Dementia Patients: Artistic Geniuses

 Many dementia patients never had an interest in art prior to the onset of their neurodegenerative diseases. These patients were profound business men or women, doctors, or other highly accepted positions in non art-related fields of professions. However, at the same time that dementia began to develop in many of these patients, an increased and unexpected interest in creating art developed as well. Why the sudden interest in art as a hobby?

Most of the patients with a developed interest in art suffered from semantic dementia. This specific subtype of dementia is connected to anomia which affects language production and eventually leads to the patient not even understanding what words are. Thus, the left hemisphere of the brain which is responsible for much of language development is hit hard by semantic dementia.

One of the main things that doctors have learned is the importance of the right side of the brain in cognitive artistry. The right hemisphere of the brain is dominant in “visual constructive ability, spatial attention, and internal representation.” Thus, when the left hemisphere is affected by semantic dementia, the right hemisphere compensates and the patients rely on what they can do while having this disease, which is create art. As the left hemisphere degenerates, impulses that may have always been present and ignored in the right hemisphere are finally recognized and utilized to create beautiful art.

Being able to produce art and participate in it's creation is beneficial for dementia patients as their world becomes confusing and they are no longer able to do the things they used to. From prominent business men to emerging artists, creativity in dementia allows patients to continue to lead a somewhat normal and fulfilling life.

 http://archneur.jamanetwork.com/article.aspx?articleid=785938

http://journals.lww.com/neurotodayonline/Fulltext/2003/06001/As_Dementia_Sets_in,_Artistic_Genius_Emerges.4.aspx

Empathy: The Best Medicine?

Empathy may be just as good of a medicine as laughter seems to be. At least, this is what researchers at Thomas Jefferson University and in Italy suggest. Empathy is an understanding of another’s emotional state or condition and in modern medicine doctors are actually trained to factor out their emotions from a situation and look at the patient and disease objectively. However, being an emphatic doctor may actually lead to less complications and better outcomes for patients, according to the study.

            The researchers measured the relationship between doctor empathy and patient hospitalization for acute metabolic complications. The researchers used the Jefferson Scale of Empathy to measure empathy in clinical settings. They also chose to compare empathy to patient hospitalization for acute metabolic complications because the prevention of such complications is likely influenced by family doctors. There were 129 patients hospitalized for such complications. 29 out of 7,224 patients who had more emphatic doctors were hospitalized compared to 42 out of 6,434 patients who had less emphatic doctors. The researchers emphasized that the number of subjects and the possible applications of the study allow for generalization of the results.

            A few weeks ago, I attended a talk by Jean Decety, a psychology researcher at the University of Chicago, who spoke about empathy and its critical role in our everyday lives. Decety spoke from both an evolutionary and adaptive perspective. According to Decety, empathy was important for the survival of early humans because it allowed them to help one another in times of need which would lead to mutual helping which would help them survive. It also allowed fathers, but mothers especially, to care and provide for their children. Now, empathy often serves to form relationships and nurture them. However, he also briefly related empathy to the medicine. Decety also spoke of encouraging empathy in medicine but cautioned that too much empathy may also be detrimental because it may hinder them from doing their jobs properly and helping others in need.

            Whether it is viewed from an evolutionary or humanistic perspective, empathy is indeed a significant factor in our lives because it allows us to better understand others. Empathy brings people closer together and allows them to live more fulfilling lives. It enriches lives with the flavors of emotion. 

http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=794107

http://ac.els-cdn.com/S187892931100048X/1-s2.0-S187892931100048X-main.pdf?_tid=59aab11c-3f51-11e2-86bc-00000aab0f6b&acdnat=1354763120_b9e6b30889e36ec15eecf48b5e6b3dfd

Empathy Declines During Medical School?

According to Dr. Jean Decety, empathy is an innate human emotion that involves feelings of concern for other people, knowing what the other is thinking or feeling, blurring the line between oneself and the other, etc.  He claims that empathy has deep, evolutionary, biochemical, and neurological underpinnings.  Empathy is mediated and moderated by multiple systems in the brain.  When we see others in pain, we are predisposed to find their distress aversive and learn to avoid actions associated with this distress.  If we looked at crying, for example, it would be an evolutionary disadvantage because an extended wail would attract predators.  Instead, however, crying ends up being a tool for the evolution of empathy; this expression provides a signal which motivates helping behavior in others.

How can Physicians employ empathy when their job, at times, calls for the most painful (surgical) procedures?  Dr. Decety did research on empathy in clinical practice and found that empathy declines during medical school.  It is challenging for doctors and nurses to engage with their patients empathetically because they are dealing with the most emotionally distressing situations such as, illness, dying, and suffering.  In one of his experiments, he found that Physicians showed no activation where the control group showed activation to touching body parts with a needle vs. a Q-Tip.  Too little or too much empathetic arousal can be detrimental to the medical practitioner’s well-being.  A couple of the benefits of lack of arousal are: no feelings of alarm or fear, frees up processing capacities to be of assistance, and no compassion fatigue.  A lack of empathy can also result in an underestimation of pain in others, poor relationship with patients, and the filtering out of emotional information.

On the other hand, a recent study shows how physician’s empathy is associated with positive clinical outcomes for patients.  Researchers from Thomas Jefferson University were interested in investigating the effect of physician empathy on patient outcomes. The study was published in Academic Medicine and focused on diabetic patients.  According to one of the research professors, Mohammadreza Hojat, “This new, large-scale research study has confirmed that empathetic physician-patient relationships is an important factor in positive outcomes.”  In this study, researchers used the patients’ hemoglobin A1c test and cholesterol levels.  They also measured physicians’ empathy level through the Jefferson Scale of Empathy (JSE).  A direct correlation was found between physicians’ JSE score and the control of the patients’ levels: the higher the physicians’ JSE score the better the control of patients’ hemoglobin A1c and cholesterol level.

Combining Dr. Decety’s research and the study from Thomas Jefferson University, we can see that although engaging in empathy may be difficult for physicians, it does have a positive effect on patients’ clinical outcomes.  Therefore, physicians should practice some level of empathy with their patients.  Empathy is an innate human emotion and serves a beneficial purpose in human wellness.

Source: http://www.sciencedaily.com/releases/2012/09/120910111708.htm

Challenges with the Unpredictable Living

We are currently in an age where some of the most diabolical diseases are being cured and where that thing called "getting old," the enemy of many, is being forcefully pushed back. Paralysis due to spinal cord injury (SCI), causing one to live a life with few opportunities while requiring constant care, is arguably one of the greatest challenges medicine faces. Though I would certainly never disregard the challenges facing therapies in, for example, cancer, therapy for the paralyzed, with the aim of a complete function return, requires the introduction of living cells into the patient. While the pharmaceuticals given to patients with other types of diseases will affect only a specific path or several pathways, living cells can potentially affect things in a thousand different ways, often in a brand new way with each case. The enormously complex systems of living cells are far beyond our comprehension as of yet and, as such, we cannot possibly predict what will occur every time we place a mass of cells into another mass of living cells. This is especially true when that second mass is the most unknown as it gets, or as we like to call, human.

This past October at Loyola's Neuroscience Seminar, Dr. Hui Ye gave a lecture on his research on stem cells relating to SCI. He and his colleagues at the University of Toronto were studying the hypothesis that oligodendrocytes could be transplanted into a region of spinal cord injury and would promote in vivo remyelination and restoration of axon conductance. This could become a new, novel type of rehabilitation therapy for individuals suffering from paralysis due to spinal cord injury, with benefits ranging from slight muscle control or feeling to near complete and normal usage of muscles. Experimentally, Ye's group focally damaged a point along the spinal cords of mice in order to recreate the damage commonly seen in humans. Injury, as seen here, causes a crushing of the axons, which leads to demyelination. Once the myelin has been removed by the immune system's cells 'cleaning' up of the area, ion channels begin to spread out uniformly along the axon. One of the primary reasons myelination is important is its segregation of different types of ion channels along the axon, creating optimal and reliable conduction speeds along the axon. The uniform arrangement of ion channels causes extremely poor conduction along the axons, disrupting communication between the brain and muscles in the peripheral nervous system.

After injuring the mice' spinal cords, Ye's group injected differing concentrations of oligodendrocytes into the injured area. Oligodendrocytes are the cells that send out 'tendrils' to axons in the central nervous system, which then wrap around and ensheathe them with myelin. In several trials, they found that the oligodendrocytes had remyelinated some of the injured spinal cord axons and almost completely restored the non-uniform arrangement of ion channels along the axon. Further, the axon conductance speeds increased and the neurons even began to communicate with downstream neurons. However, much remains to be solved: some trials yield no results of remyelination; the factors that promote oligodendrocytes living in the transplanted environment are unknown; and working out a similar procedure to conduct on human SCI patients is extremely complex. Here we face that dilemma when working with other living things: you never know how a self-replicating, complex bundle of molecules is going to act.

Kelly Fitzgerald writes about a related and newly released study in her article "Revolutionary Stem Cell Treatment Repairs Spinal Cord Injuries in Paralyzed Dogs" on Medical News Today. Researchers at Cambridge successfully transplanted olfactory ensheathing cells (OEC), cells that support axonal growth between the nose and the brain, into dogs with hind legs paralyzed due to SCI. As a control in this double blind study, they injected just the liquids bathing OECs into a separate group of paralyzed dogs. Over the months following the transplant, the dogs injected with OECs regained much of their prior motor abilities, as their hind legs began to move with coordination between the front legs. Though new communication was found where damage had disrupted it, Fitzgerald suggests that "the new nerve connections causing this recovery were happening over short distances within the spinal cord and not among long distances needing the brain to connect with the spinal cord." However, this being one of the first double blinded and randomized experiments to study the effectiveness of transplanted cells, its success is groundbreaking. Fitzgerald goes on to quote Dr. Rob Buckle, Head of Regenerative Medicine at Cambridge, "This proof of concept study... is tremendously important and an excellent basis for further research in an area where options for treatment are extremely limited." And even more hopeful, Fitzgerald states that a phase 1 human trial has determined that the procedure is safe for humans.

Though we are far, far away from completely curing SCIs and providing the paralyzed with a regain of function, research is definitely showing that we've made quite a bit of progress. It seems that we have a far better understanding of not only how the injury affects the spinal cord neurons, but also of the general approach required to heal the injuries. The extraordinarily complex living systems involved in both SCIs and potential cellular cures are slowly becoming understood, contributing to both the potential of SCI rehabilitation and our understanding of how living systems interact with one another as a whole.

Sources
[1] Dr. Hui Ye Lecture at Loyola's Neuroscience Seminar
[2]http://www.medicalnewstoday.com/articles/252982.php

Emergence of Art in Patients, Despite Brain Damage

Blessed with a great memory and extensive knowledge, we all strive to succeed in this world. But what if the memories and knowledge that define who you are suddenly gone, for instance through an injury to the brain or brain disease. Such damage to the brain can change who we are as a person and even make us sort of a “blank slate,” as described by John Locke. Although there may not be a cure for such disease or injuries, there have been instances where the patient has developed new hobbies, such as an interest in art.

                                   

An example of this is Ms. Johnson, an artist and illustrator, whose work has appeared in a range of publications, even a physics textbook. She used to be a professional artist, used to play violin, viola, piano, and guitar, and owned and flew some airplanes. However, all talents disappeared when she was stricken by viral encephalitis, a life-threatening illness that damaged pathways in her brain, especially the hippocampus. Although Ms. Johnson survived the disease, her memory was severely diminished. Unable to recall most of her life, she has to be retold many things by her sister and mother, who have both assisted in her recovery. She forgot how to walk, talk, write, and eat. She could not recognize purple, black, and orange. This is similar to the two other variants of the Fronto-Temporal Dementia (FTD) that affect language, as described by Dr. Bruce Miller. Patients with variants of FTD are often unable to recognize simple things like eraser and broccoli. When asked about it, they will inquire as to what it is. As evident, both diseases caused damage to certain pathways in the brain and affect memory (in the case of Ms. Johnson) and language (in the case of Dr. Miller’s patients. This also shows how disease affect a discrete portion of the brain, which impacts other pathways associated with it.

 

In his research about Dr. Adams, a patient with FTD, Dr. Miller explains how damage to the damage to certain pathways can allow creativity to emerge. Artists usually have right posterior brain dominance, which is inhibited in the dominant frontal cortex.  In FTD, damage to the frontal cortex allows creativity to emerge. In the case of Dr. Adams, it has lead to an emergence of artistic creativity. Stricken with FTD, Dr. Adams left her career as a scientist for art. Her famous work is converting the Bolero (a music piece) into a clear and structured painting, as evident in the picture. This shows how an artistic ability, which was never present before the brain disease can rise due to changes in some pathway.

Such a unique case is also seen in Ms. Johnson. Although she has lost most of her memories, she has been able to draw again (with help from her mother). Her art is quite different from when she was diagnosed with viral encephalitis. However, she is unable to redrew what she just finished or remember what she drew. This is due to the damage to her hippocampus. What is interesting is that she is able to recognize her old paintings when they are shown to her and her new paintings still signify her personality. As described by Dr. Michael McCloskey, a professor and researcher at John Hopkins, this ““raises interesting questions about identity: Here you’ve lost an awful lot of what makes you who you are — what’s left for art?” This mystery continues to interest researchers at John Hopkins University, who have overseen Ms. Johnson’s case. Thus, in both research, researchers are trying to further investigate why some brain diseases causes the rise of an artistic ability while diminishing language and memory.

As evident in both researches, there is still a lot left to learn about the brain. We are constantly taken by surprise with some of the symptoms that arise with diseases. Hopefully one day, with the constantly growing field of neuroscience, we will know more about this disease and have a treatment/cure that will improve the quality of life of patients and will allow them to pursue their passions. 

http://www.nytimes.com/2011/09/20/health/20amnesia.html?pagewanted=all&_r=1&

http://www.nytimes.com/2008/04/08/health/08brai.html

Zebrafish make it to Hollywood!

The zebrafish is not just your average minnow, it is a model organism commonly studied because of its rapid development, see through embryo and easily maniputable genome.  Dr. Schroeder’s lab at Loyola University Chicago, is researching the development of this organism.  Specifically, Dr. Schroeder is studying the development of neurons, mostly retinal cells, which include the bipolar cells and ganglion cells. These cells are neurons responsible for vision in the fish (similarly in humans).  Dr. Schroeder uses gateway cloning in order to extract, clone and tag a specific gene in the zebrafish. Then, using a fluorescent protein, the development of the zebrafish can be studied. But why would one study the development of the zebrafish? I mean, come on, even if it is a model organism, how cool can this fish really be?

                                          Zebrafish transparent embryo in laval development

Well, like I said before, zebrafish are not your average minnow, because of their unique developmental and genomic characteristics, the zebrafish has been studied in various areas in biology. Which is why zebrafish have made it to Hollywood, or at least have been a forerunner in modern biomedical research. For example there are genetically modified zebrafish able to detect oestrogen, a pollutant in lakes and rivers.  Zebrafish have also been used to study cancer, drug treatments, and regeneration. Yes, you read that correctly, zebrafish have regenerative capabilities of various parts of the body such as limbs, cardiac muscle, and neural cells.  Cut the zebrafish’s heart, injure its retina or spine… and it will heal itself- it will regenerate. Stem cells can be generated from zebrafish to help heal with diseases and trauma in humans.

                                          Fibroblast growth factor expressed in Zebrafish

Humans most likely do not regenerate due to an evolutionary trade off (suppressing cell growth in order to reduce cancer). After a spinal or retinal injury, the glial cells scar to prevent bleeding and further injury. This also prevents axons from getting access to the injured area, and does not allow regeneration. In zebrafish, the glial cells form a bridge that spans across the injured site. However, the glial cells allow for axon access. The injured site can, therefore, be regenerated.  Scientists at Monash University discovered a protein called the fibroblast growth factor, which accounts for the shape of glial cells and how they react to injury. This accounted for the differences between humans and zebrafish. This discovery can eventually lead to human neural repair. Other genes can lead to cardiac and limb repair. So if you thought nothing of zebrafish in the past, think again- this little organism could be the regenerative hero for humans in the near future.

Sources

http://www.futurity.org/health-medicine/zebrafish-protein-bridges-spinal-cord-injury/

http://www.sciencedaily.com/releases/2012/07/120706184353.htm

Schroeder, Eric et. al.,  In Vivo Development of retinal ON-bipolar cell axonal terminals visualized in transgenic zebrafish. Feb 2006.

How much Empathy is Needed?: A Deeper look at “Care” in the Medical Field

According to Dr. Jean Decety of the University of Chicago’s Department of Psychology, and Department of Psychiatry and Behavioral Neuroscience, when many medical students start their schooling, they show high empathy and then gradually it seems that that level declines. This has been associated with burned out personal distress and an emphasis on more care for one’s self. A medical student has his or her own “troubles” and therefore is more occupied or detached on a psychological level.  By the time that these individuals are doctors, a great number of them appear to have little or even no empathy when they practice. However, a detached perspective as a physician from a patient may not be as good as it had been perceived in the past.  

In Dr. Decety’s lecture, he explained how the concept of empathy has recently achieved an enormous amount of attention in medicine, psychopathy, justice, and the media. Empathy has deep evolutionary, biochemical, and neurological underpinnings. Empathy is mediated and moderated by multiple physiological and brain systems as well as social context. Furthermore, even the most advanced forms of empathy in humans remains connected to core mechanisms associated with communication, social attachments, and parental care. When a doctor clinically practices in the medical field, though they require mechanisms for communication and some social attachment, it can be challenging because they deal with the most emotionally distressing situations such as suffering in many forms, illness, and even death. Therefore, it has always been stigmatized  that a doctor must not be too attached to their patients, because this can be greatly detrimental for the physician. However, recent findings, such as in Can Doctors Learn Empathy? by Dr. Pauline W. Chen, shows that too little empathy when dealing with patient’s can also be detrimental for both the patient as well as the doctor.

The benefits of being apathetic during practice is that the medical practitioner feels no sense or alarm or fear while working. This also frees up processing capacities so that they can be used, and the doctor will not consistently suffer from compassion fatigue with each patient. On the other hand, the costs of lacking empathy when practicing is that the doctor underestimates the pain of others leading to poor rapport with patients. Another crucial point is that the doctor may filter out emotional information when speaking to patient that may be essential to interpretation and understanding of treatment. In agreement with Dr. Decety, Dr. Chen’s article states that “Empathy has always been considered an essential component of compassionate care, and recent research has shown that its benefits go far beyond the exam room. Greater physician empathy has been associated with fewer medical errors, better patient outcomes and more satisfied patients. It also results in fewer malpractice claims and happier doctors” (Chen).

For this reason and by the new revelations of studies and research in the last decade, a “Dr. Helen Riess has been able to create a series of empathy “training modules” for doctors. The tools are designed to teach methods for recognizing key nonverbal cues and facial expressions in patients as well as strategies for dealing with one’s own physiologic responses to highly emotional encounters” (Chen). Though empathy seemed to be rooted in much deeper things, it seems that it can also be learned like much anything else. The results of these empathy classes according to research have greatly improved doctors’ “empathetic behavior” with their patients making patients feel much more comfortable while renewing a doctor’s enthusiasm and enjoyment of his or her profession.

Knowing all the following about empathy and its correlation with the medical profession, it is evident that it must be taken into higher regard with respect to treatment of not only the illnesses that patients suffer from but also general treatment and communication with them. Maybe this could be basis for possibly creating classes during medical school so that this concept is incorporated during their formal education before they become doctors. 

Sources: http://well.blogs.nytimes.com/2012/06/21/can-doctors-learn-empathy/

Dr. Jean Decety's Lecture, "Empathy", Loyola University Chicago, Oct 30 2012