Today we heard from Dr. Anjan Chatterjee, and he started our day by asking a simple, yet sobering question: How many of you know someone with a degenerative cognitive disorder? Almost all hands went up, and for those that didn’t, it’s probably just a matter of time as friends and relatives get older (age is the number one risk factor for all of these diseases). With rising life expectancy, Anjan suggested that dementia disorders may become the scourge of the first half of this century.
Neuroscientists join an army of clinicians, behavioral researchers, and care providers in trying to find ways to prevent Alzheimer’s, Frontotemporal dementia (FTD), and Parkinson’s Disease. The neuroscience, especially the imaging, is still just beginning to emerge. For instance, the National Institutes of Health (NIH) just started the Alzheimer's Disease Neuroimaging Initiative (ADNI) in 2006. Where this initiative, and many other branches of research will lead, is yet to be determined. But Anjan provided us a framework for understanding what might be most likely to work and why. (Click below to continue).
We started the day with a lecture by Dr. Anjan Chatterjee. Anjan covered, from a clinical perspective, a series of degenerative and developmental cognitive disorders. The three degenerative dementias covered were Alzheimer’s, Frontotemporal dementia (FTD), and Parkinson’s Disease.
The afternoon started out with a lively panel discussion that turned to question of bioethics, where neuroscience meets society (and we have to think about how the two should be integrated). The panel featured Anjan Chatterjee, Seth Gilihan, Bob Schultz, and Joe Kable. This was followed by a two-part lecture led by clinical psychologist and autism expert Bob Schultz. These lectures covered (1) how the brain develops from infancy through adulthood, and (2) the roles of genes and environment on that developmental process.
II. Important Lessons
Anjan emphasized six main points, three on how we diagnose cognitive disorders and three on how we subsequently treat these disorders. On the diagnostic side, a question to always keep in mind is what Anjan calls the “diagnostic blues”: do we think that a particular disorder (a) has a horizon (above which we can diagnose someone as having the defect) and we just have to find it; or (b) does not have a horizon because in fact there is continuum (along which we all fall, some with greater/less ability in this cognitive realm).
Anjan also reminded us that suggested that clinical patterns matter. Neuroimaging cannot currently give us a Star Trek tricorder scan for a diagnosis. When evaluating modern diagnostic abilities of neuroimaging, it’s also important to remember that you can’t go from group-mean differences to individual differences. Thus, even if it’s found that, on average, a certain type of brain activity is more common in a group with a given disorder, we can’t then make the leap to say that every individual who has that type of brain activity necessarily has the disorder. We still need to rely on a clinician’s evaluation.
Anjan offered a similar set of warnings about how we should interpret the evidence we see coming off the scanner. In particular, the distinction between correlation (X and Y are related to each other) and causation (X caused Y) must be kept in mind. So too should we be vigilant for snake oil neurosalesmen who might be making claims that the science can’t yet back up. Finally, Anjan advised that we pay particular attention to those treatments that begin to flow out o the clinic and into the population. For instance, if we are enhancing a disadvantaged population clinically, those in the ‘normal’ population might also be interested in such enhancements.
III. Who’s at boot camp with me?
I haven’t mentioned the lawyers yet, but as you’d expect at a program sponsored in part by the Law and Neuroscience Program, Boot Camp is filled with a number of lawyers representing expertise in a wide range of areas. The lawyers include Marc Blitz of the Oklahoma City University School of Law, Deborah Denno of Fordham Law School, Jennifer Drobac of Indiana University Law School, attorney Ruth Greenberg specializing in post-conviction relief, Owen Jones of Vanderbilt University Law School, Adam Kolber of the University of San Diego Law School, Charles-Maxime Panaccio of the University of Ottawa Faculty of Law, Julie Seaman of Emory Law School, and Stacey Tovino of Drake University Law School.