anxiety

Anxiety linked to rising amyloid-beta levels

  • A study found an association in healthy older adults between higher amyloid beta levels and worsening anxiety.

Data from the Harvard Aging Brain Study found that higher amyloid beta levels were associated with increasing anxiety symptoms in cognitively normal older adults. The results suggest that worsening anxious-depressive symptoms may be an early predictor of elevated amyloid beta levels.

The study involved 270 cognitively healthy older adults (62-90). For five years, participants were annually assessed for depression, apathy-anhedonia, dysphoria, and anxiety.

https://www.eurekalert.org/pub_releases/2018-01/bawh-aa011118.php

Reference: 

Donovan et al. 2017. Longitudinal Association of Amyloid Beta and Anxious-Depressive Symptoms in Cognitively Normal Older Adults. The American Journal of Psychiatry DOI: 10.1176/appi.ajp.2017.17040442

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Psychological distress a risk factor for dementia

  • A large Danish study has found that the greater number of symptoms of distress in late midlife, the more likely the individual was to develop dementia later in life.

Survey data from 6,807 Danish older adults (average age 60) in the Copenhagen City Heart Study, has found that being distressed in late midlife is associated with a higher risk of dementia in later life.

The survey measured “vital exhaustion”, which is operationalized as feelings of unusual fatigue, increased irritability and demoralization and can be considered an indicator of psychological distress. Vital exhaustion is suggested to be a response to unsolvable problems in individuals' lives, in particular when being incapable of adapting to prolonged exposure to stressors.

The study found a dose-response relation between symptoms of vital exhaustion reported in late midlife and the risk of dementia later in life:

  • for every additional symptom, dementia incidence increased by 2%
  • those reporting 5 to 9 symptoms had a 25% higher risk of dementia compared to those with no symptoms
  • those reporting 10 to 17 symptoms (the maximum) had a 40% higher risk of dementia compared with not having symptoms.

Results were adjusted for gender, marital status, lower educational level, lifestyle factors and comorbidities.

https://www.eurekalert.org/pub_releases/2019-01/ip-pdi011719.php

Full paper available at: https://content.iospress.com/articles/journal-of-alzheimers-disease/jad180478

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Chemo-brain: prevalence, why it happens, and how to help

  • The largest study to date of chemo-brain shows that 45% of women with breast cancer report it's a substantial problem for months after chemotherapy.
  • A rat study suggests an effect of chemotherapy on dopamine and serotonin may be partly responsible.
  • Better cognitive function, and improved mood, are linked to frequent moderate-to-vigorous physical exercise among breast cancer survivors.
  • A new cognitive-behavioral treatment program has been trialed with positive results.

Chemo-brain common among women with breast cancer

A study involving 581 breast cancer patients and 364 healthy age-matched people (mean age 53) has found that women with breast cancer reported significantly greater cognitive difficulties for up to six months after chemotherapy. Cognitive difficulties were evaluated using FACT-Cog, an assessment that examines a person's own perceived impairment as well as cognitive impairment perceived by others.

Compared to healthy controls, the FACT-Cog scores of women with breast cancer were 45% lower at outset. This difference increased substantially after chemotherapy (see graph). The first assessment after chemotherapy was at 4.8 months, with the second 6 months after that (i.e, nearly a year after chemotherapy). Patients were also much more likely to report significant cognitive decline from diagnosis to the first post-chemotherapy assessment (45.2% vs 10.4% of the controls), and from prechemotherapy to second post-chemotherapy assessment (36.5% v 13.6%).

Having more anxiety and depressive symptoms at the outset, and having lower cognitive reserve (assessed by a reading score), were significantly associated with lower scores.

Those who received hormone therapy and/or radiation treatment after chemotherapy had similar cognitive problems to women who received chemotherapy alone.

Chemobrain a product of dysfunction in dopamine & serotonin release?

A rat study suggests one reason for chemo-brain is an effect of chemotherapy on the neurotransmitters dopamine and serotonin. Both of these are important for both mood and cognition.

After giving carboplatin (commonly used with breast, bladder, colon and other cancers) to rats over four weeks, researchers found that the release and uptake of both dopamine and serotonin in their brains became impaired, although overall levels didn’t change. The rats also showed impaired cognition.

Exercise helps memory for breast cancer survivors

A role for dopamine and serotonin in chemo-brain is consistent with findings that anxiety and depression are risk factors for chemo-brain. No surprise then, that a study has found that physical exercise helps improve cognition in breast cancer survivors.

The study used self-reported data from 1,477 breast cancer survivors, as well as from accelerometers worn by 362 of the women. It found that breast cancer survivors who did more moderate or vigorous physical activity (including brisk walking, biking, jogging, or an exercise class) had fewer subjective memory problems.

Higher levels of physical activity were associated with lower levels of fatigue and distress, and higher levels of physical confidence. The researchers suggest that exercise reduces subjective memory problems via these factors.

Cognitive-behavioral therapy may help

A cognitive-behavioral therapy called "Memory and Attention Adaptation Training" (MAAT), which helps cancer survivors to increase their awareness of situations where memory problems can arise and to develop skills to either prevent memory failure or to compensate for memory dysfunction, has been trialed in a small randomized study involving 47 Caucasian breast cancer survivors. The patients were an average of four years post-chemotherapy.

The participants were either assigned to eight visits of MAAT (30 to 45 minutes each visit) or supportive talk therapy for the same length of time. Both treatments were delivered over a videoconference network between health centers.

MAAT participants reported significantly fewer memory problems as well as improved processing speed two months after treatment. They also reported much less anxiety about cognitive problems.

https://www.eurekalert.org/pub_releases/2017-01/uorm-caw010317.php

http://www.eurekalert.org/pub_releases/2016-05/acs-ih052516.php

http://www.futurity.org/exercise-breast-cancer-memory-1200372-2/

http://www.eurekalert.org/pub_releases/2016-05/w-ctm050216.php

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Concrete thinking may reduce the power of traumatic memories

  • Focusing on concrete details when experiencing a traumatic event may, oddly enough, protect you more from the power of those memories, than if you tried to distance yourself from what you are experiencing.

Can you help protect yourself from the memory of traumatic events? A new study suggests that, by concentrating on concrete details as you live through the event, you can reduce the number of intrusive memories later experienced.

The study, aimed particularly at those who deliberately expose themselves to the risk of PTSD (e.g., emergency workers, military personnel, journalists in conflict zones), involved 50 volunteers who rated their mood before watching several films with traumatic scenes. After the first film, they rated their feelings. For the next four films, half the participants were asked to consider abstract questions, such as why such situations happened. The other half were asked to consider concrete questions, such as what they could see and hear and what needed to be done from that point. Afterward, they gave another rating on their mood. Finally, they were asked to watch a final film in the same way as they had practiced, rating feelings of distress and horror as they had for the first film.

The volunteers were then given a diary to record intrusive memories of anything they had seen in the films for the next week.

Both groups, unsurprisingly, saw their mood decline after the films, but those who had been practicing concrete thinking were less affected, and also experienced less intense feelings of distress and horror when watching the final film. Abstract thinkers experienced nearly twice as many intrusive memories in the following week.

The study follows previous findings that emergency workers who adopted an abstract processing approach showed poorer coping, and that those who processed negative events using abstract thinking experienced a longer period of low mood, compared to those using concrete thinking.

Further study to confirm this finding is of course needed in real-life situations, but this does suggest a strategy that people who regularly experience trauma could try. It is particularly intriguing because, on the face of it, it would seem like quite the wrong strategy. Distancing yourself from the trauma you're experiencing, trying to see it as something less real, seems a more obvious coping strategy. This study suggests it is exactly the wrong thing to do.

It also seems likely that this tendency to use concrete or abstract processing may reflect a more general trait. Self-reported proneness to intrusive memories in everyday life was significantly correlated with intrusive memories of the films. Perhaps we should all think about the way we view the world, and those of us who tend to take a more abstract approach should try paying more attention to concrete details. This is, after all, something I've been recommending in the context of fighting sensory impairment and age-related cognitive decline!

Abstract thinking certainly has its place, but as I've said before, we need flexibility. Effective cognitive management is about tailoring your style of thinking to the task's demands.

http://www.eurekalert.org/pub_releases/2016-05/uoo-tdc050516.php

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More evidence that stress increases risk of Alzheimer's

  • A stress hormone has been found to be associated with more amyloid-beta protein, in mice and human neurons.
  • The finding helps explain why stress is a risk factor for Alzheimer's.
  • A previous 38-year study supports this with the finding that women who scored highly in "neuroticism" in middle age, had a greater chance of later developing Alzheimer's.
  • This link was largely accounted for by chronic stress experienced by these women over the four decades.

A study involving both mice and human cells adds to evidence that stress is a risk factor for Alzheimer's.

The study found that mice who were subjected to acute stress had more amyloid-beta protein in their brains than a control group. Moreover, they had more of a specific form of the protein, one that has a particularly pernicious role in the development of Alzheimer's disease.

When human neurons were treated with the stress hormone corticotrophin releasing factor (CRF), there was also a significant increase in the amyloid proteins.

It appears that CRF causes the enzyme gamma secretase to increase its activity. This produces more amyloid-beta.

The finding supports the idea that reducing stress is one part of reducing your risk of developing Alzheimer's.

A neurotic personality increases the risk of Alzheimer's disease

An interesting study last year supports this.

The study, involving 800 women who were followed up some 40 years after taking a personality test, found that women who scored highly in "neuroticism" in middle age, have a greater chance of later developing Alzheimer's. People who have a tendency to neuroticism are more readily worried, distressed, and experience mood swings. They often have difficulty in managing stress.

The women, aged 38 to 54, were first tested in 1968, with subsequent examinations in 1974, 1980, 1992, 2000, and 2005. Neuroticism and extraversion were assessed in 1968 using the Eysenck Personality Inventory. The women were asked whether they had experienced long periods of high stress at each follow-up.

Over the 38 years, 153 developed dementia (19%), of whom 104 were diagnosed with Alzheimer's (13% of total; 68% of those with dementia).

A greater degree of neuroticism in midlife was associated with a higher risk of Alzheimer's and long-standing stress. This distress accounted for a lot of the link between neuroticism and Alzheimer's.

Extraversion, while associated with less chronic stress, didn't affect Alzheimer's risk. However, high neuroticism/low extraversion (shy women who are easily worried) was associated with the highest risk of Alzheimer's.

The finding supports the idea that long periods of stress increase the risk of Alzheimer's, and points to people with neurotic tendencies, who are more sensitive to stress, as being particularly vulnerable.

http://www.eurekalert.org/pub_releases/2015-09/uof-uhr091615.php

http://www.eurekalert.org/pub_releases/2014-10/uog-anp101414.php

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Parents' math anxiety can undermine children's math achievement

  • 1st- & 2nd-grade children learned less math and developed more math anxiety when math-anxious parents frequently helped with their math homework.
  • Children with math-anxious parents who rarely helped with their math homework were not affected.

A study of 438 first- and second-grade students and their primary caregivers has revealed that parents' math anxiety affects their children's math performance — but (and this is the surprising bit) only when they frequently help them with their math homework.

The study builds on previous research showing that students learn less math when their teachers are anxious about math. This is not particularly surprising, and it wouldn't have been surprising if this study had found that math-anxious parents had math-anxious children. But the story wasn't that simple.

Children were assessed in reading achievement, math achievement and math anxiety at both the beginning and end of the school year. Children of math-anxious parents learned significantly less math over the school year and had more math anxiety by the year end—but only if math-anxious parents reported providing help every day with math homework. When parents reported helping with math homework once a week or less often, children’s math achievement and attitudes were not related to parents’ math anxiety. Reading achievement (included as a control) was not related to parents' math anxiety.

Interestingly, the parents' level of math knowledge didn't change this effect (although this is less surprising when you consider the basic-level of math taught in the 1st and 2nd grade).

Sadly, the effect still held even when the teacher was strong in math.

It's suggested that math-anxious parents may be less effective in explaining math concepts, and may also respond less helpfully when children make a mistake or solve the problem in a non-standard way. People with high math anxiety tend to have poor attitudes toward math, and also a high fear of failing at math. It's also possible (likely even) that they will have inflexible attitudes to how a math problem “should” be done. All of these are likely to demotivate the child.

Analysis also indicated that it is not that parents induced math anxiety in their children, who thus did badly, but that their homework help caused the child to do poorly, thus increasing their math anxiety.

Information about parental anxiety and how often parents helped their children with math homework was collected by questionnaire. Math anxiety was assessed using the short (25-item) Math Anxiety Rating Scale. The question, “How often do you help your child with their math homework?” was answered on a 7-point scale (1 = never, 2 = once a month, 3 = less than once a week, 4 = once a week, 5 = 2–3 times a week, 6 = every day, 7 = more than once a day). The mean was 5.3.

The finding points to the need for interventions focused on both decreasing parents' math anxiety and scaffolding their skills in how to help with math homework. It also suggests that, in the absence of such support, math-anxious parents are better not to help!

http://www.eurekalert.org/pub_releases/2015-08/uoc-pma080715.php

http://www.futurity.org/parents-math-anxiety-979472/

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Math anxiety starts before school, impacts math achievement

"The general consensus is that math anxiety doesn't affect children much before fourth grade.” New research contests that.

Study 1: found many first grade students do experience negative feelings and worry related to math. This math anxiety negatively affects their math performance when it comes to solving math problems in standard arithmetic notation.

Study 2: found that second grade math anxiety affected second grade computations and math applications. Additionally, children with higher levels of math anxiety in second grade learned less math in third grade.

03/2013

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Worry & fatigue main reason for ‘chemo-brain’?

January, 2013

A new study points to pre-treatment reasons for declined cognitive function following chemotherapy, and suggests that anxiety may be the main driver.

The issue of ‘chemo-brain’ — cognitive impairment following chemotherapy — has been a controversial one. While it is now (I hope) accepted by most that it is, indeed, a real issue, there is still an ongoing debate over whether the main cause is really the chemotherapy. A new study adds to the debate.

The study involved 28 women who received adjuvant chemotherapy for breast cancer, 37 who received radiotherapy, and 32 age-matched healthy controls. Brain scans while doing a verbal working memory task were taken before treatment and one month after treatment.

Women who underwent chemotherapy performed less accurately on the working memory task both before treatment and one month after treatment. They also reported a significantly higher level of fatigue. Greater fatigue correlated with poorer test performance and more cognitive problems, across both patient groups and at both times (although the correlation was stronger after treatment).

Both patient groups showed reduced function in the left inferior frontal gyrus, before therapy, but those awaiting chemotherapy showed greater impairment than those in the radiotherapy group. Pre-treatment difficulty in recruiting this brain region in high demand situations was associated with greater fatigue after treatment.

In other words, reduced working memory function before treatment began predicted how tired people felt after treatment, and how much their cognitive performance suffered. All of which suggests it is not the treatment itself that is the main problem.

But the fact that reduced working memory function precedes the fatigue indicates it’s not the fatigue that’s the main problem either. The researchers suggest that the main driver is level of worry —worry interfered with the task; level of worry was related to fatigue. And worry, as we know, can reduce working memory capacity (because it uses up part of it).

All of which is to say that support for cancer patients aimed at combating stress and anxiety might do more for ‘chemo-brain’ than anything else. In this context, I note also that there have been suggestions that sleep problems have also been linked to chemo-brain — a not unrelated issue!

Reference: 

Cimprich, B. et al. 2012. Neurocognitive impact in adjuvant chemotherapy for breast cancer linked to fatigue: A Prospective functional MRI study. Presented at the 2012 CTRC-AACR San Antonio Breast Cancer Symposium, Dec. 4-8

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Feeling lonely linked to increased dementia risk

January, 2013

A study that attempts to separate the effects of social isolation from subjective feelings of loneliness concludes that feelings of loneliness have a greater effect on dementia risk.

There's quite a bit of evidence now that socializing — having frequent contact with others — helps protect against cognitive impairment in old age. We also know that depression is a risk factor for cognitive impairment and dementia. There have been hints that loneliness might also be a risk factor. But here’s the question: is it being alone, or feeling lonely, that is the danger?

A large Dutch study, following 2173 older adults for three years, suggests that it is the feeling of loneliness that is the main problem.

At the start of the study, some 46% of the participants were living alone, and some 50% were no longer or never married (presumably the discrepancy is because many older adults have a spouse in a care facility). Some 73% said they had no social support, while 20% reported feelings of loneliness.

Those who lived alone were significantly more likely to develop dementia over the three year study period (9.3% compared with 5.6% of those who lived with others). The unmarried were also significantly more likely to develop dementia (9.2% vs 5.3%).

On the other hand, among those without social support, 5.6% developed dementia compared with 11.4% with social support! This seems to contradict everything we know, not to mention the other results of the study, but the answer presumably lies in what is meant by ‘social support’. Social support was assessed by the question: Do you get help from family, neighbours or home support? It doesn’t ask the question of whether help would be there if they needed it. So this is not a question of social networks, but more one of how much you need help. This interpretation is supported by the finding that those receiving social support had more health problems.

So, although the researchers originally counted this question as part of the measure of social isolation, it is clearly a poor reflection of it. Effectively, then, that leaves cohabitation and marriage as the only indices of social isolation, which is obviously inadequate.

However, we still have the interesting question re loneliness. The study found that 13.4% of those who said they felt lonely developed dementia compared with 5.7% of those who didn’t feel this way. This is a greater difference than that found with the ‘socially isolated’ (as measured!). Moreover, once other risk factors, such as age, education, and other health factors, were accounted for, the association between living alone and dementia disappeared, while the association with feelings of loneliness remained.

Of course, this still doesn’t tell us what the association is! It may be that feelings of loneliness simply reflect cognitive changes that precede Alzheimer’s, but it may be that the feelings themselves are decreasing cognitive and social activity. It may also be that those who are prone to such feelings have personality traits that are in themselves risk factors for cognitive impairment.

I would like to see another large study using better metrics of social isolation, but, still, the study is interesting for its distinction between being alone and feeling lonely, and its suggestion that it is the subjective feeling that is more important.

This is not to say there is no value in having people around! For a start, as discussed, the measures of social isolation are clearly inadequate. Moreover, other people play an important role in helping with health issues, which in turn greatly impact cognitive decline.

Although there was a small effect of depression, the relationship between feeling lonely and dementia remained after this was accounted for, indicating that this is a separate factor (on the other hand feelings of loneliness were a risk factor for depression).

A decrease in cognitive score (MMSE) was also significantly greater for those experiencing feelings of loneliness, suggesting that this is also a factor in age-related cognitive decline.

The point is not so much that loneliness is more detrimental than being alone, but that loneliness in itself is a risk factor for cognitive decline and dementia. This suggests that we should develop a better understanding of loneliness, how to identify the vulnerable, and how to help them.

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