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  • April 3, 2017
  • 10:23 AM
  • 194 views

Financial Scam Vulnerability: Brain Risk Factors

by William Yates, M.D. in Brain Posts

It is always frustrating when you hear about a financial scam that has target a vulnerable population like the elderly population.Elderly individuals may be targeted for a variety of reasons. First, they often have financial resources. Second, they may be a generally more trustworthy group increasing risk for falling for a scam. Third, elderly may suffer from some age-related brain changes that impair cognition and judgment.A recent research study suggests specific brain deficits may increase vulnerability to financial scams in elderly populations.The designed a study with the following key design elements:Subjects: 13 older adults with a mean age of 70 years who had been financially exploited after age 60. A matched control group of 13 subjects who had been exposed to a financial scam but not been compliantMeasures: Neuropsychological testing of cognition, personality and behavior. Additionally, subjects completed structural and functional brain MRI imagingStatistics: Cases were compared to controls on key study measuresVictims of financial scams showed key differences from controls including:Brain cortex thinning in the anterior insula and posterior temporal regionsFunctional brain connectivity was reduced in default and salience regionsFunctional between network connectivity was increasedHigher scores on measures of anger and hostilityThe authors their findings support a potential role for brain impairment in salience and social cognition regions as markers for risk of financial exploitation.They note significant weaknesses in their study design including a small sample size. Nevertheless, they note clinicians should be aware of potential for increased risk of financial exploitation in elderly with evidence of damage to these key brain regions.This is an important study and goes beyond risk associated with general cognitive decline and early dementia. This study suggests that specific brain regions associated with social cognition may be linked to risk of financial scams in elderly populations.The free full-text manuscript can be accessed by clicking on the link in the citation below.Follow me on Twitter @WRY999Image of brain insula is from my iPad screen shot using the 3D Brain app.Spreng, R., Cassidy, B., Darboh, B., DuPre, E., Lockrow, A., Setton, R., & Turner, G. (2017). Financial Exploitation Is Associated With Structural and Functional Brain Differences in Healthy Older Adults The Journals of Gerontology: Series A DOI: 10.1093/gerona/glx051... Read more »

  • March 27, 2017
  • 12:07 PM
  • 225 views

Theory of Mind in Brain Development

by William Yates, M.D. in Brain Posts

Theory of Mind (ToM) is a concept describing the ability to understand what another person is thinking or feeling.Today in my neuroscience medicine news review I ran across a novel, interesting and important research study targeting brain development in ToM.Normally developing children develop ToM around 4 years of age. In the study published in Nature Communications, a research team at the Max Planck Institute in Germany studied white matter development in 3 to 4 year old children.Using a series of neuropsychological tasks, they studied white matter development using diffusion tensor brain imaging as it related to ToM skill.The research team was able to identify the following brain development features in ToM:White matter changes in the temperoparietal regions, the precuneus and the medial prefrontal cortexIncreased white matter connectivity between temperoparietal and inferior frontal brain regionsThese changes were independent of development of non-ToM cognitive abilityThe authors note in the discussion section that non-human primates fail to develop explicit ToM cognitive ability. Non-human primate brain show poor arcuate fascicle connectivity. They note that arcuate fascicle white matter connectivity appears to be key for ToM cognitive skills.This manuscript is available in free full-text format and readers with more interest in this study can access the manuscript by clicking on the citation link below.Follow me on Twitter @WRY999Image of white matter tract in human brain is from the iPad app Brain Tutor.Grosse Wiesmann C, Schreiber J, Singer T, Steinbeis N, & Friederici AD (2017). White matter maturation is associated with the emergence of Theory of Mind in early childhood. Nature communications, 8 PMID: 28322222... Read more »

  • March 20, 2017
  • 11:25 AM
  • 232 views

Opioids, Benzos and Risk for Overdose

by William Yates, M.D. in Brain Posts

The evolving epidemic of opioid overdose and overdose deaths is receiving increased public and research attention.Opioids overdoses and overdose deaths are often unintentional or accidental. It has been known that concurrent use of opioids with alcohol or benzodiazepines (i.e. Valium or Xanax) increases risk for overdose toxicity.A recent study published in the British Medical Journal confirmed the association of concurrent benzodiazepine prescription with opioid overdose.This research team examined confidential medical database records from over 500,000 patients in the U.S.Those that were enrolled in a medical plan including pharmaceutical benefits between 2001 and 2013 were included in the analysis.The key findings from the study included the following:The percentage of opioid users concurrently using a benzodiazepine rose from 9% of opioid users in 2001 to 17% of opioid users in 2013Chronic users of opioids nearly doubled their risk of opioid overdose if they took a concurrent benzodiazepine medication (4/100 persons/year to 7-8/100 person years)If the association is causal, the authors estimate emergency room visits and inpatient admissions could be reduced by 15% by stopping concurrent prescriptionsThis association of risk seems reasonable given the toxicities of opioids and benzodiazepines. Both at higher doses decrease respiratory drive potentially contributing to hypoxia and death.The authors note several take home messages for clinicians. Chronic users of benzodiazepines should be prescribed opioids cautiously if at all. Opioid prescriptions should be for short periods of time and low doses for chronic benzodiazepine patients.Likewise, if chronic opioids are necessary they should rarely be combined with intermittent or long-term benzodiazepine prescriptions.Readers with more interest in this topic can access the free full-text manuscript by clicking on the PMID link in the citation below.Photo of NCAA men's basketball tournament in Tulsa, OK is from my files.Follow me on Twitter WRY999Sun EC, Dixit A, Humphreys K, Darnall BD, Baker LC, & Mackey S (2017). Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis. BMJ (Clinical research ed.), 356 PMID: 28292769... Read more »

  • March 15, 2017
  • 12:57 PM
  • 249 views

Emotional Intelligence and the Physician

by William Yates, M.D. in Brain Posts

Emotional intelligence (EI) is characterized by the ability to recognize emotional states in self and in others.This emotional recognition may be helpful in guiding behavior and in improving interpersonal relationships.It seems logical on a face validity level to assume that higher levels of EI would be good in the selection of students for medical school.However, there are few studies assessing EI in physicians. There are fewer studies that examine whether EI influences physician behavior, patient satisfaction and ultimately patient outcomes.Rhamzan Shahid and colleagues at the Stritch School of Medicine at Loyola University Medical examined levels of EI in a group of resident physicians in training in the specialties of pediatrics and combined internal medicine-pediatrics.This was a cross-sectional study design that included comparison of residents in the first two years of training versus those in years 3 and 4. The main findings included the following:Residents tended to score high on EI overall with the highest scores on impulse control and the interpersonal composite subscaleResidents scored relatively lower on assertiveness and independence subscalesAssertiveness subscale scores were higher in the more senior residentsEmpathy scores were lower in the the more senior residentsIncreased assertiveness sub-scale scores in more senior residents might be a good thing, possibly indicating a growth in confidence and skill level. This cannot be stated definitely as this study was not longitudinally designed.The lower empathy sub-scale scores in senior residents is an interesting finding. Some might argue it is a negative consequence of training and reflects an increasing disenchantment with being a physician. The authors of the study encourage interventions to "ensure they (resident physicians) do not lose empathy".However, it may be that in a group selected for high empathy, a reduction may also represent a normal maturational process. Maybe high empathy contributes to higher physician distress in the clinical setting and potentially more burnout and depression. Maybe empathy levels that are too high produce emotional states that actually impair physician behavior and reduce effectiveness of clinical decision making.These possibilities should prompt studies correlating EI with patient satisfaction, patient outcome, physician satisfaction with medicine and their specialty and risk for physician burnout.The manuscript reviewed and commented on today is available in free full-text format by clicking on the link in the citation below.Follow me on Twitter @WRY999Photo of the lesser scaup duck is from my personal photography files.Shahid, R., Stirling, J., & Adams, W. (2016). Assessment of Emotional Intelligence in Pediatric and Med-Peds Residents Journal of Contemporary Medical Education, 4 (4) DOI: 10.5455/jcme.20170116015415... Read more »

  • March 13, 2017
  • 11:38 AM
  • 230 views

Earliest Brain Changes in Alzheimer's Disease

by William Yates, M.D. in Brain Posts

Amyloid brain plaques are well-known pathological changes associated with Alzheimer's disease. Changes preceding amyloid plaque build up are less well studied and understood. Some of this relates to limitations to current imaging technology.Klementieva and colleagues from Sweden and Spain recently published an important reserach topic in this area.Their studied used a rat model of Alzheimer's disease and imaging techniques that included infrared microspectroscopy and gel electrophoresis.The main findings of their study included the following:Conformation changes of beta amyloid and it's amyloid precursor protein (APP) start before the development of amyloid plaquesThe early changes in beta amyloid localize to the synaptic terminalsThese early changes may provide novel targets for drug developmentThese findings suggest current strategies to alter beta amyloid plaques after development may be too late to alter the course of the disease.Identification and reversal of earlier mechanisms may be a more productive drug development strategy.Readers with more interest in this topic can access the free full-text manuscript by clicking on the citation link below.Follow be on Twitter WRY999Photo of robin in back yard waterer is from my photography files.Klementieva, O., Willén, K., Martinsson, I., Israelsson, B., Engdahl, A., Cladera, J., Uvdal, P., & Gouras, G. (2017). Pre-plaque conformational changes in Alzheimer’s disease-linked Aβ and APP Nature Communications, 8 DOI: 10.1038/ncomms14726... Read more »

Klementieva, O., Willén, K., Martinsson, I., Israelsson, B., Engdahl, A., Cladera, J., Uvdal, P., & Gouras, G. (2017) Pre-plaque conformational changes in Alzheimer’s disease-linked Aβ and APP. Nature Communications, 14726. DOI: 10.1038/ncomms14726  

  • March 7, 2017
  • 11:01 AM
  • 246 views

Can Older Drivers Benefit From Training?

by William Yates, M.D. in Brain Posts

Older drivers are over-represented in motor-vehicle driving accidents.The lowest rate of fatal vehicle crashes per 100 million miles driven is found in drivers between the ages of 30-69 years of age.Fatal vehicle driving rates per miles driven is 4 to 5 times higher in drivers over 80 years of age. (IIHS.org data)So can older drivers be trained or educated to improve their safety (and the safety o those around them)?A recent randomized controlled trial examined an educational intervention in drivers 75 years and older in Australia.This intervention targeted a reduction or avoidance of seven high-risk driving situations:Night drivingDriving in the rainRight-hand (left-hand in U.S.) turns across oncoming trafficDriving during heavy trafficDriving on high-speed roadsDriving during rush hourDriving aloneThe trial found participants in the intervention group showed a greater readiness to make changes that could reduce high-risk accident exposure. However, the intervention group did not reduce total miles driven in the year following the intervention.Additionally, the intervention group did not increase their use of alternate transportation (i.e. buses or cabs) in the follow-up period.This trial showed limited response to educational training in an older-aged drivers population. Alternate approaches (adoption of high safety feature vehicles, use of newer alternative driving programs like Uber, cognitive training programs to improve psychomotor speed) may hold more promise in reducing fatal accident rates in elderly populations.Follow me on Twitter WRY999Photo of moon is from my photography files.Coxon K, Chevalier A, Brown J, Clarke E, Billot L, Boufous S, Ivers R, & Keay L (2016). Effects of a Safe Transportation Educational Program for Older Drivers on Driving Exposure and Community Participation: A Randomized Controlled Trial. Journal of the American Geriatrics Society PMID: 27943260... Read more »

  • March 2, 2017
  • 12:19 PM
  • 241 views

Improving Hearing-Aid Access in Older Adults

by William Yates, M.D. in Brain Posts

There are significant barriers to widespread use of hearing-aids in older adults with age-related hearing loss.Sensitivity to the stigma of wearing a hearing-aid is one barrier.Cost is another significant barrier. In the U.S., bilateral hearing-aid purchase amounts to a cost of $2400 to $5800. This cost is typically not covered by Medicare or other health insurance plans.I ran into a interesting manuscript on looking at an alternative less costlier approach to hearing-aid selection and purchase.Larry Humes and colleagues compared the outcome of a older adults randomized to one of three hearing aid interventions. One was standard audiology best practices, one was a placebo hearing-aid (device without amplication). A third alternative was also studied that was called an over-the-counter (OTC) intervention. This intervention included the following elements:Self-selection of hearing aid tips, tubes and devicesThree types of hearing-aids were provided for selection. Each was programmed with one of the three most common patterns of hearing lossSubjects tried various combinations of devices and listened to sample sounds of speech, music and environmental soundsSubjects were assessed after a six week trial for hearing function, satisfaction and desire to keep the deviceSubjects were randomized to pay a fee of $3500 versus $600 for devices that were identical in features. This allowed for study of the effect of cost on outcome measures.Interestingly, the OTC intervention resulted in outcomes (i.e. hearing improvement) that were very similar to audiology best practices. However, OTC subjects showed a slightly lower satisfaction score and were somewhat more likely to return devices after the study for a refund. Higher price also predicted return for refund following the study.The authors conclude:"Efficacious OTC service-delivery models (and devices) may increase accessibility and affordability of hearing aids for millions of older adults, but further research is required to evaluate various devices and approaches as well as to examine the generalization of the findings from this clinical trial."This study provides an impetus for further study of the OTC model in hearing aid selection and use. Cost issues appear to continue to be a significant barrier to wider hearing-aid access.Readers with more interest in this study can access the free full-text manuscript by clicking on the link in the citation below.Photo of wood duck is from my photography file.Follow me on Twitter WRY999Humes, L., Rogers, S., Quigley, T., Main, A., Kinney, D., & Herring, C. (2017). The Effects of Service-Delivery Model and Purchase Price on Hearing-Aid Outcomes in Older Adults: A Randomized Double-Blind Placebo-Controlled Clinical Trial American Journal of Audiology DOI: 10.1044/2017_AJA-16-0111... Read more »

  • February 28, 2017
  • 10:43 AM
  • 251 views

Outcome in Early Education Interventions (Educare)

by William Yates, M.D. in Brain Posts

Despite centuries of experience in education, the best time to start formal education is still under debate. Is five years of age too old? Is three years of age too early?One issue with early education interventions is the potential for catch-up in children starting school later. In other words, early gains with younger children may evaporate overtime.One recent research study examines effectiveness of a child development intervention known as Educare. Educare seeks to reduce the achievement gap between low-income and economically advantaged peer children.Educare is operational in 21 cities in the United States. It is somewhat unique in entering children as infants (<1 year of age) for an intensive ongoing child and parent intervention. A recent study randomized 239 infants to receive Educare or no intervention. This study found superiority for the Educare children following one-year of intervention in the following domains:Expressive communicationAuditory comprehensionProblem behaviors (reduced level)Positive parental-child interactionThe authors note the size of the effects were in the modest to medium strength.  Additionally, they note they cannot know how enduring the effects of this type of intervention might be.Additional longitudinal assessments will be needed to examine the potential of catch up in the control group. Studies of elementary, middle and senior high achievement will be needed.Aggressive early intervention programs are expensive and will need to be validated before efforts to expand this type of early childhood intervention.Follow me on Twitter WRY999Photo of children playing on the beach at sunset is from my photography files.Yazejian, N., Bryant, D., Hans, S., Horm, D., St. Clair, L., File, N., & Burchinal, M. (2017). Child and Parenting Outcomes After 1 Year of Educare Child Development DOI: 10.1111/cdev.12688... Read more »

Yazejian, N., Bryant, D., Hans, S., Horm, D., St. Clair, L., File, N., & Burchinal, M. (2017) Child and Parenting Outcomes After 1 Year of Educare. Child Development. DOI: 10.1111/cdev.12688  

  • February 3, 2017
  • 11:22 AM
  • 171 views

Brain Shape and Personality Type

by William Yates, M.D. in Brain Posts

Personality has often been conceptualized a a human feature shaped largely by nurture and environment.Unlike major neuroscience medicine disorders, personality features have been considered less influenced by brain structure and genetic influences.A recent brain structure (morphology) study puts these assumptions at risk.Roberta Riccelli along with colleagues in Italy and Florida State University studied brain structural features across 507 participants in the Human Connectome Project.All subjects completed a personality assessment using the five-factor model (FFM), a widely validated measure of five personality features.Here were the key findings from the study for each personality feature:High neuroticism: increased cortical thickness in supramarginal gyrus, superior parietal cortex, superior temporal cortex, superior prefrontal cortex and frontal pole. Also decreased surface area of superior parietal cortex, middle temporal gyrus, cuneus, superior prefrontal cortex and frontal pole.High extraversion: increased cortical thickness in precuneus and lower surface area and volume of superior temporal gyrus. Also lower cortical volume of entorhinal cortex and greater folding in the fusiform gyrus.High openness: lower cortical thickness in the postcentral gyrus, rostral anterior cingulate cortex, superior prefrontal cortex and lateral occipital gyrus. Increased surface area, cortical volume and folding in a series of parietal, temporal and frontal regions.High Agreeableness: Decreased cortical thickness, surface area, cortical volume and local gyrus formation in frontotemporal regions. Increased local gyrus formation in inferior temporal gyrus.High concientiousness: increased cortical thickness in prefrontal cortex along with lower surface area and cortical volume in middle/inferior temporal gyrus and lateral occipital gyrus regions. Decreased cortical folding in prefrontal gyrus and several other regions.These findings are of note for the diffuse number and types of structural correlates of personality features in man. The authors note the importance of the prefrontal cortex in personality:  "significantly evolved in human beings and great apes relative to other species. This could reflect that several FFM personality traits are linked to high-level socio-congnitive skills as well as the ability to modulate "core" affective responses."Look for more structural, functional and genetic study of the five factor model of personality features in human to come.Readers with more interest in this research can access the free full-text manuscript by clicking on the PMID link in the citation below.Follow the author on Twitter WRY999Photo of bald eagle head in profile is from the author's bird photography file. Riccelli R, Toschi N, Nigro S, Terracciano A, & Passamonti L (2017). Surface-based morphometry reveals the neuroanatomical basis of the five-factor model of personality. Social cognitive and affective neuroscience PMID: 28122961... Read more »

  • January 25, 2017
  • 12:06 PM
  • 370 views

Jet Lag and Baseball (MLB) Performance

by William Yates, M.D. in Brain Posts

Abrupt changes in the biological clock or circadian rhythm are noted to contribute to significant cognitive and psychomotor impairments.One practical area for this effect to potentially be important is in the area of sports performance.Alex Song and colleagues recently completed an interesting study of major league baseball (MLB) performance related to team travel patterns.The major leagues are divided into regional divisions (western, central and eastern) to minimize length of travel to and from away games. Nevertheless, significant travel continues to be part of the league and travel across the four U.S. time zones is not uncommon.This study included all MLB games between 1992-20o1. Baseball performance across a variety of variables was examined with attention to effects linked to travel and jet lag.The key findings from the study included:Most major jet lag performance impairment was noted for travel west to eastBoth east and west travel produced an increase in home runs allowedOffensive slugging percentage declines after teams travel home from away gamesThe authors conclude that starting pitchers appear to impacted by travel resulting in giving up more home runs following jet lag.The suggest teams might want to consider sending projected starting pitchers to away games a few days prior to the team's arrival.This is an important manuscript that demonstrates potential practical psychomotor effects of jet lag. Readers with more interest in the topic can access the free full-text manuscript by clicking on the PMID link in the citation below.Follow me on Twitter @WRY999Photo of Albert Pujols hitting is spring training is from the author's files.Song A, Severini T, & Allada R (2017). How jet lag impairs Major League Baseball performance. Proceedings of the National Academy of Sciences of the United States of America PMID: 28115724... Read more »

Song A, Severini T, & Allada R. (2017) How jet lag impairs Major League Baseball performance. Proceedings of the National Academy of Sciences of the United States of America. PMID: 28115724  

  • January 23, 2017
  • 10:59 AM
  • 333 views

Processing Speed Cognition in Elderly: Clinical Trial

by William Yates, M.D. in Brain Posts

Processing speed declines significantly with age and contributes to impairment and disability in old age.There is little known about whether age-related processing speed decline can be slowed with interventionA recent clinical trial by a Japanese group targeted processing speed training in a group of 72 elderly.This study found significant effects for a daily 15 minute processing speed training game over 4 weeks.In contrast to a control group, the intervention group found specific improvement in processing speed. Additionally, the study found a lower score on depressive mood symptoms following processing speed training. The game used in this study was specifically designed for the study and tested in pilot populations for the study.Readers with more interest in this study can access the free full-text manuscript by clicking on the link in the citation below.Follow the author on Twitter @WRY999Photo of gulf fritillary butterfly is from the author's files.Nouchi R, Saito T, Nouchi H, & Kawashima R (2016). Small Acute Benefits of 4 Weeks Processing Speed Training Games on Processing Speed and Inhibition Performance and Depressive Mood in the Healthy Elderly People: Evidence from a Randomized Control Trial. Frontiers in aging neuroscience, 8 PMID: 28066229... Read more »

  • December 6, 2016
  • 12:07 PM
  • 455 views

Online Insomnia Therapy Effective in Clinical Trial

by William Yates, M.D. in Brain Posts

Insomnia of sufficient severity to meet clinical significance is estimated to affect up to 20% of the general population.This makes insomnia an important public health challenge.Effective, inexpensive and accessible programs to treat insomnia are needed.One recent controlled clinical trial supports the promise of an online intervention that incorporates key elements of cognitive behavioral therapy (CBT).Lee Ritterband and colleagues at the University of Virginia recently published a controlled clinical trial of online CBT in 303 adults with chronic insomnia. The key elements of design in their study included the following elements:Subjects: Adults with chronic insomnia defined as 30 minutes of insomnia (at onset or during night) 3 nights per week for the last 6 months. Subjects were also required to have total sleep times of 6.5 hours per night or less. Additionally, the insomnia was required to produce significant distress or impairment in function. Subjects had to have a reliable source of access to the internet.Intervention: The experimental intervention was a online automated program known as "Sleep Healthy Using the Internet (SHUTi). This intervention is a weekly internet-based program lasting 6 weeks. The program mimics elements of face-to-face CBT for insomnia. The control intervention consisted of a non-tailored internet-based informational program about insomnia.Outcome Measures: Self-report measure known as the Insomnia Severity Index (ISI) along with sleep diaries. The study demonstrated a statistically significant improvement in multiple sleep measures including the ISI score, duration of onset insomnia and duration of wake time after sleep onset with SHUTi compared to control.SHUTi subjects showed a reduction of sleep onset insomnia time from an average of around 45 minutes at baseline to about 20 minutes at one year follow up.Interestingly there was no difference between experimental treatment and control in total sleep time. However, both groups showed about a 50 minute increase in total sleep time at one year of follow-up.This study is important because it not only demonstrated a significant therapeutic effect for SHUTi but this effect was maintained for a full year. This supports the durability of the the therapeutic effect for this intervention.The authors note limitations to the study include a sample that tended to be highly educated with internet access. Additionally, it was impossible for complete blinding as some subjects likely could guess their assignment based on the content of their internet intervention.Readers with more interest in the SHUTi program can access the official site HERE.  The site allows completing the online program for a fee of $135. Readers can access the free full-text manuscript by clicking on the link located in the citation below.Follow me on Twitter WRY999Photo of Christmas lights at Rhema in Tulsa Oklahoma is from my files.Ritterband LM, Thorndike FP, Ingersoll KS, Lord HR, Gonder-Frederick L, Frederick C, Quigg MS, Cohn WF, & Morin CM (2016). Effect of a Web-Based Cognitive Behavior Therapy for Insomnia Intervention With 1-Year Follow-up: A Randomized Clinical Trial. JAMA psychiatry PMID: 27902836... Read more »

  • November 29, 2016
  • 11:24 AM
  • 486 views

Your Brain On God: Reward and Motivation

by William Yates, M.D. in Brain Posts

William James authored a seminal book titled The Varieties of Religious Experience: A Study in Human Nature that was published in 1902.In this work, James reviewed the nature of religious experiences and noted a lack of scientific inquiry into this human phenomenon.James would have been extremely interested in a recent scientific inquiry into the religious experience from brain researchers at the University of Utah and Harvard University.In this study, functional magnetic resonance imaging (fMRI) was used to study the brain during a religious experience cue in a group of 19 individuals who were devout Mormons.The key elements of this study design included:Subjects: 19 young adults (7 female, 12 male) reporting weekly church attendance and daily experience of spirtitual feelingsExperimental cues: Control cues: resting state and audiovisual control. Religious experience cues: quotations from religious authorities, a period of prayer and scripture readingBrain imaging/analysis: Standard fMRI imaging using a 3T MRI scanner with analysis of areas of activation with religious experience compared with control activationsThe research team was able to identify significant brain regional areas of activation with religious cue stimulation.The authors summarized their finding in the discussion section of the manuscript:"We demonstrated in a group of devout Mormons that religious experience, identified as "feeling the Spirit," was associated with consistent brain activation across individuals within bilateral nucleus accumbens, frontal attentional, and ventromedial prefrontal cortical loci."The figure above notes the location of the key nucleus accumbens region of the brain known to be important in the brain reward response network. This brain region has been identified as a key region activated by a variety of reward experiences including feeling love, music appreciation and the euphoria associated with euphoric states induced by stimulants such as cocaine and methamphetamine.The authors propose that the observed activation of the frontal and prefrontal cortex regions may indicate a network that includes individual perception of salience of religious experience and "representation of affective meaning for the religious stimuli".This is an important study of brain effects of the religious experience. The results show exposure to religious stimuli in devout individuals activates a non-specific powerful reward response. This reward response may contribute to the motivational mechanism for doctrinal beliefs and church attendance.It is likely this type of response is not limited to devout Mormons but similar in other Christian believers and non-Christian believers where a "spiritual experience" is part of the religious experience.Readers with more interest in this research can access the full free-text manuscript by clicking on the PMID link in the citation below.Figure is an iPad screenshot from the app 3D Brain.Follow me on Twitter @WRY999Ferguson MA, Nielsen JA, King JB, Dai L, Giangrasso DM, Holman R, Korenberg JR, & Anderson JS (2016). Reward, Salience, and Attentional Networks are Activated by Religious Experience in Devout Mormons. Social neuroscience PMID: 27834117... Read more »

Ferguson MA, Nielsen JA, King JB, Dai L, Giangrasso DM, Holman R, Korenberg JR, & Anderson JS. (2016) Reward, Salience, and Attentional Networks are Activated by Religious Experience in Devout Mormons. Social neuroscience. PMID: 27834117  

  • November 21, 2016
  • 11:10 AM
  • 465 views

Benefits of Physical Activity in Parkison's Disease

by William Yates, M.D. in Brain Posts

Parkinson's disease (PD) is a progressive neurodegerative disorder estimated to affect 7 to 10 million individual worldwide.The primary mechanism for Parkinson's disease is a reduction in the neurotransmitter dopamine in the midbrain region of the substantia nigra highlighted in red in the figure.PD impairs motor and cognitive functions and leads to significant decline in psychosocial functioning.Drugs for PD can be effective in reversing and slowing the progression of the illness. However, response is often limited with relapse over time.Physical exercise appears to be an adjunctive option in the multidisciplinary treatment of PD. Martine Lauze along with colleagues in France and the U.S. recently conducted a literature review of this topic.Their review covered 106 published papers between 1981 and 2015. A total of 868 outcome measures were examined. The key findings from their review included:Physical activity is most effective in improving physical capabilitiesPhysical activity is also effective in improving physical and cognitive function capacityPhysical activity appears to improve flexibilityLesser response to physical activity was found in the domains of PD clinical symptoms, depression, psychosocial function They noted clinical PD symptoms of bradykinesia, freezing of gait and tremor were very resistant to physical acitivity interverventions. On a more hopeful note, gait and postural alterations in PD are more responsive to physical activity.Physical therapy protocols that appear to have the best chance of producing improving PD include:Gait training, walking for increased speed and enduranceStrength training for improvement muscle mass in legs and armsFlexibility exercises for upper, lower extremities and trunkInterventions to reduce risk of falls (balance)The evidence supports routine referral for physical therapy and physical rehabilitation in those suffering from Parkinson's disease.You can access the free full text manuscript in this post by clicking on the citation link below.The figure in this post is a Creative Commons file from Wikipedia authored:By Madhero88 - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=7157181Follow me on Twitter.Lauzé M, Daneault JF, & Duval C (2016). The Effects of Physical Activity in Parkinson's Disease: A Review. Journal of Parkinson's disease, 6 (4), 685-698 PMID: 27567884... Read more »

Lauzé M, Daneault JF, & Duval C. (2016) The Effects of Physical Activity in Parkinson's Disease: A Review. Journal of Parkinson's disease, 6(4), 685-698. PMID: 27567884  

  • November 17, 2016
  • 11:00 AM
  • 511 views

Missed Opportunities in Stroke Prevention

by William Yates, M.D. in Brain Posts

Rates of myocardial infarction and stroke have been declining over the last decade in the U.S. and Europe. However, a recent manuscript suggests there are still significant missed opportunities to prevent stroke.This manuscript presents results of review of electronic primary care records in the United Kingdom.The authors examines a group of over 29,000 subjects with a diagnosis of stroke or transient ischemic attack over a 10 year period.Records were reviewed to assess for compliance with guideline drug treatments that are proven to reduce the incidence of stroke including:Lipid-lowering drugsAnticoagulant drug use in those with atrial fibrillationAntihypertension drug use in hypertensionThe record review found that around 50% of subjects experiencing stroke or TIA had indications but were not receiving lipid-lowering or anticoagulant drugs prior to their cerebrovascular event. For hypertension, compliance with antihypertension drug use was 75% with 25% not receiving drug.One of the attractive features of this type of primary prevention is the potential for electronic records. Centralized records could be scanned with identification of high-risk patients that might benefit from targeted drug therapy. Patients and physicians could be alerted and a medical visit triggered to address the issue.The authors conclude that improving prevention efforts in these areas could potentially reduce the number of first strokes in the U.K. by 12,000 every year.Here is a table from the Creative Commons free full-text manuscript that outlines the indications and methods in the study for use of stroke prevention drugs.I am not aware of a similar type of study of stroke prevention in the United States.We do know that despite some promising trends in stroke reduction, significant geographic challenges remain.This map from the U.S. CDC shows the clustering of high stroke rates in the Southeastern portion of the U.S.Stroke prevention intervention efforts could be directed to areas of high risk for stroke as these areas are likely to yield the greatest results.Readers with more interest in this research can access the free full-text manuscript by clicking on the link in the citation below.U.S. Stroke map is from the U.S. CDC with data source the National Vital Statistics System, National Center for Health Statistics.Follow me on Twitter WRY999Turner GM, Calvert M, Feltham MG, Ryan R, Fitzmaurice D, Cheng KK, & Marshall T (2016). Under-prescribing of Prevention Drugs and Primary Prevention of Stroke and Transient Ischaemic Attack in UK General Practice: A Retrospective Analysis. PLoS medicine, 13 (11) PMID: 27846215... Read more »

  • November 15, 2016
  • 11:38 AM
  • 465 views

Celebrex Boosts Antidepressant Response

by William Yates, M.D. in Brain Posts

I ran into an interesting article at ScienceDaily providing data on a small sample size study of the anti-inflammatory drug celecoxib (Celebrex) in depression.Access the ScienceDaily report on this study by clicking HERE.This study focused on subjects with bipolar depression. All subjects were in a depressed phase and received the antidepressant drug escitalopram (Lexapro).Although only 55 subjects participated in this study, the results were significant and large. Adding Celebrex to escitalopram increased depression remission rates from 10% to 63%. I have summarized the data from the article in this attached graph.Additionally, the study team found a more rapid response to antidepressant drug therapy when Celebrex was added.I have been involved in use of anti-inflammatory agents in the treatment of bipolar depression. Dr. Jonathan Savitz and our colleagues at the Laureate Institute of Brain Research and the University of Kansas examined aspirin and minocycline in a clinical trial that has not yet been published.I have included the methods manuscript for our study that can be accessed by clicking the the link provided below.Neuroinflammation may be a contributing factor in a variety of brain disorders including depression. Better understanding of the role and treatment of inflammation may improve depression outcomes.Follow me on Twitter WRY999Figure in this post is an original figure from data abstracted from the research report.Savitz, J., Preskorn, S., Teague, T., Drevets, D., Yates, W., & Drevets, W. (2012). Minocycline and aspirin in the treatment of bipolar depression: a protocol for a proof-of-concept, randomised, double-blind, placebo-controlled, 2×2 clinical trial BMJ Open, 2 (1) DOI: 10.1136/bmjopen-2011-000643... Read more »

  • November 2, 2016
  • 11:09 AM
  • 442 views

Weight Training Boosts Brain Size and Performance

by William Yates, M.D. in Brain Posts

Aerobic exercise increases brain blood flow and has demonstrated beneficial effects on cognition.The effects of weight training exercise on the brain is less frequently studied. Hence, we know little about the effect and mechanism of weight training on brain function and performance.A recent study provides some needed insight on this topic.A study by C Suo and colleagues from Australia examined the effects of resistance training and cognitive skills training on brain structure and function.The key elements of design in their study included the following features:Subjects: 100 elderly subjects of average age 70 years with mild cognitive impairmentIntervention: 6 months of progressive resistance training (PRT), computerized cognitive training (CCT), both interventions or neither intervention (sham control group)Cognitive assessments: MMSE, Clinical Dementia Rating Scale and a battery of neuropsychological testsImaging: Pre- and post- 3T MRI voxel-based quantitative assessments of brain regions and resting state fMRIStatistical Analysis: SPSS linear mixed model studying three main effects, time, PRT and CCT The findings in this study were quite remarkable:PRT: Increased performance on global cognitionPRT: Increased brain gray matter volume in the posterior cingulate cortex (see image)PRT: Increase in cigulate gray matter volume correlated with improvement in global cognitionPRT: Reversed progression of brain white matter intensities, a biomarker of cerebrovasular diseaseCCT: Slowed progression of decline in overall memory performanceCCT: Enhanced connectivity between brain hippocampus and superior frontal cortex This is one of the first studies finding a significant improvement in cognitive function in elderly subjects after progressive resistance training.Additionally, the study supports PRT's potential benefit in reversing brain white matter intensities (WMI). I have previously written a blog post on the association of WMI with increased rates of dementia and premature death. You can find that post HERE.The take home message here is that both PRT and CCT appear to have beneficial effects on slowing the effects of aging on the brain. They each appear to have unique mechanisms and brain targets. A smart preventative program for brain health in the elderly would combine the two interventions.Readers with more interest in this study can access the free full-text manuscript by clicking on the link in the citation below.Image showing cingulate cortex is an iPad screen shot from the app 3D BrainFollow me on Twitter by clicking WRY999Suo C, Singh MF, Gates N, Wen W, Sachdev P, Brodaty H, Saigal N, Wilson GC, Meiklejohn J, Singh N, Baune BT, Baker M, Foroughi N, Wang Y, Mavros Y, Lampit A, Leung I, & Valenzuela MJ (2016). Therapeutically relevant structural and functional mechanisms triggered by physical and cognitive exercise. Molecular psychiatry, 21 (11) PMID: 27090304... Read more »

Suo C, Singh MF, Gates N, Wen W, Sachdev P, Brodaty H, Saigal N, Wilson GC, Meiklejohn J, Singh N.... (2016) Therapeutically relevant structural and functional mechanisms triggered by physical and cognitive exercise. Molecular psychiatry, 21(11), 1645. PMID: 27090304  

  • October 24, 2016
  • 11:19 AM
  • 487 views

Exercise After Study Boosts Memory

by William Yates, M.D. in Brain Posts

There is significant interest in activities that may boost academic achievement in the classroom.I previously posted on evidence that exercise prior to a learning task improved reading comprehension scores.You can access that post by clicking HERE.Now a study has compared two types of activities after a memorization task in male students.In this study, 60 male students completed a learning task and then were randomized into one of three activities for one hour. The three activities were playing a violent video game, a period of running or a control period of conversation. After the activity period, subjects completed a memory test.Subjects had salivary cortisol levels examined before and after the learning task at at the time of memory testing. All subjects had a increase in salivary cortisol levels after the learning phase, but only the running group demonstrated a continued rise in cortisol after the activity phase.The subjects participating in a running activity performed better on the memory retention test than those in the violent video game and the conversation control groups.  There was no correlation between salivary cortisol levels and memory retention. The authors conclude that their finding has implications for scheduling exercise during the school day for children. They recommend physical exercise following intense learning cycles to promote improved learning efficiency.Interestingly, in the United States many schools are cutting back on physical education activities due to budget constraints. Such cutbacks may contribute to declining performance on testing metrics.Readers with more interest in this topic can access the free full text manuscript by clicking on the DOI link in the citation below.Photo of monarch butterfly is from the author's files.Follow me on Twitter at WRY999Kindermann, H., Javor, A., & Reuter, M. (2016). Playing counter-strike versus running: The impact of leisure time activities and cortisol on intermediate-term memory in male students Cognitive Systems Research, 40, 1-7 DOI: 10.1016/j.cogsys.2016.01.002... Read more »

  • October 14, 2016
  • 11:50 AM
  • 447 views

Pathways to Substance Use and Abuse

by William Yates, M.D. in Brain Posts

Neuroscience medicine clinicians encounter patients every day who have both a mental and substance use disorder.This co-occurrence, or comorbidity, complicates diagnosis, treatment and outcome.The exact mechanism for this comorbidity issue is unclear.A recent study out of Washington University in St. Louis and King's College London provides some insight into this comorbidity issue.They examined participants in the Study of Addiction: Genetics and Environment (SAGE). These subjects provided genetic samples and psychiatric interviews to the research team.Five psychiatric disorders were studied including attention deficit hyperactivity, autism spectrum disorder, major depression, bipolar disorder and schizophrenia. A initial finding ruled out any link between genetic risk for autism spectrum disorder and any substance use/abuse risk.The remaining four psychiatric disorders did increase risk for substance use and abuse in a general manner. This means genetic risk for ADHD, bipolar disorder, major depression and schizophrenia all contribute to a general risk for substance use/abuse across all drug categories.Additionally, the team reported some specific drug use/abuse with individual genetic risk for ADHD, bipolar disorder, major depression and schizophrenia. These specific pathways included:Major depression polygenetic risk score and non-problem cannabis useMajor depression polygenetic risk score and severe cocaine dependenceSchizophrenia polygenetic risk score and  non-problem cannabis use and severe cannabis dependenceSchizophrenia polygenetic risk score and severe cocaine dependenceThe take-home message from this study is that genetic risk for many psychiatric disorders also contributes to a increased risk for general substance use/abuse. Additionally, some psychiatric disorders appear to increase risk for specific substance use/abuse issues.Prevention, assessment and treatment services need to address this relationship and the needs for each component of illness in those with comorbidity.Individuals with more interest in this topic can access the free full-text manuscript by clicking on the link in the citation below.Follow me on Twitter WRY999Image is an original graphic produced by me based on content in the manuscript.Carey CE, Agrawal A, Bucholz KK, Hartz SM, Lynskey MT, Nelson EC, Bierut LJ, & Bogdan R (2016). Associations between Polygenic Risk for Psychiatric Disorders and Substance Involvement. Frontiers in genetics, 7 PMID: 27574527... Read more »

Carey CE, Agrawal A, Bucholz KK, Hartz SM, Lynskey MT, Nelson EC, Bierut LJ, & Bogdan R. (2016) Associations between Polygenic Risk for Psychiatric Disorders and Substance Involvement. Frontiers in genetics, 149. PMID: 27574527  

  • October 10, 2016
  • 11:54 AM
  • 472 views

Alzheimer's Disease: Atrophy Pattern and Symptoms

by William Yates, M.D. in Brain Posts

Memory impairment is a key symptom of Alzheimer's dementia common to patients with the condition.However, additional cognitive and behavioral symptoms vary between patients with a clinical and pathological diagnosis of Alzheimer's disease.A key area of research is focused on understanding factors that contribute to symptom variability in Alzheimer's disease.A team of researchers from Singapore and Harvard Medical School recently published an important study on this topic.They analyzed structural MRI images from a group of 188 subjects in the Alzheimer's Disease Neuroimaging Initiative.Using a mathematical model known as latent Dirichlet allocation they were able to identify three distinct areas of atrophy of variable severity in their cohort. These three factors were found to be:Temporal atrophy: temporal cortex, hippocampus and amygdalaCortical atrophy: frontal, parietal, lateral temporal and lateral occipital cortex regionsSubcortical atrophy: striatum, thalamus and cerebellumIndividual patterns of atrophy within subjects were found to be stable over time. This means the atrophy patterns are not just a reflection of the stage of the Alzheimer's disease.As expected, patterns of atrophy correlated with neuropsychological domains of impairment. Temporal atrophy subjects had the greatest memory impairment. Cortical atrophy patients showed the most impairment in executive function. Subcortical atrophy subjects had lower levels of executive function and memory impairment and showed a slower rate of cognitive decline.Patients tended to fall into factor groups where more than one area of atrophy was noted, i.e. cortical and temporal atrophy but not subcortical atrophy.The authors note their findings support the heterogeneity of Alzheimer's disease affecting different cognitive and behavioral features as well as variability in disease progression.This is an important study in understanding the clinical manifestation of Alzheimer's disease. Readers with more interest in this research can access the free full-text manuscript by clicking on the link in the citation below.Follow me on Twitter @WRY999Brain image highlighting regions of the subcortex is an iPad screen shot from the app Brain Tutor.Zhang X, Mormino EC, Sun N, Sperling RA, Sabuncu MR, Yeo BT, & Alzheimer’s Disease Neuroimaging Initiative. (2016). Bayesian model reveals latent atrophy factors with dissociable cognitive trajectories in Alzheimer's disease. Proceedings of the National Academy of Sciences of the United States of America PMID: 27702899... Read more »

Zhang X, Mormino EC, Sun N, Sperling RA, Sabuncu MR, Yeo BT, & Alzheimer’s Disease Neuroimaging Initiative. (2016) Bayesian model reveals latent atrophy factors with dissociable cognitive trajectories in Alzheimer's disease. Proceedings of the National Academy of Sciences of the United States of America. PMID: 27702899  

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