Category: Intelligence

 Selective serotonin reuptake inhibitors (SSRI) such as Prozac are regularly used to treat severe anxiety and depression. They work by immediately increasing the amount of serotonin in the brain and by causing long term changes in brain function. However it can take weeks of treatment before a patient feels any effect and both beneficial effects and side effects can persist after treatment is stopped.

New research published by BioMed Central's open access journal Molecular Brain investigates physiological changes within the brain that may be caused by SSRI treatment.

The hippocampus is an area of the brain involved in long term memory and spatial awareness, and is involved in symptoms afflicting people with Alzheimer's disease, such as loss of memory and disorientation. Neuronal cells in the hippocampus can change their activity and strength of connections throughout life, a process known as plasticity, which thought to be one of the ways new memories are formed. Altered plasticity is often associated with depression and stress.

Researchers from the Department of Pharmacology, Nippon Medical School, showed that chronic treatment of adult mice with fluoxetine (Prozac) caused changes to granule cells, one of the main types of neuronal cells inside the hippocampus, and to their connections with other neuronal cells. The granule cells appeared to undergo serotonin-dependent 'dematuration', which increased their activity and reversed adult-type plasticity into an immature state. These changes to the cell's plasticity were associated with increased anxiety and in alternating between periods of hyper or hypo activity.

Katsunori Kobayashi explained, "Some of the side effects associated with Prozac in humans, such as anxiety and behavioral switching patterns, may be due to excessive dematuration of granule cells in the hippocampus."

Journal Reference:

1. Katsunori Kobayashi, Yumiko Ikeda and Hidenori Suzuki. Behavioral destabilization induced by the selective serotonin reuptake inhibitor fluoxetine. Molecular Brain, 2011, 4:12, March 16, 2011 DOI: 10.1186/1756-6606-4-12

— A longstanding debate as to whether genius is a byproduct of good genes or good environment has an upstart challenger that may take the discussion in an entirely new direction. University of Alberta researcher Marty Mrazik says being bright may be due to an excess level of a natural hormone.

Mrazik, a professor in the Faculty of Education's educational psychology department, and a colleague from Rider University in the U.S., have published a paper in Roeper Review linking giftedness (having an IQ score of 130 or higher) to prenatal exposure of higher levels of testosterone. Mrazik hypothesizes that, in the same way that physical and cognitive deficiencies can be developed in utero, so, too, could similar exposure to this naturally occurring chemical result in giftedness.

"There seems to be some evidence that excessive prenatal exposure to testosterone facilitates increased connections in the brain, especially in the right prefrontal cortex," said Mrazik. "That's why we see some intellectually gifted people with distinct personality characteristics that you don't see in the normal population."

Mrazik's notion came from observations made during clinical assessments of gifted individuals. He and his fellow researcher observed some specific traits among the subjects. This finding stimulated a conversation on the role of early development in setting the foundation for giftedness.

"It gave us some interesting ideas that there could be more to this notion of genius being predetermined from a biological perspective than maybe people gave it credit for," said Mrazik. "It seemed that the bulk of evidence from new technologies (such as Functional MRI scans) tell us that there's a little bit more going on than a genetic versus environmental interaction."

Based on their observations, the researchers made the hypothesis that this hormonal "glitch" in the in-utero neurobiological development means that gifted children are born with an affinity for certain areas such as the arts, math or science. Mrazik cautions that more research is needed to determine what exact processes may cause the development of the gifted brain.

He notes that more is known about what derails the brain's normal development, thus charting what makes gifted people gifted is very much a new frontier. Mrazik hopes that devices such as the Functional MRI scanner will give them a deeper understanding of the role of neurobiology in the development of the gifted brain.

"It's really hard to say what does put the brain in a pathway where it's going to be much more precocious," he said. "The next steps in this research lay in finding out what exact stimuli causes this atypical brain development."

Journal Reference:

1. Martin Mrazik, Stefan Dombrowski. The Neurobiological Foundations of Giftedness. Roeper Review, 2010; 32 (4): 224 DOI: 10.1080/02783193.2010.508154

 Consider the simple situation in which you are walking around the kitchen and decide to pick up your own cup of tea, which is identical to others lying on the table. Your brain chooses the correct cup of tea by using different types of information that you have stored about the position of the cup in relation to the kitchen table. The information can be represented in qualitative terms (left, right, above, below) or quantitative terms (distances and angles). Previous studies have claimed that the brain's left hemisphere is critical for processing qualitative (technically 'categorical'), information and the right for quantitative ('metric') processing.

However, new neuropsychological findings published in the February 2011 issue of Cortex show that this is not the case.

A multidisciplinary team led by cognitive neuroscientist Tim Shallice and neurosurgeon Miran Skrap working in Udine, Italy, studied the difficulties faced by 55 patients who had recently had an operation to remove a brain tumour from either the left or right side of the brain. The patients were shown a series of images of a dot inside an upright or tilted frame and were asked to reproduce its position inside an identical upright frame, a task requiring mental rotation of the image.

The team found that patients whose tumours had been in the right parietal or in the left prefrontal cortices made a considerably larger number of errors than other patients. Moreover, these two critical groups behaved rather differently from each other. The right parietal patients placed the mark in the right position with respect to a corner. However, they chose the wrong corner much more often that the other patients. The left prefrontal patients got the corner right but were otherwise highly inaccurate in their responses. It was therefore the patients with tumours of the right parietal cortex who were unable to process the categorical spatial information and perform the mental rotation. A left prefrontal tumour instead led to difficulties in the setting up of the specific program within the brain which was necessary to organize the sequence of operations required to carry out the task.

Journal Reference:

1. Tania Buiatti, Alessandro Mussoni, Alessio Toraldo, Miran Skrap, Tim Shallice. Two qualitatively different impairments in making rotation operations. Cortex, 2011; 47 (2): 166 DOI: 10.1016/j.cortex.2009.10.006

Residing in a psychosocially hazardous neighborhood is associated with worse cognitive function in older age for persons with the apolipoprotein E ε4 allele (an alternative form of the gene), according to a report in the March issue of Archives of General Psychiatry.

"A prominent genetic factor of relevance to cognitive decline is the ε4 variant of the apolipoprotein E (APOE) gene, a strong predictor of increased risk and earlier onset of Alzheimer disease," the authors write as background information in the article. Apolipoprotein E is critical for basic neurological processes relevant to non-demented neurological health. "In the present article, we tested the hypothesis that living in psychosocially hazardous neighborhood environments may interact with APOE genotype to influence cognitive function."

Brian K. Lee, Ph.D., of Drexel University School of Public Health, Philadelphia, and colleagues analyzed data from the Baltimore Memory Study on 1,124 urban residents between 50 and 70 years of age to assess the association between living in a psychosocially hazardous neighborhood and cognitive function in aging. Patients were mostly white (53.8 percent) or African American (41.5 percent), and resided in any of the 63 Baltimore neighborhoods included in the study. Psychosocially hazardous neighborhoods are defined as areas that "give rise to a heightened state of vigilance, alarm, or fear in residents that may lead to a biological stress response."

Overall, 30.4 percent of participants possessed at least one ε4 allele, however the presence of the APOE ε4 differed by race/ethnicity, with 37.3 percent of African Americans ε4 positive compared with 24.7 percent of non-African Americans.

Before adjustment for outside factors (such as race, sex, wealth, etc.), participants living in the most psychosocially hazardous neighborhoods performed substantially worse in all seven cognitive domains tested (language, processing speed, eye-hand coordination, executive functioning, verbal memory and learning, visual memory, and visuoconstruction). In adjusted analysis with both neighborhood and APOE terms, persons living in the most psychosocially hazardous neighborhoods scored lower only on eye-hand coordination than other participants. APOE ε4 was associated with worse performance in executive function and visuoconstruction (ability to organize and manually manipulate spatial information, usually in the reproduction of geometric figures).

Compared with persons negative for APOE ε4 allele in less psychosocially hazardous neighborhoods, those who are negative for the allele and were living in the most psychosocially hazardous neighborhoods did not perform worse in any of the tested domains, nor did persons positive for APOE ε4 who were living in less psychosocially hazardous neighborhoods. However, persons positive for APOE ε4 living in the most psychosocially hazardous neighborhoods performed significantly worse than all three groups in processing speed, eye-hand coordination, executive functioning and visuoconstruction.

"Our findings provide evidence that among persons with the APOE ε4 allele, cognitive performance in processing speed and executive function was significantly worse for persons residing in neighborhoods with higher levels of psychosocial hazards, with additional suggestive evidence for eye-hand coordination," the authors conclude. Additionally, "for genetically vulnerable persons, a psychosocially hazardous neighborhood environment may be detrimental for cognitive function in aging."

Journal Reference:

1. B. K. Lee, T. A. Glass, B. D. James, K. Bandeen-Roche, B. S. Schwartz. Neighborhood Psychosocial Environment, Apolipoprotein E Genotype, and Cognitive Function in Older Adults. Archives of General Psychiatry, 2011; 68 (3): 314 DOI: 10.1001/archgenpsychiatry.2011.6

Researchers at Queen's University Belfast are taking the first step towards discovering the true effectiveness of brain training exercises with the release of their own app aimed at those over 50.

The Brain Jog application is available to download free for iPhone, iPod or iPad. It is the product of 18 months of work by researchers at Queen's School of Music and Sonic Arts to find out what the over 50's are looking for in a brain training app.

Queen's researchers are encouraging as many people as possible to download and use the application. During the process, users will be asked to give feedback on their experience of playing the game. Using this information to determine what makes a good puzzle experience, the research team will continuously improve and adapt the games to make them as user friendly as possible — thereby maximizing the number of people who play on a regular, long-term basis.

In the next stage of the project, the researchers hope to track the experience and performance of these long-term players to help clarify the effects of regular brain training on aging minds.

The research is led by Donal O'Brien, a PhD student at Queen's Sonic Arts Research Centre. He said: "Brain Jog consists of four enjoyable mini games specifically designed to test and improve four areas — spatial ability, memory, mathematical ability and verbal fluency.

"This is achieved through problem solving, puzzles and reverse arithmetic, allowing users to be challenged in an engaging manner, and improve their performance with regular practice.

"Brain Jog is unique among similar apps in that it has come to fruition after extensive research and collaboration with the target audience to find out exactly what appeals to them. "By downloading this app, you can help us create a fantastic game experience for those over 50 and bring us one step closer to finding out whether or not brain training can help prevent cognitive decline and dementia.

"To participate, simply download the application for free from iTunes, answer a few questions and then play the games. There are no obligations — you can play as often as you like and stop whenever you choose.

"Plans are in place for a future study on dementia prevention using the app; but before that can happen, people of all ages are encouraged to get downloading and have fun while providing vital information to our researchers and keeping their brain active."

Brain Jog is available from the iTunes store. More information, including the link to download the app, can be found at www.brainjog.org.

 How well our brain functions is largely based on our family's genetic makeup, according to a University of Melbourne led study. The study published in The Journal of Neuroscience provides the first evidence of a genetic effect on how 'cost-efficient' our brain network wiring is, shedding light on some of the brain's make up.

Lead author Dr Alex Fornito from the Melbourne Neuropsychiatry Centre at the University of Melbourne said the findings have important implications for understanding why some people are better able to perform certain tasks than others and the genetic basis of mental illnesses and some neurological diseases.

He said how the brain's network is organized has been a mystery to scientists for years. "The brain is an extraordinarily complex network of billions of nerve cells interconnected by trillions of fibers," he said.

"The brain tries to maximize its bang-for-buck by striking a balance between making more connections to promote efficient communication and minimizing the "cost" or amount of wiring required to make these connections. Our findings indicate that this balance, called 'cost-efficiency', has a strong genetic basis."

"Ultimately, this research may help us uncover which specific genes are important in explaining differences in cognitive abilities, risk for mental illness and neurological diseases such as schizophrenia and Alzheimer's disease, leading to new gene-based therapies for these disorders."

"Although genes play a major role in brain function, the environment and other factors contribute to when things go wrong in cases of mental illness and other brain disorders," he said.

The research team, which included scientists at the Universities of Queensland and Cambridge, UK compared the brain scans of 38 identical and 26 non-identical twins from the Australian Twin Registry.

Using new techniques, the researchers were able to construct detailed maps of each person's brain network and measured the cost-efficiency of network connections for the entire brain, as well as for specific brain regions.

"We found that people differed greatly in terms of how cost-efficient the functioning of their brain networks were, and that over half of these differences could be explained by genes," said Dr Fornito.

Across the entire brain, more than half (60%) of the differences between people could be explained by genes. Some of the strongest effects were observed for regions of the prefrontal cortex which play a vital role in planning, strategic thinking, decision-making and memory.

Previous work has shown that people with more efficient brain connections score higher on tests of intelligence, and that brain network cost-efficiency is reduced in people with schizophrenia, particularly in the prefrontal cortex.

"This exciting discovery opens up a whole new area of research focus for scientists around the world," he said.

Journal Reference:

1. A. Fornito, A. Zalesky, D. S. Bassett, D. Meunier, I. Ellison-Wright, M. Yucel, S. J. Wood, K. Shaw, J. O'Connor, D. Nertney, B. J. Mowry, C. Pantelis, E. T. Bullmore. Genetic Influences on Cost-Efficient Organization of Human Cortical Functional Networks. Journal of Neuroscience, 2011; 31 (9): 3261 DOI: 10.1523/JNEUROSCI.4858-10.2011

— When your brain encounters sensory stimuli, such as the scent of your morning coffee or the sound of a honking car, that input gets shuttled to the appropriate brain region for analysis. The coffee aroma goes to the olfactory cortex, while sounds are processed in the auditory cortex.

That division of labor suggests that the brain's structure follows a predetermined, genetic blueprint. However, evidence is mounting that brain regions can take over functions they were not genetically destined to perform. In a landmark 1996 study of people blinded early in life, neuroscientists showed that the visual cortex could participate in a nonvisual function — reading Braille.

Now, a study from MIT neuroscientists shows that in individuals born blind, parts of the visual cortex are recruited for language processing. The finding suggests that the visual cortex can dramatically change its function — from visual processing to language — and it also appears to overturn the idea that language processing can only occur in highly specialized brain regions that are genetically programmed for language tasks.

"Your brain is not a prepackaged kind of thing. It doesn't develop along a fixed trajectory, rather, it's a self-building toolkit. The building process is profoundly influenced by the experiences you have during your development," says Marina Bedny, an MIT postdoctoral associate in the Department of Brain and Cognitive Sciences and lead author of the study, which appears in the Proceedings of the National Academy of Sciences the week of Feb. 28.

Flexible connections

For more than a century, neuroscientists have known that two specialized brain regions — called Broca's area and Wernicke's area — are necessary to produce and understand language, respectively. Those areas are thought to have intrinsic properties, such as specific internal arrangement of cells and connectivity with other brain regions, which make them uniquely suited to process language.

Other functions — including vision and hearing — also have distinct processing centers in the sensory cortices. However, there appears to be some flexibility in assigning brain functions. Previous studies in animals (in the laboratory of Mriganka Sur, MIT professor of brain and cognitive sciences) have shown that sensory brain regions can process information from a different sense if input is rewired to them surgically early in life. For example, connecting the eyes to the auditory cortex can provoke that brain region to process images instead of sounds.

Until now, no such evidence existed for flexibility in language processing. Previous studies of congenitally blind people had shown some activity in the left visual cortex of blind subjects during some verbal tasks, such as reading Braille, but no one had shown that this might indicate full-fledged language processing.

Bedny and her colleagues, including senior author Rebecca Saxe, assistant professor of brain and cognitive sciences, and Alvaro Pascual-Leone, professor of neurology at Harvard Medical School, set out to investigate whether visual brain regions in blind people might be involved in more complex language tasks, such as processing sentence structure and analyzing word meanings.

To do that, the researchers scanned blind subjects (using functional magnetic resonance imaging) as they performed a sentence comprehension task. The researchers hypothesized that if the visual cortex was involved in language processing, those brain areas should show the same sensitivity to linguistic information as classic language areas such as Broca's and Wernicke's areas.

They found that was indeed the case — visual brain regions were sensitive to sentence structure and word meanings in the same way as classic language regions, Bedny says. "The idea that these brain regions could go from vision to language is just crazy," she says. "It suggests that the intrinsic function of a brain area is constrained only loosely, and that experience can have really a big impact on the function of a piece of brain tissue."

Bedny notes that the research does not refute the idea that the human brain needs Broca's and Wernicke's areas for language. "We haven't shown that every possible part of language can be supported by this part of the brain [the visual cortex]. It just suggests that a part of the brain can participate in language processing without having evolved to do so," she says.

Redistribution

One unanswered question is why the visual cortex would be recruited for language processing, when the language processing areas of blind people already function normally. According to Bedny, it may be the result of a natural redistribution of tasks during brain development.

"As these brain functions are getting parceled out, the visual cortex isn't getting its typical function, which is to do vision. And so it enters this competitive game of who's going to do what. The whole developmental dynamic has changed," she says.

This study, combined with other studies of blind people, suggest that different parts of the visual cortex get divvied up for different functions during development, Bedny says. A subset of (left-brain) visual areas appears to be involved in language, including the left primary visual cortex.

It's possible that this redistribution gives blind people an advantage in language processing. The researchers are planning follow-up work in which they will study whether blind people perform better than sighted people in complex language tasks such as parsing complicated sentences or performing language tests while being distracted.

The researchers are also working to pinpoint more precisely the visual cortex's role in language processing, and they are studying blind children to figure out when during development the visual cortex starts processing language.

Journal Reference:

1. Marina Bedny, Alvaro Pascual-Leone, David Dodell-Feder, Evelina Fedorenko and Rebecca Saxe. Language processing in the occipital cortex of congenitally blind adults. Proceedings of the National Academy of Sciences, 2011; DOI: 10.1073/pnas.1014818108

New York University researchers have isolated neural activity that reflects basic mechanisms used by the brain to combine elementary pieces of language in order to construct complex ideas.

The study, which appears in the Journal of Neuroscience, was conducted by Douglas Bemis, a graduate student in NYU's Department of Psychology, and Liina Pylkkänen, an associate professor in NYU's Department of Psychology and Department of Linguistics.

Researchers have long studied the neural regions that underlie the processing of complete sentences and other complex linguistic expressions. However, much less attention has been devoted to how we comprehend minimal language combinations, such as a simple two-word, adjective-noun phrase.

To better understand how the brain functions during such simple language processing, the researchers conducted an experiment using native English speakers in which subjects were shown simple nouns presented either by themselves or preceded by a simple adjective. The subjects' brain activity during the processing of the nouns was then gauged using magnetoencephalography (MEG), a technique that maps neural activity by recording magnetic fields produced by the electrical currents produced by our brain.

During the experiment, subjects were shown common nouns ("boat") that were either part of a simple noun phrase ("red boat") or preceded by an unrelated noun ("cup, boat") or non-pronouncable consonant string ("xhl boat"). By comparing neural activity generated during the phrases with the control conditions, the researchers were able to isolate brain activity that increased during basic combinatorial processing (i.e., the adjective and the noun) compared to when no linguistic combination was present. To ensure that the subjects were processing the words correctly, they had to assess whether a following colored shape (e.g., a red boat) matched the words they had just seen.

Surprisingly, the regions of the brain typically identified with the processing of complex linguistic expressions — "Broca's" and "Wernicke's" areas — appeared to play no role in the comprehension of such basic phrases.

Instead, the MEG results revealed increased activity in the left anterior temporal lobe (LATL), followed by increased activity in the ventromedial prefrontal cortex (vmPFC) region of the brain during the processing of simple adjective-noun phrases. While these parts of the brain have previously been shown to be involved in the processing of more complex linguistic expressions, this evidence suggests that these regions play a pivotal role in the most fundamental aspects of language processing. This result, in conjunction with the absence of increased activity in Broca's and Wernicke's areas, indicates that traditional neural models of language processing must be expanded in order to encompass a wider network of brain areas than are typically included.

"Surprisingly, direct investigations into the neural underpinnings of basic combinatorial processing in language have been virtually nonexistent," the authors wrote. "This research introduces a powerful method for directly investigating these operations by allowing the linguistic expressions under consideration to be reduced to the absolute minimum: a simple adjective composed with a noun."

NewsPsychology (Mar. 1, 2011) — A new University of Colorado Boulder study indicates an ancient form of complementary medicine may be effective in helping to treat people with mild traumatic brain injury, a finding that may have implications for some U.S. war veterans returning home.

The study involved a treatment known as acupressure in which one’s fingertips are used to stimulate particular points on a person’s body — points similar to those stimulated with needles in standard acupuncture treatments, said CU-Boulder Professor Theresa Hernandez, lead study author. The results indicate a link between the acupressure treatments and enhanced cognitive function in study subjects with mild traumatic brain injury, or TBI.

“We found that the study subjects with mild traumatic brain injury who were treated with acupressure showed improved cognitive function, scoring significantly better on tests of working memory when compared to the TBI subjects in the placebo control group,” said Hernandez, a professor in CU-Boulder’s psychology and neuroscience department. “This suggests to us that acupressure could be an effective adjunct therapy for those suffering from TBI.”

The acupressure treatment type used in the study is called Jin Shin. For the study, Hernandez and her colleagues targeted the 26 points on the human body used in standard Jin Shin treatments ranging from the head to the feet. The study subjects all received treatments by trained Jin Shin practitioners.

According to practitioners, Jin Shin acupressure points are found along “meridians” running through the body that are associated with specific energy pathways. It is believed that each point is tied to the health of specific body organs, as well as the entire body and brain, Hernandez said.

“Think of the meridians as freeways and the pressure points as towns along the way,” she said. “When there is a traffic jam in Denver that causes adverse effects as far away as Boulder, clearing the energy blocks, or in this case traffic jams, helps improve flow and overall health.”

The study involved 38 study subjects, each of whom was randomly assigned to one of two groups — an experimental group that received active acupressure treatments from trained experts and a control group that received treatments from the same experts on places on the body that are not considered to be acupressure points, acting as a placebo. The study was “blinded,” meaning the researchers collecting data and the study participants themselves did not know who was in the experimental group or the placebo group until the end of the study.

The team used a standard battery of neuropsychological tests to assess the results. In one test known as the Digit Span Test, subjects were asked to repeat strings of numbers after hearing them, in both forward and backward order, to see how many digits they could recall. Those subjects receiving active acupressure treatments showed increased memory function, said Hernandez.

A second standard psychology test used for the study, called the Stroop Task, measured working memory and attention. The test subjects were shown the names of colors like blue, green or red on a computer screen. When the names of the particular colors are viewed on the screen in a different color of ink — like the word “green” spelled out in blue ink — test subjects take longer to name the ink color and the results are more error-prone, according to Hernandez. The Stroop Test subjects in the CU-Boulder study wore special caps wired with electrodes to measure the brain activity tied to specific stimuli. The results showed those who received the active acupressure treatments responded to stimuli more rapidly than those who received the placebo treatments, Hernandez said.

“We were looking at synchronized neural activity in response to a stimulus, and our data suggest the brains of those in the active acupressure group responded differently when compared to those in the placebo acupressure group,” she said.

A paper on the subject was published in the January issue of the Journal of Neurotrauma, a peer-reviewed publication on the latest advances in both clinical and laboratory investigations of traumatic brain and spinal cord injury. Co-authors on the study included CU-Boulder’s Kristina McFadden, Kyle Healy, Miranda Dettman, Jesse Kaye and Associate Professor Tiffany Ito of psychology and neuroscience.

Funded by the Colorado Traumatic Brain Injury Trust Fund, the study is believed to be one of the first placebo-controlled studies ever published in a peer-reviewed medical journal showing the benefit of acupressure to treat patients with TBI, Hernandez said.

“We would like to see if the Jin Shin treatment is useful to military veterans returning home with traumatic brain injury, a signature wound prevalent in the wars in Iraq and Afghanistan,” said Hernandez. The Jin Shin acupressure treatment can be taught to family and friends of those with TBI and can even be used as a self-treatment, which could allow for more independence, she said.

In a 2010 stroke study led by Hernandez, the researchers concluded that Jin Shin acupressure triggered a larger and faster relaxation response during active treatments and a decreased stress response following active treatments compared with what was seen in placebo treatments. Hernandez and her colleagues are embarking on a new study on the use of Jin Shin acupressure in athletes to see if the enhanced relaxation response and decreased stress seen in the stroke study can reduce the likelihood of athletic injury.

In 2002, Hernandez partnered with former Colorado Rep. Todd Saliman to initiate the Colorado Traumatic Brain Injury Trust Fund, a statute that has generated nearly $2 million to the state annually since 2004 from surcharges to traffic offenses like driving while impaired and speeding. Roughly 65 percent of the money goes toward rehabilitation and care services for individuals with TBI, about 30 percent goes for TBI research and 5 percent for TBI education. Because of the statute, nearly 4,000 Colorado citizens with TBI have received care and rehabilitation services for brain injuries.

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Story Source:

The above story is reprinted (with editorial adaptations by newsPsychology staff) from materials provided by University of Colorado at Boulder.

Journal Reference:

1. Kristina L. McFadden, Kyle M. Healy, Miranda L. Dettmann, Jesse T. Kaye, Tiffany A. Ito, Theresa D. Hernández. Acupressure as a Non-Pharmacological Intervention for Traumatic Brain Injury (TBI). Journal of Neurotrauma, 2011; 28 (1): 21 DOI: 10.1089/neu.2010.1515

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of NewsPsychology ( or its staff.

Using a sophisticated imaging test to probe for higher-level cognitive functioning in severely brain-injured patients provides a window into consciousness — but the view it presents is one that is blurred in fascinating ways, say researchers at Weill Cornell Medical College in the Feb. 25 online edition of the journal Brain.

In a novel study of six patients ranging in their function from minimally conscious state to the locked-in syndrome (normal cognitive function with severe motor impairment), the researchers looked at how the brains of these patients respond to a set of commands and questions while being scanned with functional magnetic resonance imaging (fMRI).

They found there was a wide, and largely unpredictable, variation in the ability of patients to respond to a simple command (such as "imagine swimming — now stop") and then using that same command to answer simple yes/no or multiple-choice questions. This variation was apparent when compared with their ability to interact at the bedside using voice or gesture.

Some patients unable to communicate by gestures or voice were unable to do the mental tests, while others unable to communicate by gestures or voice were intermittently able to answer the researchers' questions using mental imagery. And, intriguingly, some patients with the ability to communicate through gestures or voice were unable to do the mental tasks.

The researchers say these findings suggest that no exam yet exists that can accurately assess the higher-level functioning that may be, and certainly seems to be, occurring in a number of severely brain-injured patients — but that progress is being made.

"We have to abandon the idea that we can rely on a bedside exam in our assessment of some severe brain injuries. These results demonstrate that patients who show very limited responses at the bedside may have higher cognitive function revealed through fMRI," says the study's corresponding author, Dr. Nicholas D. Schiff, professor of neurology and neuroscience and professor of public health at Weill Cornell Medical College and a neurologist at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

While progress has been made in elucidating the range of brain function in those who are severely injured, Dr. Schiff urges caution. "Although everyone wants to use a tool like this, fMRI is not yet capable of making clear measurements of cognitive performance. There will be a range of possible responses reflecting different capabilities in these patients that we have to further explore and understand," he says.

The new study tested three levels of communication in steps that required increasing cognitive capacity, says Dr. Henning Voss, who is the study's senior investigator and associate professor of physics in radiology at Weill Cornell Medical College. "While we could not unambiguously establish communication in these brain-injured patients, our research is helping us identifying problems specific to this patient population," Dr. Voss says. "We got a clear picture about where and how to look for this kind of brain activity in response to certain commands."

Ethical Imperative

"Thousands of people suffer debilitating brain injuries every year, and there is a clear ethical imperative to learn as much as possible about their ability to communicate," says the study's lead author, Jonathan Bardin, a third-year neuroscience graduate student at Weill Cornell Medical College.

"These findings caution us against giving too much weight to negative results and open our eyes to the diversity of responses one might expect from the wide-ranging group of severely brain-injured people," he says.

The potential implications of these kinds of consciousness studies are significant, says co-author Dr. Joseph Fins, the E. William Davis, Jr., M.D. Professor of Medical Ethics, chief of the Division of Medical Ethics, and professor of medicine, professor of public health, and professor of medicine in psychiatry at Weill Cornell Medical College. "Beyond facilitating communication with these patients, these studies should communicate to society at large this population is worthy of our collective attention.

"A vast majority of severely brain injured patients around the country are receiving substandard care because they are improperly diagnosed, not given adequate rehabilitation, and often end up in nursing homes. We all want this to change," adds Dr. Fins, who is also director of medical ethics and chairman of the ethics committee at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

fMRI Reveals Consciousness's Complexity

The Weill Cornell study is a continuation of research into how fMRI can establish a line of communication with brain-injured patients in order to understand if they can benefit from rehabilitation, and to gauge their level of pain and other clinical parameters that would improve care and quality of life.

Research collaborators in Cambridge, England, and Liege, Belgium, published earlier demonstrations in 2006 and 2010 that severely brain-injured patients could respond to commands or questions. The present studies extend the earlier findings and represent an important confirmation of such measurements by independent scientists.

In the current study, the dissociations observed and the wide range of communication capacities in the patient subjects studied provide unique insights. In the first step, the six patients, as well as 14 control participants, were asked a command that formed the basis for further communication. The control volunteers were asked to imagine performing their favorite sports, the patients to imagine themselves swimming.

Then, in the three patients who could do this, and in all of the controls, the researchers asked them to use the same imagined activity to respond to one or two options in a simple two-part question. In the third multiple-choice task, they were shown a face card from a deck of playing cards, then asked to respond when either the face or suit of the card was named.

The scans showed a number of "dissociations" in these patients — "surprising instances in which patients' imaging responses diverged from their behavior," Bardin says.

One patient could generate the mental imagery but not use it to answer questions — although he could communicate accurately with gestures. Another patient, who can speak, could not carry out the mental imagery task. A third patient who could imagine swimming on command showed dramatically varied brain response patterns when tested over time.

"The patients participating in this study often have multiple or widespread brain injuries affecting not only local brain areas but the whole brain network on a wide scale," Dr. Voss says. "Even if we knew precisely all the injuries involved in a subject, our still-limited understanding of the brain networks involved in communication makes it impossible to accurately predict remaining cognitive and communicative skills in many cases. If there is no normal communication possible, fMRI can reveal cognitive capacities on several levels."

"This is a reality check, in essence, because there is a wide range of cognitive abilities in these patients, and the implications on the extreme ends of the spectrum are important," Dr. Schiff says. "There are people whose personal autonomy is abridged because they don't have a good motor channel to express themselves despite their clear mind and opinions and desires about themselves and the world. And there are people who are without cognitive capacity, but because there is a misinterpretation of what is possible, there is a willingness to hold out hope.

"Not all minimally conscious patients are the same, and not all patients with locked-in syndrome are the same," Dr. Schiff says.

Going forward, the research group, along with others in the field, is planning a major multicenter trial of fMRI along with European and Canadian colleagues supported by The James S. McDonnell Foundation to better understand both its promise and limitation in gauging cognitive abilities in severely brain-injured patients.

The current study was funded by grants from the National Institutes of Health and The James S. McDonnell Foundation, Jerold B. Katz Foundation and Buster Foundation.

Additional collaborating authors include Dr. Douglas Katz, from the Boston University School of Medicine; Dr. Douglas Ballon, Dr. Jonathan Dyke, Dr. Linda Heier and Jennifer Hersh, from Weill Cornell Medical College; and Dr. Karsten Tabelow, from the Weierstrass Institute for Applied Analysis and Stochastics in Berlin, Germany.

Journal Reference:

1. J. C. Bardin, J. J. Fins, D. I. Katz, J. Hersh, L. A. Heier, K. Tabelow, J. P. Dyke, D. J. Ballon, N. D. Schiff, H. U. Voss. Dissociations between behavioural and functional magnetic resonance imaging-based evaluations of cognitive function after brain injury. Brain, 2011; 134 (3): 769 DOI: 10.1093/brain/awr005