Brain and Drugs

    The brain is such a complex organ that many of its functions and processes are still unknown to the scientific community. For example, brain diseases are very common despite physicians and researchers knowing what the metabolic pathways affected are. Any attempt to “fix” it could end up being more hazardous than beneficial. Additionally, these disorders can be difficult to navigate and classify due to the variety of signs and symptoms. It’s only in the past few decades where mental health conditions have finally gained enough attention from medical professionals and now those who suffer from them can get better diagnosis and treatment. 

    Probably one of the most feared mental conditions due to its dramatic symptomatology is Alzheimer’s disease. A prevalent disease that lacks a clear understanding of its cause. Growing up, I remember seeing both of my parental grandparents suffering from it. I remember the immense toll it took not only in them but also on the entire family. Certainly, all chronic conditions affect the lifestyle of patients and their families, but this experience taught me how much dementia could disturb relationships and change the dynamics of a family. Some characteristics of the condition that we know are its genetic component, degeneration of brain cells, and the failed Acetylcholine metabolism. A better understanding of its molecular basis has caused the development of drugs that can be effective depending on the stage the patient is on. 

    But cells in most organs constantly deteriorate and die. What’s the difference? Many injuries can potentially be healed by our own bodies by mechanisms that ensure a full recovery. The cellular functions division and proliferation are amplified when tissues suffer damage, guaranteeing to heal. However, the brain is a unique type of tissue. The nervous system cellular components don’t possess this feature, thus traumatic or cognitive brain damages cause a permanent condition. Many examples of sports injuries are examples of this. Professional boxers suffered the loss of normal brain functions at a very young age. “Despite the comparable amount of sports training (both groups were professional) and the similar age of the athletes, the results suggest a specific deterioration of executive processing in boxers. We interpret these results as a consequence of repetitive head blows associated with professional boxing.” (Di Russo and Spinelli, 2010). 

    A similar instance that caused controversy in the sports world was born after a study that explained concussions in professional football players and their decline in mental and cognitive abilities. To cite an example, one study “found that retired NFL players with at least three concussions are three times more likely to be diagnosed with depression compared to players that do not report any concussions during their playing career. This suggests that those players with a greater number of concussions are more likely to be diagnosed with depression.” (Thomson et al. 2020) A popular case of the potential risks of contact sports occurred when New England Patriot’s player Aaron Hernandez was convicted for murder despite having a promising career. After committing suicide, he was diagnosed with chronic traumatic encephalopathy (CTE), a neurodegenerative disease that includes irreparable brain damage, aggressive impulses, lack of self-control and rage behaviors. How might have his condition influenced the crime he committed? 

    The authors of Frequency and Outcomes of a Symptom-Free Waiting Period After Sport-Related Concussions explain how “the passing of state laws related to youth concussion management. These factors, as well as increased media attention to concussions, have increased public awareness of concussion and changed the culture of reporting and managing injuries for many groups of athletes, further allowing recommendations to be realized in practice”. These new understandings will hopefully create a change of behavior and even rules for contact sports such as professional football or boxing. As a life-long soccer fan, I can understand the motivations behind people rejecting the idea of changing the game, but adjustments seem to be on the horizon in order to maintain a safe place for athletes and children who practice those sports. 

    Knowing the severity of the neurodegenerative conditions previously explored, the motivation behind developing medicine to ease the symptomatology of such diseases is understandable. Drugs can potentially alleviate many brain conditions such as Alzheimer’s or Parkinson’s diseases. For many decades, the solutions had been pain management and end-of-life support, but promising drugs have been developed to replace either the affected neurotransmitter themselves or intermediates that participate in their metabolism. 

    However, exploring the utility of drugs is much more complex because they fulfill other purposes, not only as medication. In the same way drugs can offer mitigation to cognitive diseases, they can also alter the nervous system for worse. For example, we observe the effect of multiple illicit drugs on the brain functioning. Some exert their effect by activating reward pathways or inhibiting pain, thus provoking an artificial sense of joy or happiness. This, however, is not without harmful consequences. The long-term effects of such drugs impede or diminish natural effects in our intrinsic reward pathways by interfering with the feedback mechanisms in place. The consequence is seen when more substances are needed in order to create the same response after using it for a while. 

    One common example of an alteration in the regular function of neurons is caused by cocaine. This illicit drug performs its function by interfering with the regular metabolism of Dopamine, which is not recycled back to the presynaptic neuron and it remains in the synaptic gap activating postsynaptic receptors. No wonder why Cocaine and similar molecules create cravings, dependence and powerful addictions difficult to overcome thanks to the significant changes it provokes in the biochemistry of the brain. 

    Another idea to consider is how much we know about the mechanisms and influence of drugs. The secondary effects caused in our brain and other organs can be unknown depending on the dose, clinical history, and other social determinants of health. We know that both illegal and therapeutic drugs cause changes in the physiology of the brain, and many times that is the goal of their use. But how much do we know about the long-term alterations? The plasticity of the brain is what allows us to learn and become who we are, but this same adaptability also means that this organ will malleate if the biochemical conditions change. 

    Lastly, two people can react to the same stressor or traumatic event in two opposite ways. One medication can alter the mind of one person while not provoking the same effect on the next one. We may never completely understand how the brain works, but its beauty relies on the complexity and how it can respond differently depending on the individual. 

References 

Di Russo, F., & Spinelli, D. (2010). Sport is not always healthy: Executive brain dysfunction in professional boxers. Psychophysiology, 47(3), 425–434. https://doi.org/10.1111/j.1469-8986.2009.00950.x 

Pfaller, A. Y., Nelson, L. D., Apps, J. N., Walter, K. D., & McCrea, M. A. (2016). Frequency and Outcomes of a Symptom-Free Waiting Period After Sport-Related Concussion. The American journal of sports medicine, 44(11), 2941–2946. https://doi.org/10.1177/0363546516651821 

Thomson, R., Carabello, D., Mansell, J., & Russ, A. (2020). Depression Following Concussion in Retired Professional Football Players. International Journal of Athletic Therapy & Training, 25(2), 54–56. 

 Curated Paper 2

The brain serves as a great intersection between how biology, including genetics, and our experiences sculpt each of our own worlds. It is arguably the most complex organ and exhibits some very unique characteristics compared to other organs found within the body. A single neuron within the brain can make upwards of tens of thousands of connections to other neurons which drives our minds to continually update its connections and adapt. Because of this, structures within the brain are highly susceptible to change, even by outside influence. Through the lens of disorder and damage, we have an opportunity to better learn how the brain functions from the biochemical level of neurotransmitters to the complex processes of body regulation and thought formation. Conversely, with such a complex organ, the dysfunctional possibilities are immense and cause great affliction to individuals and society.

As scientific knowledge grew about brain anatomy and psychological activity, the debate between holism and localism became elevated. Through the work of brilliant researchers, like Paul Broca, and the use imaging technology, the argument for localism looks to have taken first place in many scientific spheres. Classic cases, such as Phineas Gage, demonstrate how specific brain structures are responsible for certain behaviors and skills. Additionally, genetic related disorders give us invaluable knowledge on how neural signals are propagated through the brain and throughout the rest of the body. These pathway disruptions give us motivation to explore pathways and the interconnections between different mental processes.  

Neurodegenerative diseases and their pathologies are quite fascinating to me. From a biochemical standpoint, it is makes a lot of sense that mutated, dysfunctional proteins can cause such destruction. Yet, I am astonished that small changes, even in post-translational protein modifications, can become completely debilitating for someone’s cognitive function and overall life. In recent years, the prevalence of neurodegenerative diseases have increased. In particular Alzheimer’s disease has seen an increased death rate of 145% between 2000 and 2017 and has become the sixth-leading cause of death within the United States. Additionally, longer life expectancies paired with the large baby boom cohort is leading to an increase in Alzheimer’s dementia diagnoses which is predicted to grow to 13.8 million by the year 2050 ("2019 Alzheimer's disease facts and figures", 2019). Today, the burden of care associated with Alzheimer’s disease is already high and will only continue to worsen.

 From a 2018 study, over 16.2 million unpaid caregivers, including family members, “provided an estimated 18.5 billion hours of care to people with Alzheimer’s and other dementias,” which is valued at nearly $234 billion. Though this monetary cost is quite staggering, it is limited and does not consider the “caregivers’ increased risk for emotional distress and negative mental and physical health outcomes”, actual paid care costs, and the institutional pressures healthcare systems, particularly long-term care facilities, face ("2019 Alzheimer's disease facts and figures", 2019). Having worked as a caregiver in skilled nursing facilities and memory-care units, I can honestly report that it is exhausting work caring for people who are experiencing significant cognitive declines. Beyond the physical labor, the emotional impact is great. In my experience, I take on the worry of each resident’s wellbeing; it is on me to keep the twenty-two residents safe, to comfort them in their moments of great confusion or moments of devastating clarity, and to become a broken record answering their repeated question of “When are we having breakfast?” when it is 3:30 in the afternoon.

Currently, there is no cure for Alzheimer’s disease, but there are opportunities for better outcomes. Early detection is key to minimizing the detrimental medical, emotional, and financial costs on impacted families and society as a whole. Cognitive assessments are the main and most easily accessible form of early detection for Alzheimer’s disease, yet there is limited use of these tools. Physicians across the country report that they are important, but only half of seniors have ever received any type of assessment ("2019 Alzheimer's disease facts and figures", 2019.) Tests like the MoCA or the Mini-cog test can be easily integrated into primary care visits. By working with insurances and altering yearly physical examination standards, the implementation of quick, in-office or at home cognitive tests could be quite promising. Within the US healthcare system, there needs to be increased advocacy for early detection or else our society is going to be overwhelmed by the burden of this disease and other dementias.

On a very different note, use of psychoactive drugs and the corresponding substance use disorder can cause great strain on individuals and community wellbeing. In general, drugs seem to walk a very fine line; they can be upheld as miracles and life-saving, but are often blamed for destroying lives. Drugs are powerful and highlight the chemistry that truly drives life and function. Though often contained in a small pill, there is nothing small or insignificant about how drugs act within our bodies to alter our condition. With technological advances and the ability to make large monetary gains, some miracle drugs have been developed while creating a society that is over-medicated and dependent on drugs whether illicit or not.

Growing-up in Idaho, methamphetamine was the main drug that was talked about and that I would see many PSAs against its use. “Not even once” was the phrase that was implanted into my mind about meth. I think this narrative is talked about with other drugs, but with meth it is very true, as people experience tolerance immediately. This characteristic makes it so very addictive and harmful. For Idaho, methamphetamine was the biggest drug problem the state faced for years. The trafficking networks were quickly established throughout the state because of the immediate addictions that wanted to be fed. Additionally, there is very little success on treatment/sobriety on methamphetamine use, which is so devastating for individuals who have used it and their loved ones. In the book Beautiful Boy: A Father’s Journey Through His Son’s Addiction, David Sheff, the father, wrote, “I tried everything I could to prevent my son’s fall into meth addiction. It would have been no easier to have seen him strung out on heroin or cocaine, but as every parent of a meth addict comes to learn, this drug has a unique, horrific quality. In an interview, Stephan Jenkins, the singer in Third Eye Blind, said that meth makes you feel “bright and shiny.” It also makes you paranoid, delusional, destructive, and self-destructive. Then you will do unconscionable things in order to feel bright and shiny again.” This quote colors in the detail the devastating nature of methamphetamine use. Though not all drug use darkens an individual’s future as much as meth, it is a problem that is plaguing the US. It is obviously not an easy fix, but maybe we should start examining our society for why many people are medicating and abusing drugs. Additionally, we can work to establish research-backed methods in social and justice systems to better address mental health disorders and give aid to those who suffer from substance abuse disorder.

In conclusion, our minds are vulnerable to a broad spectrum of disorders that require more attention and adherence to proven methods of treatment and prevention.

References

2019 Alzheimer's disease facts and figures. (2019). Alzheimer's & Dementia, 15(3), 321-387.      doi:             10.1016/j.jalz.2019.01.010

BIOL 4500 - Curated Paper 2

Riley Williams

Karpel

BIOL 4500 

Curated Paper 2

It is a defining characteristic of humans to want to fit in and be accepted. Throughout our lives we try to fit into society and make sure that we are not that different from most other people. While it is true that there are some people who value societal acceptance more than others, everyone to a degree wants to feel like they belong. Diseases affect how we function, and in a similar sense, drugs do the same things to humans as well. When our normal state is altered, we might not be able to still fit into what society deems normal. This can have drastic effects on a person’s mental and emotional state, which is why it is important to look at how these things can impact a person. 

Even though bacteria are microscopic, they create one of our most important biological systems, our microbiome. Our microbiome is all of the microbes that live in and on us. We have only recently researched the effects our microbiome, especially our gut microbiome, has on our overall health and behavior. Since the knowledge of our gut microbiota is so new, a vast amount of research has come out in the last few years. One of these new findings is the ability of our gut microbes to communicate with the brain. This is very important to understand because that means that our behavior is influenced by the microbes we have in our microbiome. Even though everyone has their own distinct microbiome, there are some microbes that are shown to be more beneficial than others. If someone has many undesirable microbes then problems can arise in their gastrointestinal, neuroendocrine, or immune relationships which can eventually lead to a disease or a problem. By performing research on mice, we have come to the conclusion that by altering what bacteria someone has in their gut, we can improve not only diseases that affect the gastrointestinal tract, but stress related diseases too. This goes to show that if someone’s gut microbiota is not in balance, then they can have elevated stress levels. Prolonged stress can lead to numerous different issues, but one of the main ones is depression which definitely puts a major toll on someone’s mental health and makes it so they feel like they might not fit in. 

An imbalance in our gut microbiota can not only cause us to have prolonged periods of stress, but it can also cause gastrointestinal cancers. Evidence shows that intestinal bacteria have an effect on oncogenes, tumor progression, and how people respond to therapy. Cancer is a very prevalent issue in our society, and whenever we can find new links about the different causes, it is important to try and understand them. When someone is diagnosed with cancer, they not only have to deal with the disease, but the social and emotional side effects of it as well. Once again, a side effect of cancer is also depression. According to the National Cancer Institute, about every 2 in 10 people with cancer will suffer from depression. Not only is depression a major side effect, but people with cancer also sometimes feel a sense of loneliness and have trouble finding meaning in their life. Both of these effects have big impacts on someone’s state of being. If they feel like they are separated from the rest of society and cannot find ways to reconnect, they can greatly suffer since humans are meant to find connections with others. 

Furthermore, another major thing that can greatly impact someone’s mental and emotional state are mental disorders. There are so many mental disorders that exist. The brain is very intricate, and small changes such as just one misfolded protein can drastically affect someone’s cognitive function. People can be living their normal life until one day they recognize a new symptom, and then their entire lifestyle will have to change. A lot of my family members have mental disorders, such as Alzheimer’s and dementia. My mom is really worried about having early onset Alzheimer’s and she went through a period of time where she was doing memory training in order to help improve her brain function. Now wherever she forgets something she worries that it is Alzheimer’s. If only the thought of having one of these diseases affects someone’s mental state that much, I can only imagine how much someone who actually is suffering from the disease is affected. Alzheimer’s causes someone to suffer from many different cognitive difficulties, which can directly lead to people feeling numerous different emotions such as anger, depression, fear, and loneliness. This loss of cognitive ability and the effects that accompany it can cause someone to find it exponentially harder to be able to fit in with the rest of society because how they lived their life for decades now has to change. 

There are numerous types of traumatic brain disorders, and each one of them has detrimental effects on a person. However, mental disorders are not the only thing that can affect someone’s brain and therefore their behavior and thinking. Drugs are another thing that does this since they work by changing how our brain cells interact with each other. When drugs enter our bloodstream, they make their way towards our brain to produce their desired effects. Drugs can actually change our neural network and how our brain is wired, which changes how a person thinks and acts. This is especially dangerous since this can cause addiction due to how humans function biologically. Our bodies are based off of a reward system, and the primary neurotransmitter that is responsible for us feeling this reward is dopamine. Some drugs work by increasing dopamine. This would then cause our brains to begin to decrease our natural dopamine if there is continued use of the drug. Our brain is then tricked into thinking that the drug is necessary for our survival because it is the only thing left supplying our brain with dopamine. This causes cravings of the drug to occur and eventually dependence and addiction. Addiction is tied greatly to a myriad of negative emotions such as depression, anger, and loneliness. These effects are an even bigger issue for people who suffer from addiction because in some cases, people revert back to the drugs to overcome these emotions, which just in turn leads to a vicious cycle of them continuing to use drugs. 

 If someone uses a drug for a long period of time, this would also change their neural network which affects learning. This is a big issue for adolescents because how their brains develop during adolescence is crucial in determining the overall structure of their brain. Therefore, if teens are using drugs for long periods of time they can drastically change the wiring of their brain. This can create numerous developmental issues, such as problems learning and handling impulses and emotion. If these adolescents are altering how their brain functions early on in development, they can create a big gap between how they think and function versus how the rest of society does. This can further separate them from the rest of society which would cause them to also feel negative emotions, such as depression, which could also cause them to increase their drug usage. Therefore, whenever someone takes drugs, especially adolescents, they need to carefully monitor themselves and make sure they do not become dependent on those drugs. 

Overall, it is important to understand what things can cause people to feel separated from society. Things such as mental disorders, imbalances, cancer, and drug use are all things that can cause this. Humans need to feel a sense of community and when their lives are impacted by one of these things, it can cause a multitude of different mental and emotional effects. These mental and emotional side effects put a great toll on a person’s overall well being, which is why it is very important to understand all of these concepts. 

Hunter Jansson

Protect Your Mind

    The brain is such an important organ in our bodies, yet we still don’t know too much about it. Don’t get me wrong we know a lot, but it is only a small percentage to what is still unknown. When the brain is not performing at its best, the body can’t either, and vise versa, which is greater evidence that our bodies as a whole must be in synch to be able to live our best lives. This teaching follows the practice of Ayurveda which teaches us that as our body and mind are in balance, the rest of our life begins to fall in place as well. As we seek to obtain harmony with ourselves, our bodies will naturally respond in a way that is copacetic of a healthy lifestyle. When we are not in balance with all aspects of our lives in our mind, body and spirit, one of the three parts begins to fail the rest and eventually our whole system is off balance and can’t perform as desired. The body can’t act the way we desire when certain things begin to affect our lives. Things such as unhealthy diets, inactivity, and mental disparages can shift us out of equilibrium. But some of the most damaging, and irreversible, things to our bodies and especially our brains are injury, or drugs. 

    Before we can discuss damages to the brain we first must understand the layout of the brain and how each part is an essential piece of the puzzle. Our brain is split up in two sides, the right and the left side. The right side of the brain seems to process artistic behaviors and capabilities and focus on our creativity, while the left side of the brain processes the written word, analytics, methodology and logic (Pietrangelo, 2019). The wrinkles the we see in the cerebrum are correlated with one’s intelligence. The more wrinkles there are seems to indicate greater intelligence. This is believed due to the fact that as wrinkles form along the cerebrum, more surface area of the brain is being created and fit inside the allotted space. The increased surface area of the brain is linked with more storage of knowledge and more space for synaptic pruning. The cerebrum is subdivided into four different lobes. The first lobe, located at the forehead area, is called the frontal lobe. It is in charge of problem-solving, attention, judgment, behavior, and muscle movement. The second is the parietal lobe, located on the top back of the brain. Its functions consist of sensing pain, and understanding statements when reading. The third is the temporal lobe, located on the side of the head near the ears. This is where visual and auditory memory are stored. The last lobe on the lower back of the brain is the occipital lobe. This helps with recognition of color, words and movement. The cerebellum at the back bottom of the brain is referred to as the small brain and is as well split into two halves. Its role is controlling essential bodily functions like balance, coordination, and posture.

    Knowing where parts of the brains are situated and what roles each has allows us to better track the effects of injury in our brain. Some of the most surprising differences that occur due to brain injury are changes in behavior and personality. A young man in 1848, Phineas Gage, got a metal rod shot through his left cheek and his brain in a working accident. Even though he was able to physically recover from his injury, he appeared to become a totally different person. Before the accident many people described Mr. Gage as a hardworking and pleasant man (Kendra, 2020). But soon after, the reports changed to label Mr. Gage as a surly and aggressive person. Things such as automobile accidents, assault, falls, and sport related injuries can cause changes in behavior like was seen in 1848. Some studies have shown that 57% of people have changes in personality, 38% have recurrent outbursts of anger or aggression, and 49% develop instability. 

    An important aspect to understanding effects of injuries is to understand the recovery and repair phases that follow. What physicians are seeing is that the more brain injuries a person sustains, the greater the effects of depression, personality changes, anxiety, and other long-term changes. Right now, there are not a lot of ways to heal the brain once it has been damaged, but what physicians are focusing on is preventing further injury from happening to the person in their future. One of the reasons that there is such a struggle to find solutions to the damage of the brain is that no two cases are exactly the same, just like a fingerprint. The best theory we have decided on at the moment is a difference in nurture vs. nature in each situation. In the nurture, or environmental realm, this has more of an effect on the mind. The mind is characterized by how one thinks and acts due to ever present influences. While the nature portion, has more of an effect on the brain and how it forms due to genetics and heredity. No two cases are the same because no two people grow up with the same experiences and gene pool and then sustain the exact same cerebral injury.

    Not only do serious injury cause long term changes in personality in behavior due to the way the they damage the brain, but so can harmful and addictive chemicals called drugs. The purpose of our brain and all its many functions and abilities is to increase our survival. When we make good decisions that benefit us, our brain releases a strong chemical called dopamine, this is our feel-good reward for doing something to increase our survival value. The reason for the chemical release is to get us “addicted” to the reward which enhances our desires to complete such actions over and over. Things like food, water, safety, and other natural stimuli gives us that dopamine response driving us to continue eating, drinking, and seeking shelter. Drugs perversely trigger dopamine release in the brain, tricking it to think that what was just ingested has survival value. But the continued use of drugs habituates its effects and to keep up with the desire of the brain, greater doses or higher concentrations are sought after to fulfill the need. The brain eventually moves from a craving of the drug to eventually a dependence on the drug due to the insidious effects on our brains. Alterations to our chemical systems in our bodies can cause a paradigm of shifts in personality as well as negative impacts on the acquisition of anterograde knowledge and accurate recall of retrograde memories (Juarez-portilla, et al. 2017).

    Our brains run our body in such a way that injury and improper use of drugs ,whether they be legal or illegal, can have long term detrimental effects that even with modern medicine and technology, we are most likely unable to reverse back to a native or natural state. It is important that we are conscious of what we intake in to our body and what activities we participate in to avoid an injury that could change the rest of our lives. Eating healthy, exercise, avoidance of impure substances and lower risk activities are worth retaining what we have already. As we take simple steps to maintain balance between the body, mind, and spirit, we will indulge in much more prolific lifestyles that bring happiness and a peace of mind every day. 

Citations

Cherry, Kendra. “The Famous Case of Phineas Gage's Astonishing Brain Injury.” Verywell Mind, 2 Apr. 2020, www.verywellmind.com/phineas-gage-2795244. 

Juárez-Portilla, Claudia, et al. “Influence of Drugs on Cognitive Functions.” IntechOpen, IntechOpen, 20 Dec. 2017, www.intechopen.com/books/health-and-academic-achievement/influence-of-drugs-on-cognitive-functions. 

Letstute. Human Brain | Parts & Functions | Cerebrum & Cerebellum | Biology | LetsTute, Youtube, 27 Mar. 2018, www.youtube.com/watch?v=HieUJTLaOZY. 

Pietrangelo, Ann. “Left Brain vs. Right Brain: What's the Difference?” Healthline, Healthline Media, 8 Mar. 2019, www.healthline.com/health/left-brain-vs-right-brain. 

 Andrew Phelps

30 October 2020

Stroke and Aphasia

I work in the ER as a phlebotomist, and we have many patients a day who’s reason for the visit is, “Altered mental status” or the board says, “ams,” for short. The causes of each of their changes in mental status are extremely variable. It could be a symptom of sepsis, injury, stroke, genetic disease, or several other things that hopefully the doctors getting the big bucks can figure out. It’s wild how so many different things can affect the brain in different ways. 

A few times a day I’ll hear the call overhead, “Code stroke one” and I’ll hurry and run to the hallway with a few other staff while they bring back a patient who recently began displaying stroke symptoms. I will do my part of throwing an IV in their arm and snagging some blood samples before we send them off to get a scan of their brain to make sure there’s no hemorrhage. 

Since I’ve been working here I’ve always been intrigued by this process and intrigued by the ams and stroke patients. There’s many ways that injuries to the brain manifest themselves in the rest of the body, and many ways that things affecting the body also affect the brain. Being myself so intrigued, and being given an opportunity to research the brain and drugs that treat it, I decided to dig into strokes, complications, and treatment and how they affect the brain and beyond.

There are two main types of strokes: ischemic and hemorrhagic. In an ischemic stroke, something has blocked a blood vessel in the brain, leading the downstream cells to suffer from lack of perfusion of nutrients and death. In a hemorrhagic stroke, a blood vessel in the brain will burst and bleed into the brain tissue. Both of these damage the brain and cause similar symptoms, however the acute treatment will differ. This is why when we bring the patient back, after the physician conducts a physical exam and I insert an IV and collect blood samples, we send the patient to CT to look for a brain bleed or ischemic damage. 

If a patient presents with an ischemic stroke, there is IV medication to treat it. Tissue plasminogen activator (tPA) dissolves the blood clot that is causing the stroke and restores blood flow to the ischemic tissue. While not a complete reversal of the effects, this reduces damage and improves the prognosis for recovery. However, a patient is only a candidate for tPA treatment within 4.5 hours or so of onset of stroke symptoms. Of course, anticoagulant treatment is not viable to use in the case of a hemorrhagic stroke as was the case with an elderly patient who recently came in with severe stroke symptoms and imaging showed he had a brain bleed. In such cases, medication to relieve intracranial pressure and blood pressure are favored.

The many complications and ways a stroke affects the patient and their recovery is where it starts to get real juicy. While there are many, many complications that require attention, I would like to focus on post stroke aphasia, including types, therapy, and drug treatment. I am lucky to have a friend who is a speech and language pathologist and has experience with these patients. I was able to ask her questions to help guide my research.

Poststroke aphasia, the impairment of the patient’s ability to express and comprehend language due to brain damage, is present in 21-38% of acute stroke patients (Berthier, 2005). There are different types of aphasia and some classic syndromes depending on the area of the brain that is damaged. Wernicke's aphasia, damage to the part of the brain responsible for comprehension of speech, is also referred to as fluent aphasia or receptive aphasia. On one recent occasion I was trying to explain some things to a kind, confused elderly woman, she kept repeating, “I can hear that you're talking but I can’t understand what you’re saying.” In Wernicke’s/fluent/receptive aphasia, production of speech is not impaired, but the patient’s understanding is. My friend who works with these patients described them as being able to talk all the day long, yet their response is, well, less than 100% correlated with whatever question you’ve just asked them. 

Another common aphasia is Broca’s aphasia. Broca’s area is the region of the brain in the dominant side of the patient’s frontal lobe and has functions linked to language processing and speech production. A stroke in this area impairs the patient’s ability to express speech. While they may know what they want to say, they can’t form the words and sentences to express it. I can’t imagine how frustrating either of these syndromes would be. One afternoon I was collecting blood samples from a patient who’d had a stroke earlier that day. It took several minutes of struggled communication between us for me to understand what he was asking me for. 

While knowing the type of aphasia in a patient can be helpful, it does not always influence prognosis and applied therapy. The type of aphasia also commonly changes during therapy. The caregivers such as my friend, rather than working according to type of aphasia, always target and work according to whatever is the patient’s deficit. The patient’s prognosis for recovery depends almost solely on the severity of the stroke, and slightly on the location/type of aphasia. Previous intelligence of the patient may also help recovery and, of course, socioeconomic status influences access to resources and therefore prognosis. 

Interestingly, it has been shown that the brain is able to adapt pretty well to slow destruction of Broca’s area, keeping speech functional, likely shifting the function to a nearby part of the brain (Plaza et al., 2009). However, acute stroke gives the brain no time to dodge. Though, full recovery is possible even for patients with severe aphasia.

Recovery from stroke is possible due to the brain’s plasticity. The brain can rewire itself following an injury, making new connections. The healthy part of the brain can acquire the functions of the injured part, allowing the patient to relearn the skills they had lost. This brain plasticity allows for a high degree of spontaneous recovery, and our treatment methods are directed at modifying and boosting this process (Hara, 2015). 

Speech and language therapy (SLT) is a ubiquitous treatment, though it is not proven to be extremely effective. Researchers have been looking into drugs to be used as treatment, usually in conjunction with SLT. The results are… alright. They’re mixed. Some work better than others, yet none are demonstrated by large-scale studies to be valid. Most drugs being tested theoretically help the brain plasticity used to recover.

The most widely investigated and commonly used are dopaminergic drugs, levodopa or bromocriptine, a dopamine agonist. The treatment is most effective in patients with transcortical motor aphasia, adynamic aphasia, and mild to moderate Broca’s aphasia, but no effect in cases of severe Broca’s aphasia. The benefits are attributed to enhanced dopaminergic tone in the mesocortical pathway. The drugs increase neurotransmitter levels, stimulating widespread cerebral activity and enhancing effects of behavioural treatment. This is most helpful while the brain is most plastic in the 6-12  months following the stroke. In trials, the drug is ineffective without concurrent SLT also being applied. However, some randomized studies show the drugs to help, and some don’t. It seems that the common thing with stroke treatment, from onset to a year out, is that nothing works perfectly but we’re sure going to try our best.

1. Berthier ML. Poststroke aphasia : epidemiology, pathophysiology and treatment. Drugs Aging. 2005;22(2):163-82. doi: 10.2165/00002512-200522020-00006. PMID: 15733022.

2. National Aphasia Association. (2019, October 30). Wernicke's (Receptive) Aphasia. Retrieved October 31, 2020, from https://www.aphasia.org/aphasia-resources/wernickes-aphasia/

3. Plaza M, Gatignol P, Leroy M, Duffau H. Speaking without Broca's area after tumor resection. Neurocase. 2009 Aug;15(4):294-310. doi: 10.1080/13554790902729473. Epub 2009 Mar 9. PMID: 19274574.

4. Mayo Clinic. (2020, August 08). Stroke - diagnosis and treatment. Retrieved October 31, 2020, from https://www.mayoclinic.org/diseases-conditions/stroke/diagnosis-treatment/drc-20350119?mc_id=google

5. Toronto Stroke Networks. (2016). Neuroplasticity. Retrieved October 31, 2020, from http://strokerecovery.guide/neuroplasticity

6. Berthier ML, Pulvermüller F, Dávila G, Casares NG, Gutiérrez A. Drug therapy of post-stroke aphasia: a review of current evidence. Neuropsychol Rev. 2011 Sep;21(3):302-17. doi: 10.1007/s11065-011-9177-7. Epub 2011 Aug 16. PMID: 21845354.

7. Gill, S. K., & Leff, A. P. (2012). Dopaminergic therapy in aphasia. Aphasiology, 28(2), 155–170. https://doi.org/10.1080/02687038.2013.802286

8. Hara Y. Brain plasticity and rehabilitation in stroke patients. J Nippon Med Sch. 2015;82(1):4-13. doi: 10.1272/jnms.82.4. PMID: 25797869.

 Natalie Thomas

The Brain and Drug Addiction 

The STEM field is full of opportunities, every area that can be studied relates to another. The idea that everything is tied together is fully realized, because of the many connections between all the fields. This is no different when also discussing  specific topics as well. The human body for instance. Disease, damage, and overall changes will cause the body to experience varying circumstances, each with a different outcome. Focusing on disease and the different implications, again there are many areas that one could choose to explore. However, once the gate has been opened, the web that ties all of the systems together becomes entangled. There is no way to distinguish one topic from another, there is no pure field of study. This has been apparent as we have taken the time to discuss how the body reacts to an imbalance. 

The brain, our most complex and unknown organ. The brain has always been a mystery to scientists. Trying to make sense of it is very difficult, time consuming, and confusing at times. There are some areas of the brain that we have been able to identify and have a basic understanding of how it functions. The issue is, what causes the brain to function the way it does and how does our consciousness work? There are so many areas that we are unable to explain yet about the brain and it has become our duty to try and decipher it.

The composition of the brain produces a very complex system. There are many reactions that can occur from a single change. A change in chemical balance is one such reason that the brain would change the way it responds. Every day people are prescribed medications that are intentionally used to alter the way the body is perceiving the information being received. There are many different types of drugs that are administered each day. Whether it is a natural medicine or a synthetic source they are very useful in maintaining balance. Some drugs are recognized as legal while some are not. However, the ultimate goal is to alter the reality of the situation. This process can become an issue if not properly observed and maintained. It is vitally important to know the dangers that can come from using an unnatural substance to alter the body and brain. The inappropriate use of these compounds can lead to issues such as addiction or overdose. So, by gaining an extensive knowledge of the subject, avoidance of harm is obtainable. 

When talking about addiction, it is valuable to know that drugs change the chemical composition of the brain over time. The brain has a natural response to a phenomenon called the Reward System. This perceived accomplishment occurs when the body is able to obtain measures that will increase survival. When drugs are introduced into the brain, they essentially mimic this reward system and trick the brain. Overtime, the brain will eventually begin to produce less of the chemicals that it should be producing, because it believes that there is too much being introduced to the system. This will lead a person to increase the amount of substances to produce the same effect, eventually leading to misuse, abuse, or addiction. The importance of proper treatment cannot be understated. 

With all the knowledge that we have from striving to understand drugs and medicine comes a lot of responsibility to use it wisely. In many areas of the world, especially the United States, there is an overabundance of prescription medications and illegal substances circulating. In the United States, the opioid epidemic has overtaken the lives of many communities. Knowing this, it is so important that healthcare providers look at different avenues to relieve the symptoms that their patients are experiencing. By using the methods outlined in Ayurveda techniques, we can avoid the unnecessary need to use synthetic methods. However, in cases where the issue has already been established, the use of ayurveda can also be implemented. 

By fighting the synthetic with the natural, the body is better able to bounce back from the harm inflicted on it. There are many areas of drug addiction where this type of treatment has been proven successful in helping individuals cope with recovery. In an article called Traditional Medicine in the Treatment of Drug Addiction, the methods used are outlined. Acupuncture is one such method that has been proven effective when helping to relieve the withdrawal symptoms felt by recovering addicts. Some specific types of addiction are outlined and they are opiate, cocaine, nicotine, and alcohol. By using this traditional technique, the individuals are able to allow their internal energy, called Chi, to flow again. However, when specifically discussing the use of ayurveda techniques, one herb has been singled out. To help alleviate the symptoms of withdrawal, the use of Withania somnifera has been proven effective. This plant is known as commonly as Ashwagandha or Indian ginseng. By administering this herb, it has been reported that this herb “attenuates several neurobiological changes induced by cold, hypoxia, or restraint stress in animals including the rise in plasma corticosterone levels, increases in dopaminergic receptor population in the corpus striatum, phagocytic index, and avidity index (Lu, et.al.).” This essential means that there is less of a likelihood for relapse. 

Lu, Lin, et al. “Traditional Medicine in the Treatment of Drug Addiction.” American Journal of Drug & Alcohol Abuse, vol. 35, no. 1, Jan. 2009, pp. 1–11. EBSCOhost, doi:10.1080/00952990802455469.

Patwardhan, Bhushan, et al. “Ayurveda and Natural Products Drug Discovery.” Current Science, vol. 86, no. 6, 2004, pp. 789–799., www.jstor.org/stable/10.2307/24109136?refreqid=search-gateway:1be8eba524dc22f56c8b65b6f99a70d1.

Applying Ayurveda to the Brain: How Can It Be Disrupted?

        The brain is an organ known as the center of the nervous system and, in part, the whole body. It is arguably the most complex organ in the human body, containing over a hundred billion nerve cells that communicate with one another through neurotransmitters, which are chemical messengers that transmit a message from a neuron to a target cell. The communication between the neurons and the rest of the cells in the body thus allow the brain to perform a variety of information processing tasks that, for example, convey information about the external world and produce movement. It also allows the brain to store and utilize the memories and experiences that shape our personalities and behaviors, affecting how we perceive the environment around us. Like with any complex organ in our bodies, if something within the brain malfunctions, it can result in drastic changes in the personality and behavior of the injured person.

        One way the brain can be disrupted is through traumatic brain injuries. Traumatic brain injuries are damages to the brain that results from an external physical force (Ghajar 2000). Considering that the brain is enclosed in a hard shell of bone and surrounded by the meninges, a tissue that is unbreakable by human hands, the amount of force needed to injure the brain must be either terribly traumatic or repeated enough times to be traumatic. They are also difficult to recover from, relative to something like a broken wrist, mainly because nervous tissue is difficult to repair in the central nervous system. One drastic example of traumatic brain injury is the case of a man named Phineas P. Gage. When he was 25 years old, Gage was struck with a large iron rod that passed through the left frontal lobe area of his brain. While his physical body had seemingly completely recovered, his personality did not. He was impatient, vulgar, and rude — a drastic difference from his previous personality, causing his friends and family to go so far as to claim that he was a different man (Harlow 1868). This drastic difference in personality was caused by the damage to his frontal lobe, which is responsible for purposeful mental action, such as suppressing socially unacceptable responses and the modification of emotions to fit societal norms. While Gage’s case showcases the effects of severe damage to the brain, smaller injuries can also count as traumatic. Despite the smaller area of damage for these injuries, they still affect the brain in the same magnitude as Gage’s case, affecting the things we do not usually think about, such as retaining old memories or making new ones.

Another way that the brain can malfunction is through mental disorders. Mental disorders are a group of disorders characterized by a behavioral or mental pattern that causes significant distress or impairs personal functioning (Bolton 2008). They can be further categorized into five types: neurological disorders, storage disorders, developmental disorders, prion diseases, and personality and mood disorders. The most common type of mental disorders are personality and mood disorders. They affect a person’s behavior and emotional states, which are caused by a chemical imbalance in the brain. We often think that such disorders are unnecessary and a hindrance in our daily lives. These disorders, however, may have been useful to our human ancestors, who faced stressful situations that made the difference between living and dying. For example, anxiety may have been useful in helping them be more aware of their surroundings and activating their fight or flight response. Additionally, since food may have been difficult to come by, depression, whose symptoms often include low energy levels and sleeping longer than usual, may have come in handy in situations where they needed to preserve their energy. While the environment they are useful in are no longer the norm for us in this day and age, these chemical imbalances in the brain still persist among the human population.

The chemical balance of the brain can also be shifted by more synthetic substances such as drugs. When entered into the bloodstream, both legal and illicit drugs change a person’s physiology and psychology. They can, for example, affect the way we perceive pain and make us feel less of it, which is the main function of drugs like paracetamol. These substances act like neurotransmitters, binding to specific receptor sites in the body to affect the way we think, feel, and behave (Rang et al. 2011). There are, of course, good and bad examples of this. Legal drugs are used to help alleviate symptoms or treat a disease. Illicit drugs, on the other hand, are highly addictive and may pose both physiological and psychological problems in the long run. For starters, they can negatively affect and damage the liver, which is the organ that processes and breaks down the drugs that we ingest orally. Their main downside, however, is that they form long term connections in the brain that can affect their perceptions of the world. The brain is an organ that is constantly rewiring itself to accommodate our experiences and the different things we learn, making new connections and severing old ones. For illicit drug users, this ability of the brain can prove detrimental, particularly if they get into the illicit drugs with more drastic effects. A person who constantly uses hallucinogens, for example, can have their perceptions, ability to learn, and the ability to control their behavior could be affected and rewired forever. There is also the negative impact of addiction because most drugs affect the release and production of dopamine, which is the neurotransmitter associated with pleasure and the rewards system. Having that connection built up and reinforced by drug use can result in that person having a dependence on drugs for happiness and to reach the feeling one gets after being rewarded. 

From an Ayurvedic standpoint, it is easy to see that everything is connected, and too much of something can end up being a bad thing. In the case of traumatic brain injury, applying too much force to the head can break through the brain’s protective covering and irreversibly damage it, thus affecting important functions such as memory, information retention, and decision making. The loss of such functions, while they may seem like small issues, can lead to bigger problems in the long run. Similarly, the changes caused by mental disorders and illicit drug use exemplify the Ayurvedic concept for the need for balance in life, considering that both are due to chemical imbalances in the brain, induced with or without the help of a substance.

References

Bolton D. (2008). What is Mental Disorder?: An Essay in Philosophy, Science, and Values. OUP 

Oxford.

Ghajar J. (2000). Traumatic brain injury. Lancet (London, England), 356(9233), 923–929. 

https://doi.org/10.1016/S0140-6736(00)02689-1

Harlow, J.M. (1868). Recovery from the Passage of an Iron Bar Through the Head. Publications 

of the Massachusetts Medical Society, 2(3), 1-22. Retrieved from https://en.wikisource.org/wiki/Recovery_from_the_passage_of_an_iron_bar_through_the_head

Rang, H.P., Dale, M.M., Ritter J.M., Flower, R.J., Henderson, G. (2011). “What is 

Pharmacology.” Rang & Dale’s pharmacology (7th ed.). Edinburgh: Churchill Livingstone.

The Brain and the complex balance between structure, function, and neurotransmitter balances

    Athletes have been a prevalent part of popular culture since before the common era. Even before our modern interpretation of the Olympics, there were ancient civilizations that would organize great tournaments to exhibit individuals and their physical prowess. Among these historic sporting events were the Olympics from which the modern rendition takes its name, however, they were far from the only ancient sporting events to gain popularity. Rome held many contests in its Colosseum. Hurling was a common practice in Ireland. China played a game called cuju. The middle ages are practically characterized by jousting in the minds of every child who has ridden atop a broom pretending it to be a mount. Just as these activities draw participants, they also draw spectators. There is something exceptionally cathartic about watching another individual who has devoted a significant amount of time to honing the various musculoskeletal systems in their body to be able to outcompete those they contend with. However, there is another vital system that can often get overlooked by both spectators and athletes, as impressive displays of strength, speed, and coordination are performed during any particular race or match.

            A popular past time in America is American Football. The sport has seen countless memorable moments in the eyes of its adoring fans. With these memorable moments, many of the people that have helped to make them have received a great deal of fame, becoming icons in the world of the sport. One such player was Mike Webster, a center for the Pittsburgh Steelers for fourteen years. Over the course of his career, he was involved in countless collisions during each season, a good number of which took more of a toll on his body than many believed. After retiring, the consequences of his years of collisions began to manifest, as his memory began to fade, his body experienced sharp pains, and he sank into an emotional pit of despair. This saw him begin to exhibit out of character behavior, including living out of his car, despite having a host of people offer to host him.

It wasn’t until after he passed away owing to cardiovascular failure that those who were close to him began to understand the strange transformation that had overtaken this loved football player. Dr. Bennet Omalu was later able to observe Webster’s brain, which is when he diagnosed what had caused this character shift, Chronic Traumatic Encephalopathy. It was the first documented case in an American football player. The discovery has since led to the progression of Neurological studies both through starting a project to create a brain bank to study and the NFL making changes to try and better protect its players. However, for those who knew Webster, this transformation, regardless of the cause, must have been difficult to watch.

Webster’s story illustrates several key concepts one should be aware of when they begin to explore the brain and the mysteries that exist beneath its soft folds. First, the human brain is an extraordinarily complex biological system. It is the keystone to so much of what makes us individuals. It is what allows us to store information, create solutions, perceive the information around us, and even allows us to interact with our world through the signals its transmits through neurons to the different muscle groups, resulting in the complex contractions we use for movement. It is this system and the advantages that has been attributed to humankinds’ great technological advances. The second crucial thing that one should take away from Webster’s diagnosis is how diverse ways in which Neurological illnesses can manifest itself.

Outside of things such as memory loss, there are a number of side effects that one could experience when the brain does not function as intended. These symptoms can include but are not limited to numbness, loss of motion, inability to recall or store further information, bodily pains, and personality changes. The reasons that such symptoms begin to manifest can be even more diverse than the symptoms themselves. In the case of numbness and loss of motion as they relate to brain illnesses, these can both be caused by multiple sclerosis. Memory loss can be caused by dementia and its various forms. Personality changes and disorders are symptoms of perhaps the most diverse category of illnesses. These can include things such as autism, schizophrenia, personality disorders, and more besides.

What makes many of the diseases described above all the more fascinating is there lack of a well-defined cause. In the causes of metabolic illnesses, there are a number of mechanisms that sciences has specifically illustrated that result in these illnesses, such as how insulin resistance can result in an excess of glucose in a person’s blood, resulting in the damage that type two diabetics experience. However, this is less true for many of the illnesses of the brain. In these cases, there have been a number of factors that have been correlated with these illnesses, including genetic component, environmental risks, and lifestyle. However, often these illnesses are not associated with distinct causes, but multifaceted issues that result in these issues. As such, the common model for predicting whether an individual will manifest with such illnesses is to look at their risk factors and see if they surpass a threshold that has been associated with such manifestations. For many individuals, including Doctors like Dr. Omalu, this presents an opportunity to explore such issues and the mechanisms at play. It is likely that there is more that can be uncovered about such illnesses through exploring the unique anomalies that are present within a diagnosed individuals brain and the mechanisms that might have caused such unique structures to form or fail to form.

These formations or lack thereof are part of what allow for the complexity found in this deeply personal bodily system. This complexity has emerged as evolution has built on the primitive model of the central nervous system that has begun to develop since the time of the first chordates. This complexity, while giving us many evolutionary advantages that have allowed us to be able to become the apex predators we are today, has also given rise to the diseases describe previously. While seemingly natural illnesses and severe injuries can impair how the human brain functions, they are not the only ways an individual’s central nervous system might malfunction.

Outside of illness and injury, certain chemical compounds have the ability to alter how a person’s nervous system responds. Though it might seem strange that chemicals, including a number of naturally occurring ones, are able to alter an individual’s cognitive ability. However, the seeming strangeness of this fact diminishes significantly when it is understood that these molecules are similar enough in shape and function that they bind to the same receptors everyone uses to communicate information throughout the body. Binding to these receptors often either stimulates or represses the response these receptors would ordinarily produce, oftentimes resulting in altered mood, behavior, and perception.

In many instances, we find ourselves grateful for the fact that these molecules are able to utilize our natural signaling pathways to achieve the effects that we experience whenever we have need of them. In the case of those with pain, they are grateful whenever pain relievers bind to their nociceptors. Dementia patients are grateful that drugs like Phencyclidine and others like it inhibit the reuptake of acetylcholine, slowing the progression of their illness. In the case of people with depression, SRI’s are used to help moderate their mood. Modern medicine has capitalized on the propensity for these compounds to utilize our internal signaling to treat many conditions. However, it is for this same reason that there has been a growing epidemic within America where such medications are misused.

Among the issues that America has had to face in recent years, it has been noted that America is experiencing an epidemic as more and more people find themselves addicted to opioids. Having been prescribed these drugs that mimic the human body’s reward system, these drugs can be misused when a person seeks to elicit the sense of catharsis that comes from activating this same reward system, in spite of the fact that their purpose for using this medication is not to relieve pain. Such behavior is habit forming, and can lead a person to alter their behavior, become dependent, and—in an increasing number of unfortunate instances—overdose.

Opioids are just one of the drugs that people have a tendency to abuse. However, they are far from the only ones that are abused. One need only look at the trends in America to know that the use of illicit substances and abuse medicinal substances extends far beyond opioids. Seeing such trends tends to raise the question of what is really driving such actions, particularly when these habits can have negative consequences that manifest in their behavior and overall wellbeing. For many users, this drive comes from the way these chemicals are able to imitate dopamine. At first, such a reaction causes the body to want to reproduce it, as the brain has been fooled into thinking that the drug is essential for survival. However, continued use of such a substance results in the brain producing less dopamine naturally, resulting in the formation of cravings.

From this understanding of how these dopamine mimics affect the physiology of an individual, it is understandable that addictive tendencies are seen in those who repeatedly used such drugs. However, one might be wise in asking how such habits start, particularly as overdoes have skyrocketed in the past decade alone. From reviewing self-reporting reasons, research has highlighted that significant life stressors, socioeconomic status, and mental health issues are social components that can contribute to an individual starting to use any of these drugs. Outside of this, there are other social factors that play a fact in this seemingly personal decision. In the case of men and women, there is a slight bias that men are more likely to take drugs. Certain demographics also find themselves more likely to participate in illicit drug use than other demographics. If one were to look at the psychology behind such decisions, one might see that such factors are influenced by in-groups, reference groups, groupthink, and more social factors besides. In many cases, such decisions may in fact be influenced by the motor neurons we as people so often take for granted.

In addition to considering the influences that cause one to make choices that can potentially negatively affect their health, one should also consider the classifications that these drugs fall under. There are three types of categorical drugs, each with their own effects. Stimulants are known to increase heart rate, blood pressure, sugar levels, and more besides. Depressants are known for causing the opposite effect as stimulates, characterized by how they slow responses in the central nervous system. Psychedelics and hallucinogens are known to alter perceptions, moods, sensations, and have even been associated with anxiety attacks.

While these drugs have specific physiological effects, it is curious to observe that there are those who have mental disorders will sometimes utilize drugs as a way of regulating their condition. In the case of those with ADD, it was found that there was a connection between those whose conditions were treated medically and those who weren’t. The connection binding these two demographics together was how likely it was that they would participate in substance abuse. Those who were untreated had over an 80% greater chance of substance abuse. When one looks at the neurological causes for ADD, it might not be surprising to see why substance abuse was more present in those that went untreated. Patients with ADD have been shown to have lower neuron activity than those who do not suffer from ADD. When considering that stimulants might help to mitigate this physical side effect, it is not unreasonable to think that indulging in substances that help to counteract this issue is not uncommon and might even have a biological drive behind it. It is perhaps why those whose ADD was treated were less likely to abuse substances than their untreated counterparts.

In looking at the relatedness of mental illnesses in this light, one might postulate that individuals are using these substances to correct imbalances or accommodate for ways in which brain function deviates from the norm. This would again be indicative of how the philosophy behind Ayurveda can prove to be beneficial in medicine. For individuals like Webster, changes in behavior and attitude are closely associated with the changes in his brain structure that occurred because of the number of concussions he suffered. The deviation from what one might consider normal brain function in people with ADD is potentially what drives their decision to use substances like alcohol and other drugs. Perhaps this is why, when this deviation is alleviated through medication, there is a decrease in the number of users. It is why were we able to alleviate abnormal formations within the neurons of a patient with dementia, we might see their conditions improve, rather than keep it from deteriorating by preventing future formations. It again comes down to finding balance in an individual system if one is to maintain health throughout their body.