tag:theconversation.com,2011:/us/topics/cognitive-impairment-3794/articlesCognitive impairment – The Conversation2024-03-24T19:06:41Ztag:theconversation.com,2011:article/2209462024-03-24T19:06:41Z2024-03-24T19:06:41ZWe created a VR tool to test brain function. It could one day help diagnose dementia<figure><img src="https://images.theconversation.com/files/583308/original/file-20240321-22-fi7z9f.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5756%2C3842&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/photograph-of-a-man-in-a-red-sweatshirt-holding-a-virtual-reality-headset-6667710/">Kampus Production/Pexels</a></span></figcaption></figure><p>If you or a loved one have noticed changes in your memory or thinking as you’ve grown older, this could reflect typical changes that occur with ageing. In some cases though, it might suggest something more, such as the onset of dementia.</p>
<p>The best thing to do if you have concerns is to make an appointment with your GP, who will probably run some tests. Assessment is important because if there is something more going on, <a href="https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=09da7f8f782d61bb23411c18ba0af0faae918cdc">early diagnosis</a> can enable prompt access to the right <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/gps.2191?casa_token=4xa6QPERgQkAAAAA:znhnzCjFlILbkI3ffikVOJAVx5vtCe2qFb9DydvjbFOwlvrYTcNHrKhG7hpDQY-yyRviyUTWhaW7DU27">interventions</a>, supports and care. </p>
<p>But current methods of dementia screening have <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2301149">limitations</a>, and testing can be daunting for patients.</p>
<p>Our research suggests virtual reality (VR) could be a useful cognitive screening tool, and mitigate some of the challenges associated with current testing methods, opening up the possibility it may one day play a role in dementia diagnosis.</p>
<h2>Where current testing is falling short</h2>
<p>If someone is worried about their memory and thinking, their GP might ask them to complete a series of quick tasks that check things like the ability to follow simple instructions, basic arithmetic, memory and orientation.</p>
<p>These sorts of screening tools are really good at confirming cognitive problems that may already be very apparent. But <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010783.pub2/full">commonly used screening tests</a> are <a href="https://link.springer.com/article/10.1186/s13195-019-0474-3">not always so good</a> at detecting early and more subtle difficulties with memory and thinking, meaning such changes could be missed until they get worse. </p>
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Read more:
<a href="https://theconversation.com/these-12-things-can-reduce-your-dementia-risk-but-many-australians-dont-know-them-all-191504">These 12 things can reduce your dementia risk – but many Australians don't know them all</a>
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<p>A <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9492323/">clinical neuropsychological assessment</a> is better equipped to <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/ene.12488?casa_token=PUj3o1rEfrQAAAAA%3A_fa1cOudFpdvoGx_0u6QJRG2gzuRVWJ8h6x5qrQOKc2J7hwPjYox20DcEhRaRqyZdRXXHEkBIXuRgIH5nw">detect early changes</a>. This involves a comprehensive review of a patient’s personal and medical history, and detailed assessment of cognitive functions, including attention, language, memory, executive functioning, mood factors and more. However, this can be costly and the testing can take several hours.</p>
<p>Testing is also somewhat removed from everyday experience, not directly tapping into activities of daily living.</p>
<h2>Enter virtual reality</h2>
<p>VR technology uses computer-generated environments to create immersive experiences that feel like real life. While VR is often used for entertainment, it has increasingly found applications in health care, including in <a href="https://link.springer.com/article/10.1007/s10055-020-00495-x">rehabilitation</a> and <a href="https://journals.sagepub.com/doi/full/10.1177/0269215517694677?casa_token=-T4Vh6ZsSXYAAAAA:2S7tM5qS25Oe0YQLCqdd0wPlspOIZPv9exKcc6InL5Wn4nfyetfzQOJxgBjb-6F0LGJPWggozMEoJQ">falls prevention</a>. </p>
<p>Using VR for cognitive screening is still a new area. VR-based cognitive tests generally create a scenario such as shopping at a supermarket or driving around a city to ascertain how a person would perform in these situations.</p>
<p>Notably, they engage various senses and cognitive processes such as sight, sound and spatial awareness in immersive ways. All this may reveal subtle impairments which can be missed by standard methods.</p>
<p>VR assessments are also often more engaging and enjoyable, potentially reducing anxiety for those who may feel uneasy in traditional testing environments, and improving compliance compared to standard assessments.</p>
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<img alt="A senior woman sitting on a bed with her hand to her face." src="https://images.theconversation.com/files/583309/original/file-20240321-28-p3dtg4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/583309/original/file-20240321-28-p3dtg4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/583309/original/file-20240321-28-p3dtg4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/583309/original/file-20240321-28-p3dtg4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/583309/original/file-20240321-28-p3dtg4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/583309/original/file-20240321-28-p3dtg4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/583309/original/file-20240321-28-p3dtg4.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">Millions of people around the world have dementia.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-woman-suffering-headache-2138485783">pikselstock/Shutterstock</a></span>
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<p>Most studies of VR-based cognitive tests have explored their capacity to pick up <a href="https://www.frontiersin.org/articles/10.3389/fnhum.2021.628818/full">impairments in spatial memory</a> (the ability to remember where something is located and how to get there), and the results have been promising.</p>
<p>Given VR’s potential for assisting with diagnosis of cognitive impairment and dementia remains largely untapped, our team developed an online computerised game (referred to as semi-immersive VR) to see how well a person can remember, recall and complete everyday tasks. In our VR game, which lasts about 20 minutes, the user role plays a waiter in a cafe and receives a score on their performance.</p>
<p>To assess its potential, we enlisted more than 140 people to play the game and provide feedback. The results of this research are published across three recent papers.</p>
<h2>Testing our VR tool</h2>
<p>In our <a href="https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-024-02478-3">most recently published study</a>, we wanted to verify the accuracy and sensitivity of our VR game to assess cognitive abilities.</p>
<p>We compared our test to an existing screening tool (called the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2913129/">TICS-M</a>) in more than 130 adults. We found our VR task was able to capture meaningful aspects of cognitive function, including recalling food items and spatial memory.</p>
<p>We also found younger adults performed better in the game than older adults, which echoes the pattern commonly seen in regular memory tests.</p>
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<img alt="A senior man sitting outdoors using a laptop." src="https://images.theconversation.com/files/583311/original/file-20240321-18-smy2uf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/583311/original/file-20240321-18-smy2uf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/583311/original/file-20240321-18-smy2uf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/583311/original/file-20240321-18-smy2uf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/583311/original/file-20240321-18-smy2uf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/583311/original/file-20240321-18-smy2uf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/583311/original/file-20240321-18-smy2uf.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">Adults of a range of ages tried our computerised game.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-man-working-on-laptop-garden-1488244298">pikselstock/Shutterstock</a></span>
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<p>In a <a href="https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-024-04767-y">separate study</a>, we followed ten adults aged over 65 while they completed the game, and interviewed them afterwards. We wanted to understand how this group – who the tool would target – perceived the task.</p>
<p>These seniors told us they found the game user-friendly and believed it was a promising tool for screening memory. They described the game as engaging and immersive, expressing enthusiasm to continue playing. They didn’t find the task created anxiety.</p>
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Read more:
<a href="https://theconversation.com/we-gave-palliative-care-patients-vr-therapy-more-than-50-said-it-helped-reduce-pain-and-depression-symptoms-223186">We gave palliative care patients VR therapy. More than 50% said it helped reduce pain and depression symptoms</a>
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<p>For a third study, we spoke to <a href="https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-023-02413-y">seven health-care professionals</a> about the tool. Overall they gave positive feedback, and noted its dynamic approach to age-old diagnostic challenges.</p>
<p>However, they did flag some concerns and potential barriers to implementing this sort of tool. These included resource constraints in clinical practice (such as time and space to carry out the assessment) and whether it would be accessible for people with limited technological skills. There was also some scepticism about whether the tool would be an accurate method to assist with dementia diagnosis. </p>
<p>While our initial research suggests this tool could be a promising way to assess cognitive performance, this is not the same as diagnosing dementia. To improve the test’s ability to accurately detect those who likely have dementia, we’ll need to make it more specific for that purpose, and carry out further research to validate its effectiveness.</p>
<p>We’ll be conducting more testing of the game soon. Anyone interested in giving it a go to help with our research can register on <a href="https://brainhealthhub.com.au/projects/leaf-cafe-virtual-reality/">our team’s website</a>.</p><img src="https://counter.theconversation.com/content/220946/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>Current methods of screening for dementia have a range of limitations. Using virtual reality for cognitive screening is still a new area, but it’s showing promise.Joyce Siette, Research Theme Fellow in Health and Wellbeing, Western Sydney UniversityPaul Strutt, Senior Lecturer in Psychology, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1923902022-11-10T13:43:24Z2022-11-10T13:43:24ZConcussions can cause disruptions to everyday life in both the short and long term – a neurophysiologist explains what to watch for<figure><img src="https://images.theconversation.com/files/494518/original/file-20221109-16873-evqs5d.jpg?ixlib=rb-1.1.0&rect=400%2C16%2C5166%2C3638&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sleep plays a critically important role in the recovery process in the days following a concussion.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/skiing-accident-royalty-free-image/164528977?phrase=concussion&adppopup=true">nicolamargaret/E+ via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://www.cnn.com/2022/10/19/sport/nfl-tua-tagovailoa-concussion-spt-intl">repeat concussions</a> suffered by Miami Dolphins quarterback Tua Tagovailoa less than a week apart in September 2022 have brought the seriousness of traumatic brain injury back into the public eye and <a href="https://www.washingtonpost.com/health/2022/09/30/tua-concussion-protocol-nfl/">triggered scrutiny</a> of the NFL’s concussion protocols. And the upcoming World Cup soccer competition, which begins Nov. 20, 2022, will likely include highly visible head injuries.</em></p>
<p><em>The Conversation asked David Howell, <a href="https://profiles.ucdenver.edu/display/15074432">director</a> of the <a href="https://medschool.cuanschutz.edu/orthopedics/research/labs/howell-concussion-lab/our-research">Colorado Concussion Research Laboratory</a> at the University of Colorado School of Medicine, to explain the latest science behind concussions and why a recently injured brain is more vulnerable to repeat injury. Howell’s work focuses on the many different areas of concussion-related dysfunction and recovery, including <a href="https://doi.org/10.3390/s20216297">movement deficits</a>, <a href="https://doi.org/10.1097/jsm.0000000000000803">sleep problems</a> and <a href="https://doi.org/10.1177/03635465211069372">rehabilitation</a>.</em></p>
<h2>How widespread are concussions?</h2>
<p>The word concussion can evoke a variety of different images for different people. While concussions are most visible during high-profile sporting events, they can also occur on the playground, during the junior varsity football team practice or on the ski slope. The effects can be just as severe for children and teens as for high-profile athletes.</p>
<p>Concussion effects range from mild to severe, from short term to long term, and can affect many different facets of life. A concussion is defined as a traumatic brain injury caused by an impact to the head, resulting in an alteration of brain function. </p>
<p>A concussion often leads to disruptions to everyday life – whether it be a job, academics, sports, physical activity or sleep. Given how unique people’s brains are and how differently they may respond to the injury, concussion recognition, diagnosis and treatment remain challenging for patients and clinicians alike. </p>
<h2>What happens to the brain during a concussion?</h2>
<p>There is a complex set of events that occur within the brain during and after a concussion occurs. </p>
<p>As a result of the trauma to the brain, brain cells – or neurons – stop functioning as they typically do when healthy. Generally there is not one specific area of the brain that is affected by a concussion. Instead, the injury can affect a widespread set of brain regions, not necessarily at the impact point. Thus, each person may experience a unique set of symptoms or functional problems following the injury. </p>
<p>One main problem that arises following a concussion is an <a href="https://doi.org/10.1016/j.csm.2020.08.001">energy crisis</a> of sorts. This occurs when the brain requires a large volume of energy, in the form of glucose delivered by blood flow to the brain, to restore the injured processes. The body also may have trouble delivering blood to the brain because of a brain blood flow disruption <a href="https://doi.org/10.3389/fneur.2018.00196">caused by the injury</a>, at the very time the brain needs extra energy to restore the injured areas. This mismatch can produce a variety of different symptoms people experience following a concussion.</p>
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<figcaption><span class="caption">Research suggests that a concussion can alter the brain’s wiring.</span></figcaption>
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<h2>What signs should you look for if you suspect a concussion?</h2>
<p>Concussions produce a wide range of signs and symptoms, such as problems with walking and balance, dizziness, mood changes, disruptions to sleep and more. </p>
<p>Some of the main signs that health care providers look for following an impact to the head or body include unsteadiness of gait, loss of consciousness, seizures or other concussion symptoms like headache, cognitive impairment or problems with vision or balance.</p>
<p>It is critical that if a concussion is suspected, individuals cease playing their sport or activity. A simple mantra of “<a href="https://sportscotland.org.uk/media/3382/concussionreport2018.pdf">If in doubt, sit them out</a>” should always be applied, regardless of the setting. </p>
<h2>Why is the injured brain more vulnerable to repeat injury?</h2>
<p>Miami Dolphins quarterback Tua Tagovailoa, who was <a href="https://www.cnn.com/2022/10/19/sport/nfl-tua-tagovailoa-concussion-spt-intl">carted off the field</a> in late September 2022 after his second head injury in less than a week, serves as an example of how vulnerable the brain can be to additional trauma following an initial concussion.</p>
<p>Research shows that the rate of second concussions is highest in the immediate <a href="https://doi.org/10.1136/bjsports-2019-100579">days following an initial concussion</a>. In addition, recent studies have found that athletes who continue to play following a concussion <a href="https://doi.org/10.1177/0363546518757984">experience longer recovery times</a> and <a href="https://doi.org/10.1007/s40279-022-01668-1">more severe symptoms</a>. </p>
<p>While athletes of all ages may want to continue competing after a concussion, relying on a person with an injured brain to determine whether their brain is healthy enough to continue playing is flawed logic. Qualified health care professionals should always make these sorts of decisions for an athlete, rather than someone with a vested interest such as the athletes themselves or their coaches.</p>
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<a href="https://images.theconversation.com/files/494481/original/file-20221109-11066-izy6xc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Football players stand in a circle looking at a teammate stretched on the ground." src="https://images.theconversation.com/files/494481/original/file-20221109-11066-izy6xc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/494481/original/file-20221109-11066-izy6xc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494481/original/file-20221109-11066-izy6xc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494481/original/file-20221109-11066-izy6xc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494481/original/file-20221109-11066-izy6xc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494481/original/file-20221109-11066-izy6xc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494481/original/file-20221109-11066-izy6xc.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">Teammates gather around Miami Dolphins quarterback Tua Tagovailoa after an injury during the first half of an NFL game on Sept. 29, 2022.</span>
<span class="attribution"><a class="source" href="https://www.apimages.com/metadata/Index/Dolphins-Bengals-Football/2fc554f4223f4e0c9234f61e9f7e62da/1/0">AP Photo/Emilee Chinn/</a></span>
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<p>Given the energy crisis described above that occurs following a head injury, the brain simply cannot handle the added and cumulative stress of two injuries occurring in short succession. A second insult to the brain is often simply too much for the brain to handle, and the brain will preserve its most basic functions, such as breathing, above all else. </p>
<p>This is why it is imperative that athletes who experience a concussion be removed from the field of play and allowed to recover fully before returning to unrestricted sport participation. This often involves <a href="https://doi.org/10.1136/bjsports-2017-097699">a stepwise reintegration approach</a>, which allows for a gradual and safe reintroduction into physical activity at first, and an appropriately safe return to play under medical care.</p>
<h2>You’ve had a concussion – now what?</h2>
<p>The first step following a concussion is to stop playing sports and to rest for a day or two. Sleep is <a href="https://doi.org/10.1089/neu.2021.0295">critically important</a> in the days following a concussion. </p>
<p>A myth that continues to persist is that a person should be woken up every hour following a concussion. This is simply not supported by science. In fact, poor sleep after a concussion has been widely documented as being a <a href="https://doi.org/10.1097/jsm.0000000000000803">predictor of poor outcomes</a>, including <a href="https://doi.org/10.1177/0009922816681603">longer recovery times</a> and more severe anxiety, depression or <a href="https://doi.org/10.1089/neu.2018.6257">cognitive symptoms</a>. Waking someone up every hour applies to <a href="https://doi.org/10.1093/bja/aem128">more severe brain injuries</a> that would be ruled out by a health care provider during diagnosis.</p>
<p>In addition, <a href="https://doi.org/10.1136/bjsports-2018-100338">recent guidelines</a> and <a href="https://doi.org/10.1542/peds.2014-0966">past research</a> suggest that complete physical and cognitive rest, which is <a href="https://doi.org/10.1097/wco.0000000000000611">sometimes called cocoon therapy</a>, can actually be <a href="https://doi.org/10.3389/fneur.2019.00362">harmful to recovery</a>. </p>
<p>Therefore, it is important to keep a balanced approach in mind. Following a day or two of physical rest, people with a concussion should begin resuming <a href="https://doi.org/10.1016/j.jpeds.2020.07.049">light physical and cognitive activity</a> that does not provoke or exacerbate ongoing symptoms. </p>
<p>When a person begins to feel better following a concussion, they should gradually add in higher intensity and greater amounts and duration of exercise, dictated by whether their symptoms are not significantly provoked. Recent studies have focused on the value of an individualized aerobic exercise program in the week following a concussion. Past work suggests that performing aerobic exercise at a heart rate just below the level at which symptoms are exacerbated is <a href="https://doi.org/10.1016/s2352-4642(21)00267-4">safe and effective for recovery</a>.</p>
<p>It is important to note that the effects of a concussion may also result in secondary conditions, such as anxiety or depression due to the biological, social or psychological effects of the injury. A recent study showed that adolescents who sustained a concussion have a <a href="https://doi.org/10.1001/jamanetworkopen.2022.1235">higher risk of mental health issues</a> compared to those with an orthopedic injury.</p><img src="https://counter.theconversation.com/content/192390/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr. Howell has received research support from the Eunice Kennedy Shriver National Institute of Child Health & Human Development, the National Institute of Neurological Disorders And Stroke, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, 59th Medical Wing Department of the Air Force, MINDSOURCE Brain Injury Network, the Tai Foundation, and the Colorado Clinical and Translational Sciences Institute and he serves on the Scientific/Medical Advisory Board/owns shares for Synaptek, LLC.</span></em></p>While high-profile concussions in the NFL have brought renewed attention to the gravity of head injuries, they can also occur on the playground or during junior varsity practices – with lasting effects.David Howell, Assistant Professor of Orthopedics,, University of Colorado Anschutz Medical CampusLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1924822022-10-28T12:32:16Z2022-10-28T12:32:16ZFetterman’s struggles with language highlight the challenges after a stroke – a vascular neurologist explains aphasia and the path to recovery<figure><img src="https://images.theconversation.com/files/491777/original/file-20221025-4775-gi4cin.jpg?ixlib=rb-1.1.0&rect=0%2C11%2C3830%2C2562&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The stroke suffered by U.S. Senate candidate John Fetterman has shed light on little-known aspects of stroke recovery.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/democratic-candidate-for-u-s-senate-john-fetterman-reacts-news-photo/1243990171?phrase=John%20fetterman&adppopup=true">Mark Makela/Getty Images News via Getty Images</a></span></figcaption></figure><p><em>John Fetterman, the Democratic nominee for a hotly contested U.S. Senate seat in Pennsylvania, has been drawing scrutiny for his performance in his <a href="https://www.nbcnews.com/politics/2022-election/fetterman-says-stroke-recovery-changes-everything-s-fit-serve-senator-rcna51498">first post-stroke broadcast interview</a> and most recently, his Oct. 25, 2022, <a href="https://www.nytimes.com/2022/10/25/us/politics/debate-fracking-abortion-fetterman-oz.html">Senate debate against Republican Mehmet Oz</a>.</em></p>
<p><em>Fetterman suffered a stroke on the way to a campaign event in May 2022. His apparent post-stroke neurological effects - including auditory processing and speech issues – have caused some to <a href="https://www.cnn.com/2022/10/26/politics/john-fetterman-oz-debate-pa-senate-stroke/index.html">question his fitness for the role</a> and have become a <a href="https://www.newyorker.com/news/daily-comment/what-voters-can-and-cant-learn-from-john-fettermans-stroke">central factor in the Senate race</a>. The Conversation asked Andrew Southerland, <a href="https://uvahealth.com/findadoctor/profile/andrew-m-southerland">a vascular neurologist</a> specializing in stroke and cerebrovascular disease who sees many patients like Fetterman, to explain what Fetterman’s case can teach us about stroke recovery.</em></p>
<h2>What does the public know about Fetterman’s stroke?</h2>
<p>Fetterman has chosen not to release his full medical record, so it’s not possible to draw conclusions about the exact location or extent of brain injury resulting from his stroke. He and his team have confirmed that his initial symptoms began with feeling fatigued and slurring his speech, which his wife immediately identified as a possible stroke. </p>
<p>Because of her early recognition of his symptoms and rapid transport to a nearby facility, Lancaster General Hospital in Pennsylvania, he had the opportunity to receive a clot-busting drug called a <a href="https://www.pennmedicine.org/for-patients-and-visitors/find-a-program-or-service/heart-and-vascular/vascular-surgery-and-endovascular-therapy/vascular-procedures/thrombolysis#">thrombolytic</a> and underwent a catheter-based procedure to remove the blood clot from an artery in the brain. </p>
<p>Based on this information, experts know that Fetterman suffered <a href="https://doi.org/10.1161/STR.0000000000000211">an ischemic stroke</a> caused by a blockage of blood flow and oxygen to a certain part of the brain. Ischemic stroke accounts for <a href="https://doi.org/10.1161/CIR.0000000000001052">roughly 85% of the 800,000 new cases of stroke</a> occurring each year in the United States. The remainder are <a href="https://www.stroke.org/en/about-stroke/types-of-stroke/hemorrhagic-strokes-bleeds">hemorrhagic strokes</a> caused by bleeding in or around the brain.</p>
<p>Ischemic stroke often results in a collage of symptoms including facial droop, speech changes and limb weakness, numbness or lack of coordination on one side of the body. These symptoms help bystanders recognize the signs of stroke. When treating ischemic stroke, we in the stroke community use the motto, “Time Is Brain,” because the sooner we can restore <a href="https://doi.org/10.1001/jama.2019.8286">blood flow to the brain</a> after a stroke begins <a href="https://doi.org/10.1161/01.STR.0000196957.55928.ab">the better chance the patient has</a> of making a good recovery. </p>
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<figcaption><span class="caption">Strokes can occur in people of all ages, and it’s important to recognize the warning signs.</span></figcaption>
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<p>Fetterman has said publicly that his stroke occurred due to an abnormal rhythm of the heart called <a href="https://www.cdc.gov/heartdisease/atrial_fibrillation.htm">atrial fibrillation</a>. This is a common cause of ischemic stroke, which happens when blood clots form in the heart and travel – or embolize – to the brain. This is the origin of the term “thromboembolism,” which basically means blood clot traveling from one location to another. In the case of atrial fibrillation causing stroke, it refers to a blood clot traveling through arteries from the heart into the brain. </p>
<p>Fortunately, these <a href="https://doi.org/10.1161/STR.0000000000000375">types of stroke are highly preventable</a> simply by taking a daily anticoagulant to prevent the clots from forming. Atrial fibrillation may cause symptoms of fast heart beat or shortness of breath. But often, it is silent, coming and going in short episodes. This makes it more challenging to diagnose and treat. Current guidelines recommend starting an anticoagulant for stroke prevention in high-risk patients with atrial fibrillation.</p>
<h2>Why can stroke lead to auditory processing issues?</h2>
<p>Just like any organ or tissue in the body, normal function in the brain depends on steady blood flow and oxygen. Interruptions in this blood flow – as is the case in ischemic stroke – can lead to permanent injury called <a href="https://www.ahajournals.org/doi/10.1161/STR.0b013e318296aeca?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">infarction</a>. The location and extent of infarction after a stroke determine what deficits a patient suffer. </p>
<p>In the case of an auditory processing issue, the injury occurs in a part of the brain called the temporal lobe affecting the connection between areas where auditory and language processing occur. In other words, a stroke can disrupt how we hear and process words.</p>
<p>Recovery from stroke depends on a number of variables, including a patient’s age and other medical problems, but largely on the extent of the injury and where it occurs in the brain. </p>
<h2>How do auditory processing issues relate to cognition?</h2>
<p>Auditory processing disorders fall under a larger family of stroke deficits termed aphasia, which have to do with one’s ability to produce or comprehend various forms of language. Aphasia is often categorized as expressive, related to difficulty producing language, or receptive, meaning a difficulty understanding language. </p>
<p>The types of things that aphasia can affect include word finding, grammar, naming, reading and writing. Patients with aphasia can also struggle with <a href="https://www.aphasia.com/aphasia-resource-library/symptoms/paraphasia/#">paraphasic errors</a> – in other words, saying an incorrect word that sounds like the intended word they are trying to say. </p>
<p>Fetterman identified this specific challenge during his NBC News interview, pointing to the example of his saying “emphetic” in place of the word “empathetic.” These issues often get worse during high-pressure situations like debates. What’s unique in Fetterman’s situation is that reading words seems to be easier than hearing them, hence the use of closed captioning during his NBC News interview and his debate. </p>
<p>Aphasia is a common symptom of stroke but can also occur in <a href="https://theconversation.com/what-is-aphasia-an-expert-explains-the-condition-forcing-bruce-willis-to-retire-from-acting-180385">other neurological conditions</a> including various types of dementia.</p>
<p>Most importantly, aphasias and auditory processing disorders <a href="https://www.statnews.com/2022/10/26/for-experts-on-stroke-fetterman-oz-debate-is-a-teachable-moment/">do not necessarily imply other cognitive impairments</a>. In other words, they typically do not alter one’s intelligence, behaviors or executive abilities – neurological functions that are orchestrated by the frontal lobes of the brain. </p>
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<figcaption><span class="caption">Quick response times are critical in the moments before and after a stroke.</span></figcaption>
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<h2>What is the typical path of recovery following stroke?</h2>
<p>Fetterman now joins the ranks of more than <a href="https://doi.org/10.1161/str.0000000000000388">7 million Americans and many more around the world</a> who have suffered a stroke, a significant portion of whom remain disabled as a result. Yet, advances in life saving treatments – like the ones Fetterman received – provide hope for stroke patients who were once destined for permanent disability to now walk out of the hospital and return to independent, high-functioning lives. </p>
<p>Typically, recovery from stroke <a href="https://doi.org//10.1161/STR.0000000000000098">occurs along a continuum</a>, from the early hospitalization to a prolonged period of rehabilitation over weeks to months. Depending on the severity of the stroke and resulting deficits, this may require a period of time in an inpatient rehabilitation facility and possibly working with physical, occupational and speech therapists in an outpatient setting. In either case, stroke rehabilitation and recovery is a team sport, requiring collaboration from a multi-disciplinary group of providers along with the support of patient caregivers. </p>
<p>In the field of stroke recovery, patients gain the most ground in the first few months following a stroke event. However, recovery experts know that patients can continue to see gradual improvements well into the first year and beyond. </p>
<p>One thing that’s certain is that stroke survivors like Fetterman are a testament to the advances in clinical research and practice that paved the way for the life-saving treatments like the ones he received. And there’s nothing debatable about that.</p><img src="https://counter.theconversation.com/content/192482/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew M. Southerland, MD, MSc receives funding from the NIH/NINDS, American Heart Association/American Stroke Association, Abbvie, Inc, and Diffusion Pharmaceuticals, Inc. He is affiliated with the American Academy of Neurology's BrainPAC Executive Committee. </span></em></p>Auditory processing disorders and aphasia can make spoken speech difficult to produce and understand. But these challenges alone do not imply cognitive impairments.Andrew M. Southerland, Professor of Neurology and Public Health Sciences, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1927022022-10-27T16:23:47Z2022-10-27T16:23:47ZLong COVID: how lost connections between nerve cells in the brain may explain cognitive symptoms<figure><img src="https://images.theconversation.com/files/491460/original/file-20221024-6087-atkx08.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C7988%2C4491&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">COVID can cause long-lasting cognitive symptoms. But why?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/coronavirus-attacks-brain-3d-illustration-1862050414">Alexander Limbach/Shutterstock</a></span></figcaption></figure><p>For a portion of people who get COVID, symptoms continue for <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk/6october2022">months or even years</a> after the initial infection. This is commonly referred to as “long COVID”.</p>
<p>Some people with long COVID complain of “<a href="https://theconversation.com/what-is-and-what-isnt-brain-fog-190537">brain fog</a>”, which includes a wide variety of cognitive symptoms affecting memory, concentration, sleep and speech. There’s also growing concern about findings that people who have had COVID are at <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(22)00260-7/fulltext">increased risk</a> of developing brain disorders, such as dementia. </p>
<p>Scientists are working to understand how exactly a COVID infection affects the human brain. But this is difficult to study, because we can’t experiment on living people’s brains. One way around this is to create <a href="https://www.nature.com/articles/s41578-021-00279-y">organoids</a>, which are miniature organs grown from stem cells. </p>
<p>In a <a href="https://www.nature.com/articles/s41380-022-01786-2.pdf">recent study</a>, we created brain organoids a little bigger than a pinhead and infected them with SARS-CoV-2, the virus that causes COVID-19.</p>
<p>In these organoids, we found that an excessive number of synapses (the connections between brain cells) were eliminated – more than you would expect to see in a normal brain.</p>
<p>Synapses are important because they allow neurons to communicate with each other. Still, the elimination of a certain amount of inactive synapses is part of normal brain function. The brain essentially gets rid of old connections when they’re no longer needed, and makes way for new connections, allowing for more efficient functioning.</p>
<p>One of the crucial functions of the brain’s immune cells, or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5768411/">microglia</a>, is to prune these inactive synapses. </p>
<p>The exaggerated elimination of synapses we saw in the COVID-infected models could explain why some people have cognitive symptoms as part of long COVID.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/we-studied-how-covid-affects-mental-health-and-brain-disorders-up-to-two-years-after-infection-heres-what-we-found-188918">We studied how COVID affects mental health and brain disorders up to two years after infection – here's what we found</a>
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<h2>Parallels with neurodegenerative disorders</h2>
<p>Interestingly, this pruning process is believed to go awry in several disorders affecting the brain. In particular, excessive elimination of synapses has recently been linked to <a href="https://www.nature.com/articles/s41593-018-0334-7">neurodevelopmental disorders</a> such as <a href="https://www.nature.com/articles/s41593-018-0334-7">schizophrenia</a>, as well as <a href="https://www.frontiersin.org/articles/10.3389/fncel.2019.00063/full">neurodegenerative disorders</a> such as Alzheimer’s and Parkinson’s disease.</p>
<p>By sequencing the RNA of single cells, we could study how different cell types in the organoid responded to the virus. We found that the pattern of genes turned on and off by the microglia in our COVID-infected organoids mimicked changes seen in neurodegenerative disorders.</p>
<p>This may go some way in explaining the link between COVID and the risk of developing certain neurological disorders.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/491380/original/file-20221024-17-9wi5pg.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/491380/original/file-20221024-17-9wi5pg.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/491380/original/file-20221024-17-9wi5pg.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/491380/original/file-20221024-17-9wi5pg.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/491380/original/file-20221024-17-9wi5pg.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=425&fit=crop&dpr=1 754w, https://images.theconversation.com/files/491380/original/file-20221024-17-9wi5pg.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=425&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/491380/original/file-20221024-17-9wi5pg.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=425&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A brain organoid used in our study. You can see the microglial cells in red.</span>
<span class="attribution"><span class="source">Sellgren lab</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>A possible target for treatment</h2>
<p>One limitation of our research is that our organoid models closely resemble the foetal or early brain, rather than the adult brain. So we can’t say for sure whether the changes we noted in our study will necessarily be reflected in the adult brain. </p>
<p>However, some <a href="https://pubmed.ncbi.nlm.nih.gov/33248159/">post-mortem</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/35255491/">imaging studies</a> report neuronal death and reduction in grey matter thickness in COVID patients, which hints at similar instances of synapse loss caused by an infection in adults.</p>
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<strong>
Read more:
<a href="https://theconversation.com/new-cases-of-severe-long-covid-appear-to-be-dropping-and-vaccination-is-probably-key-187825">New cases of severe long COVID appear to be dropping – and vaccination is probably key</a>
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<p>If this proves to be a fruitful line of enquiry, we believe our findings could point to a mechanism contributing to persisting cognitive symptoms after COVID and other viral infections that affect the brain.</p>
<p>SARS-CoV-2 is an RNA virus and similar <a href="https://pubmed.ncbi.nlm.nih.gov/27337340/">processes</a> have been seen in mice infected with other RNA viruses that can also cause residual cognitive symptoms, such as the <a href="https://pubmed.ncbi.nlm.nih.gov/31235930/">West Nile virus</a>.</p>
<p>From here we want to study how different drugs could inhibit the changes we saw in the infected models, hopefully paving the way towards effective treatments. In <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6410571/">other research</a>, we’ve observed that an antibiotic called minocycline can reduce the degree to which microglia prune synapses in a dish. So we want to see if this drug can help in our brain organoid models following SARS-CoV-2 infection.</p><img src="https://counter.theconversation.com/content/192702/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Samudyata has received funding from Hjarnfonden.</span></em></p><p class="fine-print"><em><span>Carl Sellgren receives funding from Swedish Research Council, Karolinska Institutet, the regional agreement on medical training and clinical research between Stockholm County Council, One Mind Foundation/Kaiser Permanente, and Marianne and Marcus Wallenberg Foundation (C.M.S.).</span></em></p>Many people face persistent cognitive symptoms after COVID-19. A new study, which grew and examined 3D models of the human brain, offers a possible explanation as to why this might be.Samudyata, Postdoctoral researcher, Physiology and Pharmacology, Karolinska InstitutetCarl Sellgren, Assistant Professor, Department of Physiology and Pharmacology, Karolinska InstitutetLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1793652022-03-25T12:08:20Z2022-03-25T12:08:20ZLonger naps in the day may be an early sign of dementia in older adults<figure><img src="https://images.theconversation.com/files/453933/original/file-20220323-15-4vkaxs.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Older adults who nap at least once for more than an hour a day have a 40% higher chance of developing dementia.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/falling-asleep-royalty-free-image/108269786">ozgurdonmaz/E+ via Getty Images</a></span></figcaption></figure><p>Doctors often recommend <a href="https://health.clevelandclinic.org/power-naps/">“power naps”</a> as a way to compensate for a poor night’s sleep and help keep alert until bedtime. But for older adults, extensive power naps could be an <a href="https://doi.org/10.1002/alz.12636">early sign of dementia</a>.</p>
<p>Research on how napping affects cognition in adults has had mixed results. <a href="https://doi.org/10.1038/s41598-018-33209-0">Some</a> <a href="https://doi.org/10.1111/j.1365-2869.2008.00718.x">studies</a> on younger adults suggest that napping is beneficial to cognition, <a href="https://dx.doi.org/10.1016%2Fj.jalz.2019.04.009">while</a> <a href="https://doi.org/10.1093/aje/kwu036">others</a> on older adults suggest it may be linked to cognitive impairment. However, many studies are based on just a single self-reported nap assessment. This methodology may not be accurate for people with <a href="https://doi.org/10.1016/j.cger.2013.07.002">cognitive impairment</a> who may not be able to reliably report when or how long they napped.</p>
<p>As an <a href="https://scholar.google.com/citations?user=4jWQUBIAAAAJ&hl=en">epidemiologist</a> who studies sleep and neurodegeneration in older adults, I wanted to find out if changes in napping habits foreshadow other signs of cognitive decline. A <a href="https://doi.org/10.1002/alz.12636">study</a> my colleagues and I recently published found that while napping does increase with age, excessive napping may foreshadow cognitive decline.</p>
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<figcaption><span class="caption">Sleep may play a significant role in Alzheimer’s development.</span></figcaption>
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<h2>The link between daytime napping and dementia</h2>
<p><a href="https://doi.org/10.1016/S1474-4422(14)70172-3">Sleep disturbance and daytime napping</a> are known symptoms of mild to moderate Alzheimer’s disease and other forms of dementia in older adults. They often become more extreme as the disease progresses: Patients are increasingly less likely to fall asleep and more likely to wake up during the night and feel sleepy during the day. </p>
<p>To examine this link between daytime napping and dementia, my colleagues and I studied a group of 1,401 older adults with an average age of 81 participating in the <a href="https://doi.org/10.1159/000087446">Rush Memory and Aging Project</a>, a longitudinal study examining cognitive decline and Alzheimer’s disease. The participants wore a watchlike device that tracked their mobility for 14 years. Prolonged periods of inactivity were interpreted as naps.</p>
<p>At the start of the study, approximately 75% of participants did not have any cognitive impairment. Of the remaining participants, 4% had Alzheimer’s and 20% had mild cognitive impairment, a frequent precursor to dementia.</p>
<p>While daily napping increased among all participants over the years, there were differences in napping habits between those who developed Alzheimer’s by the end of the study and those who did not. Participants who did not develop cognitive impairment had nap durations that averaged 11 extra minutes per year. This rate doubled after a mild cognitive impairment diagnosis, with naps increasing to 25 extra minutes per year, and tripled after an Alzheimer’s diagnosis, with nap durations increasing to 68 extra minutes per year.</p>
<p>Ultimately, we found that older adults who napped at least once or for more than an hour a day had a <a href="https://doi.org/10.1002/alz.12636">40% higher chance</a> of developing Alzheimer’s than those who did not nap daily or napped less than an hour a day. These findings were unchanged even after we controlled for factors like daily activities, illness and medications.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/453972/original/file-20220323-15-kvzb64.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A cat is stretched out on the legs of a person sleeping n a couch." src="https://images.theconversation.com/files/453972/original/file-20220323-15-kvzb64.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/453972/original/file-20220323-15-kvzb64.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/453972/original/file-20220323-15-kvzb64.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/453972/original/file-20220323-15-kvzb64.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/453972/original/file-20220323-15-kvzb64.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/453972/original/file-20220323-15-kvzb64.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/453972/original/file-20220323-15-kvzb64.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">Napping is a normal part of aging, but not for extended periods.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/catnap-with-cat-royalty-free-image/876679498">Tom Ang/Photodisc via Getty Images</a></span>
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<h2>Napping and the Alzheimer’s brain</h2>
<p>Our study shows that longer naps are a normal part of aging, but only to a certain extent. </p>
<p><a href="https://doi.org/10.1016/j.jalz.2019.06.3916">Research</a> from my colleagues at the University of California, San Francisco, offers a potential mechanism for why people with dementia have more frequent and longer naps. By comparing the post-mortem brains of people with Alzheimer’s disease with the brains of people without cognitive impairment, they found that those with Alzheimer’s had fewer neurons that promote wakefulness in three brain regions. These neuronal changes appeared to be linked to <a href="https://www.nia.nih.gov/health/what-happens-brain-alzheimers-disease">tau tangles</a>, a hallmark of Alzheimer’s in which the protein that helps stabilize healthy neurons form clumps that hamper communication between neurons.</p>
<p>While our study does not show that increased daytime napping causes cognitive decline, it does point to extended naps as a potential signal for accelerated aging. Further research might be able to determine whether monitoring daytime napping could help detect cognitive decline.</p>
<p>[<em>Get fascinating science, health and technology news.</em> <a href="https://memberservices.theconversation.com/newsletters/?nl=science&source=inline-science-fascinating">Sign up for The Conversation’s weekly science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/179365/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yue Leng receives funding from National Institute on Aging. </span></em></p>While longer naps are a normal part of aging, excessively long dozes could be a warning signal for cognitive decline.Yue Leng, Assistant Professor of Psychiatry, University of California, San FranciscoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1704982021-11-02T15:48:30Z2021-11-02T15:48:30ZHeading the ball is linked to cognitive impairment in retired professional footballers: new research<figure><img src="https://images.theconversation.com/files/429625/original/file-20211101-15-talhb6.jpg?ixlib=rb-1.1.0&rect=6%2C12%2C4256%2C2824&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/kyiv-ukraine-may-26-2018-impressive-1103486303">Oleksandr Osipov/Shutterstock</a></span></figcaption></figure><p>The potential long-term neurological effects of concussions and other knocks to the head in professional sport have attracted significant attention and research interest over recent years.</p>
<p>Confirmation in 2014 that former England footballer <a href="https://www.bbc.co.uk/news/uk-england-birmingham-27654892">Jeff Astle</a> died as a result of <a href="https://www.nhs.uk/conditions/chronic-traumatic-encephalopathy/">chronic traumatic encephalopathy</a> (a form of dementia) — and that it was caused by regularly heading the ball — ignited a furore on <a href="https://www.bbc.co.uk/news/explainers-51135579">the risks</a> of this practice in particular.</p>
<p>New guidelines introduced this year limit the number of “higher force headers” professional English footballers are allowed to make each week in training <a href="https://www.bbc.co.uk/sport/football/58003628">to ten</a>. These are usually headers following <a href="https://www.bbc.co.uk/sport/football/57996593">a long pass</a> (more than 35 metres) or from crosses, corners or free kicks.</p>
<p>Similar guidelines had already been adopted across all <a href="https://www.theguardian.com/football/2020/feb/24/children-under-age-of-12-banned-from-heading-footballs-in-training">children’s football leagues</a> in the UK. But the question remains: <a href="https://bjsm.bmj.com/content/53/6/321">do headers</a> really cause dementia?</p>
<p>Recent work carried out at the University of Glasgow by neuropathologist William Stewart and his team analysed the death certificates of Scottish men. They found higher rates of <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1908483">dementia</a> among former professional footballers compared to the general population, with ex-footballers about 3.5 times more likely to die from a neurodegenerative disease, such as that which causes dementia, than men who didn’t play football professionally.</p>
<p>Stewart’s group also showed that dementia deaths in former professional footballers were greater among those who had played in positions where heading tended to be <a href="https://jamanetwork.com/journals/jamaneurology/fullarticle/2782750">more frequent</a>, like central defenders, for example. </p>
<p>But evidence of greater dementia risk among living former professional footballers has been lacking.</p>
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Read more:
<a href="https://theconversation.com/football-and-dementia-heading-must-be-banned-until-the-age-of-18-150575">Football and dementia: heading must be banned until the age of 18</a>
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<h2>We studied living former professional footballers</h2>
<p>Football is played by <a href="https://www.worldatlas.com/articles/what-are-the-most-popular-sports-in-the-world.html">more people</a> across the globe than any other sport, so understanding the risks associated with playing this game is important. Data on living participants, compared to those who have died, can provide more detailed information on the nature of the impairment a person may have, and help us understand what type of support they might need. </p>
<p>There has been research looking at the <a href="https://www.tandfonline.com/doi/full/10.1080/24733938.2020.1846769">cognitive effects</a> of heading the ball on younger, active players. But young players are unlikely to show signs of neurological deterioration or dementia. If they are to develop a brain impairment, this would likely only become visible after the <a href="https://www.ageuk.org.uk/information-advice/health-wellbeing/mind-body/staying-sharp/thinking-skills-change-with-age/cognitive-reserve/">reserve mental capacity</a> of youth has waned. </p>
<figure class="align-center ">
<img alt="Boys playing football." src="https://images.theconversation.com/files/429712/original/file-20211102-23-8vx2x1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/429712/original/file-20211102-23-8vx2x1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=443&fit=crop&dpr=1 600w, https://images.theconversation.com/files/429712/original/file-20211102-23-8vx2x1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=443&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/429712/original/file-20211102-23-8vx2x1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=443&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/429712/original/file-20211102-23-8vx2x1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=557&fit=crop&dpr=1 754w, https://images.theconversation.com/files/429712/original/file-20211102-23-8vx2x1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=557&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/429712/original/file-20211102-23-8vx2x1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=557&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">Limits have been placed on heading in children’s football.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/soccer-player-using-head-hit-ball-1070176523">JoeSAPhotos/Shutterstock</a></span>
</figcaption>
</figure>
<p>Our <a href="https://bpspsychub.onlinelibrary.wiley.com/doi/epdf/10.1111/jnp.12264">study</a> of former professional footballers, recently published in the Journal of Neuropsychology, goes some way to filling this gap. We collaborated with two former professional footballers’ associations in England to recruit a total of 60 former male footballers. Their average age was about 68.</p>
<p>First, we wanted to measure the former players’ overall cognitive status. We used a self-administered test called <a href="https://www.bmj.com/content/338/bmj.b2030">Test Your Memory</a>, which compares well with similar tests used by clinicians to screen for dementia.</p>
<p>And second, we wanted to collect records that were as accurate as possible about former professionals’ careers. Using a survey, we asked them about positions played, career length, training regimes, any football-related head injuries, and a few other relevant bits of information. </p>
<p>Alongside this, we wanted to ascertain the number of headers our participants made throughout their careers. Of course, this would be tricky to guess – so we asked them to estimate the average number of headers made per match and training session. We then multiplied these numbers by the number of training sessions and matches per week, and by the number of weeks of their footballing year, over the total of their careers. While the resulting estimates of total career headers are unlikely to be perfect, there isn’t really a better way to measure this.</p>
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Read more:
<a href="https://theconversation.com/how-routine-sparring-can-cause-short-term-impairment-to-boxers-brains-123820">How routine sparring can cause short-term impairment to boxers' brains</a>
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<p>We didn’t see any effect of reported head injuries on the Test Your Memory score, which was one outcome we sought to measure. But we found strong evidence that the more heading a participant had done over their professional football careers, the lower their scores. </p>
<p>We estimated that, on average, former professional footballers lost about three points off the Test Your Memory score (a drop that can be the difference between being classified as normal or as having memory problems) for each 100,000 career headers reported. This may seem like a big number – and it is – but a professional footballer can make hundreds of thousands of headers over a career. Our participants averaged around 50,000 career headers each, though this number is likely lowered by the goalkeepers in our sample, who generally reported no headers. And we didn’t include pre-season training.</p>
<p>To our knowledge, this is the first study to provide direct evidence supporting an association between heading the ball and cognitive impairment in retired professional football players. Evidence of cognitive impairment is the first step towards <a href="https://www.nhs.uk/conditions/dementia/diagnosis-tests/">a diagnosis</a> of dementia, so our results suggest there may be a link between heading the ball often and developing a neurodegenerative disease.</p>
<p>All in all, the decision to reduce headers in training is probably the right call. Although the current limit is set at ten, we do need more research to establish what might be a safe number of headers, as well as the precise effects headers may have on former players’ cognition – and what else can be done to mitigate these effects.</p><img src="https://counter.theconversation.com/content/170498/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Davide Bruno receives funding from the National Institute on Aging (U.S.). </span></em></p><p class="fine-print"><em><span>Andrew Rutherford has received no funding that is relevant, nor does he have any relevant affiliation. </span></em></p>We found the more headers former professional footballers made over their careers, the lower they tended to score on a memory test.Davide Bruno, Reader, School of Psychology, Liverpool John Moores UniversityAndrew Rutherford, Honorary Research Fellow, School of Psychology, Keele UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1476662020-10-12T18:46:14Z2020-10-12T18:46:14ZWhy do some people struggle to make ‘healthy’ decisions, day after day?<figure><img src="https://images.theconversation.com/files/362874/original/file-20201012-21-1ahvfj5.jpg?ixlib=rb-1.1.0&rect=88%2C50%2C8299%2C3684&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>To navigate our way through the world, we constantly make choices. While we’ve all made our fair share of regrettable ones, most of us eventually learn from these – and we generally take this ability for granted.</p>
<p>For some people suffering from illnesses such as schizophrenia and substance use disorder – previously referred to as “<a href="https://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.2013.12060782">substance abuse</a>” – making the right choices can be extremely difficult.</p>
<p>In fact, many mental illnesses feature problems with <a href="https://doi.org/10.1192/bjo.2020.12">cognition</a> (thinking and comprehension), including depression and bipolar disorder. Decision-making ability varies in healthy people, too, sometimes as a consequence of differences in <a href="https://doi.org/10.1016/j.neuron.2013.08.030">genetics</a>.</p>
<p>What’s happening in the brains of these people that puts them on unequal footing to the rest of us?</p>
<h2>Even simple decisions are complex</h2>
<p>It’s important to note in day-to-day situations, there’s often no distinctly “right” or “wrong” choice to be made. However, some choices do result in healthier or more productive outcomes for us and those around us. </p>
<p>Our brains carry out a suite of complex processes when making decisions. And there are four important factors in each decision we make: value, motivation, action and strategy. </p>
<p>When choosing between two options, say A and B, we first need to understand which choice will be more rewarding, or provide more <em>value</em>. Our personal <em>motivation</em> to attain this reward then acts to bias which option we choose, or whether we make a choice at all. </p>
<p>Understanding what <em>action</em> is required to obtain A, or B, is also important. Combining all this information, we try to understand which <em>strategy</em> will maximise our rewards. And this lets us improve our decision-making ability over time.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/362815/original/file-20201011-17-1te41u5.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/362815/original/file-20201011-17-1te41u5.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=598&fit=crop&dpr=1 600w, https://images.theconversation.com/files/362815/original/file-20201011-17-1te41u5.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=598&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/362815/original/file-20201011-17-1te41u5.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=598&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/362815/original/file-20201011-17-1te41u5.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=751&fit=crop&dpr=1 754w, https://images.theconversation.com/files/362815/original/file-20201011-17-1te41u5.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=751&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/362815/original/file-20201011-17-1te41u5.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=751&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There are multiple decision-making processes in the brain that help determine the choices we make.</span>
<span class="attribution"><span class="source">James P. Kesby</span></span>
</figcaption>
</figure>
<h2>Interrupted connections</h2>
<p>We refer to our personal history and past experiences to guide our future choices. But mental disorders often cause problems in the decision-making process. </p>
<p>Research shows people with schizophrenia can have trouble understanding the relationship between their <a href="https://doi.org/10.1038/s41398-017-0071-9">actions and the outcomes</a>. This means they might keep selecting A, even if they know it’s no longer as valuable as B. </p>
<p>They’re also more willing to adopt strategies based on less information, in other words “<a href="https://doi.org/10.1017/S003329171900357X">jump to conclusions</a>”, about outcomes. </p>
<p>Substance use disorder, particularly with stimulants such as methamphetamine or cocaine, often leads to people getting stuck when <a href="https://doi.org/10.1016/j.biopsych.2011.06.033">certain outcomes change</a>. </p>
<p>For example, if we reversed all the street lights so red meant “go” and green meant “stop” without telling anyone, most people would get an initial shock but would eventually alter their behaviour. </p>
<p>People with stimulant dependence, however, would take longer to learn to stop on the green light – even if they kept getting into car accidents. This is because excessive stimulant use impacts regions in the brain that are crucial to adapting to changing environments.</p>
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Read more:
<a href="https://theconversation.com/how-parents-and-teachers-can-identify-and-help-young-people-self-medicating-trauma-with-drugs-and-alcohol-104482">How parents and teachers can identify and help young people self-medicating trauma with drugs and alcohol</a>
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<h2>How the brain decodes each decision</h2>
<p>The human brain contains multiple circuits (like pathways) and chemical messengers called “neurotransmitters”. These are responsible for guiding the processes discussed above.</p>
<p>The decision-making circuits commonly associated with schizophrenia and substance use disorder include areas of the “cortex” – the outer part of our brain important for complex thought (especially the frontal lobe) – that “talk” to hub areas such as the “striatum”. The striatum lets us select and then initiate an action to achieve a specific goal.</p>
<p>Different cortical areas are used to compute different <a href="https://doi.org/10.1016/j.neubiorev.2020.07.010">processes</a> in the brain. The prefrontal cortex helps us understand when a strategy needed for success changes. So, if we replaced all the traffic lights with sirens, the prefrontal cortex would help us realise this and adjust. </p>
<p>When the anticipated outcome of a choice changes (such as if A was better, but then suddenly B became better), the orbitofrontal cortex helps us identify this. Similarly, the striatum is key for anticipating what an outcome will be and when we will get the reward.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/362888/original/file-20201012-17-l6gj2e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A basic anatomy diagram of the human brain." src="https://images.theconversation.com/files/362888/original/file-20201012-17-l6gj2e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/362888/original/file-20201012-17-l6gj2e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=418&fit=crop&dpr=1 600w, https://images.theconversation.com/files/362888/original/file-20201012-17-l6gj2e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=418&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/362888/original/file-20201012-17-l6gj2e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=418&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/362888/original/file-20201012-17-l6gj2e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=525&fit=crop&dpr=1 754w, https://images.theconversation.com/files/362888/original/file-20201012-17-l6gj2e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=525&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/362888/original/file-20201012-17-l6gj2e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=525&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The cortex is the wrinkly layer that covers our brain. The striatum sits underneath the cortex, in the forebrain.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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</figure>
<h2>Dopamine helps make your choices a reality</h2>
<p>Extensive research efforts have found the brains of people experiencing schizophrenia function differently in multiple areas. It’s believed this could contribute to decision-making problems.</p>
<p>For the psychotic symptoms observed in schizophrenia (such as hallucinations and delusions), alterations in the neurotransmitter dopamine are important. <a href="https://neuro.psychiatryonline.org/doi/full/10.1176/appi.neuropsych.24.1.1">Dopamine</a> is a chemical in the brain that’s key for anticipating rewards, making decisions and controlling the physical actions necessary to act on our choices.</p>
<p>In our <a href="https://doi.org/10.3389/fnins.2020.00542">research</a>, we’ve argued increases in dopamine in the striatum may cause problems with how the brain integrates information from the cortex, resulting in decision-making difficulties. However, this may only be the case in <a href="https://doi.org/10.1016/j.biopsych.2013.06.011">some individuals</a>.</p>
<p>Stimulants also cause excessive dopamine release. They can alter the balance between goal-directed behaviours, which are flexible and respond to environmental changes – and habits, which are automatic and hard to break.</p>
<p>Usually, when we learn something new our brain keeps adapting and incorporating new information. But this is slow and cognitively demanding. Substance dependence can accelerate a person’s progression to habitual behaviour, wherein a set strategy or response become ingrained. </p>
<p>This then makes it hard to stop seeking drugs, even if the individual no longer finds them <a href="https://doi.org/10.1016/j.neubiorev.2013.02.010">enjoyable</a>. </p>
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Read more:
<a href="https://theconversation.com/why-that-cigarette-chocolate-bar-or-new-handbag-feels-so-good-how-pleasure-affects-our-brain-91773">Why that cigarette, chocolate bar, or new handbag feels so good: how pleasure affects our brain</a>
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<h2>How we can we help people make better decisions</h2>
<p>Unfortunately, problems with cognitive ability are hard to treat. There are no medications for schizophrenia or stimulant dependence shown to reliably improve <a href="https://doi.org/10.1176/ps.2008.59.5.500">cognition</a>. This is a consequence of the human brain’s complexity. </p>
<p>That said, there are ways we can all improve our memory and decision-making, which may also help those with mental illnesses causing cognition problems. </p>
<p>For instance, <a href="https://www.psychologytools.com/professional/techniques/cognitive-remediation/">cognitive remediation therapy</a> is a behavioural approach that trains the brain to respond to certain situations better. For people with schizophrenia, it may improve <a href="https://doi.org/10.1017/S0033291717001234">visual memory</a> and perhaps more complex decision-making. </p>
<p>Not being able to navigate decisions day-to-day is one of the most debilitating aspects of <a href="https://doi.org/10.1016/j.schres.2019.10.011">disorders</a> that impact cognition. This leads to difficulties in maintaining work, keeping friends and leading a fulfilling life. </p>
<p>We need more research to understand how different brains make different decisions. Hopefully then we can improve the lives of those living with mental illness.</p>
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<strong>
Read more:
<a href="https://theconversation.com/five-things-you-need-to-know-about-mental-health-32581">Five Things You Need To Know About Mental Health</a>
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<img src="https://counter.theconversation.com/content/147666/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James Kesby receives funding fromthe National Health and Medical Research Council (NHMRC), the Brain & Behavior Research Foundation (BBRF) and Philanthroic Funding through the Queensland Brain Insititute (QBI). He is affiliated with QIMR Berghofer Medical Research Institute. </span></em></p><p class="fine-print"><em><span>Shuichi Suetani has received funding from the National Health and Medical Research Council, Metro South Health Research Support, Brisbane Diamantina Health Partners Brain and Mental Health Theme, Princess Alexandra Hospital Research Foundation, Society of Mental Health Research, AVANT and Australian and New Zealand College of Psychiatrists. Shuichi Suetani works for Queensland Health. He has received honoraria for advisory work from Seqirus and is affiliated with Queensland Brain Institute (QBI) and Griffith University.
</span></em></p>During Mental Health Week, let’s look at why some people, such as those experiencing depression or substance dependency, struggle to make decisions like everyone else.James Kesby, UQ Amplify Researcher, The University of QueenslandShuichi Suetani, Psychiatrist, Queensland Brain Institute, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1027062018-09-05T02:49:20Z2018-09-05T02:49:20ZDementia patients’ thinking ability may get worse in winter and early spring<figure><img src="https://images.theconversation.com/files/234957/original/file-20180905-45169-1713aem.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Thinking ability declines with age in those with dementia.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/tUyYnO_VdP0">Sam Wheeler/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>The seasons may affect the memory and thinking abilities of healthy older adults. A new study suggests changes in cognitive function may be associated with the time of year, declining significantly in winter and early spring. We also see new cases of mild cognitive impairment and dementia in these seasons.</p>
<p>Published today in the journal <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002647#pmed.1002647.ref002">PLOS Medicine</a>, the study suggests fluctuations in memory and thinking performance across seasons are equivalent to an approximate four-year difference in age. That is, the performance of people given memory and thinking tests in the summer and autumn would be equivalent to those about four years younger than when tested in spring and winter.</p>
<p>The authors also found new cases of <a href="https://www.alz.org/alzheimers-dementia/what-is-dementia/related_conditions/mild-cognitive-impairment">mild cognitive impairment</a> (a transitional diagnosis given prior to a dementia diagnosis) and dementia were 30% more likely in spring and winter relative to summer and autumn. </p>
<p>Dementia is when a person experiences a significant deterioration in memory and thinking abilities (cognitive function), noticed by themselves or a significant other. This goes together with a decline in their ability to perform everyday tasks such as paying bills, keeping on top of work, or even keeping themselves oriented to time and place, as well as mood changes.</p>
<p>These findings suggest there may be a need for more dementia care resources and community awareness during these colder months.</p>
<h2>What the research showed</h2>
<p>A group of researchers from Canada and the United States sought to answer the question of whether the season might influence poorer cognition in healthy adults, as well as those with dementia. Their questioning was based on previous findings in other areas of human biology, such as <a href="https://jamanetwork.com/journals/jamapsychiatry/article-abstract/493246">seasonal affective disorder</a> (depression associated with seasonal changes) and <a href="https://www.cambridge.org/core/journals/psychological-medicine/article/seasonality-of-symptom-onset-in-firstepisode-schizophrenia/BAFC8A432C269852168600809A6A5163">first-episode schizophrenia</a>. These findings suggest an association with time of year. </p>
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Read more:
<a href="https://theconversation.com/seasonal-affective-disorder-why-you-feel-under-the-weather-937">Seasonal Affective Disorder: why you feel under the weather</a>
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<p>Researchers have suggested these seasonal peaks in psychosis could be associated with stress and other social factors that may correspond with seasonal trends.</p>
<p>In the current study, the authors investigated data on around 2,700 healthy older adults from Chicago and around 500 dementia patients from Toronto. They found individuals tested in the months of July to October (summer-autumn in the Northern Hemisphere) displayed better performance than those tested in other months. This was true for both healthy adults and those with a dementia diagnosis.</p>
<p>They also found working memory (the ability to hold things in mind for a short time, such as memorising someone’s phone number) and speed of processing (how quickly someone is able to perform a task such as drawing a clock on a piece of paper) were most affected by the season. And the findings did not change if they accounted for the person’s mood, level of physical activity, sleep quality, time of day of testing, or thyroid integrity. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/234964/original/file-20180905-45143-1wizpia.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/234964/original/file-20180905-45143-1wizpia.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/234964/original/file-20180905-45143-1wizpia.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/234964/original/file-20180905-45143-1wizpia.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/234964/original/file-20180905-45143-1wizpia.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/234964/original/file-20180905-45143-1wizpia.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/234964/original/file-20180905-45143-1wizpia.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/234964/original/file-20180905-45143-1wizpia.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">The study authors argue being less physically active during the colder months wouldn’t make a difference to the findings.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/78hTqvjYMS4">Matthew Bennett/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>So, the authors argued this association was unlikely to be driven by outside environmental factors such as lower physical activity in winter months. Other confounding influences cannot be discounted. These include season-related injuries or pain such as arthritis, social isolation, changes in exposure to pollution or unaccounted-for biological factors. </p>
<h2>Biological changes</h2>
<p>Researchers also found changes in the biology of Alzheimer’s disease associated with the season. Alzheimer’s disease is a form of dementia mainly defined by two hallmark pathologies in the brain – a buildup of proteins called amyloid and tau. </p>
<p>In the purest sense, Alzheimer’s disease can only be diagnosed after death. But it is possible to measure levels of amyloid and tau during life using an imaging technique known as positron emission tomography (PET). This technology is still largely confined to research.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-causes-alzheimers-disease-what-we-know-dont-know-and-suspect-75847">What causes Alzheimer’s disease? What we know, don’t know and suspect</a>
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<p>Amyloid is known to become abnormal very early in the disease process. Examining spinal fluid extracted from participants, researchers found amyloid protein fluctuations in the cerebrospinal fluid of healthy older adults became more abnormal during winter months.</p>
<p>While the authors could not provide an explanation for this cyclical pattern in amyloid levels in the spinal fluid, they pointed out this aligned closely with memory and thinking patterns seen in the same adults.</p>
<h2>How should we read the findings?</h2>
<p>These findings are interesting and are some of the first in this area. But they need to be interpreted with a degree of scientific caution. </p>
<p>One major drawback is they’re predicated entirely on cross-sectional data. That is, people were not specifically followed during each season across the year to determine changes in their cognition. Researchers analysed data already available. </p>
<p>Further, these studies rely entirely on Northern Hemisphere data. This might not be applicable to the Southern Hemisphere.</p>
<p>These findings are correlational, so it cannot be said a particular season causes cognitive decline – it is merely associated with it. What one can imply from these data is more dementia care resources and community awareness may be needed during these months. </p>
<p>At a population level, these findings suggest a trend towards poorer cognitive performance and greater incidence of dementia cases in spring and winter, which might not simply be a case of “the winter blues”. These findings remind us to be mindful of dementia in our community, and that some may be particularly vulnerable at certain times of the year. </p>
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<strong>
Read more:
<a href="https://theconversation.com/getting-the-temperature-just-right-helps-people-with-dementia-stay-cool-97374">Getting the temperature just right helps people with dementia stay cool</a>
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<p>What remains to be done are studies specifically set up to measure cognitive performance in individuals throughout each season to determine if there really is something to feeling a bit mentally sluggish in the winter months.</p>
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<p><em>We are looking for volunteers to take part in our ongoing study to understand brain health and ageing. If you are interested, and between the ages of 40 and 65, please head to <a href="https://www.healthybrainproject.org.au/">The Healthy Brain Project</a>.</em></p>
<p><em>This article originally stated the research was published in the journal PLOS One. This has been corrected to PLOS Medicine.</em></p><img src="https://counter.theconversation.com/content/102706/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rachel Buckley receives funding from the National Health and Medical Research Council and Australian Research Council with a Dementia Research Fellowship. </span></em></p>Have you noticed your thinking ability drops during winter and spring? A new study of healthy adults and dementia patients found cognitive function declines in the colder months.Rachel Buckley, Research Fellow, Harvard Medical School, Research Fellow, Florey Institute of Neuroscience and Mental HealthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/567032016-03-30T11:32:59Z2016-03-30T11:32:59ZAntimatter changed physics, and the discovery of antimemories could revolutionise neuroscience<figure><img src="https://images.theconversation.com/files/116616/original/image-20160329-13718-zxaoge.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Antimemory, the yin to memory's yang.</span> <span class="attribution"><span class="source">Naeblys/shutterstock.com</span></span></figcaption></figure><p>One of the most intriguing physics discoveries of the last century was the existence of <a href="https://theconversation.com/explainer-what-is-antimatter-53414">antimatter</a>, material that exists as the “mirror image” of subatomic particles of matter, such as electrons, protons and quarks, but with the opposite charge. Antimatter deepened our understanding of our universe and the laws of physics, and now the same idea is being proposed to explain something equally mysterious: memory.</p>
<p>When memories are created and recalled, new and stronger electrical connections are created between neurons in the brain. The memory is represented by this new association between neurons. But a new theory, backed by animal research and mathematical models, suggests that at the same time that a memory is created, an “antimemory” is also spawned – that is, connections between neurons are made that provide the exact opposite pattern of electrical activity to those forming the original memory. Scientists believe that this helps maintain the balance of electrical activity in the brain.</p>
<p>The growth of stronger connections between neurons, known as an increase in excitation, is part of the normal process of learning. Like the excitement that we feel emotionally, a little is a good thing. However, also like emotional excitement, too much of it can cause problems.</p>
<p>In fact, the levels of electrical activity in the brain are finely and delicately balanced. Any excessive excitation in the brain disrupts this balance. In fact, electrical imbalance is <a href="http://www.nature.com/nature/journal/v477/n7363/abs/nature10360.html">thought to underlie some of the cognitive problems</a> associated with psychiatric and psychological conditions such as <a href="http://www.ncbi.nlm.nih.gov/pubmed/14606691">autism</a> and schizophrenia.</p>
<p>In trying to understand the effects of imbalance, scientists reached the conclusion that there must be a second process in learning that acts to rebalance the excitation caused by the new memory and keep the whole system in check. The theory is that, just as we have matter and antimatter, so there must be an antimemory for every memory. This precise mirroring of the excitation of the new memory with its inhibitory antimemory prevents a runaway storm of brain activity, ensuring that the system stays in balance. While the memory is still present, the activity it caused has been subdued. In this way, antimemories work to silence the original memory without erasing it.</p>
<h2>What does an antimemory do?</h2>
<p>The evidence for antimemories so far comes only from <a href="http://www.ncbi.nlm.nih.gov/pubmed/25843405">experimental work in rats and mice</a> and <a href="http://science.sciencemag.org/content/334/6062/1569.full">evidence from modelling</a>. These experiments require direct recording from inside the brain using electrodes, and given that putting metal probes into human brains typically is frowned upon, scientists have not yet been able to directly support the presence of antimemories in humans. In a <a href="http://dx.doi.org/10.1016/j.neuron.2016.02.031">paper just published in the journal Neuron</a>, a team of researchers from the University of Oxford and University College London have come up with a clever method to determine whether human memory operates on similar lines to those of our animal cousins.</p>
<p>Test subjects were asked to learn a task that created a new memory. When the researchers used fMRI brain scanning to examine the brain a few hours after learning, however, they found no trace of the memory, as it had been quietened by the antimemory. They then applied a weak flow of electricity in the area of the brain where the memory had formed (using a safe technique called <a href="http://www.hopkinsmedicine.org/psychiatry/specialty_areas/brain_stimulation/tdcs.html">anodal transcranial direct current stimulation</a>). This allowed them to reduce inhibitory brain activity in this area - disrupting the inhibitory antimemory and thus revealing the hidden memory.</p>
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<a href="https://images.theconversation.com/files/116610/original/image-20160329-13691-1aew741.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/116610/original/image-20160329-13691-1aew741.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/116610/original/image-20160329-13691-1aew741.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=323&fit=crop&dpr=1 600w, https://images.theconversation.com/files/116610/original/image-20160329-13691-1aew741.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=323&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/116610/original/image-20160329-13691-1aew741.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=323&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/116610/original/image-20160329-13691-1aew741.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=406&fit=crop&dpr=1 754w, https://images.theconversation.com/files/116610/original/image-20160329-13691-1aew741.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=406&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/116610/original/image-20160329-13691-1aew741.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=406&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">How the antimemory counters the brain activity of a memory.</span>
<span class="attribution"><a class="source" href="http://dx.doi.org/10.1016/j.neuron.2016.02.031">HC Barron et al/Neuron</a></span>
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<p>This diagram shows four coloured shapes that will be paired together by the test participant during a memory task. The two pairs of shapes are learned, with the memory represented by the orange connections between them. Having learned this pairing, the excitation in the brain caused by learning and creating the memory is balanced out by an inhibitory antimemory, represented by the new grey lines. </p>
<p>The yellow boxes below represent the rate of firing of neurons during this learning process. At first, before pairing, they respond only to the red square. After learning the pairing of the red and green squares, the neurons fire to either stimulus. As the antimemory develops this association is silenced and neurons activate only in response to the red stimulus. Finally, after temporarily disturbing the antimemory, the underlying association is evident once again, with the neurons activating to either stimulus.</p>
<p>So it seems that in humans as well as in animals, antimemories are critical to prevent a potentially dangerous build-up of electrical excitation in the brain, something that could lead to <a href="http://www.ncbi.nlm.nih.gov/pubmed/2542471">epileptic-like brain states and seizures</a>. It’s thought antimemories may also play an important role in <a href="http://www.nature.com/neuro/journal/v3/n11s/full/nn1100_1184.html">stopping memories from spontaneously activating each other</a>, which would lead to confusion and severely disordered thought processes. </p>
<p>Just as the mathematical theory of antimatter and its later discovery in nature and <a href="http://press.cern/press-releases/1996/01/first-atoms-antimatter-produced-cern">creation in a lab</a> was hugely important to 20th century physics, it seems that the investigation of these enigmatic antimemories will be potentially revolutionary for our understanding of the brain and an important focus for the coming century.</p><img src="https://counter.theconversation.com/content/56703/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Harriet Dempsey-Jones 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>The theory of antimemories could help explain many cognitive problems in the brain such as autism and schizophrenia.Harriet Dempsey-Jones, Researcher in Clinical Neurosciences, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/520982015-12-10T14:58:29Z2015-12-10T14:58:29ZMind or body – what do we need to worry about when it comes to healthy ageing?<p>European societies are living longer but as the <a href="http://www.ons.gov.uk/ons/rel/npp/national-population-projections/2014-based-projections/index.html">older population increases</a>, are these extra years healthy ones? </p>
<p><a href="http://bit.ly/1SN3HmA">Research</a> we recently published in The Lancet suggests that the answer to this question crucially depends on what you mean by “healthy”. For some health measures such as cognitive impairment, which includes problems such as memory loss and an inability to learn new things, we found that these extra years are indeed healthy. But according to other measures these extra years are also increasingly being spent with disability, although this is with milder levels of disability rather than severe. </p>
<h2>A look at the numbers</h2>
<p>Our research used the <a href="http://www.cfas.ac.uk/">Cognitive Function and Ageing Studies</a> where two groups of older people aged 65 and above were interviewed in 1991 and 2011. We looked at three health measures: cognitive impairment (rated none, mild, moderate-severe); disability in activities of daily living (rated none, mild, moderate-severe); and self-perceived health (rated poor, fair, excellent-good). </p>
<p>In this 20-year period, life expectancy of women in these groups aged 65 grew by 3.6 years (from 16.7 years to 20.3 years), an average of the remaining years lived. For men on the other hand, life expectancy grew by 4.5 years (from 13 years to 17.5 years). </p>
<p>Looking at cognitive impairment, we found that these gains were accompanied by gains in years free of any cognitive impairment (4.4 years for women and 4.2 years for men). For disability, a physical health measure, the results were not so good. Yet, men appeared to have fared better. Over the 20-year period men aged 65 gained 2.6 years free of disability, while women of the same age gained only six months. In both cases the proportion of life spent without disability had reduced over the period. </p>
<p>Because of the way we measured disability, through difficulty with activities of daily living, we could classify whether the disability was mild or more severe. Teasing out the results further, we found that the gains in years with disability were predominantly gains in mild disability. At age 65, we found that women were spending around 2.5 years more with mild disability and around seven months more with moderate or severe disability. Men on the other hand, were spending only 1.3 years more with mild disability and six months more with moderate or severe disability. </p>
<p>Our two studies also included self-perceived health, a more holistic health measure that is used by the Office for National Statistics <a href="http://www.ons.gov.uk/ons/taxonomy/index.html?nscl=Health+Expectancy">when determining healthy life expectancy estimates</a>. From our study we found that the proportion of reported life spent healthy at age 65 had risen by three to four percentage points for men and women. It is a very slight increase, but a significant one. </p>
<p>So what does this all tell us? That British people are living longer and healthier, especially in the mind, but with some less positive trends with regard to mild disability. </p>
<h2>Why do the numbers matter?</h2>
<p>One reason why mild disability has risen may be because of a rise in obesity levels over the last decades across this age group. It is well known that <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0088016">women in general have a higher prevalence of disability</a>, but they also suffer more multiple diseases. <a href="http://www.bmj.com/content/339/bmj.b4904.abstract">For example, another study reported</a>that women aged 85 had on average five diseases compared to men of the same age who had four. </p>
<p>If older people are living longer and healthier, then this <a href="http://www.theguardian.com/business/2015/jun/11/ageing-uk-population-increase-strain-government-spending-obr-warns">has considerable implications</a> for government, employers, individuals and society in terms of the economy, housing and extending working life. But our studies provide estimates of time spent with cognitive impairment (just under ten months for women and four months for men on average from any age) and more severe disability (around two years for men and three years for women). These estimates are particularly important for making policies around elderly care and could provide a basis for costing future care provision. There are other factors that will need to be considered too, including which specific diseases might be responsible for the rise in disability and whether inequalities between social groups have also widened over the period.</p><img src="https://counter.theconversation.com/content/52098/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carol Jagger receives funding from the Economic and Social Research Council and the John Templeton Foundation. </span></em></p>New research suggests Britons are living longer and in good mental shape – but it’s not good news across the board.Carol Jagger, AXA Professor of Epidemiology of Ageing, Newcastle UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/492932015-11-05T19:04:35Z2015-11-05T19:04:35ZHere’s how we can stop putting Aboriginal people with disabilities in prison<p><a href="https://www.mhdcd.unsw.edu.au/">Our research</a> shows how Australia imprisons thousands of Aboriginal people with mental and cognitive disabilities each year because of a lack of understanding, and a dearth of community-based services and support. </p>
<p>It also shows what can be done about this shameful breach of human rights.</p>
<p>We have data on hundreds of Aboriginal people with mental and cognitive disabilities that tells the story of their early and regular contact with police, courts and custody. And Aboriginal researchers in our team have spoken with Aboriginal people with disabilities, their families, communities and service providers in New South Wales and the Northern Territory so we can better understand their experiences. </p>
<h2>What will make a difference</h2>
<p>Based on that research, we are recommending these principles and strategies to underpin policy reform:</p>
<p><strong>1. Self-determination</strong></p>
<p>Self-determination is key to improving the human rights and well-being of Aboriginal people with mental and cognitive disabilities. This means an <a href="https://www.humanrights.gov.au/right-self-determination">ongoing process of choice</a> on matters affecting them, their families and communities.</p>
<p>Community-led knowledge, solutions and services to respond to the over-representation of Aboriginal people with mental and cognitive disabilities in prison should be properly supported and resourced. And we must ensure the input of Aboriginal women on their needs and aspirations given their particular disadvantage and vulnerability in the criminal justice system. We also need better services for Aboriginal people in regional and remote areas. </p>
<p>Education and cultural competency for non-Aboriginal organisations and people working in this area is crucial.</p>
<p><strong>2: Person-centred support</strong></p>
<p>Person-centred support that puts Aboriginal people with mental and cognitive disabilities at the centre of their care and that’s appropriate to their culture and context is essential. People should be supported to make decisions about their own needs and recovery. </p>
<p>Disability services and the National Disability Insurance Scheme (NDIS) need an overt strategy to support Aboriginal people with disabilities in the criminal justice system. This initiative should also cover the needs of people with borderline intellectual disability and fetal alcohol syndrome disorder (FASD), who may not be recognised as having a disability but who often need targeted support so they don’t end up in prison.</p>
<p>Specialised housing, services and treatment options should be available in the community to prevent incarceration and improve well-being.</p>
<p><strong>3. A holistic and flexible approach</strong></p>
<p>A determined holistic and flexible approach to services for Aboriginal people with mental and cognitive disabilities is needed from a young age to avoid contact with the criminal justice system. Early recognition by maternal and infant health services, early childhood and school education, community health services and police is important. </p>
<p>Governments should provide positive and preventive support that allows Aboriginal children and young people with disability to develop and flourish. We need supported housing and case management options for people with cognitive impairment to help keen them out of the the criminal justice system. The <a href="https://www.portal.facs.nsw.gov.au/Guidelines/SourceDocuments/cjp_tailored_support_packages.pdf">NSW Community Justice Program</a> is a good example. It provides specialised intensive 24-hour supported accommodation to drop in support for people with an intellectual disability who have been in the criminal justice system. </p>
<p><strong>4. Integrated services</strong></p>
<p>Government and non-government services need to work in a more integrated way to improve referral, information sharing and case management, and to better support Aboriginal people with mental and cognitive disabilities.</p>
<p>Justice, Corrections and Human Services departments and non-government services should take a collaborative approach to program pathways for Aboriginal people with disabilities who need support across their sectors. All prisoners with a cognitive impairment should be referred to the public advocate of the state or territory they are in.</p>
<h2>Better practice and prevention</h2>
<p>It’s vital that Aboriginal understandings of “disability” and “impairment” underpin support for Aboriginal people with mental and cognitive disabilities in the criminal justice system. The particular experiences and perspectives of Aboriginal women should be central.</p>
<p>Better education and information on Aboriginal people with disabilities is needed for police, teachers, education support workers, lawyers, magistrates, health, corrections, disability and community service providers to help them understand and work with Aboriginal people with cognitive impairment, mental health disorders and complex support needs. </p>
<p>More resources are also needed for Aboriginal communities, families and carers so they can better support people with mental and cognitive disabilities.</p>
<p>Our data tracks the pathways of Aboriginal people with mental and cognitive disabilities into early contact with police, courts and custody largely due to a lack of appropriate health, education, disability and community services. We heard about the racism and stigma faced by Aboriginal people with disabilities that drives the cycle of over-policing, under-servicing and incarceration.</p>
<p>This predictable path is preventable. Early intervention and diversion into holistic, therapeutic, culturally responsive, local community-based services are essential. These will enable Aboriginal people with mental and cognitive disabilities to live with dignity and support in their communities.</p>
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<p><em>This is the fifth in a series of articles by this research team. Click <a href="https://theconversation.com/au/topics/aboriginal-people-with-mental-and-cognitive-disability-43089">here</a> to read more on the Indigenous Australians with Mental Health Disorders and Cognitive Disability in the Criminal Justice System (IAMHDCD) Project.</em></p>
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<p><em>Ruth will be on hand for an Author Q&A between 10 and 11am AEDT on Friday November 6, 2015. Post your questions in the comments section below.</em></p><img src="https://counter.theconversation.com/content/49293/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elizabeth McEntyre was the Australian Postgraduate Award Industry recipient for the IAMHDCD Project.</span></em></p><p class="fine-print"><em><span>Eileen Baldry receives funding from The Australian Research Council, FaCS NSW, Dept of Justice NSW. She is affiliated with PIAC & CRC. </span></em></p><p class="fine-print"><em><span>Ruth McCausland is Vice-President of the Board of the Community Restorative Centre.</span></em></p>The predictable path into prison for Aboriginal people with disabilities is preventable. Here are some solutions.Elizabeth McEntyre, PhD Candidate in Social Work and Criminology, UNSW SydneyEileen Baldry, Professor of Criminology, UNSW SydneyRuth McCausland, Research Fellow, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/481652015-11-04T19:03:49Z2015-11-04T19:03:49ZSupporting, not imprisoning, Aboriginal people with disabilities could save millions<figure><img src="https://images.theconversation.com/files/98782/original/image-20151019-25138-vn0h0k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Early support could save lives and allow Aboriginal people with mental and cognitive disability to live with dignity in their communities.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/59152532@N05/14867882904/in/photolist-oDPMAG-yAbX-6dge6r-a7AE3h-VPCPe-yAaD-fuab9T-6N1FAn-yZmNEf-yZmNGu-zfVLuE-2cNAca-ehHtkb-zgYxLK-zhPHUZ-zfVLLb-yZmNt3-zcNrBe-yZnKtG-yZnKpJ-zeEAN5-aAGj8E-6bEJN-6bENp-6bENW-aAGjxd-8ULs5k-dPgjrr-8KLeyQ-yZsPn4-cvJs6L-4oepWC-8pxAFv-yk6v8x-zfVLQu-zfVLPC-zgYxG6-yjWLw7-zgYxwg-zgYxB6-yZsPoM-6MtNE1-ppMsw7-9z5Fp5-6bELL-6bEPq-6bENE-6bEMN-6bEKP-6bELZ">Yasmeen/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>Australia <a href="https://theconversation.com/drafts/48166/edit">imprisons thousands of Aboriginal people with mental and cognitive disability</a> from disadvantaged backgrounds. Our <a href="https://www.mhdcd.unsw.edu.au/">research</a> illustrates the huge cost of this practice – in both human and economic terms.</p>
<p>Most Aboriginal people with mental and cognitive disability are not in prison for committing serious crimes. In our study the most common offences were theft, public order offences (such as offensive behaviour), offences against justice procedures (such as resist or hinder police officer, breach of bail) and traffic and vehicle offences (such as driving without a licence). </p>
<p>Aboriginal people with disabilities end up in prison because they are not supported early by specialised and community-based services. They are there because they’re from poor and disadvantaged backgrounds and from areas with no real alternatives to custody. Some are there indefinitely because courts consider them <a href="http://www.pwd.org.au/what-we-do/aboriginal-disability-justice-campaign.html">unfit to plead</a>.</p>
<h2>The cost of the status quo</h2>
<p>The <a href="https://www.mhdcd.unsw.edu.au/">Indigenous Australians with Mental Health Disorders and Cognitive Disability in the Criminal Justice System</a> (IAMHDCD) Project draws on a data set of 2731 people who have been in prison in New South Wales, one-quarter of whom are Indigenous. We have data from police, courts, legal aid, juvenile justice and adult corrections as well as government housing, disability, correctional health, hospitals and community services. </p>
<p>This data allows us to track every time people have had contact with these government agencies over their lifetime. It has also allowed us to calculate what it costs the government to have this group managed mostly by police, courts, prison and hospital emergency departments. </p>
<p>The Productivity Commission estimates it costs <a href="http://www.pc.gov.au/research/ongoing/report-on-government-services/2015/justice/corrective-services/rogs-2015-volumec-chapter8.pdf">A$290 a day</a> to keep someone in prison. </p>
<p>We worked with government agencies to estimate other unit costs, such as what it costs police each time they record an incident; each time someone appears in court; each time someone is admitted to an emergency department; and each time someone receives a disability service. We then applied these costs to case studies of real people to calculate their lifetime <a href="https://www.mhdcd.unsw.edu.au/mhdcd-projects-studies.html">costs</a>.</p>
<p>Take, for instance, “Roy” – a 28-year-old Aboriginal man with an intellectual disability and a social personality disorder. He’s spent more than 1800 days in custody and more than 100 days in hospital for drug-related mental health and self-harm matters.</p>
<p>Roy’s contact with the criminal justice system from a young age is connected to his cognitive impairment. He left school at 13 and had his first contact with police soon after, when he was picked up for shoplifting and confessed. He then had increasingly regular contact with police. His brothers and friends often gave his name to police as an alias. </p>
<p>Just after he turned 18, Roy was picked up by police on a train without a ticket and under the influence of drugs. He was soon well known to police in inner city Sydney for begging and living on the streets. He was often admitted to emergency hospital departments due to his worsening mental health. He cycled in and out of prison on charges of theft, possession of illicit drugs, resisting arrest, assaulting police and breaches of bail. </p>
<p>We calculated Roy’s costs to government at age 30 to be almost $2 million. He has cost almost $400,000 in police resources alone. Roy’s court appearances add up to more than $100,000. His imprisonment costs amount to almost $900,000. </p>
<p>The contact with government agencies amounted to millions of dollars for each case study of an Aboriginal person we looked at. For one young woman from regional NSW, “Casey”, the cost was $5.5 million by the time she was 21. </p>
<p>By far the largest chunk of these costs are from regular contact with police, emergency hospital admissions, court appearances and prison. </p>
<h2>Failure and correction</h2>
<p>We have failed to care for and protect this group of vulnerable, disadvantaged children and adults. A lack of appropriate early intervention or services in the community has led to a predictable cycle of imprisonment. </p>
<p>The human costs of managing Aboriginal people with mental and cognitive disability via the criminal justice system are devastating. But the economic costs to governments are also significant. </p>
<p>Such costs only increase over time, as people become stuck in the system and are further disadvantaged. A lifetime of prison and crisis supports can be as high as <a href="https://www.humanrights.gov.au/sites/default/files/document/publication/Cost%20benefit%20analysis.pdf">$1 million per year</a> for some people with complex support needs. </p>
<p>Our research shows that there would be great human and economic benefit in investing as early as possible in holistic, therapeutic, culturally responsive, community-based support.</p>
<p>We could have both saved money and improved Roy’s well-being, for instance, by providing him as well as his family with early intensive case management support services, housing, and a disability support pension. We have estimated – conservatively – that the government could have saved more than <a href="https://www.humanrights.gov.au/sites/default/files/document/publication/Cost%20benefit%20analysis.pdf">$350,000 by time Roy turned 30</a>.</p>
<p>There’s growing support across Australia for initiatives that reinvest funds going to imprisoning Aboriginal people into <a href="http://www.justreinvest.org.au/">community-driven solutions</a>. Such initiatives have the potential to deliver more than money; they could save lives and allow Aboriginal people with mental and cognitive disability to live with dignity and support in their communities.</p>
<hr>
<p><em>This is the fourth in a series of articles by this research team. Click <a href="https://theconversation.com/au/topics/aboriginal-people-with-mental-and-cognitive-disability-43089">here</a> to read more on the Indigenous Australians with Mental Health Disorders and Cognitive Disability in the Criminal Justice System (IAMHDCD) Project.</em></p>
<hr>
<p><em>Ruth will be on hand for an Author Q&A between 10 and 11am AEDT on Friday November 6, 2015. Post your questions in the comments section below.</em></p><img src="https://counter.theconversation.com/content/48165/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ruth McCausland is Vice-President of the Board of the Community Restorative Centre. </span></em></p>Aboriginal people with mental and cognitive disability are managed mostly by police, courts, prison and hospitals. It’s costing us millions, when kinder and cheaper alternatives exist.Ruth McCausland, Research Fellow, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/492942015-11-03T19:04:31Z2015-11-03T19:04:31ZAboriginal people with disabilities get caught in a spiral of over-policing<figure><img src="https://images.theconversation.com/files/99776/original/image-20151027-18424-76jztk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Police often don't recognise that someone has an intellectual disability or brain injury due to a lack of training in this area, researchers have heard.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/yewenyi/2435149012/in/photolist-4HbLXN-33XyLo-8Mb678-5BzVdG-4HSG7E-4weWvM-8NPnG9-8UaiRJ-4rSscV-ncgJmV-nciQ2s-7BxMEC-8NURda-sHrFM-tb7thg-djKMJN-uC4XET-32kAj9-ak4z6t-8XtctV-992LiP-99rVL-8Meivj-cAKL6L-d13fk7-5AafsC-7BtY3n-7BtYne-iLzhDv-svzMG-8SydYE-t95PGF-33XDEy-6f8cFd-8Uaeqb-55Wptv-6wcALb-bbmL3D-3KhiUf-87Lsa6-4okqU-8Me5gw-8NFXu5-33XxXJ-svzR3-nae8Ho-34fiMH-wtCh5-iLDopG-995TRJ">Brian Yap (葉)/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>Police have become the default frontline response to Aboriginal people with mental and cognitive disabilities. In the absence of culturally responsive and therapeutic community-based support, regular police contact from a young age sets this group up for a lifetime of “management” by the criminal justice system.</p>
<p>We visited Aboriginal communities in regional and remote New South Wales and the Northern Territory as part of the <a href="https://www.mhdcd.unsw.edu.au/">Indigenous Australians with Mental Health Disorders and Cognitive Disability in the Criminal Justice System</a> project. We <a href="https://www.mhdcd.unsw.edu.au/sites/www.mhdcd.unsw.edu.au/files/u18/pdf/a_predictable_and_preventable_path_2Nov15.pdf">found</a> that police are often the first and only service to show up to a crisis involving Aboriginal people with mental and cognitive disabilities. </p>
<p>But people told us that police often don’t recognise that someone has an intellectual disability or brain injury due to their lack of training in this area. They often assume Aboriginal people are drunk or having a drug-induced mental health episode. This means police don’t respond appropriately, and an interaction can escalate quickly and badly. </p>
<p>Our study shows Aboriginal people with mental and cognitive disabilities have frequent contact with police from a younger age than non-Aboriginal people with disabilities. Their age of first contact with police was 3.4 years younger than the non-Aboriginal people in our study. </p>
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<p>Aboriginal people in our study had a higher rate of contact with police than non-Aboriginal people, both as a victim and an offender. This was the case for women in particular. Many Aboriginal people told us they felt poorly treated and targeted by police. </p>
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<p>Aboriginal people with mental and cognitive disabilities can have long histories of offending, often as a result of behaviour connected with their disability. Common among Aboriginal people in our study, for instance, were charges for offences such as offensive language or behaviour, resisting or hindering a police officer, or breaching bail conditions. </p>
<p>People told us that these histories then become used to justify police “hyper-surveillance” of Aboriginal people with mental and cognitive disabilities. Even when they are the victims, police often view this group as offenders. One Aboriginal health worker told us:</p>
<blockquote>
<p>When they do start out in the jail system and they get themselves a record, nothing is ever in the past. So how can you get help, do the right thing, get your life on track when as soon as the police see them they start harassing them?</p>
</blockquote>
<p>Aboriginal people see this kind of negative over-policing as evidence of systemic racism. They highlight the stark contrast between high levels of funding for police in their towns and a lack of funding for Aboriginal community-based mental health and disability services. </p>
<p>One remote NSW town we visited has a long history of poor relations between police and the Aboriginal community. Its population is 2300 people, about 1000 of whom are Aboriginal. There are more than 40 police already based in the town. And the police station has recently had a $16 million upgrade and its police cells expanded to hold more people.</p>
<p>Elders told us that there had been no prior liaison with the local Aboriginal community about this upgrade. Earlier this year, they wrote to the then-NSW attorney-general and justice minister about this. They raised the lack of mental health services and growing numbers of Aboriginal people in the criminal justice system with mental and cognitive disabilities – women in particular – as a matter of great concern to the Elders, families and the community. They’re still waiting for a response.</p>
<p>The way police approach Aboriginal people with mental and cognitive disabilities needs to change, one disability worker told us:</p>
<blockquote>
<p>We had two particular young coppers, straight out of the academy, full of their own importance and new-found power, who used to badger and stalk my client [who has an intellectual disability] … They went slowly slowly past him, then sped around the block, then slowly slowly passed him, then sped around the block, five times. To the point that he got so frustrated he picked up a handful of rocks and threw it at them and told them to piss off. So they then pulled in to arrest him for throwing rocks, then they pushed him against the paddy-wagon that hard that they made the dint in the paddy-wagon, and were going to charge him with [malicious damage].</p>
</blockquote>
<p>Many Aboriginal people with mental and cognitive disabilities have violent interactions with police. One Aboriginal community member told us:</p>
<blockquote>
<p>She was off her medication at that time too, pregnant, and she was confronted by the police and she became irrational in that situation. I don’t think the police over here have learnt how to deal with people with mental illness appropriately. So she became irate, they then dragged her into the police station and took her down in the foyer because, well, their excuse was the way she was acting.</p>
</blockquote>
<p>We also heard examples of police officers trying to assist young Aboriginal people with mental and cognitive disabilities to get support from human services. But a dire lack of culturally responsive, therapeutic community-based options means that police become default <a href="https://www.crcpress.com/Policing-and-the-Mentally-Ill-International-Perspectives/Chappell/9781439881163">“care managers”</a> and start to manage this group as offenders from a young age.</p>
<p>Greater understanding, accountability and community-police collaboration is urgently needed to build more positive approaches and alternatives to supporting Aboriginal people with mental and cognitive disabilities in their communities. </p>
<hr>
<p><em>This is the third in a series of articles by this research team. Click <a href="https://theconversation.com/au/topics/aboriginal-people-with-mental-and-cognitive-disability-43089">here</a> to read more on the Indigenous Australians with Mental Health Disorders and Cognitive Disability in the Criminal Justice System (IAMHDCD) Project.</em></p><img src="https://counter.theconversation.com/content/49294/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ruth McCausland is Vice-President of the Board of the Community Restorative Centre.</span></em></p><p class="fine-print"><em><span>Eileen Baldry receives funding from The Australian Research Council, FaCS NSW, Dept of Justice NSW. She is affiliated with PIAC & CRC.</span></em></p><p class="fine-print"><em><span>Elizabeth McEntyre was the Australian Postgraduate Award Industry recipient for the IAMHDCD Project.</span></em></p>Police have become the default frontline response to Aboriginal people with mental and cognitive disabilities, setting this group up for a lifetime of ‘management’ by the criminal justice system.Ruth McCausland, Research Fellow, UNSW SydneyEileen Baldry, Professor of Criminology, UNSW SydneyElizabeth McEntyre, PhD Candidate in Social Work and Criminology, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/481672015-11-02T19:09:37Z2015-11-02T19:09:37ZHow Aboriginal women with disabilities are set on a path into the criminal justice system<figure><img src="https://images.theconversation.com/files/99756/original/image-20151027-18421-vmsxb1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The needs of Aboriginal women with disabilities are not being met by any human service system, research shows.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/sidkid/2262628776/in/photolist-4rWyGY-4rSvfV-4rWynA-woExdt-vrDgUy-yk5R7W-rW6UCb-pKXnYZ-xxxZMF-wLRzuu-xG5xAd-5dg9Ps-pXvVpw-p8jnMu-p7AJ7k-pcHLZg-6EXXuc-q4kszv-p7AHJg-3cRWbs-iurEh-3cRW8N-7Ayo43-qDQsn9-3U2de7-3cMwZV-a7GNkN-MJ83p-4u6hFj-bHis1T-2CHYh-8rnWtD-bjc5t8-4Hesme-4kS1Y8-a7GNhh-XAEmY-kAYajh-ao5MLr-ordtU4-5MvCKH-aU8YBv-dH1Q5a-7wXyK-iurMJ-5twT2k-aN2co-cBpZ1U-7ys1TT-fgRKdg">sidkid/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>Aboriginal women only make up between <a href="http://www.abs.gov.au/ausstats/abs@.nsf/mf/3238.0.55.001">2% and 3%</a> of the Australian female population. But the rate of Aboriginal and Torres Strait Islander women entering prison has <a href="http://anj.sagepub.com/content/47/2/276">soared</a> from 21% of all women prisoners in 1996, to a record high of 35% in 2014. In the past year, the number of Aboriginal and Torres Strait Islander women prisoners has increased again by <a href="http://www.abs.gov.au/ausstats/abs@.nsf/mf/4512.0">6%</a> – a higher growth rate than for other women, and for Aboriginal men. </p>
<p>The <a href="https://www.mhdcd.unsw.edu.au/">Indigenous Australians with Mental Health Disorders and Cognitive Disability in the Criminal Justice System</a> (IAMHDCD) project, which draws on a vast dataset of 2731 people who have been in prison in NSW, <a href="https://www.mhdcd.unsw.edu.au/a-predictable-and-preventable-path-iamhdcd-report.html">shows</a> just how badly the system has failed Aboriginal women.</p>
<p>We tracked this group’s contact with police, courts, legal aid, juvenile justice and adult corrections, government housing, disability, hospitals and community services. We found that Aboriginal women with mental and cognitive disabilities were the most disadvantaged of those in our study, and the situation is worsening.</p>
<h2>A grim picture</h2>
<p>Aboriginal women in the group we <a href="https://www.mhdcd.unsw.edu.au/a-predictable-and-preventable-path-iamhdcd-report.html">studied</a> were 3.7 times more likely than non-Aboriginal women to have been in out-of-home care as children. </p>
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<p>Our data showed that Aboriginal women with mental and cognitive disabilities had their first police contact at a younger age and had a significantly higher number of police contacts across their lives than non-Aboriginal women. </p>
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<p><br></p>
<p>Over their lifetimes, Aboriginal women have significantly higher numbers of convictions, with Aboriginal women in the group we studied having, on average, 23 convictions over their lifetime compared to 15.2 for non-Aboriginal women.</p>
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<p>We found Aboriginal women were 2.4 times more likely than non-Aboriginal women to have been in custody as juveniles. Aboriginal women also had, on average, 8.5 remand episodes over their lifetime; non-Aboriginal women had, on average, 5.4 remand episodes over their lifetime. </p>
<p>Aboriginal women in the group had been in adult prison an average of ten times over their lifetime, compared with their non-Aboriginal counterparts who averaged six prison terms.</p>
<p>Compared to Aboriginal men and non-Aboriginal women, Aboriginal women have more complex needs. That means poorer mental health and well-being, as well as cognitive impairment, including intellectual disability and acquired brain injury. They are also more likely to have multiple disabilities and health problems.</p>
<p>Our data showed that Aboriginal women are 2.2 times more likely than non-Aboriginal women to be homeless at some point in their life. They were likely to have moved more often than their non-Aboriginal peers but lived in a smaller number of towns and suburbs.</p>
<p>Aboriginal women in our study were recorded by police as victims of crime an average of 23 times in their lives. For non-Aboriginal women, the number of reports as victims of crime was 16. </p>
<h2>Seeing it first hand</h2>
<p>Data is one thing. But it was only by interviewing Aboriginal women, hearing their stories and seeing the human impacts that we were able to get a better grip on why these patterns were emerging. </p>
<p>The interviewees shared a lot of knowledge with us about their lives and their experiences. Most of the Aboriginal women interviewed had multiple and complex support needs, and had been in prison, were at risk of going to prison, or were already in prison.</p>
<p>One Aboriginal woman who was imprisoned in the Northern Territory, far from her country and family support, had such an extreme intellectual disability that she had no awareness of her earliest release date. She had very little capacity to access disability support services after release into the community. </p>
<p>Another Aboriginal woman who had mental illness and cognitive disability had been remanded in a NSW prison for more than 12 months. While in custody, she was being cared for by an older Aboriginal woman prisoner suffering with post-traumatic stress disorder brought on by violence, and mental and emotional abuse from intimate partners. </p>
<p>A younger Aboriginal woman in her mid-20s who had been diagnosed with brain damage from inhaling petrol as a teenager had been detained as a juvenile and imprisoned as an adult four times. </p>
<p>It is clear these Aboriginal women’s needs are not being met by any human service system; they are landing in the criminal justice system because of serious policy and service gaps. </p>
<h2>Getting worse</h2>
<p>Australia has a poor record when it comes to Aboriginal and Torres Strait Islander women and their contact with criminal justice systems.</p>
<p>We’ve had a few <a href="http://www.correctiveservices.qld.gov.au/Publications/Corporate_Publications/Strategic_Documents/women_offenders_action_plan_2008_2012.pdf">reviews</a>, like the 1985 <a href="http://csa.intersearch.com.au/csajspui/bitstream/10627/632/1/Women%20task%20force%20March1985.pdf">NSW Women in Prison Task Force</a> and the NT’s Addressing the Needs of Female Offenders in Prison: Policy and Action Plan 2007-2012. Five of the 339 recommendations of the <a href="http://www.alrm.org.au/information/General%20Information/Royal%20Commission%20into%20Aboriginal%20Deaths%20in%20Custody.pdf">Royal Commission into Aboriginal Deaths in Custody National Report</a> referred to Aboriginal women. </p>
<p>These reviews have highlighted areas in need of improvement to better respond to the needs of Aboriginal women. These include police relations, access to Aboriginal Legal Services, courts and sentencing, bail applications, services provided in prison, access to probation and parole and post release care, as well as Aboriginal women-driven research.</p>
<p>Early intervention and diversion into holistic, therapeutic, culturally responsive, community-based support, case management support services, housing support and disability support pensions could help break the cycle of imprisonment for many of these women. </p>
<hr>
<p><em>This is the second in a series of articles by this research team. Click <a href="https://theconversation.com/au/topics/aboriginal-people-with-mental-and-cognitive-disability-43089">here</a> to read more on the Indigenous Australians with Mental Health Disorders and Cognitive Disability in the Criminal Justice System (IAMHDCD) Project.</em></p><img src="https://counter.theconversation.com/content/48167/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elizabeth McEntyre was the Australian Postgraduate Award Industry recipient for the IAMHDCD Project. </span></em></p>Research suggests serious problems with the way Aboriginal women, particularly those with mental and cognitive disabilities, are “managed” by the criminal justice system.Elizabeth McEntyre, PhD Candidate in Social Work and Criminology, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/481662015-11-01T19:10:56Z2015-11-01T19:10:56ZWhy Aboriginal people with disabilities crowd Australia’s prisons<figure><img src="https://images.theconversation.com/files/99775/original/image-20151027-18458-bfmipz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Aboriginal people with mental and cognitive disability are 'managed' by police, courts and prisons due to a lack of appropriate community-based services.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/treslola/6368127913/in/photolist-aGJjyR-aGJdTt-aGJ6bx-aGJLFi-aGJabe-aGJTYc-aGJzNH-aGJ3Ea-aGJokp-aGJszc-aGJX38-aGJter-aGJfG8-aGJRCM-aGK7Fv-aGK1mr-aGJxop-aGK5BD-aGJbZX-aGJrTg-aGJNKF-aGJEm2-aGK3g2-aGJmwn-wK7jbw-wv4JVN-wMEApR-sccPz3-srUNtf-scCv7m-wt7Bo9-vNVFM4-wtffNg-9NAsCc-wtn8Gt-rxcdBE-97tA6K-rrwjr2-scCu8s-sub3YF-wt9Dih-vNQ6oA-7BtXTi-vNKvQS-wtbpJS-vNsNGS-2tkwWA-7BtY3n-7BtYne-aGevrn">Kate Ausburn/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Australia imprisons thousands of Aboriginal people with mental and cognitive disability each year. A widespread lack of understanding – and action – underpins this shameful breach of human rights.</p>
<p>The number of people in Australian prisons recently reached an all time high of 33,791, with 27% or 9,264 of those prisoners <a href="http://www.abs.gov.au/ausstats/abs@.nsf/mf/4517.0">identifying as Aboriginal and Torres Strait Islander</a>. People with mental and cognitive disability who are poor, disadvantaged, and Aboriginal are overrepresented in this increase.</p>
<p>To clarify, mental disabilities include disorders such as depression, schizophrenia, anxiety, personality disorders and psychosis. People can experience these for a short time or throughout their lives. While cognitive disability covers impairments such as intellectual disability, acquired brain injury, dementia and fetal alcohol spectrum disorder (FASD). These are ongoing impairments in comprehension, reason, judgement, learning or memory. </p>
<h2>A predictable path</h2>
<p>A <a href="https://www.mhdcd.unsw.edu.au/sites/www.mhdcd.unsw.edu.au/files/u18/pdf/a_predictable_and_preventable_path_2Nov15.pdf">study</a> we released today shows how Aboriginal people with mental and cognitive disability are being “managed” by police, courts and prisons due to a dire lack of appropriate community-based services and support. </p>
<p>The <a href="https://www.mhdcd.unsw.edu.au/">Indigenous Australians with Mental Health Disorders and Cognitive Disability in the Criminal Justice System (IAMHDCD) Project</a> draws on a unique data set of 2,731 people who’ve been imprisoned in New South Wales, which holds <a href="http://www.bocsar.nsw.gov.au/Documents/custody/Q22015Custodyreport.pdf">more than a third</a> of Australia’s prison population. A quarter of people in the data set are Indigenous. </p>
<p>Throughout this article, we use “Indigenous” to match government data collection terms, and “Aboriginal” in our study findings to reflect the preference of the communities we worked with. </p>
<p>Our study includes data from police, courts, legal aid, juvenile justice and corrective services as well as government housing, disability, health and community services. The data shows that Indigenous people experience earlier and greater contact with the criminal justice system and are more disadvantaged generally than non-Indigenous people with mental and cognitive disabilities.</p>
<p>Aboriginal researchers in our team also spoke with Aboriginal people with mental and cognitive disability, their families, communities and service providers in four sites across NSW and the Northern Territory so we could better understand their experiences.</p>
<p>We found Aboriginal people with mental and cognitive disability are forced into the criminal justice system early in life. Coming from poor and disadvantaged backgrounds, they receive little support from community and disability services or the education system. </p>
<p>These people are often seen as badly behaved or too hard to control, and left to police to manage. While this also applies to non-Indigenous people with disability from disadvantaged backgrounds, we found it’s much more serious for Indigenous people. </p>
<p>Indigenous people in the group we studied were 2.6 times more likely to have been in out-of-home care as children. </p>
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<p>Their age of first contact with police was 3.4 years younger than non-Indigenous people, and they had a higher rate of contact with police as both victim and offender. </p>
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<p>Indigenous people were 2.4 times more likely to be in juvenile justice custody than non-Indigenous people. </p>
<p>And they had higher numbers and rates of convictions and more episodes of remand in prison (unsentenced). </p>
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<p>Indigenous people had higher rates of hospital admissions and were 1.2 times more likely to have been homeless – in a group with very high rates of homelessness generally. </p>
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<p>Those with complex needs (multiple diagnoses and disability) – particularly women – were the most disadvantaged. And Indigenous people from highly disadvantaged areas, especially regional and remote areas, fared the worst.</p>
<h2>Four key drivers</h2>
<p>Our research shows four major issues underlie these shocking statistics:</p>
<p><strong>1. People don’t understand what cognitive disability is</strong></p>
<p>Families, service workers, teachers, police, lawyers and magistrates don’t understand enough about cognitive impairment. They often think cognitive impairment and mental illness are the same. People with cognitive impairment, for instance, are often dealt with under mental health laws. </p>
<p>But imprisonment has serious consequences for people with cognitive impairment. People with FASD face difficulties due to low levels of understanding and diagnosis, as do those with borderline intellectual disability, because they are not recognised as having a disability by services and may not be supported by the new National Disability Insurance Scheme (NDIS). </p>
<p><strong>2. High levels of stress in some Aboriginal communities</strong></p>
<p>Aboriginal communities are under a great deal of stress from socioeconomic disadvantage, loss, grief and trauma. This comes from generations of Aboriginal people experiencing dispossession, racism, forcible removal of children, poor education and health care, overcrowded housing, early deaths of family and community members, over-policing, and high rates of incarceration.</p>
<p><strong>3. Many Aboriginal people in the criminal justice system have ‘complex support needs’</strong> </p>
<p>Aboriginal people with more than one type of impairment or disability are <a href="http://www.lawreform.justice.nsw.gov.au/Documents/report_135_final.pdf">more likely</a> to be involved in the criminal justice system. Families and communities are overwhelmed, and services are not set up to provide the kind of specialist support needed by people who experience multiple mental and cognitive disabilities, as well as drug and alcohol dependency. </p>
<p>Different diagnoses and disorders can become meshed together and masked by each other (this is known as “complex support needs”). It’s difficult for Aboriginal people with complex support needs to get appropriate help because services often focus on only one area – mental health, or intellectual disability, or drug and alcohol rehabilitation – and also because of racism and poverty. </p>
<p><strong>4. A lack of appropriate support for Aboriginal people with mental and cognitive disability</strong></p>
<p>From a young age, Aboriginal people with mental and cognitive disability are dealt with by systems of control rather than systems of care or protection. They can face discrimination on the basis of race and disability as well as having a criminal record; feel isolated and disconnected from family and community; and have limited access to appropriate community-based support options. </p>
<p>There are very few alternatives to prison and a lack of appropriate programs in prison or after release, particularly for those from regional or remote areas. And that makes return to prison very likely.</p>
<p>Our research found police and prisons have become governments’ default way of managing this vulnerable group rather than appropriately supporting them to have a life of stability and self-worth in the community. Australia’s imprisonment and re-imprisonment of Aboriginal people with mental and cognitive disability is not only shameful, it’s entirely predictable and preventable.</p>
<p><em>This is the first in a series of articles by this research team. Click <a href="https://theconversation.com/au/topics/aboriginal-people-with-mental-and-cognitive-disability-43089">here</a> to read more on the Indigenous Australians with Mental Health Disorders and Cognitive Disability in the Criminal Justice System (IAMHDCD) Project.</em></p><img src="https://counter.theconversation.com/content/48166/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eileen Baldry receives funding from The Australian Research Council, FaCS NSW, Dept of Justice NSW. She is affiliated with PIAC & CRC.</span></em></p><p class="fine-print"><em><span>Elizabeth McEntyre was the Australian Postgraduate Award Industry recipient for the IAMHDCD Project.</span></em></p><p class="fine-print"><em><span>Ruth McCausland is Vice-President of the Board of the Community Restorative Centre.</span></em></p>Australia’s high rates of imprisonment and re-imprisonment of Aboriginal people with mental and cognitive disabilities is not only shameful, it is entirely predictable and preventable.Eileen Baldry, Professor of Criminology, UNSW SydneyElizabeth McEntyre, PhD Candidate in Social Work and Criminology, UNSW SydneyRuth McCausland, Research Fellow, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/451592015-08-21T04:53:41Z2015-08-21T04:53:41ZPassage of time: why people with dementia switch back to the past<figure><img src="https://images.theconversation.com/files/92649/original/image-20150821-15946-keypcr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">We're more likely to recall memories and information we've used frequently rather than those obtained at a particular age. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-109505999/stock-photo-happy-old-gray-haired-woman-with-glasses.html?src=fvD0JBNJi4VfHXBKU1SyfA-1-80">Kristo-Gothard Hunor/Shutterstock</a></span></figcaption></figure><p>People diagnosed with dementia often have a distorted sense of time passing. My friends who are clinicians often comment on their patients with dementia preparing and arriving for their appointments many hours before they’re scheduled. </p>
<p>Dementias such as Alzheimer’s disease progressively impair cognition, causing problems with memory and planning, and day-to-day functioning, making it difficult to do things like shopping and cleaning. </p>
<p>Accurate time perception is critical in our modern society (and for much more important reasons than waiting room congestion) so this disorientation significantly affects those with dementia and their families and carers. </p>
<p>The Australian population is ageing, and with this comes an increased prevalence of dementia, Alzheimer’s disease being the most common. One in ten over-65s and one in three over-85s <a href="https://fightdementia.org.au/national/about-dementia-and-memory-loss/statistics">have dementia</a>. </p>
<p>There are neurological reasons why those affected by dementia judge the passage of time differently, and can access remote memories from many decades ago while unable to remember events of the past few hours.</p>
<h2>Time perception in dementia</h2>
<p>Those with dementia <a href="http://www.sciencedirect.com/science/article/pii/S0378512212001545">judge the passage of time</a> quicker than older adults without dementia, as well as younger adults. This is for prospective time perception, where people are instructed to estimate an upcoming time interval; and retrospective time estimation, where people judge time after the event has occurred, requiring them to mentally travel back in time. </p>
<p>As a practical example, a person with dementia is likely to underestimate how long they waited at a bus stop (if asked when the bus arrived; retrospective time perception) and how long they will be on the bus for their specified journey (if asked as the bus started; prospective time perception). </p>
<p>Those diagnosed with dementia may underestimate time due to difficulties in recollecting all events in the short-term past, creating a feeling of a relative empty time travel. Someone without dementia may remember the boy cycling his bike, the yellow car parked next to the shop, the noisy lawn mower, and the couple playing tennis, on their walk to the bus stop; while someone with dementia is likely to remember fewer of these events, creating the sense that less has occurred and therefore less time has past.</p>
<h2>Living in the past</h2>
<p>There is a link between the perception of time and memory function in those with dementia. Family members often report their loved ones with dementia sometimes live in the past, even reverting back to first languages.</p>
<p>This is because memory is not just one process in the brain, but a collection of different systems. Those with Alzheimer’s disease may have impairments in short-term memory, however remote memory can be left relatively intact. So they’re able to remember public and personal events many decades ago, but unable to recall what happened earlier that day. </p>
<p>A <a href="http://www.ncbi.nlm.nih.gov/pubmed/15814004">fascinating case study</a> illustrates this dissociation in remote and short-term memory in Alzheimer’s disease. A retired taxi driver diagnosed with Alzheimer’s disease showed remarkable spatial memory of downtown Toronto, Canada, where he had driven taxis and worked as a courier for 45 years. This was despite showing impairments in short-term memory and general cognitive functioning.</p>
<p>But while those with Alzheimer’s disease can typically remember events in the distant past better than those in the immediate past, they still perform worse than older adults without Alzheimer’s disease in memory retrieval. </p>
<p>Interestingly, <a href="http://www.ncbi.nlm.nih.gov/pubmed/23969995">it appears that</a> events and facts most frequently retrieved and used over a lifetime are those better recalled by those with Alzheimer’s disease in late life, rather than those encountered at any particular age. </p>
<p>This frequency of use memory pattern is mirrored in bilingual people with dementia. A friend commented that her Yia-Yia (Grandmother), who immigrated to Australia from Greece over 50 years ago, is increasingly conversing in Greek despite predominantly speaking English for decades (causing problems for my monolingual English-speaking friend). </p>
<p>Those with dementia often <a href="http://cbdmh.org/wp-content/uploads/2012/12/Paradis_2008.pdf">revert to their first language</a>. This commonly begins with utterances from the first language appearing in conversation from the second language. This occurs more often in those less proficient in their second language, rather than being related to the age of acquisition of their second language. </p>
<p>So, how does this happen? Probably because familiar memories rely more on the brain’s cortex, its outer layer, while short-term memories rely more on a structure called the hippocampus. The hippocampus is typically affected at the start of late-life dementias such as Alzheimer’s disease, with regions of the cortex affected subsequently. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/92646/original/image-20150821-15939-1vkqpn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/92646/original/image-20150821-15939-1vkqpn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/92646/original/image-20150821-15939-1vkqpn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=494&fit=crop&dpr=1 600w, https://images.theconversation.com/files/92646/original/image-20150821-15939-1vkqpn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=494&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/92646/original/image-20150821-15939-1vkqpn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=494&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/92646/original/image-20150821-15939-1vkqpn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=621&fit=crop&dpr=1 754w, https://images.theconversation.com/files/92646/original/image-20150821-15939-1vkqpn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=621&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/92646/original/image-20150821-15939-1vkqpn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=621&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="attribution"><a class="source" href="http://www.shutterstock.com/pic-103812083/stock-photo-drawing-of-the-brain-showing-the-hippocampus-and-areas-of-brain-involvement-in-alzheimer-s-disease.html?src=SUS_77C2URlN6bNnUEAN-A-1-1">Blamb/Shutterstock</a></span>
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</figure>
<h2>How to best respond?</h2>
<p>Families and friends of those affected by dementia often do not know how to respond when their loved ones rely on these remote memories, at heart, living in the past. It’s certainly not the case that these remote memories should be ignored or suppressed. </p>
<p>Rather than trying to bring the person with dementia back to reality, families and carers may try to enter their reality; building trust and empathy, and reducing anxiety. This is known as validation therapy but many families and carers will practise this technique without knowing its name. </p>
<p>Reminiscence therapy <a href="http://www.sciencedirect.com/science/article/pii/S0378512212001545">has also been shown to</a> increase mood, well-being and behaviour in those with dementia. This involves the discussion of past activities, events and experiences (usually with help of artefacts such as photographs, music and familiar items).</p>
<p>Alzheimer’s Australia has some fantastic <a href="https://fightdementia.org.au/support-and-services/i-care-for-someone-with-dementia/therapies-and-communication-approaches">help sheets</a> and phone line to help carers and family members communicate with loved ones with dementia. </p>
<h2>Building resilience</h2>
<p>There is nothing that can completely protect us from a future diagnosis of dementia. But a cognitively stimulating lifestyle can at least delay the onset of dementia. This means using your memory and other cognitive skills as much as possible, for example, working in a mentally challenging job, doing crosswords, and engaging in social activities. </p>
<p>The more frequently we recall and use memories over our lifetimes, the more likely we will have access to them in our old age.</p><img src="https://counter.theconversation.com/content/45159/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hannah Keage receives funding from the National Health and Medical Research Council (NHMRC). She is affiliated with the Australian Association of Gerontology and Australian Cognitive Neuroscience Society.</span></em></p><p class="fine-print"><em><span>Tobias Loetscher 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>People with dementia judge the passage of time differently, and can access remote memories from many decades ago while being unable to remember events of the past few hours.Hannah Keage, Senior Lecturer in Psychology, University of South AustraliaTobias Loetscher, Lecturer: Psychology, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/435722015-07-07T08:59:03Z2015-07-07T08:59:03ZThe value of unplugging in the Age of Distraction<figure><img src="https://images.theconversation.com/files/86288/original/image-20150624-31514-n5hh9p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Small device, but very demanding. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/mean-machine/6078011142/in/photolist-ag6oXy-rMF3c9-rMME7r-8nJeGe-nWwc4N-arpxyr-hHCyWm-bLPCz2-6FCzJa-boMxDB-boM6hr-nYyJCc-7fC5iG-7V7Y3w-nMFSb9-boMx9T-boLVQP-85YfZC-6GwzYu-boM2BH-boMavK-pg3XzX-boM36a-boM6Pk-boMbUD-boLRb4-boM18v-boMyn8-boM9Dt-hERJkT-boLZ3F-boLUg8-boLXhR-boLRst-boLSq8-boMbyB-boLZdv-boM8pe-boLYA8-boLZB6-boM4Dz-boLSVP-boM7Re-boLRRe-boMa2F-boMd4F-boMcDX-boLTxe-boM3Z4-boMdwi/">aciej_ie/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>A common experience: you are walking down the street and someone is walking in the opposite direction toward you. You see him but he does not see you. He is texting or looking at his cellphone. He is distracted, trying to do two things at the same time, walking and communicating. </p>
<p>There is also the telltale recognition of a car driver on a phone; she’s driving either too slowly or too fast for the surrounding conditions, only partly connected to what is going on around her. Connected to someone else in another place, she is not present in the here and now. </p>
<p>These types of occurrences are now common enough that we can label our time as the age of distraction. </p>
<h2>A dangerous condition</h2>
<p>The age of distraction is dangerous. A 2015 report by the National Safety Council showed that walking while texting increases the risk of accidents. More than <a href="https://www.nsc.org/in-the-newsroom/distracted-walking-injuries-on-the-rise-52-percent-occur-at-home">11,000 people</a> were injured between 2000 and 2011 while walking and talking on their phones. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/86291/original/image-20150624-31507-eye31h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/86291/original/image-20150624-31507-eye31h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/86291/original/image-20150624-31507-eye31h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/86291/original/image-20150624-31507-eye31h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/86291/original/image-20150624-31507-eye31h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/86291/original/image-20150624-31507-eye31h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/86291/original/image-20150624-31507-eye31h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/86291/original/image-20150624-31507-eye31h.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">Really bad idea: texting while driving.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/blackeycove/3647897679/in/photolist-6ymqTz-c5sSU3-7ASHom-7ANVXv-7ANVxZ-7ASH5u-7ASGZs-7ASHmE-7ASHAA-7ANVF6-7ASH2E-7ASHbU-7ANVGP-7ASHxu-7ANVBk-7ASHrY-7ASHqm-7ANVpK-7ASHtQ-7ASHpj-7ANW1X-7ASHvo-7ANVvi-7ANVD4-7ASH47-7ASHjN-ddvenY-ddveNF-ddvg9q-ddvff9-ddvdo8-ddveEj-ddvedR-ddvhCJ-ddvgxd-ddvge4-ddvhiq-ddvfQ3-7yjCYS-2qMt8E-usNLV9-usNASG-usNLuu-uKCYoZ-usNMC1-uJWdfQ-tNnZnf-tNxThP-usWEcT-uH5cGf">Paul Oka/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<p>Even more dangerous is the <a href="http://www.nsc.org/DistractedDrivingDocuments/The-Great-Multitasking-Lie-print.pdf">distracted car driver</a>. Distracted drivers have more fluctuating speed, change lanes fewer times than is necessary and in general make driving for everyone less safe and less <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4435680/">efficient</a>.</p>
<p>Texting while driving resulted in 16,000 additional road fatalities from 2001 to 2007. More than 21% of vehicle accidents are now attributable to drivers talking on cellphones and another <a href="http://www.undistracteddrivingadvocacy.net/linked/wilson_trends_in_fatalities_from_distracted_driving_in_the_united_states_1999_to_2008.pdf">5% were text messaging</a>.</p>
<h2>Cognitive impairment</h2>
<p>Multitasking relatively complex functions, such as operating handheld devices to communicate while walking or driving, is not so much an efficient use of our time as a suboptimal use of our skills. </p>
<p>We are more efficient users of information when we concentrate on one task at a time. When we try to do more than one thing, we suffer from inattention blindness, which is failing to recognize other things, such as people walking toward us or other road users. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/86295/original/image-20150624-31495-13nymyi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/86295/original/image-20150624-31495-13nymyi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/86295/original/image-20150624-31495-13nymyi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=392&fit=crop&dpr=1 600w, https://images.theconversation.com/files/86295/original/image-20150624-31495-13nymyi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=392&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/86295/original/image-20150624-31495-13nymyi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=392&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/86295/original/image-20150624-31495-13nymyi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=493&fit=crop&dpr=1 754w, https://images.theconversation.com/files/86295/original/image-20150624-31495-13nymyi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=493&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/86295/original/image-20150624-31495-13nymyi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=493&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Digital devices, which are proliferating in our lives, encourage multitasking, but does this really help our performance?</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/thomashawk/3071055422/in/photolist-5FnXMq-4bdPeu-oaeRnf-5FJTyM-b6o1Z-6UsjAC-4uNX4u-bEtsqs-5EC3Sb-8dBff4-7Xmtab-cCGnZE-kjrqx-dXxjd7-7MuTo7-3agepd-5CK8hj-pae1Qy-5RCVaP-EMpVU-8kbzxQ-nCZ8js-fxnWdn-pc7gos-fM2dv-8tf56b-2WrE-jHQNom-38EQiE-546LAj-53Sfvi-ujgnJ-nYYFun-eeLJ3B-9z6PCX-kB2EMk-4y2mwB-9pnmx8-nXCwFw-5RiEbb-tMQoq-dtZiwk-2KGwLd-8GLhXU-gpJtY6-6iyKgK-DVbyu-5Zef2Z-8sPUbP-4NKwGs">Thomas Hawk/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
</figcaption>
</figure>
<p>Multitaskers do worse on standard tests of pattern recognition and memory recall. In a now <a href="http://www.pnas.org/content/106/37/15583.long">classic study</a>, researchers at Stanford University found that multitaskers were less efficient because they were more susceptible to using irrelevant information and drawing on inappropriate memories. </p>
<p>Multitasking may not be all that good for you either. A 2010 survey of over 2,000 8- to 12-year-old girls in the US and Canada found that media multitasking was associated with <a href="http://www.researchgate.net/profile/Clifford_Nass2/publication/228453286_Media_use_face-to-face_communication_media_multitasking_and_social_well-being_among_8-to_12-year-old_girls/links/02bfe50cb68174ee6f000000.pdf">negative social indicators</a>, while face-to-face contact was associated with more positive social indicators such as social success, feelings of normalcy and hours of sleep (vital for young people). </p>
<p>Although the causal mechanism has yet to be fully understood – that is, what causes what – the conclusion is that media multitasking is not a source of happiness. </p>
<h2>Distraction-seeking creatures?</h2>
<p>There are a number of reasons behind this growing distraction. </p>
<p>One often-cited reason is the pressure of time. There is less time to accomplish all that we need to do. Multitasking then is the result of the pressure to do more things in the same limited time. But <a href="http://www.mitpressjournals.org/doi/abs/10.1162/rest.89.2.374#.VYa37ev6SEk">numerous studies</a> point to the discretionary use of time among the more affluent, and especially more affluent men. The crunch of time varies by gender and class. And, paradoxically, it is less of an objective constraint for those who often <a href="http://jamesmahmudrice.info/Time-Pressure.pdf">articulate it most</a>.</p>
<p>Although the time crunch is a reality, especially for many women and lower-income groups, the age of distraction is not simply a result of a time crunch. It may also reflect another form of being. We need to reconsider what it means to be human, not as continuous thought-bearing and task-completing beings but as distraction-seeking creatures that want to escape the bonds of the here-and-nowness with the <a href="http://www.sup.org/books/title/?id=18413">constant allure of someone and somewhere else</a>. </p>
<p>Media theorist Douglas Rushkoff asserts that our sense of time has been warped into a frenzied present tense of what he calls “digiphrenia,” the social media-created effect of being in multiple places and <a href="http://astore.amazon.com/astrostyle-20/detail/1591844762">more than one self all at once</a>.</p>
<p>There is also something sadder at work. The constant messaging, emailing and cellphoning, especially in public places, may be less about communicating with the people on the other end as about signaling to those around that you are so busy or so important, so connected, that you exist in more than just the here and now, clearly a diminished state of just being. </p>
<p>There’s greater status in being highly connected and constantly communicating. This may explain why many people speak so loudly on their cellphones in public places.</p>
<h2>Reactions</h2>
<p>The age of distraction is so recent we have yet to fully grasp it. Sometimes art is a good mediator of the very new. </p>
<p>A video art installation by Siebren Verstag is entitled<a href="https://vimeo.com/10882097"> Neither There nor There</a>. It consists of two screens. On one side a man sits looking at his phone; slowly his form loosens as pixels move to the adjacent screen and back again. The man’s form moves from screen to screen, in two places at one time but not fully in either. </p>
<p>One <a href="http://theconversation.com/how-smart-is-it-to-allow-students-to-use-mobile-phones-at-school-40621">study</a> that looked at the effect of banning cellphones in schools found that student achievement improved when cellphone were banned, with the greatest improvements accruing to lower-achieving students, who gained the equivalent of an additional hour of learning a week.</p>
<p>On many college campuses, faculty now have a closed-laptop policy after finding students would use their open laptops to skim their emails, surf the web and distract their neighbors. This was confirmed by <a href="http://www.ugr.es/%7Evictorhs/recinfo/docs/10.1.1.9.9018.pdf">studies</a> that showed that students with open laptops learned less and could recall less than students with their laptops closed.</p>
<p>We are witnessing a cultural shift occurring with the banning of devices, cellphone usage being curtailed in certain public places and policies banning texting while driving. This is reactive. We also need a new proactive civic etiquette so that the distracted walker, driver and talker have to navigate new codes of public behaviors. </p>
<p>Many coffee stores in Australia, for example, do not not allow people to order at the counter <a href="http://www.smh.com.au/digital-life/mobiles/ban-mobile-phones-retailers-say-20130703-2pbzr.html">when they are on the cellphone</a>, more <a href="http://www.emilypost.com/out-and-about/sports-and-recreation/678-cell-phones-a-golf">golf clubs</a> are banning the use of cellphones while on the course and it is illegal in <a href="http://www.ghsa.org/html/stateinfo/laws/cellphone_laws.html">38 states</a> in the US for novice drivers to use a cellphone while driving. </p>
<p>There is also the personal decision available to us all, one foreshadowed by writer and social critic Siegfried Kracauer, who lived from 1889 to 1966. In a <a href="http://monoskop.org/images/0/0f/Kracauer_Siegfried_The_Mass_Ornament_Weimar_Essays.pdf">newspaper article</a> on the impact of modernity, first published in 1924, he complained of the constant stimulation, the advertising and the mass media that all conspired to create a “permanent receptivity” that prefigures our own predicament in a world of constant texting, messaging and cellphones. </p>
<p>One response, argued Kracauer, is to surrender yourself to the sofa and do nothing, in order to achieve a “kind of bliss that is almost unearthly.”</p>
<p>One radical response is to unplug and disconnect, live in the moment and concentrate on doing one important thing at a time. Try it for an hour, then for a day. You can even call your friends to tell them about your success – just not while walking or driving, or working on your computer screen or speaking loudly in a public place.</p>
<p><em>This article was updated to correct the figure regarding the number of injuries from texting and walking.</em></p><img src="https://counter.theconversation.com/content/43572/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Rennie Short 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>As summer vacations approach, it’s worth recalling the value of disconnecting and perils of multitasking in our digitally distracted lifestyles.John Rennie Short, Professor, School of Public Policy, University of Maryland, Baltimore CountyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/378092015-02-19T16:29:30Z2015-02-19T16:29:30ZHow a simple vitamin B prescription could help people with Alzheimer’s<figure><img src="https://images.theconversation.com/files/72485/original/image-20150219-28181-1qi7x40.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Clinical benefits of B vitamins in groups at high risk of Alzheimer’s should be rigorously tested.</span> <span class="attribution"><span class="source">Vitamin B by Shutterstock</span></span></figcaption></figure><p>Age strikingly increases the risk of dementia, <a href="http://www.alzheimers.org.uk/statistics">which affects</a> around one in a hundred people aged between 65 and 69, but one in six of those aged 80 and over. As the progression of dementia takes place over many years and is not susceptible to medical treatment, the high costs of dementia are mostly those of providing long term care. The <a href="http://www.alzheimers.org.uk/dementiauk">health economic impact</a> of dementia exceeds that of cancer, heart disease and stroke combined.</p>
<p>The majority of cases of late life dementia are caused by the neurodegenerative condition known as Alzheimer’s disease. Pathologists recognise two characteristic changes in the brains of people who have died with this disease: abnormal protein aggregates deposited between nerve cells (called amyloid plaques) and bundles of chemically-altered protein filaments that destroy neurons from the inside (neurofibrillary tangles). </p>
<p>It is assumed that drugs with actions that modify one or both of these abnormal processes will give rise to some change in the clinical course of the disease. Yet after more than a decade, the race to find the first “disease modifying agent” for Alzheimer’s has still not been won. </p>
<h2>Disease progression</h2>
<p>One obstacle has been the slow evolution of the disease. Like other biological organs, the brain contains more nerve cells than are needed for survival. This redundancy is advantageous, as it can allow continuation of function following damage – due to a stroke or head injury, for example. However, when the damage in question is a disease that encroaches slowly and destroys the brain one unit at a time, compensatory activity that begins to happen in parallel obscures behavioural changes in a person until the disease is so advanced that the brain is beyond repair. </p>
<p>There are solutions to this impasse. One of the most successful has been the introduction of the term “<a href="http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=120">mild cognitive impairment</a>” to capture a group of people whose cognitive abilities have changed in later life, but who remain independent in day-to-day activities. Among people with mild cognitive impairment will be a proportion whose symptoms truly represent the earliest stages of Alzheimer’s disease. Others will find their problems remain stable, which reflects the changing cognitive profile of normal ageing. And some others will even experience an improvement. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/72486/original/image-20150219-28184-6sezyk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/72486/original/image-20150219-28184-6sezyk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/72486/original/image-20150219-28184-6sezyk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/72486/original/image-20150219-28184-6sezyk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/72486/original/image-20150219-28184-6sezyk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/72486/original/image-20150219-28184-6sezyk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/72486/original/image-20150219-28184-6sezyk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Brain differences.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/hey__paul/14043023409/in/photolist-3MYT-dKw732-noWaBg-dTW2xo-ecqicb-cL53To-noW8Ui-5DnvD4-noWj8f-nFqLdK-noWzmP-noWzd2-nFpCv1-nF8Tj8-nF8TGn-noWiN7-noWzNR-nFqLLP-noW6MS-nF8UqM-fsTWuh-k1H7g-nDocnb-9HdwNc-7C7gji">Hey Paul Studios</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>A simple and reliable (and preferably inexpensive) laboratory test to identify the subgroup destined to progress would herald a new era of disease-modifying drug discovery and large-scale trials. Unfortunately, the best of the disease biomarkers that currently available are cumbersome, expensive and only partially specific. Amyloid imaging and spinal fluid analysis will correctly detect more than <a href="http://www.ncbi.nlm.nih.gov/pubmed/22257044">90% of Alzheimer’s</a>, though positive results also occur in as many as 50% of people without the condition. </p>
<h2>Prevention because no cure</h2>
<p>An alternative strategy for reducing the burden of Alzheimer’s disease is one of prevention, based on identifying and reducing exposure to its risk factors. In its most common forms, the condition has multiple antecedents, which include both <a href="http://www.alz.org/alzheimers_disease_causes_risk_factors.asp">genetic predispositions</a> and critical environmental differences, including <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1173459/">traumatic brain injury</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/18484674">educational attainment</a> (so legislating for cycle helmets and improving the quality of state-funded education may have important long-term as well as more immediate benefits to society).</p>
<p>There is also evidence that raised blood levels of the amino acid homocysteine constitute an important independent risk factor for dementia. Some individuals are born with high concentrations of homocysteine, which damages the linings of blood vessels, causing strokes and heart attacks in people in their twenties and thirties. Ageing brings about a gradual elevation, and studies of ageing populations <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa011613">have shown</a> that higher homocysteine levels significantly increase an individual’s risk of developing dementia. </p>
<p>Recent studies <a href="http://brain.oxfordjournals.org/content/136/9/2707">associating raised homocysteine</a> with higher rates of shrinkage on brain scans, and greater neurofibrillary tangle burden at post-mortem, have strengthened the evidence for a biological connection between homocysteine and Alzheimer’s pathology.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/72492/original/image-20150219-28212-eyc9j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/72492/original/image-20150219-28212-eyc9j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=906&fit=crop&dpr=1 600w, https://images.theconversation.com/files/72492/original/image-20150219-28212-eyc9j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=906&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/72492/original/image-20150219-28212-eyc9j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=906&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/72492/original/image-20150219-28212-eyc9j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1139&fit=crop&dpr=1 754w, https://images.theconversation.com/files/72492/original/image-20150219-28212-eyc9j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1139&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/72492/original/image-20150219-28212-eyc9j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1139&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">CHConOP or B12 for short.</span>
<span class="attribution"><span class="source">B12 by Shutterstock</span></span>
</figcaption>
</figure>
<p>Homocysteine is not taken in the diet, so this enhanced risk of dementia cannot be mitigated by lifestyle changes. It is, however, critically dependent on the status in the body of B vitamins, which promote its conversion to non-toxic and biologically useful chemicals. Low levels of vitamin B12 and folic acid thus lead to higher concentrations of homocysteine, while regular dietary supplementation effects a return to normal levels. </p>
<h2>Prescribing vitamin B</h2>
<p>So, might the economic burden and individual suffering associated with Alzheimer’s disease be reduced by the simple and inexpensive expedient of prescribing B-vitamins to those with high levels of homocysteine?</p>
<p><a href="http://www.medsci.ox.ac.uk/optima/our-research/current-research/vitacog">The VITACOG trial</a>, a preliminary clinical trial in subjects with high plasma homocysteine levels, showed that the brains of those who received B-vitamins <a href="http://www.pnas.org/content/110/23/9523.short">shrank significantly less rapidly</a> than those of the placebo group, particularly in areas that are associated with early pathological changes in Alzheimer’s. </p>
<p>Such a striking result seemed to indicate the need for a nationwide trial to test whether the outcome would translate into a clinically important disease-modifying effect on the rate of progression in mild cognitive impairment.</p>
<p>The arguments for conducting the trial were overwhelming and, with the assistance of a national network of experts in dementia and clinical trials, I prepared the scientific and economic case for funding. Opposition to the idea, however, appeared from an unexpected quarter – <a href="http://ajcn.nutrition.org/content/85/2/329.full">a meta-analysis</a> of cognitive outcome data taken from completed trials of B vitamins for stroke and heart attack prevention. Somehow, a statistical miscellany of recycled results was rapidly elevated to a status little short of definitive scientific proof.</p>
<p>Meta-analysis can be a powerful way of drawing robust conclusions from the results of an experiment that has been conducted multiple times on small populations. In the B vitamin case, the numbers included in the meta-analysis were impressive. Yet numbers mean nothing if the data is neither uniform nor directly relevant to the question. Closer scrutiny revealed that few of the trials focused on dementia, that the ages of patients who took part were well below those associated with the development of Alzheimer’s disease, and that inclusion did not require the presence of mild cognitive impairment. And astonishingly, the results from the VITACOG trial were not included. </p>
<p>Unsurprisingly, the outcome of the pooled analysis was anodyne: neither the treatment nor the placebo group showed any meaningful change on any measure of cognitive status during follow-up. In other words – to quote <a href="http://www.dementiablog.org/b-vitamins-and-alzheimers-disease/#comment-2256">one of the members</a> of the original VITACOG study team – the analysis merely demonstrated that: “taking B vitamins won’t prevent cognitive decline in those who overall, do not show cognitive decline anyway.” </p>
<p>Yet the absence of any difference between the two treatment arms has been erroneously, widely, and without qualification <a href="http://tinyurl.com/kb88cvg">interpreted as evidence against</a> the benefits of B vitamins in Alzheimer’s disease. </p>
<p>In <a href="http://ajcn.nutrition.org/content/current">recently published letters</a> to the journal, I and many colleagues from around the world have pointed out the flaws in the meta-analysis and its harmful misinterpretation: harmful for medical research, for the cause of dementia prevention and, most of all, for the thousands of individuals who could have benefited from a safe and simple intervention. </p>
<p>We remain convinced that the clinical benefits of B vitamins in groups at high risk of Alzheimer’s disease should be allowed to be rigorously tested, but the damage caused by the public misinterpretation of a null study will take a while to unpick.</p><img src="https://counter.theconversation.com/content/37809/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Garrard 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>Evidence that vitamin B can reduce the levels of an amino acid that is a risk factor for dementia have been sidelined by one flawed study.Peter Garrard, Reader in Neurology, St George's, University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/243082014-03-13T14:33:02Z2014-03-13T14:33:02ZAn Alzheimer’s blood test could also help develop new drugs<figure><img src="https://images.theconversation.com/files/43859/original/dxkwwqyc-1394721049.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Three year head start.</span> <span class="attribution"><span class="source">Doctor's surgery via Shutterstock</span></span></figcaption></figure><p>US scientists <a href="http://www.bbc.co.uk/news/health-26480756">recently announced</a> they had developed a blood test that could predict your chances of developing Alzheimer’s disease, with 90% accuracy, up to three years in advance of other known symptoms. </p>
<p>The scientists from Georgetown University in Washington DC and University of Rochester School of Medicine, New York, did this by analysing the blood of 53 people who went on to develop Alzheimer’s or mild cognitive impairment from a study group of 525 people older than 70, compared to another 53 who didn’t. The difference in the levels of ten fats (phospholipids) in the blood of the two groups at the beginning <a href="http://dx.doi.org/10.1038/nm.3466">of the study</a> provided a predictive test of those at risk of developing either mild cognitive impairment or Alzheimer’s disease. </p>
<p>There are more than 800,000 people in the UK estimated to be living with dementia. More than half of these have Alzheimer’s disease, the most common cause of dementia. The cost of these diseases to the UK economy stands at £23 billion, more than the cost of cancer and heart disease combined. With the ageing demographic of the population, lack of a treatment for the underlying cause of the disease is a growing public issue.</p>
<p>The development of Alzheimer’s disease can proceed silently for up to a decade or more before any symptoms emerge and a key bottleneck in the development of treatments is the urgent need for much earlier diagnosis, before memory loss is evident and the disease becomes entrenched. Finding “biomarkers” like those identified by the US scientists in the blood samples could allow diagnosis to be made before clinical signs are first seen.</p>
<p>The fats, or phospholipids, are an important part of cell membranes, and levels in the blood are thought to reflect changes to the integrity of membranes that might happen during early neurodegeneration. Blood biomarkers are likely to provide one of the most cost effective diagnostic tools, but have so far proved elusive. Other methods are expensive, such as brain imaging, or invasive for the patient, for example spinal fluid samples.</p>
<p>The problem with current treatments is that they only help to alleviate symptoms, so a number of new treatments being developed aim to go further by slowing or stopping the underlying mechanisms. In the Institute of Integrative Biology at Liverpool University, <a href="http://news.liv.ac.uk/2013/05/29/new-chemical-approach-to-beat-alzheimers-d%20isease/">we have been developing</a> chemically synthesised compounds based on natural sugars, which strongly inhibit the action of an enzyme called beta-secretase. This enzyme is responsible for generating the small peptides made of amino acids that accumulate in clumps, or plaques, in the brains of people affected with Alzheimer’s. Targeting these plaques has been identified by drug companies as a key way to treat the disease, but it has proved difficult to inhibit this enzyme with classic small molecule drugs. </p>
<p>Successful development of drugs that have prevent or break down these plaques could result in disease-modifying therapies to slow or even halt progression of the disease.</p>
<p>Better early diagnosis could lead to advances in the development of disease-modifying drugs, which could be given to patients earlier, boosting their chances. Some promising drugs in clinical trials may have failed to produce any real benefit for the patients because they were given too late in the disease process. Testing such drugs at an earlier stage may reveal hitherto unseen benefits. </p>
<p>The blood changes discovered by Howard Federoff and his colleagues in the US study may provide a sensitive measure of early neurodegenerative events, and this could also provide a way of selecting groups of patients suitable for trialing new drugs.</p>
<p>It’s a combined front and still early days – the blood test, for example, still needs to be tested in a much larger clinical trial. The phospholipids may also provide clues for finding new biomarkers to improve the accuracy of testing. They might also permit even earlier diagnosis beyond the current three-year lead time the team describe. Extending their study to a much larger group of patients is the next step. If the data holds up this should lead to new opportunities to advance the development of new drugs in early treatment trials.</p><img src="https://counter.theconversation.com/content/24308/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jerry Turnbull works for the University of Liverpool which has submitted patents on compounds for inhibiting beta-secretase, and is also a founder, director and shareholder in IntelliHep Ltd, a spinout company which has licensed related IP from the University and is seeking to commercialise these compounds. He has received research funding in this field from Alzheimer's Research UK, MRC and BBSRC.</span></em></p>US scientists recently announced they had developed a blood test that could predict your chances of developing Alzheimer’s disease, with 90% accuracy, up to three years in advance of other known symptoms…Jerry Turnbull, Johnston Professor of Biochemistry, Institute of Integrative Biology, University of LiverpoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/233972014-02-27T06:01:06Z2014-02-27T06:01:06ZFrom Alzheimer’s to smart pills, cognitive science explained<figure><img src="https://images.theconversation.com/files/41961/original/gcsxyy6p-1392812205.jpg?ixlib=rb-1.1.0&rect=0%2C43%2C907%2C600&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pills for kicks.</span> <span class="attribution"><a class="source" href="http://www.flickr.com/photos/arenamontanus/7791376114/">arenamontanus</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p><em>Jason Shepherd, assistant professor of neurobiology and anatomy at the University of Utah <a href="http://www.reddit.com/r/science/comments/1x6aum/science_ama_series_im_jason_shepherd_from_the_u/">answered</a> questions posed by the public on Reddit. The Conversation has curated the highlights.</em></p>
<hr>
<h2>Cognitive disorders</h2>
<p><strong>What are the chances of a cure for Alzheimer’s within the next decade?</strong></p>
<p>I’m actually quite optimistic that there will be a viable and mechanistic treatment for Alzheimer’s disease (AD) in the next ten years. One major challenge is being able identify and diagnose people with AD much earlier than when they first present with symptoms because research is showing that even we had a drug that treats the root cause of AD … Giving people the drug at the late stages of the disease cannot reverse the damage done already. So people are searching for a simple blood test or diagnostic that will help identify who needs treatment very early on. Indeed, many of the current AD trials have failed because of this I believe.</p>
<p>They are now testing current therapies in a large trial in families who have a genetic form of AD where they give them the drug early, before symptoms are evident. It will take years to evaluate the outcomes but this will be an important validation of the current leading hypothesis (amyloid cascade theory).</p>
<p><strong>How likely is it that diseases like autism, schizophrenia, and Alzheimer’s could potentially be influenced by viruses, bacteria, or parasites that we currently don’t recognise or understand? For instance, I’m thinking of something like <a href="http://en.wikipedia.org/wiki/Toxoplasmosis">Toxoplasma gondii</a>.</strong></p>
<p>So far in very rare cases, viruses and bacteria have been known to cause symptoms that are reminscent of some of these diseases. However, they are usually associated with very quick onset of symptoms and rapid decline in function. So far there isn’t any evidence that a common virus is a major cause of neurological disorders. But gut in the bacteria is a fascinating area of research right now and many studies are finding that there is a big link between the gut flora and behaviour. The jury is out on whether they contribute to common neurological disorders but this is a fascinating area that may end up being very important to brain function.</p>
<p>One thing I will point out is that many of these neurodegenerative diseases have aggregation of proteins that are toxic to the brain. Scientists are trying to find ways of either reducing the aggregates or preventing them from forming the oligomeric intermediates that seem to affect brain function. The hope is that treatments that affect these processes could be beneficial for many of these diseases.</p>
<p><strong>What current scientific advancements with regard to cognitive disorders should we be excited about?</strong></p>
<p>I think one of the most exciting new areas is in the realm of genetics. It has become so cheap to sequence people’s genomes that large studies can now be conducted to look for the genetic contribution to common neurological disorders. Identifying these genes is not only very useful to scientists who want to understand the proteins that may not be working correctly … but it will also allow Doctors in the future to tailor treatments. This has revolutionised Cancer treatment, for example, because some drugs work very well on cancers caused by certain mutations. Right now we have been limited to diagnosing brain disorders purely on symptoms alone.</p>
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<h2>Brain science</h2>
<p><strong>How much of our behaviour is determined by environmental impacts like diet, sleep or toxins?</strong></p>
<p>My particular research area of interest is in fact investigating how the environment and experience modifies the brain at the cellular and molecular level. Your brain is initially hardwired by your genes, think of it as a blank computer with new hardware but now needs software to make it run. That software is constantly being updated, via experiences, even in older ages. So diet, sleep or anything else will affect behaviour a great deal. But to be clear, everyone has the hardware and so behaviour is ultimately a complex interplay between genes and experience.</p>
<p><strong>I am surprised to see the hardware/software analogy. Where does the hardware end and the software begin?</strong></p>
<p>It’s a somewhat over-used analogy but easy for people to understand. There’s obviously no clear divide but one can think of wiring/anatomy as being the hardware set by your genes. All human brains have pretty much the same connections, regions etc with subtle differences. It’s those subtle differences, though, that are altered by the functional output of the neurons or the “program” that runs on top of the hardware if that makes sense.</p>
<p><strong>What’s your take on nootropics (cognitive enhancers) in general?</strong></p>
<p>This is going to become more and more of an issue as we understand how to enhance the capacity of the brain to learn even in normal people. The law and ethics committees need to be set up in conjunction with scientists and clinicians. Caffeine is the most common drug in the world and it’s a nootropic (see this <a href="http://www.nature.com/neuro/journal/v17/n2/full/nn.3623.html%5D">recent study</a>). Each drug will have to be evaluated on its own merit and what sort of side effects come with it.</p>
<p><strong>Do you think smoking marijuana has a long-term negative effect on our brain chemistry and memory?</strong></p>
<p>This is certainly a pertinent topic right now. There are fairly good studies both in humans and in animals showing that chronic use of marijuana, <a href="http://www.newscientist.com/article/mg21528801.900-teenage-cannabis-use-leads-to-cognitive-decline.html">especially in adolescents</a> can lead to cognitive decline especially in working memory. Whether this is also applicable to adults who chronically smoke, it’s less clear. Legalising the drug has pros and cons, but I worry that increased access to the drug in teenagers will have long term consequences, let alone the fact that smoking is just bad for you in general. I just think we don’t know enough about exactly how chronic use will affect cognition. Scientists also need to figure out how much intake is bad or will lead to permanent effects.</p>
<p>Someone asked about alcohol consumption. Chronic alcoholism is extremely bad for the brain, causing all sorts of damage. It’s unclear what moderate alcohol intake does … most studies that look at this are not well controlled.</p>
<p><strong>What’s your take on free will?</strong></p>
<p>It’s a tough question and hard to really answer concretely. My take is that we all have free will to a degree but if your brain is damaged in some way … the choices you make are constrained so you may have limited free will. I find this topic fascinating because it has huge implications for the law, for example. Are psychopaths driven to make the decisions they do outside of normal free will? Is their brain just wired so differently that they have no other choice? If so, are they then culpable? These are insights that Neuroscience is going to offer I think and society will have to figure out how to deal with it from a law/ethics perspective.</p>
<p><strong>Are you optimistic that advances in neuroscience will bridge the gap between the age old “Mind-Body Problem”?</strong></p>
<p>Yes, just like chemistry and physic have been united, so can the different levels of analysis in neuroscience. It’s not going to be easy but I think it’s a great challenge. Of course, the usefulness of the explanations depends on what the question of study is.</p>
<p><strong>Could you explain some pitfalls and common mistakes people make when investigating evolutionary adaptations in cognitive psychology?</strong></p>
<p>Personally I’m not a huge fan of evolutionary psychology because I find most of them are “just so” stories that are interesting explanations but hard to really verify or test as scientific hypotheses. But clearly the brain evolved and so did its function so I think a better approach, which most scientists do now, is to use comparative approaches by studying many different animal brains.</p><img src="https://counter.theconversation.com/content/23397/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jason Shepherd 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>Jason Shepherd, assistant professor of neurobiology and anatomy at the University of Utah answered questions posed by the public on Reddit. The Conversation has curated the highlights. Cognitive disorders…Jason Shepherd, Assistant Professor of Neurobiology and Anatomy, University of UtahLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/87022012-09-11T20:23:53Z2012-09-11T20:23:53ZThe perils of pre-diseases: forgetfulness, mild cognitive impairment and pre-dementia<figure><img src="https://images.theconversation.com/files/14575/original/rqc3xb72-1345704834.jpg?ixlib=rb-1.1.0&rect=22%2C0%2C669%2C561&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A dementia diagnosis can place extreme stress on patients and their families.</span> <span class="attribution"><span class="source">James McTaggart/Wikimedia Commons.</span></span></figcaption></figure><p><em>OVER-DIAGNOSIS EPIDEMIC – David Le Couteur discusses recent changes in the definition of dementia and their ramifications.</em></p>
<p>The pattern of over-diagnosis is the same for many diseases: we screen healthy people and those with minimal symptoms; we use sophisticated technologies that detect early or minor abnormalities that may not progress; and we treat people with these abnormalities on the assumption that this will prevent significant illness and death. </p>
<p>The downside of all this medical intervention is that we’re exposing healthy people to the potential harms of diagnosis, investigation and treatment without any certainty about long-term benefits. Indeed, there’s a growing unease that this trend is being driven by the financial benefits of creating a larger market for drugs rather than genuine health gains.</p>
<p>I work in geriatric medicine and over the last few years, I have seen how the changing definitions of dementia and Alzheimer’s disease has insidiously been leading to over-diagnoses. </p>
<h2>Screening the healthy</h2>
<p>Let’s start with the schema of over-diagnosis: are we screening healthy people and those with minimal symptoms? Yes. In the past, we diagnosed older people complaining of minor memory impairment with “benign senescent forgetfulness”, and told them that it didn’t require any further action. It was, after all, benign. </p>
<p>But this terminology progressed to “mild cognitive impairment (MCI)” and now (more ominously), to <a href="http://www.ncbi.nlm.nih.gov/pubmed/22172609">pre-dementia and pre-clinical Alzheimer’s disease</a>. We are also being encouraged to screen older people for <em>any</em> memory impairment because this has now been defined as a pre-disease or early disease.</p>
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<img alt="" src="https://images.theconversation.com/files/14561/original/g8g3fsgb-1345697521.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/14561/original/g8g3fsgb-1345697521.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=475&fit=crop&dpr=1 600w, https://images.theconversation.com/files/14561/original/g8g3fsgb-1345697521.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=475&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/14561/original/g8g3fsgb-1345697521.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=475&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/14561/original/g8g3fsgb-1345697521.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=597&fit=crop&dpr=1 754w, https://images.theconversation.com/files/14561/original/g8g3fsgb-1345697521.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=597&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/14561/original/g8g3fsgb-1345697521.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=597&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">Amyloid plaques visible in the brain.</span>
<span class="attribution"><span class="source">Public Health Image Library/Wikimedia Commons.</span></span>
</figcaption>
</figure>
<p>The screening tools are usually simple questionnaires, such as the mini-mental state examination (MMSE). There’s variability in how well the assessments are performed, and forgetting the date or stumbling on a repetition task can lead to a diagnosis of mild cognitive impairment. But how many of these people actually progress to dementia? </p>
<p>Most studies show that only one in ten cases of mild cognitive impairment progress to dementia each year, and many improve. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17030753">One study</a> that followed outcomes for ten years concluded – “The majority of subjects with MCI do not progress to dementia at the long term.” </p>
<p>Yet all of these people will potentially be faced with the stigma of a dementia diagnosis and its consequences – paternalism, incapacity and loss of autonomy. And then there’s the <a href="http://www.tandfonline.com/doi/abs/10.1080/13607860410001649653">fear of impending dementia</a>, which can generate stress and despair.</p>
<h2>Better technology</h2>
<p>Are we using sophisticated technologies to detect early or minor abnormalities? Yes. In attempt to improve the diagnosis of early dementia, we now have a <a href="http://www.ncbi.nlm.nih.gov/pubmed/22172609">range of investigations</a> to detect the earliest cases before symptoms have developed. These include brain scans and measurement of biomarkers in the fluid that surrounds the brain.</p>
<p>The gold standard for such diagnoses is post-mortem brain pathology. Alzheimer’s disease is characterised by deposits of a protein called amyloid in plaques between brain cells and another protein called tau in tangles within the cells. But the relationship between amyloid plaques and the clinical features of dementia <a href="http://www.ncbi.nlm.nih.gov/pubmed/19918254">lessens as people age</a>. </p>
<p>Many older people with the characteristic pathology of Alzheimer’s disease didn’t have any features of dementia at post mortem or memory problems when they were alive. On the other hand, the majority older people with dementia have multiple changes in their brains including those related to ageing and vascular disease. So the characteristic pathology of Alzheimer’s disease is not very useful in diagnosing dementia in the largest group of people with dementia, the elderly.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/15289/original/j27tppmg-1347257333.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/15289/original/j27tppmg-1347257333.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=473&fit=crop&dpr=1 600w, https://images.theconversation.com/files/15289/original/j27tppmg-1347257333.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=473&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/15289/original/j27tppmg-1347257333.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=473&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/15289/original/j27tppmg-1347257333.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=594&fit=crop&dpr=1 754w, https://images.theconversation.com/files/15289/original/j27tppmg-1347257333.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=594&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/15289/original/j27tppmg-1347257333.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=594&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Pedro Ribeiro Simões</span></span>
</figcaption>
</figure>
<h2>Early treatment</h2>
<p>Are we treating these early abnormalities on the assumption that this will prevent the development of dementia? Yes, in some cases. </p>
<p>There are two groups of medicines available for the symptomatic treatment of Alzheimer’s disease (cholinesterase inhibitors and memantine). Although these drugs have not been proven to have any effect on influencing the progress of dementia, review articles in some medical journals promote the possibility of their “disease-modifying activity” and the <a href="http://www.ncbi.nlm.nih.gov/pubmed/18798705">need for early treatment</a> with these medicines. </p>
<p>And it’s important to add that a trial of one of these medicines attempting to show a reduction in the conversion from mild cognitive impairment to dementia found that it <a href="http://www.ncbi.nlm.nih.gov/pubmed/18322263">actually increased the death rate</a>. </p>
<p>The medicines are only funded by the <a href="http://www.pbs.gov.au/pbs/home">Pharmaceutical Benefits Scheme (PBS)</a> for moderately severe Alzheimer’s disease but undoubtedly some people will be using them (and probably a variety of alternative therapies as well) in the hope that they will delay dementia.</p>
<p>And there are other industries aiming to profit from the diagnosis of mild cognitive impairment (or early and pre-clinical dementia) by selling various brain fitness technologies ranging from video games to mobile phone apps.</p>
<p>Dementia is a tragic illness that places enormous burden and demands on patients, families and society. There’s no question of the value of increasing recognition of the care needs of people living with dementia, and for more research funding. These are essential because effective treatment and prevention of dementia will have a dramatic impact on the human race. But the growing emphasis on early diagnosis of dementia, mild cognitive impairment and preclinical dementia in everyday practice (with the subsequent risk of over-diagnosis and its consequences) seems to be giving the disease, not the patient, greater priority and importance.</p>
<p><em>Have you or someone you know been over-diagnosed? Share your story below or <a href="mailto:reema.rattan@theconversation.edu.au">email</a> the series editor.</em></p>
<p><em>This is part three of our series on over-diagnosis, click on the links below to read other articles:</em></p>
<p><em><strong>Part one:</strong> <a href="https://theconversation.com/preventing-over-diagnosis-how-to-stop-harming-the-healthy-8569">Preventing over-diagnosis: how to stop harming the healthy</a></em></p>
<p><em><strong>Part two:</strong> <a href="https://theconversation.com/over-diagnosis-and-breast-cancer-screening-a-case-study-7396">Over-diagnosis and breast cancer screening: a case study</a></em></p>
<p><em><strong>Part four:</strong> <a href="https://theconversation.com/how-genetic-testing-is-swelling-the-ranks-of-the-worried-well-9080">How genetic testing is swelling the ranks of the ‘worried well’</a></em></p>
<p><em><strong>Part five:</strong> <a href="https://theconversation.com/psa-screening-and-prostate-cancer-over-diagnosis-8568">PSA screening and prostate cancer over-diagnosis</a></em></p>
<p><em><strong>Part six:</strong> <a href="https://theconversation.com/over-diagnosis-the-view-from-inside-primary-care-8889">Over-diagnosis: the view from inside primary care</a></em></p>
<p><em><strong>Part seven:</strong> <a href="https://theconversation.com/moving-the-diagnostic-goalposts-medicalising-adhd-8675">Moving the diagnostic goalposts: medicalising ADHD</a></em></p>
<p><em><strong>Part eight:</strong> <a href="https://theconversation.com/the-ethics-of-over-diagnosis-risk-and-responsibility-in-medicine-9054">The ethics of over-diagnosis: risk and responsibility in medicine</a></em></p>
<p><em><strong>Part nine:</strong> <a href="https://theconversation.com/ending-over-diagnosis-how-to-help-without-harming-9633">Ending over-diagnosis: how to help without harming</a></em></p><img src="https://counter.theconversation.com/content/8702/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>No potential conflicts of interest</span></em></p>OVER-DIAGNOSIS EPIDEMIC – David Le Couteur discusses recent changes in the definition of dementia and their ramifications. The pattern of over-diagnosis is the same for many diseases: we screen healthy…David Le Couteur, Professor of Medicine, University of SydneyLicensed as Creative Commons – attribution, no derivatives.