Tag Archives: executive function

What is Parkinson’s Disease?

The first day of the Dance for PD workshop included an informative overview of Parkinson’s Disease by neuropsychiatrist Melissa Frumin of Brigham and Women’s Hospital in Boston, MA. She spoke to us not just as a doctor, but also as a caretaker who had first hand experience after caring for her father who had Parkinson’s. Melissa’s talk was illuminating, as it was the first time I had an understanding of some of what was going on inside my Dad’s brain and body, and I began to have a medical understanding of what he must have dealt with.

Everything that follows is from Melissa’s talk, and I was so intent on taking down the information that much of the medical description is her exact wording.

Primary Symptoms
It turns out that the cardinal symptom of PD is the tremor, which typically begins on one side in one hand with the fingers rolling in towards the palm. The tremor is a resting tremor, which means when the hand is engaged in movement the tremor seems to disappear. While asymmetrical at the start, the tremor can become bilateral, impacting the other side.

Another symptom is the slowness of movement, often manifested by a dragging of the feet and resulting in a shuffling gait. Rigidity can set in, causing a stooped posture. And the final major symptom is postural instability, making it difficult to self-respond to imbalance.

All of these symptoms are neurological. The body part is still fully functional; it is the brain’s messaging system that is no longer sending the appropriate signals to the body part. In other words, the hands and the legs could still work just fine if the brain were able to get the messages out to those body parts.

Motor Symptoms
There are a number of motor symptoms, in addition to the tremor and movement issues. Faces begin to no longer exhibit expression, causing a disconnect between what a person says they feel and what their face displays. Handwriting can become  very tiny, resulting in what is called micrographia. Vision can become blurred due to contrasts no longer being discernible. Therefore, large print does not help but books on tape could be quite useful. Constipation and difficulty swallowing are other motor issues that are due, as with all the previous symptoms, to a lack of internal coordination.

Non-motor Symptoms
Imagine how you might feel if these symptoms began to invade your existence. Now add to the mix the non-motor component of Parkinson’s – cognitive dysfunction resulting in dementia that impacts executive functioning. I have written a number of posts about executive functioning, which has to do with decision making, organization, and self-management functions. With Parkinson’s, the dementia takes a toll on the ability to multitask – the ability to tend to more than one item or activity at a time, in other words, the ability to rapidly switch between multiple activities.

The result of all of these symptoms is typically depression, though not because the person has Parkinson’s and feels bad about it (though they may, indeed, feel badly), but rather because Parkinson’s is a brain disorder that effects the ability to initiate activity. The inability to initiate can cause anxiety. Additionally, there can by psychosis manifested by hallucinations that are usually visual or auditory or smell-based, but can also be paranoid.

Couple this with sleep disturbance due to getting up in the middle of a dream to act out that dream (which can lead to falls in the night), genuine fatigue (as opposed to fatigue from depression), and drooling, and you have a sense of the toll that Parkinson’s symptoms takes on a human body.

What is happening in the brain?
The basal ganglia, a compilation of neurons that function as a unit and assists with coordinating movement, contains the substantia nigra, an area of the brain that produces dopamine. With Parkinson’s, 50 to 60 percent of the neurons in the substantia nigra begin to deteriorate, resulting in a loss of dopamine. This loss of dopamine impacts the balance of excitation and inhibition of neurons. And this loss of balance in neuron firing means that signals sent from the brain are not being executed properly. Since the basal ganglia deals with movement, sure signs of Parkinson’s are the primary symptoms detailed at the start of this post.

Statistics
In general, Parkinson’s is not a genetic disorder and is rare before the age of 40, though Michael J. Fox was an exception at age thirty-two. Worldwide some five million people are diagnosed with Parkinson’s, for which the largest risk factor is old age. And I found out just this afternoon, from a new acquaintance who is active in local and national Parkinson’s organizations, two-thirds of PD individuals are men, one-third are women.

Additional Resources

The PD Partnership – words of wisdom, from a caregiver, for caregivers and the people they care for

What is Parkinson’s Disease – includes links to numerous information resources in both print and digital format, including the Second Edition of the Parkinson’s Disease Resource List

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Ready for Prime Time

[5/3 UPDATE: A number of my posts have referenced Frances Jenkins, and she is included in the slide show below. On March 1, 2010, NPR’s Morning Edition had a five minute interview with Jenkins about The Teen Brain: It’s Just Not Grown Up Yet.]

This is the slide show that will accompany three interactive sessions spread out over April and May with a class of high school students. The sessions will cover The Teen Brain, followed by the limbic system, and finishing with the impact of drugs and alcohol on the teen brain.

I tend to not include many transitions in slide shows, but the transitions in this slide show are part of the impact of the presentation, and wish they transferred upon the upload to slideshare. For instance, the revealing of slides 17 to 20 helps bring home the point of the limbic system, and slides 24 through 29 display one word at a time, each with an effect related to the meaning of the word. After each new word is displayed, the high schoolers will be using their laptops to take self-portraits of themselves making a face to represent the emotion.

Slideshare houses my presentations, though I have yet to figure out how to get the presentation notes to display. Below are the URLs for the video clips and web sites. Hmm, just thought of a creative exercise to use with my Presentation Communication class next fall – here is a slide show without the presentation notes, now you make up the oral component!

slide 5 video clip
http://www.youtube.com/watch?v=yy994HpFudc

slide 8 video clip
http://www.loni.ucla.edu/~thompson/DEVEL/dynamic.html

All of the Frances Jensen video clips can be accessed from:
http://www.childrenshospital.org/patientsfamilies/Site1393/mainpageS1393P316sublevel357.html

slide 23 video clip comes from Tom Wujec’s TED Talk at:
http://www.ted.com/talks/tom_wujec_on_3_ways_the_brain_creates_meaning.html

and the Wizard of Oz clip comes from:
http://www.youtube.com/watch?v=wOKK8mAkiUI

While not referenced in this presentation, I highly recommend Jill Bolte Taylor’s TED Talk at:
http://www.ted.com/talks/jill_bolte_taylor_s_powerful_stroke_of_insight.html

and for entertainment while learning, Pinky & the Brain explain the parts of the brain at:
http://www.youtube.com/watch?v=Li5nMsXg1Lk

Decisions and Words, a relationship

A number of my recent posts have dealt with decision making, and here are two authors who take rather opposite views in their discussion of how and why people make some of their decisions.

Perhaps you have heard of Malcolm Gladwell and his book, Blink: The Power of Thinking Without Thinking? I have not read his book, but have heard enough about it to say he discusses the idea of decision making via intuition, or in the “blink” of an eye.

Madeleine Van Hecke, in her book Blind Spots: Why Smart People Do Dumb Things, takes a rather different perspective. She argues that decisions made quickly, on the spur of the moment, are often poorly made decisions. Sometimes we think we already know enough to make informed decisions but wind up getting side swiped by our “blind spots.” (I have not read her book, either.)

Both these authors explain themselves in places other than their books:

To Think or to Blink? – a SharpBarins post by Madeleine
Point of Inquiry interview with Madeleine

Gladwell.com – Malcolm’s blog
TED Talk by Malcolm

Executive Function, part 2

As a child, when thinking about how my brain worked, I imagined tiny people racing around my brain carrying out  directions given by the command center. Now I know … the command center is my prefrontal cortex!

Elkhonon Goldberg says that the prefrontal cortex is “the one part of your brain that makes you who you are.”

Particularly if you teach or are a parent, you have probably seen kids with less than prime functioning executive function. This is not so unusual, as the prefrontal cortex is the last area of our brains to get connected, and is not fully formed until we reach our mid-twenties.

Executive function issues are not limited to childhood and teenage years; they often can continue on to adulthood. Both children and adults who have issues with their EF can be “misunderstood as being willfully disorganized or lazy, possessing a bad attitude or, from a parental viewpoint, ‘doing this on purpose to drive me crazy.’” according to this New York Times article, Lack Direction? Evaluate Your Brain’s C.E.O.

More recently, Sandra Aamodt and Sam Wang, authors of Welcome to Your Brain, make the case in Exercise on the Brain that exercise is not only good for your body, but equally good for your brain.

In humans, exercise improves what scientists call “executive function,” the set of abilities that allows you to select behavior that’s appropriate to the situation, inhibit inappropriate behavior and focus on the job at hand in spite of distractions.

For a succinct delineation of EF’s impact on learning, along with suggestions for managing some of the issues that can arise when EF is not optimal, check out these two pages (mentioned in an early July post) at the National Center for Learning Disabilities.

Executive Function Fact Sheet
Executive Function: A Quick Look

For those who prefer listening, The Brain Science Podcast with Ginger Campbell, MD, has an in-depth discussion about executive function and our frontal lobes, based upon the book by Elkhonon Goldberg, The Executive Brain: Frontal Lobes and the Civilized Mind.

Executive Function, part 1

Do you ever put your hand or fingers to your forehead as you think something out? It’s like cupping or stoking the thought process in action. The area just behind your forehead is the prefrontal cortex, and it acts like a director, directing the recall of information stored in various parts of the brain. This recall is possible because the frontal lobes are very well connected, indeed, almost to all the other areas of your brain. The processes of planning, organizing and carrying out plans, collectively known as executive function, all rely on the prefrontal cortex.

AboutKidsHealth has a series of six articles that explain executive function at various developmental stages, the issues that arise when EF does not function properly, and discussion of ways to train EF.

What is executive function?
The development of executive function in infancy and early childhood
The development of executive function across the lifespan
Brain growth and the development of executive function
What happens when the development of executive function goes awry?
Training executive function

Along those last lines, I’ve previously referenced this June 2008 Newsweek article by Wray Herbert, Is EF the New IQ? Herbert mentions how students at the lower school level are being trained to manage their executive functioning, and postulates that perhaps this type of training is as important as basic subject and skills training.

Decisions, Decisions

When our 24 year old was in eighth grade, he chose a quote by the author of Calvin and Hobbes, Bill Waterson, to be read as he received his diploma. To paraphrase the quote:

The decisions you make now will determine the choices you have later.

I’ve always liked the flow of those words, and it doesn’t hurt that there’s plenty of truth in them, as well.

It has long been thought that the area of our brains engaged in decision making is our frontal lobes. Our pre-frontal cortex is the last part of our brains to develop. Located in the front of our brain, behind the forehead, the frontal lobes are responsible for planning, organizing, controlling behavior, short-term memory, problem-solving, creativity and judgment – all traits associated with the term “executive function”.

While adults are usually capable of clear decision making, because the frontal lobes finish forming in the mid-twenties, decision making is still a work in progress for teenagers. And although the pre-frontal cortex is linked to decision making, there are researchers studying the brain’s “assembly-line” involved in the process of thinking. You can read more about one such 2007 study carried out at the University of Pittsburgh.

Dated just yesterday, the online issue of Scientific American discusses Tough Choices: How Making Decisions Tires Your Brain. Be forewarned, lest you tire out deciding which articles to read…there are numerous links from this article to others, and from those others to still others, all discussing the process of decision making.

And here is the full quote used by my son:

Each decision we make determines the range of choices we’ll face next. If you don’t make each decision carefully, you never know where you’ll end up.

To Do, or Not To Do. That is the question.

NIke’s “Just Do It” is such a powerful, positive slogan.

Ah, but that it were so simple to follow. Before you can “just do it”, you have to make a decision, and is there anyone reading this who has never had difficulty making at least one decision?

Richard Thaler and Cass Sunstein have written a thought provoking book called Nudge (which rhymes with fudge) that should make you think twice when making decisions, among them those concerning your finances and your medical plan. They discuss a philosophy of “libertarian paternalism” whereby “governance, public or private, [uses appropriate choice architecture] to help homo sapiens who want to make choices that improve their lives, without infringing on the liberty of others.”

What fascinates me is their concept of choice architecture, which is a system designed to gently “nudge” people to make decisions that are good for them. Turns out it is all in the phrasing of the choices, and the wording of the default position. To Opt In or Not To Opt In, that is the question, to paraphrase Hamlet.

Please check out these additional pieces about the brain and financial decision making:

  • This is Your Brain On Trading – guest blogger Dr Janice Dorn “provides an in-depth brain-based discussion of the topic” for SharpBrains.com
  • Using Your Brain – an Online NewsHour piece on “what really goes on in our heads when we make economic decisions”
  • Is my brain making me buy things I don’t need? – a howstuffworks.com article on the relationship between brain chemistry and shopping decisions; includes a list of six additional online resources, as well as a list of resources used for the article

p.s. How did I make my decision to choose this Nike movie over any of the others on youtube?

  • the music
  • the juxtaposition of the two dance styles
  • the beauty of the overall piece
  • I love to dance
  • two different dance styles as visual metaphor for two different decisions or choices
  • and in that same vein, two different dance styles as visual metaphor that different ideas can complement one another