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Does Bilingualism Slow Cognitive Aging?

Research has suggested that using two or more languages on a daily basis helps older adults maintain a heightened functional state and improves neurocomputational efficiency. In a new review published in the Journal of Neurolinguistics, researchers discuss studies that have examined the effect of life-long bilingualism on age-related cognitive and neural decline, with a focus on discrepancies between different sources of evidence. The review outlines and characterizes factors which might explain inconsistencies between studies claiming that bilingualism has neurocognitive benefits and those that failed to find such evidence. The authors argue that individual variation in language proficiency and exposure, especially language switching frequency and daily frequency of use of the two languages, likely account for a significant chunk of the inconsistencies found in the literature and constrain the effectiveness of bilingualism as a cognitive and brain reserve factor. Finally, the reviews discusses studies of cognitive intervention and speculate on the potential of developing language training protocols to increase cognitive and neural resilience in older adults.

For the abstract

Exploding the Myths About Aging

We don't stop playing because we grow old, we grow old because we stop playing - George Bernard Shaw

For all that we are regularly besieged with slogans such as "60 is the new 40",  many people continue to view growing older with a sense of dread.  Despite decades of research into human aging, not to mention the fact that people are living longer and more productive lives, there still seems to be a popular belief that older adults have nothing to look forward to but worsening health problems and becoming a burden on society.

A new opinion piece published in the journal American Psychologist explores some of the common misconceptions about aging that help reinforce this pessimism about growing older.  As Manfred Diehl of Colorado State University, Michael A. Smyer of Bucknell University, and Chandra M. Mehrotra of the College of St. Scholastica point out in their article, not only has life expectancy risen steadily in the United States over the past 100 years, but advances in medicine have ensured that those extra years remain disability-free for most people.  In fact, never before in human history have adults had so many years of active life available to them, something that gerontologists refer to as the "longevity dividend" 

To read more, check out my new Psychology Today blog post.

 

Should Dementia Be Grounds for Euthanasia?

In a decision by the Netherlands Supreme Court that was passed last week, it is now lawful for doctors to euthanize patients with severe dementia, provided that the patient had previously chosen to be euthanized while still legally capable of  making that decision. 

Since the passage of one of the first assisted dying laws in 2001, the Netherlands has remained at the forefront of the euthanasia debate with an estimated 6,000 euthanasia cases as of 2016 (amounting to four percent of all deaths in the country).   Under this legislation, a candidate for euthanasia much be at least twelve years of age and with suffering that is "unbearable with no prospect of improvement."  and the euthanasia decision is independently reviewed by a second physician.    Patients between the age of twelve and sixteen are also allowed to request euthanasia with parental permission.  The decision to receive physician-assisted suicide must also be completely voluntary and with full awareness of the legal and ethical issues involved.   

Most instances of euthanasia involve the drinking a a barbiturate  compound which needs to be taken by the patient with the doctor present to avoid possible misuse or coercion.  While the majority of euthanasia cases have involved patients with incurable cancer or other serious medical ailments,   there have been an increasing number of cases of psychiatric patients being granted permission as well, something that has provoked strong controversy nationally and internationally.

The debate over dementia and euthanasia has escalated since 2018 with the resignation of medical ethicist Berna van Baarsen from a regional euthanasia board over that very question.  In one media interview, van Baarsen stressed that she was no longer capable of defending the right of dementia patients to give advance directives.  “It is fundamentally impossible to establish that the patient is suffering unbearably, because he can no longer explain it,'" she said.   

In the recent decision concerning dementia patients, people with dementia are deemed qualified for euthanasia, but only if an advance directive had been made or discussed with a doctor previously.  “For some people, the prospect of ever suffering from dementia may be sufficient reason to make an advance directive (living will). This can either be drawn up independently or discussed first with the family doctor. A physician can perform euthanasia on a patient with dementia only if such a directive exists, if statutory care is taken and if, in his opinion, the patient is experiencing unbearable suffering with no prospect of improvement,” says the Dutch government’s website.

The case that was heard by the Netherlands Supreme Court involved an unnamed female doctor who was accused of having broken the law by facilitating the death of a 74-year-old woman four years earlier.  The woman at the centre of the case had written an advanced directive years earlier, requesting the procedure in lieu of being put in a nursing home. In the directive, she had said she wished to “be able to decide while still in my senses and when I think the time is right.”  Despite the directive, prosecutors maintain that she gave "mixed signals" about proceeding, including attempting to fight off the doctor though she was no longer capable of speaking.   Though the doctor was deemed to be acting "with the best of intentions",  she was accused of acting without the patient's knowledge by slipping a sedative into her coffee.    A lethal drug was then administered and family members needed to hold the patient down as she struggled against the injection.

Though lower courts upheld the doctor's right to act, it was still sent to the Supreme Court due to concerns about possible misuse of the country's euthanasia law.   Critics have long argued that the Netherlands and other countries allowing euthanasia are on a "slippery slope" and that including conditions such as dementia and mental illness may lead to a redefining of the value of human life.   They also suggest that end-of-life decisions will be taken out of the hands of patients and given to medical doctors who may not act in the patient's best interest.    

 While cases of euthanasia for people suffering from severe dementia will remain rare for now, this may well change in the years to come due to the rising number of dementia cases expected over the next two decades, as well as the increasing number of jurisdictions approving assisted dying.   As it stands, the recent Supreme Court decision will likely influence similar cases worldwide for years to come.  

 

Can Personality Traits Protect Against Cognitive Decline in Seniors?

Cognitive complaints and engagement in cognitive activities are two consistent predictors of cognitive aging outcomes, including risk for nonnormative decline. Though research has considered predictors of complaints and engagement in general, little work has attended to the fact that these fluctuate at the daily level. A study recently published in the journal Psychology and Aging examined individual difference predictors of means and variability for engagement and complaints across 10 days in a sample of older adults (n = 136; Mage = 70.45 years). When comparing personality traits to indicators of cognitive performance, personality differences appeared better unique predictors for these measures of daily cognitive life. Specifically, even when accounting for demographics, measures of cognitive performance, and the other personality traits investigated, older adults higher on openness to experience reported fewer daily cognitive complaints and more engagement on average, as well as greater daily variability in engagement. In addition, higher neuroticism predicted greater variability in reports of cognitive complaints across days. Implications are discussed with respect to how these findings advance our understanding of cognitive complaints and engagement in daily life. (PsycINFO Database Record (c) 2020 APA, all rights reserved)

For the abstract

Primary and Secondary Caregivers in Dementia

Having 2 or more relatives involved in the informal care of people with dementia is frequent worldwide. There are, however, few comparisons of primary and secondary caregivers and even fewer of those who are caring for the same person. Our study aimed to contrast these 2 experiences of caregiving. In a recent issue of Psychology and Aging, researchers compared 2 related samples of 61 primary and 61 secondary family caregivers of the same persons with dementia in a nonrandomized cross-sectional study. Caregivers’ main outcome assessments were the Zarit Burden Interview (for subjective burden), the General Health Questionnaire (for psychological distress), and the Positive Aspects of Caregiving scale. We controlled for caregiver variables (e.g., demographics, caregiving arrangements, social support, sense of coherence) and the neuropsychiatric symptoms of dementia. Subjective burden was higher in primary than secondary caregivers (p = .013), but positive aspects of caregiving did not differ (p = .150). Psychological distress was high at clinically relevant levels in primary and secondary caregivers, without statistically significant differences between groups (p = .456). The findings demonstrate that notwithstanding the difficulties faced by primary caregivers, secondary caregivers may also experience clinically significant distress. Therefore, their needs for assistance and support should be addressed more systematically. These findings call for systemic family-focused interventions in dementia that address the support each person provides or might provide, as well as the psychological distress each person may feel. 

For the abstract

Predicting Dementia With a Smartwatch

As part of a broad-based project by Alzheimer's Research UK, a million British people over the age of 40 will begin wearing special smartwatches designed to help detect early signs of dementia.  Over the three years of the planned study, the prototype smartwatches will monitor over thirty potential indicators of dementia, including changes in speech, fine motor skills, memory, and sleep patterns.   Researchers are hoping to use the data collected in the study to identify early "fingerprints" that will allow them to predict people at risk for developing dementia later in life.   All participants have been recruited by the U.K. government's Accelerating Detection of Disease programme.

In a recent article in the Daily Telegraph, former British Prime Minister David Cameron, who is current president of Alzheimer's Research UK, described the new project as an example of how technology can be use to help dementia sufferers who are "slipping into a world of darkness".   "It has an achievable aim: to develop a gadget - a combination of a wearable device and smartphone app - to detect the earliest digital fingerprints of a disease," he wrote.  "‘This isn’t some Big Brother intervention. Just as we measure our cholesterol levels to tell us when we need a statin, we need to identify these fingerprints of diseases such as Alzheimer’s to see when we need a statin for the brain.... As prime minister, I was determined to prove this wasn’t an inevitable part of ageing but was being caused by diseases of the brain that can be tackled with research.  That’s why I put the issue on the global agenda, through summits such as the G8, and we doubled the research funding at home. And it’s why I made it my focus post-politics."

Carol Routledge, director of research at Alzheimer’s Research UK, stressed the importance of Early Detection of Neurodegenerative diseases (EDoN) technology in detecting diseases in the very early stages.  "Our research shows that 85% of UK adults would be willing to take a test that could tell them if they were in the early stages of a disease like Alzheimer’s, even before symptoms show," she said in a recent media interview.  "EDoN aims to harness the growing popularity of digital health technology and big data to revolutionise how we develop early tests for these diseases. Developing digital fingerprints that can be detected using phone apps or wearable technologies like smart watches would provide a low-cost approach to identifying those most at risk of disease,” says 

Dementia is already the leading cause of death in the U.K. and, in many cases, failure to make a proper diagnosis in the early stages can mean a significant delay in receiving treatment.  While there is, at present, no cure for more types of dementia, including Alzheimer's disease, early diagnosis and treatment can help slow down decline and allow people with dementia to remain functioning as long as possible. 

The initiative is a collaboration between Alzheimer’s Research UK and organisations including the Alan Turing Institute, University College London, and Newcastle, Exeter and Cambridge universities.   Partially sponsored by the Bill and Melinda Gates Foundation, the project hopes to secure at least £67 million in funding in the first six years and up to £100 million by 2030.

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Can Air Pollution Increase the Risk of Dementia?

Can proximity to major roads or highways, not to mention increased exposure to air pollution, make people more vulnerable to a wide range neurological disorders, including dementia?    A new research study released by the University of British Columbia suggests that it can.

The study, which was recently published in the journal Environmental Health, used data collected 678,000 adults between the ages of 45 and 84 who lived in Metro Vancouver from 1994 to 1998 and during a follow-up period from 1999 to 2003.   The adults in the sample were assessed in terms of individual exposures to road proximity, air pollution, noise, and greenness at each person’s residence using postal code data.   After collecting data during the follow-up period, including medical history, the study researchers determined that a disproportionately high percentage of adults living with fifty meters of a major road or highway had been diagnosed with Alzheimer's disease, non-Alzheimer's dementia, Parkinson's Disease, and Multiple Sclerosis.   Alternatively, results suggest that living near green spaces, such as public parks may help protect against these diseases, something that urban planners need to take into consideration for future development.

“For the first time, we have confirmed a link between air pollution and traffic proximity with a higher risk of dementia, Parkinson’s, Alzheimer’s and MS at the population level,” says lead researcher Weiran Yuchi in a recent interview.    “The good news is that green spaces appear to have some protective effects in reducing the risk of developing one or more of these disorders."   While Yushi stresses that more research is needed, these results do suggest that urban planning to increase the availability of green spaces in major cities 

Research has already demonstrated that living near major roadways can result in increased exposure to air pollutants, particularly diesel trucks which are a major source of a nitrogen dioxide, ultrafine particles, and black carbon soot)near roads.   Though pollution exposure help account for the increased link to serious illness, UBC professor Michael Brauer, who was the senior researcher for the study, suggests that there may be other reasons for the protective effect of green spaces.   

“For people who are exposed to a higher level of green space, they are more likely to be physically active and may also have more social interactions,”  said Brauer in a recent media interview.   “There may even be benefits from just the visual aspects of vegetation.”   

Neurological disorders such as dementia and Parkinson's disease, represent one of the leading causes of disability in most industrialized nations.   In the Canadian health care system alone, estimated costs were more than 10 billion dollars in 2012 and these numbers are already rising as more baby boomers develop debilitating symptoms.   With individuals over the age of 65 expected to account for one-fourth of the total population of Canada by 2035, identifying possible ways to reduce these health risks is more essential than ever.   Providing more green spaces and curbing pollution can yield important health dividends as well as helping older adults to remain functioning as long as possible.

Is Race a Factor in Quality of Dementia Care?

While dementia can occur in any family, a new study  recently published in the journal Clinical Epidemiology suggests that significant racial differences exist in terms of quality of care that dementia patients receive.   A team of researchers at University College London analysed data from 53,718 people across the UK who had a dementia diagnosis, and 1,648,889 people without dementia, drawing from The Health Improvement Network primary care database and collected between 2014 and 2016.   Based on their findings,  Asian people with dementia were 14% less likely than white patients to be prescribed anti-dementia drugs when they were potentially beneficial, and received them for an average of 15 fewer days per year.  Also, when compared to White groups, Asian and Black individuals with dementia were no more likely to be prescribed antipsychotic drugs, but those that had were prescribed them for 17 and 27 days/year more, respectively.   

Although anti-dementia drugs - cholinesterase inhibitors or memantine - are the only class of medication available for treating early symptoms of dementia such as memory or other cognitive declines,   other medications such as antipsychotics are often prescribed to treat some of the associated behavioural and psychological symptoms.   The use of antipsychotic drugs in dementia patients remains controversial in many cases given that they can be overused as a means of  "calming down" and making them more manageable.   Socioeconomic factors may also come into play in facilities with insufficient staffing or care provided.

In discussing the new study findings, lead researcher Patricia Cooper expressed concern over the racial disparities in dementia care and the overuse of antipsychotic medication.  "Rates of antipsychotic prescribing in all ethnic groups exceeded recommendations for treating the often very distressing behavioural and psychological symptoms of dementia, such as agitation or challenging behaviours, which are the most common reasons antipsychotic drugs are prescribed to people living with dementia," she said.  "While there has been a very sharp reduction in antipsychotic prescribing in the UK over the past 10 years, these figures suggest there is still work to do to ensure that people with dementia only receive potentially harmful antipsychotic drugs if there are no acceptable alternatives."

Co-author Dr Mary Elizabeth Jones (UCL Institute of Epidemiology & Health Care) has also weighed in on the dangers of overprescribing antipsychotic medication.  "While we have yet to find out whether taking antipsychotic drugs for a few weeks more increases the associated risks, which can include falls, cognitive decline, strokes and even death, it's a potentially significant inequality which we should take seriously, "  she said.  " More work may need to be done to ensure that guidelines are being consistently met, and that dementia services are culturally competent."

While previous studies looking at  American and Australian dementia patients have also found disparities in drug treatment for minority ethnic groups, this is the first time the issue has been investigated in a large UK study.   It also highlights the need for greater vigilance on the part of family members to avoid the dangers associated with overmedication and to make sure that their loved ones with dementia are getting the best possible care.  

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Is Thailand Becoming the New International Hub For Dementia Care?

Facing concerns about the spiralling cost of full-time care for patients with dementia, many families in the United Kingdom are sending them to Thailand, instead.   

In what has become a small, but growing trend,  Thailand, which already has a booming medical tourism industry, is accepting increasing numbers of international patients with dementia in their full-time care centres.  According to a recent news story,  many of the new dementia care facilities now open in Thailand are either British- or Swiss-run, or else run by Thai companies with significant British investment.   All of the centres have been approved by the Thai government and provide one-to-one round-the-clock residential care with fully trained and qualified staff.   Some of these centres have even won international awards due to the quality of service offered, all for around £750 a week.

“Thailand already has a long history of medical tourism and it’s now setting itself up as an international hub for dementia care,” said Dr Caleb Johnston, a senior lecturer in human geography at Newcastle University.   Johnson and his colleague, Prof Geraldine Pratt, head of of the University of British Columbia, have spent nine weeks in Thailand interviewing families and staff in residential care homes.  Their impressions are uniformly positive.    “There aren’t yet any official numbers as to how many people are moving out to Thailand to receive care,” said Johnston. “Relative to the total number of people living with dementia, it is a low number. But with the number of people with dementia set to increase, and the cost of looking after them also getting higher, it is likely to be an option that more and more people consider.”

Though Thailand is thousands of miles away from the U.K.,  families dealing with dementia patients often have to pay exorbitant fees to arrange full-time care.   And, given the lengthy waiting lists in place in many parts of the country, getting that care is becoming more difficult than ever.   This often means that family members are forced to stop working and provide that care themselves, something that few people have the financial resources or patience to handle for long.  

There are already 850,000 people with Dementia in the U.K., and that number will certainly be growing over the next two decades.   Though local authority residential care costs up to £700 a week, staff turnover is high and the usual  staff to patient ratio is one caregiver for six patients.   Private care facilities can cost £1000 a week or more and many families are hard-pressed to meet this cost.  

While family members often describe their distress at having to send their loved ones so far away, the emotional and financial hardship involved in keeping them at home often makes this necessary.  While   recent changes in Thai immigration rules have resulted in some patients being sent to care facilities in the Philippines, most families with relatives in Thai facilities describe their experiences very positively. 

“I’m so impressed. My wife needs someone with her 24/7," said one U.K. man.  "When I get overwhelmed and my daughter takes me away for a break, a carer doesn’t just care for my wife but shares the bed with her [because she tends to get up and walk around].  If I was in the UK, we might get a carer for 15 minutes in the morning and 15 minutes in the evening, or some ridiculous thing...I despair about the care in the UK.”

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Dementia Patient Defrauded by "Long Lost Granddaughter"

A woman in New Zealand has been charged with defrauding a 76-year-old dementia patient out of thousands of dollars after telling care staff she was his "long lost granddaughter".    In August 2017, 33-year-old Jammie Rigby contacted a Gisborne, New Zealand care facility and told them that she was the granddaughter of one of their patients,  76-year-old Ronald Boswell.   The former school teacher had been receiving full-time care for the previous twelve years due to dementia resulting from a severe head injury sustained in the 1990s during a home invasion.   While his niece had power of attorney over his financial decisions, he had no local family and staff permitted Rigby to take him on various outings around the city.  

During one of these outings, she took Boswell to a local bank and persuaded him to transfer  $3,500 from his bank account into hers with the reference 'grandad'.  A few days later,  she returned to the same bank and had him transfer a further $2,800 into her account.  There were no further outings afterward and she terminated all contact weeks later.   After the bank notified the care facility about the financial activity, staff then contacted Boswell's niece Deanna Brittenden who notified police.   

"I don't hold them accountable. I'd much rather someone erred on the side of believing people were good rather than believing everyone was out to get what they could," Brittenden said in an interview with local media.  "This woman came in under an assumed name, she met and had coffee with him a few times before taking him out, and he had no access to an eftpos card, so I don't think there was much more they could have done."    She also acknowledged that she should have notified the bank to require her approval for any withdrawals over a certain amount,  "I'd never done that because up until a few years ago he was able to go out on his mobility scooter to do shopping, get cups of coffee and so on."

Prior to the home invasion that left him brain-damaged, Ronald Boswell had been a well-known primary school teacher in northern New Zealand and it may have been there that Rigby came to know him.  Though he had been relatively independent his injury, his condition deteriorated sharply over the past two decades to the point of his requiring full-time care.  Despite his current limitations, Brittenden feels that Rigby's deceit has had an adverse effect on his condition.  "I can't put words into his mouth, but I know he was upset he didn't have the connection to the family he thought he was getting out of the relationship. It shook his confidence I think," she said.

Though Rigby is still awaiting trial, she is already well-known to local law agencies due to her previous criminal history including her role in another home invasion in which gang members stole the possessions of a man who had befriended her.  

While defrauding the elderly is a growing problem around the world, dementia patients are deemed to be particularly vulnerable.   Even people in the early stages of dementia may not be aware that they have been targeted by scamsters until it is too late.  Fortunately, there are excellent online resources available for family members worried about protecting dementia patients who might otherwise fall victim to these scams. 

 Organizations such as the AARP Fraud Watch Network provides regular alerts about active scams, and maintain a toll-free helpline (877.908.3360) for people who want tips on how to avoid fraud and guidance about next steps for victims of fraud.     In the United States, the The United States Senate Special Committee on Aging provides an annual report explaining the most common scams targeting seniors and also provides national resources for fraud victims along with a toll-free helpline (855.303.9470).  Equivalent agencies can be found in most developed nations though an Internet web search.