Oprah and Einstein photos offer clues about early dementia
You are looking at a woman's face; the contours and features seem so familiar. You see the billowing brown hair, the broad smile, the almond-shaped eyes. You may even be able to describe things about her: Famous talk show host, actress in "The Color Purple," philanthropist.
You feel a familiar pang of frustration because the name seems to be in your grasp, but you cannot come up with it.
The person, of course, is Oprah Winfrey. The inability to conjure the name of such a famous face, for some people, is one of several symptoms of a brain disease calledprimary progressive aphasia (PPA).
The disease "affects a person's ability to communicate," said Tamar Gefen, a doctoral candidate at the Cognitive Neurology and Alzheimer's Disease Center at the Feinberg School of Medicine at Northwestern University, adding that the disease attacks language centers in the brain.
"Slowly, over time a person loses the ability to name, comprehend, write and communicate," Gefen said.
The loss is not fleeting, but persistent, progressive, and socially crippling. Patients do not just have difficulty naming Oprah, but can have problems recognizing their own family members or friends. All of that makes having an accurate test for the disease important.
Whereas faces presented to patients being tested for PPA used to be people famous in the 1950s, now, more contemporary faces, like Winfrey, Princess Diana, Albert Einstein, Mohammed Ali and Barbra Streisand are being used to test for the disease. Rudy Vallee and James Cagney are also among the faces.
"We created a test that was more suitable for individuals who are now at risk for younger onset dementia," said Gefen.
It makes sense, said Gefen, since for a younger person not knowing the name of someone outside his or her cultural frame may not signal dementia. And PPA is increasingly being diagnosed at a younger age - sometimes as young as 40.
Of course, the research, published Monday in the journal Neurology, was not just about a new dementia test. Gefen and colleagues wanted to trace the pathway of damage carved in the brain by PPA.
They gave the test to 30 people with PPA, and compared them with a similar group without the disease. As predicted, the group with PPA performed significantly worse on tests of face naming, but even more revealing, brain scans of the patients showed brain damage that could explain the poor scores.
It turns out that difficulty naming faces is related to tissue atrophy on the left side of the brain, whereas difficulty recognizing a face is related to damage on both the right and left sides of the brain.
Those areas are distinct from other types of dementia, like Alzheimer's disease, in which different brain areas are affected.
"People hear dementia and think it's an umbrella term used for Alzheimer's disease and memory impairment," said Gefen. "There are distinctly different types of dementia and each points to a different underlying anatomical change."
Clarity about the damage and specificity about the type of dementia may cut down on misdiagnosis of PPA, which is often mistaken for stroke or mental illness, according to Gefen.
And it could also later mean a clear, and specific, treatment.
Mediterranean diet is brain food
Sticking to a Mediterranean diet may not just be good for your heart, it may be good for your brain as well, according to a new study.
Researchers in Spain followed more than 1,000 people for six and a half years, and found that participants who were on a Mediterranean diet and supplemented that diet with extra nuts or olive oil performed better on cognitive tests at the end of the study period than the control group, which followed a lower-fat diet. The study was published Monday in the Journal of Neurology, Neurosurgery and Psychiatry.
"We found that a Mediterranean diet with olive oil was able to reduce low-grade inflammation associated with a high risk of vascular disease and cognitive impairments," said Dr. Miguel Martinez-Gonzalez, the chairman of preventive medicine at the University of Navarra in Spain and a study author.
The Mediterranean diet is devoid of processed foods and bad fats, and high in whole grains, nuts, fruits and vegetables, legumes, fish and even red wine - all things that are high in antioxidant and anti-inflammatory compounds. These types of foods are known to help reduce vascular (circulatory) damage, inflammation and oxidative (free radical) damage in the brain.
But there are limitations to the study.
Dr. Dean Ornish, a well-known proponent of a very low-fat, largely plant-based diet says while the Mediterranean diet is good, it's unfair to compare it to a "low fat diet" in this particular study.
"It's erroneous to say (the Mediterranean diet in this study is) better than a low fat diet, when in fact they weren't following a low-fat diet," said Ornish. "If they said the Mediterranean diet improves cognition compared to standard American diet or standard Spanish diet, I would agree, but clearly, a 37% fat diet is not a low-fat diet."
Ornish, who recommends a diet that includes only 10% fat says in his studies, says he has seen similar effects - improved cognition, improved heart health and reduced depression.
"Good shouldn't be confused with optimal," when referring to the Mediterranean diet, he says.
Dr. Melina Jampolis, a physician-nutrition specialist, says the study findings are encouraging.
"The Mediterranean diet is high in antioxidants, it's anti-inflammatory, and it has a lot of vascular protective elements, so I don't think this is a stretch," said Jampolis. "In a high-risk vascular population, this could be beneficial, and it's worth evaluating further."
But she cautions that the Mediterranean diet should be stacked up against the typical American diet to get a true picture of how much it helps cognition.
While Dr. Martinez-Gonzalez agrees that the study isn't perfect, he says there is clear evidence that the Mediterranean diet is beneficial.
"The quantity of the difference between the groups was small from a clinical point of view, but it was statistically significant," he said. "The harmony, the combination of all of the micronutrients, when they are combined in traditional Mediterranean cuisine, is very important for the functioning of the central nervous system."
And he added that this is not only a healthy diet, it's a sustainable diet.
"The Mediterranean people enjoy this kind of diet every day," he said. "It is pleasant, it is healthy, it is sustainable, and it is not very expensive."
Kids’ brains can predict math tutor benefit
Kids don't all learn at the same pace, or in the same way. Extra tutoring doesn't always help either, but for some it helps a lot. Why?
Researchers, publishing this week in the journal Proceedings of the National Academy of Sciences, believe the answer is in the brain. By looking at the structures and wiring of children's brains, they've developed a method of predicting who will benefit most from tutoring.This doesn't mean, however, that you will be seeing brain scans in every school.
"What we’ve done is much more modest, in terms of trying to understand what are the systems that underlie individual differences in response to math tutoring," said Vinod Menon, professor at Stanford University School of Medicine and senior author of the study.
Methods
The study looked at 24 children in third grade, ages 8 to 9, which is a critical period for gaining basic math skills. Menon's previous research, published in 2011, found that third-graders demonstrate superior problem-solving abilities compared to second-graders, and that this is also associated with brain changes.
While 24 is a small number of subjects, it's typical for a study involving functional magnetic resonance imaging (fMRI).
One group of children underwent tutoring for eight weeks; during that time, the others did not. Before this, scientists used brain scanning technology to examine the structures and wiring of the children's brains.
Results
With tutoring, perhaps unsurprisingly, the researchers noticed that the kids were quicker and more accurate in their arithmetic problems. Some improved more than others.
"We observed a lot of variation in how much a child learns as a result of the tutoring, and we asked, what drives these individual differences?" Menon said. "Is there something in the brain structure and the way it’s wired that can predict whether child will learn a lot or a little?"
For math-phobic, numbers pose threat of pain
It appeared that IQ, working memory and initial math abilities had, on average, nothing to do with how much any given child improved during this time.
The magic formula, according to this study, was in the brain.
The volume of the hippocampus, a structure in the brain crucial for episodic memory, was associated with performance improvement with tutoring. It's instrumental in making memories for places and events over time. Researchers found it surprising that the same area appears to not only facilitate math learning, but also to predict math learning. Adults use a different brain system for learning.
How the hippocampus is functionally linked to other key areas involved in learning also appeared to be very important in predicting improvement. Namely, connections to the dorsolateral and ventrolateral prefrontal cortices (involved in memory encoding and retrieval) and the basal ganglia (important for habits and procedures) were highly predictive, Menon said. These connectivity measures were even more predictive than parameters involving the structures themselves.
"It tells us about the memory systems in which the brain uses to scaffold and build knowledge representations," he said.
Implications
Menon cautions against any interpretations of this research as evidence that some people are born with better brains for math than others. It's not clear that the brain attributes measured in the study won't change over time, even within a year, and environmental factors have a huge impact on brain development.
"One has to be really, really cautious about pushing these kinds of findings, and interpreting these findings, in that light," he said.
The model's predictability is stronger than in a purely associational study, Menon said. Researchers used a machine-learning algorithm to test out the predictability of the brain scan model before using it on the 24 children who were placed in tutoring or non-tutoring groups.
But it's currently unclear how this brain data could be used to design different learning strategies for children who are predicted to learn math less easily than others, he said.
"How this plays out for identifying children and figuring out alternate strategies, that’s future work," he said.
