Genius: Mind, Brain, and Molecules at the 92nd Street Y

What makes someone a genius? According to Nobel Laureate Eric R. Kandel, M.D., it is a person who is a “game-changer” and who “through their work, permanently changed the way we perceive the world.” It is less about IQ and more about “drive, persistence, and creativity.” At the 92nd Street Y’s third annual 7 Days of Genius in Manhattan, four eminent scientists, arguably geniuses themselves, discussed historical geniuses of the mind, brain, and molecules. The three speakers included two members of the Dana Alliance, Larry W. Swanson, Ph.D., and Thomas M. Jessell, Ph.D., as well as Robert Michels, M.D. Kandel, also a Dana Alliance member, moderated the event.

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Magnetic brain scans become more attractive

The first image many of us conjure up when someone mentions
brain scanners—whether for medical diagnosis or basic research—is the sterile
white isolation and intimidating din of a magnetic resonance imaging device.
But for many diseases, the key to better diagnosis may not be looking into
brains, as with MRIs, but looking near
them.

A new study appearing
in the Journal of Neural Engineering suggests
that magnetoencephalography (MEG) can identify the vast majority of people
suffering from post-traumatic stress disorder (PTSD).

In MEG, a helmet surrounding the head measures the tiny magnetic
fields generated by the brain’s electrical activity. This offers distinct
advantages and disadvantages over other scanning methods. For instance, MEG is
noninvasive, unlike positron emission tomography (PET), which requires patients
to ingest a mildly radioactive solution. MEG is also very fast—it works in
about 10 milliseconds—because it measures neural activity directly; MRIs
measure blood flow in the brain instead and take 20 times longer. On the other
hand, readings from MEG offer less spatial resolution than many other scanning
methods and provide less precise information about regions deep inside the
brain.

In the new research, Apostolos
Georgopoulos
, a professor of neuroscience at the University of Minnesota
and a member of the Dana Alliance for
Brain Initiatives
, and his colleagues found that MEG correctly identified at
least 67 of 74 veterans suffering from PTSD, from a group that also included
250 people with no reported neurological or mental health issues. The veterans were
a varied group, with participants both from the current Iraq and Afghanistan
campaigns as well as from World War II and Vietnam.

The researchers also reported that the strength of their
readings corresponded with the severity of symptoms in a PTSD sufferer. In other
words, a MEG test might not just identify who has PTSD but also how damaging
the disorder is and even what treatments might work best.

MEG has shown potential to diagnose other brain symptoms. In
2007, for instance, Georgopoulos and his team reported that MEG could
help detect
multiple sclerosis, Alzheimer’s disease, schizophrenia,
Sjögren’s syndrome, chronic alcoholism and facial pain. And earlier this month,
we reported on a small
study that used MEG to identify children with autism
.

As we mentioned in that post, small tests such as the PTSD
study aren’t useful in the clinic until they have been confirmed in more
expansive tests with more diverse sets of people. Still, many neurological
disorders, including a large percentage of PTSD cases, are difficult and
time-consuming to diagnose. Objective detection methods such as brain scans could
dramatically shorten that process, as well as reduce uncertainty about the
accuracy of a diagnosis or the severity of a particular case.

For soldiers, who are at high risk for PTSD, this is
crucial; their final diagnosis can drastically alter what jobs they are
expected to do, where they are sent during their next deployment and what kind
of benefits they can receive. In the most extreme cases, a doctor’s finding might
mean the difference between re-entering a dangerous war zone and safely recovering
from trauma on U.S. soil. For those kinds of cases, a fast, efficient way to
assess PTSD can’t come fast enough.

—Aalok Mehta

Dearth of depression treatment

If you’re feeling down and out but struggling to get through
it on your own, you’re not alone.

A large new survey has found that only half of those in the
United States with depression
are receiving any sort of treatment for the condition—many because they have
not been formally diagnosed.

For the study,
which appears in the January issue of Archives
of General Psychiatry,
researchers assessed nearly 16,000 people to study
how commonly depression occurs in the United States and what kinds of treatment
people with the disorder receive. Because the participants were carefully
selected from three large national surveys instead of from hospital records,
the survey represents a snapshot of the U.S. population as a whole, the
scientists say.

“We can talk about population estimates for the whole of the
U.S. Ours is a cross-sectional, nationally representative sample,” says lead
author Hector
González
, an assistant professor of family medicine and public health
sciences at Wayne State University in Detroit. “That’s the beauty of our
study.”

Approximately 9 percent of the participants either met the
criteria for depression or had met them sometime within the past 12 months. Of
those with depression, only half had received any treatment for the condition
and only one-fifth had received treatment that conformed to the American Psychological Association’s recommended
guidelines.

Because the survey team assessed each person independently
for depression based on data and interviews, those numbers include many people
who have not been officially diagnosed by a physician, González says. He does
not have firm numbers on how many people that might be but expects they
represent a significant proportion of the U.S. population.

If the sample is indeed representative, then the country holds
roughly 14 million untreated residents. People with untreated depression are
not only in danger of jeopardizing their jobs, personal relationships, and
general health, but many also have an increased risk of harming or killing
themselves. According to the Dana Guide to Brain
Health
, approximately 20 percent of depressed people will make a suicide
attempt and around 6 percent will ultimately succeed.

The survey also found that therapy is used to treat
depression more often than drugs. Although the study didn’t directly address
the reasons, one cause for the disparity might be that antidepressants seem to
work only for those patients with the most severe cases of depression. A study released
yesterday
in the Journal of the
American Medical Association
found that for mild to moderate cases of
depression, drug treatment was similar to treatment with a placebo pill. “Only
15 percent of people in the U.S. with depression have very severe depression,” González
says. “So 85 percent don’t respond to antidepressants better than placebo.”
This doesn’t mean that the drugs have lost favor, though, he adds; half of the
antidepressant prescriptions doctors now write are for conditions other than
depression.

The scientists also looked at whether incidence and
treatments differed among particular ethnic subgroups. While overall rates of
depression were similar to the national average among all groups, González
says, African and Mexican Americans had a notably reduced chance to receive
both any care at all and the recommended treatment.

The scientists plan to use their results and additional data
to see what kinds of treatments are most effective against depression.
“Depression is a leading cause of disability worldwide,” González says. “We
think we can help meet the health needs of Americans and others, by seeing how
well these people are supported.”

—Aalok Mehta

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