Your Brain: An Owner’s Manual

Delia Chiaramonte, M.D. UMSOM Center for Integrative Medicine

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Get to Know Your Brain

100 billion neurons

2% of the body’s

weight but consumes 20% of our

energy

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VISION

SENSORY (R) & MOVEMENT (L)

FACIAL RECOGNITION (R) & LANGUAGE (L)

RATIONAL THOUGHT

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A Brain in 3 Parts

• Reptilian Brain - The things babies can do – Hindbrain: breathing, heartbeat, eating, sleeping, etc.

• Mammalian Brain - Emotions – The limbic system:

• Hippocampus – memory

• Amygdala – fear

• Thalamus – gathers sensory info and sends it to higher parts of the brain

• Human Brain – Thinking – The neocortex, frontal lobes: planning, abstract ideas,

using words rather than acting out, language, empathy

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Interpersonal Neurobiology

“Neural Wifi”

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Mirror Neurons

Empathy Observational Learning

Interpersonal Relationships

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Neuroplasticity The brain is constantly reorganizing and is

shaped by its environment

“Neurons that fire together, wire

together”

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What Can Go Wrong?

Free Radical Damage

Concussion

Stress

PTSD

Time

Etc…

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Mild Traumatic Brain Injury

Concussion changes the brain Strain et al Neurology 2013, Hart et al JAMA Neurol 2013

Blood Flow Inflammation

White/gray matter changes Hea

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Concussion Symptoms Physical

• Headache

• Impaired balance/dizziness

• Sensitivity to noise/light

• Visual/hearing problems

• Fatigue/Insomnia

Cognitive

• Slowed thinking

• Impaired memory/attention

• Amnesia of the event

• Impaired executive function

• Impaired cognition/reading

Emotional

• Anxiety/new OCD

• Depression

• Personality change

• Outbursts/increased emotionality/irritability

• “Frontal release”

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Your Brain Can Get Stuck in Fear Mode

Recalibration of the brain’s alarm system

Impaired intimate relationships

Impaired sleep

Increased startle response Anxiety and depression

Flashbacks

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Trauma vs. trauma AKA “Stress”

• Most of us have (at least) “t” trauma

– Beloved dog died

– Stressful sleepaway camp experience

– Parents’ divorce

– House foreclosed

– Child kicked out of school

– Difficult breakup

“Post traumatic stress” is a spectrum

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Stress/Trauma and the Brain

Chronic stress shrinks the

hippocampus

Change is reversible

Hippocampus Amygdala

Helps us learn what to fear

Can get stuck in “on” position

Prefrontal Cortex

Able to suppress the amygdala

The “grown up”

Stress impairs PFC function

Memory

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PTSD

• Overactive Amygdala

• Underactive Prefrontal Cortex

Keonigs & Grafman Neuroscientist 2009

Amygdala

Prefrontal Cortex

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Negativity Bias

Our body values survival over quality of life

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Thank you, amygdala, for keeping us alive!

We come from a long line of anxious people

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Stress is Bad for Your Brain • Short term stress increased beta amyloid

protein in mice (found in Alzheimer’s)

Holtzman et al Proc Natl Acad Sci 2007

• Stress causes brain inflammation Sorrells et al Neuron 2009

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The Environment Can Hurt Your Brain

Free Radical Injury

Smoking and increased BMI increase free radical

injury to the brain

Peskind et al JAMA Neurol 2014

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Passage of time

Disuse of cognitive skills is associated with age-related cognitive decline

Hultsch et al Psychol Aging 1999

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Caring For Your Brain

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Manage Stress

Calm your amygdala

Boost your hippocampus

Support your prefrontal cortex Hea

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“Limbic System Therapy” Remind the limbic system how to relax

Repair the faulty alarm system

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Mindfulness Meditation

• Mindfulness meditation

–Activates the prefrontal cortex

–Reduces amygdala activity

Creswell et al Psychosom Med 2007

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Stimulate the Relaxation Response

• Meditation improved memory

• Meditation improved IQ scores and cognitive function

Mohan et al J Altern Complement Med 2011

Singh et al Altern Ther Health Med 2012

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Social Engagement

• Study of 354 people aged 50+

• Measured baseline cognitive function & social network

• Followed for 12 years

• Results:

– People with more interpersonal activity better cognitive function

Holtzman et al J Gerontol B Psychol Scho Soc Sci 2004 Health

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Move! • Physical activity improved cognitive

performance and executive control in kids

• Higher fitness level is associated with improved executive function and greater gray matter volume in the prefrontal cortex

Hillman et al Pediatrics 2014

Weinstein et al Brain Behav Immun 2012

• Also associated with greater volume of the hippocampus Erickson et al Neurobiol Aging 2014

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Exercise Improves Brain Function

• Physical activity decreased PTSD symptoms and depression better than controls (syst review, n=200)

Rosenbaum et al, Psychiatry Res 2015

• Aerobic exercisers have better cognition Hillman et al Nat Rev Neurosci 2009

• People RANDOMLY assigned to exercise improved processing speed, executive function and memory (syst review, n=2049)

Smith et al Psychosom Med 2010 Hea

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Feed Your Brain

coffee

Dark chocolate Mediterranean Diet

Omega 3 fatty acids

Fermented foods

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Your Fatty Brain

• Brain is 60% fat – insulates the nerves to rapidly transmit info between cells (myelin)

• Fish oil – omega 3 fatty acids (DHA/EPA)

• Insufficient DHA may have a role in cognitive decline/Alzheimer’s

• 6 months of DHA (900 mg) improved learning and memory in older adults with age-related cognitive decline

Cunnane et al Progress in Lipid Research 2009

Yurko-Mauro et al Alzheimers and Dementia 2010

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No

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Make Art

Bolwerk et al PLoS One 2014

Creating visual art improved brain connectivity and psychological resilience

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Your Creative Brain

• Theater program for older adults improved memory and problem solving (compared to attention control)

• Creative activities generated activity in the Prefrontal cortex (fMRI)

• Creative pursuits activate multiple parts of the brain

Noice et al Aging, Neuropsychology and Cognition 2009

Noice et al J of Aging and Health 2004

Fink et al Hum Brain Mapp 2009

Geraint et al Fron Hum Neurosci 2014 Health

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What’s the Gut Got to Do with It?

• Gut microbiome can regulate brain function and mood

• Anxious mice transplanted with gut flora from non anxious mice had decreased anxiety

Farmer et al J Physiol 2014

Mu et al Front Microbiol 2016

• Probiotics can positively impact the gut-brain axis in mice

Carli et al Am J Physiol Gastrointest Liver Physiol 2014

• …and possibly in humans

Chunlong et al Front Microbio 2016

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What About Brain Games?

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Brain Games

• Research is conflicting – some +, some - results

• Research Issues:

– Small sample size

– Passive control groups

– What is a positive result?

• Does doing better on the game count?

– Are “positive” results generalizable to things that we care about?

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Brain Games - Research

• Healthy older adults RCT of Lumosity vs. control

– 20 one hour sessions vs. 3 meetings with researchers

– Lumosity group improved processing speed, attention, visual recognition memory. No benefit in visuospatial working memory or executive control.

• Same group of patients evaluated 3 months later

– All benefits noted above disappeared

Ballesteros et al Front Aging Neurosci. 2014 Oct 14;6:277

Ballesteros Front Aging Neurosci. 2015 Apr 14;7:45.

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Mentally Stimulating Activities • Cognition is better in people who report

regular mentally stimulating activities

– Reading, cards, museums etc.

• This may be related to “brain reserve”

– e.g. Alzheimers on autopsy but cognitively nl in life

Wilson et al JAMA 2002, Verghese et al Neurology 2006

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Learning New Skills Changes the Brain

• Learning to juggle increased gray matter

• More practice of same skill no new gains

• 4 months after stopping –> gains reversed

Driemeyer et al PlosOne 2008

Skills should be novel, complex and ongoing Hea

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Keep Asking Your Brain to Learn NEW Things

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Brain-Based Therapies

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Neurofeedback “Rewiring The Brain”

• Changes structural and functional brain connectivity in Traumatic Brain Injury Munivenkatappa A et al. NeuroRehabilitation. 2014

• Regulates anxiety and phobias Zilverstand A et al. Front Behav Neurosci. 2015

• Reduces anxiety – (review) Schoenberg P and David A. Appl Psychophysiol Biofeedback. 2014

• Reduces depression and fatigue Choobforoushzadeh A et al. Appl Psychophysiol Biofeedback. 2015

• Improves memory in patients with TBI Thornton J Head Trauma Rehab 2000

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NF Also Effective For… • ADHD

• Substance abuse

• Autism

• Cognitive issues after concussion

• Enhancing memory

Arns et al Clinical EEG and Neuroscience 2009, 30+ other studies

Sokhadze et al Appl Psychophysiol Biofeedback 2014

Sokhadze et al Appl Psychophysiol Biofeedback 2008

Munivenkatappa et al Neurorehabilitation 2014

Hsueh et al Hum Brain Mapp 2016

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“Brainwave Biofeedback”

• Specific brain waves are associated with physical/emotional states

– High Beta: stressed, anxious, vigilant, excited

– Beta: wide awake, attentive, logical thinking

– Alpha: awake but relaxed, calm

– Theta: trance-like, lack of focus, pre-sleep

– Delta: deepest, dreamless sleep

Electrical activity patterns caused by the neurons of the brain communicating with each other, measured by EEG

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Neurofeedback

• QEEG, “Brain Map” diagnosis and tx planning

• Real time EEG

• Computer rewards desired brain activity

Teaches the brain to organize and regulate itself

Operant conditioning of brain neuronal activity Reward desired brain activity, ignore other

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Why Use Neurofeedback?

• Meditation and psychotherapy work with the mind to affect the brain

• NF works with the brain to affect the mind

In a brain being run by the limbic system (trauma) it can be hard to access the

mind until the brain is calmer!

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Vision Therapy Physical therapy for the eyes & brain

• Vision: learned skill using eyes & brain

• Deficit: intrinsic or from injury

• Exercises to relearn/improve:

– Eye tracking, convergence, visual perception, eye-hand coordination and visual motor integration

– Reading comprehension

• Behavioral optometrist

• 1-2x/week x few months + HW

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Used in children &

adults

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• Transcranial Magnetic Stimulation For Treatment Resistant Depression

• Uses magnetic pulses to stimulate nerve cells in the brain (depolarizes neurons in targeted brain regions)

• Also useful for PTSD-related depression

Philip et al J Trauma Stress 2016

• Strong evidence for efficacy (depr)

Liu et al BMC Psychiatry 2014

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TMS – The Details

• Electromagnetic coil placed against the head

• Repeated magnetic pulses administered

• Painless • Sessions: 40 min, 5 days/wk

for 4-6 weeks • Side effects: headache, facial

twitching, seizures (rare)

Often not covered by insurance

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Eye Movement Desensitization & Reprocessing (EMDR)

Alternating stimulation: visual, auditory or tactile

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EMDR Effective Integration of Traumatic Memory • Targets the maladaptive encoding or incomplete

processing of traumatic experiences

• May be related to REM sleep processing of info

• May be particularly effective for single trauma

Don’t need to talk about the trauma

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EMDR Evidence

• Meta-analysis of RCTs of EMDR (26 RCTs)

EMDR significantly improved PTSD sx, depression, anxiety Chen et al PLoS One 2014

• EMDR more effective than CBT for PTSD

Chen et al, J Nerv Ment Dis 2015

• May be related to enhanced limbic processing (fMRI studies)

Herkt et al PLoS One 2014 Hea

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EMDR Better Than Prozac for PTSD

• Randomized trial of EMDR, Prozac and a pill placebo in tx of PTSD and depression

• 88 people with PTSD, 8 weeks of treatment

• Results: – EMDR was more effective than Prozac/placebo in tx

PTSD (adult onset) & depression

– 75% of EMDR pts resolved all symptoms compared to 0% of Prozac group

– Less effective for developmental trauma

van der Kolk et al. J Clin Psychiatry, 2007

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Brain Health A Practical Plan

• Exercise

• Reduce your stress – relaxation response

• Stimulate your mind – novel and complex

• Stay connected

• Be creative

• Eat brain food

• Treat brain injury and dysfunction

– Neurofeedback, vision therapy, EMDR, TMS, etc.

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Neurogenesis Occurs in the human

hippocampus

Exercise stimulates NEW neuron production (mice &

humans)

Mental stimulation appears to nurture these “baby”

neurons

Kempermann et al Front Neurosci 2010

Roy et al Nat Med 2000

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Thank you for your attention Hea

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Alzheimer’s Disease

• Changes in Brain – Acetylcholine depletion

– Amyloid plaques & neurofibrillary tangles

– Neuronal death, esp. in prefrontal cortex and hippocampus (areas of learning & memory)

– Severe brain atrophy

• Goals of treatment – Cognitive function: Aricept, Exelon, Razadyne,

Namenda – regulate neurotransmittors • may help for awhile. Not a cure.

– Behavior management Hea

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The Future… The Human Connectome Project

http://www.humanconnectomeproject.org Health

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Is Vision Therapy Effective?

• RCT funded by National Eye Institute

• 12 weeks of active vision therapy plus home practice

• Significant improvement in 75% of patients

• Significantly more effective than “pencil pushups,” computer intervention and placebo

Convergence Insufficiency Treatment Trial Study Group. Archives of Ophthalmology. 2008. Oct;126:1336-49 Hea

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The Neurobiology of Stress

Executive Function

Fear Regulation

Memory

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