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“As the twig is bent, so is the tree inclined.” We have long believed that experience and stimulation in early life determines social and intellectual behavior. Indeed, Freud presented theories that personality is largely formed by the age of five. We have broadened our views since then but it is clear that the young brain is malleable, capable of neuroplasticity, based on experience, e.g., John Paul Scott, Early Experience And The Organization Of Behavior way back in 1968. What about the effects of enrichment on the brain? Rosensweig, Bennet and Diamond performed their classic experiments with rats back in the early 70s. Animals were raised in either a standard, “impoverished,” environment or an “enriched” environment that provided objects to explore and interact with. The brains of enriched rats were thicker and denser than those of impoverished rats. Hence, circumstances in […]

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We have known for quite some time that women are more likely to develop Alzheimer’s disease than men. The obvious inference is that women live longer than men, on average (the current average age of death for women is 81 and men 76). Given that age is the biggest risk factor for Alzheimer’s disease, women are more likely to live long enough to show symptoms than men. But many studies have adjusted for age and it is clear that age is not the cause of this sex difference. Indeed, the risk for Alzheimer’s disease is twice that for women than men aged 70-79 but the same for those 80 and older. There is no clear explanation for this relationship. Despite having a greater risk for Alzheimer’s disease, another interesting sex difference in memory is that healthy woman typically do better […]

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It seems that there is a mass sense of awaiting the magic bullet – the medication or the supplement – which we can take to make neurological disease go away. I hear so often how disappointed my audience is when I honestly say there is no magic potion available nor is there one that I can see on the horizon. We have come to expect medicine to offer a cure for Alzheimer’s or Parkinson’s disease just as it can offer antibiotics for certain infections or analgesics that make a migraine go away. However, if we actually understand how the brain functions, there are treatments right under our nose. I recently read Norman Doidge’s article in the Wall Street Journal (February 7/8, 2015) “Brain, Heal Thyself” with great interest. He points out how our evolving metaphors of the brain, despite having […]

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Treatment of Alzheimer’s disease begins with early detection of memory loss, well before any serious symptoms are present and there is an impact on independence. In other words, we need to have a reliable, valid way to detect minor changes in memory that exceed the inefficiencies of aging. At the present time we rely on medical screening with a test that is very insensitive to mild decline in memory – the Mini-Mental State Exam. The major problem with this approach is that it misses all but the most obvious changes in memory. Alternatively, we can seek neuropsychological evaluation to thoroughly measure and describe cognitive skills. This approach is much more sensitive but involves greater time and expense. More simply we can ask the simple question, “How’s your memory?” After all, most medical and psychological evaluation begins with self-report and a […]

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Here are some of my favorite myths regarding the brain and how memory works. – Listening to Mozart or classical music improves intelligence.  This belief is based on  the “Mozart Effect” from a 1993 study suggesting that listening to Mozart may improve intelligence.  However, subsequent research demonstrated that the effect was restricted to spatial intelligence and is temporary.  The effect is not restricted to classical music and is probably has to do with improved mood and enjoyment. – The right brain is creative whereas the left brain is logical.  This long-standing belief stems from the fact that the brain has two hemispheres that have different functions.  The right  brain controls left sided motor/sensory function whereas the left brain controls right side motor/sensory function.  Furthermore, there is a long standing debate about localized versus distributed brain functions based on injuries (e.g., […]

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Alzheimer’s disease was first described as a case study of Auguste Deter, 51 year old, in a paper by Dr. Alois Alzheimer in 1907. He visually inspected her brain after her death and described “tangled bundles of fibrils” in her cortex that we now identify as plaques and tangles. Despite having over 100 years of study, we still have more questions than answers regarding etiology and biological processes underlying this progressive neurological disease (“Alzheimer’s disease: still a perplexing problem, Krishma Chinthapelli, British Medical Journal, 2014, 349, Q4433, PMID: 25005430). Prime Minister David Cameron announced support for the world’s most extensive population study in saying “dementia now stands alongside cancer as one of the greatest enemies of humanity.” Despite launching a study with quadruple the funding of previous work, there are huge challenges to be overcome. For example he stated that […]

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There are two types of risk factors that are associated with the development of dementing conditions as we age.  First, there are factors that we cannot control.  The strongest risk factor for becoming demented is not directly controllable, age.  If you live to be in your mid-80s or older, the risk is near 50%.  There are other associated risk factors that are correlated with cognitive decline with aging such as apolipoprotein gene carrier status (Apoe4 has the greatest risk whereas Apoe2 has the least), Mild Cognitive Impairment, cancer (there is an inverse association between cancer and cognitive decline), and sex (women are at greater risk than men). Second, there are also factors over which you have at least some degree of control.  These include history of head injury (hence the desire to wear seatbelts and helmets), blood pressure at midlife […]

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Notwithstanding many technological advances, there is still no fool-proof method for diagnosing Alzheimer’s disease, (avoiding the fact that the brain changes occur decades before symptoms).  There is no blood test or imaging technique that is definitive.  Even autopsy diagnosis has its problems.  Diagnosis of Alzheimer’s disease remains a clinical diagnosis based on history, symptoms, patterns, and clinical judgment.  The criteria for a diagnosis of possible Alzheimer’s disease: The afflicted individual must be demented – disabled by the decline. Symptoms appear gradually over months to years There is progressive worsening of cognition The initial and cardinal deficit is short-term memory (i.e., new learning) Less commonly language deficits (e.g., word-finding) appear early There are deficits in other skills such as planning, reasoning, judgment, sequencing The diagnosis of possible Alzheimer’s disease: There is sudden onset of symptoms Progression is not gradual There is […]

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The AARP Bulletin ran an interesting title in April, “Am I losing my mind?”  This article is in response to the growing paranoia about memory fed by the news that the rate of Alzheimer’s is rising and that many more die of Alzheimer’s than are reported in official statistics.  It’s no wonder that if I have a senior moment, I briefly consider whether I am on the slippery path to dementia.   Dementia is a generic term that refers to more than just memory loss.  Dementia is a permanent, irreversible and, in some cases, progressive decline in brain skills that interferes with independent living – hence produces disability.  There are a multitude of possible causes of dementia.  Among sudden causes are stroke and head injury.  Slow onset progressive causes include Alzheimer’s disease, Lewy body disease, and Huntington’s chorea. You can have […]

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 We are all subject to random bouts of forgetting.  Where did I park my car?  I forgot my grocery list.  Why am I in this room?  These complaints increase with age and are the source of both jokes about senior moments and serious fear of developing Alzheimer’s disease.  However, there is a huge difference between the increasing inefficiencies in memory resulting from aging and memory loss and dementia.  The fears have produced a burgeoning business in brain training programs such as Lumosity.  Lumosity has about 50 million users and is the best known of these programs.  It promises to improve attention and the capacity to learn.  Strong promises if short-term memory begins to fail.  The Centers for Medicare Services is exploring whether to pay for memory fitness training, which would create a boom market for these services. But does brain […]

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