physicians

Trend: With 25% of US physicians aged 65+, hospitals test older doctors on mental and physical acuity

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When Are Doc­tors Too Old to Prac­tice? (The Wall Street Journal):

“In Feb­ru­ary, Robert Brown received an email that left him trou­bled. The New Jer­sey hos­pi­tal where the 71-year-old pedi­a­tri­cian was prac­tic­ing informed him that doc­tors age 72 and old­er would have to take a test to assess their phys­i­cal and men­tal health—or risk los­ing their priv­i­leges [Read more…] about Trend: With 25% of US physi­cians aged 65+, hos­pi­tals test old­er doc­tors on men­tal and phys­i­cal acuity

Study: Families’ Perspectives on ADHD and its Treatment

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In 2005 the Amer­i­can Acad­e­my of Pedi­atrics (AAP) began an ini­tia­tive to pro­mote an approach to care among its mem­bers in which “…the pedi­atric team works in part­ner­ship with a child and a child’s fam­i­ly to assure that all of the med­ical and non-med­ical needs of the patient are met.” A crit­i­cal­ly impor­tant focus of this approach is the role of the fam­i­ly and child — as devel­op­men­tal­ly appro­pri­ate — in the devel­op­ment of an over­all plan of care.

This shared deci­sion-mak­ing approach is espe­cial­ly impor­tant for con­di­tions like ADHD where there is not a sin­gle treat­ment that is the most appro­pri­ate and pre­ferred option for all patients. How­ev­er, [Read more…] about Study: Fam­i­lies’ Per­spec­tives on ADHD and its Treatment

Cognitive screenings and Alzheimer’s Disease

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The Alzheimer’s Foun­da­tion of Amer­i­ca just released a thought­ful report advo­cat­ing for wide­spread cog­ni­tive screen­ings after the age of 65 (55 giv­en the right conditions).

Accord­ing to the press release,

- “The report shat­ters unsub­stan­ti­at­ed crit­i­cism and instead empha­sizes the safe­ty and cost-effec­tive­ness of these tools and calls on Con­gress to devel­op a nation­al demen­tia screen­ing policy.”

- “Lift­ing the bar­ri­ers to ear­ly detec­tion is long over­due, Hall said. “Con­ver­sa­tions about brain health are not tak­ing place. We must edu­cate and empow­er con­sumers to talk open­ly about mem­o­ry con­cerns, par­tic­u­lar­ly with pri­ma­ry care providers, so they get the atten­tion and qual­i­ty of life they deserve.

- “Demand for screen­ings is evi­denced by the suc­cess of AFA’s recent sixth annu­al Nation­al Mem­o­ry Screen­ing Day held on Novem­ber 18, dur­ing which an esti­mat­ed 50,000 peo­ple were giv­en free con­fi­den­tial mem­o­ry screen­ings at near­ly 2,200 com­mu­ni­ty sites nation­wide. Dur­ing last year’s event, approx­i­mate­ly 16 per­cent of indi­vid­u­als who had a face-to-face screen­ing scored pos­i­tive and were referred to their pri­ma­ry care providers for fol­low-up. An AFA sur­vey of par­tic­i­pants revealed that few­er than one in four with self-report­ed mem­o­ry com­plaints had pre­vi­ous­ly dis­cussed them with their physi­cians despite recent visits.”

Excel­lent report avail­able: here

Please note that the Alzheimer’s Asso­ci­a­tion recent­ly argued in the oppo­site direc­tion (no screen­ings) — which prob­a­bly trig­gered this response.

We see emerg­ing trends that sug­gest the posi­tion in favor of cog­ni­tive assess­ments may in fact gath­er momen­tum over the next few years: wide­spread com­put­er­ized cog­ni­tive screen­ings in the US Army, insur­ance com­pa­nies like OptumHealth adding such tools to its clin­i­cal deci­sion-mak­ing sys­tems, polls such as the Amer­i­can Soci­ety of Aging’s a cou­ple of years ago indi­cat­ing a very strong demand for an “annu­al men­tal check-up”, the avail­abil­i­ty of use­ful assess­ment tools and research-based pre­ven­tive advice.

The start­ing point is to under­stand what those assess­ments are NOT: they are not diag­nos­tic tools. When used prop­er­ly, they can be used as a base­line to track per­for­mance in a vari­ety of cog­ni­tive domains over time, so that both the indi­vid­ual AND the physi­cian are not blind­ed by a one-time assess­ment, com­par­ing an indi­vid­ual with his or her peers (instead of his or her past per­for­mance) when seri­ous symp­toms have fre­quent­ly already been going on for a while.

Our con­trib­u­tor  Dr. Joshua Sil­ver­man, from Albert Ein­stein Col­lege of Med­i­cine, recent­ly gen­er­at­ed a nice debate on the top­ic by ask­ing our read­ers their reac­tion to these 3 ques­tions: [Read more…] about Cog­ni­tive screen­ings and Alzheimer’s Disease

Grand Rounds 5:12 — Healthcare Reform Q&A

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“If Dr. Rob can inter­view San­ta, why can’t I inter­view a select group of health & med­ical blog­gers? They will have some good ideas to share”.

So did Pres­i­dent-elect Oba­ma came to real­ize a few days ago. After his peo­ple kind­ly con­tact­ed our peo­ple, we felt com­pelled to grant him open access to our col­lec­tive wis­dom. With­out fur­ther ado, below you have Grand Rounds 5:12 — a Q&A ses­sion led by the incom­ing Pres­i­dent on how to reform (for the bet­ter, we hope) healthcare.

On Health Insurance

Q:  How does the blo­gos­phere per­ceive the prob­lem of hav­ing a sig­nif­i­cant group of peo­ple uninsured?

Health Insur­ance Col­orado: a grow­ing eco­nom­ic bur­den, which may lead to emer­gency rooms turn­ing peo­ple away if they are unable to pro­vide proof of health insurance.

Dr Rich: well, a recent arti­cle in the Jour­nal of the Amer­i­can Med­ical Asso­ci­a­tion showed how over­crowd­ing in Amer­i­can emer­gency rooms is NOT due to the unin­sured. Rather, it is due to insured Amer­i­cans who can­not get in to see their pri­ma­ry care physi­cians. We may need improved care both for the insured and unin­sured groups.

Insure­Blog: I’d sec­ond that. Lack of health insur­ance is a major prob­lem but is it real­ly our Biggest Problem?

It’s All about Attitude

Q: You may have heard my cam­paign mantra, “Yes We Can”. Can I count on your support? 

ButY­ouDont­Look­Sick: Yes. If Leslie Hunt can talk so open­ly about her chron­ic ill­ness (Lupus) yet ful­fill her Amer­i­can Idol dreams, we can ful­fill our dreams too.

Notes of an Anes­the­sioboist: you are talk­ing to the group of pro­fes­sion­als will­ing to self-exper­i­ment with our own body for the ben­e­fit of sci­ence and our patients.

Med­views: My wife, son, and I signed up to work as med­ical vol­un­teers for your upcom­ing inauguration.

Emergi­Blog: I am on board too. But, please, remem­ber that car­ing is the essence of nurs­ing. And that is why my patients will always be my patients and nev­er my  clients.

Neu­roan­thro­pol­o­gy: Mr. Pres­i­dent-elect, it seems to me that, despite all our good inten­tions, bal­anc­ing the bud­get and mul­ti­ple com­pet­ing pri­or­i­ties will be a chal­lenge. May I sug­gest you start prac­tic­ing some capoeira for equi­lib­ri­um training?

Shrink Rap: Hap­py to help. Now, we will need to pro­tect some time for qual­i­ty sleep time.

Train­ing

Q: I am encour­aged by your words. How can my team and I bet­ter sup­port you in your dai­ly activities?

Aequa­nim­i­tas: we need more role mod­els for us to “learn to think, observe, and com­pare” and that the patient is our “first, last, and only teacher”.

Mud­phud­der: Could­n’t agree more. We need [Read more…] about Grand Rounds 5:12 — Health­care Reform Q&A

Towards a Healthy Living & Cognitive Health Agenda

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Here you have the Novem­ber edi­tion of our month­ly newslet­ter cov­er­ing cog­ni­tive health and brain fit­ness top­ics. Please remem­ber that you can sub­scribe to receive this Newslet­ter by email, sim­ply by brain fitness and health newslettersub­mit­ting your email at the top of this page.

Thank you for your inter­est, atten­tion and par­tic­i­pa­tion in our Sharp­Brains com­mu­ni­ty. As always, we appre­ci­ate your com­ments and suggestions.

Sum­mit of the Glob­al Agenda

How can we per­suade busi­ness lead­ers, pol­i­cy-mak­ers and researchers of the urgency to devel­op and pro­mote an inte­grat­ed “Healthy Liv­ing” agen­da focused on main­tain­ing life­long phys­i­cal and cog­ni­tive health, vs. the usu­al mind­set focused on deal­ing with spe­cif­ic dis­eases and prob­lems once they arise?

In The Future of the Aging Soci­ety: Bur­den or Human Cap­i­tal?, I sum­ma­rize some of the key themes dis­cussed at the World Eco­nom­ic Forum event in Dubai on Novem­ber 7–9th. The world is aging — and in health­i­er ways. But our health­care and retire­ment sys­tems are on track to go bank­rupt — their premis­es are out­dat­ed. The cur­rent dis­ease-based research agen­da com­pounds the prob­lem. Solu­tions? 1) Pro­mote Healthy Lifestyles that help Main­tain Phys­i­cal and Cog­ni­tive Func­tion­al Abil­i­ties, 2) Redesign Envi­ron­ments to Fos­ter Health, Engage­ment and Finan­cial Secu­ri­ty, 3) Devel­op an Inte­grat­ed Healthy Liv­ing & Aging Research Agen­da. Specif­i­cal­ly, we could work with the UN and Glob­al 2000 com­pa­nies to move for­ward a new agenda.

Plan­et Earth 2.0: A New Oper­at­ing Sys­tem: Imag­ine see­ing a top sheik in Dubai, wrapped in tra­di­tion­al Arab cloth­ing, exclaim “Yes We Can (a la Oba­ma) in front of the 800 glob­al experts, adding that “we build the future with our own hands. Some of the atten­dants of the World Eco­nom­ic Forum’s Sum­mit of the Glob­al Agen­da urged us to “reboot” the sys­tem. More than a “reboot”, we may have to upgrade to a new glob­al “Yes We Can” oper­at­ing system.

Brain Fit­ness Research 

Train­ing Atten­tion and Emo­tion­al Self-Reg­u­la­tion: Dr. Michael Pos­ner, a promi­nent  cog­ni­tive neu­ro­sci­en­tist and first recip­i­ent of the Dogan Prize, grants us a fas­ci­nat­ing inter­view on what atten­tion, self-reg­u­la­tion, and effort­ful con­trol are, and how to improve them using soft­ware, med­i­ta­tion, and par­ent­ing. In his words, “we have found no ceil­ing for abil­i­ties such as atten­tion, includ­ing among adults. The more train­ing (…) the high­er the results.”

Neu­ro­plas­tic­i­ty and the Brain That Changes Itself: Lau­rie Bar­tels reviews the excel­lent book by Nor­man Doidge, explain­ing that “the neu­ro­science behind Doidge’s book involves neu­ro­plas­tic­i­ty, which is the brain’s abil­i­ty to rewire itself. This means that the brain  is our intel­li­gence,  is not some­thing fixed in con­crete but rather a chang­ing, learn­ing entity.”

Can We Pick Your Brain re: Cog­ni­tive Assess­ments?: In our view, a crit­i­cal com­po­nent in the matu­ri­ty of the brain fit­ness mar­ket will be the avail­abil­i­ty of inex­pen­sive, valid and reli­able objec­tive cog­ni­tive assess­ments,  to help mea­sure how our brain func­tions change over time and iden­ti­fy pri­or­i­ties for tar­get­ed improve­ments. Dr. Joshua Stein­er­man asks if you would be up for them?

Use It (Prop­er­ly) or Lose It

Mem­o­ry Prob­lems? Per­haps you are Mul­ti-task­ing: Dr. Bill Klemm tells us that “Mul­ti-task­ing vio­lates every­thing we know about how mem­o­ry works.” He explains that “(mul­ti-task­ing) prob­a­bly does make learn­ing less tedious, but it clear­ly makes learn­ing less effi­cient and less effective.”

Phys­i­cal and men­tal exer­cise to pre­vent cog­ni­tive decline: The Amer­i­can Med­ical News, a week­ly news­pa­per for physi­cians pub­lished by the Amer­i­can Med­ical Asso­ci­a­tion, just pub­lished an excel­lent arti­cle on the impor­tance of phys­i­cal and men­tal exer­cise. We are very hap­py to see efforts like these to train physi­cians and health pro­fes­sion­als in gen­er­al,  giv­en that most of them were trained under a very dif­fer­ent under­stand­ing of the brain than the one we have today.

Brain Fit­ness 2: Sight & Sound: PBS recent­ly announced the sec­ond install­ment of their pop­u­lar Brain Fit­ness Pro­gram show, to start air­ing soon.

MetaCar­ni­val #1: a con­ver­sa­tion across the blo­gos­phere: We often insist on “Nov­el­ty, Vari­ety and Chal­lenge” as key ingre­di­ents for good “brain exer­cise”. There are many ways to mix those ingre­di­ents — you may enjoy this one, the first inter­dis­ci­pli­nary gath­er­ing of blogs and blog car­ni­vals cov­er­ing health, sci­ence, anthro­pol­o­gy, gen­er­al advice and more.

Brain Teasers

Top 15 Brain Teasers and Games for Men­tal Exer­cise: Over the last 2 years we have pub­lished close to 100 puz­zles, teasers, rid­dles, and every kind of men­tal exer­cise (with­out count­ing our in-depth inter­views with top neu­ro­sci­en­tists). Which ones have proven most stim­u­lat­ing for you. Let us know. Here is a selec­tion of our Top 15 teasers.

Final Details

That’s all for now. Next month, we will be offer­ing anoth­er great selec­tion of arti­cles: Dr. Andrew New­berg will dis­cuss the brain val­ue of med­i­ta­tion,  Dr. David Rabin­er will review a recent study on how neu­ro­feed­back may assist in the diag­nos­tic of atten­tion deficits, and much more.

Please share this newslet­ter with your friends and col­leagues if you haven’t done so already.

Have a Hap­py Thanksgiving!

Physical and mental exercise to prevent cognitive decline

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We offered some Brain Fit­ness Pre­dic­tions in our Mar­ket Report , including…

“7. Doc­tors and phar­ma­cists will help patients nav­i­gate through the over­whelm­ing range of avail­able prod­ucts and inter­pret the results of cog­ni­tive assess­ments. This will require sig­nif­i­cant pro­fes­sion­al devel­op­ment efforts, giv­en that most doc­tors today were trained under a very dif­fer­ent under­stand­ing of the brain than the one we have today.”

The Amer­i­can Med­ical News, a week­ly news­pa­per for physi­cians pub­lished by the Amer­i­can Med­ical Asso­ci­a­tion, just pub­lished an excel­lent arti­cle along those lines:

Steps to a nim­ble mind: Phys­i­cal and men­tal exer­cise help keep the brain fit
— Neu­ro­science is uncov­er­ing tech­niques to pre­vent cog­ni­tive decline.

A few quotes:

- It’s an exam­ple that high­lights a wave of new think­ing about the impor­tance of brain fitness.

- Until recent­ly, con­ven­tion­al wis­dom held that our brains were intractable, hard-wired com­put­ers. What we were born with was all we got. Age wore down mem­o­ry and the abil­i­ty to under­stand, and few inter­ven­tions could reverse this process. But increas­ing­ly, evi­dence sug­gests that phys­i­cal and men­tal exer­cise can alter spe­cif­ic brain regions, mak­ing rad­i­cal improve­ments in cog­ni­tive function.

- With near­ly 72 mil­lion Amer­i­cans turn­ing 65 over the next two decades, physi­cians need the tools to han­dle grow­ing patient con­cerns about how to best main­tain brain health. Armed with this new brand of sci­ence, front­line physi­cians will be bet­ter equipped to address the needs of aging baby boomers, already in the throes of the brain fit­ness revolution.

- “Encour­age them to exer­cise the brain in nov­el and com­plex ways,” he says.

Full arti­cle: here

One of the physi­cians quot­ed in the arti­cle is Gary J. Kennedy, MD, Direc­tor of the Divi­sion of Geri­atric Psy­chi­a­try at Mon­te­fiore Med­ical Cen­ter in NYC and a pro­fes­sor in the Dept. of Psy­chi­a­try and Behav­ioral Sci­ences at Albert Ein­stein Col­lege of Medicine.

To put the AMA arti­cle in bet­ter per­spec­tive for Sharp­Brains read­ers, we asked Dr. Kennedy a few fol­low-up ques­tions. Below you have his questions.

Alvaro Fer­nan­dez (AF): Can you sum­ma­rize how cog­ni­tive func­tions tend to evolve as we age?

Gary Kennedy (GK): As we age cog­ni­tive func­tions that rely on [Read more…] about Phys­i­cal and men­tal exer­cise to pre­vent cog­ni­tive decline