Brain Training, Ruzzle, and CET

20130511-112031.jpgThe Zipper Girls (besties and participants in the annual Girls Adventure Weekend) introduced me to Ruzzle on our last trip. Ruzzle is a word-search app for all your i-technology. I can waste spend literally hours playing against myself, the Zipper Girls, and complete strangers. Whenever Stan hears the Ruzzle ten second count-down (each game is timed), he says, “Again? Really?” But when the term “addiction” gets tossed around, I just put on my smug face and say, “Researchers have shown that elderly adults who engage in mentally stimulating activities are less likely to develop dementia.” Is there even such a thing as RA? (Hello, my name is Trophydaughter, and I’m a Ruzzleaddict.) Yep, classifying my Ruzzle time as mental exercise let’s me engage guilt-free.

Seriously, I worry about dementia. That is, when I’m not worrying about the economy, the puffy circles under my eyes, the devaluation of the dollar, how fat I actually look, whether or not I need to own gold, the overall health of our nation, my job, my husband’s job, how outdated my house is, my sister’s health, the deer eating my yard, our healthcare system, and the ultimate fate of social security. When my grandmother died, she didn’t know who I was. The last time I visited her at the retirement community, she said, “Why are you here? Will you please stop following me?” My dad has also had some inexplicable cognitive episodes. Once he was angry with Mom for a week for stealing $20 from his top dresser drawer. Mom said he’d never even kept money in his dresser drawer.

I’ve also noticed some inexplicable cognitive issues with my sister since re-entry into her life. She can’t keep up with her stuff. She is constantly “losing” things, leaving stuff in my car, misplacing her apartment keys. She struggles with memory (as do I) but she will tell me something one day and when I bring it up again, say, “I don’t know why I told you that. That never really happened.” She will chalk a mistake up to a “life lesson” and then repeat the same mistake in a month or two as if she’s completely forgotten what happened the last time. Recently, she allowed a new friend to spend the night at her apartment and woke up to find the friend gone along with her new Nexxus tablet (which she’d saved for for months). Previously, when she’s allowed friends to stay over, they’ve stolen medication, clothing, and food from her. So why does she keep doing it? She will call me 3 or 4 times a day to tell me something because “If I don’t tell you right this minute, I won’t remember it later.” I do this too at times but I’m juggling a LOT of stuff. Which is not the case for Jerri.

She complains about her ability to concentrate. While I tend to tuck these comments away in the “How can I convince Terri I really do need Adderall?” file, I know Jerri truly believes her ability to focus has diminished significantly. She also took an online Autism test recently and scored in the “moderate” range. I’ve observed her awkwardness in many social situations – she doesn’t always pick up on visual cues and she goes down inappropriate conversation paths at times.

It has been challenging to discern what is illness vs. cognitive impairment from medication vs. this mysterious, unnamed “something else.” Just yesterday Jerri said to me, “I’ll never be the person I was before. There’s been too much brain damage.” I refuse to accept this.

user:Looie496 created file, US National Institutes of Health, National Institute on Aging created original / Foter.com / Public Domain Mark 1.0

The brain is an amazing organ and has the natural ability to repair itself which is called neuroplasticity. Neurons, or nerve cells, are the basic building blocks of the central nervous system which includes the brain. The connections between nerve cells, called synapses, allow information, in the form of nerve impulses, to travel from one neuron to the next. The human brain is made up of trillions of synapses. Its this network that allows us to feel, behave, and think. The more connections in your brain, the greater your cognitive function. When connections are broken, it impacts cognitive ability. Connections that are used regularly become stronger. Connections that aren’t used eventually get eliminated through a natural “pruning” process. “Use it or lose it” is actually a fact when it comes to connections in your brain. Drug use and excessive alcohol consumption can cause connections to deteriorate or break as can exposure to some heavy metals and pesticides, and brain trauma. But because of neuroplasticity, broken connections can sometimes be restored.

Given all this, I was enthralled by an article about CET, Cognitive Enhancement Therapy (Improving Cognition in Schizophrenia) in the Spring edition of the NAMI advocate. Per the article:

Many individuals with schizophrenia and related disorders exhibit signs of impaired cognition: they have problems paying attention, remembering, solving problems, and making decisions. Brain-imaging studies have revealed that individuals with schizophrenia show reduced activity in the prefrontal cortex, precisely the area of the brain involved in attention, working memory, and judgement.

Wow, this sounded like Jerri so my first question, since she doesn’t have a diagnosis of schizophrenia, was what are “related disorders”? Turns out that a study funded by the National Institute of Mental Health (NIMH) was just published on February 28, 2013 (Lancet, Identification of Risk Loci with Shared Effects on Five Major Disorders: A Genome-wide Analysis) that identifies specific gene associations between schizophrenia, bipolar disorder, ADHD, depression, and autism. This so fits what I’ve observed in my own immediate family where besides Jerri’s bipolar disorder, others have been diagnosed with depression, ADHD, and mild forms of autism.

But back to CET. CET involves structured activities that exercise the brain and mind. CET Cleveland is the first CET program to be established outside of academia and is currently only available at 21 sites in 10 states, however, new sites are in development in other states and YAY!!!, North Carolina is one of them. (Still trying to track down the location of the site and when the program will be up and running.) The program requires one 3.5 hr session per week for 48 weeks. Each session involves 3 components: computer-based exercises, group-based interactions, and one-on-one coaching sessions. Complete brochure in PDF format is available here. Participants are able to improve overall cognitive functioning by strengthening and developing new neural connections. Through group-based interactions and coaching, they are able to increase their understanding of how society and the workplace function. Most graduates of the program continue to improve and go on to enroll in school, work, or volunteer. To me, CET is a missing link for my sister in her recovery. This is definitely another opportunity Jerri and I will be keeping our eyes on as CET becomes more widely available. Learn more about it at cetcleveland.org.

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