tag:theconversation.com,2011:/uk/topics/cognitive-function-10438/articlesCognitive function – The Conversation2024-03-24T08:47:12Ztag:theconversation.com,2011:article/2247542024-03-24T08:47:12Z2024-03-24T08:47:12ZWorried about how to support your child’s education? Here are four useful steps you can take<p>Parents play a crucial role in supporting their children’s learning. Their involvement lays the foundation for success both inside and outside the classroom. This makes a parent’s consistent support and nurturing important at every stage of formal schooling, and even before that.</p>
<p>The key lies in creating a supportive and encouraging environment at home. </p>
<p>In the school environment, teachers tend to be instructional leaders. This means they often focus on the classroom process of teaching and learning. Together, however, parents and teachers can help boost a child’s learning by sharing educational responsibilities at home and in school.</p>
<p>Teachers often favour <a href="https://www.researchgate.net/profile/Sylvie-Barma/publication/281244508_Understanding_Complex_Relationships_Between_Teachers_and_Parents/links/57347edd08ae298602debb02/Understanding-Complex-Relationships-Between-Teachers-and-Parents.pdf">traditional modes of parental involvement</a>. This includes having parents supervise school outings or raise funds for school activities. </p>
<p>But it’s possible to find a <a href="https://www.taylorfrancis.com/books/mono/10.4324/9780429494673/school-family-community-partnerships-joyce-epstein">middle ground</a> that harnesses the experiences of teachers and parents, and communicates expectations clearly. This would lead to <a href="https://www.ingentaconnect.com/content/sbp/sbp/2018/00000046/00000011/art00003">three positive outcomes</a>: reduced misunderstandings, the development of mutual goals and establishing trust for the teacher-parent partnership.</p>
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<a href="https://theconversation.com/how-parents-and-teachers-can-make-school-a-happy-place-for-kids-53314">How parents and teachers can make school a happy place for kids</a>
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<p>For more than a decade, through the African Population and Health Research Center’s <a href="https://aphrc.org/wp-content/uploads/2020/01/Endline-Report.pdf">Advancing Learning Outcomes and Transformational Change (ALOT Change) programme</a>, I have studied how parents’ involvement in education can advance learning outcomes. This can be done by monitoring children’s progress in school and helping them complete their homework. Knowing where their children are and who their friends are, and being available to offer insights on issues related to puberty, are also crucial. </p>
<p>To support a child’s educational journey, parents across all socioeconomic groups need to do four main things. First, they need to meet their <a href="https://www.sciencedirect.com/science/article/abs/pii/S0738059311000393">family obligations</a>, which include providing food, shelter and paying school fees. Second, they should provide a conducive environment for children to work on homework assignments. Third, parents need to motivate their children to <a href="https://aphrc.org/wp-content/uploads/2020/01/Endline-Report.pdf">stay focused on learning and avoid peer pressure</a>. Finally, should the need arise, parents should seek support to be educated and empowered on how to help their children succeed in school.</p>
<h2>What to do</h2>
<p>To begin with, parents should meet their <a href="https://aphrc.org/wp-content/uploads/2018/10/GEC-Report.pdf">basic obligations</a> at home and collaborate at the community level. Ensuring children are fed and their fees are paid keeps them in school. Good nutrition <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8839299/#:%7E:text=The%20developing%20human%20brain%20requires,of%20exhibiting%20impaired%20cognitive%20skills.">improves cognitive function</a>, while paying fees <a href="https://files.eric.ed.gov/fulltext/EJ1305014.pdf#page=12">boosts school attendance</a>, enhancing a child’s learning. Across all income groups, but particularly in low-income neighbourhoods, community collaboration enables parents to access the <a href="https://safesupportivelearning.ed.gov/training-technical-assistance/education-level/early-learning/family-school-community-partnerships">support and resources necessary for their children’s learning</a>. This could mean exchanging ideas with other parents, or getting access to career advisers and sports facilities. Collaboration at the community level provides <a href="https://cepsj.si/index.php/cepsj/article/view/89">social capital</a>. This creates opportunities for <a href="https://srcd.onlinelibrary.wiley.com/doi/epdf/10.1111/cdep.12165">bonding</a>, which promotes a child’s social adjustment. </p>
<p>Second, parents should provide their children with <a href="https://www.proquest.com/openview/9e3a9e802f80705150dceec414b8ed1c/1?pq-origsite=gscholar&cbl=41842">places to study, monitor their progress with homework and understand how they are progressing through various grades</a>. Spaces for study should be quiet and well-organised, but they don’t have to be at home. They can be <a href="https://aphrc.org/wp-content/uploads/2020/01/Endline-Report.pdf#page=10">safe spaces within communities</a>, such as churches. Parents can get involved in monitoring their children’s progress by actively communicating with teachers and <a href="https://www.proquest.com/openview/9e3a9e802f80705150dceec414b8ed1c/1?pq-origsite=gscholar&cbl=41842">volunteering in schools</a>, both private and public. This allows parents to get involved in the planning, development and decision-making process of school activities for the benefit of their children.</p>
<p>Third, parents need to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8057542/">provide young children with nurturing care</a> before they begin formal education. They should maintain this caring support throughout the basic education cycle. Parents play <a href="http://41.89.164.27/handle/123456789/1187">key roles as co-educators of their children</a>. This means going beyond just providing the resources needed for learning to supporting a child’s personal development. Parents can do this by encouraging their children to ask questions, which can be answered by their older peers or mentors. Children also need <a href="https://journals.sagepub.com/doi/abs/10.1177/0033688219848770">sufficient playtime and sleep</a>. Parents should motivate their children to complete assigned school assignments by, for instance, shortening the time spent on domestic chores, especially for girls. They should also monitor and give guidance on homework where possible, and provide learning aids and materials for practical activities.</p>
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<a href="https://theconversation.com/education-in-kenyas-informal-settlements-can-work-better-if-parents-get-involved-heres-how-192149">Education in Kenya's informal settlements can work better if parents get involved -- here's how</a>
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<p>Fourth, I was part of a research team at the African Population and Health Research Centre that found that <a href="https://aphrc.org/wp-content/uploads/2020/01/Endline-Report.pdf#page=9">giving parents access to counsellors</a> to guide them on how to support their children’s schooling improved education performances in informal settlements in Nairobi, Kenya. </p>
<p>Under this intervention, parents were taught what their role is as the first supporters of their children’s education. This role includes taking the time to understand their children, opening lines of communication, discussing sexual and reproductive health matters, and encouraging positive aspirations. The <a href="https://aphrc.org/wp-content/uploads/2020/01/Endline-Report.pdf#page=16">results</a> included an improvement in children’s literacy. </p>
<p>When we asked pupils to explain the relationship between parental support and achievements in literacy and numeracy, <a href="https://aphrc.org/wp-content/uploads/2020/01/Endline-Report.pdf#page=29">they reported a better understanding of mathematical concepts, enhanced ability to interpret mathematical problem statements and improvements in understanding algebra and composition</a>. One of the reasons for this outcome was that both parents and pupils were more open with each other. They shared their opinions, needs and actions.</p>
<h2>Expected outcomes</h2>
<p>Parental involvement in education empowers children to reach their full potential. It improves their academic performance, enhances their social and emotional development, and increases their motivation and engagement. Parental involvement tends to lead to better school attendance, positive behaviour and higher aspirations for future success. When parents take an active role in their children’s learning, it fosters stronger parent-child relationships, creating a supportive environment for academic growth and personal development.</p><img src="https://counter.theconversation.com/content/224754/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Benta A. Abuya, Research Scientist, APHRC receives funding from Wellsprings Philanthropic Fund. </span></em></p>Studies show that teaching parents how to support their children can lead to improvements in literacy.Benta A. Abuya, Research Scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2231812024-03-12T06:26:19Z2024-03-12T06:26:19ZDoes intermittent fasting have benefits for our brain?<figure><img src="https://images.theconversation.com/files/579767/original/file-20240305-20-q62h9n.jpg?ixlib=rb-1.1.0&rect=17%2C8%2C5850%2C3598&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/group-elderly-women-have-breakfast-cafeteria-2237394693">Shutterstock</a></span></figcaption></figure><p>Intermittent fasting has become a popular dietary approach to help people lose or manage their <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8683964/">weight</a>. It has also been promoted as a way to reset metabolism, control chronic disease, slow ageing and <a href="https://pubmed.ncbi.nlm.nih.gov/27810402">improve overall health</a>.</p>
<p>Meanwhile, some research suggests intermittent fasting may offer a different way for the brain to access energy and provide protection against neurodegenerative diseases like <a href="https://link.springer.com/article/10.1007/s11011-023-01288-2">Alzheimer’s disease</a>. </p>
<p>This is not a new idea – the ancient Greeks believed fasting <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8839325/">enhanced thinking</a>. But what does the modern-day evidence say?</p>
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<a href="https://theconversation.com/i-want-to-eat-healthily-so-why-do-i-crave-sugar-salt-and-carbs-212114">I want to eat healthily. So why do I crave sugar, salt and carbs?</a>
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<h2>First, what is intermittent fasting?</h2>
<p>Our <a href="https://pubmed.ncbi.nlm.nih.gov/35487190/">diets</a> – including calories consumed, macronutrient composition (the ratios of fats, protein and carbohydrates we eat) and when meals are consumed – are factors in our lifestyle we can change. People do this for cultural reasons, desired weight loss or potential health gains.</p>
<p>Intermittent fasting consists of short periods of calorie (energy) restriction where food intake is limited for 12 to 48 hours (usually 12 to 16 hours per day), followed by periods of normal food intake. The intermittent component means a re-occurrence of the pattern rather than a “one off” fast. </p>
<p>Food deprivation beyond 24 hours typically constitutes starvation. This is distinct from fasting due to its specific and potentially harmful biochemical alterations and nutrient deficiencies if continued for long periods.</p>
<h2>4 ways fasting works and how it might affect the brain</h2>
<p>The brain accounts for about <a href="https://theconversation.com/how-much-energy-do-we-expend-thinking-and-using-our-brain-197990">20% of the body’s energy consumption</a>.</p>
<p>Here are four ways intermittent fasting can act on the body which could help explain its potential effects on the brain.</p>
<p><strong>1. Ketosis</strong></p>
<p>The goal of many intermittent fasting routines is to flip a “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5913738/">metabolic switch</a>” to go from burning predominately carbohydrates to burning fat. This is called ketosis and typically occurs after 12–16 hours of fasting, when liver and glycogen stores are depleted. <a href="https://www.ncbi.nlm.nih.gov/books/NBK493179/">Ketones</a> – chemicals produced by this metabolic process – become the preferred energy source for the brain. </p>
<p>Due to this being a slower metabolic process to produce energy and potential for lowering blood sugar levels, ketosis can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10844723/">cause symptoms</a> of hunger, fatigue, nausea, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8754590/">low mood</a>, irritability, constipation, headaches, and brain “fog”. </p>
<p>At the same time, as glucose metabolism in the brain declines with ageing, studies have shown ketones could provide an alternative energy source to <a href="https://www.science.org/doi/10.1126/science.aau2095">preserve brain function</a> and prevent <a href="https://pubmed.ncbi.nlm.nih.gov/32709961/">age-related neurodegeneration disorders and cognitive decline</a>.</p>
<p>Consistent with this, increasing ketones through <a href="https://pubmed.ncbi.nlm.nih.gov/31027873/">supplementation</a> or <a href="https://pubmed.ncbi.nlm.nih.gov/31757576/">diet</a> has been shown to improve cognition in adults with mild cognitive decline and those at risk of Alzheimer’s disease respectively. </p>
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<a href="https://theconversation.com/does-it-matter-what-time-of-day-i-eat-and-can-intermittent-fasting-improve-my-health-heres-what-the-science-says-203762">Does it matter what time of day I eat? And can intermittent fasting improve my health? Here's what the science says</a>
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<p><strong>2. Circadian syncing</strong></p>
<p>Eating at times that <a href="https://pubmed.ncbi.nlm.nih.gov/32480126/">don’t match our body’s natural daily rhythms</a> can disrupt how our organs work. Studies in shift workers have suggested this might also make us more prone to <a href="https://pubmed.ncbi.nlm.nih.gov/22010477/">chronic disease</a>. </p>
<p>Time-restricted eating is when you eat your meals within a six to ten-hour window during the day when you’re most active. Time-restricted eating causes changes in <a href="https://pubmed.ncbi.nlm.nih.gov/36599299/">expression of genes in tissue</a> and helps the body during rest and activity. </p>
<p>A 2021 <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7827225/">study of 883 adults</a> in Italy indicated those who restricted their food intake to ten hours a day were less likely to have cognitive impairment compared to those eating without time restrictions. </p>
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<a href="https://images.theconversation.com/files/579766/original/file-20240305-30-b9gwh4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="older man playing chess" src="https://images.theconversation.com/files/579766/original/file-20240305-30-b9gwh4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579766/original/file-20240305-30-b9gwh4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579766/original/file-20240305-30-b9gwh4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579766/original/file-20240305-30-b9gwh4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579766/original/file-20240305-30-b9gwh4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579766/original/file-20240305-30-b9gwh4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579766/original/file-20240305-30-b9gwh4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Matching your eating to the active parts of your day may have brain benefits.</span>
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<p><strong>3. Mitochondria</strong></p>
<p>Intermittent fasting may provide <a href="https://pubmed.ncbi.nlm.nih.gov/35218914/">brain protection</a> through improving mitochondrial function, metabolism and reducing oxidants.</p>
<p>Mitochondria’s <a href="https://www.genome.gov/genetics-glossary/Mitochondria">main role is to produce energy</a> and they are crucial to brain health. Many age-related diseases are closely related to an energy supply and demand imbalance, likely attributed to <a href="https://www.nature.com/articles/s41574-021-00626-7">mitochondrial dysfunction during ageing</a>. </p>
<p>Rodent studies suggest alternate day fasting or reducing calories <a href="https://journals.sagepub.com/doi/10.1038/jcbfm.2014.114">by up to 40%</a> might protect or improve <a href="http://www.ncbi.nlm.nih.gov/pubmed/21861096">brain mitochondrial function</a>. But not all studies support this theory. </p>
<p><strong>4. The gut-brain axis</strong></p>
<p>The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6469458/">gut and the brain communicate with each other</a> via the body’s nervous systems. The brain can influence how the gut feels (think about how you get “butterflies” in your tummy when nervous) and the gut can affect mood, cognition and mental health.</p>
<p>In mice, intermittent fasting has shown promise for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5913738/">improving brain health</a> by increasing survival and <a href="https://pubmed.ncbi.nlm.nih.gov/12354284/">formation of neurons</a> (nerve cells) in the hippocampus brain region, which is involved in memory, learning and emotion. </p>
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<a href="https://images.theconversation.com/files/579770/original/file-20240305-18-cqzgoc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="medical clinician shows woman a sheet of brain scans" src="https://images.theconversation.com/files/579770/original/file-20240305-18-cqzgoc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579770/original/file-20240305-18-cqzgoc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579770/original/file-20240305-18-cqzgoc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579770/original/file-20240305-18-cqzgoc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579770/original/file-20240305-18-cqzgoc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579770/original/file-20240305-18-cqzgoc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579770/original/file-20240305-18-cqzgoc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">What we eat can affect our brain, and vice versa.</span>
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<p>There’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8470960/">no clear evidence</a> on the effects of intermittent fasting on cognition in healthy adults. However one 2022 study interviewed 411 older adults and found <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9646955/">lower meal frequency</a> (less than three meals a day) was associated with reduced evidence of Alzheimer’s disease on brain imaging.</p>
<p>Some research has suggested calorie restriction may have a protective effect against <a href="https://academic.oup.com/nutritionreviews/article/81/9/1225/7116310">Alzheimer’s disease</a> by reducing oxidative stress and inflammation and promoting vascular health. </p>
<p>When we look at the effects of overall energy restriction (rather than intermittent fasting specifically) the evidence is mixed. Among people with mild cognitive impairment, one study showed <a href="https://pubmed.ncbi.nlm.nih.gov/26713821/">cognitive improvement</a> when participants followed a calorie restricted diet for 12 months. </p>
<p>Another study found a 25% calorie restriction was associated with <a href="https://pubmed.ncbi.nlm.nih.gov/30968820">slightly improved working memory</a> in healthy adults. But a <a href="https://www.sciencedirect.com/science/article/pii/S0022316623025221?via%3Dihub">recent study</a>, which looked at the impact of calorie restriction on spatial working memory, found no significant effect.</p>
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<a href="https://theconversation.com/yes-intermittent-fasting-can-boost-your-health-but-how-and-when-to-restrict-food-consumption-is-crucial-197170">Yes, intermittent fasting can boost your health, but how and when to restrict food consumption is crucial</a>
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<h2>Bottom line</h2>
<p>Studies in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9740746/">mice</a> support a role for intermittent fasting in improving brain health and ageing, but few studies in humans exist, and the evidence we have is mixed.</p>
<p>Rapid weight loss associated with calorie restriction and intermittent fasting can lead to nutrient deficiencies, muscle loss, and decreased immune function, particularly in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8749464/">older adults</a> whose nutritional needs may be higher. </p>
<p>Further, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6314618/">prolonged fasting</a> or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9042193/">severe calorie restriction</a> may pose risks such as fatigue, dizziness, and electrolyte imbalances, which could exacerbate existing health conditions. </p>
<p>If you’re considering <a href="https://www.nejm.org/doi/10.1056/NEJMra1905136?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">intermittent fasting</a>, it’s best to seek advice from a health professional such as a dietitian who can provide guidance on structuring fasting periods, meal timing, and nutrient intake. This ensures intermittent fasting is approached in a safe, sustainable way, tailored to individual needs and goals.</p><img src="https://counter.theconversation.com/content/223181/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alongside her academic role, Hayley O'Neill works as a wellness consultant.</span></em></p>Many dieters vouch for the effect of intermittent fasting on their body – but what about their brain?Hayley O'Neill, Assistant Professor, Faculty of Health Sciences and Medicine, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2083442024-02-09T12:19:13Z2024-02-09T12:19:13ZGut microbiome: meet Asaccharobacter celatus – the brain health bug<figure><img src="https://images.theconversation.com/files/538750/original/file-20230721-34776-o9yhip.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1021%2C477&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/colorful-retro-low-poly-brain-illustration-1150492685">Jolygon/Shutterstock</a></span></figcaption></figure><p>There’s a great deal of interest from scientists and the public alike in how we can keep our minds sharp and our brains healthy as we get older.</p>
<p>While some factors that increase the risk of dementia cannot be modified, <a href="https://www.thelancet.com/article/S0140-6736(13)60630-3/fulltext">including genetics</a>, there are <a href="https://www.frontiersin.org/articles/10.3389/fpsyg.2022.1070259/full">several factors</a> we do have control over that evidence has shown can offer some protection against cognitive decline.</p>
<p>For example, <a href="https://pn.bmj.com/content/20/3/234.abstract">exercise</a> reduces the likelihood of developing cognitive impairment and dementia. A <a href="https://content.iospress.com/articles/journal-of-alzheimers-disease/jad210705">healthy diet</a>, too, has been linked to better performance <a href="https://www.sciencedirect.com/science/article/abs/pii/S1552526015001946">on cognitive tasks</a>. </p>
<p>Research over recent years also suggests our <a href="https://link.springer.com/article/10.1007/s11011-016-9917-8#Sec8">gut bacteria</a> may have a role in helping us maintain our brain health as we age. My own preliminary research suggests one gut bug in particular called <em>Asaccharobacter celatus</em> (<em>A celatus</em>) could be useful.</p>
<h2>Cognitive impairment and dementia</h2>
<p>Many people report increased incidents of forgetfulness as they get older, such as mixing up dates for appointments, or briefly forgetting where they parked their car. These infrequent moments of forgetfulness are normal – a small loss of brain function is <a href="https://doi.org/10.1016/j.mayocp.2014.06.019">typical as we age</a>. </p>
<p>Yet, as brain function continues to decline, people may start to have more symptoms more often. Scientists refer to this as <a href="https://www.sciencedirect.com/science/article/abs/pii/S1064748112609324">“mild cognitive impairment”</a>. Worryingly, this often progresses to more severe impairment of brain function known as <a href="https://karger.com/dem/article/19/5-6/383/98969/Mild-Cognitive-Impairment-An-Operational">dementia</a>. </p>
<p>Dementia affects more than <a href="https://www.who.int/news-room/fact-sheets/detail/dementia">55 million people</a> around the world, and projections suggest this number will increase to <a href="https://www.alzint.org/resource/numbers-of-people-with-dementia-worldwide/">82 million</a> by 2030.</p>
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<a href="https://theconversation.com/covid-and-your-gut-how-a-healthy-microbiome-can-reduce-the-severity-of-infection-and-vice-versa-195132">COVID and your gut: how a healthy microbiome can reduce the severity of infection – and vice versa</a>
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</em>
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<h2>How gut bacteria could help</h2>
<p>The bacteria in our gut perform functions that benefit <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4425030/">our overall health</a>. For example, various bacteria are involved in <a href="https://journals.lww.com/eurjcancerprev/Abstract/1997/03001/flora_and_andogenous_vitamin_synthesis.9.aspx">producing essential vitamins</a>.</p>
<p><em>A celatus</em>, along with certain <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6770660/">other bacteria</a>, is capable of producing a compound <a href="https://doi.org/10.1099/ijs.0.64894-0">known as equol</a>. These bacteria make equol from a compound called daidzein, which is found in <a href="https://www.mdpi.com/2218-273X/10/6/950">soy products</a> including soy milk, tofu and tempeh.</p>
<p>While equol is not an essential nutrient, it has been linked to <a href="https://www.mdpi.com/1422-0067/23/19/11921">improved brain function</a> in older adults. But not everyone has enough <em>A celatus</em> in their gut <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6412946/">to produce equol</a>. </p>
<p>A range of factors influence the composition of our gut microbiota, including environment, geographic region and diet. People who have low amounts of <em>A celatus</em>, or bacteria like it, are termed “non-equol producers”. As many as <a href="https://www.mdpi.com/2072-6643/11/2/433">70% of the western population</a> are non-equol producers, while only around 50% of Japanese people don’t produce equol.</p>
<figure class="align-center ">
<img alt="An array of soy products including soy milk, tofu, soy beans and soy sauce." src="https://images.theconversation.com/files/538751/original/file-20230721-25-xuyiuq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/538751/original/file-20230721-25-xuyiuq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/538751/original/file-20230721-25-xuyiuq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/538751/original/file-20230721-25-xuyiuq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/538751/original/file-20230721-25-xuyiuq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/538751/original/file-20230721-25-xuyiuq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/538751/original/file-20230721-25-xuyiuq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"><em>A.celatus</em> bacteria make equol from a compound found in soy products.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/soy-bean-tofu-other-products-183212168">naito29/Shutterstock</a></span>
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</figure>
<p>In many cases, we can influence the make-up of our gut bacteria through <a href="https://www.mdpi.com/2072-6643/11/12/2862">our diet</a>, and this appears to be true for <em>A celatus</em>. <a href="https://ift.onlinelibrary.wiley.com/doi/full/10.1111/j.1750-3841.2010.01860.x">Research suggests</a> it’s possible to go from being a non-equol to an equol producer by consuming soy foods high in daidzein, the compound that <em>A celatus</em> converts to equol. </p>
<p>This may partly explain why people in Japan are more likely to be equol producers – they consume <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6770660/">more soy products</a> compared with people from western countries.</p>
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Read more:
<a href="https://theconversation.com/gut-bacteria-rewind-ageing-brain-in-mice-165831">Gut bacteria rewind ageing brain in mice</a>
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</em>
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<p>However, other research has shown consumption of soy foods in the diet has <a href="https://doi.org/10.1093/gerona/62.5.556">no effect on cognitive function</a>. This could be due to a low consumption of soy foods in the group being studied, or participants not having enough <em>A celatus</em> bacteria to produce equol. </p>
<p>All this suggests that, alongside the bacteria, we already have in our gut microbiome, what we eat could be equally important. Both may be required for optimal health and to help stave off cognitive decline. </p>
<h2>My research</h2>
<p>I recently completed a study which showed that <em>A celatus</em> was associated with a component of brain function known as <a href="https://www.annualreviews.org/doi/10.1146/annurev-psych-113011-143750">executive function</a>. This relates to complex cognitive tasks we perform daily, including doing maths in our head, or reorganising the day’s tasks in our mind when something unexpectedly changes. </p>
<p>I found that the more <em>A celatus</em> bacteria were in healthy older adults aged 50 to 80 (measured by sequencing stool samples), the greater their scores on an executive function test. But it’s important to note that these findings are yet to be published in a peer-reviewed journal.</p>
<p>This research appears promising, but we need more evidence to confirm the potential benefits of both <em>A celatus</em> bacteria and soy foods in helping older people maintain their brain health as they age.</p>
<hr>
<p><em>This article is part of <a href="https://theconversation.com/uk/topics/meet-your-gut-microbes-150943?utm_source=InArticleTop&utm_medium=TCUK&utm_campaign=Health2024">Meet Your Gut Microbes</a>, a series about the rich constellation of bacteria, viruses, archaea and fungi that live in people’s digestive tracts. Scientists are increasingly realising their importance in shaping our health – both physical and mental. Each week we will look at a different microbe and bring you the most up-to-date research on them.</em></p>
<hr><img src="https://counter.theconversation.com/content/208344/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nathan Nuzum currently works at University College Cork as part of APC Microbiome and receives funding from the European Union’s Horizon 2020 Research and Innovation Programme under the INSPIRE COFUND Marie Skłodowska Curie grant agreement No. 101034270.
The unpublished/original work referred to in this article was conducted at Deakin University as part of Dr. Nathan Nuzum's PhD. Dr. Nuzum's PhD supervisors for this work includes his primary supervisor Dr. Helen Macpherson, and his co-supervisors (in alphabetical order) Drs. Amy Loughman, Ashlee Hendy, Ewa Szymlek-Gay, and Wei-Peng Teo. </span></em></p>Research suggests certain gut bacteria may have a role in helping us maintain cognitive function as we age. A celatus is one of these.Nathan Nuzum, INSPIRE Postdoctoral Researcher at APC Microbiome Ireland, University College CorkLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2184032023-12-04T16:06:14Z2023-12-04T16:06:14ZExercise benefits physical and brain health in people with Down’s syndrome – new research<figure><img src="https://images.theconversation.com/files/562678/original/file-20231130-17-iuqt1y.jpg?ixlib=rb-1.1.0&rect=50%2C0%2C5568%2C3700&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An exercise as simple and accessible as walking can have significant health benefits for people with Down's syndrome.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-young-man-down-syndrome-his-2190214607">Halfpoint/ Shutterstock</a></span></figcaption></figure><p>Exercise is known to have many benefits when it comes to cognitive function – such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5934999/">improving memory</a> and <a href="https://www.sciencedirect.com/science/article/abs/pii/S0006899312004003?casa_token=4VvVk8VEeEQAAAAA:RNAGs9jDIA2bu13i47PjgMIbP1Axyeov0GNcUGGPu_U_zqPkvOSGhiCvg0Gl9ogOreE26QUfZpQ">concentration skills</a>. Research shows this is true for <a href="https://psycnet.apa.org/record/2015-55483-005">people</a> in many different <a href="https://psycnet.apa.org/record/2015-55483-005">age groups</a>, and even in those with conditions which affect their cognitive ability (such as <a href="https://www.jneurosci.org/content/42/2/288">Alzheimer’s disease</a>).</p>
<p>But until recently, it wasn’t known whether exercise also had cognitive benefits for people with Down’s syndrome – a genetic condition that affects development and learning.</p>
<p>So our research set out to discover whether a prescribed walking programme could improve both physical and cognitive health in people with Down’s syndrome. We found that exercising a few times a week not only improved physical health in people with Down syndrome, it also <a href="https://www.mdpi.com/1660-4601/20/23/7121">improved their cognitive function</a>. </p>
<h2>Changes assessed</h2>
<p>The <a href="https://cdss.ca/mindsets/">MinDSets study</a> was a collaboration between our research team at Anglia Ruskin University and the Canadian Down Syndrome Society. We recruited 83 participants (43 men and 40 women) from across North America, Asia, Europe and Africa. Participants were aged 19 to 42 years old. Activity monitors were given to participants to measure their physical and cognitive health throughout the eight-week study period.</p>
<p>Physical fitness was assessed at the start and end of the study using a <a href="https://link.springer.com/article/10.1007/s10882-018-9619-8">six-minute walk test</a>. The greater the distance a participant could walk in six minutes, the better their physical fitness. </p>
<p>Cognitive health was assessed using a <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/stroop-test#:%7E:text=The%20standard%20Stroop%20Test%20">series of tests</a> which looked at short-term memory, concentration, decision-making skills and speed of decisions.</p>
<p>Participants were then divided into four different groups. The first group did a 30-minute walk three times a week. The second group did 20 minutes of brain training games six days a week. The third group did both the walk and the brain training games. The last group was a control group – meaning they did not do any of the activities and stuck to their normal routine. </p>
<p>The group that walked three times a week increased their walking distance by nearly 10%. In the combined group, who did both the walking intervention and the brain training, they improved their walking distance by 12%. There were no changes in distance walked in either the brain training or control groups for distance walked.</p>
<p>When it came to cognitive function, the brain training group, exercise group and combined group all showed improvements in their performance on the cognitive tests. But we were surprised to find that the exercise group and combined group actually showed greater improvements in their performance on the cognitive tests than the brain training group did – particularly on tests looking at decision-making speed and answer accuracy. </p>
<figure class="align-center ">
<img alt="A young man with Down's syndrome types on a laptop." src="https://images.theconversation.com/files/562676/original/file-20231130-23-a7apjl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/562676/original/file-20231130-23-a7apjl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/562676/original/file-20231130-23-a7apjl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/562676/original/file-20231130-23-a7apjl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/562676/original/file-20231130-23-a7apjl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/562676/original/file-20231130-23-a7apjl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/562676/original/file-20231130-23-a7apjl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The brain training group also showed improvements on the cognitive tests.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/down-syndrome-adult-man-sitting-indoors-1869079057">Ground Picture/ Shutterstock</a></span>
</figcaption>
</figure>
<p>These results suggest that exercise on its own can help improve both physical health and cognitive function in people with Down’s syndrome. But combining regular exercise with brain training may provide the greatest boost to physical fitness and brain health.</p>
<p>This was an innovative study in its design, as all the participants and their caregivers became the data collectors. This approach does mean that there’s more chance of errors compared to if data was collected in the lab. But looking at a group as large as we did ensured that the results were more reflective of the Down’s syndrome population as a whole.</p>
<h2>Walking and brain health</h2>
<p>Walking is a <a href="https://www.sciencedirect.com/science/article/pii/S014976341500202X">complex task</a>. It activates numerous areas of the brain in order to drive movement and regulate <a href="https://www.sciencedirect.com/science/article/pii/S1053811909013494">stability and coordination</a>. </p>
<p>For every step you take, a flow of information is generated by the brain – and this information is <a href="https://www.researchgate.net/profile/Cyril-Camachon-2/publication/10760744_The_learning_of_goal-directed_locomotion_A_perception-action_perspective/links/5655824608ae4988a7b0b45e/The-learning-of-goal-directed-locomotion-A-perception-action-perspective.pdf">continually monitored</a> to ensure your body can readily adapt to the environment (such as if the road becomes uneven).</p>
<p>Walking therefore uses quite a bit of cognitive power. For the participants of our study, walking required them to pay attention to the task at hand – forcing them to develop their attention and concentration skills while exercising. These are transferable skills to everyday life, so when the cognitive tests were given, participants were able to put these skills to use – especially on the tasks requiring sustained focus.</p>
<p>The next step for research in this area will be to focus on what effect more complex exercises (such as dancing) may have on cognitive function.</p>
<p>Our work shows that for people with Down’s syndrome, an exercise as simple and accessible as walking can have significant benefits for both physical fitness and cognitive health.</p>
<p>This is important, as people with Down’s syndrome are at greater risk of <a href="https://jamanetwork.com/journals/jama/article-abstract/2771907">certain health conditions</a>. Many people with Down’s syndrome also often <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jar.12773">fall short</a> of recommended activity minimums, which may further increase their risk of poor health.</p><img src="https://counter.theconversation.com/content/218403/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dan Gordon received funding from the Canadian Down Syndrome Society who commissioned this work. </span></em></p><p class="fine-print"><em><span>Marie Gernigon does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A 30-minute walk three times a week was shown to improve physical health and brain function in people with Down’s syndrome.Dan Gordon, Associate Professor, Cardiorespiratory Exercise Physiology, Anglia Ruskin UniversityMarie Gernigon, Associate Professor in Exercise Physiology, Faculté des Sciences du Sport, Laboratoire CIAMS, Université Paris-SaclayLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2168282023-11-16T01:33:57Z2023-11-16T01:33:57ZDoes screen use really impact our thinking skills? Our analysis suggests it could<p>Screens have become seamlessly integrated into our daily lives, serving as indispensable tools for work, education and leisure. But while they enrich our lives in countless ways, we often fail to consider the potential impact of screen time on our cognitive abilities.</p>
<p>In a <a href="https://link.springer.com/article/10.1007/s11065-023-09612-4">new meta-analysis</a> of dozens of earlier studies, we’ve found a clear link between disordered screen use and lower cognitive functioning.</p>
<p>The findings suggest we should exercise caution before advocating for more screen time, and before introducing screens into even more aspects of daily life. </p>
<h2>Young people’s screen time is increasing</h2>
<p>In 2020, a UNSW Gonski Institute for Education report <a href="https://www.gie.unsw.edu.au/sites/default/files/documents/UNSW%20GIE%20GUD%20Phase%201%20Technical%20Report%20MAR20%20v2.pdf">noted a concerning statistic</a>: about 84% of Australian educators believe digital technologies are distracting in a learning environment.</p>
<p>And according to the ABC, a recent Beyond Blue <a href="https://www.abc.net.au/news/2023-09-18/mental-health-depression-anxiety-support-coming-for-schools/102831464">survey</a> of Australian teachers identified excessive screen time as the second-most significant challenge for young people, just behind mental health issues. </p>
<p>Despite mounting concerns, more than half of Australian schools have embraced a “<a href="https://www.linewize.io/anz/blog/the-rise-of-byod-in-australian-schools">bring your own device</a>” policy. Students are spending more time online than <a href="https://read.oecd-ilibrary.org/education/students-computers-and-learning_9789264239555-en#page46">ever before</a> and starting at increasingly younger ages. A 2021 report by <a href="https://www.commonsensemedia.org/sites/default/files/research/report/8-18-census-integrated-report-final-web_0.pdf">Common Sense Media</a> estimated tweens spend an average of 5 hours and 33 minutes using screen-based entertainment each day, while teenagers devote a whopping 8 hours and 39 minutes.</p>
<p>A surge in screen use has led to some individuals, including children, adolescents and adults, developing screen-related addictions. One example is gaming disorder, for which <a href="https://journals.sagepub.com/doi/full/10.1177/0004867420962851">2–3% of people</a> meet the criteria. </p>
<h2>What is ‘disordered screen use’?</h2>
<p>The impact of screens on our cognitive abilities – that is, our thinking skills such as attention, memory, language and problem-solving – has sparked much debate. </p>
<p>On one hand, some researchers and reporters claim screen use can have negative effects, such as <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-12701-3">health problems</a>, shortened attention <a href="https://time.com/3858309/attention-spans-goldfish/">spans</a> and hindered <a href="https://www.researchgate.net/publication/312489265_The_relationship_between_television_exposure_and_children's_cognition_and_behaviour_A_systematic_review">development</a>.</p>
<p>On the other, schools are <a href="https://www.smh.com.au/education/tech-takeover-classrooms-crowded-with-digital-devices-20200125-p53ul1.html">increasingly adopting</a> technology to boost student engagement. Tech companies are also marketing their products as tools to help you enhance your problem-solving and memory skills.</p>
<p>Our <a href="https://link.springer.com/article/10.1007/s11065-023-09612-4">recent study</a> sought to understand the potential cognitive consequences of “disordered screen-related behaviours”. This is a broad category of problematic behaviours that may include screen dependency, and persisting with screen use even when it’s harmful.</p>
<p>We conducted a meta-analysis of 34 studies that explored various forms of screen use (including gaming, internet browsing, smartphone use and social media use) and compared the cognitive performance of individuals with disordered screen use to those without it. </p>
<p>Our findings paint a concerning picture.</p>
<h2>Differences in cognitive function</h2>
<p>Across these rigorously peer-reviewed studies, individuals with disordered screen use consistently demonstrated significantly poorer cognitive performance compared to others.</p>
<p>The most affected cognitive domain was attention, and specifically sustained attention, which is the ability to maintain focus on an unchanging stimulus for an extended period.</p>
<p>The second-most notable difference was in their “executive functioning” – particularly in impulse control, which is the ability to control one’s automatic responses. </p>
<p>Interestingly, the type of screen activity didn’t make a difference in the results. The trend also wasn’t confined to children, but was observed across all age groups.</p>
<h2>Two ways to interpret the results</h2>
<p>Why do people with disordered screen-related behaviours have poorer cognitive functioning? </p>
<p>The first explanation is that disordered screen use actually leads to poorer cognitive function, including poorer attention skills (but we’ll need more experimental and longitudinal studies to establish causality).</p>
<p>If this is the case, it may be the result of being constantly bombarded by algorithms and features designed to capture our attention. By diverting our focus outward, screen use may weaken one’s intrinsic ability to concentrate over time.</p>
<p>Crucially, impaired attention also <a href="https://akjournals.com/view/journals/2006/10/1/article-p77.xml">makes it harder to disengage</a> from addictive behaviours, and would therefore make it harder to recognise when screen use has become a problem.</p>
<p>The second explanation is that people who already have poorer cognitive functioning (such as less inhibitory control) are more likely to engage in disordered screen use. </p>
<p>This could be a result of the plethora of addictive cues designed to keep us glued to our screens. Being bombarded by these could make it harder to <a href="https://akjournals.com/view/journals/2006/9/4/article-p990.xml">pull the brakes</a> on screen use.</p>
<p>Although the literature doesn’t seem to favour this explanation – and does seem to suggest that cognitive functioning is impaired as a result of disordered screen use – it’s still a possibility we can’t rule out. </p>
<p>Attention is the bedrock of everyday tasks. People with weakened attention may struggle to keep up in less stimulating environments, such as a static workplace or classroom. They may find themselves turning to a screen as a result.</p>
<p>Similarly, people with less inhibitory control would also find it more challenging to moderate their screen use. This could be what drives them towards problematic screen-related behaviours in the first place.</p>
<h2>Who should shoulder the responsibility?</h2>
<p>Research indicates people with impaired cognitive functioning usually aren’t as well equipped to moderate their own screen time. </p>
<p>Many users with disordered screen use are <a href="https://www.sciencedirect.com/science/article/pii/S0747563220302326?casa_token=BQv_N_MFffYAAAAA:AsGkAfdwXjCZHJB463G40Mx-ckS2Q1c8jSOn2SWR_9iW64eWaQsru1IJAZBDCgSPXwhZ3Qwl">young</a>, with mainly males engaging in internet gaming and mainly females engaging in social media use. Neurodiverse people are <a href="https://www.mdpi.com/1660-4601/19/9/5587">also at greater risk</a>. </p>
<p>Tech companies are driven by the goal of <a href="https://www.theguardian.com/technology/2017/apr/18/netflix-competitor-sleep-uber-facebook">capturing our attention</a>. For instance, Netflix chief executive Reed Hastings acknowledged the company’s <a href="https://www.theguardian.com/technology/2017/apr/18/netflix-competitor-sleep-uber-facebook">most formidable competitor was sleep</a>.</p>
<p>At the same time, researchers find themselves struggling to keep up with the pace of technological innovation. A potential path forward is to encourage open-access data policies from tech companies, so researchers can delve deeper into the study of screen use and its effect on individuals. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tv-can-be-educational-but-social-media-likely-harms-mental-health-what-70-years-of-research-tells-us-about-children-and-screens-216638">TV can be educational but social media likely harms mental health: what 70 years of research tells us about children and screens</a>
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<img src="https://counter.theconversation.com/content/216828/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michoel Moshel receives funding from an Australian Government Research Training Program Scholarship.</span></em></p><p class="fine-print"><em><span>Jennifer Batchelor, Joanne Bennett, and Wayne Warburton do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A meta-analysis of 34 studies has explored how disordered screen use may impact the cognitive performance of individuals.Michoel Moshel, PhD/Masters Clinical Neuropsychology Candidate, Macquarie UniversityJennifer Batchelor, Associate Professor, School of Psychological Sciences, Macquarie UniversityJoanne Bennett, Lecturer, Australian Catholic UniversityWayne Warburton, Associate Professor, Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2160582023-11-06T13:35:07Z2023-11-06T13:35:07ZWhat’s your chronotype? Knowing whether you’re a night owl or an early bird could help you do better on tests and avoid scams<figure><img src="https://images.theconversation.com/files/557337/original/file-20231102-21-hyagg8.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6000%2C1994&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Owl chronotypes function better at night, while lark chronotypes are more energized in the morning.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/blue-owl-royalty-free-image/1164845949">The Photo Matrix/Moment, nomis_g/iStock via Getty Images Plus</a></span></figcaption></figure><p>Timing is everything. For early risers and late-nighters alike, listening to your internal clock may be the key to success. From the classroom to the courtroom and beyond, people perform best on challenging tasks at a time of day that <a href="https://doi.org/10.1177/17456916231178553">aligns with their circadian rhythm</a>.</p>
<p><a href="https://theconversation.com/your-body-has-an-internal-clock-that-dictates-when-you-eat-sleep-and-might-have-a-heart-attack-all-based-on-time-of-day-178601">Circadian rhythms</a> are powerful internal timekeepers that drive a person’s physiological and intellectual functioning throughout the day. Peaks in these circadian rhythms vary across individuals. Some people, known as larks or morning chronotypes, peak early and feel at their best in the morning. Others, known as owls or evening chronotypes, peak later in the day and perform best in the late afternoon or evening. And some people show neither morning nor evening preferences and are considered neutral chronotypes.</p>
<p><a href="https://psychology.cofc.edu/about/faculty-and-staff/may-cynthia.php">As a researcher</a> seeking ways to improve cognitive function, I’ve explored whether your chronotype affects your mental performance. Understanding the kinds of mental processes that vary – or remain stable – over the course of a day may help people schedule their tasks in a way that optimizes performance. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/UbQ0RxQu2gM?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Your brain has an internal clock that influences how your body functions over the course of a day.</span></figcaption>
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<h2>Why your chronotype matters</h2>
<p>Chronotype can be measured with a <a href="https://pubmed.ncbi.nlm.nih.gov/1027738/">simple questionnaire</a> that assesses things like your perceived alertness, preferred rising and retiring times and performance throughout the day. Even without a questionnaire, most people have a sense of whether they are a lark or an owl or fall somewhere in between. Do you wake up early, without an alarm, feeling sharp? Are you mentally drained and ready for pj’s by nine? If so, you are likely a morning type. Do you sleep late and wake feeling sluggish and foggy? Are you more energized late at night? If so, you are likely an evening type. </p>
<p>People perform best on many challenging mental tasks – from <a href="https://doi.org/10.1016/0191-8869(90)90056-W">paying attention</a> and <a href="https://psycnet.apa.org/doi/10.1037/pag0000199">learning</a> to <a href="https://doi.org/10.1016/S0191-8869(02)00320-3">solving problems</a> and <a href="https://doi.org/10.1016/j.iree.2021.100226">making complex decisions</a> – when these actions are synchronized with their personal circadian peaks. This is known as the <a href="https://doi.org/10.1111/j.1467-9280.1993.tb00573.x">synchrony effect</a>. Whether you are an air traffic controller scanning the radar, a CFO reviewing an earnings report or a high school student learning chemistry, synchrony can affect how well you perform.</p>
<p>Much of the evidence for synchrony effects comes from lab studies that test both larks and owls early in the morning and late in the day. People with strong chronotypes are <a href="https://doi.org/10.1371/journal.pone.0088820">more vigilant</a> and better able to <a href="https://doi.org/10.1038/s41467-021-24885-0">sustain attention</a> at their peak relative to off-peak times. Their memories are sharper, with <a href="https://doi.org/10.3389/fpsyg.2016.01764">better list recall</a> and more success in <a href="https://doi.org/10.1080/13825585.2016.1238444">remembering “to-do” tasks</a> like taking medication.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/557340/original/file-20231102-17-6nvix8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Hand reaching out under bedsheets towards a blue alarm clock on a nightstand" src="https://images.theconversation.com/files/557340/original/file-20231102-17-6nvix8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/557340/original/file-20231102-17-6nvix8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/557340/original/file-20231102-17-6nvix8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/557340/original/file-20231102-17-6nvix8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/557340/original/file-20231102-17-6nvix8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/557340/original/file-20231102-17-6nvix8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/557340/original/file-20231102-17-6nvix8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">When you feel the urge to hit snooze may tell you something about your circadian rhythm.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/early-morning-royalty-free-image/626952608">eggeeggjiew/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<p>People are also less prone to <a href="https://doi.org/10.1525/collabra.57536">mind wandering</a> and less distracted at their optimal time. For example, a study I conducted gave participants three weakly related cue words (such as “ship,” “outer” and “crawl”). They were tasked to find another word that linked all three (such as “space”). When my team and I presented misleading words alongside the cue words (such as “ocean” for ship, “inner” for outer and “baby” for crawl), those who were tested at synchronous times were <a href="https://doi.org/10.3758/BF03210822">better at ignoring the misleading words</a> and finding the target solution than those who weren’t.</p>
<p>Synchrony also affects high-level cognitive functions like persuasion, reasoning and decision-making. Studies on consumers have found that people are more <a href="https://doi.org/10.1016/j.paid.2005.01.021">discerning</a>, <a href="https://doi.org/10.1007/s11002-013-9247-0">skeptical</a> and <a href="https://doi.org/10.1002/mar.20169">analytical</a> at their peak times. They <a href="https://doi.org/10.1016/j.ijresmar.2008.04.002">invest more time and effort</a> in assigned tasks and are more likely to <a href="https://doi.org/10.1016/j.jcps.2009.08.002">search for important information</a>. Consequently, people make <a href="https://doi.org/10.1016/j.jbusvent.2021.106165">better investment decisions</a>, are less <a href="https://doi.org/10.1111/j.1467-9280.1990.tb00226.x">prone to bias</a> and are <a href="https://doi.org/10.1007/s11002-013-9247-0">more likely to detect scams</a>. </p>
<p>At off-peak times it takes people <a href="https://doi.org/10.1016/S0191-8869(02)00320-3">longer to solve problems</a>, and they tend to be <a href="https://doi.org/10.1016/j.paid.2012.10.031">less careful</a> and more <a href="https://doi.org/10.1111/j.1467-9280.1990.tb00226.x">reliant on mental shortcuts</a>, leaving them <a href="https://doi.org/10.1007/s11002-013-9247-0">vulnerable to flashy marketing schemes</a>. Even ethical behavior can be compromised at non-optimal times, as people are <a href="https://doi.org/10.1177/0956797614541989">more likely to cheat</a> at their off-peak times.</p>
<h2>In the classroom and the clinic</h2>
<p>The basic mental abilities that are affected by synchrony – including attention, memory and analytical thinking – are all skills that contribute to academic success. This connection is especially significant for teens, who <a href="https://doi.org/10.1080/00221325.2010.535225">tend to be night owls</a> but typically start school early.</p>
<p>One study randomly assigned over 700 adolescents to exam times in the early morning, late morning or afternoon. <a href="https://doi.org/10.1177/0748730414564786">Owls had lower scores</a> relative to larks in both morning sessions, but this disadvantage disappeared for owls taking the exam in the afternoon. Early start times may put student owls a step behind larks.</p>
<p>Time of day may also be a consideration when conducting assessments for cognitive disorders like attention-deficit disorder or Alzheimer’s disease. Scheduling time may be particularly significant for <a href="https://doi.org/10.3389/fpsyg.2019.00003">older adults, who tend to be larks</a> and often show <a href="https://doi.org/10.1080/17470210902834852">larger synchrony effects</a> than young adults. Performance is better at peak times on <a href="https://doi.org/10.1080/13825585.2015.1028326">several key neuropsychological measures</a> used to assess these conditions. Failing to consider synchrony may affect the accuracy of diagnoses and subsequently have consequences for clinical trial eligibility and data on treatment effectiveness.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/557341/original/file-20231102-27-tovoh8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Person writing on a piece of paper on a clipboard with a pen" src="https://images.theconversation.com/files/557341/original/file-20231102-27-tovoh8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/557341/original/file-20231102-27-tovoh8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/557341/original/file-20231102-27-tovoh8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/557341/original/file-20231102-27-tovoh8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/557341/original/file-20231102-27-tovoh8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/557341/original/file-20231102-27-tovoh8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/557341/original/file-20231102-27-tovoh8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">What time of day you take a cognitive test may influence your results.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-hand-writing-on-clipboard-with-a-pen-royalty-free-image/1434437996">Violeta Stoimenova/E+ via Getty Images</a></span>
</figcaption>
</figure>
<p>Of course, synchrony doesn’t affect performance on all tasks or for all people. Simple, easy tasks – like recognizing familiar faces or places, dialing a close friend’s phone number or making a favorite recipe – are unlikely to change over the day. Furthermore, young adults who are <a href="https://doi.org/10.1080/07420528.2023.2256843">neither larks nor owls</a> show less variability in performance over the day.</p>
<p>For those who are true early birds or night owls, tackling the toughest mental tasks at times that align with their personal circadian peaks could improve their outcomes. When small improvements in performance offer an essential edge, synchrony may be one secret to success.</p><img src="https://counter.theconversation.com/content/216058/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cindi May received funding from the National Institute on Aging. She currently serves on the board for Disability Rights South Carolina.</span></em></p>Synchronizing your daily activities to your circadian rhythm could help you improve your performance on a variety of cognitive tasks − and even influence diagnosis of cognitive disorders.Cindi May, Professor of Psychology, College of CharlestonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2081022023-10-24T19:19:31Z2023-10-24T19:19:31ZWhy do people with hoarding disorder hoard, and how can we help?<figure><img src="https://images.theconversation.com/files/532818/original/file-20230620-21-5g5yq2.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C5296%2C3673&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Hoarding disorder is an under-recognised serious mental illness that <a href="https://pubmed.ncbi.nlm.nih.gov/25909628/">worsens with age</a>. It affects <a href="https://pubmed.ncbi.nlm.nih.gov/31200169/">2.5% of the working-age population</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/27939851/">7% of older adults</a>. That’s about 715,000 Australians.</p>
<p>People who hoard and their families often feel ashamed and don’t get the support they need. Clutter can make it hard to do things most of us take for granted, such as eating at the table or sleeping in bed. </p>
<p>In the gravest cases, homes are completely unsanitary, either because it has become impossible to clean or because the person <a href="https://pubmed.ncbi.nlm.nih.gov/23482436/">saves garbage</a>. The <a href="https://pubmed.ncbi.nlm.nih.gov/18275935/">strain on the family</a> can be extreme – couples get divorced, and children grow up feeling unloved. </p>
<p>So why do people with hoarding disorder hoard? And how can we help?</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/532822/original/file-20230620-27-dakmks.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/532822/original/file-20230620-27-dakmks.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/532822/original/file-20230620-27-dakmks.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/532822/original/file-20230620-27-dakmks.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/532822/original/file-20230620-27-dakmks.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/532822/original/file-20230620-27-dakmks.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/532822/original/file-20230620-27-dakmks.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/532822/original/file-20230620-27-dakmks.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Research has shown genetic factors can play a role in hoarding.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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Read more:
<a href="https://theconversation.com/obsessive-compulsive-disorder-is-more-common-than-you-think-but-it-can-take-9-years-for-an-ocd-diagnosis-196651">Obsessive compulsive disorder is more common than you think. But it can take 9 years for an OCD diagnosis</a>
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</em>
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<h2>What causes hoarding disorder?</h2>
<p>Saving millions of objects, many worthless by objective standards, often makes little sense to those unfamiliar with the condition. </p>
<p>However, most of us<a href="https://www.sciencedirect.com/science/article/pii/S2352250X21000282?via%3Dihub"> become attached to at least a few possessions</a>. Perhaps we love the way they look, or they trigger fond memories.</p>
<p>Hoarding involves this same type of object attachment, as well over-reliance on possessions and <a href="https://pubmed.ncbi.nlm.nih.gov/32402421/">difficulty being away from them</a>.</p>
<p>Research has shown genetic factors play a role but there is no one <a href="https://pubmed.ncbi.nlm.nih.gov/27445875/">single gene that causes hoarding disorder</a>. Instead, a range of psychological, neurobiological, and social factors can be at play.</p>
<p>Although some who hoard report being deprived of material things in childhood, emotional deprivation may play a <a href="https://pubmed.ncbi.nlm.nih.gov/20934847/">stronger role</a>. </p>
<p>People with hoarding problems often report excessively cold parenting, difficulty connecting with others, and more <a href="https://pubmed.ncbi.nlm.nih.gov/34717158/">traumatic experiences</a>.</p>
<p>They may end up believing people are unreliable and untrustworthy, and that it’s better to rely on objects for comfort and safety. </p>
<p>People with hoarding disorder are often as attached or perhaps <a href="https://akjournals.com/view/journals/2006/11/3/article-p941.xml">more attached to possessions</a> than to the people in their life. </p>
<p>Their experiences have taught them their self-identity is tangled up in what they own; that if they part with their possessions, they will lose themselves.</p>
<p>Research shows <a href="https://www.sciencedirect.com/science/article/pii/S0005789421000253?via%3Dihub">interpersonal problems</a>, such as loneliness, are linked to greater <a href="https://pubmed.ncbi.nlm.nih.gov/32853881/">attachment to objects</a>.</p>
<p>Hoarding disorder is also associated with high rates of <a href="https://pubmed.ncbi.nlm.nih.gov/34923357/">attention deficit and hyperactivity disorder</a>. Difficulties with <a href="https://pubmed.ncbi.nlm.nih.gov/30907337/">decision-making</a>, planning, <a href="https://akjournals.com/view/journals/2006/12/3/article-p827.xml">attention</a> and categorising can make it hard to organise and <a href="https://pubmed.ncbi.nlm.nih.gov/20542489/">discard possessions</a>. </p>
<p>The person ends up avoiding these tasks, which leads to unmanageable levels of clutter.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/554198/original/file-20231017-27-lby73s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A room is filled wall-to-wall with electronic equipment and other items." src="https://images.theconversation.com/files/554198/original/file-20231017-27-lby73s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/554198/original/file-20231017-27-lby73s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/554198/original/file-20231017-27-lby73s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/554198/original/file-20231017-27-lby73s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/554198/original/file-20231017-27-lby73s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/554198/original/file-20231017-27-lby73s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/554198/original/file-20231017-27-lby73s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some end up believing it’s better to rely on objects rather than people.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Not everyone takes the same path to hoarding</h2>
<p>Most people with hoarding disorder also have strong beliefs about their possessions. For example, they are more likely to see beauty or usefulness in things and believe objects possess <a href="https://link.springer.com/article/10.1023/A:1025428631552">human-like qualities</a> such as intentions, emotions, or free will.</p>
<p>Many also feel responsible for objects and for the environment. While others may not think twice about discarding broken or disposable things, people with hoarding disorder can <a href="https://pubmed.ncbi.nlm.nih.gov/30041077/">anguish over their fate</a>. </p>
<p>This need to control, rescue, and protect objects is often at odds with the beliefs of friends and family, which can lead to conflict and <a href="https://pubmed.ncbi.nlm.nih.gov/32853881/">social isolation</a>. </p>
<p>Not everyone with hoarding disorder describes the same pathway to overwhelming clutter. </p>
<p>Some report more cognitive difficulties while others may have experienced more emotional deprivation. So it’s important to take an individualised approach to treatment. </p>
<h2>How can we treat hoarding disorder?</h2>
<p>There is specialised cognitive-behavioural therapy (CBT) tailored for hoarding disorder. <a href="https://academic.oup.com/edited-volume/46862/chapter-abstract/413932715?redirectedFrom=fulltext">Different strategies</a> are used to address the different factors contributing to a person’s hoarding. </p>
<p>Cognitive-behavioural therapy can also help people understand and gradually challenge their beliefs about possessions. </p>
<p>They may begin to consider how to remember, connect, feel safe, or express their identity in ways other via inanimate objects.</p>
<p>Treatment can also help people learn the skills needed to organise, plan, and discard. </p>
<p>Regardless of their path to hoarding, most people with hoarding disorder will benefit from a degree of exposure therapy. </p>
<p>This helps people gradually learn to let go of possessions and resist acquiring more.</p>
<p>Exposure to triggering situations (such as visiting shopping centres, op-shops or mounds of clutter without collecting new items) can help people learn to tolerate their urges and distress.</p>
<p>Treatment can happen in an individual or group setting, and/or via <a href="https://pubmed.ncbi.nlm.nih.gov/35640322/">telehealth</a>.</p>
<p>Research is underway on ways to <a href="https://pubmed.ncbi.nlm.nih.gov/34409679/">improve</a> the <a href="https://www.sciencedirect.com/science/article/pii/S2666915322001421">treatment</a> options further through, for example, learning different emotional regulation strategies.</p>
<h2>Sometimes, a harm-avoidance approach is best</h2>
<p>Addressing the emotional and behavioural drivers of hoarding through cognitive behavioural therapy is crucial.</p>
<p>But hoarding is different to most other psychological disorders. Complex cases may require lots of different agencies to work together.</p>
<p>For example, health-care workers may work with fire and housing officers to ensure the person can <a href="https://pubmed.ncbi.nlm.nih.gov/31984612/">live safely at home</a>.</p>
<p>When people have severe hoarding problems but are reluctant to engage in treatment, a <a href="https://pubmed.ncbi.nlm.nih.gov/21360706/">harm-avoidance approach</a> may be best. This means working with the person with hoarding disorder to identify the most pressing safety hazards and come up with a practical plan to address them.</p>
<p>We must continue to improve our understanding and treatment of this complex disorder and address barriers to accessing help.</p>
<p>This will ultimately help reduce the devastating impact of hoarding disorder on individuals, their families, and the community.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/my-possessions-spark-joy-will-the-konmari-decluttering-method-work-for-me-110357">My possessions spark joy! Will the KonMari decluttering method work for me?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/208102/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jessica Grisham has received funding from the International Obsessive-Compulsive Disorder Foundation.</span></em></p><p class="fine-print"><em><span>Keong Yap receives funding from the International Obsessive-Compulsive Disorder Foundation. </span></em></p><p class="fine-print"><em><span>Melissa Norberg has received funding from the International Obsessive-Compulsive Disorder Foundation and the Psyche Foundation for her research on hoarding disorder. </span></em></p>Addressing the emotional and behavioural drivers of hoarding through therapy is crucial. But sometimes, a harm-avoidance approach is best.Jessica Grisham, Professor in Psychology, UNSW SydneyKeong Yap, Associate Professor of Psychology, Australian Catholic UniversityMelissa Norberg, Professor in Psychology, Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2127392023-09-20T15:34:32Z2023-09-20T15:34:32ZAlzheimer’s disease blood tests: here’s what they look for, and what they can tell you about your risk<figure><img src="https://images.theconversation.com/files/548347/original/file-20230914-17-84hld1.jpg?ixlib=rb-1.1.0&rect=48%2C0%2C5360%2C3570&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Blood tests would offer a faster, less invasive way of diagnosing Alzheimer's disease.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hands-lab-technician-tube-blood-sample-441264445">angellodeco/ Shutterstock</a></span></figcaption></figure><p>Despite affecting <a href="https://www.alzheimers.org.uk/about-us/news-and-media/facts-media">55 million people worldwide</a>, Alzheimer’s disease still has no cure. But recent advancements in the field have seen a number of <a href="https://theconversation.com/new-alzheimers-drug-what-you-need-to-know-about-donanemabs-promising-trial-results-205156">promising drugs</a> that can slow the disease’s progression pass late-stage clinical trials.</p>
<p>The catch with these types of drug is that they’re most effective when <a href="https://jamanetwork.com/journals/jama/article-abstract/2807533">taken soon after</a> symptoms begin. Unfortunately, current diagnostic techniques may not catch Alzheimer’s early enough for these drugs to have a marked effect. </p>
<p>Evidence suggests that signs of Alzheimer’s disease could be detected in the blood <a href="https://pubmed.ncbi.nlm.nih.gov/23477989/">up to 20 years</a> before symptoms start. Catching the disease this early could have a major effect on treatment outcomes for patients. </p>
<p>A couple of US companies have now developed Alzheimer’s blood tests that are available for consumers to purchase, either direct from the supplier or at the request of the patient’s doctor. But while these tests can detect signs of the disease, their results should still be interpreted with caution.</p>
<h2>Alzheimer’s disease diagnosis</h2>
<p>Alzheimer’s disease is diagnosed using a combination of tests.</p>
<p>Cognitive tests look at a person’s memory recall and thinking abilities. Biomarker tests look for signs of the disease in a person’s body, in a brain imaging scan or sample of cerebrospinal fluid (the liquid that surrounds the brain and spinal cord). These biomarkers have been found to correlate with three major signs of Alzheimer’s disease:</p>
<ol>
<li>An accumulation of amyloid-beta plaques outside brain cells</li>
<li>Tau protein tangles inside brain cells</li>
<li>Brain cell death (known as neurodegeneration).</li>
</ol>
<p>Not all of these signs need to be present for a person to be diagnosed with Alzheimer’s disease, although the presence of amyloid-beta plaques and/or tau tangles in the brain <a href="https://aaic.alz.org/downloads2023/NIA-AA-Revised-Clinical-Criteria-AAIC-2023.pdf">are essential</a>. Conversely, some people may have biomarker changes <a href="https://www.nia.nih.gov/health/how-biomarkers-help-diagnose-dementia#:%7E:text=A%20positive%20amyloid%20scan%20may,the%20results%20of%20other%20tests.">but may never</a> develop Alzheimer’s disease symptoms.</p>
<p>As these <a href="https://pubmed.ncbi.nlm.nih.gov/23477989/">biomarker changes</a> can be <a href="https://www.cell.com/neuron/pdf/S0896-6273(20)30433-5.pdf">detected in the blood years before</a> other signs appear in the brain, this could provide a faster and less invasive way of diagnosing Alzheimer’s disease.</p>
<h2>Blood tests</h2>
<p>Most of the blood tests currently available to purchase measure two different types of amyloid-beta in the blood: amyloid-beta 42 and amyloid-beta 40. The ratio between these two proteins is then calculated. The lower the ratio is, the higher a person’s likelihood of having <a href="https://www.sciencedirect.com/science/article/pii/S235287291730043X">amyloid plaques</a> and therefore <a href="https://pubmed.ncbi.nlm.nih.gov/30569084/">Alzheimer’s disease</a>.</p>
<p>One such test, <a href="https://www.sciencedirect.com/science/article/pii/S0009898121001601">PrecivityAD</a>, has been approved for doctors to use in people who exhibit symptoms of Alzheimer’s in the US, and has been <a href="https://single-market-economy.ec.europa.eu/single-market/ce-marking_en#:%7E:text=The%20letters%20'CE'%20appear%20on,health%2C%20and%20environmental%20protection%20requirements.">deemed safe for use</a> in the European Union. In patients with cognitive symptoms, doctors will send a blood sample to the company which then measures the amyloid-beta ratio. The company also looks for another protein, called apolipoprotein E, to investigate the patient’s genetic risk of Alzheimer’s.</p>
<figure class="align-center ">
<img alt="A nurse takes a blood sample from an elderly woman." src="https://images.theconversation.com/files/548351/original/file-20230914-21-fixngd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/548351/original/file-20230914-21-fixngd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/548351/original/file-20230914-21-fixngd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/548351/original/file-20230914-21-fixngd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/548351/original/file-20230914-21-fixngd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/548351/original/file-20230914-21-fixngd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/548351/original/file-20230914-21-fixngd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">PrecivityAD looks for amyloid-beta.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/nurse-taking-blood-samples-senior-female-1859594491">Newman Studio/ Shutterstock</a></span>
</figcaption>
</figure>
<p>An algorithm then accounts for the biomarker levels and patient’s age, providing a probability score. A high score means the patient probably has Alzheimer’s disease. Results are available within a few days.</p>
<p>The PrecivityAD test has been used in <a href="https://www.aafp.org/pubs/afp/issues/2022/0100/p79.html">several studies</a> and has shown a <a href="https://www.sciencedirect.com/science/article/pii/S0009898121001601">high correlation</a> with signs of Alzheimer’s disease. But this does not mean it’s 100% accurate all the time, and nor can it predict how the disease will progress in that person.</p>
<p>Studies that have used this test also excluded certain participants (such as those with chronic health conditions) to avoid affecting how the test’s results were interpreted. The majority of the participants were also white. This makes it uncertain how accurate these tests will be for people of diverse backgrounds or those with other health conditions.</p>
<p>Another test, produced by <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/quest-diagnostics-launches-alzheimers-blood-test-consumers-2023-07-31/">Quest</a>, measures the same amyloid-beta ratio. This test can be purchased directly by the consumer without a doctor’s referral – although you’ll need to book a time to have your blood sample collected. </p>
<p>This test has not yet been approved in the US or EU, nor has it undergone the extensive testing PrecivityAD has. In addition, the results may be complicated for the average person to interpret without the help of a doctor. </p>
<h2>Accurate results</h2>
<p>It’s important to interpret your results from these tests carefully for a couple of reasons.</p>
<p>At the moment, these tests only look for one of the biomarkers of Alzheimer’s disease. This means that it can’t detect signs of other forms of dementia – and only provides information on one aspect of Alzheimer’s disease itself. So even if a person’s test comes back negative for Alzheimer’s, if they’re experiencing other concerning symptoms (such as memory loss), it’s important they visit a GP as they could still have another form of dementia – or another condition altogether.</p>
<p>On the other hand, if the test is used by someone with no symptoms but who has abnormal biomarkers, this could cause unnecessary distress – making them think they have, or will develop, Alzheimer’s. </p>
<p>Although these tests are useful in investigating the possibility of having Alzheimer’s disease, using them in isolation is still not as accurate as the tests currently used by qualified doctors. But this area is rapidly evolving and, someday, these tests may be just as good. </p>
<p>Researchers are now looking at how accurate tests looking at <a href="https://www.nature.com/articles/s43587-023-00471-5#:%7E:text=Step%201%20consisted%20of%20a,uncertain%20outcomes%20at%20step%201.">concentrations of tau protein</a> in a patient’s blood are. Tau may be <a href="https://aaic.alz.org/releases_2020/blood-biomarkers-tau.asp">more accurate</a> than amyloid-beta at detecting both plaques and tangles in a patient’s brain. </p>
<p>There are also a few tests in development that look at both tau and amyloid-beta – including a newer version of PrecivityAD, namely <a href="https://precivityad.com/news/c2n-diagnostics-introduces-the-precivityad2-blood-test">PrecivityAD2</a>. Other tests in development look at additional biomarkers, including a very promising <a href="https://www.nature.com/articles/s41582-023-00857-4">finger-prick test</a>, which has shown a good correlation with brain scans and cerebrospinal fluid results so far. </p>
<p>It’s clear that exciting advancements are happening in the field to make Alzheimer’s disease diagnoses more accessible and accurate. Once these tests are refined to improve accuracy, they could offer new hope to patients – allowing them to be diagnosed and treated in the early stages of the disease.</p><img src="https://counter.theconversation.com/content/212739/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>These blood tests results need care when interpreting, and they can not they predict how the disease will affect each person.Eleftheria Kodosaki, Research Fellow in Neuroimmunology, UCLDeborah Alawode, PhD Student, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2068472023-08-17T12:35:47Z2023-08-17T12:35:47ZCan coffee or a nap make up for sleep deprivation? A psychologist explains why there’s no substitute for shut-eye<figure><img src="https://images.theconversation.com/files/542680/original/file-20230814-9571-esc8z7.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A cup of coffee might provide you some pep, but it won't fully make up for lost sleep. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-showing-arm-raised-up-holding-coffee-cup-on-royalty-free-image/1147318074">nopponpat/iStock via Getty Images Plus</a></span></figcaption></figure><p>There is no denying the importance of sleep. Everyone feels better after a good night of sleep, and lack of sleep can have <a href="https://theconversation.com/health-care-workers-are-frazzled-and-poor-sleep-may-turn-stress-into-poor-mental-health-199944">profoundly negative effects</a> on both the body and the brain. So what can be done to substitute for a lack of sleep? Put another way, how can you get less sleep and still perform at your peak?</p>
<p><a href="https://scholar.google.com/citations?user=g35Ez50AAAAJ&hl=en">As a psychologist</a> who studies the ways in which sleep benefits memory, I’m also interested in how sleep deprivation harms memory and cognition. After some initial research on <a href="https://theconversation.com/feeling-sleepy-you-might-be-at-risk-of-falsely-confessing-to-a-crime-you-did-not-commit-54229">sleep deprivation and false confessions</a>, my students at Michigan State University’s <a href="http://psychology.psy.msu.edu/sleeplab/">Sleep and Learning Lab</a> and I wanted to see what interventions could reverse the negative effects of sleep deprivation. </p>
<p>We found a simple answer: There is no substitute for sleep. </p>
<h2>Sleep deprivation impairs cognition</h2>
<p>For many years, scientists have known that sleep deprivation reduces the ability to <a href="https://doi.org/10.1038%2Fs41386-019-0432-6">maintain attention</a>. When asked to monitor a computer screen and press a button whenever a red dot appears – a pretty simple task – participants who are sleep deprived are much more likely to have lapses in attention. They don’t notice a bright red dot and fail to respond within a half-second. These lapses in attention are due to a <a href="https://www.cdc.gov/niosh/emres/longhourstraining/pressure.html">buildup in pressure to sleep</a> and are more common at points in the 24-hour circadian cycle when the body expects to be sleeping.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/dqONk48l5vY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Sleep deprivation can seriously damage your body.</span></figcaption>
</figure>
<p>Research investigating the effect of sleep derivation on more complex types of thinking has shown somewhat mixed results. So my team and I sought to determine how keeping people awake for one night affected different types of thinking. We had participants perform various cognitive tasks in the evening before we randomly assigned them to either go home and sleep or stay awake all night in the laboratory. The participants who were permitted to sleep returned in the morning, and everyone completed the cognitive tasks again. </p>
<p>Along with impairments in attention, we also found that sleep deprivation led to <a href="http://dx.doi.org/10.1037/xge0000495">more placekeeping errors</a>. Placekeeping is a <a href="https://doi.org/10.1037/a0030986">complex ability</a> that involves following a series of steps in order without skipping or repeating any of them. This would be similar to following a recipe to bake a cake from memory. You wouldn’t want to forget to add eggs or accidentally add the salt twice.</p>
<h2>Can caffeine replace sleep?</h2>
<p>Next, we set out to test different ways to potentially make up for a lack of sleep. What would you do if you did not sleep enough last night? Many people would reach for a cup of coffee or an energy drink. One 2022 survey found that <a href="https://foodinsight.org/caffeine-consumer-consumption-habits-and-safety-perceptions/">over 90% of the American adults sampled</a> consume some form of caffeine daily. We wanted to see whether caffeine would help maintain attention and avoid placekeeping errors after sleep deprivation. </p>
<p>Interestingly, we found that caffeine improved the ability to pay attention in sleep-deprived participants so well that their performance was <a href="https://doi.org/10.1037/xlm0001023">similar to people who slept all night</a>. Giving caffeine to people who had a full night of sleep also boosted their performance. So caffeine helped everyone maintain attention, not just those who did not sleep. This result was not surprising, as other studies have had <a href="https://doi.org/10.1016/j.nbscr.2020.100051">similar findings</a>. </p>
<p>However, we found that caffeine <a href="https://doi.org/10.1037/xlm0001023">did not reduce placekeeping errors</a> in either the sleep-deprived group or the group that slept. This means that if you are sleep deprived, caffeine may help you stay awake and play Candy Crush, but it likely will not help you ace your algebra exam.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/542687/original/file-20230814-26-ht98cu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Person with glasses sleeping on a stack of thick files, surrounded by coffee cups and paperwork" src="https://images.theconversation.com/files/542687/original/file-20230814-26-ht98cu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/542687/original/file-20230814-26-ht98cu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542687/original/file-20230814-26-ht98cu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542687/original/file-20230814-26-ht98cu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542687/original/file-20230814-26-ht98cu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542687/original/file-20230814-26-ht98cu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542687/original/file-20230814-26-ht98cu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Your body turns up the pressure to sleep the longer it goes without it.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/exhausted-businesswoman-lying-down-on-the-desk-and-royalty-free-image/1199872302">cyano66/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<h2>Can naps make up for lost sleep?</h2>
<p>Of course, caffeine is an artificial way to replace sleep. We also reasoned that perhaps the best way to replace sleep would be with sleep. You have likely heard that <a href="https://theconversation.com/guilty-about-that-afternoon-nap-dont-be-its-good-for-you-89023">naps during the day</a> can boost energy and performance, so it is logical to think that a nap during the night should have a similar effect. </p>
<p>We gave some of our participants the opportunity to nap for either 30 or 60 minutes during an overnight deprivation period between 4 a.m. and 6 a.m. This time period roughly coincides with the lowest point of alertness in the circadian cycle. Importantly, we found that participants who napped <a href="https://doi.org/10.1093/sleep/zsab152">did no better</a> on either the simple attention task or the more complex placekeeping task than those who stayed up all night. </p>
<p>Thus, a nap in the middle of the night had no discernible benefits to cognitive performance during the morning after a night of overall sleep deprivation. </p>
<h2>Get your z’s</h2>
<p>While caffeine may help you stay awake and feel more alert, it likely won’t help you with tasks that require complex thought. And while a short nap may make you feel better on nights that you need to stay awake, it probably won’t help your performance. </p>
<p>In short, sufficient sleep is essential to your mind and brain, and there is simply no substitute for sleep.</p><img src="https://counter.theconversation.com/content/206847/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kimberly Fenn receives funding from the Office of Naval Research. </span></em></p>While a cup of joe or a brief nap during an all-nighter might help you feel a little more alert, it won’t offset cognitive impairments from sleep deprivation when you’re performing complex tasks.Kimberly Fenn, Professor of Psychology, Michigan State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2103192023-07-26T14:11:52Z2023-07-26T14:11:52ZLong COVID: brain function still affected for some up to two years after infection – new research<figure><img src="https://images.theconversation.com/files/539543/original/file-20230726-19593-9s5n36.jpg?ixlib=rb-1.1.0&rect=11%2C0%2C7337%2C4902&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/high-angle-view-senior-man-collecting-1776503864">LightField Studios/Shutterstock</a></span></figcaption></figure><p>Difficulties with cognitive functions or skills, such as the ability to recall memories, concentrate on tasks, or find the right words in conversation, are commonly reported following a COVID infection. These symptoms are often referred to as “<a href="https://www.nhsinform.scot/long-term-effects-of-covid-19-long-covid/signs-and-symptoms/long-covid-brain-fog">brain fog</a>”, and are especially common among people who have long-term or persistent symptoms called <a href="https://www.rnz.co.nz/national/programmes/saturday/audio/2018899512/prof-danny-altmann-the-burden-of-long-covid">long COVID</a>. </p>
<p>At the <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk/30march2023">latest count</a> in March 2023, there were 1 million people in the UK with long COVID who reported difficulty concentrating, and three-quarters of a million who reported memory loss or confusion.</p>
<p>In the short term, brain fog symptoms can affect people’s ability to carry out their normal <a href="https://theconversation.com/long-covid-effects-on-fatigue-and-quality-of-life-can-be-comparable-to-some-cancers-new-research-207257">daily tasks</a>, such as work and childcare, and reduce their quality of life. </p>
<p>In the longer term, mild cognitive impairment can develop into more severe conditions, such as <a href="https://www.alzheimers.org.uk/about-dementia/types-dementia/mild-cognitive-impairment-mci">dementia</a>. COVID infection generally has been linked to an <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(22)00260-7/fulltext">increased risk</a> of being diagnosed with dementia.</p>
<p>So to support people in the short and longer term, it’s important to understand the nature, size and duration of the effects of brain fog and long COVID more generally on cognitive function. </p>
<p>In a <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589537023002638/fulltext">new study</a>, my colleagues and I set out to understand whether a COVID infection, and symptom duration, affected performance in cognitive tests, and how test performance changed over time. We found people with persistent symptoms fared worse in these tests up to two years after a COVID infection.</p>
<h2>Brain training</h2>
<p>To test cognitive skills, we invited participants in the <a href="https://cssbiobank.com/">COVID Symptom Study Biobank</a> to complete a series of 12 brain-training-style tasks online in July 2021 and again in April 2022. In the first round, more than 3,300 people completed the test. Another 2,400 completed the second round, of whom 1,700 had also participated in the first round.</p>
<p>The COVID Symptom Study Biobank is a study that began in 2020, recruiting people from the COVID Symptom Study smartphone app (now the <a href="https://health-study.joinzoe.com/">ZOE Health Study</a>) which tracks symptoms and COVID tests. The study includes over 8,000 people both with and without a history of COVID infection and with a range of shorter- and longer-term COVID symptoms.</p>
<p>The tasks aimed to cover a range of elements of brain function, including visual memory, attention, verbal reasoning and motor control. Some tasks involved remembering words and shapes after a short delay of less than a minute, or a longer delay of around 20 minutes. </p>
<p>Other tasks included watching sequences of numbers appear on the screen and then repeating the sequences, clicking on a moving “bullseye” target, and deciding if pairs of words have the same meaning. Similar versions of the test are available for anyone to try <a href="https://www.cognitron.co.uk/">online</a>. </p>
<p>We then recorded how accurately people completed the tasks and their response times. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-covid-can-disturb-your-sleep-and-dreams-and-what-could-help-194798">How COVID can disturb your sleep and dreams – and what could help</a>
</strong>
</em>
</p>
<hr>
<h2>What we found</h2>
<p>When we compared how accurately people with or without a history of COVID completed the test in the first round, we saw that people with an infection had lower scores on average across the 12 tasks. </p>
<p>Digging deeper, we saw that the effect of COVID on test performance was biggest for people with a longer symptom duration of more than three months. These people meet the <a href="https://cks.nice.org.uk/topics/long-term-effects-of-coronavirus-long-covid/background-information/definition/">criteria</a> for having long COVID.</p>
<p>By also testing how other factors affected test scores, we were able to put into context how big an impact COVID had. For example, we saw that older people and people experiencing psychological distress scored lower in the tests. </p>
<p>The effect for the long COVID group was comparable to a ten-year increase in age, or experiencing mild to moderate distress versus no distress. However, COVID’s effect on test scores was not as large as other factors, such as education level.</p>
<figure class="align-center ">
<img alt="A woman sitting on a couch with a hand on her forehead." src="https://images.theconversation.com/files/539485/original/file-20230726-25-9s5n36.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/539485/original/file-20230726-25-9s5n36.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/539485/original/file-20230726-25-9s5n36.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/539485/original/file-20230726-25-9s5n36.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/539485/original/file-20230726-25-9s5n36.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/539485/original/file-20230726-25-9s5n36.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/539485/original/file-20230726-25-9s5n36.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Brain fog is a common symptom of long COVID.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-tired-business-woman-headache-older-2080533058">Andrii Zastrozhnov/Shutterstock</a></span>
</figcaption>
</figure>
<p>When we considered how people felt about their recovery from COVID, we saw that people who weren’t reporting symptoms anymore and felt “back to normal” did no worse on the tests than people who hadn’t had COVID in the first place. This was even true for people who’d had more than three months of symptoms, which is good news. But it’s important to note that only one in six of those who had persistent symptoms felt fully recovered. </p>
<p>People who’d had COVID, including those who’d had more than three months of symptoms, were no slower than people without infection. This was another positive, as slower reaction times <a href="https://cheba.unsw.edu.au/news/reaction-time-test-predicts-risk-dementia">can be a sign</a> of more serious cognitive impairment.</p>
<p>In the second round of testing, we saw no significant changes in test performance. This meant that the group with lower scores in 2021 were still feeling the effects of COVID on their brain function in 2022, up to two years after their initial infection.</p>
<h2>Limitations and where to next</h2>
<p>It’s important to note some limitations in our study. We don’t have test results for people before their COVID infection, which limited our analysis to comparing results across different groups.</p>
<p>Also, our participants were mostly female, and there was a higher proportion of people identifying as being from white backgrounds and living in more affluent areas than in the general UK population.</p>
<p>Nonetheless, our study shows the need to monitor those people whose brain function is most affected by COVID, to see how their cognitive symptoms continue to develop and to provide support towards recovery.</p><img src="https://counter.theconversation.com/content/210319/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nathan Cheetham receives funding from The National Institute for Health and Care Research. </span></em></p>We used a series of ‘brain training’ style tasks to assess how a COVID infection and persistent symptoms affected cognitive function.Nathan Cheetham, Senior Postdoctoral Data Scientist, Twin Research & Genetic Epidemiology, King's College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2082432023-06-27T11:35:04Z2023-06-27T11:35:04ZNapping may be beneficial for your brain – here’s how<figure><img src="https://images.theconversation.com/files/534277/original/file-20230627-19-gst25p.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4992%2C3337&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Daily naps may help preserve brain health.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-man-sleeping-on-sofa-book-285560465">Dragon Images/ Shutterstock</a></span></figcaption></figure><p>Sleep plays an important role in keeping the brain healthy, which is why people are advised to get at least <a href="http://dx.doi.org/10.1016/j.sleh.2014.12.010">7-9 hours each night</a>. When people have difficulties with sleep, for example, they usually feel more stressed. This is because a lack of sleep activates the body’s <a href="https://doi.org/10.2147/NSS.S134864">stress response</a>, which affects different brain and body systems. This could lead to stress-related disorders. </p>
<p>Napping also appears to be <a href="https://pubmed.ncbi.nlm.nih.gov/21075238/">beneficial to the brain</a> – with research showing that even brief naps of 5-15 minutes can instantly improve how well you perform mentally. But could frequent napping have long-term benefits for our brains? Our latest study shows that they might – we found that habitual naps <a href="https://doi.org/10.1016/j.sleh.2023.05.002">may help preserve brain health</a>.</p>
<p>Our study aimed to uncover the potential causal relationship between daytime napping, cognitive function and brain volume. We focused on reaction time and memory because these cognitive abilities tend to <a href="https://jamanetwork.com/journals/jama/article-abstract/2276710">decline as we get older</a>. We also examined the hippocampus (an important brain structure for memory) and total brain volumes because they play a significant role in explaining differences in <a href="https://doi.org/10.1002/hbm.22959">memory and overall thinking skills</a>.</p>
<p>To conduct our study, we used a technique called <a href="https://jamanetwork.com/journals/jama/article-abstract/2664027">Mendelian randomisation</a>. This uses genetic markers to assess the relationship between exposures and outcomes (such as certain traits or diseases). We analysed data from 378,932 people aged 40-69 who had participated in the <a href="https://www.ukbiobank.ac.uk/">UK Biobank study</a> (a large-scale biomedical database) We only studied people with white European ancestry, as they accounted for more than 80% of the participants of the Biobank study. </p>
<p>We looked at <a href="https://doi.org/10.1038/s41467-020-20585-3">genetic variations</a> previously discovered to be associated with daytime napping, based on the question “Do you have a nap during the day?” with possible responses: “never or rarely”, “sometimes” and “usually”. We used structural magnetic resonance imaging (MRI) data to study brain volumes and the results of computerised games that involved identifying matches of cards to test cognitive abilities.</p>
<figure class="align-center ">
<img alt="An elderly woman naps on a couch." src="https://images.theconversation.com/files/534278/original/file-20230627-29-8znql4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/534278/original/file-20230627-29-8znql4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/534278/original/file-20230627-29-8znql4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/534278/original/file-20230627-29-8znql4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/534278/original/file-20230627-29-8znql4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/534278/original/file-20230627-29-8znql4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/534278/original/file-20230627-29-8znql4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The most frequent nappers had the largest brain volume on average.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/elderly-take-nap-senior-asian-woman-1477517666">mangpor2004/ Shutterstock</a></span>
</figcaption>
</figure>
<p>We discovered that people who had genetic variations associated with napping also had larger total brain volume on average.</p>
<h2>Brain volume</h2>
<p>Our brains naturally shrink gradually as we age. But this process is accelerated in people with <a href="https://doi.org/10.1016/S0047-6374(01)00426-2">neurodegenerative diseases</a> such as Alzheimer’s. Some studies have also shown that people with cognitive impairment may experience a <a href="https://doi.org/10.1016/j.dadm.2015.11.002">decrease in brain volume</a>. </p>
<p>Additionally, previous research has indicated a connection between sleep problems and <a href="https://doi.org/10.1016/j.sleep.2017.04.002">reductions in brain volume</a> in various regions of the brain, which can be linked to cognitive decline. However, it’s important to note that these findings have been inconsistent across different studies, with some studies <a href="https://doi.org/10.5665/sleep.2638">not finding any associations</a> between sleep disruptions and structural brain changes. But overall this suggests that poor sleep may decrease brain volume – subsequently affecting brain health. </p>
<p>Our findings demonstrate a larger total brain volume with more frequent napping. This suggests that regular napping may act as a safeguard, compensating for inadequate sleep and preserving brain health.</p>
<p>Surprisingly, we did not find evidence to suggest that napping has an impact on reaction time, visual memory or the volume of the hippocampus. We speculate that different people’s napping experiences – such as nap duration and timing – and the tests employed to study cognitive abilities may have influenced our results. Moreover, these discoveries hint at the possibility that frequent daytime napping may affect other brain regions and mental skills, like alertness, which should be explored in future studies.</p>
<p>Our findings help clarify the impact of daytime napping on brain health, which may limit cognitive decline as a person ages. In the future, it would be valuable to investigate these associations in other ancestries and age groups. Moreover, it is important to replicate these findings by using different data sets and research methods. But, as far as we know right now, taking a brief nap in the early afternoon may be restorative and re-energising for those who need it – and may also be beneficial to brain health.</p><img src="https://counter.theconversation.com/content/208243/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Victoria Garfield receives funding from the Diabetes, Research and Wellness Foundation; the British Heart Foundation; and Diabetes UK. </span></em></p><p class="fine-print"><em><span>Hassan S Dashti and Valentina Paz do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Our study revealed that people who nap frequently have larger brain volume.Valentina Paz, Assistant Researcher in the MRC Unit for Lifelong Health and Ageing, UCLHassan S Dashti, Instructor in Anaesthesia Medicine, Harvard UniversityVictoria Garfield, Senior Research Fellow in Genetic Epidemiology, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2061692023-05-24T18:07:45Z2023-05-24T18:07:45ZRhythmically stimulating the brain with electrical currents could boost cognitive function, according to analysis of over 100 studies<figure><img src="https://images.theconversation.com/files/527837/original/file-20230523-25-ialkgs.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1999%2C1499&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A meta-analysis helps resolve conflicting evidence on the benefits of tACS.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/brain-stimulation-conceptual-image-royalty-free-image/1178748384">Science Photo Library via Getty Images</a></span></figcaption></figure><p>Figuring out how to enhance a person’s mental capabilities has been of considerable interest to psychology and neuroscience researchers <a href="https://scholar.google.com/citations?user=x40PdqgAAAAJ&hl=en">like me</a> <a href="https://doi.org/10.1007/s11948-009-9142-5">for decades</a>. From improving attention in high-stakes environments, like air traffic management, to reviving memory in people with dementia, the ability to improve cognitive function can have far-reaching consequences. New research suggests that <a href="https://theconversation.com/brain-stimulation-can-rewire-and-heal-damaged-neural-connections-but-it-isnt-clear-how-research-suggests-personalization-may-be-key-to-more-effective-therapies-182491">brain stimulation</a> could help achieve the goal of boosting mental function.</p>
<p>In the <a href="https://reinhartlab.org/">Reinhart Lab</a> at Boston University, my colleagues and I have been examining the effects of an emerging brain stimulation technology – <a href="https://www.science.org/doi/10.1126/scitranslmed.abo2044">transcranial alternating current stimulation, or tACS</a> – on different mental functions in patients and healthy people.</p>
<p>During this procedure, people wear an elastic cap embedded with electrodes that deliver weak electrical currents oscillating at specific frequencies to their scalp. By applying these controlled currents to specific brain regions, it is possible to alter brain activity by <a href="https://doi.org/10.1073/pnas.1815958116">nudging neurons to fire rhythmically</a>.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/yoEu2mEdLjw?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Another type of transcranial electric stimulation, tDCS, applies a direct electrical current to the brain.</span></figcaption>
</figure>
<p>Why would rhythmically firing neurons be beneficial? Research suggests that brain cells <a href="https://doi.org/10.1016/j.cub.2012.06.061">communicate effectively</a> when they coordinate the rhythm of their firing. Critically, these rhythmic patterns of brain activity show <a href="https://doi.org/10.1001/jamapsychiatry.2015.0483">marked abnormalities</a> during neuropsychiatric illnesses. The purpose of tACS is to externally induce rhythmic brain activity that promotes healthy mental function, particularly when the brain might not be able to produce these rhythms on its own.</p>
<p>However, tACS is a relatively new technology, and how it works is still unclear. Whether it can strengthen or revive brain rhythms to change mental function has been a topic of considerable debate in the field of brain stimulation. While some studies <a href="https://doi.org/10.1038/s41467-019-13417-6">find evidence</a> of changes in brain activity and mental function with tACS, others suggest that the currents typically used in people <a href="https://doi.org/10.1038/s41467-018-02928-3">might be too weak</a> to have a direct effect.</p>
<p>When faced with conflicting data in the scientific literature, it can be helpful to conduct a type of study <a href="https://training.cochrane.org/handbook/current/chapter-10">called a meta-analysis</a> that quantifies how consistent the evidence is across several studies. A previous meta-analysis conducted in 2016 <a href="https://doi.org/10.1016/j.neuropsychologia.2016.04.011">found promising evidence</a> for the use of tACS in changing mental function. However, the number of studies has more than doubled since then. The design of tACS technologies has also become <a href="https://doi.org/10.1016/j.cub.2016.04.035">increasingly sophisticated</a>.</p>
<p>We set out to perform a new meta-analysis of studies using tACS to change mental function. To our knowledge, this work is the <a href="https://www.science.org/doi/10.1126/scitranslmed.abo2044">largest and most comprehensive meta-analysis</a> yet on this topic, consisting of over 100 published studies with a combined total of more than 2,800 human participants. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/527841/original/file-20230523-27-bw5s8e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Electrodes being placed on a person's head" src="https://images.theconversation.com/files/527841/original/file-20230523-27-bw5s8e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/527841/original/file-20230523-27-bw5s8e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=377&fit=crop&dpr=1 600w, https://images.theconversation.com/files/527841/original/file-20230523-27-bw5s8e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=377&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/527841/original/file-20230523-27-bw5s8e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=377&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/527841/original/file-20230523-27-bw5s8e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=474&fit=crop&dpr=1 754w, https://images.theconversation.com/files/527841/original/file-20230523-27-bw5s8e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=474&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/527841/original/file-20230523-27-bw5s8e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=474&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Transcranial alternating current stimulation involves placing an electrode on a person’s scalp.</span>
<span class="attribution"><a class="source" href="https://flic.kr/p/SRnZ5m">J.M. Eddins Jr/U.S. Air Force via Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<p>After compiling over 300 measures of mental function across all the studies, we observed <a href="https://www.science.org/doi/10.1126/scitranslmed.abo2044">consistent and immediate improvement</a> in mental function with tACS. When we examined specific cognitive functions, such as memory and attention, we observed that tACS produced the strongest improvements in <a href="https://theconversation.com/cognitive-flexibility-is-essential-to-navigating-a-changing-world-new-research-in-mice-shows-how-your-brain-learns-new-rules-204259">executive function</a>, or the ability to adapt in the face of new, surprising or conflicting information. </p>
<p>We also observed improvements in the ability to pay attention and to memorize information for both short and long periods of time. Together, these results suggest that tACS could particularly improve specific kinds of mental function, at least in the short term.</p>
<p>To examine the effectiveness of tACS for those particularly vulnerable to changes in mental function, we examined the data from studies that included older adults and people with neuropsychiatric conditions. In both populations, we observed reliable evidence for <a href="https://www.science.org/doi/10.1126/scitranslmed.abo2044">improvements in cognitive function</a> with tACS. </p>
<p>Interestingly, we also found that a specialized type of tACS that can target two brain regions at the same time and manipulate how they communicate with each other can both <a href="https://www.science.org/doi/10.1126/scitranslmed.abo2044">enhance or reduce cognitive function</a>. This bidirectional effect on mental function could be particularly useful in the clinic. For example, some psychiatric conditions like depression may involve a reduced ability to process rewards, while others like bipolar disorder may involve a highly active <a href="https://doi.org/10.1097%2FYCO.0000000000000122">reward processing system</a>. If tACS can change mental function in either direction, researchers may be able to develop flexible and targeted designs that cater to specific clinical needs. </p>
<p>Developments in the field of tACS are bringing researchers closer to being able to safely enhance mental function in a noninvasive way that doesn’t require medication. Current statistical evidence across the literature suggests that tACS holds promise, and improving its design could help it produce stronger, long-lasting changes in mental function.</p><img src="https://counter.theconversation.com/content/206169/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This work was supported by grants from the National Institutes of Health (R01-MH114877; R01-AG063775) and a gift from an individual philanthropist, all to Robert M. G. Reinhart, Ph.D., Associate Professor at the Department of Psychological and Brain Sciences, Boston University.</span></em></p>Transcranial alternating current stimulation, or tACS, is a type of brain stimulation that can change neural activity and improve memory, attention and executive function.Shrey Grover, Ph.D. Candidate in Psychological and Brain Sciences, Boston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2042592023-04-26T15:12:44Z2023-04-26T15:12:44ZCognitive flexibility is essential to navigating a changing world – new research in mice shows how your brain learns new rules<figure><img src="https://images.theconversation.com/files/522864/original/file-20230425-26-ozwsdf.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A class of inhibitory neurons can make long-distance connections across both hemispheres of the brain.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/brain-shape-labyrinth-with-staircase-royalty-free-image/1384468191">akinbostanci/iStock via Getty Images Plus</a></span></figcaption></figure><p>Being flexible and learning to adapt when the world changes is something you practice every day. Whether you run into a new construction site and have to reroute your commute or download a new streaming app and have to relearn how to find your favorite show, changing familiar behaviors in response to new situations is an essential skill.</p>
<p>To make these adaptations, your brain changes its activity patterns within a structure called the <a href="https://doi.org/10.1146/annurev.neuro.24.1.167">prefrontal cortex</a> – an area of the brain critical for cognitive functions such as attention, planning and decision-making. But which specific circuits “tell” the prefrontal cortex to update its activity patterns in order to change behavior have been unknown. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/i47_jiCsBMs?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The prefrontal cortex of the brain is involved in executive functions like self-control and decision-making.</span></figcaption>
</figure>
<p>We are a <a href="https://scholar.google.com/citations?user=a-dRpwgAAAAJ&hl=en">team of</a> <a href="https://scholar.google.com/citations?user=EYE8lYIAAAAJ&hl=en">neuroscientists</a> who study how the brain processes information and what happens when this function is impaired. In our newly published research, we discovered a <a href="https://www.nature.com/articles/s41586-023-06012-9">special class of neurons</a> in the prefrontal cortex that may enable flexible behavior and, when they malfunction, may lead to conditions such as schizophrenia and bipolar disorder.</p>
<h2>Inhibitory neurons and learning new rules</h2>
<p><a href="https://www.brainfacts.org/brain-anatomy-and-function/cells-and-circuits/2021/how-inhibitory-neurons-shape-the-brains-code-100621">Inhibitory neurons</a> dampen the activity of other neurons in the brain. Researchers have traditionally assumed they send their electrical and chemical outputs only to nearby neurons. However, we found a particular class of inhibitory neurons in the prefrontal cortex that communicate across long distances to neurons in the opposite hemisphere of the brain.</p>
<p>We wondered whether these long-range inhibitory connections are involved in coordinating changes in activity patterns across the left and right prefrontal cortex. By doing so, they might provide the critical signals that help you change your behavior at the right moment.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/522868/original/file-20230425-22-cg77ik.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Microscopy image of an interneuron" src="https://images.theconversation.com/files/522868/original/file-20230425-22-cg77ik.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/522868/original/file-20230425-22-cg77ik.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=923&fit=crop&dpr=1 600w, https://images.theconversation.com/files/522868/original/file-20230425-22-cg77ik.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=923&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/522868/original/file-20230425-22-cg77ik.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=923&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/522868/original/file-20230425-22-cg77ik.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1160&fit=crop&dpr=1 754w, https://images.theconversation.com/files/522868/original/file-20230425-22-cg77ik.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1160&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/522868/original/file-20230425-22-cg77ik.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1160&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Interneurons connect other neurons together.</span>
<span class="attribution"><a class="source" href="https://flic.kr/p/G2ScFK">NICHD/McBain Laboratory via Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>To test the function of these long-range inhibitory connections, we observed mice performing a task that required them to learn a rule to receive a reward and then later adapt to a new rule in order to continue receiving the reward. In this task, mice dug in bowls to find hidden food. Initially, the smell of garlic or the presence of sand within a bowl might indicate the location of the hidden food. The specific cue associated with the reward would later change, forcing the mice to learn a new rule. </p>
<p>We found that silencing the long-range inhibitory connections between the left and right prefrontal cortex <a href="https://www.nature.com/articles/s41586-023-06012-9">caused the mice to get stuck</a>, or perseverate, on one rule and prevented them from learning new ones. They were unable to change gears and learn that the old cue was now meaningless and the new cue signaled food.</p>
<h2>Brain waves and flexible behavior</h2>
<p>We also made surprising discoveries about how these long-range inhibitory connections create behavioral flexibility. Specifically, they synchronize a set of “brain waves” called <a href="https://doi.org/10.1523/jneurosci.0990-16.2016">gamma oscillations</a> across the two hemispheres. Gamma oscillations are rhythmic fluctuations in brain activity that occur roughly 40 times per second. These fluctuations can be detected during many cognitive functions, such as when performing a task that requires holding information in your memory or making different movements based on what you see on a computer screen. </p>
<p>Though scientists have observed the presence of gamma oscillations for many decades, their function has been controversial. Many researchers think that the synchronization of these rhythmic fluctuations across different brain regions doesn’t serve any useful purpose. Others have speculated that synchronization across different brain regions enhances communication between those regions.</p>
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<figcaption><span class="caption">Fluctuations in neural activity manifest as brain waves, or neural oscillations.</span></figcaption>
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<p>We found a completely different potential role for gamma synchrony. When long-range inhibitory connections synchronize gamma oscillations across the left and right prefrontal cortex, they seem to also <a href="https://www.nature.com/articles/s41586-023-06012-9">gate communication between them</a>. When mice learn to disregard a previously established rule that no longer leads to a reward, these connections synchronize gamma oscillations and seem to stop one hemisphere from maintaining unneeded activity patterns in the other. In other words, long-range inhibitory connections seem to stop input from one hemisphere from “getting in the way” of the other when it is trying to learn something new. </p>
<p>For example, the left prefrontal cortex can “remind” the right prefrontal cortex about your usual route to work. But when long-range inhibitory connections synchronize these two areas, they also seem to shut off these reminders and enable new patterns of brain activity corresponding to your new commute to take hold.</p>
<p>Finally, these long-range inhibitory connections also <a href="https://www.nature.com/articles/s41586-023-06012-9">trigger long-lasting effects</a>. Shutting off these connections just once caused mice to have trouble learning new rules several days later. Conversely, rhythmically stimulating these connections to artificially synchronize gamma oscillations can reverse these deficits and restore normal learning.</p>
<h2>Cognitive flexibility and schizophrenia</h2>
<p>Long-range inhibitory connections play an important role in cognitive flexibility. The inability to appropriately update previously learned rules is one <a href="https://pubmed.ncbi.nlm.nih.gov/16965182/">hallmark form of cognitive impairment</a> in psychiatric conditions such as schizophrenia and bipolar disorder. </p>
<p>Research has also seen <a href="https://doi.org/10.1523/jneurosci.0990-16.2016">deficiencies in gamma synchronization</a> and abnormalities in a class of prefrontal inhibitory neurons, which includes the ones we studied, in people with schizophrenia. In this context, our study suggests that treatments that target these long-range inhibitory connections may help improve cognition in people with schizophrenia by synchronizing gamma oscillations.</p>
<p>Many details of how these connections affect brain circuits remain unknown. For example, we do not know exactly which cells within the prefrontal cortex receive input from these long-range inhibitory connections and change their activity patterns to learn new rules. We also do not know whether there are specific molecular pathways that produce the long-lasting changes in neural activity. Answering these questions could reveal how the brain flexibly switches between maintaining and updating old information and potentially lead to new treatments for schizophrenia and other psychiatric conditions.</p><img src="https://counter.theconversation.com/content/204259/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Vikaas Sohal receives funding from the National Institutes of Health, the Simons Foundation Autism Research Initiative, the UCSF Dolby Family Center for Mood Disorders, and the Bay Area Psychedelic Research consortium.</span></em></p><p class="fine-print"><em><span>Kathleen Cho receives funding from the Institut national de la santé et de la recherche médicale (Inserm) and the Marie Skłodowska-Curie Individual Fellowship (MSCA-IF). </span></em></p>Learning new rules requires the suppression of old ones. A better understanding of the brain circuits involved in behavioral adaptation could lead to new ways to treat schizophrenia and bipolar disorder.Vikaas Sohal, Professor of Psychiatry, University of California, San FranciscoKathleen Cho, Principal Investigator in Neuroscience, InsermLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2027822023-04-04T11:07:01Z2023-04-04T11:07:01ZMatcha tea: what the current evidence says about its health benefits<figure><img src="https://images.theconversation.com/files/519271/original/file-20230404-24-ye6cnz.jpg?ixlib=rb-1.1.0&rect=17%2C0%2C5973%2C3988&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Matcha comes from green tea leaves, which are ground up into a powder.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/green-matcha-tea-drink-accessories-on-1054049189">Ekaterina Markelova/ Shutterstock</a></span></figcaption></figure><p>Although matcha tea has been around for centuries, it’s recently increased in popularity. This may be due to its favour with celebrities such as Jennifer Aniston and Gwyneth Paltrow, and because of its purported health benefits – with many claiming matcha has even greater benefit for our health than <a href="https://pubmed.ncbi.nlm.nih.gov/20370896/">green tea</a> does. </p>
<p>All green tea comes from the same plant: <em>Camellia sinensis</em>. Green tea (known as sencha) is produced from the unfermented leaves of this plant. <a href="https://www.mdpi.com/1420-3049/26/1/85">Matcha tea</a> (known as tencha) involves shading the plant from less intense sunlight, then harvesting, steaming and drying the leaves before they’re ground into a powder.</p>
<p>So whereas green tea is consumed as brewed dried leaves, matcha tea involves consuming the whole leaf powder – which means it may potentially provide <a href="https://www.mdpi.com/1420-3049/26/1/85">more nutritional benefit</a> than a regular cup of green tea. However, research into matcha is just beginning – meaning there’s still a lot we don’t know yet about just how beneficial it may be.</p>
<h2>Benefits of green tea</h2>
<p>Green tea is thought to have <a href="https://www.tandfonline.com/doi/abs/10.1080/13590840802518785;https://www.tandfonline.com/doi/abs/10.1080/07315724.2006.10719518">many health benefits</a>. This is due to certain compounds found in green tea called polyphenols, which have antioxidant properties – meaning these compounds may interact with other unstable molecules that can cause damage to our cells.</p>
<p>The polyphenols in green tea have been associated with modest reductions in <a href="https://nutritionj.biomedcentral.com/articles/10.1186/s12937-020-00557-5">cholesterol levels</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2855614/#:%7E:text=This%20beneficial%20effect%20has%20been,stroke%20and%20coronary%20heart%20disease.">blood pressure</a> in humans.
Furthermore, two meta-analyses suggest that drinking green tea <a href="https://pubmed.ncbi.nlm.nih.gov/36505265/">may reduce the risk </a> of <a href="https://ajcn.nutrition.org/article/S0002-9165(23)02217-7/fulltext">developing heart disease</a>. It’s thought that specific polyphenol compounds called <a href="https://biomeddermatol.biomedcentral.com/articles/10.1186/s41702-020-0057-8">catechins</a> found in green tea may contribute to its protective effects. </p>
<p>Other studies suggest that green tea may <a href="https://pubmed.ncbi.nlm.nih.gov/30205425/">lower the risk of certain types of cancer</a> as these catechins may interfere with <a href="https://www.sciencedirect.com/science/article/pii/S1756464620303960">cancer cell growth</a>.</p>
<p>Additionally, green tea may also affect the <a href="https://pubmed.ncbi.nlm.nih.gov/25650043">body’s metabolism</a> in the short term by enhancing the body’s ability to <a href="https://pubmed.ncbi.nlm.nih.gov/18326618/">burn fat during exercise</a> somewhat. In the longer term, green tea may potentially influence changes to the expression of <a href="https://pubmed.ncbi.nlm.nih.gov/23493529/">certain genes associated with fat burning</a>. This could mean that regular green tea consumption may, in part, modestly influence our <a href="https://pubmed.ncbi.nlm.nih.gov/19074207/">ability to lose fat</a> over time, especially in combination with exercise. </p>
<h2>How matcha measures up</h2>
<p>A typical cup of green tea might contain about <a href="https://www.mdpi.com/2076-3417/11/11/5087/htm">70mg of catechins</a>, which is about double that of black tea (although <a href="https://pubmed.ncbi.nlm.nih.gov/21115335/">many factors</a>, such as water temperature and how long the tea is brewed, can affect this). Matcha tea, however, could contain more than <a href="https://www.sciencedirect.com/science/article/pii/S2665927122002180">three times</a> the amount of catechins per serving, with one study reporting a staggering <a href="https://pubmed.ncbi.nlm.nih.gov/14518774/">137 times more</a> catechins than regular green tea. </p>
<p>This means matcha <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231151/">contains more antioxidants</a> than other tea, which could explain its benefits for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231151/">cardiovascular and immune health</a>. </p>
<p>And because you’re consuming the whole tea leaf, matcha may contain more potent amounts of other natural ingredients – including amino acids such as L-theanine. In both animal and human studies, the L-theanine in matcha has been associated with both <a href="https://pubmed.ncbi.nlm.nih.gov/30308973/">reduced anxiety</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/31111111/">stress</a>. </p>
<figure class="align-center ">
<img alt="The leaves of the Camellia sinensis (green tea) plant." src="https://images.theconversation.com/files/519274/original/file-20230404-18-cnrfkl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/519274/original/file-20230404-18-cnrfkl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519274/original/file-20230404-18-cnrfkl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519274/original/file-20230404-18-cnrfkl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519274/original/file-20230404-18-cnrfkl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519274/original/file-20230404-18-cnrfkl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519274/original/file-20230404-18-cnrfkl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Matcha and green tea are derived from the same plant.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/tea-camellia-sinensis-upper-leaves-on-2108031074">AnnaNel/ Shutterstock</a></span>
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<p>Matcha also contains <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7796401/">higher levels of caffeine</a> by weight – around 20-40mg per gram, which is 2-4 times higher than that found in an equivalent amount of coffee beans. As such, recent studies investigating matcha have looked at the combined effects of its catechin and caffeine content. Two recent studies looking at women in their late twenties found that drinking matcha tea modestly improved the <a href="https://pubmed.ncbi.nlm.nih.gov/29345213/">amount of fat burned</a> while walking by <a href="https://pubmed.ncbi.nlm.nih.gov/32875933/">up to 35%</a>. </p>
<p>These results are broadly <a href="https://pubmed.ncbi.nlm.nih.gov/33652910/">similar to other studies</a> conducted <a href="https://pubmed.ncbi.nlm.nih.gov/18326618">using green tea extract</a>, suggesting that matcha is just as effective, but not more so, than green tea. As such, matcha may provide some additional benefits when used alongside exercise. But it will be important for future studies to investigate whether matcha also boosts the effect of exercise in other groups.</p>
<h2>Other possible benefits</h2>
<p>Matcha has also been <a href="https://pubmed.ncbi.nlm.nih.gov/28056735/">shown to improve</a> alertness, decision-making, memory and focus. In one study, participants who were given 4g of matcha powder as a drink scored better on <a href="https://pubmed.ncbi.nlm.nih.gov/28784536/">cognitive tests</a> looking at attention, information processing, reflexes and memory compared to those who were given a placebo. </p>
<p>Other research also indicates that several cups of green tea a day may prevent <a href="https://www.mdpi.com/1420-3049/26/16/4897">age-related cognitive decline</a>. This may be, in part, linked with the stress-reducing effects of L-theanine, as well as a potent catechin called “epigallocatechin gallate” or EGCG which is particularly <a href="https://www.sciencedirect.com/science/article/pii/S2665927122002180">high in matcha</a>. So while it’s likely matcha will have a similar cognitive benefit as green tea, it will be important for future studies to look at matcha more specifically. </p>
<p>Research in this area is still young, and more studies – particularly with adults – are needed to truly understand just how beneficial matcha may be. But if you’re someone who likes to start their day with a cup of tea or coffee, you may want to consider <a href="https://pubmed.ncbi.nlm.nih.gov/36582446/">switching to matcha</a>. Not only is this a great way to get your caffeine fix, but it may also potentially have other benefits to your health. Between <a href="https://www.sciencedirect.com/science/article/pii/S2665927122002180">2-4g of matcha a day</a> (equivalent to 2-4 cups) may be enough get some of these reported benefits over time.</p><img src="https://counter.theconversation.com/content/202782/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Justin Roberts works for both Anglia Ruskin University and Danone Nutricia Research in the area of Nutritional Physiology and Functional Nutrients. He has previously received project funding specific to green tea research (not matcha) from both High5 Ltd and Biocare Ltd, and has published research in this area.</span></em></p><p class="fine-print"><em><span>Henry Chung does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Matcha may potentially provide more nutritional benefit than a regular cup of green tea.Justin Roberts, Associate Professor, Nutritional Physiology for Health and Exercise, Anglia Ruskin UniversityHenry Chung, Lecturer in Sport and Exercise Science, University of EssexLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2016022023-03-20T16:19:01Z2023-03-20T16:19:01ZAlzheimer’s disease: problems with the brain’s energy supply could be a cause<figure><img src="https://images.theconversation.com/files/516357/original/file-20230320-1425-yqlsjf.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C8000%2C4491&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Mitochondria help ensure our cells have the energy they need to function.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/mitochondria-cross-section-view-mitochondrion-3d-2017459415">ART-ur/ Shutterstock</a></span></figcaption></figure><p>Scientists have been working to understand the root causes of dementia and Alzheimer’s disease for decades now. But one of the reasons we don’t yet have a cure for this disease is because of the complexity of the human brain – alongside the complexity of the disease itself. </p>
<p>One of the leading theories in the field suggests that Alzheimer’s disease is caused by the abnormal accumulation of two proteins called <a href="https://pubmed.ncbi.nlm.nih.gov/24493463/">amyloid beta and tau</a> in the brain, resulting in plaques and tangles. Amyloid plaques are clumps that form between neurons, which can damage surrounding cells, while tau tangles block communication between nerve cells.</p>
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<a href="https://theconversation.com/alzheimers-disease-surprising-new-theory-about-what-might-cause-it-192143">Alzheimer's disease: surprising new theory about what might cause it</a>
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<p>For years now, scientists have been trying to understand how the accumulation of these proteins begins and how this affects brain health, leading to memory loss. Despite the huge amount of research that’s happened to date, there’s not been much success in <a href="https://pubmed.ncbi.nlm.nih.gov/31706733">treating and preventing</a> Alzheimer’s disease.</p>
<p>This has led many experts in the field to wonder whether there’s something else we should also be looking at in the brain when it comes to understanding and curing Alzheimer’s disease. </p>
<p>A recent article in <a href="https://www.newscientist.com/article/mg25734290-100-restoring-the-brains-mitochondria-could-slow-ageing-and-end-dementia/">New Scientist</a> describes an idea which could be important in the field of brain health. This article highlights an alternative theory: that damage to mitochondria (the energy-producing structures within cells) could actually be the cause of Alzheimer’s.</p>
<h2>Energy deficit</h2>
<p>Mitochondria are found in virtually all the body’s cells. They use both oxygen and breakdown products from food to make a high energy molecule known as adenosine triphosphate (ATP). ATP is like your cells’ energy currency – kind of like a rechargeable battery. Our cells use ATP for the energy needed to carry out everyday functions and maintain their own health. Once used up, mitochondria can reload it with energy.</p>
<p>Mitochondria also have a host of other functions important for cellular health, such as telling the cell’s nucleus (the cell’s hub of genetic information) to carry out important functions, and sending signals to other cells. They’re also packed full of antioxidants – molecules that protect cells from damage. </p>
<p>Mitochondria are particularly important for the brain. The human brain only accounts for around 2% of our total body weight, yet even at rest, the brain uses <a href="https://www.nature.com/articles/s41598-019-47783-4.pdf">around 20%</a> of the body’s total energy expenditure. As the control centre of the body, the brain needs this energy in order to carry out its many important functions which make virtually everything we do possible – whether that’s blinking, smiling or memorising a poem. </p>
<p>So, our brain cells – particularly our neurons, the brain cells that send and receive signals from our brain to the rest of the body – have high energy needs. This is why each neuron can contain <a href="https://www.nature.com/articles/s41598-019-47783-4.pdf">thousands of mitochondria</a>. </p>
<figure class="align-center ">
<img alt="A digital drawing of our brain's neurons sending signals throughout the body." src="https://images.theconversation.com/files/516358/original/file-20230320-24-6hgbkd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/516358/original/file-20230320-24-6hgbkd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=343&fit=crop&dpr=1 600w, https://images.theconversation.com/files/516358/original/file-20230320-24-6hgbkd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=343&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/516358/original/file-20230320-24-6hgbkd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=343&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/516358/original/file-20230320-24-6hgbkd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=431&fit=crop&dpr=1 754w, https://images.theconversation.com/files/516358/original/file-20230320-24-6hgbkd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=431&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/516358/original/file-20230320-24-6hgbkd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=431&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Our neurons need a lot of energy to make virtually everything we do possible.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/neuronal-network-electrical-activity-neuron-cells-1691666992">MattLphotography/ Shutterstock</a></span>
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<p>It’s thought that neurons are formed at birth and do not get regenerated at any point in a person’s life. Instead, their mitochondria and cellular parts are constantly turning over and being renewed. This ensures that their mitochondria remain healthy – which in turns ensures the neuron can function properly. Essentially, this means that as long as the mitochondria are healthy, the neuron is too. </p>
<p>But what would happen if the mitochondria stopped being able to <a href="https://pubmed.ncbi.nlm.nih.gov/16285865/">produce enough energy</a> for our cells to carry out their functions and repair damage? This would mean the cells may start to accumulate damage. In neurons, this could result in damage – and even death. </p>
<p>This is the foundation of the mitochondrial cascade hypothesis. </p>
<h2>Mitochondrial loss</h2>
<p>The <a href="https://pubmed.ncbi.nlm.nih.gov/15193340">mitochondrial cascade hypothesis</a> was actually first published by scientist and clinician professor Russell Swerdlow in 2004. This landmark article reviewed numerous studies which had previously found evidence of mitochondrial damage in Alzheimer’s disease. In the paper, Swerdlow proposed a new theory suggesting that problems with mitochondria and their function could provide an alternative explanation for why Alzheimer’s disease develops. </p>
<p>However, despite <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6684616">increasing evidence</a> showing mitochondrial loss in the neurons of <a href="https://pubmed.ncbi.nlm.nih.gov/27154981/">patients with Alzheimer’s</a>, the idea that <a href="https://pubmed.ncbi.nlm.nih.gov/30026371">mitochondrial dysfunction</a> could be a cause has remained on the fringes of dementia research. There are many reasons why this is the case. </p>
<p>First, a large proportion of the limited funding given to dementia research in the past few decades has gone to scientists studying amyloid beta and tau. This was thanks to promising studies in the field which suggested that removing or reducing the amount of <a href="https://pubmed.ncbi.nlm.nih.gov/25753046/">amyloid beta and tau</a> in the brain could have an effect on cognitive function. </p>
<p>Second, until relatively recently the methods used to study mitochondria in humans have been limited – meaning that we’ve also been limited in our ability to detect, prevent or cure mitochondrial dysfunction. But <a href="https://pubmed.ncbi.nlm.nih.gov/35623561/">developments in the field</a> may soon make it possible to transfer healthy mitochondria into cells. This could therefore allow us to study what would happen if we replaced damaged mitochondria in the neurons of patients with Alzheimer’s disease.</p>
<p>But while it’s clear that problems with the brain’s mitochondria are linked to neurodegenerative diseases, there are still many questions we need to answer before we can start developing treatments. For example, we need to understand what damages the brain’s mitochondria, and how to prevent this damage. </p>
<p>Dementia is a complex disease. This may mean there isn’t a one-size-fits-all cure for it. It could be the case that we may need to target multiple different mechanisms in order to treat the disease.</p><img src="https://counter.theconversation.com/content/201602/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Afshan Malik receives funding from the charity Alzheimer's Research UK</span></em></p>Mitochondria, which are found in every cell in the body, play an important role in brain function.Afshan Malik, Reader in Diabetes and Mitochondrial Research, King's College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1957072023-01-05T13:28:06Z2023-01-05T13:28:06ZLong COVID stemmed from mild cases of COVID-19 in most people, according to a new multicountry study<figure><img src="https://images.theconversation.com/files/502487/original/file-20221221-12-8m982k.jpg?ixlib=rb-1.1.0&rect=10%2C0%2C6699%2C4476&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Symptoms of long COVID-19 include fatigue, shortness of breath and cognitive issues.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/portrait-of-young-african-american-female-with-n95-royalty-free-image/1249011420?phrase=%20COVID-19%20WEARING%20N-95%20MASK&adppopup=true">Morsa Images/Digital Vision via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em> </p>
<h2>The big idea</h2>
<p>Even mild COVID-19 cases can have major and long-lasting effects on people’s health. That is one of the key findings from our <a href="https://doi.org/10.1001/jama.2022.18931">recent multicountry study</a> on long COVID-19 – or long COVID – recently published in the Journal of the American Medical Association. </p>
<p><a href="https://www.who.int/europe/news-room/fact-sheets/item/post-covid-19-condition">Long COVID is defined</a> as the continuation or development of symptoms three months after the initial infection from SARS-CoV-2, the virus that causes COVID-19. These symptoms last for at least two months after onset with no other explanation.</p>
<p>We found that a staggering 90% of people living with long COVID initially experienced only mild illness with COVID-19. After developing long COVID, however, the typical person experienced symptoms including fatigue, shortness of breath and cognitive problems such as brain fog – or a combination of these – that affected daily functioning. These symptoms had an impact on health as severe as the <a href="https://doi.org/10.1016/S2214-109X(15)00069-8">long-term effects of traumatic brain injury</a>. Our study also found that women have twice the risk of men and four times the risk of children for developing long COVID.</p>
<p>We analyzed data from 54 studies reporting on over 1 million people from 22 countries who had experienced symptoms of COVID-19. We counted how many people with COVID-19 developed clusters of new long-COVID symptoms and determined how their risk of developing the disease varied based on their age, sex and whether they were hospitalized for COVID-19. </p>
<p>We found that patients who were hospitalized for COVID-19 had a greater risk of developing long COVID – and of having longer-lasting symptoms – compared with people who had not been hospitalized. However, because the vast majority of COVID-19 cases do not require hospitalization, many more cases of long COVID have arisen from these milder cases despite their lower risk. Among all people with long COVID, our study found that nearly one out of every seven were still experiencing these symptoms a year later, and researchers don’t yet know how many of these cases may become chronic.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/e0REUL7pniU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Long COVID can affect nearly any organ in the body.</span></figcaption>
</figure>
<h2>Why it matters</h2>
<p>Compared with COVID-19, <a href="https://theconversation.com/deciphering-the-symptoms-of-long-covid-19-is-slow-and-painstaking-for-both-sufferers-and-their-physicians-164754">relatively little is known about long COVID</a>. </p>
<p>Our systematic, multicountry analysis of this condition delivered findings that illuminate the potentially steep human and economic costs of long COVID around the world. Many people who are living with the condition are <a href="https://doi.org/10.1001/jama.2022.18931">working-age adults</a>. Being unable to work for many months could cause people to lose their income, their livelihoods and their housing. For parents or caregivers living with long COVID, the condition may make them unable to care for their loved ones. </p>
<p>We think, based on the pervasiveness and severity of long COVID, that it is keeping people from working and therefore contributing to labor shortages. Long COVID could also be a factor in how <a href="https://doi.org/10.1016/S0140-6736(22)00008-3">people losing their jobs</a> has disproportionately affected women.</p>
<p>We believe that finding effective and affordable treatments for people living with long COVID should be a priority for researchers and research funders. Long COVID clinics have opened to <a href="https://doi.org/10.1016/S2213-2600(21)00031-X">provide specialized care</a>, but the treatments they offer are limited, inconsistent and <a href="https://www.cnbc.com/2022/12/01/long-covid-costs-patients-an-average-9000-a-year-in-medical-expenses.html">may be costly</a>. </p>
<h2>What’s next</h2>
<p>Long COVID is a complex and dynamic condition – some symptoms disappear, then return, and new symptoms appear. But researchers don’t yet know why. </p>
<p>While our study focused on the three most common symptoms associated with long COVID that affect daily functioning, the condition can also include symptoms like loss of smell and taste, insomnia, gastrointestinal problems and headaches, among others. But in most cases these additional symptoms occur together with the main symptoms we made estimates for.</p>
<p>There are many unanswered questions about what predisposes people to long COVID. For example, how do different <a href="https://doi.org/10.1038/s41591-022-01909-w">risk factors</a>, including smoking and high body-mass index, influence people’s likelihood of developing the condition? Does getting <a href="https://doi.org/10.1038/s41591-022-02051-3">reinfected</a> with SARS-CoV-2 change the risk for long COVID? Also, it is unclear how protection against long COVID changes over time after a person <a href="https://doi.org/10.1016/j.eclinm.2022.101624">has been vaccinated</a> or boosted against COVID-19.</p>
<p>COVID-19 variants also present new puzzles. Researchers know that <a href="https://theconversation.com/will-omicron-the-new-coronavirus-variant-of-concern-be-more-contagious-than-delta-a-virus-evolution-expert-explains-what-researchers-know-and-what-they-dont-169020">the omicron variant</a> is less deadly than previous strains. Initial evidence shows <a href="https://doi.org/10.1016/S0140-6736(22)00941-2">lower risk of long COVID</a> from omicron compared with earlier strains, but far more data is needed. </p>
<p>Most of the people we studied were infected with the <a href="https://doi.org/10.1002/jmv.28118">deadlier variants</a> that were circulating before omicron became dominant. We will continue to build on our research on long COVID as part of the <a href="https://www.healthdata.org/gbd/">Global Burden of Disease</a> study – which makes estimates of deaths and disability due to all diseases and injuries in every country in the world – in order to to get a clearer picture of how COVID-19’s long-term toll shifted once omicron arrived.</p><img src="https://counter.theconversation.com/content/195707/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>While there are still far more questions than answers about long COVID-19, researchers are beginning to get a clearer picture of the health and economic consequences of the condition.Sarah Wulf Hanson, Lead Research Scientist of Global Health Metrics, University of WashingtonTheo Vos, Professor of Health Metric Sciences, University of WashingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1949692023-01-03T13:27:22Z2023-01-03T13:27:22ZKick up your heels – ballroom dancing offers benefits to the aging brain and could help stave off dementia<figure><img src="https://images.theconversation.com/files/500091/original/file-20221209-19531-psjcx1.jpg?ixlib=rb-1.1.0&rect=16%2C0%2C5450%2C3663&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Not only is it good aerobic exercise, but dancing may help the elderly with reasoning skills and memory.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/senior-couple-dancing-together-in-community-center-royalty-free-image/858729852?phrase=ballroom%20dancing%20elderly&adppopup=true">Thomas Barwick/Stone via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em> </p>
<h2>The big idea</h2>
<p>Social ballroom dancing can improve cognitive functions and reduce brain atrophy in older adults who are at increased risk for Alzheimer’s disease and other forms of dementia. That’s the key finding of my team’s <a href="https://doi.org/10.1123/japa.2022-0176">recently published study</a> in the Journal of Aging and Physical Activity.</p>
<p>In our study, we enrolled 25 adults over 65 years of age in either six months of twice-weekly ballroom dancing classes or six months of twice-weekly treadmill walking classes. None of them were engaged in formal dancing or other exercise programs.</p>
<p>The overall goal was to see how each experience affected cognitive function and brain health. </p>
<p>While none of the study volunteers had a dementia diagnosis, all performed a bit lower than expected on at least one of our dementia screening tests. We found that older adults that completed six months of social dancing and those that completed six months of treadmill walking improved their executive functioning – an umbrella term for planning, reasoning and processing tasks that require attention.</p>
<p>Dancing, however, generated significantly greater improvements than treadmill walking on one measure of executive function and on processing speed, which is the time it takes to respond to or process information. Compared with walking, dancing was also associated with reduced brain atrophy in the hippocampus – a brain region that is key to memory functioning and is particularly affected by Alzheimer’s disease. Researchers also know that this part of our brain can undergo neurogenesis – or grow new neurons – <a href="https://doi.org/10.1073/pnas.0611721104">in response to aerobic exercise</a>. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/unmbhUvnGow?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Research shows those who regularly dance with a partner have a more positive outlook on life.</span></figcaption>
</figure>
<p>While several previous studies suggest that dancing has beneficial effects <a href="https://doi.org/10.1093/ageing/afaa270">on cognitive function in older adults</a>, only a few studies have compared it directly with traditional exercises. Our study is the first to observe both better cognitive function and improved brain health following dancing than walking in older adults at risk for dementia. We think that social dancing may be more beneficial than walking because it is physically, socially and cognitively demanding – and therefore strengthens a wide network of brain regions. </p>
<p>While dancing, you’re not only using brain regions that are important for physical movement. You’re also relying on brain regions that are important for interacting and adapting to the movements of your dancing partner, as well as those necessary for learning new dance steps or remembering those you’ve learned already. </p>
<h2>Why it matters</h2>
<p>Nearly 6 million older adults in the U.S. and 55 million worldwide <a href="https://doi.org/10.1016/j.jalz.2019.01.010">have Alzheimer’s disease</a> or a <a href="https://www.who.int/news-room/fact-sheets/detail/dementia">related dementia</a>, yet there is no cure. Sadly, the efficacy and ethics surrounding recently developed drug treatments <a href="https://doi.org/10.1080/21507740.2022.2129858">are still under debate</a>. </p>
<p>The good news is that older adults can potentially <a href="https://doi.org/10.1016/S0140-6736(20)30367-6">lower their risk for dementia</a> through lifestyle interventions, even later in life. These include reducing social isolation and physical inactivity. </p>
<p>Social ballroom dancing targets both isolation and inactivity. In these later stages of the COVID-19 pandemic, a better understanding of the <a href="https://doi.org/10.1177/23337214211005223">indirect effects of COVID-19</a> – particularly those that increase dementia risk, such as social isolation – is urgently needed. In my view, early intervention is critical to prevent dementia from becoming the next pandemic.
Social dancing could be a particularly timely way to overcome the adverse cognitive and brain effects associated with isolation and fewer social interactions during the pandemic.</p>
<h2>What still isn’t known</h2>
<p>Traditional aerobic exercise interventions such as treadmill-walking or running have been shown to lead to modest but reliable improvements in cognition – <a href="https://doi.org/10.1177/1745691617707316">particularly in executive function</a>. </p>
<p>My team’s study builds on that research and provides preliminary evidence that not all exercise is equal when it comes to brain health. Yet our sample size was quite small, and larger studies are needed to confirm these initial findings. Additional studies are also needed to determine the optimal length, frequency and intensity of dancing classes that may result in positive changes. </p>
<p>Lifestyle interventions like social ballroom dancing are a promising, noninvasive and cost-effective path toward staving off dementia as we – eventually – leave the COVID-19 pandemic behind.</p><img src="https://counter.theconversation.com/content/194969/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Helena Blumen receives funding from National Institute on Aging</span></em></p>Dancing requires physical, social and cognitive engagement and, as a result, it may bolster a wide network of brain regions.Helena Blumen, Associate Professor of Medicine and Neurology, Albert Einstein College of MedicineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1908872022-09-20T18:35:53Z2022-09-20T18:35:53ZCanada must take action now on dementia: Recommendations to help lower risks in an aging population<figure><img src="https://images.theconversation.com/files/485695/original/file-20220920-18-sqr9n1.jpg?ixlib=rb-1.1.0&rect=502%2C120%2C6156%2C4044&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A new study predicts a significant increase in the number of Canadians living with dementia over the next three decades.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>There is a great deal of sobering news for Canadians in the <a href="https://alzheimer.ca/en">Alzheimer Society of Canada’s</a> new study. The recently released first volume of <a href="https://alzheimer.ca/en/research/reports-dementia/landmark-study-report-1-path-forward"><em>Navigating the Path Forward for Dementia in Canada: The Landmark Study</em></a> predicts a significant increase in the number of Canadians living with dementia over the next three decades. </p>
<p>Among the study’s findings:</p>
<ul>
<li>More than one million Canadians are forecast to be living with dementia by the end of 2030, with the figure predicted to rise to 1.7 million by 2050.</li>
<li>In 2020, 8.4 per cent of Canadians over 65 had some form of dementia. By 2050, when the baby boomer generation is over the age of 85, the percentage of Canadians over 65 living with dementia is expected to increase to 13.2 per cent.</li>
<li>On average, care partners, such as family and friends of people living with dementia, provide 26 hours of care per week. If current trends continue, the number of hours provided by family and friends could reach almost 1.4 billion hours annually by 2050. This is equivalent to over 690,000 full-time jobs.</li>
</ul>
<p>The numbers illustrate the potential for significant challenges for the health-care system, and Canadians should rightly view them as a wake-up call. But the study also offers a glimpse at a more hopeful future, showing several scenarios in which the number of potential dementia cases can be reduced across Canada by addressing the risk factors associated with the condition.</p>
<p>A delay in the onset of dementia by even just a single year would mean 500,000 fewer cases of dementia in Canada by 2050. The impact of this decrease, on both the number of people living with dementia and those who care for them, would be profound.</p>
<h2>Recommendations for action</h2>
<figure class="align-center ">
<img alt="An older couple sitting on a sofa looking at each other, the man with his arm around the woman." src="https://images.theconversation.com/files/485697/original/file-20220920-3560-dob2c4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/485697/original/file-20220920-3560-dob2c4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/485697/original/file-20220920-3560-dob2c4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/485697/original/file-20220920-3560-dob2c4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/485697/original/file-20220920-3560-dob2c4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/485697/original/file-20220920-3560-dob2c4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/485697/original/file-20220920-3560-dob2c4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Care partners, such as family and friends of people living with dementia, provide an average of 26 hours of care per week.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>The report makes several recommendations to governments at all levels to support those living with the disease and their care partners. For example, the federal government approved a <a href="https://www.canada.ca/en/public-health/services/publications/diseases-conditions/dementia-strategy.html">national dementia strategy in 2019</a> that included key areas for action — especially a public health approach to risk reduction. As yet, that strategy has not been fully costed or appropriately funded. </p>
<p>Similarly, the strategy sets a goal to fund chronically underfunded research in dementia to a minimum of one per cent of overall dementia care. This has still not been implemented, despite the report’s calls for immediate action.</p>
<p>Another issue is that primary care physicians are the first point of contact for people living with dementia as well as their care partners. Yet, they are poorly resourced to provide appropriate care, with no clear pathway through a complex health system. The new report calls for providing primary care clinicians with more training to make timely diagnosis of dementia symptoms and an improved fee structure that prioritizes the time spent with people living with dementia and their care partners. </p>
<h2>Modifiable factors</h2>
<figure class="align-center ">
<img alt="Older man with a beard reading a book sitting on a sofa" src="https://images.theconversation.com/files/485698/original/file-20220920-16-v7h2bt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/485698/original/file-20220920-16-v7h2bt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/485698/original/file-20220920-16-v7h2bt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/485698/original/file-20220920-16-v7h2bt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/485698/original/file-20220920-16-v7h2bt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/485698/original/file-20220920-16-v7h2bt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/485698/original/file-20220920-16-v7h2bt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Activities that stimulate the brain and encourage lifelong learning include reading, playing games or speaking a second language.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>One of the most effective tools to reduce the prevalence of dementia is to address what are known as <a href="https://doi.org/10.1016/S0140-6736(20)30367-6">modifiable factors</a>. While a person can’t control their sex at birth, age or genetic background, there are actions that can promote overall good health and reduce the risk of dementia, some of which are very specific to dementia. These include:</p>
<ul>
<li>Monitoring and controlling blood pressure and cholesterol levels;</li>
<li>Staying physically fit through regular activities, including walking and exercise;</li>
<li>Enjoying activities that stimulate the brain and encourage lifelong learning, such as reading, playing games or speaking a second language;</li>
<li>Staying in touch with family and friends to keep an active social circle;</li>
<li>Limiting consumption of alcohol and tobacco;</li>
<li>Using hearing aids to deal with hearing loss issues;</li>
<li>Maintaining a positive attitude by finding purposeful, meaningful engagement in life;</li>
<li>Making healthy food choices and avoiding unnecessary stress.</li>
</ul>
<p>Ultimately, the only way to create a world without dementia is by supporting research that will lead to more effective treatments and, potentially, cures. <a href="https://doi.org/10.1016/S1474-4422(10)70304-5">Research is already showing some promising efforts</a> in terms of delaying the onset of dementia. </p>
<p>While there’s room for optimism, we must be clear in our understanding that dementia will be a public health challenge in Canada for many years to come. Providing quality care for people living with dementia is the right thing to do. </p>
<p>Meanwhile, the findings of this report can alert Canadians to an issue that, if left unchecked, will affect hundreds of thousands of Canadian older adults and their families.</p><img src="https://counter.theconversation.com/content/190887/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Saskia Sivananthan works for the Alzheimer Society of Canada. She also serves as a member of the Ministerial Advisory Board on Dementia for the Public Health Agency of Canada.</span></em></p>Action is needed to hold off a wave of dementia cases in an aging population. One of the most effective tools to reduce the prevalence of dementia is to address modifiable factors.Saskia Sivananthan, Affiliate Professor, Department of Family Medicine, McGill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1824492022-05-10T16:13:51Z2022-05-10T16:13:51ZMenopause: HRT’s brain-protecting effect may be overstated<figure><img src="https://images.theconversation.com/files/462215/original/file-20220510-22-3lndx0.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C5615%2C3724&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Hormone replacement therapy can help women manage menopause symptoms.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hormone-replacement-therapy-181678289">Image Point Fr/ Shutterstock</a></span></figcaption></figure><p>Many women expect hot flushes, dry skin and night sweats when they reach the menopause. But the effect the menopause can have on the brain is rarely mentioned. This is something a recent Channel 4 documentary presented by Davina McCall explored. </p>
<p>The documentary, called <a href="https://www.channel4.com/programmes/davina-mccall-sex-mind-and-the-menopause">Sex, Mind and the Menopause</a>, discussed how the menopause can cause a range of brain-related symptoms, including brain fog, mood changes and memory problems. It also suggested that taking hormone replacement therapy (HRT) some years before the menopause may be the solution to these problems – alongside potentially halving a woman’s risk of developing dementia.</p>
<p>With around 4.4 million women of working age going through the menopause in the UK, it’s clear that we need solutions to help those suffering from brain-related and other menopause symptoms. But HRT might not live up to what the documentary suggested it to be.</p>
<h2>Brain changes</h2>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/34969617/">Around 23% of women</a> experience measurable changes in brain function during menopause – especially to their memory. These changes typically occur in the early stages, during perimenopause (the transitional period before menopause, typically between 40 and 44 years of age when oestrogen levels begin to drop and the frequency and intensity of periods start changing).</p>
<p>This is something the documentary touched on, with one doctor using brain scans of perimenopausal women to show that brain activity was 25% lower compared with premenopausal women (the time before perimenopause). However, the documentary did not show viewers that these brain changes are <a href="https://news.weill.cornell.edu/news/2021/06/imaging-study-reveals-brain-changes-during-the-transition-to-menopause">usually temporary</a> – often reversing a couple of years after reaching the menopause – when a woman no longer has periods. This is typically between 45 and 55 years of age.</p>
<p>These temporary brain changes may be caused by other menopause symptoms that can <a href="https://www.sciencedirect.com/science/article/pii/S1521693421001644#sec7">affect sleep</a>, such as night sweats. Since sleep plays an important role in brain function, not sleeping properly could lead to concentration and memory problems. No evidence to date has conclusively shown whether or not the hormonal changes that happen during this period are the cause of brain changes in humans. </p>
<p>While there is <a href="https://www.nice.org.uk/guidance/NG23/documents/385">good evidence</a> that HRT can help reduce the severity of some menopause symptoms (including hot flushes and night sweats), it’s less certain whether such treatments have any long-term benefit on <a href="https://link.springer.com/article/10.1007/s40266-021-00887-x">memory and brain function</a>. </p>
<h2>Dementia risk</h2>
<p>Another argument the documentary makes is that taking HRT can significantly reduce a woman’s risk of developing Alzheimer’s disease – the most common form of dementia. They drew on the results of an American study of over 400,000 women that showed those who used HRT had a <a href="https://pubmed.ncbi.nlm.nih.gov/34027024/">50% lower risk of dementia</a>. This was especially true if they were taking natural hormones, such as oestradiol (an oestrogen steroid hormone).</p>
<p>But there is one <a href="https://www.researchgate.net/publication/242595488_Health_Prior_to_Hormone_Use_Matthews_et_al_Reply_to_Grodstein">key issue</a> with this type of observational study. Previous studies have shown that women who decide to take HRT were better educated, exercised regularly, had a healthier weight and lower blood pressure and cholesterol levels compared with women who chose not to take HRT. All of these factors are <a href="https://www.routledge.com/New-Developments-in-Dementia-Prevention-Research-State-of-the-Art-and-Future/Irving-Hogervorst-Oliveira-Kivipelto/p/book/9780367583200">known to decrease dementia risk</a>.</p>
<p>While the study took these factors into account, having a good education or a healthy lifestyle may still have had a greater influence on reducing dementia risk than taking HRT by itself during the menopause did. </p>
<figure class="align-center ">
<img alt="Woman uses HRT cream on her wrist." src="https://images.theconversation.com/files/461589/original/file-20220505-19-m4ndtz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/461589/original/file-20220505-19-m4ndtz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/461589/original/file-20220505-19-m4ndtz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/461589/original/file-20220505-19-m4ndtz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/461589/original/file-20220505-19-m4ndtz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/461589/original/file-20220505-19-m4ndtz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/461589/original/file-20220505-19-m4ndtz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Women who decide to take HRT may be less likely to develop dementia because of their lifestyle.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hormone-replacement-therapy-173838089">Image Point Fr/ Shutterstock</a></span>
</figcaption>
</figure>
<p>While a large UK study showed that taking HRT during the menopause can lower a woman’s risk of being diagnosed with dementia, this effect was much smaller (only <a href="https://www.theguardian.com/society/2021/sep/29/hrt-not-linked-to-increased-risk-of-dementia-says-study">around 8-12% lower</a>) – and was only seen in women taking the hormone oestradiol. It is worth noting that this study looked a both women who had experienced natural menopause as well as those who had early menopause because of surgery. It’s believed that premature surgical menopause (before the age of 40) <a href="https://academic.oup.com/humrep/article/31/5/926/1749616">increases dementia risk</a> unless these women take a replacement oestrogen treatment – such as oestradiol. So while the study showed lower dementia risk in some women taking this hormone therapy, this might only have been the case for those who had an already elevated risk because of early menopause. It’s also worth noting that overall, there was no association between taking hormones during the menopause and dementia in the UK study. </p>
<p>This UK study also showed that taking oestrogen alongside progesterone (the standard hormone treatment for the menopause prescribed to women who still have a womb), either eliminated the beneficial effect of oestrogen treatment alone – or even increased the risk of dementia slightly. <a href="https://pubmed.ncbi.nlm.nih.gov/20202765/">Previous studies</a> have also shown an <a href="https://pubmed.ncbi.nlm.nih.gov/30842086/">increased risk</a> of dementia when taking a combination hormone – though this risk was typically seen in women who were over 60 or if they were taking hormones for more than ten years. Giving these older women sex steroids has been associated with negative effects, <a href="https://arizona.pure.elsevier.com/en/publications/hormones-cognition-and-dementia-state-of-the-art-and-emergent-the">accelerating damage</a> to the brain cells. </p>
<p>It’s also worth noting that taking combined hormone treatments for more than five years is linked to a greater risk of <a href="https://www.bmj.com/content/371/bmj.m3873">breast cancer</a> – though this <a href="https://thebms.org.uk/wp-content/uploads/2016/04/WHC-UnderstandingRisksofBreastCancer-MARCH2017.pdf">risk is small</a>, especially when compared with, say, the risk of cancer from being overweight or smoking. As such, most <a href="https://www.nice.org.uk/guidance/ng23/chapter/recommendations">medical guidelines</a> suggest that taking combined hormones for menopause symptoms is safe for up to five years after the menopause.</p>
<p>Hormone replacement therapy can be effective for many women in alleviating a range of menopausal symptoms, particularly hot flushes. Whether HRT can prevent dementia or alleviate brain-related symptoms due to the menopause is still unclear. But fortunately, any brain changes that happen because of the menopause are usually temporary.</p><img src="https://counter.theconversation.com/content/182449/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eef Hogervorst received funding from ARUK, the British Council and Alzheimer;'s association to investigate oestrogenic treatment for memory improvement and dementia prevention. She was also invited to join the NICE committee as dementia expert to help revise HRT guidelines</span></em></p><p class="fine-print"><em><span>Rebecca Hardy has received funding from the MRC and ESRC. She was an epidemiological topic expert advisor on the NICE Menopause Guideline Development Group.</span></em></p><p class="fine-print"><em><span>Emma D'Donnell does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s still unclear whether HRT can protect brain function and prevent dementia.Eef Hogervorst, Professor of Biological Psychology, Loughborough UniversityEmma D'Donnell, Senior Lecturer in Exercise Physiology, Loughborough UniversityRebecca Hardy, Professor of Epidemiology and Medical Statistics, Loughborough UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1779852022-04-07T12:26:45Z2022-04-07T12:26:45ZMental health problems come with an added ‘cost’ of poorer cognitive function – a neuropsychologist explains<figure><img src="https://images.theconversation.com/files/455334/original/file-20220330-5678-1x2xdee.jpg?ixlib=rb-1.1.0&rect=120%2C86%2C5630%2C3707&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The cognitive difficulties that accompany mental health disorders can potentially lead to misdiagnoses and improper treatment.
</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/backlit-teenager-sitting-in-a-dark-indoor-doorway-royalty-free-image/1281225732?adppopup=true">Elva Etienne/Moment via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>All types of mental disorders come with a hidden cost in the form of cognitive dysfunction, including deficits in memory, attention, executive functions and processing speed, according to a <a href="https://doi.org/10.1016/j.cpr.2021.102007">comprehensive study</a> that my colleagues and I published in June 2021 in the journal Clinical Psychology Review. </p>
<p>We found that both diagnosable mental disorders, as well as some common symptoms such as anxiety and worry, carry a so-called “cognitive price.” We termed this phenomenon “The C Factor” – short for cognitive dysfunction. This can be defined either as lower performance on cognitive tests or reduction in cognitive abilities such as attention and memory. Our analysis suggests that it can be <a href="https://doi.org/10.1007/s00127-014-1001-2">found across disorders</a> and that it constitutes an integral part of poorer mental health.</p>
<p>Our team analyzed data from all existing meta-analyses and systematic reviews of cognitive function across all disorders recognized by the <a href="https://www.psychiatry.org/psychiatrists/practice/dsm">Diagnostic and Statistical Manual of Mental Disorders</a>. We included 97 meta-analyses covering 29 disorders. Overall, our study incorporated data from more than 200,000 individuals.</p>
<h2>Why it matters</h2>
<p>In recent decades, mental disorders have become <a href="https://blogs.scientificamerican.com/observations/mental-illness-is-far-more-common-than-we-knew/">increasingly prevalent in the U.S.</a> and around the world, particularly in young adults and adolescents. Even before the pandemic, <a href="https://www.nami.org/mhstats#">1 in 5 Americans suffered from a mental disorder</a>. </p>
<p>In fact, the most comprehensive study to date examining the worldwide prevalence of mental disorders projected that 55% of Americans will <a href="https://pubmed.ncbi.nlm.nih.gov/18188442/">meet criteria for at least one mental disorder</a> over the course of their lifetime. Notably, that study – which was conducted 15 years ago – examined diagnosable disorders. But, in fact, the prevalence of lifetime experience of clinically meaningful symptoms in the general population is much higher. For example, one study found that although only about 20% of Americans will meet formal criteria for major depressive disorder in their lifetime, <a href="https://doi.org/10.1146/annurev-publhealth-031912-114409">62% of Americans will experience meaningful symptoms of depression</a>.</p>
<p>Since our findings demonstrate that poorer mental health is associated with at least some degree of cognitive dysfunction, this type of deficiency may be far more common than previously thought. </p>
<p>These findings are important because some mental disorders may be misdiagnosed based on cognitive dysfunction. For instance, a college student who struggles with <a href="https://doi.org/10.1016/j.jocrd.2012.09.001">obsessive-compulsive disorder</a> should be expected to have some difficulties in areas such as concentration, organization, time management and memory. However, in such a case, these cognitive challenges do not stem from conditions such as dyslexia or attention deficit hyperactivity disorder, but rather from OCD. This potential confusion may lead to a misdiagnosis. </p>
<p>Indeed, ADHD, a disorder characterized by deficits in executive functions, <a href="https://www.pghr.org/post/the-global-misdiagnosis-of-adhd-and-the-devastating-long-term-effects">is one of the most misdiagnosed disorders</a> across all age groups. According to one 2010 study, about 20% of youths diagnosed with ADHD and receiving medications <a href="https://doi.org/10.1016/j.jhealeco.2010.06.003">are misdiagnosed</a>. In addition, there is evidence that doctors all too readily prescribe <a href="https://doi.org/10.1542/peds.2014-1500">stimulant medications for symptoms of inattention</a>, even without a complete or formal diagnosis of ADHD. </p>
<p>Therefore, lack of knowledge about cognitive dysfunctions associated with OCD in the example above could lead to inappropriate treatment. Indeed, stimulant medication <a href="https://doi.org/10.4088/jcp.15r10601">may increase irritability and anxiety</a> and exacerbate cognitive dysfunction in such individuals. So it is crucial that mental health professionals gain a better understanding of how mental health and cognitive dysfunction go hand in hand, particularly in the context of misinterpretation of cognitive symptoms.</p>
<h2>What still isn’t known</h2>
<p>Two major questions arise from the results of our study. First, why does any significant mental health issue come with a cost in the form of cognitive dysfunction? That seems surprising given that various mental health disorders differ significantly in terms of symptoms and type of interventions. Our team is working to unravel the factors that can have a negative impact on cognitive functioning, including reduced motivation, low effort and lower self-efficacy.</p>
<p>Second, what is the actual mechanism underlying this phenomenon? For example, if we find that general suffering is common to all mental disorders, what is the specific mechanism by which suffering hinders performance on cognitive tests? More research is needed to examine these questions.</p>
<p>[<em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-youresmart">You can read us daily by subscribing to our newsletter</a>.]</p><img src="https://counter.theconversation.com/content/177985/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amitai Abramovitch does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>While only about 20% of people would qualify for a formal diagnosis of a mental disorder, more than 60% express symptoms of those disorders – and those symptoms can lead to cognitive difficulties.Amitai Abramovitch, Associate Professor of Psychology, Texas State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1804992022-04-04T20:43:37Z2022-04-04T20:43:37ZBruce Willis’s aphasia diagnosis draws attention to a common language disorder<figure><img src="https://images.theconversation.com/files/456211/original/file-20220404-13-kc2qvo.jpg?ixlib=rb-1.1.0&rect=230%2C15%2C3052%2C2302&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Aphasia is a language disorder that affects about 30 per cent of stroke patients.</span> <span class="attribution"><span class="source">(Denis Makarenko/Shutterstock.com)</span></span></figcaption></figure><p>Until the recent news that <a href="https://variety.com/2022/film/news/bruce-willis-retiring-acting-apashia-1235219017/">Bruce Willis</a> had been diagnosed with aphasia and was retiring from acting, many people were <a href="https://www.aphasia.org/2020-aphasia-awareness-survey/">unfamiliar with the condition</a>. Despite its low profile, aphasia is not uncommon. </p>
<p>Across <a href="https://www.sac-oac.ca/news-events/news/speech-hearing-month-2021-what-aphasia">Canada</a> and the <a href="https://www.aphasia.org/">United States</a>, it’s estimated that more than two million people are living with aphasia and its associated challenges in communication and in using and understanding language.</p>
<p><a href="https://www.aphasia.ca/">Aphasia</a> affects language abilities, including listening, speaking, reading and writing. Some common language symptoms that occur in individuals living with aphasia are:</p>
<ul>
<li><p>Difficulty coming up with the right word. An individual might use a related word (for example, they may say or write “daughter” when trying to find the word “niece”) or even use a made up word (for example, say or write “pitsy” when trying to find the word “niece”).</p></li>
<li><p>Making mistakes in grammar or syntax such as omitting word endings. Examples include leaving off the plural “s” or “ed” to indicate past tense, or putting words in the wrong order, such as: “The cat was his ran house out.”</p></li>
<li><p>Needing more time to process what is said to them and needing more time to formulate a response.</p></li>
<li><p>Difficulty understanding individual letters, speech sounds or words when listening or reading, even though prior to the onset of aphasia, these letters, sounds and words were automatically understood.</p></li>
</ul>
<p>For individuals with aphasia who use sign language, their ability to use and understand signs is also negatively affected. Some people with aphasia may also experience problems using and understanding nonverbal means of communication, such as gestures and facial expressions.</p>
<h2>Causes of aphasia</h2>
<figure class="align-center ">
<img alt="A silhouette of a head with a maze, and a red line going from through the maze from the braid to the mouth" src="https://images.theconversation.com/files/456217/original/file-20220404-15-yuez6j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/456217/original/file-20220404-15-yuez6j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=376&fit=crop&dpr=1 600w, https://images.theconversation.com/files/456217/original/file-20220404-15-yuez6j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=376&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/456217/original/file-20220404-15-yuez6j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=376&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/456217/original/file-20220404-15-yuez6j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=472&fit=crop&dpr=1 754w, https://images.theconversation.com/files/456217/original/file-20220404-15-yuez6j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=472&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/456217/original/file-20220404-15-yuez6j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=472&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Aphasia affects language abilities including listening, speaking, reading and writing.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Aphasia is not a disease, but rather a consequence of damage to the language-dominant regions of the brain. This brain damage is typically caused by a stroke (<a href="https://www.heartandstroke.ca/stroke/what-is-stroke">interruption of blood flow to or within the brain</a>), or sometimes by a traumatic brain injury, a brain tumour or an infection, such as meningitis. Stroke is the <a href="https://doi.org/10.3109/17549507.2010.520090">most common cause</a>, with aphasia affecting approximately <a href="https://doi.org/10.1016/j.apmr.2016.03.006">30 per cent of stroke patients</a>. </p>
<p>Aphasia is also <a href="https://doi.org/10.1002/ana.410110607">a key component</a> of a progressive neurodegenerative disease called <a href="https://www.aphasia.org/aphasia-resources/primary-progressive-aphasia/">primary progressive aphasia</a>, a type of <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/dementia/frontotemporal-dementia">frontotemporal dementia</a>.</p>
<p>Because the parts of the brain that support language also support other cognitive abilities, individuals living with aphasia may experience some difficulties in <a href="https://doi.org/10.1044/1058-0360(2012/11-0067)">attention, memory and thinking skills</a> like problem solving or planning. People living with aphasia may be challenged in these other cognitive functions because we often use and understand language in concert with these other functions. For example, rehearsing out loud or using your inner mind’s voice to repeat silently the items you have been asked to pick up at the store.</p>
<p>There is great <a href="https://doi.org/10.1093/brain/awab377">variability in the language symptoms</a> experienced by individuals living with aphasia. For example, one individual may experience significant difficulties equally across all language modalities. Another person may experience difficulties primarily in their verbal output and few difficulties with understanding what is said, written or gestured. </p>
<p>Likewise, there is a spectrum of aphasia severity. Some people with aphasia may only be able to understand short, common words. Others may only experience comprehension difficulties when reading books or following complex podcasts that include, for example, technical jargon or complex stories. </p>
<p>Variability also is common among those living with aphasia who are bilingual or multilingual. One individual with aphasia might experience similar difficulties in all of their languages while another might struggle more in one versus another of their languages.</p>
<h2>Living with aphasia</h2>
<figure class="align-right ">
<img alt="A bald man in a black suit with other people behind him" src="https://images.theconversation.com/files/456213/original/file-20220404-21-pldbem.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/456213/original/file-20220404-21-pldbem.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=852&fit=crop&dpr=1 600w, https://images.theconversation.com/files/456213/original/file-20220404-21-pldbem.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=852&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/456213/original/file-20220404-21-pldbem.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=852&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/456213/original/file-20220404-21-pldbem.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1071&fit=crop&dpr=1 754w, https://images.theconversation.com/files/456213/original/file-20220404-21-pldbem.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1071&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/456213/original/file-20220404-21-pldbem.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1071&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Like Bruce Willis, who has retired from acting, many people with aphasia are unable to remain in their vocation of choice.</span>
<span class="attribution"><span class="source">(THE CANADIAN PRESS/Frank Gunn)</span></span>
</figcaption>
</figure>
<p>Regardless of the breadth and severity of the language symptoms, aphasia is challenging for those living with the language disorder, as well as for their family and friends. Having aphasia can make it difficult to complete daily activities like reading prescription medication labels, booking an appointment or using a phone. </p>
<p>Like Willis, many individuals with aphasia will not be able to remain in their vocation of choice. Aphasia also can lead to negative consequences for social roles, relationships and activities. Consider how many components of parenting involve language (listening to your child’s day at school, reading with your child, reprimanding) and how essential communication is to maintaining close relationships with family and friends. </p>
<p>Most leisure activities similarly involve language, whether it is reading for pleasure, watching movies or travelling. Because of these daily struggles, many individuals with aphasia also experience <a href="https://doi.org/10.1186/s13063-016-1257-9">mental health issues such as depression</a>.</p>
<h2>Assessment and services for people with aphasia</h2>
<p>However, there is help and hope for those with aphasia. Decades of aphasia research indicate <a href="https://doi.org/10.1002/14651858.CD000425.pub4">there are many interventions</a> to improve individuals’ language abilities and help them compensate for their language impairments. An important first step for getting help is <a href="https://doi.org/10.1161/STR.0b013e3181e7512b">seeking an assessment from a speech-language pathologist</a>. </p>
<p>Given the various manifestations of aphasia, a comprehensive assessment is needed to determine its presence and an individual’s language and communication strengths and weaknesses. The assessment also will help the <a href="https://www.sac-oac.ca/">speech-language pathologist</a> identify <a href="https://www.heartandstroke.ca/services-and-resources/aphasia-services">interventions that can help individuals living with aphasia</a> and their family and friends achieve their language and communication goals.</p>
<p>In addition to assessment and intervention services, family and friends can <a href="https://www.sac-oac.ca/sac-resource-page-stroke-awareness">find other ways</a> to <a href="https://www.aphasia.ca/">support someone living with aphasia</a>. </p>
<p>By sharing his diagnosis of aphasia, Willis and his family are helping <a href="https://doi.org/10.1080/02687038.2019.1702847">increase awareness</a> of this complex and often debilitating language disorder. Increasing awareness among the public and health-care professionals is an important step in ensuring that individuals living with aphasia <a href="https://doi.org/10.1080/09638288.2020.1722264">can participate in their community and receive appropriate health-care services</a>.</p><img src="https://counter.theconversation.com/content/180499/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Across Canada and the United States, more than two million people are living with aphasia and its language and communication challenges.Laura Murray, Associate Dean of Graduate and Postdoctoral Studies, Faculty of Health Sciences, Western UniversityJ.B. Orange, Professor and Acting Director, School of Communication Sciences and Disorders; Scientific Director, Canadian Centre for Activity and Aging, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1798052022-03-25T14:59:53Z2022-03-25T14:59:53ZLong-term antibiotic use by middle-aged women may affect cognitive function – new study<figure><img src="https://images.theconversation.com/files/454400/original/file-20220325-15-oytuk.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6709%2C4476&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People may need to take long-term antibiotics for a range of conditions.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/crop-close-young-african-american-woman-1863927673">fizkes/ Shutterstock</a></span></figcaption></figure><p>Antibiotics are one of the most commonly prescribed drugs in the world. They’re used to treat many different bacterial infections. While most people may only be on a course of antibiotics for a week or two at a time, some may take antibiotics for a longer period to treat certain chronic conditions, such as pneumonia or acne.</p>
<p>While antibiotics can be life-saving, long-term use can come with several side effects – not least of which is the risk of bacteria developing antibiotic resistance. And now, a recent study has also linked long-term antibiotic use by middle-aged women to an <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0264649">increased risk of cognitive decline</a>.</p>
<p>To conduct their study, the researchers collected data from 14,542 participants who had taken part in the Nurses’ Health Study II. This study monitored the health and wellbeing of nurses every two years between 2014-2018. The average age of participants at the start of the study was 54.</p>
<p>The researchers recorded the participants’ antibiotic use up to four years prior to the start of the study. Some women had taken long-term antibiotics (two months or more) for a variety of conditions – such as respiratory problems or acne. Others had not been prescribed any antibiotics. The researchers measured cognitive ability using online tests that participants completed, which measured factors such as learning and working memory.</p>
<p>The women were followed up seven years later to see whether long-term antibiotic use in middle-age had lasting effects on cognition. Women who had previously used long-term antibiotics scored lower on learning, working memory, motor speed and attention tests compared to non-users. It’s unknown whether short-term antibiotic use had a similar effect as this wasn’t reported. </p>
<h2>Gut health</h2>
<p>Though the findings only show a link between antibiotic use and cognitive decline, the researchers think that gut microbiome changes caused by long-term antibiotic use may be the reason some women experienced poorer cognitive function. </p>
<p>Our bodies contain millions of tiny microbes invisible to the human eye. These bacteria and viruses quietly keep our health in check. But many things can disturb our microbiome’s balance – including poor diet and <a href="https://www.mdpi.com/2227-9059/8/11/502/htm">antibiotic use</a>. </p>
<figure class="align-center ">
<img alt="Woman holds an antibiotic pill between her thumb and index finger." src="https://images.theconversation.com/files/454401/original/file-20220325-17-10zqpx6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/454401/original/file-20220325-17-10zqpx6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/454401/original/file-20220325-17-10zqpx6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/454401/original/file-20220325-17-10zqpx6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/454401/original/file-20220325-17-10zqpx6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/454401/original/file-20220325-17-10zqpx6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/454401/original/file-20220325-17-10zqpx6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Antibiotics can disrupt our gut microbiome.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/selective-focus-medicine-pills-capsules-hand-405634465">Joe Besure/ Shutterstock</a></span>
</figcaption>
</figure>
<p>While antibiotics kill bacteria that cause infections in our body, they can also may kill other bacteria, including helpful ones. Even a small disruption in our microbiome’s balance can have an impact on our health – linked to conditions such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6039952/">inflammatory bowel disease</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/30366260/">type 2 diabetes</a>, <a href="https://www.sciencedirect.com/science/article/pii/S1931312817304407">obesity</a> and <a href="https://theconversation.com/how-parasites-and-bacteria-could-be-changing-the-way-you-think-and-feel-71309">mental health problems</a>. </p>
<p>Our <a href="https://www.sciencedirect.com/science/article/pii/S0163725815002259?via%3Dihub">gut microbiome and brain</a> are also connected, which is why a healthy gut is important for brain health. For example, the proteins our brain cells use to communicate are <a href="https://www.mdpi.com/2072-6643/13/6/2099">manufactured by gut microbes</a>. When the gut microbiome becomes unbalanced these <a href="https://www.frontiersin.org/articles/10.3389/fnins.2019.00369/full">proteins become damaged</a>. Not only does this affect how our brain works, it may even contribute to conditions such as <a href="https://theconversation.com/your-gut-microbiome-may-be-linked-to-dementia-parkinsons-disease-and-ms-144367">dementia, Parkinson’s disease</a> and even <a href="https://www.mdpi.com/2227-9059/9/8/875">schizophrenia</a>.</p>
<p>Given the microbiome’s connection to brain health and <a href="https://www.frontiersin.org/articles/10.3389/fnagi.2019.00170/full">cognition</a> and extensive evidence which shows antibiotics can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4831151/">disrupt the microbiome</a>, it seems plausible that long-term antibiotic use can affect the cognitive functions of the brain. For example, there’s evidence antibiotic use in early childhood – an important time for brain and cognitive development – can have <a href="https://pubmed.ncbi.nlm.nih.gov/31041458/">negative effects on cognition</a> up to 11 years later.</p>
<p>Though few studies have measured both antibiotic use and cognitive function in adults, some studies have shown broad-spectrum antimicrobials (including antibiotics) can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007723/">affect our cognitive function</a> – causing side effects such as confusion, delirium and poorer attention in both men and women, even after short-term use.</p>
<p>While this recent study showed a link between long-term antibiotic use and cognitive decline, the study has some of limitations to take into account. First, the online cognitive test only assessed four functions. This means we don’t have a full picture of cognitive health, and we do not know if there are other cognitive deficits in addition to those measured in the study. </p>
<p>Another shortfall is that researchers did not collect faecal samples. This means we don’t actually know whether the microbiome changed significantly after long-term antibiotic use – and whether this change persisted. Though the researchers were able to show that antibiotic use had a greater link to poorer cognitive function than other lifestyle factors (such as diet, or other health conditions), it will still be important for future research to look at whether the microbiome really plays a role in antibiotic use and cognitive function.</p>
<p>The age of the participants is also an important factor, as the average age was 54 at the start of the study – which is the time most women experience menopause. Menopause causes <a href="https://www.menopause.org/for-women/sexual-health-menopause-online/changes-at-midlife/changes-in-hormone-levels">hormonal changes</a> that can affect everything from how the immune system works, sleep quality, weight, blood pressure and even concentration and thinking. </p>
<p>Some research also shows that the menopause <a href="https://www.frontiersin.org/articles/10.3389/fcimb.2021.702628/full">alters the microbiome</a>. As such, it will be important to future studies to include men in mid-life to see whether they show similar effects.</p>
<p>These research findings indicate that it’s important to pay attention to gut health at all stages of life. Fortunately, there are many things you can do to make your microbiome healthier – such as eating a high-fibre diet and using prebiotics and probiotics. Fresh air and exercise also have positive effects on the microbiome. Of course for persistent problems medical attention should be sought.</p><img src="https://counter.theconversation.com/content/179805/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lynne A Barker has recently accepted a role on the Medical Advisory Board of a probiotic company</span></em></p>Our gut microbiome is connected to almost every aspect of our health – including brain health.Lynne A Barker, Associate Professor in Cognitive Neuroscience, Sheffield Hallam UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1767672022-02-23T15:18:00Z2022-02-23T15:18:00ZHow memory ‘clutter’ makes it harder to remember things as we get older<figure><img src="https://images.theconversation.com/files/447611/original/file-20220221-13-nvzret.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C5694%2C3796&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/retirement-couples-take-care-each-other-1633813924">KAMONRAT/Shutterstock</a></span></figcaption></figure><p>Memories are a crucial part of what makes us who we are. Yet we all know it can become <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1123445/">more difficult</a> to remember things as we get older. From forgetting why you came into a room, to not being able to recall details of a special family event, to forgetting familiar names.</p>
<p>Forgetting things can even be a way of defining old age. Many people will cry something along the lines of “oh my goodness, I’m getting old” when they can’t remember something that had previously been easy to recall. </p>
<p>This forgetfulness as we get older is easy to demonstrate but harder to explain. An obvious explanation might be that remembering things becomes difficult because something changes in the brain that makes it more difficult to store information.</p>
<p>But <a href="https://www.cell.com/trends/cognitive-sciences/fulltext/S1364-6613(21)00310-7?utm_source=EA">a paper</a> published recently in the journal Trends in Cognitive Sciences has presented an alternative explanation for this phenomenon: that our memories remain good, but they get cluttered as we age.</p>
<p>First, it’s important to understand that memory isn’t an accurate recording of life as it happens. Imagine if you remembered every single detail of every minute of every hour of every day. It would be overwhelming, and most of the information you remembered would be fairly pointless. </p>
<p>If you’re remembering what you had for breakfast this morning, is it relevant to be able to remember the shape of the cloud you could see outside the window, or the number of times you blinked while you ate? Instead, we attend to different parts of our environment, and the attention we pay to different parts of our experience shapes our memory.</p>
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Read more:
<a href="https://theconversation.com/why-we-become-more-forgetful-with-age-and-what-you-can-do-about-it-70102">Why we become more forgetful with age – and what you can do about it</a>
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<h2>Reviewing the evidence</h2>
<p>The authors of this new study reviewed a range of evidence on this topic. They suggest that instead of a difficulty in storing memories, poorer memory as we get older is a result of being less able to focus our attention on relevant target information, meaning we put too much information into our memory. This is not something we have any control over – it just seems to be a natural consequence of ageing.</p>
<p>Why would focusing on too much information make us worse at remembering it? Think of something you do every day in the same way, like brushing your teeth. You can probably remember whether you brushed your teeth this morning, but can you really remember the difference between the time you brushed your teeth this morning, and the time you brushed them yesterday? Or the day before that? Situations like brushing your teeth are hard to remember as individual events because they have so much in common. They are therefore easy to confuse. </p>
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<img alt="An elderly woman is comforted by a younger woman." src="https://images.theconversation.com/files/447616/original/file-20220221-14-156u3st.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/447616/original/file-20220221-14-156u3st.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/447616/original/file-20220221-14-156u3st.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/447616/original/file-20220221-14-156u3st.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/447616/original/file-20220221-14-156u3st.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/447616/original/file-20220221-14-156u3st.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/447616/original/file-20220221-14-156u3st.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">It’s well known that people tend to forget more as they age.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/health-visitor-talking-senior-woman-during-1937848606">pikselstock/Shutterstock</a></span>
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<p>Events which are distinct from one another are more memorable. The less events overlap in terms of their content, the less chance there is to confuse one event for another, or mix up what happened in those different events. For example, it’s easy to remember what happened when you took the dog for a walk and what happened when you went swimming separately. They’re highly unlikely to be confused because they share so little in common.</p>
<p>So, if older people are less focused when they put things into their memories, then their memories will be “cluttered” with information that doesn’t matter. This clutter means there will be more chance for information from one memory to overlap with information from another. This in turn means there will be more chance for memories to be confused with one another, making it harder to remember what happened.</p>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/32573381/#affiliation-2">previous study</a>, which was included in the review, shows this theory in action. An older and a younger group were shown two types of objects (faces and scenes) and told which type of object they would be tested on. The older adults exhibited higher levels of brain activity when they were shown the irrelevant objects later on. Further, the more brain activity they demonstrated in response to these irrelevant objects, the poorer their memory for the objects they were trying to remember.</p>
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Read more:
<a href="https://theconversation.com/how-simple-policy-changes-can-help-us-age-better-and-prevent-cognitive-decline-126314">How simple policy changes can help us age better and prevent cognitive decline</a>
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<p>The review found that not only do older adults add clutter to their memory by taking in too much information from the environment, but they also accumulate information from knowledge gained over many years. This means older people have more material to navigate when trying to access a memory, which can compound the errors we make in memory as we age.</p>
<h2>But the news isn’t all bad</h2>
<p>According to the researchers, evidence suggests that older people demonstrate preserved, and at times enhanced, creativity as a result of their “enriched memories”.</p>
<p>When we are faced with a novel problem, sometimes we need to come up with a creative solution. This can involve bringing together bits of knowledge we have that may not be obviously connected, or remembering similar (though not identical) previous experiences which might be relevant. </p>
<p>The “clutter” in an older person’s memory might be a strength in this process. Being able to make connections between apparently unrelated memories could allow them to find creative solutions to problems by drawing on a much bigger range of experience.</p>
<p>So perhaps we can stop seeing ageing and the inevitable memory decline that comes with it as only a bad thing.</p><img src="https://counter.theconversation.com/content/176767/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alexander Easton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Forgetfulness is often regarded as a sign of old age. But what exactly is going on in the brain that makes it more difficult for older people to remember things?Alexander Easton, Professor of Psychology, Durham UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1647542021-08-16T12:08:30Z2021-08-16T12:08:30ZDeciphering the symptoms of long COVID-19 is slow and painstaking – for both sufferers and their physicians<figure><img src="https://images.theconversation.com/files/415730/original/file-20210811-21-1xw5nik.jpg?ixlib=rb-1.1.0&rect=758%2C100%2C4801%2C3567&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People suffering from long-term effects of COVID-19 face uncertainty about the nature of their symptoms and how long they might last.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/portrait-of-senior-woman-with-face-mask-standing-royalty-free-image/1256056382?adppopup=true"> Halfpoint Images/Moment via Getty Images</a></span></figcaption></figure><p>My first patient that day was a woman in her early 40s, an avid marathon runner who had contracted COVID-19 in March 2020. Now, 13 months later, she noted that she still felt fatigued and short of breath. She also noticed her heart was racing whenever she walked around. She reported having daily headaches, numbness and tingling in her legs, and difficulty with memory, which had affected her work.</p>
<p>This woman was coming in to see me, a <a href="https://www.researchgate.net/scientific-contributions/Allison-Navis-2131988399">neurologist specializing in infectious diseases</a>, for symptoms that we physicians now all-too-commonly know as long, or long-haul, COVID-19.</p>
<p>While we have yet to determine a precise definition for long COVID-19, we typically consider it the persistence or development of new symptoms that last more than <a href="https://doi.org/DOI:%2010.1136/bmj.m3026">four weeks after COVID-19 recovery</a>. Long COVID-19 often involves a constellation of symptoms affecting many parts of the body, but the <a href="https://www.sciencedirect.com/science/article/abs/pii/S0025619621003566">most commonly reported</a> are fatigue, shortness of breath, chest pains, cognitive changes, headaches, sensory changes and pain. </p>
<p>A year and a half into the COVID-19 pandemic, it remains unclear how many people are affected by long COVID-19. Some data suggests <a href="https://doi.org/10.1038/s41591-021-01292-y">4.5% of people</a> infected with COVID-19, or about 1 in 22, will have symptoms beyond eight weeks post-COVID, while other studies point to <a href="https://doi.org/10.1186/s12879-021-06359-2">closer to 49%</a>. Some studies show that among people hospitalized for COVID-19, <a href="https://doi.org/10.1016/S0140-6736(20)32656-8">up to 63%</a> continued to have symptoms – specifically fatigue or muscle weakness – six months later.</p>
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<a href="https://images.theconversation.com/files/415727/original/file-20210811-23-2v6nue.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Doctors treating elderly man during COVID-19 pandemic" src="https://images.theconversation.com/files/415727/original/file-20210811-23-2v6nue.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/415727/original/file-20210811-23-2v6nue.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415727/original/file-20210811-23-2v6nue.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415727/original/file-20210811-23-2v6nue.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415727/original/file-20210811-23-2v6nue.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415727/original/file-20210811-23-2v6nue.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415727/original/file-20210811-23-2v6nue.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">People hospitalized with COVID-19 have a far greater chance of developing long COVID-19.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/doctors-checking-patient-in-ward-during-covid-19-royalty-free-image/1296010649?adppopup=true">Morsa Images/DigitalVision via Getty Images</a></span>
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<p>In April 2020, because of the overwhelming number of patients we had, I was pulled from my regular duties as a neurologist and asked to take care of patients on a COVID-19 unit in the hospital. It was my first experience seeing how sick people were and the extent of harm the virus could cause. Given the severity of illness, we were concerned that many people would need long-term care. </p>
<p>So my institution, Mount Sinai, decided to open one of the <a href="https://www.mountsinai.org/about/covid19/center-post-covid-care">first multidisciplinary centers for post-COVID care</a>. I was asked to be the lead clinical neurologist for the center. Since then, I have personally seen several hundred long COVID-19 patients and worked on research studies with the aim of untangling the complexities of <a href="https://doi.org/10.1056/NEJMp2109285">what is happening with the condition</a>.</p>
<h2>The puzzling nature of long COVID-19</h2>
<p>While data on long COVID-19 has <a href="https://doi.org/10.1038/s41591-021-01433-3">started to emerge</a>, less is known about the neurological symptoms. The most common neurological symptoms appear to be <a href="https://doi.org/10.1002/acn3.51350">cognitive changes</a>, including “brain fog” – such as sluggishness and lack of sharpness – as well as headaches, sensory changes, muscle or nerve pain and loss of smell. </p>
<p>We are also seeing many cases of “dysautonomia,” or impaired regulation of the nervous system that controls heart rate and blood pressure – the “fight or flight” part of the nervous system. This condition can lead to sensations of a racing heart and dizziness.</p>
<p>Part of the challenge in understanding long COVID-19 is that many of the symptoms, like fatigue and brain fog, can stem from a variety of conditions from hormonal or metabolic changes to sleep disruption or depression. Trying to determine a direct line between cause and effect in the general public, regardless of COVID-19 infection, often does not lead to clear answers. </p>
<p>Although many long COVID-19 sufferers tend to report the same general symptoms, it is likely that there are different underlying causes leading to these symptoms in different people. For example, <a href="https://doi.org/10.1515/jtim-2016-0016">post-intensive care syndrome</a> (PICS) can occur in anyone who has had a prolonged stay in the ICU, whether or not it was related to COVID-19. PICS is caused by prolonged immobility, mechanical ventilation and metabolic changes that occur during severe illness or infection. The symptoms of PICS often overlap with those of long COVID. </p>
<p>For other symptoms, such as joint or back pain, doctors might be able to pinpoint a cause, like arthritis or a pinched nerve. But the question remains whether that was present before the COVID-19 infection and the infection simply triggered a response that caused the pain to be unmasked, or whether these are new developments in a patient’s body.</p>
<p>What’s more, many diagnostic tests come back normal, or they show common and nonspecific changes. We are not observing widespread strokes, lesions or inflammatory changes on imaging. We may see small changes in blood vessels, known as <a href="https://doi.org/10.1111/j.1749-6632.2010.05758.x">microvascular ischemic changes</a>, but these are extremely common in anyone with high blood pressure, diabetes or even migraines. And tests of the nerves in the arms and legs may show damage in some cases – what we call neuropathy. But that is not always the case, and these can occur regardless of COVID-19 status. This makes it challenging to draw a direct link to COVID-19.</p>
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<a href="https://images.theconversation.com/files/415751/original/file-20210811-27-1rqjqjv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Screens displaying coronavirus and brain wave research" src="https://images.theconversation.com/files/415751/original/file-20210811-27-1rqjqjv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/415751/original/file-20210811-27-1rqjqjv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=316&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415751/original/file-20210811-27-1rqjqjv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=316&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415751/original/file-20210811-27-1rqjqjv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=316&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415751/original/file-20210811-27-1rqjqjv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=398&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415751/original/file-20210811-27-1rqjqjv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=398&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415751/original/file-20210811-27-1rqjqjv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=398&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Brain imaging has so far yielded inconclusive evidence about what is causing long COVID-19.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/laboratory-equipment-coronavirus-and-brainwave-royalty-free-image/1295324817?adppopup=true">janiecbros/iStock via Getty Images Plus</a></span>
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<h2>What we do know</h2>
<p>This doesn’t mean we are at a complete loss about what is happening. The constellation of symptoms resembles a <a href="https://www.healthline.com/health-news/fauci-warns-about-post-viral-syndrome-after-covid-19">post-viral syndrome</a>, which refers to prolonged symptoms after an infection. Sometimes the infection might be from a known source, <a href="http://dx.doi.org/10.1136/pgmj.64.753.559">such as Epstein-Barr virus (which causes mononucleosis)</a>, but often symptoms follow a general viral illness. </p>
<p>Many people suffering from those conditions will report experiencing some viral-type illness and afterward having persistent fatigue, brain fog and other symptoms that we now often see with sufferers of long COVID-19. The similarity in symptoms suggests that long COVID-19 may not be unique to COVID-19 but rather a general post-infectious process. </p>
<p>Long COVID-19 symptoms can also closely resemble those of <a href="https://www.cdc.gov/me-cfs/index.html">myalgic encephalomyelitis</a>, often known as chronic fatigue syndrome, or another poorly understood disease called <a href="https://doi.org/10.1161/CIRCULATIONAHA.112.144501">postural orthostatic tachycardia syndrome</a>. Both of these are associated with fatigue, dysautonomia and brain fog, among other symptoms. We researchers don’t yet understand what causes either condition. But medications for symptoms, pacing of exercise and physical therapy <a href="https://www.cdc.gov/me-cfs/treatment/index.html">can be helpful</a> for both myalgic encephalomyelitis and long COVID-19.</p>
<h2>Where do researchers go from here?</h2>
<p>I often tell my patients that normal test results don’t mean everything is normal. Our tests may not be sensitive enough, or we are looking at the wrong thing, or we need to develop new tests. <a href="https://doi.org/10.1002/acn3.51350">Neuropsychological evaluations</a> can provide formal information on cognitive functioning and may show changes in memory, attention, language or problem-solving. These results can be helpful in determining rehabilitation strategies for brain fog, but unfortunately, they are not designed to explain why these changes are occurring. </p>
<p>Imaging of the brain, with MRI or CT scans, has so far not provided much information on the underlying cause. It could be that they are not sensitive enough to pick up on small changes; if this is the case, different types of scans – such as functional MRIs – that are either able to get better pictures or look at metabolic changes in the brain might be helpful. However, these are not commonly available outside of research. </p>
<p>Other studies that might enlighten us about the underlying cause of symptoms include bloodwork that might show <a href="https://doi.org/10.1093/cid/ciab611">elevations in autoimmune markers</a> or <a href="https://doi.org/10.1007/s11910-021-01130-1">changes in hormones</a>. The immune system involves a balance of many factors, and impaired regulation of this system after an infection can cause inflammation; this, combined with hormonal or metabolic changes, could potentially lead to long COVID-19 symptoms. While these are not answers, they offer potential leads and further clues for researchers to explore.</p>
<p>To better understand long COVID-19, we need to have a clear picture of who is affected. While communities of color have often been <a href="https://doi.org/10.1001/jamanetworkopen.2020.21892">more severely affected</a> by COVID-19, they are also <a href="https://www.pbs.org/newshour/show/in-medical-research-racial-diversity-is-a-matter-of-life-or-death">likely to be</a> <a href="https://doi.org/DOI:%2010.3390/jcm9082442">underrepresented in studies</a>. </p>
<p>As a result, we researchers need to engage broadly across communities to ensure we fully understand who is affected by long COVID-19, as well as what risk factors might be at play in determining long-term outcomes. Research needs to also focus on gaining a better understanding of the less understood diseases like myalgic encephalomyelitis, as they seem to most resemble what we are seeing.</p>
<p>The ultimate goal in understanding long COVID-19 is to figure out how to prevent it from happening – and prevent as much suffering as we can. While I have seen people get better from long COVID-19, I have many patients who continue to suffer over a year later. It has also affected the health care workers whose goal is to help others heal, but are left with few answers to provide. Until research yields more answers on what could be causing long-COVID, we are left with trying to minimize symptoms and waiting.</p><img src="https://counter.theconversation.com/content/164754/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Allison Navis receives funding from the NIH Loan Repayment Program</span></em></p>Researchers are piecing together clues to better understand the puzzling array of symptoms in those who never seem to fully recover from COVID-19.Allison Navis, Assistant Professor of Neurology, Icahn School of Medicine at Mount SinaiLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1544232021-02-26T14:56:27Z2021-02-26T14:56:27ZNapping in the afternoon can improve memory and alertness – here’s why<figure><img src="https://images.theconversation.com/files/386680/original/file-20210226-17-e5d9ur.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6608%2C4520&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Short and long naps both have benefits.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/caucasian-woman-sleeping-bed-1115266718">Rawpixel.com/ Shutterstock</a></span></figcaption></figure><p>Some people swear by an afternoon nap – whether it’s to catch up on lost sleep or to help them feel more alert for the afternoon ahead. Even Boris Johnson supposedly favours a <a href="https://www.thetimes.co.uk/article/boris-johnson-is-partial-to-a-power-nap-b8tgps0bs">power nap</a> during his work day (though the prime minister’s staffers <a href="https://www.itv.com/news/2021-01-19/no-10-insists-boris-johnson-does-not-take-afternoon-naps-after-reports-of-half-hour-kips">contest this claim</a>). Winston Churchill, Albert Einstein, and Leonardo Da Vinci were all <a href="https://www.telegraph.co.uk/health-fitness/body/naps-good-now-perfect-time-indulge/">famous nappers</a>. </p>
<iframe id="noa-web-audio-player" style="border: none" src="https://embed-player.newsoveraudio.com/v4?key=x84olp&id=https://theconversation.com/napping-in-the-afternoon-can-improve-memory-and-alertness-heres-why-154423&bgColor=F5F5F5&color=D8352A&playColor=D8352A" width="100%" height="110px"></iframe>
<p>But while many of us may not feel we usually have enough time to squeeze a nap into our day, working from home during the pandemic may now afford us an opportunity to give napping a try. </p>
<p>Napping is a great way to feel more <a href="https://www.sciencedirect.com/science/article/pii/S1087079216300946?casa_token=rA8MQnBnyW4AAAAA:m4Z6C5-OgAv1ZEUdulH5gm1-BcVuL08ye1ka6JTGFz58JGi6KOguQxLZf8Whyoxdzqqf8AMn58c">rested and alert</a> – and some research shows it can benefit our cognitive function. However, you may want to consider how long you have to sleep before heading to bed for your midday nap.</p>
<p>If you need to be alert <a href="https://academic.oup.com/sleep/article/29/6/831/2708239">right after waking up</a> (for example, if you’re catching a few extra minutes of sleep during your lunch break), so-called “power naps” of 10-30 minutes are recommended. Longer naps may cause some initial drowsiness – though they keep sleepiness at bay <a href="https://www.sciencedirect.com/science/article/pii/B9780444537027000099?casa_token=-xTczWQ1TG4AAAAA:Prkf9VjhTLwLJs-k43kBgixT9h4hawe8X3VMZ8_X4jthJi_-H60p_QmkZFAjZsl-hyG2o6YVVjI">longer</a>. But drinking coffee <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1469-8986.1997.tb02148.x?casa_token=AGSbfvXmAJ8AAAAA:5ZjqYOuVjKekezYiL8coOApSoGjZNOasADEuZ3SBnS_xKbQPK1wYoOXY2K689Kwd2nN6q7p6dhXCM-Y">directly before a nap</a> may help you wake up <a href="https://academic.oup.com/sleep/article/24/7/813/2750094?login=true">without feeling drowsy</a> while also <a href="https://academic.oup.com/sleep/article/29/1/39/2708061">boosting your alertness</a>.</p>
<p>While short naps are great for increasing energy, longer naps are both more restorative and <a href="https://www.nature.com/articles/nn1078">beneficial for learning</a>. For example, they improve activation of the hippocampus – an area of the brain important for <a href="https://academic.oup.com/sleep/article/43/9/zsaa058/5813764">learning and memory</a>. A <a href="https://www.sciencedirect.com/science/article/abs/pii/S1087079209000963?casa_token=y1HMxJcfOjgAAAAA:k2A4HkhOV-wrUY2dhu-NeKNUURsdq8yUb8XvVuqdnhDzj6kBUTgCCT5xip9nmo2hHrLa-BTg5LU">one to two hour afternoon nap</a> is shown to benefit both your motor skills and your ability to recall facts and events.</p>
<p>A <a href="https://gpsych.bmj.com/content/34/1/e100361">recent study</a> from China has even suggested that regular afternoon napping is linked to better cognitive function in older adults. The researchers asked 2,200 over-70s about their napping habits before having them undergo a series of cognitive tests which measured things like memory and language skills. They found that those who usually napped were less likely to have cognitive impairments than those who didn’t. This was true regardless of age or level of education. </p>
<p>But nap length may play a role here – a <a href="https://agsjournals.onlinelibrary.wiley.com/doi/full/10.1111/jgs.14368">similar study</a> showed that those who usually napped for 30-90 minutes had better overall cognition compared to those who napped for longer or shorter, or who didn’t nap at all.</p>
<h2>Why naps work</h2>
<p>The reasons why short naps are so beneficial for alertness and focus are not well understood. It’s possible that napping helps the brain <a href="https://www.sciencedirect.com/science/article/pii/S1087079215001033?casa_token=dRDwFlEYp78AAAAA:n7YIwXXfI7J7pcZBxlFHLlha2O6tlQ3tlyZGGoTXVKV-eJBzV-KS8jr8608mUijQ9-EVV_aTEG0">clean up sleep-inducing waste products</a> that would otherwise inhibit brain activity, and that they <a href="https://www.jneurosci.org/content/30/26/9007">replenish the brain’s energy stores</a>. Short naps may also help improve your attention by letting particularly sleepy areas of the brain recover, thereby preventing instability in the brain’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363380/">networks</a>.</p>
<figure class="align-center ">
<img alt="Man waking up from nap on the couch." src="https://images.theconversation.com/files/386682/original/file-20210226-17-kce1f6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/386682/original/file-20210226-17-kce1f6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/386682/original/file-20210226-17-kce1f6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/386682/original/file-20210226-17-kce1f6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/386682/original/file-20210226-17-kce1f6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/386682/original/file-20210226-17-kce1f6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/386682/original/file-20210226-17-kce1f6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Longer naps are more restorative, but you may feel more drowsy after waking up.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/handsome-sick-caucasian-unshaven-man-pajamas-1509656846">Dusan Petkovic/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Longer naps, on the other hand, are more restorative partly because there is time to enter multiple sleep stages, each of which supports <a href="https://www.sciencedirect.com/science/article/pii/S1087079209000963?casa_token=y1HMxJcfOjgAAAAA:k2A4HkhOV-wrUY2dhu-NeKNUURsdq8yUb8XvVuqdnhDzj6kBUTgCCT5xip9nmo2hHrLa-BTg5LU">different learning processes</a>. For example, during REM (rapid eye movement) sleep, the brain is almost as active as when awake. This activity in different brain regions – including those important for learning and memory – may be why REM sleep supports both <a href="https://www.nature.com/articles/nn.4479">long-term memory</a> and <a href="https://www.sciencedirect.com/science/article/abs/pii/S1087079217301533?via%3Dihub">emotional memory</a>. </p>
<p>During REM sleep in particular, the brain <a href="https://www.nature.com/articles/nn.4479">strengthens newly developed connections</a> that are important for improvements in motor skills. Longer sleep also reduces unimportant connections, and this balance can improve how quickly and effectively the brain works as a whole.</p>
<p>Non-REM sleep – the sleep stage we spend most of our time in – contains both slow brain waves and sleep spindles. The sleep spindles are periodic burst-like signals between different brain areas, which are believed to reactivate and consolidate memories. Both the <a href="https://www.nature.com/articles/nn.2253">slow brain waves</a> and the spindles <a href="https://academic.oup.com/sleep/article/43/9/zsaa058/5813764">increases plasticity</a> – the brain’s ability to learn and adapt to new experiences.</p>
<p>Although napping has many positive short-term effects, they are not recommended for people who <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jsr.12594">suffer from insomnia</a>. Because naps decrease sleepiness, they may make it harder to fall asleep when going to bed in the evening. Naps should also be avoided in situations where optimal performance are needed instantly afterwards, as it may take some time to fully wake up. </p>
<p><a href="https://www.nature.com/articles/s41467-020-20585-3">Other research</a> has shown that frequent napping was related to high BMI and high blood pressure. Napping was more common in shift workers, retired people, and smokers, and in people with genes related to sleep disorders or obesity. To what degree napping was harmful or beneficial for these groups remains unknown, but it’s clear that napping is more common in groups who have disturbed sleep or need more sleep.</p>
<p>If you’re finding that your attention span is wavering in the afternoon while working from home, perhaps try squeezing a nap into your lunch break. Short naps are great at improving alertness and attention – and if you have time for a longer nap, this can support memory and learning.</p><img src="https://counter.theconversation.com/content/154423/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Napping in the afternoon can benefits both motor skills and your ability to recall facts.John Axelsson, Associate Professor, Psychology, Karolinska InstitutetTina Sundelin, Research Fellow in Psychology, Stockholm UniversityLicensed as Creative Commons – attribution, no derivatives.