Baffling Chronic Pain Linked To Weird Rewiring Of Brain
ScienceDaily (Nov. 27, 2008) — Scientists peered at the brains of people with a baffling chronic pain condition and discovered something surprising. Their brains looked like an inept cable guy had changed the hookups, rewiring the areas related to emotion, pain perception and the temperature of their skin.
The new finding by scientists at Northwestern University's Feinberg School of Medicine, begins to explain a mysterious condition that the medical community had doubted was real.
The people whose brains were examined have a chronic pain condition called complex region pain syndrome (CRPS.) It's a pernicious and nasty condition that usually begins with an injury causing significant damage to the hand or the foot. For the majority of people, the pain from the injury disappears once the limb is healed. But for 5 percent of the patients, the pain rages on long past the healing, sometimes for the rest of people's lives.
About 200,00 people in the U.S. have this condition.
In a hand injury, for example, the pain may radiate from the initial injury site and spread to the whole arm or even the entire body. People also experience changes in skin color to blue or red as well as skin temperature (hotter at first, then becoming colder as the condition turns chronic.) Their immune system also shifts into overdrive, indicated by a hike in blood immune markers.
The changes in the brain take place in the network of tiny, white "cables" that dispatch messages between the neurons. This is called the brain's white matter. Several years ago, Northwestern researchers discovered chronic pain caused the regions in the brain that contain the neurons -- called gray matter because of it looks gray -- to atrophy.
This is the first study to link pain with changes in the brain's white matter. It will be published November 26 in the journal Neuron.
"This is the first evidence of brain abnormality in these patients," said A. Vania Apkarian, professor of physiology at the Feinberg School and principal investigator of the study. " People didn't believe these patients. This is the first proof that there is a biological underpinning for the condition. Scientists have been trying to understand this baffling condition for a long time."
Apkarian said people with CRPS suffer intensely and have a high rate of suicide. "Physicians don't know what to do," he said. "We don't have the tools to take care of them."
The new findings provide anatomical targets for scientists, who can now look for potential pharmaceutical treatments to help these patients, Apkarian said. He doesn't know yet if chronic pain causes these changes in the brain or if CRPS patients' brains have pre-existing abnormalities that predispose them to this condition.
In the new study, the brains of 22 subjects with CRPS and 22 normal subjects were examined with an anatomical MRI and a diffusion tensor MRI, which enabled scientists to view the white matter. In addition to changes in white matter, the CRPS patients' brains showed an atrophy of neurons or gray matter similar to what has been previously shown in other types of chronic pain patients.
Apkarian said the white matter changes in patients' brains is related to the duration and intensity of their pain and their anxiety. It is likely that white matter reorganizes in other chronic pain conditions as well, but that has not yet been studied, he noted.
Friday, November 28, 2008
Wednesday, November 26, 2008
How Is Our Left Brain Different From Our Right?
ScienceDaily (Nov. 25, 2008) — Since the historical discovery of the speech center in the left cortex in 150 years ago, functional differences between left and right hemisphere have been well known; language is mainly handled by left hemisphere, while spatial recognition is more specialized to the right hemisphere. However, the structural differences of synapses underlying left-right difference of the brain remained unknown.
Japanese research team, led by Prof Ryuichi Shigemoto in National Institute for Physiological Sciences, Dr Yoshiaki Shinohara and his colleagues found that synaptic size and shape in the center of the spatial memory (i.e. hippocampus) were asymmetrical between synapses receiving input from the left and right hemisphere. Hajime Hirase in Brain Science Institute in RIKEN helped this study, and it was done under Japan Science Technorogy Agency support.
They investigated the electron microscopic structure of synapses in left and right hippocampus, and found synapses made by terminals from the right hippocampus are large, complex in shape, and rich in the GluR1 subunit of AMPA-type glutamate receptors. In contrast, synapses receiving input from the left hippocampus are small and rich in the NR2B subunit of NMDA receptors. That means, both synaptic structure and synaptic molecules differ between synapses with left and right inputs.
"Long-term potentiaon (LTP), that is known as the cellular mechanism of learning and memory, depends on the allocation of glutamate receptors in hippocampus.
According to our present finding, synapses receiving right input may be more suitable to initiate LTP. This finding may help understand how our left and right brains work differently", said Prof Shigemoto.
This report is published in Proceedings of National Academy of Sciences in the week of Nov 17, 2008.
Japanese research team, led by Prof Ryuichi Shigemoto in National Institute for Physiological Sciences, Dr Yoshiaki Shinohara and his colleagues found that synaptic size and shape in the center of the spatial memory (i.e. hippocampus) were asymmetrical between synapses receiving input from the left and right hemisphere. Hajime Hirase in Brain Science Institute in RIKEN helped this study, and it was done under Japan Science Technorogy Agency support.
They investigated the electron microscopic structure of synapses in left and right hippocampus, and found synapses made by terminals from the right hippocampus are large, complex in shape, and rich in the GluR1 subunit of AMPA-type glutamate receptors. In contrast, synapses receiving input from the left hippocampus are small and rich in the NR2B subunit of NMDA receptors. That means, both synaptic structure and synaptic molecules differ between synapses with left and right inputs.
"Long-term potentiaon (LTP), that is known as the cellular mechanism of learning and memory, depends on the allocation of glutamate receptors in hippocampus.
According to our present finding, synapses receiving right input may be more suitable to initiate LTP. This finding may help understand how our left and right brains work differently", said Prof Shigemoto.
This report is published in Proceedings of National Academy of Sciences in the week of Nov 17, 2008.
How To Know You're Having a Stroke; Most Stroke Pts Don't Think They're Having a Stroke; Time is Crucial
The Mayo Clinic released the following announcement:Do you know you're having a stroke?Symptom awareness can improve recoveryA Mayo Clinic study shows a majority of stroke patients don't thinkthey're having a stroke -- and as a result -- delay seeking treatmentuntil their condition worsens. The findings appear in the current issueof Emergency Medicine Journal at http://emj.bmj.com/.
Researchers studied 400 patients who were diagnosed at Mayo Clinic'semergency department with either acute ischemic stroke or a transientischemic attack (TIA), a temporary interruption of blood flow to part ofthe brain.Less than half of the patients -- 42 percent -- thought they were havinga stroke. In fact, most in the study did not go to the emergency roomwhen symptoms appeared. The median time from onset of symptoms toarrival at the hospital was over three and a half hours. Most said theythought the symptoms would simply go away. The delay in seeking medicalhelp was the same among men and women.When asked how they knew about stroke symptoms, nearly one-fifth saidthey thought a stroke always came on gradually. Just over half (51.9percent) said they thought that seeking medical care immediately wasimportant.Significance of the findings"Time is crucial in treating stroke," says Latha Stead, M.D., emergencymedicine specialist and lead author of the study. "Each individual'smedical background differs and affects recovery, but in general thesooner a patient experiencing a stroke reaches emergency care, the morelikely the stroke can be limited and the condition managed to preventfurther damage and improve recovery." The researchers say their findingsclearly indicate that better public
understanding of stroke symptomswill lead to a faster response and better outcomes.What you should knowStrokes can happen quickly or can occur over several hours, with thecondition continually worsening. The thrombus or clot that is causingthe stroke can frequently be dissolved or disintegrated so blood canagain flow to the brain. In such cases, immediate treatment can mean thedifference between a slight injury and a major disability. Interestinglyonly 20.8 percent of the participants knew about such treatment. By useof stents, medications and other technology, physicians can stop astroke from spreading and greatly limit damage. Stroke symptoms include:
* Sudden numbness, weakness, or paralysis of your face, arm or leg-- usually on one side of the body
* Sudden difficulty speaking or understanding speech (aphasia)
* Sudden blurred, double or decreased vision
* Sudden dizziness, loss of balance or loss of coordination
* A sudden, severe "bolt out of the blue" headache or an unusualheadache, which may be accompanied by a stiff neck, facial pain, painbetween your eyes, vomiting or altered consciousness
* Confusion or problems with memory, spatial orientation or perceptionIn such cases, a stroke gives no warning. But one possible sign of animpending stroke is a TIA.
The signs and symptoms of TIA are the same asfor a stroke, but they last for a shorter period -- several minutes to afew hours -- and then disappear, without leaving apparent permanenteffects. You may have more than one TIA, and the signs and symptoms maybe similar or different. A TIA indicates a serious risk that a full-blown stroke may follow
Researchers studied 400 patients who were diagnosed at Mayo Clinic'semergency department with either acute ischemic stroke or a transientischemic attack (TIA), a temporary interruption of blood flow to part ofthe brain.Less than half of the patients -- 42 percent -- thought they were havinga stroke. In fact, most in the study did not go to the emergency roomwhen symptoms appeared. The median time from onset of symptoms toarrival at the hospital was over three and a half hours. Most said theythought the symptoms would simply go away. The delay in seeking medicalhelp was the same among men and women.When asked how they knew about stroke symptoms, nearly one-fifth saidthey thought a stroke always came on gradually. Just over half (51.9percent) said they thought that seeking medical care immediately wasimportant.Significance of the findings"Time is crucial in treating stroke," says Latha Stead, M.D., emergencymedicine specialist and lead author of the study. "Each individual'smedical background differs and affects recovery, but in general thesooner a patient experiencing a stroke reaches emergency care, the morelikely the stroke can be limited and the condition managed to preventfurther damage and improve recovery." The researchers say their findingsclearly indicate that better public
understanding of stroke symptomswill lead to a faster response and better outcomes.What you should knowStrokes can happen quickly or can occur over several hours, with thecondition continually worsening. The thrombus or clot that is causingthe stroke can frequently be dissolved or disintegrated so blood canagain flow to the brain. In such cases, immediate treatment can mean thedifference between a slight injury and a major disability. Interestinglyonly 20.8 percent of the participants knew about such treatment. By useof stents, medications and other technology, physicians can stop astroke from spreading and greatly limit damage. Stroke symptoms include:
* Sudden numbness, weakness, or paralysis of your face, arm or leg-- usually on one side of the body
* Sudden difficulty speaking or understanding speech (aphasia)
* Sudden blurred, double or decreased vision
* Sudden dizziness, loss of balance or loss of coordination
* A sudden, severe "bolt out of the blue" headache or an unusualheadache, which may be accompanied by a stiff neck, facial pain, painbetween your eyes, vomiting or altered consciousness
* Confusion or problems with memory, spatial orientation or perceptionIn such cases, a stroke gives no warning. But one possible sign of animpending stroke is a TIA.
The signs and symptoms of TIA are the same asfor a stroke, but they last for a shorter period -- several minutes to afew hours -- and then disappear, without leaving apparent permanenteffects. You may have more than one TIA, and the signs and symptoms maybe similar or different. A TIA indicates a serious risk that a full-blown stroke may follow
Tuesday, November 25, 2008
Brain AbnormalitiesThat May Play Key Role in ADHD
ScienceDaily (Nov. 24, 2008) — A study published in the online advance edition of The American Journal of Psychiatry for the first time reveals shape differences in the brains of children with ADHD, which could help pinpoint the specific neural circuits involved in the disorder. Researchers from the Kennedy Krieger Institute in Baltimore, Md. and the Johns Hopkins Center for Imaging Science used a new analysis tool, large deformation diffeomorphic mapping (LDDMM), which allowed them to examine the precise shape of the basal ganglia.
The study found boys with ADHD had significant shape differences and decreases in overall volume of the basal ganglia compared to their typically developing peers. Girls with ADHD did not have volume or shape differences, suggesting sex strongly influences the disorder's expression.
Previous studies examining the basal ganglia in children with ADHD were limited to volume analysis and had conflicting results, with some reporting a smaller volume and some reporting no difference in volume. LDDMM provides detailed analysis of the shape of specific brain regions, allowing for precise examination of brain structures well beyond what has been examined in previous MRI studies of ADHD. In this study, LDDMM was used to map the brains of typically developing children in order to generate a basal ganglia template. This is the first reported template of the basal ganglia. After creating LDDMM mappings of the basal ganglia of each child with ADHD, statistical analysis was conducted to compare them to the template.
In this study, the initial volume analysis revealed boys with ADHD had significantly smaller basal ganglia volumes compared with typically-developing boys. Moving beyond the standard volume analysis, the LDDMM revealed shape abnormalities in several regions of the basal ganglia. Comparison of the standard volume and LDDMM analysis of girls with ADHD and their typically developing peers failed to reveal any significant volume or shape differences.
The multiple shape differences found in boys with ADHD suggests that the disorder may not be associated with abnormalities in one specific neural circuit. Rather, it appears the disorder involves abnormalities in parallel circuits, including circuits important for the control of complex behavior and more basic motor responses, such as hitting the brake pedal when a traffic light turns yellow. Findings revealing abnormalities in circuits important for basic motor response control may be crucial to understanding why children with ADHD have difficulty suppressing impulsive actions.
"This study represents a major advancement in our ability to examine the neuroanatomic features of ADHD and other developmental disorders," said Dr. Stewart H. Mostofsky, senior study author and a pediatric neurologist in the Department of Developmental Cognitive Neurology at the Kennedy Krieger Institute. "Using LDDMM, we can more accurately measure the impact of ADHD on brain development, which will not only bring us closer to unlocking the biological basis of the disorder, but help us better diagnose and treat patients."
Researchers used MRI scans to examine children ages 8-13 years, including: 47 children with ADHD and a control group of 66 typically developing children. Researchers compared the LDDMM mappings of children with ADHD to their typically developing peers, and then went a step further by repeating the analysis separately for boys and girls. Children with ADHD who had a history of other neuropsychiatric diagnoses including conduct disorder, mood disorder, generalized anxiety disorder, separation anxiety disorder and/or obsessive-compulsive disorder were excluded from the study. Additionally, none of the children with ADHD had a learning disability or a history of speech/language disorders.
Potential next steps include research that carefully examines whether the brain abnormalities found in this study can predict certain behavioral features of ADHD. Future studies will also examine structural features associated with the ability to compensate and respond to therapy. The researchers also plan to use LDDMM analysis on children in a wider age range to see if changes in the basal ganglia occur over time.
The Center for Imaging Science at Johns Hopkins University, under the direction of Director Dr. Michael I. Miller, was a key collaborator in this study.
The study found boys with ADHD had significant shape differences and decreases in overall volume of the basal ganglia compared to their typically developing peers. Girls with ADHD did not have volume or shape differences, suggesting sex strongly influences the disorder's expression.
Previous studies examining the basal ganglia in children with ADHD were limited to volume analysis and had conflicting results, with some reporting a smaller volume and some reporting no difference in volume. LDDMM provides detailed analysis of the shape of specific brain regions, allowing for precise examination of brain structures well beyond what has been examined in previous MRI studies of ADHD. In this study, LDDMM was used to map the brains of typically developing children in order to generate a basal ganglia template. This is the first reported template of the basal ganglia. After creating LDDMM mappings of the basal ganglia of each child with ADHD, statistical analysis was conducted to compare them to the template.
In this study, the initial volume analysis revealed boys with ADHD had significantly smaller basal ganglia volumes compared with typically-developing boys. Moving beyond the standard volume analysis, the LDDMM revealed shape abnormalities in several regions of the basal ganglia. Comparison of the standard volume and LDDMM analysis of girls with ADHD and their typically developing peers failed to reveal any significant volume or shape differences.
The multiple shape differences found in boys with ADHD suggests that the disorder may not be associated with abnormalities in one specific neural circuit. Rather, it appears the disorder involves abnormalities in parallel circuits, including circuits important for the control of complex behavior and more basic motor responses, such as hitting the brake pedal when a traffic light turns yellow. Findings revealing abnormalities in circuits important for basic motor response control may be crucial to understanding why children with ADHD have difficulty suppressing impulsive actions.
"This study represents a major advancement in our ability to examine the neuroanatomic features of ADHD and other developmental disorders," said Dr. Stewart H. Mostofsky, senior study author and a pediatric neurologist in the Department of Developmental Cognitive Neurology at the Kennedy Krieger Institute. "Using LDDMM, we can more accurately measure the impact of ADHD on brain development, which will not only bring us closer to unlocking the biological basis of the disorder, but help us better diagnose and treat patients."
Researchers used MRI scans to examine children ages 8-13 years, including: 47 children with ADHD and a control group of 66 typically developing children. Researchers compared the LDDMM mappings of children with ADHD to their typically developing peers, and then went a step further by repeating the analysis separately for boys and girls. Children with ADHD who had a history of other neuropsychiatric diagnoses including conduct disorder, mood disorder, generalized anxiety disorder, separation anxiety disorder and/or obsessive-compulsive disorder were excluded from the study. Additionally, none of the children with ADHD had a learning disability or a history of speech/language disorders.
Potential next steps include research that carefully examines whether the brain abnormalities found in this study can predict certain behavioral features of ADHD. Future studies will also examine structural features associated with the ability to compensate and respond to therapy. The researchers also plan to use LDDMM analysis on children in a wider age range to see if changes in the basal ganglia occur over time.
The Center for Imaging Science at Johns Hopkins University, under the direction of Director Dr. Michael I. Miller, was a key collaborator in this study.
Tinnitus: Psychological Treatment and Neurostimulation Offer Hope
ScienceDaily (Nov. 24, 2008) — A remarkable number of patients with tinnitus demonstrate withdrawal behaviour and have a negative view of life. Feelings of anxiety and depression result in patients experiencing the complaint as a major burden on their quality of life. In addition to psychological treatment, neurostimulation now also appears to be a very promising therapy.
This is the result of research conducted by Hilke Bartels of the University Medical Center Groningen. She will be awarded a PhD by the University of Groningen on 26 November 2008.
Patients with tinnitus hear noises that do not originate outside but within the body itself. They can be squeaks, whistles or whooshing noises, or even rumbles, knocking or rustling sounds. It is estimated that 10-30 percent of the Dutch suffer from tinnitus. Four to five percent of these people feel seriously limited as a result; for example, they can’t concentrate properly anymore, or have trouble sleeping. The complaint usually starts when people are between the ages of 40 and 60 and their hearing is not what it used to be.
Overactive brains
For a long time it was assumed that the cause of tinnitus lay in the auditory organ itself. However, it is now clear that the brain is responsible: overactive parts of the brain in the auditory region emit continuous signals that are the cause of the ‘phantom noise’. This over-activity is usually the result of hearing loss. However, noise (buzzing in the ears after visiting a concert or discotheque), an infection or an operation on the ear, or a jaw or neck problem can also cause the symptoms.
With the help of the image-forming technologies PET and fMRI, Bartels mapped the over-activity of the relevant parts of the brain. She was thus able to confirm existing theories about the complaint.
Negative attitude
Bartels’s research has revealed that a remarkable number of tinnitus patients are depressed and have a negative attitude towards life. They do not dare to share these feelings with others, which means they experience little social support, which in turn leads to withdrawal behaviour. This is also described as the so-called ‘type D personality’. No fewer than 94 of the 265 tinnitus patients investigated had such a personality type. These patients experienced significantly more psychological discomfort, the research revealed. Anxiety and depression appear to strengthen the effect of tinnitus. People with a type D personality in particular should undergo treatment that concentrates on the reduction of anxiety and depression, according to Bartels.
Effective neurostimulation
A psychological approach is not the only light on the horizon, however. Between 2001 and 2003, the UMCG started an experimental treatment regime whereby the relevant brain areas were continuously stimulated with the help of a pulse generator, a sort of pacemaker. An evaluation revealed that four of the six patients treated in this way had significantly positive long-term results. The patients indicated that the ‘noise’ was reduced to manageable levels and awarded the treatment a mark of 7 out of 10. Neurostimulation with a magnet outside the skull also looks like an interesting treatment option. The tinnitus of 5 of the 24 patients who underwent this experimental treatment was temporarily suppressed.
Recommendations
Thus far no treatment has been shown to be effective for the majority of tinnitus patients. Current treatment options have either a medical, an audiological or a psychological basis. According to Bartels, a multidisciplinary approach is essential. She also calls for the use of validated questionnaires to chart the nature and the impact of tinnitus.
This is the result of research conducted by Hilke Bartels of the University Medical Center Groningen. She will be awarded a PhD by the University of Groningen on 26 November 2008.
Patients with tinnitus hear noises that do not originate outside but within the body itself. They can be squeaks, whistles or whooshing noises, or even rumbles, knocking or rustling sounds. It is estimated that 10-30 percent of the Dutch suffer from tinnitus. Four to five percent of these people feel seriously limited as a result; for example, they can’t concentrate properly anymore, or have trouble sleeping. The complaint usually starts when people are between the ages of 40 and 60 and their hearing is not what it used to be.
Overactive brains
For a long time it was assumed that the cause of tinnitus lay in the auditory organ itself. However, it is now clear that the brain is responsible: overactive parts of the brain in the auditory region emit continuous signals that are the cause of the ‘phantom noise’. This over-activity is usually the result of hearing loss. However, noise (buzzing in the ears after visiting a concert or discotheque), an infection or an operation on the ear, or a jaw or neck problem can also cause the symptoms.
With the help of the image-forming technologies PET and fMRI, Bartels mapped the over-activity of the relevant parts of the brain. She was thus able to confirm existing theories about the complaint.
Negative attitude
Bartels’s research has revealed that a remarkable number of tinnitus patients are depressed and have a negative attitude towards life. They do not dare to share these feelings with others, which means they experience little social support, which in turn leads to withdrawal behaviour. This is also described as the so-called ‘type D personality’. No fewer than 94 of the 265 tinnitus patients investigated had such a personality type. These patients experienced significantly more psychological discomfort, the research revealed. Anxiety and depression appear to strengthen the effect of tinnitus. People with a type D personality in particular should undergo treatment that concentrates on the reduction of anxiety and depression, according to Bartels.
Effective neurostimulation
A psychological approach is not the only light on the horizon, however. Between 2001 and 2003, the UMCG started an experimental treatment regime whereby the relevant brain areas were continuously stimulated with the help of a pulse generator, a sort of pacemaker. An evaluation revealed that four of the six patients treated in this way had significantly positive long-term results. The patients indicated that the ‘noise’ was reduced to manageable levels and awarded the treatment a mark of 7 out of 10. Neurostimulation with a magnet outside the skull also looks like an interesting treatment option. The tinnitus of 5 of the 24 patients who underwent this experimental treatment was temporarily suppressed.
Recommendations
Thus far no treatment has been shown to be effective for the majority of tinnitus patients. Current treatment options have either a medical, an audiological or a psychological basis. According to Bartels, a multidisciplinary approach is essential. She also calls for the use of validated questionnaires to chart the nature and the impact of tinnitus.
Tuesday, November 18, 2008
Unraveling Mystery of Brain Aneurysms
ScienceDaily (Nov. 15, 2008) — Yale researchers have taken the first critical steps in unraveling the mysteries of brain aneurysms, the often fatal rupturing of blood vessels that afflicts 500,000 people worldwide each year and nearly killed Vice President-elect Joseph Biden two decades ago.
An international team — led by Murat Gunel, professor of neurosurgery and neurobiology, and Richard Lifton, Sterling Professor and chair of genetics, and a Howard Hughes Medical Institute investigator — scanned the genomes of more than 2,000 individuals suffering from intracranial aneurysms along with 8,000 healthy subjects. They discovered three chromosome segments, or loci, where common genetic variations can create significant risk for ruptured aneurysms, which in turn cause strokes.
The subjects came from hospitals in Finland, the Netherlands and Japan, and the results were similar in all groups, indicating that these variations increase risk among diverse human populations.
The findings, reported online in the journal Nature Genetics, could lead to new screening tests to identify hundreds of thousands of people at risk for strokes caused by bleeding and point to new therapies that might be able to strengthen blood vessels in the brain before they burst.
"Even though we have made significant strides in treating unruptured aneurysms, until now we have not had an effective means of identifying the majority of individuals at risk of developing this deadly problem. These genetic findings provide a starting point for changing that equation," Gunel said.
The median age when hemorrhagic stroke occurs is 50 years old, and usually there are no warning signs. In the majority of cases, the resulting strokes cause death or severe brain damage. Without an understanding of the cause of these events, physicians have been left to respond after the fact, once the damage has largely been done. Biden was one of the lucky individuals who survived a ruptured aneurysm with minimal damage — although at the time he was stricken, his condition was thought to be grave enough that a priest was summoned to confer last rites.
The Yale study showed that the risk of harboring an aneurysm increased with the number of risk variants, or alleles. Individuals with the highest number of risk alleles tripled their risk of an aneurysm, researchers found.
Based on this large collaborative study, a screening test may one day be able to identify those who are at higher risk of forming brain aneurysms or suffering a bleeding stroke as a result.
"These findings provide fundamental insights into the genetic and biochemical changes that cause this devastating brain disease, providing hope that we may also be able to provide preventive therapy before rupture occurs," Lifton said.
For instance, the new findings implicate variations in the gene SOX17, which is known to play a crucial role in the early development and repair of endothelial cells that make up the arterial walls of blood vessels. "These variations may interfere with the ability to produce cells that repair damage to the blood vessels, suggesting a path forward for developing new approaches to prevention," Gunel said.
Kaya Bilguvar of Yale was first author of the paper. Other Yale researchers included Shrikant Mane, Christopher E. Mason, Murim Choi, Emilia Gaal, Yasa Bayri, Luis Kobl, Zulfikar Arlier, Sudhakar Ravuri, and Matthew W. State.
The work was funded by the National Institutes of Health, the Yale Center for Human Genetics and Genomics, the Yale Program on Neurogenetics and the Howard Hughes Medical Institute.
Citation: Nature Genetics, Nov. 9, 2008
An international team — led by Murat Gunel, professor of neurosurgery and neurobiology, and Richard Lifton, Sterling Professor and chair of genetics, and a Howard Hughes Medical Institute investigator — scanned the genomes of more than 2,000 individuals suffering from intracranial aneurysms along with 8,000 healthy subjects. They discovered three chromosome segments, or loci, where common genetic variations can create significant risk for ruptured aneurysms, which in turn cause strokes.
The subjects came from hospitals in Finland, the Netherlands and Japan, and the results were similar in all groups, indicating that these variations increase risk among diverse human populations.
The findings, reported online in the journal Nature Genetics, could lead to new screening tests to identify hundreds of thousands of people at risk for strokes caused by bleeding and point to new therapies that might be able to strengthen blood vessels in the brain before they burst.
"Even though we have made significant strides in treating unruptured aneurysms, until now we have not had an effective means of identifying the majority of individuals at risk of developing this deadly problem. These genetic findings provide a starting point for changing that equation," Gunel said.
The median age when hemorrhagic stroke occurs is 50 years old, and usually there are no warning signs. In the majority of cases, the resulting strokes cause death or severe brain damage. Without an understanding of the cause of these events, physicians have been left to respond after the fact, once the damage has largely been done. Biden was one of the lucky individuals who survived a ruptured aneurysm with minimal damage — although at the time he was stricken, his condition was thought to be grave enough that a priest was summoned to confer last rites.
The Yale study showed that the risk of harboring an aneurysm increased with the number of risk variants, or alleles. Individuals with the highest number of risk alleles tripled their risk of an aneurysm, researchers found.
Based on this large collaborative study, a screening test may one day be able to identify those who are at higher risk of forming brain aneurysms or suffering a bleeding stroke as a result.
"These findings provide fundamental insights into the genetic and biochemical changes that cause this devastating brain disease, providing hope that we may also be able to provide preventive therapy before rupture occurs," Lifton said.
For instance, the new findings implicate variations in the gene SOX17, which is known to play a crucial role in the early development and repair of endothelial cells that make up the arterial walls of blood vessels. "These variations may interfere with the ability to produce cells that repair damage to the blood vessels, suggesting a path forward for developing new approaches to prevention," Gunel said.
Kaya Bilguvar of Yale was first author of the paper. Other Yale researchers included Shrikant Mane, Christopher E. Mason, Murim Choi, Emilia Gaal, Yasa Bayri, Luis Kobl, Zulfikar Arlier, Sudhakar Ravuri, and Matthew W. State.
The work was funded by the National Institutes of Health, the Yale Center for Human Genetics and Genomics, the Yale Program on Neurogenetics and the Howard Hughes Medical Institute.
Citation: Nature Genetics, Nov. 9, 2008
Exercise Increases Brain Growth Factor and Receptors, Prevents Stem Cell Drop in Middle Age
The American Physiological Society released the following announcement:
Exercise increases brain growth factor and receptors, prevents stem celldrop in middle age
BETHESDA, Md. (Nov. 18, 2008)
A new study confirms that exercise canreverse the age-related decline in the production of neural stem cellsin the hippocampus of the mouse brain, and suggests that this happensbecause exercise restores a brain chemical which promotes the productionand maturation of new stem cells.Neural stem cells and progenitor cells differentiate into a variety ofmature nerve cells which have different functions, a process calledneurogenesis. There is evidence that when fewer new stem or progenitorcells are produced in the hippocampus, it can result in impairment ofthe learning and memory functions. The hippocampus plays an importantrole in memory and learning.The study, "Exercise enhances the proliferation of neural stem cells andneurite growth and survival of neuronal progenitor cells in dentategyrus of middle-aged mice," was carried out by Chih-Wei Wu, Ya-TingChang, Lung Yu, Hsiun-ing Chen, Chauying J. Jen, Shih-Ying Wu, Chen-PengLo, Yu-Min Kuo, all of the National Cheng Kung University MedicalCollege in Taiwan. The study appears in the November issue of theJournal of Applied Physiology, published by The American PhysiologicalSociety.
Rise in corticosterone or fall in nerve growth factor?The researchers built on earlier studies that found that the productionof stem cells in the area of the hippocampus known as the dentate gyrusdrops off dramatically by the time mice are middle age and that exercisecan slow that trend. In the current study, the researchers wanted totrack these changes in mice over time, and find out why they happen.
One hypothesis the researchers investigated is that the age-relateddecline in neurogenesis is tied to a rise in corticosterone in middleage. Elevation of corticosterone has been associated with a drop in theproduction of new stem cells in the hippocampus.The second hypothesis is that nerve growth factors -- which encouragenew neural cell growth but which decrease with age -- account for thedrop in neurogenesis. Specifically, the study looked at whether adecrease in brain-derived neurotrophic growth factor leads to a declinein new neural stem cells.Variables studied.
The researchers trained young (3 months), adult (7 months), early middle-aged (9 months), middle-aged (13 months) and old (24 months) mice to runa treadmill for up to one hour a day.The study tracked neurogenesis, age, exercise, serum corticosteronelevels and brain-derived neurotrophic factor (BDNF) and its receptorTrkB levels in the hippocampus. The researchers focused on middle age asa critical stage for the decline of neurogenesis in the mice. As expected, the study found that neurogenesis drops off sharply inmiddle-aged mice. For example, the number of neural progenitor andmitotic (dividing) cells in the hippocampus of middle-aged mice was only5% of that observed in the young mice.The researchers also found that exercise significantly slows down the loss of new nerve cells in the middle-aged mice. They found thatproduction of neural stem cells improved by approximately 200% comparedto the middle-aged mice that did not exercise. In addition, the survivalof new nerve cells increased by 170% and growth by 190% compared to thesedentary middle-aged mice.
Exercise also significantly enhanced stemcell production and maturation in the young mice. In fact, exerciseproduced a stronger effect in younger mice compared to the older mice.How does this happen?Based on these results, it appears that nerve growth factor has more todo with these findings than the corticosterone:
* The middle-aged exercisers had more brain-derived neurotrophicfactor and its receptor, TrkB, compared to the middle-aged mice that didnot exercise. This suggests that exercise promotes the production ofbrain-derived neurotrophic factor which, in turn, promotesdifferentiation and survival of new brain cells in the hippocampus.
* Exercise did not change the basal level of serum corticosterone inmiddle-aged mice. This suggests that the reduction of neurogenesisduring aging is not due to the drop in corticosterone levels.
Exercise increases brain growth factor and receptors, prevents stem celldrop in middle age
BETHESDA, Md. (Nov. 18, 2008)
A new study confirms that exercise canreverse the age-related decline in the production of neural stem cellsin the hippocampus of the mouse brain, and suggests that this happensbecause exercise restores a brain chemical which promotes the productionand maturation of new stem cells.Neural stem cells and progenitor cells differentiate into a variety ofmature nerve cells which have different functions, a process calledneurogenesis. There is evidence that when fewer new stem or progenitorcells are produced in the hippocampus, it can result in impairment ofthe learning and memory functions. The hippocampus plays an importantrole in memory and learning.The study, "Exercise enhances the proliferation of neural stem cells andneurite growth and survival of neuronal progenitor cells in dentategyrus of middle-aged mice," was carried out by Chih-Wei Wu, Ya-TingChang, Lung Yu, Hsiun-ing Chen, Chauying J. Jen, Shih-Ying Wu, Chen-PengLo, Yu-Min Kuo, all of the National Cheng Kung University MedicalCollege in Taiwan. The study appears in the November issue of theJournal of Applied Physiology, published by The American PhysiologicalSociety.
Rise in corticosterone or fall in nerve growth factor?The researchers built on earlier studies that found that the productionof stem cells in the area of the hippocampus known as the dentate gyrusdrops off dramatically by the time mice are middle age and that exercisecan slow that trend. In the current study, the researchers wanted totrack these changes in mice over time, and find out why they happen.
One hypothesis the researchers investigated is that the age-relateddecline in neurogenesis is tied to a rise in corticosterone in middleage. Elevation of corticosterone has been associated with a drop in theproduction of new stem cells in the hippocampus.The second hypothesis is that nerve growth factors -- which encouragenew neural cell growth but which decrease with age -- account for thedrop in neurogenesis. Specifically, the study looked at whether adecrease in brain-derived neurotrophic growth factor leads to a declinein new neural stem cells.Variables studied.
The researchers trained young (3 months), adult (7 months), early middle-aged (9 months), middle-aged (13 months) and old (24 months) mice to runa treadmill for up to one hour a day.The study tracked neurogenesis, age, exercise, serum corticosteronelevels and brain-derived neurotrophic factor (BDNF) and its receptorTrkB levels in the hippocampus. The researchers focused on middle age asa critical stage for the decline of neurogenesis in the mice. As expected, the study found that neurogenesis drops off sharply inmiddle-aged mice. For example, the number of neural progenitor andmitotic (dividing) cells in the hippocampus of middle-aged mice was only5% of that observed in the young mice.The researchers also found that exercise significantly slows down the loss of new nerve cells in the middle-aged mice. They found thatproduction of neural stem cells improved by approximately 200% comparedto the middle-aged mice that did not exercise. In addition, the survivalof new nerve cells increased by 170% and growth by 190% compared to thesedentary middle-aged mice.
Exercise also significantly enhanced stemcell production and maturation in the young mice. In fact, exerciseproduced a stronger effect in younger mice compared to the older mice.How does this happen?Based on these results, it appears that nerve growth factor has more todo with these findings than the corticosterone:
* The middle-aged exercisers had more brain-derived neurotrophicfactor and its receptor, TrkB, compared to the middle-aged mice that didnot exercise. This suggests that exercise promotes the production ofbrain-derived neurotrophic factor which, in turn, promotesdifferentiation and survival of new brain cells in the hippocampus.
* Exercise did not change the basal level of serum corticosterone inmiddle-aged mice. This suggests that the reduction of neurogenesisduring aging is not due to the drop in corticosterone levels.
Saturday, November 15, 2008
Bad Health Habits and Lifestyle Choices Are Among Alzheimer's Causes
Stress, inactivity and even certain medications can weaken memory.
By Melissa Healy November 17, 2008
When it comes to preserving memories, we are sometimes our own worst enemies. The lives we lead often undermine the complex process of creating and retrieving memories. And they can boost the odds of our developing diseases -- including Alzheimer's -- that further ravage the brain's mechanisms of memory. Here are things that science tells us pose the greatest threat to our memories: Knowing them, says UCLA neurologist Dr. Gary Small, may allow us "to act early to prevent."Medications
Want a healthier brain for clearer thinking and better memory?Researcher says this nutrient may reverse "up to 12 years of decline"
www.hsibaltimore.com
Brain Food
Attend 4 Stimulating Lectures by Ivy League Profs - Stay Sharp
www.onedayu.com
Many medications prescribed widely in the U.S. can cause memory problems. Among the most likely to disrupt memory are benzodiazepines (including Ativan, Valium and Xanax). Any drug that can cause drowsiness can disturb concentration and absorption of new facts -- there are legions of those, including over-the-counter antihistamines.Some drugs have been discovered by accident to have memory-disrupting qualities and have been hailed as possible treatments for those at risk of post-traumatic stress disorder. Beta blockers, prescribed widely, have been shown to reduce the emotional power of certain memories and are being investigated by the U.S. military. Propofol, a sedative colloquially known as "milk of amnesia," can also erase a few minutes of memory.Untreated heart disease
High blood pressure, high cholesterol, Type 2 diabetes and obesity all raise the risk of stroke, which can affect memory profoundly. Studies have also found those with Type 2 diabetes at three times greater risk for Alzheimer's as the general population. Those with high cholesterol and blood pressure in midlife are also at greater risk. And obesity (particularly excess fat around the middle) has been linked to higher dementia rates 30 years later.
StressResearchers know that high emotion surrounding an event assures that it will be committed to memory. As the brain floods with adrenaline and norepinephrine, the mechanisms of memory are excited. Episodes of high stress, intense happiness, love and sadness can preserve a sharp memory. But when stress is constant and the brain is bathed chronically in stress hormones such as cortisol, attention grows weak and events are stored fitfully in short-term memory and fitfully committed to long-term memory. Established memories are poorly retrieved.Cortisol overload will cause many of the brain cells with memory functions to power down. And over time, chronic stress will degrade communications between cells in brain regions important to learning and memory. Even several hours of steady stress can flood the brain with hormones that disrupt memory, according to a March report by UC Irvine researchers in the Journal of Neuroscience.
Alcoholism causes progressive brain shrinkage and disrupts communications between regions involved in storing and retrieving memories. In the extreme, an alcoholic can exhibit total loss of long-term memories. But memory "blackouts" and fragmented recollection are common even among social drinkers, researchers have found. Heavy alcohol use can also cause vitamin B1 deficiencies, which along with vitamin B12 deficiencies can negatively affect memory.
epression sabotages concentration and with it, memory. Brain-imaging reveals that depression decreases activity in the brain's frontal lobes, a linchpin of memory-making.A study reported in 2006 by University of Rochester researcher Mark Mapstone found that among middle-aged women, those with depressive symptoms had more complaints of memory lapses and poorer performance registering new information than those without mood disturbance.Mapstone found that the women did not show cognitive problems on neuropsychological tests. With their attention spread thin by competing demands and mood disturbances affecting concentration, many fear they have Alzheimer's when in fact they may have problems getting information into the memory stream, rather than storing or retrieving it. Attention-deficit disorder and sleep deprivation are thought to have similar effects.
Couch potato lifestylePhysical and mental exercises are essential to keeping memory functioning: Lack of either is associated with memory problems, especially as we age.The brain, like any organ, benefits from improved blood flow that comes with aerobic activity. And its tissues are strengthened with increased use. Plus, studies show that those with higher education levels and a habit of mental stimulation build up a "cognitive reserve" that reduces the symptom severity even when their brains are under attack by Alzheimer's. "It's a common sense expression, but it seems to be true: A huge amount of data says use it or lose it," says UC Irvine neuroscientist James McGaugh
By Melissa Healy November 17, 2008
When it comes to preserving memories, we are sometimes our own worst enemies. The lives we lead often undermine the complex process of creating and retrieving memories. And they can boost the odds of our developing diseases -- including Alzheimer's -- that further ravage the brain's mechanisms of memory. Here are things that science tells us pose the greatest threat to our memories: Knowing them, says UCLA neurologist Dr. Gary Small, may allow us "to act early to prevent."Medications
Want a healthier brain for clearer thinking and better memory?Researcher says this nutrient may reverse "up to 12 years of decline"
www.hsibaltimore.com
Brain Food
Attend 4 Stimulating Lectures by Ivy League Profs - Stay Sharp
www.onedayu.com
Many medications prescribed widely in the U.S. can cause memory problems. Among the most likely to disrupt memory are benzodiazepines (including Ativan, Valium and Xanax). Any drug that can cause drowsiness can disturb concentration and absorption of new facts -- there are legions of those, including over-the-counter antihistamines.Some drugs have been discovered by accident to have memory-disrupting qualities and have been hailed as possible treatments for those at risk of post-traumatic stress disorder. Beta blockers, prescribed widely, have been shown to reduce the emotional power of certain memories and are being investigated by the U.S. military. Propofol, a sedative colloquially known as "milk of amnesia," can also erase a few minutes of memory.Untreated heart disease
High blood pressure, high cholesterol, Type 2 diabetes and obesity all raise the risk of stroke, which can affect memory profoundly. Studies have also found those with Type 2 diabetes at three times greater risk for Alzheimer's as the general population. Those with high cholesterol and blood pressure in midlife are also at greater risk. And obesity (particularly excess fat around the middle) has been linked to higher dementia rates 30 years later.
StressResearchers know that high emotion surrounding an event assures that it will be committed to memory. As the brain floods with adrenaline and norepinephrine, the mechanisms of memory are excited. Episodes of high stress, intense happiness, love and sadness can preserve a sharp memory. But when stress is constant and the brain is bathed chronically in stress hormones such as cortisol, attention grows weak and events are stored fitfully in short-term memory and fitfully committed to long-term memory. Established memories are poorly retrieved.Cortisol overload will cause many of the brain cells with memory functions to power down. And over time, chronic stress will degrade communications between cells in brain regions important to learning and memory. Even several hours of steady stress can flood the brain with hormones that disrupt memory, according to a March report by UC Irvine researchers in the Journal of Neuroscience.
Alcoholism causes progressive brain shrinkage and disrupts communications between regions involved in storing and retrieving memories. In the extreme, an alcoholic can exhibit total loss of long-term memories. But memory "blackouts" and fragmented recollection are common even among social drinkers, researchers have found. Heavy alcohol use can also cause vitamin B1 deficiencies, which along with vitamin B12 deficiencies can negatively affect memory.
epression sabotages concentration and with it, memory. Brain-imaging reveals that depression decreases activity in the brain's frontal lobes, a linchpin of memory-making.A study reported in 2006 by University of Rochester researcher Mark Mapstone found that among middle-aged women, those with depressive symptoms had more complaints of memory lapses and poorer performance registering new information than those without mood disturbance.Mapstone found that the women did not show cognitive problems on neuropsychological tests. With their attention spread thin by competing demands and mood disturbances affecting concentration, many fear they have Alzheimer's when in fact they may have problems getting information into the memory stream, rather than storing or retrieving it. Attention-deficit disorder and sleep deprivation are thought to have similar effects.
Couch potato lifestylePhysical and mental exercises are essential to keeping memory functioning: Lack of either is associated with memory problems, especially as we age.The brain, like any organ, benefits from improved blood flow that comes with aerobic activity. And its tissues are strengthened with increased use. Plus, studies show that those with higher education levels and a habit of mental stimulation build up a "cognitive reserve" that reduces the symptom severity even when their brains are under attack by Alzheimer's. "It's a common sense expression, but it seems to be true: A huge amount of data says use it or lose it," says UC Irvine neuroscientist James McGaugh
Thursday, November 13, 2008
It's Never Too Late To Grow Your Brain
It's never too late to grow your brain TheStar.com - Atkinson 2008 - It's never too late to grow your brain
There's much people can do to preserve and even enhance brain function — at any age.
Related stories. With medical breakthroughs, the quest for eternal youth and longevity has never been more in reach. But we may be searching for the wrong things, according to two University of Chicago scientists. Good news: there are many easy ways to mitigate the effects aging has on your brain. It's just a matter of firming up that grey matter. From Harvard-educated medical doctor Andrew Weil to naturopath Alan Logan, the advice about nourishing the brain is consistent.
The maximum human lifespan is 122, achieved by Jeanne Calment, who lived in the south of France all her life and ate a healthy Mediterranean diet.
Related Graphics
Brain fitnessSome simple techniques for improving brain function.
THE SERIES Toronto journalist Judy Steed has been writing about social issues for 30 years. Last fall, she embarked on a one-year project to document the most pressing policy implications of our aging society as part of the 2008 Atkinson Fellowship in Public Policy.She has visited dozens of nursing homes and interviewed hundreds of health-care workers, policy-makers and seniors to present this weeklong portrait.
MEMORY: Scientific research into neurological function has an uplifting message these days: It's never too late, and there's a lot you can do to preserve, and even improve, how your brain works
November 13, 2008 Judy SteedSpecial to the Star
"You can teach an old dog new tricks," says Dr. Donald Stuss, a leading neuroscientist. "The brain can potentially grow new cells and make new connections."
Until quite recently, medical science held that the brain, when fully developed, was "a finished deal," Stuss says. Now we know – thanks in part to the groundbreaking insights generated by Baycrest's Rotman Research Institute, where Stuss is director of research and senior scientist – that there is still much to learn.
Case in point: the brain's plasticity. The newly discovered extent of the flexibility and adaptability of our grey matter means "the brain can reorganize, brain networks can change, the brain is not a fixed, limited system," Stuss says. "The brain can generate new neurons and more brain regions can be recruited, brought into play, to help us as we get older."
This knowledge – gained through imaging technologies that show us the brain in action, letting us watch different regions of the brain light up, enabling the measurement of magnetic changes in neurons – has revolutionized scientists' approach to the brain, transformed medical education, and given us hope of delaying, if not preventing, brain dysfunction.
"Different areas of the brain can take over when others are damaged," Stuss says. "The brain can recruit capacity from other parts of the brain."
To take advantage of these incredible new findings, we have to change how we age.
We have to learn how to stimulate our brain in order to keep it healthy into advanced old age.
These are the odds: over the age of 85, between a third and a half of the population will develop dementia, in the present circumstances.
This is what longevity can mean: long years of not knowing what's going on, not knowing who you are.
Aging boomers may boast about their prospects for unprecedented longevity, but the harsh truth is that you can't enjoy old age if you haven't got the healthy brain to go with it.
At Extendicare Lakefield – a typical Ontario nursing home, just outside Peterborough – 86 is the average age of admission, and 85 per cent of residents have dementia.
But it doesn't have to be that way.
That's where the astounding new brain research comes in. The future of neuroscience lies in the exploration of brain regeneration.
Given the demographics – all the aging baby boomers living in fear of dementia, eager to be the first generation to benefit from the new research – and all the money flowing into brain research at advanced scientific facilities around the world, it's no wonder brain researchers can barely contain their excitement.
Thanks to the revolution in brain imaging, modern neuroscience is poised to penetrate the ultimate mysteries of the brain: how memory functions, what causes dementia, how brain deterioration can be prevented.
"There's a whole host of new therapies coming down the pipe," says Dr. Max Cynader, director of the Brain Research Centre at University of British Columbia. "We're the lucky ones."
We're in the right place at the right time, if we live long enough.
Certainly Cynader's Brain Research Centre is benefiting from the unprecedented passion for figuring out the brain. His centre has received upwards of $37 million since 2007 from government and private sources, enough to recruit some of the finest minds in the world.
"Health is more than the absence of disease," Cynader says. "What mechanisms in the brain enable us to age well? How can we avoid neuro-degenerative dysfunction?"
These questions signal a profound shift: from studying advanced brain failure – people with Alzheimer's disease – scientists are turning their attention to preventing dysfunction, supporting brain health, lowering the risks of brain disease – just as we've learned how to prevent heart disease.
After 25 years studying Alzheimer's disease, Dr. Gary Small of UCLA's world renowned Brain Research Institute, is embracing the shift. "It's easier to protect the healthy brain and treat it earlier, rather than trying to treat the brain already damaged (by dementia)."
Small is at the forefront of another development in brain research: "the digital divide," in which "digital natives" – kids who've grown up with technology – are worlds apart from "digital immigrants" — older folks.
Small's results, recorded in a new book entitled iBrain: Surviving the Technological Alteration of the Modern Mind, are startling.
For instance, he found that young men who play violent video games have "an impaired ability to recognize human facial expressions."
Our use of technology, and the way it "distracts from our human experience of face-to-face contact," he asserts, is having a profound impact on the actual wiring of the brain.
More proof of the brain's plasticity – and more uncharted territory for brain researchers to explore
There's much people can do to preserve and even enhance brain function — at any age.
Related stories. With medical breakthroughs, the quest for eternal youth and longevity has never been more in reach. But we may be searching for the wrong things, according to two University of Chicago scientists. Good news: there are many easy ways to mitigate the effects aging has on your brain. It's just a matter of firming up that grey matter. From Harvard-educated medical doctor Andrew Weil to naturopath Alan Logan, the advice about nourishing the brain is consistent.
The maximum human lifespan is 122, achieved by Jeanne Calment, who lived in the south of France all her life and ate a healthy Mediterranean diet.
Related Graphics
Brain fitnessSome simple techniques for improving brain function.
THE SERIES Toronto journalist Judy Steed has been writing about social issues for 30 years. Last fall, she embarked on a one-year project to document the most pressing policy implications of our aging society as part of the 2008 Atkinson Fellowship in Public Policy.She has visited dozens of nursing homes and interviewed hundreds of health-care workers, policy-makers and seniors to present this weeklong portrait.
MEMORY: Scientific research into neurological function has an uplifting message these days: It's never too late, and there's a lot you can do to preserve, and even improve, how your brain works
November 13, 2008 Judy SteedSpecial to the Star
"You can teach an old dog new tricks," says Dr. Donald Stuss, a leading neuroscientist. "The brain can potentially grow new cells and make new connections."
Until quite recently, medical science held that the brain, when fully developed, was "a finished deal," Stuss says. Now we know – thanks in part to the groundbreaking insights generated by Baycrest's Rotman Research Institute, where Stuss is director of research and senior scientist – that there is still much to learn.
Case in point: the brain's plasticity. The newly discovered extent of the flexibility and adaptability of our grey matter means "the brain can reorganize, brain networks can change, the brain is not a fixed, limited system," Stuss says. "The brain can generate new neurons and more brain regions can be recruited, brought into play, to help us as we get older."
This knowledge – gained through imaging technologies that show us the brain in action, letting us watch different regions of the brain light up, enabling the measurement of magnetic changes in neurons – has revolutionized scientists' approach to the brain, transformed medical education, and given us hope of delaying, if not preventing, brain dysfunction.
"Different areas of the brain can take over when others are damaged," Stuss says. "The brain can recruit capacity from other parts of the brain."
To take advantage of these incredible new findings, we have to change how we age.
We have to learn how to stimulate our brain in order to keep it healthy into advanced old age.
These are the odds: over the age of 85, between a third and a half of the population will develop dementia, in the present circumstances.
This is what longevity can mean: long years of not knowing what's going on, not knowing who you are.
Aging boomers may boast about their prospects for unprecedented longevity, but the harsh truth is that you can't enjoy old age if you haven't got the healthy brain to go with it.
At Extendicare Lakefield – a typical Ontario nursing home, just outside Peterborough – 86 is the average age of admission, and 85 per cent of residents have dementia.
But it doesn't have to be that way.
That's where the astounding new brain research comes in. The future of neuroscience lies in the exploration of brain regeneration.
Given the demographics – all the aging baby boomers living in fear of dementia, eager to be the first generation to benefit from the new research – and all the money flowing into brain research at advanced scientific facilities around the world, it's no wonder brain researchers can barely contain their excitement.
Thanks to the revolution in brain imaging, modern neuroscience is poised to penetrate the ultimate mysteries of the brain: how memory functions, what causes dementia, how brain deterioration can be prevented.
"There's a whole host of new therapies coming down the pipe," says Dr. Max Cynader, director of the Brain Research Centre at University of British Columbia. "We're the lucky ones."
We're in the right place at the right time, if we live long enough.
Certainly Cynader's Brain Research Centre is benefiting from the unprecedented passion for figuring out the brain. His centre has received upwards of $37 million since 2007 from government and private sources, enough to recruit some of the finest minds in the world.
"Health is more than the absence of disease," Cynader says. "What mechanisms in the brain enable us to age well? How can we avoid neuro-degenerative dysfunction?"
These questions signal a profound shift: from studying advanced brain failure – people with Alzheimer's disease – scientists are turning their attention to preventing dysfunction, supporting brain health, lowering the risks of brain disease – just as we've learned how to prevent heart disease.
After 25 years studying Alzheimer's disease, Dr. Gary Small of UCLA's world renowned Brain Research Institute, is embracing the shift. "It's easier to protect the healthy brain and treat it earlier, rather than trying to treat the brain already damaged (by dementia)."
Small is at the forefront of another development in brain research: "the digital divide," in which "digital natives" – kids who've grown up with technology – are worlds apart from "digital immigrants" — older folks.
Small's results, recorded in a new book entitled iBrain: Surviving the Technological Alteration of the Modern Mind, are startling.
For instance, he found that young men who play violent video games have "an impaired ability to recognize human facial expressions."
Our use of technology, and the way it "distracts from our human experience of face-to-face contact," he asserts, is having a profound impact on the actual wiring of the brain.
More proof of the brain's plasticity – and more uncharted territory for brain researchers to explore
Wednesday, November 12, 2008
Steps to a nimble mind: Physical and mental exercise help keep the brain fit
Neuroscience is uncovering techniques to prevent cognitive decline.
By Kathleen Phalen Tomaselli, AMNews correspondent. Nov. 17, 2008.
The brain -- containing 100 billion neurons, 900 billion glial cells, 100 trillion branches and 1,000 trillion receptors -- reacts to stimuli in a series of electrical bursts, spanning a complex map of connections. Whether calculating an algorithmic equation or learning the tango, our brain continuously changes in response to our ideas, actions and activities.
Each time a dance step is learned, for instance, new pathways are formed. "Dancing is excellent for the brain and body," says Vincent Fortanasce, MD, clinical professor of neurology at the University of Southern California in Los Angeles. He wrote the Anti-Alzheimer's Prescription. "Not only are you moving around more, your brain is in constant motion as it recalls steps and movements. It's an example that highlights a wave of new thinking about the importance of brain fitness.
Until recently, conventional wisdom held that our brains were intractable, hard-wired computers. What we were born with was all we got. Age wore down memory and the ability to understand, and few interventions could reverse this process. But increasingly, evidence suggests that physical and mental exercise can alter specific brain regions, making radical improvements in cognitive function. "When you challenge the brain with new skills and new ways of doing things, it increases connections in the brain," says Ericka P. Simpson, MD, a neurologist who co-directs the MDA Neuromuscular Clinics and directs the ALS clinical research division at the Methodist Hospital System Neurological Institute in Houston. "It increases synaptic density."
With nearly 72 million Americans turning 65 over the next two decades, physicians need the tools to handle growing patient concerns about how to best maintain brain health. Armed with this new brand of science, frontline physicians will be better equipped to address the needs of aging baby boomers, already in the throes of the brain fitness revolution. "They are the gatekeepers of information, and people listen," says Eduardo Locatelli, MD, MPH, a neurologist and medical director of the Florida Neuroscience Center in Fort Lauderdale. Dr. Locatelli implements brain fitness techniques for his postsurgery epilepsy patients as well as patients who present with mild- to moderate-stage Alzheimer's and dementia. "Encourage new experiences. ... Use it or lose it. Challenge it and gain."
The plastic brain
Within the brain, the pathways and regions that are most utilized generally grow and become stronger while other parts shrink. "The brain is very Darwinian, it's survival of the fittest," says Edward Taub, PhD, a behavioral neuroscientist at the University of Alabama at Birmingham, who has researched neuroplasticity since the 1970s. "At one time it was believed we did not use 90% of our brain. That is false. The brain is a zero sum game. Every part of the brain is used. It has enormous plasticity."
Thus, by challenging the brain and forcing the use of different pathways, brain maps can be altered. And such changes offer young and old -- even brain-injured individuals -- an opportunity to learn or re-learn things. "Vocabulary can increase into age 90," says Gary J. Kennedy, MD, a professor in the Dept. of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine. He also directs the geriatric psychiatry division at Montefiore Medical Center in the Bronx, N.Y. "As people age they may be slower, but they are capable of more and more complex projects."
Brain volume shrinks up to 1% every year after age 65.
To best illustrate neuroplasticity, consider stroke patients with damaged limbs. Contrary to traditional therapy, which works to strengthen the good limb, Taub restrains the uncompromised limb, forcing patients to use the damaged arm or leg. The therapy, constraint-induced movement therapy, also known as CI therapy, helps to rewire the brain.
"The more you use it, more neurons are available ... the more demand for cortical space and the more the patient is able to use the [damaged] arm," Taub said. Over time, small steps lead to improvements in activities of daily living. Ultimately, the damaged limb, at least in part, recovers because, although the brain does not regrow damaged areas, it re-routes around them.
When the brains of CI patients were examined, a tremendous increase in grey matter was detected, and interestingly, Taub says, the healthy part of the brain was recruited for the task. Some of Taub's research was published in the Nov. 1, 2006, Journal of the American Medical Association.
CI applications are now being explored for other forms of brain injury.
Young brains, old brains?
Mental agility begins declining around age 24, says Dr. Fortanasce. But there is a big difference between agility and capacity. "I may be slower, but what I know now far outweighs what I knew at 24," he says. "Some individuals perform their greatest creative work in late life. Verdi, for example, composed Othello at 73 and Falstaff at 79."
Greg Jicha, MD, PhD, assistant professor of neurology at the University of Kentucky College of Medicine, shares related stories, such as that of an 82-year-old who learned to play the trumpet. "I've heard people say, 'You can't teach an old dog new tricks.' That can't be further from the truth," says Dr. Jicha, who also heads the healthy brain aging research group at the university's Sanders-Brown Center on Aging. "When you look at the plasticity of the adult brain, it is amazing."
Mental agility, but not capacity, begins declining around age 24.
But age also brings anatomic changes. Brain weight and blood flow to the brain decrease by 20%. The number of fibers and nerves decrease by 37%. And brain volume shrinks up to 1% every year after age 65. Dr. Fortanasce also points to hormonal shifts, with the presence of dopamine and serotonin diminishing as cortisol, an aging hormone, increases. "Between age 20 and 70, we lose nearly 90% of youth hormones."
So what keeps some brains younger than their chronology? Experts point to a prescription of neurobics. This concept includes life-long learning, trying new things, a healthy diet, social interactions, sleep and physical activity. "Exercise can actually increase neurogenesis and increase the size of the hippocampus," says Dr. Fortanasce, who promotes isometrics and weight-bearing exercise. "Exercise also increases youth hormones. And novelty, doing new things, builds branches."
In a 2006 study in the Journal of Aging and Physical Activity, Brandeis University researchers found that strength training increased the participants' working memory span. The higher the level of resistance, the more memory improved, suggesting that strength training benefits not only the muscles but also the mind.
Dr. Locatelli suggests reversing daily patterns. People who take the same route to work every day need to push themselves beyond their comfort zones. A person can try to eat using his or her weaker hand, for instance. Or someone could listen to another type of music than the type usually favored. Activate unfamiliar areas of the brain, Dr. Locatelli says. The key is new places, socializing with different people, and reading new things.
And primary care physicians can help communicate this message.
"When a patient expresses concern about memory loss, never cast it off as associated with age," says Tom Perls, MD, MPH, associate professor of medicine at Boston University Medical Center. Dr. Perls also heads the New England Centenarian Study. "This is an incredibly serious issue. Losing brain function is devastating." Ask about memory. And rule out other conditions like depression or low thyroid first. "Encourage them to exercise the brain in novel and complex ways," he says.
Exercising new connections
So what about dance steps? At McGill University in Montreal, researchers found that the tango may be better than walking for improving execution of complex tasks because it incorporates elements found in standard neurological rehabilitation programs. It's also fun and social.
Participants, ages 62 to 90, were randomly assigned to a walking group or a tango dancing group, meeting two hours twice a week for 10 weeks. The tango group improved in balance, posture and motor coordination, as well as cognition.
Physical and mental exercise improve cognitive function.
According to new research published in the October issue of the journal Nature Neuroscience, University College London scientists say complex brain processes that enable the memorization and replication of activities such as playing the piano or riding a bicycle require the execution of complicated sequences of movements involving dozens of muscles. According to their research, pianists who learned and practiced their art from an early age had elevated amounts of myelin. This finding suggests that when people learn new skills, myelination might occur. Earlier studies indicated that brains of patients diagnosed with senile dementia had lowered amounts of myelin.
The emphasis, though, is the importance of embracing the complex and novel. And Joe Hardy, PhD, a cognition neuroscientist who develops brain plasticity training programs, says some common-sense advice from physicians is not based on good evidence. "They often recommend doing crossword puzzles," he says. "But evidence suggests that crossword puzzles are not helpful."
Hardy has been developing brain games for the San Francisco-based company Posit Science. The games -- the Brain Fitness Program and Insight -- have been tested in several randomized clinical trials funded by the National Institutes of Health. The results indicate that the brain age clock can roll back 10 years. "The key thing in terms of exercise for the brain: You need to do new things, thus forming new paths," he says.
Some have even compared this new era in brain health to the 1950s, when heart health came to the fore. "New things are coming out all the time, and we are going to see a revolution in brain health," Hardy says. "I think this is going to change the way people age."
Discuss on Sermo Back to top.
ADDITIONAL INFORMATION:
Increasing cognitive reserve
Who will live to be 100?
In a bit of fortune-telling fun, a series of lifestyle-related questions might offer a calculated prediction. The Life Expectancy Calculator can help patients find out how they rate right now and how changes in diet, exercise or sleep patterns might add years to the forecast. The calculator is available online (www.livingto100.com). This tool was created by Tom Perls, MD, MPH, associate professor of medicine at Boston University Medical Center, who heads the New England Centenarian Study.
A related and very important question is whether your patients' brains -- or maybe your own -- will stay young as bodies age.
According to Dr. Perls, building cognitive reserve delays the onset of memory loss, and research suggests that novel and complex brain activities can delay cognitive decline and extend lifespan. "There's a natural tendency to lose muscle as we age," he says, and by building cognitive reserve, people are exercising their temporal lobes as they would their quads.
Dr. Perls has categorized a series of games based on cognitive function, available online (fun.eons.com/brain_games). For instance, stimulating areas in the temporal and frontal lobes with games that focus on recall and retention of past and present information targets memory. For language, focus on the parietal lobe with word-building games that prompt production and understanding of spoken and written communication. Exercising the frontal lobe can be done with problem-solving puzzles and strategy games in which players control and apply mental skills.
For motor function, engage the parietal lobe edge with navigation-type games that encourage body movement through the interaction of the brain, nerves and muscles. For visual-spatial skills, stimulate the occipital and temporal lobes. Games involving discrimination, perception, attention and tracking objects visually can achieve this goal.
Back to top.
London cabbies have bigger hippocampi
London cabbies' brains grow on the job. According to studies by scientists at the University College London Institute of Neurology -- the first published in the April 11, 2000, issue of Proceedings of the National Academy of Sciences with follow-up research presented in 2006 and 2007 -- these professional drivers have a larger posterior hippocampus, the brain region tied to learning and navigation.
Researchers credit complex daily tasks, such as navigating a labyrinth of 320 standard routes in a six-mile area, with increasing brain size. And functional MRI demonstrated that the longer on the job, the bigger the brain.
Still, there may be a price. As brain regions continually competed for space, the posterior hippocampus grew while the anterior hippocampus, which is associated with memory, decreased. "The brain has enormous plasticity," says Edward Taub, PhD, a behavioral neuroscientist at the University of Alabama at Birmingham. He has studied neuroplasticity since the 1970s. "Every part of the brain is used. The more you use a function, it may be at the expense of another."
As an outgrowth of the early taxi driver studies, U.S. scientists began exploring the effects of employing complicated navigational skills. At Brandeis University in Waltham, Mass., scientists created the virtual taxicab video game to study the way brains work. As subjects play, they become increasingly proficient in navigating complex routes, which researchers believe is tied to building cognitive maps of the environment.
Additionally, German scientists reported in the June 2006 issue of The Journal of Neuroscience that the brains of German medical students, while studying for final exams, showed increases in the posterior hippocampus, similar to the London cabbie study. Three months later, according to MRI imaging, the hippocampus had returned to its former size.
Weblink
Life Expectancy Calculator (www.livingto100.com)
Dr. Perls' brain games (fun.eons.com/brain_games
By Kathleen Phalen Tomaselli, AMNews correspondent. Nov. 17, 2008.
The brain -- containing 100 billion neurons, 900 billion glial cells, 100 trillion branches and 1,000 trillion receptors -- reacts to stimuli in a series of electrical bursts, spanning a complex map of connections. Whether calculating an algorithmic equation or learning the tango, our brain continuously changes in response to our ideas, actions and activities.
Each time a dance step is learned, for instance, new pathways are formed. "Dancing is excellent for the brain and body," says Vincent Fortanasce, MD, clinical professor of neurology at the University of Southern California in Los Angeles. He wrote the Anti-Alzheimer's Prescription. "Not only are you moving around more, your brain is in constant motion as it recalls steps and movements. It's an example that highlights a wave of new thinking about the importance of brain fitness.
Until recently, conventional wisdom held that our brains were intractable, hard-wired computers. What we were born with was all we got. Age wore down memory and the ability to understand, and few interventions could reverse this process. But increasingly, evidence suggests that physical and mental exercise can alter specific brain regions, making radical improvements in cognitive function. "When you challenge the brain with new skills and new ways of doing things, it increases connections in the brain," says Ericka P. Simpson, MD, a neurologist who co-directs the MDA Neuromuscular Clinics and directs the ALS clinical research division at the Methodist Hospital System Neurological Institute in Houston. "It increases synaptic density."
With nearly 72 million Americans turning 65 over the next two decades, physicians need the tools to handle growing patient concerns about how to best maintain brain health. Armed with this new brand of science, frontline physicians will be better equipped to address the needs of aging baby boomers, already in the throes of the brain fitness revolution. "They are the gatekeepers of information, and people listen," says Eduardo Locatelli, MD, MPH, a neurologist and medical director of the Florida Neuroscience Center in Fort Lauderdale. Dr. Locatelli implements brain fitness techniques for his postsurgery epilepsy patients as well as patients who present with mild- to moderate-stage Alzheimer's and dementia. "Encourage new experiences. ... Use it or lose it. Challenge it and gain."
The plastic brain
Within the brain, the pathways and regions that are most utilized generally grow and become stronger while other parts shrink. "The brain is very Darwinian, it's survival of the fittest," says Edward Taub, PhD, a behavioral neuroscientist at the University of Alabama at Birmingham, who has researched neuroplasticity since the 1970s. "At one time it was believed we did not use 90% of our brain. That is false. The brain is a zero sum game. Every part of the brain is used. It has enormous plasticity."
Thus, by challenging the brain and forcing the use of different pathways, brain maps can be altered. And such changes offer young and old -- even brain-injured individuals -- an opportunity to learn or re-learn things. "Vocabulary can increase into age 90," says Gary J. Kennedy, MD, a professor in the Dept. of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine. He also directs the geriatric psychiatry division at Montefiore Medical Center in the Bronx, N.Y. "As people age they may be slower, but they are capable of more and more complex projects."
Brain volume shrinks up to 1% every year after age 65.
To best illustrate neuroplasticity, consider stroke patients with damaged limbs. Contrary to traditional therapy, which works to strengthen the good limb, Taub restrains the uncompromised limb, forcing patients to use the damaged arm or leg. The therapy, constraint-induced movement therapy, also known as CI therapy, helps to rewire the brain.
"The more you use it, more neurons are available ... the more demand for cortical space and the more the patient is able to use the [damaged] arm," Taub said. Over time, small steps lead to improvements in activities of daily living. Ultimately, the damaged limb, at least in part, recovers because, although the brain does not regrow damaged areas, it re-routes around them.
When the brains of CI patients were examined, a tremendous increase in grey matter was detected, and interestingly, Taub says, the healthy part of the brain was recruited for the task. Some of Taub's research was published in the Nov. 1, 2006, Journal of the American Medical Association.
CI applications are now being explored for other forms of brain injury.
Young brains, old brains?
Mental agility begins declining around age 24, says Dr. Fortanasce. But there is a big difference between agility and capacity. "I may be slower, but what I know now far outweighs what I knew at 24," he says. "Some individuals perform their greatest creative work in late life. Verdi, for example, composed Othello at 73 and Falstaff at 79."
Greg Jicha, MD, PhD, assistant professor of neurology at the University of Kentucky College of Medicine, shares related stories, such as that of an 82-year-old who learned to play the trumpet. "I've heard people say, 'You can't teach an old dog new tricks.' That can't be further from the truth," says Dr. Jicha, who also heads the healthy brain aging research group at the university's Sanders-Brown Center on Aging. "When you look at the plasticity of the adult brain, it is amazing."
Mental agility, but not capacity, begins declining around age 24.
But age also brings anatomic changes. Brain weight and blood flow to the brain decrease by 20%. The number of fibers and nerves decrease by 37%. And brain volume shrinks up to 1% every year after age 65. Dr. Fortanasce also points to hormonal shifts, with the presence of dopamine and serotonin diminishing as cortisol, an aging hormone, increases. "Between age 20 and 70, we lose nearly 90% of youth hormones."
So what keeps some brains younger than their chronology? Experts point to a prescription of neurobics. This concept includes life-long learning, trying new things, a healthy diet, social interactions, sleep and physical activity. "Exercise can actually increase neurogenesis and increase the size of the hippocampus," says Dr. Fortanasce, who promotes isometrics and weight-bearing exercise. "Exercise also increases youth hormones. And novelty, doing new things, builds branches."
In a 2006 study in the Journal of Aging and Physical Activity, Brandeis University researchers found that strength training increased the participants' working memory span. The higher the level of resistance, the more memory improved, suggesting that strength training benefits not only the muscles but also the mind.
Dr. Locatelli suggests reversing daily patterns. People who take the same route to work every day need to push themselves beyond their comfort zones. A person can try to eat using his or her weaker hand, for instance. Or someone could listen to another type of music than the type usually favored. Activate unfamiliar areas of the brain, Dr. Locatelli says. The key is new places, socializing with different people, and reading new things.
And primary care physicians can help communicate this message.
"When a patient expresses concern about memory loss, never cast it off as associated with age," says Tom Perls, MD, MPH, associate professor of medicine at Boston University Medical Center. Dr. Perls also heads the New England Centenarian Study. "This is an incredibly serious issue. Losing brain function is devastating." Ask about memory. And rule out other conditions like depression or low thyroid first. "Encourage them to exercise the brain in novel and complex ways," he says.
Exercising new connections
So what about dance steps? At McGill University in Montreal, researchers found that the tango may be better than walking for improving execution of complex tasks because it incorporates elements found in standard neurological rehabilitation programs. It's also fun and social.
Participants, ages 62 to 90, were randomly assigned to a walking group or a tango dancing group, meeting two hours twice a week for 10 weeks. The tango group improved in balance, posture and motor coordination, as well as cognition.
Physical and mental exercise improve cognitive function.
According to new research published in the October issue of the journal Nature Neuroscience, University College London scientists say complex brain processes that enable the memorization and replication of activities such as playing the piano or riding a bicycle require the execution of complicated sequences of movements involving dozens of muscles. According to their research, pianists who learned and practiced their art from an early age had elevated amounts of myelin. This finding suggests that when people learn new skills, myelination might occur. Earlier studies indicated that brains of patients diagnosed with senile dementia had lowered amounts of myelin.
The emphasis, though, is the importance of embracing the complex and novel. And Joe Hardy, PhD, a cognition neuroscientist who develops brain plasticity training programs, says some common-sense advice from physicians is not based on good evidence. "They often recommend doing crossword puzzles," he says. "But evidence suggests that crossword puzzles are not helpful."
Hardy has been developing brain games for the San Francisco-based company Posit Science. The games -- the Brain Fitness Program and Insight -- have been tested in several randomized clinical trials funded by the National Institutes of Health. The results indicate that the brain age clock can roll back 10 years. "The key thing in terms of exercise for the brain: You need to do new things, thus forming new paths," he says.
Some have even compared this new era in brain health to the 1950s, when heart health came to the fore. "New things are coming out all the time, and we are going to see a revolution in brain health," Hardy says. "I think this is going to change the way people age."
Discuss on Sermo Back to top.
ADDITIONAL INFORMATION:
Increasing cognitive reserve
Who will live to be 100?
In a bit of fortune-telling fun, a series of lifestyle-related questions might offer a calculated prediction. The Life Expectancy Calculator can help patients find out how they rate right now and how changes in diet, exercise or sleep patterns might add years to the forecast. The calculator is available online (www.livingto100.com). This tool was created by Tom Perls, MD, MPH, associate professor of medicine at Boston University Medical Center, who heads the New England Centenarian Study.
A related and very important question is whether your patients' brains -- or maybe your own -- will stay young as bodies age.
According to Dr. Perls, building cognitive reserve delays the onset of memory loss, and research suggests that novel and complex brain activities can delay cognitive decline and extend lifespan. "There's a natural tendency to lose muscle as we age," he says, and by building cognitive reserve, people are exercising their temporal lobes as they would their quads.
Dr. Perls has categorized a series of games based on cognitive function, available online (fun.eons.com/brain_games). For instance, stimulating areas in the temporal and frontal lobes with games that focus on recall and retention of past and present information targets memory. For language, focus on the parietal lobe with word-building games that prompt production and understanding of spoken and written communication. Exercising the frontal lobe can be done with problem-solving puzzles and strategy games in which players control and apply mental skills.
For motor function, engage the parietal lobe edge with navigation-type games that encourage body movement through the interaction of the brain, nerves and muscles. For visual-spatial skills, stimulate the occipital and temporal lobes. Games involving discrimination, perception, attention and tracking objects visually can achieve this goal.
Back to top.
London cabbies have bigger hippocampi
London cabbies' brains grow on the job. According to studies by scientists at the University College London Institute of Neurology -- the first published in the April 11, 2000, issue of Proceedings of the National Academy of Sciences with follow-up research presented in 2006 and 2007 -- these professional drivers have a larger posterior hippocampus, the brain region tied to learning and navigation.
Researchers credit complex daily tasks, such as navigating a labyrinth of 320 standard routes in a six-mile area, with increasing brain size. And functional MRI demonstrated that the longer on the job, the bigger the brain.
Still, there may be a price. As brain regions continually competed for space, the posterior hippocampus grew while the anterior hippocampus, which is associated with memory, decreased. "The brain has enormous plasticity," says Edward Taub, PhD, a behavioral neuroscientist at the University of Alabama at Birmingham. He has studied neuroplasticity since the 1970s. "Every part of the brain is used. The more you use a function, it may be at the expense of another."
As an outgrowth of the early taxi driver studies, U.S. scientists began exploring the effects of employing complicated navigational skills. At Brandeis University in Waltham, Mass., scientists created the virtual taxicab video game to study the way brains work. As subjects play, they become increasingly proficient in navigating complex routes, which researchers believe is tied to building cognitive maps of the environment.
Additionally, German scientists reported in the June 2006 issue of The Journal of Neuroscience that the brains of German medical students, while studying for final exams, showed increases in the posterior hippocampus, similar to the London cabbie study. Three months later, according to MRI imaging, the hippocampus had returned to its former size.
Weblink
Life Expectancy Calculator (www.livingto100.com)
Dr. Perls' brain games (fun.eons.com/brain_games
Any new symptom in an older person should be considered a drug side effect until proven otherwise
They are the drugged-out generation, and they're not who you think they are.
They're 80. And 85 and 90 and 95 – overmedicated seniors clogging emergency departments, blocking hospital beds and sicker than they have any reason to be.
The Number 1 drug users in North America, outside of patients in long-term care facilities, are women over the age of 65. Twelve per cent are on 10 or more meds, sometimes up to 20 or more drugs; 23 per cent take at least five drugs. In long-term care, seniors are on six to eight medications, on average. Fifteen per cent of seniors admitted to hospital are suffering drug side effects. It's not uncommon to find seniors dizzy and dotty from being prescribed so many drugs. "You'd fall down, too, if you were on so many drugs," says Dr. William Dalziel, a prominent Ottawa geriatrician.
Typically, overmedicated seniors have been seen by numerous specialists who have prescribed various medications to treat a host of chronic ailments – high blood pressure, hypertension, diabetes, osteoporosis, arthritis, heart disease, cancer – but there hasn't been any oversight by a geriatrician skilled in looking at the big picture and assessing contra-indications and side effects.
Ask any doctor with expertise in seniors what their top health concerns are and they all cite overmedication.
Dr. Mark Nowacynski, an exceedingly rare family doctor who does home visits on a full-time basis, shakes his head. "So many old people are prescribed so many drugs, they don't know what they're for and they often don't take them properly," he says.
Nowacynski recalls taking care of an old man who was seeing six specialists.
"He was very anxious and confused; the specialists' advice often conflicted. I was astounded at how many meds he was on, more than 20. He wasn't taking them as prescribed and he was suffering from various side effects and interactions that weren't being monitored."
Over time, Nowacynski – or Dr. Mark, as his patients call him – was able to wean his patient down to fewer than 10 drugs.
One of the reasons overmedication is such a serious issue, apart from the biological aspects, is that seniors become vulnerable to serious falls when they're excessively drugged, and serious falls can lead to a downward spiral of hospitalization, extreme fear of going out, isolation and death. As well, many seniors have trouble sleeping; instead of being encouraged to tire themselves out with exercise and activities, they may become habituated to sleeping pills that leave them groggy during the day.
Another problem, says Dr. Paula Rochon, a Baycrest geriatrician, is that doses for older people should often be much lower than for younger people. She notes that Valium is long acting and very sedating and shouldn't be prescribed at all to seniors.
Not only does overmedication cost the health-care system millions of dollars annually in unnecessary, expensive prescriptions but also the entire system slows down – and wait times for other patients lengthen – as emergency departments and hospitals struggle to diagnose drug-related problems.
Doctors and nurses trained in the ailments of old age and alert to the problem of overmedication can resolve many of these issues quite quickly, but most doctors haven't had any significant geriatric training. Stories are legion about elders blocking emergency rooms and being admitted to hospital, with doctors thinking the old people are having heart attacks and ordering expensive tests when the problem is simply overmedication.
In 1995, the Canadian Medical Association Journal found that doctors who wrote the most prescriptions also had the highest death rates among their patients.
"This study found that some doctors, in trying to maximize the number of patients they could process per day, did not take the time necessary to find out what was wrong with these patients," writes David Foot in his bestseller Boom, Bust, Echo. "That kind of medical practice results in overmedicated and inappropriately medicated patients."
According to Dr. Jerry Gurwitz, chief of geriatric medicine at the University of Massachusetts Medical School: "Any new symptom in an older person should be considered a drug side effect until proven otherwise."
At Baycrest, Toronto's health sciences centre focused on geriatric care, Rochon has spent years working with the facility's doctors, researchers and residents in long-term care to find solutions to overmedication.
"When you're dealing with complex conditions (in seniors) and all these drugs, how do doctors make the right choices?" she asks. "It gets complicated for everybody."
Thanks to her efforts, Baycrest has developed software for a computerized physician order entry system. Instead of scrawling, often illegibly, on a prescription pad, doctors sign in to a database and get full access to residents' medical histories and comprehensive pharmacological information, before they order prescriptions.
Baycrest's wireless networks were upgraded and the centre became the first long-term care facility in Canada, and one of the first in North America, to do its drug prescribing electronically.
"At a glance, you can look at the patients' history, get their age, weight, see what other meds they're on, see their medication history, allergies, blood work, other consults," Rochon says. "Everything you need is at your finger tips."
The U.S. Department of Health and Human Services was so impressed that it funded a landmark study to determine Baycrest's effectiveness in reducing adverse drug events in long-term care. The U of M's Gurwitz, who was a principal investigator, stated that Baycrest was "ahead of the curve in adopting health information technology" and "there are few places like Baycrest in all of North America in which to carry out such a study."
Prescribing is now much improved at Baycrest, Rochon says, and "doctors are making better decisions because they've got better information."
Most Toronto hospitals have followed Baycrest's lead and use computerized physician order systems.
The Ontario government has responded to the issue with the MedsCheck program (MedsCheck.ca), in which pharmacists are paid to assess seniors' medications and detect problems. People who have an OHIP card and are taking three or more prescription drugs for a chronic condition are eligible. On presenting their card, they receive a one-on-one, private consultation for up to 30 minutes with a pharmacist, who will make sure they are taking their drugs properly and educate them about possible adverse drug reactions.
"Some over-the-counter medications can interfere with certain health conditions and adversely affect some prescription medications," the MedsCheck website states. Decongestants, for instance, may be taken to relieve cold symptoms, but they can have the effect of raising blood pressure. Vitamin C can reduce the efficacy of chemotherapy.
Still missing, however, is a Canada-wide policy. In 2002, Roy Romanow recommended a National Drug Agency that would include a national program for managing medications to, among other things, monitor prescriptions and adverse drug reactions among seniors.
"The evidence is that new drugs come on the market every few days and in Canada there is no comprehensive process to address their safety, quality and cost-effectiveness," Romanow says. "Health Canada says it does this, but it doesn't, not like the Food and Drug Administration in the United States."
Romanow says a national program would make a huge difference in the daily lives of seniors, the major consumers of drugs in Canada.
Six years since Romanow's prescription, it has yet to be filled.
They're 80. And 85 and 90 and 95 – overmedicated seniors clogging emergency departments, blocking hospital beds and sicker than they have any reason to be.
The Number 1 drug users in North America, outside of patients in long-term care facilities, are women over the age of 65. Twelve per cent are on 10 or more meds, sometimes up to 20 or more drugs; 23 per cent take at least five drugs. In long-term care, seniors are on six to eight medications, on average. Fifteen per cent of seniors admitted to hospital are suffering drug side effects. It's not uncommon to find seniors dizzy and dotty from being prescribed so many drugs. "You'd fall down, too, if you were on so many drugs," says Dr. William Dalziel, a prominent Ottawa geriatrician.
Typically, overmedicated seniors have been seen by numerous specialists who have prescribed various medications to treat a host of chronic ailments – high blood pressure, hypertension, diabetes, osteoporosis, arthritis, heart disease, cancer – but there hasn't been any oversight by a geriatrician skilled in looking at the big picture and assessing contra-indications and side effects.
Ask any doctor with expertise in seniors what their top health concerns are and they all cite overmedication.
Dr. Mark Nowacynski, an exceedingly rare family doctor who does home visits on a full-time basis, shakes his head. "So many old people are prescribed so many drugs, they don't know what they're for and they often don't take them properly," he says.
Nowacynski recalls taking care of an old man who was seeing six specialists.
"He was very anxious and confused; the specialists' advice often conflicted. I was astounded at how many meds he was on, more than 20. He wasn't taking them as prescribed and he was suffering from various side effects and interactions that weren't being monitored."
Over time, Nowacynski – or Dr. Mark, as his patients call him – was able to wean his patient down to fewer than 10 drugs.
One of the reasons overmedication is such a serious issue, apart from the biological aspects, is that seniors become vulnerable to serious falls when they're excessively drugged, and serious falls can lead to a downward spiral of hospitalization, extreme fear of going out, isolation and death. As well, many seniors have trouble sleeping; instead of being encouraged to tire themselves out with exercise and activities, they may become habituated to sleeping pills that leave them groggy during the day.
Another problem, says Dr. Paula Rochon, a Baycrest geriatrician, is that doses for older people should often be much lower than for younger people. She notes that Valium is long acting and very sedating and shouldn't be prescribed at all to seniors.
Not only does overmedication cost the health-care system millions of dollars annually in unnecessary, expensive prescriptions but also the entire system slows down – and wait times for other patients lengthen – as emergency departments and hospitals struggle to diagnose drug-related problems.
Doctors and nurses trained in the ailments of old age and alert to the problem of overmedication can resolve many of these issues quite quickly, but most doctors haven't had any significant geriatric training. Stories are legion about elders blocking emergency rooms and being admitted to hospital, with doctors thinking the old people are having heart attacks and ordering expensive tests when the problem is simply overmedication.
In 1995, the Canadian Medical Association Journal found that doctors who wrote the most prescriptions also had the highest death rates among their patients.
"This study found that some doctors, in trying to maximize the number of patients they could process per day, did not take the time necessary to find out what was wrong with these patients," writes David Foot in his bestseller Boom, Bust, Echo. "That kind of medical practice results in overmedicated and inappropriately medicated patients."
According to Dr. Jerry Gurwitz, chief of geriatric medicine at the University of Massachusetts Medical School: "Any new symptom in an older person should be considered a drug side effect until proven otherwise."
At Baycrest, Toronto's health sciences centre focused on geriatric care, Rochon has spent years working with the facility's doctors, researchers and residents in long-term care to find solutions to overmedication.
"When you're dealing with complex conditions (in seniors) and all these drugs, how do doctors make the right choices?" she asks. "It gets complicated for everybody."
Thanks to her efforts, Baycrest has developed software for a computerized physician order entry system. Instead of scrawling, often illegibly, on a prescription pad, doctors sign in to a database and get full access to residents' medical histories and comprehensive pharmacological information, before they order prescriptions.
Baycrest's wireless networks were upgraded and the centre became the first long-term care facility in Canada, and one of the first in North America, to do its drug prescribing electronically.
"At a glance, you can look at the patients' history, get their age, weight, see what other meds they're on, see their medication history, allergies, blood work, other consults," Rochon says. "Everything you need is at your finger tips."
The U.S. Department of Health and Human Services was so impressed that it funded a landmark study to determine Baycrest's effectiveness in reducing adverse drug events in long-term care. The U of M's Gurwitz, who was a principal investigator, stated that Baycrest was "ahead of the curve in adopting health information technology" and "there are few places like Baycrest in all of North America in which to carry out such a study."
Prescribing is now much improved at Baycrest, Rochon says, and "doctors are making better decisions because they've got better information."
Most Toronto hospitals have followed Baycrest's lead and use computerized physician order systems.
The Ontario government has responded to the issue with the MedsCheck program (MedsCheck.ca), in which pharmacists are paid to assess seniors' medications and detect problems. People who have an OHIP card and are taking three or more prescription drugs for a chronic condition are eligible. On presenting their card, they receive a one-on-one, private consultation for up to 30 minutes with a pharmacist, who will make sure they are taking their drugs properly and educate them about possible adverse drug reactions.
"Some over-the-counter medications can interfere with certain health conditions and adversely affect some prescription medications," the MedsCheck website states. Decongestants, for instance, may be taken to relieve cold symptoms, but they can have the effect of raising blood pressure. Vitamin C can reduce the efficacy of chemotherapy.
Still missing, however, is a Canada-wide policy. In 2002, Roy Romanow recommended a National Drug Agency that would include a national program for managing medications to, among other things, monitor prescriptions and adverse drug reactions among seniors.
"The evidence is that new drugs come on the market every few days and in Canada there is no comprehensive process to address their safety, quality and cost-effectiveness," Romanow says. "Health Canada says it does this, but it doesn't, not like the Food and Drug Administration in the United States."
Romanow says a national program would make a huge difference in the daily lives of seniors, the major consumers of drugs in Canada.
Six years since Romanow's prescription, it has yet to be filled.
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