Noteworthy News Articles on Mental Health Topics, October 18-25, 2005
Benedict Carey, New York Times- 10/18/2005 They seem almost alive: snapshots of the living human brain. Not long ago, scientists predicted that these images, produced by sophisticated brain-scanning techniques, would help cut through the mystery of mental illness, revealing clear brain abnormalities and allowing doctors to better diagnose and treat a wide variety of disorders. And nearly every week, it seems, imaging researchers announce another finding, a potential key to understanding depression, attention deficit disorder, anxiety. Yet for a variety of reasons, the hopes and claims for brain imaging in psychiatry have far outpaced the science, experts say. After almost 30 years, researchers have not developed any standardized tool for diagnosing or treating psychiatric disorders based on imaging studies. Several promising lines of research are under way. But imaging technology has not lived up to the hopes invested in it in the 1990's -- labeled the "Decade of the Brain" by the American Psychiatric Association -- when many scientists believed that brain scans would turn on the lights in what had been a locked black box. Now, with imaging studies being published at a rate of more than 500 a year, and commercial imaging clinics opening in some parts of the country, some experts say that the technology has been oversold as a psychiatric tool. Other researchers remain optimistic, but they wonder what the data add up to, and whether it is time for the field to rethink its approach and its expectations. "I have been waiting for my work in the lab to affect my job on the weekend, when I practice as a child psychiatrist," said Dr. Jay Giedd, chief of brain imaging in the child psychiatry branch at the National Institute of Mental Health, who has done M.R.I. scans in children Monday through Friday for 14 years. "It hasn't happened. In this field, every year you hear, 'Oh, it's more complicated than we thought.' Well, you hear that for 10 years, and you start to see a pattern." Psychiatrists still consider imaging technologies like M.R.I., for magnetic resonance imaging, and PET, for positron emission topography, to be crucial research tools. And the scanning technologies are invaluable as a way to detect physical problems like head trauma, seizure activity or tumors. Moreover, the experts point out, progress in psychiatry is by its nature painstakingly slow, and decades of groundwork typically precede any real advances. But there is a growing sense that brain scan research is still years away from providing psychiatry with anything like the kind of clear tests for mental illness that were hoped for. "I think that, with some notable exceptions, the community of scientists was excessively optimistic about how quickly imaging would have an impact on psychiatry," said Dr. Steven Hyman, a professor of neurobiology at Harvard and the former director of the National Institute of Mental Health. "In their enthusiasm, people forgot that the human brain is the most complex object in the history of human inquiry, and it's not at all easy to see what's going wrong." For one thing, brains are as variable as personalities. In a range of studies, researchers have found that people with schizophrenia suffer a progressive loss of their brain cells: a 20-year-old who develops the disorder, for example, might lose 5 percent to 10 percent of overall brain volume over the next decade, studies suggest. Ten percent is a lot, and losses of volume in the frontal lobes are associated with measurable impairment in schizophrenia, psychiatrists have found. But brain volume varies by at least 10 percent from person to person, so volume scans of patients by themselves cannot tell who is sick, the experts say. Studies using brain scans to measure levels of brain activity often suffer from the same problem: what looks like a "hot spot" of activity change in one person's brain may be a normal change in someone else's. "The differences observed are not in and of themselves outside the range of variation seen in the normal population," said Dr. Jeffrey Lieberman, chairman of the psychiatry department at Columbia University Medical Center and director of the New York State Psychiatric Institute. To make matters even more complicated, many findings are disputed. In people with severe depression, for instance, researchers have found apparent shrinkage of a part of the temporal lobe called the hippocampus, which is critical for memory. But other investigators have not been able to replicate this finding, and people with injuries to the hippocampus typically suffer amnesia, not depression, psychiatrists say. For problems like attention-deficit disorder and bipolar disorder, the experts say, psychiatrists have much less research on which to base their theories. Most fundamentally, imaging research has not answered the underlying question that the technology itself has raised: which comes first, the disease or the apparent difference in brain structure or function that is being observed? For a definitive answer, researchers would need to follow thousands of people from childhood through adulthood, taking brain scans regularly, and matching them with scans from peers who did not develop a disorder, experts say. Given the expense and difficulty, such a study may never be done, Dr. Hyman said. One investigator has used imaging research to fashion a small, experimental psychiatric treatment. In a series of studies of people with severe depression, Dr. Helen Mayberg, a professor of psychiatry at Emory University in Atlanta, found a baffling pattern of activity. Using PET scanning technology, Dr. Mayberg found sharp dips and spikes of activity in about a half-dozen areas of these patients' brains as their moods improved while they were taking either antidepressant drugs or placebos. The changes were similar in all patients, but it was difficult to tell how the scattering of the dips and spikes were related. By analyzing the peaks and valleys on the scans as part of a circuit - networked together, like a string of Christmas lights--Dr. Mayberg found that one spot in particular seemed to modulate the entire system, like a transformer or a dimmer. She confirmed the importance of this spot, called Brodmann area 25, by scanning the brains of mentally healthy people while they remembered painful episodes from their lives: while sad they, too, showed increased activity in this area. In March, Dr. Mayberg and a team based at the Rotman Research Institute in Toronto reported on six patients who had had electrodes implanted in their brains next to Brodmann area 25. All had been severely depressed for at least a year, and they had responded poorly to available therapies. The implanted electrodes, often used to treat Parkinson's disease, produce a current that slows neural activity, for reasons scientists do not yet understand. So far, the researchers reported in the journal Neuron, four of the six people have shown significant and lasting recovery; all four are still on antidepressant drugs but at reduced doses. And all four have returned to work or their usual routines, Dr. Mayberg said. The widely reported experiment has generated more than 300 requests from people to be considered for the operation, she added. "It's very important to understand that this is experimental, and the next step is to replicate what we did, with a placebo, and that could send us right back to the drawing board," Dr. Mayberg said in an interview. The findings so far are encouraging, she said, "but the idea that this is something for every severely depressed patient -- well, shame on us if we suggest that. The brain is a very big place and we had better have a very good idea of what we're doing before holding this out as a treatment." Many people would rather not wait for the science of imaging to mature, however. At clinics in California, Washington, Illinois, Texas and elsewhere, doctors offer brain scans to people with a variety of conditions, from attention-deficit hyperactivity disorder, often called A.D.H.D., to depression and aggressive behavior. Dr. Daniel Amen, an adult and child psychiatrist based in Newport Beach, Calif., said he performed 28,000 scans on adults and children over the past 14 years, using a technique called Spect, or single photon emission computed tomography. In an interview, Dr. Amen said that it was unconscionable that the profession of psychiatry was not making more use of brain scans. "Here we are, giving five or six different medications to children without even looking at the organ we're changing," he said. He said the scans had helped him to distinguish between children with attention deficit problems who respond well to stimulants like Ritalin and those who do poorly on the drugs. In a series of books and medical articles, Dr. Amen argued that the images helped convince people that the behavior problems had a biological basis and needed treatment, with drugs or other therapies. "They increase compliance with treatment and decrease the shame and guilt" associated with the disorders, he said. At the Brainwaves Neuroimaging Clinic in Houston, doctors use the scans to diagnose and choose treatment for a range of psychiatric problems, according to a clinic spokeswoman. And a variety of doctors advertise the imaging services, particularly for attention-deficit disorder, on the Internet. But the experts who study imaging and psychiatry say there is no evidence that a brain scan, which can cost more than $1,000, adds significantly to standard individual psychiatric exams. "The thing for people to understand is that right now, the only thing imaging can tell you is whether you have a brain tumor," or some other neurological damage, said Paul Root Wolpe, a professor of psychiatry and sociology at the University of Pennsylvania's Center for Bioethics. He added, "This imaging technology is so far from prime time that to spend thousands of dollars on it doesn't make any sense." The big payoff from imaging technology, some experts say, may come as researchers combine the scans with other techniques, like genetic or biochemical tests. By radioactively marking specific receptors in the brain, for example, researchers are using brain scans to measure how brain chemicals known to affect mood, like dopamine, behave in people with schizophrenia, compared with mentally healthy peers. Imaging researchers are also studying depression-related circuits to see how they may arise from genetic variations known to put people at risk for depression. And as always, the technology itself is improving: a new generation of M.R.I. scanners, with double the resolution power of the current machines, is becoming more widely available, Dr. Lieberman said. "With increased resolution, we'll be able to do more sensitive and more precise work, and I would not be surprised if anatomy alone based on volume will be a diagnostic feature," he said. "We have gained an enormous amount knowledge from thousands of imaging studies, we are on the threshold of applying that knowledge, and now it's a matter of getting over the threshold." But for now, neither he nor anyone else can say when that will happen.
Diana Henriques, New York Times- 10/19/2005 When Carrie Beth Walsh and her two toddlers landed at the airport in Seoul, South Korea, last year, there was no sign of her husband, an Army pilot who had been transferred there six weeks earlier. He eventually showed up in a taxi, broke and unprepared for his family's arrival -- no rental car for the drive to his base, no apartment, no credit cards in his wallet that were not already up against his loan limits. "He was making more than $60,000 a year," Ms. Walsh said. "But we were always broke." She soon learned why. Her husband, Warrant Officer Aaron W. Walsh, had pumped more than $20,000 into the Army's own slot machines on bases in South Korea. Last month, his marriage and career shattered, Mr. Walsh, who is 33, resigned from the Army to avoid a court-martial on desertion charges stemming from his gambling habit.
Associated Press, 10/22/2005 AUGUSTA, Maine --Domestic violence often has an impact on victims where they work, a state-sponsored survey of more than 120 domestic violence victims suggests. And that can lead to increased absenteeism, higher health costs and decreased productivity, says the survey and report released Friday by the Maine Department of Labor and Family Crisis Services. "It hurts our economy," Gov. John Baldacci said at a news conference that marked Domestic Abuse Awareness Month. "Its hurts our families and children. And I think it hurts the reputation of our state." Baldacci and state Labor Commissioner Laura Fortman urged employers to enact domestic-violence action plans, and to remember that abuse is not the victim's fault. The survey showed that abuse sometimes takes place at work, even if women moved away or hid from their abusers. Seventy-eight percent said the abuser showed up at their workplace, and 13 percent said they were actually assaulted at work. Nearly 80 percent of the women responding said abuse at home caused them to arrive late to work, and 87 percent said the abuser made harassing calls to their work phone. Ninety-eight percent of the women said the violence affected their ability to concentrate while on the job. It also said that 93 percent were unaware that Maine law requires employers to provide time off to victims of domestic violence, sexual assault and stalking. Six out of 10 women surveyed said they lost or quit a job as a result of domestic violence. Survey results also suggested that some employers were unresponsive to victims' concerns and that many victims feared they'll be fired if they ask for help. 'Lincoln's Melancholy': Sadder and Wiser Patricia Cohen, New York Times Book Review- 10/23/2005 LINCOLN'S MELANCHOLY How Depression Challenged a President and Fueled His Greatness. By Joshua Wolf Shenk. 350 pp. Houghton Mifflin Company. $25. Can the generally disappointing crop of national leaders today be attributed to the Prozac Generation's addiction to cheeriness? That is one strain of thought in Joshua Wolf Shenk's book, which argues that Abraham Lincoln's lifelong struggle with depression was responsible for his becoming one of America's greatest presidents. The idea that suffering fuels creativity and wisdom is an old one, but in a country where 25 million people take antidepressants, it has its limits. The emotionally suffering artist stokes our romantic imagination; the emotionally suffering politician evokes panic. Who wants to think about Eeyore nose to nose with bin Laden? But depression, Shenk says, has gotten bad press. This is not a contrarian's gimmick; he has firsthand knowledge. In previous writings about his own depression, Shenk credited it with shaping his personality. That he would then conclude the same about his hero should not be all that surprising. If "Lincoln's Melancholy," a thoughtful but uneven book, is the product of a particularly personal experience, it is also the result of the latest currents in psychology and Lincoln studies. After years of dismissing the significance of Lincoln's inner life, scholars have reversed course in the last two decades. (A history of this history is nicely summarized in the afterword.) And in a series of 1998 lectures at Harvard, Andrew Delbanco linked Lincoln's private despair with his public work. "The lesson of Lincoln's life," he said, is that "a passion to secure justice" can be a "remedy for melancholy." Shenk inverts this formulation. Melancholy, he declares, led Lincoln to have that passion. In making the case, he synthesizes the latest research, recounts family history and eyewitness testimony, and even offers readers his own interpretation of Lincoln's poetry. Trying to capture the mental state of someone who lived 150 years ago, however, is like trying to hold fast to a shadow. Fortunately, Shenk has a nuanced understanding of the difficulties: how psychiatric diagnoses can't account for reality's complexity; how some areas, like Lincoln's sex life, are unknowable; how incomplete sources, intuition and common sense are used to construct a story we call history. The structure of Shenk's story is like that of a mythic tale in which the hero sets out on a journey, goes through various trials and then uses the knowledge he gained along the way to triumph. That this journey takes place across the landscape of depression rubs against the modern American grain. "Whereas 'melancholy' in Lincoln's time was understood to be a multifaceted phenomenon that conferred potential advantages along with grave dangers, today we tend to discount its complexities," Shenk writes. "As a culture Americans have strangely decided to endow optimism with unqualified favor. Politicians today compete to be the most optimistic, and accuse their opponents of pessimism, as if it were a defect." This obsession with optimism operates like a kind of cultural Prozac. Shenk suggests that our culture's relentlessly exaggerated cheer interferes with sound political judgment. It's a provocative analysis, based on an imaginative blend of psychology and history. But that approach doesn't work nearly as well when applied to the specifics of Lincoln's life. In Shenk's eyes, Lincoln went through three stages of depression. The first hit in 1835, when he was 26, and remained through the ups and downs of his early political career in Illinois. "I am now the most miserable man living. . . . I must die or be better," he wrote in 1841. A presumed love affair with a friend who died, Ann Rutledge, has generally been cited as the cause of his first breakdown. But Shenk is skeptical, as he is also skeptical that Lincoln's second breakdown was caused by a temporary breakup with his future wife, Mary Todd. Depressives overreact to small events as much as to major ones, and Shenk discusses any number of things -- including severe political troubles, profound doubts about Mary Todd, feelings for other women and bleak weather (a frequent trigger) - that could have been the cause. More important is what turned Lincoln from thoughts of suicide, and that was a sense of purpose, an "irrepressible desire" to achieve something meaningful. Lincoln's marriage in 1842 to the emotionally troubled Mary Todd marks the second stage, Shenk writes. Stoic resignation (though not the most auspicious mood for a wedding) replaced the public exhibitions of despair. He maintained that reserve; in 1850, this candid chronicler of emotion barely mentioned the death of his 3-year-old son, Eddie. And though Lincoln remained an unconventional thinker, he increasingly turned to the Bible for solace. During this period, when he won election to the House of Representatives but lost out on two Senate seats, Lincoln adapted, Shenk says, working frantically and developing the discipline, creativity and perseverance that would later serve him in his political crusade. Finally, in the mid-1850's, Lincoln transformed his personal struggle into a struggle for universal justice. He responded to the loss of the Senate race to Stephen A. Douglas in 1858 not with suicidal musings but with resolve: "The cause of civil liberty must not be surrendered at the end of one, or even, one hundred defeats." Later, during the dark days of the Civil War, President Lincoln wrote, "I expect to maintain this contest until successful, or till I die." His experience with melancholy provided him with the creative juice that inspired his greatest writings, as well as with the religious feeling that inspired his idea of nationhood and his own role as an "instrument" of a higher power charged with a sacred trust. At the end comes the hero's triumph: the Emancipation Proclamation fulfills his lifelong dream. Referring to his earlier rejection of suicide, Lincoln told a friend that he had indeed accomplished something meaningful: "I believe in this measure my fondest hopes will be realized." Shenk provides some fascinating details about Lincoln and offers a sensitive portrait of his emotional state. But in the end, no psychological profile can do justice to Lincoln's life. And the speculative "may haves" and "might haves" don't stretch far enough to connect cause with effect. For starters, some essential facts don't fit. The qualities that Shenk argues were the direct result of Lincoln's struggle with depression were clearly evident early in life, before the cloud of melancholy cast its shadow. Although Shenk writes that a sense of purpose was "the key that unlocked the gates of a mental prison," Lincoln had that drive from the beginning. "Even in his early days," Lincoln "believed that there was a predestined work for him in the world," his friend O. H. Browning said. In Lincoln's first published political speech, in 1832, he said his greatest ambition was to be "truly esteemed of my fellow men, by rendering myself worthy of their esteem." Nowhere in the book does Lincoln explicitly say, as Shenk insists, that his own emotional suffering sensitized him to the suffering of slaves. Shenk also overstates his case for Lincoln's melancholy, as when he characterizes perfectly appropriate responses - openly crying at the death of a close friend, disappointment at a political loss - as evidence of depression. When the specifics don't fit the story line, Shenk is forced to do some patchwork, so that the explanation of Lincoln's "depressive realism" is followed a few pages later by an explanation of why his faith in progress and redemption also makes him a "tragic optimist." And while depressives may be politically acute, creative and spiritual, they don't have a monopoly on these attributes. It's obvious that the sum total of experience makes someone who he is. Precisely how that alchemy works is the mystery. Shenk's repeated references to Lincoln's gloomy appearance may be telling in a way he did not intend. By drawing attention so frequently to the outermost expression of Lincoln's sadness, he underscores how little we ultimately know about its innermost workings. Storm Still Swirls in the Minds Of Many Kids Who Fled Katrina Kevin Merida, Washington Post- 10/23/2005
Mireya Navarro, New York Times- 10/23/2005 Katherine Keliher, 9, of Lakeville, Minn., could sleep an extra hour every weekday morning if she wanted to. But she would rather get up early, sit down at her computer and spend that time trading instant messages with her best friends, five girls she will soon see at school. "We just talk about, like, 'What are you going to do today?' and stuff like that," Katherine said. Her mother, Judy Keliher, says she isn't looking to deprive Katherine of her messaging access. "For fourth graders this is critical," she said, understanding that video games, cellphones, iPods and other high-tech gear are just part of growing up in a digital world. But Ms. Keliher is concerned about the amount of time her children, including a son, Matthew, 14, spend there. So she is asserting some control. She says she will allow only one computer in the house and limits Matthew's and Katherine's screen time each night. "I don't like them to be home and be lazy, not at the expense of doing other things that need to get done," said Ms. Keliher, 43, who is divorced and works full time as the manager of a hardware store. "I just put it into the whole scope of a healthy lifestyle." In interviews and surveys many parents say that their children spend too much time in front of computers and on cellphones. Some parents worry that long, sedentary hours spent at a computer may lead to weight gain, or that an excess of instant and text messaging comes at the expense of learning face-to-face social skills. Some complain of having to compete for their childrens' attention more than ever. A report on teenagers and technology released this summer by the Pew Internet and American Life Project found that teenagers' use of computers has increased significantly. More than half of teenage Internet users go online daily, up from 42 percent in 2000, the report said; 81 percent of those users play video games, up from 52 percent. Instant messaging has become "the digital communication backbone of teens' daily lives," used by 75 percent of online teenagers, according to the Pew report. "Parents are really struggling with this," said David Walsh, the president of the National Institute on Media and the Family, a nonprofit educational organization in Minneapolis that began a program this year to help families reduce screen time and increase physical activity. "As the gadgets keep evolving, they keep consuming more and more of our kids' time. Our kids need a balanced diet of activity, and the problem is that it's getting out of balance. I don't think as a society we're dealing with it yet." Technological advances have produced generational conflicts before, of course, whether the gadget was a rabbit-ear television set, a transistor radio or a personal computer. The young would find the latest thing exciting and freeing. Parents would worry that it was distracting and cramping academic and social development. So it goes today. Only now it is not a single high-tech wonder that concerns parents but a seemingly constant and ever-more-sophisticated tide of them. As new technological devices beckon -- Apple recently rolled out an iPod that can play video -- young people are not necessarily shedding old media. A survey of 8- to 18-year-olds by the Kaiser Family Foundation this year found that the total amount of media content young people are exposed to each day has gone up by more than one hour over the past five years, to eight and a half hours. But because they are multitasking, young people are packing that content into an average of six and a half hours a day, including three hours watching television, nearly two hours listening to music, more than an hour on the computer outside of homework (more than double the average of 27 minutes in 1999) and just under an hour playing video games. Neither the Kaiser nor the Pew report found evidence of impending doom in all that exposure. The Pew report noted, for example, that despite their great affection for technology, teenagers still spent somewhat more time socializing with friends in person than on the telephone or through e-mail or instant and text messaging. And as teenagers get older, the report found, they tend to be less interested in diversions like online games and more inclined to use the Web for information. "It's not something I think is a crisis," said Elizabeth Hartigan, the managing editor of L.A. Youth, a newspaper and Web site for high school students in Los Angeles. "Teen pregnancy is a crisis."For a great number of young people, Ms. Hartigan said, high-tech gear was not an issue because their families can't afford much beyond a television set. Others are just not that interested. "Some kids get really into it, but some kids are obsessed with fashions or boyfriends or cars," she said. Ariel Edwards-Levy, 16, a staff writer with L.A. Youth, agreed that computer use is "a sedentary activity, and if you let yourself be obsessive, it's an issue." "But some parents don't understand that it's a different medium," she said. "It's mostly just a tool, and it can be used very well. The resources online are amazing. You can meet people and reconnect with people." Many parents say they are limiting screen time, checking their children's Web-surfing histories and using filters to block objectionable material. Another strategy is to keep only one computer in the house and to place it in a common area, like the family room, better to monitor children's online habits. Paula Hagan Bennett, a lawyer from the San Francisco Bay area, says she uses a variety of methods to manage how and when her four boys -- ages 16, 14, 12 and 5 - are connected. For the two older boys that means controlling the use of their cellphones. "It's not for them to be chattering," said Ms. Bennett, 48, who insists that calls are for contacting parents, not friends, and should last no longer than three minutes. For the 12-year-old it means limiting computer screen time and disabling the instant messaging function. He was unhappy about it, she said, and had no trouble reinstalling it when she wasn't looking. (Ms. Bennett prevailed.) But she said she views instant messaging as she does most cellphone conversations among young people. "It's a waste of time," she said, "because most of the time they're talking about nothing." As for her 5-year-old, technology is not yet an issue, but Ms. Bennett said that in affluent Marin County, where she lives, she has seen young children watching "Barney and Friends" on portable DVD players in the backs of cars. Linda Folsom, a media producer for the Walt Disney Company theme parks, decided to stick to a "motherly nag mode" rather than impose restrictions on her 14-year-old daughter, Alana, who "tends to be constantly on the I.M.," Ms. Folsom said. While doing homework Alana will write a paragraph, respond to an instant message, then go back to her schoolwork, her mother said. "She says the I.M. is related to the project she's working on," Ms. Folsom said. "But if I hear giggling, I put in a comment: 'It doesn't sound like homework to me.'" But Ms. Folsom, 46, and her husband, Scott, 57, a PTA leader in Los Angeles, said they had no reason to crack down on Alana because she earned good grades and behaved well. But they have insisted that she eat dinner with them and that she practice her clarinet and play soccer. Alana sees her instant chatting as harmless. "It's just rambling," she said. And it is fun to be able to have a five-way chat with friends, she said. But she said she knows when it's time to type the message: "I'm doing homework. Leave me alone." "If it starts controlling you rather than you controlling it, that's when you stop," Alana said. Ms. Folsom said she felt that the technology was robbing her of her daughter's company more and more. There was a time, she said, when father, mother and child would listen to the same music in the car. "Now she plays the iPod, and she's in her own music world," Ms. Folsom said. David Levy, a University of Washington professor who studies high-tech communications and quality of life, acknowledges that the young have become adept at managing multiple sources of information at once, but he questions whether the ability to multitask has curbed their "ability to focus on a single thing, the ability to be silent and still inside, basically the ability to be unplugged and content." "That's true for the whole culture," he said. "Most adults have a hard time doing that, too. What we're losing is the contemplative dimension of life. For our sanity, we need to cultivate that." Some parents seem to be getting that message. When the National Institute on Media and the Family went looking for a few hundred families in Minnesota and Iowa to participate in a research project this year that calls for reducing the amount of time third to fifth graders spend in front of a computer or television screen, 1,300 families signed up. Ms. Keliher, a Lakeville school board member, is one of the participants. She thought the project would help 9-year-old Katherine "acknowledge the amount of time she spends on the screen." But as parents try to monitor their children's habits, some said there is also a need to be realistic. "We as parents tend to overreact a little bit to this," Mr. Folsom said. "This is the virtual playground. It's part of growing up."
Laurie Tarkan, New York Times- 10/25/2005 When Sara Martinez noticed her memory slipping, it seemed an especially cruel turn of events. "I've always had an excellent memory. It was my claim to fame," said Ms. Martinez, 57. "Now, I forget people's names, I forget appointments, I forget scenes from the opera." Ms. Martinez, who lives in New York, said she was also worried about her future. Her father died of a dementia that she believes was Alzheimer's disease; her mother, still living, has lost her memory to a disorder called vascular dementia. So when a friend told her about a study at New York University that uses an electroencephalograph to monitor brain waves and predict who will get Alzheimer's, Ms. Martinez enrolled. Buoyed by preliminary reports of early detection tests for Alzheimer's, an increasing number of people, worried about their family history or their own forgetfulness, are seeking clues about their mental fate. A wide variety of detection methods are being studied, including the EEG, sophisticated brain-scanning techniques, paper-and-pencil neuropsychological tests, genetic tests and even scratch-and-sniff tests. But some experts worry that expectations for the tests run far ahead of the science. "People have a sense that they can go in at 55 and be assured they're not going to get Alzheimer's," said Bill Thies of the Alzheimer's Association. But the accuracy of the tests so far, he noted, is low. And, he said, he worries that if people who take the tests are told that they are at high risk, they may become unnecessarily anxious or start taking unproven drugs to try to avoid Alzheimer's. "It's dangerous to claim these tests are predictive," said Dr. Steven DeKosky, director of the Alzheimer's Disease Research Center at the University of Pittsburgh. "Could you look at a scan of anybody and predict whether they're not going to develop Alzheimer's disease in say three or four years? No," he said. "The differences are subtle; there isn't anything that's dramatically different in the brains of people who don't yet have the disease." Still, the tests offer the hope of more accurate prediction techniques in the future. "Five to 10 years ago, we wouldn't have been talking about this whole issue of predicting Alzheimer's in normal individuals," said Dr. Ronald C. Peterson, director of Alzheimer's research at the Mayo Clinic in Rochester, Minn. "That wasn't even on the radar screen." Dr. David Bennett, director of the Alzheimer's disease center at Rush University Medical Center in Chicago, said that what was driving the push for early diagnosis was not so much the tests "but the realization that once the disease is full blown, the possibility of bringing someone back is small." Dr. Bennett said, "Our best chance of helping people is intervening early, though we don't have any drugs that will prevent Alzheimer's yet." An estimated 4.5 million Americans suffer from Alzheimer's, a progressive and fatal deterioration of the brain. The disease affects about 1 percent of 60-year-olds, but 30 percent of 85-year-olds. And another 4.5 million people are believed to suffer from what experts call mild cognitive impairment, a condition that progresses to full-blown Alzheimer's in an estimated 80 percent of cases. Dr. D. P. Devanand, co-director of the Memory Disorders Center at New York State Psychiatric Institute, said it was unlikely that Alzheimer's could be predicted with any accuracy using a single test. Instead, experts are developing mathematical models to combine the results of a number of testing methods and then compute a risk assessment for an individual patient. These prediction models would be similar to those now offered to women with a high risk of breast cancer. It is too early to say whether the EEG technique used in the N.Y.U. study will be included in such a formula. But initial results of the research are promising. The researchers, led by Leslie S. Prichep, reported that, among people in their 60's and 70's, an EEG predicted with 95 percent accuracy who would develop Alzheimer's within seven years. The findings were published online on Oct. 6 by the journal Neurobiology of Aging. "The abnormalities we detected were not subtle at all," Dr. Prichep said. "They were so deviant from normal aging values that there's no doubt in my mind that when we look back even earlier, we'll still pick up abnormalities." Dr. Prichep and others agree that more trials are needed to confirm the N.Y.U. findings. The study was small and only 44 of 118 people who enrolled completed it. Another promising prediction technique being studied by researchers is brain imaging. Some studies have used M.R.I. scans to examine the size of the hippocampus, a brain region involved in memory, on the theory that reduced volume of the hippocampus may be an early indicator of Alzheimer's. In one study presented by Dr. Peterson last April at the annual meeting of the American Academy of Neurology, patients were followed with annual M.R.I.'s and other tests for an average of five to eight years. "Those who developed mild cognitive impairment had smaller hippocampi very early on," Dr. Peterson said. But, he cautioned, "Not all shrinkage leads to Alzheimer's." PET brain scans can also detect early Alzheimer's by measuring the brain's use of glucose, an indication of energy use. Studies have found that Alzheimer's patients have reduced glucose metabolism in areas of the brain that are compromised, and PET scans have found signs of a slowdown in glucose metabolism in patients years before Alzheimer's was diagnosed. But these studies, said Dr. DeKosky, who does research with the scans, are not aimed at early detection. "When you look at a large number of people you're following every year, you can see correlations over time, but for any one case, you couldn't make the call," he said. Instead, researchers hope that such imaging studies will show how the diseased brain changes over time and how these changes relate to Alzheimer's symptoms. Then drug researchers will have better markers to assess whether Alzheimer's medicines are affecting its progression. A third approach to predicting Alzheimer's focuses on its symptoms in an effort to devise tests sensitive enough to capture the earliest hints. Forgetfulness, for example, is often assessed by the use of paper-and-pencil tests. The most predictive is called a delayed recall test, in which a person is given a paragraph to read and then is distracted for about 10 minutes before being asked questions about it. People who score poorly, studies find, fall somewhere on the spectrum between mild cognitive impairment and Alzheimer's. Other researchers are focusing on the sense of smell, which Alzheimer's patients lose early on. Dr. Devanand has developed a quick scratch-and-sniff smell test of 10 aromas that are most predictive of loss of smell, including strawberry, smoke, lilac, lemon and leather. In one study, the five- to eight-minute test proved as accurate as the best neuropsychological tests in predicting who progresses from mild cognitive impairment to Alzheimer's at a follow-up an average of four years later. But the Alzheimer's Association warns against taking an at-home smell test that is sold in pharmacies and on the Internet. "This is still an active area of research, and we don't have any data showing that it can make a diagnosis," Dr. Thies said. Many conditions, like the common cold, smoking and certain drugs can also hamper smell, he noted. "We don't know if these tests generate a large amount of anxiety and cause a net harm in society," he said. Other early predictors of Alzheimer's that need further study include weight loss and a subtle decline in the ability to perform tasks like shopping, driving, cooking and managing medications and finances. One of the most reliable indicators that a person is at high risk of Alzheimer's is the presence of a gene called apolipoprotein E4, which protects brain cells and is governed by three genes, E2, E3 and E4. Inheriting the E4 version of the gene from one parent raises the risk of Alzheimer's about threefold; inheriting the E4 version from both parents raises the risk fourteenfold, Dr. Peterson said. "But like smoking and lung cancer," he added, "your risk is increased, but it's not definitive that you'll get it." Despite lack of evidence for a predictor, many are so worried about developing Alzheimer's that they are eager to take any test available. Dr. Prichep at N.Y.U. said that after her EEG study's findings received wide publicity, she received calls from healthy people who wanted to fly to New York to be tested. Ms. Martinez, for her part, said she was glad that she enrolled in Dr. Prichep's study. The researchers first gave her neuropsychological tests to assess her memory. Then, they told her that her scores indicated she had mild cognitive impairment. For the EEG testing, electrodes were attached to her scalp, and her brain waves were monitored for 30 minutes. She will not be told the results of the test, a condition she agreed to when she enrolled. But she said she had enrolled in another study of a drug to delay the onset of Alzheimer's. "I was happy to know that I wasn't crazy," she said. "Everyone said to me that my forgetfulness was normal aging, but I knew myself."
Eric Nagourney, New York Times- 10/25/2005 Men who smoke are less likely to make a woman pregnant than nonsmokers, and the more they smoke the worse their chances are, a new study finds. Researchers from the State University at Buffalo School of Medicine say that male smokers experience changes in their sperm that make fertilization more difficult. The study was presented last week at a conference of the American Society of Reproductive Medicine. The lead author of the study, Lani Burkman, an associate professor in the department of gynecology and obstetrics, said earlier studies had shown that when nicotine and its byproduct, cotinine, were added to sperm in the lab, they changed the way the sperm moved. For this study, the researchers took sperm samples from smokers and tested their fertility by putting the sperm in dishes with part of the cover from a woman's egg, known as a zona. Sperm from nonsmokers were placed in other dishes with another part of the same zona. The smokers' sperm were able to break down the egg wall but they were much less able to make a good bond. "If the tail is very weak, it will never push itself through the zona," Dr. Burkman said. The study estimated that the sperm of chronic smokers (people who have smoked four or more cigarettes a day for at least two years) were on average 75 percent less fertile than those of nonsmokers. The researchers saw differences between heavy and light smokers, suggesting that men trying to have children will benefit if they smoke less. Women have chemical receptors to nicotine on their eggs like those on sperm so, they said, smoking is likely to lessen fertility for them, too. The effect of quitting smoking has not been determined. "Do they bounce back to normal?" Dr. Burkman asked. "We don't have the answer yet." Push Is On to Keep Sex Criminals Locked Up Jonathan Saltzman, Boston Globe- 10/25/2005 Attempts by prosecutors to keep convicted sex offenders locked up indefinitely even after they serve their prison sentences have reached an all-time high, as district attorneys use recent changes in Massachusetts law that expanded the pool of criminals considered potentially too dangerous to walk the streets, court officials say. The number of petitions filed to commit soon-to-be released sex offenders for an indefinite term to the state Treatment Center in Bridgewater has risen sharply, from 75 in 2003 to 124 in 2004. This month, 157 petitions -- a number that includes those filed this year, plus a backlog from prior years -- were pending statewide, according to Superior Court officials.
A. At my very worst, I was lying in bed and I thought, "I'm going to kill myself." And I began to think, "What's the best way? Maybe the bathtub, slit the wrists." But then I thought my sister might be the one to find me, and I didn't want her to walk in to a mess. So slit the wrists, keep the clothes on, there would only be some red bath water.
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