Questioning brain health status quo in depression and Alzheimer’s

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mentalhealthpuzzleTwo good recent pieces in The New York Times bring to the fore­front the need to ques­tion sta­tus quo mind­set and prac­tices about how to mea­sure and enhance brain health.

Sleep Ther­a­py Seen as an Aid for Depression

  • “Cur­ing insom­nia in peo­ple with depres­sion could dou­ble their chance of a full recov­ery, sci­en­tists are report­ing. The find­ings, based on an insom­nia treat­ment that uses talk ther­a­py rather than drugs, are the first to emerge from a series of close­ly watched stud­ies of sleep and depres­sion to be released in the com­ing year…If the fig­ures con­tin­ue to hold up, the advance will be the most sig­nif­i­cant in the treat­ment of depres­sion since the intro­duc­tion of Prozac in 1987.”
  • “The ther­a­py that Dr. Man­ber, Dr. Car­ney and the oth­er researchers are using is called cog­ni­tive behav­ior ther­a­py for insom­nia, or CBT‑I for short. The ther­a­pist teach­es peo­ple to estab­lish a reg­u­lar wake-up time and stick to it; get out of bed dur­ing wak­ing peri­ods; avoid eat­ing, read­ing, watch­ing TV or sim­i­lar activ­i­ties in bed; and elim­i­nate day­time napping.”

Alzheimer’s Anx­i­ety

  • “In April 2012, the Food and Drug Admin­is­tra­tion approved Eli Lilly’s radioac­tive mol­e­cule for patients who are being eval­u­at­ed for Alzheimer’s dis­ease and oth­er caus­es of cog­ni­tive decline that result in for­get­ful­ness or disorientation.”
  • “The ques­tion patients and their fam­i­lies should be ask­ing is, what does this test real­ly offer? …Let’s be clear: it does not cure the dis­ease or affect symp­toms. At best it iden­ti­fies what might be caus­ing a patient’s for­get­ful­ness. But, at worst, it can get that diag­no­sis wrong. Accord­ing to the company’s own post-mortem study of 59 ter­mi­nal­ly ill patients, false pos­i­tives in scans for the pres­ence of amy­loid were report­ed in up to 3 per­cent of cas­es, while up to 20 per­cent of cas­es result­ed in a false neg­a­tive: patients were diag­nosed as not hav­ing amy­loid and thus Alzheimer’s, even when they did…To make things more con­fus­ing, while col­lo­qui­al­ly called an “Alzheimer’s test,” the scan doesn’t diag­nose Alzheimer’s demen­tia — it only deter­mines the pres­ence of amy­loid. And our under­stand­ing of the con­nec­tion between the two is shaky. While every­one who has Alzheimer’s also has amy­loid, not every­one with amy­loid has Alzheimer’s demen­tia. Almost a third of cog­ni­tive­ly nor­mal elder­ly peo­ple have these pro­tein clus­ters in their brains. On the scan they would light up. But those patients don’t have Alzheimer’s demen­tia and we don’t know how like­ly they are to devel­op it in the future. Imag­ine the anguish of that error.”

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