The Twins Who Share A Brain

Channel 4 recently broadcast an interesting documentary as part of their 'Bodyshock' series, dealing with a set of twins who are joined at the head. I wrote some notes while watching the documentary:

Tatiana and Krista Hogan are regarded as a 'medical marvel'. While instances of twins being born joined at the heads are rare, ithis particular case is certainly a marvel in living memory. Their mother, Felicia Hogan, discovered this information at her 21-week scan. As she was 21 years of age at the time and already had two older children, the medical staff offered her the option to have a termination in view of the weight of responsibilities she would have if she went through with the birth. Felicia opted against the offer and, at the time of birth, doctors were surprised at the survival of both mother and babies. They also noticed something strange: when one twin was injected, the other spontaneously cried. Further observations from family as the twins were growing up, such as one twin 'zoning out' when looking at something while the other twin's eyes twitched, made them speculate as to whether the twins shared senses.

How could this be possible? Four months after the twins were born, they underwent a CT scan to check for any indications. It was found that they shared brain matter and arterial structures in an interconnected fashion, so there could be no possibility of surgical separation as sometimes occurs in other cases of conjoined twins. Furthermore, it was discovered that both twins shared the same thalamus, which is the brain structure responsible for processing sensory inputs and relaying them to other structures - a communications control room.

(Tatiana, bottom left, and Krista, bottom right, with their mother Felicia, top left.
Image courtesy: Macleans.ca)

The documentary followed the progress of the Hogan twins over the course of a year or so. At around age 2 years and 4 months, the twins weren't able to walk but could stand with support, and had begun to talk using simple expressions like "stop that!" in response to stimulation. Also, it was possible to see the birthing of two distinct personalities.

Tatiana's qualities include being the more "intellectual" of the two (whatever that means for a 2 year old child!), and is very loving, engages in frequent hugging and kissing behaviours, of a happy disposition. By contrast, Krista, who can also be loving and happy, tends to be more hot-tempered, exhibiting protest (crying) behaviours and is more aggressive, will scream to get what she wants and can even be a bit of a "bully" according to Felicia. However, separate personalities though they are, they are already beginning to learn the value of cooperation and they work together on simple tasks such as coordinating movement to stand up and attempt to walk. If you tickle Krista, Tatiana giggles.

Some of the usual medical problems affecting many pairs of conjoined twins also affect the Hogans. Despite being smaller and thinner, Tatiana's heart pumps for both of them and is thus at risk of enlargement and possible failure. Tatiana's heart also works twice as hard to supply the brain's arterial system with blood. Over time, her heart rate has thankfully dropped and is much closer to Krista's, but the possibility of further complications as the twins age always looms.

It was also discovered that when the twins slept, Tatiana would stop breathing for up to 20 seconds. A surgical operation was needed to remove the huge adenoids that were causing the problem, but when Tatiana was anaesthetised it was observed that she was borrowing a large amount of blood to keep her going. The trouble with this was that Krista didn't have enough blood to be anaesthetised herself, which meant she had to be awake (and suffer pain?) when Tatiana went under the knife.

The rest of the documentary focused largely on the Hogan family's meeting with another pair of craniopagus twins, Lori and George Schappell, who are also joined at the head but have separate brains. The Schappells have enjoyed fame to an extent by appearing on a variety of talk shows, television dramas and singing contests, and were able to discuss their situations and give advice for the Hogans in matters of parenting and how to engage the Hogan twins in relationship skills.

At a later date, further tests were carried out to investigate further the possibility of shared senses. They concluded that the "brain of one twin records signals from the other's visual field". The explanation proffered for this told about how images entering the eyes of a twin travel along a "neuron highway" to the other's visual cortex, meaning that one twin can see what the other witnesses. Fascinating.

Virginia Woolf's Last Letter

Virginia Woolf (1882-1941) was one of the foremost literary figures of the 20th Century, having produced several novels, short stories, and diaries. A number of traumatic events in her life, such as the death of her parents in her teens and sexual abuse at the hands of her half-brothers, may have contributed to the depression that plagued her throughout her life. Although her literary output remains largely unaffected, she was subject to periodic mood swings and associated illnesses until her suicide at age 59.

In a letter to her husband, regarded as her suicide note, she revealed a glimpse of life as a voice-hearer:


Transcript:

Tuesday.

Dearest,

I feel certain that I am going mad again. I feel we can't go through another of those terrible times. And I shan't recover this time. I begin to hear voices, and I can't concentrate. So I am doing what seems the best thing to do. You have given me the greatest possible happiness. You have been in every way all that anyone could be. I don't think two people could have been happier till this terrible disease came. I can't fight any longer. I know that I am spoiling your life, that without me you could work. And you will I know. You see I can't even write this properly. I can't read. What I want to say is I owe all the happiness of my life to you. You have been entirely patient with me and incredibly good. I want to say that - everybody knows it. If anybody could have saved me it would have been you. Everything has gone from me but the certainty of your goodness. I can't go on spoiling your life any longer.

I don't think two people could have been happier than we have been.

V.

When a Man becomes a Woman

Interesting article in The Guardian the other day, about how virtual reality (VR) can be used in certian circumstances to change a male's sense of self into that of a woman's, the perceived experience being so powerful that the men reacted quite sharply (i.e. like a woman) to a slap. Patronising as that sounds, the state of mind does remain an interesting feature and it reminded me of a particular religious tradition that urges it's male adherents to emulate a type of female consciousness. Perhaps I may write more on this later, here's the article for now:

Virtual reality used to transfer men's minds into a woman's body

Researchers projected men's sense of self into a virtual reality woman, changing the way they behaved and thought

* Ian Sample
* guardian.co.uk, Wednesday 12 May 2010 22.00 BST

Scientists have transferred men's minds into a virtual woman's body in an experiment that could enlighten the prejudiced and shed light on how humans distinguish themselves from others.

In a study at Barcelona University, men donned a virtual reality (VR) headset that allowed them to see and hear the world as a female character. When they looked down they could even see their new body and clothes.

The "body-swapping" effect was so convincing that the men's sense of self was transferred into the virtual woman, causing them to react reflexively to events in the virtual world in which they were immersed.

Men who took part in the experiment reported feeling as though they occupied the woman's body and even gasped and flinched when she was slapped by another character in the virtual world.

"This work opens up another avenue for virtual reality, which is not just to transform your sense of place, but also your sense of self," said Mel Slater, a virtual reality researcher at the Catalan Institute of Research and Advanced Studies and University College London. "There isn't any other technology that allows you to look down and see another body that isn't yours and give you the illusion that it is," he said.

"If you can temporarily give people the illusion that their bodies are different, then the evidence suggests it also affects their behaviour and the way they think. They can have new experiences: a person who is thin can know what it's like to be fat. A man can have an experience of what it's like to be a woman."

In the study, 24 men took turns wearing a VR headset that immersed them in a virtual room. Some men saw the virtual environment through the eyes of a female character who was sitting down, while others had a viewpoint that was just to the side of her.

During the experiment, a second virtual female approached and appeared to rub the person's shoulder or arm. Researchers in the lab mimicked this sensation in the real world for some of the volunteers by rubbing their shoulder or arm, helping to reinforce their feeling of occupying the character's body.

Later in the study, the second character lashed out and slapped the face of the character the men were playing. "Their reaction was immediate," said Slater. "They would take in a quick breath and maybe move their head to one side. Some moved their whole bodies. The more people reported being in the girl's body, the stronger physical reaction they had."

Sensors on the men's bodies showed their heart rates fell sharply for a few seconds and then ramped up – a classic response to a perceived attack.

As expected, the body swapping effect was felt more keenly by men who saw their virtual world through the female character's eyes than those whose viewpoint was slightly to one side of her. In all cases, the feeling was temporary and lasted only as long as the study.

The study, which appears in the online science journal PLoS One, suggests that our minds have a very fluid picture of our bodies. The research is expected to shed light on the thorny neuroscientific puzzle of how our brain tells the difference between a part of our own body, and something else in the wider world.

The work might also improve rehabilitation for patients who have experienced strokes and other medical problems by immersing them in a world that helps them to use their bodies to the full again.

Introducing: Petri Dish Talk

I was delighted to stumble across a neuroscience blog that I hadn't seen before. Petri Dish Talk is run by Mohammed Rahman, a neurobiology researcher who now works in biotech, and who has also worked with drugs that affect the CNS such as Carbidopa and Divalproex, which are used to treat Parkinson's and Bi-polar disorder respectively.

Among the few posts currently published, Rahman discusses the tension between research and industrialisation in his first offering. He suggests that departmentalising projects will allow errors to slip through the net in spite of well-intentioned lab researchers, and that biotech industries should do more to ensure research and experimental integrity instead of following a business model that tends to be blinkered and short-sighted in regard to such concerns.

After a very brief and informative post on BOLD fMRI that excellently serves as an expanded definition of the term, he launches into a more detailed post about dendritic pruning within the wider issue of neuroplasticity. With decent illustrations, Rahman talks about how Long-Term Potentiation (LTP) is one of the many theories advanced to explain this adaptability of the brain and the mechanism by which the dendrites are pruned. He ends with looking forward to a future in which neuroplasticity will be vigorously studied and what it will have to say about our minds as a physical structure (and rightly so).

In the last two posts we are treated to a double-whammy that explains how meditation can bring about neurophysiological changes, by virtue of a 2007 PNAS paper on the neural correlates of attentional expertise in long-time meditation practitioners, that long-time (focused) experts tend to have specialised attentional networks with a simultaneous decrease in "chatter". In the second part, Rahman discusses a 2008 paper that discusses these changes: larger volumes of grey matter in the hippocampus and frontal cortex. On the face of it,this seems as natural as a professional athlete gaining muscle mass due to exercise, so in the same way an experienced meditator gains greater "strength" in certain neural circuits due to focus and concentration-oriented meditating.

Overall I think this is a good start for a blog and I was impressed with the quality of the information as well as the easily readable presentation. I'll definitely be looking forward to more contributions.

Foot Discovered In Baby Brain

Ok guys, for the first time I have something that's

NSFW!

Pity that isn't my own work, I'm lazy right now and nicked this via Joanne Manaster and KevinMD.com. Still, you gotta admit this story treads the fine line between Whoa and Pass-Me-That-Buckettttt. The Denver Channel is running a story about a medical first - a foot found growing inside a newborn's brain. I have nothing to add so I'm just gonna post the entire article here. Graphic image ahead, you have been warned:

COLORADO SPRINGS, Colo. -- A Colorado Springs family is part of one of the strangest cases in medical history.

Dr. Paul Grabb, a pediatric brain surgeon, said he was surprised when he discovered a small foot growing inside the brain of 3-day-old Sam Esquibel. "The foot literally popped out of the brain," Grabb told TheDenverChannel Wednesday.

The appendage threatened the newborn's life.

When Grabb performed the life-saving surgery at Memorial Hospital for Children in Colorado Springs, he was in for another surprise: he also found what appeared to be parts of an intestine in the folds of the infant's tiny brain, in addition to another developing foot, hand and thigh. "I've never seen anything like it before," Grabb told the Colorado Springs Gazette. "It looked like the breach delivery of a baby coming out of the brain."


Sam was delivered on Oct. 1, within hours of an ultrasound that showed what appeared to be a tumor developing in the brain of the fetus. Three days later, Grabb performed the surgery to remove it. The reason for the strange growth was not clear at first. It was thought to be a teratoma -- a congenital brain tumor composed of foreign tissue such as muscle, hair or teeth -- or a fetus in fetu, which is a developmental abnormality in which a fetal twin begins to form within the other.

Grabb, the only pediatric brain surgeon in southern Colorado, said that the formal pathology report identified the mass as a teratoma because of how perfectly formed the structure was but there is a fine line between that and the fetus in fetu. "So it's unclear if a fetal twin began to form within another," Grabb said.

Grabb said he sees a teratoma once every few years but it doesn't compare to Sam's. Teratoma tumors do not usually grow as complex as a foot. "You show those pictures to the most experienced pediatric neurosurgeons in the world, and they've never seen anything like it," Grabb told the Gazette. "This is completely abnormal."

Grabb said neurologically, Sam is expected to do well. Sam's brain tumor can come back so he will be monitoring that in the months and years to come.

Mom Says Baby A Miracle

Sam's mom, Tiffnie, told TheDenverChannel on Wednesday that her son is doing well but that she didn't want to appear on camera because she doesn't want to exploit her child and make him appear like a freak in the eyes of the world.

"This is our baby," Tiffnie explained, in tears.

She said when she first talked to the Gazette, she thought the story would only appear in the small-town paper. But it has circled the globe and she is getting calls from national and international media outlets. "I am so overwhelmed right now ... We've been bombarded with calls," Tiffnie said.

DenverChannel.com Reporter Jane Slater held the infant with the baby blue eyes and round face and said "he is the cutest baby I've ever seen." Sam's at a healthy weight -- as evidenced by his pudgy arms and legs -- which explains why family members call him the "Michelin Man," Slater said.

He was alert and happy, with a barely visible inch-long scar which stretched from his hairline to the top of his cheek. Sam is still recovering from the surgery and shows weakness on one side of his body and some trouble with higher-level eye functions. He is already undergoing rehabilitation.

Tiffnie had said that her pregnancy was easy and there were no signs of complications until the ultrasound on Oct. 1. She and her husband had given up on the idea of having any children after years of trying and then Sam was conceived. Tiffnie said she doesn't mind driving to the hospital every week or month for Sam's MRI and blood checks, considering that he is healthy and happy.

"It's a miracle," she said.

In the meantime, Grabb wonders about the possibilities for medical science. "How does the body form complete extremities? Who is to say we can't grow a heart, leg or foot?" Grabb asked the Denver Post earlier. "This could show a window of what's possible."

"It's always impressive to see these sorts of things but it's not as unsual as you would think," said Dr. Rich Gustafson, with Cherry Creek Pediatrics. "Teratomas can be found in abdomens or other parts of the body ... what made this case so unusual is how perfectly formed the foot was and being in the skull as well. Usually, it's a totally safe and benign tumor. Often, it gets picked up in adulthood but now with ultrasound, you're actually picking more up as they are getting fetal ultrasounds."

700-year-old Brain Found Preserved!

Evolutionary psychology tends to receive harsh criticism, and often rightly so. One of the main reasons for this is the severe lack of evidence for many of it's proposals given that the paucity of fossilised brains fails to bolster many a case. And it isn't even anyone's fault. That's just the way it goes sometimes, that the brain is a jelly-like substance that is subject to decay after death, and there's no way we can objectively analyse or verify any differences in brains of long ago with brains of today.

This isn't set to change anytime soon, but the remarkable discovery of a medieval child's brain was the subject of a Neuroimage paper published recently. This is extremely exciting on many counts: the brain has been so fantastically preserved that it is possible to identify the frontal, temporal and occipital lobes, and even the sulci and gyri, the grooves and furrows channeled into brains.



However it is only the left-hemisphere that survived and not the entire brain, which had also shrunk to about 80% of it's original weight due to the (natural) mummification process. Although it was first discovered in 1998 and preserved all this time in a formalin solution, it was found in the skull of a 13th Century infant that was exhumed at an archaeological dig in north-west France. The body of the 18-month-old child was wrapped in leather and kept in a wooden coffin with a pillow underneath the head.

The presence of acidic clay soil and fresh briny water around the burial site is believed to have contributed towards the excellent preservation of the brain. To a certain degree, even the innate cellular structure had been preserved, so much so that intact neurons and dendrites - branched fibres that extend from the cell body of a neuron - had survived for observation in the 21st Century. It was also possible to identify grey and white matter. Apart from the external burial conditions, the toughness of the neuronal myelin sheath and collagen fibres are said to be the reasons for why the brain tissue had been nicely preserved.

It cannot be said for sure how the infant died, but the presence of an unhealed circular head fracture may have been the likeliest cause. High levels of hemosiderin suggested that the infant had heavy bleeding for several days prior to death. Poor little mite.
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Papageorgopoulou, C., Rentsch, K., Raghavan, M., Hofmann, M., Colacicco, G., Gallien, V., Bianucci, R., & Rühli, F. (2010). Preservation of cell structures in a medieval infant brain: A paleohistological, paleogenetic, radiological and physico-chemical study NeuroImage, 50 (3), 893-901 DOI: 10.1016/j.neuroimage.2010.01.029

What is "Self Transcendence"?

A recent study by Italian researchers uncovered the fact that neurosurgery involving certain brain structures can effect personality changes that make one feel more "spiritual". 88 patients underwent pre- and post-surgical personality assessments while treated for tumours, and the results were combined with lesion mapping procedures (to precisely locate lesions) after surgery to measure changes in a personality construct called Self-Transcendence (ST). It was found that patients with posterior lesions experienced a considerable increase in 'spirituality' after the surgical removal of their tumours than those with anterior lesions, and that those with more aggressive types of tumour were most likely to describe themselves as religious. For a fuller report and discussion of this fascinating study, please see Mo Costandi's Neurophilosophy.

As I read through various articles detailing this announcement, I became intrigued at the constant mention of ST as a measure of personality. In his paper, Cosimo Urgesi describes ST as reflecting "the enduring tendency to transcend contingent sensorimotor representations and to identify the self as an integral part of the universe as a whole." ST is among several other personality dimensions in the psychobiological Temperament and Character Inventory (TCI) that was devised by C. R. Cloninger and colleagues in 1994. The TCI has been used in genetics to show ST as a heritable trait, and in molecular neurosciences to show ST related to the functioning of the serotoninergic system. According to Cloninger et al. (1993) their model followed on from previous research that confirmed four dimensions of temperament; novelty-seeking, harm avoidance, reward dependence, and persistence, and added three more dimensions that mature in adulthood; self-directedness, cooperativeness and self-transcendence.

In their discussion of ST, Cloninger et al. begin with the amusing sentence: "Most people meditate or pray daily, which is more frequent than sexual intercourse according to population surveys". They go on to note the lack of spirituality-related traits from personality inventories including the well-known Five Factor Model, which is odd considering that spirituality is an integral aspect of people's lives and mental activity. In describing their definition of spirituality, they say:

"Self-transcendence refers generally to identification with everything conceived as essential and consequential parts of a unified whole. This involves a state of 'unitive consciousness' in which everything is part of one totality. In unitive consciousness, there is no individual self because there is no meaningful distinction between self and other—the person is simply aware of being an integral part of the evolution of the cosmos. This unitive perspective may be described as acceptance, identification, or spiritual union with nature and its source ... The person may identify (or feel a sense of spiritual union) with anything or everything. They may experience the feeling that they are part of or being guided by a wonderful intelligence, which is possibly the divine source of all phenomena. Ultimately, there may be loss of all distinctions between self and other by identifying with the concept of an immanent God as one-in-all."

So it all sounds rather New-Agey (the paper mentions Buddhism and nirvana, Taoism and Advaita Vedanta), but I was still curious about the actual questions themselves. In formulating questions to measure personality dimensions, care is taken to ensure that they accurately represent the concepts they try to measure. Moreover, statistics such as Cronbach's Alpha are employed to ensure that the measure has a high level of internal consistency; the higher, the better it is at measuring a personality construct. In this context ST consisted of three sub-scales; Self-forgetfulness vs. self-consciousness, transpersonal identification, and spiritual acceptance vs. materialism, all three exhibiting a Cronbach Alpha of above 0.7. This indicates that each of the three sub-scales were reliable in excess of 70% in measuring what they claimed to measure.

PsychMaven kindly helped me aquire a copy of the TCI. Bearing in mind that the "questions" are actually statements that one ought to rate on a 5-point scale (1 = Definitely false, 5 = Definitely true), here is the complete list (in order of appearance) that purport to contribute to the ST dimension of personality:

12. I often feel a strong sense of unity with all the things around me.

25. Often I have unexpected flashes of insight or understanding while relaxing.

29. I sometimes feel so connected to nature that everything seems to be part of one living process.

32. I think that most things that are called miracles are just chance.

42. Sometimes I have felt like I was part of something with no limits or boundaries in time and space.

43. I sometimes feel a spiritual connection to other people that I cannot explain in words.

52. Sometimes I have felt my life was being directed by a spiritual force greater than any human being.

56. I have had moments of great joy in which I suddenly had a clear, deep feeling of oneness with all that exists.

68. I often become so fascinated with what I’m doing that I get lost in the moment – like I’m detached from time and place.

73. I often feel a strong spiritual or emotional connection with all the people around me.

91. I have made real personal sacrifices in order to make the world a better place – like trying to prevent war, poverty and injustice.

95. It often seems to other people like I am in another world because I am so completely unaware of things going on around me.

99.I often feel like I am a part of the spiritual force on which all life depends.

106. I have had personal experiences in which I felt in contact with a divine and wonderful spiritual power.

112. Often when I look at an ordinary thing, something wonderful happens – I get the feeling that I am seeing it fresh for the first time.

118. Religious experiences have helped me to understand the real purpose of my life.

143. I believe that all life depends on some spiritual order or power that cannot be completely explained.

148. I often feel so connected to the people around me that it is like there is no separation between us.

151. I am often called “absent-minded” because I get so wrapped up in what I am doing that I lose track of everything else.

157. I often do things to help protect animals and plants from extinction.

175. I have a vivid imagination.

190. I would gladly risk my own life to make the world a better place.

206. I think it is unwise to believe in things that cannot be explained scientifically.

212. Often I become so involved in what I am doing that I forget where I am for a while.

223. I have had experiences that made my role in life so clear to me that I felt very excited and happy.

232. Reports of mystical experiences are probably just wishful thinking.

It could be argued that statements such as these are anything but 'transcendent'. As Costandi eloquently put it in his report, Urgesi et al. fall short in their study of truly defining spirituality because it is likely that different patients will hold different ideas of spirituality and how it affects their lives. Furthermore, spirituality is an area that consists of many ideas apart from 'transcendence' which, by all accounts, is generally taken to refer to a state of being philosophically and affectively 'above and beyond' this world and all forms of mundane issues. Although many items deal with experiencing spiritual connections and having a sense of oneness with the universe, items that attempt to measure patients' attempts to save plants and animals from extinction hardly qualify as being transcendent and neither does gladly risking one's life for any purpose do the same. Having a "vivid imagination", however, is certainly a questionable inclusion which is bound to draw some sarcastic remarks.

We may quibble about the exactness of ST items and whether they accurately measure spirituality, the neurological findings nevertheless support the dependence of religious beliefs on brain function and even further increases evidence that religious beliefs can be experimentally studied. Urgesi et al. even go as far as to say that "dysfunctional parietal neural activity may underpin altered spiritual and religious attitudes and behaviours".
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Urgesi, C., Aglioti, S., Skrap, M., & Fabbro, F. (2010). The Spiritual Brain: Selective Cortical Lesions Modulate Human Self-Transcendence Neuron, 65 (3), 309-319 DOI: 10.1016/j.neuron.2010.01.026

Cloninger CR, Svrakic DM, & Przybeck TR (1993). A psychobiological model of temperament and character. Archives of General Psychiatry, 50 (12), 975-90 PMID: 8250684

We've Been Nominated!

The team at ResearchBlogging.Org and Seed Media Group are honouring the best bloggers who discuss peer-reviewed research in the first Research Blogging Awards. Over 400 nominations were made, and an expert panel of judges have whittled them down to 5-10 blogs per category which are deemed to be the "best of the best".

I feel very honoured to have my blog nominated under the category of Best Blog - Psychology, and would like to thank the judges for this. I would also like to give a very heartfelt thank you to all my readers.

To view a record of my peer-reviewed research posts, please see a list of all my research posts or my user page at ResearchBlogging. Voting is underway as registered bloggers have been sent invitation by ResearchBlogging.Org. If you're not registered (and blog about peer-reviewed research) but would like to vote, register here.

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UPDATE 23 March 2010: The award for Best Blog-Psychology went to Christian Jarrett of the BPS Research Digest. And I wish him a hearty congratulations on the achievement.

Mr. Crowley's Suicide Solution

Wine is fine,
But whiskey's quicker.
Suicide is slow with liquor.
Take a bottle, drown your sorrows,
THEN IT FLOODS AWAY TOMMORROW!!

So goes the first verse of 'Suicide Solution', an infamous song of Ozzy Osbourne's that deals with the dangers of alcohol abuse, and which was the central feature in two legal cases against him where he was charged with inciting the suicides of heavy metal fans after they listened to the song. In fact, controversy has dogged Osbourne since the beginning of his career with the founding of the influential heavy metal group Black Sabbath, who are credited with having invented the genre. Although Osbourne was found not guilty in those cases, other related matters referred to the issues of including satanic imagery in song lyrics, stage performances and album covers, as well as allegations of surreptitious backmasking of satanic messages in said albums, all things that were said to be bad infuences on young adults. Osbourne has claimed he harbours no satanic beliefs and that the inclusion of such imagery in his musical corpus was purely for reasons of showmanship.

Similarly, the music of Marilyn Manson is said to have contributed to at least one fan's suicide. But more seriously the students who carried out the Columbine High School massacre and the SuccessTech Academy shootings were said to have been heavily influenced by Manson's music. Around 50 churches were also burned down between 1992 and 1996 in Norway, for which many fans of the developing black metal scene claimed responsibility.

It isn't just the fans who are supposedly influenced adversely. Mayhem vocalist Per Yngve Ohlin, better known by his stage name 'Dead', was notorious for mutilating himself on stage with hunting knives and broken glass. Finally in 1991, and almost as a fitting homage to his nom de plume, he sat down among his bandmates and calmly slashed his wrists and neck with small cuts before inserting a shotgun into his mouth and blowing his brains everywhere. Other bandmates were famous for regular conflicts, culminating in the brutal murder of guitarist Øystein Aarseth by bassist Varg Vikernes.

If one looks deeper in the issue, one is sure to find many more horror stories of murders and depressive suicides with the common denominator of metal music. Indeed, one wouldn't be blamed for automatically assuming that individuals attracted to such music may tend to be prone to depression and/or exhibit anti-social behaviour of other kinds. But is there any actual data to substantiate this?

Vaughan Bell of mindhacks.com was kind enough to alert and send me a paper published late last year that attempts to analyse if there is a link between mental health and the enjoyment of such music. The main research questions that the study sought to answer were:

• Do metal music fans in France exhibit great levels of anxiety and depression?
• What variables mediate the levels of anxiety and depression for metal music fans?

Recours et al. (2009) surveyed 333 French metal fans by administering the Hospital Anxiety and Depression Scale (HADS), a simple test that aims to detect, obviously, notable anxiety and depression. Among other things, they analysed differences in gender, age, status, education, motivation and level of participation in metal culture. This included intimate items such as the behaviour of participants at metal concerts and whether they had body modifications such as piercings and tattoos.

Summary of the very interesting results: Out of 333 participants, 282 were male (87.8%) and 39 were female (12.15%), the mean age of which was 22.6 years old. (age range: 13-44 years). Half of them were students, 41.7% of the rest being employed and the remainder being both students and employed. Average years immersed in metal music culture was 9.22 years with average concerts attended per year was 16. Slightly over one-third had a tattoo or piercing while just 5.3 had a combination of both. The most popular subgenres of metal music indulged in were death metal (37.7%), black metal (22.7%) and thrash metal (18%). Motivations for attending concerts included the expectedly high 95.9% to enjoy the music, followed by 84.6% attending for the "ambience". Only 33.9% cited drinking as a reason to attend, and very small percentages of people attended in order to sample drugs (4.98%), sell drugs (2.72%), and to fight (0.91%).

Factor analyses revealed a three-dimensional structure, and an orthagonal rotation was performed to analyse how pertinent the depression and anxiety factors were. These two factors ended up explaining 38.71% of the variance (27.55% = anxiety, 11.17% depression), with reliability factors using Cronbach's Alpha being 0.70 and 0.67 respectively. In plain language, this means that - based on the answers provided - the HADS test was 70% and 67% reliable in detecting anxiety and depression respectively.

All in all, the results showed that the respondents exhibited low levels of anxiety and depression. The HADS instrument can be used to determine an arbitrary cutoff point as there is no generally accepted cutoff. The creators of the instrument, Zigmond & Snaith (1994), recommended a cutoff of 7/8 for possible and 10/11 for probable anxiety or depression. Following previous research Recours et al. chose 11 as a cutoff score for each dimension of anxiety and depression, implying that respondents exhibiting a score greater than 11 would be considered to have a serious level of anxiety or depression. The results found the average scores to be 7.26 and 3.76 for anxiety and depression respectively, far below the chosen cutoff levels. However, as in all populations there were some individuals scoring above the cutoff (15.6% anxiety, 3.4% depression) but these cannot be said to be due to the influence of metal music.

Multiple regression analyses revealed that none of the other variables (age, gender, concert attendance, etc.) had a link to mental health in terms of either anxiety or depression, but surprisingly the same analyses revealed a relationship between mental health and writing song lyrics, drinking at concerts, and having scarifications. Also, links were revealed between mental health, education level and employment status. However, these relationships were still nowhere near the 'danger' cutoff point of 11.

In conclusion, the authors discuss the huge gender bias towards males among other things, and suggest it as being 'very' representative of the culture of metal music. Maybe so, but let's get to discussing the drawbacks of this study:

The study was carried out over the Internet. The HADS instrument is effectively a questionnaire that was administered over a non-personal medium, but even with personal contact there is no way to certify the replies as genuine. In this way Internet-administered tests contain an extra layer of uncertainty. The authors state that they considered 'personal' measures such as approaching "morbidly dressed" metal fans on the street, but this would isolate metal fans who do not attire themselves in such an "obvious" way. But at least they entered 10 different Internet forums dedicated to metal music in order to have a realistic possibility of contacting individuals with an almost certain interest in metal music and culture. However, another category of isolation occurs here as genuinely depressed people are least likely to complete a questionnaire.

Also, by the authors' admission, France happens to be a country where the growth of cults are strictly controlled, and where "French officials are particularly concerned about Satanic cults related to metal music". Apparently a Govt. ministry has warned parents to limit their children's exposure to metal music and also to monitor their access to metal-oriented websites. Could it be possible that the majority of the French metaller population aren't exposed to the most extreme of metal subgenres? After all, throughout the entire paper scant mention is made of any specific group and metal music is referred to in categorical format; black, death, and thrash. Passing mentions are made of Slayer, Black Sabbath, Megadeth and Metallica, bands that have a certain notoriety but are also decidedly mainstream. Aren't French teenagers aware of bands like Arch Enemy, Goatwhore, Amon Amarth, Dimmu Borgir, Extol, Kult ov Azazel, and others? These are things to consider.

It was also interesting to observe how the results pointed to an unnoted third factor before orthogonal rotation enabled relevance to the anxiety and depression factors. So I agree with the authors that further research needs to be undertaken in order to determine which factor(s) can aptly describe the 61.3% of the variance that wasn't accounted for by anxiety and depression.

In closing, the authors offer reasons for why the general conclusions point to lower levels of anxiety and depression among metal lovers. It is proposed that the predominant themes of satanism, gloom and death give airing to subjects infrequently discussed in society and which are treated in a somewhat taboo manner. Although metal music is classed as entertainment in contrast to real images of death, it presents such themes as "typical occurrences that are not outside the norm" and I interpret that as a desensitising factor of sorts. So metal music lovers who frequently indulge in this pastime are more often exposed to morbid themes that have the effect of eventually desensitising them and enabling them to treat it more of the entertainment that it is supposed to be.

But then, what of all the horror stories referred to earlier? What about Dead's suicide? What about the terrible Marilyn Manson-inspired school shootings? Ozzy Osbourne's "satanism"? A tentative proposal is that metal music has a malevolent effect on individuals with certain vulnerabilities, and this is precisely why further research is needed in order to uncover these details. It is for this reason that I do not heartily share the confident assertions of the authors that their "representative" sample (from one country!) indicates low levels of anxiety and depression among metal lovers. Typical quote:

"The results indicate that fans of metal music are in good health with respect to anxiety and depression ... [and] indicate that, contrary to critics who suggest that images of death and destruction in metal music have harmful consequences, the mental health of fans of this type of music is generally good."

Hmmm, when they put it that way it's hard not to agree, but only tentatively. A more accurate representation of this study is that it simply provides an indicative snapshot rather than a comprehensive description.

Speaking of which, it's been ages since I've been to a Motörhead concert...


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Recours, R., Aussaguel, F., & Trujillo, N. (2009). Metal Music and Mental Health in France Culture, Medicine, and Psychiatry, 33 (3), 473-488 DOI: 10.1007/s11013-009-9138-2

Snaith, R. Philip, and Anthony S. Zigmond (1994). HADS: Hospital Anxiety and Depression Scale. Windsor: NFER Nelson.

Junkie On The Phone

Kirsten Emott is an MD from British Columbia who also writes poetry. The March 2010 issue of the British Journal of Psychiatry has published a poem of hers that was originally printed in The Naked Physician: Poems About the Lives of Patients and Doctors by R. Charach.

Junkie On The Phone

You don’t have a headache.

The GP you named doesn’t know you.

The pharmacist recognizes your name.

You even called me before.

I won’t prescribe the drugs.

Play the game elsewhere.

Call up some other doctor.

Set out your lies:

"Doctor, here is my lie.

I want you to join me in my lying.

Pretend I am sick.

Give me what will make me sicker.

Give me a stick

with which to beat myself.

Help me to die."

[VIDEO] Kid Loses Half His Brain

In consonance with the last posting, I came across this segment of an American kid who lost half his brain/skull in a shooting incident:

Thugs left man with half a head

I don't often read tabloids, but I noticed this intriguing report in The Sun lately:

Thugs left man with half a head

By STAFF REPORTER

Published: 11 Sep 2009

VICIOUS thugs who punched this man so hard he was left with HALF A HEAD have got off scot free.

Horrified Steve Gator had to have the front of his skull removed by stunned surgeons after his head was smashed against a pavement in the sickening attack. And now the 26-year-old has been told that the teen attackers who disfigured him will escape justice after his case was dropped.

Steve, of Romford, Essex, was attacked after confronting one of the yobs who had been taunting him about his cousin. Another of the violent louts hit him so hard that he was sent flying and struck his head on the path. Steve plunged into a coma for two weeks as his shattered mum and distraught family kept a bedside vigil at Queen's Hospital, Romford.

His brain quickly began swelling and surgeons were forced to remove the front half of his skull just hours after he was admitted.

Grief-stricken mum Nina Gator was warned her son had just a terrifying 15 per cent chance of survival. Two days later cops charged a pair of teenage boys with the savage attack which shocked the neighbourhood. Steve, who has had to quit his job, was left seriously brain damaged and now suffers frequent seizures, has difficulty talking, and his memory is seriously impaired. Mrs Gator, who is his main carer, last night blasted the shock move. The 47-year-old said: "I can't believe it. Everyone is entitled to their day in court."

CPS lawyers claim they needed more proof before going ahead with the case. But Mrs Gator stormed: "Our boy is walking around with half a head - what more evidence do they need? "His sparkle is totally gone. He used to be so independent but he can't work any more and he can't drive." She added: "He's got half a head and he's completely lost his confidence. There's absolutely nothing protecting his brain now it's just under his skin."

Just from looking at the picture, it seems obvious that with this traumatic brain injury (TBI) his frontal lobes are practically destroyed and quite possibly the front parts of his midbrain. The frontal lobe is an extremely important structure responsible for a variety of functions. It is the 'Command HQ' for emotions, and controls and regulates functions such as memory, language, movement, and problem-solving. It is also responsible for more subtle things like judgment, planning, reasoning, spontaneity or impulse control, and some effects on social and sexual behaviour. As such, the frontal lobe administrates much of our very personality and sense of identity. It is also the largest 'lobe' structure, meaning that there is more of it to carry a greater risk of damage. As the story mentions, Gator's "sparkle is totally gone". It is tempting to draw parallels with the tale of Phineas Gage, another individual dubiously famed for frontal lobe damage.

A friend, The Neurocritic, pointed out that Gator may need several cranioplasties in order to rebuild his skull, and highlighted a recent Neurosurgical Focus literature review that discusses the types of post-operative complications associated with the surgical procesure underwent by Gator. Known as a decompressive craniectomy, and consisting of a partial removal of the skull in order to allow the swelling brain to expand without being squeezed, we start with contusion blossoming; the surgery leaves massive bruises which can be observed via pre-op and post-op CT scans.

Lesions - a mass lesion may develop on the opposite side of the brain to the injury or elsewhere in the brain. As Gator's frontal lobes were destroyed, it is possible that a lesion may develop around the back end and possibly affect the parietal lobes, which deals generally with perception, orientation and recognition.

Herniation - a small protrusion (or more) of neural tissue may remain in the early period after swelling subsides, sometimes through the cranial defect as is observed with 'normal' skin hernias. Gator has no such defect though, as the front of the skull was smashed.

Subdural Effusions - a collection of pus beneath the outer lining of the brain. This condition usually results from bacterial meningitis, but because craniectomies affect the circulation of cerebrospinal fluid (CSF) it is possible that buildups may accumulate. Similar to blood clots. Hygromas may also occur, which are buildups of CSF without blood. To counteract these, a craniectomy should be accompanied with a duraplasty, a reconstructive operation on the dura mater, the outermost and fibrous membrance covering the brain and spinal cord. Duraplasties have been observed to lower the incidence of subdural effusions occurring.

Infection - this may seem a rather obvious effect of any medical procedure, to guard against, but craniectomies (bone removal) will necessitate cranioplasties (bone reconstruction). As such, opening old scars and exposing the brain upto or after a month after the incident runs the risk of contracting infection and delaying healing. The review suggests a minimum wait of 3 months before replacing the bone, and that storage of the bone in a freezer can also increase the risk of infection.

Hydrocephalus - "water on the brain", refers to accumulations of CSF in neural cavities. This is unfortunately a common occurrence beyond a month after the injury, and will need specialised procedures (shunt treatment) to deal with it if it occurs.

Syndrome of the Trephined - another unfortunate common occurrence after decompressive craniectomies, of which common symptoms include dizziness, headaches, concentration difficulties, mood disturbances, irritability, and memory problems. Because Gator's particular situation involved the destruction of his frontal lobes, he will unfortunately suffer much worse symptoms than these. However, in general terms when the motor functions are affected, this then becomes known as motor trephine syndrome.

Bone resorption - when one undergoes a decompressive craniectomy, you're likely to have stray bone fragments swimming around and there's around a 50% chance that bone resorption will occur, which is when bone cells (known as osteoclasts) break down the bone and release minerals like calcium directly into the blood.

Persistent vegetative state - clearly the saddest effect of all extreme brain injuries. While decompressive craniectomies are effective at ameliorating intra-cranial pressure and reducing the risk of death, they offer no guarantee of restoring brain function once the patient suffers a TBI. The risks of surviving into a vegetative or minimally conscious state after undergoing craniectomy range upwards of 15-20%.

It may be that Steve Gator's clinicians need to be vigilant and ensure that his treatment is as risk-free as possible. And of course, wishing him all the best to recover well.
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Stiver, S. (2009). Complications of decompressive craniectomy for traumatic brain injury Neurosurgical FOCUS, 26 (6) DOI: 10.3171/2009.4.FOCUS0965

Ain't Taking This Lying Down..!

Apologies for the lack of activity in recent months, I have been absorbed in a number of promising projects as well as taking a much-needed vacation.

An interesting report in New Scientist magazine suggests that insults are handled better when lying down rather than sitting or standing up. According to the article, University students who were insulted while seated exhibited neural activity consonant with "approach motivation", which describes to desire to approach and explore. This activity appeared absent in a control group insulted while lying down. Eddie Harmon-Jones, a cognitive scientist at Texas A&M University, interprets this as suggesting that one might be more inclined to attack if one were in the upright state, whereas while lying down we may be more inclined to brood.

At first glance this seems a little odd to me. Brooding is quite different to receiving insults and possibly reacting to them. Brooding means a certain amount of thinking and contemplation is occurring. It isn't the done thing to offer or accept anecdotal evidence as important fact, but from personal experience I've sometimes become more enraged over an incident by brooding about it (while lying down) than I have reacted to insults while sitting or standing upright. Would that mean my reactions contradict this research? The real value of psychological research lies in the ability to translate insights and findings into our lives and observe how relevant or useful they are, and I also have to consider these things personally. I downloaded and read the paper for this experiment; technically it is not an actual paper but a 'short report', a brief description of the subject and experimental method followed by conclusions. A mini-paper. Here's an extract:

"Body movements affect emotional processes. For example, adopting the facial expressions of specific emotions (even via unobtrusive manipulations) affects emotional judgments and memories (Laird, 2007). Manipulated body postures can affect behavior: slumped postures lead to more ‘‘helpless behaviors’’ (Riskind & Gotay, 1982). Simple body postures may also affect other emotive responses and the neural activations associated with them."

That's from the very first paragraph, and to me it seems to get more unreal every time I think about it. I don't dispute that body postures can affect neural activation (anything can affect neural activation, that's kind of what the brain does in the first place, reacting and responding to stimuli) but it seems overstated a bit much. The link between body posture and affectability on emotional reaction looks tenuous when compared with something as fundamental as the availability of oxygen and the human requirement to inhale it to live. But let's take a look at the study: 23 females and 23 males (n = 46) were randomly assigned to write a polemical essay featuring their views on a hot topic (e.g. smoking in public, abortion, etc.) and were told assessment would be carried out by another participant. After attaching EEG sensors, participants were randomly assigned to the upright or lying positions on a reclining chair while hearing themselves being rated on six characteristics including intelligence (1 = unintelligent, 9 = intelligent). Needless to say, participants heard negative reviews of themselves and fumed.

To be more specific, all 'reclined' participants heard negative reviews of themselves while only half 'uprights' heard negative. The other half heard slightly positive reviews. It's good to add a little variety to these things to account for different causes and effects, but I think the total sample size here was too small. Gender effects were accounted for too; males and females were randomly assigned to the two conditions, and male participants heard male-voiced feedback with females hearing female-voiced feedback. For future research, switching gender-voice feedback would make an interesting manipulation.

The results showed that for those in the upright position, the left prefrontal cortex (PFC) was substantially activated more than those who were reclining. Even though both sets of participants expressed similar levels of anger in response to the negative feedback, the left PFC has been linked to anger and approach motivation. This suggests a marked reduction in approach motivation when lying down.

What this means in reality remains under question: Does body posture really affect emotional reactions that much? Similar levels of anger existed between both groups, but those who were lying down appeared less inclined to do something about it? How might those students have reacted with the absence of inhibitory factors? I know that this is preliminary research but these are just some of the questions that need to be researched and accounted for.

Why? Because although some people may consider a study like this to be "fluff psychology" and a little boring, clinicians need to take these types of things a little more seriously when you consider that a large proportion of serious neuroscience is carried out with reclining participants in fMRI-scanners. So I agree with the conclusion of Harmon-Jones' paper; that research is required to help evaluate neuroimaging techniques requiring supine positions. There may not be much to it, but it's worth an exploration.
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Harmon-Jones, E., & Peterson, C. (2009). Supine Body Position Reduces Neural Response to Anger Evocation Psychological Science DOI: 10.1111/j.1467-9280.2009.02416.x

If You Had Half a Brain..

A great story made its way onto the interwebz lately. The Daily Mail reports:

"A 10-year-old girl born with half a brain has both fields of vision in one eye, scientists said today. The youngster, from Germany, has the power of both a right and left eye in the single organ in the only known case of its kind in the world.

"University of Glasgow researchers used Functional Magnetic Resonance Imaging (fMRI) to reveal how the girl’s brain had rewired itself in order to process information from the right and left visual fields in spite of her not having a whole brain."

BBC News goes further with:

"In the case of the German girl, her left and right field vision is almost perfect in one eye. Scans on the girl showed that the retinal nerve fibres carrying visual information from the back of the eye which should have gone to the right hemisphere of the brain diverted to the left ... 'Despite lacking one hemisphere, the girl has normal psychological function and is perfectly capable of living a normal and fulfilling life. She is witty, charming and intelligent.'"

Get that? The only known case in the world where brain plasticity (the ability of the brain to reorganise itself after injury) is displayed for all to see. Plasticity doesn't always work this way, there are many cases where plasticity effects haven't achieved the mark of restoring all or most of the impaired brain function. Epilepsy patients, for example, who undergo a hemispherectomy (removal of a half of a brain) in order to prevent the onset of severe seizures, among other things tend to lose an entire field of vision in both eyes; they only see people and objects in one half of their visual field, as in the illustration below:



Neither was this a case of brain injury; the anonymous girl (known only as 'AH') failed to adequately develop her cerebral right hemisphere in the womb. As a result, she is without a right-brain and also without the use of her right eye. She also has a slight left-hemiparesis (weakness affecting half of the body) but close to normal vision in both hemifields of her normal left eye.

In a study published by the Proceedings of the National Academy of Sciences (PNAS), a team led by Lars Muckli of the University of Glasgow used fMRI to investigate how the visual cortex had remapped itself. In a healthy individual, the cerebral cortex contains "maps" for vision, sound, motion and touch, which develop and modify over time dependent on several factors including genetic cues and neural activity. In the mammalian brain (that is, human brain) the visual cortex is made up of distinct sections dealing with vision, the main one being an area known simply as 'V1', the primary visual cortex. 'V2' deals with quarterfield representations in the area of vision, effectively dealing with the 'up' and 'down' areas of both the right and left hemispheres of vision, while 'V3' is a structure in front of V2 that, among other things, performs a supporting role for V2. There is also the question of retinotopic maps, a direct mapping of the spatial arrangement of the retina, located in visual structures including the cortex and thalamus.

As per materials provided by the University of Glasgow, "visual information is gathered by the retina at the back of the eye and images are inverted when they pass through the lens of the pupil so that images in your left field of vision are received on the right side of the retina, and images from the right are received on the left." The part of the retina close to the nose is known as the nasal retina whereas the other part is referred to as the temporal retina, being in proximity to the temples. Both halves transmit received information through separate nerve fibres. In a normal situation, the nerve fibres of the nasal retina cross over in the optic chiasm, a brain structure located at the bottom of the brain near the hypothalamus, and are processed by the hemisphere on the opposite side. The nerve fibres of the temporal retina remain in the same hemisphere (ipsilateral), meaning that the left and right visual fields described earlier are processed by opposite sides of the brain.



[DIGRESSION]Vision is not the only modality to be processed in this strange way. It actually reflects the larger processing activities of the intact brain which tends to process all other modalities in opposite sides of the brain. To wit, touch and hearing for example that is "entered" into the right side of the body (right body, right ear) are processed by the left-brain, and touch/hearing entered into the left body/ear is processed by the right-brain. This is generally referred to as contralateral processing, when input is processed by the 'opposite' half of the brain. Those inputs processed by the 'same' side of the brain is known as ipsilateral processing. For more information, please read about Basic Visual Pathways.[/DIGRESSION]

The MRI scan displays the complete lack of a right-hemisphere: The optic chiasm is shown here (top l-r) in the transverse and enlarged transverse planes, and (bottom l-r) in the coronal and saggital planes. A rudimentary optic nerve is pointed out in the enlargement by the green arrow but with no discernible optic tract, and it can also be seen how the left-hemisphere is spilling over into the right-domain. The vacant right-hemisphere is filled with cerebrospinal fluid (CSF).

In AH's fascinating case, it was found that the nasal retinal nerve had connected to her left-brain. A possible interpretation for AH's condition is suggested by the authors: The lack of a right-brain prevented an opposite connection from being made, which led the optic nerve fibers to "connect" with ipsilateral structures instead.

Remembering that normal cases require a crossing in the optic chiasm, and AH's connections were essentially ipsilateral, how exactly does AH see both visual fields with only one eye? After all, if the entire right hemisphere is missing, AH should see only the left hemifield. The answer lies with the Lateral Geniculate Nucleus (LGN), a structure that is embedded deep in the thalamus and which processes visual information from the retina. In AH, both the nasal and temporal retina would need to be mapped onto the LGN to allow for the processing of both hemifields. Again a similar suggestion of ipsilateral projections were presented as being the solution, instead of the usual contralateral connections, and that a mirror-symmetric representation of the hemifields would be received and processed by the thalamus. Similar cases have been seen in achiasmatic dogs where optic nerve fibres terminated in the ipsilateral LGN.

'Islands' were also found to have formed in the left-hemisphere to deal especially with processing of the left hemifield, to compensate for the missing right-brain activity.

The loss of AH's right-hemisphere was discovered at age 3 when she was treated for brief seizures and twitching taking place on her left side. It is speculated that the right-brain failed to develop between Day 28 and Day 49 of embryonic development. Despite the situation, she is able to engage quite capably in activities that require a fair amount of balance, such as riding a bicycle or roller-skating. Truly an extraordinary case in more ways than one.

For a professional view, please see Dr. Steven Novella's entry on this case.
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Muckli, L., Naumer, M., & Singer, W. (2009). Bilateral visual field maps in a patient with only one hemisphere Proceedings of the National Academy of Sciences DOI: 10.1073/pnas.0809688106

Image: CT Brain Art

New Scientist magazine currently has a gallery up featuring beautiful art made from real live CT scans of different body parts. Radiologist Kai-hung Fung digitally manipulates images of CT scans so as to make them look more appealing. One of his shots featuring the inside of the nose won the 2007 International Science and Engineering Visualisation Challenge.

Here is a shot featuring the brain:



It is a view of the brain from above it. One can see the complex network of arteries and veins (dark blue) and the base of the skull is shown in green.

Michael Jackson: Buried Without His Brain

After witnessing the media blaze related to Michael Jackson's recent death, I started hearing a number of reports that Jackson would be buried without his brain. Rather an odd thought as I watched the live memorial along with millions of other people around the globe, that the body in the gold-plated coffin wasn't an entire specimen. According to one such report, Jackson's brain is being held for further testing to determine the extent to which it was damaged by years of painkillers and other medications.

After scouting through the interwebz for a more scientific explanation, I discovered that Vaughan Bell had written up a good explanation on his excellent Mind Hacks blog. I hope he won't mind me nicking it, but I think it's that good that it deserves repetition:

According to press reports Michael Jackson will be buried without his brain because it is still 'hardening'. Although this may seem unusual, the 'hardening' process is actually a standard part of any post-mortem examination where the brain is thought to be important in the cause of death, such as in suspected overdose.

It involves removing the brain from the skull and leaving it to soak in a diluted mixture of formaldehyde and water called formalin. This soaking process usually takes four weeks and the brain genuinely does harden.

A 'fresh' brain is a pinkish colour and has the consistency of jelly, gello or soft tofu meaning it is difficult to examine and the various internal structures are often hard to make out.

After soaking the brain, it has the consistency and colour of canned mushrooms making it easier to slice, examine and photograph. However, because the brain is so soft to start with, it can't just be dropped in a tank of fixing solution, because it will deform under its own weight.

To solve the problem it is usually suspended upside down in a large bucket of formalin by a piece of string which is tied to the basilar artery.

After it has 'hardened' or 'fixed' it is sliced to look for clear damage to either the tissue or the arteries. Small sections can also be kept to examine under the microscope.

Because this part of the post-mortem takes several weeks preparation it is usually only carried out with the family's permission as the body may need to be buried without it, or the burial delayed until the procedure is finished.

This also means that this form of post-mortem brain examination is usually only carried out where there is a feeling that examining the brain can help clarify the cause of death - which is what pathologists are often most concerned with.

In cases such as Michael Jackson's, where the effects of drugs are suspected to play a part, pathologists will be looking for evidence of both sudden-onset and long-term brain damage. If they find it, they'll be trying to work out how much it could have been caused by drug use and how much it contributed to the death.

So now you know.

Can Alzheimer's Be Cured?

An excellent article over at Scientific American. As I eventually hope to be involved with Alzheimer's in my career, I found it so good that I fancied reproducing it here on this blog.

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P. Murali Doraiswamy is the head of biological psychiatry at Duke University and is a Senior Fellow at Duke’s Center for the Study of Aging. He’s also the co-author of The Alzheimer’s Action Plan, a guide for patients and family members struggling with the disease. Mind Matters editor Jonah Lehrer chats with Doraiswamy about recent advances in Alzheimer’s research and what people can do to prevent memory loss.

What do you think are the biggest public misconceptions of Alzheimer's disease?

The two biggest misconceptions are “It’s just aging” and “It’s untreatable, so we should just leave the person alone.” Both of these misconceptions are remnants of an outdated view that hinders families from getting the best diagnosis and best care. They were also one of the main reasons I wanted to write this book.

Although old age is the single biggest risk for dementia, Alzheimer’s is not a normal part of aging. Just ask any family member who has cared for a loved one with Alzheimer’s and they will tell you how different the disease is from normal aging. Alzheimer’s can strike people as young as their forties; there are some half a million individuals in the United States with early-onset dementia. Recent research has pinpointed disruptions in specific memory networks in Alzheimer’s patients, such as those involving the posteromedial cortex and medial temporal lobe, that appear distinct from normal aging.

The larger point is that while Alzheimer’s is still incurable it’s not untreatable. There are four FDA-approved medications available for treating Alzheimer symptoms and many others in clinical trials. Strategies to enhance general brain and mental wellbeing can also help people with Alzheimer’s. That’s why early detection is so important.

Given the rapid aging of the American population - by 2050, the Alzheimer's Association estimates there will be a million new cases annually - what are the some preventative steps that people can take to prevent or delay the onset of the disease?

Unfortunately, there isn’t yet a magic bullet for prevention. You can pop the most expensive anti-aging pills, drink the best red wine, and play all the brain games that money can buy, and you still might get Alzheimer’s. While higher education is clearly protective, even Nobel Laureates have been diagnosed with the disease, although it’s likely their education helped them stave off the symptoms for a little bit.

My approach is more pragmatic - it’s about recognizing risks and designing your own brain health action plan. The core of our program is to teach people about the growing links between cardiovascular markers (blood pressure, blood sugar, body weight and BMI, blood cholesterol, C-reactive protein) and brain health. A population study from Finland has developed a fascinating scale that can predict 20-year risk for dementia – sort of a brain aging speedometer. Obesity, smoking, lack of physical activity, high blood pressure, and high cholesterol are some of the culprits this study identified. So keeping these under control is crucial.

Depression is another risk factor for memory loss, so managing stress and staying socially connected is also important. B vitamins may prevent dementia in those who are deficient and there are some simple blood tests that can detect this. For the vast majority of people, however, there are no prescription medications that have been proven to prevent dementia. This means that a brain-healthy lifestyle is really our best bet for delaying the onset of memory loss.

In the near future we will likely have prevention plans that are personalized based on genetic, metabolic and neurological information. In familial Alzheimer’s disease, pre-implantation genetic diagnosis has already been used to successfully deliver babies free of a deadly Alzheimer causing mutation—though only time will tell if deleting such dementia risk genes in humans has other consequences.

Your book talks about a new technique that allows doctors to image amyloid plaques in the brain. How will these change the diagnosis of the disease?

Amyloid PET scans are in the late stages of validation testing to see if they can improve the accuracy of clinical diagnosis. The Alzheimer’s brain is defined by beta-amyloid plaques and tangles but, at present, these can only be definitively diagnosed with an autopsy. If an amyloid PET scan is “plaque negative” that will tell a doctor that Alzheimer’s is unlikely to be the diagnosis and help reassure the family. Early findings suggest that people who carry risk genes are more likely to have plaque positive scans even before they develop symptoms - suggesting that the scans could possibly be useful for predicting future risk. If true, this might eventually lead to a change in diagnostic terminology where “preclinical” Alzheimer’s is diagnosed purely based on biomarker and scan findings long before memory symptoms start. Therapies to treat Alzheimer’s by blocking amyloid plaques are already in trials but are currently given blindly to patients without knowing their brain plaque status—raising their risk for side effects and treatment failure. So this scan may also help drug development by helping select the most appropriate subjects for treatment and then monitoring treatment effects. Amyloid accumulation with aging is seen in many animal species and the scan offers us a tool to study what role plaque plays in normal brain aging. So this could do for the brain what colonoscopy did for the gut!

Will science ever find a cure for Alzheimer's?

It’s an incredibly tough puzzle to crack but the pace of research is so great that new drug targets are being reported daily. I think a form of cure is more likely to come from delaying the onset rather than by growing new brain cells to repair lost tissue. Realistically speaking there are several fundamental questions we don’t fully understand and have yet to answer: What causes the disease? Why do plaques and tangles form? Why are the memory centers the first to be destroyed? On the positive side, there are several dozen drugs in clinical trials.

What recent scientific advances in treating or understanding Alzheimer's are you most excited about?

I’m most excited about diagnostic advances. By using a combination of biomarkers, genetic tests and new brain scans, we are inching very close to predicting not only who will develop Alzheimer’s but the exact age when they may start developing symptoms. This offers huge opportunities for conducting prevention trials. Of course, it also brings a whole host of ethical challenges, since our diagnostic and predictive abilities are advancing far faster than our ability to prevent Alzheimer’s.

On the treatment side, there are several developments that I am excited about. The interactions between vascular disease and memory loss suggest that at least some aspects of Alzheimer’s may be modifiable through diet and exercise. Dimebon, a drug that improves mitochondrial function, has yielded promising results and is in final stages of testing. In addition, therapeutic strategies which target the brain’s own ability to repair itself – for example, by delivering nerve growth factor through viral vectors – are in clinical trials. Until we have a cure, however, it’s really important to focus on improving the quality of life of people with Alzheimer’s.