Wednesday, December 26, 2018

Your genes are more than your ancestry

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Chapter Two
Genes and Your Brain

Before there was “23 and Me” and, there was James D. Watson and Francis Crick and the double helix. While we can learn about our heritage via our genes, understanding our genetic make-up is already leading to greater understanding, treatments, and possible cures for brain diseases such as Alzheimer’s, Parkinson’s, and stroke.
James D. Watson (pictured) and Francis Crick won the Nobel prize in 1953 for discovering the “double helix” structure of DNA, showing how a great amount of genetic information can be compactly stored in each cell and replicated easily.

The human genome, whose mapping and sequencing was initially completed in 2003 and revised since, is the blueprint for homo sapiens. The genome contains the complete instruction manual for building a human being from our approximately 20,000 genes. Wrapped tightly in a spiral ladder of DNA, our genes are found in the nucleus of each of the 37.2 trillion cells in our bodies (except mature red blood cells).

At least 30 percent of the different genes that make us human are expressed in the brain and spinal cord (the central nervous system). By far this is the highest proportion of genes expressed in any area of our bodies. Far more than just determining our height and hair color or telling us where our ancestors lived, our genes (“nature”) influence the development and function of the brain, and control how we think, move, and behave. Having said that, our genes are not our destiny. Combined with the effects of “nurture,” changes in these genes can also determine whether we are at risk for a particular disease and if we are, how it might develop.

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Saturday, November 3, 2018

A national sleep crisis: Pt. 1

Poor sleep impairs work and productivity, raises risks of car crashes, and may play a key role in risk for developing Alzheimer's disease.

It's serious stuff.

In this excerpt from Healing the Brain: Stress, Trauma and Development, we take a close look at sleep.

Fighting a National Sleep Crisis

Many people view sleep as merely a “down time” when their brains shut off and their bodies rest. People may cut back on sleep, thinking it won’t be a problem, because other responsibilities seem much more important. But research shows that a number of vital tasks carried out during sleep help people stay healthy and function at their best. While you sleep, your brain is hard at work forming the pathways necessary for learning and creating memories and new insights. Without enough sleep, you can’t focus and pay attention or respond quickly. A lack of sleep may even cause mood problems. Also, growing evidence shows that a chronic lack of sleep increases your risk of obesity, diabetes, cardiovascular disease, and infections.

Public Domain Pictures
Researchers acknowledge that regular, consistent sleep plays a major role in brain and body health

Despite growing support for the idea that adequate sleep, like adequate nutrition and physical activity, is vital to our well-being, people are sleeping less. The nonstop “24/7” nature of the world today encourages longer or nighttime work hours and offers continual access to entertainment and other activities. To keep up, people cut back on sleep. A common myth is that people can learn to get by on little sleep (such as less than 6 hours a night) with no adverse effects. Research suggests, however, that adults need at least 7–8 hours of sleep each night to be well rested. Indeed, in 1910, most people slept 9 hours a night. But recent surveys show the average adult now sleeps fewer than 7 hours a night.

Chronic sleep loss or sleep disorders may affect as many as 70 million Americans.

More than one-third of adults report daytime sleepiness so severe that it interferes with work, driving, and social functioning at least a few days each month. Evidence also shows that children’s and adolescents’ sleep is shorter than recommended. These trends have been linked to increased exposure to electronic media. Lack of sleep may have a direct effect on children’s health, behavior, and development. Chronic sleep loss or sleep disorders may affect as many as 70 million Americans. This may result in an annual cost of $16 billion in health care expenses and $50 billion in lost productivity.

What Makes You Sleep? Although you may put off going to sleep in order to squeeze more activities into your day, eventually your need for sleep becomes overwhelming. This need appears to be due, in part, to two substances your body produces. One substance, called adenosine, builds up in your blood while you’re awake. Then, while you sleep, your body breaks down the adenosine. Levels of this substance in your body may help trigger sleep when needed.

A buildup of adenosine and many other complex factors might explain why, after several nights of less than optimal amounts of sleep, you build up a sleep debt. This may cause you to sleep longer than normal or at unplanned times during the day. Because of your body’s internal processes, you can’t adapt to getting less sleep than your body needs. Eventually, a lack of sleep catches up with you. The other substance that helps make you sleep is a hormone called melatonin. This hormone makes you naturally feel sleepy at night. It is part of your internal “biological clock,” which controls when you feel sleepy and your sleep patterns. Your biological clock is a small bundle of cells in your brain that works throughout the day and night. Internal and external environmental cues, such as light signals received through your eyes, control these cells. Your biological clock triggers your body to produce melatonin, which helps prepare your brain and body for sleep. As melatonin is released, you’ll feel increasingly drowsy. 


Tuesday, October 23, 2018

Sandra Day O'Connor and Alzheimer's

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Alzheimer's Disease--Facts and Treatments

Alzheimer’s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills, and eventually the ability to carry out the simplest tasks. In most people with Alzheimer’s, symptoms first appear in their mid-60s. Estimates vary, but experts suggest that more than 5 million Americans may have Alzheimer’s.

... Alzheimer's Disease - Stem ...
Researchers are uncovering the secrets behind Alzheimer’s disease, a major public health threat.
Alzheimer's disease is currently ranked as the sixth leading cause of death in the United States, but recent estimates indicate that the disorder may rank third, just behind heart disease and cancer, as a cause of death for older people.

While there is no cure for Alzheimer’s disease, researchers are making advances on treatments that delay the onset and progress of the disease.

Alzheimer’s is the most common cause of dementia among older adults. Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—and behavioral abilities to such an extent that it interferes with a person’s daily life and activities. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend completely on others for basic activities of daily living.

The causes of dementia can vary, depending on the types of brain changes that may be taking place. Other dementias include Lewy body dementia, frontotemporal disorders, and vascular dementia. It is common for people to have mixed dementia—a combination of two or more disorders, at least one of which is dementia. For example, some people have both Alzheimer's disease and vascular dementia.

In 1906, Dr. Alois Alzheimer noticed changes in the brain tissue of a woman who had died of an unusual mental illness. Her symptoms included memory loss, language problems, and unpredictable behavior. After she died, he examined her brain and found many abnormal clumps (now called amyloid plaques) and tangled bundles of fibers (now called neurofibrillary, or tau, tangles).

These plaques and  tangles in the brain are still considered some of the main features of Alzheimer’s disease. Another feature is the loss of connections between nerve cells (neurons) in the brain. Neurons transmit messages between different parts of the brain, and from the brain to muscles and organs in the body.

Montreal Neurological Institute
Cross sections of the brain show atrophy, or shrinking, of brain tissue caused by Alzheimer's disease.
Scientists continue to unravel the complex brain changes involved in the onset and progression of Alzheimer’s disease. It seems likely that damage to the brain starts a decade or more before memory and other cognitive problems appear.

During this preclinical stage of Alzheimer’s disease, people seem to be symptom-free, but toxic changes are taking place in the brain. Abnormal deposits of proteins form amyloid plaques and tau tangles throughout the brain, and once-healthy neurons stop functioning, lose connections with other neurons, and die.

The damage initially appears to take place in the hippocampus, the part of the brain essential in forming memories. As more neurons die, additional parts of the brain are affected, and they begin to shrink. By the final stage of Alzheimer’s, damage is widespread, and brain tissue has shrunk significantly.

Tuesday, October 2, 2018

Dr. Ford, Memory, Trauma. Part 2

In her testimony, Dr. Christine Ford discussed her traumatic memories. In our book, Healing the Brain: Stress, Trauma and Development, we look at exactly what Dr. Ford describes. Here is Part 2 of an except from "Wounds that Time Won't Heal."

A Harvest of Psychiatric Disorders

Changes to normal body chemistry induced by physical, sexual, and psychological trauma in childhood may lead to psychiatric difficulties that show up in childhood, adolescence, or adulthood. The victim’s anger, shame, and despair can be directed inward to produce symptoms such as depression, anxiety, and suicidal ideation, or directed outward as aggression, impulsiveness, delinquency, hyperactivity, and substance abuse

Childhood trauma may fuel a range of persistent psychiatric disorders. One is somatoform disorder (also known as psychosomatic disorder), in which patients experience physical complaints with no discernible medical cause. Another is panic disorder with agoraphobia (fear of open spaces) in which patients experience the sudden, acute onset of terror and may narrow their range of activities to avoid being outside, especially in public, in case they have an attack.

People with PTSD keep re-experiencing a traumatic event in waking life or in dreams, and they actively avoid situations that might bring back memories of the trauma.

More complex, difficult-to-treat disorders strongly associated with childhood abuse are borderline personality disorder and dissociative identity disorder. Someone with borderline personality disorder characteristically sees others in black-and-white terms, first putting them on a pedestal, then vilifying them after some perceived slight or betrayal. Such people have a history of intense but unstable relationships, feel empty or unsure of their identity, often try to escape through substance abuse, and experience self-destructive impulses and suicidal thoughts. They are plagued by anger, most often directed at themselves.

In dissociative identity disorder, formerly called multiple personality disorder (the phenomenon behind Robert Louis Stevenson’s “Dr. Jekyll and Mr. Hyde”), at least two seemingly separate people occupy the same body at different times, each with no knowledge of the other. This can be seen as a more severe form of borderline personality disorder. In borderline personality disorder, there is one dramatically changeable personality with an intact memory, as opposed to several distinct personalities, each with an incomplete memory.  

Of the many disorders associated with childhood abuse, depression or heightened risk for developing it, may be a consequence of reduced activity of the left frontal lobes. If so, the stunted development of the left hemisphere related to abuse could easily enhance the risk of developing depression. Similarly, excess electrical irritability in the limbic system, and alterations in development of receptors that modulate anxiety, set the stage for the emergence of panic disorder and increase the risk of post-traumatic stress disorder.

Alterations in the neurochemistry of these areas of the brain also heighten the hormonal response to stress, producing a state of hypervigilance and right-hemisphere activation that colors our view with negativity and suspicion. Alterations in the size of the hippocampus, along with limbic abnormalities shown on an EEG, further enhance the risk for developing dissociative symptoms and memory impairments.

Changes to normal body chemistry induced by physical, sexual, and psychological trauma in childhood may lead to psychiatric difficulties that show up in childhood, adolescence, or adulthood.

Researchers have also found that 30 per cent of children with a history of severe abuse meet the diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD), although they are less hyperactive than children with classic ADHD. Very early childhood abuse appears particularly likely to be associated with emergence of ADHD-like behavior problems. Interestingly, one of the most reliable brain structure findings in ADHD is reduced size of the cerebellar vermis. The cerebellar vermis receives information from the spinal cord about the sense of touch and proprioception. Proprioception is the ability to sense or perceive the spatial position and movements of the body. The cerebellar vermis also receives information from the body about hearing, vision, and balance.

Some studies have also found an association between reduced size of the mid portions of the corpus callosum and emergence of ADHD-like symptoms of impulsivity. Hence, early abuse may produce brain changes that mimic key aspects of ADHD.

An Increased Startle Response?

Researchers also think that childhood trauma may lead to what is called an exaggerated "startle response" on into adulthood. When startled, people experience a number of reactions. The heart may race,  sweat increase, breath rate get faster, muscles tense (to the point someone might even jump), and people may feel scared. When someone jumps out from behind and yells, “Boo!” that may initiate a startle response. This is an ongoing area of investigation.

Traumatized Children and Youth in Romania--A Tragedy of Huge Proportions

Beginning in the 1960s, the country of Romania's harsh economic policies meant that most families were too poor to support multiple children. So, without other options, thousands of parents left their babies in government-run orphanages.

By Christmas day 1989, when revolutionaries overthrew the government, an estimated 170,000 children were living in more than 700 state orphanages. As the regime crumbled, journalists and humanitarians swept in. In most institutions, children were getting adequate food, hygiene and medical care, but had woefully few interactions with adults, leading to severe behavioral and emotional problems.

Unlike growing up in a family, the children didn't have lots of interactions with adults holding them, talking to them, singing or playing with them, and that lack of stimulation affected their brain development.

An American scientist who went to study the crisis, recalls "a boy in a red T-shirt and sweats skipped up to me, grabbed my hand, and wouldn’t let go. His head didn’t reach my shoulders, so I figured he was eight or nine years old. He was 13, my guide said. The boy kept looking up at me with an open, sweet face, but I

Wikimedia Commons
Harsh economic conditions and government actions beginning in the 1960s forced many families in Romania to abandon children to state homes.

found it difficult to return his gaze. Like most of the other kids, he had crossed eyes — strabismus, a professor would explain later, a common symptom of children raised in institutions, possibly because as infants they had nothing to focus their eyes on. A couple of dozen kids gathered around us in a tight circle, chirping and giggling loudly as children do. At one point they broke into a laughing fit, and I asked my guide what happened. They were gawking at the whiteness of my teeth, he said. Two of the girls, somewhere in that gaggle, were pregnant."

Children were getting adequate food, hygiene and medical care, but had woefully few interactions with adults, leading to severe behavioral and emotional problems

Mary Barrett, a prospective American adoptive mother recalls that she met an 11-month-old named Daniel. "He had an eagerness," she remembers. "He was alert. He was cruising the side of his crib and looking for stimulation." The small boy had been in a hospital crib his whole life and fed only by bottle. Mary spoon-fed him a mashed banana. He reacted with surprise she recalls, "It was very odd and strange to him."

The Barretts adopted Daniel when he was 13 months old. He was small for his age, scoring in the fifth percentile of height and weight. They thought it would be a matter of "playing catch-up," says Mary. That it was "a case of delay that would be overcome by paying extra attention." She says she remained optimistic for two years. But certain things didn't seem right.

Wikimedia Commons
At state-run institutions in Romania, children received food, hygiene and medical care, but had woefully few interactions with adults, leading to severe behavioral and emotional distress.

Strong or Traumatized Youth--We Reap What We Sow

Whether abuse of a child is physical, psychological, or sexual, it sets off a ripple of hormonal changes that wire the child’s brain to cope with a hostile world. Abuse predisposes the child to have a biological basis for fear, though he may act and pretend otherwise. Early abuse molds the brain to be more irritable, impulsive, suspicious, and prone to be swamped by fight-or-flight reactions that the rational mind may be unable to control. The brain is programmed to a state of defensive adaptation, enhancing survival in a world of constant danger, but at a terrible price.

To a brain so tuned, the Garden of Eden would seem to hold its share of dangers; building secure, stable relationships may later require extraordinary personal growth and transformation.

Sunday, September 30, 2018

Dr. Ford, Trauma, and Memory, Part 1

In her testimony, Dr. Christine Ford discussed her traumatic memories. In our book, Healing the Brain: Stress, Trauma and Development, we look at exactly what Dr. Ford describes. Here is Part 1 of an except from Chapter 3, "Wounds that Time Won't Heal."

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  • Short-term vs.long-term stress (good stress vs. bad stress)
  • Altered brain chemistry from stress
  • Trauma and the vulnerable brains of children and youth
  • The importance of touch in brain development
  • The tragedy of Romanian children raised by the state

Imagine you are a zebra grazing on the plains of Africa. It's midday. The sun is bright, the food is plentiful.

Suddenly you sense an attack. A lion is chasing you. Its fight or flight in action.

Your brain tells your body to prepare for a fight or take flight. The body responds by preparing extra hormones to create more energy and by increasing the rate the heart pumps blood to the muscles. For most animals, this stress reaction lasts for just a short time and it saves lives.

Wikimedia Commons
Why don’t zebras get ulcers? According to Dr. Robert Sapolsky, their stress is decidedly short-term, not long-term.

As a body is preparing for fight or flight, however, practically all systems, such as digestion, physical growth and warding off diseases, are placed on hold. This means that people for whom stress has become a way of life are endangering their overall health. Researchers have learned by studying primates whose systems are similar to human beings that those who learn to have control over their lives and are able to reduce or avoid stress live longer and healthier lives.

Are zebras better equipped to deal with stress than humans? No. However, according to Dr. Robert Sapolsky, author of Why Zebras Don't Get Ulcers, "For a zebra, stress is three minutes of some screaming terror running from a lion. After the chase, either it's over or they are." On the other hand humans, he says, have constructed a network of social stressors. Since we are obliged to live in this framework, stress builds up.
While the stress response activates automatically, its duration and intensity relies on factors such as individual temperament.

How do the brain and the body react to stress? Stress, such as the threat of attack, forces various changes in the body. First, adrenaline causes an increase in heart rate and blood pressure so that blood can be sent to muscles faster. Second, the brain’s hypothalamus signals the pituitary gland to stimulate the adrenal gland (specifically the adrenal cortex) to produce cortisol.
Stress, such as the threat of attack, forces changes in the body carried out by the hypothalamus, pituitary, adrenal axis (HPA).

This stress hormone, a longer-acting steroid, helps the body to mobilize energy. However, prolonged exposure to cortisol can damage virtually every part of the body. Chronic high blood pressure can cause blood vessel damage and the long-term shutdown of digestion can lead to ulcers.

Why do some people experience more stress than others? Individuals who feel they have control over their lives appear to experience less stress. It also depends on personality and temperament. Aggressive, competitive types are more likely to define a situation as stressful than a passive, accommodating personality. A universal stress producer seems to be social isolation.

PTSD: A Breakthrough in Diagnosis

In 1980 the mental health community established the diagnosis of Post Traumatic Stress Disorder, PTSD, and revolutionized the way the field views the effects of stress. This change acknowledged that many of the symptoms people experience after exposure to trauma can be long-lasting, if not permanent. Before that shift, the field tended to view stress-related symptoms as a transient, normal response to an adverse life event, not requiring intensive treatment.

Furthermore, before 1980, people who did develop long-term symptoms following trauma were viewed as implicitly vulnerable; the role of the actual event in precipitating their symptoms was minimized. For a while, in a reversal of previous thinking, experts expected most trauma survivors to develop PTSD. More recent research has confirmed that only about 25 per cent of individuals who are exposed to trauma develop PTSD.

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Wednesday, September 5, 2018

When An American President "Loses It”

When A President "Loses It”

By: James F. Toole, M.D.
Cerebrum, Dana Foundation, 1998

Learn about the astonishing, complex brain.

It has happened, of course—and not infrequently. Just in this century, American presidents who continued to serve in office while seriously neurologically impaired include Woodrow Wilson, Franklin D. Roosevelt, and Dwight D. Eisenhower. In the first two, there is a credible historical case that the results were catastrophic on a world scale. But the real question is: Could it happen again?...

Once officials are elected or appointed, there is no legal requirement for periodic physical, mental, or behavioral examinations while they are serving in office. When the average life span was 60 years, senility was a less common problem. Now, with the graying of America (and soon the world), devastating neurological diseases and other conditions have a much greater likelihood of wreaking havoc on an individual’s mental functioning. Isn’t it time for the law to require health examinations, and public revelation of the results, before election and periodically thereafter while an individual is serving in office—just as there are legal protections of the public in other areas of society? After all, we have laws governing the packaging of foods, construction of automobiles, and periodic inspection for continuing registration and licensing of vehicles and drivers. Why don’t we have similar requirements for public officials (as we have already for aviators)? Unfortunately action is stalled, in part because it contravenes traditions of confidentiality in matters relating to health. Society desperately needs correction of this Achilles’ heel before it is too late.

Why does our nation tolerate this appallingly dangerous flaw in our system? Can there be any brake on this unregulated system— or must we live in danger of catastrophe? A first step was taken in 1965, when Senator Birch Bayh proposed an amement to the U.S. Constitution. On February 10, 1967, Article 25 was ratified by a sufficient number of state legislatures. In it, succession is clearly defined in cases of removal of the president from office by death or resignation. The vice president shall become president, as happened when President Richard M. Nixon was replaced by Vice President Gerald R. Ford.

Section 2 is equally clear on succession to the office of the vice president, as occurred when Ford was appointed vice president after the resignation of Spiro T. Agnew.

Section 3 is straightforward. If the president voluntarily submits a written statement that he is unable to discharge the powers and duties of his office, they shall be discharged by the vice president as acting president until the president submits another document stating that he has recovered. This sequence occurred when President Reagan transferred power to Vice President George Bush in anticipation of undergoing general anesthesia for colon surgery and then resumed office immediately thereafter.

In Section 4, however, there seems the potential for a serious dilemma:

Whenever the vice-president and a majority of either the principal officers of the executive department or of such other body as Congress may by law provide, transmit to the president pro tempore of the Senate and the Speaker of the House of Representatives their written declaration that the president is unable to discharge the powers and duties of his office, the vice president shall immediately assume the powers and duties of the office as acting president.

What is the mechanism for determining that the president is unable to serve? How does one inform the president that he is not capable of performing in office? Judging from past experience, it would require the most extreme conditions for the vice president or members of the cabinet to remove their leader. They have a built-in political incentive to maintain the status quo because, if the president is removed, the cabinet that serves him may be replaced as well. Furthermore, these officials are not medical professionals and so cannot have full insight into the dangers of having a mentally impaired leader.

There is an even greater problem in implementation of the next part of Section 4. It states:

Thereafter, when the president transmits to the president pro tempore of the Senate and the Speaker of the House of Representatives his written declaration that no disability exists, he shall resume the powers and duties of his office unless the vice-president and a majority of either the principal officers of the executive department or of any such body as Congress may by law provide, transmit within four days to the president pro tempore of the Senate and the Speaker of the House of Representatives their written declaration that the president is unable to discharge the powers and duties of his office. Thereupon Congress shall decide the issue, assembling within 48 hours for that purpose if not in session.

These two clauses conceal potential stumbling blocks. Together, they could enable a cognitively impaired President who lacked insight into his mental deficiency to obstruct governmental procedures for removal from office (or to resume office), despite persistent deficits. Only a specially trained physician has the skills to determine the presence, treatment, and prognosis for neurologic and psychiatric disease.