Category: Inside the Brain

I’ve just found an amazing Terry Pratchett article published in the Journal of Mental Health earlier this year entitled ‘Diagnosing Clapham Junction syndrome’ where he discusses his experience with dementia.

Pratchett was diagnosed with posterior cortical atrophy, usually considered to be an atypical form of Alzheimer’s disease that is focused on the back of the brain and tends to cause particular disruption to visual abilities.

You can’t battle it, you can’t be a plucky “survivor”. It just steals you from yourself. And I’m 60; that’s supposed to be the new 40. The baby boomers are getting older, and will stay older for longer. And they will run right into the dementia firing range. How will a society cope? Especially a society that can’t so readily rely on those stable family relationships that traditionally provided the backbone of care?

What is needed is will and determination. The first step is to talk openly about dementia because it’s a fact, well enshrined in folklore, that if we are to kill the demon then first we have to say its name. Once we have recognized the demon, without secrecy or shame, we can find its weaknesses. Regrettably one of the best swords for killing demons like this is made of gold – lots of gold. These days we call it funding. I believe the D-day battle on Alzheimer’s will be engaged shortly and a lot of things I’ve heard from experts, not always formally, strengthen that belief. It’s a physical disease, not some mystic curse; therefore it will fall to a physical cure. There’s time to kill the demon before it grows.

I have to say, in one section, Pratchett is probably a little hard on clinicians in terms of how long it takes to diagnose dementia, which is not an easy task.

Dementia is usually defined as a decline in mental abilities that happens faster than would be expected from normal ageing and is associated with degeneration of the brain.

There are many types of dementia, and diagnosis is often broken down into ‘possible’, ‘probable’ and ‘confirmed’ versions.

Rather frustratingly, for those wanting a precise and confident diagnosis of, let’s say, Alzheimer’s disease, a ‘confirmed’ diagnosis can only be officially made on the basis of close examination of the brain tissue after the symptoms are known.

In practice this means that dementia can only be ‘confirmed’ after death. The result is that most people get a diagnosis of ‘possible’ or ‘probable’ dementia.

The former is made when the person has known cognitive problems and estimates that they were much better before, and the latter only when testing has shown that there has been a definite decline over at least six months.

For a diagnosis of Alzheimer’s, this needs to affect at least two areas of mental functioning, so a tried and tested decline in just memory over six months would still leave some doubt. This means a wait of a year can be pretty standard for a ‘probable’ diagnosis.

After finally getting his diagnosis after experiencing difficulties for some time, Pratchett says “you could have used my anger to weld steel”. It’s worth saying that the frustration is shared.

By the way, Pratchett’s article was published in a special open-access edition of the Journal of Mental Health focussing on classification where several people discuss their experience of hearing their diagnosis.

There’s a particularly good piece by Mark Vonnegut, son of science fiction author Kurt Vonnegut who was previously diagnosed with schizophrenia and is now a qualified doctor, working as a primary care pediatrician.
 

Link to Terry Pratchett on ‘Diagnosing Clapham Junction syndrome’.
Link to table of content for open-access edition.

The Guardian has an excellent article on how tropical diseases are a major and largely unrecognised risk to the mental agility of young children as parasites directly or indirectly affect the brain.

Frustratingly, the diseases are widespread and, in many cases, easily treatable, if only the resources were available.

Unfortunately, the same problems that make treatment scarce also mean that the conditions are under-researched and it’s still not clear in many cases how the diseases end up causing mental deterioration.

We are still a long way from understanding the mechanisms by which a given disease may affect cognitive function. For instance, a parasitic worm infection may have its main effect on educational progress by causing diarrhoea and malaise, leading the child to miss school or to be listless and unmotivated in the classroom. But there may be more direct effects on brain development caused by malabsorption of nutrients or iron-deficiency anaemia. It has also been suggested that the toxins generated by some parasites may affect brain function.

Such effects may be temporary, the child catching up with his or her peers once the infection has been cured, or long-lasting, if brain development is disrupted during a critical phase. Research in this area is difficult, but is urgently needed if we are to develop effective preventive strategies.

 

Link to Guardian piece ‘Out of sight, out of mind’.

This week’s edition of Nature is a special issue on schizophrenia and it includes an open-access feature article on the neuroscience of why the disorder only tends to appear in young-adulthood.

One of the themes to come out of the piece is how symptoms of schizophrenia, like delusions and hallucinations, lie on a continuum – the idea being that we all have reality distortions to varying degrees and that these distortions themselves may vary in intensity.

In about a third of people, these will intensify into florid psychosis and a diagnosis of schizophrenia, but for others, the experiences seem self-limiting.

One of the big questions in schizophrenia research is to understand what happens in the mind and brain during this transition and, of course, if possible, to prevent it by early treatment.

This has sparked a great deal of heated debate because up to two thirds of ‘at risk’ people will never develop schizophrenia anyway, and yet might be unnecessarily labeled and medicated.

It’s probably worth noting that the idea of a ‘continuum of psychotic symptoms’ is popular but also still not very well defined, as a locked editorial in the latest issue of Psychological Medicine makes clear.

It’s possible to see a sliding scale in the intensity of experiences, how often they occur, and the emotional impact they have, among many other things, but its not clear how you would go about disproving a continuum in many cases.

The Nature article is a remarkably broad look at the whirlwind of issues surrounding how schizophrenia develops and tackles the issue from the basic neuroscience to the ethics of early treatment.

There’s loads more great stuff on schizophrenia in the same issue, sadly most of it locked out of the internet, but if you want more neuroscience, there is another open-access article on the contentious issue of whether the brain’s glial cells communicate.
 

Link to article ‘Schizophrenia: The making of a troubled mind’.
Link to article ‘Neuroscience: Settling the great glia debate’.
Link to table of contents for this issue.

I’ve just read an incredible article on conjoined twins Tatiana and Krista Hogan who have parts of the brain in common and may be sharing thoughts and perceptions.

Adding to the conundrum, of course, are their linked brains, and the mysterious hints of what passes between them. The family regularly sees evidence of it. The way their heads are joined, they have markedly different fields of view. One child will look at a toy or a cup. The other can reach across and grab it, even though her own eyes couldn’t possibly see its location.

“They share thoughts, too,” says Louise. “Nobody will be saying anything,” adds Simms, “and Tati will just pipe up and say, ‘Stop that!’ And she’ll smack her sister.” While their verbal development is delayed, it continues to get better. Their sentences are two or three words at most so far, and their enunciation is at first difficult to understand. Both the family, and researchers, anxiously await the children’s explanation for what they are experiencing.

It’s probably worth noting that while rare, Tatiana and Krista are by no means the only conjoined twins who share a brain.

Perhaps most famous are Lori and George Schappell. If you’re not aware of the Schappells, click the link as they have led amazing lives and would be inspiring individuals even if they were they not conjoined.

This makes me wonder why the issue of shared perceptions has never been tested before.

From a scientific point of view, these studies would be important because parents often swear that their child has ‘special abilities’ which mysteriously seem to vanish when formally tested – as any child psychologist will tell you.

But perhaps it’s simply the case that none of the twins have ever been keen to take part in studies on the effect of having a shared brain.
 

Link to Macleans article ‘A piece of their mind’.

All in the Mind kicks off a new three-part series on ‘Cultural Chemistry’ with a programme about the effects and politics of the stimulant khat which has an important place in several East African cultures.

The plant is used widely in Somalia, Ethiopia and Yemen and when chewed it causes a mild buzz owing to low levels of a naturally occurring amphetamine-like compound called cathinone.

Although originally rooted in Africa, the plant is available across the world although its legal status varies – from banned in the USA to completely legal in Britain.

It is used traditionally like coffee to perk people up and make them more chatty although it is often the subject of controversy because it has been linked with triggering psychosis and aggression in some people – although the scientific evidence is far from clear.

I managed to try khat once after I discovered it on sale at a grocery in Leicester. Although it did cause a slight buzz I was most struck by the taste as it is incredibly tannin-like, making the experience a little like chewing on a tea bag.

But as All in the Mind notes, as the plant is strongly linked to specific social settings, it’s difficult to understand its effects without considering the environment in which it’s taken and the programme does a fantastic job of exploring the complex mix.

Coffee is next up in the ‘Cultural Chemistry’ series which should be worth keeping an eye on as there might be something a little special later on. Also, there’s more on the All in the Mind blog and a call for you to contribute your own recordings.
 

Link to All in the Mind Cultural Chemistry series on khat.
Link to more details and additional audio on the AITM blog.