Seniors isolated by COVID-19 concerns should find other ways to connect than in-person contact

Mental health for seniors is a huge concern, especially in the current COVID-19 pandemic where 80 percent of the deaths have been in individuals over the age of 65. The pandemic has drastically uprooted many people's ways of life, especially when it comes to in-person social interactions.

"Often, during times of struggle, people turn to their social support, but that is hard given that in-person contact has been reduced," said Lee Isaac, PsyD, a neuropsychology post-doctoral fellow in the Department of Psychiatry at the University of Arkansas for Medical Sciences. "The things I would recommend include finding other ways to connect. That includes phone calls, emails, text messages, and video calls. Technology is a huge barrier for individuals in this age group, but I recommend reaching out to people in their lives. Many of us have become very familiar with these new technologies, and family members may be able to help."

The risk factors for COVID-19 are generally cardiovascular risk factors, which also increase risk for dementia. Because of that, Isaac said he can't over emphasize the importance of physical exercise, so long as it is not medically contraindicated. Something as simple as a daily 30-minute walk can strongly benefit someone's mood while helping brain health.

"This does not mean high intensity exercise," he said. "It means taking your dog for an extended walk."

Exercise helps control cardiovascular risk - high blood pressure, high cholesterol, and diabetes - as does remaining at a healthy weight and eating a nutritious, balanced diet. Sleep is less talked about, but is also important. Many individuals suffer from sleep apnea and may not know it.

"If someone snores, then I suggest they follow-up with a sleep specialist to help determine if they have sleep apnea," Isaac said. "Also, trying to limit other negative factors for health, like smoking or alcohol consumption, are important."

During the pandemic, it is particularly important to reach out for professional help.

"This is an unprecedented time, and is not like anything we've experienced before," Isaac said. "It is the norm, not the exception, to be struggling during this time, especially if there are other stressors, like the loss of a loved one. I'd strongly recommend that individuals get connected with mental health providers, both therapists and psychiatrists, to help them through this time."

Humans, by nature, are social creatures who need interaction with others to varying degrees. There are many inventive things that people can do through technology such as book clubs, playing bridge, and holding a virtual get-together.

"The goal is to remain active," Isaac said. "It is easy during the pandemic, especially if no longer working, to become inactive. Pick-up a new skill, or an old hobby that you haven't done recently, such as crafting, working, painting, or anything that can keep you busy."

At present, the available therapeutics for Alzheimer's disease (AD) have remained relatively unchanged for a number of years. Fortunately, more than ever, there is a continued push for finding treatments.

"Last year, the National Institutes of Health increased their funding for Alzheimer's and dementia research by $350 million, which made the annual funding reach an all-time high of $2.8 billion," Isaac said. "I only expect the funding and focus on this area to continue to grow as the demographic make-up of our country continues to age. Hopefully, that will result in better treatments going forward."

Now, more than ever, it is understood that processes that cause dementia have likely been on-going for a number of years before major symptoms appear, and certainly before diagnosis. One of the big areas of research is early detection.

"In particular, biomarkers have received a large emphasis in AD research," Isaac said. "Biomarkers are objective markers of biologic function that can be accurately and reproducibly measured. Biomarkers have included an emphasis on CSF and imaging techniques, but there is increased use of functional imaging, blood biomarkers, and saliva."

Isaac said the ability to accurately detect AD earlier will allow physicians to make more targeted treatments and hopefully make a bigger impact on slowing, or completely stopping, the progression of the disease. "However, it is such a complex and multifactorial process and there is still much work to be done in the area," he said.

People starting to show signs of dementia should see their physician and, if the physician feels it is appropriate, consult with a neurologist and a neuropsychologist to be evaluated by a specialist who is more familiar with these disorders. Neuropsychologists like Isaac evaluate individuals' cognitive functioning through an interview with the patient and their family, and then testing, which assesses cognitive functioning and, to a lesser extent, emotional functioning. The assessment will test their cognitive thinking skills and be able to objectively quantify any weaknesses or areas of concern. The neuropsychologist will make recommendations about the best way forward and what to expect in the future.

Senior brain health is complex. To make that even more complicated, AD is often associated with decreased awareness of deficits. That means patients with AD often report less symptoms or completely deny symptoms. Family members can usually be helpful in providing an outside perspective. One thing that can also help is using a short cognitive screener like the Montreal Cognitive Assessment. However, not everyone is trained or feels comfortable giving the MoCA,

"So, if there is any question, then I strongly recommend primary care providers refer patients for neuropsychological evaluation," Isaac said. "Earlier detection means earlier treatment, and it helps to keep these individuals safe. Individuals with dementia are at risk for difficulty managing their medical conditions, unsafe driving, and exploitation. The sooner we know, the sooner we can help families provide them the support that they need."

Isaac received his doctoral degree in clinical psychology from La Salle University in Philadelphia, Penn., and completed his doctoral internship at UAMS. Prior to that, he completed a master's degree in counseling psychology from Temple University.

Isaac grew up in Lexington, Ky., and completed his undergraduate degree at the University of Kentucky. His parents say he has had a natural affinity for wanting to serve others with compassion and empathy since he was a child. His interest truly came alive while in his master's program. He was completing an internship in a hospice where he was working with patients and their families. He worked with one patient who had

AD, but was exceptionally skilled in chess.

"For over two years, I played chess with this gentleman," Isaac said. "I would have to introduce myself every time I came. However, it took me six months to first beat him in chess, and he still regularly beat me at the end. So, the dichotomy between his ability to retain his knowledge of chess and play at a high level, and the clear cognitive deficits, were fascinating to me and really was the final tender to light my path toward neuropsychology."

Isaac's hobbies include reading and exercise. He and his wife, Kate, are also avid hikers and have picked up more kayaking and canoeing since moving to Arkansas.

For more information, go online to: Alzheimer's Association Research