Author: NRS Lifespan

Cognitive overload is a state of mental exhaustion that occurs when a person’s working memory is overwhelmed by too much information. Research has shown that cognitive overload can have a direct impact on our ability to learn, make decisions, and retain information. This can be seen in our day-to-day lives when someone takes on more tasks than they can handle in a small timeframe, resulting in high levels of stress and frustration.

While cognitive overload can occur in many different situations, there are four main causes that are widely recognized: multitasking, information overload, poor time management, and complex tasks. Trying to complete multiple tasks at once can lead to cognitive overload because the brain can have difficulty rapidly switching between tasks. In addition, people who take in extensive amounts of information through social media may also be at risk for cognitive overload.

The effects of cognitive overload on an individual can present as decreased productivity and burnout because they are taking on too much at one time, and it can also lead to poor decision-making as they can be considering too many options in too little time. Individuals in a state of cognitive overload can experience the following symptoms: difficulty concentrating, forgetfulness, and anxiety.

To manage cognitive overload, an individual should have a list of tasks in order or priority; tasks should be simplified; allow for regular breaks throughout the day; and create a supportive and healthy environment to work in. In addition to this, individuals should try and eliminate distractions when working, along with taking notes as opposed to trying to remember everything. Implementing these tactics can help lessen an individual’s cognitive load and stress levels while also optimizing learning!

For more information about cognitive overload, or for an in-depth plan to treat these symptoms, please call our office.

Gianna Scimemi, MA
Psychometrician & Doctoral Student

ALTERNATIVE CONSIDERATIONS TO REMEDY BRAIN FOG

I am going to this month step out of the usual blog regarding organic brain functions in terms of various diagnoses.  I have been encountering many patients complaining of “brain fog” from a variety of sources, for example, COVID, poor sleep, diet, stress, autoimmune, etc.  A couple of years ago, many of the COVID-19 patients I have seen were reporting complaints of “brain fog.”  The patients stated they felt like their brain was clouded and did not work as efficiently as before.  Also, many of them believed there was a link to poor sleep, and, furthermore, stress at work.

Eventually, what turned out to be the case in many patients had to do with breathing.  After understanding many of the examples the patients reported, it became obvious that their cognitive complaints in terms of “brain fog” were above and beyond residuals from COVID-19.  I started suggesting a course of biofeedback and deep breathing relaxation.  Some of the patients also suffered allergies, and needless to say problems with nasal congestion.  For these patients, I suggested nasal strips and follow-up with an alerigist and clearing these recommendations with their family doctor.

What I came to realize is that the majority of the patients reported dramatic changes in their “brain fog.”  Many of them reported that cognition improved along with improved sleep, better management of their stress, more energy, and ultimately a lifting of their mood.

In summary, it cannot be overstated the importance of healthy deep breathing besides diet, exercise, medical follow-up adherence, and lifestyle management.

If we can be of any assistance in our health psychology department in helping you with these approach strategies, give us a call.

Robert B. Sica, Ph.D., ABN
Owner- Principal Partner, Neuropsychological Rehabilitation Services|LifeSpan
Board-Certified in Neuropsychology
Post-Doctoral Fellowship Supervisor
Jersey Shore University Medical Center, Neuroscience Division
Department of Psychiatry and Behavioral Health
Clinical Assistant Professor, Hackensack Meridian School of Medicine

In an ever-changing world, the concept of resiliency has emerged as a vital trait, influencing not just our daily lives but also the very structure of our brains. Resiliency, the ability to bounce back from adversity and adapt to challenges, is more than just a psychological asset; it’s a neurological phenomenon with profound implications for mental health and cognitive function.

At its core, resiliency is about managing stress, overcoming obstacles, and adapting to change. It’s a dynamic process that involves a blend of psychological, emotional, and behavioral strategies. But how does this process impact our brains?

When we encounter stress, our brain activates a range of responses to manage the situation. The hypothalamus, pituitary gland, and adrenal glands work together to release stress hormones like cortisol and adrenaline. While this acute stress response can be beneficial in short bursts, chronic stress can have detrimental effects, including impaired cognitive function and emotional regulation.

The good news is that resiliency is not just a trait but a skill that can be cultivated and enhanced. This ability to adapt and recover from stress involves brain plasticity—the brain’s capacity to reorganize itself by forming new neural connections. Resilient individuals often exhibit a higher degree of brain plasticity, enabling them to better manage stress and recover more effectively from adverse experiences.

Research has shown that practicing resilience can lead to changes in brain areas associated with emotional regulation, such as the prefrontal cortex and the amygdala. The prefrontal cortex helps us make rational decisions and control impulses, while the amygdala is involved in processing emotions. A resilient brain tends to have a more balanced interaction between these regions, contributing to improved emotional regulation and cognitive flexibility.  Just like physical exercise strengthens muscles, mental practices can enhance resiliency. Techniques such as mindfulness meditation, cognitive-behavioral strategies, and positive self-talk can foster resilience. These practices help rewire the brain, promoting a healthier response to stress and boosting overall well-being.

Mindfulness meditation, for instance, has been shown to increase gray matter density in areas of the brain linked to emotional regulation and self-awareness. Cognitive-behavioral therapy (CBT) can alter negative thought patterns, enhancing problem-solving skills and emotional resilience. These changes not only improve how we handle stress but also support long-term mental health.

Resiliency is a powerful trait that goes beyond mental strength; it’s intricately linked to brain function and structure. By understanding and nurturing our capacity for resilience, we can positively impact our brain’s ability to manage stress, adapt to change, and maintain emotional balance. As we cultivate resiliency utilizing the strategies above, we harness the brain’s incredible ability to grow and adapt, ultimately leading to a more balanced and fulfilling life.

In essence, resiliency is not just about surviving challenges but thriving in the face of them. By investing in our ability to bounce back, we invest in our brain’s health and our overall well-being.

This is the first blog post in a series of four articles to spotlight mental health issues that arise in connection to the perimenopausal, menopausal, and post-menopausal phases of a woman’s life. Menopause typically occurs around 50-52 years old preceded by 4-8 perimenopausal years. It stretches across 33% of a woman’s lifespan on average but receives very little research funding and attention. This is not an anecdotal statement. Experts in women’s reproductive health estimate that 1.1 million academic medical articles exist on trying to conceive (TTC) and pregnancy, 97,000 studies on menopause, and only 6,500 on perimenopause. This is striking considering that a significant portion of women (around 15% in the US) will never have children, yet every biological woman will navigate the process of perimenopause to menopause. In 2024, only 31% of ob/gyn residencies reportedly have curriculum that includes perimenopause and menopause. This truly is the wild, wild west of women’s health.

To be clear, menopause isn’t simply about saying goodbye to one’s reproductive years. Menstruation is an output marker of ovarian functioning and health as coordinated by your neuroimmunoendocrine system. Let’s pause to appreciate this complexity – (1) neuro meaning nervous system (brain) involvement, which encompasses your biology intersecting with your psychology; (2) immuno meaning the status of your immune and digestive health; and (3) endocrine meaning the multiple structures and pathways in your body involved in hormone production, modulation, communication and function.

Several hormones are involved in the process of menstruating, perhaps most notably is estrogen. Estrogen transforms from a very active and dynamic hormone from the time that women are in their teens to forties to a very passive and static hormone from 50s until the time of death.  We are learning each year how protective estrogen is to a woman’s health. Estrogen is involved in brain health, mental health, cardiac health, metabolic health, digestive health, and bone health. A very broad but science-backed finding is that the further away from high estrogen levels a woman is, higher levels of chronic illness are found. However, chronic illness or frailty is not an inevitable outcome of going through menopause. There are several behavioral and lifestyle interventions that mitigate the effects of the unavoidable biological process of menopause so that cognitive, physical, and psychological health can be stabilized and preserved.

This series will identify the risk factors women should be aware of and also the specific behavioral and lifestyle changes that are currently recommended by experts in women’s health. All of this information should be discussed with your personal doctors — generalizations do not necessarily apply across the board and the best medicine is personalized medicine that is delivered in a supportive, informed doctor-patient relationship.

Sources:

Cleveland Clinic

https://my.clevelandclinic.org/health/diseases/21841-menopause

Landry, A. (May 2024)

https://www.forbes.com/sites/adairalandry/2024/05/31/menopause-impacts-33-of-a-womans-life-its-time-to-stop-the-stigma/

Russell, Jones, & Newhouse (2019). “The role of estrogen in brain and cognitive aging”, Neurotherapeutics, 16, 649-665.

Developing Children and Oppositional Defiant Disorder (ODD)

Many parents may have difficulty identifying why their child is having behavioral issues and they don’t know why their child is often uncooperative and acting defiant. Oppositional Defiant Disorder, known as ODD, is a behavioral disorder that causes children to display these behaviors, and it may be the answer as to why your child is having problems. There is not one specific reason a child may be diagnosed with ODD, but many factors can contribute to this condition. ODD can be influenced by relationships, environment, genetics, and other psychological health factors, which can lead to a child being uncooperative and defiant. ODD often coexists with other psychological conditions such as ADHD, anxiety, and depression which are becoming more and more prevalent in children today.

The common signs of ODD consist of, but are not limited to;

·       Frequent loss of temper

·       Being uncooperative/unwilling to follow rules

·       Argumentative to authority figures and/or peers

·       Lack of ownership for mistakes/blaming others for their problems

·       Opposition to small and unimportant rules and requests

Along with the different behaviors, the severity of ODD may depend on the setting the behaviors are taking place. Mild cases of ODD may occur in one setting such as at home with a parent or at school with a teacher, whereas more severe cases can be observed across many different settings. The frequency of these behaviors must also be monitored because not every child who shows opposition is subject to ODD. These signs and symptoms typically need to surface consistently at least once per week over the course of six months in order to show that an issue may be present.

Without proper intervention, ODD can cause issues for children as they develop into adolescents and adults. Early intervention is essential to helping your child reach their full potential and prevent further issues related to ODD. If you believe your child may be showing signs of ODD, contact our office for a consultation to learn more.

Oppositional defiant disorder. (ODD) – Signs, Symptoms & Treatment | Nationwide Children’s Hospital. (n.d.). https://www.nationwidechildrens.org/conditions/oppositional-defiant-disorder

Substance Abuse and Mental Health Services Administration. (n.d.). Table 18, DSM-IV to DSM-5 oppositional defiant disorder comparison – DSM-5 changes – NCBI bookshelf. DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t14/

Cerebrovascular accidents (CVA’S) more commonly known as stroke, remains a major health concern around the world.  Within the United States, approximately 800,000 individuals are diagnosed and treated for stroke annually.  It is the 4th leading cause of death behind cardiovascular disease (e.g., heart attack), cancer, and accident-related trauma.  When symptoms arise, it must be considered a “medical emergency” and one that requires acute medical attention.  The acronym (FAST) is associated with stroke:

·        FACE, does the face droop to one side?

·        ARMS, does an individual have motor weakness in one arm as opposed to the other?

·        SPEECH, does the individual present with slurred or difficulty repeating words?

·        TIME, this is of the essence, call 911 or seek emergency medical attention immediately if you notice these symptoms!

As noted above, typical symptoms associated with stroke include, but are not limited to numbness, weakness, or paralysis, generally involving one side of the body including the face, arm, or leg, speech difficulty (e.g., slurred speech, inability to repeat words or phrases), imbalance or poor coordination during walking, or severe headache.

Two primary causes of stroke are the result of a blocked or clogged artery in the brain (ischemic stroke) for leaking/perforation of a blood vessel in the brain (e.g., hemorrhagic stroke).  The latter may also be due to a rupture of an irregular or thin-walled group of blood vessels known as an arteriovenous malformation (AVM).  A transient ischemic attack (TIA) may manifest with symptoms associated with stroke but only occur briefly and rarely resulting in any type of permanent brain damage.  However, TIA’s are clearly a precursor for a future stroke.

While emergency medical treatment, medications, and rehabilitation often reduces the risk for permanent and disabling symptoms, the “best medicine” is undoubtedly prevention.  While you cannot change a person’s age, race or ethnicity, sex, or genetic predisposition, there are many ways to prevent or reduce the risk of stroke, as noted below:

·        Monitor or control blood pressure; high blood pressure is the leading cause of stroke

·        Lower cholesterol levels; having a balanced diet, exercises, using prescribed medication

·        Control blood sugar levels; diabetes is a contributing factor to stroke

·        Limit alcohol intake; excessive heavy or binge drinking raises an individual’s blood pressure

·        Stop smoking or vaping; these activities increase the risk for stroke

·        Never use illegal drugs; only used prescribed medication

·        Watch your weight; be aware of your weight and body mass index (BMI) as obesity increases the risk of stroke

·        Participate in a regular exercise program; this should include both cardio and weight lifting training

·        Maintain a healthy diet; this should include eating fruits and vegetables and limiting the intake of sugar, salt, and unhealth fats

·        Comply with prescribed medications; this will help in the management of high blood pressure, high cholesterol, and diabetes

·        Stress management; there is a positive correlation between any stroke and high levels of anxiety and life-stressors

In summary, common strategies for stroke prevention are best identified and implemented through the recommendations of your primary care physician and other appropriate medical specialists.  More importantly, you as the patient, must comply with the aforementioned strategies for stroke prevention and treatment recommendations.

For additional information regarding stroke treatment or prevention, please contact our office at 732-988-3441.

Michael J. Raymond, Ph.D., ABN, FACPN
Board Certified Neuropsychologist #232
Licensed Psychologist #35S100252900

The diagnosis of ataxia for your child is a difficult experience for any parent.
Ataxia is a very complex disease and can be challenging to understand and diagnose, especially
when working with young children. In simple terms, ataxia can be interpreted as impaired
coordination and medically understood as a disease of the nervous system. This can
impact balance, speech, and fine motor skills. Additionally, it is not a singular condition but instead a
symptom to underlying neurological concerns.

When recognizing the development of ataxia it is important to be aware of the various forms
that can be present. Prominently, deciphering whether the ataxia is acute or chronic is crucial.
Following this, most cases of acute ataxia stem from underlying causes, while chronic ataxia can
arise from either primary or secondary factors. The diagnostic process consists of a thorough
neurological and physical examination, as well as review of medical and family history. In some
cases brain imaging tests are needed to make further distinctions, including MRI or CT scans.

Following the diagnosis, the focus shifts to managing symptoms and, if identifiable,
addressing the underlying cause. While advances have been aquired for some disorders that
correlate to ataxia in recent years, most hereditary disorders that are associated with it are not fully
treatable. At present, treatments are limited to addressing vitamin E deficiency and ataxia alongside
coenzyme Q deficiency. Although there is an increasing number of disorders undergoing clinical
trials and product development, the focus primarily revolves around only two forms of ataxia,
Friedreich ataxia and Ataxia Telangiectasia. Symptoms can be alleviated and improved through
other remedies such as occupational, speech, and physical therapy, medications and adaptive
technology. Additionally, comprehensive genetic testing results can help eliminate the possibility of
other medical conditions, offering clarity and accuracy in diagnosis. The insights gained from an
in-depth genetic analysis not only aid in ruling out alternative diseases but also empower patients
and their families with knowledge to make informed decisions about their healthcare and familial
risks.

Most importantly, it is essential to care for your child emotionally and physically, and
approach this disease with a well informed mindset. Continue to educate yourself about ataxia in
order to advocate and support your child effectively. With appropriate care, many children with
ataxia have fulfilling lives and are capable of achieving their goals and aspirations. Embrace the
journey, celebrate milestones, and remember that you are not alone. Together, as a family and with
the support of healthcare professionals and community resources, you can navigate the challenges
of ataxia and help your child thrive.

David R. Lynch, Ashley McCormick, Kimberly Schadt, Elizabeth Kichula, Pediatric Ataxia: Focus on
Chronic Disorders, Seminars in Pediatric Neurology, Volume 25, 2018, Pages 54-64, ISSN
1071-9091, https://www.sciencedirect.com/science/article/abs/pii/S1071909118300019

Chronic Traumatic Encephalopathy (CTE) is a brain condition usually associated with boxers and football players.  Recent American Medical Association Journal (JAMA Neurology) revealed surprising evidence:  Of 152 brain examinations from contact sports athletes under the age of 30, more than 40% had evidence of CTE, suggesting that it can start much earlier than expected.

What happens in the brain?  When the head receives a blow or a sudden stop and acceleration as happens with a football tackle, the brain moves inside the skull, creating shearing forces that could damage tiny blood vessels (microhemorrhages), and nerve connections (axonal injuries).

As the brain bounces back and forth, the damage causes an abnormal protein called Tau to build up inside the folds of the brain surface called the cerebral cortex sulci.  Tau protein eventually builds up in the sulci and is diagnostic for CTE.  The cortex is the part of your brain responsible for thinking, memory, reasoning, emotions, and learning.

Who is at risk?  There are 4 million sports-related concussions occurring in the US each year, and about 70% of people with repeated concussions may develop CTE.  A big question is why some people develop it and others do not.  It may be that some athletes are at higher risk genetically.

Diagnosis

Researchers are developing guidelines for before-death diagnosis based on history and symptoms called Trauma Encephalopathy Syndrome (TES).  To diagnose TES, an athlete must have:

• A history of repeated head trauma.
• CTE symptoms, at least 12 months.
• A history of symptoms getting worse.
• No other diagnosis that could cause the symptoms.

CTE develops in stages.  The earliest symptoms are subtle cognitive, emotional, and behavioral changes.  These stages include:

• Mood symptoms – Depression, anxiety, and paranoia.
• Behavioral symptoms – Impulsive or aggressive, and anger.
• Cognitive systems include confusion, short-term memory, and poor judgment.
• Motor signs walking and balance problems, and trouble speaking.

There is no cure for CTE, but symptoms can be treated.  Here at NRS|LS, we are one of the seven original programs treating concussion and traumatic brain injury, extending back to 1978.  The following are the stages that need to be applied in order to help the individual:

1.     Consultation.  The athlete needs to understand the nature of his/her changed profile.

2.     A neuropsychological examination.  This is a “blueprint” that describes the functional expression of the physical changes that have occurred in the brain in the form of thinking changes, and behavior.  It enables a rehabilitative program to help the athlete understand what they have, what the adjustment strategies are, an understanding of the functional expression of these problems in daily functioning, and what they can do about it.

3.     Biofeedback.  Many of the athletes develop significant adjustment reactions in the form of depression, as well as agitation.

4.     Cognitive rehabilitation.  These are cognitive exercises enabling the athlete to develop compensatory strategies adjusting to their thinking problems.

5.     Medication.  There are medications for mood changes, depression, and anxiety.  Some medications used for Parkinson’s and Alzheimer’s may help memory and movement problems.

In closing, untreated CTE may increase the risk of accidental death or suicide.  Life expectancy for people with CTE is about 70 years old.  Education and intervention is critically needed for this population.

If you have a history of repeated head traumas, be it sports, accidents, etc., please call us and we will certainly be able to help you understand your situation and what you can do about it.

______________________________
Robert B. Sica, Ph.D., ABN
Board-Certified in Neuropsychology
Director, Neuropsychological Rehabilitation Services|LifeSpan
Director, Post-Doctoral Fellowship Supervisor
Jersey Shore University Medical Center, Neuroscience Division
Department of Neurology and Psychiatry
Clinical Assistant Professor, Rutgers-Robert Wood Johnson Medical School
Clinical Assistant Professor, Hackensack Meridian School of Medicine

Some Facts About Concussion

Concussion, also called mild traumatic brain injury, can occur due to motor vehicle accidents, hitting the head during a fall, or playing contact sports. Symptoms following the event depend on the severity of the injury and vary from mild confusion and disorientation to a complete brief loss of consciousness. These symptoms occur due to an abnormal movement of the brain inside a skull, which disrupts the functioning of the brain cells at the molecular level. These changes are often undetectable during the neuroimaging studies. Neuropsychological testing is method that is sensitive in identifying neurocognitive changes after a concussion such as problems with attention, information processing, memory, reasoning, etc.

The most severe symptoms are experienced within minutes and hours after the injury and gradually improve within days or weeks. Most people fully recover after 3-6 months. The length of recovery depends on many factors, such as the specifics of the injury, the person’s age, medical conditions, history of previous concussions, stress, previous psychological history, and current psychological symptoms, including anxiety and depression. Some people continue to experience headaches, sleep problems, fatigue, vision or balance abnormalities, and behavioral changes after the expected time of recovery. These symptoms, with proper treatment, can also improve.

The research indicates that it is essential for patients to receive accurate information and education about concussion and have positive, realistic expectations about the recovery process. A lack of information leads to a so-called ‘misattribution bias’ where patients think of common mild cognitive fluctuations caused by fatigue, pain, or psychological symptoms as symptoms of severe and permanent brain injury.

At NRS|LS, patients receive comprehensive care (i.e. neuropsychological and psychological testing, counseling, cognitive rehabilitation, etc.) for concussion and post-concussive symptoms. Please call our office if you have any questions or would like a consultation.

Eleonora Gallagher, Psy.D.
Clinical Psychologist #7297
Neuropsychology Post-Doctoral Fellow

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Aphasia is a language condition that affects an individual’s ability to understand and express language, as well as their ability to read and write. Aphasia most often occurs suddenly as the result of brain injury caused by a stroke, head injury, or brain tumor, but it can also present slowly in progressive neurological conditions such as Alzheimer’s or different types of dementia.

While there are multiple different types of aphasia, many of them fall into two broad categories that are referred to as fluent and non-fluent. The most common type of fluent aphasia is called Wernicke’s aphasia, and it is caused by damage to the temporal lobe. This condition is characterized by an individual who can speak fluently, but what they are saying may be confusing and lack meaning to others. In addition, people with Wernicke’s aphasia are often unaware of their spoken mistakes, which can cause a great deal of frustration.

Moving to non-fluent aphasia, the most common type is Broca’s aphasia. This is caused by damage to the left side of the frontal lobe, which is an area that is responsible for speech and motor movements. People with this kind of aphasia may speak in short, fragmented sentences that lack connecting words such as “but,” “or,” and “and.” Despite their lack of fluency, individuals with Broca’s aphasia are still able to use words in the correct context.

Neuropsychological evaluation is an excellent tool for identifying the different types of aphasia. In addition, it is always recommended to evaluate the totality of brain functions in order to best serve the patient. If you or a loved one is experiencing symptoms pertaining to a neurological condition, please call our office to schedule a consultation.

Gianna Scimemi, M.A.
Psychometrician & Doctoral Student