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MILD OR MODERATE NEUROCOGNITIVE DISORDER

 

We live in a world that constantly asks us to learn new things, new procedures, and to remember them. This system continuously puts us to the test.

 

One speaks about mild or moderate cognitive disorder (DSM 5.0 Mild Neurocognitive disorder, APA 2013) when a decline in even only one of the following functions occurs: Attention, Learning and Memory, Language, Motor Perception, or Social Intelligence) that may not interfere with the usual work or social activities of the patient: but it is the subject themselves who realizes that their performance has worsened.

 

Scientists debate if, in this phase, one can already say it is a disorder or illness, but what is certain is that the earlier one intervenes, the better the evolution will be: therefore it is better to prevent the worst case scenario than to wait around resigned!

 

Often this perception is accompanied by anxiety or increased irritability which heightens the problem. Sometimes problems present themselves under a clear sky, other times they follow a traumatic event, or they are accompanied by another disease, or even by a delicate phase of life (e.g. Menopause.)

 

What can be done?

 

PROGRAM

1. Diagnosis and evaluation: is it a truly cognitive problem or is it something else?
– A battery of neuropsychological tests, in order to evaluate variations and even levels and to monitor the situation over time

2. Intervention, determined on the basis of individual evaluations
– Continual Electric Stimulation (daily stimulation for 10 sessions)
– Magnetic Transcranial Stimulation in selected cases (A cycle of 15 or more sessions)

For such treatments, they must be accompanied by follow-up sessions (the resumption of regular care)

 

PROGRAME FOR THE IMPROVEMENT OF COGNITIVE FUNCTIONS  

 

The same program can be indicated for an Improvement of cognitive performance (cognitive enhancement), when requested, for example the need to learn a new language or procedure, following a period of intellectual inactivity, after a long period of illness or an infectious one.

 

Article about memory:

 

The memory of the future, in this way we will construct our recollections

 

It is possible to remember things never felt or erase negative experiences from the mind. Science is rewriting the brain. Like in a movie. Magnetic stimuli, small electric shocks. And experimental drugs. Tests are being multiplied (like in a science fiction movie) they transfer new information to the brain. In order to treat mental disorders, but also to create artificial intelligences up until now unpublished.

by ELENA DUSI

La_Repubblica, 28 ottobre 2013

 

MEMORIES erased. Recollections created on nothing. Electrodes that deliver electric current to the deep layers of the brain. Magnetic stimuli capable of altering the perception of beauty and what is right. Gentle shocks of a few milliamperes that give a ‘wake up alarm’ to neurons. Miniscule brains the in embryotic state grown in a test tube instead of a mother’s womb from stem cells. And the astrophysicist Stephen Hawking in the meantime reassures: “We will reach immortality. We will be able to one day transfer information from our brain to an artificial backup.”

 

A similar idea – the architecture of the human mind reproduced in the silicon of a computer – will receive a billion euro in ten years from the European Union. This is not science fiction, but rather a flagship project which involves 90 universities and research centers in 22 countries on the continent. In the USA, contemporaneously, for an analogous initiative President Obama has promised 3 billion dollars.

The sanctum of our conscious and personality has therefore ceased to be impenetrable. The homo faber began to put his hand to the most sacred and protected part of himself. After decades of results not exactly egregious by the chemistry and by pharmaceutical drugs, the new “artisans” of the grey matter now promise concrete results for some mental illnesses. Transmitting a bit of concern, mixed just right with hope.

 

It sounds like the plot from “Total recall”, but it is a real experiment: studying some small mice in his laboratory at the University of California at Irvine, professor of Neurobiology Norman Weinberger has succeeded to insert some miniscule electrodes to the brain, until reaching the auditory cortex. And there he implanted some artificial memories: memories of experiences (in this case a sound stimulation) that never happened. The description of the experiment was published on August 29 in Neuroscience.

Weinberger today explains: “Our research demonstrates that it is possible to insert in the brain specific memory contents. These recollections are completely false: they do not come from experience. According to our results it would be possible to create fake memories also in humans, but at this stage of research we have only the objective to unveil how the mechanism for the fixation of recollections works. We do not ask ourselves about therapeutic aims.”

 

On the same street we find the experiments on humans of a drug that in contrast, erases memories. The objective is to help people struck by Post-traumatic stress disorder which particularly affects former soldiers. The substance used is called “Propanolol” and it sabotages the delicate process that happens in the brain when an experience is stored in the form of a memory.

This chemical substance – under study for about ten years on veterans and on victims of accidents who arrive at the Emergency room – takes off from the principle that the more charged an experience is will emotional significance (primarily fear, but also joy or anxiety), the more the memory will be fixed in an indelible fashion. The propanolol mitigates the emotional response to trauma. And thus dampens the pre-eminence of a painful event in the hierarchy of memories.

Erasing or writing memories as if the brain were a blackboard is one of the inventions that was born in movies even before in the laboratories. In “Eternal Sunshine of the Spotless Mind” two former lovers turn to a clinic in order to eliminate every mnemonic trace of their relationship. The effect, paradoxically, is to forget what happened and to fall in love with each other again in a new encounter. In “Total Recall” a company promises their clients the creation of memories drawn from experiences that they would have so wished to have had. The protagonist has implanted in himself the memory of the life of a spy that he always dreamed of. But a technical problem provokes a series of misadventures in which it isn’t possible to distinguish anymore between reality and artificial recollections.

“Some experiments manipulate the brain effectively. And thus they also manipulate the mind,” Michele Di Francesco comments, the rector of the University Institute of Higher Learning of Pavia (Istituto Universitario di Studi Superiori di Pavia) and one of the founders of the young Italian Society of Neuro-ethics (Società Italiana di Neuroetica). “Memory is the bases of our identity and without recollections, the “poetic I,” one empties. Of course, techniques such as deep brain stimulation promise to improve the symptoms of Parkinson’s Disease.

 

But for all their potential, these methods require caution.” The risk is that the man of “know thyself” may take a shortcut which brings him to “change thyself”. “That would be the peak,” continues Di Francesco, “if our species which has always changed the world thanks to its intelligence and culture, now would start to change even itself. Moments of crises help to grow. If a situation makes us sad, the better reaction is to change the situation, not to erase the sadness.”

 

Among the instruments used in order to “enter” in the brain and modify its circuits there is electric and magnetic stimulation. The first is used for Parkinson’s Disease or in extreme forms of Depression: a very thin electrode is inserted in the brain in a permanent manner and it sends small shocks to precise groups of neurons. 700 thousand people in the world are under this method. The American DARPA (Defense Advanced Research Projects Agency) decided a week ago to finance with 70 million dollars these stimulators. And the science fiction writer Michael Crichton dedicated Terminal Man to technology: the brain of an epileptic man is inserted with a computer covered with electrodes. But the apparatus sends erratic impulses, and the patient becomes a criminal.

Nothing similar has ever happened in reality. But a small current on the exterior of the cranium (nothing to do with the energy of electroshock) has shown to have bizarre effects. In May, in an experiment of the University of Vancouver published in Current Biology, 25 volunteers wore a little helmet with some electrodes, receiving a shock of 1 milliampere. Their speed in making mental calculations was improved up to 5 times. But the effect disappeared after six months.

How the doping with the current works is not clear, but in June another experiment added mystery to the phenomenon. A series of shocks at 2 milliamperes (10thousand times less than an electric outlet, and the sensation of a light sting on the head) has made the 99 volunteers rather more generous in rating as beautiful to some faces shown in photographs. The technique has thus far interested a company that produces videogames. The Foc.us has put on the market at 249 dollars an earbud that administers small shocks. “Make your synapses faster, with Transcranial Electric stimulation” says the slogan of a technology perhaps escaped too much in a hurry from the laboratories.

Other than debates on Prozac, anyhow. With the pharmaceutical industry that in the arena of mental illness has not gone forward in respect to the active principles of the Sixties, the new orientation appears to be that of grasping “English keys and screwdrivers.” The American business Medtronic which sells apparatus for electric stimulation claims to have satisfied more than 100thousand patients affected by chronic pain, epilepsy, compulsive eating and other dependencies. “The use of electrodes in the brain,” according Todd Sacktor, neurologist of the State University of New York “remains the last resort, because it requires surgical intervention. Even if these instruments are useful in research, in my opinion the future of therapy is in the always more perfected use of brain scans, drug treatment, and psychotherapy.”

The transition from the chemistry of drugs to electric stimulation is that which instead Josef Parvizi, director of the Cognitive Electro-Physiology program at Stanford hopes for: “The language of the brain is a combination of chemistry and electricity. Up until now in trying to treat the diseases of the brain the chemical approach has been perfected, through drugs. But the cost to the rest of the body has been high. Let’s take epilepsy. If we assume a kilo of pills, 900 grams end up in the liver, the pancreas, the bones, and only 100 grams reach the target organ, that is the brain. But 99 grams will go to ease cognitive areas that have nothing to do with epilepsy, giving cloudy vision, feeling faint, prostration. Only one gram will hit the neurons responsible for the illness. This is a brutal approach, one that must be overcome. With more targeted drugs. But also, if necessary, with electricity.”