Brain Injury Law Blog : Head Injury : Coma : Personal Injury : Las Vegas Nevada Lawyer & Attorney Tim Titolo

I was reviewing Feeds from the Center for Disease Control and came across this "Return to Play Progression."  Young athletes, as well as professional athletes, need protection while in the heat of the moment.  Coaches and Health Care providers can control crucial decisions as discussed below.

 Baseline (Step 0): As the baseline step of the Return to Play Progression, the athlete needs to have completed physical and cognitive rest and not be experiencing concussion symptoms for a minimum of 24 hours. Keep in mind, the younger the athlete, the more conservative the treatment.

Step 1: Light Aerobic Exercise
The Goal: only to increase an athlete’s heart rate.
The Time: 5 to 10 minutes.
The Activities: exercise bike, walking, or light jogging.
Absolutely no weight lifting, jumping or hard running.

Step 2: Moderate Exercise
The Goal: limited body and head movement.
The Time: Reduced from typical routine
The Activities: moderate jogging, brief running, moderate-intensity stationary biking, and moderate-intensity weightlifting

Step 3: Non-contact Exercise
The Goal: more intense but non-contact
The Time: Close to Typical Routine
The Activities: running, high-intensity stationary biking, the player’s regular weightlifting routine, and non-contact sport-specific drills. This stage may add some cognitive component to practice in addition to the aerobic and movement components introduced in Steps 1 and 2.

Step 4: Practice
The Goal: Reintegrate in full contact practice.

Step 5: Play
The Goal: Return to competition

The Center for Disease Control espouses that an athlete should be free of symptoms prior to being put back into play.  If symptoms are present, the athlete should not be put back into play for at least 24 hours.  A health care provider should carefully monitor the athlete after injury.

Online training for Health Care Professionals can be accessed here.  Health Care Professionals can access state, league, or sports governing body’s laws or policies on concussion.

Protecting our kids and teens from concussions should be a priority. Check out An International Consensus Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008.

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 When children have been exposed to family violence, their brains become increasingly "tuned" for processing possible sources of threat, a new study reports. The findings, reported in the Dec. 6 issue of Current Biology, reveal the same pattern of brain activity in these children as seen previously in soldiers exposed to combat.

This sheds new information on the Shaken Baby Syndrome in infants and all the way through childhood.  The changes don't reflect damage to the brain. Rather, the patterns represent the brain's way of adapting to a challenging or dangerous environment. Still, those shifts may come at the cost of increased vulnerability to later stress.

Violence against women in a family also has serious consequences for the children's growth, health, and survival. There are several possible explanations for why violence against a mother can affect her children's health. During pregnancy the fetus grows less, and after birth the mother's mental health is crucial both for her emotional contact with the children and for her ability to care for the children. What's more, women who have been subjected to violence often have weaker social networks and often lack economic resources to seek medical care for their children, for example. This means that the children's health is dependent on the economic resources and the protection that the environment can offer.

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 Derek Boogaard's brain was preserved.  Although the Hockey player was dead, a request came to the family to not cremate Boogaard until they could carve his brain out of his skull to study it.  That was May 2011.  The results came in October.

Boogaard had chronic traumatic encephalopathy, commonly known as C.T.E., a close relative of Alzheimer’s disease. It is believed to be caused by repeated blows to the head. It can be diagnosed only posthumously, but scientists say it shows itself in symptoms like memory loss, impulsiveness, mood swings, even addiction.

More than 20 dead former N.F.L. players and many boxers have had C.T.E. diagnosed.  Typically they are left in a permanently scarred state in later life.

The issue of repeated trauma is explained in a video.  To read more about this particular case you can read the New York Times Article.

The Center for the Study of Chronic Traumatic Encephalopathy states the following:

Chronic Traumatic Encephalopathy (CTE) is a progressive degenerative disease of the brain found in athletes (and others) with a history of repetitive brain trauma, including symptomatic concussions as well as asymptomatic subconcussive hits to the head. CTE has been known to affect boxers since the 1920s. However, recent reports have been published of neuropathologically confirmed CTE in retired professional football players and other athletes who have a history of repetitive brain trauma. This trauma triggers progressive degeneration of the brain tissue, including the build-up of an abnormal protein called tau. These changes in the brain can begin months, years, or even decades after the last brain trauma or end of active athletic involvement. The brain degeneration is associated with memory loss, confusion, impaired judgment, impulse control problems, aggression, depression, and, eventually, progressive dementia.

 A new paper published in the Journal of Neuropathology and Experimental Neurology suggests head trauma may also lead to a neurodegenerative disorder mimicking ALS.  This paper adds to literature suggesting an elevated risk of ALS in veterans and professional soccer players who have suffered head injuries, and is certain to contribute to the controversy regarding the link between head trauma and ALS. A recent article in the New York Times points out that Lou Gehrig himself may have had this entity rather than ALS.

Researchers at Albert Einstein College of Medicine of Yeshiva University and Montefiore Medical Center, the University Hospital and academic medical center for Einstein, used diffusion tensor imaging, an advanced type of MRI-based imaging technique, as well as cognitive tests, to assess brain function in amateur football players. Their findings indicate the possibility of brain injury from frequently heading the ball.

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The Journal of Cognitive Neuroscience published a study by the U.S. Department of Energy's Brookhaven National Laboratory concluding that the more gray matter you have in the decision-making, thought-processing part of your brain, the better your ability to evaluate rewards and consequences. The study shows this link between structure and function in healthy people -- and the impairment of both structure and function in people addicted to cocaine.

Differences in gray matter volume -- the amount of brain matter made up of nerve cell bodies, as opposed to the "white matter" axons that form the connections between cells -- have been observed in a range of neuropsychiatric diseases when compared with healthy states.

The test utilized MRI, EEG and P300 studies. To explore this structure-function relationship, the scientists performed magnetic resonance imaging (MRI) brain scans to measure brain volume in 17 healthy people and 22 cocaine users.

The implications are important for understanding the potential loss of control and disadvantageous decision-making that can occur in people suffering from drug addiction.  There are still questions about whether these changes in brain structure and function are a cause or a consequence of addiction. But the use of multimodal imaging techniques, as illustrated by this study, may open new ways to address these and other questions relevant to understanding human motivation in both health and disease states, with particular relevance to treating drug addiction.

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Free Video Lecture: Memory and the Brain

Taught by Jeanette Norden Vanderbilt University Ph.D., Vanderbilt University School of Medicine

It's almost impossible to accurately describe the power and importance of memory. Whether you're fondly reminiscing over an event from a childhood vacation, quickly memorizing a phone number or address, or learning a new skill on the job, memory is so interwoven into our everyday lives that we can sometimes take it for granted. So how does memory actually work?

Modern neuroscience has uncovered a wealth of new insights into the fascinating ways our brains create and harness the power of memory, so that understanding this process is no longer a mystery. The key to memory lies in the dynamic nature of the synapses in our brains—a feature known as synaptic plasticity. Far from being static structures, these synapses are able to be continually shaped and reshaped by everyday experiences.

In Memory and the Brain, you explore

• the different categories of memory;
• the areas of the brain involved in creating and shaping memories; and
• the ways that our synapses change based on experiences in the world.

Watch this free video lecture and delve into the fascinating science behind how your brain works to create and use memories.

Click here to watch the video.

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I came across this announcement while reviewing upcoming conferences.  I have worked with the excellent physicians at Craig Hospital.

Craig Hospital 2012 Brain Injury Summit

A Meeting of the Minds
January 9-11, 2012
Beaver Creek, Colorado

Craig Hospital invites you to join us in one of North America’s most popular winter venues for a state-of-the-art continuing education experience designed for professionals committed to enhancing the lives of persons with brain injury and their families. Please visit the official conference website at:

http://www.braininjurysummit2012.org.

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 The Tell Tale Brain

I completed The Tell-Tale Brain: A Neuroscientist's Quest for What Makes Us Human by V.S. Ramachandran.   The preeminent neuroscientist V.S. Ramachandran has, without a doubt, raised the bar in this, his newest book, The Tell-Tale Brain. He states in the preface, "Readers who have assiduously followed my whole oeuvre over the years will recognize some of the case histories that I presented in my previous books, Phantoms in the Brain: Probing the Mysteries of the Human Mind and A Brief Tour of Human Consciousness: From Impostor Poodles to Purple Numbers. These same readers will be pleased to see that I have new things to say about even my earlier findings and observations. Brain science has advanced at an astonishing pace over the past fifteen years, lending fresh perspectives on - well, just about everything. After decades of floundering in the shadow of the "hard" sciences, the age of neuroscience has truly dawned, and this rapid progress has directed and enriched my own work." And what an enriching book this is!

     Ramachandran describes several neurological case studies that illustrate how people see, speak, conceive beauty and perceive themselves and their bodies in 3-D space. He explains the phenomenon of Phantom Limb Pain. He approaches the issues from evolutionary, philosophical, anatomical, psychological, and neurological perspectives.

Watch and hear Dr. Ramachadran describe how mirror neurons formed the foundation of civilization.

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I came across a most amazing video of neuro-anatomist, Jill Bolte Taylor's, personal journey through her own stroke.  In 1996, Dr. Taylor had a stroke.  The process of a blood clot shutting down her left sided brain is stunning.  The message she imparts is both beautiful and provoking. 

Her video is roughly 20 minutes.  I recommend everyone find some time, get a cup of coffee, and watch the video.  It is worth it.

I have been stuck between hard science and cognition of the spirit for many years.  When in a room full of scientists I find my inclinations are toward scientific explanations.  However when in a group of more spiritual minded folks, I try to impart science into spirituality.  I was genuinely moved by Dr. Taylor's video.

She segregates left and right brain function to allow a message I rarely hear.  This is not some journey through a tunnel toward the light scenario, although one could readily understand how that observation is reported by non-scientific folks who have near-death experiences.  This is more.

The left brain, Dr. Taylor explains, is the "I am" side of the brain that works to separate us from the energy in the universe.  The right side is where we appreciate that energy.   Sounds geeky and but if not for her credentials, I would have thought as much.  In her words, she found "nirvana" in the experience of losing her left sided brain as a hematoma almost took her life.

If you need inspiration, click on this link to Dr. Taylor's encounter.  Please, leave a comment, if you feel inclined, as to your thoughts.  I suspect many neuroscientists will have their explanations, but see what yours is and share it with me.

I will follow up on this post after reading Dr. Taylor's book My Stroke of Insight.

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Since I received a flurry of comments on my Motorcycle Helmet Blog of recent, see Nevada Helmet Law Repeal and comments at http://brainandspine.titololawoffice.com/2011/05/articles/brain-injury/nevada-helmet-law-repeal/ , I thought I would forward a tweet by fellow blogger Steve Gursten.  Steve is a great Michigan Personal Injury Trial Attorney.

The title of the article EDITORIAL: Helmet law repeal is a horrible idea  is http://theoaklandpress.com/articles/2011/06/09/opinion/doc4df0f7e007da2700519623.txt?viewmode=default

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 The Brain On Trial

Is Criminal behavior regulated by “free will?” Is free will something that is actually free at all? Neuroscientist, David Eagleman[1], recently published an article in The Atlantic, July/August 2011, The Brain on Trial.[2] He describes how the foundations of our criminal-justice system are beginning to crumble, and proposes a new way forward for law and order.

My interest in theological, philosophical, psychological and biological explanations ranging from the reason for suffering in this world and free will versus fate/destiny was discussed in my blog a few years back.

Can I freely choose to not eat chocolate cake? Can I freely invoke my long term understanding of the cake’s short term benefits versus its long term costs to overpower my short term understanding of my desire to eat it? Clearly the obesity crisis in our country and others would say ‘sometimes, but not most.’ Certainly eating chocolate cake is not a crime. But let’s apply the same ideas to crime and recidivism.

Neuroscientist, Wolf Singer argued that crime itself should be taken as evidence of brain abnormality, even if no abnormality can be found, and criminals treated as incapable of having acted otherwise.[3]

Conversely, at an Ethics and Public Policy Conference on Neuroscience and the Human Spirit,[4]  the question was asked: "Do . . . scientific advances challenge the first principles that the majority of our citizens believe provide the very foundation upon which our civilization rests—free will and the capacity to make moral choices? . . . Does [the] growing understanding of genetic and environmental influences on human behavior leave any room for free will?"

The conclusion advanced “accepting a compatibilist, naturalistic view of freedom and morality will unify our self-understanding. Since moral mechanisms have a clear social function that science can help us to understand and improve, no longer will morality have to seek shelter from science. We may not be free in the exceptional, ultimate sense we once supposed, but we are more than compensated by the pragmatic benefits that flow from recognizing our complete inclusion in the causal order. The "human spirit"—our dignity, freedom, and power—is not threatened by science, only shown its true home in the natural world.”

In his lengthy article, David Eagleman sets out court dramas of those recently brought to trial. Judges and juries compare, as they instruct and are instructed, to weigh their analysis against a “reasonable person” standard. Many times, we all engage in the blame game by asserting, “Well I would not have done that.” However that may be missing the point according to Eagleman. “Changes in the balance of brain chemistry, even small ones, can also cause large and unexpected changes in behavior [:]” Addictive personalities and gambling; Pedophiles and the desire to look at children. Also included are not just unacceptable behaviors but, as mentioned earlier, compulsive eating, excessive alcohol consumption, and hypersexuality, to name a few.

“The lesson from all these stories is the same: human behavior cannot be separated from human biology….Perhaps not everyone is equally “free” to make socially appropriate choices.” Do we really have free will to choose or is that really an illusion? Eagleman states “Many of us like to believe that all adults possess the same capacity to make sound choices. It’s a charitable idea, but demonstrably wrong. People’s brains are vastly different.”

Starting at birth we are the product of our parent’s genes. “When it comes to nature and nurture, the important point is that we choose neither one. We are each constructed from a genetic blueprint, and then born into a world of circumstance that we cannot control in our most-formative years….The unique patterns of neurobiology inside each of our heads cannot qualify as choices; these are the cards we are dealt.”

Turing to the legal system and courts, the standard applied assumes we are ‘practical reasoners’ which, in turn, presumes beings with free will. Eagleman uses the example of those inflicted with Tourette’s syndrome, who suffer from doing things they do not will to do: sticking out her tongue, voicing inappropriate language and others. The point is that a Tourette’s patient’s free will cannot over ride her sense of “free won’t.” Similarly, high-level behaviors can take place in the absence of free will.

“Historically, clinicians and lawyers have agreed on an intuitive distinction between neurological disorders (“brain problems”) and psychiatric disorders (“mind problems”). The two ends of the spectrum have been those whose brain injuries (e.g. Parkinson’s) who cannot help some of their behavior, while most others are simply thought of as freely choosing actors.

Therefore, prisons have, according to Eagleman, become de-facto mental-health-care institutions. Incarceration does little to rehabilitate those with mental illness and increases cases of recidivism.   Courts around the country and in Nevada have begun mental-health courts and drug courts based on better understanding of the problems of recidivism. 

Eagleman proposes a new approach. He posits the understanding that the brain “operates like a team of rivals, with different neural populations competing to control the single output channel of behavior.” Something he terms the ‘prefontal-workout.’ Essentially he is trying to defeat the short term brain circuits to overcome bad behavior. It is similar to bio-feedback of the 1970s. So when we see that delicious piece of chocolate cake, we can overcome the choice to eat it, which is essentially against our will. More importantly when one is faced with a socially unacceptable behavior, can he invoke a system to squelch the urge and make a better choice?

Eagleman concludes by saying that “neuroscience is beginning to touch on questions that were once only in the domain of philosophers and psychologists, questions about how people make decisions and the degree to which those decisions are truly ‘free.’ These are not idle questions. Ultimately, they will shape the future of legal theory and create a more biologically informed jurisprudence.”

David Eagleman’s article is available on The Atlantic's site and in print.

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Cell Phone Use Causes Concern for Damaging the Brain.

First they thought coffee was bad for you, now they see it has benefits.  Same for moderate Red wine intake.  Now cell phones are under scrutiny.

The dramatic increase in use of cellular telephones has generated concern about possible negative effects of radiofrequency signals delivered to the brain. However, whether acute cell phone exposure affects the human brain is unclear.  Cell phones have not been persuasively linked to brain cancer, but that doesn't mean that their associated radiation has no effect on our brains and bodies.  

A new study shows that these pervasive devices can alter the brain's glucose metabolism, a marker of neuronal activity.The findings are published in the February 23 issue of  JAMA, Journal of the American Medical Association.

In healthy participants and compared with no exposure, 50-minute cell phone exposure was associated with increased brain glucose metabolism in the region closest to the antenna. This finding is of unknown clinical significance.

The bottom line is we know it affects the brain but we do not know to what end.  I will follow this issue.

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 Depression is something that can be related to brain activity.  It is frequently associated with traumatic brain injury as a sign, symptom or consequence.

The frequency of depression can also be affected by external situations.  Recent data reveals that depression for Men due to Social and Economic Environment is prevalent.  Emory University School of Medicine experts write in the  British Journal of Psychiatry about the tendency.

"Dubbed by some the 'Mancession', the economic downturn has hit men particularly hard because of its disproportionate effect on traditional male industries such as construction and manufacturing. Research has shown that roughly 75% of jobs lost in the United States since the beginning of the recession in 2007 were held by men. There is little reason to believe that traditional male jobs will return in significant numbers with economic recovery.

 Neuroscientists at Cold Spring Harbor Laboratory (CSHL), Brookhaven National Laboratory (BNL) and UC San Diego (UCSD) have collected evidence suggesting that a previously overlooked portion of the brain could be a prime locus of human depression. An upcoming article in the journal Nature will contain the findings.

 "It covers an area only about 1-2 mm across." So far only two brain imaging studies have implicated the LHb in depression because of the difficulty in resolving it using existing technologies such as PET and fMRI.

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 Good News to Migraine sufferers!  Relief may be a surgery away.

New evidence reveals Surgery to "deactivate" migraine headaches produces lasting good results.  Nearly 90 percent of patients have at least partial relief at five years' follow-up, reports a study in the February issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS)

And what is even  better is In about 30 percent of patients, migraine headaches were completely eliminated after surgery, according to the new study, led by Dr. Bahman Guyuron of Case Western Reserve University and the Cleveland Clinic.

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I have learned that people who pray and meditate actually lower stress and brain function.  I have yet to make meditation a daily part of my life, but recent studies may change my routine. 

 In a study that will appear in the January 30 issue of Psychiatry Research: Neuroimaging, Participant-reported reductions in stress were correlated with decreased grey-matter density in the amygdala, which is known to play an important role in anxiety and stress.

Previous studies found structural differences between the brains of experienced mediation practitioners and individuals with no history of meditation, observing thickening of the cerebral cortex in areas associated with attention and emotional integration. But those investigations could not document that those differences were actually produced by meditation.

 Meditation group participants reported spending an average of 27 minutes each day practicing mindfulness exercises, and their responses to a mindfulness questionnaire indicated significant improvements compared with pre-participation responses.

So lets start changing our brains by meditating.  If anyone can share a personal experience where meditation has noticeably changed stress or anxiety please let me know.

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 It may surprise you to know that older driver's actually see more than younger drivers.  And that is why they have difficulty driving.

It turns out that as the brain ages, the visual intake gets bigger.  Older brains attempt to take in the background of all motion in their field of vision.  This makes the brain's ability to focus on relevant movement, important when reacting to driving movements, more difficult.

In a healthy, young person, a brain region called the middle temporal visual area, or MT, actively suppresses often irrelevant background motion so that he or she can concentrate on t

he more important motions of smaller objects in the foreground.

But this above average motion perception is not something to look forward to as we age. Because the brain is spending its limited resources constantly paying attention to the unimportant motions of background objects, it has a harder time noticing the motions of smaller objects.

Fellow blogger, Dr. Virginia Campbell, recently posted an interview the authors of "Sleights of Mind: What the Neuroscience of Magic Reveals about Our Everyday Deceptions" by Stephen L. Macknik, Susana Martinez-Conde, Sandra Blakeslee.  This book is the result of the authors' yearlong, world-wide exploration of magic and how its principles apply to our behavior. Magic tricks fool us because humans have hardwired processes of attention and awareness that are hackable—a good magician uses your mind's own intrinsic properties against you in a form of mental jujitsu.

You can read about the findings in the Journal of Neuroscience.

 

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 The issue for Supreme Court Justices is whether police action " here, a knock on the door" that triggers a reaction on the other side, such as noise that suggests destruction of evidence, should justify a warrant-less entry.  The findings of a recent study show that early marijuana use is associated with poorer executive functioning, and that the younger a person starts, as well as the quantities used, may play a significant role in impairment.

Newly appointed Justice, Elena Kagan, worries that the court could make it too easy for police to avoid the time and effort of getting a warrant.  Police would then be able to justify warrant-less entry based on smelling "pot" and "hearing a noise."Justice Scalia on the other hand sees warrant-less entry based on smell and noise as consistent with the Constitution.   He views police "taking advantage of the stupidity of the criminals" as justification.

The better response to a knock on the door by police is to say, "Oh, heck, no, you can't come in, do you have a warrant."  Presumably this would trigger the necessity of getting a warrant before entering. Arguably this would give occupants time to flush or dispose of the marijuana.

The issue is before the Supreme Court based on a 2005 ruling in Kentucky.  The State Court said the police cannot rely on urgent circumstances they themselves create to enter a home without a warrant.Neurology Today reports in December 2010, that marijuana users who started smoking before age 16 scored consistently lower on cognitive tests than those who started smoking later in life and in healthy individuals who had never used the drug.  These findings add to a growing body of research indicating that heavy marijuana use be adolescents may have long-term consequences on cognitive development.  Read more by clicking on Neurology Today.

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Las Vegas Human Brain Injury Blog

We normally attribute smoking to lung cancer. A Recent Study now links smoking to later life dementia. My mother smoked more than a pack a day and finally succumbed to the disease. Her cancer originated in the lungs and metastasized to her brain. The 6 month ordeal was absolutely heartbreaking. And she quit smoking after getting the diagnosis which was obviously too late. She was my personal longitudinal study subject of the consequences of smoking. And she thought she was so clever with her moth balls to hide the odor and pretend she was not smoking. And I remember during the year prior to her diagnosis how her apartment, food she prepared, clothes she washed, and just about everything else smelled like moth balls. A far cry from theEast Coast Long Island Italian aromas of holiday cooking I cherished from my childhood.

Beginning January 1, 2011, the 79 million-member baby boom generation will begin - at a rate of 10,000 per day - reaching the age of 65. Growing older, while not the cause of Alzheimer's, is the single most significant factor in gauging a person's risk of the disease. The Alzheimer's Association estimates that the number of Americans with this devastating disease will balloon from just over 5 million today to 7.7 million by the year 2030 and could reach nearly 16 million by the middle of the century.

And now we have increased risk of dementia due to smoking.

“We found a two-fold increase in risk [of dementia] among those who smoked two packs per day, a 44 percent increase in those who smoked one to two packs, and 37 percent increase in those smoking one-half a pack per day in mid-life,” Dr. Whitmer told Neurology Today. I wonder if my mother began having dementia that ended up being masked by the cancer. She was forgetting things more.

The study, published in the October 2010 issue of Archives of Internal Medicine, sought to discover whether smoking, a know risk factor for several life-threatening diseases, had long-term association with dementia. This link is previously controversial. The study compiled data over many years. The results revealed a 100% increase in dementia. This does not leave a lot of room to think heavy smokers are immune from related dementia.

So what can you do besides not start or quit smoking? Take more Fish Oil? Not so fast.

Fish oil is oil derived from the tissues of oily fish. Fish oils contain the omega-3 fatty acids eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA), precursors to eicosanoids that

are known to reduce inflammation throughout the body, Studies published in 2004 and 2009 have suggested that fish oil may reduce the risk of depression and suicide. One such study reported that patients who were given the omega-3 fatty acid docosahexaenoic acid fared no better cognitively or functionally than those who took a placebo over 18 months. and are thought to have many health benefits.

So now you know. To decrease the risk factor for dementia – DO NOT SMOKE. If you think you’re decreasing the risk factor by taking Fish Oil, you may not be. As for me, I continue to not smoke and continue taking Fish Oil.

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Brain Injuries often occur fast (in milliseconds) to small places in the brain (microscopic cells).   Speed and size require specific understanding in relation to forces.  This must be important to all of us since just a moment of inattention can result in significant forces being imposed on our heads.  Think of the truck or car crash you did not see coming.  Or the fall you took.  The resulting impacts can change our brains and cause a whole constellation of symptoms and consequences.

Biomechanical forces  (the research and analysis of the mechanics of living organisms and the application of engineering principles to and from biological systems) to the head and body are predictors of brain injury.  In cases of trauma, like car, motorcycle and truck collisions, in addition to sports trauma, like hockey, football and boxing (to name a few), the amount of pressure exerted on the head and the amount of time that elapses during the application of pressure, cause microscopic changes to the structure of the brain.  Microscopic because the damage occurs at the cellular level with axons and dendrites shearing. 

This, in turn, causes metabolic changes (biochemical processes) and other changes in chemistry that result in cognitive impairments, emotional impairments and physical impairments.

Head injury expert Kim Gorgens, a neuropsychologist at the University of Denver (DU), says that most concussions deliver 95 g's to the human body upon impact.

Concussions range in significance from minor to major, but they all share one common factor — they temporarily interfere with the way your brain works. They can affect memory, judgment, reflexes, speech, balance and coordination.

Usually caused by a blow to the head, concussions don't always involve a loss of consciousness. In fact, most people who have concussions never black out. Some people have had concussions and not even realized it.

Concussions are common, particularly if you play a contact sport such as football. But every concussion, no matter how mild, injures your brain. This injury needs time and rest to heal properly. Luckily, most concussions are mild and people usually recover fully.

G-force is a unit of force equal to the force exerted by gravity. In addition, the average football player receives 103 g's when hit during a game. In comparison, the average g-force experienced by military fighter pilots is nine g's. 

Let that sink in for perspective.
 

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Lou Ruvo Brain Center - Working Together to Fight Alzheimer’s

This month I continue covering the Cleveland Clinic Lou Ruvo Center for Brain Health. Recall last month a new Director was appointed. This month the Center is emphasizing its progress and plans for future progress.

Some perspective: There are 5.3 million Americans with Alzheimer’s disease (including 29,000 Nevadans). This number is estimated to reach 16 million by 2050. September 21 is World Alzheimer's Day – a day when the Alzheimer's Association joins with organizations and people around the globe to raise awareness about Alzheimer's and its impact on our families, communities and nations. Today, 35 million people worldwide are affected by Alzheimer's and related dementias, and this number is growing rapidly. World Alzheimer's Day is an opportunity to raise awareness about Alzheimer's disease and the need for more education, support and research.

The Lou Ruvo Center, located in downtown Las Vegas is consistently performing clinical studies and reaches out to all volunteers to help. Education is the goal, Jeffrey Cummings, a medical director at Lou Ruvo Center for Brain Health explains, “Patients must participate in trials if there is to be any progress in developing new treatments for Alzheimer’s disease. Trials are critically important partnerships among patients and families, doctors and scientists to advance new treatments for the Alzheimer’s disease.” Las Vegas Sun Sept. 19, 2010.

The Lou Ruvo Center for Brain Health has been in various stages of opening as construction was completed and is now fully operational. World Alzheimer’s day is September 21 and The Center announces it has great plans and hopes for finding a cure. And of course this gives Las Vegas some notoriety in the field of medicine – something most would agree is sorely needed.

First, While most previous drugs have failed, the drugs being tested today are based on years old science (it takes 7 to 10 years for a drug to be approved by the FDA) Since we now have a better understanding of which proteins damage the brain (build up of a toxic peptide called beta amyloid) we can be more focused. (See my post on July 15, 2009.)

Second, newer and better brain imaging technology and spinal fluid tests significantly affect drug development. This is revolutionizing the way we think about Alzheimer’s disease. These new imaging techniques give researchers a clearer picture of those likely to develop Alzheimer’s later in life at an earlier age.

Third, early diagnosis is a major goal. Since we are able to detect disease onset sooner, a patient may still make crucial decisions regarding care and more while their faculties are still more or less intact.   Participation in health care and other life decisions prior to intellectual decline is an important aspect of any patient’s care.

If you are interested in participating in clinical trials contact Cleveland Clinic’s Lou Ruvo Center for Brain Health by clicking here.

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New research supported in part by grants from the National Institute of Aging, part of the federal government's National Institutes of Health, and the U.S. Department of Defense, brings hope to the understanding and treatment of Alzheimer's Disease.

Reported in the Sept. 2 issue of the journal Nature,  the problem in Alzheimer's disease,  is beta-amyloid, a protein that accumulates in the brain and causes nerve cells to weaken and die.

Alzheimer’s disease is an irreversible, progressive brain disease that slowly destroys memory and thinking skills, and eventually even the ability to carry out the simplest tasks. In most people with Alzheimer’s, symptoms first appear after age 60.

Alzheimer’s disease is the most common cause of dementia among older people. Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—to such an extent that it interferes with a person’s daily life and activities. Estimates vary, but experts suggest that as many as 5.1 million Americans may have Alzheimer’s.

Drugs designed to eliminate plaques made of beta-amyloid have a fatal problem: they need to enter the brain and remove the plaques without attacking healthy brain cells.  Scientists have learned an enormous amount about how beta-amyloid plaques are formed and the toxic effects that these structures as well as the earlier forms of beta-amyloid have on neurons and synapses. These findings have opened up new avenues of investigation and new possibilities for therapeutic targets. New research from the laboratory of Nobel Prize winner Paul Greengard, however, suggests that treatments modeled on the blockbuster cancer drug Gleevec could be the solution. 

Gleevec has the unique ability to bind to a protein that triggers the production of beta-amyloid plaques. The new research from Greengard's lab shows that this protein, called gamma-secretase activating protein (GSAP), dramatically and selectively increases the production of beta-amyloid peptide, which makes up the senile plaques found in the brains of most people with Alzheimer's. 

We are still far from shouting "success" and "cure" but we are inching closer.  Scientists are conducting studies to learn more about plaques, and other features of Alzheimer’s disease. They can now visualize plaques by imaging the brains of living individuals. They are also exploring the very earliest steps in the disease process. Findings from these studies will help them understand the causes of Alzheimer’s.

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 We are almost through August and more than half way through Summer 2010. Parents, children and kids are preparing for the return to school in the next couple of weeks. In Nevada, public schools start August 30.

Meanwhile Nevada, and particularly Las Vegas, continues to muddle through the recession which for Southern Nevada has been a novel experience. The unemployment rate is close to 15% as I write.  The city many thought was immune from economic storms has seen itself hardest hit. Hopefully things will improve.

We face a heated election where the Tea Party candidate, Sharon Angle, accuses Democrat incumbent, Harry Reid, for the current state of plummeted home values while Reid criticizes Angle for not making job creation a part of her job!

The Station Casino’s recent resurface from Bankruptcy with owners, Frank and Lorenzo Fertitta, manning the helm, may be a boost. Of course some creditors had to write off $4,000,000,000 – four billion dollars! But maybe the massive adjustment will re establish the local casino group and have a positive impact on Las Vegas. 

Today’s report of the M Resort, opening just over a year ago, being put up for sale may result in an interesting bid; especially if Boyd gets back into the picture. Boyd’s recent failed effort to take over Station properties may be a prelude to an M resort bid.  Although my sources tell me that Station may make a bid to buy M resort now that they have shaken off 4 billion in debt.

I am reporting on 2 separate topics relating to Brain and Spine Injury issues. First is a look at the Cleveland Clinic’s Las Vegas Lou Ruvo Center. Second is the recent revelation concerning veterans. 

Lou Ruvo Brain Center

Nevada, and specifically Las Vegas, may be on its way to becoming the "go-to" place in the country for Brain Health.  The Cleveland Clinic Lou Ruvo Center for Brain Health (CCLRCBH) provides state-of-the-art care for cognitive disorders and for the family members of those who suffer from them.

 For persons with mild cognitive impairment such as early stage dementia and Alzheimer’s disease, the center offers the most up-to-date and technologically advanced diagnostic imaging services, including 3-Tesla MR, performed by one of the leading neuroimaging academic centers in the world. The CCLRCBH also offers a multimodal treatment program for persons with mild cognitive disorders, including physical exercise, cognitive rehabilitation, and cognitive enhancing medications.

Recently named to head up the Center, leading researcher and neurologist Jeffery L. Cummings, MD, will be the Director of the Cleveland Clinic Lou Ruvo Center for Brain Health.

Prior to joining Cleveland Clinic, Dr. Cummings was the director of the Mary S. Easton Center for Alzheimer’s Disease Research and a professor of Neurology and Psychiatry and Biobehavioral Sciences at David Geffen School of Medicine at UCLA.

He is past president of the Behavioral Neurology Society and of the American Neuropsychiatric Association. Dr. Cummings has authored or edited 30 books and published more than 600 peer-reviewed papers.
 

Misdiagnosis Hurt U.S. Soldiers

We now know that during the height of the Iraq war, the Army routinely misdiagnosed hundreds of soldiers with “personality disorder.” In doing this, the Army was categorizing veterans being dismissed from duty, with a pre-existing condition. Pre existing conditions are not covered by the military health care for veterans.

Leaving wounded veterans ineligible for military health care and with a stigma attached to mental weakness, advocates for veterans, congress and the public actively pushed for re-evaluation of veterans conditions. The Nation, published an article exposing the practice and caused the Defense Department to change its policy. 

All soldiers diagnosed with Personality disorder prior to 2008 are being re-evaluated. Before 2008, over 1000 soldiers were dismissed based on personality disorder. In 2009 only 260 were dismissed for personality disorder.   By 2008, 14,000 soldiers were diagnosed with brain injury or post traumatic stress disorder.   The number of personality disorder cases dropped 75%. Watch this You Tube video.

The significance for those men and women that serve the country in the military is staggering. Could you imagine sacrificing life and limb only to have the U.S. government tell you that you suffered a pre-existing personality disorder? Why, you might ask, did the Army, for example, not make that determination until after my sacrifice of life and limb? How convenient for the Army to take advantage of the sacrifice and not pay the veteran when they can no longer make the sacrifice.

We now know about PTSD as it relates to war, something the Vietnam veterans did not benefit from. We also know, unlike Vietnam, that more soldiers stay alive after blast and concussion trauma due to the enhanced protective gear.

I really hope that the U.S. will be proactive in caring for its military. I think we should all support brain injury groups like the Brain Injury Association of America who are on the front lines, so to speak, in getting legislation for brain injured survivors.

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You may not want to miss this.  ABC News announces a new primetime series, “Nightline Prime,” which premieres Thursday, August 19 examining the mystery and science of the brain.

Each installment will focus on a different research areas, including emotion's impact on the brain, medical emergencies involving the brain, violence and the brain, and food and the brain.

The four installments of Secrets of Your Mind begin airing Thursday, August 19 at 10:00pm ET/PT and continue on the three subsequent Thursdays:
Here is a rundown of each of the shows:

 Thursday, August 19: “Nightline” co-anchor Cynthia McFadden explores the brain in love. She follows a remarkable story of love lost and found again after a traumatic brain injury. McFadden also talks to a man who is literally paralyzed by love—a peculiar brain condition that causes his body to shut down when he experiences feelings of love for his wife.

Thursday, August 26: Martin Bashir takes a journey inside the mind of a psychopath. Bashir examines evil’s origin in the brain and whether people can be born with a tendency for evil or violent behavior and if it can be detected in childhood. In his reporting, Bashir visits death row for a close-up look at two of the country’s most notorious serial killers. He also speaks exclusively to the distraught father of Chris Benoit, the pro-wrestler who murdered his family then himself.

 Thursday, September 2: “Nightline” co-anchor Terry Moran embeds with Dr. Bailes for a first-hand look at life-and-death drama inside the operating room. It’s a race against time as cameras capture an aneurism bursting on the operating table and Dr. Bailes and his team have only seconds to react.
 

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Read this article featured in Discover about Lou Gehrig and the disease that bears his name:

That may seem a strange question, akin to asking who’s buried in Grant’s tomb. But a new study proposes that some athletes diagnosed with Lou Gehrig’s disease may in fact have a different fatal disease that is set off by concussions.

Researchers have previously investigated the link between athletes and this neurodegenerative disease, more technically known as amyotrophic lateral sclerosis (ALS). A recent study examined what seemed to be a higher than usual incidence of Lou Gehrig’s disease among soccer players, and, of course, the disease bears the name of a New York Yankee who was famously undaunted by the hard knocks of his sport. Though it’s impossible to determine now whether Lou Gehrig suffered from ALS or a different condition (Gehrig was cremated), the study’s lead author speculates that Lou Gehrig’s disease might be a misnomer:

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A recent study was funded by the National Institute of Mental Health entitled "Stigma Experience Among Adolescents Taking Psychiatric Medications."  This breaks open the issue of stigma in patients treated for mental illness as it applies to teenagers.

Teenagers reimagine the way people think about adolescents. No longer society's scourge and scapegoat, the teenager emerges from David Bainbridge's fascinating study as an awe-inspiring natural phenomenon that evokes reverence and wonder. Bainbridge, an anatomist, suggests that the second decade is the most important in the human lifecycle. In lively prose, he explains the science behind the changes that occur both on the surface of the teenage body and deep within the teenage brain, from lanky limbs and bad skin to falling in love, sleeping till noon, and the irresistible allure of sex, drugs, and rock‘n’roll. Observed through a scientific lens, these bizarre biological transformations and behavioral anomalies snap into focus, as not only a beautifully choreographed sequence of steps on the path to adulthood, but also as a key evolutionary factor in the success of the species.

Teenagers have their own special place in the study of development and brain science. 

The study evaluated boys and girls between the ages of 12 and 17 who are taking medications. Researchers found that at least 90 percent of the study's participants reported experiencing some form of stigma. It has led to shame, secrecy and limiting social interactions.

While the stigma associated with wounded veterans, soldiers and adults is relatively known, this data suggests young people are burdened as well.  Individuals, young and old, with mental illnesses suffer from public and self-stigmas. The researchers were concerned about how the youth internalized the public discrimination, or stereotyping of their illnesses, and if these stigmas experienced at a young age might impact the individuals as adults.

1 in 6 adults and almost 1 in 10 children suffer from a diagnosable mental illness. Yet, for many, the stigma associated with the illness, can be as great a challenge as the disease itself. This is where the misconceptions stop. This is where bias comes to an end.

Here are some interesting Fact versus Fiction data I found on the internet. 

FICTION: People with a mental illness are often violent.

 FACT: Actually, the vast majority of people with mental health conditions are no more violent than anyone else. People with mental illness are much more likely to be the victims of crime.

 FICTION: Mental illness is a sign of weakness.

 FACT: A mental illness is not caused by personal weakness—nor can it be cured by positive thinking or willpower - proper treatment is needed.

 FICTION: Only military personnel who have been in combat can suffer from PTSD.

 FACT: While PTSD is prevalent in men and women who have seen combat, experiencing or witnessing a traumatic event can trigger PTSD, including violent personal assaults such as rape or robbery, natural or human-caused disasters, or accidents.

 FICTION: People with a mental illness will never get better.

 FACT: For some people, a mental illness may be a lifelong condition, like diabetes. But as with diabetes, proper treatment enables many people with a mental illness to lead fulfilling and productive lives.

 FICTION: Children don’t suffer from mental illness.

 FACT: Millions of children are affected by depression, anxiety and other mental illnesses. As a matter of fact, 1 in 10 children suffer from a diagnosable mental illness. Getting treatment is essential.

 FICTION: “Mental illness can’t affect me!”

 FACT: Mental illness can affect anyone. While some illnesses have a genetic risk, mental illness can affect people of all ages, races and income levels, whether or not there is a family history. 

I also ran across a cool blog on Facebook called bringchange2mind. Check it out.
 

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A new classification of depressive subtypes of depression has been proposed in the current issue of Psychotherapy and Psychosomatics.  In keeping current on the new DSM being revised, as I have been writing about in previous posts, certain authors are recommending a revamping of depression subtypes to effect treatment. 

Lichtenberg and Belmaker argue that a simple diagnosis is no longer sufficient to guide treatment.  They propose the following subtypes:

Type A: Depression with Anxiety

Type B: Acute Depression

Type C: Adult Depression after Childhood Trauma

Type D: Depressive Reaction to Separation Stress

Type E: Postpartum Depression

Type F: Late-Life Depression

Type G: Psychotic Depression

Type H: Atypical Depression

Type I: Bipolar Depression

Type J: Depression Secondary to Substance Abuse or to a Medical Condition.

 One of the major challenges in treatment of depression seems to be the heterogeneity of the disorder. It is not uncommon to see significant differences in symptomatic presentation of depress patients.  Besides there are differences in age of onset, severity of course, treatment response and comorbid conditions. One assumption is that the heterogeneity is simply because there are different subtypes of depression,

says Tanvir Singh, MD and Alina Rais, MD, Dept. Psychiatry, University of Toledo Medical Center in their article entitled Subtypes of Depression.

I will anxiously await more information on the revised DSM.  For more information visit www.depression.com.

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New Evidence that prevention will not cure Alzheimer's.  Here is some news that will turn your head around.  Just when you thought you might be doing everything right, you find out you might be wrong.  This reminds me of how much cigarette smoking is condoned Europe.  If you have ever been on an elevator in Italy or France you can not help but notice (and ingest) second hand smoke from the habitual smokers.  Now why is that?  Did Woody Allen's prediction in Sleeper come true?  Are cigarettes really good for you!?  And now the following.

An independent panel of experts meeting in the US concluded there is no evidence that you can prevent or slow down Alzheimer's, a progressive and fatal brain disease, even if you keep yourself active with exercise, social interaction, brain puzzles, or take fish oil, other supplements, or medication.  That is exactly the opposite of what we have been told.

The National Institutes of Health determined that the value of these strategies for delaying the onset and/or reducing the severity of decline or disease hasn't been demonstrated in rigorous studies.  Interestingly, the panel's assessment of the available evidence revealed that progress to understand how the onset of these conditions might be delayed or prevented is limited by inconsistent definitions of what constitutes Alzheimer's disease and cognitive decline. Other factors include incomplete understanding of the natural history of the disease and limited understanding of the aging process in general. The panel recommended that the research community and clinicians collaborate to develop, test, and uniformly adopt objective measures of baseline cognitive function and changes over time.
 

Alzheimer's Disease and Cognitive Decline, Structured Abstract. April 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/tp/alzcogtp.htm actually concludes:

The current research on the list of putative risk or protective factors is largely inadequate to confidently assess their association with AD or cognitive decline. Further research that addresses the limitations of existing studies is needed prior to be able to make recommendations on interventions.

 But the initial ramifications may make us all rethink taking up smoking!  If you have not seen it, watch Woody Allen explain it in this short video.

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What is Inteligent Design and What is Random?  I recently came across a statement by Wasserman and Blumberg in the May-June issue of American Scientist that I want to share.

Do not take this too seriously...or do.

Although evolutionists and creationists strongly disagree about the role that intelligent design plays in the origins of bodies and brains, they curiously agree about the role that intelligent design plays in the origins of human inventiveness. However, both camps would do well to focus less on perceived foresight and purpose and more on the actual origins of behavior.

Contemporary evolutionists such as Richard Dawkins should move beyond the arcane argument over where to draw the line between things that "really are designed" and "things that only appear to be designed." By doing so, Wasserman and Blumber note, we will better appreciate the actual forces that unite the processes of change across both evolutionary and developmental timescales.
And that I like:  appreciating the actual forces that unite the processes of change across both evolutionary and developmental timescales.  Is your language science?  Is it theology or philosophy?  Do you call it God, Jesus, Mohammad, or simply "the force?"  I believe something is there, what ever you want to call it.

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Interestingly, devices similar to pacemakers that regulate blood flow through heart control, promote good neuropsychological health.  A March 2010 study confirms.

A standard test of the implantable cardioverter defibrillator (ICD) is linked to significant thought-processing problems that improve for most patients within a year after the device is inserted, according to research reported in Circulation: Arrhythmia and Electrophysiology, a journal of the American Heart Association.

 Conclusions—ICD implantation is associated with neuropsychological impairment which dissipates for the majority of recipients after 12 months. Short-term memory function and attention are particularly vulnerable to changes in oxygen during ICD testing. Although, anxiety and depression are prevalent, there is little evidence for the direct impact of mood on cognition, and deficits appear not to be associated with reduced quality of life. These results provide evidence for longitudinal outcomes of ICD surgery and have implications for patient rehabilitation and adjustment.

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Since I recently posted on the topic linking high blood pressure to dementia, I came across my doctor's newsletter on Blood Pressure.  I reprint it here for those interested.

The leading cause of death and disability in the United States is from cardiovascular diseases, and the most common disease is high blood pressure.  High blood pressure, also known as
hypertension, usually does not have any symptoms – hence, the nickname “silent killer.”

Unfortunately, one-third of those who have high blood pressure do not realize it and are not aware of their risk for heart disease. Therefore, many people live years without treatment, possibly damaging their heart, blood vessels, and kidneys.

Lifestyle choices (e.g., weight control, tobacco use, proper nutrition, regular exercise) can help
prevent and/or control high blood pressure. The following are common questions and answers about blood pressure.

What is blood pressure?

It is the force of blood against the walls of arteries. Systolic pressure (the top number) is the force as the heart beats. Diastolic pressure (the bottom number) is the force as the heart relaxes.

A blood pressure reading of 120/80 mmHg is articulated as “120 over 80.”

What is the meaning of the numbers?

A systolic pressure of 120 or less is considered normal. Diastolic pressure of 80 or less is considered normal. Therefore, 120/80 or less is a normal blood pressure. The chart below shows normal blood pressure levels, as well as the levels of high blood pressure.

What are the dangers of high blood pressure?

High blood pressure places an additional strain on the circulatory system (i.e., heart and blood vessels).  This strain results in arteries becoming thicker, narrower, and weaker, sometimes causing an obstruction.  A completely obstructed artery often leads to heart attacks, strokes, kidney disease, and dementia.

Is low blood pressure a health problem?

The training effect of regular exercise, especially when working out rigorously, is a lower blood pressure. At times, an individual who does not exercise may experience regular low blood pressure. If symptoms do not accompany the low pressure, it usually is not serious. However, if
blood pressure suddenly drops, it may indicate an underlying problem causing inadequate blood flow to the heart, brain, and other vital organs. Symptoms may include dizziness or lightheadedness.

What are some tips to prevent/control high blood pressure?

Healthy living is at the heart of preventing and controlling high blood pressure. Are you:
 Maintaining a healthy weight?
 Engaging in regular physical activity (fi ve 30-minute sessions of aerobic exercise and two
30-minute strength training sessions per week)?
 Eating a low-fat, high-nutrient diet (fruits, vegetables, low-fat dairy foods, low sodium)?
 Limiting alcohol consumption?

References:
1. NIH – National Heart, Lung, Blood
Institute, www.nhlbi.nih.gov
2. American Heart Association,
www.heart.org
3. Blood Pressure Association (United
Kingdom), www.bpassoc.org.uk
Exceptional Doctors. Exceptional Care. Exceptional Results.
LivingWell
The Link Between Heart Health and Blood Pressure
February 2010
 

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 Another study has found that hypertension may contribute to increased risk of dementia, this time with evidence of actual brain abnormalities. I previously wrote about the link between Hypertension and Alzheimer's disease.

This is especially relevant to those who are not controlling their blood pressure. Blood pressure is not something one feels is high or low. Specific medical evaluation, blood pressure test, is necessary. 

Data from an offshoot of the Women's Health Initiative found that participants' baseline blood pressure was strongly correlated with volume of lesions in their brains' white matter, according to Lewis Kuller, MD, DrPH, of the University of Pittsburgh, and colleagues.

Along with earlier studies linking blood pressure to clinical dementia, the evidence "supports tight control of blood pressure levels, especially beginning at younger and middle age as a possible and perhaps only way to prevent dementia," Kuller and colleagues concluded online in the Journal of Clinical Hypertension.

Treating hypertension in the elderly appears to protect against dementia and cognitive decline.  Uncontrolled hypertension in older patients increases the risk of cognitive impairment. Hypertensive patients had a 70% greater risk of non-amnestic mild cognitive impairment compared with nonhypertensive patients according to Christiane Reitz, M.D., Ph.D., of Columbia University in New York. (C Reitz et al. "Hypertension and the risk of mild cognitive impairment." International Society of Vascular Behavioral and Cognitive Disorders meeting, July 11-14, San Antonio. Final program and abstract book. Abstract O-6)

For each year an individual took medication to lower blood pressure, the risk of dementia decreased by about 3%, found Rita Peila, Ph.D., an epidemiologist at the National Institute on Aging and a scientist at the Pacific Health Research Institute in Honolulu.

My question is whether a person who controls their blood pressure and hypertension with medicine can decrease their risk of dementia to that of someone without hypertension.  I predict that other risk factors would need to be accounted for but, other things being equal, can a person with controlled high blood pressure eliminate the risk of dementia?

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Findings published in Nature Neuroscience help explain why light makes Migraine Headaches worse. 

Ask anyone who suffers from migraine headaches what they do when they're having an attack, and you're likely to hear "go into a dark room." And although it's long been known that light makes migraines worse, the reason why has been unclear. 

Migraine is a recurring, episodic neurological disorder characterized as throbbing headache that is commonly associated with a variety of other symptoms (for example, nausea, vomiting, irritability and fatigue).  Migraines are chronic headaches that can cause significant pain for hours or even days. Symptoms can be so severe that all you can think about is finding a dark, quiet place to lie down.

For light to make pain worse, the pathways have to converge somewhere, thought the researchers at Beth Israel Deaconess Medical Center.  Exacerbation of migraine headache by light is prevalent among blind individuals. Light can increase the electrical activity in neurons.

One expert said these findings should put to rest any suggestion that patients exaggerate their sensitivity to light; they are not whining or imagining their symptoms.

"A neural mechanism for exacerbation of headache by light."
Rodrigo Noseda, Vanessa Kainz, Moshe Jakubowski, Joshua J Gooley, Clifford B Saper, Kathleen Digre & Rami Burstein.
Nature Neuroscience, Advance online publication 10 January 2010.
DOI:10.1038/nn.2475

 

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People often confuse coma as being necessary for brain injury to occur.  This is far from the facts or truth.  However coma usually confirms that brain injury has, in all probability, robbed the individual of cognition or motor function.  Only rarely does one recover completely from coma.

I thought a refresher on what Coma and Glasgow Coma Scale are would be helpful.

A coma, or being comatose, is a deep state of unconsciousness - longer-term comatose patients may be reclassified as being in a permanent vegetative state. Recall Terry Schiavo. The patient cannot be awakened and does not respond to pain, light or sound in a normal way - the person in coma cannot react with the surrounding environment. A person in a coma does not take voluntary actions and does not have sleep-wake cycles.

The inability to waken differentiates coma from sleep. Levels of unconsciousness and unresponsiveness vary, depending on how much of the brain is functioning.  Neurological Experts and family often argue about whether the comatose patient can hear voices or perceive events or the presence of people. 

Coma may occur for various reasons, such as intoxication, CNS (central nervous system) diseases, a traumatic injury, and hypoxia (oxygen deprivation). Coma can be induced deliberately with pharmaceutical agents - perhaps in order to protect the patient from intense pain during a healing process, or to preserve higher brain function following another form of brain trauma.

Comas generally do not last for more than a few weeks. A patient whose state does not change after an extended period is often reclassified as being in a persistent vegetative state. Unfortunately, those in a persistent vegetative state for over twelve months rarely wake up.

Another condition is known as "Locked-In Syndrome."  Locked-in syndrome is a rare neurological disorder characterized by complete paralysis of voluntary muscles in all parts of the body except for those that control eye movement. It may result from traumatic brain injury, diseases of the circulatory system, diseases that destroy the myelin sheath surrounding nerve cells, or medication overdose. Individuals with locked-in syndrome are conscious and can think and reason, but are unable to speak or move. The disorder leaves individuals completely mute and paralyzed. Communication may be possible with blinking eye movements

A book and movie called "The Butterfly and Diving Bell" was written by Jean-Dominique Bauby who could only move his eyelid.  Through the help of an interpreter, he wrote the entire book, letter by letter, by moving his eyelid when the letter was identified.
 

What are the possible causes of a coma?

A coma can have several possible causes, including:

• Diabetes - if the blood sugar levels of the diabetes patient rise too much they will have hyperglycemia, the opposite is hypoglycemia (blood sugar levels are too low). Sustained periods of hyperglycemia or hypoglycemia can result in coma.
   
• Hypoxia (lack of oxygen) - a person who nearly drowned may not awaken because of a shortage of blood (which carries oxygen) to the brain. The same may occur to somebody who is resuscitated after a heart attack.
   
• Infections - those which cause inflammation of the brain, spinal cord or tissues surrounded the brain can result in coma if symptoms are severe enough. Examples include encephalitis or meningitis.
   
• Stroke - a condition where a blood clot or ruptured artery or blood vessel interrupts blood flow to an area of the brain. A lack of oxygen and glucose (sugar) flowing to the brain leads to the death of brain cells and brain damage, often resulting in impairment in speech, movement, and memory - and sometimes coma.
   
• Toxins and drug overdoses - exposure to carbon monoxide can result in brain damage and coma, as can some drug overdoses.
   
• Traumatic brain injuries - these include injuries from vehicle accidents and violent attacks. They are the most common cause of comas.

Diagnostic Tools

Lumbar puncture (spinal tap) - this can determine whether there is an infection. The doctor inserts a needle into the patient's spinal canal, measures pressure and extracts fluid.   Ruling out meningitis usually utilizes spinal tap.

Imaging scans of the brain - these will help determine whether there is any brain injury/damage, and where. Examples include:

• CT (computed tomography) scan - also known as a CAT (Computer Axial Tomography) scan. It is a medical imaging method that employs tomography. Tomography is the process of generating a two-dimensional image of a slice or section through a 3-dimensional object (a tomogram). The medical device is called a CTG scanner; it is a large machine and uses X-rays. It used to be called an EMI scan, because it was developed by the company EMI.
   
• MRI (magnetic resonance imaging) scan - an MRI machine uses a magnetic field and radio waves to create detailed images of the body, which in this case would be the brain. Most MRI machines look like a long tube, with a large magnet present in the circular area. When beginning the process of taking an MRI, the patient is laid down on a table. Then depending on where the MRI needs to be taken, the technician slides a coil to the specific area being imaged. The coil is the part of the machine that receives the MR signal. MRI scans are good for examining the brainstem and deep brain structures. The doctor may inject a special dye which shows up on the scans and distinguishes healthy tissue from damaged tissue. 
   
• EEG (electroencephalography) - the device measures the electrical activity within the brain. Electrodes are placed on the patient's scalp; they pick up electrical impulses that occur in the brain. These impulses are recorded on the EEG device. An EEG can tell whether the patient is having non-convulsive seizures. 
•  
• PET (Positron Emission Tomography) - a nuclear medicine imaging technique which produces a three-dimensional image or picture of functional processes in the body. The system detects pairs of gamma rays emitted indirectly by a positron-emitting radionuclide (tracer), which is introduced into the body on a biologically active molecule. Images of tracer concentration in 3-dimensional space within the body are then reconstructed by computer analysis.

 Glasgow Coma Scale (GCS)

This scale is very useful for determining conciousness in severe cases.  Unfortunately it is fequently misused in cases of mild and moderate traumatic brain.  For instance, Mild Traumatic Brain Injury, which many times has devasting consequences, is defined by the same value on GCS as for a completely normal individual.  Hence those with incentive to discredit the reality of brain injury point to the "normal" GCS.

The GCS scores patients according to verbal responses, motor responses (physical reflexes), and how easily they can open their eyes.

• Eyes - Glasgow Coma Scale
  
  Score of 1 - does not open eyes.
  Score of 2 - opens eyes in response to painful stimuli (when given pain).
  Score of 3 - opens eyes in response to voice.
  Score of 4 - opens eyes spontaneously.
  
  
   
• Verbal - Glasgow Coma Scale
  
  Score of 1 - makes no sound.
  Score of 2 - incomprehensible sounds (mumbles).
  Score of 3 - utters inappropriate words.
  Score of 4 - confused, disorientated.
  Score of 5 - oriented, chats normally.
  
   
• Motor (physical reflexes) - Glasgow Coma Scale
  
  Score of 1 - makes no movements.
  Score of 2 - extension to painful stimuli (straightens limb when given pain).
  Score of 3 - abnormal flexion to painful stimuli (moves in a strange way when given pain).
  Score of 4 - flexion/withdrawal to painful stimuli (moves away when given pain).
  Score of 5 - localizes painful stimuli (can pinpoint where pain is).
  Score of 6 - obeys commands.
  
  
   
• Brain injury will be classified in the Glasgow Coma Scale as:
  
  Coma = a score of 8 or less.
  Moderate = a score of 9 to 12.
  Minor = a score of 13 or more.

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Size is not what counts in the hunt for the most intelligent.  Whales have brains weighing 9 kg (with over 200 billion nerve cells), and human brains vary between 1.25 kg and 1.45 kg (with an estimated 85 billion nerve cells). A honeybee's brain weighs only 1 milligram and contains fewer than a million nerve cells. 
 

Insects may have tiny brains, but they can perform some seriously impressive feats of mental gymnastics.

According to a growing number of studies, some insects can count, categorize objects, even recognize human faces -- all with brains the size of pinheads.

WATCH VIDEO: Take a closer look at the lives of mosquitoes, maggots and other creepy crawlies.

Despite many attempts to link the volume of an animal's brain with the depth of its intelligence, scientists now propose that it's the complexity of connections between brain cells that matters most. Studying those connections -- a more manageable task in a little brain than in a big one -- could help researchers understand how bigger brains, including those of humans, work.

Scientists at Queen Mary, University of London, state that contrary to popular belief, we can't say that brain size predicts the capacity for intelligent behavior.

Research repeatedly shows how insects are capable of some intelligent behaviors scientists previously thought were unique to larger animals.

Research suggests that bigger animals may need bigger brains simply because there is more to control - for example they need to move bigger muscles and therefore need more and bigger nerves to move them.

The entire article is presented in the journal Current Biology.  Read more here.

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A presentation by the American Heart Association's (AHA) annual Scientific Sessions in Orlando revealed the pooling results from 21 studies, involving 622,381 men and women, to conclude that the risk of stroke for those with migraines is 2.3 times those without.

Researchers at Johns Hopkins have affirmed that migraine headaches are associated with more than twofold higher chances of the most common kind of stroke: those occurring when blood supply to the brain is suddenly cut off by the buildup of plaque or a blood clot.

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Here is a good one for all us musicians...

Regularly playing a musical instrument changes the anatomy and function of the brain and may be used in therapy to improve cognitive skills.

There is growing evidence that musicians have structurally and functionally different brains compared with non-musicians. In particular, the areas of the brain used to process music are larger or more active in musicians. Even just starting to learn a musical instrument can changes the neurophysiology of the brain.

Lutz Jäncke, a member of Faculty of 1000 Medicine, proposes using music in neuropsychological therapy, for example to improve language skills, memory, or mood. In a review for Faculty of 1000 Biology Reports, an online publication in which leading researchers highlight advances in their field, Jäncke summarizes recent studies of professional musicians

Read More.

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Traumatic Brain Injury many times produces feelings of fatigue.  The theory is that since the brain needs to work harder after trauma to compensate for interrupted neural pathways, a feeling of tiredness results.  To make matter worse, that tiredness is also accompanied, many times by insomnia.  TBI sufferers are usually tired due to the hyper activity required to maintain previous function in addition to insomnia.

The American Academy of Sleep Medicine defines insomnia as unsatisfactory sleep that impacts daytime functioning. More than one third of adults report some degree of insomnia within any given year, and 2 to 6 percent use medications to aid sleep. Insomnia is associated with increased morbidity and mortality caused by cardiovascular disease and psychiatric disorders and has other major public health and social consequences, such as accidents and absenteeism.

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I recently posted the article entitled "10 Brainiest Cities."  To follow up the other end of the scale I now post an article by the same reporter revealing the 10 Lowest Cities.

Zach Miners, U.S. News & World Report

Find more:

Not every state in the union can be full of geniuses, right? At least that's what, at first glance, one might conclude after seeing the results of the "life'sDHA Index of Brain Health," an assessment that ranks all 50 states and the District of Columbia according to what its creators consider to be factors supporting brain health.

Washington, D.C., and nine brain-healthy states made the top 10 list. Here are the 10 lowest-ranking states: Indiana, North Dakota, South Carolina, Arkansas, Kentucky, Tennessee, Mississippi, Alabama, Oklahoma and, dead last, Louisiana.

The brain health evaluations, performed by researchers at Martek Biosciences Corp., were determined through an analysis of third-party data on the diet, physical health, mental health and social well being of the residents of each state.

Read the whole article here.

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I came across the ADDA website , www.add.org,and thought I would share it.  Many of us have or know kids or relatives with ADD.  Here is the latest newletter.

The kids are back in school and things are settling into a routine on the home front so it's time to catch up at work.  Everyone I talk to says they have too much to do and not enough hours in a day. Linda Walker's productivity tips in this month's article will come in especially handy.
 
ADDA is working hard to change public opinion and public policy concerning adults with ADHD. ADHD Awareness Day, which happened last Wednesday, September 16, is one such initiative. I hope you all had a happy ADHD Awareness Day!
 
Janet Kramer's story of Rose, a 23 year old mother who spent 18 months in prison for self-medicating her ADHD due to mandatory sentencing laws, touched many people.  Janet, an ADDA Board Member and Co-Chair of the ADDA Work Group on ADHD and Corrections, is leading the charge to prevent exactly this type of situation.
 
I'm proud to announce that along with other significant national organizations, ADDA became a signatory on a letter supporting S. 714, the National Criminal Justice Commission Act of 2009, which positively addresses issues very relevant to our members. Congratulations, Janet, the ADDA board and to you, our members. Without your support, we couldn't continue to do what we do for you.

ADDA works hard to bring you valuable services, so I'm sure you're aware of our Webinars program.  Well, there are more exciting Webinars coming up! For ADDA members only, next Wednesday, September 23, Marjorie Johnson will help us manage anger and conflict and the following Wednesday, September 30, Dr. Theresa Cerulli will explain medication management for ADHD.  On October 7, Ari Tuckman will hold a Q & A session that's open to everyone. If you've got questions, Ari's got answers!

This just in! Last Friday (September 18, 2009), Global TV in Canada aired an excellent documentary called "ADD and Loving It!" I watched it and thoroughly enjoyed it. It provided a balanced take on adult ADHD, and (politely) shot down all the usual arguments against it (bad parenting, food additives, etc.). I don't know if Global TV has any plans to air it again, or if it'll be available in the US, but it will be available for the next few days (until September 25, 2009 at http://news.globaltv.com/Loving/2009300/story.html. Enjoy!

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A new study ranks the 'brain health' of all 50 states, with a heavy emphasis on a healthful omega-3 fat.   Zach Miners, U.S. News & World Report.  Omega-3 is very good for brain behavior and health.

If you sometimes find it difficult to concentrate or experience the occasional "senior moment," don't be too hard on yourself. It might just be the state you live in.

To raise awareness about the state of the nation's "brain health" and to encourage people to take action toward improving their own brain function, researchers released an index that purports to rank the "brain smarts" of all 50 states and the District of Columbia.

 Read the entire article here.

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 The belief that healthy older brains are substantially smaller than younger brains may stem from studies that did not screen out people whose undetected, slowly developing brain disease was killing off cells in key areas, according to new research. As a result, previous findings may have overestimated atrophy and underestimated normal size for the older brain.
 

The seeming age-related atrophy in gray matter more likely reflected pathological changes in the brain that underlie significant cognitive decline than aging itself, the authors wrote. As long as people stay cognitively healthy, the researchers believe that the gray matter of areas supporting cognition might not shrink much at all.

"The Prevalence of Cortical Gray Matter Atrophy May Be Overestimated In the Healthy Aging Brain,"
Saartje Burgmans, PhD student, Martin P. J. van Boxtel, PhD, MD, Eric F. P. M. Vuurman, PhD, Floortje Smeets, PhD student, and Ed H. B. M. Gronenschild, PhD, Maastricht University; Harry B. M. Uylings, PhD, Maastricht University and VU University Medical Center Amsterdam; and Jelle Jolles, PhD, Maastricht University;
Neuropsychology, Vol. 23, No. 5.
 

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Advance in neuroimaging are always exciting as they assist doctors and clinicians in treating patients with traumatic brain injury. 

Functional magnetic resonance imaging (fMRI) is a technique widely used in studying the human brain. However, it has long been unclear exactly how fMRI signals are generated at brain cell level. This information is crucially important to interpreting these imaging signals. Scientists from the Academy of Finland's Neuroscience Research Programme (NEURO) have discovered that astrocytes, support cells in brain tissue, play a key role in the generation of fMRI signals.

Functional magnetic imaging has become a highly popular method in basic neurobiological research, psychology, medicine as well as in areas of study that interface with the social sciences and economics, such as neuroeconomics. fMRI imaging does not directly measure the activity of nerve cells or neural networks, but local changes in cerebrovascular circulation during the execution of certain functions. Interpretation of the measurement data obtained with this method therefore requires a close knowledge of the cell-level mechanisms that are responsible for these local changes in cerebrovascular circulation.
 

Read morehere.

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A New Study from  the University of Tulsa, published in the Journal of Clinical and Experimental Neuropsychology (Neuropsychological impairment and psychosis in mania. Journal of Clinical and Experimental Neuropsychology, 2009;31(5):523-532),  finds Deficits involving executive function, working memory, speed of information processing, and new learning Occur in many people with mania. Factors that predict impairment remain poorly understood, but there are indications that psychotic features may correspond with increased risk of neurocognitive dysfunction during manic episodes.

"The current study examined neuropsychological function in 40 inpatients with bipolar I mania, 24 of whom presented with psychotic features. Compared to a control group, the inpatients showed worse executive function, speed of information processing, new learning, and dexterity. Nonetheless, presence of psychotic features failed to distinguish the inpatients with mania. Thus, psychotic features do not appear to increase neurobehavioral morbidity in people with mania, but presence of mania clearly corresponded with neurobehavioral dysfunction," wrote M.R. Basso and colleagues, University of Tulsa.

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People who consume high amounts of caffeine each day are more likely to suffer occasional headaches than those with low caffeine consumption, a team of researchers at the Norwegian University of Science and Technology (NTNU) reports in a study recently published in the Journal of Headache Pain.

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The incidence of Alzheimer's is known to affect adult brains in later years.  But did you know the incidence also increases after and as a result of traumatic brain injury?

Alzheimer's disease is the most common form of dementia. The disease gets worse as it develops - it is a progressive disease. There is no current cure for Alzheimer's, although there are ways of slowing down its advance and helping patients with some of the symptoms. Alzheimer's is also a terminal disease - it is incurable and causes death.

According the National Institute on Aging, there are estimated to be between 2.4 million and 4.5 million Americans who have Alzheimer's. There are approximately 417,000 people in the UK with Alzheimer's, according to the Alzheimer's Society.

Alzheimer's disease is a progressive neurologic disease of the brain leading to the irreversible loss of neurons and the loss of intellectual abilities, including memory and reasoning, which become severe enough to impede social or occupational functioning.

An excellent look at the history, causes and diagnosis of Alzheimer's can be found by clicking here.

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My collegue and friend David Kracke writes from Oregon:

Tim;

Thanks for sharing this informative and important study. I have always suspected this relationship between TBI and symptoms consistant with Alzheimer's Disease. Having a study to confirm it helps significantly.

FYI: Check out an opinion piece I wrote that ran last month in the Oregonian: http://www.oregonlive.com/opinion/index.ssf/2009/06/maxs_law_one_tragedy_that_need.html

Thanks, Tim. Keep up the good work.

David Kracke
Attorney,
Portland, Oregon
503-224-3018

Thanks David.  Same to you and hopefully I can visit Portland soon.  I'll call you when I do.

Tim

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Here is a New 5 minute test designed to test your memory for Alzheimers.

Click here to take the test. 

Click here to score the test.

http://www.linkedin.com/news?viewArticle=&articleID=48367685&gid=131689&srchCat=RCNT&articleURL=http%3A%2F%2Fwww%2Ealzheimersreadingroom%2Ecom%2F2009%2F07%2Falzheimers-reading-room-press-release%2Ehtml&urlhash=5whm

How did you do?

Read more by clicking here.

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People in early stages of Alzheimer's disease have trouble focusing on what is important to remember, according to University of California-Los Angeles (UCLA) researchers.

"One of the first telltale signs of Alzheimer's disease may be not memory problems, but failure to control attention," said lead researcher Alan Castel, UCLA assistant professor of Psychology.

Read the study published in Neurspsychology, June 2009, by clicking"Early Alzheimer's patients fail to remember what's important." Asian News International. Al Bawaba (Middle East) Ltd. 2009.

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I had the opportunity to hold a brain during my trip to the morgue a few years ago. It was an amazing experience. The brain is soft and infirm. It looks relatively symmetrical with each half held together at the corpus callosum.  

But each half is not perfectly symmetrical and that goes against the pop psychological “left-right brain” theories. Actually each half is not a mirror image of the other which enables us to perform different tasks at the same time.

“In the 1990s psychologist Michael Corballis of the University of Auckland in New Zealand argued that the asymmetry of the brain – known as lateralization - was a key step in the evolution of our species, giving us language and additional mental powers that other animals lack.

“Today Corballis readily admits he was wrong. Lateralized brains are not unique to humans. Parrots prefer picking up things with their left foot. Toads tend to attack other toads from the right but go after prey from the left. Zebra fish are likely to look at new things with their right eye and familiar things with their left….”

The May 2009 edition of Discover Magazine published an article by Carl Zimmer who frequently publishes on brain issues. He says, “One hypothesis is that a lateralized brain is more powerful than one that works like a mirror image. Instead of two matching parts of the brain performing an identical task, one can take charge, leaving the other free to do something else.”

It seems that our ability to multitask is owed largely to our not so symmetrical brain halves. Zimmer’s article is fascinating and can be read by clicking here.

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I found this article entitled  Building a Better Brain in The April issue of Discover Magazine and thought I would share this excerpt with my readers.

The Attention Edge
Pay attention to this paragraph and you are selectively concentrating on a task or idea while ignoring distractions like that dog barking down the street or your cell phone ringing. In a world of information overload and increasing multi-multitasking, you do not have to suffer from ADHD to have trouble focusing. You need no diagnosis to benefit from drugs that cut through the chaos and help you get things done.

Attention-focusing drugs, of course, have been here for years: Amphetamines, nicknamed “go pills,” were discovered in the late 19th century. By the 1940s these central nervous system stimulants were widely used to treat asthma and had become popular as “pep” and diet pills. They were embraced by members of the armed forces, especially pilots, who had to remain attentive to myriad tasks despite constant danger and fatigue. Rife with serious side effects, including hallucinations, anorexia, and heart problems, dextroamphetamine (trade name Dexedrine, better known as speed) is rarely used today by civilians. But the amphetamine mix Adderall and the amphetamine-related drug methylphenidate (Ritalin, Methylin, Concerta, among others) are commonly prescribed.

Exactly how these drugs work their magic remains unknown, but stimulants like Ritalin and modafinil influence the neurotransmitters dopamine and norepinephrine, which are essential for attention and memory skills. Both drugs inhibit reuptake, or reabsorption, of these neurotransmitters by neurons, thus prolonging their action. Modafinil also indirectly alters the action of glutamate, the main neurotransmitter used by neurons in the brain to send signals down the line. The center of action for all these drugs, says University of California at Davis psychiatrist Michael Minzenberg, is the prefrontal cortex, the part of the brain that is responsible for executive functions like sorting out conflicting thoughts, making choices, predicting events, and exerting social control.

Read the whole thing by clicking here.

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William Burke of Neurologica wrote me about a project sponsored by Neurologica.  Here is a little of what they do:

According to a Cleveland Clinic study published in the March/April issue of the Journal of the American Healthcare Radiology Administrators, NeuroLogica’s CereTom® Portable Head/Neck multi-slice CT Scanner was found to have a dramatic economic and clinical benefit while imaging Intensive Care Unit (ICU) patients.

The study, conducted by Thomas Masaryk M.D., Department Chair of Diagnostic Radiology at Cleveland Clinic, and colleagues, concluded that portable head/neck CT scanning:

1.Provided significant savings in terms of cost and time while providing clinicians with diagnostic images equivalent to that of their fixed full body scanners

2.Allowed the fixed conventional scanner to be dedicated for a greater number of outpatient studies by eliminating the bottleneck of time-intensive ICU patients

3.Eliminated clinical dangers associated with the transport of critically ill patients

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I will never forgot the experience of deposing the coroner in a brain injury case.  The deposition was at the morgue.  Afterward, we, the attorneys for all parties and the court reporter, were treated to a tour.  What amazed me most was how numbed the folks working there were to the noxious fumes that pushed their way into your olfactory center.

Then as a personal favor to me, I was permitted to hold brains that had been removed from bodies.  I was able to get a never before view of the brain's structure, texture and size. 

I recently came across an interesting article from someone having a similar experience. Discover Magazine contributor, Carl Zimmer, published "The Brain The Big Similarities & Quirky Differences Between Our Left and Right Brains," in the May 2009 issue.  Brain lateralization is the cooperation of right and left brain.  He states:

No matter how lateralized the brain can get, though, the two sides still work together. The pop psychology notion of a left brain and a right brain doesn’t capture their intimate working relationship. The left hemisphere specializes in picking out the sounds that form words and working out the syntax of the words, for example, but it does not have a monopoly on language processing. The right hemisphere is actually more sensitive to the emotional features of language, tuning in to the slow rhythms of speech that carry intonation and stress.

Neuroscientists know that the hemispheres work together and that they do so by communicating through the corpus callosum. But exactly how the hemispheres cooperate is not so clear. Perhaps paired regions take turns being dominant. That is known to happen in some animals. For instance, dolphins use this strategy to sleep and swim at the same time: One hemisphere remains active for hours, then fades while the other takes over. Bird brains switch as well. In order to sing, a songbird makes the two sides of its lungs open and close. The two hemispheres of the bird’s brain take turns controlling the song, each dominating for a hundredth of a second.

The intimate cooperation between the two hemispheres makes it all the more remarkable that a person can survive with just one—a sign that the brain is far more malleable than we once thought. After a hemisphere is forced to manage on its own, it can rewire itself to handle all the tasks of a full brain. In fact, two hemispheres can cause more trouble than one if they cannot talk clearly to each other. Neuro­scientists have linked some mental disorders, including dyslexia and Alzheimer’s, with a breakdown in left-right communication.

The two sides of the brain may be a legacy that we inherited from our wormlike ancestors. But their delicate balance of symmetry and specialization is now woven into the very essence of human nature.

Read the full article here.

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The Diagnsotic and Statistical Manual IV (DSM IV) serves as the psychiatric source book for diagnosing disorders.    The manual is used in worker's compensation cases, personal injury cases, including brain injury, and in clinical and forensic psychiatric practice.

Now the Diagnsotic and Statistical Manual V (DSM V) is being created.  Shari Roan of the LA Times writes:

Psychiatrists are debating what is normal and what constitutes an illness. When that edition of the book often referred to as the “bible of psychiatry” is released in 18 months, most agree it will contain significant revisions based on information gathered from newer imaging techniques and genetic studies. Mental health advocates hope that the new edition will include information to help with diagnoses of those with mild versions of disorders, as well as those suffering from multiple disorders.

Leaders from the APA, the World Health Organization (WHO) and World Psychiatric Association (WPA) determined that additional information and research planning was needed related to specific diagnostic areas. The manual is being updated to deal with things obesity, gambling, sex addiction and Internet addiction -- formerly dismissed as harmful habits that could be defeated with willpower -- may also be labeled illnesses.
 

Read more on DSM V by clicking here.

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Biotech Week reported on May 23, 2009:

Remembering what's most important is central to daily life. For example, if you went to the grocery store but left your shopping list at home, you'd at least want to remember the milk and bread, if not the jam. Or, when packing for a trip, you'd want to remember your wallet and tickets more than your slippers or belt.

Even very early in Alzheimer's disease, people become less efficient at separating important from less important information, a new study has found (see also American Psychological Association).

 Knowing this, clinicians may be able to train people in the early stages of Alzheimer's to remember high-value information better, according to a report in the May issue of Neuropsychology, published by the American Psychological Association.

Neuropsychology is the area of neuroscience that studies relationships between brain function and behavior, with a central focus on human brain-behavior relationships. Neuropsychological research attempts to map the brain structures and functions that are critical for particular mental/cognitive, emotional, and behavioral capacities.

As my father approaches 70 and my grandmother 87, early onset of Alzheimers is a reality for me.  Making sure they get proper diagnosis and treatment is paramount should signs and symptoms appear.  We should all be mindful of those we love as they age.

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Senator Kennedy suffers from a specific cancer of the brain.  It had been more than 10 years since a new treatment for glioblastoma was approved, but the U.S. Food and Drug Administration has now granted accelerated approval for the cancer drug Avastin for use against the aggressive brain cancer tumors, Business Week reports.

The FDA (Food and Drug Administration, USA) approved Avastin (bevacizumab) for patients with GBM (glioblastoma multiforme) whose cancer carries on progressing after standard therapy. GBM is a rapidly progressing cancer - it invades brain tissue and can may have a significant effect on a patient´s mental abilities and physical activities. Approximately 6,700 people each year in the USA are affected by GBM.

Unfortunately, the cancer nearly always comes back, even when treated with surgery, radiation and/or chemotherapy.

Richard Pazdur, M.D., director of the Office of Oncology Drug Products in the FDA's Center for Drug Evaluation and Research, said "This type of cancer is very resistant to therapy and thus challenging to treat. Avastin provides a therapy for patients with progressive GBM who have not responded to other medications."
 

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The American Association of Neurological Surgeons reported research on Depression this month.

Electroconvulsive therapy (ECT) is effective in approximately 70 percent of cases in which antidepressant medications do not provide adequate relief of symptoms. However, as many as 20 to 50 percent of patients who initially respond well to ECT treatment, suffer a relapse within six months, therefore, periodic maintenance therapy is often required.

Researchers at three medical schools, Harvard, University of Pittsburg and Medical College of Wisconsin, counducted a study entitled "Long Term Follow-up of Cortical Stimulation to Treat Major Depressive Disorder."  They investigated ECT stimulation for patients with major depressive disorder.

The World Health Organization rates major depression as the top cause of disability worldwide, with an estimated 340 million people suffering from an episode of major depression every year. While most patients with major depression find relief through a combination of psychotherapy and medication, about 20 percent of patients fail to respond. Patients who are most resistant to medications, psychotherapies, and electroconvulsive therapy (ECT) have little hope of recovery, and suffer a heightened risk of suicide and mortality. Sadly, statistics show that the suicide rate in people with major depression is as high as 15 percent.

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A history of diabetes and elevated levels of cholesterol, especially LDL cholesterol, are associated with faster cognitive decline in patients with Alzheimer's disease, according to a new study from Columbia University Medical Center researchers. These results add further evidence of the role of vascular risk factors in the onset and progression of Alzheimer's disease.
 

Read the full article by clicking here.

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New Advances allow detection of mental disorders which can arise from traumatic brain injury.

Researchers using functional magnetic resonance imaging were able to distinguish with 93 percent accuracy people with schizophrenia from those with bipolar disorder and a healthy control group.

To read the entire article click here.

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A new study reveals by Italian and American neuroscientists In Nature Neuroscience reveals that ,  a simple decision-making task does not involve the frontal lobes, where many of the higher aspects of human cognition, including self-awareness, are thought to originate. Instead, the regions that decide are the same brain regions that receive stimuli relevant to the decision and control the body's response to it.

And for anyone who read Malcolm Gladwell's "Blink," there is support for the assertions that decisions are deeply seeded resonses.

Read more here.

Visit my website by clicking here www.titololawoffice.com.

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Although the idea that instrumental learning can occur subconsciously has been around for nearly a century, it had not been unequivocally demonstrated. Now, a new study published by Cell Press in the August 28 issue of the journal Neuron used sophisticated perceptual masking, computational modeling, and neuroimaging to show that instrumental learning can occur in the human brain without conscious processing of contextual cues.

The old adage that you should always trust your instincts is supported for the first time by a scientific study.

But there has been a more subtle phenomenon, billed as the foundation of intuition, where a seasoned poker player may play more successfully because they can pick up subtle signals in the body language of their opponents - without consciously realising it - to work out if they are bluffing..

Now, a new study published in the journal Neuron uses a blend of techniques, including brain scanning, to provide the first hard evidence that this so called "instrumental learning" can occur, showing we should trust our instincts.

In popular books such as Blink, it has been claimed that this form of intuition can result in a better decision than conscious reasoning, says lead author Dr Mathias Pessiglione from the Wellcome Trust Centre for Neuroimaging at the University College London.

Read more here.

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An article in the LA Times reports a study concluding that Brain Stimulation Improves Severe Depression.

Major depressive disorder affects about 14 million people in the U.S., and 10% to 20% of them do not respond to standard medical treatment, according the study.

In the fast-paced atmosphere of the modern world, where everyone has somewhere to be or something that needs to be taken care of, it's very easy for our lives to fall out of focus. Whether we're taking care of the needs of others or pushing to maintain our stamina in a hectic workplace, we often put our own personal needs at the end of our to-do lists. It's very easy for the blues to hang on a little longer than it should.

The nine men and 11 women in the trial had not improved on multiple medications, psychotherapy and electroconvulsive therapy. Subjects had been taking an average of four medications when the trial began in 2003 and had suffered from major depression for an average of 6.9 years.

Deep brain stimulation is approved to treat essential tremors and Parkinson's disease. Electrodes, which are permanently implanted in the brain, are powered by batteries and can be turned on and off by an external controller.
 

A new study with expanded participants is underway.

Read the article by clicking here.

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