Tag: alzheimer disease

Bioethics Blogs

How you’ll grow up, and how you’ll grow old

By Nathan Ahlgrim
Nathan Ahlgrim is a third year Ph.D. candidate in the Neuroscience Program at Emory. In his research, he studies how different brain regions interact to make certain memories stronger than others. In his own life, he strengthens his own brain power by hiking through the north Georgia mountains and reading highly technical science…fiction.

An ounce of prevention can only be worth a pound of cure if you know what to prevent in the first place. The solution to modifying disease onset can be fairly straightforward if the prevention techniques are rooted in lifestyle, such as maintaining a healthy diet and weight to prevent hypertension and type-II diabetes. However, disorders of the brain are more complicated – both to treat and to predict. The emerging science of preclinical detection of brain disorders was on display at Emory University during the April 28th symposium entitled, “The Use of Preclinical Biomarkers for Brain Diseases: A Neuroethical Dilemma.” Perspectives from ethicists, researchers conducting preclinical research, and participants or family members of those involved in clinical research were brought together over the course of the symposium. The diversity of panelists provided a holistic view of where preclinical research stands, and what must be considered as the field progresses.
Throughout the day, panelists discussed different ethical challenges of preclinical detection in the lens of three diseases: preclinical research and communicating risk in the context of Autism Spectrum Disorder (ASD), interventions and treatment of preclinical patients in the context of schizophrenia, and the delivery of a preclinical diagnosis and stigma in the context of Alzheimer’s disease.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Predicting Psychosis: Exploring Pre-Clinical Signs for Mental Illness

By Sunidhi Ramesh

This post is based on the January edition of the “Neuroethics and Neuroscience in the News” series in which Dr. Elaine Walker from Emory University discussed the ethics of assessing risk and treating brain diseases before they can be diagnosed.
This self-portrait is often used to depict the distorted
reality that many schizophrenia patients face.
(Image courtesy of Wikimedia Commons.)

“This calculator,” a 2016 headline states, “can predict your risk of developing psychotic disorders.”

Psychotic disorders, including schizophrenia and bipolar disorder with psychotic features, are characterized by noticeable deficits in “normal” behavior accompanied by hallucinations, delusions, paranoia, an early onset (the average age of onset is in the late teens or early twenties), and a derailed life course.
Because of its early age at onset, the DALY (disability adjusted life years) value for psychosis is significantly greater than that of other illnesses (1). It’s no surprise, then, that researchers are asking questions. Are there measures that can be taken to keep at-risk populations from enduring a life-hindering disability?
Fifteen years ago, the answer would be no. Today, it (just might be) yes. 

How? Researchers have recently identified patterns in pre-clinical psychotic symptoms— patterns that many psychotic patients exhibit long before they are formally diagnosed with a disorder.
In schizophrenia and other psychotic disorders that “interfere with a person’s ability to think clearly, manage emotions, make decisions and relate to others,” this pre-clinical period is called the prodromal period. During this time, patients often experience gradual disruptions in behavioral functioning (like being suspended from school or losing friends) that are accompanied by subclinical or reduced psychotic symptoms (like hallucinations and delusions).

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

On the ethics of machine learning applications in clinical neuroscience

By Philipp Kellmeyer

Dr. med. Philipp Kellmeyer, M.D., M.Phil. (Cantab) is a board-certified neurologist working as postdoctoral researcher in the Intracranial EEG and Brain Imaging group at the University of Freiburg Medical Center, German. His current projects include the preparation of a clinical trial for using a wireless brain-computer interface to restore communication in severely paralyzed patients. In neuroethics, he works on ethical issues of emerging neurotechnologies. He is a member of the Rapid Action Task Force of the International Neuroethics Society and the Advisory Committee of the Neuroethics Network.
What is machine learning, you ask? 
As a brief working definition up front: machine learning refers to software that can learn from experience and is thus particularly good at extracting knowledge from data and for generating predictions [1]. Recently, one particularly powerful variant called deep learning has become the staple of much of recent progress (and hype) in applied machine learning. Deep learning uses biologically inspired artificial neural networks with many processing stages (hence the word “deep”). These deep networks, together with the ever-growing computing power and larger datasets for learning, now deliver groundbreaking performances at many tasks. For example, Google’s AlphaGo program that comprehensively beat a Go champion in January 2016 uses deep learning algorithms for reinforcement learning (analyzing 30 million Go moves and playing against itself). Despite these spectacular (and media-friendly) successes, however, the interaction between humans and algorithms may also go badly awry.

The software engineers who designed ‘Tay,’ the chatbot based on machine learning, for instance, surely had high hopes that it may hold its own on Twitter’s unforgiving world of high-density human microblogging.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Alzheimer’s Disease: Tau Protein Predicts Early Memory Loss

Caption: PET scan images show distribution of tau (top panel) and beta-amyloid (bottom panel) across a brain with early Alzheimer’s disease. Red indicates highest levels of protein binding, dark blue the lowest, yellows and oranges indicate moderate binding.
Credit: Brier et al., Sci Transl Med

In people with Alzheimer’s disease, changes in the brain begin many years before the first sign of memory problems. Those changes include the gradual accumulation of beta-amyloid peptides and tau proteins, which form plaques and tangles that are considered hallmarks of the disease. While amyloid plaques have received much attention as an early indicator of disease, until very recently there hadn’t been any way during life to measure the buildup of tau protein in the brain. As a result, much less is known about the timing and distribution of tau tangles and its relationship to memory loss.

Now, in a study published in Science Translational Medicine, an NIH-supported research team has produced some of the first maps showing where tau proteins build up in the brains of people with early Alzheimer’s disease [1]. The new findings suggest that while beta-amyloid remains a reliable early sign of Alzheimer’s disease, tau may be a more informative predictor of a person’s cognitive decline and potential response to treatment.

The study, led by Beau Ances and Matthew Brier of Washington University, St. Louis, set out to explore how the accumulation of tau and beta-amyloid, though linked to different pathological processes, are related clinically in tracking the progression of Alzheimer’s disease. To take a look, they imaged beta-amyloid and used a newly available imaging agent for tau that, when injected into a person’s bloodstream, binds to the protein and makes it visible in positron imaging tomography (PET) scans of the brain.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

The Alzheimer Disease International Conference 2016 – “Think Global, Act Local”

Members of the World Young Leaders in Dementia reflect on the Alzheimer’s Disease International Conference. The Alzheimer Disease International Conference 2016 (ADI 2016) took place in Budapest (22 – 21 April 2016) and was open

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Disentangling Alzheimer’s, Dementia, and Aging

Katie Aubrecht shares her thoughts on Alzheimer’s, dementia, and aging as these intersect with The Alzheimer Conundrum: Entanglements of Dementia and Aging.

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The World Health Organization and Alzheimer Disease International published Dementia: A Public Health Priority (2012) that highlights the global prevalence of Alzheimer’s disease and other dementias. The report projects that the number of people living with dementia worldwide will triple by the year 2050. It also calls on governments to recognize dementia as “an increasing threat to global health” – a threat that requires a global response. As well, the report explains why dementia is such a problem – because it is a burden that will only get worse over time. Who is dementia a threat to? And, who is it a burden for? The answer seems to be “everyone”: individuals living with dementia, their families, friends and communities, entire countries, and even the world.

Two years before this report was published, the Alzheimer Society of Canada published Rising Tide: The Impact of Dementia on Canadian Society. This report called on Canadians to challenge governments to take action and redirect investments to where they could have the greatest impact. To this day, there is no national dementia care strategy in Canada. Meanwhile, dementia care remains an issue of importance to Canadians and health researchers, policy makers, and practitioners. This was evident in the focus on dementia at the 2015 Canadian Academy of Health Sciences forum, The Rising Tide of Dementia in Canada: Facing the Critical Challenge by 2025. Meanwhile, in June 2015 Nova Scotia introduced a dementia care strategy, Towards Understanding.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Interview: Daniel P. Sulmasy on informed consent

Interview: Daniel P. Sulmasy on informed consent

Daniel P. Sulmasy is the Kilbride-Clinton Professor of Medicine and Ethics in the Department of Medicine and Divinity School at the University of Chicago, where he serves as Associate Director of the MacLean Center for Clinical Medical Ethics and as Director of the Program on Medicine and Religion. He is also a member of the Presidential Commission for the Study of Bioethical Issues (PCSBI). Professor Sulmasy has written numerous books on topics related to bioethics, and published many articles in bioethics and medical ethics journals.

In this exclusive interview with BioEdge, Professor Sulmasy shared his thoughts on the complex notion of informed consent. 

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Xavier Symons: Some academics deride the ‘fetishization’ of informed consent or the ‘cult of consent’. What’s going on? Most of us see it as our greatest safeguard.

I understand the sentiment, but informed consent is still critically important. Informed consent has become bureaucratized and, unfortunately, therefore equated by many health care professionals with merely obtaining a signature on a form. Too few practitioners take consent to be a process and a serious moral obligation.

While this can also be true in the research setting, I also think too many ethicists and researchers view informed consent as a sufficient justification for enrolling in human experimentation, and that is also misguided. Some experiments are just too risky or too scientifically flawed to justify doing them even if subjects do consent. These days, patients need more than ever to be involved in their care. The informed consent process is the entrée to their involvement.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Is Multilingualism a Form of Cognitive Enhancement?

The following post is part of a special series emerging from Contemporary Issues in Neuroethics, a graduate-level course out of Emory University’s Center for Ethics.

People often ask me what language I dream in. I usually tell them that I dream in both languages – Romanian and English – and that it depends on the content of the dream and on the people featured in it. I associate emotional states with my native Romanian, while organized, sequential thinking is easier in English. Most of the time, I am not even aware of the identity of the language I produce and hear in my dreams.

Leaving the mysterious dimension of dreams behind, how does the multilingual brain navigate the world? Faced with an information-dense environment, it is able to switch its language of appraisal at the moment’s need. Consider the increasingly large group of bilingual English-speaking Hispanics in the United States. Most of them use English in their academic and work environments, then effortlessly switch to Spanish when talking to family members and other Spanish speakers. They also retrieve autobiographical memories in the original language of encoding without losing any more details than a monolingual individual. Given a context, multilingual individuals are able to adjust to the linguistic requirements of the situation. The multilingual brain is, therefore, an adaptable brain.

This leads us to the next point of inquiry. How does speaking several languages sculpt the brain? The Brain and Language Laboratory for Neuroimaging led by Dr. Laura-Ann Petitto has been investigating the differential activity in monolingual and bilingual brains during comprehension tasks, and has found that bilinguals show increased activation in the left inferior frontal cortex, an area associated with semantic processing and behavior inhibition.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Predicting Alzheimer’s Disease: Potential Ethical, Legal, and Social Consequences

(This post oriignally appeared, in very slightly different form,  in the Neuroethics Blog on June 17, 2014, here.)

Would you want to know the date and time of your death? Life-Line, the first published fiction by Robert A. Heinlein, one of the giants of 20th century science fiction, explored that question. The story’s protagonist, Hugo Pinero, had invented a machine that could tell precisely when individuals would die, but, as Pinero found to his distress, he could not intervene to change their fates.

Would you want to know whether you would be diagnosed with Alzheimer disease (AD)? This question is rapidly leaving the realm of science fiction; indeed, it already has for some unlucky people. Our ability to predict who will suffer from this evil (and I chose that word carefully) condition is proceeding on several fronts and may already be coming into clinical use.

This post will briefly note the ways in which AD prediction is advancing and what some of the ethical, legal, and social implications of such an ability would be, before asking “should we care?”

Science

Several different techniques are providing information about an individual’s risk of being diagnosed with AD, including genetics, biomarkers, and neuroimaging.

Genetics can predict AD with great confidence for about one person in a thousand. People who carry a mutated version of the PS1 gene (or, much more rarely, mutated versions of the PS2 or APP genes) are nearly certain to be diagnosed with AD, unless they die earlier from something else, and with an early onset version that typically strikes in one’s 40s or 50s.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Predicting Alzheimer’s Disease: Potential Ethical, Legal, and Social Consequences

By Henry T. Greely, J.D.


Henry T. (Hank) Greely is the Deane F. and Kate Edelman Johnson Professor of Law and Professor, by courtesy, of Genetics at Stanford University. He directs the Stanford Center for Law and the Biosciences and the new Stanford Program in Neuroscience and Society  SPINS). He is also a member of the AJOB Neuroscience Editorial Board.

Would you want to know the date and time of your death? Life-Line, the first published fiction by Robert A. Heinlein, one of the giants of 20th century science fiction, explored that question. The story’s protagonist, Hugo Pinero, had invented a machine that could tell precisely when individuals would die, but, as Pinero found to his distress, he could not intervene to change their fates.

Would you want to know whether you would be diagnosed with Alzheimer disease (AD)? This question is rapidly leaving the realm of science fiction; indeed, it already has for some unlucky people. Our ability to predict who will suffer from this evil (and I chose that word carefully) condition is proceeding on several fronts and may already be coming into clinical use.

This post will briefly note the ways in which AD prediction is advancing and what some of the ethical, legal, and social implications of such an ability would be, before asking “should we care?”

Via the BBC


Science

Several different techniques are providing information about an individual’s risk of being diagnosed with AD, including genetics, biomarkers, and neuroimaging.

Genetics can predict AD with great confidence for about one person in a thousand.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.