Sleep, Memory, and the Brain

Dan commented on the contraindications of Namenda plus Aricept. Since many of us are on the both of these agents, would you mind giving all of us more information which you obtained during the study in which you participated. We’d all appreciate it, I’m sure.   Thanks, Dan.

If you read my post the other day about my sleep deprivation for several and how it affected my brain, the following article explains in detail the reasoning behind this.

Sleep, Memory, and the Brain

When you’re sleep deprived, cognition is one of the first functions to decline. Shortchange yourself on sleep by staying up late, continue this night after night, and you ultimately shortchange your memory. And if the problem is not resolved, your memory — and your brain — will not be functioning in the best way possible.

In this excerpt from our Johns Hopkins Memory Bulletin, neurologists Marilyn Albert, Ph.D. and Guy McKann, M.D. answer questions about sleep and how it affects the brain and memory.

Q.  How much sleep does an adult need each night?

A.  As people get older, a decrease begins in both the total time sleeping and the amount of time spent in the stage of sleep associated with dreaming. A newborn sleeps 16 hours per day. In contrast, the baby’s 30-year-old mother sleeps six hours per day (if she’s lucky), and only one quarter of this time, or two hours, is occupied by the deepest stage of sleep.

Starting in middle age (between 45 and 60), not only does the amount of sleep per night start to decrease, but also the character of sleep changes. People at these ages spend less time in the stage of sleep associated with dreaming and more time in the lighter stages.

As people get older, they are more likely to shift the time when they sleep, some going to bed and to sleep earlier and waking up earlier. Others are the opposite, staying up late into the night and sleeping much of the day. When people are in their 80s, these changes are even more pronounced. Their total time asleep per day may be only six or seven hours, including time spent in daytime naps. Even though a person may take several naps a day, the total time sleeping in naps is rarely over an hour. The idea that older individuals should sleep soundly for eight to 10 hours is clearly wrong.

As a rule of thumb, one hour of sleep is required for two hours of being awake. As we get older, that ratio becomes closer to 45 minutes of sleep to each two hours awake. In other words, throughout the day you gradually accumulate a “sleep debt.” By the end of a 16-hour day, a younger person owes the “sleep bank” eight hours. In contrast, an older person has a sleep debt of only about six hours. By the end of a week, you may have accumulated a sleep debt of eight to 10 hours.

Q.  What are the effects of sleep deprivation?

A.  If you don’t allot enough time for sleep, you become sleep deprived. Besides being sleepy during the daytime, sleep-deprived people often have problems with their thinking. They are slower to learn new things, they may have problems with memory, and their ability to make judgments may be faulty, enough so that they may think they are really starting to “lose it” when the problem is really not enough sleep.

Elderly people do not recover from sleep deprivation as quickly as younger people. In experimental situations where people are kept awake for 24 hours, those in their 70s take at least a day longer to recover from their subsequent daytime sleepiness than younger people. Gender may also make a difference in the time it takes to recover from sleep deprivation; women seem to be able to recover faster than men.

True or False

Spring onions and shallots are exactly the same.

False. Shallots, or scallions, differ from other onions in that instead of having a single bulb, it divides into a cluster of smaller bulbs.

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Swallow This! Bittersweet Memory Pills

 

pill-bottleThis week I had three very good days in a row. So good that I overblogged on those days. Pam even said, “You’re spending a lot of time on the computer. Why don’t you take a break?” I felt well. So well that on this past Wednesday evening I began to ponder whether I really needed to take all these ‘memory pills.’ ‘Dementia pills.’ Nothing wrong with me. I don’t think I need to take them. I could go to work again. On those days you feel poorly, kick yourself a good one and get going. It’s all in your head (oops, excuse the pun).

So I mentioned it to Pam. A good mistake, I guess. Talking about tough love! The earth shook. The dogs barked. And the wind blew. I ended up stammering, “Yes, yes. I’ll take them and no, I didn’t stop taking them. I swear to God with both hands on the Bible.” Caregivers……..tough love does work!  My red face grin.  icon_redface

Later that evening, Chad said goodnight to which I responded, “I hope you don’t die tonight.” In my heart, I was trying and meaning to say, “OK. You have a good night and sleep well.” I walked into the bedroom. Again the earth shook. Pam told me how inappropriate my comment to Chad was. I wasn’t sure what she was talking about.

Evidence of lacking good judgment twice within hours of each other. Before going to bed, she said, “You really did stop your medicine, didn’t you?” I had to convince her that I didn’t. Whether it was poor judgment, word or phrase finding difficulty or just plain not thinking, it wasn’t the read David. Pam reminded me of my past couple of years and the symptoms I’ve shown. She reminded me of my abnormal SPECT scan.

And then the next morning — Thursday. I awakened having slept poorly. I was in a fog and feeling fuzzy. My gait was a little stiff and slow. Good morning, Lewy Body Dementia. I see you’re back. Reality smacked me in the face! With no sarcasm at all, Pam said, “Do you still want to go off the Namenda and Aricept?” I had no retort……..

David

Which type of specialist (neurologist, psychiatrist, gerontologist or family doctor should a dementia patient see for diagnosis and follow-up)?

3 Tips for Today

  

  1. Buy whatever kids are selling on card tables in their front yards.
  2. Treat everyone you meet as you want to be treated.
  3. Admit your mistakes.

 

 Question:  “Which type of specialist (neurologist, psychiatrist, gerontologist or family doctor should a dementia patient see for diagnosis and follow-up)?

 

Answer:  My suggestion would be (if possible) to do the following:

a.      Have a neurologist specializing in dementia do the initial evaluation, workup and diagnosis.

b.      Have the same neurologist do all the follow-up visits. If this is not possible then the second best option would be to have a good gerontologist for follow-up.

c.      Have an open and understanding psychiatrist in the wing in case the patient develops pyschiatric symptoms such as depression, anxiety, delusions, etc. However, the primary provider may also be willing to do this. I am very fortunate. My particular neurologist is a world reknowned Dr. who is a dementia expert and does ongoing research in the field. He prefers to have a psychiatrist handle any emerging psychiatric symptoms/problems.

d.   An internist or family doctor can best be utilized to follow through with any and all physical/medical problems.

 

This seems like the patient would need a lot of physicians for his/her care. But I think it provides the best overall care and treatment.

 

Let’s continue with my story. Yesterday I finished my post discussing my diagnosis of Bell’s Palsy in June 2007. So after 6 weeks of steroids and an antiviral agent, I thought all was well and I returned to work at the hospital. I continued to have intermittent tremors and some trouble concentrating. But I covered the attention span and concentration issues fairly well (so I thought). Others around me commented on how hard I was working and that I was doing a good job. The Doc later told me I had enough cognitive reserve to be able to cover and to compensate so that I appeared and acted normally.

 

In mid-September 2007, I again drove to work on a Monday morning as usual. I remember moderating a morning meeting at 8:15. At the end of the meeting the last thing I remember was that I asked a question to the participants. “But why aren’t we going over these papers?” Little did I know we already had done that. They rushed me to the local emergency room. For the next few months I remember very little. I have vague dream-like memories of being in several hospitals, getting tests and seeing many Drs. Finally in October 2007, I was diagnosed with Lewy Body Dementia at the University of California San Francisco (UCSF) at the Aging and Memory Center.

 

Tomorrow………..my reactions and how this new diagnosis altered my life forever.

 

Dr. David

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