Amy Wong, MS – Brain Blogger Health and Science Blog Covering Brain Topics Wed, 30 May 2018 15:00:03 +0000 en-US hourly 1 Blood Pressure and Accelerated Brain Aging Sun, 20 Jan 2013 12:00:26 +0000 With the constant stresses endured in everyday life, it is no wonder society’s blood pressures are shooting through the roof as soon as the morning alarm rings. In the US alone, an estimated 50 million individuals are affected by increased blood pressure, 62% of which are associated with attributable risk factor for cerebrovascular disease. Despite these concerning statistics, less than 60% of identified individuals receive treatment for their hypertension and only about a third of the population achieve adequate control of blood pressure. Now, new research published by Charles DeCarli in Lancet Neurology aids in the push towards greater awareness of blood pressure levels even amongst the healthy middle-aged population. DeCarli and his team found similar accelerated brain aging images in both young middle-aged people with high blood pressure compared to those whose blood pressure levels would not normally warrant the need for clinical intervention.

In the study, DeCarli and colleagues examined data collected from 579 individuals taking part in the Framingham Heart Study, a longitudinal investigation initiated over 60 years ago to examine cardiovascular health of people living in Framingham, Massachusetts. For the purposes of the current research, participants were mostly in their late 30s during the initial data collection phase in 2009. Upon entry into the study, participants had their blood pressure taken and were assigned to one of three groups according to the results: normal blood pressure, prehypertensive, or high blood pressure. Next, they underwent magnetic resonance imaging (MRI) brain scans that measured any white matter injury and gray matter atrophy (fractional anisotropy, white-matter hyperintensities). When these brain imaging measurements were combined, a global measure was produced that allowed for the comparison of brain health among different blood pressure groups.

Surprisingly, the researchers found that the brains of 30-year-olds with high blood pressure looked similar to the brains of people in their 40s who had normal blood pressure. They summarized that systolic blood pressure was associated with injury to white matter microstructure and regional grey matter in healthy young adults. Furthermore, injury worsened continuously as blood pressure increased and was significantly different between normotensive and prehypertensive subjects in some anatomical regions. Most importantly, these anatomical differences that were exhibited in subjects at fairly young ages were similar to the abnormal distributions seen within high blood pressure subjects later in life. Although a biological mechanism for how high blood pressure may cause increased brain aging was not proposed, the authors did suggest that blood pressure can lead to arterial stiffness which impedes blood flow and thus, reduce the supply of oxygen and essential nutrients to the receiving axons. In support of this proposal, arterial stiffness has been associated with cognitive impairment in elderly individuals in past research studies.

Although further research is required before any definite conclusions can be drawn, the current research findings do extend to those of earlier studies that indicate white-matter injury to begin before the age of 50 years old. The authors concluded that their “results emphasizes the need for optimum control of blood pressure, which is neither routinely achieved nor subject to testing in many randomized controlled clinical trials”. In the meantime, we can continue to increase our awareness regarding this topic, stressing the importance for regular monitoring for adverse blood pressure levels in order to promote healthy brain aging.


Chobanian, A., Bakris, G., Black, H., Cushman, W., Green, L., Izzo, J., Jones, D., Materson, B., Oparil, S., Wright, J., & Roccella, E. (2003). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report JAMA: The Journal of the American Medical Association, 289 (19), 2560-2571 DOI: 10.1001/jama.289.19.2560

Hanon O, Haulon S, Lenoir H, Seux ML, Rigaud AS, Safar M, Girerd X, & Forette F (2005). Relationship between arterial stiffness and cognitive function in elderly subjects with complaints of memory loss. Stroke; a journal of cerebral circulation, 36 (10), 2193-7 PMID: 16151027

Maillard P, Seshadri S, Beiser A, Himali JJ, Au R, Fletcher E, Carmichael O, Wolf PA, & Decarli C (2012). Effects of systolic blood pressure on white-matter integrity in young adults in the Framingham Heart Study: a cross-sectional study. Lancet neurology, 11 (12), 1039-47 PMID: 23122892

Yoshita M, Fletcher E, Harvey D, Ortega M, Martinez O, Mungas DM, Reed BR, & DeCarli CS (2006). Extent and distribution of white matter hyperintensities in normal aging, MCI, and AD. Neurology, 67 (12), 2192-8 PMID: 17190943

Image via Andrey_Popov / Shutterstock.

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Statins Against Alzheimer’s Disease Wed, 02 Jan 2013 12:00:48 +0000 As the population ages, it is universally acknowledged that some will succumb to the awful fate of Alzheimer’s Disease (AD), a neurological disorder that accounts for 60-80% of all cases of dementia. Characterized by a decline in cognitive and social functions and severe memory loss, AD affects nearly 35% of the population over 85 years of age. Histopathologically, markers of AD include the formation of senile plaques, caused by the extracellular accumulation of amyloid fibrils in the brain, and intraneuronal aggregates of neurofibrillary tangles with lead to progressive brain dysfunction.

Recent figures indicate that as many as 35 million people worldwide have dementia, a value that is projected to almost double within the next two decades. Thus, it is no wonder that medical research is constantly trying to discover the most effective preventative measure to slow progression of the disease. Although the exact cause of AD remains elusive, several risk factors are hypothesized to be involved in its development, including high levels of plasma cholesterol. Indeed, accumulation of cholesterol has been associated with senile plaques and in transgenic models of AD. Taking into account the association between high plasma cholesterol and AD, Tramontine and colleagues recently conducted a study to explore the role of statins — a class of lipid-lowering drugs — in the protection against the disease. Although the positive effects of statins on cardiovascular diseases are well known, their potential neuroprotective effects demand further characterization.

The authors used the experimental intracerebroventricular (ICV) streptozotocin (STZ) animal model to demonstrate metabolic changes that are very similar to those found in the sporadic form of AD. In this model, deficits in learning, memory, and cognitive behavior have been reported. In addition, increased oxidative damage, alterations in glucose utilization and neuronal damage have been described. Molecularly, astrocytes play a fundamental role in glutamate metabolism by regulating extracellular levels of glutamate and intracellular levels of glutamine. They also participate in antioxidant defenses in the production of glutathione, coupled to glutamate metabolism. Changes in neurochemical parameters, such as glutamate uptake, glutamine synthetase activity, and glutathione have been investigated in the disease.

The authors administered 0.1 mL of pravastatin (5 mg/kg) to the animals every two days for four weeks. Serum biochemical measurements, hippocampal tissue samples, glutamine synthetase activity, glutathione levels, and glutamate uptake were examined. It was reported that glutathione content was reduced in the STZ-treated animals about 30% compared with the sham group, indicating the development of oxidative stress. However, administration of pravastatin was able to prevent the effect of STZ on glutathione content. Furthermore, pravastatin was able to prevent the observed decrease in hippocampal glutamine synthetase activity in the STZ treated animals. Finally, STZ-treated rats were found to have reduced total content of glutathione in there hippocampal slices, an effect that was reversed in animal models that were administered with pravastatin.

Glutatmatergic neurotransmission, gluatamate metabolism and antioxidant defense are strongly coupled in the neuroprotection against AD development. The current study suggests that pravastatin can interfere with these parameters by reversing some of the negative effects initiated by the disease. Hopefully with the increasing gains of medical research, future studies will also be able to demonstrate the contribution of statins in reducing cognitive impairment and brain damage in AD patients.


Maccioni RB, Muñoz JP, & Barbeito L (2001). The molecular bases of Alzheimer’s disease and other neurodegenerative disorders. Archives of medical research, 32 (5), 367-81 PMID: 11578751

Mori T, Paris D, Town T, Rojiani AM, Sparks DL, Delledonne A, Crawford F, Abdullah LI, Humphrey JA, Dickson DW, & Mullan MJ (2001). Cholesterol accumulates in senile plaques of Alzheimer disease patients and in transgenic APP(SW) mice. Journal of neuropathology and experimental neurology, 60 (8), 778-85 PMID: 11487052

Tramontina AC, Wartchow KM, Rodrigues L, Biasibetti R, Quincozes-Santos A, Bobermin L, Tramontina F, & Gonçalves CA (2011). The neuroprotective effect of two statins: simvastatin and pravastatin on a streptozotocin-induced model of Alzheimer’s disease in rats. Journal of neural transmission (Vienna, Austria : 1996), 118 (11), 1641-9 PMID: 21744242

Image via melissaf84 / Shutterstock.

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Music Therapy for the Alzheimer’s Disease Patient Fri, 07 Dec 2012 12:00:59 +0000 It has been said that music can help heal the soul. Now this old saying has transferred its healing powers onto improving memory-based interventions for the Alzheimer’s disease patient.

Currently, Alzheimer’s disease (AD) affects approximately 5.2 million Americans aged 65 years and older, a number that is expected to reach 7.7 million by 2030. The disease has significant detrimental effects on the functional quality of life of both the patients and their caregivers. Although there exists numerous studies examining potential disease modifying drugs to combat AD, the number of new individuals suffering from the disease continues to grow daily, generating great urgency to implement non-pharmacological interventions that may help to improve daily functioning and quality of life of AD patients in the years ahead.

Music therapy represents a low cost intervention with a wide range of benefits reported in previous studies, including improvements on measures of anxiety and depression, agitation, autobiographical memory recall, and a variety of cognitive functions. However, no study has examined the potential benefit of music-based therapies specifically targeted to enhance new memory formation and improvement in instrumental activities of daily living. Furthermore, there are no accepted music-based memory enhancement therapies for the care of patients with AD despite some anecdotal reports of effective use of mnemonics in a therapeutic setting. It is under this current knowledge that Ally and colleagues sought to further investigate the effects of music on memory in patients with AD by making the content of the song lyrics relevant for the daily life of an older adult.  In addition, the means by which musical encoding alters several different aspects of episodic memory was also examined.

Twelve AD and seventeen healthy elderly individuals were asked to view a series of simple song lyrics on a computer screen, first with the words being sung by a young woman, then with the words being spoken by the same woman, and finally with no accompanying sound at all. After reading, seeing and hearing four-line selections from eighty test lyrics, the subjects were asked if any of the lyrics were recognizable to them. It was found that the AD group significantly improved in lyrical recall when the words were set to music rather than just spoken. In contrast, healthy individuals exhibited no difference in the amount of words remembered between music-driven or spoken lyrics.

What does this mean for the future of AD patients? Ally and his colleagues hope that the effects of music mnemonics may eventually help patients in the area of general memory-related functioning, as well as improve quality of life, depression, agitation, cognitive functioning, and other factors that are known to benefit from non-mnemonic music interventions. As an everyday example, the authors presented the hypothetical case of an AD patient in an assisted living facility who had become regularly agitated by his inability to remember where he lives. By implementing a customized musical mnemonic with encoded facts about the facility, repetitive presentation of this mnemonic may produce a number of positive changes for the patient, including improved mood and decreased distress, enhanced familiarity with the assisted living facility, and enhanced confidence in knowing where he lives, especially if prompted by the musical mnemonic.

Music is a celebrated expression of art that has the ability to move within all individuals regardless of age, race, or gender. Now that music therapy has become an accepted practice in medicine, there is great potential for it to be translated into practical methods that can improve the lives of individuals suffering from AD.


Guétin S, Portet F, Picot MC, Pommié C, Messaoudi M, Djabelkir L, Olsen AL, Cano MM, Lecourt E, & Touchon J (2009). Effect of music therapy on anxiety and depression in patients with Alzheimer’s type dementia: randomised, controlled study. Dementia and geriatric cognitive disorders, 28 (1), 36-46 PMID: 19628939

Hebert LE, Scherr PA, Bienias JL, Bennett DA, & Evans DA (2003). Alzheimer disease in the US population: prevalence estimates using the 2000 census. Archives of neurology, 60 (8), 1119-22 PMID: 12925369

Irish M, Cunningham CJ, Walsh JB, Coakley D, Lawlor BA, Robertson IH, & Coen RF (2006). Investigating the enhancing effect of music on autobiographical memory in mild Alzheimer’s disease. Dementia and geriatric cognitive disorders, 22 (1), 108-20 PMID: 16717466

Simmons-Stern NR, Deason RG, Brandler BJ, Frustace BS, O’Connor MK, Ally BA, & Budson AE (2012). Music-based memory enhancement in Alzheimer’s Disease: Promise and limitations. Neuropsychologia, 50 (14), 3295-3303 PMID: 23000133

Thompson RG, Moulin CJ, Hayre S, & Jones RW (2005). Music enhances category fluency in healthy older adults and Alzheimer’s disease patients. Experimental aging research, 31 (1), 91-9 PMID: 15842075

Image via Triff / Shutterstock.

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Depressed About Wrinkles? BOTOX Can Help Thu, 01 Nov 2012 11:00:23 +0000 The signs of aging can never seem to escape us: your eyes get puffier, your wrinkles lines extend in length, and the creases at the corners of your mouth deepen substantially. Soon, you remember a friend’s nonchalant remark that you seem to look angry all the time…even when you’re smiling.  Perhaps you are angry, both angry and sad that your youthful vigilance has come and gone all too quickly. Thankfully, there may be one treatment available that can offer a boost to your spirits: a recent study published in the Journal of Psychiatric Research reported that single treatment of age lines with botulinium toxin A (BTX-A or BOTOX) may alleviate depressive symptoms in patients who do not improve sufficiently on previous medication.

According to the World Health Organization (WHO), depression is one of the leading causes of disability, affecting as much as 121 million people worldwide. Although there are various effective treatments available, some patients register unsatisfactory responses to therapy causing their depression to enter into chronicity. Negative emotions such as anger, fear and sadness are prevalent facial expressions in depression that are associated with activation of the corrugator and procerus muscles in the glabellar region of the face. Injection of BTX-A to this facial region has been previously used to inhibit the activity of the corrugator and procerus muscles for the cosmetic treatment of frown lines. Unexpectedly, recipients of this treatment have also reported an increase in emotional wellbeing beyond the desired cosmetic benefit. Specifically, reduced levels of fear and sadness have been observed.

Taking these findings into account, the capacity for BTX-A to counteract negative emotions may also have clinical implications. To explore whether the attenuation of facial psychomotor features associated with depression may produce alleviation of affective symptoms, Wolmer et al. recently conducted a randomized controlled trial of BTX-A injection to the glabellar region as an adjunctive treatment of major depression. Thirty subjects, both men and women were included into the study and randomly assigned to treatment or placebo group. Subjects were included if their age ranged from ages 25-65 years old, had a diagnosis of on-going major depressive disorder according to the DSM-IV, and exhibited moderate to severe vertical glabellar lines during maximum voluntary frowning.

At baseline, the treatment and placebo group did not differ in any of the collected characteristics.  However, the treatment group showed a significant improvement in depressive symptoms compared to the placebo group at the 16-week follow-up mark, measured by the Hamilton Depression Rating Scale (HAM-D). Even after only one BTX-A treatment at the 6 week mark, BTX-A recipients’ depression scores were reduced on average by 47.1% compared to only 9.2% in placebo-treated participants. The authors concluded that a single treatment of the glabellar region with BTX-A may shortly accomplish a strong and sustained alleviation of depression in patients, although the mechanism of such effect has yet to be elucidated.

Although the mechanisms remain unclear, the authors do not attribute aesthetic benefit as a major contributor to mood improvement as they did not enroll patients into the study who were cosmetically concerned about their frown lines. Notably, treatment response also did not depend on a positive appraisal of the cosmetic change. However, the authors believe that it is possible that a more positive facial expression and improved feedback both from one’s own face in the mirror and from social interaction partners may have contributed to mood enhancement.

What does this mean for the future of BTX-A and its clinical applications? It is possible to extend these findings onto other muscles in the lower sections of the face (e.g. depressor angulis oris and mentalis muscles) and examine any mood-elevating effects.  Modulation of mood states with BTX-A may also be effective in the treatment of other clinical conditions involving negative emotions, like anxiety disorders. If true, findings from these studies would support the concept that facial musculature can not only express, but regulate mood states as well.


Gilmer WS, Trivedi MH, Rush AJ, Wisniewski SR, Luther J, Howland RH, Yohanna D, Khan A, & Alpert J (2005). Factors associated with chronic depressive episodes: a preliminary report from the STAR-D project. Acta psychiatrica Scandinavica, 112 (6), 425-33 PMID: 16279871

Lewis MB, & Bowler PJ (2009). Botulinum toxin cosmetic therapy correlates with a more positive mood. Journal of cosmetic dermatology, 8 (1), 24-6 PMID: 19250162

Sommer B, Zschocke I, Bergfeld D, Sattler G, & Augustin M (2003). Satisfaction of patients after treatment with botulinum toxin for dynamic facial lines. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], 29 (5), 456-60 PMID: 12752511

Wollmer MA, de Boer C, Kalak N, Beck J, Götz T, Schmidt T, Hodzic M, Bayer U, Kollmann T, Kollewe K, Sönmez D, Duntsch K, Haug MD, Schedlowski M, Hatzinger M, Dressler D, Brand S, Holsboer-Trachsler E, & Kruger TH (2012). Facing depression with botulinum toxin: a randomized controlled trial. Journal of psychiatric research, 46 (5), 574-81 PMID: 22364892

Image via PhotographyByMK / Shutterstock.

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Retain Your Memory with a Brighter Smile Wed, 17 Oct 2012 11:00:33 +0000 It is common sense that practicing good oral hygiene equates to healthier gums and teeth. Not only does it diminish the number of cavities, gingivitis, and promote proper healing and regeneration of the oral tissues, but the general public would be gratefully spared from the pungent smells of bad breath. Recently, Paganini-Hill and colleagues reported that the benefits of good dental habits are not only limited to that of the buccal cavity—it is also associated with a lower risk of dementia in older adults.

The effect of oral hygiene on the general health of elderly people is a topic that has garnered increasing interest over the recent years. As the severity of cognitive impairment and dementia escalates, individuals tend to have fewer teeth, more dental caries, more periodontal disease, less use of dentures, and poorer oral hygiene. Furthermore, these mounting denture-related problems have created an additional burden for caregivers. Thus, it is necessary to decipher the relationship between oral hygiene and dementia such that early interventions can be implemented to reduce cognitive impairment in the elderly.

Although cross-sectional studies have shown that dental health behaviors are related to cognitive ability, no longitudinal study has examined dental health practices as potential risks factors for dementia until recently. Here, the authors hypothesized that better preventive dental health behaviors would be related to lower risk of dementia. The study followed a large cohort of 6,173 elderly men and women (median age 81) for up to 18 years. Individuals were instructed to complete postal health surveys asking about their dental health status and behaviors. Questions included inquiries regarding the number of natural teeth, dentures worn, number of visits to a dentist, and oral health habits. Participants were also asked to indicate how often they brushed their teeth in the morning, at night before bed, and during the day; cleaned their dentures; and used dental floss, mouth wash, and tooth pick. Dementia cases were identified from follow-up questionnaires, hospital records, death certificates, and in-person evaluations.

It was found that men with inadequate oral hygiene habits who did not wear dentures had a 91% greater risk of dementia than those with adequate oral hygiene habits. This risk was also associated with women, although not significant. Additionally, dentate individuals who did not brush their teeth daily had a 22-65% greater risk of dementia than those who brushed their teeth three times a day. Implementing tools such as dental floss, mouth wash, or a tooth pick had little effect on risk. Dementia risk was also greater in men who paid infrequent visits to their dentist compared to those who had seen their dentist two or more times in a year. For denture wearers, cleaning dentures was not significantly related to dementia risk.

What potential mechanisms are behind these findings? There have been a few studies that have prospectively evaluated oral health and its relationship to the development of cognitive impairment and dementia. Potential mechanisms include infection and inflammation, lower extracellular acetylcholine release, and nutrition. One study found that individuals with Alzheimer’s disease were more likely to have the oral Treponema bacteria in their brains than in controls. Additionally, periodontal disease and tooth loss have been associated with arteriosclerosis, heart disease, and stroke, which are in turn risk factors for dementia.

Either way, practicing good oral hygiene is an admirable habit regardless of age, sex, or cognitive ability. If you are not doing so already, perhaps these findings will help you to adopt such changes in your lifestyle. Not only will you enjoy the aesthetic perks of a whiter smile, but you would potentially lower your risk at forgetting where you last left your keys. So, prevent that fridge door from being unnecessarily opened and start brushing!


Avlund K, Holm-Pedersen P, Morse DE, Viitanen M, & Winblad B (2004). Tooth loss and caries prevalence in very old Swedish people: the relationship to cognitive function and functional ability. Gerodontology, 21 (1), 17-26 PMID: 15074536

Chalmers JM, Hodge C, Fuss JM, Spencer AJ, & Carter KD (2002). The prevalence and experience of oral diseases in Adelaide nursing home residents. Australian dental journal, 47 (2), 123-30 PMID: 12139265

Meurman JH, & Hämäläinen P (2006). Oral health and morbidity–implications of oral infections on the elderly. Gerodontology, 23 (1), 3-16 PMID: 16433636

Paganini-Hill A, White SC, & Atchison KA (2012). Dentition, dental health habits, and dementia: the leisure world cohort study. Journal of the American Geriatrics Society, 60 (8), 1556-63 PMID: 22860988

Stewart R, & Hirani V (2007). Dental health and cognitive impairment in an English national survey population. Journal of the American Geriatrics Society, 55 (9), 1410-4 PMID: 17767683

Wu B, Plassman BL, Crout RJ, & Liang J (2008). Cognitive function and oral health among community-dwelling older adults. The journals of gerontology. Series A, Biological sciences and medical sciences, 63 (5), 495-500 PMID: 18511753

Image via Yuri Arcurs / Shutterstock.

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Is Hoarding A Symptom Or A Disorder? – It’s Place in the DSM-V Thu, 04 Oct 2012 11:00:19 +0000 We have all seen it before on reality television — mound and mounds of rotten foods, unsalvageable trinkets, and even cat poop fill every nook and cranny of what was once a livable space. As we cover our mouths in disgust, we cannot help but shake our heads at the homeowners’ uncontrollable hoarding habits. Suddenly, you remember your own oddball collection of rare porcelain statues, used notebooks, or whatever your fetish of the month is and wonder: how do you know when you have crossed the line from savvy collector to obsessive hoarder? Are you suffering from a type of obsessive compulsive disorder (OCD), or even, a new hoarding disorder (HD) in itself?

The collecting of objects has always been regarded as both a benign and normative human behavior; so much so that industry has been quick to capitalize on the apparent mass appeal of this activity. Because of the ubiquitous attraction of collecting that has been garnered over the past years, researchers in the realm of academia have also developed interest in the study of its behavior. For psychologists, descriptors of collecting behavior have proliferated from the perspectives of psychodynamics, behavioral neurology, social psychology, and other fields. Although some may view object accumulation as a leisurely activity that provides psychological benefit to the participant, clinical psychologists have become more concerned in its ability to hinder normal performances. This excessive form of acquisition, or “hoarding”, carries potential to impair one’s individual, interpersonal, and occupational functioning.

Previously, hoarding has always been characterized as a dimension of OCD, whereby hoarding was regarded as a symptom rather than a distinct diagnostic entity. In the early 1900s, theoretical conceptualizations of hoarding features were defined on an idiosyncratic level by Freud; that is, they were merely viewed as behavioral characteristic peculiar to an individual or group or people. In the mid-1990s, Frost and Hartl shifted this idiosyncratic view of “compulsive hoarding behavior” into one that was defined operationally. Under this view, three specific characteristics of hoarding behavior were produced: (1) the acquisition of and failure to discard a large number of possessions that seem to be useless or of limited value; (2) living spaces sufficiently cluttered so as to preclude activities for which those spaces were designed; and (3) significant distress or impairment in functioning caused by hoarding. The purpose of developing such operational criteria was to create a mindset among the scientific community that hoarding behavior was actually pathological rather than idiosyncratic. Subsequently, this view became widely-accepted across the research and clinical communities and allowed for the first construct consistent investigations of hoarding behavior.

The view of hoarding as a symptom of OCD has begun to shift in the past few years. This was demonstrated by one descriptive study conducted by Mataix-Cols and colleagues that examined community-based participants with hoarding behaviors. When hoarding was used as the factor of inclusion in the study (rather than as an established diagnosis of OCD or OCPD), only 18% of the 217 participants met diagnostic criteria for OCD. As a result of this study and others in literature that have produced similar results, HD is currently being considered for inclusion in the upcoming 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

Under the structural definition developed by Frost and Hartl, many rewordings of HD have been developed and turned-over in the recent years to reflect the changing and growing literature on hoarding behavior. It is with these circumstances that the proposed diagnostic criteria for HD were developed for the DSM-V. The criteria, and their presenting symptoms, are listed as follows:

  • Criterion A – Persistent difficulty discarding or parting with personal possessions, regardless of their actual value.
  • Criterion B – The difficulty is due to strong urges to save items and/or distress associated with discarding.
  • Criterion C – The symptoms result in the accumulation of a large number of possessions that fill up and clutter active living areas of the home or workplace to the extent that their intended use is no longer possible. If all living space is uncluttered, it is only because of the interventions of third parties (e.g. family members, cleaners, authorities).
  • Criterion D – The symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning (including maintaining a safe environment for self and others).
  • Criterion E – The hoarding symptoms are not due to a general medical condition (e.g. brain injury, cerebrovascular disease).
  • Criterion F – The hoarding symptoms are not restricted to the symptoms of another mental disorder (e.g. hoarding due to obsessions in Obsessive Compulsive Disorder, cognitive deficits in Dementia, restricted interests in Autism Spectrum Disorder, and food storing in Prader–Willi Syndrome).

The understanding of hoarding and best practices for clinical treatment are quickly evolving given the increasing knowledge gains from research and clinical practice. Hopefully, with the new diagnostic criteria in place, opportunities and challenges in the care of patients who meet the diagnostic criteria of hoarding will improve in both meaningful and engaging ways.


American Psychiatric Association DSM-V Development (2012). Hoarding Disorder.

Anderson SW, Damasio H, & Damasio AR (2005). A neural basis for collecting behaviour in humans. Brain : a journal of neurology, 128 (Pt 1), 201-12 PMID: 15548551

Grisham JR, Norberg MM, Williams AD, Certoma SP, & Kadib R (2010). Categorization and cognitive deficits in compulsive hoarding. Behaviour research and therapy, 48 (9), 866-72 PMID: 20542489

Mataix-Cols D, Frost RO, Pertusa A, Clark LA, Saxena S, Leckman JF, Stein DJ, Matsunaga H, & Wilhelm S (2010). Hoarding disorder: a new diagnosis for DSM-V? Depression and anxiety, 27 (6), 556-72 PMID: 20336805

Subkowski P (2006). On the psychodynamics of collecting. The International journal of psycho-analysis, 87 (Pt 2), 383-401 PMID: 16581582

Image via MCarper / Shutterstock.

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The Psychology Behind the Lipstick Effect Wed, 26 Sep 2012 11:00:18 +0000 What is the cost of beauty? Apparently not even an empty wallet can slow down the desired red pucker of a woman’s lips.

Although data from previous recessionary periods consistently demonstrate that times of economic turmoil generally force consumers to downsize on all sorts of spending — from groceries, to homes, to vacations (hence, coining the term “stay-cation”) — there is one consumer good that has fared unusually well in the midst of layoffs and home foreclosures: beauty products. For example, sales figures from one of the world’s biggest cosmetics companies — L’Oreal — showed a surprising growth of 5.3% in 2008, a year when the rest of the economy was suffering record declines in sales. The notion that women may spend relatively more money on beauty enhancing products during economic recessions has been dubbed by journalists as the lipstick effect.

Although the idea of the lipstick effect appears counterintuitive, this phenomenon is not a recent observation. The influence of diminished monetary status on women beautification behaviors is believed to have occurred even during the Great Depression, when sales of women’s cosmetic products boomed unexpectedly. To understand how and why economic recessions might influence women’s psychology and behavior, one research team recently presented five interconnected studies that provided novel insights into women’s mating psychology, consumer behavior, and the relationship between the two. These studies are described below.

Study 1 – The researchers used real-world data to examine the relationship between economic condition and consumer spending over the last 20 years. They found that fluctuating economic conditions, as indexed by unemployment, were related to consumer spending priorities. Higher unemployment was associated with decreased spending on products unrelated to appearance (e.g. furniture) and increased spending on appearance related products (e.g. cosmetics and clothing).

Study 2 – Men and women were instructed to indicate their desire for products that could or could not enhance attractiveness after being primed with economic recession or control cues.  It was found that exposure to recession cues decreased both men and women’s desire to purchase products unrelated to appearance; however, the same recession cues persistently increase women’s desire to purchase appearance related products.

Study 3 – The mediating mechanisms of the lipstick effect were tested. It was revealed that the psychological processes driving the lipstick effect were rooted in women’s mating psychology. The authors rationalized that because there are fewer men with access to resources during recessionary periods, women’s desire for a resourcefully wealthy mate increased in response to recession cues.

Study 4 – The model described in study 3 was supported by the results of study 4. Here, the influences of beauty product prices on the lipstick effect were tested. It was found that recession cues did not increase women’s desire for discount brand beauty products because they were perceived as being less effective at enhancing attractiveness to mates. These results detract from the previous hypothesis that that the lipstick effect reflects a general spending shift wherein women choose to buy inexpensive indulgences (e.g. $40 tube of lipstick) in the place of more expensive ones (e.g. $2500 luxury designer handbag). Instead, the findings suggest that the lipstick effect reflects a strategic spending shift towards products that women believe will make them more attractive to mates.

Study 5 – Finally, the type of women who were most likely to exhibit the lipstick effect were determined. It was found that when jeans, perfume, and high-heeled boots were advertised as serving a mate attraction function, economic recession cues increased women’s desirability for those products. On the contrary, when the same products were advertised serving a non-mating function, the lipstick effect was suppressed. Thus, the authors concluded that economic recessions are most likely to spur yearning for beauty products in women who are intentionally trying to attract a relationship partner.

Despite quick judgments garnered from the casual observer that splurges on beauty products during recessionary periods are rather senseless, these findings suggest that the shift in women’s spending may actually reflect a deeper, strategic, and adaptive rationality. As described by the authors, “women’s psychologies may have been shaped to respond to economic resource scarcity by allocating more effort into securing a financially secure mate in an environment where such mates are scarce”. Whether absurdly moronic or brilliantly rooted through ancestral psychology, one thing remains true: the lipstick effect continues to persist throughout the ages, its name founded on a product creation that epitomizes the core of the phenomenon—the seductive attraction of ruby red lips.


Hill SE, Rodeheffer CD, Griskevicius V, Durante K, & White AE (2012). Boosting beauty in an economic decline: Mating, spending, and the lipstick effect. Journal of personality and social psychology, 103 (2), 275-91 PMID: 22642483

Koehn, NF. Estee Lauder and the market for prestige cosmetics. Harvard Business School Cases. 2001 Feb;801-362, 1-44.

Image via Seprimor / Shutterstock.

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Heading Into Brain Injury – Should We Be Concerned? Sun, 29 Jul 2012 11:00:05 +0000 Like any other sports fanatic, nothing else evokes a greater wave of emotional outbursts from me than a really good game. Whether I am watching a speedy game of basketball or a crawling game of baseball, feelings of celebration, anxiety, and disappointment can billow through my body within the span of a few seconds. In June, the UEFA Euro 2012 was all the rage amongst sports fans, causing many professionals to cancel work meetings, return late from lunch breaks, or simply remain home on the grounds of an “unidentified but completely legitimate sickness”. As I was one of those many individuals crowding around a large food court flat screen, milking the last few seconds of my fifth (and very necessary) break, I could not help but cringe every time I witnessed a player heading a soccer ball.

Because I work in trauma research, I have become very familiar with cases of chronic traumatic encephalopathy (CTE) in professional athletes. CTE is a progressive neurodegenerative disease that can only be diagnosed post-mortem in individuals who have suffered from repetitive head trauma. Gross pathological findings of CTE include reduced brain weight, enlarged lateral and third ventricles, thinning of the corpus callosum, cavum septum peallucidum with fenestrations, scarring, and neuronal loss of the cerebellar tonsils. The disease has been closely tied to athletes who participate in contact sports like boxing, martial arts, American football, professional wrestling and hockey.

Although CTE cannot be verified until post-mortem, those who do suffer from the disease have been reported to lead difficult lives. Take for example, the case of Andre Waters, a retired NFL player who took his life in 2006 at the young age of 44. Prior to his untimely death, Waters manifested a history of cognitive and neuropsychiatric impairments which included chronic depression, suicide attempts, insomnia, paranoia, and impaired memory. Even more concerning was that this was not the first reported incidence of CTE in a retired NFL player. Previous cases have also documented mental disorders in these subjects, including depression, deficits in memory and judgment, and Parkinsonian symptoms.

Despite years of mass media coverage criticizing the impact of head-jarring sports on the brain, the concern for “heading” in soccer players have only recently surfaced. Heading is a technique unique to the sport whereby players use their unprotected heads to deflect, stop, or redirect the ball for both offensive and defensive purposes. In November 2011, researchers from the Albert Einstein College of Medicine in New York reported that professional soccer players who frequently “head” the ball approximately 1000-1500 times a year may develop changes in the brain that are analogous to those with mild traumatic brain injury (mTBI).

The researchers tested two groups of soccer players: frequent headers versus non-frequent headers based on their responses to a detailed and standardized questionnaire. An advanced magnetic resonance technique known as diffusion tensor imaging (DTI) was used to measure microscopic changes in the brain’s white matter. In healthy white matter, the direction of water movement is fairly uniform whereas previous studies have associated mTBI with disruption of this uniformity. The investigators found that frequent headers had significant disruptions in uniformity in the frontal, temporal, and occipital regions compared to infrequent headers.

In fact, there has been one publically reported case of a “formidable header” who died in 2002 from a degenerative brain disease. Jeffrey Astle, a legendary figure in England who peaked in his career in the 1960s was found to have histological changes in his brain consistent with CTE. These deformities lead the coroner to conclude that minor repetitive trauma was the cause of his death and a verdict of ‘‘death by industrial disease” was documented.

Where do these reports leave soccer moms and their maternal duty to protect their children’s mental capacity? Before anyone jumps into panic mode, let us review the evidence thus far. First, researchers have reported that frequent headers may develop changes in the brain that are similar to those with mTBI. However, this statement should be interpreted with caution as the study had a small sample size (n=38), only 25% were women with no children included, and the number of “heads” per year were based on retrospective self-report by the participants.

Second, Jeffrey Astle succumbed to a “death by industrial disease”. However, the leather balls used during his career were much heavier and could easily absorb moisture over the course of a game, adding as much as 20% extra weight. If we recall Newton’s second rule of force = mass x acceleration, then the force of impact between the ball and the player’s cranium should be dependent on the mass of the ball (i.e. the greater the mass, the greater the force impacting a player’s head). Today, the balls used are much lighter and made entirely of synthetic, hydrophobic material.

There is no denying that repetitive impact to the head can have cumulative detrimental effects that may lead to long-term psychological consequences. However, there is little evidence to prove that heading in today’s soccer can lead to CTE, and the research conducted so far is certainly insufficient to support the ban of heading altogether. Until then, it is recommended that proper heading techniques should be employed to minimize energy transfer to the brain.  Still, I cannot help but twitch every time I witness the ball impact a player’s head. I fear that repetitive heading may only become clinically evident decades into the future—when it has already become too late for our generation now.


Omalu BI, DeKosky ST, Minster RL, Kamboh MI, Hamilton RL, & Wecht CH (2005). Chronic traumatic encephalopathy in a National Football League player. Neurosurgery, 57 (1) PMID: 15987548

Omalu BI, DeKosky ST, Hamilton RL, Minster RL, Kamboh MI, Shakir AM, & Wecht CH (2006). Chronic traumatic encephalopathy in a national football league player: part II. Neurosurgery, 59 (5) PMID: 17143242

Omalu BI, Hamilton RL, Kamboh MI, DeKosky ST, & Bailes J (2010). Chronic traumatic encephalopathy (CTE) in a National Football League Player: Case report and emerging medicolegal practice questions. Journal of forensic nursing, 6 (1), 40-6 PMID: 20201914

Radiological Society of North America (2011). ‘Heading’ A Soccer Ball Could Lead to Brain Injury.  [Press release]. Retrieved from

Saulle M, & Greenwald BD (2012). Chronic traumatic encephalopathy: a review. Rehabilitation research and practice, 2012 PMID: 22567320

Image via Mike Flippo / Shutterstock.

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On the Brain Map to Genius Sun, 22 Jul 2012 01:02:47 +0000 We’ve all heard about it before or have witnessed it in some form of media. The awkward, silent boy sits quietly by himself in the corner. Although he is sitting his demeanor is far from calm: his head twitches, his fingers collapse together in fidgety entanglements, and his body rocks back and forth with constant frequency. All the while, his eyes remain glued onto some inanimate object in the distance. To the causal bystander, the young boy suffers from autism, a neurodevelopmental disorder characterized by social impairments, communication difficulties, and restricted, repetitive, and stereotypical patterns of behavior. However, those who know the boy understand that there is far more to his physical quirks than meets the eye. The boy sitting in front of them is, in fact, an extraordinary talent in calendar calculating.

Whether it be congenital or acquired, savant syndrome has fascinated scientists for years. Individuals with savant syndrome demonstrate outstanding, domain-specific mental capabilities in art, calendar calculating, and/or mathematics despite suffering from severe mental disabilities in behavioral, cognitive, and emotional domains. For example, a savant may remarkably pinpoint the exact day of the week of any given date (almost instantaneously) but lack complete awareness of basic time facts, such as the number of minutes in an hour. Still, these “islands of genius” exhibit some superpower-like abilities that even the most celebrated prodigies wished they possessed. Only one question remains: what exactly goes on in their brains and how do they differ from your “average” genius?

Although research in the field of savants remains scarce, one group of scientists from Germany recently compared the neural architectural brain activity of a 45-year old calendar-calculating and art savant (CD) to a 35-year old math prodigy (AB). They hypothesized that if the brain is modular in neural organization (i.e. the functional components of all brains operate separate from each other with respect to specific mental domains), then calendar calculating should demonstrate considerable similarities in brain activity between CD and AB during performance.

A special calendar task was constructed for the study whereby 56 past and future dates (excluding the day of the week), covering periods between 1100 and 1800, and 2200 and 2800, were presented for 2000 ms at the beginning of each trial. Immediately after, a template of four possible weekdays was presented. Through button pressing, the subjects had to choose the correct day corresponding to the formerly presented date. Functional data for both participants were collected using functional MRI (fMRI) from the start of the presented date, through the mental processing period, and ended after the targeted button pressing selection.

Contrary to their hypothesis, CD and AB adopted different brain strategies during performance. CD displayed activation patterns in the left frontal, bilateral parietal and occipital, right thalamic, and right cerebellar regions and across the cingulated gyrus and left insula. This suggested that CD recruited cortical networks related to visual processing, as well as subcortical regions and the cerebellum which are associated with motor and/or procedural/implicit processing. In contrast, AB’s activation patterns were most pronounced in the left inferior frontal and left inferior parietal regions, and in the right precuneus. Activation of these regions suggested that the strategy employed was based on number vector knowledge and rules, serving as a marker system from which the subject easily calculated or allocated the respective weekday to a given date.

Based on these differences, the authors concluded that activation patterns produced by complex mental processes can vary considerably across individuals even when performing the same tasks within a particular mental domain. Thus, these differences should be considered while studying neural architectural activity rather than focusing exclusively on the modular organization of the brain. In the case of calendar counting, performance may be strongly influenced by unique and individualistic developmental states, learning histories, and idiosyncrantic strategies. In other words, unless you were born with it, grew up under the right environment, and the universe was feeling highly circumstantial that day, the chances of developing savant-like abilities is extremely unlikely.

So what kind of practical advice is available for the average person on their desired mental climb to Einstein-status? To be honest, very little, if nothing at all. Unless congenital, the only other reported cases of savants occur after severe trauma (e.g. brain injury, stroke) and it is not recommend to place intentional harm on the brain in hopes of acquiring a “superpower.” Until then, we can remain challenged and fascinated by this mysterious convoluted organ while enjoying our own abilities to fly and dodge bullets…in our dreams.


National Institute of Neurological Disorders and Stroke. Autism Fact Sheet. May 4, 2012.

Fehr T, Wallace GL, Erhard P, & Herrmann M (2011). The neural architecture of expert calendar calculation: a matter of strategy? Neurocase, 17 (4), 360-71 PMID: 21547846

Image via Korn / Shutterstock.

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