Brain Beat

On this episode of the Brain Beat Podcast, Dr. Peter Arnett will be acting as host and Dr. John DeLuca, Senior Vice President for Research and Training at the Kessler Foundation and professor at Rutgers medical school, will be talking about cognitive rehabilitation.  Dr. DeLuca is internationally recognized in this field, has written over 350 articles and book chapters on this topic, and is a co editor for the Encyclopedia of Clinical Neuropsychology.  Having received over $38 million in research grants, his most recent work pertains to cerebral mapping of human cognitive processes using functional neuroimaging in addition to developing research techniques to improve cognitive impairment. 

The pair open up this episode by talking about cognitive rehabilitation and why these treatments are not as accessible as they should be.  As a truly individualized plan for care, cognitive rehabilitation seeks to assuage any issues related to a brain injury or trauma a patient may have.  Symptoms typically come in forms of memory loss or fatigue, but cognitive rehabilitation can also be used to treat attention deficit disorders in children.  One approach to treat these symptoms is spaced learning, a technique that stresses the importance of intervals.  Dr. DeLuca goes on to discuss more cognitive rehabilitation approaches like recording lectures and joining book clubs, and draws the episode to a close by reiterating just how important this individualized treatment plan is, and why it’s a shame that access to it isn’t more fair. 

Episode Highlights:

• Cognitive rehabilitation as a program treating the entire patient
• How patients can access cognitive rehabilitation treatments
• The importance of individualized care
• Rehabilitation techniques
• Spaced Learning
• Why anxiety and depression might prohibit memory retrieval 
• Unfair access to healthcare

Quotes:

“A cognitive rehabilitation program treats the entire patient.”

“One of the interesting things about the pandemic is that teleservices, telerehabilitation, and telemedicine have become more of an acceptable way to obtain treatment.  I would certainly say before the pandemic, that would have been a huge challenge.”

“A cognitive rehabilitation approach may start off with quite a few sessions, but it could end up where let's just say a few months from now, you're meeting once a month with a therapist to deal with the lingering issues, which may be for example, fatigue.”

“It doesn't have to be a full blown severe brain injury that you go for cognitive rehabilitation, it can be more subtle problems.”

“So even when there are areas of the brain that are damaged, when you provide cognitive services, the brain can actually reroute those kinds of things that need to be done to make sure that the tasks or the behaviors can be once again functional.”

“We always want to help our patients. And, and sometimes, you know, you have to be able to try to get the treatment that you need. Unfortunately, it may not be the easiest thing in the world.”

Links:

National Academy of Neuropsychology Foundation website

Kessler Foundation

Helen Bundy Medsger, LBD Peer Mentor, Support Group Facilitator and Support Services Volunteer, Lewy Body Dementia Association, is Heidi’s very special guest on today’s episode. For over 30 years, Helen has been the primary caregiver and health care advocate for two generations of her family who have suffered from Parkinson’s Disease with Lewy Body Dementia, and three members of her family have succumbed to the disease: her father, sister and youngest brother. In addition to being an advisor to Lewy Body Ireland, she is the facilitator of the North Bay Lewy Body Dementia Support Group, is a support services volunteer for the Lewy Body Dementia Association, a trained LBD caregiver peer mentor, and a member of the University of California – San Francisco (UCSF) Memory & Aging Center’s Family Advisory Council. Helen is also a member of the Dementia Community Research Advisory Panel at the Global Brain Health Institute, a former LBD consultant to the Care Ecosystem Study at UCSF’s Memory & Aging Center, and a speaker for various organizations on the topic of caregiving LBD. Most recently, she was federally appointed one of two caregiver representatives to the Advisory Council on Alzheimer’s Research, Care, and Services under the U.S. Dept. of Health and Human Services making recommendations to the HHS Secretary and Congress.

Heidi and Helen open the episode by discussing the traumatic experience of trying to treat and care for a family member with Lewy Body Dementia, especially when there was a lack of research and a high misdiagnosis rate.  Helen details the symptoms and behavioral changes her father underwent, and notes that no medications slow or stop the progression of LBD.  To those with family members suffering from LBD, Helen emphasizes how important it is to allow the patient to express their desires early in the disease process when they’re still capable of doing so, and highly recommends that social and physical engagement is absolutely paramount for LBD patients. Helen adds that, in addition to the patients themselves, the family and loved ones also deserve and need help during this emotionally draining time, and understands that while therapeutic support groups might not be for everyone, some form of therapy can do so much for those dealing with the brunt of caregiving duties. She delves into her sister’s experience getting involved in LBD research and how beneficial that experience was, and addresses the healthcare system and why it’s not conducive for those with LBD.  Helen draws the conversation to a close by directing the audience to the LBD Association website for additional resources.

Episode Highlights: 

• Helen on losing family members to LBD
• LBD as the most expensive form of dementia
• Young onset isn’t all that rare for LBD patients
• The effectiveness of PET scans (specifically DaTscan), cardiac MIBG, sleep studies, and biomarker testing currently in development
• Patient sensitivity to medications; no medications slow or stop the progression of LBD
• The importance of the patient expressing desires early in the disease process
• The importance of social and physical engagement
• Therapy options for family members and loved ones 
• LBD as a systemic disease
• Why getting involved in research can be a good thing
• Why doctors need to be patient with those with LBD

Quotes: 

“It wasn't until 1996 that he passed away–that the first diagnostic criteria for LBD was published. And to be honest, I really thought his diagnosis was a one-off, just a random occurrence in the family.”

“I've heard it time and time again referred to LBD as the most common dementia you've never heard of.”

“So, the one qualifying statement I want to make in all of this, and that's something I'd like to direct to the physicians: just because an individual is under the age of 65, and historically, most dementias show up 65 and above–whether they're under that age or even under the age of 50, don't assume it can't be Lewy Body Dementia. Young onset is truly not that rare.” 

“This is a disease associated with the abnormal buildup of a protein called Alpha synuclein in the brain. So these deposits are called Lewy bodies, and they develop in nerve cells in brain regions involved in thinking, movement, behavior, as well as mood. This protein is also associated with Parkinson's disease, and can also be seen in Alzheimer's disease.”

“Frequently, though, the most significant issues that come up, though, truly do encompass responding to the psychiatric symptoms and sensitivity to medications.”

“Here in California, there are caregiver resource centers that work to support and train and teach the families coping strategies. Over the course of the last few years, many health care systems are developing caregiver support systems that provide training and outreach.”

“Exercise is known as the magic bullet, so Pharma is not going to reap a dime, but you are going to reap a huge benefit.”

“There is a push globally to involve people living with dementia and their caregivers in the design and all phases of research.”

“The bulk of our healthcare systems are set up to reimburse physicians and hospitals for a specified amount of appointment time, depending upon a specified billing code that they submit for reimbursement. The problem with that is that those with Lewy Body Dementia and other dementias process information slower than they used to.”

Links: 

Lewy Body Dementia Association Resource Slides

National Academy of Neuropsychology Foundation website

LBDA.org

Dr. Peter Arnett, Immediate Past President of NAN, hosts the podcast this week and welcomes Dr. Igor Grant, who will be talking with us today about cannabis. Dr. Grant is a Distinguished Professor and Director of the HIV Neurobehavioral Research Program and the Center for Medicinal Cannabis Research at UCSD who has served as Chair of the UCSD Department of Psychiatry from 2014 to 2019. He's a neuropsychiatrist who graduated from the University of British Columbia School of Medicine and received specialty training in psychiatry at the University of Pennsylvania, and additional training in neurology at the Institute of Neurology in London. Dr. Grant's academic interests focus on the effects of various diseases on the brain and behavior, emphasizing neuropsychological translational studies in HIV and drugs of abuse. He has contributed to approximately 800 scholarly publications and is the principal investigator of several NIH studies. In addition, NAN has recognized Dr. Grant with the Nelson Butters Award for research contributions to clinical neuropsychology and the Distinguished Lifetime Contribution to Neuropsychology Award. Dr. Grant is the Past President of the International Neuropsychological Society, otherwise known as INS, which honored him with the Paul Satz INS Career Mentoring Award. In addition to all these accomplishments, he is also the Founding Editor of the Journal of the International Neuropsychological Society, otherwise known as JINTS.

In this episode, Dr. Grant tells us about the history of the Center for Medicinal Cannabis Research and what it learned about the specific diseases or conditions that can be aided by cannabis. He provides insight into anecdotal evidence that THC was useful in diabetes and HIV/AIDS patients for relieving neuropathic pain. Dr. Grant, however, expresses concern over the long-term durability of this effect because the studies were relatively short-term. He comments on the proportion of THC used in different interventions, the regulations surrounding cannabis, which is considered a Schedule I drug, and gives an example of guidelines a typical doctor should follow when deciding to use cannabis.

Dr. Grant then talks about the benefits and risks of medical cannabis, sharing its impact on cognitive function if one already has a dementing disorder and preexisting anxiety or depression. He sheds light on his ongoing research and funding sources for research and elaborates studies of cannabidiol on people with early psychotic symptoms. Dr. Grant reveals that CBD and THC may help in breaking addiction. Other studies Dr. Grant delves into include one to help people with sleeping disorders and autism, a NIDA -supported study looking at kids experimenting with drugs from age 9 and following them through teen and early childhood, the dynamics and effects of abstinence, and the impact of cannabis on driving safety. Finally, he addresses gaps in our knowledge of cannabis that need to be pursued and impediments to research and discoveries in cannabis.

Episode Highlights:

• The history and work of the Center for Medicinal Cannabis Research
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• Diseases or conditions that can be aided by cannabis
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• Benefits of marijuana to patients with HIV/AIDs and diabetes
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• The role of THC in managing neuropathic pain
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• Cannabis regulations
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• Guidelines for doctors to determine whether to prescribe cannabis
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• Risks and benefits of medical cannabis
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• The impact of THC on the cognitive function of a person with a dementing disorder
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• The dynamics and effects of taking THC with preexisting anxiety and depression
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• Dr. Grant's ongoing research
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• Sources of funding for research
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• A study on cannabidiol in people with early psychotic symptoms
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• How CBD helps in addiction treatment
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• Measurable cognitive impairments in recreational users
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• The dynamics, effects, and studies of abstinence
• Cannabis and driving safety
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• Gaps in our knowledge of cannabis that need to be pursued
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• Impediments to cannabis research and studies
• 
  

Quotes:

"There was a lot of anecdotal evidence that neuropathic pain, which is a kind of chronic, painful condition, with hypersensitivity and so forth, that maybe marijuana was useful, in that our patients with HIV AIDS that we were studying as part of a different program, were reporting this consistently."

"Those early studies did show that THC-containing products were helpful, at least in the short term, in managing neuropathic pain. And that's been confirmed in many studies in other places as well."

"Cannabis continues to be a Schedule I drug, which means basically that it's something that's classified with other compounds that are very dangerous and for which there isn't appropriate medical information of benefit. By the way, the latter is definitely not true anymore, but it's still sitting there."

"In the state of California, we have worked with our medical board to develop kind of a decision tree to guide physicians in whether or not in the first instance to even consider medicinal cannabis."

"In our state, it's legal. But you have to understand at the federal level, it's not legal. So doctors in California, for example, cannot write a prescription. They could lose their DEA registration, which would really impair their medical practice. So there's this gray area all the time."

"What I would just say informally is that we find that relatively low concentrations of THC appear to be helpful, so you don't have to get stoned."

"That doesn't mean it's 100% safe. No medicine is, right?"

"In older people, THC can increase heart rate. It can change blood pressure. So if you are a patient with serious heart disease, even these smaller or modest doses of THC could be harmful. Again, the studies have not been extended to large groups of older people with comorbid conditions."

"If you have a dementing disorder, certainly THC, like any other kind of drug that impairs, could impair cognitive function, could make it significantly worse."

"It is true that THC can produce anxiety in some people. It's a minority, but that's a known side effect and has been reported by speaking to people smoking marijuana that they get very anxious, get a panic attack even and so forth."

"Cannabidiol doesn't have many bad side effects the way some of our antipsychotic drugs do.”

"Is it possible that CBD may help in addiction treatment? There's again some evidence that CBD may reduce the craving that addicted people or animals have."

"I was involved in a meta-analysis years ago where we found that once you looked at studies that examined people who were abstinent at least for a week or two or more, there were really essentially no differences in cognitive functioning. There was a very teeny effect that we observed on a memory measure."

"Then, a second larger meta-analysis was conducted about a decade later. And that had the benefit of having more studies where people were truly abstinent. And they found that once you looked at that subgroup, they found no effect at all, like any neurocognitive measure."

"There is no question, though, if you are stoned all the time as a kid, you're not going to learn as well; you're going to get behind. And there's no question that the kind of everyday function outcomes is not good. But whether that's due to brain injury is a whole other matter."

"The person who has used occasionally or rarely or even modestly, I think the likelihood that the marijuana is a factor in any neuropsych impairment is very low unless they're actually stoned."

"In my experience, it's going to be unlikely that marijuana itself is the explanation for a significant neuropsych. But it may contribute, especially if they're still under the influence."

Links:

National Academy of Neuropsychology Foundation website

r. Pete Stavinoha joins Dr. Heidi Rossetti on today's episode. Dr. Stavinoha is a board-certified clinical neuropsychologist and Professor of Pediatrics at the University of Texas, MD Anderson Cancer Center, and a fellow of the National Academy of Neuropsychology. In addition, he works with children, adolescents, and young adults with a variety of neurologic illnesses and neurodevelopmental disorders. Dr. Stavinoha has authored over 100 peer-reviewed articles and co-authored two books for parents that have been translated into multiple languages, including Stress-Free Discipline: Simple Strategies for Handling Common Behavior Problems and Stress-Free Potty Training: A Commonsense Guide to Finding the Right Approach for Your Child. In this episode, Dr. Stavinoha shares his wealth of pre-birth to adulthood brain development knowledge.

Dr. Stavinoha begins by talking about what happens with the brain in gestation. He then details the neural tube, the development and function of the forebrain, midbrain, and hindbrain, cell proliferation and migration, and potential complications in premature birth that affect brain development. He talks at length about factors that impact fetal brain development, emphasizes the value of good nutrition in brain development, and discusses other strategies such as exercise, stress management, and music, among others, that parents can employ to optimize brain development in utero. Dr. Stavinoha then converses about what happens in the brain in early childhood, the impact of the environment around the child on brain development, how infant and early childhood behavior reflects what's going on in the developing brain, and addresses common misperceptions parents have about their child's behavior or brain. He also offers some sage advice for parents, and shares what they can expect when their child has a  pediatric neuro-psych assessment as well as where to find someone qualified to do that type of assessment with their child. Filled with a vast amount of quality information and advice from a proven leader in the field, today’s episode is truly a masterclass in brain development that parents and non-parents alike need to hear.

Episode Highlights:

·   The brain in gestation

·   The neural tube and the development and functions of the forebrain, midbrain, and hindbrain

·   Cell proliferation and migration

·   Potential complications in premature birth that affect brain development

·   Factors that impact fetal brain development

·   The importance of good nutrition and a healthy lifestyle for brain development

·   How to optimize brain development in utero

·   Synapses and their function in brain development

·   The effect of the environment on brain development

·   The importance of security, predictability, and protection from toxic stress in early childhood

·   Toxic stress: What it is and its impact on brain development

·   Tolerable stresses and how they build resilience

·   Impact of the COVID pandemic on children

·   Sensitive periods and critical periods in childhood

·   The need to emphasize reading with your child

·   Brain plasticity and how it changes throughout a child's growth.

·   How infant and early childhood behavior reflects what's going on in the developing brain

·   Common misperceptions that parents have about their child's behavior or brain

·   Ignore – the single best solution to a temper tantrum

·   Brain function in school-aged children

·   Brain function in adolescents

·   How parents determine if their child's behavior is outside the normal development

·   What to expect from a child pediatric neuro-psych assessment

·   How to find a great pediatric neuro-psych assessment professional

Quotes:

"So we have forebrain, that is going to become the cerebral cortex, the part that most people think of as the brain, like the big, big part. And then, we have the midbrain, which are many important structures that help manage bodily functions, memory functions, and things. And then we have the hindbrain, which is going to really be the most basic structure of the brain, and then the spinal cord is going to develop off of that."

"Good nutrition is important because the developing brain needs the proper fuel."

"In the developing brain, all these new connections are happening, very active process, but there are certain ones that are going to be really important that they do need to be stabilized. And so the brain has a process for doing that, to make them much less vulnerable."

"A feeling of security and predictability, that's an aspect that, if in place, can also promote healthy brain development, and then protection from toxic stress. Those are all aspects of the environment of significant brain development."

"And if the child can endure that [tolerable stresses], this actually can go into building their resilience later."

"So you want to develop reading, but you're also developing language, planting the seeds for later language comprehension. You're planting the seeds for later inferential thinking, but you're also promoting a positive relationship with your child and closeness. And so you're doing so many things at once with what seems to be such a simple activity."

"If we have too many synapses, that creates a possibility of interference. So as we prune these down, what we're really pruning down to are the ones that are most useful to us, the most functional, but also that improves our efficiencies and how we're able to do things in a more efficient manner, meaning both that we're better at it, but also that it uses less energy to do it."

"The biggest misconception is that parents will often ascribe adult level responsibility or accountability to the kid’s behavior. So a great example is a temper tantrum. When I'm looking at a temper tantrum, you look at it from the standpoint of the child does not yet have the brain capacity for frustration tolerance."

"By paying attention to them, we do not mean to reinforce the tantrum, but that's what we might end up doing. Whereas if we ignore it, we're not feeding, we're not giving that tantrum any fuel at all. So the child then is dependent on themselves to self-regulate, then the tantrum will inevitably wind down."

"When parents tell me that ignoring doesn't work, I always ask them the last time their child had a tantrum in an empty room. And their child never has a tantrum in an empty room. It's always when there's a human around."

"That's something where if a child really is standing out, then that would be a potential goal for a formal assessment to see if that child really is advanced in certain cognitive areas."

"A healthy lifestyle is going to be the foundation for a healthy brain."

Links:

National Academy of Neuropsychology Foundation website

Stress-Free Discipline: Simple Strategies for Handling Common Behavior Problems

Stress-Free Potty Training: A Commonsense Guide to Finding the Right Approach for Your Child

Dr. Nada Gligorov, the Director of Graduate Studies and Associate Professor at the Alden March Bioethics Institute at Albany Medical College, joins Peter Stavinoha on the podcast today to talk about neuroethics. Prior to joining the Bioethics Institute, she was Associate Professor of Medical Education at the Icahn School of Medicine at Mount Sinai. Dr. Gligorov has published in leading journals in bioethics and philosophy including the Hastings Center Report, the American Journal of Bioethics, Neuroscience, Neuroethics, and the Monist. She has served as a member of the American Philosophical Association's Committee on philosophy and medicine from 2018 to 2020, and she's currently the chair of the American Society for Bioethics and Humanities, Neuroethics Affinity Group. She is also the author of a book titled Neuroethics and the Scientific Revision of Common Sense which she discusses with Peter here today.

Dr. Gligorov kicks off the episode by describing what neuroethics is and gives us an overview of her book Neuroethics and the Scientific Revision of Common Sense.  She defines common sense and talks about neuroimaging and the different aspects of it, and then sheds more light on neuro privacy, mental privacy, the safeguards to mental privacy, and additional issues that could arise from doing neuroscience research. She also discusses the concept of freewill, the friction between neuroscience and freewill, her thoughts on the neuroethical issues related to impairments or alterations of consciousness and making decisions for others at the end of life. The implications of neurodegenerative or neurologic injuries, brain injuries, dementia, that result in a loss of cognitive capacity, and those kinds of conditions when cognitive capacity for decision making has been impaired are also covered, and our guest delves further into neurologic compromise and cognitive enhancement She finishes up by sharing her understanding of parents making decisions on behalf of their kids and by exploring pain as a mental state, giving some insight into the cognitive influence of pain through the placebo and nocebo effects. A true expert in her field, Dr. Nada Gligorov possesses a great deal of wisdom and knowledge which she generously shares with listeners in today’s thought provoking conversation.

Episode Highlights:

●  Description of Neuroethics

●  Overview of Neuroethics and the Scientific Revision of Common Sense

●  Common Sense

●  Neuroimaging

●  Neuro and mental privacy

●  Safeguards to mental privacy

●  Issues arising from neuroscience research such as incidental findings

●  The concept of free will

●  Neuroscience vs. freewill

●  Making decisions for others at the end of life

●  Implications of neurodegenerative or neurologic injuries

●  Neurologic compromise, cognitive enhancement and the implications

●  Drawing the line between enhancement and treatment

●  The placebo and nocebo effects as they relate to pain

Quotes:

“Common sense morality is an everyday way in which we talk about other people, meaning that the way in which we explain and predict our own behavior related to morality, and the way in which we explain and predict other people's behavior.”

“It’s through the popularization of neuroscience and the fact that we hear about neuroscience research in the popular media and from other sources as well that we have started to incorporate some of those scientific facts into our moral concepts, and by using those scientifically influenced moral concepts, we are also explaining and predicting human behavior in everyday life based on this scientific influence.”

“As an individual might have diminished states of consciousness, we tend to also think of them as having diminished freewill or even sometimes diminished cognition. But I think that it's actually not necessary to think of consciousness as being the primary ingredient there. It's not just that people are losing or have diminished states of consciousness; it's much more that they're losing some of their other capabilities.”

“When you're losing your cognition, you're losing aspects of your memory; you are losing your ability to appreciate information and apply it to yourself. You're less able to really hold a variety of different alternatives in your mind and use those to make decisions.”

“The ethical use of medicine should correspond with the treatment of disease or the prevention of disability, but it shouldn't be used to enhance normal human abilities or to promote certain desirable traits that we would like to achieve but we don't have.”

“And even just the concept of normal can be related a lot to our cultural and other ideas about what constitutes normal functioning. So it can be actually very hard to make the distinction between cognitive enhancers and the medical use of medicine.”

“Parents are, in essence, inherently surrogates. They're making decisions in a way that can either promote or not the overall well-being of their kids and even affect their future.”

“One can say that pain is a biological and psychological process, meaning that there are biological underpinnings of the sensation of pain and also psychological.”

“If people have positive treatment expectations, they're much more likely to experience relief from their pain if they believe that the medicine will help them.”

“If somebody tells you that you're likely to experience a high intensity pain, that might actually cause the individual to experience high intensity pain.”

Links:

National Academy of Neuropsychology Foundation website

The Human Microbiome: Ethical, Legal, and Social Concerns

Neuroethics and the Scientific Revision of Common Sense

Dr. Peter Arnett, Immediate Past President of NAN, hosts the podcast this week and welcomes Dr. Munro Cullum, PhD, ABPP, Professor of Psychiatry, Neurology, and Neurological Surgery at UT Southwestern Medical Center, where he holds the Pamela Blumenthal Distinguished Professorship in clinical psychology, to the show. A board-certified clinical neuropsychologist, Dr. Cullum has been involved in research, teaching, and clinical practice in neuropsychology, serving his field in multiple roles at the national level and contributing to major organizations over the past 30 years of his career. Currently the President of the Sports Neuropsychology Society, Dr. Cullum’s research focuses in part on the short and long term effects of concussions, and today he brings his vast amount of knowledge and experience in this area to this informative and fascinating conversation.

He begins by describing how he got started in studying sports concussions, and then goes on to examine baseline testing, the validity concerns associated with it, and alternative assessment models to be considered. He also reviews such aspects of concussions as common symptoms, recovery times and protocols, lingering symptoms, post-concussion syndrome, as well as how anxiety and depression can become factors in concussions. Neuroimaging, managing athletes with concussions, blood testing, and the risk of later life problems are also explored. The episode concludes as Dr. Cullum shares his advice regarding when athletes should consider retirement, Chronic Traumatic Encephalopathy and Traumatic Encephalopathy Syndrome, as well as his final thoughts for listeners. Bringing information from the forefront of research into the science of concussions, Dr. Cullum offers a masterclass here today in understanding and treating this increasingly common condition as he continues to fulfill his stated mission of educating the general public about this timely and essential topic.

Episode Highlights:

• Dr. Cullum’s start in studying sports concussion
• Baseline testing for athletes and validity concerns surrounding it
• Alternative assessment models
• Some of the most common concussion symptoms
• Recovery times and protocols for concussions
• Lingering symptoms and their risk factors
• Dr. Cullum’s perspective on post-concussion syndrome
• Anxiety and depression
• Circumstances warranting neuro imaging
• Managing athletes following concussions
• Blood testing for concussions
• The risk of later in life problems related to concussions
• His advice for when athletes should consider retirement
• Chronic Traumatic Encephalopathy (CTE) concerns
• Traumatic Encephalopathy Syndrome (TES)
• Dr. Cullum’s final thoughts

Quotes:

“If you think about it, most of us either have experienced or know someone who's experienced a concussion or someone will have traumatic brain injury.”

“It always falls back to clinical decision making, I think, regardless of what the scores necessarily suggest.”

“To experience a concussion, you just have to shake up the brain enough to cause that brief disruption in normal cognitive efficiency or cognitive functioning to produce symptoms.”

“Kids tend to take longer to recover than adolescents who take longer to recover than adults.”

“We really need to get these folks back to their pretty normal routines as quickly as possible.”

“We have to be mindful of the potential symptoms that can occur unrelated to the concussion itself, but related to the nature of the injury.”

“We have to pay attention to any lingering symptoms that are presented, but it's a complex challenge clinically.”

“The biggest predictor of lingering symptoms is severity and initial symptoms.”

“Treatments are all dependent on the symptoms.”

“Everybody's looking for a blood based biomarker, and we don't have any right now that will diagnose concussion.”

“The actual risk of developing a neuro degenerative condition after concussion is pretty low.”

“CTE is a rare condition, so what I tell parents is, ‘It is a rare disorder. The likelihood of your child developing this years and years down the road is quite unlikely.’”

“But I think our job as a psychologist, is to educate your patients, the families, but also the public, and, when we can, the media.”

“It's also a wonderful area that brings together important cutting edge research with real world clinical problems and challenges.”

Links:

National Academy of Neuropsychology Foundation website

Sports Neuropsychology Society Homepage

Updating The Seven Sins of Memory with Dr. Daniel Schacter

Dr. Daniel Schacter, professor and past chair of psychology at Harvard University and world leader in the neuroscience of memory, joins Heidi on the podcast today to provide an update on his now 20 year old seminal work, The Seven Sins of Memory: How the Mind Forgets and Remembers. Throughout his illustrious career, Dr. Schacter has made pioneering contributions that have shaped our understanding of memory, and his work, including over 400 peer-reviewed articles, has garnered numerous accolades, including election to the American Academy of Arts and Sciences and the National Academy of Sciences. He has received several awards for his research, including the Warren Medal from the Society of Experimental Psychologists, Award for Distinguished Scientific Contributions from the American Psychological Association, and he has recently completed an updated 20th anniversary edition about the Seven Sins of Memory that will be published in the fall.

Today, Dr. Schacter begins by sharing what he has learned about memory since he first published his book, reviewing the seven sins, and highlighting his most surprising findings regarding them. He then conducts a masterclass on memory, addressing such topics as Highly Superior Autobiographical Memory (HSAM), the impact of the pandemic, recent media and political messaging, technology, and virtual learning upon our memories, as well as the role memory plays in such complex situations as racism. He also explores memory’s role in imagining our future, how its vices can also be virtues, the projects he is most excited about currently, and finishes up by sharing his advice regarding brain and memory health. An undisputed expert in the field, Dr. Schacter has most likely forgotten more about memory than many of us actually know about it, rendering this truly an episode you will not soon forget.

Episode Highlights:

• What Dr. Schacter has learned over the past two decades about the ways memory is imperfect
• The seven sins of memory
• His most unexpected findings
• Highly Superior Autobiographical Memory (HSAM), anti-transcience, and the struggles of those who exhibit them
• How our memories of the tumultuous events of the past year and a half might play out in our lives
• How media or political messaging after the election or the Capitol Riot might affect memories of those events
• How the sins of memory play a role in our understanding of, or reaction to, such complex situations as our troubled history with racism
• How the ubiquitous nature of technology has changed our memory
• Differences in our memory for things that we did or learned virtually
• The impact on the memory of having a copious photographic record of your life
• How the vices of memory can also be virtues
• Memory’s role in imagining our future
• The role of emotion in memory
• Techniques we can use to improve memory
• The projects in his lab that he is most excited about at the moment
• Dr. Schacter’s advice regarding brain/memory health

Quotes:

“I was impressed that in looking back over 20 years by how much more we've learned both at the basic science level, and also at the applied level.”

“What really seems to be different about these folks compared to most of us is that they lose information about their personal experiences over time much more slowly than most of us do.”

“It turns out that testing memory, practicing retrieval, boosts long term recall.”

“It turns out that it might be that there's kind of a self-testing or retrieval practice effect that accounts for the Highly Superior Autobiographical Memory folks remembering this stuff from the remote past so well.”

“The thought was that it may not be such a good thing to have this kind of extraordinary memory ability, because you've got all this stuff floating around your mind, and it might prevent you or inhibit you from functioning at a more abstract level, because you have so much concrete detail.”

“Persistence, which is the seventh of the seven sins can be really, psychologically, quite crippling when we have a difficult or traumatic experience, and then we just can't stop it from coming to mind.”

“I suspect that memory for a lot of events, you know, within a period of COVID, won't exhibit persistence - it'll just be kind of a fuzzy faded memory.”

“We have many laboratory studies dating back to some of the classic work of Elizabeth Loftus, first in the 1970s, showing how misinformation can contaminate memory.”

“I think we can see in those kinds of findings that some of what we knew already from cognitive psychology, about creation of false memories can interact with our pre-existing knowledge now, so that we're biased to remember, one way or another.”

“Basically, what it shows is that many of us are, most of us will, tend to preferentially associate certain positive or negative attributes with, for example, different races.”

“Something seems to be happening out there in society, in these last 20 years or so, where these implicit biases may be, because of the way we discuss it and what's presented in media, are tempering a bit.”

“I think there is some evidence that in certain situations, there can be a negative impact of technology on memory, but it's not nearly as general or broad as some people might have you think.”

“Who would ever think you could possibly forget that your baby's in the backseat, but this only started when it became necessary to put car seats in the back seat that were no longer allowed in the front seat. And that took away kind of a reminder cue - you wouldn't think it would be necessary - but this is absentmindedness. It’s very cue dependent.”

“On the bright side, I think you can say that technology can help by being able to provide reminders, you know, that can even prevent death in this extreme case.”

“I think that photo review can prove memory for an event that actually happened, it can possibly impair memory for related events that aren't retrieved, and in the case, for example, of looking at somebody else's Instagram, you might become convinced that you participated in an event that you really didn't participate in.”

“Memory is not really just about the past. The key function of memory is to allow us to think ahead and to simulate future events. So we want to be able to use our past experience in a flexible way, recombine elements of past experiences, so we can simulate novel upcoming events.”

“When we misattribute by mixing up elements of two different events, what we might be seeing there is a feature of memory that is actually very adaptive when we want to use memory flexibly to recombine information and run simulations of novel events.”

“A lot of the processes that underlie remembering the past also underlie imagining the future.”

“There's good evidence to believe that our episodic memories or memories, for particular experiences can be helpful in boosting our ability to think creatively.”

“Staying active, using our memory when we can, but also, you know, relying on external devices in ways that can be beneficial.”

“Something that has been shown to impact brain structures involved in memory and memory performance is simple aerobic exercise.”

Links:

National Academy of Neuropsychology Foundation website

The Seven Sins of Memory

The Seven Sins of Memory: An Update

Project Implicit

Dr. John Randolph is a board-certified clinical neuropsychologist, brain health coach and consultant, and member of the Adjunct Faculty at the Geisel School of Medicine at Dartmouth College. He earned his PhD in Clinical Psychology, with an emphasis in Neuropsychology at Washington State University, and completed clinical and research fellowships in Neuropsychology and Neuroimaging at the Geisel School of Medicine at Dartmouth. He's Past President of the New Hampshire Psychological Association, a National Academy of Neuropsychology (NAN) Fellow, and recent Program Chair for a national conference focused on the science of brain health. He's also the author of the recently released general audience book, The Brain Health Club: Using the Power of Neuroscience to Improve Your Life. He works with individuals, groups, and organizations interested in developing better strategies to enhance brain health. 

Today Dr. Randolph joins host, Dr. Peter Arnett, to discuss how brain health relates to successful aging, which day-to-day activities we can do to improve memory function, and what kinds of physical exercise are best for the brain (and for how long). Dr. Randolph explains the crucial role that social engagement plays in brain health, and how increased isolation has been particularly challenging during the pandemic. The benefits of “cross training” with crossword puzzles, reading, woodworking, and other mental activities daily are also addressed. Dr. Randolph talks about the importance of a Mediterranean-style diet, sleeping well, and stress management for cognitive functioning. Finally, he reminds listeners that it’s never too late to make changes toward better brain health, and encourages us to take gradual steps toward this goal.

Episode Highlights:

• Successful aging is intimately related to brain health
• Exercise, social activity, mental activity, brain-healthy diet, managing stress, sleeping well  are all very important not just for brain health, but for the overall aging process
• Moderate activity for 30 minutes a day, 5 days per week is best for maintaining brain health, but any level of activity is beneficial
• The brain is nourished by social interaction and being around people we care about
• Three types of social activity that really matter: how frequently we’re active with other people; how large our social network is; and social support
• These are associated with brain health and also reduce the risk of developing dementia
• COVID has been a particularly challenging time in terms of maintaining social connections, even with the advent of Zoom calls and FaceTime
• Cross Training with the brain, and doing a variety of different mental activities each day, helps to prevent memory problems
• Mixed evidence for whether computerized games help
• Benefits of Mediterranean-style diet
• Findings on health benefits of wine and dietary supplements are inconsistent - the most important priority is to have a balanced diet
• It’s never too late to start making important changes to help promote better brain health
• Sleep is critically important for cognitive function
• There are a lot of simple, free things you can do every day to promote brain health - focus on taking gradual steps

Quotes:

“Successful aging is really intimately related to brain health.”

“We know that there are certain day-to-day activities we can engage in that also really help promote brain health. And these include things like exercise, social activity, mental activity, eating a brain-healthy style of diet, like the Mediterranean style diet, managing stress, sleeping well - these are all things that we have a certain amount of control over, and we know can really improve not just brain health, but the overall aging process.”

“Exercise is one of the most exciting developments in neuroscience in the last 20 years. When we think of what exercise does for the brain, it's remarkable.”

“It's important to emphasize that any level of exercise is good. If it's hard to get to that level, for various reasons...any sort of movement is important.”

“When we're socially active, it makes us feel good to be around people that we care about. And we feel sort of emotionally nourished by those interactions. But the brain really gets nourished as well, when we're more socially engaged.”

“All three aspects of social activity that I just mentioned, are very associated with brain health, and also reduced risk of developing dementia.”

“When people are more socially isolated, when people feel lonely, that can actually be toxic for the brain.”

“I think more generally, the idea is to do a bit of what we could call Cross Training with mental activity. There's some evidence that that seems to be particularly helpful.”

“The Mediterranean-style diet...includes lots of fruits and vegetables, whole grains, olive oil, fish, and maybe some poultry - trying to minimize red meat - and beans, nuts, legumes. When people eat that sort of collective nutritional style, that tends to have a significantly lower risk of Dementia for people that adhere to that style of diet.”

“The more we can lean toward a Mediterranean brain-healthy style of diet, the better off we tend to be both in the moment and also projecting down the road.”

“I would say that exercise, more social activity, more mental activity, all of those, it's never too late to start making some important changes.”

“Sleep is critically important for brain health.”

“I think there's something very empowering about that idea, that there are things that we can do day-to-day that are free or inexpensive and generally available to all of us, that can make quite a bit of difference in promoting brain health.”

Links:

National Academy of Neuropsychology Foundation website

The Brain Health Club: Using the Power of Neuroscience to Improve Your Life by Dr. John Randolph (2019). New York, NY: W.W. Norton and Company.

Brain Beat is a podcast series produced by the National Academy of Neuropsychology Foundation. Each episode features experts discussing current topics related to brain health and brain functioning. Tune in to fine tune your understanding of the mind!