Anosognosia

 From Greek origin meaning "without knowledge of the disease." You may also hear it called "lack of insight." What it boils down to is that the person is unaware of their condition and unable to accept it.
This is not a stubborn attitude or driven from denial. It is the brain being incapable of processing the fact that their thoughts and moods don’t reflect reality. Accompanied with confabulation (generation of fabricated stories that the patient believes to be true), and blindness are suggestive of damage to occipital lobes of the brain.

COVID-19: Information and Misinformation

 There is an informative JAMA publication by Dr. Bruce Miller that addresses the current state of information regarding the pandemic. The interference of misinformation with information is described as a severe threat to such complex public health issues. An array of symptoms include antimask behavior, antivaccine beliefs, conspiracy theories about the origins of COVID-19, and vocal support by elected officials for unproven therapies. Some articles pointed out that only 50% heed the recommendations to wear a mask in public places. The relationship between antiscience viewpoints and low science literacy underscores new findings regarding the brain mechanisms that form and maintain false beliefs. Here is the summary of this publication:

Science Literacy Is Essential

خاستگاه آگاهی در فروپاشی ذهن دوجایگاهی

مدتی پیش توسط یکی از دوستان کتابی سه جلدی به من معرفی شد به نام  "خاستگاه آگاهی در فروپاشی ذهن دوجایگاهی"  نوشته ی جولیان جینز. البته کتاب جدید نیست ولی نکات قابل تاملی را مطرح می کند. فکر می کنم بی ارتباط با پروژه ی فکریی که من با معرفی کتاب "کارکردهای ذهنی در جوامع عقب افتاده "نوشته ی لوسین لوی-برول افتتاح کردم نباشد. ساعات زیادی به بحث در باره ی این موضوع گذشت و غضب بسیاری را به جان خریدیم. هنوز این کتاب را نخوانده ام اما نکاتی اجمالی در باره ی این کتاب را این جا می آورم. شایان ذکر: متن ذیل عینا از پست ارسالی یکی از دوستان و بدون دخل و تصرف آورده شده است. پدرام

در یادداشت مترجمان چنین بیان می شود:"باید در یابیم که هوموساپینس, موجودی که در روند تکامل در اثر یک جهش بوجود آمد و برای دهها هزار سال زندگیش تفاوت چندانی با میمونها نداشت چگونه به آگاهی دست یافت و علم, هنر و اخلاق آفرید..."و این کتاب با عنوان مبهم و نثر ثقیل آن تلاشی است برای پاسخگویی به این سوال اساسی.خاستگاه آگاهی در فروپاشی ذهن دوجایگاهی تلفیقی است از روانشناسی, نورولوژی, تاریخ, ادبیات و... برای درک ماهیت آگاهی و چگونگی بوجود آمدن آن. حاصل کار, یک اثر سه جلدی است که در یک مجموعه یک جلدی گردآوری شده و توسط متخصصان نورولوژی و اعصاب ترجمه شده است.نویسنده در ابتدا به برخی از تعاریف نادرست در مورد اینکه آگاهی چیست می پردازد و در ادامه با بحثی پیرامون این مساله که آگاهی چه چیزی نیست به مسایل جالبی نظیر: "آگاهی لازمه یادگیری نیست", "آگاهی برای تفکر لازم نیست"و "آیا آگاهی الزامی است؟" اشاره می کند.در فصل دوم کتاب اول زیربنای بحث اصلی کتاب مطرح می شود بدین گونه که نویسنده معتقد است که آگاهی با زبان آغاز می شود و آن هم با زبان استعاره! "ادراک به شیوه استعاری" و "زبان استعاری ذهن" در این فصل مورد بحث قرار می گیرد. با استفاده از زبان استعاره واقعیتهای دنیای بیرونی در مورد ادراکات, حسیات, تجارب و نیازهای درونی بازتاب یافته و منجر به خلق فضای درونی در انسان می گردد که ما در آن فضا قادر به دیدن, شنیدن, پس و پیش رفتن, روایت کردن و در کل تمام حرکاتی هستیم که در فضای بیرونی از آن بهره مندیم و اکنون با جادوی استعاره قادر به تجسم خلاق تمام آن فضای بیرونی در جایی در درون خود می باشیم.ایده ذهن دوجایگاهی که بلافاصله بعد از این مبحث مطرح می شود عقیده ای جنجالی است. نویسنده معتقد است آگاهی پدیده ای نیست که از شروع حیات انسانها با ما همراه بوده باشد! او معتقد است آگاهی زمانی حوالی هزاره قبل از میلاد در انسان بوجود آمده است! برای اثبات این ادعا نویسنده ایده ذهن دوجایگاهی و بلافاصله بعد از آن مغز دوجایگاهی را مطرح می کند. او معتقد است انسان ناآگاه دارای دو بخش خدایی و انسانی بوده است و ندای خدایان در سراسر هزاره های طولانی راهنما, راهبر و فرمانروای زندگی انسانها بوده است. توهمات شنوایی و  حتی بینایی که در تمام لحظات زندگی همراه انسانها بوده اند در عمل, نقش آگاهی کنونی را برای انسان بازی می کرده اند.فصل پنجم کتاب اول که نظریه مغز دوجایگاهی را بیان می کند از جمله جذابترین بخشهای کتاب است. بحثی است نورولوژیکی در مورد منشا نداهای دوجایگاهی. نویسنده با تکیه بر تجارب و دانسته های عصب شناسی معتقد است که نیمکره راست به عنوان جایگاه خدایان و نیمکره چپ مغز مرکز تسلط قدرتهای انسانی است. بخشهای "ردپای اعمال خداگونه در نیمکره راست" و "تفاوت نیمکره ها در کارکردهای شناختی انعکاسی از تفاوتهای انسان و خداست" سرشار است از مثالهای حیرت آور و تکان دهنده مبتنی بر علم نورولوژی در مورد اثبات این عقاید. ایجاد دوباره نداها در اثر تحریکات قسمتهای خاصی در نیمکره راست, خاموشی نیمکره راست و توانایی سخنگویی نیمکره چپ در حالی که هر دو نیمکره قادر به فهم زبانند, مستقل بودن نیمکره ها از یکدیگر به طوری که در برخی از بیماران که ارتباط این دو نیمکره با هم قطع شده دست چپ (مربوط به نیمکره راست خاموش) چیزی را حس میکند یا میکشد اما زبان (نیمکره چپ) نامی اشتباه به زبان می آورد به طوری که نیمکره راست از جواب غلط نیمکره چپ دلخور می شود. "شاید مثل دلخوری آتنه هنگامی که او موهای زرد آشیل را گرفت و پیچاند و نگذاشت که شاه خود را بکشد یا دلخوریهای یهوه از تبه کاریهای مردمش" نمونه ای از این مثالهاست. "به هر حال مطالعه برخی بیماران که ارتباط دو نیمکره شان قطع شده است با قاطعیت نشان می دهد که دو نیمکره چنان عمل می کنند که به نظر می رسد مثل دو فرد مستقل هستند که در عصر دوجایگاهی بودند. به نظر من, فرد بود و خدایش"!! کتاب اول با بحثی پیرامون منشا تمدن و چگونگی بوجود آمدن زبان به پایان می رسد.در کتاب دوم "گواهی تاریخ" نویسنده می کوشد با سیری در تاریخ از ابتدای بوجود آمدن تمدن تا هزاره قبل از میلاد شواهدی از سلطه ذهن دوجایگاهی, شنود نداهای توهمی خدایان و نبود آگاهی را ارائه نماید. این شواهد شامل اطلاعاتی نظیر اطاعت از ندای پادشاهان مرده، تجسم خدایان در قابل بتها و انتساب نداهای توهمی به آنها, شاه- خدایان زنده  و صدها مثال و شاهد دیگر می گردد. نویسنده می کوشد نشان دهد که فرمان خدایان باستانی با رعایت سلسله مراتبهای اجتماعی توسط تمام مردم قابل شنیدن بوده و اطاعت مطلق و بدون تاملی به دنبال داشته است. این خدایان مالک جان و مال انسانها بوده و در تمام لحظات زندگی آنها حضور داشته و نقش آگاهی ناداشته را در راهبری و راهنمایی انها ایفا می کرده اند. این اقتدار الهی در هزاره های دوم تا اول قبل از میلاد به دلایل چندی رو به کاهش می نهد. نوشتن یکی از دلایل اصلی آغاز محو شدن نداهای دو جایگاهیست. خط و قانون جای فرمانهای شنوایی را می گیرد. مهاجرت, تجارت و در هم آمیختگی اقوام مختلف باعث تضعیف و برخورد خدایان مختلف, ایجاد جنگها, خصومتها و کشتارهایی می شود که تا آن زمان در تاریخ حیات بشر بی سابقه بوده اند و در نهایت نداهای توهمی کم رنگتر و ناشنیدنیتر می شوند. با تضعیف نداها انسان دوجایگاهی هراسان از سکوت خدایان تلاش می کند تا به هر نحو ممکن عدم حضور آنها را توجیه و آنها را فراخوانی کند. نخستین فرشتگان و دیوان در این زمان ابداع می شوند و انسان ناآگاه و ناامید برای احضار خدایان به غیب گویی, فال و قرعه کشی رو می آورد. نخستین نیایشها و ایده بهشت نیز از این زمان آغاز می شود زیرا انسان دوجایگاهی که خدایان را در تمام لحظات زندگی همراه داشته تا این زمان نیازی به نیایش احساس نمی کرده است.نویسنده در بخش "آگاهی خردورزانه یونان" با توسل به ایلیاد و اودیسه به ارائه نخستین شواهد آگاهی یونانی و کلماتی که او آنها را "اقنومهای پیش آگاهی" می نامد, می پردازد و سیر تحولی این کلمات را از مفاهیم جسمانی و بیرونی تا مضامین درونی و آگاهانه بررسی می کند. در آخرین بخش از کتاب دوم که بحثی پیرامون آگاهی عبرانیهاست تقلیل یافتن خدایان متعدد به یک خدای واحد (یهوه) و شواهد آگاهی در عهد عتیق بررسی می شود. در این قسمت اشاره به افرادی می شود که با حفظ ذهن دوجایگاهی و تداوم شنیدن نداهای خدا یا خدایان به عنوان خیل عظیم پیامبران عبرانی شناخته می شوند و چگونگی رانده شدن آنان را از اجتماع آگاه آن روز عبرانیها بیان می کند.کتاب سوم که به بررسی "آثار ذهن دوجایگاهی در جهان مدرن" می پردازد با اشاره ای به غیب گویی معابد آغاز می شود که تلاشی است برای احضار خدایان و چاره جویی از آنها در گرفتن تصمیمات مختلف. ردپای دیگر ذهن دوجایگاهی در جهان مدرن را می توان در مفهوم تسخیر حال چه مثبت (قدیسان) و چه منفی (جن زدگی) جستجو کرد. بحث بسیار جالب نویسنده در خصوص شعر و آواز و موسیقی و ارتباط آن با نیمکره راست خداگونه بسیار در خور تامل و تفکر است. مسایلی که در مورد ماهیت خداگونه شعر بیان میشود برای ما ایرانیان به هیچ وجه غریب و ناآشنا نیست! هیپنوتیسم ردپایی دیگر از ذهن دوجایگاهی در جهان مدرن فرض شده و بحثی کامل در مورد آن انجام شده است و سرانجام کتاب با فصل مربوط به شیزوفرنی به پایان خود نزدیک می شود. شیزوفرنی شاید نزدیک ترین تشابه به ذهن دوجایگاهی گذشته های دور باشد. "شنود توهمات شنوایی", "افول من تمثیلی", "فروپاشی فضای ذهنی" و "شکست در روایت سازی" از جمله مشکلاتی است که بیمار شیزوفرنیک با آن دست به گریبان است و با در نظر گرفتن خصوصیات مشابه برای ذهن دوجایگاهی می توان به این نتیجه جالب توجه رسید که نسلهای ناآگاه پیشین در واقع نمود عینی بیماران شیزوفرنیک عهد حاضر بوده اند!!! طلایه داریهای علم که عنوان اخرین فصل کتاب است, بحثی است پیرامون مقوله علم و دین و اینکه به رغم تمام تلاشها و حرف و حدیثها این دو هنوز از هم جدا نشده و هدف نهایی و والای علم رسیدن به الهویت, درک عظمت الهی  و بازگشت به معصومیت گم شده در هزاره های تاریخ عنوان میشود.

Migraine : Update on New Therapies

Drugs with a better efficacy or side–effect profile than triptans may soon become available for acute treatment. The future may also look brighter for some of the very disabled chronic migraineurs thanks to novel drug and neuromodulation therapies.

•The oral calcitonine gene–related peptide antagonist Telcagepant is efficacious in acute treatment.
•Triptans, as other drugs, are more efficient if taken early but nonsteroidal anti–inflammatory drugs and analgesics remain useful for acute treatment, according to several meta–analyses.
•Single–pulse transcranial magnetic stimulation during the aura rendered more patients pain–free (39%) than sham stimulation (22%) in one study.
•Topiramate could be effective for migrainous vertigo, but it did not prevent transformation to chronic migraine in patients with high attack frequency.
•Onabotulinumtoxin A was effective for chronic migraine and well tolerated, but the therapeutic gain over placebo was modest; the clinical profile of responders remains to be determined before widespread use.
•Occipital nerve stimulation was effective in intractable chronic migraine with 39% of responders compared to 6% after sham stimulation. This and other neuromodulation techniques, such as sphenopalatine ganglion stimulation, are promising treatments for medically refractory patients but large controlled trials are necessary.
•One study suggests that outcome of patent foramen ovale closure in migraine might depend on anatomic and functional characteristics.

study by : Magis D et al

@Current Opinion in Neurology

Alzheimer's Association

It's always satisfying to pursue worthy ideas and join a right cause.
Lethean Cottage is glad to share some useful information  with the readers in order to improve the public understanding about the disease.
if you're willing to join the cause :

Facebook.com/actionalz

twitter.com/alzassociation
and here :you can find some useful information about the disease
and you can add some useful items to your website:use texts,videos,banners,etc so we can make sure as many people as possible have access to the basic information.

Regards

Pedram 

Walking reduces Alzheimer's progression, 1.5-tesla MRI shows

With the help of 1.5-tesla MRI, researchers at the University of Pittsburgh have found that walking 5 miles per week helps reduce the progression of mild cognitive impairment and Alzheimer's disease in adults already afflicted with the condition, according to a study presented today at the RSNA annual meeting.

The findings expand upon results of a previous study released last month, which found that walking at least 6 miles per week helped to preserve brain size and prevent the onset of dementia in healthy adults.
"Physical activity boosts the brain's resistance to Alzheimer's," said lead study author Cyrus Raji, PhD, from the university's department of radiology. "People who walked more had a slower progression of Alzheimer's disease and mild cognitive impairment over five years, and, as a result, they had a better preservation of the hippocampus, the frontal lobes, and the temporal lobes."
Patients were recruited from the Cardiovascular Health Study - Cognition Study (CHS-CS), which began approximately 20 years ago to explore coronary heart disease and stroke in people ages 65 and older.



Physical activity



Raji and colleagues analyzed the relationship between physical activity and brain structure in 426 people, including 299 healthy adults (mean age, 78 years) and 127 cognitively impaired adults (mean age, 81 years). Among the 127 cognitively impaired adults, 83 people had mild cognitive impairment and 44 adults had Alzheimer's dementia.
"Mild cognitive impairment is believed to be a very early presentation of dementia with symptoms that are not as advanced as Alzheimer's," Raji said. "As many as 50% of the people who have mild cognitive impairment go on to develop Alzheimer's."
In addition to the MRI scans, patients were given the mini-mental state exam (MMSE) to track cognitive decline over five years. Physical activity levels were correlated with MRI and MMSE results. The analysis adjusted for age, gender, body fat composition, head size, education, and other factors.
Among those who began the study as normal and eventually developed Alzheimer's and mild cognitive impairment over 10 years, the people who walked 5 miles per week -- a little less than 1 mile per day -- had similar preservation of brain volume compared to people who remained healthy longer.

image1

Alzheimer's progression

"What excites me the most is that individuals who walked 5 miles per week and developed mild cognitive impairment and Alzheimer's disease did not lose as much brain tissue over time," Raji said. "So the people who walked more had a slower progression of Alzheimer's disease and mild cognitive impairment and, as a result, they had a better preservation of the hippocampus, the frontal lobes, and the temporal lobes."
Another significant finding came from the longitudinal MMSE test results. "In the people who developed Alzheimer's disease and walked 5 miles per week, their MMSE scores went down only one point over 10 years," Raji said. "With sedentary individuals who developed Alzheimer's, their scores went down five points over 10 years."
These findings persisted even after adjusting for factors such as age, gender, race, education, and stroke. The researchers directly attributed the improvement in memory loss to the preserved hippocampal volume from walking.


image2

Raji and his colleagues plan to continue their research of what factors contribute to Alzheimer's and mild cognitive impairment by looking at diet.

"A lot of research is being done to determine if fish oil, for example, can have a beneficial effect in preventing Alzheimer's disease or reducing the risk," he said. "There have been studies done in the past suggesting that fish oil, which helps make up the building blocks of cell membranes and helps with cholesterol metabolism, might have other beneficial effects on the brain as well."

By Wayne Forrest

image 1 :The images compare the beneficial effects of physical activity on the brains of 299 healthy aging individuals to the positive relationships between exercise and brain structure in 127 people with either mild cognitive impairment or Alzheimer's. In both normal aging and cognitive impairment, physical activity preserves volume in brain areas that are important for memory, learning, and attention. These structures include the prefrontal cortex and temporal cortex. The top row of images shows these relationships in a 3D rendering of the brain, while the bottom row shows the prefrontal cortex findings in side view cutaway images of the brain.

image 2 :Side-view cutaway images show the sparing of brain volume in 299 healthy aging people (left) and 127 individuals with cognitive impairment and Alzheimer's (right). In both groups, there is more frontal lobe volume with walking about 1 mile per day, which translates to a reduced risk for cognitive impairment in the healthy aging group and slower decline in the cognitively impaired group.

The Resilient Brain

Those whose familiarity with Oliver Sacks extends only to his vivid book titles — “The Island of the Color­blind,” “An Anthropologist on Mars,” “The Man Who Mistook His Wife for a Hat” — may picture his writing as a gallery of grotesques, a parade of the exotically impaired. Sacks, a practicing neurologist, does specialize in case studies of highly unusual patients. But even as he entertains and diverts with his dramatic tales, Sacks has always been up to something else: he is gently educating us about the frailties and flaws — and the strengths and capacities — of “normal” people, those whose afflictions are of the most ordinary sort. You may never have confused your spouse for an item of outerwear, but have you ever failed to recognize the face of an acquaintance? Fumbled for a word that eluded your grasp? Read a sentence three times and still didn’t get it?
Such familiar slips, and how we handle them, are the stealth subjects of Sacks’ latest book. “The Mind’s Eye” is a collection of essays — some of which have already appeared in The New Yorker — but it has a remarkably graceful coherence of theme, tone and approach. Once again, Sacks explores our shared condition through a series of vivid characters: the woman who couldn’t talk, the man who couldn’t read, the “prosopagnosic” who couldn’t identify her own face in a photograph. (For those who wonder just how Sacks locates such people, it soon becomes clear that many of his patients find him, after recognizing themselves in his writing. They enter his care through the pages of his books, and in turn become characters in his next round of stories.)
The sufferers who write to Sacks receive a deeply empathetic response. Of one correspondent, a woman who has lost the capacity to read (but, remarkably, retains the ability to write), Sacks notes that he responded to her by telephone. “I normally would have written back,” he tells us, but in this case calling “seemed to be the thing to do.” Over time this patient, afflicted with a degenerative brain condition called posterior cortical atrophy, loses her ability to recognize objects and people, though she retains a keen sense of color and shape. When Sacks meets her in person to see how she navigates her everyday life, he dresses head to toe in red so she can keep track of him in a crowd.
Given to such un-self-consciously generous gestures, Sacks would seem to be the ideal doctor: observant but accepting, thorough but tender, training his full attention on one patient at a time. For the patient’s benefit and for ours, he illuminates every uncanny detail, brings out every excruciating irony. The woman for whom Sacks dresses in red, for example, is a virtuoso pianist, and the first sign of her malady is a sudden inability to read music. She is joined in these pages by a novelist who wakes up one morning unable to read, and an intensely sociable woman who is suddenly struck dumb. But Sacks is not primarily interested in documenting pathology, or even curing disease, which in most cases is impossible. There are no miraculous “awakenings” here.
Rather, he is most engaged by the process of compensation, how people make up for what they have lost, wresting new possibilities from their newly imposed limits. There’s the blind man who develops super-sensitive hearing, the deaf woman who catches tiny shifts in facial expression — and that pianist, who loses her ability to read music but gains new richness in her thinking about music. “She felt that her musical memory, her musical imagery, had become stronger, more tenacious, but also more flexible, so that she could hold the most complex music in her mind, then rearrange it and replay it mentally, in a way that would have been impossible before,” Sacks writes.



Sometimes these compensations are biological, he explains. The brain, plastic even into adulthood, reshapes itself to fit a new reality. In people who become blind as adults, Sacks notes, the part of the brain that once processed visual information does not atrophy, but is reallocated for another use. “The visual cortex, deprived of visual input, is still good neural real estate, available and clamoring for a new function.”
At other times, compensation takes the form of an ingenious tool. The social butterfly rendered mute by a stroke uses a lexicon, a book full of words to which she can point. (The lexicon is devised for her by a speech pathologist who is herself, Sacks notes in passing, a quadriplegic.) The novelist employs a journal-like “memory book” to teach himself how to read again. Such tools can help forge a new whole from patients’ shattered identities. As the novelist puts it, “The memory book returned a piece of myself to me.”
Sacks is most attuned to the psychological and emotional adjustments patients make to their new status; he clearly admires how they have gone on “to develop other ways of doing things, capitalizing on their strengths, finding compensations and accommodations of every sort.” In her piano playing, Sacks writes, the woman who could no longer read “not only coped with disease, but transcended it.”
So rewarding are the compensations of Sacks’ patients, in fact, that we begin to feel as if the tragedies that befell them were not tragedies at all, but — as the self-help books say — opportunities for growth. Then we arrive at the book’s penultimate essay, about Sacks’ own ocular cancer. His story is told in journal entries, dated from December 2005 to December 2009, which take on a deepening urgency as we experience along with him one event after another: the strange symptoms, the grim diagnosis, the painful treatment, the halting, incomplete recovery. Sacks’ jaunty confidence and sanguine attitude disappear, replaced by a panicked and sometimes piteous voice that is new to the reader and (if I may be so ungenerous) quite unwelcome. On Dec. 25, 2005, he writes: “Everyone says ‘Merry Christmas!’ and I reply in kind, but this is the darkest Christmas I have ever known. The New York Times today has pictures and stories of various figures who have died in 2005. Will I be among those figures in 2006?”



I found myself longing for the return of the ideal doctor of earlier chapters, and then I saw. He was right there, teaching us one more lesson: that compensation is meager consolation, that loss is painful, no matter what replaces it. Even those of us who have never lost our sight or faced a cancer diagnosis know how profoundly unsettling change can be. A move to a new job or a new neighborhood may make us, for a time, full of complaint and self-pity. It is characteristic of Sacks’ generosity to his patients that he allows only himself to be seen in this light.



Yet Sacks does eventually rally, his playful spirit intact. He notices that the blind spot, or scotoma, in his tumor-­stricken right eye resembles the shape of Australia, “complete with a little bulge in the southeast corner — I thought of this as its Tasmania.” He observes that if he keeps his gaze steady for a few moments, his brain will “fill in” his blind spot with imagery borrowed from the parts of the scene he can see. The ever resilient brain, he remarks, “does not just fill in color, it fills in patterns too, and I enjoyed experimenting with my own scotoma, testing its powers and limitations.” Sacks calls this activity “scotomizing.”



Irrepressible though he may be, Sacks will not let us forget the sober lesson of his experience. He ends the essay not with a cheering paean to human resilience, but with a bleak new turn of events. A hemorrhage has further clouded his vision, leaving him with a gaping “nowhere” in his right visual field. “Time will tell whether I am able to adapt to this new visual challenge,” he writes.



Perhaps Sacks will take comfort from his novel-writing patient, who with great effort taught himself to read again. “The problems never went away,” the novelist reports, “but I became cleverer at solving them.”