Unraveling the Interplay of Omicron, Reinfections, and Long Covid

The latest covid-19 surge, caused by a shifting mix of quickly evolving omicron subvariants, appears to be waning, with cases and hospitalizations beginning to fall.

Like past covid waves, this one will leave a lingering imprint in the form of long covid, an ill-defined catchall term for a set of symptoms that can include debilitating fatigue, difficulty breathing, chest pain, and brain fog.

Although omicron infections are proving milder overall than those caused by last summer’s delta variant, omicron has also proved capable of triggering long-term symptoms and organ damage. But whether omicron causes long covid symptoms as often — and as severe — as previous variants is a matter of heated study.

Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy, is among the researchers who say the far greater number of omicron infections compared with earlier variants signals the need to prepare for a significant boost in people with long covid. The U.S. has recorded nearly 38 million covid infections so far this year, as omicron has blanketed the nation. That’s about 40% of all infections reported since the start of the pandemic, according to the Johns Hopkins University Coronavirus Research Center.

Long covid “is a parallel pandemic that most people aren’t even thinking about,” said Akiko Iwasaki, a professor of immunobiology at Yale University. “I suspect there will be millions of people who acquire long covid after omicron infection.”

Scientists have just begun to compare variants head to head, with varying results. While one recent study in The Lancet suggests that omicron is less likely to cause long covid, another found the same rate of neurological problems after omicron and delta infections.

Estimates of the proportion of patients affected by long covid also vary, from 4% to 5% in triple-vaccinated adults to as many as 50% among the unvaccinated, based on differences in the populations studied. One reason for that broad range is that long covid has been defined in widely varying ways in different studies, ranging from self-reported fogginess for a few months after infection to a dangerously impaired inability to regulate pulse and blood pressure that may last years.

Even at the low end of those estimates, the sheer number of omicron infections this year would swell long-covid caseloads. “That’s exactly what we did find in the UK,” said Claire Steves, a professor of aging and health at King’s College in London and author of the Lancet study, which found patients have been 24% to 50% less likely to develop long covid during the omicron wave than during the delta wave. “Even though the risk of long covid is lower, because so many people have caught omicron, the absolute numbers with long covid went up,” Steves said.

A recent study analyzing a patient database from the Veterans Health Administration found that reinfections dramatically increased the risk of serious health issues, even in people with mild symptoms. The study of more than 5.4 million VA patients, including more than 560,000 women, found that people reinfected with covid were twice as likely to die or have a heart attack as people infected only once. And they were far more likely to experience health problems of all kinds as of six months later, including trouble with their lungs, kidneys, and digestive system.

“We’re not saying a second infection is going to feel worse; we’re saying it adds to your risk,” said Dr. Ziyad Al-Aly, chief of research and education service at the Veterans Affairs St. Louis Health Care System.

Researchers say the study, published online but not yet peer-reviewed, should be interpreted with caution. Some noted that VA patients have unique characteristics, and tend to be older men with high rates of chronic conditions that increase the risks for long covid. They warned that the study’s findings cannot be extrapolated to the general population, which is younger and healthier overall.

“We need to validate these findings with other studies,” said Dr. Harlan Krumholz, director of the Yale New Haven Hospital Center for Outcomes Research and Evaluation. Still, he added, the VA study has some “disturbing implications.”

With an estimated 82% of Americans having been infected at least once with the coronavirus as of mid-July, most new cases now are reinfections, said Justin Lessler, a professor of epidemiology at the University of North Carolina Gillings School of Global Public Health.

Of course, people’s risk of reinfection depends not just on their immune system, but also on the precautions they’re taking, such as masking, getting booster shots, and avoiding crowds.

New Jersey salon owner Tee Hundley, 43, has had covid three times, twice before vaccines were widely available and again this summer, after she was fully vaccinated. She is still suffering the consequences.

After her second infection, she returned to work as a cosmetologist at her Jersey City salon but struggled with illness and shortness of breath for the next eight months, often feeling like she was “breathing through a straw.”

She was exhausted, and sometimes slow to find her words. While waxing a client’s eyebrows, “I would literally forget which eyebrow I was waxing,” Hundley said. “My brain was so slow.”

When she got a breakthrough infection in July, her symptoms were short-lived and milder: cough, runny nose, and fatigue. But the tightness in her chest remains.

“I feel like that’s something that will always be left over,” said Hundley, who warns friends with covid not to overexert. “You may not feel terrible, but inside of your body there is a war going on.”

Although each omicron subvariant has different mutations, they’re similar enough that people infected with one, such as BA.2, have relatively good protection against newer versions of omicron, such as BA.5. People sickened by earlier variants are far more vulnerable to BA.5.

Several studies have found that vaccination reduces the risk of long covid. But the measure of that protection varies by study, from as little as a 15% reduction in risk to a more than 50% decrease. A study published in July found the risk of long covid dropped with each dose people received.

For now, the only surefire way to prevent long covid is to avoid getting sick. That’s no easy task as the virus mutates and Americans have largely stopped masking in public places. Current vaccines are great at preventing severe illness but do not prevent the virus from jumping from one person to the next. Scientists are working on next-generation vaccines — “variant-proof” shots that would work on any version of the virus, as well as nasal sprays that might actually prevent spread. If they succeed, that could dramatically curb new cases of long covid.

“We need vaccines that reduce transmission,” Al-Aly said. “We need them yesterday.”

How to Stay Positive

Human emotions are powerful. From love and joy to fear and anger, our emotions have the ability to impact almost every aspect of our lives and even determine how we respond to life’s challenges. And while it may seem like emotions are beyond our control at times, the truth is that whether we feel good or bad on any given day is within our power. The way you feel on any given day has a lot to do with your perception—how you see things—and not necessarily the events themselves. For example, if you read a news article and think, “This news makes me sad;’ then, chances are you’ll also feel sad for the rest of that day. But what if instead of thinking about the news as “making” you sad, you recognized it as sad but not something you can control or that can control you. Chances are you will remain happier that day. This goes for anything in life. If you change your perception from negative to positive, almost all bad events will seem less challenging and more manageable. This can be accomplished by taking control of your responses and not seeing events as “making” you do or feel something.

How to Stay Positive in a Negative World

Our world can be a challenging place sometimes, and when we are met with negative people, situations, and emotions, it can be easy to fall into negative thinking and feeling. However, as you work to stay positive, it is important to remember that all situations and emotions can be interpreted differently. Although they may appear to be negative, they are only that way if we allow them to be. When we start to view negative events and situations as neutral, we begin to have more choice in how we respond to them and how we let them affect us. Instead of letting negative emotions take over and cause us to fall into a spiral of negativity, we can choose to let them exist, acknowledge them, and simply walk on by.

Practice Mindfulness

One of the best ways to keep your mind focused on positivity is through mindfulness. Mindfulness is a practice that has come from many different cultures and traditions, and it has been shown to provide many positive benefits in mental health, including the ability to stay focused and positive. When you practice mindfulness, you bring your attention to the present moment in an open, non-judgmental way. This helps you to view negative thoughts as just that—thoughts—and nothing more. You can then choose to let them pass through your mind without holding onto them or allowing them to affect your mood.

Commit to Positivity

One of the best ways to stay positive is to commit to it. When you commit to positivity, you choose the importance of your well-being. This kind of commitment can help you to focus on the things that are good in your life and that support your mental health. In turn, this commitment to positivity will help you to overcome negative thoughts and emotions when they do arise. If you decide that staying positive is truly important to you and you are ready to commit to it, you can create your own personal plan to help you stay on track. There are many different ways you can do this, and it may take some time before you feel like you have the right formula that works for you. Make your own small goals to help you practice positivity each day.

Finding Meaning in Everything

When you focus on the positive, it’s important not to ignore the negative, but rather to see it as an opportunity to find meaning. You can find positive meaning in all situations, even those that appear negative. For example, if you lose your job, you can find a positive meaning in it by realizing that now is a time to pursue your dream job or to improve your skills or change careers. If a loved one is diagnosed with a serious illness, you can find a positive meaning in it by realizing that you have a chance to become closer as a family and make the most of the time you have left with them. That doesn’t remove the pain or hardship but it does allow for flashes of joy and learning. Every situation holds an opportunity for positive meaning, and it’s up to you to see it that way.

Conclusion

When you are feeling down or anxious, remember that your emotions are not permanent. It can sometimes be difficult to see this when you are in the middle of a challenging situation, but once you are out of the situation, you will see that you can let those emotions go and move on from them. Remember that your emotions are connected to your perception and that how you choose to perceive situations can have a huge impact on how you feel. When you are faced with a difficult situation, take a step back, take a deep breath, and ask yourself what you can learn from the situation and how you can use that to make your life better in the future. When you stay positive and use your emotions to your advantage, you are better able to cope with life’s challenges and have a more fulfilling life.

Beyond Burnout: Docs Decry ‘Moral Injury’ From Financial Pressures Of Health Care


Dr. Keith Corl was working in a Las Vegas emergency room when a patient arrived with chest pain. The patient, wearing his street clothes, had a two-minute exam in the triage area with a doctor, who ordered an X-ray and several other tests. But later, in the treatment area, when Corl met the man and lifted his shirt, it was clear the patient had shingles. Corl didn’t need any tests to diagnose the viral infection that causes a rash and searing pain.

All those tests? They turned out to be unnecessary and left the patient with over $1,000 in extra charges.

The excessive testing, Corl said, stemmed from a model of emergency care that forces doctors to practice “fast and loose medicine.” Patients get a battery of tests before a doctor even has time to hear their story or give them a proper exam.

“We’re just shotgunning,” Corl said.

The shingles case is one of hundreds of examples that have led to his exasperation and burnout with emergency medicine. What’s driving the burnout, he argued, is something deeper — a sense of “moral injury.”

Corl, a 42-year-old assistant professor of medicine at Brown University, is among a growing number of physicians, nurses, social workers and other clinicians who are using the phrase “moral injury” to describe their inner struggles at work.

The term comes from war: It was first used to explain why military veterans were not responding to standard treatment for post-traumatic stress disorder. Moral injury, as defined by researchers from veterans hospitals, refers to the emotional, physical and spiritual harm people feel after “perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations.”

Drs. Wendy Dean and Simon Talbot, a psychiatrist and a surgeon, were the first to apply the term to health care. Both wrestled with symptoms of burnout themselves. They concluded that “moral injury” better described the root cause of their anguish: They knew how best to care for their patients but were blocked from doing so by systemic barriers related to the business side of health care.

That idea resonates with clinicians across the country: Since they penned an op-ed in Stat in 2018, Dean and Talbot have been flooded with emails, comments, calls and invitations to speak on the topic.

Burnout has long been identified as a major problem facing medicine: 4 in 10 physicians report feelings of burnout, according to a 2019 Medscape report. And the physician suicide rate is more than double that of the general population.

Dean said she and Talbot have given two dozen talks on moral injury. “The response from each place has been consistent and surprising: ‘This is the language we’ve been looking for for the last 20 years.’”

Dean said that response has come from clinicians across disciplines, who wrestle with what they consider barriers to quality care: insurance preauthorization, trouble making patient referrals, endless clicking on electronic health records.

Those barriers can be particularly intense in emergency medicine.

Corl said he has been especially frustrated by a model of emergency medicine called “provider-in-triage.” It aims to improve efficiency but, he said, prioritizes speed at the cost of quality care. In this system, a patient who shows up to an ER is seen by a doctor in a triage area for a rapid exam lasting less than two minutes. In theory, a doctor in triage can more quickly identify patients’ ailments and get a head start on solving them. The patient is usually wearing street clothes and sitting in a chair.

These brief encounters may be good for business: They reduce the “door to doc” time — how long it takes to see a doctor — that hospitals sometimes boast about on billboards and websites. They enable hospitals to charge a facility fee much earlier, the minute a patient sees a doctor. And they reduce the number of people who leave the ER without “being seen,” which is another quality measure.

But “the real priority is speed and money and not our patients’ care,” Corl said. “That makes it tough for doctors who know they could be doing better for their patients.”

Dean said people often frame burnout as a personal failing. Doctors get the message: “If you did more yoga, if you ate more salmon salad, if you went for a longer run, it would help.” But, she argued, burnout is a symptom of deeper systemic problems beyond clinicians’ control.

Emergency physician Dr. Angela Jarman sees similar challenges in California, including ER overcrowding and bureaucratic hurdles to discharging patients. As a result, she said, she must treat patients in the hallways, with noise, bright lights and a lack of privacy — a recipe for hospital-acquired delirium.

“Hallway medicine is such a [big] part of emergency medicine these days,” said Jarman, 35, an assistant professor of emergency medicine at UC-Davis. Patients are “literally stuck in the hallway. Everyone’s walking by. I know it must be embarrassing and dehumanizing.”

For example, when an older patient breaks an arm and cannot be released to their own care at home, they may stay in the ER for days as they await evaluation from a physical therapist and approval to transfer to rehab or a nursing home, she said. Meanwhile, the patient gets bumped into a bed in the hallway to make room for new patients who keep streaming in the door.

Being responsible for discharging patients who are stuck in the hallway is “so frustrating,” Jarman said. “That’s not what I’m good at. That’s not what I’m trained to do.”

Jarman said many emergency physicians she knows work part time to curtail burnout.

“I love emergency medicine, but a lot of what we do these days is not emergency medicine,” she said. “I definitely don’t think I’ll make it 30 years.”

Also at UC-Davis, Dr. Nick Sawyer, an assistant professor of emergency medicine, has been working with medical students to analyze systemic problems. Among those they’ve identified: patients stuck in the ER for up to 1,000 hours while awaiting transfer to a psychiatric facility; patients who are not initially suicidal, but become suicidal while awaiting mental health care; patients who rely on the ER for primary care.

Sawyer, 38, said he has suffered moral injury from treating patients like this one: A Latina had a large kidney stone and a “huge amount of pain” but could not get surgery because the stone was not infected and therefore her case wasn’t deemed an “emergency” by her insurance plan.

“The health system is not set up to help patients. It’s set up to make money,” he said.

The best way to approach this problem, he said, is to help future generations of doctors understand “how decisions made at the systems level impact how we care about patients” — so they can “stand up for what’s right.”

Whether these experiences amount to moral injury is open for discussion.

Cynda Rushton, a nurse and professor of clinical ethics at Johns Hopkins University, who has studied the related notion of “moral distress” for 25 years, said there isn’t a base of research, as there is for moral distress, to measure moral injury among clinicians.

But “what both of these terms signify,” Rushton said, “is a sense of suffering that clinicians are experiencing in their roles now, in ways that they haven’t in the past.”

Dean grew interested in moral injury from personal experience: After a decade of treating patients as a psychiatrist, she stopped because of financial pressures. She said she wanted to treat her patients in longer visits, offering both psychotherapy and medication management, but that became more difficult. Insurers would rather pay her for only a 15-minute session to manage medications and let a lower-paid therapist handle the therapy.

Dean and Talbot created a nonprofit advocacy group called Moral Injury of Healthcare, which promotes public awareness and aims to bring clinicians together to discuss the topic.

Their work is attracting praise from a range of clinicians:

In Cumberland County, Pennsylvania, Mary Franco, who is now 65, retired early from her job as a nurse practitioner after a large corporation bought out the private practice she worked in. She said she saw “a dramatic shift” in the culture there, where “revenue became all-important.” The company cut in half the time for each patient’s annual exam, she said, down to 20 minutes. She spent much of that time clicking through electronic health records, she said, instead of looking the patient in the face. “I felt I short-shrifted them.”

In southern Maine, social worker Jamie Leavitt said moral injury led her to take a mental health break from work last year. She said she loves social work, but “I couldn’t offer the care I wanted to because of time restrictions.” One of her tasks was to connect patients with mental health services, but because of insurance restrictions and a lack of quality care providers, she said, “often my job was impossible to do.”

In Chambersburg, Pennsylvania, Dr. Tate Kauffman left primary care for urgent care because he found himself spending half of each visit doing administrative tasks unrelated to a patient’s ailment — and spending nights and weekends slogging through paperwork required by insurers.

“There was a grieving process, leaving primary care,” he said. “It’s not that I don’t like the job. I don’t like what the job has become today.”

Corl said he was so fed up with the provider-in-triage model of emergency medicine that he moved his ER clinical work to smaller, community hospitals that don’t use that method.

He said many people frame burnout as a character weakness, sending doctors messages like, “Gee, Keith, you’ve just got to try harder and soldier on.” But Corl said the term “moral injury” correctly identifies that the problem lies with the system.

“The system is flawed,” he said. “It’s grinding us. It’s grinding good docs and providers out of existence.”

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

The Necessity of Psychotherapy

Years ago I wrote an essay about the death of psychotherapy. While I did not state that psychotherapy is currently dead, I did state that much of it might die in the wake of advances in understanding the neurobiology of psychological disorders. It will take decades for these advances to occur (if they ever do) so this post will now serve to balance my post from years ago.

I’m going to start with a story about two people (these are based on real events but names, situations, and identifying details have been changed to protect confidentiality). Jim was convicted of a violent crime and spent a number of years in prison. He was required to attend treatment throughout his years in prison – anger management and other therapies. He had a history of alcohol and drug abuse. A while after he got out of prison, he started therapy again to help him through some difficulties, including his experiences with homelessness. Jim was a very pleasant person to interact with; he was well-read and insightful. He was trying to improve his life.

The second person was named Frank. He was also homeless but was staying with a friend. He had past drug and alcohol abuse but had been free from drugs for about a year. He was anxious, paranoid, and not the most pleasant person to interact with. He had never received treatment for depression, which he experienced chronically and severely. He exhibited little insight into his problems. He thought the negative events in his life were all someone or something else’s fault.

The first patient had learned a lot from his psychotherapy over the years. The second never had therapy. While they were very different people, they experienced similar challenges and psychological issues over the years. Without disregarding individual differences, the patient who had had years of therapy had a lot of insight and self-knowledge but the other patient had very little.

Jim had been a violent man but over the years and through therapy, he learned a great deal of self-control and restraint. Psychotropic medications could not have taught Jim this. For him, psychotherapy was highly successful. Without out it he might not have been the pleasant person that he was.

Therapy teaches you skills; it gives you tools to deal with maladaptive thoughts and behaviors. It allows you opportunity to sort through your experiences and thoughts in a safe place. It allows to to talk to someone else without being judged. Therapy is thus treatment and education. It can have as strong or stronger effects on mood and behavior as medications and the benefits can last longer. Understanding biology is necessary to understand behavior but it is not sufficient to explain all behavior, at least not with our current knowledge. Will we ever had sufficiently advanced knowledge of neuroscience and biology to no longer need psychotherapy? I don’t know but if we do, it won’t happen for many years.

Today is the Best Day

You miss a lot of life when you spend life living for yesterday and tomorrow but wish today will just hurry up and end. We need to enjoy today and make the best out of what we have, whatever our circumstances might be and wherever we are. Even in horrible circumstances we can choose our attitude and outlook.

If we strive to enjoy today, this doesn’t mean we forget the past and it doesn’t mean we don’t plan for the future. We can’t change the past and the future isn’t here yet but we can change the present. We can remember the past and hope for the future and in doing so change the present. It takes action now to decide you want to be better and then diligent work to make it happen.

One in five older adults experience brain network weakening following knee replacement surgery

Gainesville, FL – A new University of Florida study finds that 23 percent of adults age 60 and older who underwent a total knee replacement experienced a decline in activity in at least one region of the brain responsible for specific cognitive functions. Fifteen percent of patients declined across all brain networks the team evaluated.

“In essence, normally synchronized parts of the brain appeared more out of sync after surgery,” said Jared Tanner, Ph.D., the study’s co-lead author and a research assistant professor in the department of clinical and health psychology in the UF College of Public Health and Health Professions, part of UF Health.

Patients who were cognitively weaker before surgery – with worse working memory, slowed mental processing and evidence of brain atrophy as seen in imaging scans – demonstrated the biggest network declines after surgery.

Researchers say they do not yet know if or how patients perceive these network declines. They may contribute to brain “fuzziness” some patients experience right after surgery.

The study, which was published today online ahead of print in the Journal of Alzheimer’s Disease, was conducted to help scientists understand the causes of postsurgical cognitive impairment, which causes memory and thinking problems in about 15 to 30 percent of older adult patients, Tanner said. In most cases, these thinking and memory problems will resolve within six months to a year after surgery.

“Our study builds on 50 years of research into how the aging brain responds to anesthesia and surgery,” Tanner said. “We know older age and cognitive impairment before surgery are risk factors, but the specific causes are not known.”

For the UF study, the team conducted cognitive and brain imaging tests before and after surgery on 48 patients ages 60 and older undergoing a knee replacement. Results were compared with age-matched adults who have knee osteoarthritis, but did not have surgery.

The researchers used resting state functional MRI to look at patterns of blood flow in the brain while patients were lying still. Imaging data helped researchers understand how blood flow changes affected connections across brain networks that are responsible for functions such as memories of oneself and others, determining what outside stimuli deserve further attention, and working memory.

Participants who did not have surgery did not demonstrate any changes across the two brain scans, but 23 percent of participants who had knee replacement surgery showed large declines in connectivity in at least one brain network when tested 48 hours after surgery.

“It was surprising to observe such significant effects of orthopedic surgery on the human brain,” said Haiqing Huang, Ph.D., the study’s other lead author, a data manager at the University of Pittsburgh’s Brain Aging & Cognitive Health Lab and a graduate of the biomedical engineering program at the UF Herbert Wertheim College of Engineering.

The investigators say more research is needed to learn if the brain network changes persist.

“Our goals include investigating if patients who have this brain change after surgery continue to show this change later in their recovery, say at three months or one year after the surgery,” said Catherine Price, Ph.D., the study’s senior author and a UF associate professor of clinical and health psychology and anesthesiology.

People with concerns about their attention or memory should discuss them with their surgical team, Tanner said. At UF Health, neuropsychologists and anesthesiologists have established what is believed to be the first clinical service to identify older adults who may be at risk of developing cognitive problems after surgery so that health care providers can intervene to lessen the impact.

“We strongly believe clinicians need to consider preoperative memory and attention abilities in their patients,” said Price, also the co-director of the Perioperative Cognitive and Anesthesia Network, or PeCAN, service. “Across the nation, however, cognition is not routinely assessed prior to surgery.”

There are also actions patients can take on their own, based on previous studies of healthy aging.

“The brain is resilient and there are things we can do to help protect our brains before and after surgery,” Tanner said. “Exercise, following a Mediterranean-style diet (primarily vegetables, fruits and whole grains), remaining mentally and socially active and otherwise striving to stay as healthy as possible – all might help patients’ brains cope with surgery better,” Tanner said.

Mingzhou Ding, Ph.D., of the J. Crayton Pruitt Family department of biomedical engineering in the Herbert Wertheim College of Engineering, served as the study’s other senior author. The project is part of a larger investigation involving Thomas Mareci, Ph.D., of the department of biochemistry and molecular biology in the College of Medicine and the Evelyn F. and William L. McKnight Brain Institute; Hari Parvataneni, M.D., of the department of orthopaedics and rehabilitation in the College of Medicine; Ilona Schmalfuss, M.D., of the department of radiology in the College of Medicine; Mark Rice, M.D., and Cynthia Garvan, Ph.D., of the department of anesthesiology in the College of Medicine; and Ann Horgas, Ph.D., of the department of biobehavioral nursing science in the College of Nursing. The research was supported by funding from the National Institutes of Health.

Press release source.

Reference

Huang H, Tanner J, Parvataneni H, Rice M, Horgas A, Ding M, Price C (2018) Impact of Total Knee Arthroplasty with General Anesthesia on Brain Networks: Cognitive Efficiency and Ventricular Volume Predict Functional Connectivity Decline in Older Adults. J Alzheimers Dis 62, 319-333.

Health Insurance and Medical Costs Survey

Please take a minute to fill out this seven question survey (you don’t have to answer all the questions); all responses remain anonymous and are collected for my own interest. If you do not live in the United States of America, please disregard.

Create your own user feedback survey

Collaborative Learning: The Example of Quizlet

One of the benefits of the internet and world wide web are the opportunities for collaborative learning and work. The distributed structure of the internet mirrors the brain in many ways. While specific parts of the brain are specialized for specific tasks, wide areas of the brain are needed to do just about anything. The interconnectedness of major brain networks are visualized in the following image.

brain_networks

Portions of the internet have also been visualized in similar ways, such as this image produced in 2010 by AT&T Labs.

ATT_internet_map

What does this have to do with collaborative learning?

One example is the site Quizlet.com (I have no affiliation with them). Quizlet is a site billing itself as providing “Simple tools for learning anything. Search millions of study sets or create your own. Improve your grades by studying with flashcards, games and more.”

People can create study sets (digital flashcards) about just about any topic. The site is particularly helpful for middle and high school students who can access content created by others or provide their own content.

Do you need to study vocabulary words for the SAT? There is a study set with words that might appear on the test.

Do you need to study for an AP Psychology test? Here’s a set of terms that might be helpful.

Whether you are lazy and don’t want to create your own study materials, are interested in learning something new, have a big test coming up, or want to help other people, sites like Quizlet provide opportunities for collaborative learning.

Image sources

Hagmann P, Cammoun L, Gigandet X, Meuli R, Honey CJ, Wedeen VJ, Sporns O (2008) Mapping the structural core of human cerebral cortex. PLoS Biology Vol. 6, No. 7, e159.

http://www.research.att.com/export/sites/att_labs/groups/infovis/news/img/ATT_Labs_InternetMap_0730_10.pdf

Cognitive Rehabilitation Strengthens Brain Connections

There is increased interest in brain and cognitive rehabilitation to treat people with mild thinking and memory problems. Parkinson’s disease, while typically viewed as a neurodegenerative motor disorder, also affects thinking and memory. In a small clinical trial with Parkinson’s disease patients, patients received either occupational therapy or cognitive rehabilitation. Those who had cognitive rehabilitation showed increases in functional connectivity (a measure of time-linked correlations between changes in blood flow in different parts of the brain) between the left inferior temporal lobe and the left and right dorsolateral prefrontal cortex. These are brain areas important for a number of cognitive functions including memory, planning, and mental manipulation of information. If you need help to boost your mental health you can get brain supplements from Neuro Hacks, this can help optimize your brain performance. Those who did not receive cognitive intervention did not have increases in connectivity.

What does this mean for Parkinson’s disease and for cognitive rehabilitation? It’s difficult to say with this small study. It’s also unknown how long the changes last. Without a restructuring of the brain and continued cognitive rehabilitation it is not likely that the effects will last more than weeks or months after the rehabilitation ends.

To expand on this study (to bring in other research) and put things in simple terms, if people want to protect their brains they best they can as they age, they need to remain physically and mentally active and in good physical and mental shape. Learn new things. Travel to new locations. Take up a physically demanding hobby or dedicated exercise. This won’t solve all our aging problems but it will help a lot.

Reference

Díez-Cirarda, M., Ojeda, N., Peña, J. et al. Brain Imaging and Behavior (2016). doi:10.1007/s11682-016-9639-x

Memory Problems in Some With Parkinson’s Disease

From a recent news release by Jill Pease at the University of Florida.

Using a combination of neuropsychological testing and brain imaging, University of Florida researchers have discovered that in a group of recently-diagnosed patients with Parkinson’s disease, about one quarter have significant memory problems.

Parkinson’s disease is commonly known as a movement disorder that leads to tremors and muscle rigidity, but there is growing recognition of cognitive problems associated with the disease. One of the most common is slower thinking speed that causes patients to have trouble quickly retrieving information. The UF study identifies a subset of patients who have a different kind of cognitive issue — memory problems, or difficulty learning and retaining new information.

The findings were published July 24 in the journal PLOS ONE.

“While a large proportion of people with Parkinson’s will experience slower thinking speed, which may make them less quick to speak or have difficulty doing two things at once, we now know that there are a subset of individuals with Parkinson’s disease who have memory problems,” said Catherine Price, Ph.D., the study’s senior author and an associate professor in the UF College of Public Health and Health Professions’ department of clinical and health psychology, part of UF Health. “It is important to recognize which people have issues with learning and memory so we can improve diagnostic accuracy and determine if they would benefit from certain pharmaceutical or behavioral interventions.”

For the UF study, 40 people in the early stages of Parkinson’s disease and 40 healthy older adults completed neuropsychological assessments and verbal memory tests.

About half the participants with Parkinson’s disease struggled with an aspect of memory, such as learning and retaining information, or recalling verbal information, said lead author Jared Tanner, Ph.D., an assistant research professor in the UF department of clinical and health psychology who conducted the study as part of his dissertation research for a UF doctoral degree in clinical psychology.

“And then half of those participants, or nearly one quarter of all participants with Parkinson’s, were really having a difficult time consistently with their memory, enough that it would be noticeable to other people,” said Tanner, adding that researchers were encouraged by the fact that most participants in the initial stages of Parkinson’s were not having significant memory problems.

All participants received brain scans, which used new imaging techniques that allowed the scientists to navigate the pathways of white matter fibers, the tissue through which messages travel across the brain. The methodology was developed by the research group ofThomas Mareci, Ph.D., a professor of biochemistry and molecular biology in the UF College of Medicine, and is described in a paper published July 14 in PLOS ONE.

Experts have theorized that cognitive problems in Parkinson’s are caused by a shortage of the brain chemical dopamine, which is responsible for patients’ motor issues. But with the help of imaging, the UF researchers were able to spot changes in the brain’s gray and white matter that appear unrelated to dopamine loss and are specific to those patients with Parkinson’s who have memory problems.

“Not only is gray matter important for memory, in Parkinson’s disease white matter connections between the temporal lobe and a region in the posterior portion of the brain called the retrosplenial cortex were particularly important in the recall of verbal information,” Tanner said. “People with Parkinson’s disease who had stronger connections between these areas of the brain did better at remembering information.”

Tanner’s study is part of a larger research project supported by a $2.1 million grant from the National Institute of Neurological Disorders and Stroke of the National Institutes of Health. Researchers led by Price are using imaging and cognitive testing to determine profiles for the cognitive problems that most commonly affect patients with Parkinson’s. The information gleaned from the research could help clinicians foreshadow the type of cognitive impairment a patient may experience over time, if any, and tailor treatment plans accordingly.