Better View of the Brain

Contributed by: Dennis Fortier, President, Medical Care Corporation
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The enormous complexity of the brain makes understanding how it works, and how diseases affect its function, a daunting challenge. This challenge has been exacerbated by the microscopic scale of neurons and synapses, which makes it nearly impossible to gather information visually.

Now, researchers at Stanford University have developed a method for staining thin slices of brain tissue, capturing a series of high resolution images, and then stitching the images together to create a visual model of brain structure. Their paper on the method is published this week in Nature and the photo below shows the level of synaptic detail that their approach renders.

This is pretty exciting as it could greatly improve our ability to inspect brain tissue and to understand brain function; both of which could play a role in accelerating our understanding of the field.
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Detection vs. Diagnosis

Contributed by: Dennis Fortier, President, Medical Care Corporation
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These are two terms that are similar but distinct in their meaning and, unfortunately, often used interchangeably by the press when writing about health care and clinical practices. The primary purpose of this post is to sensitize readers that news stories can be misleading when writers are careless in choosing between them.

In clinical practice, to "detect" a problem is to objectively observe symptoms caused by the problem or to hear a subjective but credible complaint from the patient about a symptom that is not visible (i.e. back pain). To "diagnose" a problem is to ascertain the specific medical condition that is causing the problem.

Here is an example from the field we follow. A physician would "detect" memory loss by objectively establishing that a patient's recall ability is not in the normal range for the patient's age and educational peer group. The physician need not know the cause of the problem to detect it.

Once detected, the memory loss would then be "diagnosed" as (for example) a thyroid disorder, or as Alzheimer's disease, or as any number of other memory impairing medical conditions. The diagnosis informs the forthcoming decisions about treatment.

In general, much of the news about neuro-psychological tests being developed is news about improving our ability to detect problems. Much of the news about bio-markers is news about improving our ability to diagnose problems. In the realm where I see the most common misuse of these terms, much of the news about imaging techniques crosses between the two.

Alzheimer's disease: Early Risks Assessment

Contributed by: Dennis Fortier, President, Medical Care Corporation
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Alzheimer's disease appears to slowly damage the brain for many years prior to the appearance of clear symptoms. As such, we generally do not detect and diagnose AD until irreversible brain damage has occurred and memory loss and/or behavioral disturbances are pronounced. At that point, the extent of the underlying damage is severe and a return to full cognitive function is unlikely if not impossible.

With this view, we know that the best opportunity to intervene meaningfully is during the period prior to the manifestation of clear symptoms. To do so, we must improve our ability to evaluate early stage risks and to objectively identify subtly abnormal cognitive function at the individual level.

In recent months, experts in the fields of epidemiology, risk assessment, cognitive evaluation, imaging, and biomarker development have convened under the auspices of the National Alzheimer's Association to discuss a framework for improving early risk assessment. An overview of their discussions is published in the current issue of Alzheimer's and Dementia: Early Risk Assessment for Alzheimer's Disease. In this article, lead author Maria Carillo clearly outlines the state of the field and identifies those questions most germane to future progress.