Using Mental Strategies Can Alter the Brain's Reward Circuitry

From New York University news release:Using Mental Strategies Can Alter The Brain's Reward Circuitry

The cognitive strategies humans use to regulate emotions can determineboth neurological and physiological responses to potential rewards, ateam of New York University and Rutgers University neuroscientists hasdiscovered. The findings, reported in the most recent issue of thejournal Nature Neuroscience, shed light on how the regulation ofemotions may influence decision making.Previous research has demonstrated these strategies can alter responsesto negative events. However, less understood is whether such strategiescan also efficiently regulate expectations of a future reward or adesired outcome.

Scientists have already determined that the expectationof a potential reward brings about positive feelings and aidsrecognizing environmental cues that predict future rewards. Central tothis process is the role of the striatum, a multi-faceted structure inthe brain that is involved in reward processing--and which is especiallyengaged when potential rewards are predicted or anticipated.However, the striatum signal is not always beneficial. Its activity also correlates with drug-specific cravings, most likely increasing urges to partake in risk-seeking behavior in the pursuit of rewards that aredetrimental. Therefore, understanding how to regulate or control thepositive feelings associated with reward expectation is an importantline of inquiry.

The NYU study was conducted by a team of researchers from the laboratoryof NYU Professor Elizabeth Phelps, who co-authored the work withMauricio R. Delgado, now a professor at Rutgers University, and M.Meredith Gillis, an NYU graduate student. They sought to betterunderstand the influence of emotional regulation strategies on thephysiological and neural processes relevant to expectations of reward.The study's subjects were presented with two conditioned stimuli, a blueand a yellow square that either predicted or did not predict a potentialmonetary reward. Prior to each trial, participants were also given awritten cue that instructed them to either respond to the stimulus("think of the meaning of the blue square, such as a potential reward")or regulate their emotional response to the stimulus ("think ofsomething blue in nature that calms you down, such as the ocean").Skin conductance responses (SCRs) of the participants were taken at thebeginning of each conditioned stimulus. These served as a behavioralmeasure of physiological reaction potentially related to reward anticipation.

The results showed that the participants' emotion regulation strategiescould influence physiological and neural responses relevant to theexpectation of reward. Specifically, results from the SCRs revealed thatthe subjects' emotion regulation strategies decreased arousal that waslinked to the anticipation of a potential reward."Our findings demonstrated that emotion regulation strategies cansuccessfully curb physiological and neural responses associated with theexpectation of reward," said Delgado. "This is a first step tounderstanding how our thoughts may effectively control positive emotionsand eventual urges that may arise, such as drug cravings."The work was supported by the James S. McDonnell Foundation, theBeatrice and Samuel A. Seaver Foundation, and the National Institute onDrug Abuse.

Troops To Get Cognitive Screening

Troops To Get Cognitive Screening
By LISA CHEDEKEL Courant Staff Writer
June 25, 2008


The military will begin giving cognitive tests this summer to troops heading to war, in an effort to get a baseline measure of their reaction time, memory, concentration and other brain functions, which could be referenced in case they are injured.

The introduction of the neuropsychological screening comes in response to pressure from Congress and veterans' advocates. They have been pushing the military to assess the cognitive functioning of all deploying troops so symptoms of mild traumatic brain injury, dubbed the "signature injury" of the Iraq war, can be detected more easily during and after combat.Assistant Defense Secretary S. Ward Casscells recently directed military leaders to begin pre-deployment screening of troops by late-July, using a computer-based test known as the Automated Neuropsychological Assessment Metrics, or ANAM, a Department of Defense spokeswoman confirmed in written responses to The Courant.

The testing, which takes about 15 to 20 minutes, will "allow for greater levels of accuracy when making assessments following injury," said the spokeswoman, Cynthia Smith

Study Reveals How ADHD Drugs Work

The University of Wisconsin, Madison, issued an announcement about newresearch findings: Here's the announcement:

Although millions depend on medications such as Ritalin to quellsymptoms of attention deficit hyperactivity disorder (ADHD), scientistshave struggled to pinpoint how the drugs work in the brain.But new work at the University of Wisconsin-Madison is now starting toclear up some of the mystery. Writing in the journal BiologicalPsychiatry, UW-Madison researchers report that ADHD drugs primarilytarget the prefrontal cortex (PFC), a region of the brain that isassociated with attention, decision-making and an individual'sexpression of personality.The finding could prove invaluable in the search for new ADHDtreatments, and comes amidst deep public concern over the widespreadabuse of existing ADHD medicines."There's been a lot of concern over giving a potentially addictive drugto a child (with ADHD)," says lead author Craig Berridge, a UW-Madisonprofessor of psychology. "But in order to come up with a better drug, wemust first know what the existing drugs do."A behavioral disorder that afflicts both children and adults, ADHD ismarked by hyperactivity, impulsivity and an inability to concentrate.The National Institute of Mental Health estimates that 2 millionchildren in the U.S. suffer from the condition, with between 30 to 70percent of them continuing to exhibit symptoms in their adult years.Despite public anxiety over the treatment of a behavioral condition withdrugs, doctors have continued to prescribe meds like Adderall, Ritalinand Dexedrine because - quite simply - they work better than anything else.ADHD drugs fall into a class of medications known as stimulants. ADHDstimulants boost levels of two neurotransmitters, or chemical messengersin the brain, known as dopamine and norepinephrine. Dopamine is thoughtto play a role in memory formation and the onset of addictive behaviors,while norepinephrine has been linked with arousal and attentiveness.Berridge notes that scientists have learned little about how ADHD drugswork because past studies have primarily examined the effects of themedicines at high doses. High-dose stimulants can cause dramatic spikesin neurotransmitter levels in the brain, which can in turn impairattention and heighten the risk of developing addiction."It is surprising that no one was looking at low-dose (ADHD) drugsbecause we know that the drugs are most effective only at low doses,"says Berridge. "So we asked the natural question: what are these drugsdoing at clinically relevant doses?"To answer that question, Berridge and his team monitoredneurotransmitter levels in three different brain regions thought to betargeted by ADHD drugs: the PFC and two smaller brain areas known as theaccumbens which has been linked with processing "rewards," and themedial septum, which has been implicated in arousal and movement.Working with rats, the researchers conducted laboratory and behavioraltests to ensure that animal drug doses were functionally equivalent todoses prescribed in humans. Then, using a type of brain probe - aprocess known as microdialysis - the UW-Madison team measuredconcentrations of dopamine and norepinephrine in the three differentbrain areas, both in the presence and absence of low-dose ADHD stimulants.Under the influence of ADHD drugs, dopamine and norepinephrine levelsincreased in the rats' PFC. Levels in the accumbens and medial septum,however, remained much the same, the scientists found."Our work provides pretty important information on the importance oftargeting the PFC when treating ADHD," says Berridge, "In particular ittells us that if we want to produce new ADHD drugs, we need to target[neurotransmitter] transmission in the PFC."In the future, Berridge and his colleagues plan to look deeper withinthe PFC to gain more detailed insights into how ADHD medicines act onnerves to enhance cognitive ability.Other contributors to the study include UW-Madison co-authors DavidDevilbiss, Matthew Andrzejewski, Ann Kelley, Brooke Schmeichel,Christina Hamilton and Robert Spencer, and Yale Medical Schoolresearcher Amy Arnsten.

What is Post-Concussive Syndome (PCS)?

Post-Concussive Syndrome (PCS) or concussion is a a cluster of cognitive, behavioral, and emotional symptoms that occur after a blow, fall, or hit to the head. This type of injury can disrupt the normal function of the brain. While the symptoms are often described as mild and not life threatening, they can be disabling.
Some symptoms may appear right away, while others may take days or weeks after the injury.
Sometimes the injury may make it hard for people to recognize or admit that they are having problems.


TEN COMMON SIGNS OF POST-CONCUSSIVE SYNDROME (PCS)

1. Low grade headaches that won't go away
2. Difficulty paying attention or concentrating
3. Difficulty remembering things
4. Difficulty organizing and planning
5. Slowness in thinking
6. Getting lost easily
7. Lack of energy
8. Loss of sense of smell or taste
9. Ringing in ears
10. Behavior and personality changes


After a concussion, some people may lose consciousness, but not always - YOU CAN HAVE A BRAIN INJURY WITHOUT LOSING CONSCIOUSNESS.
Sometimes a whiplash can cause a concussion.


A neuropsychological evaluation is essential in 1) determining whether your difficulties are due to PCS or something else and 2) in providing treatment recommemdations as indicated.

If you or a loved one is experiencing any of these problems, please contact our office (949) 481-8414 to schedule a neuropsychological evaluation.

Top 10 Reasons to See a Neuropsychologist

If you are experiencing any of these symptoms, please contact our office for consultation


1.) ATTENTION AND CONCENTRATION Highly distractibleLose my train of thought easilyBecome easily confused and disorientedBlackout spells (fainting)My mind goes blankAura (strange feelings)Don’t feel very alert or aware of things Other concentration or awareness problems


2.) MEMORY Forgetting where I leave things (e.g., keys, gloves, etc.) Forgetting names Forgetting what I should be doing Forgetting where I am or where I am going Forgetting events that happened quite recently (e.g., my last meal) Need someone to give me a hint so I can remember things Relying more and more on notes to remember how to do things Forgetting how to do things, but I can remember facts Forgetting faces of people I know (when they are not present) Frequently forgetting appointments Other memory problems.


3) DIFFICULTY SOLVING EVERYDAY PROBLEMS Difficulty figuring out how to do new things Difficulty planning ahead Difficulty figuring out problems that most other people can do Difficulty thinking as quickly as needed Difficulty doing things in the right order (sequence problems) Difficulty verbally describing the steps involved in doing something Difficulty changing a plan or activity in a reasonable amount of time Difficulty completing an activity in a reasonable amount of time Difficulty doing more than one this at a time Difficulty switching from one activity to another activity Easily frustrated Other problem solving difficulties:


4.) SPEECH, LANGUAGE, AND MATH SKILLS Difficulty finding the right word to say Difficulty understanding what others are saying Unable to speak Difficulty staying with one idea Difficulty writing letters or words (not due to motor problems) Slurred Speech Odd or unusual speech sound Difficulty with math (e.g., checkbook balancing, making change, etc.) Difficulty understanding what I read Difficulty speaking Other speech, language, or math problems:


5.) NONVERBAL SKILLS Difficulty telling right from left Difficulty doing things I should automatically be able to do (e.g., brushing teeth, etc.) Problem drawing or copying Difficulty dressing (not due to physical difficulty) Problems finding my way around places I’ve been to before Difficulty recognizing objects or people Parts of my body do not seem as if they belong to me Unaware of time (e.g., time of day, season, year) Slow reaction to timeOther nonverbal problems


6.) MOTOR AND COORDINATION Fine motor control problems (e.g., using a pencil, key, etc.) Weakness on one side of my body Difficulty holding onto things Tremor or shakiness Muscle tick or strange movements My writing is very small My writing is very large Walking more slowly than other people Feeling stiff Balance problems Difficulty starting to move Jerky muscles Muscles tire quickly Often bumping into things Other motor or coordination problems.


7.) SENSORY Loss of feeling or numbnessTingling or strange skin sensationsDifficulty telling hot from coldProblems seeing on one sideBlurred visionBlank spots in visionBrief periods of blindnessSee “stars” or flashes of lightDouble visionDifficulty looking quickly from one object to another object Need to squint or move closer to see clearly Losing hearing Ringing in my ears or hearing strange sounds Difficulty tasting food Difficulty smelling Smelling strange odors Other sensory problems.

8.PHYSICALHeadachesDizzinessNausea or vomitingUrinary incontinenceLoss of bowel controlExcessive tirednessSensitivity to bright lightsSensitivity to loud noisesOther physical problems.

9.) MOOD/EMOTION Sadness or depressionAnxiety or nervousness StressSleeping problems: (Falling Asleep, Staying Asleep) Become more angry easily Euphoria (feeling on top of the world) Much more emotional (e.g., cry more easily) Feel as if I just don’t care anymore

10.) BEHAVIORS Doing things automatically (without awareness) Less inhibited (to do things I would not do before) Difficulty being spontaneousChange in eating habitsChange in interest in sexLoss of energyIncrease of energyExperiencing nightmares on a daily/weekly basis Loss of sexual desire Increase in weight, Loss of weight Lack of interest in pleasurable activities Increase in irritability Increase in aggression Other recent changes in behavior or personality.

If you or your family is experiencing any of these symptoms, we invite you to call our office for consultation. Call (949) 481-8414

Alzheimer's, Grape Seed Extract, & Red Wine,

The Society for Neuroscience issued a news release about a study intoday's issue of *The Journal of Neuroscience*:Study indicates grape seed extract may reduce cognitive declineassociated with Alzheimer's diseaseNutritional supplement as effective as red wine in preventing amyloidbeta plaque build upA compound found in grape seed extract reduces plaque formation andresulting cognitive impairment in an animal model of Alzheimer'sdisease, new research shows. The study appears in the June 18 issue ofThe Journal of Neuroscience.Lead study author Giulio Pasinetti, MD, PhD, of Mount Sinai School ofMedicine and colleagues found that the grape seed extract preventsamyloid beta accumulation in cells, suggesting that it may block theformation of plaques. In Alzheimer's disease, amyloid beta accumulatesto form toxic plaques that disrupt normal brain function.The researchers tested a grape seed polyphenolic extract product sold asMegaNatural-AZ, made by Polyphenolics, which in part supported thestudy. Polyphenolic compounds are antioxidants naturally found in wine,tea, chocolate, and some fruits and vegetables. To determine whether theextract could mitigate the effects of Alzheimer's disease, theresearchers used mice genetically modified to develop a conditionsimilar to Alzheimer's disease. They exposed pre-symptomatic"Alzheimer's mice" to the extract or placebo daily for five months. Thedaily dose of the polyphenolic extract was equivalent to the averageamount of polyphenolics consumed by a person on a daily basis.After the five-month period, Alzheimer's mice were at an age at whichthey normally develop signs of disease. However, the extract exposurereduced amyloid beta accumulation and plaque formation in brains ofAlzheimer's mice and also reduced cognitive decline: compared toplacebo, extract-exposed Alzheimer's mice showed improved spatialmemory. These data suggest that before symptoms begin, the grape seedextract may prevent or postpone plaque formation and slow cognitivedeterioration associated with Alzheimer's disease.Moderate consumption of red wine--approximately one glass for women andtwo glasses for men, according to the Food and Drug Administration--andits constituent grape compounds has reported health benefits,particularly for cardiovascular function. Pasinetti previously foundthat red wine reduced cognitive decline in mice genetically modified todevelop Alzheimer's disease. In subsequent studies, Pasinetti andcolleagues have attempted to isolate which of the nearly 5,000 moleculescontained in red wine are important in disease prevention. "Our intentis to develop a highly tolerable, nontoxic, orally available treatmentfor the prevention and treatment of Alzeheimer's dementia," Pasinetti said."The potential of natural compounds to provide real health benefits tobrain function is only now beginning to be realized by brainresearchers. The lesson they may eventually learn is that sometimes youjust can't improve upon Mother nature," said Gary Arendash, PhD, of TheByrd Alzheimer's Institute, an expert unaffiliated with the study.Chemical analysis showed that the major polyphenol components in thestudy's grape seed extract product are catechin and epicatechin, whichare also abundant in tea and cocoa. These components differ fromresveratrol, a polyphenol that has been reported to reduce amyloid betasecretion in cells and generally increase lifespan by mimicking calorierestriction. Resveratrol appears to be effective only at extremely highdoses, which may limit its use in people. In contrast, the catechins inthe extract product studied appear to be effective at much lower doses.Karen Hsiao Ashe, MD, PhD, at the University of Minnesota andMinneapolis VA Medical Center, another expert unaffiliated with thestudy, cautioned that additional research must be completed before thesefindings translate to a human population. "Unanswered questionspertaining to the polyphenolic extract's use in humans to preventAlzheimer's disease include: when to start taking it, for how long, howmuch to take, and most importantly, how does a person know if it ishelping to prevent the aggregation of amyloid beta protein in the brain?These questions must be answered before polyphenolics can be recommendedas a preventive measure for Alzheimer's disease," Ashe said.

INFORMATION ABOUT THE NEUROPSYCHOLOGICAL EVALUATION/EXAM PROCESS

A comprehensive neuropsychological evaluation consists of record review, interview focusing on problems/difficulties, followed by standardized paper and pencil tests of cognitive, behavioral, emotional, and personality functions. The whole process typically lasts approximately 4-6 hours, completed in 1-day or divided into several days, depending on the fatigue level and time. The results of the evaluation and recommendations are discussed in person in a feedback session with opportunity for questions/concerns. Our services are covered by most insurance companies. However, we urge you to contact your insurance company to confirm benefits.


The evaluation begins with an interview focusing on the difficulties you’ve been experiencing, your medical history and psychosocial history. This typically lasts 1 ½ - 2 hours, depending on the issues involved.
The interview is followed by formal tests of cognitive (e.g., attention, concentration, learning and memory, speed of thinking, language, reasoning, judgment, and motor skills), emotional, and behavioral functioning, as well as personality structure. This portion lasts 3-5 hours.


You should be well-rested and have something to eat prior to the appointment. You will be provided with breaks throughout the exam.
Please bring your reading glasses and/or hearing aids.


Call our office (949) 481-8414 if you have any questions.


Bring the Following Documents to First Appointment (if applicable):
Hospital records including Discharge Summary, ICU Transfer Summary, emergency room notes, doctor’s progress notes, consultation reports, psychology reports, reports from any rehabilitation disciplines, report of imaging studies (CT and MRI scans, Skull X-rays), and EEG results. I do not usually require nursing notes.
A list of current medications with dosages.
Ambulance records.
Professional consultation reports from professionals.
.
Complete reports from any psychological or neuropsychological tests which have been performed.
Any other relevant information.

WHO BENEFITS FROM THE RESULTS OF A NEUROPSYCHOLOGICAL EVALUATION?

Explanation of examination results can be very helpful to persons with cognitive, behavioral, emotional, or personality difficulties and their families. Consultation can also help neurologists, neurosurgeons, psychiatrists, psychologists, physiatrists, internists, physical medicine and rehabilitation specialists, employers, insurance providers, administrators, case managers, agencies, and other professionals including: attorneys, learning centers, nurses, counselors, social workers, therapists, and teachers.

How Can a Neuropsychological Evaluation Help Me?

Neuropsychological evaluation is critical for understanding which brain functions are impaired and which remain intact. An effective evaluation can tell the neuropsychologist how the injury or illness specifically affects thinking and behavior. Is the person able to concentrate on tasks? For how long? Under what conditions? Does it matter whether the information is verbal or nonverbal? Standard neurological or physical exams, and even neuroimaging studies (CT scan, MRI), cannot provide this information.


Neuropsychological evaluation may be essential to determine whether a person actually has a brain injury. This is especially true following "mild" brain injury, when effects of an injury may be subtle and easily confused with other factors, such as stress, medications, or depression. Was the person's brain really injured? How? Is impairment still evident? What is the cause of the impairment? How do emotional or psychological factors influence performance or concerns? Is the person's performance in the evaluation a true reflection of how he or she will behave and think on a day-to-day basis? If not, why not? These are the types of diagnostic questions a neuropsychologist can answer.


A number of real-life questions can be answered by neuropsychological evaluation. Is the person who was injured competent? Can he or she be left alone? Drive? Manage money? Live independently? Return to work or school? What type of treatment or therapy will be
needed?


Neuropsychological evaluation is also critical in monitoring the course of recovery or the effectiveness of rehabilitation. Is the person getting better? How much? Has treatment been helpful?