Hi, I don’t normally do this, and I don’t have many followers but here it goes. A few years back my gram had several strokes that left her paralyzed on the left side of her face, arm and leg. She cannot hear or see out of her left side, nor move her mouth. Our insurance had cut us off because they told us she’d never get better. My grandpa took a job delivering papers in order to pay for her medicine. It’s only him and I taking care of her and we’re struggling to help her out. My gram needs the care she deserves. Please reblog or tell a friend any little bit helps :)

http://www.gofundme.com/helpmygram

Redrawing Language Map of the Brain

For 140 years, scientists’ understanding of language comprehension in the brain came from individuals with stroke.

Based on language impairments caused by stroke, scientists believed a single area of the brain – a hotdog shaped section in the temporal lobe of the left hemisphere called Wernicke’s region – was the center of language comprehension.  Wernicke’s was thought to be responsible for understanding the meaning of single words and sentences, two separate and critical functions.

But Northwestern Medicine scientists have updated and redrawn the traditional brain map of language comprehension based on new research with individuals who have a rare form of dementia that affects language, Primary Progressive Aphasia (PPA).

The new research shows word comprehension is actually located in a different brain neighborhood – the left anterior temporal lobe, a more forward location than Wernicke’s. And sentence comprehension turns out to be distributed widely throughout the language network, not in a single area as previously thought.

The paper was published June 25 in Brain.

“This provides an important change in our understanding of language comprehension in the brain,” said lead study author Dr. Marek-Marsel Mesulam, director of Northwestern’s Cognitive Neurology and Alzheimer’s Disease Center.

Mesulam also is a professor of neurology at Northwestern University Feinberg School of Medicine and a neurologist at Northwestern Memorial Hospital.

Knowing where language comprehension is located offers a more precise target for future therapies that could potentially protect or restore language function.

The stroke connection

Strokes cut off blood supply to regions of the brain and cause destruction of both neurons and fiber pathways passing through that region.

In the 1870s, a scientist named Carl Wernicke observed a specific region damaged by stroke and resulting language impairments. This area, consequently named Wernicke’s region, was identified as the seat of language comprehension.  

“People who had strokes that affected Wernicke’s region couldn’t explain what a word such as umbrella meant,” Mesulam said. “Secondly, they had difficulty understanding sentence construction. If you said, ‘Put the apple on top of the book,’ even if they understood the meaning of apple and book, they wouldn’t be able to carry out the command because they can’t understand the construction of the sentence.”  

Something doesn’t add up

But Mesulam, the world’s leading expert in PPA, for years had been puzzling over the fact that his PPA patients with damage in Wernicke’s area did not have the word comprehension impairment seen in stroke patients. They still understood individual words. And their sentence comprehension was inconsistent; some understood sentences; some didn’t.

“It was becoming clear over the many years I saw these patients, that there was some disconnect between what textbooks said and what we saw in our patients,” Mesulam said. “We did this study to analyze the discrepancy. The view of brain as seen from stroke did not match the view of the brain when seen from PPA.”

He and colleagues began a study of PPA patients, conducting quantitative MRI imaging of their brains and testing their language.

Northwestern scientist Emily Rogalski conducted the imaging in 72 PPA patients with damage inside and outside of Wernicke’s area. She measured cortex thickness in all of these areas. Cortex thickness is an indirect measure of the number of neurons and brain health. Thinning of the cortex in PPA indicates the destruction of neurons by the disease.

PPA patients still understand words

Rogalski, a research associate professor, found PPA patients who lost cortical thickness in Wernicke’s area still could understand individual words and had varied impairment of sentence comprehension. None of these patients had the global type of comprehension impairment described in stroke patients with Wernicke’s aphasia.

Severe word comprehension loss was only seen in PPA patients who had diminished cortical thickness in a region of the brain completely outside of Wernicke’s area, in the front part of the temporal lobe. This part of the brain is not prone to the effects of stroke, so its role in comprehension had been missed in prior language maps.

The discrepancy between the traditional map of comprehension and what was seen in PPA can be explained by the different ways the two diseases injure Wernicke’s area. In PPA, the neurodegenerative disease does not destroy the underlying fiber pathways that allow language areas to work together. But, in stroke patients, those critical highways passing through Wernicke’s had been blown up. So, the messages from other parts of the brain to the left anterior temporal lobe – the spot for word comprehension – were simply not getting through, Mesulam posits.

“What is happening here is no different from the charting of galaxies in outer space,” Mesulam said. “You look through one kind of telescope, you see one picture; you look through another infrared telescope, you get another picture. We are all in this pursuit of how to piece together different perspectives to get a better sense of how the brain works.”

“In this case, we saw a different map of language by comparing two different models of disease, one based on strokes that destroy an entire region of brain, cortex as well as underlying pathways, and the other on a neurodegenerative disease that attacks mostly brain cells in cortex rather than the region as a whole,” Mesulam said.

Strokes steal 8 years’ worth of brain function, new study suggests

Having a stroke ages a person’s brain function by almost eight years, new research finds – robbing them of memory and thinking speed as measured on cognitive tests.

In both black and white patients, having had a stroke meant that their score on a 27-item test of memory and thinking speed had dropped as much as it would have if they had aged 7.9 years overnight.

For the study, data from more than 4,900 black and white seniors over the age of 65 was analyzed by a team from the University of Michigan U-M Medical School and School of Public Health and the VA Center for Clinical Management Research. The results will be published in the July issue of Stroke and are available online.

Researchers married two sources of information for their analysis: detailed surveys and tests of memory and thinking speed over multiple years from participants in a large, national study of older Americans, and Medicare data from the same individuals.

They zeroed in on the 7.5 percent of black study participants, and the 6.7 percent of white participants, who had no recent history of stroke, dementia or other cognitive issues, but who suffered a documented stroke within 12 years of their first survey and cognitive test in 1998.

By measuring participants’ changes in cognitive test scores over time from 1998 to 2012, the researchers could see that both blacks and whites did significantly worse on the test after their stroke than they had before.

Although the size of the effect was the same among blacks and whites, past research has shown that the rates of cognitive problems in older blacks are generally twice that of non-Hispanic whites. So the new results mean that stroke doesn’t account for the mysterious differences in memory and cognition that grow along racial lines as people age.

The researchers say the findings underscore the importance of stroke prevention.

“As we search for the key drivers of the known disparities in cognitive decline between blacks and whites, we focus here on the role of ‘health shocks’ such as stroke,” says lead author and U-M Medical School assistant professor Deborah Levine, M.D., MPH. “Although we found that stroke does not explain the difference, these results show the amount of cognitive aging that stroke brings on, and therefore the importance of stroke prevention to reduce the risk of cognitive decline.”

Other research on disparities in cognitive decline has focused on racial differences in socioeconomic status, education, and vascular risk factors such as diabetes, high blood pressure and smoking that can all contribute to stroke risk. These factors may explain some but not all of the racial differences in cognitive decline.

Levine and her colleagues note that certain factors – such as how many years a person has vascular risk factors, and the quality of his or her education, as well as genetic and biological factors – might play a role in racial differences in long-term cognitive performance.

But one thing is clear: strokes have serious consequences for brain function. On average, they rob the brain of eight years of cognitive health. Therefore, people of all racial and ethnic backgrounds can benefit from taking steps to reduce their risk of a stroke. That includes controlling blood pressure and cholesterol, stopping or avoiding smoking, controlling blood sugar in diabetes, and being active even in older age.

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Make Health Last: What Will Your Last 10 Years Look Like? by the Heart and Stroke Foundation.

MedStar Washington Hospital Center Saves Critical Time Diagnosing Stroke Patients With MRI By Borrowing “Lean” Manufacturing Principles

Using efficiency principles borrowed from “lean” manufacturing processes, two Washington-area hospitals have gotten a life-saving drug to stroke patients significantly quicker, while also obtaining better diagnostic information using MRI. That’s according to a new study published online ahead of print in the May 13 issue of Neurology®, the medical journal of the American Academy of Neurology.

National benchmarks call for getting stroke patients from the door of the emergency room to injection with the clot-busting drug known as intravenous tissue plasminogen activator, or IV tPA in 60 minutes or less because the sooner tPA is administered, the better the outcome. But before the drug can be administered, patients must receive either a CT or MRI scan, to determine whether they are suitable candidates for the drug treatment. While an MRI can provide more valuable diagnostic information, it takes longer than a CT scan. So, few hospitals in the country routinely use an MRI as first-line brain imaging for acute stroke patients.

MedStar Washington Hospital Center and Suburban Hospital in Bethesda, Md., found that by analyzing and changing their work processes, they could reduce “door-to-needle” times from 93 to 55 minutes, a 40 percent difference and meet the benchmark of 60 minutes or less while using MRI for first-line brain imaging, according to the study’s physicians. This research was supported by the NIH’s National Institute of Neurological Disorders and Stroke.

“Using MRI scans gives doctors valuable information to help make treatment decisions, including the location and size of the stroke if present, when it occurred, the extent of blood vessel blockage and amount of brain tissue at risk, new or old bleeding, and potentially the cause of the stroke,” said Amie Hsia, MD, medical director of the Comprehensive Stroke Center at MedStar Washington Hospital Center, and the study’s senior author. “We borrowed ideas from manufacturers who use ‘lean’ production processes to make their plants more efficient, and applied them to healthcare. Our colleagues at Washington University in St. Louis had previously applied these principles to the evaluation of stroke with CT, which inspired us to take a similar approach with MRI.”

A critical factor in improving efficiency is teamwork among all the different areas involved in evaluating stroke patients, including emergency room physicians, nurses and technicians; radiology and laboratory staff; and acute stroke team physicians and nurses.

“We wanted to share with other hospitals exactly how we streamlined our processes so they could see what’s possible, and consider applying similar interventions within their own institutions, to be able to use MRI scans when needed to quickly guide treatment decisions for patients with suspected stroke,” added Dr. Hsia.

Among the efficiency-improving steps taken by the hospitals were creating process maps to identify roadblocks causing delays, reorganizing the work flow to reduce handoffs, and assigning specific roles to each member of the stroke team. The study’s authors concluded that by using these approaches, other hospitals could reduce their door-to-needle times as well, and begin using MRI scans. The time-saving techniques are known as SMART, or Screening with MRI for Accurate and Rapid stroke Treatment.

In addition, according to Dr. Hsia, many of these interventions can also be applied to hospitals that primarily use screening CT scans, because they affect the processes before and after the brain scan rather than the imaging itself.

Arroz Caldo

Filipino Arroz Caldo is a rice porridge dish comprised of chicken, fish sauce, garlic, and ginger, occasionally garnished with scallions. Thicker than chicken noodle soup, thinner than rice congee, its ubiquity in the Philippines and in Filipino-prevalent US communities lends to many interpretations of the Philippines’s second most well-renowned meal. Every Filipino lays claim to their Lola making the best tasting Arroz Caldo. Of course, they are all correct.

The fish sauce often imparts a brown tinge to the Arroz Caldo’s otherwise white color. Soft chicken shreds, released from their bones, gracefully dot the porridge and occasionally intermingle with julienned ginger wisps. They all delicately suspend together without crowding. Not my Lola’s Arroz Caldo. Hers is different.

“Acquaintance,” my grandmother quizzes, not diverting her gaze from the Webster’s Dictionary in her hands. “A-Q-U …” I begin erroneously, before my grandmother furls her brow and purses her lips. It is the first day I am preparing for my second grade Spelling Bee, and already Lola has abandoned my official training book for the dictionary because, in her estimation, “there are harder words.” I start over, and keep repeating until I get it right. Fourteen days later, I will discover that I am not a participant in the Spelling Bee, but merely an alternate speller in the event that the main competitor fell ill. My grandmother nonetheless sits patiently in the audience with me, to watch the entire competition for which I do not qualify.

Dr. Lourdes “Lulu” Costes Ungson was born on October 6, 1923 in the Philippines, one of nine children. “Lourdes’s marital status?” asks Evette, a transition specialist at the Lorenzen Angeleno Mortuary in Reseda, California. “Married,” answers my mother, sitting across from her at the large dark cherry wood table, flanked by me and my brother Ross. It is July 6, 2015. As she scans the death certificate form for more questions, Evette apologizes timidly if any of her queries seem indelicate - it’s her first time doing this. “Occupation?” The three of us look at each other, before saying in reverential near-unison: “Educator.“

After receiving her Masters and Ph.D., Lourdes would be sent by the United Nations on scholarship to study at UCLA and eventually direct radio and television education in Australia. Her official Philippine Government ranks as Supervisor for the Department of Education, Director of State Scholarship Council, and Board Member of Directors of Aviation Education could not have been easy for a woman to attain at that time. I am told that my grandmother was a strict disciplinarian who did not suffer fools, but this was not the Lola that I knew. The Lola I knew collected rocks.

They had to be the right kind of rocks, though. “Red, like this one,” she instructs my brothers and me sagely, while we scour the green expanses of Balboa park. It is 1987 and Lourdes is the same age that my mother is today. We grinningly forage for hours, undeterred that most rubble we find is too red, too sharp, too large or too puny. When we do find the right rock, our ultimate validation is placing it in her tiny wrinkling hand, while her other hand tightly clutches a crumpled tissue. My brother Raymond is about to discard a smooth, round, navy blue stone before Lola interrupts him: “We should save that.”

You’d be forgiven for passing Lulu on the street. A tiny Asian woman below five feet in height, donning Jesus-themed scarves and wildly mismatched prints — how many other elderly women matched her physical description in the Southern California area? “DO YOU WANT LARGE, MEDIUM, OR SMALL SIZE?” over-pronounces the attendant from behind a fast food register. It is 1991 and my sister is boiling with anger that a man who appears to have read less books than my grandmother has written believes that my grandmother doesn’t speak English. “Small,” answers my sister bitterly, while my hearing-impaired grandmother continues to smile at the gentleman.

Lola’s Arroz Caldo does not have the stylistic delicacy of restaurant Arroz Caldo, and is perhaps more appetizing for it. Lola’s dish is a pitch-white congregation, chicken thighs still wrapped in their goose-pimpled skin, wide flat beads of yellow oil floating on the surface. A lot of the rice has split from boiling for so long. You have to be careful when you’re eating it, because the ginger is not shredded finely. It comes in square chunks. And the chunks sting.

It is my second year of medical school, and my parents inform me that my grandfather is at a police station with my grandmother in Sherman Oaks, California. She has been arrested for shoplifting at a local department store. It is clear that she is confused about her location, and during the interview, occasionally forgets her husband’s name.

Alzheimer’s Dementia is an equal opportunity employer that doesn’t discriminate against ethnic or educational background. Lola’s memory and cognitive function decline rapidly and her gift of written and spoken communication is almost completely silenced. She cannot express her anxieties or go to the bathroom on her own. She cannot draw a clock or distinguish between her daughter and granddaughter. She cannot communicate when she is feeling sick.

“Lola was diagnosed with pneumonia, dehydration, and sepsis, at Northridge hospital” texts my mom to me and the rest of my family. “Is this serious? Will she be ok?” It is Thursday, July 2, 2015. My brother tells us more information from the admitting ER doc. Fever. Elevated white count. Heart rate 130. Respiratory rate greater than 20. Crackles on exam. Lactic acid 5.2. Not responsive. Increased troponin. SIRS with sepsis, non-responsive, 91 years old, unknown source of infection, elevated troponin. I pause, close my eyes, and tilt my head back. I know my Lola will be dead by tomorrow.

It is unclear exactly what happened. With my grandmother’s presenting hospital laboratory values we can paint a guess. Lola likely suffers a mild stroke that she is unable to convey to her caretakers. The same part of her brain that defied the corrupt Marcos Presidency now isn’t unable to instruct her lungs to breathe properly. An infection forms in the lethargic alveoli sacs of the same lungs that conducted dozens of speeches and instructed hundreds of students. The infection spreads to her blood. The same heart that beat faster as she conspired with Ninoy and Cory Aquino now cannot keep up with her body’s increasing demands, and she suffers a heart attack. Insufficient blood reaches her small intestine and the mesenteric ischemic tissue designs a bowel obstruction. Her dehydrated kidneys do not have enough fluid and go into complete failure. Her heart beats too fast and loses its rhythm before she goes into cardiac arrest.

My grandfather is by my grandmother’s bedside when the hospital staff performs chest compressions, advanced cardiac life support, and intubation. My brother Raymond and my mother arrive at Northridge Hospital soon afterwards. It is July 3, 2015. “I thought she was DNR/DNI?” I ask my brother over the phone. “Mom and Lolo switched it, so they could say goodbye,” responds my brother. There is a thick weakening silence on the phone as we both lament the painful process that will immediately follow. We know that each moment we prolong this decision, the more difficult it will become. My brother requests one more morphine push, before asking the supervising physician to extubate Lola at 9:40 PM.

“Time of death?” continues Evette at the Lorenzen Angeleno Mortuary, moving further down the death certificate. “July 3rd, 2150 hours” I respond placidly. Evette informs us that the certificate is complete. It is Monday, July 6, and we are making the final arrangements for my grandmother’s funeral and burial services. Rocky, a large, soft-spoken man and funeral coordinator, kindly and professionally guides us through our various choices for prayer cards, flowers, and headstones.

It is 1987. My brothers and I are back from Balboa park and are dashing messily around my grandparents’ front yard, scattering rocks everywhere. Lulu patiently waits before restoring order to the stone garden — refining, and adding our newest acquisitions of the day to the mosiac. It is hard to see unless you step back. Our perfectly red rocks become a new beak for a swan, swimming in a smooth, round, navy blue ocean.

It is July 9, 2015, the morning of a lovely, intimate religious ceremony in for Lourdes. A grand bouquet of white flowers is delivered by a woman in a black “Taco Bell” jacket. The card reads “We’re very sorry about your lost [sic], we love you so much. Alejandra and the Taco Bell Team.” We discover that my grandparents have been eating at that fast food restaurant almost every day, and the staff worried when Lolo and Lola had not dined there for four days. Rocky asks us if we would like to see Lola’s body one last time before the casket is sealed. My mother and I decline. We already have the final Lola image we want in our memories.

It is 2009. I finish my bowl of Lola’s Arroz Caldo, leaving only chunks of chewed ginger in the bottom of the dish. The very best part about this serving is that I do not realize it is my final one.

_____________________________

adoodlinby roav donleyjan saileshcreates

Remapping the Brains Language Area

Old beliefs upended as dementia research yields new locations for word and sentence comprehension.

The research is in Brain. (full access paywall)

Research: “The Wernicke conundrum and the anatomy of language comprehension in primary progressive aphasia” by M-Marsel Mesulam, Cynthia K. Thompson, Sandra Weintraub, and Emily J. Rogalski in Brain doi:10.1093/brain/awv154

Image: Based on language impairments caused by stroke, scientists believed a single area of the brain – a hotdog shaped section in the temporal lobe of the left hemisphere called Wernicke’s region – was the center of language comprehension.  Wernicke’s was thought to be responsible for understanding the meaning of single words and sentences, two separate and critical functions. The image is for illustrative purposes only. Image credit: NIH.