Tuesday, October 23, 2018

Sandra Day O'Connor and Alzheimer's

Get your brain facts here!

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.