Category: Neuropsychology

Food and the Brain

You are what you eat. It’s a cliché phrase that most of us have heard but probably have not put much thought into. We know that certain types of diets can lead to health problems, such as obesity, diabetes, and high cholesterol, but did you know that what you eat can also have an impact on your brain? Which, in turn, can have affect your mood, energy level, and cognitive functioning?

Historically, nutritional science has not been emphasized in the study of psychiatric or neurologic conditions. It has only been within the last few years that we are beginning to have a better understanding of the relationship between nutrition and the brain. The following lists just a few tidbits of information to demonstrate the importance of food on our brain functioning.

Food and the Developing Brain

Nutritional deficiencies in childhood could have an impact on the developing brain. For example, iron deficiencies and lack of essential fatty acids have been associated with poor myelination of brain cells[1], which could lead to problems with processing speed and attention. Studies have also shown that children diagnosed with ADHD also have a very high rate of magnesium deficiency. In one study, 95% of the ADHD group tested had a magnesium deficiency! [2] Thus, ensuring proper nutrition in children exhibiting behavioral or cognitive problems is an essential first step before moving to more drastic measures such as prescribing controller prescription medications.

Food and the Adult Brain

A healthy diet still has its uses in the adult brain. Our brain is a very busy organ that is not only in charge of our thinking processes and feelings but sending signals to the rest of our body to control its functioning. The brain requires a lot of energy to run, and the source of that energy is largely in the food that we eat. Just as putting in high-grade gasoline can keep a car running efficiently in the long-term, the quality of the food that we eat will also maximize our brain health.

It is important to eat a wide variety of food that provides all the essential nutrients that our bodies need to function efficiently. A poor diet lacking in certain nutrients can lead to “brain fog” symptoms such as fatigue, difficulties concentrating, and slower processing. We have all experienced these symptoms to some degree (think to when you last tried to do something cognitive complex while on an empty stomach!)

Furthermore, nutritional deficiencies have been associated with a number of different neuropsychological symptoms. For example. vitamin D and vitamin B (particularly B12)[3] deficiencies are associated with depression as well as cognitive impairment.[4]  However, too much of a mineral can also lead to problems, as this often leads to development of free radicals that can damage cells. Iron toxicity has been associated with neurodegenerative diseases like Alzheimer’s disease or Parkinson’s disease.[5]

Preventing Risk Factors for Cerebrovascular Disease

Using the analogy of food as fuel, think of your blood vessels as the pumps that are feeding your brain. Diets that are high in unhealthy fats can lead to clogging of those pumps which can lead to reduced blood and oxygen flow to the brain over time. Likewise, too much protein or too much glucose in the bloodstream can also lead to oxidation and hardening of blood vessels over time, which narrows the pathways for blood flow. This is why hypertension is considered to be the biggest risk factor for strokes. Diabetes and high cholesterol are other conditions that can lead to cerebrovascular changes over time. A proper diet to reduce these risk factors is vital.

Special Diets to Prevent Neurological Symptoms

In general, a balanced diet with lots of vegetable varieties, complex carbohydrates, and healthy fats is best for our general physical and brain health. However, some people may require a different ratio of macronutrients (proteins, fats, carbohydrates) to help with specific health conditions. For example, several studies have shown that keto diets may be effective in preventing seizures in children with epilepsy.[6] More recent studies are also looking into ketones providing a neuroprotective effect against neurodegenerative conditions, such as Alzheimer’s disease, though this is still up for debate.[7] However, it is cautioned that a ketogenic diet can lead to deprivation of nutrients that would be found in a more balanced diet. Consideration of starting a keto diet should be discussed with one’s physician and ideally a dietitian to determine a healthy meal plan.

The Microbiome

Most recently, there has been an explosion of research investigating the microbiome, which is the universe of bacteria that lives within our bodies. These bacteria outnumber our human cells, and they play a role in digestion and the immune system. Gut bacteria imbalances have been associated with inflammatory conditions such as irritable bowel disease.[8]

Furthermore, we have learned that there is bidirectional communication between the gut and the brain through several different pathways. Studies have suggested that, at least in rats, certain bacteria found in the gut appears to influence the development of emotional behavior, stress- and pain-modulation systems, and brain neurotransmitter systems.[9] Further research is being conducted on how this translates to human beings.

In short, science is finally catching up to examine the interconnection between nutrition with neuropsychiatric conditions. There is still much to learn, but it is apparent that what we eat can have profound effects on our general health, which includes our brain!

Nutritional Counseling at PNBC

Nutrition is something that is often overlooked that we at PNBC feel is important to include as part of a comprehensive treatment plan for neuropsychological conditions. We are happy to announce that we will soon be offering nutritional counseling services with a registered dietitian (RD) who will work in tandem with our psychologists and therapists.

 

Written by Delia Silva, PsyD, ABPP-CN. Dr. Silva is a board-certified neuropsychologist and owner of Pacific Neurobehavioral Clinic.

 

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[1] Yehuda, S., Rabinovitz, S., & Mostofsky, D. I. (2006). Nutritional deficiencies in learning and cognition.

[2] Kozielec, T., & Starobrat-Hermelin, B. (1997). Assessment of magnesium levels in children with attention deficit hyperactivity disorder (ADHD). Magnesium Research10(2), 143-148.

[3] Oh, R., & Brown, D. L. (2003). Vitamin B12 deficiency. American family physician67(5), 979-986.

[4] Etgen, T., Sander, D., Bickel, H., Sander, K., & Förstl, H. (2012). Vitamin D deficiency, cognitive impairment and dementia: a systematic review and meta-analysis. Dementia and geriatric cognitive disorders33(5), 297-305.

[5] Altamura, S., & Muckenthaler, M. U. (2009). Iron toxicity in diseases of aging: Alzheimer’s disease, Parkinson’s disease and atherosclerosis. Journal of Alzheimer’s Disease16(4), 879-895.

[6] Levy, R. G., Cooper, P. N., Giri, P., & Weston, J. (2012). Ketogenic diet and other dietary treatments for epilepsy. Cochrane database of systematic reviews, (3).

[7] Włodarek, D. (2019). Role of ketogenic diets in neurodegenerative diseases (Alzheimer’s disease and Parkinson’s disease). Nutrients11(1), 169.

[8] Morgan, X. C., & Huttenhower, C. (2012). Human microbiome analysis. PLoS Comput Biol8(12), e1002808.

[9] Mayer, E. A., Tillisch, K., & Gupta, A. (2015). Gut/brain axis and the microbiota. The Journal of clinical investigation125(3), 926-938.

Anxiety’s Impact on Cognitive Functioning

Anxiety is an emotion that we feel in response to a threat or a potential threat. Often, it helps us out. For example, anxiety can motivate us to practice an upcoming presentation for class, take a step back when standing at the edge of a tall building, or prepare for an important occasion like meeting in-laws for the first time.

 

However, anxiety can become unmanageable and unhelpful.

 

It can cause physiological symptoms such as shortness of breath, racing heart, and shakiness. Anxiety can also cause us to change our behavior. For example, we may frequently check that the front door is locked or avoid doing things we want or need to do (e.g., speak up in a work meeting). Finally, it can impact our thoughts such as worrying about things that could happen in the future like trouble paying bills or upcoming social events.

 

These anxiety-related symptoms can capture and maintain our attention, and make it harder to focus on the task at hand. When anxiety has reached the level that it feels unmanageable or difficult to control, it can make the very things we are anxious about more difficult. For example, when anxious during a presentation at school, we may begin to feel ourselves sweat and shake. Soon, all we can focus on are the physiological symptoms we are experiencing and the thought, “everyone must be noticing how anxious I am right now.” We may decide to cut the presentation short, which may temporarily relieve the anxiety but teach us that we couldn’t handle that experience, making it harder the next time around.

 

This situation is just one example of how anxiety can cause cognitive problems, such as difficulty focusing, remembering important details, and making decisions. Some experience anxiety in social situations and can have thinking difficulties when around new or influential people, such as coworkers or a boss, or when anticipating being in that situation. Others feel anxious in relation to a traumatic or stressful event that occurred in the past and may have difficulty focusing when thoughts of the event arise and/or in response to specific reminders of the event. For some, anxious thoughts are nearly constant, and may generalize to just about any stressful situation that could arise such as worry about losing loved ones or becoming ill.

 

If you have anxiety along with other conditions, such as: trouble sleeping, depression, attention deficit hyperactivity disorder (ADHD), chronic pain, traumatic brain injury (TBI), and/or alcohol and substance use, that can have a negatively compounding effect on cognitive functioning. Imagine that your ability to think (e.g., memory, attention, problem solving) is a pie, and each of these conditions represent a piece. If you have anxiety, it eats a piece of the pie. ADHD eats up another one. Poor sleep eats up another one. Pain eats up another one. Then you are left with only a couple pieces to get through the day—whether it be work, school, and/or caring for loved ones—it just doesn’t seem like enough!

 

Here is the good news. There are many great strategies to help manage anxiety including breathing techniques and mindfulness, physical activity, and engaging in self-care. That being said, sometimes anxiety and related conditions are too much to manage on our own. Seeing a clinician can be really helpful as a guide through these techniques and to provide treatments that have been shown to improve anxiety and cognitive abilities in large-scale studies. Clinicians at PNBC provide psychotherapy to individuals with anxiety and commonly co-occurring conditions who may be experiencing cognitive difficulties in their everyday life.

 

Written by Sarah Jurick, Ph.D. Dr. Jurick is a neuropsychologist at Pacific Neurobehavioral Clinic, PC. 

About Neuropsychological Evaluations

What is a neuropsychologist?

A neuropsychologist is a clinical psychologist with specialized training in the applied science of brain-behavior relationships. Neuropsychologists use cognitive and psychological tests to assess, diagnose, and provide treatment recommendations for individuals with neurological, medical, and psychiatric conditions. These assessments provide a better understanding of each patient’s cognitive, behavioral, and emotional strengths and weaknesses. A thorough definition can be found here at the National Academy of Neuropsychology’s website.

Neuropsychologists hold licenses in clinical psychology. However, not every clinical psychologist has the training necessary to competently practice neuropsychology. Therefore, when looking at a neuropsychologist’s credentials, it is recommended to find one that is board-certified by the American Board of Professional Psychology in the specialty of clinical neuropsychology (ABPP-CN), or the American Board of Professional Neuropsychology (ABN). There are also neuropsychologists who are not board-certified, but may have met the Houston Conference training standards that is accepted within the field of neuropsychology.

How is a neuropsychological evaluation performed?

Typically, a neuropsychological assessment will involve: A comprehensive interview with the neuropsychologist to gather information pertaining to the questions at hand, review of relevant records (for example medical records or school reports), and neuropsychological (cognitive and psychological) testing. After the evaluation, the neuropsychologist writes a report that presents the results of the evaluation, a diagnosis and conceptualization of how the individual is functioning, and appropriate recommendations that will lead to the next steps of treatment planning. Feedback and education on the results of the evaluation are provided to patients whenever possible.

What does a neuropsychological evaluation test for?

The testing looks at several areas of cognition associated with brain functioning. These domains include:

  • General intellectual abilities
  • Academic achievement
  • Motor and sensory functioning
  • Attention and processing speed
  • Expressive and receptive language abilities
  • Visuospatial/perceptual abilities
  • Learning & memory
  • Executive functions (higher-order thinking abilities, i.e. problem-solving, abstract reasoning, etc.)
  • Personality and emotional functioning

How long does a neuropsychological evaluation take?

It depends on the nature of the referral question. It can typically take anywhere from two hours up to ten hours of face-to-face time with the patient. For longer evaluations, it is possible to break it up into different days.

What happens after the neuropsychological evaluation?

The neuropsychological report should help to clarify diagnostic questions and provide a treatment plan. For most clinical evaluations, the neuropsychologist should have a feedback session with the patient to discuss the results of the evaluation, the diagnosis, and the recommended course of treatment. Depending on the diagnosis, there may be recommendations for different specialists to provide treatment. The neuropsychological evaluation is a valuable tool to plan out a course of action to help treat conditions.

What are some reasons to get a neuropsychological evaluation?

A neuropsychlogical assessment with adults would be useful for a number of reasons that include:

  • Diagnostic clarification for treatment planning
  • Differentiate between psychiatric and neurologic conditions
  • Help determine the cause of cognitive or emotional symptoms
  • Identify cognitive strengths and weaknesses
  • Diagnose or rule out attention deficit/hyperactivity disorder (ADHD) and specific learning disabilities
  • Rule out and differentiate between different types of dementias (ex: Alzheimer’s disease vs. frontotemporal dementias vs. vascular dementia vs. Lewy body dementia, among others)
  • Measuring changes in cognitive functions after a traumatic brain injury or acquired neurologic conditions such as strokes (cerebrovascular accident), anoxic brain injuries, multiple sclerosis, toxic chemical exposure, encephalitis, brain tumors, or post-surgical changes.

How can I schedule a neuropsychological evaluation at PNBC?

Please click on this link to learn how to make a referral or make an appointment.

Author: Delia Silva, PsyD, ABPP-CN

Brain Overview

The brain is divided into two halves, called hemispheres. Clinically, they are described as the “dominant” and “non-dominant” hemispheres. The dominant hemisphere is generally the half in which language abilities are housed, which for most people is the left (about 99% of right-handed people and 85% of left-handed people). While all aspects of thinking use both the left and right halves of your brain, certain functions are thought to be lateralized, or more strongly associated, with specific hemispheres.

Each hemisphere can be divided into specific areas called lobes (frontal, parietal, temporal, and occipital), as well as lower brain structures, the cerebellum and the brain stem. Each of these areas are generally associated with specific brain functions.

FRONTAL LOBES
•Higher-order thinking
•Problem-solving
•Abstract reasoning
•Emotional control
•Decision-making
•Planning and organization
•Behavioral regulation
•Motor skills
•Speech production
•Memory retrieval
TEMPORAL LOBES
•Learning and memory
•Language comprehension
•Auditory perception
PARIETAL LOBES
•Spatial perception
•Object recognition
•Writing
•Drawing
•Reading
•Math
•Attention
OCCIPITAL LOBES
• Vision
CEREBELLUM
•Balance
•Coordination
•May be associated with higher-order thinking abilities
BRAIN STEM (AND MIDBRAIN)
•Orientation and arousal
•Regulation of bodily functions (i.e. breathing, sleep, blood pressure)
•Movement and sensation

Author: Delia Silva, PsyD, ABPP-CN

Overview of Traumatic Brain Injuries (TBI)

What is a TBI?

A traumatic brain injury (TBI) occurs when external forces (for example, from falling, car accident, or assault) cause an injury to the brain. The injury itself can be penetration to the brain, bruising, bleeding, or stretching of the connections between the neurons (brain cells), called axons. The severity of the TBI can be graded as mild, moderate, or severe, and is determined by a number of factors from the date of injury. Sometimes, secondary injuries can result after a TBI, such as a stroke or increased intracranial pressure from swelling.

What are the symptoms of TBI? What can I expect from the recovery?

Symptoms of TBI vary greatly, depending on the parts of the brain that were affected, the severity of the TBI, and the mechanism of injury. Confusion is a common early symptom, in which the affected individual is not fully aware of the situation, and may not be oriented to the date or even aspects about themselves (for example, their age). Agitation and socially inappropriate behavior are common symptoms early on after a TBI, and are attributable to the effects of the brain injury, not necessary the patient’s personality. For moderate and severe injuries, it can take several weeks or months until the person is no longer confused and/or agitated. However, cognitive and behavioral symptoms can persist. In general, the most improvement in rehabilitation occurs in the first 6 months, but the brain can continue to recover for years after an injury. The prognosis for how much recovery a person is able to make depends on the severity of the injury.

MTBI is synonymous with “concussion.” In general, people who suffer mTBI have an excellent prognosis and are expected to make a full recovery within a month, as the brain structures are typically not permanently affected from a concussion. However, there are a minority of individuals who continue to experience symptoms beyond the period of neurological recovery, and are diagnosed as having “postconcussive syndrome.” There are a number of reasons why symptoms can persist, and a thorough neuropsychological evaluation is indicated in these cases to determine the causes and proper treatment. The neuropsychological evaluation takes into account other medical or physical conditions, side effects from medications, psychological factors, and rules out neurodegenerative conditions.

How Can a Neuropsychologist Help with TBI?iStock_000026150244_Large

A neuropsychological evaluation is a valuable tool for an individual recovering from a traumatic brain injury. It provides the patient with detailed information about their cognitive strengths and weaknesses, which includes assessment of: memory, attention, expressive and receptive language, visual/perceptual abilities, motor and sensory functioning, and executive functions (problem solving, multi-tasking, organizing, coming up with strategy, ability to self-monitor, etc.). Knowing these strengths and weaknesses can help in directing the focus of cognitive rehabilitation and developing strategies to compensate for deficits. It can also assist in determining whether a person is able to return to work, or guide the person in finding new opportunities in which their strengths will be utilized. In the case of mild TBI as described above, a neuropsychological evaluation is the gold standard for determining treatment of postconcussive syndrome. A neuropsychological evaluation can also be performed at different points in time during the recovery process to objectively measure and track changes in cognitive functioning.

A neuropsychologist or psychologist can also provide treatment for individuals with TBI. Clinicians at PNBC provide psychotherapy to individuals with TBI who may be having difficulties adjusting to the new changes in their mental and physical functioning. TBI can be devastating to a person’s sense of self. Our clinicians can help patients go through the emotional process of grieving their losses and reaching a state of acceptance in which they can realize new meaning and opportunities in their lives. Patients are provided with education regarding their brain injury and tools to help with compensating for cognitive deficits. Often times, patients receive structured cognitive rehabilitation from a speech and language pathologist or occupational therapist at a more comprehensive brain injury treatment program.

Dementia/Neurodegenerative Diseases/Major Neurocognitive Disorders

What is Dementia?

The term “dementia” refers to a group of conditions that deteriorate the brain over time, causing changes in cognition (thinking), behavior, and physical functioning. When the symptoms are severe enough to impact a person’s ability to function independently, dementia can be diagnosed. They are now more commonly referred to as “neurodegenerative diseases” or “major neurocognitive disorders (MND).”The most common form of MND is Alzheimer’s disease, which accounts for 60-80% of all cases of dementia. Behaviorally, Alzheimer’s disease characterized by symptoms of short-term memory problems, communication, reasoning, navigating the environment, and knowing how to use objects. In the end stages, physical functioning is affected, and there may be some drastic changes in personality.

The second most common form is vascular dementia, which can occur when an individual has suffered multiple strokes. Depending on what parts of the brain were affected, the symptoms can appear to be similar to Alzheimer’s disease.

Frontotemporal dementias (FTD) are another category of conditions that are neuropathologically distinct, affecting certain parts of the frontal and temporal lobes. Some individuals with FTD might exhibit early symptoms of personality change with little to no apparent change in their memory. Others might have a marked decline in their ability to express themselves.

Parkinson’s Disease (PD) is a neurological condition affecting motor functions and causes tremors. However, the neuronal pathways affected in Parkinson’s disease can also affect cognition. In some individuals, the symptoms may be severe enough to be considered a “Parkinson’s Dementia.” Additionally, there are a number of other neurological conditions that appear similar to Parkinson’s disease, but have distinct features that indicate other parts of the brain that are not typically affected with a pure Parkinson’s condition are involved.

Lewy body dementia is a condition that has similar features to both Alzheimer’s disease and Parkinson’s disease, and often includes symptoms of psychosis.

Each form of dementia has a distinct pathology, which makes proper diagnosis important when medications are being considered. Additionally, some types of dementia may have a rapid course whereas others have a much slower progression. Knowing what type of dementia one has is important for planning important issues, such as caregiving, safety implementations, and legal matters.

Senior lady and her granddaughterWhy is a Proper Diagnosis Important?

Unfortunately, there is no cure for MNDs. However, there are medications to treat specific symptoms associated with dementia. A proper diagnosis of a dementia subtype is important because some medications that may be used for one condition can actually worsen symptoms if the person actually has a different neurological condition. For example, if a person with undiagnosed Lewy body disease (LBD) who is experiencing symptoms of psychosis (delusions or hallucinations) and was misdiagnosed as schizophrenic may be given traditional antipsychotic medications, which can worsen their condition. Using the same example, this person may also have tremors and be misdiagnosed as having Parkinson’s disease, but some anticholinergic medications used to treat the tremors can worsen the symptoms of psychosis. Worsening of symptoms can lead to even more rapid decline and neurodegeneration.

A proper neuropsychological evaluation will examine the clinical history, neurologic and behavioral presentation, and use objective cognitive tests in order to arrive to the most accurate diagnosis of an MND. The neuropsychologist can then refer the patient and family members to the right doctors or organizations to help with treatment and provide support and education. Additionally, the neuropsychologist can work with caregivers to help them understand the limitations of the patient, and determine the most optimal environment to promote well-being and safety.