Depression among the Elderly

This question from S.R. in Tuckahoe:  Thank you for the information about SAD, but my grandma seems to have SAD all of the time. Any thoughts?

Seasonal affective disorder, or SAD, is a mood disorder that predictably happens at about the same time every year.

Typically it begins in the late fall and continues through the winter and is related to the decreasing amount of sunlight and its effect on the production of various brain hormones, particularly serotonin. If someone is sad all of the time, then they don’t have SAD but could be sad for a myriad of other reasons.

Symptoms like:

• difficulty concentrating, remembering details and making decisions
• fatigue and decreased energy
• feelings of guilt, worthlessness and/or helplessness
• feelings of hopelessness and/or pessimism
• insomnia, early-morning wakefulness or excessive sleeping
• irritability, restlessness
• loss of interest in activities or hobbies once pleasurable, including sex
• overeating or appetite loss
• persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment
• persistent sad, anxious or "empty" feelings

are all classical signs of depression. If this sounds like your grandma, then it is important that she see a mental health professional because left untreated not only is her quality of life negatively impacted but she could become suicidal. Therefore, treating depression isn’t a do-it-yourself-at–home kind of thing but should be taken seriously.

As we age our production of hydrochloric acid in our stomach decreases, which makes it harder to digest and absorb some important nutrients. Furthermore, the accumulated effects of the “wear and tear” of life begin to take their toll, again increasing our need for many different nutrients.

In the recently published article  "The effect of low-dose omega 3 fatty acids on the treatment of mild to moderate depression in the elderly: a double-blind, randomized, placebo-controlled study," it was again demonstrated how important good nutrition is. They reported that just a small daily intake of fish oil containing only 300 mg each of EPA and DHA can have useful effects against depression in the elderly population.

Now that winter seems to be finally abating, go with your grandma for long and regular walks, the exercise and sun exposure will do you both good, make sure she is eating a broad and varied diet with a good daily multivitamin and include some fish oil in her supplements. In our office we use the Metagenics brand of fish oil because of its purity and mild taste.

Maintain Your Brain: Tips to Retain Concentration and Memory

This question from E.T. in Bridgehampton: Last week you wrote about depression and you mentioned trouble with concentration, my dad has trouble with his memory and concentration but I don’t think that he’s depressed. Any ideas?

Many of us in the “49 and holding” crowd joke about “senior moments.”

But when they start happening to you more often, they’re not funny at all. Instead, they’re frustrating, embarrassing and perhaps even worrisome especially to your kids who immediately have visions of nursing homes and diapers. Have you ever walked into a room — and forget what you went in to get? Run into someone you haven’t seen lately — and can’t recall their name? (I can never remember names.) Misplaced your glasses, your house keys or your car? It’s ironic. Just when you’ve got life almost figured out with all of this wisdom and experience under your belt, your brain is no longer “old reliable.” You never know when it’s going to trip you up, frustrate you, embarrass you, or make you wonder if you’re starting to lose your marbles.

So what’s a dad to do? Researchers at Harvard have been doing extensive studies in this area, lest they suffer the same fate as us mortals, and have dutifully been reporting their findings. Aside from stress and the myriad distractions of daily life, they have concluded that there are both structural and functional reasons for our brain faux pas.

Once we become an (AARP) card carrying member of the “49 and holding” crowd, structural changes become evident in our brain. Oxidative damage and the accumulation of toxins cause damage to the protective myelin sheath which makes our nerves short circuit a bit thus causing “data loss.”

Furthermore, as we age our levels of neurotransmitters and brain hormones, decrease causing a functional slowing of the transmission of information. The pharmaceutical industry has responded with drugs like Provigil, Aricept and Namenda to name but a few. These drugs try to close the gate after the chickens already flew the coop by manipulating neurotransmitter levels.

From a more pro-active perspective there are some natural supplements that have proven themselves to be helpful. Phosphatidylserine restores the brain's supply and output of acetylcholine, the neurotransmitter so important to memory, and so may turn back the clock in an aging brain. Alpha-glycerylphosphorylcholine, or Alpha-GPC is a cholinergic brain supplement that increases the synthesis and secretion of the neurotransmitter acetylcholine, which is the brain's messenger responsible for sending signals across the brain and to the muscles of the body. And Acetyl L-Carnitine (ALC) is basically a fat soluble amino acid that has the ability to cross the blood-brain barrier and get to the brain blood circulation, where it acts as a powerful antioxidant, which helps in prevention of the brain cells' deterioration. Its supplementation has been shown to be neuroprotective in instances of cerebral ischemia and may be useful in treating peripheral nerve injury. There are numerous supportive supplements ranging from blueberries to ginko and vinpocetine, to name but a couple.

Back to our friends at Harvard who put together 10 research-proven tips for a better memory:

1. Believe in yourself. Middle-aged and older learners do worse on memory tasks when exposed to negative stereotypes about aging and memory, and better if exposed to messages about memory preservation into old age.

2. Economize your brain use. Take advantage of calendars and planners, maps, shopping lists, file folders and address books to keep routine information accessible. Designate a place at home for your glasses, keys, and other items you use frequently.

3. Organize your thoughts. New information that’s broken into smaller chunks, such as the hyphenated sections of a phone or social security number, is easier to remember than a single long list.

4. Use all your senses. The more senses you use when you learn something, the more of your brain will be involved in retaining the memory.

5. Expand your brain. Widen the brain regions involved in learning by reading aloud, drawing a picture or writing down the information you want to learn (even if you never look back at your notes).

6. Repeat after me. When you want to remember something you have just heard or thought about, repeat it out loud. For example, if you’ve just been told someone’s name, use it when you speak with him or her: “So John, where did you meet Camille?”

7. Space it out. Instead of repeating something many times in a short period, as if you were cramming for an exam, re-study the essentials after increasingly longer periods of time — once an hour, then every few hours, then every day.

8. Make a mnemonic. Mnemonic devices are creative ways to remember lists. They can take the form of acronyms — such as the classic “Every good boy does fine,” to remember the musical notes E, G, B, D and F on the lines of the treble clef.

9. Challenge yourself. Engaging in activities that require you to concentrate and tax your memory will help you maintain skills as you age. Discuss books, do crossword puzzles, try new recipes, travel and undertake projects or hobbies that require skills you aren’t familiar or comfortable with.

10. Take a course. Memory-improvement courses are becoming more common. Choose one run by health professionals or experts in psychology or cognitive rehabilitation. Stay away from courses that center on computer or concentration games, which generally won’t help you with real-life memory problems. Select a course that focuses on practical ways to manage everyday challenges.

Embarrassing Digestive Problems

This question from F.K. in Sagaponack: My husband seems to be healthy but his digestive problems can be ... embarrassing, any ideas?

Digestive problems can occur for numerous reasons and many a book has been penned about them.

As usual, any problem that is new, severe, of rapid onset or accompanied by pain or blood in the stool should be checked out by your physician. Fortunately, most problems are of a functional nature.

As we age, three things commonly happen to our digestive tract. Things tend to slow down, so we need more roughage/fiber and water. Our stomach’s production of hydrochloric acid decreases as does our production of digestive enzymes. As a result we can develop symptoms of gas, bloating and indigestion as the good bacteria in our digestive tract are thrown out of balance by their changing environment.

To add fuel to the fire, as our production of hydrochloric acid and enzymes decreases, it makes us more susceptible to infections. Over time the accumulated assaults of innumerable tiny and sometimes not so tiny infections in the digestive tract can cause damage to what are referred to as the “tight junctions,” so that incompletely digested molecules are absorbed into our blood stream. This will then lead to the development of food allergies which will only make these symptoms worse.

Now, what is hubby to do? First, to address the slowing down issue — which allows food to putrefy and produce gas — eat more fiber, drink more fluids and exercise.

As we exercise — fast walking, bicycling or swimming being among the best — it not only helps our muscle tone, bone density and svelte appearance, but it also stimulates our gut to move more regularly, hopefully at least twice per day. To compensate for our decreased production of hydrochloric acid, the natural supplement Betaine HCL right before meals can be very helpful. Taking a supplement like Similase BV after meals can support our decreased production of digestive enzymes. To minimize the effects of inflammation and infection, making sure that we have plenty of good microbes in our digestive tract is of vital importance. Probiotics like Jarro-Dophilus or Pro-Flora can easily fit the bill here.

If the digestive problems remain then coming in for food allergy testing and addressing the undigested molecules that are leaking into the blood stream can often solve the problem, if not then more extensive testing is indicated. Until then, Glade air freshener can work wonders.