Test­ing Pro­gram Fails Sol­diers, Leav­ing Brain Injuries Unde­tected (ProPublica):

“In 2007, with road­side bombs explod­ing across Iraq, Con­gress moved to improve care for sol­diers who had suf­fered one of the war’s sig­na­ture wounds, trau­matic brain injury.

Law­mak­ers passed a mea­sure requir­ing the mil­i­tary to test sol­diers’ brain func­tion before they deployed and again when they returned. The test was sup­posed to ensure that sol­diers received proper treatment.

Instead, an inves­ti­ga­tion by ProP­ub­lica and NPR has found, the test­ing pro­gram has failed to deliver on its promise, offer­ing sol­diers the appear­ance of help, but not the real­ity. Read the rest of this entry »

(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).

—

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 nou­vellestudes 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.