Category: News

Chemo Brain: What is It?

Chemo brain, also known as cancer-related cognitive impairment or chemotherapy brain fog, is a condition that can be caused by chemotherapy treatment, the cancer itself, or other cancer treatments. Of note, chemo brain is not dementia and there is no evidence that it leads to dementia.

“It feels as if you’re wearing a cap on your head that’s made of fog.” – Cancer survivor

Symptoms of chemo brain include forgetfulness, word finding difficulties, poor focus and concentration, difficulty multitasking, taking longer to complete routine tasks, disorganization, and feeling sluggish.

Chemo brain is extremely common. In fact, as many as 75% of cancer patients have experienced it during their treatment, and approximately one third of patients continue to struggle with it after treatment. For most individuals, the effects resolve within 6-9 months. But for others, the fog persists for years and sometimes even decades.

Unfortunately, the cognitive side effects of cancer treatment can be debilitating, leading to a cancer patient’s inability to return to work and/or school. The goal is for individuals not only to live as long as possible, but also live a high-quality life.

Research has shown that individuals with chemo brain benefit from Cognitive Rehabilitation, which is a treatment focused on learning to adapt and cope with the above symptoms. The NRS|LS Cognitive Rehabilitation Program offers an individualized treatment plan with a full range of services, from consultation to treatment completion.

If you or a loved one is suffering from cognitive changes secondary to a cancer diagnosis, please call our office for a consultation.

 

Michelle Blose, PsyD
Neuropsychology, Post-Doctoral Fellow
NJ Permit: TP# 203-032

Fatigue: Facts & Tips

Have you asked yourself:

Am I just tired?
What is the difference between being tired and having “fatigue”?
Is there something physically wrong with my body to cause me to feel tired or is this stress?

“Being tired all the time” is quickly rising to the top of the list of complaints to medical doctors who have the difficult task of trying to identify whether a patient is tired (AKA chronically sleepy) or fatigued (AKA chronically lacking energy). Hard to tell the difference, right?

There are actually three different forms of fatigue:

  • Physical fatigue – which may occur at the end of a long, busy day
  • Pathological fatigue – refers to tiredness brought on by overworking the body’s defense system (the “stress-fatigue” connection)
  • Psychological fatigue – result from constant worry, excessive productivity, depression, boredom, and isolation

Medical doctors may refer to clinical health psychologists to evaluate and treat fatigue brought on by stress and emotional factors. Psychologists also consider the behavioral and cognitive elements that often accompany the physical feeling of having very little energy, such as:

  • the inability to initiate activity (how hard it is to start something)
  • reduced capacity to maintain activity (how long one can do something before burning out, “stamina”); and
  • difficulty with concentration, memory, and emotional stability (“brain fog”-type symptoms).

Seeing your medical doctor is a great first place to start if you’re concerned about these issues. It is important to rule out medical causes for diminished energy and potential sleep disorders. If you would like to meet with a clinical health psychologist to discuss, call the scheduling department at 732-988-3441 to set up a consultation appointment.

Lauren Gashlin, PsyD
Clinical Health Psychologist

 

Posttraumatic Stress Disorder (PTSD) after a Motor Vehicle Accident

There are about six million motor vehicle accidents (MVAs) that occur in the U.S. each year, with 2.5 million resulting in injuries. Many times injuries sustained are psychological and emotional in nature. In fact, the National Institute of Mental Health (NIMH) research found that 39.2% of MVA survivors develop symptoms of posttraumatic stress disorder (PTSD).

What is PTSD?

PTSD is triggered by a life-threatening event. The American Psychiatric Association (APA) defines PTSD as a psychiatric disorder that develops when an individual experiences or witnesses a traumatic event with secondary psychological symptoms. Traumatic events could include a serious car accident in which a person is threatened with serious injury or death.

Common PTSD Symptoms

  • Anxiety
  • Depression
  • Fearfulness
  • Sleep problems
  • Recurring nightmares
  • Flashbacks from the accident
  • Headaches
  • Avoidance behaviors (e.g., avoiding driving or being near a car)
  • Irritability
  • Guilty feelings

Risk Factors for PTSD after MVA

  • Dissociation (e.g., feeling of being detached from reality) during or after the accident
  • High emotionality during or after the accident (e.g., fear, helplessness, horror, guilt)
  • Perceived life threat to self or others
  • History of mood disorders (e.g., depression, anxiety)
  • Prior experience of trauma
  • Obsessive thinking and avoidance behaviors
  • Lack of social support after accident

Treatment

High emotionality can follow after an MVA. Most victims report experiencing shock, guilt, fear, and helplessness. Typically, these symptoms subside over time. But if symptoms persist or get worse, one should seek treatment. There are many effective treatments available for PTSD, and recovery is possible. At NRS|LS, we offer cognitive behavioral therapy (CBT) for PTSD, including Biofeedback. Here, you can learn necessary skills to cope with emotional symptoms and regain control over your life.

If you or someone you know is struggling with symptoms following an MVA, please call our office for a consultation.

Basia Andrejko-Gworek, Ph.D.
Clinical Psychology, Post-Doctoral Fellow
Permit# TP #213-03

 

Gender Differences in Autism Spectrum Disorder

Autism Spectrum Disorder, or ASD, is a neurodevelopmental condition that represents with a variety of clinical characteristics.  Some signs could be weaknesses in social skills and communication, restricted interests, repetitive behaviors, etc. The CDC estimates that 1 in every 54 US children has autism. However, not all children, adolescents or adults are diagnosed equally.  The male-to-female ratio for ASD diagnoses in the US is widely reported as 4:1 (Green et al., 2019). The disparity widens as intelligence increases, suggesting that females with higher cognitive and language abilities tend to receive diagnoses later or go unidentified completely (Jamison et al., 2017). This ratio is likely a misrepresentation of the true prevalence of ASD across gender, a complex issue underpinned by a number of contributing factors.

The diagnostic gap is, in part, caused by bias towards the detection of male symptoms in existing diagnostic techniques. Meta-analysis studies on how clinicians diagnose ASD show that female patients, on average, have less restricted and repetitive behaviors and interests.  These gender discrepancies have created a body of data with drastically greater male representation than female representation, upon which further analysis is performed, perpetuating the diagnostic gap.

There are also differences in the presentation of ASD in male and female persons, observed throughout the lifespan. Childhood and adolescence are two highly sensitive periods for the detection of ASD and are also where these differences in presentation are most observed (Jamison et al., 2017). A 2014 study on the “female phenotype” of ASD found that, beginning in childhood, the speech of females contains more vocabulary words related to emotions when compared to males. Females with ASD are also reported to have restricted interests related to people and animals instead of inanimate objects, common in males (Green et al., 2019). In adolescence, there is a notable gender divergence in the psychiatric comorbidities reported in individuals with ASD. Compared to females, males show heightened rates of externalizing disorders, including possible oppositional tendencies, hyperactivity, and inattention. After the age of 15, females with ASD have “exceptionally high risk” of developing depression and experience elevated rates of internalizing disorders, like anxiety and eating disorders, compared to adolescent males with ASD (Green et al., 2019). On average, females are diagnosed later in life than males. This can mean a lifetime of feeling misunderstood, possibly contributing to this observed pattern.

It is also important to consider the contributions that social constructions of gender make in the diagnostic gap in ASD. Stereotypes and socialization play a role in how parents, educators, and clinicians interpret certain behaviors and recognize them as symptoms of AS

As these factors are identified and discussed in ASD literature, progress is being made to close the diagnostic gap. Recent studies show a trend towards a lower gender ratio and a dissociation of gender from intellectual disability, which suggests that improvements are being made in identifying high-functioning females (Lai et al., 2015). With sensitivity to the differences between male and female presentations, ASD research should focus on identifying all persons on the spectrum and to identify each person’s strength/weakness and grow to be more inclusive in the future.

If you have any questions, please call our office.

Steven P. Greco, PhD, ABN
Board Certified, Neuropsychology

References:

Green, R. M., Travers, A. M., Howe, Y. & McDougle, C. (2019). Women and autism spectrum disorder: Diagnosis and implications for treatment of adolescents and adults. Current Psychiatry Reports, 22, 1-8. DOI: 10.1007/s11920-019-1006-3

Jamison, R., Bishop, S. L., Huerta, M. & Halladay, A. K. (2017). The clinician perspective on sex differences in autism spectrum disorders. Autism, 21(6), 772-784. DOI: 10.1177/1362361216681481

Lai, M., Lombardo, M. V., Auyeung, B., Chakrabarti, B. & Baron-Cohen, S. (2015). Sex/gender differences and autism: Setting the scene for future research. Journal of the American Academy of Child & Adolescent Psychiatry, 54(1), 11-24. DOI: 10.1016/j.jaac.2014.10.003

 

4 WAYS TO REDUCE DEMENTIA RISK

More than 8 million Americans currently suffer from Alzheimer’s disease, and that number is likely to rise to 16 million by 2060.

Alzheimer’s accounts for 60% to 80% of dementia cases.  Vascular dementia–linked to strokes and problems with blood flow to the brain–accounts for 10%.  Lewy body dementia, frontotemporal dementia, and mixed dementia make up the remainder. Neurological changes, vascular disease, and inflammation are the main sources that cause dementia symptoms.  However, research is showing a whole list of underlying triggers that may lead to cognitive decline. Here are some examples:

1.     Bad sleep habits and sitting a lot are a dangerous duo. Lack of physical activity and poor sleep are linked to the build-up of Alzheimer-related proteins in the brain.

2.     Diabetes seems to have a direct link to dementia through elevated blood sugar that changes activity in the brain.  These elevated blood sugars can impair working memory in ways that are similar to what happens to neurons in Alzheimer’s.  One study found that people with Type 2 diabetes had an 88% higher risk of dementia than those without the disease.

3.     Your liver’s health affects your brain’s health. Some proteins are produced in the liver and travel to the brain, which could cause health concerns.

4.     Gum disease may be a trigger for dementia. It is suggested that mouth bacteria when gums are inflamed damage blood vessels that provide blood flow to the brain.

LIFESTYLE TIPS TO PREVENT DEMENTIA

So what can you do to reduce your risk?  Here are four of the latest tips:

1.     Research shows that if you have diabetes, keeping five to seven of the risk factors for dementia (smoking, elevated A1c levels, blood pressure, BMI, lack of physical activity, and your diet) within guideline recommended ranges will reduce your risk for dementia to the same level as for people without diabetes.

2.     Vitamin B12, along with other Vitamin Bs, may also have a role in protecting you from Alzheimer’s.  Have your blood level tested, eat foods that supply vitamin B12 (sardines, trout, tuna, and fortified cereals), and take supplements to boost your level.

3.     A healthy liver protects your brain.  Your diet should contain little saturated fat, reduced red or processed meats or added sugars, and lots of healthy fats found in olive oil and salmon.

4.     Weight loss. Obesity changes fat in your arteries into inflammatory problems that causes blockages, a contributor to dementia.

If you or any family members are suffering cognitive changes due to a dementia diagnosis, please call our office for a consultation to learn more about preventing and treating dementia.

Robert B. Sica, PhD, ABN
Board certified, Neuropsychology
Founder, Director

Gut Checking our Mental Health: The Brain-Gut Connection Simplified

“Brain-gut connection,” “mind-body,” “big brain”, “little brain.” These phrases are catchy in popular press articles but get little attention in traditional medical and mental health practices. One simple reason for this disconnect is that the brain-gut pathway spans across a large portion of our body and, in a health system that compartmentalizes the body into one specialty area at a time (how many specialists exist now?), it’s hard to understand conditions in a true “mind-body” approach.

But let’s break it down simply. The brain-gut connection is like a two-lane highway between two destinations: the brain (“the big brain”) and the gut (“the little brain”). The gut is called the “little brain” because its chemical makeup is remarkably similar to our “big” brain, especially regarding neurotransmitter functioning. Traffic flows in both directions (top-down AND bottom-up) and there are a bunch of exits along the GI tract. In situations where there is gut dysfunction (think IBS, leaky gut, fibromyalgia-rooted stomach issues, etc.), the traffic signals going back up to the big brain can cause symptoms of depressed mood, anxiety, brain fog, etc. And, vice versa, problems in the big brain can jam up traffic going down the GI tract and cause nausea, constipation, stomachaches, etc.

The complexity of this relationship often causes confusion amongst medical providers leading to delays in proper diagnosis and treatment. Mental health professionals have been slow to incorporate this knowledge into more sophisticated treatment plans. However, at NRS|Lifespan, our clinical health psychology program integrates this information into a scientifically-informed evaluation and treatment approach. The strategies we use aim to optimize the health of the brain-gut pathway and complement medical treatments to undo the damage of undetected brain-gut conditions.

If interested, call our office at 732-988-3441 to schedule a consultation appointment with our clinical health psychologist.

Lauren Gashlin, PsyD
Licensed Clinical-Health Psychologist

 

 

Rehabilitation of Visual Processing Deficits following Brain Injury

Visual processing deficits are common sequelae in individuals who have sustained a brain injury.  Visual processing includes the acquisition of visual information and the appropriate use and manipulation of that information based upon task or environmental demands.  Following brain injury, visual processing deficits can manifest in various ways, and will likely interfere with the patient’s progress and rehabilitation outcome.

Vision is the most important sensory system that humans use to obtain information about the surrounding environment.  The visual system consists of the eyeball, the optic nerve, and several areas of the brain, which interact in complex ways that are currently only partially understood.  Many people use the term “visual perception” to describe how the visual system operates, although the actual process of visual perception enables us to make sense of information processed by this sensory system.

There are a large number of identifiable visual processing skills operating within the visual system, and there have been several attempts to describe them in some kind of rational framework.  These include the Deficit Skill Approach, which categorizes visual processing into specific deficits, and the Information Processing Models, which describe the reception, organization, and assimilation of visual information on a continuum from simple to complex.

The rehabilitation of visual processing deficits begins once the visual assessment is completed and specific deficits are identified.  Treatment can be multi-disciplinary and be provided by a variety of professionals including optometrists, neuropsychologists, and vision, cognitive, and occupational therapists.  As with other areas of cognitive rehabilitation, there are two broad approaches to the treatment of visual processing deficits: adaptive and remedial.  Utilizing these approaches in combination may result in the most successful rehabilitation outcome.  Adaptive treatment is provided in activities of daily living (ADLs).

It is well documented that visual processing deficits are a common problem following brain injury.  The impact of these deficits is likely compounded by associated or coexisting problems along with cognitive, behavioral, psychological, and medical conditions.  Proper and comprehensive visual assessment is vital in identifying potential visual deficits.  Once these deficits have been identified, visual (cognitive) rehabilitation strategies can be implemented.  Undoubtedly, effective treatment and rehabilitation for visual processing deficits will result in improved functional adaptation, better rehabilitation outcomes, and a more favorable prognosis.

For additional information or to schedule a consultation, please contact our office at 732-988-3441.

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

Psychological Time Zones

When we think, we time travel. If we are not present, then we are either thinking about the past or the future. These are the three psychological time zones: Past, Present, and Future. Being aware of what “Time Zone” you are in—i.e. Past, Present, or Future–is an important first step in controlling maladaptive thoughts and behaviors. There are appropriate times to be present, to reflect, and to imagine. First, we must establish if we are in the appropriate zone.

I once heard on the radio an excellent metaphor to better explain this point. Imagine your zones as though it were a car. A car is designed with a very large front windshield for optimal visibility. There are also small rear-view and side-view mirrors to see either yourself or things behind you. When we drive, we want to spend most of our time looking at the things directly in front of us and a little bit ahead. If we look too far down the road, our view is obstructed, and it would be dangerous to focus on things you can’t yet see for excessive periods of time. If we spend all our time looking behind us, then we never see where we are going.

We should strive to spend most of our time being present (through the windshield). Thinking about the past is not necessarily bad; who doesn’t like sitting with friends over an old photo album or rehashing memories? History teaches us to learn and adapt. However, if we don’t take away lessons from our past, we can find ourselves cycle of negative thoughts and behaviors.  Therefore, learn from past but be present focused. Regarding future thinking, it’s critical to plan. But, to worry and try to look beyond what we can anticipate will increase anxiety and reactive stress. By being aware of “your time zone” and adjusting to your thought process, we can improve both your feelings and behaviors.

To summarize:

1) Mindfully establish your zone

2) Evaluate if it’s helpful in the moment

3) Shift if not appropriate time zone

3) Adjust if engaging in a time zone in a maladaptive manner (i.e. negative self-talk about a mistake we made)

4) Practice daily mindfulness exercise to help improve awareness

 

George Corradino, LPC
Professional Licensed Counselor

 

How to Deal with Chronic Pain.

About 20% of adults in the U.S. experience chronic pain every day or almost every day. Chronic pain is different from acute pain. Acute pain resolves typically within twelve weeks. Chronic pain persists either beyond twelve weeks or the expected time for healing. Chronic pain is often secondary to traumatic injury or medical conditions like diabetes, cancer, etc. Examples of neurological disorders accompanied by chronic pain include multiple sclerosis, stroke, Parkinson’s disease, etc. Most commonly, chronic pain can affect your back, hips, knees, feet, head, etc.

A variety of factors influence the severity and time course of pain. According to the U.S. Pain Foundation, older age, gender, genetics, history of having surgery, being overweight, and stress- and trauma-related psychological conditions can have an influence on pain.

Your brain is primarily responsible for pain perception on biological and psychological levels. Since pain is unpleasant, the awareness of pain contributes to its interpretation as a threat of actual or potential damage occurring to the body. Not surprisingly, this interpretation results in increased stress, leading to elevations in anxiety, irritability, problems with thinking, fatigue, sleep disturbances, and other psychological and neuropsychological symptoms. Depression and anxiety are psychological conditions that affect people with chronic pain bidirectionally. For example, chronic pain can lead to depression and vice versa.

The current recommended treatment of chronic pain includes a combination of pharmacological interventions, no-pharmacological interventions, and psychological treatment. The types of psychological treatment used for patients with chronic pain may include Medical Adjustment Counseling®, Biofeedback therapy, Physical therapy, etc.

Here at NRS|Lifespan, our comprehensive team offers a unique approach to treating chronic  pain via Medical Adjustment Counseling® (MAC). MAC® is a specialized, counseling approach that is tailored to the individual’s unique health needs.  The goal is to improve coping skills, understand your medical condition, and learn to apply practical strategies to deal with your chronic pain.

For more information, please call our office.

Eleonora Gallagher, Psy.D.
Neuropsychology Post-Doctoral Fellow
NJ Permit: TP# 213-079

References

1. Hadjistavropoulos, T., & Craig, K. D. (2004). Pain: psychological perspectives. Psychology Press.
2. Johnson M. I. (2019). The Landscape of Chronic Pain: Broader Perspectives. Medicina (Kaunas, Lithuania), 55(5), 182. https://doi.org/10.3390/medicina55050182
3. Yong, R. J., Mullins, P.M., & Bhattacharyya, N. Prevalence of chronic pain among adults in the United States. PAIN: February 2022 – Volume 163 – Issue 2 – p e328-e332doi: 10.1097/j.pain.0000000000002291
4. www.uspainfoundation.org

Caring for the Caregiver: Ways of Helping You Care for a Person with Memory Loss

Balancing caregiving with work and other family obligations can be stressful. Don’t overlook the stressful impacts of caregiving. It is important to reassess your loved one’s needs periodically – and your ability to provide care. It is important to get help and relief from the stress of caregiving. These tips can help you find the support you need:

1.     Ask for help: a) make a list of ways others can help, b) ask a friend or relative to help out for an hour each week, and c) don’t wait for a crisis, ask for and accept help on a regular basis.

2.     Take time for yourself: a) consider using respite care, homecare, or adult day care, b) schedule regular time for yourself, and c) plan to spend an hour each day or an afternoon once a week away from caregiving.

3.     Express your feelings and avoid isolation: a) recognize that feelings of frustration, sadness, anger, and depression are common under the circumstances and b) join a caregiver support group.

4.     Take care of your health: a) make sure to eat and rest, b) get moving, even 10 minutes of exercise a day can help, c) learn and use stress reduction techniques (visualization, meditation, breathing exercises), and d) don’t put off your own medical care.

5.     Learn about the condition: a) find out about different forms and stages of dementia so that you are not taken by surprise when new behaviors occur and b) if you can, provide information to family and friends so they will know how best to support you.

6.     Look for signs of burnout: Not taking care of your own health? Feeling lonely? Crying or losing your temper more than usual? These are all signs that you may need help.

Remember, you will be better able to care for another if you don’t take time for yourself. No one can do it all. You have to be your first priority.

Additional information and resources for caregivers:

 

Michelle Blose, PsyD
Neuropsychology, Post-Doctoral Fellow
NJ Permit: TP# 203-032