Category: Memory Disorders

Casey Anthony on the Brain

The women were sitting around the facility living room watching the Casey Anthony trial.  The assisted living facility had recently installed a big screen TV, and it has been tuned to the trial since it began.  The ladies were convinced of Casey Anthony’s guilt; that she murdered her daughter.  An elderly gentleman stood in back of the couch on which the ladies conversed.  One of the women asked the man if Casey Anthony was guilty.  He replied that he was unsure.  The women were in shock.

As voyeurs into this lurid spectacle, we are regaled with many incidental details.  There is certainly no smoking gun, nor any other direct evidence of guilt.  The bits of reality that float down are suspicious, but not damning.  Even unimaginative people could use the available clues to invent scenarios that do not involve murder.  The defense offered one such scenario, but failed to prove their contentions.  Perhaps it was an unnamed boyfriend that directly or indirectly caused the child’s death.  Perhaps it was a total stranger that directly or indirectly caused Kaylee Anthony’s death.  Perhaps Casey was concealing her complete indifference, and never believed that she would be charged with murder.  Perhaps Casey Anthony has no idea what befell her daughter.  The various stories told to family and police may have concealed her indifference, as opposed to concealing a murder.

The low probability of discovering the truth produces tension and viewership.  Few people would watch sporting events if the outcome was guaranteed.  The frustration and tension produced by uncertainty compels the public to watch for clues that could reveal the truth.  For most people, a state of uncertainty is intolerable over an extended period of time.  People may actually express relief at hearing bad news, not because they are masochistic, but because their need to know has been satisfied.  Since the Casey Anthony trial is unable to discover the truth, the uncertainty will remain, and so will the interest.
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Humans naturally form associations between events based upon time, similarity and function.  This does not mean these associations are accurate or even helpful, but it is the way our brains function.  Not limited to associating bits of information together, our brains find reasons why the associations exist.  For example, surgeons who stimulate brain regions while the patient is awake note particular reactions.  If the surgeon stimulates a motor area that lifts their arm, the patient will reply that they “felt” like moving that arm.  If a particular memory is aroused by electrical stimulation, the patient will find a commonplace cause for that particular recollection.  Our brains are machines that form associations and causal links.

The women viewing the Casey Anthony trial believed their causal associations entirely, and could not fathom someone choosing to be uncertain.  They latched on to the causal links formed by the prosecution, since it fit the few available clues.  The defense failed to produce a story that fit the available clues.   The public then had to choose between adopting the prefabricated causal links, or formulating their own conclusions.  Since it is easier to buy off the rack than have clothes tailor made, the judgment of the public was a foregone conclusion.  Do not fret at the passing of this news event.  Like other unsolved crimes, interest will remain on a reduced level.  Think Jimmy Hoffa and the Lindbergh baby.  We can now add Kaylee Anthony to the list.

Memory Meds

It was a bit shocking. The wife remarked on the comments of her husband’s neurologist.  He was rumored to malign memory enhancing drugs used in the treatment of Alzheimer’s Disease.  He was of the opinion that this class of drugs benefited the drug companies more than the victims of a senile dementia.  The wife was understandably confused by the disparity between the opinion of the neurologist and the claims of the drug companies.  The shock was the public admission of what many physicians voice in private.

Over the last ten years, most patients I’ve evaluated with a change in mental status, due to any cause, have already been prescribed memory enhancing medications.  The drug companies caution that these drugs should be limited to the victims of a senile dementia of the Alzheimer’s type.  It is very common to observe these drugs used in the treatment of stroke and head injuries.  Is this a good thing?

Unfortunately, this clinician has never witnessed a significant increase of verbal memory performance as a consequence of these medications.  This experience applies both to the preferred use of these drugs in the treatment of Alzheimer’s, as well as off-label use of memory enhancing medications.  It is not intended as a blanket condemnation, rather it reflects the lack of statistically significant benefit displayed on well-normed tests of verbal memory.  There may be many people who have a significant increase of verbal memory with the use of these drugs, but none of these responders have been evaluated by this clinician.  Memory enhancing drugs that boost the neurotransmitter acetylcholine may display increased agitation, weight loss, and even chronic nausea with vomiting.  These reactions are fortunately not universal.  This clinician has witnessed the resolution of these symptoms many times after a reduction or discontinuation of the medication.  Personal experience of medication that affects glutamate levels in the brain is that they are neither very harmful or helpful in the treatment of moderate to severe Alzheimer’s Disease.

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The latter stages of Alzheimer’s Disease are often fraught with weight loss and agitation.  Victims of a senile dementia become too inattentive to sit through a whole meal, requiring frequent prompts and even hand feeding to keep up their body weight.  By the middle stages of Alzheimer’s, the loss of other cognitive functions largely negates a mild increase in verbal memory.  These mid-stage patients would still have trouble with planning, praxis, attention, judgment, flexibility, etceteras.  Even a significant increase in verbal memory would not return these victims to an independent lifestyle.   Memory enhancing drugs that commonly produce symptoms of weight loss and agitation should be used with obvious caution.

This clinician’s advice is to proceed with, you guessed it, caution.  Consider having a neuropsychologist perform pre and post testing to measure any significant increase in verbal memory as a consequence of these medications.  If there is not a significant increase in verbal memory after a six week trial, consider requesting the attending physician to reduce and eventually discontinue the medication.  If an acetylcholine boosting medication is utilized, and the patient develops weight loss and agitation, work with the physician to determine if the symptoms are secondary to the memory medication.  Senile dementia of the Alzheimer’s type is a horrid disease that can cripple an entire family.  Pills without a clear benefit should be considered as a risk to the patient over time; possibly creating undesired symptoms and interacting with other medications in an unpredictable fashion.  I strongly suggest to formulate conclusions based upon observation-not advertising.