GUIDELINES

Stress is a reaction to a demand for change. It is caused by stressors, which are particular experiences – both internal and external – that call for that demand for change. When the demand for change exceeds the capacity of the body or mind to respond, we speak of a stress overload.

Although stress is a natural, positive part of existence that moves us into increasing competence, most people use the word to describe something closer to distress. That is because when distress persists and is unrelenting in its demand, making it impossible for the person to relax, it begins to create difficulties in the body.

In this section, we identify ways to determine if stress is an issue, explain how cortisol and other hormones contribute to diagnoses of Alzheimer’s and other forms of dementia,

SYMPTOMS OF STRESS[1]
Stress is expressed differently by different people, so it’s not always easy to identify. However, here are some common signals:

  1. Denial: Person has a difficult time acknowledging stress and the effect it may be having on self and family.
  2. Anger/frustration: Person finds oneself frequently angry with others because they feel misunderstood.
  3. Social withdrawal: Person withdraws from friends, family, and favorite activities.
  4. Anxiety: a feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome.
  5. Depression: feelings of severe despondency and dejection.
  6. Exhaustion: Person acts so exhausted that completing necessary daily tasks is almost impossible.
  7. Sleep disorders: Person loses sleep frequently or can’t wake up.
  8. Irritability: Person acts moodier than usual and is subject to frequent outbursts of frustration and/or anger.
  9. Lack of concentration: Person can’t seem to stay focused on tasks or conversations with others.
  10. Health problems: Person is experiencing symptoms that seem to be taking a mental or physical toll.

The connection between stress and Alzheimer’s and other forms of dementia is clear: studies have shown that compared to healthy people, patients with Alzheimer’s disease have elevated levels of cortisol that appear early on in the disease progression and correlate with their degree of memory impairment.

HOW CORTISOL CAUSES AD

How does that impairment occur? Animal studies have shown that increases in circulating cortisol lead to an accumulation in the brain of sticky proteins called amyloid-beta peptide (Ab) in between neurons and tau inside neurons (brain cells) respectively, causing the widespread loss of synaptic and neuronal function that underlies dementia, memory loss, and Alzheimer’s disease.[2], [3]

Cortisol easily crosses the blood–brain barrier, where, in sufficient quantities, it can impede learning and memory by binding to brain receptors on neurons in specific areas, such as the hippocampus, the amygdala, and frontal lobes. Researchers have observed that individuals with hippocampal atrophy and cognitive decline have high concentrations of cortisol as well as inflammatory cytokines such as Il-6. This basic sequence is exacerbated by these other factors:

  1. Multiple inflammatory mediators.

     Current research indicates that chronic stress arousal activates multiple other inflammatory mediators, including the NF-?B system, which creates widespread inflammation in the brain, especially in the hippocampus.  This massive flood of central inflammation has been shown to be a hallmark of AD.[4], [5]

  1. Benzodiazepines. When stress is expressed as anxiety and sleep disorders, many people turn to pharmaceuticals such as the benzodiazepines for relief.  This raises a sharp concern, as a recent study conducted by researchers from France and Canada found that the widely prescribed benzodiazepines are associated with an increased risk of developing Alzheimer’s disease (AD).  The researchers found that the higher the dosage of and the lengthier the patient’s use of benzodiazepine, the greater the risk of developing AD. The results of the study were most troubling for people who frequently used higher doses of benzodiazepines for 5 years or more. Compared to individuals who took no sleep medication whatsoever, patients who took the equivalent of full daily doses for 3 to 6 months over a 5-year period were 32% more likely to develop AD. The risk factor shot up to 84% for participants who’d taken benzodiazepine for over six months.[6], [7],

Fortunately, benzodiazepine is not the only recourse for the sleep deprived.

Severe physical or emotional trauma.

     Severe emotional and physical trauma unleash inflammatory mediators. It is not surprising, therefore, to hear that in a study by Argentinian researchers, 72 percent of the Alzheimer’s patients—nearly three out of four—were found to have experienced severe emotional stress during the two years preceding their diagnosis. In the control group, by contrast, only 26 percent, or one in four, had undergone major stress or grief. Most of the stresses encountered by the Alzheimer’s group involved:

  1. Bereavement; death of a spouse, partner, or child
  2. Violent experiences, such as assault or robbery
  3. Car accidents
  4. Financial problems, including “pension shock”
  5. Diagnosis of a family member’s severe illness,[8]
  1. Lifelong cortisol exposure.

      It’s not only singular or isolated episodes of stress that lead to brain damage. AD and other forms of emotional and cognitive dysfunction are also a function of the sum of cortisol exposure over a lifetime (especially in middle age and beyond).[9],[10],[11] The evidence links decreased memory performance with a greater risk of AD in people reporting: (a) higher levels of work-related stress; (b) having stress-prone personalities; (c) enduring early childhood stressors such as abuse, trauma, and neglect; and/or (d) suffering from midlife stressors as well. In a study specific to women, for each additional stressor reported, the risk of later developing AD increased 20%.[12], [13], [14], [15], [16]

THE ROLE OF HIDDEN STRESSORS

            Stress needn’t be triggered by external events. Long after actual events, researchers at Ohio University in Athens, Ohio showed that ruminating on a stressful incident can increase the levels of C-reactive protein, a marker of inflammation in the body.  The Ohio study—the first of its kind to directly measure this effect—has broad implications throughout the medical world, since inflammation is a hallmark of most diseases, from diabetes to heart disease, cancer, and Alzheimer’s.[17]

            In fact, a great deal of stress is generated by thinking and emotional patterns that may appear to be triggered by external events, but are actually related to an internally generated set of beliefs, expectations, and attitudes toward life, oneself, or others. This network of predispositions are like a set of spectacles, through which a person can look at any situation and any trigger. Thus, they find evidence wherever they look that their beliefs are accurate. Examples: “I always get the rough end of the stick.” “No matter how hard I try, nothing works for me” “I’m just stupid.” “It runs in the family.” “You (I) Just can’t trust anyone.”

Underneath these theme statements lie unresolved emotional issues and traumatic histories. Such habits of negative thinking and speaking incline people to move toward situations characterized by pain, hopelessness, and stress, rather than those that offer more peaceful possibilities.

            These are issues that can often be addressed through psychotherapy. Although high-quality research to identify precise levels of improvement is sorely lacking, early indications are that Cognitive Behavioral Training, (CBT) or Dialectical Behavior Training (DBT) produce enough benefit to warrant further investigation. A number of studies have shown that effectiveness of the therapeutic experience depended less on the type of therapy than on the quality—empathy, intuition, and experience—of the particular therapist. So find someone who is open-hearted, compassionate, and wise who is also a deep listener with a sense of humor. If they charge for their time, it’s likely to be worth it. Your greatest risk is increased peace of mind and some new ways of looking at things. Here are some of the alternatives they may suggest.

REMEDIES FOR STRESS

There are safe, effective, non-pharmaceutical treatments that can alleviate stress without increasing the risk of Alzheimer’s disease.

  1. Identify sources of stress in one’s life and particular triggers.
  2. Remove oneself from these situations whenever possible.
  3. For situations one can’t leave, identify what help might be available to ease the situation.
  4. Play with different ways of interpreting the situation. Even the most difficult situation tends to have a positive effect for someone on the planet. For example, there are those who look back and realize that challenges they faced in life were merely “gifts” that motivated them to question their lives and see possibilities for a future they were too afraid to confront before. Many comment later that these challenges ultimately led to a more fulfilling career, relationship, or lifestyle.
  5. Define and maintain boundaries for others that specify what behavior is and is not acceptable. Inform them of these new limits. Learn to say no without having to be angry or abused.
  6. Learn what environments/methods of relaxation help you shift gears.
  7. Remember two heads are better than one and talk to someone: Share how you’re feeling with a trusted family member or friend, someone who will listen without judging or criticizing you in any way.  If this is not possible, then seek out a good therapist you can relate to.
  8. Change your environment.  For example, if high levels of stimulation in your environment are causing you stress, find a quiet place where you can relax and regroup.
  9. Learn to say no. Do not put yourself in situations that are stressful for you out of a sense of obligation.  Get plenty of rest to help conserve your energy.
  10. Take a break.  If something becomes too difficult for you, put it aside and come back to it later.  For those with religious and/or spiritual beliefs, repeat “I let go and let God.” Or “This too shall pass.” Or “I have faith this problem has already been solved for me.”
  11. Nurture yourself by shifting what you are doing physically, mentally, and emotionally. For example:

 – Work out intensely
 – Go for a walk
 – Spend time enjoying the unconditional love of a pet.
 – Write your thoughts and feelings in a journal
 – Take long baths
 – Spend time gardening
 – Listen to music
 – Get a massage.
 – Watch a television program you find relaxing or enjoyable 
 – Spend time doing yoga
 – Do some deep breathing exercises
 – Meditate

The most powerful and economical remedy for stress is often meditation combined with some of the activities from this list. Studies show, however, that meditation alone can also produce remarkable changes in stress levels.

More On Meditation: Kirtan Kriya (Kk)

Research shows meditation to be one of the very best strategies for alleviating stress. Numerous studies have demonstrated that meditation reduces stress and cortisol levels and improves multiple measures of health and cognition.[18]

For example, one group launched a preliminary study designed to determine if putting subjects with memory loss problems through a simple 8-week meditation program could improve memory and cerebral blood flow (CBF). It did: After meditation training, participant scores on neuropsychological tests of verbal fluency, Trail Making Test (B), and logical memory improved significantly, and so did baseline CBF ratios, which posted significant improvements (p< 0.05) in the prefrontal, superior frontal, and superior parietal cortices.[19]

In another study, ten participants were asked to meditate for 11 minutes twice daily for 8 weeks. Before and after the intervention, participants were measured for the following: (1) perceived stress (Perceived Stress Scale); (2) sleep (General Sleep Disturbance Scale); (3) mood (Profile of Mood States); (4) memory functioning (Memory Functioning Questionnaire); and (5) blood pressure.  Adherence was good (meditation sessions completed/week: X = 11.4 ± 1.1).

  • Outcomes: Participants demonstrated improvement in all major outcomes, including perceived stress (P < 0.001), mood (overall, P = 0.07; depression (P = 0.01), sleep (P < 0.04), retrospective memory function (P = 0.04), and blood pressure (systolic, P = 0.004; diastolic, P = 0.065).
  • Conclusions:  Findings of this exploratory trial suggest that an 8-week meditation program may offer an acceptable and effective intervention for reducing perceived stress and improving certain domains of sleep, mood, and memory in adults with cognitive impairment and their caregivers.[20],

There are a hundred different meditation techniques. We’ve chosen to focus on Kirtan Kriya (KK) because it is cost-effective, easy for aging individuals to learn and practice, requires only 12 minutes a day; and proven to improve memory.

  • In one study of caregivers and their patients (people with subjective cognitive decline and mild cognitive impairment and their caregivers—both groups at high risk for developing AD), KK was successfully employed to improve memory in both groups.  
  • KK has also been shown to improve sleep, decrease depression, reduce anxiety, down-regulate inflammatory genes, up-regulate immune system genes, improve insulin and glucose regulatory genes, and increase telomerase by 43%; the largest improvement ever recorded.
  • KK also improves psycho-spiritual well-being and spiritual fitness, important for maintaining cognitive function and preventing AD.

It is the premise of this review that meditation in general, and KK specifically, along with other strategies such as dietary modification, physical exercise, mental stimulation, and socialization, may be beneficial as part of an AD prevention program.  (See KK details below)

Kirtan Kriya (which is pronounced KEER-tun KREE-a) is a type of meditation from the Kundalini yoga tradition, and it has been practiced for thousands of years. KK is sometimes called a singing exercise, as it involves singing the sounds, Saa Taa Naa Maa along with repetitive finger movements, or mudras. This non-religious practice can be adapted to several lengths, but practicing it for just 12 minutes a day has been shown to reduce stress levels, improve cognition and increase activity in areas of the brain that are central to memory.

From an Eastern perspective, it is believed that the placement of the tongue on the roof of the mouth while making these sounds stimulates 84 acupuncture points on the upper palate. This causes a beneficial bio-chemical transformation in the brain. In addition, Western research has revealed that coordinating the fingertip position with the sounds enhances blood flow to particular areas in the motor-sensory part of the brain.

The Alzheimer’s Research and Prevention Foundation recommends practicing KK in the traditional way to fully reap the benefits of the exercise. Each component of KK calls on a specific part of the neurological system, and each is vital to the whole. Substitutions, such as replacing the Kirtan Kriya sounds with other sounds, or replacing the meditation as a whole with other relaxing tasks, have not been proven equally effective.

How do you practice Kirtan Kriya? It involves doing several things at once, physically and mentally, which is part of the reason it is so effectiveness:

  1. Sit with your spine straight,
  2. Close your eyes.
  3. Repeat the Saa Taa Naa Maa sounds (or mantra)
  4. Simultaneously, Use the mudras, or KK finger positions:
    1. On Saa, touch the index fingers of each hand to your thumbs.
    2. On Taa, touch your middle fingers to your thumbs.
    3. On Naa, touch your ring fingers to your thumbs.
    4. On Maa, touch your little fingers to your thumbs.
  5. Vary the way you express the sounds
    1. For two minutes, sing in your normal voice.
    2. For the next two minutes, sing in a whisper.
    3. For the next four minutes, say the sounds silently to yourself.
    4. Then reverse the order, whispering for two minutes, and then out loud for two minutes, for a total of twelve minutes.
  6. With each syllable, focus your attention on the L form (see below), while your eyes are closed, with a continuous flow. Imagine the sound flowing down through the top of your head and out the middle of your forehead (your third eye point).

To come out of the exercise, inhale very deeply, stretch your hands above your head, and then bring them down slowly in a sweeping motion as you exhale.

SEEK AN INTEGRATIVE PHYSICIAN

Acupuncture, aromatherapy, herbal medicine, functional medicine, and homeopathy are some forms of alternative medicine that can help prevent and alleviate a number of symptoms associated with stress and/or dementia. Here is a little more information on just two of those systems:

  • Functional medicine seeks to restore normal function to various systems of the body through proper diet, correcting nutritional deficiencies, healing “leaky gut,” addressing mitochondrial dysfunction, encouraging stress reduction techniques such as yoga and meditation, and detoxification when necessary
  • Homeopathic medicine is a 200-year-old, uniquely individualized system of medicine used by over 500 million people worldwide. It is based on the “law of similars” or “like cures like:” The same remedy that can cause symptoms in a healthy person can cure those same symptoms in a sick person by varying the dose of the substance. Homeopathy uses small “nano-doses” of natural substances to stimulate the person’s innate immune system, bringing it back into balance. It can powerfully and effectively alleviate stress by “freeing” the body of the residues of trauma, grief, shock, and loss. Homeopathic physicians have found homeopathy especially helpful in easing the behavioral changes that many patients with Alzheimer’s disease experience, e.g., irritability, heightened anxiety, delusional behavior, and sleep disturbances.  The correct constitutional remedy can also have profound effects on motivation and memory; it is not unusual for the spouse to say that after the remedy, his or her partner will start doing tasks around the home again and be more engaged in general in everyday life.

 

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[1] From (ALZ.ORG)

[2] University of California Irvine: Institute for Memory Impairments and Neurological Disorders.   http://www.alz.uci.edu/stress-and-its-influence-on-alzheimer%E2%80%99s-disease/#sthash.Aa5idp5D.dpuf.

[3] High cortisol levels are associated with cognitive impairment no-dementia (CIND) and dementia.  Clinica Chimica Acta, Volume 423, 23 August 2013, Pages 18–22

[4] Stress, Meditation, and Alzheimer’s Disease Prevention: Where The Evidence Stands

Khalsa, Dharma Singha:  Journal of Alzheimer’s Disease, vol. 48, no. 1, pp. 1-12, 2015

[5] Stress, Inflammation and Aging, Helen Lavretsky, Paul A. Newhouse:  

Am J Geriatric Psychiatry. 2012 Sep; 20(9): 729–733.

[6] Benzodiazepine use and risk of Alzheimer’s disease: case-control study.  Billioti de Gage S, Moride Y. Ducruet T, Kurth T, Verdoux H, Tournier M, Pariente A, Bégaud B:  BMJ (2014); 349.

[7] Benzodiazepine use and risk of dementia: prospective population based study. Billioti de Gage S, Moride Y. Ducruet T, Kurth T, Verdoux H, Tournier M, Pariente A, Bégaud B:  BMJ (2012); 345

[8] XXI World Congress of Neurology, Vienna, 21-26 September 2013.

[9] Effects of stress throughout the lifespan on the brain, behavior and cognition.  

Lupien SJ, McEwen BS, Gunnar MR, Heim C:Natl Rev Neurosci 10: 434445

[10] Basal cortisol levels and cognitive deficits in human aging.

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[11] Cortisol levels during human aging predict hippocampal atrophy and memory deficits. Lupien S, de Leon M, de Santi S, Convit A, Tarshish C, Hauger RL, Meaney MJ, et al.      Nat Neurosci1 (1998): 69-73329

[12] Vulnerability to stress, anxiety, and development of dementia in old age.

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[13] Chronic psychological distress and risk of Alzheimer’s disease in old age.

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[14]The effects of prolonged stress and APOE genotype on memory and cortisol in older adults. Peavy GM, Lange KL, Salmon DP, Patterson TL, et al:  Biol Psychiatry 62 2007): 472478

[15] Early-life risk factors for Alzheimer disease.

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[16] Long term neuroendocrine effect of childhood maltreatment.

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[17] 2013 annual meeting of the American Psychosomatic Society in Miami, Florida

[18] Meditation effects on cognitive function and cerebral blood flow in subjects with memory loss: a preliminary study. Newberg AB1, Wintering N, Khalsa DS, Roggenkamp H, Waldman MR:   J Alzheimers Dis. 2010;20(2):517-26.

[19] Meditation effects on perceived stress, sleep, mood, and memory function in adults with cognitive impairment or early stage AD and their caregivers: a pilot study. Innes KE1, Selfe TK, Brown CJ, Rose KM, Thompson-Heisterman A:   Evid Based Complement Altern Med 2012: 927509

[20] Cerebral blood flow changes during chanting meditation. Khalsa DS, Amen D, Hanks C, Money N, Newberg AN (2009)   Nucl Med Commun 30, 1-6.