July 2003

Crossroads has added another beneficial service for our clients. We now test for neurotransmitters. Neurotransmitters are natural chemicals made within the body that relay messages, information and signals from nerve to nerve throughout the body.
We are now testing for Epinephrine (the major stress neurotransmitter related to blood pressure and heart rate), Norepinephrine (a stress neurotransmitter related to anxiety and insomnia), Dopamine (necessary for relaxation and mental alertness), Serotonin ( a master neurotransmitter which modulates stress hormones), and GABA (an inhibitory neurotransmitter and related to insomnia, anxiety and depression).

This month Dr. Curtis Cripe and Dr. Martha Grout will be presenters at the 11th Annual International Conference on Thinking in Scottsdale, AZ. Their topic is entitled "Attention Deficit Hyperactivity Disorder: A New Paradigm for Treatment."

Everyone is somewhere on the Neurodevelopmental Spectrum. Where are you on it .... where do you want to be?

Accelerated neurodevelopment allows us the ability to maximize and use our intellectual, physical, and emotional strengths simultaneously, no matter where we begin on the spectrum.

When accelerating brain power, daily tasks such as working, studying, and sports become easier to do and manage. The brain is functioning at optimal levels and is able to make quick attentional shifts on demand.

This is the state of mind that peak performers call "the zone" and is accessible at will.

Oxford Offers Members Alternative Care 5/19/2003 Oxford Health Plans Inc. of Trumbull said it is offering members access to consultative services for complementary and, alternative medicine (CAM) through the Carol and Morton Siegler Center for Integrative Medicine, part of the Saint Barnabas Ambulatory Care Center in Livingston, N.J. Depending on their specific health concerns and treatment preferences, members can meet with medical doctors and CAM practitioners to discuss integrating both therapies into their care plans, Oxford said. Oxford members can access the Siegler Center's full network of acupuncturists, massage therapists, nutritionists and yoga instructors using Oxford's CAM-contracted rate program. Through the contracted rate program, members select a participating provider, schedule an appointment and pay the provider a negotiated rate at the time of the visit. Access may vary by state and product. Stanford Researchers Uncover Mystery Behind How Skull Plates Fuse Source: Stanford University Medical Center 2003-04-10 STANFORD, Calif. - Stanford University Medical Center researchers have identified a protein responsible for ensuring correct skull growth in newborn mice. The protein, called Noggin, inhibits fusion of bony plates in the skull until developmentally appropriate. The scientists hope that Noggin may one day replace surgery as a way to treat premature skull fusion in infants. "About 1 in 2,000 children has growth plates in their skull that fuse prematurely," said Michael Longaker, MD. "The brain is rapidly expanding in size during the first two years of life. If the brain's container - the skull - can't expand in a similar fashion, you have a big problem." Left untreated, the condition can lead to mental retardation, blindness and seizures, as well as a severely misshapen head. Longaker, a pediatric craniofacial surgeon at Lucile Packard Children's Hospital and a professor of surgery at the School of Medicine, can correct the defect by removing sections of fused bone from an infant's skull. But the operation is complex. And because it's difficult to accurately predict how much room is needed for expansion, the procedure may need to be repeated as the brain grows. At first, Longaker and his colleagues suspected that the root of the problem was the inappropriate expression of proteins that stimulate bone growth in the skull. They began comparing when and where these proteins were produced, but they started on the wrong track. "It's not as simple as promoting bone induction," said Longaker, the principal investigator of the research, which is published in the April 10 issue of Nature. "It turns out that the inhibitors are equally important. We had been missing the point." The researchers discovered that the bone-promoting proteins are present between all the skull growth plates in mice: those that are actively fusing and those that are not. In contrast, Noggin, a known inhibitor of bone formation, was found only between plates that remained open. The scientists began to suspect that, like a testy chaperone at a high school dance, Noggin keeps the two edges of the skull apart. And like anxious teenagers, the bones reach out to each other when Noggin is removed from the mix. Noggin's new role in skull fusion was confirmed dramatically when the scientists injected a Noggin-producing virus between the bone plates along mice foreheads. The plates, which normally would have fused, remained open. This resulted in the animals developing blunt muzzles and wide-set eyes. Although the results were clear, there was another mystery to be solved. In a seemingly futile loop, the very bone-promoting protein required for fusion also induced Noggin production. Then the researchers found that over-expression of another protein, called FGF2, inhibited Noggin expression in cell culture. The finding correlated with the fact that some human disorders characterized by premature skull fusion are caused by mutations in a receptor for FGF2 that kick the protein into overdrive. These mutants also turned off Noggin expression. "We had been wondering how FGF2, which is involved in promoting new blood vessels, stimulated bone formation," said Longaker. "Now we know that it works, in part, by decreasing the amounts of inhibitors of bone formation." The scientists are now working to understand how FGF2 decreases Noggin production, with an eye to a less-invasive treatment for infants with premature fusion. But such treatment would likely require early diagnosis of any problems. "Can Noggin unlock an existing bone bridge? That would be a tall order," said Longaker. "But if premature fusion could be diagnosed before birth, a window of therapy could present itself." He envisions a day when sophisticated prenatal ultrasound or genetic testing could identify infants at risk before fusion began. By injecting Noggin-producing cells or viruses into the breach between growth plates, physicians could stave off inappropriate fusion until the brain finished expanding. "Unlike some gene therapy challenges, we wouldn't need to express Noggin for the life of the child," said Longaker. "The first two years would be adequate." Such a treatment would represent a huge leap over existing therapy. "Craniofacial surgery is more of a chisel-and-saw approach," he added. "We've had technical improvements, but it hasn't really evolved. This finding represents a biomolecular approach that may re-establish normal growth and appearance of the skull, which is the most important research outcome."   Shamans in the highlands of Mexico traditionally prescribe specially prepared medicinal plants for diabetes. After many years of field studies and laboratory tests, researchers from the University of Bonn have been able to confirm that these natural remedies really are highly effective and, what's more, have few side effects. In Mexico a factory is now planned which will produce plant-based anti-diabetes capsules. The know-how of traditional healers could thereby contribute towards solving a pressing problem: the WHO estimates that by 2025 every seventh Mexican will be suffering from diabetes: just under 12 million people. The traditional healers (shamans) recognize their diabetes patients by taste. "If the patient has the appropriate symptoms - feels very thirsty, has a strong urge to pass urine, is tired, and has lost weight - the healer tests to see whether the patient's blood or urine tastes sweet," the Bonn phytochemist Dr. Helmut Wiedenfeld explains. "If so, the diagnosis is obvious." "Sweet blood" is by no means rare in the Mexican highlands: in many villages eight out of 10 adults "have sugar," Wiedenfeld adds. Scientists suspect that the reason is genetic predisposition and the wrong diet. Traditionally, Mexican village doctors rely on specific medicinal plants when treating diabetes. Together with his staff, Wiedenfeld has tested different natural preparations on diabetic rats. "Initially without much success," he recalls. This changed when his assistant Ivan Perez was allowed to look over the shaman's shoulder for several months in the highland village of Xochipala. "The key often lies in the preparation," Wiedenfeld explains. The healer in Xochipala mixes the medicinal plant with maize, for example, or other ingredients, and allows the mixture to stand for some time. "Molecular scissors" in the maize then cut up the component substances of the anti-diabetes plant into smaller fragments. "And one of these fragments is effective against diabetes," says Wiedenfeld. From this mixture the healer obtains a drink which he calls "agua de uso," or "water for everyday use." His patients have to drink half a liter a day of this water. In the meantime the scientists have managed to manufacture capsules of the powdery active substance involved. Three capsules contain as much of the active substance as 250 grams of the plant material, corresponding to a day's dosage. The first clinical trials are already underway. A company producing natural medicine has expressed an interest in this new organic medication. Provided the tests run successfully, there will soon be a factory built in the highlands to produce anti-diabetes capsules. The farmers will obtain a guaranteed commitment to purchase the medicinal plants which have been collected or grown and the locals will benefit from the newly created jobs. Most of the locals suffer from type 2 diabetes (non-insulin-dependent diabetes), what used to be called "adult-onset diabetes;" however, in the meantime it is known that type 2 diabetes can occur before adulthood. The factors which trigger or exacerbate the disease are diets rich in carbohydrates and fat, combined with lack of exercise. Treatment mainly involves using synthetic substances, which, however, may result in side effects such as nausea, allergic reactions, or changes in the blood count. "One problem with this disease is usually the late diagnosis. Since, in the early stages, the blood glucose level does not increase as sharply as in type 1 diabetes, for instance, it is only rarely detected in routine check-ups," Wiedenfeld points out. Especially since the routine checks are usually carried out on an empty stomach, when the patient's blood glucose concentration is low. If it is treated too late, the patient can expect severe follow-up effects which may include blindness or the loss of limbs. Traditional healers, too, are aware of the importance of the correct diet to prevent diabetes developing. "In 1993 a new village was discovered in the Mexican highlands. One of the first marvels of civilization to reach it was a well-known sweetened soft drink," Wiedenfeld says. The village shaman is skeptical of the enormous consumption of this sugary beverage. "In the meantime he recommends his diabetics to switch to the sugar-free light version." This article was prepared by Biotech Week editors from staff and other reports.

A quantitative controlled MRI study of the brain in 28 persons with Asperger syndrome. Nieminen-von Wendt T, Salonen O, Vanhala R, Kulomaki T, von Wendt L, Autti T. Hospital for Children and Adolescents/Child Neurology, Helsinki University Central Hospital, Helsinki, Finland. BACKGROUND: As structural brain abnormalities have been reported in infantile autism, the aim of this study was to determine whether such findings also exist in Asperger Syndrome (AS). METHODS: The diagnosis of Asperger Syndrome was based on the criteria in ICD-10 and DSM-IV. Brain magnetic resonance imaging (MRI) was performed with a 1.5 T imager. T2-weighted axial and coronal slices and T1-weighted three dimensional sagittal slices were obtained and visual and quantitative analysis were performed. SUBJECTS: There were 28 Asperger individuals, 17 children and adolescents (age 6-19 years, mean 12.4 years), 11 adults (age 20-60 years, mean 37. 9 years) and 28 healthy age and gender matched controls. RESULTS: Mild inconsistent alterations were detected in 13/28 of the individuals with Asperger Syndrome compared to 6/23 in the comparable controls. There were no differences between the right and left hemispheres, nor was there any abnormality in terms of myelination or migration. The anterior-posterior diameters of the mesencephalon were statistically significantly shorter in the Asperger syndrome individuals than in the controls. CONCLUSIONS: No consistent focal brain abnormalities for Asperger Syndrome were detected. The reduced diameters of the mesencephalon in the Asperger group support the hypothesis that the mesencephalon may be involved in the pathogenesis of Asperger Syndrome. FMRI evidence for an organization of prefrontal cortex by both type of process and type of information. Johnson MK, Raye CL, Mitchell KJ, Greene EJ, Anderson AW. Departments of Psychology and Diagnostic Radiology, Yale University, New Haven, CT 06520-8205, USA. Neuroimaging evidence is conflicting regarding whether human prefrontal cortex (PFC) shows functional organization by type of processes engaged or type of information processed. Most studies use complex working or long-term memory tasks requiring multiple processes and the combinations of processes recruited for different materials may vary. Using functional magnetic resonance imaging (fMRI) and simple tasks suggested by a component process approach, we found activity in left PFC when participants thought about (refreshed) a just-seen item and in right PFC when participants noted whether an item had been presented previously. Furthermore, the distribution of activation in left or right PFC varied with type of information. Thus, at the component process level, PFC shows functional organization by both process and type of information. Cognitive impairment in remission in bipolar affective disorder. Rubinsztein JS, Michael A, Paykel ES, Sahakian BJ. Department of Psychiatry, University of Cambridge. BACKGROUND: Although the traditional view of bipolar affective disorder is that the majority of patients have full remission between episodes, recent evidence suggests that residual cognitive deficits are present. The aim of this study was to determine whether memory and executive deficits were present in a well-defined clinically remitted group of patients. METHODS: This was a case-control study of bipolar patients in remission (N = 18). Subjects had to fulfil stringent clinical criteria for inclusion into the study and had to have been in remission for at least 4 months. Subjects also had no history of substance dependence. The cognitive battery examined memory and executive function. RESULTS: Patients in excellent clinical remission and who reported good social adaptation showed imipairment on tests of visuospatial recognition memory. Accuracy on four tests of executive function was not impaired in patients in remission compared with controls, although response latency on these executive tests was still impaired. CONCLUSIONS: As our group and others have shown, patients with mania and unipolar depression show generalized impairment on tests of memory and executive function. In comparison, this study has demonstrated that patients in remission show a relatively specific impairment in memory with recovery of accuracy measures on executive function task. The increased response latency on the executive tasks suggests a possible small residual impairment. These findings suggest that in netIroanatomical terms, more posterior cortical function (temporal lobe) has not improved but there is at least some recovery of frontal lobe function in remission. Brain anatomy and sensorimotor gating in Asperger's syndrome. McAlonan GM, Daly E, Kumari V, Critchley HD, van Amelsvoort T, Suckling J, Simmons A, Sigmundsson T, Greenwood K, Russell A, Schmitz N, Happe F, Howlin P, Murphy DG. Department of Psychological Medicine, Institute of Psychiatry, London, UK. Asperger's syndrome (an autistic disorder) is characterized by stereotyped and obsessional behaviours, and pervasive abnormalities in socio-emotional and communicative behaviour. These symptoms lead to social exclusion and a significant healthcare burden; however, their neurobiological basis is poorly understood. There are few studies on brain anatomy of Asperger's syndrome, and no focal anatomical abnormality has been reliably reported from brain imaging studies of autism, although there is increasing evidence for differences in limbic circuits. These brain regions are important in sensorimotor gating, and impaired 'gating' may partly explain the failure of people with autistic disorders to inhibit repetitive thoughts and actions. Thus, we compared brain anatomy and sensorimotor gating in healthy people with Asperger's syndrome and controls. We included 21 adults with Asperger's syndrome and 24 controls. All had normal IQ and were aged 18-49 years. We studied brain anatomy using quantitative MRI, and sensorimotor gating using prepulse inhibition of startle in a subset of 12 individuals with Asperger's syndrome and 14 controls. We found significant age-related differences in volume of cerebral hemispheres and caudate nuclei (controls, but not people with Asperger's syndrome, had age-related reductions in volume). Also, people with Asperger's syndrome had significantly less grey matter in fronto-striatal and cerebellar regions than controls, and widespread differences in white matter. Moreover, sensorimotor gating was significantly impaired in Asperger's syndrome. People with Asperger's syndrome most likely have generalized alterations in brain development, but this is associated with significant differences from controls in the anatomy and function of specific brain regions implicated in behaviours characterizing the disorder. We hypothesize that Asperger's syndrome is associated with abnormalities in fronto-striatal pathways resulting in defective sensorimotor gating, and consequently characteristic difficulties inhibiting repetitive thoughts, speech and actions.

EEG/ERP

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Research Methodology in Neurofeedback by Siegfried Othmer (July 15, 2002) A couple of recent scientific papers on the placebo effect reached the popular media, and prompt us to revisit the whole issue of how research might be done to everyone's satisfaction in neurofeedback. The first of these articles was a review of some 47 studies of anti-depressants that had been submitted to the FDA to gain approval for anti-depressant medications. In more than half of those studies, the drugs did no better than placebo. And overall, the improvement with drugs was only 18% greater than it was with placebos. The second of these studies involved functional imagery of drug responders, placebo responders, and non-responders. It found that placebo responders also showed changes in their functional imagery, and that these changes differed from those induced by the effective medications. "After all, the 250 studies on Ritalin don't help to decide whether a particular child will be helped, and at what dosage. They are not much good in deciding what to do in the moment." These studies elevate the importance of the placebo effect once again in everyone's considerations, which can only serve to increase the burden of proof for neurofeedback. Our traditional answer to this challenge has been to point out that the placebo effect is not really on the other team as far as neurofeedback is concerned. Let me explain. From the perspective of drug interventions, the placebo is the catch-all phrase that subsumes all mechanisms other than the drug itself by which recovery may have been achieved. This includes spontaneous recovery, self-regulation-induced recovery, "the natural course of the disease" (e.g., natural waxing and waning of symptoms), and the results of changes in the psychodynamic milieu. In another recent study reviewing the placebo effect, it was shown that the majority of the benefit being ascribed to the placebo could be understood in terms of the "natural course of the disease." This is particularly true of depression, where episodes of depression are usually episodic, and recovery is achieved in time regardless of any intervention. However, this still leaves room for a "real" placebo effect of some significance. And this real placebo effect is presumably mediated by "spontaneous" or psychodynamically mediated changes in the quality of brain self-regulation. The possibility of such a self-regulation response helps to make the case for neurofeedback. It does not undermine it. Presumably the natural waxing and waning of depression and other conditions is also reflective of changes in the quality of brain self-regulation. From our perspective, then, the placebo effect, in all its manifestations, is just a stalking horse for self-regulation-mediated recovery. As such, it is our ally, and we are inclined to take umbrage at the dismissal of a real change as being "just a placebo effect." We have to take skeptics where they are, however, and the question will still be asked, what part of neurofeedback-induced recovery is ascribable to "specific" and to "non-specific" effects of the training. The best study to answer this question was Barry Sterman's serendipitously fully controlled, fully blinded cat study with the monomethylhydrazine. However, if we have to answer this same question with regard to each of the conditions we work with, what are we to do? The traditional answer has been to compare the active treatment with sham treatment, or to do reversal designs. Reversal designs are no longer ethically permitted (we are not allowed to make people worse), and even placebo designs have their ethical problems. But let's pursue the idea of sham-training a little further. It is extraordinarily difficult to do well. When Sterman did it, he acknowledged that trainees in fact discovered the subterfuge (no surprise). So the blind was broken, and the whole objective of doing a blinded study was not met. To do sham-training well, we have to simulate everything about the person's EEG, including in particular the movement artifacts and the eye-blink artifacts. The only way to do this successfully is to work somehow with the person's actual EEG. The more difficult standard to meet is that the clinician must be just as invested in success with the placebo treatment as with the experimental treatment, so that any placebo effect may be invoked. How do we fool the clinician who is at the controls into being motivated? The obvious answer is that we must employ an active treatment that also promises some benefit, rather than a total sham treatment. Even having done this, an asymmetry prevails. The clinician knows which is the experimental design, and which is the "B" design. There will be a natural tendency to "lean" in favor of the experimental treatment. The only way for a true "equipoise" to exist with respect to two treatments is for the clinician not to know which is better, and therefore to be motivated to succeed with both. We have here devised what I think is the perfect experimental design for neurofeedback, an A/B design between two active treatments in which a fundamental doubt exists as to which is better, and outcomes are compared. In this approach, we may lose 'contrast' between treatment and sham, but we heighten our sensitivity to differential effects. We already know that it is not a big deal to demonstrate recovery from depression. What the world will take notice of is differential effects of specific treatment protocols. Now I will point out that in our clinical work, with our generic protocols, we have in fact been working with this research design all along. Essentially all of our training protocols come in pairs, and are used as necessary to balance each other. The original training on the midline at Cz bifurcated for us into left- and right-hemisphere specificity of "C3beta" and "C4SMR" training. The more recent "C3-C4" training is bifurcating for us into a combination of F3-F4 and P3-P4. Higher-frequency training is complemented by lower-frequency training, etc. Each new client faces the clinician with fundamental ambiguities about protocols that are only resolved on the basis of the differential effects of each protocol. An analogy that comes to mind is the optometrist who refines his choice of optical correction by means of A/B comparisons. This approach allows much greater refinement than the single-ended approach of "can you read this?" Eventually the optometrist reaches the point where the person can no longer tell which is better. Clinicians using our approach likewise do not settle down to a single protocol until an equivalent resolution is obtained by an elaborate A/B comparison process. Because of the high responsiveness of the individual to specific protocols in-session, feedback is usually quick. This means that the therapist is also in a relatively fast feedback loop of typically no more than a few minutes, but lasting at most a session or two. This gives neurofeedback practitioners an enormous advantage over pharmacologists. After all, the 250 studies on Ritalin don't help to decide whether a particular child will be helped, and at what dosage. They are not much good in deciding what to do in the moment. By contrast, the neurofeedback practitioner is using best research practice with each and every client. So our answer to those who ask: "where are your controlled studies?" is that we are doing them, one subject at a time. There is almost never a time when we are not doing what would be called for in a "best-practices" controlled research design. Things can't get much better than this. EEG signature and phenomenology of alpha/theta neurofeedback training versus mock feedback. Egner T, Strawson E, Gruzelier JH. Department of Cognitive Neuroscience and Behaviour, Imperial College of Science,London Alpha/theta (a/t) neurofeedback training has in the past successfully been used as a complementary therapeutic relaxation technique in the treatment of alcoholism. In spite of positive clinical outcomes, doubts have been cast on the protocol's specificity when compared to alternative relaxation regimes. This study investigated the basic tenet underlying the a/t training rationale, that accurate a/t feedback representation facilitates the generation of these frequency components. Two groups of healthy volunteers were randomly assigned to either (a) real contingent a/t feedback training or (b) a noncontingent mock feedback control condition. The groups were compared on measures of theta/alpha (t/a) ratios within and across training sessions, as well as activational self-report scales after each session. The contingent a/t feedback group displayed significant within-session t/a ratio increments not evident in the mock control group, as well as higher overall t/a ratios in some but not all of the training sessions. No differences were found between the groups in terms of subjective activational phenomenology, in that both groups reported significantly lower levels of activation after training sessions. The data demonstrate that irrespective of considerations of clinical relevance, accurate a/t neurofeedback effectively facilitates production of higher within-session t/a ratios than do noncontingent feedback relaxation.

The mediating effects of effort upon the relationship between head injury severity and cognitive functioning Author(s): Alan Moss ; Christopher Jones ; Dene Fokias ; David Quinn Source: Brain Injury  Volume: 17 Number: 5 Page: 377 -- 387 Publisher:Taylor & Francis Health Sciences Abstract: Primary objective: Given that poor effort may have a profound impact upon the results of neuropsychological assessment, it is of critical importance that assessment of effort is incorporated into the interpretation of a patient's neuropsychological profile. The current study examines the relationship between head injury severity (as measured by length of post-traumatic amnesia) and level of cognitive functioning in patients passing or failing a test of effort (Test of Malingered Memory). Research design: A cross-sectional correlational design was employed in a consecutive cohort of 78 persons with ongoing compensation claims. Methods and procedures: Head injury severity was assessed by duration of post-traumatic amnesia. All participants received a clinical interview followed by neuropsychological assessment. Main outcomes and results: A systematic and interpretable negative correlation between head injury severity and intellectual and memory functioning was demonstrated in persons passing the test of effort. However, in persons failing the test of effort no such relationships were demonstrated. Conclusions: The implications for the interpretation of neuropsychological test data are discussed. It is strongly recommend that valid interpretation of neuropsychological assessment data should include consideration of at least one test of effort. Even minor head injuries can seriously damage the brain Robert A. Dershewitz, M.D., Sc.M., FAAP Part of the cultural indoctrination of young athletes is to "hang tough'' and to get back into the game as quickly as possible. From the orthopedic and neurologic point of view, this may be the worst advice possible. Let me use head trauma as an example. Concussions, or traumatic brain injuries as they are now known medically, range from mild to severe. Some 75 percent of brain-injured people experience only mild concussions, and fortunately, the majority of those sustaining a mild concussion recover completely. Symptoms of brain injury in young children include listlessness, changes in personality, sleeping patterns and playing, and unsteady walking. School performance may decline. Older children and adolescents, like adults, may have problems concentrating and remembering, headaches, sleep disturbances, fatigue, and show behavioral changes such as irritability, depression and emotional outbursts. Many head injuries can be prevented, e.g., by wearing helmets while riding bicycles and motorcycles and when at-bat playing baseball. Once a head injury occurs, further problems (called secondary injuries) can be prevented by making sure that the child does not further injure his brain during this vulnerable period. For example, a major bleed into the brain may occur if there is another minor injury to the head before the initial injury has fully recovered. With a minor concussion (defined as temporary confusion without loss of consciousness and a full recovery of mental alertness within 15 minutes), the athlete may return to play once certified as normal by a qualified person. Even if there was no loss of consciousness, any child with any neurologic sign (e.g. disorientation, slurred speech, confusion lasting for more than 15 minutes) must NOT be allowed to return to the sport. (The Indiana Medical Association is even more conservative by recommending that high schoolers who require more than five minutes to become symptom-free should not be allowed to return.) In any event, the child with a minor concussion should be closely observed for deteriorating neurologic symptoms that day and must have a normal neurologic assessment after one week of rest before being allowed to return to action. Severe concussions are those in which consciousness is lost. These children need a thorough and immediate neurologic assessment, often including a neuroimaging study, e.g., a CT scan. The soonest the athlete can return to sports is one week. According to John Doherty, a Munster athletic trainer, athletes at most major colleges nationwide are given a computerized baseline neuropsychological exam when they first arrive on campus. If an athlete then suffers a concussion, he or she is required to reproduce baseline scores as well as be medically cleared to resume sports participation. Locally, Munster High School adapted this practice. "It gives a much more objective look at how the brain is working following a concussion and eliminates the guesswork about when it is and isn't safe to return" Doherty said. Recovery from brain injury is variable, with rest being critical as well as the avoidance of the potential for a secondary injury. With some injuries, and with some neurologic sequelae, referral to a neurologist, neurosurgeon, or neuropsychologist may be advisable. , is a pediatrician at Healthy Kids Care Center in Munster and is affiliated with The Community Hospital in Munster. He also is editor of Ambulatory Pediatric Care, a major textbook in Pediatrics and Associate Editor of Journal Watch, an international medical newsletter. Temporary and permanent signs of interhemispheric disconnection after traumatic brain injury. Peru A, Beltramello A, Moro V, Sattibaldi L, Berlucchi G. Dipartimento di Scienze Neurologiche e della Visione, Sezione Fisiologia Umana, Universita di Verona, Strada Le Grazie, 8, I-37134, Verona, Italy. The corpus callosum is frequently damaged by closed head traumas, and the resulting deficits of interhemispheric communication may vary according to the specific position of the lesion within the corpus callosum. This paper describes a single case who suffered a severe traumatic brain injury resulting in a lesion of the posterior body of the corpus callosum. Among the classical symptoms of interhemispheric disconnection, left hand anomia, left upper limb ideomotor dyspraxia, left visual field dyslexia and dysnomia, and left ear suppression in a dichotic listening task were observed shortly after the injury but recovered completely or almost completely with the passage of time. The only symptom of interhemispheric disconnection which was found to persist more than 4 years after the injury was an abnormal prolongation of the crossed-uncrossed difference in a simple visuomotor reaction time task. This prolongation was comparable with that observed in subjects with complete callosal lesions or agenesis. The results suggest that the posterior body of the corpus callosum may be an obligatory interhemispheric communication channel for mediating fast visuo-motor responses. The transient nature of other symptoms of interhemispheric disconnection suggests a relatively wide dispersion of fibers with different functions through the callosal body, such that parts of them can survive a restricted lesion and allow functional recovery of hemispheric interactions. An assessment of the evolution in time of symptoms of interhemispheric disconnection following restricted callosal lesions may reveal fine and coarse features of the anatomo-functional topography of the corpus callosum. Catecholamine functioning in children with traumatic brain injuries and children with attention-deficit/hyperactivity disorder. Brain Res Cogn Brain Res 2003 May Konrad K, Gauggel S, Schurek J. Department of Child and Adolescent Psychiatry, Aachen, Germany Recent studies suggest that children with attention deficit/hyperactivity disorder (ADHD) and children with traumatic brain injuries (TBI) show changes in similar neuronal networks, including the dopaminergic (DA) and norepinephrinergic (NA) systems. Therefore, indirect measures of catecholamine activity were assessed. Twenty-six children with TBI, 31 children with ADHD, and 26 normal controls, 8 to 12 years of age, were investigated with a 90-min cognitive test battery. Before and after the tests, urine samples were collected to measure catecholamine activity in response to cognitive stress. Spontaneous eyeblinking as an indirect measure of DA activity was counted. Children with TBI and ADHD excreted significantly more normetanephrine in resting situations and less epinephrine (EPI) after cognitive stress, and showed a decreased blink rate compared to normal controls. Children with TBI also showed a higher excretion of metanephrine in the resting situation in comparison to children with ADHD and controls. Whereas children with ADHD showed a higher tonic activity of the NA system and a less adaptive EPI excretion in response to cognitive stress, children with TBI seem to be additionally impaired in their tonic EPI excretion. Our study provides further support for similar but also different neurobiochemical characteristics in both groups.

Comparison of Brain Models for Active vs. Passive Perception Walter J Freeman University of California at Berkeley Information Sciences 116: 97-107, 1999. Abstract In a passive information processing system a stimulus input gives information, which is transduced by receptors into trains of impulses that signify the features of an object. The symbols are processed according to rules for learning and association and are then bound into a representation, which is stored, retrieved and matched with new incoming representations. In active systems perception begins with the emergence of a goal that is implemented by the search for information. The only input accepted is that which is consistent with the goal and anticipated as a consequence of the searching actions. The key component to be modeled in brains provides the dynamics that constructs goals and the adaptive actions by which they are achieved. Volumetric MRI studies of mood disorders: Do they distinguish unipolar and bipolar disorder? Stephen M Strakowski, Caleb M Adler and Melissa P DelBello Bipolar and Psychotic Disorders Research Program, Department of Psychiatry, University of Cincinnati College of Medicine Bipolar Disord 2002: 4: 80±88. The authors reviewed magnetic resonance imaging volumetric imaging results in major mood disorders, particularly comparing similarities and differences from studies of bipolar disorder and unipolar major depression. Abnormalities of cerebral brain regions appear inconsistently in mood disorders and, when present, typically consist of decreased frontal or prefrontal cortical volumes in both unipolar depression and bipolar disorder. In contrast, subcortical and medial temporal abnormalities are more commonly observed and are diÄerent between these two major classes of affective illness. Specifically, whereas structural enlargement of the basal ganglia and amygdala have been observed in bipolar disorder, in unipolar depression, these structures appear to be smaller in patients than healthy subjects. These fndings suggest that affective illnesses may share in common an underdeveloped or atrophied prefrontal region, leading to loss of cortical modulation of limbic emotional networks. The affect of this loss results in unipolar depression or cycling (mania with depression) depending on the abnormalities of the subcortical structures involved. The cerebellum may also play a role in the presentation of mood disorders. This hypothesis remains speculative as much more research is needed to speciffically examine how morphometric brain abnormalities translate into the neurophysiologic deficits that produce mood disorders. Attention and movement-related motor cortex activation: a high-density EEG study of spatial stimulus-response compatibility. Praamstra P, Oostenveld R. Behavioral Brain Sciences Centre, University of Birmingham, Birmingham, UK Visual spatial attentional activation of motor areas has been documented in single cell neurophysiology and functional imaging studies of the brain. Here, we investigate a candidate event-related brain potential representing visuospatial attentional activity in motor areas of the cortex. The investigation aimed to elucidate the neural origin and the functional characteristics of this brain potential, which has been labelled N2cc and is typically observed in spatial stimulus-response compatibility tasks. High-density EEG was recorded in 10 subjects while they performed a Simon-type spatial stimulus-response compatibility task and a control task where the same stimuli were assigned to Go-Nogo response alternatives. The N2cc showed a time course parallel to the posteriorly distributed N2pc, associated with visuospatial selection. Scalp distribution and current source density reconstructions allowed a spatial separation of N2pc and centrally distributed N2cc and were compatible with a source for the N2cc in the lateral premotor cortex. Comparisons across tasks demonstrated that the N2cc depends on bilateral response readiness, ruling out an exclusively attentional interpretation. Instead, the activity appears associated with visuospatial attentional processes that serve the selection and suppression of competing responses, in accord with a function of the dorsal premotor cortex in response selection. Together, the results consolidate the N2cc as a new ERP component relevant to the investigation of visuospatial motor processes.

LORETA findings in depression and effects of antidepressant drugs. Anderer P, Saletu B, Semlitsch HV, Pascual-Marqui RD. Section of Sleep Research and Pharmacopsychiatry, Department of Psychiatry, University of Vienna, Vienna, Austria. Noninvasive electrophysiological neuroimaging applied to cognitive components of event-related potentials (ERPs) may differentiate between structural and energetic processes related to information processing. The structural level, revealed by the location of the local maxima of the current source density distribution, describes the time-dependent network of activated brain areas. The magnitude of the source strength, a measure of the energetic component, describes the allocation of processing resources. ERPs were recorded in an odd-ball paradigm and low-resolution brain electromagnetic tomography (LORETA) was applied for standard and target ERP components. In a group of 60 menopausal depressed patients of 45-60 years of age, reduced P300 source strength was observed bilaterally, temporally and medially prefrontally reaching to rostal parts of the anterior cingulate, compared with 29 age-matched controls. In a double-blind, placebo-controlled study, 2 mg of the antidepressant citalopram induced a significant increase of P300 source strength in the (left) prefrontal cortex and precuneus compared with placebo, reaching to the posterior cingulate. Similar increases were observed after 800 mg S-adenosyl-L-methionine (SAMe) administered intravenously in ten young healthy subjects aged 22-33, and they were even more pronounced in ten elderly healthy subjects aged 56-71. Thus, ERP-tomography identified changes in energetic sources in brain areas predominantly involved in depression and in antidepressant action. Enhancing neuronal plasticity and cellular resilience to develop novel, improved therapeutics for Difficult-to-Treat depression. Biol Psychiatry 2003 Apr 15 Manji HK, Quiroz JA, Sporn J, Payne JL, Denicoff K, A Gray N, Zarate CA, Charney DS. Laboratory of Molecular PathophysiologyNational Institute of Mental Health, Bethesda, Maryland There is growing evidence from neuroimaging and ostmortem studies that severe mood disorders, which have traditionally been conceptualized as neurochemical disorders, are associated with impairments of structural plasticity and cellular resilience. It is thus noteworthy that recent preclinical studies have shown that critical molecules in neurotrophic signaling cascades (most notably cyclic adenosine monophosphate [cAMP] response element binding protein, brain-derived neurotrophic factor, bcl-2, and mitogen activated protein [MAP] kinases) are long-term targets for antidepressant agents and antidepressant potentiating modalities. This suggests that effective treatments provide both trophic and neurochemical support, which serves to enhance and maintain normal synaptic connectivity, thereby allowing the chemical signal to reinstate the optimal functioning of critical circuits necessary for normal affective functioning. For many refractory patients, drugs mimicking "traditional" strategies, which directly or indirectly alter monoaminergic levels, may be of limited benefit. Newer "plasticity enhancing" strategies that may have utility in the treatment of refractory depression include N-methyl-D-aspartate antagonists, alpha-amino-3-hydroxy-5-methylisoxazole propionate (AMPA) potentiators, cAMP phosphodiesterase inhibitors, and glucocorticoid receptor antagonists. Small-molecule agents that regulate the activity f growth factors, MAP kinases cascades, and the bcl-2 family of proteins are also promising future avenues. The development of novel, nonaminergic-based therapeutics holds much promise for improved treatment of severe, refractory mood disorders.

Hippocampal map realignment and spatial learning 28 April 2003  Ephron S Rosenzweig1, A David Redish1, 5, Bruce L McNaughton1, 2, 3 & Carol A Barnes1, 2, 4   Division of Neural Systems, Memory, and Aging, University of Arizona, Tucson, Arizona Department of Psychology, University of Arizona Department of Neurology, University of Arizona, The spatial selectivity of hippocampal neurons suggests that they contribute to an internal representation of current location. The activity of hippocampal pyramidal cells was recorded while adult (10–13 months old) and aged (24–28 months old) rats performed a task in which two spatial reference frames were put in conflict. Rats attempted to find an unmarked goal whose position was fixed relative to only one of the two reference frames. The ability of a rat's hippocampus to adjust to the conflicting information and use the 'correct' position estimate (hippocampal map 'realignment') was correlated with the rat's ability to find the hidden goal. In addition, aged rats were impaired relative to adult rats in both goal-finding accuracy and map realignment. Thus, changes in the effectiveness with which the hippocampal spatial representation is updated on the basis of external cues may contribute to both within-age-group spatial learning variability and age-related spatial learning deficits.  FOXP2 in focus: what can genes tell us about speech and language? Gary F. Marcus and Simon E. Fisher Trends in Cognitive Sciences, 2003, 7:6:257-262 Abstract The human capacity for acquiring speech and language must derive, at least in part, from the genome. In 2001, a study described the first case of a gene, FOXP2, which is thought to be implicated in our ability to acquire spoken language. In the present article, we discuss how this gene was discovered, what it might do, how it relates to other genes, and what it could tell us about the nature of speech and language development. We explain how FOXP2 could, without being specific to the brain or to our own species, still provide an invaluable entry-point into understanding the genetic cascades and neural pathways that contribute to our capacity for speech and language. Broca's area and the language instinct July 2003 Volume 6 Number 7 Mariacristina Musso1, Andrea Moro2, Volkmar Glauche1, Michel Rijntjes1, Jürgen Reichenbach3, Christian Büchel1 & Cornelius Weiller1 Department of Neurology, University of Hamburg, Germany. University San Raffaele, Milano, Italy. Institute for Diagnostic and Interventional Radiology, Friedrich Schiller University, Jena, Germany. Language acquisition in humans relies on abilities like abstraction and use of syntactic rules, which are absent in other animals. The neural correlate of acquiring new linguistic competence was investigated with two functional magnetic resonance imaging (fMRI) studies. German native speakers learned a sample of 'real' grammatical rules of different languages (Italian or Japanese), which, although parametrically different, follow the universal principles of grammar (UG). Activity during this task was compared with that during a task that involved learning 'unreal' rules of language. 'Unreal' rules were obtained manipulating the original two languages; they used the same lexicon as Italian or Japanese, but were linguistically illegal, as they violated the principles of UG. Increase of activation over time in Broca's area was specific for 'real' language acquisition only, independent of the kind of language. Thus, in Broca's area, biological constraints and language experience interact to enable linguistic competence for a new language.

Agnosiacs might think a leoraffe is real Like many teenage boys Michael is a sports fanatic. He's passionate about his team Everton and loves playing squash. But unlike most other football fans Michael, aged 19, can't actually see and recognise the players properly. Ten years ago he was involved in a serious car smash and now sufferers from a disorder of the brain's visual processing system called visual agnosia. He has lost the normal long-term "memory banks" used to recognise visual information. Michael can see moving objects, colours and shapes, but needs other prompts such as voices to give him the complete picture to recognise people by. Reality Dr Ros McCarthy, a neuropsychologist at Cambridge University, said Michael and other people with visual agnosia often found it difficult to recognise even very familiar faces. "They may not even recognise the faces of their wives or parents. "It is not like conventional blindness you can't imagine what it is like to have this by just closing your eyes. Patients like these use methods of deduction to help them cope Sal Anderson "From being an active and happy boy Michael now had a significant paralysis on one side and he now he suffers difficulty seeing or recognising anybody. "If you were to ask him whether I was wearing glasses he would say that he didn't know." Now Michael's experiences, along with those of another five people with visual agnosia are being made into five or six short films to educate the public about the condition. A gulltelope The series of four minute films are funded by the Wellcome Trust and will be shown in cinemas across the country. Entitled "Eye See", the films also feature a story based on the case of another person with visual agnosia who could not tell whether the animals he sees were real or fantasy figures. Shown a picture of a "babex", part ibex and part baboon he thought it was a real animal. He was also confused by the imaginary "bunnyphant", which is a mixture of rabbit and an elephant. Coping Film maker Sal Anderson, said that although many people with visual agnosia managed to cope in society that they often had significant problems recognising emotions and facial expressions. "Patients like these use methods of deduction to help them cope. If they can hear a voice and a movement then they know it is a person. "Someone with visual agnosia will know that when a person's lips curl up then they are smiling and if they have tears coming down their face then they are crying." Visual agnosiacs cannot be "cured", but Dr McCarthy said she hoped the films would help show the public their interpretations of the world. "We want to show that this is just as valid a way of looking at it - it's just different." she said. Salience modulates 20–30 Hz brain activity in Drosophila   28 April 2003  Bruno van Swinderen & Ralph J Greenspan The Neurosciences Institute Fruit flies selectively orient toward the visual stimuli that are most salient in their environment. We recorded local field potentials (LFPs) from the brains of Drosophila melanogaster as they responded to the presentation of visual stimuli. Coupling of salience effects (odor, heat or novelty) to these stimuli modulated LFPs in the 20–30 Hz range by evoking a transient, selective increase. We demonstrated the association of these responses with behavioral tracking and initiated a genetic approach to investigating neural correlates of perception.     Visual search strategies are indexed by event-related lateralizations of the EEG. 2003 Apr Biol Psychol ;63(1):79-100 Wolber M, Wascher E. Max-Planck Institute for Psychological Research, Cognitive Psychophysiology of Action, Munich, Germany Two processes have been proposed for picking out information from a visual scene. A parallel process that detects salient features and a following serial process for higher order vision. However, this separation is still under dispute. The current study investigated whether event-related lateralizations (ERLs) of the electroencephalogram are a useful tool to examine these two processes. In a visual search for a colour- or form singleton or a conjunction target, reaction time (RT), P3 amplitudes and ERLs served as dependent variables. RT replicated earlier results for colour and conjunction targets. P3 amplitudes decreased and ERL latencies increased for these conditions. However, form singletons showed RT-, P3- and ERL-results comparable to conjunction targets. ERL-results differed in some conditions from RTs. The results suggest that target attributes alone cannot dissociate between different search strategies but showed that efficient as well as less efficient processes can be utilised for the same targets proposing that processing demands are determined by the inter-relation of target and the distractors.   What is a visual object? Jacob Feldman Trends in Cognitive Sciences, 2003, 7:6:252-256 Abstract The concept of an 'object' plays a central role in cognitive science, particularly in vision, reasoning and conceptual development – but it has rarely been given a concrete formal definition. Here I argue that visual objects cannot be defined according to simple physical properties but can instead be understood in terms of the hierarchical organization of visual scene interpretations. Within the tree describing such a hierarchical description, certain nodes make natural candidates as the 'joints' between objects, representing division points between parts of the image that cohere internally but do not perceptually group with one another. Thus each subtree hanging from such a node corresponds to a single perceived 'object'. This formal definition accords with several intuitions about the way objects behave.

Response inhibition deficits in obsessive-compulsive disorder. Bannon S, Gonsalvez CJ, Croft RJ, Boyce PM. Department of Psychology, University of Wollongong, Australia. Difficulty inhibiting irrelevant information may play a central role in the aetiology of obsessive-compulsive disorder (OCD). The aim of the present study was to determine whether OCD subjects exhibit deficits in behavioural and cognitive inhibition compared with a clinical control group diagnosed with panic disorder. All subjects were administered a Go/Nogo task (a measure of behavioural inhibition) and a Stroop test (a measure of cognitive inhibition). OCD subjects made more commission errors on the Go/Nogo task, and they made more errors and displayed longer reaction times on the interference trial of the Stroop task. Trends towards correlations were observed between OCD severity scores and Stroop reaction time, where the more severe the OCD symptoms the faster was the response. No correlations between clinical symptomatology or subject demographics and the Go/Nogo task were observed. It was demonstrated that OCD subjects exhibit deficits in behavioural and cognitive inhibition, which together may underlie the repetitive symptomatic behaviours of the disorder, such as compulsions and obsessions. Anterior cingulate: single neuronal signals related to degree of reward expectancy. Science. 2002 May 31 Shidara M, Richmond BJ. Neuroscience Research Institute, National Institute of Advanced Industrial Science and Technology,Tsukuba, Ibaraki Japan. As monkeys perform schedules containing several trials with a visual cue indicating reward proximity, their error rates decrease as the number of remaining trials decreases, suggesting that their motivation and/or reward expectancy increases as the reward approaches. About one-third of single neurons recorded in the anterior cingulate cortex of monkeys during these reward schedules had responses that progressively changed strength with reward expectancy, an effect that disappeared when the cue was random. Alterations of this progression could be the basis for the changes from normal that are reported in anterior cingulate population activity for obsessive-compulsive disorder and drug abuse, conditions characterized by disturbances in reward expectancy. Neural correlates of anxiety associated with obsessive-compulsive symptom dimensions in normal volunteers. Biol Psychiatry 2003 Mar Mataix-Cols D, Cullen S, Lange K, Zelaya F, Andrew C, Amaro E, Brammer MJ, Williams SC, Speckens A, Phillips ML. Division of Psychological Medicine, GKT School of Medicine and Institute of Psychiatry, London, United Kingdom The neural correlates of anxiety associated with obsessive-compulsive symptomlike provocation in normal volunteers are unknown.Ten healthy volunteers participated in four functional magnetic resonance experiments. Subjects were scanned while viewing alternating blocks of emotional (normally aversive, washing-relevant, checking-relevant, or hoarding-relevant pictures) and neutral pictures, and imagining scenarios related to the content of each picture type. Nonparametric brain mapping analyses were used.In response to the provocative pictures in all experiments, increases in subjective anxiety and activation in bilateral ventral prefrontal, limbic, dorsal prefrontal, and visual regions were demonstrated. Anxiety related to different symptom dimensions was associated with different patterns of activation: provocation of washing-relevant anxiety predominantly activated dorsal and ventral prefrontal regions; checking-relevant anxiety predominantly activated dorsal prefrontal regions; and hoarding-relevant anxiety predominantly activated ventral prefrontal regions and the left amygdala. Our findings support a dimensional model of obsessive-compulsive disorder (OCD) whereby 1) the brain systems implicated in the mediation of anxiety in response to symptom-related material in normal subjects are similar to those identified in OCD patients during symptom provocation, and 2) anxiety associated with different symptom dimensions is associated with differential patterns of activation of these neural systems. Further investigation of the neural basis of OCD symptom dimensions is required.

TRADITIONAL CHINESE MEDICINE

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Universitiy of New Mexico Doctor Supplements Western Medicine In Dr. Arti Prasad's native India, it wasn't unusual for medical treatments to combine elements of Western, herbal and Ayurvedic medicine. That hasn't been true in the United States, though, at least not over the last century. Strong walls have been built between Western medicine -- also called allopathic -- and some of the more traditional or alternative treatments. But that is starting to change. After a couple years of trying, Prasad has succeeded in setting up a section of integrative medicine in the University of New Mexico's Department of Internal Medicine. As head of that section, she is working with others to help doctors learn about treatments that many of their patients are pursuing. Dr. Pope Moseley, chairman of the department, said he thinks Prasad's section fits right in with the university's mission. "We're trying to develop the newest technology. That may be what you classically think of as high-tech, but it's also to investigate and apply appropriate integrative models," he said. "We should employ all techniques in the medical armature." People already search out and use herbs, supplements, bodywork and other therapies -- that fact of life is what started Prasad on this path in the first place. "People were asking me questions about herbs, about nutrition," she said. Her most common answer: "I don't know much about that." "I had no idea what St. John's wort, valerian or kava were six years ago," she said, naming some common herbs used for depression or anxiety. But, in response to her patients' questions, Prasad started to learn on her own, reading books or attending conferences that addressed complementary therapies. "I had forgotten during my training that there are limitations to Western medicine," she said. "There are also limitations to alternative medicine. But if you can combine them, you can do a better job. Our responsibility is to make our patients feel better." About 70 percent of the time, patients don't tell their doctors that they are trying complementary therapies, Prasad said. It would be better if doctors knew what their patients were doing -- and if they knew how helpful those therapies are, she said. "It's better to have open communication so we can guide patients on making the best choices," she said. One of the keys, she said, is simply for doctors to listen to their patients, something many of them don't feel they have much time for these days. Prasad's section is involved in a number of activities to bring greater awareness to integrative medicine: * Curriculum -- Medical students at UNM won't necessarily take separate courses on complementary treatments, but information may be woven into their education. For example, Prasad said, a case study about a runner with osteoarthritis in the knee may include information about the supplements glucosamine and chondroitin. "We're slowly doing it," she said of the curriculum change. "It may take three to five years." * Residents -- Efforts have been made to incorporate information about complementary therapies into residencies for medical graduates. Some discussion is under way about setting up elective rotations for residents to spend some time with non-Western practitioners. * Current health professionals -- Continuing education programs and lectures have been developed for physicians and other health professionals. This Thursday from 8 to 9 a.m., for example, Dr. James Gordon, director of the Center for Mind-Body Medicine in Washington, D.C., will speak about integrative medicine in the Nursing/Pharmacy Auditorium, as part of the Internal Medicine Grand Rounds. It's open to health care professionals but not the general public. Also, a Symposium of Integrative Medicine Professionals in the Land of Enchantment is set for Oct. 3-5 at the Albuquerque Hilton. It will feature Dr. Andrew Weil, best-selling author and director of the integrative medicine program at the University of Arizona School of Medicine. * Clinics -- Dr. Brian Shelley offers a complementary and alternative medicine consultation clinic from 8 a.m. to noon Fridays at UNM's Northeast Heights Clinic, 7801 Academy NE. He also directs an integrative pain clinic 1 to 5 p.m. on the first and third Tuesdays of the month at First Choice Community Healthcare, 1231 Candelaria NW. * Direct care -- UNM is preparing to hire a doctor of Oriental medicine to provide acupuncture to UNM patients. Weekly yoga classes are being offered to UNM cancer patients and hospital employees, and other complementary treatments may be integrated into the cancer program. * Research -- Several medical students are working on projects involving complementary medicine, and Prasad is working on research that is investigating alternative approaches to treatment of disorders such as arthritis and fibromyalgia. "We are very evidence-based," Prasad said. But when other doctors say there isn't evidence to support some non-Western treatments they may not have looked for the evidence, she said. A computer search revealed more than 600,000 citations on research into complementary and alternative medicine, she said. She said the reaction she has gotten from other UNM doctors has been mixed. "Some will not accept it and are very critical of what I am trying to do," she said. Most though, have been positive, she added. "Practices are based on the current, best evidence," Prasad said.

COOPERATION OF FRONTAL AND PARIETAL BRAIN AREAS AS A FUNCTION OF COGNITIVE TRAINING Erdmute Sommerfeld, Anke Hensel and Andrea Hildebrandt University of Leipzig, Germany ABSTRACT In solving memory based problems working memory is realizing control processes involved in the temporary maintenance and manipulation of information. Such control processes can be reduced on the basis of cognitive training. However, in terms of inner psychophysics, the relationship between the process of cognitive training and changes in the cooperation of cortical subsystems supporting these processes remains an open issue. The work presented in this paper was guided by the idea that functional cooperation of specific cortical subsystems is indicated by synchronization of relevant brain areas. EEG coherence was used to assess the synchronization of spatially separate brain areas as a function of increasing practice on the task. The paradigm consisted of memory based tasks of syllogistic reasoning. The present study investigated training-dependent EEG coherence changes across eight phases of cognitive training. The results show a training-dependent decrease as well of the reaction time as of the interregional coherence of fronto-parietal electrode pairs within the left hemisphere in the analyzed 4-7.5 Hz and 13-20 Hz frequency bands. This supports our hypothesis that a training-dependent reduction of mental effort for control processes is accompanied by a reduction of the strength of the functional coupling between specific frontal and parietal brain regions. However, there exist certain differences between the trainingdependent functions. Based on these different functions it is possible to reveal functional relations between the process of cognitive training and accompanying changes of the functional coupling between cortical subsystems underlying task performance. Performance data alone are not sufficient for a full understanding of learning processes, in particular for understanding the nature of the changes taking place during learning. What processing parameters indicate effects of cognitive training? With regard to the solution of memory based problems, what parameters indicate a decrease in the mental effort demanded by control processes involved in the short-term storage and online manipulation of information? One promising way to answer this question is to look for activation in task relevant cortical subsystems and synchronization between them. On the basis of functional magnetic resonance imaging it could be shown that prefrontal cortex along with parietal cortex appears to play a role in active maintenance of information (for instance Cohen et al., 1997). Based on these findings, it is of special interest to look for functional couplings of frontal and parietal subsystems during task performance before, meanwhile and after cognitive training. EEG coherence can be used to 2 measure the synchronization of specific brain areas (Rappelsberger & Petsche, 1988; Petsche, 1996; Schack et al., 1999). However, what are the frequency bands responsible for executive control and for active maintenance of information? On the basis of EEG power and coherence analyses it could be shown that the theta frequency band (ca. 4-7 Hz) plays an important role in the maintenance of new information (Petsche & Etlinger, 1998; Sarnthein et al., 1998). The experimental results of Klimesch et al. (1996) argue that theta synchronization is selectively related to the encoding of new information. It was found that changes in mental effort for control processes are indicated by changes in coherence between specific frontal and posterior areas in parts of the beta frequency band (ca. 13-20Hz) (Petsche & Etlinger, 1998; Sommerfeld et al., 1999). In the analysis of three practice phases it could be shown that the training-dependent reduction of mental effort for control processes is accompanied by a decrease of the interregional coherence between specific frontal and parietal areas in the 13- 20 Hz (beta1) frequency band (Sommerfeld & Krause, 1998). The present study was designed to extend these findings by examining eight training phases. Additionally, it was hypothesized that the mental effort for the temporary maintenance of information will be reduced over the course of practice, manifesting itself by a decrease of the interregional coherence between specific frontal and parietal areas in the theta frequency band. This assumption is also based on the theory of Lisman et al (1994) about relations between the activity of the hippocampus in the theta frequency band and the short-term maintenance of information. METHOD Subjects Five healthy right-handed volunteers (18-26 years of age; two males, three females) participated in the experiment. Cognitive tasks and procedure The elements used were geometrical patterns (Sommerfeld & Krause, 1998). Training effects were examined across eight phases of cognitive training (TP1, ... , TP8), with an interval between successive phases TPi and TPi+1 (i = 1,3,5,7) of nearly two hours and between phases TPj and TPj+1 (j = 2,4,6) of about one and a half weeks. In each phase, subjects had to answer 444 questions. During task performance, EEG activity was recorded from the scalp at 19 electrode positions according to the 10-20. Subjects sat in front of a computer screen. They pressed a button, and after a constant delay of 600 ms a question of the type was displayed. Subjects then had to decide and to press a response button accordingly. The reaction time (RT) was defined as the time interval between the onset of question presentation and subjects’ keypress response. Subjects were instructed to respond as quickly and accurately as possible. Data analysis For each subject, the mean reaction time (RT) and the absolute and the percentage coherence duration (CD) were analyzed as a function of the training phase (TP1, ... , TP8). The type of coherence considered here is the interregional coherence between the nine electrode pairs of the frontal electrode positions F3, Fz, F4 and the parietal positions P3, Pz, P4. The threshold for the coherence duration was set to 0.65. The analyses were restricted to band coherence within the theta frequency band (4-7.5 Hz) and the beta1 frequency band (13-20 Hz). Only correct-decision trials without EEG artifacts were examined. To determine the significant RT differences between the training phases a variance analysis in combination with a Scheffe procedure was computed. RESULTS Reaction time (RT): For all subjects studied, the RT at first decreased as a function of cognitive training and then it remains constant. Coherence duration (CD) in the beta1 frequency band (13-20 Hz): In all subjects, the percentage CD in at least two of the left (and the middle) fronto-parietal electrode pairs F3/P3, F3/Pz, Fz/P3 and Fz/Pz was going to be significantly lower in a certain training phase TPi (i>3) than at the beginning (TP1). In the training phase TPi, and during the following steps one could find no significant increase at any electrode pair (with the exception of one training-phase in one subject). In contrast to the RT the absolute CD increased in between times after an initial decrease . Coherence duration (CD) in the theta frequency band (4-7.5 Hz): In the case of a fast training-dependent decrease of the absolute CD in the beta1 band the training-dependent CD in the theta band is an analogous function as in the beta1 band. In the case of a slow trainingdependent decrease of the absolute CD in the beta1 band the initial slow decrease in the beta1 band is accompanied by an increase of the CD within the theta band in at least one of the right (and the middle) fronto-parietal electrode pairs F4/P4, F4/Pz, Fz/P4 and Fz/Pz. The training-dependent functions of the reaction time and the absolute interregional coherence duration at the electrode pair Fz/Pz in the theta and beta1 frequency bands are given in Figure 2 for two selected subjects, a “fast learner” and a “slow learner”. Differential contribution of NMDA receptors in hippocampal subregions to spatial working memory Inah Lee1 & Raymond P. Kesner1, 2 University of Utah Medical Center Department of Psychology N-methyl-D-aspartate (NMDA) receptor–dependent synaptic plasticity in the mammalian hippocampus is essential for learning and memory. Although computational models and anatomical studies have emphasized functional differences among hippocampal subregions, subregional specificity of NMDA receptor function is largely unknown. Here we present evidence that NMDA receptors in CA3 are required in a situation in which spatial representation needs to be reorganized, whereas the NMDA receptors in CA1 and/or the dentate gyrus are more involved in acquiring memory that needs to be retrieved after a delay period exceeding a short-term range. Our data, with data from CA1-specific knockout mice, suggest the possibility of heterogeneous mnemonic function of NMDA receptors in different subregions of the hippocampus. Computational models of the hippocampal region: linking incremental learning and episodic memory Mark A. Gluck, Martijn Meeter and Catherine E. Myers Abstract The hippocampal region, a group of brain structures important for learning and memory, has been the focus of a large number of computational models. These tend to fall into two groups: (1) models of the role of the hippocampal region in incremental learning, which focus on the development of new representations that are sensitive to stimulus regularities and environmental context; (2) models that focus on the role of the hippocampal region in the rapid storage and retrieval of episodic memories. Rather than being in conflict, it is becoming apparent that both approaches are partially correct and might reflect the different functions of substructures of the hippocampal region. Future computational models will help to elaborate how these different substructures interact. Hemispheric asymmetries of memory: the HERA model revisited Reza Habib, Lars Nyberg and Endel Tulving Trends in Cognitive Sciences, 2003, 7:6:241-245 Abstract The hemispheric encoding/retrieval asymmetry (HERA) model is a process-specific description of experimental data provided by a large set of functional neuroimaging studies. According to HERA, left prefrontal cortex (PFC) is more involved than right PFC in episodic memory encoding, whereas right PFC is more involved than left PFC in episodic memory retrieval. Recently it has been claimed that this description does not hold for non-verbal materials. Here we propose a more precise formulation of HERA than previously, and argue that there is sufficient evidence to conclude that HERA, as reformulated, is true for both verbal and non-verbal materials.