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Wednesday, August 24, 2016

Psychotic Experiences Linked to Cognitive Changes

Psychotic Experiences Linked to Cognitive Changes

Recent research suggests that people who have psychotic experiences, but no diagnosis of psychotic illness, have altered cognitive functioning compared with people without psychotic experiences.

A substantial minority of the general population, around six percent, experiences subclinical psychotic experiences, report MSc student Josephine Mollon of King’s College London, UK, and colleagues in the journal JAMA Psychiatry.

“Evidence suggests that subclinical psychotic experiences may lie on a continuum with clinically significant psychotic symptoms, and therefore be informative for research into the cause of psychotic illness,” they write.

Both disorders share risk factors such as low IQ, childhood maltreatment, and stressful life events, as well as similar brain scan results such as deficits in grey and white matter.

The researchers looked at neuropsychological functioning and psychotic experiences in adults, taking into account sociodemographic characteristics and age. They used information gathered from household surveys covering 1,677 people aged 16 years or older, living in two areas of London, UK. Average age was 40 years.

Participants’ psychotic experiences were measured using the Psychosis Screening Questionnaire, which is administered by an interviewer. It assesses psychotic experiences in the previous year, covering thought disorder, paranoia, strange experiences, and hallucinations. The tool also covers hypomania, a mild form of mania, marked by elation and hyperactivity, but this was not assessed as the focus was on psychosis.

Cognitive functioning was measured with a series of tests looking at verbal knowledge (using a reading test), working memory, general memory, and cognitive processing speed. From this, an overall IQ score was calculated.

One in ten of the participants had previously had psychotic experiences. This group was not significantly different from those without psychotic experiences on overall IQ or processing speed. But they scored less highly on verbal knowledge, working memory, and general memory.

Medium to large impairments in cognitive functioning were seen among participants aged 50 years and older with psychotic experiences. These differences remained once socioeconomic status, cannabis use, and common mental disorders were taken into account.

The team writes, “The profile of cognitive impairment in adults with psychotic experiences differed from that seen in adults with psychotic disorders, suggesting important differences between subclinical and clinical psychosis.”

Commenting on the study, researcher Josephine Mollon says, “Psychotic symptoms, such as hallucinations and delusions, are core features of psychotic disorders. A significant minority of the general population also reports subclinical psychotic experiences.

“We used population-based survey data to characterize cognitive functioning in adults with psychotic experiences while adjusting for important sociodemographic characteristics and investigating the effect of age.”

She continues, “Those with subclinical psychotic experiences did not show an impairment in processing speed, which is severely compromised in psychotic patients, suggesting that processing speed deficits indicate vulnerability to psychosis.

“Moreover, psychotic experiences, together with cognitive deficits, may be most challenging in those aged 50 years and older. Even mild, subclinical psychotic experiences, when combined with the effects of aging, may strain cognitive reserves and lead to large, burdensome cognitive deficits.”

In conclusion, Mollon adds, “Our findings suggest a continuum of psychotic experiences and cognitive deficits in a much larger proportion of the population than that seen in clinical practice. Effective treatment of such deficits could be helpful for many individuals.”

She recommends that future research on the topic should involve long-term studies “to elucidate how psychotic experiences interact with cognitive deficits throughout the life course and to identify risk and resiliency factors.”

This study is the first to investigate the effect of age on cognitive impairment associated with psychotic experiences in adults. Some previous studies suggest that these experiences are most prevalent in adolescence and old age, while others have not found significant age differences. Among the participants in this study, psychotic experiences were more likely in the youngest group but remained sizable in the other age groups.

Because the data in this study came from household surveys, the researchers could look for possible mechanisms behind the links they found with psychotic experiences and cognition.

They say, “First-degree relatives were significantly impaired on verbal knowledge, whereas unrelated cohabitants showed no impairment. Our findings suggest that a complex interplay of genetic, biological, and psychosocial factors lies behind the association between psychotic experiences and neuropsychological impairment.

“This pattern of verbal knowledge impairment suggests common genetic and/or family environmental factors.”

Reference

Mollon, J. et al. Psychotic Experiences and Neuropsychological Functioning in a Population-based Sample. JAMA Psychiatry, 30 December 2015 doi: 10.1001/jamapsychiatry.2015.2551



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Mice Study Shows How Sleep Deprivation Harms Memory

Mice Study Shows How Sleep Deprivation Harms Memory

Findings from an international research effort are helping scientists understand the way in which sleep deprivation negatively affects memory.

Researchers from the Universities of Groningen (Netherlands) and Pennsylvania found that in mice, five hours of sleep deprivation leads to a loss of connectivity between neurons in the hippocampus, a region of the brain associated with learning and memory.

The study, to be published in the journal eLife, is the first to provide detail on why memory is harmed when sleep deprived.

“It’s clear that sleep plays an important role in memory – we know that taking naps helps us retain important memories. But how sleep deprivation impairs hippocampal function and memory is less obvious,” says first author Robbert Havekes, PhD, Assistant Professor at the Groningen Institute for Evolutionary Life Sciences.

It has been proposed that changes in the connectivity between synapses – structures that allow neurons to pass signals to each other – can affect memory.

To study this further, the researchers examined the impact of brief periods of sleep loss on the structure of dendrites, the branching extensions of nerve cells along which impulses are received from other synaptic cells, in the mouse brain.

They first used the Golgi silver-staining method to visualize the length of dendrites and number of dendritic spines in the mouse hippocampus following five hours of sleep deprivation, a period of sleep loss that is known to impair memory consolidation.

Their analyses indicated that sleep deprivation significantly reduces the length and spine density of the dendrites belonging to the neurons in the CA1 region of the hippocampus.

They repeated the sleep-loss experiment, but left the mice to sleep undisturbed for three hours afterwards. This period was chosen based on the scientists’ previous work showing that three hours is sufficient to restore deficits caused by lack of sleep.

The effects of the five-hour sleep deprivation in the mice were reversed so that their dendritic structures were similar to those observed in the mice that had slept.

The researchers then investigated what was happening during sleep deprivation at the molecular level.

“We were curious about whether the structural changes in the hippocampus might be related to increased activity of the protein cofilin, since this can cause shrinkage and loss of dendritic spines,” Havekes says.

“Our further studies revealed that the molecular mechanisms underlying the negative effects of sleep loss do in fact target cofilin.

“Blocking this protein in hippocampal neurons of sleep-deprived mice not only prevented the loss of neuronal connectivity, but also made the memory processes resilient to sleep loss. The sleep-deprived mice learned as well as non-sleep deprived subjects.”

Ted Abel, PhD, Brush Family Professor of Biology at the University of Pennsylvania and senior author of the study, explains: “Lack of sleep is a common problem in our 24/7 modern society and it has severe consequences for health, overall wellbeing, and brain function.

“Despite decades of research, the reasons why sleep loss negatively impacts brain function have remained unknown. Our novel description of a pathway through which sleep deprivation impacts memory consolidation highlights the importance of the neuronal cell network’s ability to adapt to sleep loss.

“What is perhaps most striking is that these neuronal connections are restored with several hours of recovery sleep. Thus, when subjects have a chance to catch up on much-needed sleep, they are rapidly remodeling their brain.”

Source: Elife/EurekAlert



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Banned Chemicals Continue to Increase Risk of Autism

Banned Chemicals Continue to Increase Risk of Autism

Chemicals banned decades ago continue to increase the risk of autism. In a new study, investigators discovered exposure during pregnancy to chemicals used in certain pesticides and as insulating material banned in the 1970s, can significantly increase the odds of autism spectrum disorder in children.

Researchers discovered children born after being exposed to the highest levels of certain compounds of the chemicals during their mother’s pregnancy were roughly 80 percent more likely to be diagnosed with autism when compared to individuals with the very lowest levels of these chemicals. That also includes those who were completely unexposed.

The dangerous substances — known as organochlorine chemicals – were banned in the United States in 1977. However, these compounds can remain in the environment and become absorbed in the fat of animals that humans eat, leading to exposure.

With that in mind, Kristen Lyall, ScD, assistant professor in Drexel University’s A.J. Drexel Autism Institute, and her collaborators, decided to look at organochlorine chemicals during pregnancy since they can cross through the placenta and affect the fetus’ neurodevelopment.

“There’s a fair amount of research examining exposure to these chemicals during pregnancy in association with other outcomes, like birth weight — but little research on autism, specifically,” Lyall said.

“To examine the role of environmental exposures in risk of autism, it is important that samples are collected during time frames with evidence for susceptibility for autism — termed ‘critical windows’ in neurodevelopment. Fetal development is one of those critical windows.”

Their paper describing this study was titled, “Prenatal Organochlorine Chemicals and Autism,” and published in Environmental Health Perspectives.

Lyall teamed with researchers including Gayle Windham, PhD, Martin Kharrazi, PhD, Lisa Croen, PhD, as well as an expert on measuring organochlorine chemicals, Andreas Sjodin, PhD.

The team looked at a population sample of 1,144 children born in Southern California between 2000 and 2003. Data was accrued from mothers who had enrolled in California’s Expanded Alphafetoprotein Prenatal Screening Program, which is dedicated to detecting birth defects during pregnancy.

Participants’ children were separated into three groups: 545 who were diagnosed with autism spectrum disorder, 181 with intellectual disabilities but no autism diagnosis, and 418 with a diagnosis of neither.

Blood tests taken from the second trimester of the children’s mothers were used to determine the level of exposure to two different classes of organochlorine chemicals: Polychlorinated biphenyls (PCBs, which were used as lubricants, coolants and insulators in consumer and electrical products) and organochlorine pesticides (OCPs, which include chemicals like DDT).

“Exposure to PCBs and OCPs is ubiquitous,” Lyall said. “Work from the National Health and Nutrition Examination Survey, which includes pregnant women, shows that people in the U.S. generally still have measurable levels of these chemicals in their bodies.”

However, Lyall emphasized that exposure levels were key in determining risk.

“Adverse effects are related to levels of exposure, not just presence or absence of detectable levels,” she said. “In our Southern California study population, we found evidence for modestly increased risk for individuals in the highest 25th percentile of exposure to some of these chemicals.”

It was determined that two compounds in particular — PCB 138/158 and PCB 153 — stood out as being significantly linked with autism risk.

Children with the highest in utero levels (exposure during their mother’s pregnancy) of these two forms of PCBs were between 79 and 82 percent more likely to have an autism diagnosis than those found to be exposed to the lowest levels.

High levels of two other compounds, PCB 170 and PCB 180, were also associated with children being approximately 50 percent more likely to be diagnosed — again, this is relative to children with the lowest prenatal exposure to these PCBs.

None of the OCPs appeared to show an association with higher autism diagnosis risk.

In children with intellectual disabilities but not autism, the highest exposure to PCBs appeared to double the risk of a diagnosis when compared to those with the lowest exposure. Mid-range (rather than high) OCP exposure was also associated with an increased level of intellectual disability diagnosis when measured against children with the lowest exposure levels.

“The results suggest that prenatal exposure to these chemicals above a certain level may influence neurodevelopment in adverse ways,” Lyall said.

These results are a first step to suggest these compounds may increase risk of development of autism, and Lyall and her colleagues are eyeing up more work in the field.

“We are definitely doing more research to build on this — including work examining genetics, as well as mixtures of chemicals,” Lyall said. “This investigation draws from a rich dataset and we need more studies like this in autism research.”

Source: Drexel University



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Feeling Left Out when My Husband Is with His Family

From the U.S.: I have been married to my husband for 3 years. His family is out of the country and visit us for 3 to 4 weeks every year. He has a younger sister who is very attention seeking and comes and lives with us for a month every year. She never tries to get friendly with me and is very clingy to her brother – my husband.

i always feel left out when she is around as they keep doing sibling things. she is immature and keeps hugging him taking pictures of the 2 of them etc.

i try to find something i can do alone for those few weeks, but at the back of my mind feel sad and depressed that my husband forgets about me when she is around. He is very loving when its just the 2 of us, but is overly attached to his family when they are around and I feel left out and ignored. If i let him know he says I should be ok with that for a few weeks when they are around.

A: I don’t have enough information to comment on whether your husband is “over-attached.” He may simply be “attached,” which is a good thing. A man who is loving and loyal to his family is usually a man who knows how to be loving and loyal to his wife. If his family was asking him to choose them over you, it would be another story. I don’t see that in your letter. Instead, I see a family that misses him and that tries to pack 12 months of contact into 1 month.

You didn’t mention how old his sister is. If she is over 21 and inappropriately hugging, it might be advisable for your husband to start asserting some boundaries. That’s a “might.” Since I can’t witness what goes on, I can’t venture a definite. If she has a boyfriend or is dating, it’s probably not a problem but if her only affectionate contact with a male is your husband, it may not be helpful for him to go along with all of it.

If you were seeing me as a couple, I’d be asking your husband what he can do to reassure you that he hasn’t “forgotten” you during his family visits. And I’d be advising you to make more effort to befriend the sister by taking her on some “girls’ only” lunches or shopping trips or events. You’ll learn more about her when she isn’t so focused on her brother. It would be helpful if your husband supported you by encouraging his sister to go with you.

I wish you well.
Dr. Marie



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App Improves Health Behaviors for People Living with HIV

App Improves Health Behaviors for People Living with HIV

A smartphone app has been found to help people with HIV take their daily medications and reduce substance abuse.

University of Buffalo researchers found that participants not only found the app easy and convenient to use — they were also willing to provide honest responses.

“Reporting was actually high – we had 95 percent compliance with daily report completion. A key finding of our study was the ability for people living with HIV to feel comfortable reporting on sensitive health behaviors,” said Sarahmona Przybyla, the study’s lead author.

A willingness to report the use of alcohol or drugs was significant because substance use is one of the most reliable predictors of poor adherence to antiretroviral therapy (ART), explain the researchers.

Their findings were more surprising considering that the majority of the 26 study participants had never used a smartphone before. After some initial smartphone training from research staff, they completed their reports with ease.

The study appears in the journal AIDS Research and Treatment.

Participants were recruited from two Buffalo-area clinics and were asked to use the app — named Daily Reports of Using Medications, or DRUM — to complete their reports, which took three to five minutes, between 4 p.m. and 6 p.m. each day for two weeks.

Every afternoon, the 26 study participants received a text message reminder asking them to fill out their report. If they missed that day’s report, they were given the option to do a make-up when they logged into the app the next day.

Researchers were deliberate in their wording of the questions. “People living with HIV continue to be a stigmatized population, so we didn’t want any of the questions we developed to draw attention to their disease. We never used ‘HIV’ or ‘ART’ – anything that would inadvertently out someone as having HIV,” Przybyla said.

A sample medication question was, “Did you take your first dose?” A change in daily routine was the most commonly reported reason participants didn’t take their medication, followed by simply forgetting. Use of alcohol or drugs was the third most common reason.

Participants who confirmed they had used alcohol or drugs in the past 24 hours were given a series of follow-up questions that asked why they used the substance and where they were when they used it, with a dropdown menu of answer choices.

Each participant was provided with a five-digit passcode to access the app, ensuring privacy and confidentiality. Data from the completed reports was sent in real time directly to UB’s Research Institute on Addictions, which helped develop the app along with Przybyla.

In the future, the app could aid in users’ decision to use alcohol since some participants in this study reported that it helped them understand exactly how much they were drinking.

And it helped users establish a pattern. “I think the surprising thing is how much the app and the text reminders helped the participants to develop a routine,” said Rebecca Eliseo-Arras, a study co-author and senior research analyst at UB’s Research Institute on Addictions.

“For instance, some reported that the text message reminded them to do the report, but the report actually made them think about whether or not they took their medication and, if they didn’t, that it prompted them to go take their medications.”

Participants completed 347 out of 364 possible daily reports over the two-week span. They reported drinking alcohol on 51.6 percent and marijuana use on 35.4 percent of reporting days.

In follow-up interviews after the two weeks, researchers asked study members about their experience using the app. “Many said it was a piece of cake and that they actually looked forward to doing their daily reports,” Przybyla said.

“We also asked people where they were when they completed their reports. A lot of them said they were out and about. They never felt like they had to go hide in a bathroom to fill out the survey each day.”

Przybyla said it’s important to note that the average time since diagnosis among study participants was 17 years and that many of their friends and relatives were likely aware they had HIV. As a result, participants probably felt more comfortable completing the reports around others than someone who was more recently diagnosed and may not have been open about disclosing their disease status to others.

Three-quarters of the sample was male, and slightly more than half were African American. The average age was 48.

Investigators believe the app could help lead to quicker intervention in cases where a patient has missed a number of doses. “Life expectancy has changed dramatically as a result of advances in pharmacotherapy, which is wonderful, but adherence is key. You can live a long, healthy life with HIV, but you have to take your meds,” said Przybyla.

“Now that we have this data, we can reach out to people with HIV and say, ‘We’ve noticed you’ve been using substances and that seems to be related to the fact that you’ve missed your doses — what can we do to help you?’ It’s putting prevention in their pockets.”

Source: University of Buffalo



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Music at Work Enhances Teambuilding

Music at Work Enhances Teambuilding

From retail shops to health care complexes, music is used to improve the customer experience and mold behavior. New research reviews the effects of music for enhancing the worksite environment for employees.

In the study, Cornell University investigators used a pair of lab experiments to learn that music can play an important role in enhancing cooperative spirit.

Researchers Kevin Kniffin, Jubo Yan, Brian Wansink and William Schulze devised the experiments to test the effect of different types of music on the cooperative behavior of individuals working as a team.

The summary paper appears in the Journal of Organizational Behavior.

For each study, participants were grouped into teams of three. Each team member was given multiple opportunities to either contribute to the team’s value using tokens or keep the tokens for personal use.

When happy, upbeat music was played – researchers chose the “Happy Days” theme song, “Brown Eyed Girl” by Van Morrison, “Yellow Submarine” by the Beatles and “Walking on Sunshine” by Katrina and the Waves – team members were more likely to contribute to the group’s value.

When music deemed unpleasant was played – in this case, heavy metal songs by less than well-known bands – participants were more likely to keep tokens for themselves.

The researchers found contribution levels to the public good when happy, upbeat songs were played were approximately one-third higher compared to the less pleasant music.

When researchers conducted a second experiment testing how people react when no music is played, the results were the same. The researchers conclude that happy music provokes people to more often make decisions that contribute to the good of the team.

“Music is a pervasive part of much of our daily lives, whether we consciously notice it or not,” said Kniffin, a behavioral scientist at Cornell and lead author on the paper.

“Music might melt into the background in places like supermarkets or gyms and other times it’s very prominent like places of worship or presidential nominating conventions. Our results show that people seem more likely to get into sync with each other if they’re listening to music that has a steady beat to it.”

Wansink, director of the Cornell Food and Brand Lab, added: “What’s great about these findings, other than having a scientific reason to blast tunes at work, is that happy music has the power to make the workplace more cooperative and supportive overall.”

The researchers suggest managers consider not only the customer experience but also workers’ when picking the day’s music.

Starting the day with this simple consideration in mind could result in happier employees and more teamwork.

“Lots of employers spend significant sums of time and money on off-site team-building exercises to build cooperation among employees. Our research points to the office sound system as a channel that has been under appreciated as a way to inspire cooperation among co-workers,” said Kniffin.

Source: Cornell University



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Hidden Stroke Victims: The Young

Jamie Hancock, 38, at her house in Rocklin, Calif., on June 30, 2016. Six years ago, Hancock suffered a stroke caused by a tear in her artery. (Heidi de Marco/KHN)

Jamie Hancock, 38, at her house in Rocklin, Calif., in June 2016. Six years ago, Hancock suffered a stroke caused by a tear in her artery. (Heidi de Marco/KHN)

ROCKLIN, Calif. — The headaches were excruciating and wouldn’t go away. Her doctor said they were migraines. Then, one morning a few weeks later, Jamie Hancock stood up from the couch and discovered she couldn’t move the right side of her body. When she spoke, her speech was slurred.

At the hospital, doctors told her she was having a stroke. The 32-year-old Hancock, whose children were just 1 and 3, had a sobering epiphany: “My whole life is changed forever.”

Now, six years later, no one would know she is a stroke survivor. A lifelong dancer, she is fit and muscular. She speaks clearly and walks quickly as she shuttles her kids around, runs errands and teaches dance classes.

But the effects — for her and other young stroke victims — linger just below the surface. They are there when she gets mad at her family, when she can’t remember what she needs at the grocery store, when she tires after working for a few hours. The noise and light can be unbearable, forcing her to escape to a dark room.

Some days Hancock tries to be the energetic and sociable working mom she was before the stroke. Then she crashes.

“I sort of forget I have a disability and I think I can do everything anyone else my age can do,” she said. “But I can’t.”

***

Hancock is among a growing number of younger adults who’ve had strokes, which occur when blood flow to the brain is blocked or a vessel in the brain bursts. Because strokes are most often associated with old age, symptoms in younger adults may be overlooked, according to patients, advocates and physicians. And their need for rehabilitation — to return to active lives as parents and employees, for instance — can be underestimated.

“The American public is still very locked on stroke being an [affliction] of the elderly,” said Amy Edmunds, who started a nationwide advocacy and support organization called YoungStroke. “But we are an emerging population … and we really need to be recognized.”

The rate of hospitalization for strokes dropped nationwide by 8 percent between 2000 and 2010 (from 250 to 204 per 100,000), but in those same ten years it increased almost 44 percent for people ages 25 to 44, though from a much smaller base (from 16 to 23 per 100,000), according to research published in May in the Journal of the American Heart Association.

Jamie Hancock, 38, serves lunch to her children Blythe, 9, and Andrew, 7, on June 30, 2016. Hancock said she lost the cognitive ability to do certain tasks which made it difficult to keep her full-time, office job. (Heidi de Marco/KHN)

Hancock serves lunch to her children Blythe, 9, and Andrew, 7. Hancock said she lost the cognitive ability to do certain tasks which made it difficult to keep her full-time, office job. (Heidi de Marco/KHN)

The reasons for the rising prevalence among young people are not clear, but physicians believe that growing risk factors such as hypertension, smoking and obesity contribute. And because younger patients aren’t as aware that they can get strokes, they may not be proactive about controlling those risk factors. Older patients, by contrast, may be more inclined to exercise, eat healthy and take preventive medications.

“Older people are educated and understand they need to take care of themselves and are doing all the things to prevent strokes,” said Lisa Yanase, a stroke neurologist at Providence Health & Services in Oregon. “Young adults … think they are bulletproof. They haven’t had the realization that these things can actually be bad for them.”

Some young people also may have strokes because of drug abuse, and others because of undiagnosed genetic conditions. Hancock’s stroke was caused by a tear in the artery.

Strokes are still more common among older adults though. People ages 18 to 50 years old account for only about 10 percent of the 795,000 strokes that occur each year, according to the American Heart Association.

When their patients are younger, doctors don’t always immediately recognize strokes, said Lucas Ramirez, a physician at Keck Hospital of USC and one of the co-authors of the journal article. Young adults may also be unaware they are having a stroke, jeopardizing their chances of receiving critical, time-sensitive treatment.

Common symptoms, for all ages, include sudden confusion or numbness, slurred speech or severe headache.

Hancock said she had no idea of the warning signs. “I had heard about strokes, but I thought they were for the elderly,” she said.

***

Years had passed since the stroke, and now the Fourth of July was just a few days away. Hancock had promised her children they could buy fireworks. Blythe, 9, and Andrew, 7, selected several sets. But when the clerk handed the bag to the kids, one of Andrew’s wasn’t inside.

“Mom, where’s my rocket man?” he asked.

Hancock told her son to stop. But he asked again — and again.

“Hold on!” she yelled. “I’m trying to focus on paying. You know I have a hard time with focusing.”

Jamie Hancock, 38, and her children Blythe, 9, and Andrew, 7, get ready for a shopping trip to the grocery store on June 30, 2016. Hancock said her stroke made her forgetful, so Blythe has to help her keep track of things around the house. (Heidi de Marco/KHN)

Hancock and her children get ready for a shopping trip to the grocery store in June 2016. Hancock said her stroke made her forgetful, so Blythe has to help her keep track of things around the house. (Heidi de Marco/KHN)

Hancock said she never used to be that way. Now, she has trouble multitasking and gets angry about minor things — her daughter playing music too loud, her son bouncing the ball inside the house. “My family pays the price,” she lamented.

Both children say they’ve learned what to do when their mom gets stressed. Andrew gives her hugs. Blythe helps her take deep breaths. “Sometimes she has really good days and sometimes she has horrible days,” Blythe said.

In addition to the emotional roller coaster, Hancock said she has lost the cognitive ability to do some things, such as handling the family finances.

There is less money to go around, too. Just a few months after the stroke, Hancock returned to her job as an executive assistant at the California Restaurant Association. But she had trouble concentrating, couldn’t manage her time or meet deadlines — and she eventually left. She later got fired from a subsequent job.

“I would get distracted really, really easily,” she said. “I still do.”

Hancock said she spiraled into depression, which therapists later told her was likely a symptom of the stroke. She also became addicted to a painkiller prescribed to treat her headaches. She said it helped her get through the day without feeling exhausted.

With the assistance of Suboxone, a medication to treat opiate addiction, Hancock got sober. But that didn’t stop her mood swings. There were times when she slammed cabinets so hard they fell off their hinges.

Her husband, Ken Hancock, said the stroke and its aftermath nearly tore their family apart. At first, he just felt scared. For a while, his wife couldn’t wash her own hair or pick up their children. When she cooked, one of her hands shook.

A meditation book sits on Jamie Hancock’s living room table. After her stroke, Hancock said she needs to find ways to calm herself down during stressful moments. (Heidi de Marco/KHN)

A meditation book sits on Hancock’s living room table. After her stroke, she said she needs to find ways to calm herself down during stressful moments. (Heidi de Marco/KHN)

He concentrated on getting his wife to appointments and taking care of her and their children. But as she got better physically, he said, she became worse emotionally. The addiction didn’t help, and they argued frequently. “It was a terrible, terrible cycle,” he said. “It took a long time to realize better things were around the corner.”

Now, the family is in a better place, he said. Jamie Hancock sees a therapist and takes medication that is normally used to treat schizophrenia. The volatility has subsided.

Ken Hancock said his wife’s brain injury isn’t visible, but it’s there. “She is still trying to recover, and we are sort of in the same boat with her,” he said.

***

On a June afternoon, Hancock sat in her living room with another young stroke survivor, Jen Ruzicka Lee, an ER nurse and longtime runner who was stricken last year at age 43. Lee returned to nursing part-time in April, but she still stutters and uses a walker.

They laughed and nearly cried as they talked about the impact of different medications, becoming intimate with their husbands again and the daily guilt they felt about the effect of the strokes on their children.

Both women said they had attended a few stroke support groups but couldn’t relate to the older participants. “They would say, ‘You need to nap,” Hancock recounted. “That’s great, but I can’t. I have kids.”

Support groups and rehabilitation programs are typically designed for older adults, said Edmunds, the YoungStroke founder, who was hit by the disease at age 45. Many young stroke survivors have to figure out how to continue raising children and working while dealing with the effects of a stroke.

Blythe Hancock, 9, and Andrew Hancock, 7, at their home in Rocklin, Calif., on June 30, 2016. Jamie Hancock says she feels guilty about the stress her children have to endure due to the side effects of her stroke. (Heidi de Marco/KHN)

Hancock says she feels guilty about the stress her children have to endure due to the side effects of her stroke. (Heidi de Marco/KHN)

“It’s a different landscape for younger adults,” Edmunds said. “We need skills to help us get on with our lives post-stroke, which could conceivably be as long as pre-stroke.”

Hancock and Lee, along with two other women, have become an informal support network. They text often and meet for coffee when they can. This month, they had a family barbecue.

Being a young stroke survivor, Hancock said, “is a whole different ballgame.”

***

Hancock tried to return to dancing soon after her stroke. She couldn’t do a single turn on the floor, and walked out in tears.

“I had to learn to walk again so I don’t know why I thought in my brain I could take an advanced dance class,” she said.

Over time, Hancock regained her strength. She said she doesn’t think her brain will ever be able to handle a 40-hour work week. Teaching dance part-time can even be too tiring some days.

On this evening, however, Hancock energetically stepped into a brightly lit dance studio. She and five young students warmed up to music. Hancock instructed them to run through the dance routine they had practiced the previous night.

“Let’s see what you remember,” she said.

Then she smiled. “Let’s see what I remember, too.”

KHN’s coverage in California is funded in part by Blue Shield of California Foundation.



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