FROM CHAPTER TWO
“Your Brain and Heart Surgery”
By GUY MCKHANN, M.D., AND BRENDA PATOINE
Our working hypothesis is that surgical patients who go on to suffer cognitively started out with some level of cerebrovascular disease to begin with—it just may not have been far enough along to produce noticeable clinical symptoms. Several lines of evidence support this hypothesis.
The implications of this concept, should it prove true, are important. We may need to carefully rethink how we screen people for surgery, how we talk to people about the risks of surgery, and what needs to be done to lower risk factors that are modifiable. In addition, this hypothesis would affect the contentious debate raging right now about the comparative risks and benefits of bypass surgery versus “nonsurgical” interventions such as stenting, in which a catheter embedded with a mechanical device is threaded through an artery in the groin to fix problem arteries in the heart. The risk of latent cognitive decline with surgery has entered into this debate and is often cited by proponents of nonsurgical techniques as one more reason their approach is better.
There are public health implications as well. Despite decades of health messages urging otherwise, Americans are notorious for lifestyles that increase the risk of heart disease, such as eating too much fat and not getting enough exercise. Perhaps we will pay more attention if we understand that a heart-healthy lifestyle also might help save our brains.
I don’t know of anyone who desires to spend their golden years in the fog of cognitive dysfunction or dementia, and baby boomers seem to be particularly inclined to take steps to protect their mental health. Such protection could go a long way toward improving public health and controlling health-care costs, given the dire predictions about the looming impact of age-related brain diseases as boomers grow old. The message is clear: do your heart good and you do good for your brain as well.
FROM CHAPTER FIVE
“The Political Brain”
BY GEOFFREY K. AGUIRRE, M.D., Ph.D.
Neuroscientists from the University of California, Los Angeles, led by Marco Iacoboni, had used functional magnetic resonance imaging to measure the responses of undecided voters to the candidates. Their conclusions were startling in their depth and breadth. One Republican candidate, Fred Thompson, was found to evoke particularly strong feelings of empathy. Further, while some voters said that they disapproved of Hillary Clinton, their brain activity revealed that they had unacknowledged impulses to like her. The study had seemingly reached into the minds of voters and plucked out their hidden emotions and conflicts. Perhaps political talk-show hosts and Gallup pollsters would soon be unnecessary. Why analyze and poll when the feelings and intentions of voters could be read directly from their brains?
Instead of sparking a revolution in political science, however, the editorial provoked broad condemnation from the neuroscience community. Within days the New York Times had published a letter from 17 scientists who argued that the study was fundamentally flawed. At scientific meetings and on the discussion boards of Web sites the hue and cry continued (http://kolber.typepad.com/ethics_law_blog/2007/11/this-is-your-br.html). The prominent scientific journal Nature published a scathing editorial that lamented the absurdity of the study. After more than a decade of increasing publicity for brain-scanning results in the lay press, the Iacoboni editorial had provoked a backlash. Neuroimaging had jumped the shark.
FROM CHAPTER SIX
“A Wound Obscure, Yet Serious: Consequences of Unidentified Traumatic Brain Injury Are Often Severe”
BY WAYNE A. GORDON, Ph.D.
John, at age 3, was hit on the head by a swing at the playground. His mother called her pediatrician, who told her that she need not go to the ER because John had not lost consciousness. Immediately, her happy-go-lucky son seemingly became a different child: anxious and clingy. For a few years thereafter, John would occasionally shake his fists up and down, out of the blue, then stop; such episodes were later recognized as undiagnosed seizures. Initially, he did well academically but not socially. He became the butt of jokes and was labeled by his teachers as unmotivated and inappropriate. Over many years, John’s mother sought help from the schools he attended, his pediatrician, several neurologists, tutors and the like. No one was able to help. Finally, when John was an adolescent, a tutor told his mother that his reading problems were not typical and that he should be seen by a neurologist. The mother tried again. The boy was sent for a type of brain scan called single-photon emission computerized tomography, or SPECT, which showed major damage where the swing had hit his head 16 years earlier. However, the neurologist told her that there was nothing to be done; he was mistakenly of the opinion that it had been too long after John’s injury for any intervention to be of use. John’s mother persevered and found a program for him that could help address his cognitive and behavioral difficulties. Unfortunately, he was so emotionally damaged by so many years of being misunderstood—not only by everyone around him but also by himself—that despair won out. His traumatic brain injury ultimately ended in his suicide.
The brain injuries we see on the evening news, when soldiers return from war with visible, grievous wounds, are clearly evident: this is known TBI. Unidentified traumatic brain injury occurs not just in cases such as John’s but also in military combat or in civilian life whenever injury to the brain leaves no visible physical evidence. The cognitive, behavioral and/or emotional problems that follow are clearly evident but are not identified as consequences of the injury. Unidentified TBI is a common phenomenon, one that needs attention from medical, educational and military systems—the last because TBI is “the signature injury”1 of the wars in Iraq and Afghanistan.