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Wednesday, December 26, 2007

Alzheimer's Disease

An nice feature article in today's New York Times:

Scientists Want to Find Alzheimer’s Before a Mind Fails
By DENISE GRADY
The New York Times
Published: December 26, 2007


[ ... Read the full article ... ]

Thursday, December 13, 2007

The Game Brain

From sfgate.com and The San Francisco Chronicle, continued penetration of pop neuropsychology into everyday life:

'Brain gym' may exorcise Boomers' fears about aging
Heidi Benson, Chronicle Staff Writer
Thursday, December 13, 2007

Marathon-happy Baby Boomers, those 78 million Americans born from 1946 to '64, were the first generation to make a religion of physical fitness. Now, they are investing time and money to maintain what's above their six-pack abs and rippling biceps: their brains.

"People are living longer, and they want their brains to keep up with their bodies," said Lisa Schoonerman, who is on top of the trend.

She and her life partner, Jan Zivic, have opened a "brain gym," called vibrantBrains, on Sacramento Street in San Francisco.

"Studies show that regular mental workouts are WD-40 for the brain," Schoonerman said. "It's preventative maintenance."


[ ... Read the full article ... ]

Tuesday, December 11, 2007

Alzheimer's Disease: Sarah Polley's Movie, Away From Her

Sarah Polley has won another award for her movie:

From The Vancouver Sun:

Polley wins N.Y. film critics award
CanWest News Service
Published: Tuesday, December 11, 2007

Canadian filmmaker Sarah Polley has won the New York Film Critics Circle's best first film award for her directorial debut Away From Her, an adaptation of Alice Munro's short story The Bear Came Over the Mountain. Academy award-winning actress Julie Christie took the best actress award for her performance in Polley's film as a woman suffering from the onset of Alzheimer's disease.

© The Vancouver Sun 2007

[ ... Read the full article ... ]

The Game Brain





The New York Times continues its coverage of cognitive agility with a column today by Jane Brody discussing different cognitive and physical ways to promote a fit mind:

Mental Reserves Keep Brains Agile
by Jane E. Brody
The New York Times
11 December 2007

[ ... Read the full column ... ]

Saturday, December 08, 2007

Alzheimer's Disease (AD): Dementia Telephone Screening

Tomorrow's Sunday New York Times Magazine is its annual new ideas of the past year issue. Among the many shiny ideas presented is telephone screening for dementia:

Alzheimer’s Telephone Screening
By RON FEEMSTER
The New York Times
Published: December 9, 2007

This year, researchers completed work on a 50-question telephone quiz to help them identify Alzheimer’s patients long before they exhibit typical symptoms. Such a quiz may soon become part of regular medical care.

This new tool measures what the researchers call “cognitive vital signs” like short-term memory loss, which is the most important early sign of Alzheimer’s, and detects declines in everyday abilities like using a telephone, preparing meals or managing finances. The quiz also picks up behavioral warning signs including apathy, irritability and depression.

“If somebody is failing these cognitive tests, they already have the characteristics of the disease,” says Jeffrey Cummings, director of the Alzheimer Disease Center at U.C.L.A., “just in a very early and mild form.” Cummings says the quiz reliably shows when a person crosses the line between normal mental life and the mild cognitive impairment found in early Alzheimer’s, but adds that anyone who fails should get a detailed follow-up exam.

[ ... Read the full article ... ]

Tuesday, December 04, 2007

Alzheimer's Dementia: "To Screen, Or Not To Screen"

A short piece in today's Washington Post about the potential problems and potential benefits of broad screenings for dementia of Alzheimer's disease in the general population of aging persons:

To Screen, or Not to Screen
Experts Debate Mass Testing For Alzheimer's Disease
By Alicia Ault
Special to The Washington Post
Tuesday, December 4, 2007; Page HE01

[ ... Read the full article ... ]

Thursday, November 29, 2007

Neuropsychology Abstract of the Day: Epilepsy

Meador KJ, Gevins A, Loring DW, McEvoy LK, Ray PG, Smith ME, Motamedi GK, Evans BM, & Baum C. Neuropsychological and neurophysiologic effects of carbamazepine and levetiracetam. Neurology. 2007 Nov 27; 69(22): 2076-2084.


Department of Neurology, University of Florida, McKnight Brain Institute (L3-100), 100 South Newell Drive, Gainesville, FL 32610, USA.

BACKGROUND: The relative effects of levetiracetam (LEV) and carbamazepine (CBZ) on cognitive and neurophysiologic measures are uncertain. METHODS: The effects of LEV and CBZ were compared in healthy adults using a randomized, double-blind, two-period crossover design. Outcome measures included 11 standard neuropsychological tests and the score from a cognitive-neurophysiologic test of attention and memory. Evaluations were conducted at screening, baseline pre-drug treatment, end of each maintenance phase (4 weeks), and end of each washout period after drug treatment. RESULTS: A total of 28 adults (17 women) with mean age of 33 years (range 18 to 51) completed the study. Mean maintenance doses (+/-SD) were CBZ = 564 mg/day (110) and LEV = 2,000 mg/day (0). CBZ was adjusted to mid-range therapeutic level. Mean serum levels (+/-SD) were CBZ = 7.5 mcg/mL (1.5) and LEV = 32.2 mcg/mL (11.2). An overall composite score including all measures revealed worse effects for CBZ compared to LEV (p less than/or= 0.001) in the primary analysis and for CBZ (p less than/or= 0.001) and LEV (p less than/or= 0.05) compared to non-drug in secondary analyses. Across the 34 individual variables, CBZ was worse than LEV on 44% (15/34); none favored CBZ. Compared to the non-drug average, CBZ was worse for 76% (26/34), and LEV was worse for 12% (4 of 34). Sensitivity and specificity of standard neuropsychological tests and the cognitive-neurophysiologic test were determined to direct future studies; detection was most accurate by the cognitive-neurophysiologic test. CONCLUSIONS: Levetiracetam produces fewer untoward neuropsychological and neurophysiologic effects than carbamazepine in monotherapy at the dosages and timeframes employed in this study.

PMID: 18040014 [PubMed - in process]

Diversity Program in Neuroscience Fellowship

From the American Psychological Association:

GRADUATE FELLOWSHIPS
IN PSYCHOLOGY AND NEUROSCIENCE

Do you want to take charge of your career? Do you need financial support for graduate school or postdoctoral studies? Are you interested in ethnic minority issues? Then the Minority Fellowship Program is for you!

The Minority Fellowship Program (MFP) offers the following fellowships

The Mental Health and Substance Abuse Services (MHSAS) Fellowship is aimed at those pursuing doctoral degrees in clinical, counseling, and school psychology, or other mental health services areas. This program is primarily for individuals who want to deliver services.

The MHSAS Postdoctoral Fellowship is aimed at early career doctoral recipients who are interested in developing a career in mental health service delivery, policy, or services-related research.

The Diversity Program in Neuroscience Fellowship is geared to those pursuing careers in neuroscience. Predoctoral and postdoctoral fellowships are offered. Doctoral students or early career doctoral recipients in psychology or any life science discipline related to neuroscience may apply.

Note: Individuals may apply to only one of the MFP fellowships.

The application deadline is January 15.

About the Minority Fellowship Program
The MFP’s mission is to increase the knowledge and research related to ethnic minority mental health and to improve the quality of mental health and substance abuse services delivered to ethnic minority populations. We do this by providing financial support, professional development activities, and professional guidance to students pursuing doctoral degrees in psychology and neuroscience. Our mission is consistent with Healthy People 2010, the Surgeon General’s Report on Mental Health, and other federal initiatives to reduce health disparities.

For more information or to apply for a fellowship, visit our web site at www.apa.org/mfp or contact us at:

APA/MFP
750 First Street, NE
Washington, DC 20002-4242
(202) 336-6127
Email: mfp@apa.org

Monday, November 26, 2007

Calling All Iowans: Alzheimer's Disease

From the Radio Iowa website:

Task force seeks public input on Alzheimer's disease
Monday, November 26, 2007, 8:46 AM
By Pat Curtis

"A task force in Iowa that's looking for ways to improve services to Alzheimer's patients is asking for your help. John McCalley, director of the Iowa Department of Elder Affairs, says all Iowans are invited to take an on-line survey.

He says the survey is mainly designed for Alzheimer's patients and their family members or care givers. McCalley, who also chairs the 17-member Alzheimer's disease Task Force, says the state's current services to dementia patients are somewhat uncoordinated. He says funding is provided to Area Agencies on Aging across the state, but those services face limited funding, especially in rural areas.

An estimated 65,000 Iowans have Alzheimer's disease and that number is expected to grow as Iowa's population ages. McCalley says the survey only takes 5 to 10 minutes to complete. He says the questions on the survey allow individuals to document their experiences with Alzheimer's and suggestions for improving Iowa's services.

McCalley says he'd like the surveys completed by December 10, so his group can compile a report and present recommendations to the Iowa Legislature in January."

===

The online survey for Iowans can be found as a link on the Radio Iowa webpage linked to above.

Sunday, November 18, 2007

Love and Alzheimer's: Sarah Polley's Away From Her and Sandra Day O'Connor

Love in the Time of Dementia
By KATE ZERNIKE
Published: November 18, 2007
The New York Times

Kudos to the headline writer for the reference to Love in the Time of Cholera, the wonderful book, which after twenty years has now been released as a movie. Kudos also to Kate Zernike for this wonderful first line to her piece in today's Times:

"So this, in the end, is what love is."

[ ... Read the full piece ... ]

Away from Her.

Thursday, November 15, 2007

Neuropsychology Abstract of the Day: Attention

Pattyn N, Neyt X, Henderickx D, & Soetens E. Psychophysiological investigation of vigilance decrement: Boredom or cognitive fatigue? Physiology and Behavior. 2007 Oct 3; [Epub ahead of print.]

Department of Cognitive & Biological Psychology, Vrije Universiteit Brussel, Pleinlaan, 2, 1050 Brussel, Belgium; Department of Behavioral Sciences, Royal Military Academy, Renaissancelaan, 30, 1000 Brussel, Belgium.

The vigilance decrement has been described as a slowing in reaction times or an increase in error rates as an effect of time-on-task during tedious monitoring tasks. This decrement has been alternatively ascribed to either withdrawal of the supervisory attentional system, due to underarousal caused by the insufficient workload, or to a decreased attentional capacity and thus the impossibility to sustain mental effort. Furthermore, it has previously been reported that controlled processing is the locus of the vigilance decrement. This study aimed at answering three questions, to better define sustained attention. First, is endogenous attention more vulnerable to time-on-task than exogenous attention? Second, do measures of autonomic arousal provide evidence to support the underload vs overload hypothesis? And third, do these measures show a different effect for endogenous and exogenous attention? We applied a cued (valid vs invalid) conjunction search task, and ECG and respiration recordings were used to compute sympathetic (normalized low frequency power) and parasympathetic tone (respiratory sinus arrhythmia, RSA). Behavioural results showed a dual effect of time-on-task: the usually described vigilance decrement, expressed as increased reaction times (RTs) after 30 min for both conditions; and a higher cost in RTs after invalid cues for the endogenous condition only, appearing after 60 min. Physiological results clearly support the underload hypothesis to subtend the vigilance decrement, since heart period and RSA increased over time-on-task. There was no physiological difference between the endogenous and exogenous conditions. Subjective experience of participants was more compatible with boredom than with high mental effort.

PMID: 17999934 [PubMed - as supplied by publisher]

Wednesday, November 14, 2007

News About Ion Channels

A press release from the NIH:

Scientists Zero in on the Cellular Machinery that Enables Neurons to Fire

If you ever had a set of Micronauts — toy robots with removable body parts — you probably had fun swapping their heads, imagining how it would affect their behavior. Scientists supported by the National Institutes of Health have been performing similar experiments on ion channels — pores in our nerve cells — to sort out the channels' key functional parts.

In the November 15 issue of Nature, one group of researchers shows that a part of ion channels called the paddle is uniquely transplantable between different channels. Writing in the same issue, another group exploited this property to probe the three-dimensional structure of ion channels on an atomic scale.

"The effects of many toxins and therapeutic drugs, as well as some diseases, can be wholly explained by changes in ion channel function," says Story Landis, Ph.D., director of the National Institute of Neurological Disorders and Stroke (NINDS), part of the NIH. "We also know that ion channels are at least a contributing player in epilepsy, chronic pain, Parkinson's disease and other disorders. As we learn more about how channels work, we're able to pursue more approaches to treatment."

Ion channels are proteins that control the flow of electrically charged salt particles (ions) across the nerve cell membrane. It's the opening and closing of these channels that enables nerve cells to fire off bursts of electrical activity. A built-in voltmeter, called a voltage sensor, pops the channel open when the nerve cell is ready to fire. The papers in Nature hone in on a part of the voltage sensor called the paddle, named for its shape.

In the first study, a team led by NINDS senior investigator Kenton Swartz, Ph.D., shows that the paddle works as a modular unit. Using recombinant DNA technology, they swapped the paddle from an ion channel found in an ancient, volcano-dwelling bacterium to a channel found in rat brain. As long as the paddle was intact, the hybrid channel still worked. This portability could one day be exploited to test potential drugs. For example, researchers who want to target a paddle from a poorly characterized ion channel could stick it into a well-studied channel where the effects of drugs are easier to measure.

Other results in the paper suggest that the paddle itself will be a useful target for new therapeutic drugs. Dr. Swartz's group found that the paddle is the docking site for certain toxins in tarantula venom, which are known to interfere with ion channel opening. There are hints that scorpions, sea anemones and cone snails make similar toxins, Dr. Swartz said. If nature has found ways to manipulate ion channel function, medicinal chemists might be able to do the same, he said.

In the second study, supported by the National Institute of General Medical Sciences (NIGMS), researchers took advantage of the paddle's unique transplantability to create a hybrid ion channel ideal for structural studies. Led by Roderick MacKinnon, M.D. — a Nobel Laureate, an investigator of the Howard Hughes Medical Institute and a biophysicist at Rockefeller University in New York — the team produced data that explain how the voltage sensor is positioned within the membrane and how it triggers channel opening.

"The determination of the three-dimensional structures of ion channels has yielded a framework to understand their fascinating functional properties," says NIGMS director Jeremy M. Berg, Ph.D. "These new results show how clever experimental designs can focus on key questions and steer the direction of additional studies."

NINDS and NIGMS are components of the National Institutes of Health (NIH). NINDS (www.ninds.nih.gov) is the nation’s primary supporter of biomedical research on the brain and nervous system. NIGMS (http://www.nigms.nih.gov) supports basic biomedical research that is the foundation for advances in disease diagnosis, treatment and prevention.

The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

References:

Alabi AA, Bahamonde MI, Jung HJ, Kim JI, Swartz KJ. "Portability of Paddle Motif Function and Pharmacology in Voltage Sensors." Nature, November 15, 2007.

Long SB, Tao X, Campbell EB, MacKinnon R. "Atomic Structure of a Kv Channel in a Lipid Membrane-Like Environment." Nature, November 15, 2007.

Tuesday, November 13, 2007

Brainy Non-Brain Event: Joe Strummer: The Future is Unwritten

Julien Temple's new documentary about Joe Strummer, The Future is Unwritten, opened a couple of weeks ago at the IFC off 4th Street in Manhattan. An excellent movie about an extraordinary musician! Check it out when it comes to your city.

Neuropsychology Abstract of the Day: Schizophrenia

Barrera A, McKenna PJ, & Berrios GE. Two new scales of formal thought disorder in schizophrenia. Psychiatry Research. 2007 Nov 6; [Epub ahead of print]

Warneford Hospital, Oxford, OX3 7JX, UK.

Information provided by patients and respective carers may help to understand formal thought disorder (FTD) in schizophrenia. Two scales, one for patients (FTD-patient) and one for carers (FTD-carer), were constructed to assess pragmatics, cognitive, paralinguistic, and non-verbal aspects of communication. In the first scale the patients themselves assess their verbal communication; in the second scale the carer assesses the speech of the respective patient. Both scales exhibited internal reliability and evidence of good test-retest reliability. Higher total scores on both scales (FTD-patient and FTD-carer) were significantly associated with positive FTD, but not with negative FTD. Principal component analysis of the scales yielded a multidimensional structure. It is suggested that FTD in schizophrenia may be associated with a range of deficits (e.g. pragmatics, lexical activation, working memory, sustained attention). These scales, in conjunction with the clinician's assessment, can provide a more comprehensive picture of FTD in schizophrenia, revealing its dimensions and making it possible to establish associations between symptoms of FTD and neuropsychological, neurophysiologic, and neuroimaging data. In addition, they provide service users' and carers' perspectives for the assessment of communication in schizophrenia.

PMID: 17997165 [PubMed - as supplied by publisher]

Brain MRI Tessellation

From the excellent blog, MedGadgets, a post about MRI dynamic computer modelling for neurosurgical interventions: link.

Monday, November 12, 2007

Swarm Intelligence: Ants and the Collective Mind

Carl Zimmer has a piece in tomorrow's New York Times about swarm intelligence. Read Carl's blog The Loom at this link.


From Ants to People, an Instinct to Swarm
Carl Zimmer
13 November 2007
The New York Times

If you have ever observed ants marching in and out of a nest, you might have been reminded of a highway buzzing with traffic. To Iain D. Couzin, such a comparison is a cruel insult — to the ants.

Americans spend a 3.7 billion hours a year in congested traffic. But you will never see ants stuck in gridlock.

Army ants, which Dr. Couzin has spent much time observing in Panama, are particularly good at moving in swarms. If they have to travel over a depression in the ground, they erect bridges so that they can proceed as quickly as possible.

“They build the bridges with their living bodies,” said Dr. Couzin, a mathematical biologist at Princeton University and the University of Oxford. “They build them up if they’re required, and they dissolve if they’re not being used.”

The reason may be that the ants have had a lot more time to adapt to living in big groups. “We haven’t evolved in the societies we currently live in,” Dr. Couzin said.

[ ... Read the full article ... ]

Neuropsychology Abstract of the Day: Deep Brain Stimulation (DBS)

This looks like an interesting article that I've added to my list of pubs to read:

Schiff ND & Fins JJ. Deep brain stimulation and cognition: moving from animal to patient. Current Opinions in Neurology. 2007 Dec; 20(6): 638-642.

Department of Neurology and Neuroscience, Weill Medical College of Cornell University, New York, New York, USA.

PURPOSE OF REVIEW: Brain electrical stimulation has been proposed as a strategy to improve chronically impaired cognitive function. This brief review places a small number of recent studies into a broader historical context and identifies important challenges for further development of this area of research. RECENT FINDINGS: Behavioral improvements following severe brain injury with central thalamic deep brain stimulation were observed in experimental studies conducted in rodents and a report on a single human. These findings suggest that this technique warrants further study as a method to modulate cognitive function in the setting of acquired brain injury. SUMMARY: This area of research offers the promise of new avenues to engage patients with nonprogressive brain injuries who, at present, have rather limited therapeutic options. These efforts, however, will require careful attention to issues of research and clinical ethics and study design.

PMID: 17992082 [PubMed - in process]

Thursday, November 08, 2007

The Game Brain

An excellent op-ed piece in today's New York Times about the value of exercise - of the physical variety - in mental gymnastics. A Risser suggestion to supplement the intent of the opinion writers: get out there and walk around, but take a camera with you - not only do you get the physical exercise, but you challenge yourself cognitively (and may well get some framable results!)

Exercise on the Brain
By SANDRA AAMODT and SAM WANG
Published: November 8, 2007

[snip]

How might exercise help the brain? In people, fitness training slows the age-related shrinkage of the frontal cortex, which is important for executive function. In rodents, exercise increases the number of capillaries in the brain, which should improve blood flow, and therefore the availability of energy, to neurons. Exercise may also help the brain by improving cardiovascular health, preventing heart attacks and strokes that can cause brain damage. Finally, exercise causes the release of growth factors, proteins that increase the number of connections between neurons, and the birth of neurons in the hippocampus, a brain region important for memory. Any of these effects might improve cognitive performance, though it’s not known which ones are most important.

[snip]

[ ... Read the full piece ... ]

Thursday, October 18, 2007

Upcoming Event: 27 November 2007, NYC

If you are a student of clinical neuropsychology at either an undergraduate or graduate level and live in the New York region but do not know very much about Arthur Benton and his contributions to this field of our's, you owe it to yourself to consider attending this talk in late November!


The New York Neuropsychology Group Presents
The Arthur L. Benton Annual Lecture


Pioneers of Neuropsychology: An Insider's Guide to Arthur Benton

Kerry Hamsher, Ph.D., ABPP-CN

Tuesday, November 27, 2007
7 - 8 PM
Refreshments to Follow

FREE for NYNG Members
$10 for Non NYNG Members
FREE FOR ALL STUDENTS!

Stony Brook Manhattan
110 East 28th Street
(Between Park Ave South & Lexington Ave)
New York, NY

This year, the Annual New York Neuropsychology Group's Distinguished Speaker series is renamed in honor of the late Dr. Arthur L. Benton, a giant in the field of neuropsychology. Dr. Benton was the first speaker in this annual lecture series when it was initiated in 1986. We are pleased that this year's lecture will be "An Insider's Guide to Arthur Benton," presented by Dr. Kerry Hamsher, a friend and colleague of Dr. Benton, and an influential neuropsychologist in his own right.

Dr. Hamsher writes,

"Arthur Benton was a scientist, a scholar, a clinician, and a professional with each of these roles informing the others. To make the best use of his place in the history of neuropsychology, he should be recognized not only for his contributions, but also for how he went about the things he chose to do. In this presentation, we will take a short journey following some of Dr. Benton's intellectual pursuits, with the goal of identifying values worthy of preservation that benefit the science and profession of neuropsychology."

We hope you will join us for this special occasion.

The Arthur L. Benton Annual Lecture is a joint meeting with the Psychology Section of the New York Academy of Sciences

Co-Sponsored by Stony Brook University

Further information at www.nyng.org

Tuesday, October 16, 2007

Alzheimer's Disease (AD): Conscientiousness

From the Newsweek website:

Make Your Bed, Save Your Brain
The author of a new study says conscientious people may have less risk of developing Alzheimer's disease.
By Karen Springen | Newsweek Web Exclusive
Oct 1, 2007 | Updated: 12:46 p.m. ET Oct 2, 2007

An interview with neuropsychologist Robert Wilson about a recent study he and colleagues completed:

[snip]

A new study, appearing this month in the Archives of General Psychiatry, suggests that being conscientious—hardworking, goal-oriented, dependable—may lower the risk of developing Alzheimer's. Researchers studied 997 older Catholic priests, nuns and monks (average age: 75) who did not have dementia when the study began in 1994. The subjects rated themselves on a "conscientiousness scale," responding to such questions as "I am a productive person who always gets the job done." Over the 12 years of the study, 176 participants developed Alzheimer's, and they tended to be individuals who were less conscientious.

[snip]

[ ... Read the interview ... ]

Monday, October 15, 2007

Alzheimer's Disease (AD) in African-American Elderly

From today's Houston Chronicle:

Harris County hopes blacks will seek help for Alzheimer's
Studies suggest more suffer brain disease than whites, but it is often unreported
By LESLIE CASIMIR
Oct. 15, 2007, 12:22AM
Copyright 2007 Houston Chronicle

[snip]

Officials from the Harris County Area Agency on Aging hope to highlight this issue and stop the cycle of denial and silence. Last week, health officials released The Book of Alzheimer's for African-American Churches, which explains Alzheimer's and the crisis enveloping the community.

About 20,000 copies will be distributed in the Houston area, county officials said. The book is filled with local voices that explain the basic facts of the disease. It also offers practical advice on how loved ones should help the afflicted and seek outside support. County officials say they hope that worshippers will trust and embrace the information.

"African-Americans appear less likely to request help and use community resources than caregivers in the other groups," said Dr. Victor Narcisse, a local gerontologist who is featured in the book and has conducted research on this form of dementia among blacks. "There is a tendency to take care of things, which is fine, but it is very difficult to take care of a person with Alzheimer's disease."

[snip]

[ ... Read the full article ... ]

Sunday, October 14, 2007

Neuropsychology Abstract of the Day: Agitation in Alzheimer's Disease (AD)

Howard RJ, Juszczak E, Ballard CG, Bentham P, Brown RG, Bullock R, Burns AS, Holmes C, Jacoby R, Johnson T, Knapp M, Lindesay J, O'Brien JT, Wilcock G, Katona C, Jones RW, DeCesare J, Rodger M; CALM-AD Trial Group. Donepezil for the treatment of agitation in Alzheimer's disease. New England Journal of Medicine. 2007 Oct 4; 357(14): 1382-1392.

Medical Research Council Neurogeneration Research Centre, Institute of Psychiatry, King's College London, London, United Kingdom.

BACKGROUND: Agitation is a common and distressing symptom in patients with Alzheimer's disease. Cholinesterase inhibitors improve cognitive outcomes in such patients, but the benefits of these drugs for behavioral disturbances are unclear. METHODS: We randomly assigned 272 patients with Alzheimer's disease who had clinically significant agitation and no response to a brief psychosocial treatment program to receive 10 mg of donepezil per day (128 patients) or placebo (131 patients) for 12 weeks. The primary outcome was a change in the score on the Cohen-Mansfield Agitation Inventory (CMAI) (on a scale of 29 to 203, with higher scores indicating more agitation) at 12 weeks. RESULTS: There was no significant difference between the effects of donepezil and those of placebo on the basis of the change in CMAI scores from baseline to 12 weeks (estimated mean difference in change [the value for donepezil minus that for placebo], -0.06; 95% confidence interval [CI], -4.35 to 4.22). Twenty-two of 108 patients (20.4%) in the placebo group and 22 of 113 (19.5%) in the donepezil group had a reduction of 30% or greater in the CMAI score (the value for donepezil minus that for placebo, -0.9 percentage point; 95% CI, -11.4 to 9.6). There were also no significant differences between the placebo and donepezil groups in scores for the Neuropsychiatric Inventory, the Neuropsychiatric Inventory Caregiver Distress Scale, or the Clinician's Global Impression of Change. CONCLUSIONS: In this 12-week trial, donepezil was not more effective than placebo in treating agitation in patients with Alzheimer's disease. (ClinicalTrials.gov number, NCT00142324 [ClinicalTrials.gov].). Copyright 2007 Massachusetts Medical Society.

PMID: 17914039 [PubMed - indexed for MEDLINE]

Comment in: New England Journal of Medicine. 2007 Oct 4; 357(14): 1441-1443.

Saturday, October 13, 2007

Neuropsychology Abstract of the Day: Aphasia and the Assessment of Depression

Townend E, Brady M, McLaughlan K. A Systematic Evaluation of the Adaptation of Depression Diagnostic Methods for Stroke Survivors Who Have Aphasia. Stroke. 2007 Oct 11; [Epub ahead of print]

From the NMAHP Research Unit, Buchannan House, Glasgow Caledonian University, UK; and the NHS Grampian, Department of Speech and Language Therapy, Spynie Hospital, Morayshire, UK.

BACKGROUND AND PURPOSE: One in 3 stroke survivors has aphasia (impaired language comprehension and expressive abilities). Conventionally, depression diagnosis uses language-based methods. We aimed to systematically review methods that have been used to diagnose depression and adaptations to these methods intended for people with aphasia. METHODS: We systematically reviewed stroke studies (to January 2006) that included a depression diagnosis and individuals with aphasia. We extracted data related to depression diagnostic methods used for individuals with/without aphasia. We sought clarification from authors when required. RESULTS: A total of 60 studies included people with aphasia. Almost half the studies (29/60; 48%) adapted their main depression diagnostic method (most typically a clinical interview and published criteria) for individuals with aphasia. Adaptive methods included: using informants (relatives or staff), clinical observation, modifying questions and visual analogue scales. Evidence of the validity or reliability of these adaptations was rarely reported. However, use of informants or clinical observation did achieve the inclusion of most people with aphasia in the diagnosis of depression. Remaining studies, that did not report adaptive methods, suggested that conventional language-based methods are suitable for individuals with only 'mild' aphasia. CONCLUSIONS: People with aphasia can be and have been included in depression diagnostic assessments. However, we suggest that depression and language experts collaborate to develop a more valid method of depression diagnosis for patients with aphasia that has good reliability.

PMID: 17932334 [PubMed - as supplied by publisher]

Monday, October 08, 2007

Neuroimaging and Vegetative States in The New Yorker

Silent Minds
What scanning techniques are revealing about vegetative patients.
by Jerome Groopman
15 October 2007
The New Yorker

[ ... Read the piece ... ]

Nobel Knockout!

From the Nobel Assemble press release:

The Nobel Assembly at Karolinska Institutet has today decided to award The Nobel Prize in Physiology or Medicine for 2007 jointly to

Mario R. Capecchi, Martin J. Evans and Oliver Smithies

for their discoveries of "principles for introducing specific gene modifications in mice by the use of embryonic stem cells"


Summary

This year's Nobel Laureates have made a series of ground-breaking discoveries concerning embryonic stem cells and DNA recombination in mammals. Their discoveries led to the creation of an immensely powerful technology referred to as gene targeting in mice. It is now being applied to virtually all areas of biomedicine – from basic research to the development of new therapies.

Gene targeting is often used to inactivate single genes. Such gene "knockout" experiments have elucidated the roles of numerous genes in embryonic development, adult physiology, aging and disease. To date, more than ten thousand mouse genes (approximately half of the genes in the mammalian genome) have been knocked out. Ongoing international efforts will make "knockout mice" for all genes available within the near future.

With gene targeting it is now possible to produce almost any type of DNA modification in the mouse genome, allowing scientists to establish the roles of individual genes in health and disease. Gene targeting has already produced more than five hundred different mouse models of human disorders, including cardiovascular and neuro-degenerative diseases, diabetes and cancer.

[ ... Read the full release ... ]

Wednesday, October 03, 2007

Upcoming Event: 30 November - 05 December, Philadelphia

The 61st annual meeting of the American Epilepsy Society (AES) will take place in Philadelphia, from the 30th of November through the 5th of December.

Details about the meeting can be found on the meeting webpage of the AES website.

Sunday, September 30, 2007

Alzheimer's: Sarah Polley's Movie Away From Her - Directors Guild of Canada Award

Sarah Polley's movie won a Canadian film award this weekend:

From the CBC:

Polley's film big winner at Director's Guild Awards
Last Updated: Sunday, September 30, 2007 | 9:38 AM ET
The Canadian Press

Sarah Polley's poignant Away From Her was the big winner at the 2007 Directors Guild of Canada Awards on Saturday.

The film was honoured as best picture, and Polley was named best director; her husband, David Wharnsby, won the prize for best picture editing.

The critically acclaimed movie chronicles the intrusion of Alzheimer's disease into the lives of an aging couple, played by Gordon Pinsent and Julie Christie.

[ ... Read the full article ... ]

Read my earlier post about this movie here.

Friday, September 28, 2007

60-Second Psych and 60-Second Lectures

Scientific American has created a courtesy weekly podcast to highlight research about the brain and behavior.

The podcast can be accessed at this webpage: Scientific American webpage.

Not a bad way to spend a minute! Which, by the way, reminds me to mention that if you are in Philadelphia, the University of Pennsylvania still has several of its outdoors 60-second lectures remaining over the next few weeks, which are always fun to attend!

Office of Inspector General Report on FDA Oversight of Clinical Trials

Available in a .pdf document from the "What's New" page of the OIG website here: Link for OIG webpage.

Thursday, September 27, 2007

Donald Stein's Research: Recovery from Traumatic Brain Injury (TBI)

Yesterday's Wall Street Journal ran a feature article about neuroscientist Donald Stein and his career exploring facets of recovery from traumatic brain injury (TBI):

One Doctor's Lonely Quest To Heal Brain Injury
After 40 Years, Skeptics Back Hormone Therapy; Experiments in a Trailer
By THOMAS M. BURTON
September 26, 2007; Page A1

[snip]

Dr. Stein still wanted to figure out why those brain-injured rats seemed to recover. But he says he concluded that he wouldn't win tenure if he pursued the question.

In 1966, with a wife and young child to support, he left MIT to take a job as a psychology professor and director of the brain-research lab at Clark University in Worcester, Mass.

His growing interest in the possibility of recovery from brain injury put him in a tiny minority. Most neurologists at the time still agreed with Nobel laureate Santiago Ramón y Cajal, who wrote in 1913, "In the adult brain, nervous pathways are fixed and immutable. Everything may die, nothing may be regenerated."

Starting in the late 1960s, Dr. Stein began publishing research that suggested the Nobel winner was wrong.

His lab began methodically studying precisely why some rats stayed smart despite injury. The researchers would place rats in a large vat of water. The rats had to swim to reach a safe platform in a test called a "water maze." Then the scientists surgically damaged the animals' brains to study what happened after injury: Would they still be able to maneuver through the maze? The rats that recovered quickly were all female, although not all of the females recovered.

Dr. Stein considered whether the explanation might be something complex, like molecular or genetic differences between males and females. But investigating that would take much more time and money than seeing if a female hormone might yield some clues. First his team evaluated estrogen, but didn't find a major correlation. Then they tried progesterone -- a female hormone that helps protect fetuses from injury during pregnancy.

In these early experiments, Dr. Stein tested female rats to see if they would recover better or worse at different times during their hormonal cycles that resemble human menstruation. Progesterone levels rise and fall during these cycles, and these early studies did indeed show that female rats that were high in progesterone recovered faster.

Dr. Stein thought he had a big part of the answer to the question that had been vexing him for years. The medical establishment, however, largely shrugged off the results.

[snip]

[ ... Read the article ... ]

Neurodegenerative Diseases: Progranulin (PGRN) Mutation and TDP-43

From a National Institutes of Health (NIH) press release on the 26th:

Scientists Suggest New Pathway Causing Cell Death in Dementia

Scientists have discovered a link between a mutated gene and a protein found in dead brain cells of people who suffer from a form of dementia and other neurological disorders. The finding, reported in the Sep. 26, 2007, issue of the Journal of Neuroscience, demonstrates for the first time a pathological pathway that ultimately results in cell death related to frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig's disease). The discovery could eventually play a role in the design of new drug therapies. The study was funded by the National Institute on Aging (NIA) at the National Institutes of Health (NIH).

Leonard Petrucelli, Ph.D., and Dennis W. Dickson, M.D, of the Mayo Clinic in Jacksonville, Fla., led the international team of scientists in the study supported by the Mayo Clinic Foundation.

The study, in cell cultures, showed that a cell death pathway is involved. A cascade of events begins with a mutation in the gene progranulin (PGRN) located on chromosome 17. Normally, high levels of PGRN exist in a cell to promote cell growth and survival. But when progranulin gene mutations occur, low levels of PGRN result. The investigators showed that this causes a protein called TDP-43 to be cut into two fragments. These fragments then migrate from their usual location in the nucleus into the surrounding cytoplasm of the cell where they form inclusions, or insoluble clumps of protein. This abnormal process results in the neurodegeneration in people with FTD and ALS.

"This research defines a novel disease mechanism that may be important in a number of age-related neurological diseases," said Marcelle Morrison-Bogorad, Ph.D., Director of the Neuroscience and Neuropsychology Program at the NIA. "It opens a window on possible future applications, from approaches to novel therapeutic targets to the continued exploration of cell survival systems."

[ ... Read the full press release ... ]

Wednesday, September 26, 2007

Neuropsychology Abstract of the Day: Alzheimer's Disease (AD), fMRI, and Cognition

Diamond EL, Miller S, Dickerson BC, Atri A, Depeau K, Fenstermacher E, Pihlajamäki M, Celone K, Salisbury S, Gregas M, Rentz D, & Sperling RA. Relationship of fMRI activation to clinical trial memory measures in Alzheimer disease. Neurology. 2007 Sep 25; 69(13): 1331-1341.

Memory Disorders Unit, Brigham and Women’s Hospital, 221 Longwood Ave, Boston, MA 02115

BACKGROUND: Functional MRI (fMRI) has shown promise as a tool to characterize altered brain function in Alzheimer disease (AD) and for use in proof of concept clinical trials. FMRI studies of subjects with AD have demonstrated altered hippocampal and neocortical activation while encoding novel stimuli compared to older controls. However, the relationship between fMRI activation and performance on standardized clinical trial memory measures has not been fully investigated. OBJECTIVE: To determine whether patterns of activation during an associative-memory fMRI paradigm correlate with performance on memory measures used in AD clinical trials. METHODS: Twenty-nine subjects with AD underwent neuropsychological testing, including the AD Assessment Scale (ADAS-Cog), and an associative-encoding fMRI paradigm. Scores were entered as regressors in SPM2 analyses of the differential fMRI activation to novel-vs-repeated (NvR) stimuli. To account for cerebral atrophy, native-space structure-function analyses were performed with subjects' high-resolution structural images. RESULTS: Performance on the ADAS-Cog verbal memory component, and the ADAS-Cog total score, correlated with NvR activation in left superior temporal (p = 0.0003; r = -0.51) and left prefrontal (p = 0.00001; r = -0.63) cortices. In a subgroup with more extensive neuropsychological testing (n = 14), performance on the Free and Cued Selective Reminding Test was correlated with activation in these same regions. fMRI activation remained correlated with performance even when accounting for atrophy. CONCLUSIONS: The relationship between functional MRI (fMRI) activation and standardized memory measures supports the potential use of fMRI to investigate regional mechanisms of treatment response in clinical trials of novel therapies for Alzheimer disease. GLOSSARY: AD = Alzheimer disease; ADAS-Cog = AD Assessment Scale; EPI = echoplanar imaging sequence; FA = flip angle; FCSRT = Free and Cued Selective Reminding Test; FLAME = FMRIB's Local Analysis of Mixed Effects; fMRI = Functional MRI; FOV = field of view; GLM = general linear model; HRF = hemodynamic response function; LFG = left fusiform gyrus; LPFC = left prefrontal cortex; LSTG = left superior temporal gyrus; MMSE = Mini-Mental State Examination; MTL = medial temporal lobe; NvR = novel-vs-repeated; ROI = region of interest; TE = echo time; TR = repetition time.

PMID: 17893294 [PubMed - as supplied by publisher]

Tuesday, September 25, 2007

MacArthur Fellows: Yoky Matsuoka, A Neurorobotics Expert, Becomes One

Congratulations to Yoky Matsuoka for becoming a MacArthur Fellow. She is an Associate Professor in the Department of Computer Science and Engineering at the University of Washington, Seattle.

Read about her work in rehabilitation neurorobotics.

Saturday, September 22, 2007

Alzheimer's: Sarah Polley's Movie, Away From Her


From Australia's National Nine News:

Alzheimer's struggle brought to screen
Friday Sep 21 08:19 AEST

At just 28 years of age, Canadian director Sarah Polley has made a debut feature film that directors twice her age and experience would be proud of.

Also a talented actress, she is best known to Australian audiences for her acting roles as a supermarket checkout chick in the 1999 crime thriller Go and a schoolgirl in Atom Egoyan's The Sweet Hereafter.

For her directorial debut, Away From Her, Polley chose to tell the story of a couple in their 60s who are dealing with Alzheimer's disease.

It is hardly a film you would expect a 20-something film-maker to produce.

The fact that she convinced Oscar winners Julie Christie and Olympia Dukakis to be part of the movie is even more impressive.

"During rehearsals, all of a sudden it dawned on me that I was directing people who were twice my age, and who had a good deal more experience than I did, and who were actors that I have grown up in awe of," Polley told AAP from her home in Toronto.

"I think when you're trying to make a film it's such a struggle to get everything together, and get the financing, that you don't really believe it's going to happen.

"So to all of a sudden get these people in a room was actually a little bit of a shock."

Not that it all came together easily.

From the start Polley pictured Christie, Dukakis, and Gordon Pinsent in the main roles, but getting them to play those parts took some convincing.

"In the case of Julie it was hard," Polley said.

"I wrote the part for her, and I was friends with her, but I knew that it was going to be an uphill battle to get her - she's just not somebody who rushes into acting jobs.

"It took about eight months of phone calls, emails and listening to her concerns, and in the end she did it, which was great because I really couldn't have imagined anyone else playing the part."

The film is based on a short story by Alice Munro called The Bear Came Over the Mountain, about a man coming to terms with the institutionalisation of his Alzheimer's-affected wife, and how he copes when she transfers her affections to another man.

Polley fell in love with the story and wrote the screenplay herself.

"I think what really drew me to the short story was that it was incredibly romantic, but not at all in an idealistic way," she says.

"It was completely grounded in reality and all its complications and nightmares, but there's some kind of intangible thread that remains between these two people, despite how many times they may have betrayed each other, or felt abandoned by each other.

"That to me rang true, and it spoke to a kind of marriage that I think doesn't get that much air time."

Polley spent months researching Alzheimer's disease, talking to doctors and families who had dealt with it in order to present an accurate depiction of the condition.

"The thing is every Alzheimer's case is totally different," she says.

"So there are some people who feel like this is a moment by moment description of what they went through with their mother or their wife, but there are other people it feels completely wrong to because that wasn't their experience."

The film was selected for the Toronto and Sundance film festivals and has sparked rumours of an Oscar nomination for Christie.

The sensitive treatment of the subject, the subtlety of the script and the assuredness of the direction have not been missed by critics who have heaped praise on Polley, and named her a director to watch.

"I'm very flattered by it," says Polley, clearly uncomfortable with the hype.

"But in a way I felt like it wasn't a great mystery how to tell this story.

"So I'm happy people feel that way, but I sort of feel it's the film anybody would have made if they'd made a film of the story."

Toronto-based Polley says she has no intention to move to the US to further her career, and is happy living and working in Canada.

With its snow-covered scenery set to a Neil Young soundtrack, Away From Her is a noticeably Canadian film. But Polley says that wasn't a deliberate move.

"I didn't place a great emphasis on making sure that it felt Canadian, but I did put a big emphasis on making sure I wasn't avoiding it seeming Canadian," she said.

"I think there has been a really big push to make our films seem less and less Canadian for the last few years."

She says the Australian and Canadian film industries are struggling with the same issues in that respect.

"Australia and Canada have an enormous amount in common from what I can tell," Polley says.

"(Both) have very distinct cultural identity and yet feeling somewhat colonised - obviously historically by the English, and then culturally by the Americans.

"At first I think both Canada and Australia were famous for making more sort of artistic films, and then we both went through this phase of commercialisation where all our movies were for export, and then there was this real push to try to make our movies more American.

"It seems to me that we're both slowly edging our way back to what we're really good at."

Away From Her opens on October 4.

National Nine News

Thursday, September 20, 2007

Amnesia in The New Yorker

From the current issue of The New Yorker:

The Abyss
Music and amnesia
by Oliver Sacks
September 24, 2007

The experience of Clive Wearing and his spouse, Deborah.


[ ... Read the article ... ]

Wednesday, September 19, 2007

Neuropsychology Abstract of the Day: Aphasia

van de Sandt-Koenderman WM, Wiegers J, Wielaert SM, Duivenvoorden HJ, & Ribbers GM. A computerised communication aid in severe aphasia: An exploratory study. Disability and Rehabilitation. 2007 Apr 30;:1-9 [Epub ahead of print].

Rijndam Rehabilitation Center, Rotterdam.

Purpose. To investigate the efficacy of TouchSpeak (TS), a handheld computerised communication aid for aphasia. Method. A pre-post one-group design was used with a referred sample of 34 patients with a severe aphasia and a need for alternative and augmentative communication (AAC). The participants were trained to use TS in two self-chosen communicative situations. The ability to navigate the hierarchical vocabulary and overall communicative ability were assessed. Participants rated their communicative success with and without TS. Three years after completion of the training, participants were interviewed about their present use of TS. Results. In total, 76% used TS outside the clinic in two trained communicative situations. Overall communicative ability improved, as tested in untrained scenarios. Quality of communication with TS was rated higher than without TS. Fifty per cent obtained their own TS after the training and after 3 years 6% still used TS. Conclusions. Aphasic communication can be supported effectively by TS. Patients with a severe aphasia are able to master a hierarchical computerised vocabulary and to use it in daily life for specific communicative situations. In addition, TS may also have a generalised effect on overall communicative ability. For most patients, the supportive role of TS is temporary.

PMID: 17852317 [PubMed - as supplied by publisher]

Friday, September 07, 2007

Starting Work on My New Book

This weekend I crack open the files on my next book and begin work on it, which I plan to complete by the end of 2008. This will be a weekend and vacation-time effort, which is the only way I can fit it in.

I've co-authored three academic books in the past and written a number of general-readership articles, but this will be my first venture into a book-length work written for a more general audience. The closest I've come to this in the past was a monograph (monograph:book as novella: novel) on magnetic resonance imaging (MRI) waaaay back in 1984, so I'm looking forward to the task!

The topic is on my area of expertise: the neuropsychological assessment of persons and what we can learn from these tests about the brain-behavior functioning of individuals.

Thursday, September 06, 2007

Neuropsychology Abstract of the Day: Speech and the Cerebellum

Ackermann H, Mathiak K, & Riecker A. The contribution of the cerebellum to speech production and speech perception: Clinical and functional imaging data. Cerebellum. 2007; 6(3): 202-13.

Department of General Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen.

A classical tenet of clinical neurology proposes that cerebellar disorders may give rise to speech motor disorders (ataxic dysarthria), but spare perceptual and cognitive aspects of verbal communication. During the past two decades, however, a variety of higher-order deficits of speech production, e.g., more or less exclusive agrammatism, amnesic or transcortical motor aphasia, have been noted in patients with vascular cerebellar lesions, and transient mutism following resection of posterior fossa tumors in children may develop into similar constellations. Perfusion studies provided evidence for cerebello-cerebral diaschisis as a possible pathomechanism in these instances. Tight functional connectivity between the language-dominant frontal lobe and the contralateral cerebellar hemisphere represents a prerequisite of such long-distance effects. Recent functional imaging data point at a contribution of the right cerebellar hemisphere, concomitant with language-dominant dorsolateral and medial frontal areas, to the temporal organization of a prearticulatory verbal code ('inner speech'), in terms of the sequencing of syllable strings at a speaker's habitual speech rate. Besides motor control, this network also appears to be engaged in executive functions, e.g., subvocal rehearsal mechanisms of verbal working memory, and seems to be recruited during distinct speech perception tasks. Taken together, thus, a prearticulatory verbal code bound to reciprocal right cerebellar/left frontal interactions might represent a common platform for a variety of cerebellar engagements in cognitive functions. The distinct computational operation provided by cerebellar structures within this framework appears to be the concatenation of syllable strings into coarticulated sequences.

PMID: 17786816 [PubMed - in process]

Wednesday, September 05, 2007

Neuropsychology Abstract of the Day: Cognitive Function in Pediatric Neuro-oncology

Nathan PC, Patel SK, Dilley K, Goldsby R, Harvey J, Jacobsen C, Kadan-Lottick N, McKinley K, Millham AK, Moore I, Okcu MF, Woodman CL, Brouwers P, Armstrong FD; Children's Oncology Group Long-term Follow-up Guidelines Task Force on Neurocognitive/Behavioral Complications After Childhood Cancer. Guidelines for identification of, advocacy for, and intervention in neurocognitive problems in survivors of childhood cancer: A report from the Children's Oncology Group. Archives of Pediatric and Adolescent Medicine. 2007 Aug; 161(8): 798-806.

Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada.

With modern therapies and supportive care, survival of childhood cancer has increased considerably. Patients who have survived cancers involving the central nervous system or who have received therapy toxic to the developing brain are at risk of long-term neurocognitive sequelae. Negative outcomes are observed most frequently in survivors of acute lymphoblastic leukemia and brain tumors. The Children's Oncology Group Long-term Follow-up Guidelines Task Force on Neurocognitive/Behavioral Complications After Childhood Cancer has generated risk-based, exposure-related guidelines designed to direct the follow-up care of survivors of pediatric malignancies based on a comprehensive literature review and expert opinion. This article expands on these guidelines by reviewing the risk factors for the development of neurocognitive sequelae and describing the expected pattern of these disabilities. We herein present recommendations for the screening and management of neurocognitive late effects and outline important areas of school and legal advocacy for survivors with disabilities. Finally, we list resources that can guide patients, their parents, and their medical caregivers as they face the long-term neurocognitive consequences of cancer therapy.
PMID: 17679663 [PubMed - indexed for MEDLINE]

The Healthy Brain Initiative: Promoting Cognitive Health

The Healthy Brain Initiative website.

From the website:

[snip]

"The lack of cognitive health – from mild cognitive decline to dementia—can have profound implications for an individual’s health and well-being. Older adults and others experiencing cognitive decline may be unable to care for themselves or to conduct necessary activities of daily living, such as meal preparation and money management. Limitations in the ability to effectively manage medications and existing medical conditions are of particular concern when an individual is experiencing cognitive decline or dementia. If cognitive decline could be prevented or better treated, lives of many older adults could be improved.

"Opportunities for maintaining cognitive health are growing as public health professionals gain a better understanding of risk factors for cognitive decline. The public health community should embrace cognitive health as a priority, invest in its promotion, and enhance our ability to move scientific discoveries rapidly into public health practice."

[snip]

Tuesday, September 04, 2007

Happy Third Anniversary to Me!

BrainBlog turns three years old today.

Neuropsychology Abstract of the Day: Chronic Congestive Heart Failure and Neuropsychological Function

Vogels RL, Oosterman JM, van Harten B, Scheltens P, van der Flier WM, Schroeder-Tanka JM, & Weinstein HC. Profile of Cognitive Impairment in Chronic Heart Failure. Journal of the American Geriatrics Society. 2007 Aug 28; [Epub ahead of print].

Department of Neurology, Sint Lucas-Andreas Hospital, Amsterdam, The Netherlands.

OBJECTIVES: To determine the frequency and pattern of cognitive dysfunction in outpatients with chronic congestive heart failure (CHF) and to identify the corresponding demographic and clinical correlates. DESIGN: Case-control study. SETTING: Outpatient clinic in a community hospital. PARTICIPANTS: Sixty-two outpatients with CHF, 53 controls diagnosed with cardiovascular disease uncomplicated by CHF (cardiac controls), and 42 healthy controls were investigated. MEASUREMENTS: Neuropsychological assessment included tests of mental speed, executive function, memory, language, and visuospatial function. Composite z-scores for five cognitive domains and mean z-score for overall cognitive performance were computed. The cutoff score to indicate cognitive impairment was defined as the overall healthy participants' cognitive z-score minus 2 standard deviations. Independent demographic and clinical predictors of cognitive impairment were identified using linear regression analysis. RESULTS: Patients with CHF showed a pattern of general cognitive impairment, including impairment of executive function, memory, language, mental speed, and attention. Twenty-five percent (P=.04) of patients with CHF were classified as cognitively impaired, compared with 15% of the cardiac controls and 4% of the healthy controls. Independent predictors of cognitive impairment in patients with CHF were estimated intelligence, New York Heart Association class, and presence of the apolipoprotein (Apo)E epsilon4 allele. CONCLUSION: Cognitive dysfunction is relatively common in patients with CHF, with deficits being most prominent in the domains of executive function, memory, language, and mental speed. Disease severity and ApoE genotype are likely to be important determinants for cognitive impairment in patients with chronic CHF.

PMID: 17727641 [PubMed - as supplied by publisher]

Sunday, September 02, 2007

Promoting Academic Writing

Interesting piece in today's New York Times about writers taking promotional book "tours" via blogs:

The Author Will Take Q.’s Now
By KARA JESELLA
Published: September 2, 2007

[snip]

Bloggers have written about books since, well, the beginning of blogging. But a blog book tour usually requires an author or publicist to take the initiative, reaching out to bloggers as if they were booksellers and asking them to be the host for a writer’s online visit. Sometimes bloggers invite authors on their own. In an age of budget-conscious publishers and readers who are as likely to discover books from a Google search as from browsing at a bookstore, the blog book tour makes sense. Although a few high-profile authors have had their books sent to bloggers — James Patterson recently promoted a young-adult book this way — most of the authors are lesser-known and less likely to be reviewed in the mainstream press.

[snip]

[ Read the full article ... ]

Chemotherapy and Neuropsychological Functioning

From yesterday's Milwaukee Journal-Sentinel:

Lost in cancer's fog
'Chemobrain' impairs thinking, memory after chemotherapy; anecdotal brain effects are just starting to get serious study

By JOHN FAUBER
01 September 2007
Milwaukee Journal-Sentinel

[snip]

In two small groups of testicular and breast cancer patients, between 60% and 70% of the patients experienced some cognitive decline that was tied to the onset of their chemotherapy, said Christina Meyers, a professor and chief of neuropsychology at the M.D. Anderson Cancer Center in Houston.

"It's subtle," she said. "We are not talking about dementia or anything grossly obvious."

Within one year, about half of the patients were back to their pretreatment levels of cognitive ability, Meyers said.

[snip]

[ ... Read the full article ... ]

Friday, August 31, 2007

Awakenings at Columbia

From The New York Times:

Oliver Sacks Joins Columbia Faculty
By MOTOKO RICH
September 1, 2007

Attracted by his breadth of interests, ranging from schizophrenia to music, Columbia University has appointed Oliver Sacks, the neurologist and writer, as its first Columbia artist, a newly created designation.

Beginning next week, Dr. Sacks, who has been a clinical professor of neurology at Albert Einstein College of Medicine in the Bronx for the past 42 years, is leaving to become a professor of clinical neurology and clinical psychiatry at the Columbia University College of Physicians and Surgeons, a post he will occupy in addition to the new artist position.

The new appointment will allow Dr. Sacks, the author of 10 books and a frequent contributor to The New Yorker, to range freely across Columbia’s departments, teaching, giving public lectures, conducting seminars, seeing patients and collaborating with other faculty members. Many of the details of his appointment have yet to be worked out, but among other things, he will be teaching in the university’s creative writing department as well as at the medical school.

[ ... Read the full article ... ]

Thursday, August 30, 2007

New Position-Openings Board Provided by the Neurotechnology Industry Organization (NIO)

Zack Lynch has posted a message on his Brain Waves blog about his NIO's new job-postings page. Please read the posting for an introduction and take a look at the cool new board:

Brain Waves posting

Neurotech Job Board

The Social Behavior of Spiders?

From the Associated Press, a report of curious cooperative behavior ... or merely a fluke:

Spiders Create Giant Web
By THE ASSOCIATED PRESS
August 30, 2007
Filed at 7:02 a.m. ET

WILLS POINT, Texas (AP) -- Entomologists are debating the origin and rarity of a sprawling spider web that blankets several trees, shrubs and the ground along a 200-yard stretch of trail in a North Texas park.

Officials at Lake Tawakoni State Park say the massive mosquito trap is a big attraction for some visitors, while others won't go anywhere near it.

''At first, it was so white it looked like fairyland,'' said Donna Garde, superintendent of the park about 45 miles east of Dallas. ''Now it's filled with so many mosquitoes that it's turned a little brown. There are times you can literally hear the screech of millions of mosquitoes caught in those webs.''

Spider experts say the web may have been constructed by social cobweb spiders, which work together, or could be the result of a mass dispersal in which the arachnids spin webs to spread out from one another.

[ ... Read the full report ... ]

Wednesday, August 29, 2007

Neuropsychology Abstract of the Day: Mild Cognitive Impairment (MCI) and Neuropsychological Testing

Belleville S, Chertkow H, & Gauthier S. Working memory and control of attention in persons with Alzheimer's disease and mild cognitive impairment. Neuropsychology. 2007 Jul; 21(4): 458-469.

Research CenterInstitut Universitaire de Geriatrie de Montreal, Montreal, PQ, Canada

The goal of the present study was to assess 3 attentional control processes--divided attention, manipulation capacities, and inhibition--in persons with mild cognitive impairment (MCI) and with mild Alzheimer's disease (AD). Manipulation capacities were tested by comparing immediate serial recall with alphabetical-order recall of words. Divided attention was tested with the Brown-Peterson procedure, in which participants divide their attention between simple addition tasks and consonant trigrams over delays. Inhibition was tested with the Hayling procedure, in which participants complete sentences with words irrelevant to their context. Persons with AD showed severe impairment on the 3 attentional control components. Persons with MCI exhibited impaired performance on the Brown-Peterson procedure but normal performance on the other 2 tasks. With AD and MCI participants, there was a negative correlation between general cognitive deficits and impairment on attentional control tasks, indicating that attentional control deficits increase in the MCI/AD continuum. When separating MCI with and without significant subsequent decline, those with subsequent decline showed impaired performance on both the Brown-Peterson procedure and manipulation task. These data suggest that control of attention tasks can track AD at a preclinical stage and that impairment increases gradually during the preclinical phase of AD.
PMID: 17605579 [PubMed - indexed for MEDLINE]

Tuesday, August 28, 2007

The Best of the Brain

While travelling on neuropsych business over the past week, I've been totally enjoying the new collaboration between Dana Press and Dr. Floyd Bloom - an edited book of feature articles from Scientific American.

The book contains 21 articles of the many that have appeared in the magazine from 1999 onward.

My favorite is the last one, "The Quest for a Smart Pill," by Stephen Hall. I may be mistaken, but I believe Hall has also written on this topic for the journal, Science. It deals with memory- and other cognitive-function- enhancing drugs currently under development by a number of biotech companies and some of the ethical issues involved in this domain.

Good reads on the neurobiology of psychiatric disorders and computer-brain interfaces also are included. Articles by Antonio Damasio, Eric Kandel, and Fred Gage are representative of some of the neuroscientific leaders found in the book. Science journalist Carl Zimmer is represented, as well.

List price of $25.00, The Best of the Brain from Scientific American, edited by Floyd Bloom (Dana Press, 2007).

Sunday, August 26, 2007

Omneuron and fMRI

From today's New York Times:

Mind Over Matter, With a Machine’s Help
By JASON PONTIN
Published: August 26, 2007

[snip]

Omneuron is one of a number of new companies that are commercializing a brain-scanning technology called real-time functional magnetic resonance imaging, or fMRI. Using large scanners to measure blood flow to different parts of the brain, the technology makes the brain’s activity visible by revealing which of its parts are busiest when we perform different tasks.

While fMRI dates back to the early 1990s, hitherto it has been used mainly by doctors in hospitals to make diagnoses. The commercialization of brain scanning is a recent development, spurred by the refinement of the technology. Omneuron, which Dr. deCharms founded in 2001 and whose research has been funded by the National Institutes of Health, uses fMRI to teach people how to play with their own heads. Other entrepreneurs are working on ways to deploy fMRI as a lie detector, a tool for conducting marketing research or an instrument to make brain surgeries safer and more precise.

Here’s how Omneuron uses fMRI to treat chronic pain: A patient slides into the coffin-like scanner and watches a computer-generated flame projected on the screen of virtual-reality goggles; the flame’s intensity reflects the neural activity of regions of the brain involved in the perception of pain. Using a variety of mental techniques — for instance, imagining that a painful area is being flooded with soothing chemicals — most people can, with a little concentration, make the flame wax or wane. As the flame wanes, the patient feels better. Superficially similar to an older technology, electroencephalogram biofeedback, which measures electrical feedback across multiple areas of the brain, fMRI feedback measures the blood flow in precise areas of the brain.

“We believe that people will use real-time fMRI feedback to hone cognitive strategies that will increase activation of brain regions,” Dr. deCharms said. With practice and repetition, he said, this could lead to “long-term changes in the brain.”

[snip]


[ ... Read the full article ... ]

Thursday, August 23, 2007

Neuropsychology Abstract of the Day: ADHD Drivers

Reimer B, D'Ambrosio LA, Coughlin JF, Fried R, & Biederman J. Task-induced fatigue and collisions in adult drivers with attention deficit hyperactivity disorder. Traffic Inj Prev. 2007 Sep; 8(3): 290-299.

AgeLab, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.

Objective. This study compares collision involvement between adult drivers with attention deficit hyperactivity disorder (ADHD) and control participants in a simulation experiment designed to enhance the effects of fatigue. Because the effects of ADHD include difficulties in maintaining attention, drivers with ADHD were hypothesized to be more susceptible to the effects of fatigue while driving. Methods. Data are drawn from a validated driving simulation study, portions of which were focused on enhancing the effects of fatigue. The simulator data are supplemented with written questionnaire data. Drivers with ADHD were compared with controls. Results. The self-report data indicated that drivers with ADHD were more likely to report having been involved in an accident within the previous five years. Simulation data showed that time of day of participation in the experiment were significantly related to likelihood of collision, and that these effects were further exacerbated by ADHD status. Participants with ADHD were more likely than controls to be involved in a crash in the simulator regardless of time of day, but the effects were particularly pronounced in the morning, and the rate of increase in accident involvement from the late afternoon into the evening was greater among participants with ADHD. No differences in self-reported sleep patterns or caffeine use were found between participants with ADHD and controls. Conclusions. The results suggest that drivers with ADHD became fatigued more quickly than controls. Such drivers thus face greater risk of involvement in accidents on highways or open roadways where the visual and task monotony of the environment contribute to greater driver fatigue.

PMID: 17710720 [PubMed - in process]

Risperdal (risperidone) and Pediatric Schizophrenia and Bipolar DIsorder

An FDA press release from yesterday:

FDA Approves Risperdal for Two Psychiatric Conditions in Children and Adolescents

The U.S. Food and Drug Administration today approved Risperdal (risperidone) for the treatment of schizophrenia in adolescents, ages 13 to 17, and for the short-term treatment of manic or mixed episodes of bipolar I disorder in children and adolescents ages 10 to 17. This is the first FDA approval of an atypical antipsychotic drug to treat either disorder in these age groups.

Until now, there has been no FDA-approved drug for the treatment of schizophrenia for pediatric use and only lithium is approved for the treatment of bipolar disorder in adolescents ages 12 and up.

“The pediatric studies of Risperdal provided an opportunity to assess the effectiveness, proper dose, and safety of using this product in the pediatric population,” said Dianne Murphy, M.D., director of FDA’s Office of Pediatric Therapeutics. “These data have permitted the identification of the effective pediatric dose ranges and have provided an evidence-based approach for treating these disorders in pediatric patients.”

The FDA first approved Risperdal in 1993 for the treatment of schizophrenia in adults. The drug later was approved for the short-term treatment of acute manic or mixed episodes associated with bipolar I disorder in adults and the treatment of irritability associated with autistic disorder in children and adolescents 5 to 16 years old.

Evidence to support this approval was collected through studies the FDA requested as part of its pediatric drug development initiatives.

The efficacy of Risperdal in the treatment of schizophrenia in adolescents was demonstrated in two short-term (6 to 8 weeks), double-blind, controlled trials. All patients were experiencing an acute episode of schizophrenia at the time of enrollment. Treated patients generally had fewer symptoms, including a decrease in hallucinations, delusional thinking, and other symptoms of their illness.

The efficacy of Risperdal in the treatment of manic or mixed episodes in children or adolescents with bipolar I disorder was demonstrated in a three-week, randomized, double-blind, placebo-controlled, multicenter trial in patients who were experiencing a manic or mixed episode. Treated patients generally had fewer symptoms, including a decrease in their elevated mood and hyperactivity, and other symptoms of their illness.

Drowsiness, fatigue, increase in appetite, anxiety, nausea, dizziness, dry mouth, tremor, and rash were among the most common side effects reported.

Schizophrenia is a serious and disabling psychiatric disorder. Symptoms may include hallucinations, delusions, and disorganized thinking. Bipolar disorder, also known as manic-depressive illness, is a serious psychiatric disorder that causes wide shifts in a person's mood, energy, and ability to function.

Risperdal is manufactured by Janssen, L.P. of Titusville, N.J.

For more information:

FDA Office of Pediatric Therapeutics
link

National Institute of Mental Health—Schizophrenia
link

National Institute of Mental Health—Bipolar Disorder
link

Tuesday, August 21, 2007

Wednesday, August 15, 2007

HIV Dementia

From the BBC's website:

HIV's double hit on brain cells
HIV can trigger learning and memory deficits by launching a double attack on the brain, research shows.


It was already known that a protein on the surface of the virus could kill off mature brain cells.

But the latest study shows it also prevents the production of replacements by crippling cells with the potential to step in and take their place.

The University of California at San Diego study appears in the journal Cell Stem Cell.

The researchers hope their work, which was carried out on mice, will aid efforts to find new ways to combat HIV-associated dementia.

Researcher Dr Marcus Kaul said: "It's a double hit to the brain.

"The HIV protein both causes brain injury and prevents its repair."

The success of antiretroviral therapies in keeping "viral load" down has helped to reduce the severity of HIV-associated dementia in recent years.

However, the condition is becoming more common as people with HIV are living longer.

Part of the problem is that anti-HIV drugs find it tough to enter the brain.

Disrupted chemistry

The researchers had already shown that a protein called gp120, which is found on HIV's outer coating, can kill off brain cells by disrupting their internal chemistry.

In the latest study, they showed that gp120 also slows production of new brain cells in the hippocampus, a brain region central to learning and memory.

Under normal circumstances, these newborn cells become integrated into existing brain circuits and are thought to contribute to certain forms of learning and memory.

It appears the same chemical disruption that kills cells is also responsible for blocking production of replacements.

Dr Kaul said: "This indicates that we might eventually treat this form of dementia by either ramping up brain repair or protecting the repair mechanism."

Keith Alcorn, senior editor of the HIV information service NAM, said: "The discovery that HIV affects stem cell proliferation in the brain is bound to add to concerns that people with HIV doing well on antiretroviral therapy may nevertheless face a higher risk of dementia in years to come.

"Antiretroviral drugs have lowered viral load so that HIV will not kill cells directly, but we don't know the consequences for brain functioning of a long-term low level of infection.

"It may be that low level infection is enough to interfere with the regeneration pathways in the way shown in this experiment."

Vanessa Griffiths, clinical director at the HIV charity Terrence Higgins Trust said: "This is fascinating research, but at an extremely early stage.

"It may well produce benefits for people with HIV, but that is still some years away."


[ ... Read the full article ... ]

Tuesday, August 14, 2007

Dementia and the Sniff Magnitude Test

From today's New York Times:

Sniff Test May Signal Disorders’ Early Stages
By ELIZABETH SVOBODA
Published: August 14, 2007

[snip]

The Sniff Magnitude Test, developed with the aid of a $1.3 million grant from the National Institutes of Health, consists of a nasal tube called a cannula attached to a plastic container about the size and shape of a coffee thermos. Chemical vapors inside the canister are released through the tube, exposing subjects to a series of smells, some more objectionable than others.

“People describe some of the smells as skunky or sewerlike,” said Jason Bailie, a University of Cincinnati graduate student working on the test. “There’s also one that smells like banana.”

As patients take whiffs of each new fragrance, sensors in the thermos unit measure the negative pressure the inhalations produce. The size and intensity of these sniffs turn out to be important gauges of olfactory ability. After detecting a strong or disagreeable odor, people with a normal sense of smell take very small sniffs to avoid smelling it. Subjects with an impaired sense of smell, on the other hand, continue taking deep whiffs, because the scent does not register in their brains.

[snip]

The Cincinnati team’s efforts have piqued the interest of other researchers, including Dr. Doty and Alan Hirsch of the Smell and Taste Research and Treatment Foundation, who is using the Sniff test in his clinical practice. “They’ve chosen some very good odors that stimulate the olfactory system effectively,” Dr. Doty said. “This is a very novel approach — it just needs to be tested more broadly.”

Still, Dr. Doty added, the Sniff Magnitude Test may not be the ideal way to assess every patient with cognitive deficits. “Very early in life, we make a connection between an odor and its source,” he said. “We give it a name. If the connection between the name of an odor and the odor itself is what’s breaking down in an Alzheimer’s patient, this test might not be as helpful,” because it does not tell evaluators how a patient identifies and categorizes smells. The Sniff Magnitude Test is likely to raise red flags only if an impending cognitive disorder directly affects a patient’s olfactory abilities.

[snip]

[ ... Read the full article ... ]

Monday, August 13, 2007

Light-Switch Technology: Channelrhodopsin-2

From tomorrow's New York Times:

The Beam of Light That Flips a Switch That Turns on the Brain
By INGFEI CHEN
Published: August 14, 2007

[snip]

One of the newest, fastest strategies co-opts a photosensitive protein called channelrhodopsin-2 from pond scum to allow precise laser control of the altered cells on a millisecond timescale. That speed mimics the natural electrical chatterings of the brain, said Dr. Karl Deisseroth, an assistant professor of bioengineering at Stanford.

“We can start to sort of speak the language of the brain using optical excitation,” Dr. Deisseroth said. The brain’s functions “arise from the orchestrated participation of all the different cell types, like in a symphony,” he said.

Laser stimulation can serve as a musical conductor, manipulating the various kinds of neurons in the brain to reveal which important roles they play.

This light-switch technology promises to accelerate scientists’ efforts in mapping which clusters of the brain’s 100 billion neurons warble to each other when a person, for example, recalls a memory or learns a skill. That quest is one of the greatest challenges facing neuroscience.

The channelrhodopsin switch is “really going to blow the lid off the whole analysis of brain function,” said George Augustine, a neurobiologist at Duke University in Durham, N.C.

[ ... Read the full article ... ]

Thursday, August 09, 2007

Virtual Skulls: Research Applications

From the Canadian Broadcasting Corporation's website, a report from the Australian Broadcasting Corporation:

Virtual skull could lead to better crash helmets
Last Updated: Thursday, August 9, 2007 | 8:57 AM ET
Australian Broadcasting Corporation

A sophisticated new computer-generated virtual skull could help researchers study evolution and design better crash helmets, says an Australian scientist.

The virtual chimp skull was designed by Dr. Stephen Wroe of the University of New South Wales and colleagues from the University of Newcastle.

"It's the most sophisticated model of a chimp skull ever made," said Wroe, a paleontologist with an interest in skull mechanics.

[ ... Read the full article ... ]

Tuesday, August 07, 2007

Neuropsychology Abstract of the Day: Assessing Non-motor Symptoms in Parkinson's Disease

Chaudhuri KR, Martinez-Martin P, Brown RG, Sethi K, Stocchi F, Odin P, Ondo W, Abe K, Macphee G, Macmahon D, Barone P, Rabey M, Forbes A, Breen K, Tluk S, Naidu Y, Olanow W, Williams AJ, Thomas S, Rye D, Tsuboi Y, Hand A, & Schapira AH. The metric properties of a novel non-motor symptoms scale for Parkinson's disease: Results from an international pilot study. Movement Disorders. 2007 Aug 2; [Epub ahead of print].

National Parkinson Foundation Centre of Excellence, Kings College Hospital, London, United Kingdom.

Non-motor symptoms (NMS) in Parkinson's disease (PD) are common, significantly reduce quality of life and at present there is no validated clinical tool to assess the progress or potential response to treatment of NMS. A new 30-item scale for the assessment of NMS in PD (NMSS) was developed. NMSS contains nine dimensions: cardiovascular, sleep/fatigue, mood/cognition, perceptual problems, attention/memory, gastrointestinal, urinary, sexual function, and miscellany. The metric attributes of this instrument were analyzed. Data from 242 patients mean age 67.2 +/- 11 years, duration of disease 6.4 +/- 6 years, and 57.3% male across all stages of PD were collected from the centers in Europe, USA, and Japan. The mean NMSS score was 56.5 +/- 40.7, (range: 0-243) and only one declared no NMS. The scale provided 99.2% complete data for the analysis with the total score being free of floor and ceiling effect. Satisfactory scaling assumptions (multitrait scaling success rate >95% for all domains except miscellany) and internal consistency were reported for most of the domains (mean alpha, 0.61). Factor analysis supported the a prori nine domain structure (63% of the variance) while a small test-retest study showed satisfactory reproducibility (ICC > 0.80) for all domains except cardiovascular (ICC = 0.45). In terms of validity, the scale showed modest association with indicators of motor symptom severity and disease progression but a high correlation with other measures of NMS (NMSQuest) and health-related quality of life measure (PDQ-8) (both, rS = 0.70). In conclusion, NMSS can be used to assess the frequency and severity of NMS in PD patients across all stages in conjunction with the recently validated non-motor questionnaire. (c) 2007 Movement Disorder Society.

PMID: 17674410 [PubMed - as supplied by publisher]

Monday, August 06, 2007

Neuropsychopharmacology Text Available Online

A big thank you to Zack Lynch of Brain Waves for posting about the availability online of a comprehensive neuropsychopharmacology textbook.

Here is the link to Brain Waves, which links to the text: link.

The text is a publication by and is available on the website of the American College of Neuropsychopharmacology (ACNP), a professional society. Additionally, the ACNP is noted for the exceptional quality of its conferences.

Sunday, August 05, 2007

Losing Betsy: A Journey Through Dementia

The latest installment in a compelling feature series in The Seattle Times:

Losing Betsy — A move nobody wanted
By Marsha King
The Seattle Times
05 August 2007

[snip]

"I've always said I want to keep her as long as I can," Jeff said several weeks ago. "But I'm kind of reaching the end of my ability to do this stuff."

Sooner than expected, that day arrived.

Seven years ago, when she was 46, Betsy got a shocking diagnosis — early onset dementia — probably Alzheimer's disease. Since then, she's gone from forgetting how to fold laundry to forgetting who she is.

On the morning of July 13, Jeff moved his wife to a state-licensed adult family home in Renton.

Now 53, Betsy would be the youngest resident by 24 years.

[snip]


[ ... Read the full article ... ] Includes links to earlier reports in the series.

Friday, August 03, 2007

Neuropsychology Abstract of the Day: Agitation in Alzheimer's Disease (AD)

Mahlberg R, Walther S, Eichmann U, Tracik F, & Kunz D. Effects of rivastigmine on actigraphically monitored motor activity in severe agitation related to Alzheimer's disease: A placebo-controlled pilot study. Archives of Gerontology and Geriatrics. 2007 Jul-Aug; 45(1): 19-26.

Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Turmstr. 21, D-10559 Berlin, Germany.

Acetylcholinesterase inhibitors (AChEIs) are effective in the treatment of cognitive symptoms in Alzheimer's disease (AD). Because the behavioral and psychological symptoms of dementia (BPSD) have also been attributed to central cholinergic deficits, we examined whether the AChEI rivastigmine can reduce motor activity as measured in a rater-independent manner by wrist actigraphy in agitated AD patients. A total of 20 consecutive AD inpatients (13 females, 7 males, 80.4+/-9.1 years, S.D.) were included from our geriatric psychiatry unit, all of whom were exhibiting agitated behavior not attributable to delirium. Patients were assigned randomly and in a single-blinded fashion to rivastigmine 3mg or placebo for 14 days. Motor activity levels were monitored using an actigraph worn continuously on the wrist of the non-dominant hand. At the beginning and end of the study, patients were assessed using the Neuropsychiatric Inventory (NPI) and Nurses' Observation Scale for Geriatric Patients (NOSGER). Patients in the rivastigmine group exhibited less agitation than placebo recipients on the NPI-agitation subscale, but not on NOSGER. Actigraphic measurements showed a tendency towards reduced motor activity in the rivastigmine group. Because rivastigmine usually exerts its main effects after a longer period of time, the short-term effects seen in our study justify further controlled clinical trials examining the use of rivastigmine in BPSD by means of actigraphy.

PMID: 16963137 [PubMed - indexed for MEDLINE]

MEDIA: Obsessive-Compulsive Disorder (OCD) and Time Magazine

From the current issue of Time:

When Worry Hijacks The Brain
Thursday, Aug. 02, 2007
By JEFFREY KLUGER

[ ... To read the article, click here ... ]

Wednesday, August 01, 2007

Deep Brain Stimulation

A curious case report discussed in today's New York Times:

Man Regains Speech After Brain Stimulation
By BENEDICT CAREY
Published: August 1, 2007

A 38-year-old man who spent more than five years in a mute, barely conscious state as a result of a severe head injury is now communicating regularly with family members and recovering his ability to move after having his brain stimulated with pulses of electric current, neuroscientists are reporting.

[snip]

The new report, which appears in the journal Nature, provides the first rigorous evidence that any procedure can initiate and sustain recovery in such a severely disabled person, years after the injury occurred. An estimated 100,000 to 300,000 Americans subsist in states of partial consciousness, and most are written off as beyond help.

Doctors said it was not clear how many such patients would benefit from the treatment, in which two wire electrodes are implanted deep in the brain. The procedure also raises sticky ethical questions about operating on patients who cannot give their consent, they said.

“We really see this as a first step, but it should open doors that have not been open before for patients like this,” said Joseph T. Giacino, associate director of neuropsychology at the JFK Johnson Rehabilitation Institute and the New Jersey Neuroscience Institute, in Edison. Dr. Giacino performed the study with doctors from the Weill Cornell Medical College and the Cleveland Clinic Foundation.

[ ... Read the full report ... ]

Monday, July 30, 2007

Wandering in Elderly CNS Patients: Neeka's Backlog

"Neeka's Backlog" is a blog written in Kiev by Veronica Khokhlova. Unfortunately, her topic over the past week or so has been the search for her father who had sustained a series of strokes and who wandered away from a family that was trying its best and, several days later, from a hospital that should have done better.

The blog was a definitive voice during the Orange Revolution and becomes equally compelling in these entries. The narrative of these days is the clearest that I've ever read and should be read by any professional caring for individuals with dementia or related CNS disorders.

Multiple Sclerosis

From a National Institutes of Health press release issued on the 29th:

After a Decades-Long Search, Scientists Identify New Genetic Risk Factors for Multiple Sclerosis

A pair of large-scale genetic studies supported by the National Institutes of Health has revealed two genes that influence the risk of getting multiple sclerosis (MS) — data sought since the discovery of the only other known MS susceptibility gene decades ago. The findings could shed new light on what causes MS — a puzzling mix of genes, environment and immunity — and on potential treatments for at least 350,000 Americans who have the disease.

"These studies describe the first genes conclusively linked to MS in more than 20 years," said Ursula Utz, Ph.D., a program director at the National Institute of Neurological Disorders and Stroke (NINDS), a part of NIH. "This breakthrough was made possible through persistence, an elegant search strategy, and genomic data and techniques that were not available until recently."

Both studies involved scanning DNA samples from more than 20,000 MS patients and unaffected individuals in the U.S. and Europe, and looking for single nucleotide polymorphisms (SNPs), which are single-letter variations in a gene's DNA code. Published simultaneously today in the New England Journal of Medicine and Nature Genetics, the studies demonstrate an association between MS and SNPs in two genes that encode interleukin receptors, proteins that serve as antennae on the surface of immune cells.

[ ... Read the full press release ... ]

Tuesday, July 10, 2007

Stroke and the Myomo e100

From today's New York Times:

In Latest Robotics, New Hope for Stroke Patients
By AMANDA SCHAFFER
The New York Times
Published: July 10, 2007

Mary O’Regan more or less ignored her left arm for 20 years.

As a sophomore in college, in 1986, she fell off the back of a friend’s dirt bike and hit her head on concrete, later suffering a stroke. After intensive medical and physical therapy, she learned to speak and walk again. She went back to school and then to work. (And, as it happened, two of her brothers ended up marrying two of the nurses who had taken care of her.) Still, much of her left side remained numb, and she did not regain use of her left arm.

Last year, however, Ms. O’Regan, now 40 and living in Westwood, Mass., enrolled in a clinical trial for a new robotic device called the Myomo e100, designed to help stroke patients regain motion in their arms. The device, worn as an arm brace, works by sensing weak electrical activity in patients’ arm muscles and providing just enough assistance that they can complete simple exercises, like lifting boxes or flipping on light switches. By practicing such tasks, patients may begin to relearn how to extend and flex the arm, rebuilding and strengthening neurological pathways in the process.

“The device is designed to help get patients over a functional hump” so they can start moving the weakened arm again, said John McBean, a mechanical engineer who developed the technology with Kailas Narendran, an electrical engineer and computer scientist. (The two began the project in 2002, in a graduate robotics class at M.I.T.)

“And the more they are able to use the arm, the more improvement they begin to see,” Mr. McBean continued. “So it’s a virtuous cycle.”

[ ... Read the full article ... ]