If I told you that a theater company and a medical school collaborated to produce one of the best plays of the year, would you believe me?
Probably not, because this is not the case. However, this unlikely partnership of industries did produce a substantial therapeutic program for people who are currently suffering the cognitive deficits associated with dementia.
Based on the theory of cognitive reserve - or the brain’s resilience to neuropathological damage – it is widely hypothesized that creative and interactive activities, such as painting, singing, and acting, would help patients maintain their cognitive functions for as long as possible.
With this hypothesis and the guidance of the Lookingglass Theater Company, the Feinberg School of Medicine at Northwestern University formed the first-ever “Memory Ensemble.” The cast included six elderly patients suffering from early stages of memory loss, a common symptom attributable to various types of dementia.
Quoted as “one of the first-of-its-kind,” the directors of this production sought to design a program that would improve the quality of life for these patients by setting up a safe and supportive environment. With the serene scene set, patients were encouraged to express every emotion and/or words associated with their neurological deficits to help them alleviate any pains or questions of uncertainty accompanied by these disorders.
As a part of a seven week pilot study, the ensemble would meet and participate in various cognitive activities, including an impromptu-style of acting that actively engaged the patients both physically and mentally. As a baseline measure, metaphor-based warm-up exercises prompted the patients to choose a color that symbolizes their current emotional state. Prior to their regularly scheduled regime, the patient’s reports ranged from a happy sunny yellow to a melancholy blue. Nevertheless, after a stretching routine, body-sculpting exercises portraying various feelings, and an active discussion of the hardships involved with their disorders, all of the patients were quick to describe their emotional state at the end of the workshop as a happy yellow.
Although these patients verbally reported an improvement in their quality of life within the given time period, it was noted that this qualitative research study could not quantitatively provide evidence in support of their hypothesis. Thus, a lack of evidence from this study could be detrimental to implementing this therapeutic program in hospitals across the US simply because of the lack of funding.
Though not discussed in this article, pre- and post-study fMRI scans and intermittent neuropsychological tests could provide quantitative insight on whether or not such a therapeutic program significantly contributes to the patient’s cognitive reserve. Pre- and post-study fMRI scans of the patients performing these neuropsychological tests can be compared to control subjects, as well as across-patients and within-patients, in order to identify the statistical differences between the patterns of activity associated with each task. Other measures, such as reaction time, can also be recorded to correlate with the patients behavioral performance to provide more information and insight on whether or not this is an effective prevention program.
Despite this predicament, I must say that I am very impressed and optimistic about this new style of therapy because it helps the patient positively cope with such a disastrous and unfortunate mental disorder. In the future, I hope that quantitative measures, as discussed before, will be implemented to help facilitate and disambiguate the uncertainty pertaining to dementia-related research.
Cognitive Reserve – Dr. Yaakov Stern (2009) - Neuropsychologia (PDF)
The familiar mantra “practice makes perfect” may be taken too literally. The definition of effective practice as the constant repetition of a particular exercise – a golf swing, a tennis serve, a dance step – is faulty, as it turns out.
Time has reported on a study published in Nature Neuroscience by neuroscientists at the University of Southern California and UCLA. The study compares the results of repetitive, “constant practice” with the results of “variable practice.” In one experiment, scientists instructed a group of subjects to copy a movement with their forearm as displayed by a line on a computer screen. One group representing constant practice repeated a movement holding their arm at 60-degrees 120 times. The variable practice group was asked to do the same 60-degree movement only 60 times, but they were also asked to do three other movements 20 times each. The two groups did equally well in practice. However, when they were retested 24 hours later, the variable practice group outperformed the rote repetition group on the 60-degree task.
So, variable practice works – but why? Some of the subjects from each group were treated with transcranial magnetic stimulation (TMS). A portion of each group had TMS in the prefrontal cortex, and another portion received TMS in the primary motor cortex. The prefrontal cortex is the part of the brain that allows for executive functions like reasoning and planning while the primary motor cortex deals with simple, physical task learning. Fittingly, when the prefrontal cortices of variable-practice group members were “messed with” by TMS, the performance of the participants declined. Performance levels also decreased when constant-practice subjects underwent TMS in their primary motor cortices. It seems that “tedium is bad for the brain,” and it needs variety to actively learn by using higher structures like the prefrontal cortex to better retain what has been practiced.
It would be interesting to find out whether or not this concept applies to different types of learning, like studying for exams or playing an instrument. Even when training a dog, it is suggested to work amid distractions and to increase the time between clicking the “clicker” to let the dog know it has performed a task correctly and rewarding it with a treat. A higher level of focus seems to occur when there are more variables in the practice routine. My piano teacher must have been on to something when she gave me so much homework!
Article: Practice Structure and Motor Memory -Nature Neuroscience
One hundred years ago, when Alzheimer’s Disease (AD) was even more of a mystery than it is now, amyloid protein aggregates were described as black spots that showed up on brain slices after autopsy. These aggregates, commonly known as plaques, denote the telltale sign that a patient has AD. Until recently, these plaques could only be detected after death, but Dr. Daniel Skovronsky, creator of Avid Radiopharmaceuticals, may have a solution.
On July 11th, Dr. Skovronsky will present his latest findings at the international meeting of the Alzheimer’s Association in Honolulu. He has spent the last five years creating a fluorine radioactive dye to be used in positron emission tomography (PET) scans. The results of these PET scans are engineered to be so accurate that they can compete with brain autopsies, the only method currently available to determine whether a patient has AD.
The Food and Drug Administration (FDA) questioned Dr. Skovronsky about his fluorine-18 dye and whether the results of fluorine-18 PET scans compare to the definitive results of brain autopsies. Dr. Skovronsky recruited thirty-five patients in hospice with ranging levels of memory loss; all of these patients would receive a PET scan and would have their brains autopsied post-mortem. The results of each patient’s PET scan matched his or her autopsy results.
If approved by the FDA, Dr. Skovronsky’s work will lead to an increase in accuracy in the diagnosis of Alzheimer’s disease. Currently, 20% of patients diagnosed with AD are revealed to not have the disease when an autopsy is performed. With fluorine-18, Dr. Skovronsky has fine-tuned a method to detect amyloid plaques in the brain in a living patient, which is a feat within itself. Previously, the only way one could determine whether a patient had the disease or not was through autopsy – a posthumous procedure. Now, patients could have the chance to receive an accurate diagnosis while they are still alive and earlier in their lives.
In addition to simply detecting plaque, fluorine-18 will also aid in understanding the development of the disease, for plaques were found in patients deemed as healthy when they took memory tests. Currently, people who are not diagnosed with AD earlier in life will not receive treatment until the disease has developed more, and they will likely not receive any preventative medicine. With Dr. Skovronsky’s PET scans, doctors could diagnose the development of the disease earlier and administer preventative measures to slow down the development of the disease. Also, patients who are currently misdiagnosed with AD do not receive the correct treatments that they need for the diseases that are actually causing their memory loss or dementia, like depression.
The Vanishing Mind – Promise Seen for Detection of Alzheimer’s – NYTimes
The Alzheimer’s Disease Neuroimaging Initiative positron emission tomography core – Alzheimer’s Dement. 2010
In Vivo Imaging of Amyloid Deposition in Alzheimer Disease Using the Radioligand 18F-AV-45 (Flobetapir F 18) – The Journal of Nuclear Medicine