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by Cathryn Jakobson Ramin, April 6, 2007 9:58 AM
In my book, Carved In Sand, I write about our inability to fend off distractions in middle age. One of my favorite research studies dealt with what one scientist called "the neuronal bouncer ? just like the one outside the front doors of a nightclub, handling the velvet rope." The way he described it, in youth, that bouncer does a really good job of determining what is allowed into your working memory, and what is turned away at the door. As you get older, the bouncer goes on more and more coffee breaks, and your mind, left unguarded, is subject to invasions from all sorts of riff-raff. Instead of concentrating on the project before you, you find yourself thinking about what to have for dinner. I loved the metaphor, and I've used it a lot in radio and print interviews. This morning, just prior to my second appearance this week on Good Morning America, I was living it. Usually ? because I know my neural bouncer quit long ago ? I'm conscientious about keeping my environment as free as possible from distractions. Unlike some people, I don't keep the radio or TV on while I'm doing other things, because they prevent me from thinking straight. I can't even tie my shoes if there's something intriguing on the Discovery Channel ? that's how bad it is. The producer at GMA picked me up from my hotel right on time, and walked me across the street for hair and makeup. Once in the chair ? TV blaring (even I knew that it would be wrong to ask them to lower the volume on Diane Sawyer so that I could concentrate), the fun began. While the hairdresser crimped my limp locks, and the makeup artist swabbed and sponged away the dark circles under my eyes, producers surrounded me, dropped documents in my lap, and started asking questions about the frontal lobes and the hippocampus ? which was spelled how? Was it correct to say..? My head buzzed. My shoulders ached. I couldn't talk, because my lips were being glossed. I wished to shout: "Did anyone read my book? Because if you did, you ought to know that I can't talk to more than one person at a time!" That was just the beginning. We tiptoed on to the stage, winding our way amongst the always-present mob of technical crew and talent. A polite young man reached gingerly inside my sweater to position the microphone. Once escorted to my chair on the stage, I tried to compose myself, but this was unlikely: Ms. Sawyer was on the set, ready to talk to me about our segment. Although the noise and bustle level in the room was astounding, Ms. Sawyer spoke in a very soft voice. I leaned forward to hear her, commanding myself to focus on her words, despite the fact that another young man had decided that the microphone had to be repositioned and again had a hand down my sweater. In the split second we had remaining, I tried to remember what I'd said yesterday on the show ? otherwise, I'd be likely to repeat myself. I drew a blank. Five, four, three, two, one ? all was silence, and then we were on. A miracle: total, in-the-flow focus. No one there ? no one in the world ? but the two of us. I answered her questions. I think I smiled. I might have thrown in a joke. And then, as fast as it had begun, it was over, the stage was abuzz, and I was on my way out the door. I barely avoided the knife-sharp edge of a monitor, aimed at my forehead, on the way out. Everybody congratulated me on a really good two-part segment, and I thanked them, doing my best to carefully pack away, in my treasure chest of memories, all that had happened since Tuesday. ÷ ÷ ÷ If you'd like to continue to read Cathryn's blog over the coming weeks, go to
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by Cathryn Jakobson Ramin, April 5, 2007 3:22 PM
I don't mean to be unsympathetic, but I have to believe that from the day he signed his contract with the New England Patriots, middle linebacker Ted Johnson knew he had chosen a career path that mandated headlong collisions with speeding flesh dressed in helmets and shoulder pads. The same could be said for other professional athletes whose brains have recently made the news ? the late Andre Waters, formerly of the Philadelphia Eagles, and Bob Brudzinski, who played 13 seasons with the Miami Dolphins and the Los Angeles Rams. They took some hard knocks ? okay, a lot of them ? and they've paid a grave price. But what about the rest of us? You don't have to be a football player to put your head in jeopardy. According to the National Center for Injury Prevention and Control, at least 1.1 million people each year sustain mild traumatic brain injuries. No doubt, that number is set too low: Most people who sustain such "minor" injuries do not go to the emergency room or a doctor's office. They go home and lie down on the sofa. The assumption has always been that our skulls ? which seem pretty hard ? function as protective shells. In fact, what's inside ? a brain with the consistency of gently scrambled eggs ? is very vulnerable. Throughout our lives, the injuries that we experience accumulate in a way that can result in noticeable cognitive deficits. It is impossible to say how many middle-aged adults who presume they are suffering from age-related memory impairment, or maybe adult ADHD, are actually feeling the consequences of a series of earlier head injuries. Until a decade ago, scientists regarded mild traumatic brain injury ? where there is no loss of consciousness or evident structural damage ? as inconsequential. You were expected to recover quickly and entirely from such an accident, and anyone who presented symptoms after a month or two was considered to be "malingering," probably in the interest in settling a large lawsuit. Only in the last several years have experts begun to understand what happens when your brain meets the bony protuberances behind the forehead, surrounding the prefrontal cortex. Forget about being knocked unconscious: Most mildly concussed individuals remain wide awake, working their way through a variety of symptoms, from feeling dazed and confused to seeing stars. Often, there's a touch of amnesia involved ? they're not sure what happened to them, before, during or immediately after the impact. As used here, the word "impact" requires some clarification. You can have a concussion when your head encounters an immovable object ? for instance, the windshield during an auto accident. But the collision can also occur internally. Slam on the brakes when you're driving twenty miles an hour, secure in your seatbelt and guess what: Your car screeches to a stop, but your brain keeps going. In fact, this three-pound bolus of fat smacks your bony prefrontal protuberances at your previous pace, and then begins to imitate a Superball, ricocheting all over the place. Car accidents are responsible for the bulk of mild traumatic brain injuries, but increasingly, we're finding other ways to mess up our heads. Sports injuries account for more than 20 percent of the mild traumatic brain injuries each year. You can have a closetful of helmets ? biking, riding, rafting, hockey, lacrosse, skiing, even river rafting ? and while they'll do wonders to preserve the exterior of your skull, they don't help much with what is inside. You can wallop your head executing perfectly innocent maneuvers: one Los Angeles woman I know walked headlong into a low hanging branch of a sturdy oak tree while reading a catalog from an art gallery she'd just visited, and knocked herself flat. Some weeks later, she was cleaning up a Coke that had exploded in the little refrigerator under a granite counter in her family room. She stood up suddenly ? and wham, she was down again. Right about the time that you're catching your breath, impressed with your evasive driving skills and your anti-lock brakes, the cascade of damage inside your head begins. Researchers are still trying to understand exactly what happens when these injuries occur. The hypothesis posed in Friday's article about Mr. Johnson ? that arteries in the brain constrict, make it impossible to deliver sufficient glucose ? is only part of the story. When the brain makes contact with the sharp bones inside the skull, small blood vessels may rupture, releasing blood in into the cranium, which unlike other parts of the body, cannot expand to encompass it. The brain is uncomfortably squeezed for space. "Second impact syndrome," as too often experienced by Mr. Johnson and other athletes, is especially dangerous because that second hit increases that intracranial pressure. Often, as the brain does its Superball routine, microscopic tears develop in the myelin sheath surrounding the nerve fibers that transmit information from one part of the brain to another. These torn nerve fibers, called axons, develop scar tissue, which will eventually affect the speed and efficiency of synaptic impulses. Typically, we put our mild head injuries behind us, heading back to work or school. Weeks or months later, we're befuddled when we find that we're suffering from inexplicable impairment ? typically, problems with working memory and executive function, cognitive faculties regulated mostly by the prefrontal cortex. The real damage shows up long after the injury has been forgotten, as ruptured axons, rife with scar tissue, begin to die, reducing the capacity to process information. For many people who experience mild traumatic head injuries, the senior moments start coming fast and furiously, no matter what age they are. It's becoming evident that even mild traumatic head injuries (defined as injuries where you do not lose consciousness) may lead to an increased risk of Alzheimer's disease, particularly if you are a carrier of a genetic variant called the ApoE-4 allele. So far, most of the research (performed on rats at the University of Pennsylvania's Head Injury Center) suggests that repetitive mild brain trauma accelerates the emergence of Alzheimer's disease. No one has nailed down how this happens, but the theory is that the axons sheared in the Superball routine release a sudden bounty of lipids, which attract hordes of greedy free radicals, which in turn step up oxidative damage to the brain. It's been hypothesized that excessive oxidation makes neurons more vulnerable to the effects of amyloid proteins, and may also escalate the development of amyloid plaques, which slowly strangle nerve cells. In the Times, Bob Brudzinksi, the 52-year-old ex-linebacker, observed that he and his team members used their heads "too much, in the wrong way." The same could be said for the rest of us: Head injuries that seem to be part of the hard knocks of daily life ? an infant's tumble off a bed, a child's leap from a jungle gym or unfortunate banana-peel slip off a skateboard ? can take their toll. The dedicated and sometimes obsessively competitive people who coach children's sports ought to acknowledge that they are not capable, at a glance, of assessing whether a young athlete might have suffered a concussion. No matter how good a player is, the only place for him or her after a bell-ringing incident (even a suspected one) is on the bench for a couple of weeks, to avoid the vastly increased danger of second-impact syndrome. Parents
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by Cathryn Jakobson Ramin, April 4, 2007 10:11 AM
I always loved that title ? it's Grace Paley's. Yesterday, I experienced them first-hand. It happened so fast. Early in the morning, I was sitting at my desk, looking at a tour schedule that, to my way of thinking, included plenty of good stuff ? bookstore readings, radio and print interviews and local affiliate TV tapings. The USA Today piece had just been published, and I was happy. Casually, I considered how best to pack my suitcase for my departure on Saturday night. At 9:30 a.m., I threw on some clothes and headed up the highway for a haircut. The salon is a noisy place, and even if I could have heard my phone ring in my bag on the floor, I wouldn't have answered it in mid-snip. I glanced at the screen as I paid my bill, and noticed that I had four voice mails ? a lot for me. Before I crossed the parking lot to my car, the cell rang again, and my publicist asked where I'd been ? she had big news. "Getting my hair done," I said. "Well, that's a good thing," she said, "because you're booked on Good Morning America, and you have to leave tomorrow." Months ago, when we sent GMA the publicity materials for Carved in Sand, we'd had high hopes, tempered with low expectations. This was my first book, and attractive as the subject matter was, it would be sheer hubris to think that I'd make it to the big time. "Can you do it?" Camille asked. "My calendar," I said. "Let me think." In the course of writing the book, I learned that two places that I once successfully stored information ? the figurative "back of my mind" and the metaphorical "top of my head," (as in, "off the top of my head") ought to be avoided at all costs. I have proven, again and again, that there is no longer any such place as the "back of my mind," and anything that comes "off the top of my head" is bound to be seriously inaccurate. "My older son's birthday," I wailed. "Thursday. And my younger son's classroom performance of A Midsummer Night's Dream. He's Bottom." There was silence on the other end. I knew what she was thinking. Would I really give up an opportunity like this in order to celebrate a 17th birthday, or view a bunch of 7th graders reciting Shakespeare? We'd run lines for weeks, and the kid had the part down. I sucked up the guilt. Briefly, I bathed in it. Then, I told her to say yes, wondering all the while how I was going to leave on my tour three days early. I'd sorted out a few clothes over the weekend, but the to-do list that remained was legion. My husband would not be pleased. Two and a half weeks away was a great long stretch that had to be carefully planned and negotiated. Now, it had stretched to three. Within minutes, GMA's machine was in motion. Last second airline tickets (ooh, how much did those cost?), limousines, hotel rooms and media escorts were all in place. Suddenly, my publisher, HarperCollins, a company that had taken a "let's wait and see what happens" attitude for months, loved me and couldn't do enough. Overnight, it seemed that my professional life had been transformed. At three in the afternoon, around the time I usually turn from working writer to full-time mom, another call came. GMA would like to send a producer and a camera crew to my house for some pre-taping ? just a little interview and some B-roll footage. Could they meet me at home at 5pm? That gave me two hours, and to be honest, I still hadn't found a moment to take a shower. My hair, freshly conditioned with some expensive thing the stylist insisted I needed, hung limply. I was to dress casually, as I would if I were hanging around the house. I assured the producer that he did not want to see ? ever ? what I looked like when I was hanging around the house. Remarkably, my once-a-week house-cleaning service had been in just that morning, so at least I was not going to have to get out the mop. I called the kids and my husband, warning them of the tornado that was about to strike. "Where are you?" I asked my elder son, when I reached him on his cell. "On the way to work," he said. "Um, when you get home, there will be a camera crew from Good Morning America in the house," I said. Another moment of silence. Then, with the utmost cool, the kind that an about-to-be 17-year-old musters better than anyone else: "O...kay, then." The crew turned up on time, and instantly, it was a party. Our two dogs assumed that the crew was there to film them, and began to bark insanely, while they chased each other from kitchen to dining room to living room. To escape, I suggested that we get some footage along the walking path near my house, with San Francisco Bay in the background. Back at home, they taped a long cuddle session with my boys on the sofa, photo albums open before us. "We really do this," I assured the producer. "It's one of our favorite ways to remember things, especially when it's going to be somebody's birthday." Around 9pm, the crew departed. We all looked at each other, thoroughly exhausted. "This means you're not going to be here for my birthday, are you, Mom?" my older son said morosely. "What about my presents and my birthday dinner?" I shook my head, and again the guilt washed over me. I'd never missed a family birthday celebration before. In fact, I'd made a big deal about how showing up for family events was not optional, looking ahead to the years when the guys would have wives. And a mother. "I am very, very sorry," I told him. "But this is important, for all of us." Could I really expect him to understand? Was he that grown up? One look at his face told me that he was struggling. I invited him to bring a friend and meet me for the weekend in Los Angeles in a couple of weeks, where I'd be giving a reading. "We'll go out for a fancy dinner," I said brightly. "We'll have fun. It will be
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by Cathryn Jakobson Ramin, April 3, 2007 10:16 AM
Yesterday, I wore my reporter's cap in this space, writing about Scooter Libby's putative cognitive deficits. Today, in the middle of my book tour, I'm going to try to catch up with myself. As of this morning, Carved in Sand is on the shelves of nearly every bookstore in America. A feature story about my journey appears in USA Today. For a slew of reasons, that is amazing. A decade ago, my cognitive firepower was definitely on the wane. As I write in the first pages of the book, "Something was happening to my mind. I felt vague and foggy. I couldn't remember what I'd read for much longer than it took to get to the bottom of the page." I was suffering from something ? but I couldn't name it. I though that maybe I'd lost my edge ? a sad thing at 40, especially when the career I loved ? investigative reporting and feature writing for magazines ? depended largely on my ability to retain and synthesize information. I couldn't think of anyone I could tell, so I kept my troubles to myself. If the same difficulties hadn't cropped up a few years later among just about everybody I knew ? irritating glitches involving proper names, elusive mental calendars ? I might have stayed silent. Instead, I decided to make myself a guinea pig, exploring every possible intervention, in an effort to figure out what was going on upstairs. When I decided to take on Carved in Sand in my mid-forties, my confidence in my mind had seeped away. The steel trap I'd possessed in my twenties and thirties had been replaced with a kitchen colander. Frankly, the prospect of tackling relentlessly complex subject matter ? neuroscience, biochemistry, and genetics ? made me woozy. For months, I went blind with anxiety when I scanned the dense pages of peer-reviewed professional journals that formed the basis of my research. But here's what surprised me: My editors and agent were absolutely confident that I had what it took to pull it off. They produced contracts and proffered advances, carefully ignoring the facts that I'd laid before them in my book proposal: My middle-aged mind was behaving unnervingly. When, in the interest of full disclosure, I noted this, they might as well have clasped their hands over their ears. Often (usually in the middle of the night), I wondered what had allowed these experienced professionals to take such a bold step. Did they not see what I knew too well ? that someone had snatched the poles from my intellectual tent? When they talked to me and read my work, did they somehow encounter a smarter, more insightful version of me than I could find in myself? Couldn't they hear me grasping for words, fudging conversations when proper names disappeared, arriving windblown and out of breath because I was looking for a building I'd been to several times ? on the wrong block? Wasn't it obvious? Finally, I concluded that their interests were wonderfully selfish: They, too, were in middle age, struggling with daily episodes of forgetfulness. For them, I was a Russian monkey-cosmonaut: If I ? who had the nerve to go public with my cognitive shortcomings ? could find a solution, maybe they ? and the whole middle-aged world ? could benefit. Their confidence ? which never flagged ? worked miracles. They knew, certainly, that responsibility was (and continues to be) my middle name. It's a known fact that I'm constitutionally unable to let anyone down. They knew that I was meticulous, even compulsive in my research ? the nagging voice that tells me that something is still missing from the picture won't shut up until I get to the bottom of a difficult question. But these traits ? however laudable ? wouldn't have been enough to produce a book of the size and scope of Carved in Sand. They had no way of knowing that I'd be able to sustain a narrative for 265 pages, or that I could manage the many hundreds of interviews that were required, nor that, once the book was published, I could handle three media appearances a day for a month straight. They took it for granted that I possessed the mental filing cabinet that would allow me to produce nearly 500 full citations ? the list of endnotes that appear on page after page at the end of the book In short, those editors and that literary agent made a wager. They banked on my brain ? that it was still good enough, and that it would get better. They bet right: The very work of writing Carved in Sand was exactly the antidote I needed. The intense mental effort involved ? which went on seven days a week, for over three years kicked my lazy neurons back into action. Some days, I swore I could feel it happening, the ebullience of the hook-up...synaptic connections zinging to life, new associations made, deeper understanding emerging. In Carved in Sand, I write about new research that suggests that the best way to maintain your brain is to offer it relentless challenges. Get out of your routine, and take on something that doesn't come easily. Take up chess. Learn salsa dancing. Get into a bridge game. Leave the microwave alone. Instead, shop for and cook ? from a recipe ? a complicated meal ? and time it so you get several courses on the table in a timely fashion.Or, if you have four years, write a
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by Cathryn Jakobson Ramin, April 2, 2007 10:42 AM
In early March, after ten days of deliberation, a jury convicted Vice President Cheney's former chief of staff, Lewis Libby, Jr. on four felony counts, including obstruction of justice, false statements and perjury. The four men and seven women who sat on that jury rejected Libby's claim ? that he suffered from memory lapses ? as nothing more than a convenient excuse. Was the jury right? Or has it ignored certain facts of midlife? In middle age, memory fades and attention fails, leaving us with what may be described as a Scooter Libby problem ? a faulty recollection of names, dates and who said what to whom. Cognitive neuroscientists, among them Denise Park of the University of Illinois, Cheryl Grady at the University of Michigan and Mark McDaniel, at Washington University are among those currently investigating the underpinnings of these midlife brain changes, which affect the hippocampus and the frontal lobes, reducing the availability of working memory and leaving us more easily distracted. In the Starr Report, published in 1998, former President Bill Clinton, then 52, told government counsel Sol Weisenberg: "If I could say one thing about my memory...I have been shocked and so have members of my family and friends of mine at how many things I have forgotten in the last six years ? I think because of the pressure and pace and volume of events in a president's life...I'm amazed ? there are a lot of times that I literally cannot remember what happened last week." I'm more attuned than most people to such cognitive changes, because I've just finished writing a book about what happens to the mind in middle age. In the course of my research I interviewed more than 300 midlife individuals, many of them high achieving professionals. Most bemoaned their forgetfulness: they'd had steel traps for minds in their thirties, but something had happened. As I watched the Libby affair play out, I wondered: Could he, as the New York Times reported, have had nine conversations with officials and reporters about Valerie Wilson, recalled only one of them, with Tim Russert, and gotten the date wrong on that? Could his memory be that bad? Mr. Libby said that he'd forgotten about his discussion with Mr. Cheney, regarding Valerie Wilson, and when he heard about her again, from NBC's Tim Russert, "it was like hearing about it for the first time." John Hannah, Mr. Libby's aide, observed that in the course of a single day, his boss had trouble recalling who had told him what. What Mr. Libby and his aide described is what cognitive scientists refer to as "faulty source memory" ? an inability to remember who told you what, which often leads to misattribution. It's not a small problem, if you consider that the American system of justice is predicated on our belief that memory is reliable ? when you are called to the stand and swear to tell the whole truth, that's what you're going to do. It doesn't always work that way: When you're faced with a deep, empty cavern where there's supposed to be information, unintentional fabrication often occurs. University of California at Irvine's Elizabeth Loftus and Harvard's Daniel Schacter's investigations demonstrate that memory is both undependable and subject to rearrangement. Instead of sending back the accurate but unacceptable message: "I don't have the slightest idea," the mind helpfully knits together and delivers a plausible, if inaccurate scenario. In the Libby affair, memory failures were not limited to the defendant. Under cross-examination, Judith Miller, a middle-aged New York Times reporter, alluded to the unreliability of her own memory for events that occurred more than a few months in the past. Tim Russert, also middle-aged, usually so cool and in control in his role as host of NBC's Meet the Press, began to fray under prosecuting attorney Patrick J. Fitzgerald's "some of your own medicine" interrogation. Russert, asked to recall the details of a three-year-old conversation about a matter that likely seemed minor to him at the time, fought his way through the cobwebs. I don't know how many nights Mr. Libby had been up pacing before he stood before that Grand Jury in 2004, or whether, to help him through the crisis, his physician prescribed a benzodiazepine like Ativan, which would explain his preternatural calm and expressionless demeanor. But anxiety, sleep deprivation, chronic stress, and the side effects of anti-anxiety drugs (and some antidepressant drugs) can punch holes in a midlife memory that already feels more like a kitchen sieve than a steel trap. Indeed, Lewis Libby's forgetfulness could reflect a graver situation: he could be suffering from mild cognitive impairment, which is not as benign as it sounds: For many, this is the earliest stage of Alzheimer's disease. At 56, he's too young, you say? Not so. In the course of my research, I met people in their fifties and early sixties ? a former common pleas judge and a family law attorney ? who are now in the mid-to-late stages of Alzheimer's disease. For several years, while the judge wielded his gavel, and the lawyer mediated her family law cases, they struggled privately with fading memory, until colleagues caught on and forced them to retire. Many scientists, including John C. Morris at Washington University in St. Louis, hypothesize that Alzheimer's lays down its insidious roots in middle age, and that the key to successful intervention depends on early diagnosis. Scooter Libby may be guilty, as charged, or he may be telling the truth ? his once-reliable memory has turned treasonous. As a journalist, rather than a physician, I am unqualified to comment on Mr. Libby's cognitive state, but if he is as forgetful as his aide says he is, a complete neurocognitive evaluation is in order. Such an evaluation should be conducted not by his internist, but by a team of specialists trained to assess the differences between normal middle-aged cognitive changes, and the emergence of neuropathology. Across the country, university hospitals, especially those affiliated with the National Institute on Aging's Alzheimer's Disease Neuroimaging Initiative are actively studying the early stages of this disease. Such a diagnosis would have profound implications for Mr. Libby. He might save himself some jail time. But he could also volunteer to be part of a more useful kind of investigation ? a scientific one, where he could participate in a study meant to help scientists find the best way to intervene in this disease, before neurons begin to die and symptoms of dementia emerge full-blown
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