(Editor’s Note: given the growing media attention to three apparently separate worlds -cognitive enhancement via drugs, brain fitness training software, computerized neurocognitive assessments-, I found it refreshing to see our co-founder Elkhonon Goldberg introduce the topic of cognotropic drugs with an integrative perspective in the much updated new edition of his classic book, now titled The New Executive Brain: Frontal Lobes In A Complex World. Below goes an excerpt).

For many neuropsychologists, like myself, science is a labor of love, but seeing patients is bread and butter. Traditionally, the clinical contribution of neuropsychology has been mostly diagnostic, with precious little to offer patients by way of treatment. Neuropsychology is not the only clinical discipline for years consigned to helpless voyeurism. Every discipline concerned with cognition shares this humbling predicament. A psychiatrist treating a schizophrenic patient or a depressed patient finds him- or herself in a similar position. There are ample pharmacological tools to treat the patient’s psychosis or mood, but very few to treat the patient’s cognition. Even though psychiatrists increasingly recognize that cognitive impairment is often more debilitating in their patients than psychosis or mood disorder, traditionally, very little direct effort has been aimed at improving cognition.

A neurologist treating a patient recovering from the effects of head injury does not fare much better. There are adequate means to control the patient’s seizures but not his or her cognitive changes, despite the fact that cognitive impairment is usually far more debilitating than an occasional seizure. Society has been so preoccupied with saving lives, treating hallucinations, controlling seizures, and lifting depression that cognition (memory, attention, planning, problem solving) has been largely ignored. Granted, various neuroleptics, anticonvulsants, antidepressants, sedatives, and stimulants do have an effect on cognition, but it is an ancillary effect of a drug designed to treat something else.

Alzheimer’s disease and other dementias have been society’s wake-up call. Here, in the most affluent country in the most affluent of times, human minds were succumbing to decay before human bodies, a sharp challenge to the tacit popular belief that the “body is frail but soul is forever.” This provided an impetus for the development of an entirely new class of drugs, which can be termed familially as “cognotropic.” Their primary and explicit purpose is to improve cognition.

Since medical and public preoccupation with dementia focuses on memory, most of the pharmacological efforts have been directed at improving memory. At the time of this writing, a handful of drugs known as “Alzheimer’s drugs” or “memory enhancers” have been approved by the U.S. Food and Drug Administration (FDA). In reality, both designations are somewhat misleading. The drugs in question are Read the rest of this entry »

Good article today in the NYT on “chemo brain” – some typical short-term and long-term cognitive consequences of chemotherapy.

The Fog That Follows Chemotherapy (New York Times)

One quote is critical – for chemo brain and also for a variety of clinical conditions that present associated cognitive impairments:

“Controlling for brain function before cancer treatment begins can help determine cause and effect. In one study, cancer patients took a battery of neuropsychological tests before starting chemotherapy, three weeks after completing treatment, and again one year later. Although a third of the patients had signs of cognitive impairment before therapy began, the number jumped to 61 percent after treatment, and half remained impaired a year later.”

As we have discussed before, I believe that inexpensive computerized cognitive assessments will start to become widely available in only a few years, to help set up individualized cognitive baselines and inform clinical diagnoses and treatments. For more, you can read Computerized Cognitive Assessments: opportunities and concerns

(Editor’s Note: I recently came across an excellent book and resource, The Alzheimer’s Action Plan: The Experts’ Guide to the Best Diagnosis and Treatment for Memory Problems, recently released in paperback. Dr. Murali Doraiswamy, one of the authors and leading Alzheimer’s expert, kindly helped us create a 2-part article series to share with SharpBrains readers advice on a very important question, “How can we help the public at large to distinguish Alzheimer’s Disease from normal aging — so that an interest in early identification doesn’t translate into unneeded worries?” What follows is an excerpt from the book, pages 72-78, discussing the Pros and Cons of the most common assessments).

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While no single test (other than a brain biopsy, which is a very invasive and risky procedure) can conclusively prove that a person has Alzheimer’s, many tests can give us a good idea. A list of all the tests that help us assess memory and thinking problems appears at the end of this chapter. Meanwhile, let’s take a good look at the whys and hows of a thorough memory assessment.

WHAT A DIFFERENCE AN EXTRA TEST CAN MAKE

To understand why getting tested (and retested as symptoms change and the disease progresses) is important, check out the experience of Katherine, who went to the doctor complaining of a memory slowdown. She took five of the most important neuropsychological tests, which assess brain function without actually physically looking at the brain. Then she underwent brain scans, a cardiovascular workup, and blood tests to see what else was going on that might be undermining her mental function. Read the rest of this entry »

A round-up of interested news during the month:

1) Training Young Brains to Behave (New York Times)

2) Head Games (OpEd in New York Times)

3) Will Gerontology recognize the Brain? (American Society on Aging event)

4) Brain function gets a boost from walking (Los Angeles Times)

5) An idea whose time has (finally) come (McKnight’s Long Term Care News)

6) Train your brain (Financial Times Germany)

7) Toman auge ejercicios que adiestran la mente (Milenio, Mexico)

Trois nouvelles études IDATE : Serious Games (Publi-News, France)

Links and commentary below.  Read the rest of this entry »

You may have seen this insighful OpEd last Friday in the New York Times, by clinical neuropsychologist Gerald Tramontano:

Head Games

- “CHILDREN aged 5 to 18 suffer at least 96,000 sports-related concussions every year in the United States, the Centers for Disease Control and Prevention estimates. Even more troubling, as many as 20 percent of all high school football players sustain concussions annually, studies show.”

- “The only way to know for sure whether a concussion victim’s brain has returned to normal is to compare the results of neuropsychological tests conducted before and after the injury. That requires preparing athletes for the season by putting them through baseline testing.”

Comment: Great OpEd, raising awareness of a problem with growing importance – not only in terms of sports concussions, but also car accidents, strokes, and a variety of life-events that may provoke brain damage – and introducing readers to the need for cognitive baselines for specific individuals.

Now, we will probably need to go further than the author of the OpEd suggests. There are simply not enough neuropsychologists in the whole planet to test one-person at a time for 4-hours each, and the cost of trying so would be astronomical.

The more realistic route is to combine a) fully-automated computer-based assessments as a baseline, b) the involvement of a neuropsychologist when needed, probably both to supervise the whole assessment program for a sports team, for example, and then to supervise the post-damage rehabilitation process.