginning tended to have slower reaction times and less brain activation during learning.

It’s simplistic to say that low GABA is good, however! GABA is a vital chemical. Interestingly, though, low GABA has been associated with stress — and of course, stress is associated with faster reaction times and relaxation with slower ones. The point is, we need it in just the right levels, and what’s ‘right’ depends on context. Which brings us back to ‘responsiveness’ — more important than actual level, is the ability of your brain to alter how much GABA it produces, in particular places, at particular times.

However, baseline levels are important, especially where something has gone wrong. GABA levels can change after brain injury, and also may decline with age. The findings support the idea that treatments designed to influence GABA levels might improve learning. Indeed, tDCS is already in use as a tool for motor rehabilitation in stroke patients — now we have an idea why it works.

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[2202] Stagg, C J., Bachtiar V., & Johansen-Berg H.
(2011).  The Role of GABA in Human Motor Learning.
Current Biology. 21(6), 480 - 484.

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Hippocampal volume and PTSD

April, 2011

A new study supports the association between hippocampal size and recovery from PTSD, pointing to the role of neurogenesis in stress resilience.

Following previous research suggesting that the volume of the hippocampus was reduced in some people with chronic PTSD, a twin study indicated that this may not be simply a sign that stress has shrunk the hippocampus, but that those with a smaller hippocampus are at greater risk of PTSD. Now a new study has found that Gulf War veterans who recovered from PTSD had, on average, larger hippocampi than veterans who still suffer from PTSD. Those who recovered had hippocampi of similar size to control subjects who had never had PTSD.

The study involved 244 Gulf War veterans, of whom 82 had lifetime PTSD, 44 had current PTSD, and 38 had current depression.

Because we don’t know hippocampal size prior to trauma, the findings don’t help us decide whether hippocampal size is a cause or an effect (or perhaps it would be truer to say, don’t help us decide the relative importance of these factors, because it seems most plausible that both are significant).

The really important question, of course, is whether an effective approach to PTSD treatment would be to work on increasing hippocampal volume. Exercise and mental stimulation, for example, are known to increase the creation of new brain cells in the hippocampus. In this case, the main mediator is probably the negative effects of stress (which reduces neurogenesis). There is some evidence that antidepressant treatment might increase hippocampal volume in people with PTSD.

The other conclusion we can derive from these findings is that perhaps we should not simply think of building hippocampal volume / creating new brain cells as a means of building cognitive reserve, thus protecting us from cognitive decline and dementia. We should also think of it as a means of improving our emotional resilience and protecting us from the negative effects of stress and trauma.

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Acupressure may help treat TBI

March, 2011

A placebo-controlled study reveals a treatment for mild traumatic brain injury that sufferers can administer themselves.

A study involving 38 people suffering from mild traumatic brain injury (TBI) has found that those receiving acupressure treatments from trained experts (eight treatments over 4 weeks) scored significantly better on tests of working memory compared to those who received treatments from the same experts on places on the body that are not considered to be acupressure points.

Acupressure involves the practitioner using his fingertips to stimulate particular points on a person's body. The acupressure treatment type used in the study was Jin Shin. This treatment can be taught to family and friends of those with TBI and can even be used as a self-treatment, making it a good candidate for an adjunct treatment for TBI.

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Mindfulness meditation training changes brain structure in 8 weeks

February, 2011

After 8 weeks practicing mindfulness meditation, measurable changes occurred in brain regions associated with memory and emotion.

Brain images of 16 participants in an 8-week mindfulness meditation program, taken two weeks before and after the program, have found measurable changes in brain regions associated with memory, sense of self, empathy and stress. Specifically, they showed increased grey-matter density in the left hippocampus, posterior cingulate cortex, temporo-parietal junction, and cerebellum, as well as decreased grey-matter density in the amygdala. Similar brain scans of a control group of non-meditators (those on a waiting list for the program) showed no such changes over time.

Although a number of studies have found differences in the brains of experienced meditators and those who don’t practice meditation, this is the first to demonstrate that those differences are actually produced by meditation.

The Mindfulness-Based Stress Reduction program involved weekly meetings that included practice of mindfulness meditation and audio recordings for guided meditation practice. Participants reported spending an average of 27 minutes each day practicing mindfulness exercises.

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Sleep deprivation eliminates fear generalization

January, 2011

In a small study, a sleepless night after trauma prevents the development of PTSD symptoms.

Given all the research showing the importance of sleep for consolidating memories, it should come as no great surprise that the reverse is also true: depriving yourself of sleep could help you forget experiences you would prefer not to remember.

In the study, 28 student volunteers were shown 14 short video clips, half of which showed safe driving down a city street, and half showed the car being involved in a nasty crash. Half of the volunteers were then deprived of sleep while the other half received a normal night's sleep. The next day, they were shown pictures and asked to indicate whether they had appeared in the clips they had seen. They were also asked to rate the fear evoked by the image, and their physiological responses measured. They were tested again 3 and 10 days later.

While there was no difference between the two groups in picture recognition, the control group rated the images from the crash videos as fearful, and these responses generalized over time to the other images. However, those who were sleep deprived showed such reactions only on the first day.

The finding suggests a possible therapy for PTSD or other anxiety disorders.

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Drug prevents post-traumatic stress syndrome

January, 2011

A new drug is successful in preventing PTSD in mice if delivered within 5 hours of the trauma.

A mouse study has revealed the brain becomes overly stimulated after a traumatic event causes an ongoing, frenzied interaction between two brain proteins long after they should have disengaged. However, the injection of newly developed drugs into the hippocampus within a five hour window calmed this process, and prevented the development of a post-traumatic fear response.

The new research shows the potential for PTSD occurs when a stressful event causes a flood of glutamate, which then interacts with a second protein (Homer1a). This protein continues to stimulate metabotropic glutamate receptor 5 [mGluR5] after the glutamate has dissipated. The new drugs bind mGluR5 and reverse its activity.

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Abused, neglected children have lower IQ in teens

January, 2011

A large study has found significantly lower IQ in teenagers who have suffered abuse and/or neglect.

An Australian study of 3796 14-year-olds has found that those who had been reported as having suffered abuse or neglect (7.9%) scored the equivalent of some three IQ points lower than those who had not been maltreated, after accounting for a large range of socioeconomic and other factors. Abuse and neglect were independent factors: those who suffered both (and 74% of those who suffered neglect also suffered abuse) were doubly affected.

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Stress in middle age could contribute to later dementia

September, 2010

A long-running study of Swedish women has revealed that dementia risk is greater in those who experienced periods of stress in middle age.

Data from a 35-year study of women from Gothenburg in Sweden has revealed that the risk of dementia was about 65% higher in women who reported repeated periods of stress in middle age than in those who did not. The risk increased with number of periods of stress, with women who reported stress on all three occasions they were asked (1968, 1974 and 1980) having more than double the risk of dementia. Stress was defined as a sense of irritation, tension, nervousness, anxiety, fear or sleeping problems lasting a month or more due to work, health, family or other problems. Of the 1462 women in the sample used, 11% developed dementia, 65% of which was Alzheimer’s and 25% vascular dementia.

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Post-traumatic stress disorder increases dementia risk

September, 2010

A very large study has found that military veterans with PTSD were twice as likely to develop dementia in old age, compared to vets without PTSD.

A study involving over 180,000 older veterans (average age 68.8 at study start), of whom 29% had PTSD, has revealed that those with PTSD had a significantly greater risk of developing dementia. Over the seven years of the study, 10.6% of the veterans with PTSD developed dementia compared to 6.6% of those without PTSD. When age was used as the time scale, the risk for those with PTSD was more than double. Results were similar when those with a history of head injury, substance abuse, or clinical depression, were excluded.

One possibility for the link is that the stress induced by PTSD contributes to the development of dementia.

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