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Aging, Chronic Disease, Events, Health Policy, Neuroscience, Public Health, Women's Health

Alzheimer’s forum with Rep. Jackie Speier spurs conversation, activism

Alzheimer's forum with Rep. Jackie Speier spurs conversation, activism

10776927963_3dd8d244da_zWhat happens when you bring together a woman with Alzheimer’s, a congresswoman, a policy expert and two doctors? No, this isn’t a joke – but an intro to an informative and wide-ranging discussion on Alzheimer’s disease and its effects on women.

“I was pretty ignorant until fairly recently,” said Rep. Jackie Speier (D-CA), who organized the forum Alzheimer’s: A women’s health issue held in San Mateo, Calif. yesterday. She also penned an opinion piece published recently in the San Francisco Chronicle. “I had no idea that two out of three people diagnosed with Alzheimer’s are women.”

Although it’s the fifth leading cause of death in California, Alzheimer’s receives much less federal money than many other major diseases, she said.

To spur conversation and provide information, Speier invited Cynthia Ortiz Guzman, a former nurse who suffers from Alzheimer’s; Ruth Gay, director of public policy and advocacy for the Alzheimer’s Association; Elizabeth Landsverk, MD, medical director of ElderConsult, and Stanford’s Michael Greicius, MD, MPH, an associate professor of neurology and neurology and medical director of the Stanford Center for Memory Disorders. Greicius has done research on women’s risk of the disease.

Nearly all of the 150-plus people who attended the forum had a loved one who suffered from Alzheimer’s. “We still have a good life, but there is so much that needs to be done,” Guzman told them.

Greicius and Landsverk fielded questions about how to diagnose and treat Alzheimer’s as well as promising directions of research.

At Stanford, Greicius said a person with memory impairment would meet with a neurologist, take a several hour neuropsychological exam, have bloods tests and a brain scan, and meet with social workers and nurses. He emphasized that this is far above the level of care available in more community medical centers. Sometimes physicians are able to find biomarkers that signal Alzheimer’s presence more than a decade before symptoms appear he said.

Greicius urged attendees to find out if they’re eligible for a neurological research trial at Stanford and to consider donating their brains and the brains of their loved ones to use for research. He also thanked Speier for focusing attention on Alzheimer’s.

“We’ve got to get the attention of policymakers to address this issue,” Speier said, adding that she might try to secure federal funds as part of the defense budget.

Gay, who recently traveled to Washington, D.C. to advocate for the disease, agreed. “We know that today we need a game changer – we need people to step forward and speak out about this disease,” she said.

Previously: Science Friday explores women’s heightened risk for Alzheimer’s, The state of Alzheimer’s research: A conversation with Stanford neurologist Michael Greicius and The toll of Alzheimer’s on caretakers 
Photo by Marjan Lazarevski

Complementary Medicine, In the News, Mental Health, Neuroscience, Research

An oasis of peace in “the 500 channel universe”: Research on mindfulness and depression

An oasis of peace in "the 500 channel universe": Research on mindfulness and depression

1135112859_45dc222725_zEarlier this month, the American Psychological Association issued a feature on mindfulness and depression, highlighting research that suggests mindfulness is an effective way to ameliorate and treat mood disorders, particularly recurrent depression. Some of the featured research suggests a strong neurological basis for the association.

Zindel Segal, PhD, a psychologist at the University of Toronto who is quoted in the article and who was on the three-person team that created Mindfulness-Based Cognitive Therapy (MBCT), wonders if all the attention mindfulness is now receiving is part of a backlash against “the 500 channel universe” of distractions in modern society. It’s not a pill that can be taken and done with, though – it’s a restructuring of mental attitude that requires maintenance. Through MBCT, people learn to pay attention to sensations and feelings rather than evaluative thoughts.

The studies in the review suggest that MBCT works at least as well as medication to prevent recurrence, that it is effective for peri-natal depression, and that it may work especially well for people with histories of relapse or depression stemming from childhood. A brief prepared for the Department of Veterans Affairs found that mindfulness approaches were most effective against depression compared to other health conditions.

I found the neuroscience particularly interesting: Part of the reason for MBCT’s effectiveness may be that practicing mindfulness increases connectivity and tissue density in certain areas of the brain. This is a classic example of neuroplasticity – the idea that neurological pathways can adapt and change throughout one’s life.

Norman Farb, PhD, a neuroscientist at the University of Toronto, distinguishes two forms of self-reference that activate different areas of the brain: extended/narrative self-reference, which links experiences across time, and momentary/experiential self-reference, which is centered on the present. Mindfulness exercises emphasize the present, in contrast with destructive narrative patterns of thought common in those suffering from stress, anxiety, and depression. In Farb’s study, fMRI results show that regular mindfulness practice strengthens areas of the brain that focus on the moment. It suggests that although we habitually integrate these two forms of self-reference, they can be neurally dissociated through attentional training.

Neural differences may have effects even when someone is not actively engaging in mindfulness: A study led by Veronique Taylor at the University of Montreal showed that the experienced meditators has less activity in narrative self-referential areas than novice meditators even in a resting state. Another study led by Harvard University neuroscientist Sara Lazar, PhD, showed that over the course of an 8-week mindfulness stress reduction program, the gray matter in participants’ amygdala shrank in density, while density increased in areas related to sustained attention and emotion regulation. The amygdala is implicated in anxiety as well as depression, which correlates with the finding that the participants’ stress levels decreased.

According to the feature, Segal has been impressed with the dramatic rise in popularity of meditation over the past 20 years, which “resonates with people’s desires to find a way of slowing down and returning to an inner psychological reality that is not as easily perturbed,” he says. Perhaps most encouragingly, mindfulness practice has no adverse side-effects or contraindications, so I would expect to see more research into its efficacy, which could be good for all of us in our “500 channel universe.”

Previously: Mindfulness training may ease depression and improve sleep for both caregivers and patients, Using mindfulness-based programs to reduce stress and promote health, Using mindfulness therapies to treat veterans’ PTSD, How mindfulness-based therapies can improve attention and health and Study shows mindfulness may reduce cancer patients’ anxiety and depression.
Photo by ronsho

Neuroscience, Research, Stanford News

A little noise in the brain’s wiring helps us learn

A little noise in the brain's wiring helps us learn

shutterstock_139305437It didn’t come as a surprise to me when I learned from neuroscience postdoctoral scholar Tatiana Engel, PhD, that all of us have a bit of noise in how our neurons fire. In response to the same signal, they’ll usually fire one way then occasionally fire a different way.

I, myself, blame a number of my quirks on noisy and confused neurons.

Engel told me that Stanford Neurosciences Institute director William Newsome, PhD, had discovered those noisy neurons almost two decades ago. He had trained animals to detect whether dots on a screen were moving to the right or left. He found that the way a single noisy neuron fired was also reflected in how the animal categorized the dots – if the neuron indicated right, the animal chose right and vice versa.

In a story I wrote Engel said, “[It]was exciting to me to realize that we are used to thinking about ourselves as agents who are in charge of our decisions and in charge of our thoughts, but the brain might be playing tricks with us.”

Engel recently published work she did in computer models in which she tried to understand why the neurons didn’t fire the same way every time. What she found is that if neurons don’t have a bit of a bias to begin with they don’t learn through a reward system. Essentially without occasionally firing left when the dots are moving right, the neuron can’t ever improve its accuracy.

The type of learning Engel studied is the same kind of learning we use when learning to categorize food into groups we like or don’t like, or to categorize music or even objects. Her work appears in Nature Communications.

Previously: Stanford neurobiologist Bill Newsome: Seeking gains for the brain and Deciphering “three pounds of goo” with Stanford neurobiologist Bill Newsome
Image from Shutterstock

Biomed Bites, Neuroscience, Research, Science, Videos

Circuit breaker: One Stanford scientist and his quest to control epileptic seizures

Circuit breaker: One Stanford scientist and his quest to control epileptic seizures

Welcome to Biomed Bites, a weekly feature that introduces readers to some of Stanford’s most innovative researchers.

John Huguenard, PhD, was wooed by the magic of anti-epileptic drugs when he was in graduate school at Duke University.  “I was fascinated by the idea that a drug that you could take would block the seizure without affecting normal brain function,” Huguenard says in the video above.

Now a professor of neurology and neurological sciences at Stanford, Huguenard and his colleagues have taken a deep dive into the brain’s circuits, trying to figure out exactly how and why the circuits “go haywire” during an epileptic seizure and what can be done to prevent that from happening.

He has discovered that those broad-based anti-epileptic drugs that once fascinated him might not be the best approach to treat epilepsy. “We’re learning that if we can focus our therapies on very small portions of the brain, we can reduce the chances of side  effects even more,” Huguenard says.

Learn more about Stanford Medicine’s Biomedical Innovation Initiative and about other faculty leaders who are driving biomedical innovation here.

Previously: Brain’s wiring more dynamic than originally thought, The brain makes its own Valium: Built-in seizure brake? and Light-switch seizure control? In a bright new study, researchers show how

Behavioral Science, Complementary Medicine, Neuroscience, NIH, Patient Care, Research

“Tranceformation:” David Spiegel on how hypnosis can change your brain’s perception of your body

4254170454_4f55755317_zWhen we think of cognitive function, we usually think of having the power to alter our reasoning, while we passively respond to our perceptions. What if we could do the inverse: manipulate our perception, while merely responding to reasoning and language? That is the basic neurological explanation of hypnosis, says David Spiegel, MD, director of the Center on Stress and Health and medical director of the Center for Integrative Medicine.

Spiegel spoke on new research in hypnosis yesterday morning during the Integrative Medicine Research Lecture Series presented by the National Center for Complementary and Integrative Health (NCCIH). Despite its Greek etymology, hypnosis does not involve going to sleep; it’s more like a narrowing of attention. “Hypnosis is to consciousness what a telephoto lens is to a camera,” Spiegel explained.

When hypnotized, you put outside of awareness what would normally be in consciousness (dissociation), and become less likely to judge what people tell you (suggestibility). The idea of this often makes people nervous, because we’re evolved to respond to nuanced social cues. But a growing body of scientific evidence suggests that overcoming this nervousness can yield a wealth of health benefits.

Hypnosis can be an effective method for managing pain, and treating anxiety and stress-related disorders. Past studies have shown that people hypnotized before operative care have a shorter procedure time and a significant reduction in intraprocedural complications, such as hypoxemia and vomiting. One study showed that in select cases “hypnosis as sole anesthesia works extremely well,” Spiegel said.

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Neuroscience, Patient Care

My dance with dystonia

My dance with dystonia

We’ve partnered with Inspire, a company that builds and manages online support communities for patients and caregivers, to launch a patient-focused series here on Scope. Once a month, patients affected by serious and often rare diseases share their unique stories; this month’s column comes from a patient advocate who describes herself as a “battle-clever dystonia damsel.”

4704705307_3dd45d8ed2_zMy dance with dystonia, a rare neurological movement disorder, has been a mangled cha-cha-cha with a wayward partner. Seems I keep taking steps forward then back — ever shifting my center of gravity — while engaging in a never-ending battle over who assumes the lead. In terms of mechanics, think of dystonia as a travesty of muscular timing orchestrated by the brain and executed by body parts moving off tempo. Imagine trying to master a new dance routine and your feet fly over the dance floor in scattered disarray. That’s dystonia.

Life took its unexpected turn when I was 8 and various body parts began to assert minds of their own. First my right arm insisted on straying off course when I wrote. Then the chaos spread to my left leg. In a creeping progression that eventually stabilized, a degree of unrest extended to all my limbs. Articulatory challenges gradually manifested. While dystonia is a game changer, over the years it’s become my second skin. I find it hard to recall time before dystonia.

When I was diagnosed in the 1970s, patients and their families exhibited far greater reluctance to broadcast their health conditions, especially when a disorder struck early in life. Disability was all too absent from the landscape, especially living in a small suburban town. We’d yet to witness the proliferation of the Internet let alone a grid of online media breaking down barriers and opening up lines of communication.

I didn’t encounter a soul with dystonia until my mid 20s. Often, I felt apart and alone. It was a challenge viewing my condition with any kind of perspective. How I wished there was someone out there who understood.

How far we’ve progressed over 40+ years. Accessing health information is as easy as a trip to Google to enter a superhighway, rife with two-way traffic. Significantly, information flows from patients as well as to them. Abundant resources have ushered in an era of patient empowerment where the scientific community no longer holds a monopoly on medical explanation. In this era of cyber-connection, patients have stepped forward to educate themselves, chronicle their stories and support one another. Health activism burgeons across the Web. Online support networks abound, even for a rare condition like dystonia.

Launching my own dystonia blog (Chronicles of a Dystonia Muse) seemed a rash step until I found myself amid a veritable revolution of personal sites and health communities steering disability and chronic illness into the light.

As for me, it’s the same cha-cha-cha – stepping forward, then back. But in this age of openness, I’ve moved on to a better place deep inside myself, traveling untold miles along the road to self-acceptance. The fellow patients I encounter serve as an unending reminder that I’m not alone in my health struggles and lend me critical perspective. I may not move like everyone else but at my core I’m just like everyone else.

Pamela Sloate is a health activist who is involved in an array of awareness efforts. She moderates a patient support group, advocates for the dystonia community, and advances fundraising. She holds degrees from Brown University and NYU School of Law, and her career spans law, marketing and non-profit administration. Her blog is Chronicles Of A Dystonia Muse.
Photo by Dominic Alves

Chronic Disease, Immunology, Infectious Disease, Neuroscience, Research, Stanford News

ME/CFS/SEID: It goes by many aliases, but its blood-chemistry signature is a giveaway

ME/CFS/SEID: It goes by many aliases, but its blood-chemistry signature is a giveaway

signature

It’s the disease that dare not speak its name without tripping over one of its other names. Call it what you will – chronic fatigue syndrome (CFS), myalgic encephalomyelitis (ME) or its latest, Institute of Medicine-sanctioned designation, systemic exertion intolerance disease (SEID). It’s very real, affecting between 1 million and 4 million people in the United States alone, according to Stanford infectious-disease sleuth Jose Montoya, MD, who has closely followed more than 200 SEID patients for several years and done extensive testing on these patients in an effort to find out what’s causing their condition.

Different authorities have quoted different numbers regarding those with SEID. The name-calling and number-assigning squishiness stems from the fact that beyond its chief defining symptom – overwhelming, unremitting exhaustion lasting for six months or longer – it’s tough to pin down. Additional symptoms can range from joint and muscle pain, incapacitating headaches or food intolerance to sore throat, lymph-node enlargement, gastrointestinal problems, abnormal blood-pressure or hypersensitivity to light, noise or other sensations.

Research into the hows and whys of SEID has been plagued by the inability to establish any characteristic biochemical or neuroanatomical underpinnings of the disorder. Although many viral suspects have been interrogated, no accused microbial culprit has been indicted. To this day, there are no valid laboratory tests for diagnosing SEID.

But a burst of insight into SEID’s physiological substrate came only months ago when Stanford neuroradiologist Mike Zeineh, MD, PhD, working with patients from Montoya’s registry, found that they shared a pattern of white-matter loss in specific parts of the brain. The discovery drew a great deal of attention in the press as well as the CFS community. (See our news release about that study for details.)

Now a high-profile, multi-institution team including Montoya has published a study in Science Advances showing yet another physiological basis for a diagnosis of SEID: a characteristic pattern, or “signature,” consisting of elevated levels of various circulating immune-signaling substances in the blood.

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Imaging, Neuroscience, Research, Videos

Exploring the science of decision making

Exploring the science of decision making

Every day we make decisions that affect our work, personal relationships and health. With stakes this high, it’s no wonder many of us dread decision-making and wish we knew how to make better choices.

The first step towards making better decisions is to understand how the process works. This animation from Worldview Stanford’s upcoming course, The Science of Decision Making, shows the regions of the brain that are activated as we evaluate information.

Enrollment is now open for this interdisciplinary course, which explores and applies the nitty-gritty science of making a choice. If you’re unable to participate in the class, but you’d like to learn more about how to make better decisions, you can visit the Worldview Stanford blog for a sample of animations, videos and content from this course and their other offerings (.pdf).

Previously: Exploring the intelligence-gathering and decision-making processes of infantsIs there a connection between consuming mass media and making healthy choices?Genetics may influence financial risk-takingStanford neurobiologist Bill Newsome: Seeking gains for the brain and How does the brain plan movement? Stanford grad students explain in a video

Neuroscience, Research, Sleep, Stanford News

Stumbling upon circadian rhythms

Stumbling upon circadian rhythms

PrintIn my job as a science writer, I get to hear lots of amazing stories of discovery. In some cases, researchers have worked diligently to solve one question for decades. Others I talk to describe exciting Eureka! moments where their data suddenly made sense. But some of my favorite stories are those where a scientist is studying one thing, only to make an off-the-cuff observation that leads them in a totally new direction.

In researching circadian rhythms for the latest issue of Stanford Medicine magazine, I heard lots of this last kind of story. There are many obvious ways that circadian rhythms influence biology: our sleep cycles, the way our stomachs start to grumble for lunch at the same time every day, and how many plants close their flowers each night. But scientists are also starting to reveal lots of hidden, unexpected ways that circadian rhythms – the natural cycles in living organisms – affect us. Over just the past few years, researchers in disparate fields have made chance observations that have made them think twice about the timing of their experiments; daily circadian cycles in our bodies can affect everything from how we metabolize drugs to how our immune system acts, they’ve found.

Craig Heller, PhD, who co-directs the Stanford Down Syndrome Research Center, told me about how he was testing a new drug to improve memory in mice with Down syndrome. During the course of his experiments, he noticed that mice who received the drug at night didn’t respond the same way as mice that received a dose in the morning. It led him to start investigating the link between learning, memory, and daily sleep cycles. What he discovered doesn’t just have implications for Down syndrome, but for learning and memory more broadly.

Then, sleep researcher Emmanuel Mignot, MD, PhD, of the Stanford Center for Narcolepsy, walked me through the story of how he and other scientists discovered a link between the immune system and narcolepsy. It all started, he explained, after an odd epidemiological observation: narcolepsy was more often diagnosed in the spring than in the fall.

Of course, lots of what we know about how circadian clocks tick along inside our bodies, keeping time with the world around us, comes from tireless, carefully planned out benchwork, and that can’t be discredited. But some of the most surprising new links I describe in my feature come from scientists taking leaps across fields to explain something they found curious. Check out my feature, “Hacking the Biological Clock,” to learn more about what Heller, Mignot, and other scientists have found on these journeys of discovery.

Sarah C.P. Williams is a freelance science writer based in Hawaii.

Previously: Stanford Medicine magazine reports on time’s intersection with health, Study shows altered circadian rhythms in the brains of depressed people and Narcolepsy = autoimmune disease
Illustration by Harry Campbell

Aging, Chronic Disease, In the News, Media, Neuroscience, Women's Health

Science Friday explores women’s heightened risk for Alzheimer’s

Science Friday explores women's heightened risk for Alzheimer's

More than two-thirds of the Americans living with Alzheimer’s are women — some like the character Alice in the movie “Still Alice,” who suffers from an early onset form of the disease.

Science Friday tackled that topic Friday, with guests Michael Greicius, MD, MPH, associate professor of neurology and director of the Stanford Center for Memory Disorders, and Roberta Diaz Brinton, PhD, professor of pharmacology at the University of Southern California. The two quickly disputed the belief that more women get Alzheimer’s disease because they live longer.

“The way women age puts them at risk,” Brinton said. As they transition through menopause, some women develop cognitive symptoms such as insomnia, depression and short-term memory loss, leaving them at greater risk for Alzheimer’s, she explained.

Women who have a form of a gene called APOE-e4 are particularly at risk, although it doesn’t seem to affect men, Greicius said. The gene interacts with estrogen.

Scientists are continuing to decipher the link between estrogen and Alzheimer’s and the possibility of hormone therapies, as well as the connection — if any — between pregnancy and Alzheimer’s risk, the scientists told listeners.

The 18-minute segment is available here.

Previously: Blocking a receptor on brain’s immune cells counters Alzheimer’s in mice, The state of Alzheimer’s research: A conversation with Stanford neurologist Michael Greicius, Having a copy of ApoE4 gene variant doubles Alzheimer’s risk for women but not for men and The toll of Alzheimer’s on caretakers

Stanford Medicine Resources: