Grow Think Thrive

✨ All things cognitive rehabilitation and wellness.

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This is Harley. She's never rolled down a hill before, but she's super proud of her first attempt. 13/10 nailed it

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MEMORY is not a unitary system. It is a multi-stage process, and brain injury can disrupt any stage independently or in combination. Understanding where the breakdown occurs is essential for selecting appropriate compensatory strategies and setting treatment goals.

✨ ENCODING is the process of registering and transforming incoming information into a memory trace. It is highly dependent on attention, arousal, and the ability to organize incoming information. In brain-injured patients, encoding deficits are extremely common, particularly following frontal lobe or diffuse axonal injuries, and are frequently misidentified as "forgetting." If information was never adequately encoded, it cannot be stored or retrieved. Clinically, this means that a patient who "doesn't remember" a therapy session may never have fully processed the information in the first place.

✨ STORAGE refers to the consolidation and maintenance of encoded information over time. Consolidation involves the transfer of information from temporary, hippocampally dependent representations to more distributed cortical networks, a process that occurs over hours to weeks and is heavily influenced by sleep. Damage to medial temporal lobe structures (e.g., hippocampus), as seen in hypoxic brain injury, herpes encephalitis, or certain stroke patterns, can produce profound storage deficits (anterograde amnesia), even when encoding and retrieval mechanisms are relatively intact.

✨ RETRIEVAL is the process of accessing stored information when needed. Retrieval deficits are common after frontal lobe injuries and often present as inconsistent memory performance: the patient may recall information spontaneously at one time but not another, or may benefit significantly from cues or recognition formats. This pattern suggests the information has been stored, but the patient has difficulty initiating a systematic search. Retrieval deficits are generally more amenable to compensatory strategy use than storage deficits.

🤔 Clinical implication:
Differentiating between encoding, storage, and retrieval deficits, often clarified through neuropsychological evaluation, directly informs whether intervention should focus on improving the conditions of learning (encoding supports), external memory aids (storage compensation), or cueing and retrieval strategy training.

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Health insurance companies (Cigna, Aetna, etc.) using AI to downcode.

Review their press releases versus real world actions.

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End of Dieting by Joel Fuhrman
$1.99 Kindle

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✨️ CHECK SODIUM LEVELS

Drug-induced hyponatremia is more common than you think and it impairs cognition.

Thiazide diuretics affect up to 30% of patients. Antidepressants like SSRIs cause syndrome of inappropriate antidiuresis in up to 32%, especially in older adults. Risk peaks within weeks of starting these medications.

Even mild chronic hyponatremia impairs attention, memory, and executive function. In moderate-profound cases (sodium <130 mEq/L), deficits are measurable across multiple cognitive domains.

👍 The good news?
It's largely reversible with sodium correction.

Common culprits:
• Thiazide diuretics
• Antidepressants (SSRIs, tricyclics)
• Antipsychotics
• Anticonvulsants (carbamazepine)
• Proton pump inhibitors

🤔 That subtle confusion in your patient on hydrochlorothiazide + sertraline? Check the sodium.

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“The sky was dark and gloomy, and yet there was a cheerfulness abroad that came from the sound of Christmas bells and the presence of Christmas trees.”

- Charles Dickens

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@creepydotorg Claymore
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@JVMonte2 "Mountains" (Interstellar movie)
- Hans Zimmer

https://t.co/AJgcKAiAKV

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“The woods are lovely, dark and deep.”
- Robert Frost

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Still relevant after 10 years.

📚How Not to Die: Discover the Foods Scientifically Proven to Prevent and Reverse Disease
- Michael Greger, MD

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@Matt_Pinner the Government

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@Georgebabs_ Cheek To Cheek
- Ella Fitzgerald &amp; Louis Armstrong

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@Wisdom_HQ Louis Armstrong

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✨ANXIETY and DEPRESSION after BRAIN INJURY are common, persistent, and often overlooked.✨

Across multiple studies, the same pattern appears: mental health symptoms increase after an acquired brain injury, and the elevated risk can last for years.

We see ANXIETY rise from about
🔸1 in 5 people before the injury to
🔸more than 1 in 3 long-term.

DEPRESSION shows an even steeper rise, with long-term rates reaching
🔸more than 40% in some groups.
Even decades after moderate-to-severe TBI,
🔸about 1 in 4 people are still experiencing major depression.

The FIRST YEAR after injury is the most vulnerable period. Nearly 78% of new psychiatric diagnoses occur during this time. Anxiety may lessen over time, but depressive symptoms tend to persist.

The risk is greater for
🔸women
🔸unemployed individuals
🔸those with pre-injury mental health issues
🔸people with more severe injuries
🔸ICU stays
🔸anyone facing obstacles in their recovery.

Over half of patients develop entirely new psychiatric symptoms that were not present before the injury.

And the combination matters: anxiety and depression TOGETHER ARE COMMON, and they increase the risk of suicidality.
Within 5 years after injury,
🔸about 3% ATTEMPT SUICIDE and
🔸more than 8% experience SUICIDAL THOUGHTS.

This is why
🔸routine screening
🔸early detection
🔸proactive mental health support
are essential.

🧾

PMID:
26729611
37086742
34156769
26867715
29939106
34884299
27919428

doi:10.1001/jamanetworkopen.2024.50499

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