Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Report] Report Will Aid in Detecting, Diagnosing Cognitive Impairment

From the 5 February 2015 post at The Gerontological Society of America

 

For Immediate Release
February 6, 2015
Contact: Todd Kluss
tkluss@geron.org
(202) 587-2839

A new report from The Gerontological Society of America’s Workgroup on Cognitive Impairment Detection and Earlier Diagnosis outlines a course of action for increasing the use of evidence-based cognitive assessment tools as part of the Medicare Annual Wellness Visit (AWV).

The AWV was established by 2010’s Affordable Care Act to allow Medicare beneficiaries to receive preventive and assessment services during visits with their primary care providers. And although detection of cognitive impairment is among the required AWV services, no specific tools are mandated and no data are available regarding tools used for this purpose.

The new report outlines a plan for addressing this shortcoming and shows how increased detection leads to earlier and optimal diagnostic evaluation, referral to post-diagnosis support and educational services in the community, and ultimately to improved health-related outcomes and well-being for Medicare beneficiaries with diagnosed dementia and their families.

“The Medicare AWV offers a universal opportunity for primary care providers to start a conversation with older adults and their families about cognitive changes that might be worthy of further investigation,” said Richard Fortinsky, PhD, chair of the workgroup. “Our workgroup’s report provides guidance for providers so they can start this conversation and, as appropriate, employ evidence-based assessment tools to detect cognitive impairment.”

The report is available at www.geron.org/ci. The website also contains a link to a companion webinar held in January, led by workgroup members Katie Maslow, MSW, and Shari M. Ling, MD.

“Increased detection of cognitive impairment is essential for earlier diagnosis of Alzheimer’s disease and related dementia — and also earlier diagnosis leads to more timely linkage of older adults and their families with community-based services and supports,” Maslow said.

In the report, the workgroup outlines a recommended for four-step process achieving its goals.

Step 1 is to kickstart the cognition conversation. To increase detection of cognitive impairment and promote earlier diagnosis of dementia in the Medicare population, the GSA workgroup endorses that primary care providers use the AWV as an annual opportunity to kickstart — that is, to initiate and continue — a conversation with beneficiaries and their families about memory-related signs and symptoms that might develop in older adulthood.

Step 2 is to assess the patient if he or she is symptomatic. The GSA workgroup endorses use of a cognitive impairment detection tool from a menu of tools having the following properties: it can be administered in
five minutes or less; it is widely available free of charge; it is designed to assess age-related cognitive impairment; it assesses at least memory and one other cognitive domain; it is validated in primary care or community-based samples in the U.S.; it is easily administered by medical staff members who are not physicians; and it is relatively free from educational, language, and/or cultural bias. The report provides a list of tools that may be suitable for this purpose.

Step 3 is to evaluate with full diagnostic workup if cognitive impairment is detected. The GSA workgroup recommends that all Medicare beneficiaries who exceed threshold scores for cognitive impairment based on the cognitive assessment tools used in step 2 undergo a full diagnostic evaluation. Numerous published clinical practice guidelines are available to primary care providers and specialists to help them arrive at a differential diagnosis.

Step 4 involves referral to community resources and clinical trials, depending on the diagnosis. The GSA workgroup recommends that all Medicare beneficiaries who are determined to have a diagnosis of Alzheimer’s disease or related dementia be referred to all appropriate and available community services to learn more about the disease process and how to prepare for the future with a dementia diagnosis.

“The GSA workgroup views this suggested four-step process as a framework for communicating with a wide variety of stakeholders about the critical importance of incorporating cognitive impairment detection into everyday clinical practice with older adults,” Fortinsky said. “We look forward to building on this report by helping to plan additional activities intended to disseminate and implement the report’s recommendations in communities throughout the country.”

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The Gerontological Society of America (GSA), the nation’s oldest and largest interdisciplinary organization devoted to research, education, and practice in the field of aging. The principal mission of the Society — and its 5,500+ members — is to advance the study of aging and disseminate information among scientists, decision makers, and the general public. GSA’s structure also includes a policy institute, the National Academy on an Aging Society, and an educational branch, theAssociation for Gerontology in Higher Education.

 

February 7, 2015 Posted by | health care | , , , | Leave a comment

[Press release] Male, stressed, and poorly social

Male, stressed, and poorly social.

Stress undermines empathic abilities in men but increases them in women

Stress, this enemy that haunts us every day, could be undermining not only our health but also our relationships with other people, especially if we are men. In fact, stressed women apparently become more “prosocial”. These are the main findings of a study carried out with the collaboration of Giorgia Silani, from the International School for Advanced Studies (SISSA) of Trieste. The study was coordinated by the Social Cognitive Neuroscience Unit of the University of Vienna and saw the participation of the University of Freiburg.

“There’s a subtle boundary between the ability to identify with others and take on their perspective – and therefore be empathic – and the inability to distinguish between self and other, thus acting egocentrically” explains Silani. “To be truly empathic and behave prosocially it’s important to maintain the ability to distinguish between self and other, and stress appears to play an important role in this”.

Stress is a psycho-biological mechanism that may have a positive function: it enables the individual to recruit additional resources when faced with a particularly demanding situation. The individual can cope with stress in one of two ways: by trying to reduce the internal load of “extra” resources being used, or, more simply, by seeking external support. “Our starting hypothesis was that stressed individuals tend to become more egocentric. Taking a self-centred perspective in fact reduces the emotional/cognitive load. We therefore expected that in the experimental conditions people would be less empathic” explains Claus Lamm, from the University of Vienna and one of the authors of the paper.

More in detail…

The surprise was that our starting hypothesis was indeed true, but only for males. In the experiments, conditions of moderate stress were created in the laboratory (for example, the subjects had to perform public speaking or mental arithmetic tasks, etc.). The participants then had to imitate certain movements (motor condition), or recognise their own or other people’s emotions (emotional condition), or make a judgement taking on another person’s perspective (cognitive condition). Half of the study sample were men, the other half were women.

“What we observed was that stress worsens the performance of men in all three types of tasks. The opposite is true for women” explains Silani.

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Why this happens is not yet clear. “Explanations might be sought at several levels”, concludes Silani. “At a psychosocial level, women may have internalized the experience that they receive more external support when they are able to interact better with others.

This means that the more they need help – and are thus stressed – the more they apply social strategies. At a physiological level, the gender difference might be accounted for by the oxytocin system. Oxytocin is a hormone connected with social behaviours and a previous study found that in conditions of stress women had higher physiological levels of oxytocin than men”.

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March 28, 2014 Posted by | Psychiatry, Psychology | , , , | Leave a comment

Brain’s Failure to Appreciate Others May Permit Human Atrocities

From the 15 December 2011 Medical News Today article

A father in Louisiana bludgeoned and beheaded his disabled 7-year-old son last August because he no longer wanted to care for the boy. For most people, such a heinous act is unconscionable.

But it may be that a person can become callous enough to commit human atrocities because of a failure in the part of the brain that’s critical for social interaction. A new study by researchers at Duke University and Princeton University suggests this function may disengage when people encounter others they consider disgusting, thus “dehumanizing” their victims by failing to acknowledge they have thoughts and feelings.

This shortcoming also may help explain how propaganda depicting Tutsi in Rwanda as cockroaches and Hitler’s classification of Jews in Nazi Germany as vermin contributed to torture and genocide, the study said.

“When we encounter a person, we usually infer something about their minds. Sometimes, we fail to do this, opening up the possibility that we do not perceive the person as fully human,” said lead author Lasana Harris, an assistant professor in Duke University’s Department of Psychology & Neuroscience and Center for Cognitive Neuroscience. Harris co-authored the study with Susan Fiske, a professor of psychology at Princeton University.

Social neuroscience has shown through MRI studies that people normally activate a network in the brain related to social cognition — thoughts, feelings, empathy, for example — when viewing pictures of others or thinking about their thoughts. But when participants in this study were asked to consider images of people they considered drug addicts, homeless people, and others they deemed low on the social ladder, parts of this network failed to engage.

What’s especially striking, the researchers said, is that people will easily ascribe social cognition — a belief in an internal life such as emotions — to animals and cars, but will avoid making eye contact with the homeless panhandler in the subway.

“We need to think about other people’s experience,” Fiske said. “It’s what makes them fully human to us.”…

Read the entire article

 

 

 

December 15, 2011 Posted by | Uncategorized | , , , , , , | Leave a comment

   

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