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Pharmacists can answer many medication questions.

About 30% of older Americans take five medications or more daily. The most prescribed medications include cholesterol-lowering statins, high blood pressure meds, and diabetes drugs. It can be quite challenging to keep up with which med is for what condition, when and how to take them and understanding each medication’s side effects. Adding to the complexity is that prescriptions are likely written by various specialists who may not be aware of all the medications a person is taking. You might wonder if it’s OK to take all the pills at the same time, if you should double a dose if you skip one, or if there are cheaper alternatives. Those questions can be answered by your pharmacist.

Medication Therapy Management

Clinical pharmacists (PharmD) are best positioned for medication therapy management services, says geriatric pharmacist Dominick A. Bailey, PharmD, BCPS, UCLA Santa Monica Medical Center. “We train specifically in pharmacology and therapeutics and are well equipped to perform a comprehensive medication review,” he explains. “These reviews, combined with our expertise, help to uncover possible drug-to-drug interactions, adverse drug events, high medication costs, compliance issues, and other medication-related issues.”

PharmDs usually work directly with providers to develop the best possible medication action plans for patients. Most insurance plans, particularly Medicare Part D, reimburse for medication therapy management services. Ask your pharmacist or insurance provider if the medication management service is available. If a PharmD is not accessible, Bailey advises people to reach out to their primary care providers for a comprehensive review. Bring in an accurate and updated medication and medication pill bottles that include the medication name, strength, frequency of dosing and prescriber. Including the prescriber is especially important to help primary care providers coordinate medication management. In the long run, it’s most efficient to have all your prescriptions filled at one pharmacy.

Drugs to Avoid or Use with Caution

The most used tool to identify potentially inappropriate medications for older adults is known as the Beers list. The American Geriatrics Society regularly updates the list every three years to help healthcare providers improve the safety of prescribing medications. The recommendations are based on five categories: drugs that are potentially inappropriate in most older adults, drugs that should typically be avoided in older adults with certain conditions, drugs to use with caution, drug-drug interactions, and drug dose adjustment based on kidney function.

The following drugs are some of the most common Bailey says should be avoided by people ages 65 and older. However, you should never stop taking any medication without speaking to your healthcare provider first.

Benadryl (diphenhydramine) belongs to a medication class called anticholinergics. This medication class is associated with an increased risk of confusion, dry mouth, constipation, and urinary retention. These are all factors that increase the risk of falls, which can be detrimental for older adults. Diphenydramine is often added to other medications like acetaminophen and sold as sleep aids, so people may not be aware they are taking it. Your pharmacist may be helpful in avoiding this medication.

Xanax (alprazolam) and Valium (diazepam) belong to a class of medications called benzodiazepines (BZD). Older adults have increased sensitivity to BZDs. In general, all BZDs increase the risk of cognitive impairment, delirium, falls, fractures, and motor vehicle crashes in older adults.

Ambien (zolpidem) belongs to a class of medications called benzodiazepine-receptor agonists. These agents have adverse events similar to those of BZDs in older adults (e.g., delirium, falls, fractures). “These medications have been shown to increase emergency department visits, hospitalizations, and motor vehicle crashes as well,” says Bailey. “Additionally, these agents have shown minimal improvement in sleep onset and duration in older adults.”

Taking Control of Your Medicine

To better assess if a medication is meeting your healthcare goals, monitor how you feel and report your experiences honestly with physicians. If you frequently skip doses or forget to take your medications, discuss this because there may be other options, such as extended-release or combination medications.

“Pairing medications with routine activities is a great strategy to help with adherence,” suggests Bailey. “For example, a twice-a-day medication could be paired with brushing your teeth, or a thrice-a-day medication could be paired with all meals.”

In addition to using a simple daily pill organizer, there also are a wide variety of pill dispensers, boxes, and organizers with timers and alarms (see Epill.com). Medications should be reviewed annually.

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High blood pressure is notoriously hard to bring down. In some cases, individuals may be unaware they have been prescribed a medication that keeps their blood pressure high. A recent study published in JAMA Internal Medicine included 27,599 adults in the United States and found that 18% of those with hypertension and 15% overall were taking a medication known to raise blood pressure. The most common offenders were antidepressants, prescription nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, and estrogens. According to the authors, their goal was not to suggest these medications are inappropriate for patients with hypertension, nor to recommend alternatives, but to remind physicians of their potential impact and suggest they consider using a different drug or minimizing the dose and duration of use. Also know that many over-the-counter nonprescription drugs may also raise blood pressure. These include ibuprofen (Advil, Motrin) and naproxen (Aleve); corticosteroids such as prednisone; and cold or allergy medications containing decongestants like pseudoephedrine. Pseudoephedrine, a common ingredient in nasal decongestants, acts directly on blood vessels and heart rate to increase blood pressure. Herbal supplements may be natural products, but some are not safe. The side effects of licorice root (consumed in large amounts over time), ephedra, and guarana can raise blood pressure. If you’re dealing with high blood pressure or other heart-health matters, read the package inserts that accompany your prescriptions, looking for warnings directed at people with high blood pressure or taking blood-pressure medications.

Clearance of Protein Linked to Alzheimer’s Controlled by Circadian Cycle

The brain’s ability to clear a protein closely linked to Alzheimer’s disease is tied to our circadian cycle (sleep/wake cycle), according to research published in PLOS Genetics. The research underscores the importance of healthy sleep habits in preventing the protein amyloid-beta 42 (AB42) from forming clumps in the brain and opens a path to potential Alzheimer’s therapies. “Circadian regulation of immune cells plays a role in the intricate relationship between the circadian clock and Alzheimer’s disease,” says study author Jennifer Hurley, an expert in circadian rhythms and associate professor of biological science at Rensselaer Polytechnic Institute. “This tells us a healthy sleep pattern might be important to alleviate some of the symptoms in Alzheimer’s disease, and this beneficial effect might be imparted by an immune cell type called macrophages/microglia.” The circadian system is composed of a core set of clock proteins that anticipate the day/night cycle by causing daily oscillations in the levels of enzymes and hormones. Disruption of the circadian system is increasingly associated with diseases like diabetes, cancer, and Alzheimer’s. A telltale sign of Alzheimer’s disease is plaques, extracellular clumps of AB42 in the brain. Macrophages (referred to as microglia when they reside in the brain), which are immune cells that seek and destroy unwanted material, and clear AB42 from the brain by ingesting it in a process called phagocytosis. When this process is disrupted, the macrophages don’t ingest the AB42. Researchers theorize that if they could encourage greater AB42 clearance, perhaps by boosting the amplitude of daily oscillations, they might increase the clearance of AB42 and prevent damage to the brain.

Biohybrid Fish Made from Human Cardiac Cells Swims like the Heart Beats

Harvard University researchers, in collaboration with colleagues from Emory University, developed the first fully autonomous biohybrid fish from human stem-cell-derived cardiac muscle cells. The artificial fish swims by recreating the muscle contractions of a pumping heart, bringing researchers one step closer to developing a more complex artificial muscular pump and providing a platform to study heart diseases like arrhythmia. According to the researchers, most of the work in building heart tissue or hearts is focused on replicating the simple beating of the heart in the engineered tissues. But in this study, researchers focused on identifying the key biophysical principles that make the heart work, using them as design criteria, and replicating them in a system, a living, swimming fish. The device offers insights into artificial muscular pumps, a step toward building an artificial heart. The research was published in Science.

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Psychologist, psychotherapist, psychotherapy symbol. Two abstract human profile. Vector

Caring for a family member with dementia can stir feelings of sadness, guilt, frustration, and other emotions, as well as trigger symptoms of anxiety and depression. But a study led by researchers at Massachusetts General Hospital (MGH) suggests that a type of therapy that enhances a caregiver’s sense of empathy for the person in their care may not only improve depression symptoms, but may also increase happiness.

The intervention is called mentalizing imagery therapy (MIT). Mentalizing refers to the ability to understand your own mental state and that of others. For caregivers, this means sensing what an individual is feeling and wanting and then being able to provide a healthy and helpful response. People who practice MIT use mindfulness to become aware of the emotional and cognitive aspects of their own experiences and then create visualizations of their care receivers to imagine the thoughts and feelings they experience. MIT training also involves solving hypothetical situations, again by focusing on their own mental state and that of the person in their care.

“MIT teaches mindfulness and guided imagery skills to help caregivers better understand the mind of their loved one and how they are reacting to that person,” says psychiatrist Felipe A. Jain, MD, investigator and director of Healthy Aging Studies at MGH’s Depression Clinical and Research Program. “This therapy pushes the boundaries of how we think about ourselves and interact with others and incorporates new views on self and identity.”

He adds that in addition to helping participants learn to view emotional reactions to challenging situations from different perspectives and to feel more connected to their communities and their natural environment, the therapy also focuses on stress reduction and increased self-compassion.

Reducing Caregiver Stress

While many caregivers tending to relatives with Alzheimer’s disease or other types of dementia approach their roles with empathy and compassion, stress levels can nevertheless become overwhelming. Caregiving can be especially challenging when a person’s behavior and emotions deviate significantly from those of the caregiver. The chronic stress associated with caregiving can sometimes cause a person to say or do things that they may feel guilty about later.

In addition to high rates of depression and anxiety, family caregivers often suffer from physical ailments related to the stress of their caregiving responsibilities. In the MGH study, published recently in the journal Psychotherapy and Psychosomatics, researchers looked at whether MIT or standard caregiver support groups would be better at reducing stress levels and improving the quality of life of family caregivers.

Managing Emotions

Support groups are among the most common interventions for family caregivers, but they can provide only so much to people under varying degrees of stress. “Although support groups provide caregivers with helpful information and an opportunity to share their experiences with each other, for many people they are not effective for managing the negative emotions associated with caring for a loved one with dementia,” Dr. Jain says.

In the study, Dr. Jain and his colleagues found that caregivers who participated in MIT had lower rates of depression and anxiety and better well-being than caregivers who attended a traditional support group. The 46 caregivers in the study were randomly assigned to the MIT group or a support group. Both groups took part in four weekly 120-minute sessions. The MIT group participated in weekly mindfulness exercises, including low-impact stretching and breath-focused meditation, as well as specific guided imagery exercises that changed week to week. The support group focused on challenges each caregiver faced and psychoeducational topics related to caregiving.

At the end of the study, researchers found that MIT significantly outperformed the support group in improving depression, anxiety, mindfulness, self-compassion, and well-being. Both groups appeared to experience improvements in self-reported depression symptoms.

Interestingly, just one week after therapy ended, the positive psychological effects of MIT continued while the benefits faded for participants in the support group. After that first week, depression symptoms were 41 percent lower than before therapy in MIT, but only 15 percent lower in the support group. The significant benefits for MIT persisted at follow-up three months after the initial course of therapy. Similarly, happiness had increased by the end of the study by 20 percent in MIT but only 5 percent in the support group.

“MIT is designed to be a short-term intervention to help people reframe how they view themselves as caregivers and how they experience their loved ones,” says Dr. Jain. “Support groups are longer-term interventions designed to maintain support for caregivers over the course of the disease. There is a need for both.” He and his fellow investigators are planning a larger clinical trial this year that will study whether MIT can be effectively delivered using telehealth and smart phones so caregivers can participate in the therapy remotely.

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The passage of light through the eyeball is hindered by the presence of the vitreous floaters, which generate shadows on the retinal surface. © Rob3000 | Dreamstime.com

You’ve been staring at your computer screen for hours typing on a white background and occasionally notice some small floating black blobs in your visual field. Do you just need a break? Or is something more serious going on? Most of the time, these floating visual particles are fleeting and not of concern. Neither are so-called flashes, which appear spontaneously like a sudden camera flash.

“Both floaters and flashes are more common as we get older, and for most people these symptoms are due to an age-related degenerative change in the vitreous, the gel-like substance that occupies most of the volume of the eye,” explains ophthalmologist Pradeep Prasad, MD, UCLA Stein Eye Institute. “However, floaters and flashes can also be associated with retinal tears or detachments, which can be vision-threatening. For this reason, it is imperative to see an eye-care provider immediately when there is a new onset or abrupt change in floaters, flashes, or obscured vision. If a retinal tear or detachment is identified, early intervention can confer a better prognosis.”

Inside the Eyeball

The retina is the light-sensitive layer of tissue that lines the inside of the eye. It transports visual messages through the optic nerve to the brain. When the retina is pulled away from its normal position, or detached, it can cause permanent vision loss if not promptly treated. If a retinal blood vessel is torn, blood will spread into the vitreous and block vision. Any time vision is lost, even partially, it’s an emergency, requiring immediate medical attention.

Floaters are in the gel-like vitreous inside the eyeball. With aging, the vitreous shrinks, collapses, and sometimes pulls away from the retina, causing tissue to strand or clump and cast shadows on the retina. Floaters are especially noticeable when you look at white surfaces, such as a computer screen. You are more likely to get floaters if you are:

nearsighted (you need glasses to see far away)

have had cataract surgery

have had inflammation (swelling) inside the eye

have been poked or struck in the eye

Floaters often go away on their own and don’t usually need medical attention. “You can’t prevent floaters, but it can take months or a year before symptoms diminish or disappear,” says Dr. Prasad. “In very rare cases, floaters can be so bothersome that they interfere with daily life. If that occurs, they can be surgically removed.”

When to Seek Urgent Eye Care

While abrupt loss of vision is a medical emergency, suddenly seeing more floaters and flashes is considered “urgent.” You should see an eye doctor within 24 hours. Dr. Prasad recommends a retina specialist or an ophthalmologist or optometrist well-versed in performing a dilated retinal evaluation with scleral depression (a process of pushing on the outer wall of the eye while looking inside the eye to visualize the far edges of the retina).

“Earlier medical care is always better,” emphasizes Dr. Prasad. “If we see the tear, we can fix it immediately in the clinic with a laser. It generally takes less than 10 minutes and is a very low-risk procedure.”

It’s also a very effective procedure to prevent a tear from turning into a detachment. Once that tear turns into a detachment, it usually requires surgery to fix.

The Value of Routine Eye Care

The odds of developing an eye condition increases after the age of 65. People with greater risk for eye diseases (for example, people with diabetes) should schedule eye examinations at least once per year. While many people get an undilated eye exam using imaging, a dilated eye exam is needed for a better look inside the eye. “Although retina imaging can be helpful to monitor for other retinal diseases like diabetic retinopathy, imaging alone is not sufficient to rule out a retinal tear or detachment,” explains Dr. Prasad. “Most retinal tears occur at the far edges of the retina, which are not adequately visualized, even with wide-angle retinal fundus cameras.”

If you have no symptoms or risk factors for eye disease, schedule a comprehensive eye exam that includes a dilated eye exam every one to two years.

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The wake-up help your morning coffee provides may be enough to keep it a part of your everyday routine, but a recent study suggests you can feel even better about having a second cup. In an Australian study published in Frontiers in Aging Neuroscience, researchers found some important markers related to coffee consumption and the rate of cognitive decline and Alzheimer’s disease. In a 10-year study of more than 200 older adults—none of whom had any cognitive impairment at the start of the study, researchers noted that higher coffee intake was associated with healthier executive function, which includes planning, attention and self-control. Drinking more coffee was also associated with a slower accumulation of amyloid protein in the brain, a key factor in the development and progression of Alzheimer’s disease. Though this was an observational study and did not prove that higher coffee intake helped maintain better brain function, researchers were encouraged that such a simple and largely harmless lifestyle choice could provide important benefits. The study suggests that having two cups of coffee per day may be more beneficial than one cup, though the research did not determine a maximum amount of coffee that conferred brain benefits without having any negative impacts. This study and others in recent years have noted that it isn’t just the caffeine that may provide a cognitive boost. Other studies have noted that decaffeinated coffee may have protective qualities, too. It may be that certain compounds in coffee, such as phenylindanes—which form during the roasting of coffee beans—are the ingredients for better memory, attention, organization…and a pleasant way to start the day.

It’s the Same Old Song, But It Just Might Keep Your Memory Rockin’

Listening to your favorite songs may bring back happy memories, and in a recent study out of Canada, that music may also help you retain all types of memories, too. In a small, pilot study, researchers found that repeatedly listening to familiar songs that have some meaning in your life appears to produce changes in mental function and brain structures. The study, published in the Journal of Alzheimer’s Disease, included 14 older adults with mild cognitive impairment. After listening to music they loved and that held important memories, the study participants experienced some positive changes in the brain, particularly in the neural pathways of the brain regions that correlate with memory performance on neurological testing. As part of the study, volunteers listened daily to playlists of emotionally meaningful songs they had known for at least 20 years. Before and after the three-week study, the participants underwent functional MRI brain scans, during which they heard songs from their playlists. At the end of the study, memory and cognition test scores improved, echoing findings from previous studies that have shown how familiar music can help trigger memories and calm moods in older adults with dementia. Though much more research must be done to better understand the mechanism between music and memory, it appears that listening to old favorites may boost your memory skills and tug at your heartstrings a little, too.

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When your mind starts to assign something serious to a momentary mental mix-up, it’s important to maintain some perspective, advises Jennifer Gatchel, MD, PhD, a geriatric psychiatrist at Massachusetts General Hospital. “Not all ‘senior moments’ or mid- to late-life changes in our thinking are signs of dementia or signs that we are going to progress to dementia,” she says. “It’s like other symptoms you might have in your body. Not every pain or other symptom is going to lead to the worst possible outcome. Try to minimize your worry about it, because unfortunately, worry and depression can actually make our thinking and brain function worse.”

The Aging Brain

Dr. Gatchel further suggests that it may be helpful to think of changes in our memory and other brain functions as you would other physical changes that develop as we get older. “A good analogy is that these moments represent normal wear and tear on the brain,” she explains. “It’s like joints that become less efficient as we age because of simple wear and tear over time. But we don’t think of that as a disease process.”

As the brain ages, certain changes occur in its structure and function. Volume in certain regions of the brain shrinks. There is decreased neurotransmitter production. Neurotransmitters are chemical messengers that relay signals from one brain cell to another. And the connectivity between different regions of the brain decreases over time, too.

All of these changes can contribute to moments of confusion, greater difficulty concentrating, and trouble recalling both new and old pieces of information. But how do you know if a memory lapse is just a benign blip or a red flag?

Is This Something New?

Dr. Gatchel says it’s important to know how you normally think and behave. “Always relate these things to yourself,” she says. “Is this a change for you? You may be someone who always misplaces things, so forgetting where you put your keys one day isn’t a big change. But if you’re someone who has a system and always puts things where you can find them and then you start misplacing them, that would be a concern. If you start doing that regularly, that would be a noticeable change for you.”

Another important way to determine whether memory lapses are possible signs of cognitive decline is whether the information you drew a blank on comes back to you later. If you can’t come up with a name in the moment, but then think about it later and it comes right to you, then that could be considered a minor and harmless moment to chalk up to age-related brain change. But if you have more and more moments in which names or other information completely escape you, even after coming back to them later in the day or the next day, you may want to take note of how often these things happen.

It’s also worth noting that minor details, like the name of a character actor from an old movie or the entrée you ordered on your anniversary dinner a few years ago, tend to slip away over time, in part to make room for new information and new memories. 

© fizkes | Getty Images
Occasional memory lapses or moments of confusion are normal, unavoidable aspects of aging. But when they become more frequent or you find yourself unable to recall important, personal information or make sense of a particular situation, you should consider talking with a doctor about this change in your thinking skills.

“If you’re forgetting names or other information that are salient to you—things about your friends and family, for example—that would represent a change and should be a concern,” Dr. Gatchel says. “Another concern is having difficulty navigating places you travel to regularly.”

When you’re not sure which road to take or you get confused at a busy intersection, you may be compromising your safety and the safety of others. “That sort of thing is a change to your baseline and should be concerning,” Dr. Gatchel says.

Reversible Changes

Not all new moments of confusion or forgetfulness are due to normal, age-related brain changes or more serious cognitive decline. Certain medications or metabolic changes, such as vitamin B12 deficiency or thyroid disease, can affect cognition. The same is true for a period of poor sleep or too much stress.

Dr. Gatchel notes that if a noticeable change in memory or thinking skills appears abruptly, then think about what is new in your life. Did you just start a new medication or increase the dosage of an existing medication? Do these moments occur around the same time each day?

If you suspect that changes in your thinking may be linked to something new—like your diet, medication regimen, or other lifestyle change—then talk with your doctor. Some medical conditions, such as urinary tract infections or other infections, can affect how you think. Dr. Gatchel says that treating a new health problem or making other adjustments may reverse any new nagging memory lapses or similar concerns.

Keys to Healthy Aging

Dr. Gatchel notes that some age-related change in brain function and structure is inevitable—the result of time and genetics, primarily. But other changes are largely affected by environmental and lifestyle factors over which we have some control. And one of the most important behaviors we can control that helps promote healthy circulation to the brain, greater brain cell production, and protection is exercise.

“It doesn’t have to be rigorous exercise,” she says. “But some regular physical activity can have a positive impact on cognitive health and mental health.” She also recommends staying mentally active and engaged, especially through social interaction. In addition, quitting smoking and adopting a heart-healthy diet, such as the Mediterranean-style eating plan, will promote greater vascular health and better brain function.

“It’s also very important to maintain an adequate level of sleep,” she says, adding that sleep apnea or other sleep problems should be evaluated by a doctor. Remedies for insomnia or other sleep challenges don’t always involve medications. You may be able to try some non-medication options first.

Takeaway

The next time you stumble trying to recall something you know is in your memory somewhere, relax. Don’t let your mind race to a scary place. “If you’re prone to thinking the worst, set some boundaries for yourself,” Dr. Gatchel says. “Talk with someone else about it. Ask if they’ve noticed a change. Remember, you’re not alone. Everyone deals with this eventually, and most age-related changes are not signs of dementia.”

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Science, August 2021

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Surveys conducted by the American Psychological Association and the National Alliance for Mental Illness in recent years have consistently found that this time of year is associated with higher stress levels, increased feelings of loneliness and sadness, unrealistic expectations, and reflections on past holiday seasons that don’t measure up to those of today.

David Mischoulon, MD, PhD, director of the Depression Clinical and Research Program at Massachusetts General Hospital, says the triggers for depressive or anxious symptoms can come from just about anywhere. However, they are frequently related to missing family members and friends or mingling with others who don’t bring positive energy to the festivities.

“For the individual without very many friends or family connections, it can be a difficult time,” Dr. Mischoulon says. “They may not have anyone to spend the holidays with, and seeing other people enjoying themselves, leaving town to visit relatives, etc., can amplify feelings of loneliness and lead to sadness or even depressive or anxious feelings. Even people who have relatives and friends with whom to spend holiday time may actually find this stressful. This is particularly true in families that are large and/or may have individuals who have difficulty getting along.”

But there are other causes of the holiday blues, some of which may be avoided by finding a new perspective.

Pressure to Party

Whether it’s yet another feel-good holiday-themed television movie or even subtle pressure from your work colleagues, neighbors, or relatives, there can be an unmistakable sense that making merry is the only option at this time of year.

“Many people may feel pressured to do things or to have to enjoy themselves during the holidays, perhaps because they worry that their friends or coworkers may think there is something strange about them if they do not,” Dr. Mischoulon says. “This can lead to ‘pressure to have fun,’ so to speak, and there are people who even lie about their holiday plans in order not to draw attention to themselves.”

If you want or need to turn down an invitation to a holiday party or other event, it’s best to do so early and with as little explanation as possible. Making up excuses can trigger feelings of guilt, which may exacerbate any anxiety you’re already feeling. And if you feel you can confide in the person hosting an event, talking about why you don’t want to attend may be helpful. You can always offer to spend time with that person in a quieter atmosphere.

Coping with Loss

Because the holidays are so often linked with family get-togethers, the loss of a loved one is underscored with every day on the calendar. And for people who have a particularly traumatic loss, such as a spouse, child, or parent, the holidays can easily trigger feelings of grief. “If they were used to spending the holidays with their loved ones, the holidays then represent a reminder of their loss and become a reason for sadness rather than joy,” Dr. Mischoulon says.

Opting for a more toned-down holiday season may help you get through the season. But keep in mind that isolation carries its own set of emotional and psychological risks, so spending some time with one or more people who bolster your spirits can help.

COVID Complications

Like last year at this time, the COVID-19 pandemic continues to cast a shadow over the holiday season. Unlike last year, however, vaccinations are offering some level of protection and peace of mind. However, traveling and spending time in crowded, indoor settings, as well as navigating gatherings of vaccinated and unvaccinated people can still be challenging.

“Individuals who are in families or groups that include vaccinated and unvaccinated people need to make an additional set of decisions,” Dr. Mischoulon says. “What sort of physical contact etiquette—hugs, kisses, elbow bumping—is appropriate? The question about masking is also complicated. Because people have different views about masks, this could lead to conflicts in situations where there are both masked and unmasked people. Ideally, the host of the event should set some ground rules and inform all invitees in advance about them, so that each individual may decide for themselves whether they are comfortable with the rules, and thus determine whether or not to participate.”

Make It a Healthy Holiday Season

Regardless of how much or little you do this holiday season, it’s important not to neglect your health. “The holidays make people vulnerable to stress,” Dr. Mischoulon says. “There are also holiday-related lifestyle factors that may impact negatively on mood. These include increased use of alcohol and increased consumption of food, especially sweets at holiday parties in the workplace or in social settings. The cold weather in certain parts of the country may also make it harder for people to get out and exercise. A little bit of temperance here can help. Going easy on the alcohol, which can be a depressant, and moderating one’s diet is a good idea.”

Self-care is important all year round, but especially so in times when you’re feeling overwhelmed or vulnerable.

Beat the Blues

Wherever you are on the holiday blues spectrum, Dr. Mischoulon recommends starting the season by being honest with yourself. Acknowledge what (or who) brings you down or makes you upset. At the same time, think of the people and activities that bring you joy. Take stock of your feelings and share your concerns with trusted friends and family members.

“The key to managing holiday-related emotional issues is what Socratic wisdom proclaimed: ‘Know thyself,’” Dr. Mischoulon advises. “Each individual should figure out whether and what type of holiday activity may trigger them, and prepare in advance. For example, getting mentally prepared for a family get-together where they may be strife can be a good idea. If the individual has a therapist, talking it out with the therapist for a few weeks before the event can help the individual develop resilience and coping strategies for whatever issues may emerge, whether they are internal or external.”

And if you want to skip the celebrations and traditions altogether, that’s okay. “Above all, people should also give themselves permission to opt out of the holidays if they want to,” Dr. Mischoulon says. MMM

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Less Stress and More Joyful Celebrations appeared first on University Health News.

A widely used type 2 diabetes drug that helps lower blood glucose levels may also lower the risk of dementia, according to a study published recently in The BMJ. Researchers found that dipeptidyl peptidase-4 (DPP-4) inhibitors are associated with lower levels of amyloid build-up in the brain and slower cognitive decline. The study, which included 282 people with Alzheimer’s disease, found that people who took DPP-4 inhibitors had lower amyloid burden (a hallmark of Alzheimer’s disease) compared with their peers who took other diabetes drugs or even people without diabetes. Previous research has shown a strong association between high blood glucose levels and greater accumulation of the protein amyloid. Studies examining other diabetes drugs’ impact on AD have produced mixed results. The researchers involved with this study suggest that the next step should be a clinical trial to evaluate the benefits of DPP-4 on amyloid progress, independent of diabetes status.

Effects of Deficient Sleep Linger Long After Sleep Returns to Normal

In a small study examining the effects of sleep deficiency, researchers in Poland found that one week after a 10-day period of sleep restriction, participants were still experiencing deficits in their cognitive, behavioral, and motor functioning. The researchers used electroencephalogram (EEG) to measure electrical activity in the brain, daily quizzes to measure reaction time and accuracy, and other measures of functioning. Only reaction time had recovered to the baseline levels measured at the start of the study, prior to the sleep restriction. The study, published in the journal PLOS ONE, suggests that recovering from extended periods of sleep deprivation may take much longer than previously thought.

People with Parkinson’s Disease May Benefit From One of Seven Walking Strategies

When walking becomes more difficult for someone with Parkinson’s disease (PD), trying a different strategy to move more easily may produce a significantly improved gait, according to a study published in Neurology, the medical journal of the American Academy of Neurology. Dutch researchers identified seven walking strategies, many of which were unknown to the more than 4,000 PD patients in the study. The strategies included compensation strategies, such as internal cueing (walking to a count in your head), external cueing (like walking to a metronome), changing the balance requirement (including making wider turns), changing one’s mental state (including relaxation techniques), adapting a new walking pattern (such as jumping or walking backwards), observation and motor imagery (such as watching another person walk), and other forms of leg motion (bicycling and crawling, for example). The researchers found that 23 percent of the people in the study had never tried any of these strategies, but when the approaches were introduced, many of the PD patients found at least one method that improved their walking ability. Internal cueing proved to be the most effective. The findings suggest that a one-size-fits-all approach to walking therapy doesn’t work because individuals may find greater success with one strategy compared to another.

Changing Your Attitude About Leisure May Ease Your Stress Levels

In a series of studies, researchers found that people who view productivity as the ultimate goal and leisure as wasteful and unproductive are much more likely to enjoy leisure less and experience poorer mental health outcomes later in life compared with people who see value in leisure activities. The study, published in the Journal of Experimental Psychology, found that folks who are down on leisure time can be persuaded to think differently. If leisure can be viewed as part of a larger goal that provides identifiable benefits, rather than leisure being an end in itself, then skeptical people are more likely to enjoy leisure activities. While it can be difficult for some people to change their attitudes about leisure, the researchers said that helping skeptics think about leisure as a way to improve energy, strengthen social bonds and connection, and provide other helpful benefits can effectively help them enjoy those activities more and perhaps avoid mood disorders later on. MMM

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Researchers suggest treatment for fibromyalgia should include a multidisciplinary approach combining pharmacological and non-pharmacological treatments. One very promising non-pharmacological option, they believe, is a fibromyalgia diet. This includes adding certain nutrient-rich foods (i.e., fish and green, leafy veggies) and subtracting those that may affect the central nervous system (i.e., MSG and soy sauce).

What Foods Trigger Fibromyalgia Pain? Certain foods may do more harm to the fibromyalgic body than good. To feel better, it may be necessary to cut them out. As stated by the Italian researchers mentioned above, “it seems reasonable to eliminate some foods from the diet of FM patients, for example excitotoxins.” These excitotoxins, a group of neurotransmitters, can cause injury or death to brain and nerve cells if consumed in high enough quantities. Examples include glutamate (i.e., MSG) and aspartame (i.e., the sweetener of the same name).

Foods which contain glutamate can enhance pain in those who suffer from fibromyalgia, says Kathleen Holton, PhD, MPH, a Nutritional Neuroscientist, Assistant Professor in Health Studies, and member of the Center for Behavioral Neuroscience at American University. “This includes processed foods with food additives, as well as some naturally occurring sources of free glutamate like soy sauce, fish sauces, and aged cheeses such as parmesan,” she says.

Another fibromyalgia diet no-no is gelatin. Since some gelatin-containing medications can’t be avoided, Holton recommends opening the gelatin capsule and mixing the medicine with a food like apple sauce instead.

What Foods Should You Avoid on a Fibromyalgia Diet? Other foods that may increase symptoms include processed foods that contain a long list of ingredients. “A good rule of thumb is that ingredient labels should be short, easy to read, and should only contain things you can add to a food,” says Holton. “For example, can you add ‘natural flavor’ to a food? Another example would be yeast. You can easily add yeast to a bread recipe but wouldn’t use ‘autolyzed yeast extract.’ Additives like ‘monosodium glutamate’ and all ‘hydrolyzed proteins’ should also be avoided.”

Multiple studies have found a link between eating gluten and increased fibromyalgia symptoms. This non-celiac gluten sensitivity may be an underlying cause of fibromyalgia, so it’s best to cut it out while on a fibromyalgia diet.

What Foods are Good for Fibromyalgia? Now for the good news. You can still enjoy yummy things while keeping fibromyalgia symptoms at bay. The most important foods to eat on a fibromyalgia diet are nutrient-packed whole foods, says Holton. “Certain nutrients can protect against the over excitation caused by glutamate additives,” she explains. Here are a few nutrients to increase:

1. Omega-3 fatty acids (e.g., from fish, cod liver oil, walnuts, canola oil, and flax seeds)

2. Magnesium (e.g., from nuts, seeds, green, leafy vegetables, fish, and whole grains)

3. Zinc (e.g., from meat, shellfish, nuts, and seeds)

4. Antioxidants (e.g., from lemons, garlic, onions, peppers, various fruits, and greens)

Basically, the ideal fibromyalgia diet, according to Holton, “would be something like the Mediterranean Diet, where a person is consuming fish, a little meat, lots of vegetables and fruit, and including green leafy vegetables, beans, nuts, and seeds.”

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