Will COVID-19 create more dementia? Dementia, Alzheimer's and the latest research

There are problems enough, but will COVID-19 lead to an upsurge in dementia and if so, what can be done about it? 

Here is the challenge. Given ICU can be a great place to be when you really need, recent research confirms what many have observed. One in four people had cognitive impairment a year after release from an ICU that was similar in severity to having mild Alzheimer’s, and 1-in-3 had cognitive impairment similar to that seen with moderate traumatic brain injury. 

So if someone ends up in ICU with COVID-19, and one imagines even more so if on a ventilator, the risks of developing dementia would be real. But there is hope, so this week we examine what mindfulness and meditation in particular have to offer – to anyone at risk of dementia, to those already affected by it, and their caregivers, but first

        Thought for the day

Meditation is all about the pursuit of nothingness. 

It is like the ultimate rest. 

It is better than the best sleep you have ever had.

It is a quieting of the mind. 

It sharpens everything, 

Especially your appreciation of your surroundings.

It keeps life fresh.

Hugh Jackman - long term meditator

The context

The world population is aging and the prevalence of dementia is increasing. By 2050, those aged 60 years and older are expected to make up a quarter of the population. With that, the number of people with dementia is increasing. Unfortunately, there is no current medical cure for dementia. The progression of symptoms with no hope of improvement is difficult to cope with, both for patients and their caregivers. 

Mindfulness training has shown to improve psychological well-being in a variety of mental health conditions. Research has shown preliminary but promising results for mindfulness-based interventions to benefit people with dementia and caregivers. So what follows are summaries quoting fairly directly from 4 key research papers that investigated what might be possible. The results are encouraging…

1. Review : Mindfulness, meditation, cognition and stress in people with Alzheimer's disease (AD), dementia, mild cognitive impairment and subjective cognitive decline – 2018. 

This study investigated how the use of meditation as a behavioural intervention can reduce stress and enhance cognition, which in turn ameliorates some dementia symptoms. Ten papers were identified and reviewed. 

There was a broad use of measures across all studies, with cognitive assessment, quality of life and perceived stress being the most common. Three studies used functional magnetic resonance imaging to measure functional changes to brain regions during meditation. 

The interventions fell into the following three categories: mindfulness, most commonly mindfulness-based stress reduction(MBSR) (six studies); Kirtan Kriya meditation (three studies); and mindfulness-based Alzheimer's stimulation (one study). Three of these studies were randomised controlled trials. 

All studies reported significant findings or trends towards significance in a broad range of measures, including a reduction of cognitive decline, reduction in perceived stress, increase in quality of life, as well as increases in functional connectivity, percent volume brain change and cerebral blood flow in areas of the cortex. 

Russell-Williams J, Jaroudi W et al. Mindfulness and meditation: treating cognitive impairment and reducing stress in dementia. Rev Neurosci. 2018;29(7):791-804. doi:10.1515/revneuro-2017-0066

2. Do adults with MCI have the capacity to learn mindfulness meditation? - 2019

High levels of chronic stress negatively impact the hippocampus and are associated with increased incidence of Mild Cognitive Impairment (MCI) and Alzheimer’s disease(AD). While mindfulness meditation may mitigate the effects of chronic stress, it is uncertain if adults with MCI have the capacity to learn mindfulness meditation.

Chronic stress negatively impacts the hippocampus, and high levels of chronic stress are associated with an increased incidence of MCI and AD. [6–8] Adults who are prone to high levels of psychological distress are more likely to develop dementia.[9] Animal research demonstrates that high levels of cortisol (the “stress hormone”) can damage the hippocampus[10], a key structure involved in memory processing that atrophies with Alzheimer’s disease. Thus, other stress-reducing interventions, such as meditation and yoga, might be helpful for adults with MCI.

Previous studies have shown that the hippocampus is selectively activated during meditation,[15–17] and experienced meditators have larger volumes and gray matter concentration in their hippocampi compared to matched controls.[18] In addition, research has shown that an eight-week MBSR class may increase gray matter density in the hippocampi of adults.[19] MBSR is thus a stress-reducing intervention that impacts the hippocampus and could potentially interrupt the progression of MCI through these effects. 

The period of time when an individual has MCI is transient and offers a rare window of opportunity prior to the development of dementia; finding an intervention that could help patients at this point of time could be invaluable. Since adults with MCI still have brain plasticity,[20] we hypothesized that adults with MCI would be able to learn and benefit from mindfulness meditation and yoga. 

What did the research find? Most adults with MCI were able to learn mindfulness meditation and had improved MCI acceptance, self-efficacy, and social engagement. So in summary, cognitive reserve may be enhanced through a mindfulness meditation program even in patients with MCI.

Wells RE, Kerr C, Dossett ML, et al. Can Adults with Mild Cognitive Impairment Build Cognitive Reserve and Learn Mindfulness Meditation? Qualitative Theme Analyses from a Small Pilot Study. J Alzheimers Dis. 2019;70(3):825-842. doi:10.3233/JAD-190191

3. Review of already well researched mindfulness techniques - 2018

Although there is a wide variety of interventions that include components of mindfulness (e.g., Acceptance and Commitment Therapy), this review focuses on the two programs with the largest evidence base, the mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT). These group-based programs have been studied in healthy populations and in those with mental or physical disorders, showing satisfactory to good efficacy (Chiesa and Serretti, 2009; Hofmann et al., 2010; Hempel et al., 2014).

Although current research supports the rationale for MBI with persons with dementia and their caregivers, only few RCTs have been conducted and more research is necessary

What can be said is participants receiving MBSR showed greater improvement in memory, but not cognitive control. Moreover, the MBSR group improved on measures of worry, depression, and anxiety, and decreased cortisol level for those with high baseline cortisol.

Studies with persons with Mild Cognitive Impairment (MCI) or Severe Cognitive Impairment (SCD) have looked at the effect of Mindfulness Based Interventions (MBI). This is informative for dementia research, since individuals with MCI have an increased annual conversion rate of 5–17% to Alzheimer’s disease (Cheng et al., 2017), and approximately 60% over a 15-year period of persons with SCD will continue to develop Alzheimer’s disease (Reisberg et al., 2008).

Studies with persons with MCI or subjective memory complaints have looked at the effect of MBI. One pilot study found a trend toward improvement of cognition, quality of life, and well-being for people in the mindfulness condition (Wells et al., 2013). A RCT showed that the participants in the MBI group showed less memory deterioration and greater decrease in depressive symptoms compared to the control group (Larouche et al., 2016).

Although these studies demonstrate feasibility of MBSR with older adults with SCD and MCI, and preliminary evidence for memory improvement, more research is necessary to investigate whether MBI can influence cognitive decline.

Berk L, Warmenhoven F, van Os J, van Boxtel M. Mindfulness Training for People With Dementia and Their Caregivers: Rationale, Current Research, and Future Directions. Front Psychol. 2018;9:982. Published 2018 Jun 13. doi:10.3389/fpsyg.2018.00982

4. Mindfulness practice can improve health outcomes of MCI - 2017.

Growing evidence has linked mindfulness to cognitive and psychological improvements that could be relevant for mild cognitive impairment (MCI). This Australian study reported long-term mindfulness practice may be associated with cognitive and functional improvements for older adults with MCI. The researchers concluded mindfulness training could be a potential efficacious non-pharmacological therapeutic intervention for MCI.

Wong WP, Coles J, Chambers R, Wu DB, Hassed C. The Effects of Mindfulness on Older Adults with Mild Cognitive Impairment. J Alzheimers Dis Rep. 2017;1(1):181-193. Published 2017 Dec 2. doi:10.3233/ADR-170031

Finally, what might be possible?

It does need to be said that dementia is now well identified as another of the chronic degenerative diseases - like cancer, heart disease and MS. All these other known chronic degenerative diseases have been shown to be prevented by Lifestyle interventions. Once present, their symptoms have all been shown to be significantly lessened by Lifestyle interventions; and all have shown some signs – ranging up to major – of reversal through Lifestyle interventions. So why not dementia???

And what are Lifestyle interventions? The things you can do for yourself – like what you eat and drink, your exercise levels, relaxation, mindfulness and meditation. Many believe the mind-based interventions are key, both due to their direct effects and because the mind decides what we do with our lifestyle. Get the mind into a good state and everything else follows – we eat better, drink more wisely, are more inclined to exercise and so on.

RELATED BLOGS

Here are the links to 3 consecutive blogs that clarify just what dementia and Alzheimer’s are Alzheimer’s is the most common form of dementia), what the risks are and how prevention is possible; maybe even some recovery. Plus an intruiging post on the link between Alzheimers and impotence

1. Dementia, Alzheimer’s and other related conditions explained

2. The causes explained

3. One dozen proven things you can do to prevent dementia

4. Alzheimers and impotence – what is the link? Why is it so significant?

Purpose Built App – Allevi8

The new, free mindfulness/meditation based App I have been involved in developing – Allevi8 – has been specifically designed to assist people affected by chronic degenerative disease. We targeted 5 main issues – stress and mental health, emotional health, pain management, healing and finding meaning amidst adversity.

So while many others recognise the need for help with these areas – especially now in the era of the pandemic – it provide free access to specific techniques for people facing chronic degenerative disease. Dementia is one of those conditions.

Allevi8 is available via a simple search in your App store. Also, we do have a meditation session via Zoom that goes out live each Monday. This session is well attended and many report how helpful it is to receive practice tips and meditate in a like-minded community each week. To join us, simply download Allevi8 and the link will be sent by email. All of this is free, however, you might like to consider paying it forward – there is a secure donation facility on the App under “Gift”.

Two-types-of-Mindfulness

 Currently, mindfulness is all the rage in meditation land as it is easy to teach, easy to learn, easy to integrate into our lives, easy to research – and it delivers on its promises – it works! 

Yet when it comes to the actual practice of mindfulness, did you know there are two types, and why it is important to practice one before the other? So this week, some practice tips along with explanation of the two types of mindfulness (drawn from the content of my recent book, Blue Sky Mind - the Art of Meditation), but first

Thought for the day

The general idea is that if you open yourself up 

To what the given situation is, 

Then you see its completely naked quality. 

You do not have to put up a defence mechanism anymore, 

Because you see through it 

And you know exactly what to do. 

You just deal with things, 

Rather than defending yourself.

Chogyam Trungpa

Mindfulness can be defined as the awareness that comes from paying attention to our present moment experience, deliberately and non-judgementally. So how does it work in practice? There are two ways we can pay attention to our present moment experience — with focussed mindfulness and with open mindfulness.

1. Focussed mindfulness - This is where we choose to pay attention to just one thing. 

This way of deliberately focusing our attention gives us a way to block out other thoughts and distractions and helps to settle a restless mind. It is easy to learn, easy to practise, and translates easily into daily life.

Common things to focus upon include the breath, the sounds around about us, the sensations in our body and our thoughts as they travel through our mind.

With focussed mindfulness we need to concentrate and maintain our focus. This takes energy. If we do find our mind becoming distracted or wandering, we need to notice that and bring our attention back to our chosen point of concentration. And while this does take some energy, some effort; focussed mindfulness is the best way to begin learning mindfulness and practising it formally. 

2. Open mindfulness –  This is where we do not focus our attention on one particular thing, but remain more open and pay attention to whatever it is that does happen to come into our awareness.

So in this version of mindfulness we simply aim to remain open and curious. This can be likened to a wise old woman sitting back and watching children play. There is an ease and a comfort with what the children are doing, perhaps even an inner knowing that it is just games they are playing. Maybe too a level of care to notice if anyone does need help, yet no particular need to interfere or change anything; just a deep contentment to observe the children at play.

To accomplish open mindfulness as a part of our meditation, we start by sitting and relaxing, then if our attention goes to some sounds from outside, we simply notice them, free of any judgement or commentary. We leave the sounds as they are.

Then if our attention is taken by some sensations in our body, we simply notice those. Maybe then thoughts fill our awareness and again, the aim is to simply notice them; let go of any afterthought, any commentary, any judgement. Simply notice whatever it is that does come into our awareness, and leave it as it is. Open mindfulness.

Open mindfulness requires less effort than focussed mindfulness, but when we do it the potential to become distracted is greater. So it makes good sense to learn, practise and become reasonably adept with focussed mindfulness first because this is how we learn the technique of mindfulness and develop our basic skills. 

Focussed mindfulness definitely requires effort, the effort to focus our attention and learn a new technique. However, as we develop some capacity with this version of mindfulness, we move on into open mindfulness. And good news. Once we have some experience with it, open mindfulness requires little effort. In fact, when open mindfulness is flowing well, it is completely effortless. 

In open mindfulness there is nothing specific we need to focus upon. It is inherently relaxing. There is just one significant potential difficulty. When compared to focussed mindfulness, with open mindfulness it is relatively easy to become caught up or distracted by whatever it is that does come into our awareness. So the key to open mindfulness is learning and developing the capacity to remain undistracted. 

While we are in the process of developing our capacity with open mindfulness, we need to take account of the fact that as life goes on we may well experience times where our thoughts and emotions do distract us seriously. At such times, without beating ourselves up with feelings of guilt or shame, we may well benefit from devoting our regular practice to a more focussed form of mindfulness. Then, as we do come to feel more settled, we can expand out into open mindfulness once more. 

So to finish, more good news. Whether it be focussed or open mindfulness we are practicing, once we have learnt how to relax our body, settle our mind, sit still and remain undistracted, then we truly are making some progress. And the best bit? As we do remain undistracted, that deeper stillness of meditation begins to unfold; to become more apparent. Open mindfulness makes for a natural prelude to the deeper experience of real meditation.

May your mindfulness lead you into meditation…

The secret to less doing, more being

 Doing, doing, doing. With so many people busy doing this and doing that; doing, doing, doing; how is it we call ourselves “human beings” rather than “human doings”?

This week we go Out on a Limb once again and explore the differences between human doings and human beings, and examine how a simple mind shift can have us being more and yet actually doing more. Also news of the first weekly meditation Zoom gatherings for those using our Allevi8 App, but first

Thought for the day

Love thy neighbour

As thy self

Mark 12 : 31

Love this quote. It points directly to a common misinterpretation amongst Christians; and having grown up deeply steeped in Christianity I can speak from experience. 

The problem? Putting the focus on “love thy neighbour” and overlooking “As thy self”. 

The image of the Christian martyrs is both heroic and compelling. Giving up all, even their own lives for the sake of others; the love of others. Compelling. And many completely noble and without fault. Yet so many people I have spoken with over the years, inspired by that ethos have given freely and fully of themselves while neglecting themselves only to end up exhausted, often disillusioned, burnt out and dissatisfied.

The injunction in the quote is clear… “As thy self”. 

So the first thing to clarify is that all of us do want to help others. Of course. However, what is also clear is that to help others we need to start with ourselves. Once we have some inner stability, strength and resources, then we are well placed not only to help others but to sustain our efforts, be effective long-term and to enjoy the process, even if it entails hard work. We then have a good chance of ending up both accomplished and satisfied. This much is reasonably obvious.

But then we can go further… “As thy self”… Which self is being spoken of? The active self? The ego with all its plans, hopes and fears? Its infinite capacity to become distracted, to complicate even simple matters, to surreptitiously put itself ahead of others under the guise of service – and so on. You probably get what I mean.

But then there is that more essential part of self. Now to be clear, nothing wrong with the active, ego driven self. We all have that and it is a part of who we are. But does it drive us, or does it take us for a useful ride – as in we control it and use it for good purpose?

For the essential self - some call it soul, some call it Atma, or the true nature of our mind – this self is inherently pure and filled with love, clarity and wisdom. It is like saying a lemon tree produces lemons and an orange tree produces oranges. Both are useful, but they are different. The essential self can only produce love, clarity and wisdom. That is a fact.

So here is the thing; the simple shift that leads us to be less ego-centric and more true self-centric. Meditation. When we meditate we have this opportunity to get to know our mind, and our self, better. All aspects. The active mind and the still mind. The ego and the true self. 

And when through meditation we begin to glimpse something of that Still Mind, we come to experience something of its innate qualities and we come to know something of this true self – quite naturally. 

The fruit that flows from the meditation tree is love, clarity and wisdom. Simple really. Just requires some technique and regular practice. And not allowing that mischievous active mind to get in the way too much and block the flow. 

It is all about letting go of the doing and allowing the being… And paradoxically, it turns out the more we “be”, the more we can “do”. Win – win!

Happy Meditating

Allevi8 – our new, free meditation App

Ruth and I have been heartened by early responses to Allevi8. If you have not sampled it as yet, it contains specific practices designed to alleviate stress and anxiety, build emotional and mental health, relieve pain, foster healing and help find meaning amidst tough times.

It is free, there is a choice of Ruth’s voice or mine. You can pay it forward if you find it useful and want others to benefit. Simply search Allevi8 in your App store.

And for those who are using it, we start the first of what are planned to be weekly Zoom meditations this Monday, 9th August from 8pm EST to 8.45. Once you join the App, within a short while, an email will be sent with the link to the weekly meditation meetings. Join us?

The Joy of Giving

This promises to be somewhat of a self-indulgent post – about the joy of giving something valuable away for free. About money and how it carries so many deep-seated habits, conflicts and confusions around attachment, values and our capacity to be generous.

And maybe a gentle prompt to reconsider your own relationship with money, especially amongst these times of a pandemic when there is a natural tendency to tighten up and hold onto whatever we already have. Where does generosity, a sense of community and sharing come into all of that?; but first



             Thought for the day

     Work is love made visible. 
     And if you cannot work with love, 
     But only with distaste, 
     It is better that you should leave your work 
     And sit at the gate of the temple 
     And take alms from the people who work with joy

                            Khalil Gibran







Not many will know that when I started the work with people affected by cancer way back in 1981, my initial thought was to offer it freely and rely upon donations for it to progress. Truth is I was talked out of this by my first wife and especially Dr Ainslie Meares. Ainslie, that renowned psychiatrist who introduced therapeutic meditation to the Western world, advise me people in the West only value what they pay for.

So that work evolved into a charitable foundation where fee for service was supplemented by a strong fundraising program. For decades we raised about 25 – 30% of the annual turnover of the foundation and used much of this to offset the program fees.

Amidst this there were plenty of examples of people’s relationships to money. Wealthy people who cried poor and insisted upon discounts. Seriously disadvantaged people who gave a little but in a way that what they gave was highly meaningful – and valued. Wealthy people who gave more but relative to their worth was very little and hence not so meaningful.

Experiments with offering programs by donation and regularly receiving around 25% of what would have been the standard fees if it had been a fee for service event.

Fascinating conversations before and after free events…
“How much is the donation?”

A : :There is no set amount, it is up to you…”

“Yes but how much is it?”


Flying Faith Airlines. This is what we called the principle of proceeding with an important new venture when the money for it was not yet to hand. Proceeding with Faith and expecting the money to follow. Getting into financially difficult situations (quite regularly over the years), only to be bailed out by a major gift or bequest.

Significantly for me, never feeling stressed by money. A deep confidence that with the right motivation held by the bulk of our staff, it would all work out well. And it did

But now a new App – Allevi8. To charge or to offer for free?

What a relief. My business partners agree – it has to be offered freely.

Now to be clear, a huge amount of time and money has gone into developing this App. And yes, the 3 of us are in the fortunate situation where we are not dependent upon income from this particular App to keep us alive financially. And yes, we would like to make a profit.



However, there is such a delight in offering it for free.

The joy of giving.

It is such a good feeling not to need to “sell” the product.

We have made it the best we can.

We offer it freely.


If people respond to it, appreciate it and want it to become available to others, then yes, please do pay it forward and contribute.

And notice this.

When something like an Allevi8 is offered freely, it frees you up. There are no barriers. No need to consider “can I afford it?”. “Does this represent value for money?”. “Is it worth $5 a month? $10?”

No, it is simply. Download it. Try it. If it is of no value, no harm done. If you like it and just want to use it for free, no harm done – and please do feel good that other people are making it available for you. If you like it and want to Pay it Forward, no harm done! But maybe a good feeling.

The Joy of Giving

Allevi8 – the new, free meditation-based App

My heart goes out to everyone confronted by major illness. Stress, anxiety and mental illness can follow a diagnosis. Sleep can be disturbed, emotions challenged. I experienced enough of pain myself; and then how best to heal, how to make sense of it all?

With this in mind, Ruth and I have contributed to a new, free App - Allevi8 - specifically designed to provide meditation-based answers to all these related issues. And in this challenging time of the pandemic, it seems many others may well benefit as well. Allevi8 is easy to locate and download in the Apple and Android App stores; and it is free.

So this week, all the details including news of regular guided meditation practice sessions on Zoom, but first

          
           Thought for the day

     What lies before us  

     And what lies behind us

     Are small matters

     Compared to what lies within us.

     And when we bring 

     What is within us

     Out into the world

     Miracles happen.

              Henry David Thoreau

There are many meditation Apps around these days. Over the last 10 years I have partnered with my good friend Saurabh Mishra as we worked on various versions ourselves. Safe to say we have learnt heaps amidst a tough IT environment.

A specific App for people in need
What we realize is there are few if any specific Apps designed for people affected by major illness – to be clear, chronic, degenerative diseases like cancer, MS, diabetes, heart disease, Parkinson's, Alzheimer’s.

Having worked with people affected by these challenging conditions for decades and having seen over and over how much meditation-based practices can alleviate the symptoms that so frequently accompany these conditions, it seemed natural to bring together all we have learnt with Apps to make these specific techniques widely available.

We have been fortunate to gather a great team to make it all possible...

Allevi8 is offered freely
All of us involved with Allevi8 have felt the benefits of these techniques in our personal and professional lives.

Therefore, we are keen to make the practices freely available.

We figure that if like us, people value them (after using them and feeling the benefits) then they may well be inspired to donate a small amount, “Pay it Forward” as it were, keep the App going and help make it possible for the next person to use it freely.

Available in the voices of Ruth and myself 
Ruth and I have recorded specific practices to provide deep relaxation, guided mindfulness, contemplation and meditation, as well as guided imagery.

Five challenging needs addressed 
We have specifically addressed 5 main areas that our research highlighted are the areas of most concern amongst people affected by chronic degenerative disease. They are

1. Stress, anxiety and mental illness; including sleep disturbances.

2. Emotional distress – dealing with difficult emotions

3. Pain management – personal techniques you can use that work

4. Healing – how to use inner resources to foster healing on all levels

5. Meaning – how to make sense of all the changes and challenges major illness brings.

The contents
There is a main meditation practice that is relevant to all 5 domains, and then specific practices for each. While you may be drawn initially to Allevi8 for say pain management or healing, you will have access to all the practices.

Also, there is a self-referencing questionnaire that enables the App to assist you to self-monitor and evaluate your progress.

Those who are already familiar with the work of Ruth and myself will find some familiarity, but there are several practices that have not been readily available before.

You can choose to listen to Ruth’s voice or my own; or vary it around…

The App is designed to be used by those directly affected by major illness, their families and carers, as well as health professionals in this field.

A great deal of care has gone into ensuring the Allevi8 App is easy to use, easy to navigate and of course, that it works well. Happily, early users have provided very positive feedback.

Join us on-line to meditate together
Finally, as a bonus, we plan to commence a weekly virtual meditation group for Allevi8 users via Zoom.

Seems many of us have now experienced how meaningful and supportive it can be to link with like-minded people via some of these amazing new IT functions.

So when you register, you need to provide your email (which of course will be both respected and secured), and from this we will send a Zoom link for these sessions.

Ruth and I will be leading them and we plan some special guests as time flows along.

So please feel free to support this new initiative and try the App. Also, please do share it with friends and people you know who may be in need. It is free…

Available in all good App stores! Simply search for Allevi8.

May your practice flow
And bring substantial and sustainable benefits…