Plasticity in brains of middle age and older adults

Following on from our last post about brain neuroplasticity, this blog focuses on the ability of the brains of middle aged and older adults (ages 50 +) to change in response to environmental input.

This is particularly good news because of all individuals who were told their brain was fixed, none were given this message more so that people in this age group!

Initial evidence that brain training works!

The data came from the Iowa Healthy and Active Minds Study and investigated the efficacy of attention-based visual 'brain training' exercises. Brain training exercises are typically computer based programs which present activities that aim to restore or improve cognitive functioning in various areas, usually: attention, memory, communication and planning/organisation. They can be used as part of a program of cognitive remediation for people who have sustained brain damage, or to miminise cognitive decline that occurs naturally with age.

Participants in the experimental groups underwent brain training exercises with different levels of supervision and follow up. The training came in the form of a game that challenged participants to visually process multiple things on the screen at once. A control group underwent crossword puzzle training sessions. Progress was measured by assessing particiants' "useful field of view", what they are able to attend to out of the corner of their eye, which is known to shrink with age.

Initial findings showed improvements in the useful field of view and performance on other cognitive tests of the experimental groups compared to the control group. This distinction indicates that it is the content of the training itself that is having the effect, rather than general stimulation.

The findings add to what scientists are beginning to learn: brain training has the potential to strengthen neural connections in the brain and may help to keep people of all ages mentally sharp! There are a broad range of online options for brain training exercises for those of us trying to keep our brains active and 'plastic'.

If you have sustained a brain injury and are looking for a specific treatment program, please contact us to find out more about our cognitive remediation services.

And stay tuned for more information about neuroplasticity...

What do you mean my brain is plastic?

It's strange but true, our brains are like plastic!

What this means is that our brains can be 'moulded'. As we learn, think, grow and gain new experiences our brains change and reorganise themselves. The fancy scientific term for this is "neuroplasticity".

While the neuroplasticity of children's brains has been well established, until fairly recently it was thought that adult's brains were fixed or hard-wired and unable to be moulded. Hence cliches like "you can't teach an old dog new tricks".

Well, luckily for anyone over the age of 18, it it turns out that you can!

The next series of blogs focuses on research and case studies that demonstrate that our brains have the ability to adapt to our environment and that we can keep on learning and improving throughout out lives. Another big thanks to ANTS-er Karen who is on top of all the fascinating neuro news!

Brain adapts when a limb is damaged

A fascinating study undertaken by Prof Lutz Jancke and colleagues at the University of Zurich in Switzerland has shown that when a limb is damaged and immobilised the thickness in the cerebral cortex (brain matter) associated with that part of the body reduces.

In a study that is the first of its kind, 10 right-handed people who had broken their dominant (right) arms had MRI brain scans within 48 hours of their accidents before their arms where placed in plaster/slings and again 16 days later while immobilised. The researchers also measured signals sent from brain to the right arm and the dexterity of their non-dominant left hand.

They found that the thickness of the motor cortex (brain cells that control movement) on the left side of the brain (which controls the right arm) decreased significantly in response to the arm's lack of use, and the signals from that part of the brain to the hand reduced. Whereas the dexterity of the left hand increased, as did the thickness of the part of the brain controlling movement in the left hand - in this case particularly the pre-motor cortex, which is involved in planning complex movements.

Dr Penelope McNulty of Neuroscience Research Australia said about the study:

"It just shows how dynamic the brain remodelling really can be. As far as I'm aware, this is one of the first studies to show that inactivity produces plasticity in the human brain."

This study has implications for the treatment of many conditions where there is loss of use of a part of the body, such as strokes.

It also reinforces that when it comes to the brain you need to use it or lose it!

We'd love to hear from you! Maybe you have a story about how your brain has changed, or maybe you'd like to know more about how to make the most of your exceptional brain. You can post a comment below or contact us here.

Nature v's Nurture? New Evidence regarding Intelligence

Nature v's Nurture

For decades, scientists, educators and psychologists have debated the contribution of our genes v's our environment to our intellectual functioning.

New research has quantified the contribution of both.

In a longitudinal study of almost 2,000 people, professors at the University of Edinburgh, University of Aberdeen and University of Queensland determined that genes are responsible for 40% of our lifetime intelligence, with the other 60% being determined by the environment.

The study commenced 80 years ago when intelligence tests were administered to almost all children born in Scotland in 1921 and 1936. Professor Deary from the University of Edinburgh tracked down 2,000 of these individuals who agreed to be re-tested and to supply gene samples for DNA analysis. They were aged from 65 to 79 years at the time of re-testing. Researchers examined the test scores and more than half a million genetic markers.

They found that intelligence was remarkably stable across the lifespan, but there were also examples of people whose functioning improved or worsened over time. The study of genetic markers allowed Professor Deary, Professor Visscher and colleagues to create an estimate of to what extent genetic differences affect how intelligence changes across a lifetime.

While the outcomes show that both genes and environment play an important role in our intellectual functioning, genes are somewhat easier to study. Measuring detailed environmental factors is, according to Geneticist Professor Peter Visscher from the University of Queensland: "very very difficult". The researchers hope that this study will provide impetus for further research on the specific factors that are important for development of intelligence.

This research is critically important because intelligence is a predictor of many factors including lifespan, health and income. Understanding what influences our cognitive abilities may help us better manage conditions which affect the brain, such as dementia.

Molly goes into rehabilitation

Molly Meldrum has recently been transferred from hospital to a private rehabilitation centre, Epworth Rehabilitation Home.

Reportedly, the focus of his rehabilitation will be on improving his memory. Specifically, according to his brother, Brian, "getting things into the short term memory to the extent that they're passed onto the long term memory". There are ongoing reports that he is disoriented, has memory lapses, can only participate in limited conversation and that his recovery is likely to be gradual and prolonged.

Given his age and the likely severity of his traumatic brain injury, these outcomes are unsurprising. However, a rehabilitation program will ensure that Molly has the best possible recovery.

What is rehabilitation

Rehabilitation can be physical or cognitive, and in the case of traumatic brain injury, usually both. Our focus will be on cognitive rehabilitation.

Cognitive (thinking skills) rehabilitation has two components: restoration of functions that can be restored (remediation) and using intact skills to compensate for impaired skills (compensation). Processes that lend themselves well to restoration are things like unilateral visual inattention, where an individual does not attend properly to objects/information on one side. With practice and use of specific techniques to draw the patient's focus to the neglected side, this can often be restored.

Memory, particularly in cases of severe injury and with older patients, is often very difficult to restore. Compensation is the best option for treating memory problems. Common memory compensation techniques are using calendars, labelling objects, placing commonly used items in the same place each time, asking others to provide reminders and using techniques that optimise use of the memory process least impaired (e.g. if visual memory is better than verbal memory the use of charts/pictures can help).

The first step and the cornerstone of treatment for traumatic brain injury is a thorough neuropsychological assessment to identify level of functioning and pinpoint strengths and weaknesses. For more information about our assessment and treatment services, visit the ANTS website or contact us.

Molly Meldrum and TBI in the elderly

On 15 December 65 year-old Ian “Molly” Meldrum fell 3 metres downstairs whilst putting up Christmas decorations in his home, striking his head and fracturing his skull. He was hospitalised, sedated and placed on a ventilator to help him breathe. From the little information released by the media on his condition and recovery since the fall it appears that: Molly was unconscious for several days and possibly more than a week – although it is understood that he was in an induced coma for part of that time He regained consciousness after Christmas but remains disoriented and confused

• He is only able to respond to basic commands and is unable to carry on a conversation
• He can recognise close family members at times but this is inconsistent

These factors suggest that Molly sustained a traumatic brain injury (TBI) that was at least in the severe and possibly extremely severe, range.

Today’s ABC news report predicts that Molly has “a very, very long haul ahead of him”.

Research supports this assertion. Older age is an important predictor of worse outcome after TBI, even with relatively minor head injuries. A study by Mosenthal and colleagues (2002) found that elderly patients had twice the in-hospital mortality of younger TBI patients, the mortality rate increasing for each decade over 50 years. Elderly survivors of TBI are more likely to have a severe disability or be in a persistent vegetative state. The incidence of complications and poorer outcome after surgery are also worse for older patients.

The best predictors of a favourable outcome following TBI are younger age and lesser severity of TBI.
While this doesn't bode well for Molly, he does appear to be making some progress and all signs are that his functioning will continue to improve. It is also likely that he is getting the best possible care, which can make all the difference in ensuring the best possible recovery.

The thoughts of the ANTS team are with Molly and his family and we wish him a speedy recovery.

If you would like more information about TBI, cognitive rehabiliation or other ANTS services, please contact us.

References
Mosenthal, A.C., Lavery, R.F., Addis, M., et al. (2002). Isolated traumatic brain injury: Age is an independent predictor of mortality and early outcome. Journal of Trauma, 52(5), 907-911.
http://www.couriermail.com.au/news/molly-still-faces-an-uphill-battle/story-e6freon6-1226236078834
http://www.theaustralian.com.au/news/nation/meldrum-remains-in-intensive-care-faces-long-haul-to-recovery/story-e6frg6nf-1226236011605
http://www.heraldsun.com.au/news/more-news/molly-meldrum-recognises-brother/story-fn7x8me2-1226233539168
http://www.clinicalgeriatrics.com/articles/Traumatic-Brain-Injury-Elderly?page=0,8

Exceptional autism brains

As promised, this blog further demonstrates both the complexity of our brain and the relationship between brain and behaviour, this time with reference to Autism Spectrum disorders.

Autism Spectrum disorders (ASD) are pervasive developmental disabilities characterised by marked difficulties with social interaction and communication and restricted and repetitive interests and behaviours. As the name implies, the condition is on a continuum, meaning that the range and severity of the difficulties people with an ASD experience can vary widely.

There are a number of subtypes, the most common being autistic disorder and Asperger's disorder. ASDs are reasonably common, with as many as 1 in 110 children affected. They are more prevalent in boys than girls.

While there is no cure, the best possible outcomes are achieved through early intervention (such as social skills training), which is why getting a clear diagnosis is an important first step.

Research on ASDs is in its relatively early stages and there is still a lot of debate surrounding the cause, diagnosis and subtypes. One area of debate surrounds a subtype , sometimes referred to as regressive autism, where children develop normally until a certain age, at which point they not only stop developing in certain areas, but and they lose skills gained (such as the ability to communicate in age-appropriate ways).

The brains of boys with regressive autism are different

A ground-breaking study recently conducted at the MIND Institute at the University of California has found that compared both to children without ASD and to those with a different form of ASD, boys who go on to develop regressive autism show abnormal brain growth as early as four months of age. In "the largest study of brain development in preschoolers with autism to date", involving 180 subjects, it was found that these boys experienced a growth spurt during which their brains grew six percent larger between the ages of four and 19 months. There was no evidence of this occuring in girls.

The data was based on head circumference measurements taken from paediatric visits in infancy and magnetic resonance imaging (MRI) scans done at age three. The boys with regressive autism had normal head circumference at birth. This significantly increased by as early as approximately four months and most commonly between four to six months, well before symptoms of ASD became evident.

The important outcome of this study, as noted by the researchers is that "rapid head growth beginning around four-six months of age may be a risk factor for future loss of skills"

The ability to detect possible autism from routine tests at such an early age is invaluable as the importance of early intervention can not be overstated. Neuropsychologists are involved in the diagnosis of ASD and can also assist in developing appropriate interventions. Clinical Psychologists, Psychologists, Speech Therapists and Occupational Therapists are also often involved in interventions for children with ASD and their parents.

Thanks again to Karen Wallace for alerting me to this fascinating article.

On behalf of Jamie Berry and the whole Advanced Neuropsychological team, we wish all our followers, readers and their families a wonderful holiday season. Stay safe!

Our exceptional brain (continued)

As discussed in our earlier blog, Neuro-what-ology, neuropsychology has evolved along with our burgeoning understanding of the human brain. Two recent studies further illuminate the complexity and awesomeness of this vital organ, and the relationship between brain and behaviour.

Studies such as these are vital to the practice of neuropsychology as they help inform assessment practices and treatment programs and assist with interpretation of results.

Also, they make a great dinner party conversation topic!

Thanks to Karen Wallace, Clinical Neuropsychologist, and fellow ANTSer for sniffing out these great articles.

Synaesthesia and the visual cortex

The first study concerns synaesthesia – a condition where people experience a sense separate to the one being stimulated, such as seeing colours while reading words. Dr Devin Terhune and colleagues from the University of Oxford in the UK found that there is a "fundamental" difference between the brains of people with and without synaesthesia.

People with synaesthesia appear to have an overactive visual cortex, the part of the brain that is responsible for processing visual information, located in the Occipital lobe at the back of the brain.

Over time, this overactivity appears to create changes in the regions of the brain responsible for processing information about letters, colours and numbers during development.

The researchers stimulated the visual cortex of individuals with and without synaesthesia by producing a magnetic field from a coil applied to the scalp. In both cases stimulation resulted in ‘phosphenes’, or flashes of light or other visual images, but those individuals without the condition required three times greater stimulation in order to experience phosphenes.

The researchers hoped that the findings could be used to reduce or eliminate synaesthesia, or even to train those without it to learn digit or word-colour associations, which could be useful when studying mathematics, English or music.

The study was published on November 18, 2011 in Current Biology.

If you’d like to read about the second study, stay tuned...and visit our blog again next week.

If you’d like more information about Advanced Neuropsychological Treatment Services, please visit our website or contact us via our online enquiry form.