The road to a healthy heart is the road to a healthy brain

What if we told you that you could live your life in simple ways that give you a very, very good chance of having a healthy heart and a sharp brain well into old age?

No special drugs, no special surgeries, no amazing scientific discoveries and no wonder cures.

Sounds pretty good, doesn’t it? And it’s simple. Science is beginning to understand that the route to a healthy brain and healthy heart might be pretty much on the same road. The important mileposts on that road: eating smartly, getting moderate exercise, controlling your weight, your blood pressure and your cholesterol levels and stopping smoking.

The two of us — one a brain expert, the other a heart expert — will talk about brains and hearts and health this Monday night, Feb. 24, as part of the OHSU Brain Institute’s Brain Awareness Season lecture series. Our lecture will begin at 7 p.m. at the Newmark Theater in downtown Portland.

We’ll talk about how science has known for years that following some of these “living healthy” principles can help your heart health. But we’re increasingly seeing that the same good practices that help your heart also seem to help your brain.

For example, science knows no absolute cure or prevention — yet — for dementia. But there are hints.

A long-term study of 678 Roman Catholic nuns (known, not surprisingly, as the Nun Study) has shown that in patients with an equivalent number of “plaques” and “tangles” in the brain associated with Alzheimer’s disease, only those who also had had small strokes showed signs of dementia. That could mean small strokes somehow “activated” the dementia in brains that had the plaques.

And that suggests that if you decrease your risk factors for stroke — by following those “living healthy” principles — you also decrease your risk of dementia.

We’re also increasingly understanding how important prenatal nutrition is to that baby’s health — heart health, brain health and overall health — as an adult. Lower birth weight from poor prenatal nutrition means a higher risk of stroke and heart disease. And many organs, including the heart and brain, grow abnormally when nutrition is poor before birth.

There’s a lot more to talk about, in terms of how lifestyle decisions you make every day have a long-term effect on your heart and brain. So join us Monday night — on the road to better heart and brain health.

And you don’t have to stop learning on Monday. You can learn much more by joining the OHSU Brain Institute’s just-launched Healthy Brain campaign. The campaign will offer monthly tips and a way to celebrate your progress and learn more from each other and OHSU experts in September.

Joe Quinn, M.D.

Director, OHSU Parkinson Center
Professor, Department of Neurology
OHSU Brain Institute

Kent L. Thornburg, Ph.D.
M. Lowell Edwards Chair,
 Professor of Medicine, OHSU School of Medicine
Director, Center for Developmental Health, Knight Cardiovascular Institute
Director, Bob and Charlee Moore Institute for Nutrition & Wellness


Your brain … in love

Neuroscientists have long wondered whether or not there’s a love locus in the brain; a spot where romance resides amidst the complex circuits and intricate chemicals that comprise our emotional nervous system. Recent studies have surprised us as neurologists; there is such a spot and, interestingly, it involves the nerve cells and neural circuits that drive us to crave food, water and even illicit drugs. And these are not the circuits that involve lust or sexual desire.

Recent studies support this love locus by demonstrating brain images in functional MRI scans. These specialized scans display pictures that capture the activity, not just the structure (as in regular MRI scans) of brain cells. Young, love-crazed college students were shown pictures of the objects of their affection while undergoing functional MRI scans. Behold, the parts of the brain that were activated when the students saw their love’s photograph were the areas that have a high concentration of dopamine, one of the brain’s key neurotransmitters.

Dopamine is a chemical that carries messages that influence reward, craving, and, also, drug addiction. So, in effect, these young lovers were truly “addicted” to one another, and, in fact, were found to have physically painful withdrawal symptoms when their fresh young love was thwarted.

But what about those of us long past the dizzying, delirious highs of a fevered, lovesick youngster? Actually, there is great news for those of us much farther into our relationships with the one we love. A recent study from Stony Brook University in New York demonstrated that some mature couples — who had been in love for years, even decades — still had the burst of frenzied activity in the dopamine pathways in the brain when they looked at pictures of their longtime lovers. Just as if they were college students. So no one can say that young love fades and passion wanes over time, at least not from a neurobiological standpoint!

Love does live on, but it also has many facets. I was particularly enthralled by a study from the University of Minnesota, whose researchers asked young men and women to make four lists: of their friends, the people they loved, the people they thought sexually attractive, and, lastly, those with whom they were “in love.”

The last list most often had just one name. But, consistently, that name was also on all the other lists. True love is a powerful force that embraces friendship, affection, sexual attraction and romantic impulse. It is as intoxicating as a drug. So this Valentine’s Day, I hope you appreciate the complex pathways in your brain that comprise those feelings you have of potent and enduring romantic love. Whatever your age, and however long you have been in love.

Tarvez Tucker, M.D.
Associate Professor of Neurology and Neurocritical Care
OHSU Brain Institute


Next OHSU brain awareness lecture: fighting traumatic brain injury

The impact of concussions and other traumatic brain injuries on society are staggering.

How staggering? Consider these numbers:

• Each year in the U.S., 3.4 million people suffer a traumatic brain injury, or TBI.

• TBI is one of the leading causes of death and disability in America. Each year, 53,000 Americans die due to TBI.

• Eight teenagers die every day in the U.S. from TBI.

• There are 5 million Americans living with TBI-related disabilities; direct and indirect costs of TBI in the U.S. is $76 billion per year.

The non-profit I work for — One Mind for Research — is led by retired U.S. Army General Peter Chiarelli, former commander of the multi-national corps in Iraq. He has seen first hand how TBI has affected America’s soldiers. And he is now helping to lead the fight to find ways to battle and prevent TBI.

One Mind for Research’s mission is to fund groundbreaking research and accelerate development of better diagnostics, better treatments, and ultimately, preventions and cures for a wide range of mental illnesses and brain injuries. One of our most important goals is to help science make advances in understanding, treating and, ultimately, preventing and curing TBI.

While TBI affects millions of people worldwide, it is a silent epidemic — its symptoms are frequently invisible, thus difficult to diagnose and treat. But while symptoms aren’t always easy to notice, TBI leads to motor, cognitive, and social impairments that interfere with an individual’s ability to be productive.

One Mind’s initial research project is called the “Gemini Program,” which will include 3,000 to 5,000 patients with traumatic brain injury and, in some cases, post traumatic stress. The patients will participate in a multi-year longitudinal study that will help researchers learn more about these devastating conditions.

Want to learn more about the fight against TBI? I am speaking this coming Tuesday evening — Feb. 18 — in Portland as part of the Brain Awareness Season lecture series sponsored by the OHSU Brain Institute. Gen. Chiarelli has prepared a video presentation that will also be shown at the lecture.

I hope you can join me. We need more people to understand TBI — and to join us in the fight against it.

Janet Carbary
Chief Financial Officer
One Mind for Research


Brain Insitute speaker: Mad Cow expert and neuroscience pioneer

Did you know that, according to the American Red Cross, you are forbidden from donating blood in the United States if you have spent a cumulative time of three months or more in the United Kingdom, from Jan. 1, 1980 through December 31, 1996?

The reason? It stems from the discovery that in some parts of the world, cattle can get an infectious, fatal brain disease called Mad Cow Disease. In these same locations, humans have started to get a new disease called variant Creutzfeld-Jacob Disease, also a fatal brain disease.

Jean Manson, Brain Awareness Lecture Series speaker

All of this relates to the first lecturer in the OHSU Brain Institute’s popular Brain Awareness Season lecture series. The lecture, at 7 p.m. on Monday Feb. 10 at the Newmark Theater in downtown Portland, will be presented by Jean Manson, one of the world’s leading experts on the group of diseases that include Mad Cow Disease.

But first, a few more details on what Mad Cow Disease has to do with humans.

Scientists believe that variant Creutzfeld-Jacob Diseases is Mad Cow Disease that has somehow transferred to humans, possibly through the food chain. There is now evidence from a small number of case reports involving patients and laboratory animal studies that vCJD — as it’s sometimes called — can be transmitted through blood transfusion. There is no test for vCJD in humans that could be used to screen blood donors and to protect the blood supply. This means that blood programs — like the American Red Cross’s — must take special precautions to keep vCJD out of the blood supply by avoiding collections from those who have been where this disease is found.

Which means that the OHSU Brain Institute’s first lecturer — a world renowned expert on this group of diseases — is not allowed to give blood in the United States.

Manson is head of the neurobiology division of the Roslin Institute in Edinburgh, Scotland. (The Roslin Institute is where the world’s most famous sheep, Dolly, was cloned.) She is also chair of Neurodegenerative Disease at the University of Edinburgh.

Professor Manson is an internationally recognized research scientist in what are called transmissible spongiform encephalopathies, or TSEs, a group of fatal diseases that affect the brain and nervous system of many animals, including humans. They’re also called prion diseases. Mad Cow Disease and Creutzfeld-Jacob Disease are within this group of diseases.

Research into the prion diseases not only tries to advance scientific knowledge into these mysterious diseases. It also has led to research advances in conditions such as Alzheimer’s disease.

Professor Manson will be talking about all of that during her lecture. She’ll also talk about the differences in how neuroscientists in the United Kingdom and the United States investigate brain disease.

Although I don’t study prion diseases specifically, my own research focuses on the aging brain and neuroendocrine changes that lead to cognitive impairment in the elderly. So as a neuroscientist, I’m very interested in her work.  (We also share the blood-giving problem; like Manson, I can’t give blood in the United States, since I’m originally from the U.K.)

I’m going to be there to listen. It promises to be fascinating.

Henryk Urbanski, Ph.D., D.Sc.
Professor and senior scientist, divisions of Neuroscience and Reproductive & Developmental Sciences, Oregon National Primate Research Center
Professor, Departments of Behavioral Neuroscience and Physiology & Pharmacology, OHSU Brain Institute

Vitamin D, mood and memory in persons with Parkinson’s disease

Vitamin D has become a hot topic in recent years. For many years, vitamin D has been known to play a role in bone health. More recent research suggests it may have a much broader role in multiple body systems.

In regard to the brain, we know that there are receptors for vitamin D in most parts of the human brain. In persons without Parkinson’s disease, some research suggests vitamin D may be related to mood and cognitive function. These data are somewhat limited, however, and a definitive conclusion has not been drawn.

To look more closely at mood, memory and their relationship with vitamin D in persons with Parkinson’s, some colleagues and I conducted an observational study of 286 people with Parkinson’s. We did testing of cognitive function and mood and had blood drawn. When correcting for age, disease duration, and Parkinson’s disability, we found associations between vitamin D concentrations and several measures of language function. These included how many animals or vegetables a person could name in one minute, known as verbal fluency, and how good they were at remembering a list of words. This relationship — between higher vitamin D levels and better language function — was present in those persons with Parkinson’s who were not demented, but not present in those with dementia. In regard to mood, a self reported scale of depression showed an association with vitamin D concentrations — again, just in the non-demented subset of Parkinson’s patients.

It appears that there may be a relationship between vitamin D and cognition and mood in persons with Parkinson’s. Cause and effect cannot be determined from this type of study. It is possible, for example, that persons with Parkinson’s who are depressed are less likely to get outside and therefore have lower vitamin D concentrations.

To determine if a relationship truly exists, good intervention studies are needed to see what happens to cognition and mood when vitamin D concentrations are increased in persons with Parkinson’s. Currently we are pursuing a research project looking at this with a joint OHSU and Portland VA Medical Center study. We hope to have results in the next year or two.

Amie Peterson, M.D.
Assistant Professor of Neurology
OHSU Parkinson Center of Oregon
OHSU Brain Institute

A toast to your health

There’s possibly no better time to highlight this research story than on New Year’s eve: a drink or two a day — a glass of wine, a glass of beer — might also keep the doctor away.

That’s what colleagues and I found in a study published this month in the journal Vaccine. We studied the drinking behaviors of rhesus macaque monkeys, who were given 22-hour-a-day access to a mixture of alcohol and water — and allowed to drink or not drink it. What we found after 14 months of study: the immune system of the monkeys that drank “moderate” amounts of alcohol were actually bolstered — more than the monkeys who drank more heavily and more than a control group of monkeys who drank a low-calorie sugar solution. We defined “moderate” drinking as monkeys who had a blood alcohol level of 0.02 to 0.04 percent (A blood alcohol level of 0.08 percent is the limit for humans to be able to legally drive a vehicle.).

The media coverage of our work — which has been extensive, in USA Today, Time, The Daily Beast and elsewhere — has focused on the happy news that drinking in moderation might help boost our immune system and help us fight off infection. But my colleague, Ilhem Messaoudi Powers (formerly at OHSU, now at the University of California-Riverside), and I want our research to go beyond that. We want to better understand how our body is reacting to moderate alcohol to actually have this effect. The goal would be to then find new, alcohol-free ways — maybe new medications — to boost the immune system, in generally healthy people and in people with immunodeficiency.

Of course, based on what we’ve found, it looks like people might be able to get that boost by enjoying their New Year’s Eve with that glass of wine, as well.  But remember — it’s all about moderation.

Kathy Grant, Ph.D.
Professor of Behavioral Neuroscience
OHSU Brain Institute


Ask our expert: Aging & declining mental ability

Q: Does getting older always mean losing mental ability?

A: Part of normal brain aging may mean a slowing of mental processing, especially in your memory. Although many patients ask, it’s difficult to prescribe any particular type of mental exercise for your brain, though learning things that get you out of your normal routine can help, such as learning a new language or trying a different type of puzzle.

But your best option is physical activity: Research has shown that aerobic exercise — such as walking, swimming, biking or hiking — for about 30 minutes a day, five times a week can promote the release of growth factors in the brain that create new cells.

Joseph Quinn, M.D.
Professor of Neurology
Layton Aging & Alzheimer’s Disease Center
OHSU Brain Institute

Do you have a question you’d like one of our expert to answer? Share it with us in the comments section below.

How our brains wash away the gunk during sleep

You wake on Saturday morning, drag your body out of bed and survey your home. You had entertained houseguests the night before, and it shows. Friends and family had filled your home, loud voices and much conversation echoed within your walls and everyone went home much later than you had planned. And now it is time to pay the piper. A full Saturday’s worth of dishwashing, floor scrubbing and shelf wiping stares you back in the face.

Such is our common experience, something each of us can likely relate to. New research, however, suggests that your brain may feel the same way at the end of a long day of thinking.

The brain is just like any other organ in the body in that the spaces in between its cells must be regularly swept clean to keep things running smoothly. Yet it has remained a bit of mystery how the brain accomplishes this task.

See, in the rest of the body, the lymphatic system takes care of most of this cleaning of the spaces between cells. The brain, however, has no lymphatic system.

In the summer of 2012, our research team reported in the journal Science Translational Medicine the discovery of a clever anatomical pathway by which the brain accomplishes this task of cleaning out the spaces between cells. Basically, it uses spaces on the outside of blood vessels as a dedicated set of plumbing that allows cerebrospinal fluid, or CSF, that surrounds the brain to wash through the brain, essentially flushing debris and waste out. This washing depended on water movement through support cells in the brain called “glial cells.” Thus we termed this brain-wide clearance pathway the “glymphatic system.”

Anyone who has every pulled an all nighter, or has had young children, knows that after a night with little or no sleep, not only do you feel more tired, but your mind is foggier. Why a good night’s sleep leaves the mind clear and crisp, and indeed why we would need sleep at all (since it represents “wasted” time not doing something more productive), has been one of the persistent mysteries in neuroscience.

In a study published last week in the journal Science, our team reported findings that may shed light on this question. By imaging the flushing of fluid through the brains of live mice that were awake or naturally asleep using a technique called 2-photon microscopy, we found that the rate of cleaning in the brain differed dramatically between the waking brain and the sleeping brain.

When the brain is asleep, we found that its cells shrink in order to open up the spaces between them, which allows CSF to flush through the sleeping brain at about 20 times the rate seen in the waking brain. This translated to a doubling in the efficiency of waste clearance from the sleeping versus waking brain. These findings suggest that part of the function of sleep is restorative – that it provides the brain an opportunity to tidy up and clean out the day’s accumulated waste when the activities of waking life aren’t getting in the way. It’s like cleaning up on a Saturday after Friday night’s houseguests have left.

These new findings do not simply illuminate a potential purpose of sleep, but may inform our understanding of the role of sleep disturbances in the setting of neurodegenerative diseases like Alzheimer’s disease. Alzheimer’s disease is believed to be caused by the buildup of plaques made up of a protein called amyloid beta in the aging brain. Two recent studies published in the journal JAMA Neurology have shown that in human patients that haven’t yet developed Alzheimer’s disease, poorer sleep quality is associated with greater buildup of amyloid beta plaques. Whether this is because bad sleep promotes amyloid beta accumulation, or whether low-level brain damage caused by amyloid beat promotes sleep disturbance has not been clear. However, our study suggests that one of the functions of sleep is the clearance of amyloid beta, and supports the idea that the inability to get proper sleep could promote the development of neurodegeneration.

While this most recent study was led by Dr. Maiken Nedergaard at the University of Rochester Medical Center in New York, follow-on studies are currently underway here at OHSU. In January of this year, I was recruited from the University of Rochester to come to OHSU and establish a research program based in part upon my work in this brain-wide, waste-clearance pathway. Bringing this research here to OHSU was made possible in large part by the generous gift from Phil and Penny Knight establishing the Knight Cardiovascular Institute at OHSU, of which I am now a part.

Using 2-photon microscopy and other approaches, we are working to define how this waste-clearance system becomes impaired in the aging brain and the contribution that damaged, aging blood vessels in the brain make to this process. The goal is to find key steps in this degenerative process that could be targeted with drugs to stop the failure of amyloid beta clearance and the accumulation of amyloid beta plaques in the brain.
With a lot of smart people working together, we hope that the discoveries that we’ve made so far in mice will translate to new opportunities to change the course of Alzheimer’s disease in patients.

Jeffrey Iliff
Assistant Professor of Anesthesiology and Peri-Operative Medicine
Knight Cardiovascular Institute

OHSU Brain Institute


Lewy body dementia — a less-known cause of cognitive problems

Not all people with cognitive problems have Alzheimer’s disease. While Alzheimer’s is the most common reason for memory problems as people get older, there are other types of dementia.

Lewy body dementia or Lewy body disease is a much less common cause of cognitive problems and is seen in about seven in a thousand people over the age of 65. People with LBD tend to have trouble with visual spatial function and executive function. Executive function involves the ability to carry out complex tasks that have multiple steps, such as baking a cake. Early in the course of the disease, persons with LBD often have a fairly good memory. For example, remembering a list of words told to them five minutes before.

People with LBD may also have hallucinations or delusions. They may see people who are not present or have false beliefs such as thinking their house belongs to someone else. They often fluctuate in their degree of cognitive problems, having some days when they seem to do very well and others when they really struggle.

On a physical exam, the doctor may see some features similar to Parkinson’s disease such as slowed walking, smaller movements and handwriting, and stiffness. It is also common that people with LBD have a history of a disorder of sleep called REM sleep behavior disorder, or RBD. RBD often starts many years before cognitive problems develop. In RBD, people act out their dreams (which occur during REM sleep) and can injure themselves and their bed partner.

Unfortunately, there are not perfect treatments for LBD. But medications called cholinesterase inhibitors can help some patients. Rivastigmine is the one that has been studied the most extensively. Memantine is a different type of medication that may help some patients as well.

One of the most important things to be aware of is that people with LBD can respond very poorly to many typical antipsychotic medications, such as haloperidol and chlorpromazine. These medications are often used to treat delusions and are also given frequently for agitation. The typical ones should be avoided in LBD. There are two antipsychotics — quetiapine and clozapine — that can be used if delusions and hallucinations are problematic. If the parkinsonian features are prominent, a medication used to treat Parkinson’s disease, levodopa, may also be tried.

People with cognitive problems as well as RBD or hallucinations may have Lewy body dementia — not Alzheimer’s Disease. In this type of dementia, a neurological consultation is often particularly helpful.

Amie Peterson, M.D.
Assistant Professor of Neurology
OHSU Parkinson Center of Oregon
OHSU Brain Institute

Designing a migraine-free lifestyle — especially for women

One in five women in America suffer from migraine headaches. In the throes of a migraine attack, simple head movement intensifies the pain. Eating or exercising is out of the question. Sometimes a migraine sufferer can’t even get out of bed.  There are 28 million Americans who have these disabling headaches — three times as many women as men. Almost half of them don’t see a doctor, don’t know their headaches are migraine or are trying to treat them on their own.

Beat a migraineThere are many new treatment options to keep migraineurs on the tennis court, at their son’s soccer game and alert and energetic at the office or factory … and not in bed! Consulting a physician is the first step. But there are many ways to avoid migraine triggers in everyday life.

What people with migraine experience as a headache is actually the final stage of a complex process. Many factors appear to set off, or “trigger,” the cascade of events in the brain. Migraine triggers include an odd array of sensory inputs, as well as substances contained in certain foods and beverages. Recognizing and avoiding specific triggers can enable migraine sufferers to craft a headache-free lifestyle.

Practical Tips for Preventing Migraine

• Wake up early on Saturday and Sunday. Get up the same time each day, even if you have stayed out late the night before. Change in sleep routine can make you vulnerable to morning headache. And, when you sleep in till noon on Sunday, you’ll most likely drink less coffee or tea, putting you in “mini-caffeine withdrawal” and inviting a headache.

• Drink water instead of diet soda. Diet drinks contain artificial sweeteners, such as aspartame, and many have caffeine, both of which can trigger migraine headache.

• Use the money you’ve saved on diet drinks to purchase sunglasses with photochromic lenses that automatically darken when exposed to UV rays. Wear prescription sunglasses while driving. Even on an overcast day (which NEVER happens in Portland, of course!) glare from the windshield and reflected light from nearby cars can cause you to squint, tensing the muscles of your scalp and face. Many individuals with migraine are exquisitely sensitive to light, called photophobic; and bright, reflected light while driving, or on computer screens placed near windows, can precipitate headache.

• Begin your exercise routine with a slow and gentle warm up. Abrupt vigorous exercise can rapidly increase blood flow to the brain and dilated vessels throb and may set in motion the cascade of changes in blood vessels and electrical activity of nerve cells that characterize what’s happening in your brain during migraine pain.

• Watch for abrupt changes in weather. The medical literature is controversial about barometric pressure or wind patterns being true provokers of headache, but most of my patients report a sensitivity to weather pattern change. While of course we can’t alter the weather, we can be vigilant about avoiding other migraine triggers, such as lack of sleep or red wine, during rapid weather fluctuations. Often it’s a combination of two or more migraine triggers that actually result in full-blown migraines.

• Be wary of common food “triggers” of migraine. Culprits include wine (especially red), aged cheese such as Brie, blue, cheddar (pizza!), MSG, aspartame, peanuts or peanut butter, processed and preserved foods such as luncheon meats, and onions. Not all of these foods serve as triggers for all migraineurs. But being a food-detective, keeping a brief food diary for a week or two, can be a smart preventative move.

• Be especially cautious with alcohol. Alcohol serves as a cerebral vasodilator, activating nerve endings that supply these vessels as they expand, triggering vascular headache. In addition, alcohol acts as a diuretic; dehydration can compound many types of head pain.

• Avoid dehydration. Dehydration, in children as well as adults, makes nausea and vomiting from any cause, including migraine, worse.  Sufficient water intake, especially when exercising, can protect against the headache and accompanying nausea of migraine symptoms. A feeling of thirst is not an early indicator of your body’s volume status. By the time you feel thirsty, your plasma volume is already low. Your best guide to your body’s hydration status is the color of your urine. It should be pale yellow. Any darker means you need to increase your daily water intake. Remember many foods have high water content: watermelon and celery, of course, but also many fish, such as salmon, and eggs.

There are many factors we can’t control that influence headache vulnerability, such as genetics and hormonal changes. But fortunately, we are able to modify many aspects of our lifestyle to reduce migraine frequency and intensity.

Tarvez Tucker, M.D.
Associate Professor of Neurology and Neurocritical Care
OHSU Brain Institute






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