Monday, January 2, 2023

BRAIN HEALTH REVIEW [Part 3]: POST-COVID BRAIN FOG & WORK PERFORMANCE

Written by: Marilyn Abrahamson, MA,CCC-SLP - CBHC

For some, Post-Covid brain fog can cause everyday cognitive tasks to be more difficult, causing the thought of returning to work to become daunting. Among the many symptoms of Long Covid, one study suggests that up to 80% of Covid-19 survivors suffer from neuropsychological symptoms such as memory impairment, attention deficit, executive dysfunction, difficulty with word finding, multitasking, and impaired visual/spatial skills. These are skills people need to properly perform their jobs, and without these skills, people can become overwhelmed by the smallest tasks.

Another study specifically measured the effects of brain fog on quality of life (QoL) at work. It showed that QoL at work was reduced for over 75% of study participants continuing to experience brain fog symptoms. There were many symptoms included under the umbrella term brain fog, however, in this study, memory problems and difficulty with multitasking had the most significant impact on QoL at work.


With this in mind, many employers are now being asked to help by making accommodations that include delaying deadlines, allowing more flexible work schedules, and reducing workloads.

HOW AND WHY COVID-19 CAUSES BRAIN FOG SYMPTOMS
Researchers have discovered multiple causes of persistent neurocognitive symptoms after having Covid-19.  Three of the most common are as follows:

NEUROINFLAMMATION: Increased levels of inflammatory cytokines (molecules produced by the immune system that help the body fight infection) have been found within the brain for weeks after a bout with Covid-19. When the immune system becomes uncontrolled, it can cause increased inflammation in the brain, resulting in poor communication between the brain cells and nerve pathways, causing the brain to feel foggy and slow.

REDUCED OXYGEN AND BLOOD FLOW TO THE BRAIN: Covid-19 is primarily a respiratory virus and can cause hypoxia (reduced levels of oxygen) in some patients. This reduction of oxygen and blood flow to the brain can result in a metabolic disturbance, disrupting the connection between brain cells and the blood vessels that supply them with nourishment. Imaging studies showed the same metabolic changes in both the brains of patients who had suffered from hypoxia as well as those with Long Covid brain fog symptoms. Notably, this is also a similar mechanism for lingering cognitive symptoms after traumatic brain injury.

DISTRACTION CAUSED BY THE PRESENCE OF OTHER LINGERING SYMPTOMS: This is not exclusive to Covid-19, but the symptoms of brain fog can be partially attributed to associated symptoms such as acute or long-standing bouts with headaches, fatigue, and body aches. The presence of any type of physical discomfort or emotional upset can make cognitive tasks more difficult due to distraction, causing the lack of attention, focus and concentration.


HOW TO COPE WITH SYMPTOMS
If brain fog symptoms are significantly affecting work performance, deep cognitive testing can be performed by a neuropsychologist (SLP). Evaluation and treatment for cognitive symptoms can also be offered by a speech-language pathologist. Treatment by an SLP will likely include brain exercises as well as instruction in compensatory strategies for memory and attention. There are also brain-healthy habits people can engage in on their own.

● Exercise is key. Both aerobic exercise and strength training are important for brain health.

● Puzzles or brain training apps like Brain HQ can be helpful.

Try to get 7-8 hours of good quality sleep each night.

Eat a brain healthy diet high in monounsaturated fats, plant protein, whole grains, and seafood.

Stay connected with others and socialize often.

Try mindfulness and meditation to help reduce stress and improve focused attention.

Learning and using both internal and external memory strategies. There are strategies for name recall, remembering lists and reminders, organizational systems and calendar management. These are compensatory strategies that help people work around the part of their brains that are not working as well as they did before.

Pacing oneself. If fatigue sets in, it can cause more fogginess. Taking a break is the best way to reset and recharge.

Aside from seeing their personal physician, consulting a mental health professional is crucial if a person is experiencing mood changes or depression. 



SUPPLEMENTAL:

"5 NEGATIVE ANTIGEN TESTS DO NOT MATCH  HOW OFF I FEEL..."

In August of 2021, David (last name withheld) got hit with the Delta Variant, knocking him completely off his feet! With flu-like symptoms, he saw stars for most of his recuperation period while taste and smell were completely shut down. For 1 week, David quarantined in his office - armed with every super-food, every kind of soup and immune booster his support team could find.  Being fully vaccinated only meant he had a better chance of NOT DYING, but as the world was only a year into the data collection, there was still so much left to understand about the recuperation period as well as its long standing effects.  (see complete article)


THE SCIENCE OF THE MAGNETIC GAZE & THE HEALING POWER OF PAW-SITIVITY 
Written by: Dr. Roberta Kline

The relationship between dogs and humans began since the beginning of time when dogs looked to humans as a means of survival. Numerous studies have reported the significant benefits of pet ownership and interactive coexistence -  from stress reduction to social fulfilment to a healthier lifestyle.  Science is now providing insights into how this works, and the two hormones that are responsible: OXYTOCIN and CORTISOL.  A landmark study in 2015 revealed how dogs and their owners emotionally bond, and it’s related to the production of oxytocin – also known as the bonding hormone. When released, oxytocin creates a powerful social attachment between one person and another and creates that “feel good” sense of nurturing and closeness. 

It is known that a lengthy eye contact (or mutual gaze) forges a unique engagement between two individuals that somehow activates the release of our oxytocin, which also mediates a powerful emotional bond. One of the best-known examples of this is in the bond created between mother and infant. The oxytocin response is a feedback loop- a nurturing gaze from mom releases oxytocin in the infant, which stimulates production of oxytocin in the mother, then further stimulating nurturing behavior into a self-sustaining positive feedback loop. (See complete article)






2022: THE EVER-ESCALATING RISE IN ANXIETY (Generalized Anxiety Disorder)  

By: Soraya Behzadi

Introduction (by: IPHA News Editorial Team): The medical community classifies Generalized Anxiety Disorder as "a condition of excessive worry about everyday issues and situations". It is identified as 'persistent worrying', over-thinking or recurring anxiety about specific matters and areas that are beyond actual proportion to their real impact. GAD encompasses irregular worrying, fatigue, restlessness, irritability, loss of focus and trouble sleeping.  This next feature is presented within our BRAIN HEALTH issue partly aligned with our post Covid-19 (Brain Fog) review due to the significant correlation between a global spike in anxiety disorder cases within our pandemic culture.  This mental health wave reflects many links between cognitive and physiological distress due to the biochemical effects of post-Covid issues - where amplified anxiety is reported as one of the many.

Anxiety is one of the most prevalent mental illnesses today, affecting individuals of all ages. Chronic anxiety, a condition where individuals suffer from excessive worry about everyday issues and situations, is increasing, affecting youths at an earlier age than anticipated. Despite knowing this chronic illness has affected many physically and mentally, there is still much to be researched and discovered.

Traditional stigmas of associating a mental health disorder with weakness and emotional dysregulation, has been one of the downfalls toward treatment advancement. Many articles speak upon the severity of Generalized Anxiety Disorder (GAD) but the common cause and basic treatment in order to help these individuals seem to lack an overall conclusion. This can lead patients feeling hopeless with their disorder, not knowing where to start when it comes to finding beneficial coping mechanisms. This article is set out to be informative regarding GAD and hopes to not only bring new information, but more clarity on individuals that struggle with chronic anxiety.


The DSM-5, categories GAD as excessive anxiety and worry, occurring more days for at least 6 months. These worries can range from events regarding professional life to personal relationships. The symptoms that can arise from anxiety include restlessness, being easily fatigued, difficulty concentrating, irritability, or sleep disturbances [2].

Many people struggle with GAD. One particular individual I observed, Patient X, is a twenty year old female. In her early adolescent years, the patient struggled with somniphobia, fear of worrying about dying in her sleep. This fear manifested into a period of vast anxiety that limited her from getting an adequate amount of sleep for a one month period. During her first semester in college, bullying by her roommate triggered her initial insomnia attack. Feeling out of control, she developed intense insomnia averaging 1-3 hours of sleep for the duration of the semester. Seeking treatment, 3 milligrams of Eszopiclone was prescribed, but was not effective. She went back home, hoping to ease her anxiety, but it manifested into distortions regarding body image, academic performance, and personal relationships.

The patient's symptoms included a resting heart rate of 110 bpm alongside a 25 pound weight loss (130 lbs to 105 lbs). For a period of 9 months, she encountered excessive anxiety and negativity about herself and the world around her. Reading self help books and engaging in intense exercise weekly was not effective. With lack of sleep and adequate nutrition, her academic performance declined.

The patient can be diagnosed with GAD. When reviewing the criteria from the DSM-5, the symptoms listed prior persisted for more than a period of 6 months[2]. The study, “The Neurobiological Mechanisms of Generalized Anxiety Disorder and Chronic Stress,” researchers described symptoms of GAD to include, “feeling restless, being easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension, and sleep disturbance” [3]. She experienced feeling mentally and emotionally fatigued as her insomnia persisted. She lacked the ability to concentrate on her daily priorities, and became consumed with the possible negative outcomes of the future. Restlessness and decreased appetite was a result of having GAD.

Looking into the patient's family history, a genetic component could be a possible cause of her GAD. Researchers found that women have higher rates of anxiety disorders than men, “The National Comorbidity Survey found that rates for GAD were women: 6.6% vs. men: 3.6%” [5]

From a cognitive perspective, the patient developed GAD from feeling a disproportionate level of worry over an emotional trigger. If she focused on the negative outcomes of any situation, she would be able to gain more control having already predicted the outcome. Patient X experienced two types of cognitive biases to threat, attentional bias as well as interpretive bias (Rathus et al., 2017). Factors contributing to GAD include basic personality trait neuroticism in which she experiences a higher tendency towards negative emotions and moods. Anatomic or neurotransmitter irregularities can also cause a decreased hippocampal volume and cognitive abilities, where there are lower levels of the neurotransmitters that regulate mood like GABA and serotonin.

The standard treatment offered to patients with GAD is commonly (the gold standard) Cognitive Behavioral therapy (CBT). CBT can also be known as talk therapy, in which “psychotherapy involves working with a therapist to reduce your anxiety symptoms.” [4]. In CBT, she would undergo fortune telling, catastrophizing and emotion regulation therapy (ERT). Reconstructing distorted cognitions will teach her how to imagine her most anxious thoughts and prove her ability to be able to handle the potential threat.

Weight loss and lack of sleep can be addressed with antidepressants, SSRIs, and benzodiazepines to help ease her back into a more regulated mental state. (Rathus et al., 2017). The importance of studying GAD can be supported in the article, “Achieving Remission in Generalized Anxiety Disorder.” Researchers speak about the remission rates patients have achieved while battling GAD, “Between 50% and 60% of patients respond clinically to therapy, but only one-third to one-half attain remission or realize full recovery during the acute phase of treatment. Patients who achieve a sustained remission are less likely to experience relapse” [1].  With treatments of CBT and anti-anxiety medications, the patient will be able to live a comfortable life with GAD. With this path, patients will not be defined by their diagnosis, but will learn to adapt to it over time with a proper treatment plan.


REFERENCES

1.) Laura A. Mandos, PharmD , Jennifer A. Reinhold, PharmD, BCPS, BCPP , Karl Rickels, MD. (2009). Achieving Remission in Generalized Anxiety Disorder. Psychiatric Times. https://www.psychiatrictimes.com/view/achieving-remission-generalized-anxiety-disorder.   (2.) American Psychiatric Association. (2013). Anxiety disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596.dsm05   (3.) Patriquin, M. A., & Mathew, S. J. (2017). The Neurobiological Mechanisms of Generalized Anxiety Disorder and Chronic Stress. Chronic Stress. https://doi.org/10.1177/2470547017703993   (4.) Mayo Foundation for Medical Education and Research. (2017, October 13). Generalized anxiety disorder. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/generalized-anxiety-disorder/diagnosis-treatment/drc-20361045.   (5.) McLean, C. P., Asnaani, A., Litz, B. T., & Hofmann, S. G. (2011). Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness. Journal of psychiatric research, 45(8), 1027–1035. https://doi.org/10.1016/j.jpsychires.2011.03.006





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Everything is energy. Quantum physics has demonstrated that everything exists as a vibrational energy. Some forms of energy have a frequency low enough to make the object solid and therefore visible and physically tangible, such as concrete, trees, mountains, and the human body. Others, such as sound, light, heat and gravity are invisible – but they are no less real. The Biofield is a relatively new term developed in 1992 to describe the concept of energy in a more unified way, integrating knowledge gained from traditional practices with that of modern science.  Three of the main scientific principles underlying our current understanding of the Biofield energy are thermodynamics, physics and quantum physics.  (See complete feature article)


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RECENT CONTRIBUTORS

MARILYN ABRAHAMSON, MA, CCC-SLP : As a Brain Health Education Specialist at Ceresti Health, Marilyn offers initiatives that supports education and empowerment of family caregivers. She also writes for and edits the Ceresti’s monthly newsletter and produces all brain health education and brain-health coaching programs for caregivers.  Marilyn's prior work is as a NJ Licensed Speech-Language Pathologist since 1987 and is an Amen Clinics Certified Brain Health Coach.

SORAYA BEHZADI is an aspiring medical student and researcher in neurological studies focusing on holistic practice to help alleviate mental health, like generalized anxiety disorder. She received a bachelor's degree in clinical psychology with a minor in biological sciences from Hunter College. 
 Aside from being a medical assistant at local urgent cares, her current field placement under affiliations with the Integrative Pain Healers Alliance/Brain Health Collective fuels her interests in brain health initiatives from imaging to holistic perspectives.

ROBERTA KLINE, MD (Educational Dir. /Women's Diagnostic Group) is a board-certified ObGyn physician, Integrative Personalized Medicine expert, consultant, author, and educator whose mission is to change how we approach health and deliver healthcare. She helped to create the Integrative & Functional Medicine program for a family practice residency, has consulted with Sodexo to implement the first personalized nutrition menu for healthcare facilities, and serves as Education Director for several organizations including the Women’s Diagnostic Health Network, Mommies on a Mission. Learn more at https://robertaklinemd.com/





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BRAIN HEALTH REVIEW [Part 3]: POST-COVID BRAIN FOG & WORK PERFORMANCE

Written by: Marilyn Abrahamson, MA,CCC-SLP - CBHC For some, Post-Covid brain fog can cause everyday cognitive tasks to be more difficult, ca...