Shaheen E Lakhan, MD, PhD, MEd, MS, FAAN – Brain Blogger http://brainblogger.com Health and Science Blog Covering Brain Topics Wed, 30 May 2018 15:00:03 +0000 en-US hourly 1 https://wordpress.org/?v=4.9.6 Scholarship for College Students Living with a Neurological Disorder http://brainblogger.com/2016/10/25/scholarship-for-college-students-living-with-a-neurological-disorder/ http://brainblogger.com/2016/10/25/scholarship-for-college-students-living-with-a-neurological-disorder/#respond Tue, 25 Oct 2016 12:00:24 +0000 http://brainblogger.com/?p=22422 Bella Soul is a charity that empowers college students faced with chronic illness, physical disabilities, and disease through scholarships and emotional support. I have partnered with them to serve on and advise their scholarship committee on a voluntary basis. Their First Annual Luke G. Neurological Scholarship will award $500 to $1,000 to full-time students enrolled in college and living with a neurological disorder.

The application process is simple and starts with emailing Bella Soul at livebellasoul@gmail.com with the following three items:

1) Demographics:
– Name
– Date of Birth
– University/College
– Year/Grade
– GPA
– Neurological Disease/Disorder

2) Proof of Enrollment:
– Demonstrates full-time, college enrollment.
– Does not need to be a transcript.

3) Essay:
– Three-pages, double spaced about the triumphs and struggles of living with a neurological disease/disorder.
– Give examples of how your disease/disorder has impacted your education, your social life, and how you have learned from these challenges.
– Include what advice you would tell someone who is struggling with the same neurological disorder.

The other members of the scholarship committee and I will review the applicants the first week of January. The deadline for applying is by December 31st (end of day). Looking forward to reading your stories and funding your future!

Image via thelester / Pixabay.

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Brains Behaving Badly – A Tale of Two Brains http://brainblogger.com/2016/02/22/brains-behaving-badly-a-tale-of-two-brains/ http://brainblogger.com/2016/02/22/brains-behaving-badly-a-tale-of-two-brains/#respond Tue, 23 Feb 2016 01:30:31 +0000 http://brainblogger.com/?p=21420 National Geographic Channel will air “Brain Games: Brains Behaving Badly ” on Sunday, February 28 at 9pm EST. As part of a virtual roundtable, Brain Blogger was selected to screen the episode and address the thought provoking question raised therein:

Are humans hardwired for transgressions? Why are some of the brain’s most basic instincts considered bad behavior? Why does bad behavior come so naturally to us?

As a neurologist, when the brain goes haywire, I often witness the reversion of humankind to its primal self. The cortex of the human brain has evolved in such a way that it is often responsible for the differences between us and animals. Strokes, seizures, trauma, infection, and degeneration of certain brain structures are fascinating to encounter in that they induce certain transgressions. Here, I provide just two patient examples that I came across early in my neurology career.

Case 1: One my first “strange” cases as a neurology resident was an elderly woman who came to my clinic accompanied by her son who whispered to me to help her stop the “excessive humping” (pelvic thrusting is the medical description). We tested her for seizures and vitamin deficiencies to account for this behavior which were all normal. However, both of her temporal lobes lit up on her brain MRI and I immediately knew what she had — Kluver-Bucy Syndrome. Aside from indiscriminate hyper-sexuality, the full constellation of symptoms includes increased oral exploration, placidity, strong tendency to react to visual stimulus, and inability to recognize familiar objects. It was actually the herpes simplex virus that attacked both of her temporal lobes which was easily treated with some antiviral medications — with return of her normal prudent self.

Case 2: About mid-way through my training, a priest came into my neurology clinic with his wife complained that he would gamble all of the household funds at a casino nearly two hours away. The behavior escalated to the point where even the weekly church collections were gambled away — actions very uncharacteristic of this otherwise noble individual. In my office, I noticed that he had a tremor of right hand of pill-rolling quality. The rest of my neurological exam confirmed that in fact he had Parkinson’s disease. This and other disorders affecting the orbitofrontal cortex such as in frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS) can lead to pathologic gambling. Briefly, the orbitofrontal cortex represents a critical structure in a nervous system involved in decision making and processing rewards.

In short, our brains may have been very well hardwired for transgression, but evolutionary changes to certain neural structures, connections, and social behavioral constructs have halted their manifestation.

Keep thinking…

References

Bechara A, Damasio H, & Damasio AR (2000). Emotion, decision making and the orbitofrontal cortex. Cerebral cortex (New York, N.Y. : 1991), 10 (3), 295-307 PMID: 10731224

Poletti M, Lucetti C, Logi C, Baldacci F, Cipriani G, Nuti A, Borelli P, & Bonuccelli U (2013). Cognitive correlates of negative symptoms in behavioral variant frontotemporal dementia: implications for the frontal lobe syndrome. Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 34 (11), 1893-6 PMID: 23532547

Image via Fer Gregory / Shutterstock.

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The God Brain – Is Religion Hardwired? http://brainblogger.com/2016/02/15/the-god-brain-is-religion-hardwired/ http://brainblogger.com/2016/02/15/the-god-brain-is-religion-hardwired/#respond Mon, 15 Feb 2016 17:17:05 +0000 http://brainblogger.com/?p=21402 National Geographic Channel will shortly air “Brain Games: The God Brain” (premiering Sunday, February 21 at 9 pm ET). As part of a virtual roundtable, Brain Blogger was selected to screen the episode and address the thought provoking question raised therein:

The question of whether religion has been hardwired into our brains or an evolutionary adaptation has been debated for decades, however, more recently we have uncovered scientific underpinning for both possibilities.

The question of whether religion has been “hardwired” into our brains or an evolutionary adaptation has been debated for decades, however, more recently we have uncovered scientific underpinning for both possibilities.

It should first be noted that our brains process all of our experiences whether actual (reading this article right now) or imagined (your dreams tonight). Your reality is just that… your reality, and not that of your neighbors.

There are innate programs that are run by our brain’s CPU such as breathing, heart rate control, and sneezing. Complex tasks such as tying our shoes are generally run by multiple brain processes spanning visual perception to motor skills. Is the religious experience just another brain program?

Barrett equates religion to language acquisition where “we come into this world cognitively prepared for language; our culture and upbringing merely dictate which languages we will be exposed to.” Brain Blogger’s own Dr. Jennifer Gibson discussed how “the brain seems predisposed to a belief in all things spiritual” back in 2008.

Scientists have approached the question of the neurobiological underpinnings of the spiritual or religious experience in largely five different ways:

First, a variety of brain imaging and monitoring techniques such as EEG, MRI including functional MRI (fMRI), PET, and SPECT have compared data on brain activity and blood flow in specific spiritual practices. Some studies have identified specific brain areas that are consistently active (or suppressed) during the religious practice.

Second, capitalizing on the religious/spiritual experience seen with hallucinogenic agents, LSD, ecstasy, and other drugs which act on the serotonergic system have been used to study metabolic changes.

Third, patients with neurological and psychiatric diseases such as temporal lobe epilepsy and schizophrenia are used as a prime population of spiritual experiences or alterations in religious beliefs.

Fourth, studies are done with prayer and meditation for a host of physical and mental health conditions such as anxiety and hypertension.

Fifth, psychologists and anthropologists deemed that children left to their own devices would have some conception of God. Some attribute this to our innate sense of detecting patterns in the world (as to discern predators or prey in nature), while other propagate the notion of a “supersense” — or a cognitive tendency to infer hidden forces in the world working for good or ill.

As the original question remains unanswered, we are early… the neuroscientific study of religious and spiritual phenomena remains in its infancy. There is mounting evidence of a biological correlate to these phenomena, however, this does not necessarily negate an actual spiritual component.

Keeping thinking.

References

Newberg AB (2014). The neuroscientific study of spiritual practices. Frontiers in psychology, 5 PMID: 24672504

Harris S, Kaplan JT, Curiel A, Bookheimer SY, Iacoboni M, & Cohen MS (2009). The neural correlates of religious and nonreligious belief. PloS one, 4 (10) PMID: 19794914

Nencini P, & Grant KA (2010). Psychobiology of drug-induced religious experience: from the brain “locus of religion” to cognitive unbinding. Substance use & misuse, 45 (13), 2130-51 PMID: 20388013

Image via Bruce Rolff / Shutterstock.

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Training the Brain and the Startle Response http://brainblogger.com/2016/02/08/training-the-brain-and-the-startle-response/ http://brainblogger.com/2016/02/08/training-the-brain-and-the-startle-response/#respond Mon, 08 Feb 2016 18:38:10 +0000 http://brainblogger.com/?p=21387 National Geographic Channel will shortly air “Brain Games: Meet The Brain” (premiering Sunday, February 14 at 9 pm ET). As part of a virtual roundtable, Brain Blogger was selected to screen the episode and address the thought provoking question raised therein:

Do you think individuals can train their brain to respond in a particular way to certain situations, or do you think our brain’s innate “startle response” is too hardwired to alter?

I will address the roundtable question from a clinician’s standpoint. In short, yes we can “train” our brains to respond in very “particular” ways and yes our “startle response” is “hardwired.” The question was phrased to suggest that these two concepts are mutually exclusive, however, I will present an alternate reality in which both co-exist.

With the development of electroencephalography (EEG), we finally had a glimpse into the living brain without cracking it open. Using small electrodes over the scalp, we were able to detect the electrical activity of the brain without even breaking the skin. EEG still remains the golden standard for detecting epileptic seizure activity in neurology offices’ worldwide. And, from it’s advent, it has been used as the first modality in neurofeedback — a collection of techniques that train the brain and help improve its functions. It has most successfully been applied to ADHD, epilepsy, depression, anxiety, and Parkinson’s disease.

The technologies for neurofeedback expanded beyond EEG to other advanced modalities including functional magnetic resonance imaging (fMRI), functional near infrared spectroscopy (fNIRS), and magnetoencephalography (MEG). One just needs to read NeuroRegulation (formerly the Journal of Neurotherapy) for the plethora of clinical applications using neurofeedback.

With such mounting evidence that we can train our brains through EEG and other neurofeedback methods, we come back to the “startle response” — which is really a defensive reflex stemming from the brainstem aimed to protect the body from threats. It is best illustrated in infants in what is known as the Moro reflex. Watch this video of a baby’s normal response (the Moro reflex) to an unexpected touch:

As we age, this “primitive reflex” dampens and it takes a lot (like free falling in a roller coaster) to trigger it. It is only when problems arise in the brain do resemblants of the startle response return with great regularity. In the neurodegenerative disease Creutzfeldt–Jakob disease (CJD) responsible for a rapid onset of dementia, the startle response in heightened and may cause uncontrolled jerks of the body (myoclonus). The same can occur in juvenile myoclonic epilepsy — a very common form of epilepsy. Much rarer, the startle response may never go away in the case of hereditary hyperekplexia — a genetic neurological condition where patients experience a short period of rigidity and inability to move in response to threatening stimuli (e.g. loud noise).

After all, our brain’s have a finite number of processing units. So, when you touch, yell, or shine a bright light at someone, you are using up these limited projections in their brain. The threshold that “startles” someone is specific person-to-person and time-to-time — it depends on other things on the mind, our state of anxiousness, and the overall health of the brain (as we saw with epilepsy and dementia earlier). There is a great review article by Guirado and colleagues just published in Cerebral Cortex that outlines the research to date on how these signals compete for our attention.

In the end, we can train our minds to respond a certain way to stimuli and the startle response is hardwired, but, modulated by many biopsychosocial factors.

References

Kandemir M, Gündüz A, Uzun N, Yeni N, & K?z?ltan M (2015). Auditory startle response is normal in juvenile myoclonic epilepsy. Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 36 (7), 1247-9 PMID: 25805707

Guirado R, Umemori J, Sipilä P, & Castrén E (2016). Evidence for Competition for Target Innervation in the Medial Prefrontal Cortex. Cerebral cortex (New York, N.Y. : 1991), 26 (3), 1287-94 PMID: 26637448

Thibault RT, Lifshitz M, & Raz A (2016). The self-regulating brain and neurofeedback: Experimental science and clinical promise. Cortex; a journal devoted to the study of the nervous system and behavior, 74, 247-61 PMID: 26706052

Arns M, Heinrich H, & Strehl U (2014). Evaluation of neurofeedback in ADHD: the long and winding road. Biological psychology, 95, 108-15 PMID: 24321363

Image via Zastolskiy Victor / Shutterstock.

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Cartoon – Diets and Sustained Weight Loss http://brainblogger.com/2015/06/23/cartoon-diets-and-sustained-weight-loss/ http://brainblogger.com/2015/06/23/cartoon-diets-and-sustained-weight-loss/#respond Tue, 23 Jun 2015 22:00:41 +0000 http://brainblogger.com/?p=19908 Reference

Gudzune KA, Doshi RS, Mehta AK, Chaudhry ZW, Jacobs DK, Vakil RM, Lee CJ, Bleich SN, & Clark JM (2015). Efficacy of commercial weight-loss programs: an updated systematic review. Annals of internal medicine, 162 (7), 501-12 PMID: 25844997

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Cartoon – Alcohol Prevent Chronic Kidney Disease? http://brainblogger.com/2015/06/21/cartoon-alcohol-prevent-chronic-kidney-disease/ http://brainblogger.com/2015/06/21/cartoon-alcohol-prevent-chronic-kidney-disease/#respond Sun, 21 Jun 2015 22:00:34 +0000 http://brainblogger.com/?p=19903 Reference

Koning SH, Gansevoort RT, Mukamal KJ, Rimm EB, Bakker SJ, Joosten MM, & PREVEND Study Group (2015). Alcohol consumption is inversely associated with the risk of developing chronic kidney disease. Kidney international, 87 (5), 1009-16 PMID: 25587707

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Cartoon – Confirming the HPV Vaccination Is Safe http://brainblogger.com/2015/06/19/cartoon-confirming-the-hpv-vaccination-is-safe/ http://brainblogger.com/2015/06/19/cartoon-confirming-the-hpv-vaccination-is-safe/#respond Fri, 19 Jun 2015 21:00:18 +0000 http://brainblogger.com/?p=19911 Reference

Scheller NM, Svanström H, Pasternak B, Arnheim-Dahlström L, Sundström K, Fink K, & Hviid A (2015). Quadrivalent HPV vaccination and risk of multiple sclerosis and other demyelinating diseases of the central nervous system. JAMA, 313 (1), 54-61 PMID: 25562266

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Cartoon – Antibiotic Overuse in America http://brainblogger.com/2015/06/17/cartoon-antibiotic-overuse-in-america/ http://brainblogger.com/2015/06/17/cartoon-antibiotic-overuse-in-america/#respond Thu, 18 Jun 2015 01:30:39 +0000 http://brainblogger.com/?p=19899 Reference

Hicks LA, Bartoces MG, Roberts RM, Suda KJ, Hunkler RJ, Taylor TH Jr, & Schrag SJ (2015). US outpatient antibiotic prescribing variation according to geography, patient population, and provider specialty in 2011. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 60 (9), 1308-16 PMID: 25747410

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Cartoon – Head Lice in School Children http://brainblogger.com/2015/05/23/cartoon-head-lice-in-school-children/ http://brainblogger.com/2015/05/23/cartoon-head-lice-in-school-children/#respond Sat, 23 May 2015 19:00:13 +0000 http://brainblogger.com/?p=19712 Reference

Devore CD, Schutze GE, & COUNCIL ON SCHOOL HEALTH AND COMMITTEE ON INFECTIOUS DISEASES (2015). Head lice. Pediatrics, 135 (5) PMID: 25917986

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Genetic Basis to ALS – Interview with Robert Baloh of Cedars-Sinai http://brainblogger.com/2015/05/22/genetic-basis-to-als-interview-with-robert-baloh-of-cedars-sinai/ http://brainblogger.com/2015/05/22/genetic-basis-to-als-interview-with-robert-baloh-of-cedars-sinai/#respond Fri, 22 May 2015 12:00:27 +0000 http://brainblogger.com/?p=19493 Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder with no real disease-modifying therapy. Only until recently did we attribute a small portion of individuals with ALS with a genetic basis. Research from Robert Baloh, MD, PhD, Director of Neuromuscular Medicine at Cedars-Sinai, and colleagues at Washington University in St. Louis, discovered the much larger role of genetics in ALS. Here, I interview Baloh on his findings.

Shaheen Lakhan: Can you provide us with an overview of ALS?

Dr. Robert Baloh's lab with Staff at Cedars-Sinai Medical CenterRobert Baloh: ALS, amyotrophic lateral sclerosis, is a neuromuscular disorder: It attacks nerve cells in the brain, brainstem and spinal cord that control muscles. The timing and sequence of progression is unpredictable, but it often begins in the arms or legs and eventually affects the breathing muscles in the chest.

ALS is often considered a very rare disease, but it probably is about as common as other neurodegenerative diseases, such as Parkinson’s disease. The reason ALS seems rare is that few patients survive long – people generally live only three to five years after onset – so unlike other disorders, there is not a growing number of patients living with the disease.

The disorder often is called Lou Gehrig’s disease after the New York Yankees’ first baseman who died of ALS in 1941. Even today, no significant disease-slowing treatments have been found, but we are able to offer therapies that improve patient quality of life. In recent years, there has been a surge in research to find the underlying genetic, molecular and cellular changes that cause the disease. With those discoveries, we expect to begin developing effective interventions.

Research funding increased dramatically when the ALS Ice Bucket Challenge brought much greater attention to finding cures for ALS.

SL: Is ALS inheritable?

RB: Yes, some cases are. Until very recently, we believed that about 10 percent of ALS cases had a genetic origin – there was a family history of the disease. The remaining 90 percent or so were considered “sporadic.”

SL: What is the difference between sporadic and familial ALS?

RB: ALS occurs when one or more changes in certain genes take place. A case is considered familial if a newly diagnosed patient has a previous family history of the disease, but if a new patient is the first family member diagnosed, the case is called sporadic – occurring without a previous genetic explanation.

SL: What has your research group found?

RB: Our study, which involved researchers from Cedars-Sinai and Washington University in St. Louis, found that family history may play a much larger role than previously believed – accounting for more than one-third of all ALS cases rather than only one-tenth. Examining DNA from 391 patients with ALS, we looked at 17 genes already known to be associated with the disease. We found many new or very rare mutations in ALS genes in people with no family history of the disease, suggesting that these supposedly “sporadic” cases may actually have a familial background.

We also found that patients who had mutations in two or more of these ALS genes had disease onset about 10 years earlier than those with defects in only one gene. Often, ALS is caused by well-known defects in single genes, but recent studies suggested that some cases might be brought on by the simultaneous occurrence of two or more “lesser” genetic defects. In theory, each mutation alone might not cause disease, but in combination they exceed the threshold for disease development. Not only does our study support that possibility, it shows that multiple defects can influence the way the disease manifests in individuals – striking 10 years earlier.

SL: What are the potential clinical implications of your research?

RB: We think we are entering a new phase of ALS research and treatment in which we will be able to analyze a patient’s entire genetic makeup and deliver gene-specific therapies to correct detected defects. We recently conducted a disease-in-a-dish study with cells from patients with defects in a gene that commonly causes ALS. Using small segments of genetic material to target the defects, we showed that this type of gene therapy can improve neurons from patients with the disease.

In addition, with the discovery of new and rare genetic mutations in ALS, we may be able to identify at-risk patients earlier because we can follow families previously unknown to have a genetic basis.

SL: Any closing remarks for our Brain Blogger readers?

RB: In our study, we used new technology that quickly and efficiently determines the organizational structure of large numbers of genes, but we focused only on 17 genes already known to be associated with ALS. Even though we identified the involvement of many new and rare mutations in ALS development, the majority of cases are caused by factors we do not yet understand. Therefore, more research using similar technology may help us discover other genes that influence ALS risk, providing more targets for future therapy.

Reference

Cady J, Allred P, Bali T, Pestronk A, Goate A, Miller TM, Mitra RD, Ravits J, Harms MB, & Baloh RH (2015). Amyotrophic lateral sclerosis onset is influenced by the burden of rare variants in known amyotrophic lateral sclerosis genes. Annals of neurology, 77 (1), 100-13 PMID: 25382069

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Cartoon – Nuts Reduce Heart Disease and Death http://brainblogger.com/2015/05/21/cartoon-nuts-reduce-heart-disease-and-death/ http://brainblogger.com/2015/05/21/cartoon-nuts-reduce-heart-disease-and-death/#respond Thu, 21 May 2015 12:00:37 +0000 http://brainblogger.com/?p=19503 High intake of nuts has been linked to a reduced risk of heart disease and mortality in earlier studies, however, have been criticized for being conducted largely in European populations with high socioeconomic status (SES). Researchers from Vanderbilt looked at urban Chinese and Black populations from low SES and nut consumption on health. They found that “consumption was associated with decreased overall and cardiovascular disease mortality across different ethnic groups and among individuals from low SES groups”.

Reference

Luu HN, Blot WJ, Xiang YB, Cai H, Hargreaves MK, Li H, Yang G, Signorello L, Gao YT, Zheng W, & Shu XO (2015). Prospective Evaluation of the Association of Nut/Peanut Consumption With Total and Cause-Specific Mortality. JAMA internal medicine PMID: 25730101

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Cartoon – Walking Groups and Health http://brainblogger.com/2015/05/18/cartoon-walking-groups-and-health/ http://brainblogger.com/2015/05/18/cartoon-walking-groups-and-health/#respond Mon, 18 May 2015 19:00:19 +0000 http://brainblogger.com/?p=19513 A meta-analysis of 42 studies shows that walking groups have wide-ranging health benefits including reduced systolic blood pressure, diastolic blood pressure, resting heart rate, body fat, body mass index (BMI), and total cholesterol. Further, measures of physical functioning were greater in adults in walking groups including VO2 max (measure of the maximum volume of oxygen that an individual can use), SF-36 (health survey), and 6?min walk time (the distance an individual is able to walk over a total of six minutes on a hard, flat surface).

Hanson S, & Jones A (2015). Is there evidence that walking groups have health benefits? A systematic review and meta-analysis. British journal of sports medicine PMID: 25601182

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Cartoon – Vegetarians and Colorectal Cancer http://brainblogger.com/2015/05/15/cartoon-vegetarians-and-colorectal-cancer/ http://brainblogger.com/2015/05/15/cartoon-vegetarians-and-colorectal-cancer/#respond Fri, 15 May 2015 19:00:44 +0000 http://brainblogger.com/?p=19520 Vegetarian diets may be associated with an overall lower incidence of colorectal cancers. Researchers from Loma Linda University analyzed data from the “The Adventist Health Study 2” of 96,354 Seventh-Day Adventist men and women between 2002-2007. The incidence of colorectal cancer in order of least to greatest was as follows: pescovegetarians (diet that includes fish or other seafood, but not meat or poultry), lacto-ovo vegetarians (no meat, fish, or poultry), vegans (no animal products), semivegetarians (those who ate meat, poultry, or fish less than once per week), and nonvegetarians.

Reference

Orlich MJ, Singh PN, Sabaté J, Fan J, Sveen L, Bennett H, Knutsen SF, Beeson WL, Jaceldo-Siegl K, Butler TL, Herring RP, & Fraser GE (2015). Vegetarian Dietary Patterns and the Risk of Colorectal Cancers. JAMA internal medicine PMID: 25751512

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Cartoon – Sleep Therapies and Health http://brainblogger.com/2015/05/13/cartoon-sleep-therapies-and-health/ http://brainblogger.com/2015/05/13/cartoon-sleep-therapies-and-health/#respond Wed, 13 May 2015 23:28:53 +0000 http://brainblogger.com/?p=19715 Reference

Irwin MR, Olmstead R, Breen EC, Witarama T, Carrillo C, Sadeghi N, Arevalo JM, Ma J, Nicassio P, Bootzin R, & Cole S (2015). Cognitive Behavioral Therapy and Tai Chi Reverse Cellular and Genomic Markers of Inflammation in Late Life Insomnia: A Randomized Controlled Trial. Biological psychiatry PMID: 25748580

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Cartoon – Purpose in Life and Improved Health http://brainblogger.com/2015/05/12/cartoon-purpose-in-life-and-improved-health/ http://brainblogger.com/2015/05/12/cartoon-purpose-in-life-and-improved-health/#respond Tue, 12 May 2015 19:00:24 +0000 http://brainblogger.com/?p=19506 Researchers looks at data from the Health and Retirement Study that tracked older Americans of at least 50 years of age for six years. Individuals with increased sense of purpose in life were more likely to engage in preventative screening tests such as cholesterol testing, mammography, pap smear, and prostate examination. Further, there were fewer days hospitalized for those with greater purpose in life.

Reference

Kim ES, Strecher VJ, & Ryff CD (2014). Purpose in life and use of preventive health care services. Proceedings of the National Academy of Sciences of the United States of America, 111 (46), 16331-6 PMID: 25368165

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