Brain Facts

Brain Facts
Brain Facts
A Primer on the brain and nervous system
Brain Facts
A PRIMER ON THE BRAIN AND NERVOUS SYSTEM
THE SOCIETY FOR NEUROSCIENCE
The Society for Neuroscience is the world’s largest organization of scientists and physicians dedicated to understanding the brain, spinal cord, and peripheral nervous system.
Neuroscientists investigate the molecular and cellular levels of the nervous system; the
neuronal systems responsible for sensory and motor function; and the basis of higher order
processes, such as cognition and emotion. This research provides the basis for understanding
the medical fields that are concerned with treating nervous system disorders. These medical
specialties include neurology, neurosurgery, psychiatry, and ophthalmology.
Founded in 1969, the Society has grown from 500 charter members to more than 38,000
members worldwide. The Society has more than 100 local or regional chapters. With activities ranging from lectures to networking events and information sharing, SfN chapters enable
individual members to engage their colleagues at the local level.
The mission of the Society is to:

Advance the understanding of the brain and the nervous system by bringing together
scientists of diverse backgrounds, by facilitating the integration of research directed at
all levels of biological organization, and by encouraging translational research and the
application of new scientific knowledge to develop improved disease treatments and
cures.
 Provide professional development activities, information, and educational resources for
neuroscientists at all stages of their careers, including undergraduates, graduates, and
postdoctoral fellows, and increase participation of scientists from a diversity of cultural
and ethnic backgrounds.
 Promote public information and general education about the nature of scientific discov-
ery and the results and implications of the latest neuroscience research. Support active
and continuing discussions on ethical issues relating to the conduct and outcomes of
neuroscience research.
 Inform legislators and other policy-makers about new scientific knowledge and recent
developments in neuroscience research and their implications for public policy, societal
benefit, and continued scientific progress.
The exchange of scientific information occurs at an annual fall meeting where more
than 16,000 reports of new scientific findings are presented and more than 30,000 people
attend. This meeting, the largest of its kind in the world, is the arena for the presentation of
new results in neuroscience.
The Society’s weekly journal, The Journal of Neuroscience, contains articles spanning the
entire range of neuroscience research and has subscribers worldwide. The Society’s ongoing
education and professional development efforts reach teachers and help promote the education of Society members. Print and electronic publications inform members about Society
activities.
A major goal of the Society is to inform the public about the progress and benefits of
neuroscience research. The Society accomplishes this goal by providing information about
neuroscience to schoolteachers and encouraging its members to speak to young people about
the human brain and nervous system.
Contents
Introduction.. ................................................................................................................ 4
The Neuron..................................................................................................................... 6
Neurotransmitters and Neuromodulators

Second Messengers
Brain Development.. ...................................................................................................... 10
Birth of Neurons and Brain Wiring

Paring Back

Critical Periods
Sensation and Perception........................................................................................... 15
Vision

Hearing
Taste and Smell


Touch and Pain
Learning, Memory, and Language.............................................................................. 22
Learning and Memory

Language
Movement..................................................................................................................... 25
Sleep.. ............................................................................................................................. 28
Brain Activity During Sleep

Sleep Disorders

How Is Sleep Regulated?
Stress.. ........................................................................................................................... 31
The Immediate Response

Chronic Stress
Aging............................................................................................................................ 34
Aging Neurons

Intellectual Capacity
Neural Disorders: Advances and Challenges............................................................ 36
Addiction  Alzheimer’s Disease  Amyotrophic Lateral Sclerosis  Anxiety Disorders  Attention Deficit
Hyperactivity Disorder  Autism  Bipolar Disorder  Brain Tumors  Down Syndrome
Dyslexia  Huntington’s Disease  Major Depression  Multiple Sclerosis  Neurological AIDS
Neurological Trauma  Pain  Parkinson’s Disease  Schizophrenia  Seizures and Epilepsy  Stroke
Tourette Syndrome
New Diagnostic Methods............................................................................................ 55
Imaging Techniques

Gene Diagnosis
Potential Therapies....................................................................................................... 59
New Drugs  Trophic Factors
Gene Therapy

Engineered Antibodies

Small Molecules and RNAs

Cell and
Neuroethics.................................................................................................................. 62
Glossary....................................................................................................................... 64
INDEX.. ............................................................................................................................ 69
Neuroscience Resources.............................................................................................. 75
Introduction
It sets humans apart from all other species
Gene-Environment Interactions Most major diseases that
by allowing us to achieve the wonders of walking on the moon and
have a genetic basis are strongly influenced by the environment.
composing masterpieces of literature, art, and music. The human
For example, identical twins have an increased risk compared
brain — a spongy, three-pound mass of fatty tissue — has been
with nonidentical siblings of getting the same disease; however, if
compared to a telephone switchboard and a supercomputer.
one twin gets the disease, the probability that the other will also
But the brain is much more complicated than either of these
be affected is only 30 to 60 percent. Environmental influences
devices, a fact scientists confirm almost daily, with each new dis-
include many factors such as toxic substances, diet, and level of
covery. The extent of the brain’s capabilities is unknown, but it is
physical activity but also encompass stressful life events.
the most complex living structure known in the universe.
This single organ controls body activities, ranging from heart
Brain Plasticity The brain possesses the ability to modify
neural connections to better cope with new circumstances. Sci-
rate and sexual function to emotion, learning, and memory. The
entists have begun to uncover the molecular basis of this process,
brain is even thought to influence the immune system’s response to
called plasticity, revealing how learning and memory occur and
disease and to determine, in part, how well people respond to medi-
how declines might be reversed. These discoveries are leading to
cal treatments. Ultimately, it shapes our thoughts, hopes, dreams,
new approaches to the treatment of chronic pain.
and imaginations. In short, the brain is what makes us human.
Neuroscientists have the daunting task of deciphering the
New Drugs Researchers have gained insight into the mechanisms of molecular neuropharmacology, which provides a new under-
mystery of this most complex of all machines: how as many as 100
standing of the mechanisms of addiction. These advances have led
billion nerve cells are produced, grow, and organize themselves
to new treatments for depression and obsessive-compulsive disorder.
into effective, functionally active systems that ordinarily remain in
working order throughout a person’s lifetime.
The motivation of researchers is twofold: to understand human
Imaging Revolutionary imaging techniques, including magnetic resonance imaging and positron emission tomography, have
revealed the brain systems underlying attention, memory, and
behavior better — from how we learn to why people have trouble
emotions and indicate dynamic changes that occur in schizophre-
getting along together — and to discover ways to prevent or cure
nia and other disorders.
many devastating brain disorders.
Cell Death The discovery of how and why neurons die, as well
The more than 1,000 disorders of the brain and nervous system
as the discovery of stem cells, which divide and form new neurons,
result in more hospitalizations than any other disease group, includ-
has many clinical applications. This has dramatically improved the
ing heart disease and cancer. Neurological illnesses affect more than
outlook for reversing the effects of injury in both the brain and the
50 million Americans annually, at costs exceeding $460 billion. In
spinal cord. The first effective treatments for stroke and spinal cord
addition, mental disorders, excluding drug and alcohol problems,
injury based on these advances have been brought to clinical practice.
strike 44 million adults a year at a cost of some $148 billion.
Since the Decade of the Brain, which ended in 2000, neuroscience has made significant discoveries in these areas:
Genetics Disease genes have been identified that are key to
Brain Development New principles and newly discovered
molecules responsible for guiding nervous system development now
give scientists a better understanding of certain disorders of childhood. Together with the discovery of stem cells, these advances are
several neurodegenerative disorders, including Alzheimer’s disease,
pointing to novel strategies for helping the brain or spinal cord re-
Huntington’s disease, Parkinson’s disease, and amyotrophic lateral
gain functions lost as a result of injury or developmental dysfunction.
sclerosis. These discoveries have provided new insight into underly-
Federal neuroscience research funding of more than $5
ing disease mechanisms and are beginning to suggest new treat-
billion annually and private support will continue to expand our
ments. With the mapping of the human genome, neuroscientists
knowledge of the brain in the years ahead.
have been able to make more rapid progress in identifying genes
This book provides only a glimpse of what is known about
that either contribute to or directly cause human neurological dis-
the nervous system, the disorders of the brain, and some of the
ease. Mapping animal genomes has aided the search for genes that
exciting avenues of research that promise new therapies for many
regulate and control many complex behaviors.
neurological diseases.
4 Brain Facts | introduction
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THE BRAIN. Cerebral cortex (top image). This
part of the brain is divided into four sections: the
occipital lobe, the temporal lobe, the parietal lobe,
and the frontal lobe. Functions, such as vision,
hearing, and speech, are distributed in selected
regions. Some regions are associated with more
than one function. Major internal structures (bottom image). The (1) forebrain is credited with the
highest intellectual functions — thinking, planning,
and problem-solving. The hippocampus is involved
in memory. The thalamus serves as a relay station
for almost all the information coming into the brain.
Neurons in the hypothalamus serve as relay stations for internal regulatory systems by monitoring
information coming in from the autonomic nervous
system and commanding the body through those
nerves and the pituitary gland. On the upper
surface of the (2) midbrain are two pairs of small
hills, colliculi, collections of cells that relay specific
sensory information from sense organs to the brain.
The (3) hindbrain consists of the pons and medulla
oblongata, which help control respiration and heart
rhythms, and the cerebellum, which helps control
movement as well as cognitive processes that
require precise timing.
THE TOLL OF SELECTED BRAIN AND NERVOUS SYSTEM DISORDERS ON AMERICANS*
Condition
Total Cases
Cost per Year (U.S. dollars)
Sleep Disorders
70 million
100 billion
Hearing Loss
32 million
2.5 billion
20.9 million
70 billion
Traumatic Brain Injury
5.3 million
60 billion
Stroke
5.2 million
51 billion
Alzheimer’s Disease
5 million
148 billion
Schizophrenia
2 million
32.5 billion
Parkinson’s Disease
1 million
5.6 billion
Multiple Sclerosis
400,000
10.6 billion
Spinal Cord Injury
250,000
10 billion
30,000
2 billion
All Depressive Disorders
Huntington’s Disease
* Estimates provided by the Centers for Disease Control and Prevention, National Institutes of Health, and voluntary organizations.
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introduction
| Brain Facts 5
The Neuron
A specialized cell designed to transmit informa-
nizes a particular chemical messenger. A neurotransmitter fits into
tion to other nerve cells, muscle, or gland cells, the neuron is the
this region in much the same way that a key fits into a lock. And
basic working unit of the brain. The brain is what it is because of
when the transmitter is in place, this interaction alters the target
the structural and functional properties of interconnected neurons.
cell’s membrane potential and triggers a response, such as the gen-
The brain contains between 1 billion and 100 billion neurons,
eration of an action potential, contraction of a muscle, stimulation
depending on the species.
of enzyme activity, or inhibition of neurotransmitter release from
The neuron consists of a cell body, dendrites, and an axon. The
cell body contains the nucleus and cytoplasm. The electrically
the target cell.
Increased understanding of neurotransmitters in the brain and
excitable axon extends from the cell body and often gives rise to
of the action of drugs on these chemicals — gained largely through
many smaller branches before ending at nerve terminals. Dendrites
animal research — guides one of the largest fields in neuroscience.
extend from the neuron cell body and receive messages from other
Armed with this information, scientists hope to understand the circuits
neurons. Synapses are the contact points where one neuron commu-
responsible for disorders such as Alzheimer’s disease and Parkinson’s
nicates with another. The dendrites and cell body are covered with
disease. Sorting out the various chemical circuits is vital to understand-
synapses formed by the ends of axons from other neurons.
ing how the brain stores memories, why sex is such a powerful motiva-
Neurons signal by transmitting electrical impulses along their
axons, which can range in length from a tiny fraction of an inch to
three feet or more. Many axons are covered with a layered myelin
sheath, which speeds the transmission of electrical signals along the
tion, and what makes up the biological basis of mental illness.
Neurotransmitters and neuromodulators
Acetylcholine The first neurotransmitter, identified about 75
axon. This sheath is made of specialized cells called oligodendrocytes
years ago, was acetylcholine (ACh). This chemical is released by
in the brain and Schwann cells in the peripheral nervous system.
neurons connected to voluntary muscles (causing them to contract)
Nerve impulses involve the opening and closing of ion channels, which are selectively permeable, water-filled molecular tunnels
that pass through the cell membrane and allow ions — electrically
and by neurons that control the heartbeat. ACh also serves as a
transmitter in many regions of the brain.
ACh is formed at the axon terminals. When an action poten-
charged atoms — or small molecules to enter or leave the cell. The
tial arrives at the nerve terminal, the electrically charged calcium
flow of these ions creates an electrical current that produces tiny
ion rushes in, and ACh is released into the synapse, where it at-
voltage changes across the neuron’s cell membrane.
taches to ACh receptors on the target cells. On voluntary muscles,
The ability of a neuron to generate an electrical impulse
this opens sodium channels and causes the muscle to contract.
depends on a difference in charge between the inside and outside
ACh is then broken down by the enzyme acetylcholinesterase and
of the cell. When a nerve impulse begins, a dramatic reversal in
resynthesized in the nerve terminal. Antibodies that block one type
the electrical potential occurs at one point on the cell’s membrane,
of receptor for ACh cause myasthenia gravis, a disease characterized
when the neuron switches from an internal negative charge to a
by fatigue and muscle weakness.
positive charge state. The change, called an action potential, then
Much less is known about ACh in the brain. Recent discover-
passes along the membrane of the axon at speeds up to several
ies suggest, however, that it may be critical for normal attention,
hundred miles per hour. In this way, a neuron may be able to fire
memory, and sleep. Because ACh-releasing neurons die in Alzheim-
impulses multiple times every second.
er’s patients, finding ways to restore this neurotransmitter is one
Upon reaching the end of an axon, these voltage changes trigger the release of neurotransmitters, the brain’s chemical messengers.
Neurotransmitters are released at nerve terminals, diffuse across the
goal of current research. Drugs that inhibit acetylcholinesterase are
presently the main drugs used to treat Alzheimer’s disease.
Amino acids Amino acids, widely distributed throughout the
intrasynaptic space, and bind to receptors on the surface of the target
body and the brain, serve as the building blocks of proteins. Certain
cell (often another neuron but also possibly a muscle or gland cell).
amino acids can also serve as neurotransmitters in the brain.
These receptors act as on-and-off switches for the next cell.
Each receptor has a distinctly shaped region that selectively recog-
6
Brain Facts | the
neuron
The neurotransmitters glycine and gamma-aminobutyric acid
(GABA) inhibit the firing of neurons. The activity of GABA is
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increased by benzodiazepines (e.g., Valium) and by anticonvulsant
Key questions remain about the NMDA receptor’s precise struc-
drugs. In Huntington’s disease, a hereditary disorder that begins during
ture, regulation, location, and function. Developing drugs to block or
midlife, the GABA-producing neurons in brain centers that coordinate
stimulate activity at NMDA receptors holds promise for improving
movement degenerate, thereby causing uncontrollable movements.
brain function and treating neurological and psychiatric disorders.
Glutamate and aspartate act as excitatory signals, activating,
Catecholamines Dopamine and norepinephrine are widely
among others, N-methyl-d-aspartate (NMDA) receptors, which have
present in the brain and peripheral nervous system. Dopamine is
been implicated in activities ranging from learning and memory to
present in three principal circuits in the brain; these circuits con-
development and specification of nerve contacts in a developing
trol movement, cause psychiatric symptoms such as psychosis, and
animal. The stimulation of NMDA receptors may promote benefi-
regulate hormonal responses.
cial changes in the brain, whereas overstimulation can cause nerve
cell damage or cell death in trauma and stroke.
The dopamine circuit that regulates movement has been
directly linked to disease. Due to dopamine deficits in the brain,
people with Parkinson’s disease show symptoms including muscle tremors, rigidity, and
difficulty in moving. Thus, medical scientists have found that the administration of
levodopa, a substance from which dopamine
is synthesized, is an effective treatment for
Parkinson’s, allowing patients to walk and
perform skilled movements more successfully.
Another dopamine circuit is thought
to be important for cognition and emotion;
abnormalities in this system have been
implicated in schizophrenia. Because drugs
that block certain dopamine receptors in the
brain are helpful in diminishing psychotic
symptoms, learning more about dopamine is
important to understanding mental illness.
In a third circuit, dopamine regulates
the endocrine system. Dopamine directs
the hypothalamus to manufacture hormones
and hold them in the pituitary gland for
release into the bloodstream or to trigger
the release of hormones held within cells in
the pituitary.
NEURON. A neuron fires by transmitting
electrical signals along its axon. When signals
reach the end of the axon, they trigger the release
of neurotransmitters that are stored in pouches
called vesicles. Neurotransmitters bind to receptor
molecules on the surfaces of adjacent neurons. The
point of virtual contact is known as the synapse.
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the neuron
| Brain Facts
7
Nerve fibers containing norepinephrine are present through-
Trophic factors Researchers have discovered several small
out the brain. Deficiencies in this transmitter occur in patients with
proteins in the brain that are necessary for the development, func-
Alzheimer’s disease, Parkinson’s disease, and Korsakoff’s syndrome,
tion, and survival of specific groups of neurons. These small proteins
a cognitive disorder associated with chronic alcoholism. Thus,
are made in brain cells, are released locally in the brain, and bind to
researchers believe norepinephrine may play a role in both learning
receptors expressed by specific neurons. Researchers also have identi-
and memory. Norepinephrine is also secreted by the sympathetic
fied genes that code for receptors and are involved in the signaling
nervous system in the periphery to regulate heart rate and blood
mechanisms of trophic factors. These findings are expected to result
pressure. Acute stress increases the release of norepinephrine from
in a greater understanding of how trophic factors work in the brain.
sympathetic nerves and the adrenal medulla.
This information should also prove useful for the design of new thera-
Serotonin This neurotransmitter is present in the brain
and other tissues, particularly blood platelets and the lining of the
digestive tract. In the brain, serotonin has been implicated in sleep,
pies for brain disorders of development and for degenerative diseases,
including Alzheimer’s disease and Parkinson’s disease.
Hormones In addition to the nervous system, the endocrine
mood, depression, and anxiety. Because serotonin controls the dif-
system is a major communication system of the body. While the
ferent switches affecting various emotional states, scientists believe
nervous system uses neurotransmitters as its chemical signals, the
these switches can be manipulated by analogs, chemicals with
endocrine system uses hormones for its chemical signals. The pan-
molecular structures similar to that of serotonin. Drugs that alter
creas, kidneys, heart, adrenal glands, gonads, thyroid, parathyroid,
serotonin’s action, such as fluoxetine, relieve symptoms of depression
thymus, and pituitary gland are sources of hormones. The endo-
and obsessive-compulsive disorder.
crine system works in large part through the pituitary gland, which
Peptides These are chains of amino acids linked together.
secretes hormones into the blood. Because fragments of endorphins
Peptides differ from proteins, which are much larger and have more
are released from the pituitary gland into the bloodstream, they
complex combinations of amino acids.
might also function as endocrine hormones. This system is very im-
In 1973, scientists discovered receptors for opiates on
portant for the activation and control of basic behavioral activities
neurons in several regions of the brain, suggesting that the brain
such as sex, emotion, responses to stress, and the regulation of body
must make substances very similar to opium. Shortly thereafter,
functions, including growth, reproduction, energy use, and metabo-
scientists made their first discovery of an opiate produced by the
lism. Actions of hormones show the brain to be very malleable and
brain that resembles morphine, an opium derivative used medi-
capable of responding to environmental signals.
cally to kill pain. They named it enkephalin, literally meaning
The brain contains receptors for thyroid hormones and the six
“in the head.” Soon after, other types of opioid peptides, endor-
classes of steroid hormones — androgens, estrogens, progestins, gluco-
phins, were discovered. Endorphins, whose name comes from
corticoids, mineralocorticoids, and vitamin D. The receptors are found
endogenous morphine, act like opium or morphine to kill pain
in selected populations of neurons in the brain and relevant organs
or cause sleepiness.
in the body. Thyroid and steroid hormones bind to receptor proteins
The precise role of the naturally occurring opioid peptides is
unclear. A simplistic hypothesis is that they are released by brain
that in turn bind to DNA and regulate the action of genes. This can
result in long-lasting changes in cellular structure and function.
neurons in times of stress to minimize pain and enhance adaptive
The brain has receptors for many hormones; for example, the
behavior. The presence of opioid peptides may explain, for exam-
metabolic hormones insulin, insulinlike growth factor, ghrelin, and
ple, why injuries received during the stress of combat are often not
leptin. These hormones are taken up from the blood and act to af-
noticed until hours later. Neurons containing these opioid peptides,
fect neuronal activity and certain aspects of neuronal structure.
however, are not limited to pain-sensing circuits.
Opioids and their receptors are closely associated with path-
In response to stress and changes in our biological clocks, such
as day and night cycles and jet lag, hormones enter the blood and
ways in the brain that are activated by painful or tissue-damaging
travel to the brain and other organs. In the brain, hormones alter the
stimuli. These signals are transmitted to the central nervous system
production of gene products that participate in synaptic neurotrans-
— the brain and spinal cord — by special sensory nerves, small
mission as well as the structure of brain cells. As a result, the circuitry
myelinated fibers, and tiny unmyelinated C fibers. Scientists have
of the brain and its capacity for neurotransmission are changed over a
discovered that some C fibers contain a peptide called substance P
course of hours to days. In this way, the brain adjusts its performance
that causes the sensation of burning pain. The active component of
and control of behavior in response to a changing environment. Hor-
chili peppers, capsaicin, causes the release of substance P.
mones are important agents of protection and adaptation, but stress
8
Brain Facts | the
neuron
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and stress hormones, such as the glucocorticoid cortisol, can also alter
these gases simply diffuse into adjacent neurons and act upon
brain function, including learning. Severe and prolonged stress can
chemical targets, which may be enzymes.
cause permanent brain damage.
Reproduction in females is a good example of a regular, cyclic
While exact functions for carbon monoxide have not been
determined, nitric oxide has already been shown to play several
process driven by circulating hormones: The neurons in the hypo-
important roles. For example, nitric oxide neurotransmission gov-
thalamus produce gonadotropin-releasing hormone (GnRH), a peptide
erns erection in the penis. In nerves of the intestine, it governs the
that acts on cells in the pituitary. In both males and females, this
relaxation that contributes to the normal movements of digestion.
causes two hormones — the follicle-stimulating hormone (FSH) and
In the brain, nitric oxide is the major regulator of the intracellular
the luteinizing hormone (LH) — to be released into the bloodstream.
messenger molecule — cyclic GMP. In conditions of excess gluta-
In males, these hormones are carried to receptors on cells in the
mate release, as occurs in stroke, neuronal damage following the
testes, where they release the male hormone testosterone, an
stroke may be attributable in part to nitric oxide.
androgen, into the bloodstream. In females, FSH and LH act on the
ovaries and cause the release of the female hormones estrogen and
progesterone. Testosterone, estrogen, and progesterone are often
referred to as sex hormones.
Second messengers
Substances that trigger biochemical communication within
cells, after the action of neurotransmitters at their receptors, are
In turn, the increased levels of testosterone in males and
called second messengers; these intracellular effects may be respon-
estrogen in females act back on the hypothalamus and pituitary to
sible for long-term changes in the nervous system. They convey the
decrease the release of FSH and LH. The increased levels of sex
chemical message of a neurotransmitter (the first messenger) from
hormones also induce changes in cell structure and chemistry that
the cell membrane to the cell’s internal biochemical machinery.
lead to an increased capacity to engage in sexual behavior. Sex hor-
Second-messenger effects may endure for a few milliseconds to as
mones also exert widespread effects on many other functions of the
long as many minutes.
brain such as attention, motor control, pain, mood, and memory.
Sexual differentiation of the brain is caused by sex hormones
An example of the initial step in the activation of a secondmessenger system involves adenosine triphosphate (ATP), the
acting in fetal and early postnatal life, although recent evidence
chemical source of energy in cells. ATP is present throughout the
points to genes on the Y chromosome contributing to this process.
cytoplasm of all cells. For example, when norepinephrine binds to
Scientists have found statistically and biologically significant differ-
its receptors on the surface of the neuron, the activated receptor
ences between the brains of men and women that are similar to sex
binds a G protein on the inside of the membrane. The activated G
differences found in experimental animals. These include differenc-
protein causes the enzyme adenylyl cyclase to convert ATP to cyclic
es in the size and shape of brain structures in the hypothalamus and
adenosine monophosphate (cAMP). The second messenger, cAMP,
the arrangement of neurons in the cortex and hippocampus. Sex
exerts a variety of influences within the cell, ranging from changes
differences go well beyond sexual behavior and reproduction and
in the function of ion channels in the membrane to changes in the
affect many brain regions and functions, ranging from mechanisms
expression of genes in the nucleus, rather than acting as a messen-
for perceiving pain and dealing with stress to strategies for solving
ger between one neuron and another.
cognitive problems. Although differences exist, the brains of men
and women are more similar than they are different.
Anatomical differences have also been reported between the
Second messengers also are thought to play a role in the manufacture and release of neurotransmitters and in intracellular movements and carbohydrate metabolism in the cerebrum — the largest
brains of heterosexual and homosexual men. Research suggests that
part of the brain, consisting of two hemispheres — as well as the
hormones and genes act early in life to shape the brain in terms of
processes of growth and development. In addition, direct effects of
sex-related differences in structure and function, but scientists are
second messengers on the genetic material of cells may lead to long-
still putting together all the pieces of this puzzle.
term alterations in cellular functioning and ultimately in behavior.
Gases Scientists identified a new class of neurotransmitters
that are gases. These molecules — nitric oxide and carbon monoxide
— do not act like other neurotransmitters. Being gases, they are not
stored in any structure, certainly not in synaptic storage structures.
Instead, they are made by enzymes as they are needed and released
from neurons by diffusion. Rather than acting at receptor sites,
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the neuron
| Brain Facts
9
Brain Development
The cells of the nervous system
including schizophrenia. Other research suggests that genes that are
connect with one another in trillions of remarkably specific pat-
important for brain development may also play a role in susceptibil-
terns that form and change over the course of an organism’s life.
ity to autism spectrum disorders. And by applying knowledge about
These connections develop among various types of neurons, a pro-
how connections form during development, regeneration following
cess that begins in the embryo. First, appropriate types of neurons
injury to the brain now is viewed as distinctly possible.
must arise in appropriate numbers and migrate to appropriate plac-
Knowing how the brain is put together is essential for under-
es. The axons and dendrites that form the connections then extend
standing its ability to reorganize in response to external influences
from these nerve cells, and the growth of axons must be guided over
or injury. These studies also shed light on brain functions such as
long distances so they reach the appropriate targets. Axons must
learning and memory. The brain evolves from the embryo to the
recognize specific target cells. The connections that form initially
adult stage, and during infancy and childhood it possesses unique
then mature, with the activity and experience of early postnatal life
attributes that contribute to differences in learning ability as well as
playing a key role in their refinement. The degree of complexity in
vulnerability to specific brain disorders. Neuroscientists are begin-
the brain, and therefore the amount of interaction required to regu-
ning to discover some general principles that underlie developmen-
late its development, is far greater than in other organs of the body.
tal processes, many of which overlap in time.
Scientists studying development are working to reveal how these
complicated processes of connecting and reshaping occur.
Many initial steps in brain development are similar across spe-
Birth of neurons and brain wiring
Three to four weeks after conception, one of the two cell layers
cies, although later steps are different. By studying these similarities
of the gelatinlike human embryo, about one-tenth of an inch long,
and differences, scientists can learn about normal human brain de-
starts to thicken and build up along the middle. As the cells continue
velopment and can learn how brain abnormalities, such as mental
to divide and this flat neural plate grows, parallel ridges, similar to
retardation and other disorders, can be prevented or treated.
the creases in a paper airplane, rise across its surface. Within a few
Advances in the study of brain development have become
days, the ridges fold in toward each other and fuse to form the hollow
increasingly relevant for medical treatments. For example, several
neural tube. The top of the tube thickens into three bulges that form
diseases that most scientists once thought were purely disorders of
the hindbrain, midbrain, and forebrain. The first signs of the eyes and
adult function are now being considered in developmental terms,
the hemispheres of the brain appear later in development.
BRAIN DEVELOPMENT. The human brain and nervous system begin to develop at about three weeks’ gestation with the closing of the neural tube (left image). By
four weeks, major regions of the human brain can be recognized in primitive form, including the forebrain, midbrain, hindbrain, and optic vesicle (from which the eye
develops). Irregular ridges, or convolutions, are clearly seen by six months.
10
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development
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NEURON
MIGRATION. A
cross-sectional view of
the occipital lobe (which
processes vision) of a
three-month-old monkey
fetus brain (center)
shows immature neurons
migrating along glial
fibers. These neurons
make transient connections
with other neurons before
reaching their destination.
A single migrating neuron,
shown about 2,500 times
its actual size (right), uses
a glial fiber as a guiding
scaffold. To move, it needs
adhesion molecules, which
recognize the pathway,
and contractile proteins to
propel it along.
The embryo has three layers that undergo many interactions in
mesodermal tissue lying beneath the developing spinal cord,
order to grow into organ, bone, muscle, skin, or neural tissue. Skin
marks directly adjacent neural cells to become a specialized class
and neural tissue arise from one layer, the ectoderm, in response to
of glial cells. Cells farther away are exposed to lower concentra-
signals provided by the adjacent layer, the mesoderm.
tions of sonic hedgehog, and they become the motor neurons
A number of molecules interact to determine whether the
that control muscles. An even lower concentration promotes the
ectoderm becomes neural tissue or develops in another way to
formation of interneurons, which relay messages to other neurons,
become skin. Studies of spinal cord development in frogs show that
not muscles.
one major mechanism depends on specific proteins that inhibit
A combination of signals also determines the type of chemical
the activity of other proteins. In areas where no inhibition occurs,
messages, or neurotransmitters, that a neuron will use to com-
the tissue becomes skin. In areas where proteins secreted from the
municate with other cells. For some cells, such as motor neurons,
mesoderm do lead to inhibition, the tissue becomes neural.
the type of neurotransmitter is fixed, but for other neurons, it is a
Once the ectodermal tissue has acquired its neural fate, more
matter of choice. Scientists found that when certain neurons are
signaling interactions determine which type of brain cell forms. The
maintained in a dish with no other cell types, they produce the
mature nervous system contains a vast array of cell types, which can
neurotransmitter norepinephrine. In contrast, if the same neurons
be divided into two main categories: the neurons, responsible primar-
are maintained with other cells, such as cardiac, or heart, tissue,
ily for signaling, and supporting cells called glial cells.
they produce the neurotransmitter acetylcholine. Since all neurons
Researchers are finding that the destiny of neural tissue de-
have the genes required to produce these molecules, it is the turn-
pends on a number of elements, including cell position within the
ing on of a particular set of genes that begins the production of
nervous system, that define the environmental signals to which
specific neurotransmitters. Many researchers believe that the signal
the cells are exposed. For example, a key factor in spinal cord devel-
to engage the gene and, therefore, the final determination of the
opment is a secreted protein called sonic hedgehog that is similar to a
chemical messengers that a neuron produces, is influenced by
signaling protein found in flies. The protein, initially secreted from
factors coming from the targets themselves.
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brain development
| Brain Facts
11
Neurons are initially produced along the central canal in the
sources found near the growth cone. The growth cones, in turn,
neural tube. These neurons then migrate from their birthplace to a
bear molecules that serve as receptors for the environmental cues.
final destination in the brain. They collect together to form each
The binding of particular signals with receptors tells the growth
of the various brain structures and acquire specific ways of transmit-
cone whether to move forward, stop, recoil, or change direction.
ting nerve messages. Their axons grow long distances to find and
These signaling molecules include proteins with names such as
connect with appropriate partners, forming elaborate and specific
netrin, semaphorin, and ephrin. In most cases, these are families of
circuits. Finally, sculpting action eliminates redundant or improper
related molecules; for example, researchers have identified at least
connections, honing the specific purposes of the circuits that re-
15 semaphorins and at least 10 ephrins.
main. The result is a precisely elaborated adult network of 100 bil-
Perhaps the most remarkable finding is that most of these
lion neurons capable of body movement, perception, emotion,
proteins are common to worms, insects, and mammals, including
and thought.
humans. Each protein family is smaller in flies or worms than in
As neurons are produced, they move from the neural tube’s ven-
mice or people, but its functions are quite similar. It has therefore
tricular zone, or inner surface, to near the border of the marginal zone,
been possible to use the simpler animals to gain knowledge that can
or outer surface. After neurons stop dividing, they form an intermedi-
be applied directly to humans. For example, the first netrin was dis-
ate zone where they gradually accumulate as the brain develops.
covered in a worm and shown to guide neurons around the worm’s
The migration of neurons occurs in most structures of the
“nerve ring.” Later, vertebrate netrins were found to guide axons
brain but is particularly prominent in the formation of a large
around the mammalian spinal cord. Receptors for netrins were
cerebral cortex in primates, including humans. In this structure,
found in worms and proved invaluable in finding the correspond-
neurons slither from the place of origin near the ventricular surface,
ing, and related, human receptors.
along non-neuronal fibers that form a trail, to their proper desti-
Once axons reach their targets, they form synapses, which
nation. Proper neuron migration requires multiple mechanisms,
permit electric signals in the axon to jump to the next cell, where
including the recognition of the proper path and the ability to
they can either provoke or prevent the generation of a new signal.
move long distances. One mechanism for long-distance migration is
The regulation of this transmission at synapses, and the integration
the movement of neurons along elongated fibers that form transient
of inputs from the thousands of synapses each neuron receives, are
scaffolding in the fetal brain. In another mode, inhibitory interneu-
responsible for the astounding information-processing capacity of
rons migrate tangentially across the brain. Many external forces,
the brain. For processing to occur properly, the connections must
such as alcohol, cocaine, or radiation, prevent proper neuronal
be highly specific. Some specificity arises from the mechanisms that
migration and result in misplacement of cells, which may lead to
guide each axon to its proper target area. Additional molecules
mental retardation or epilepsy. Furthermore, mutations in genes
mediate target recognition, whereby the axon chooses the proper
that regulate migration have been shown to cause some rare genetic
neuron, and often the proper part of the target, once it arrives at
forms of retardation and epilepsy in humans.
its destination. Several of these recognition molecules have been
Once the neurons reach their final location, they must make
the proper connections for a particular function to occur; for ex-
identified in the past few years.
Researchers also have had success identifying the ways in
ample, vision or hearing. They do this through their axons. These
which the synapse differentiates once contact has been made.
thin appendages can stretch out a thousand times longer than the
The tiny portion of the axon that contacts the dendrite becomes
cell body from which they arise. The journey of most axons ends
specialized for the release of neurotransmitters, and the tiny portion
when they meet thicker appendages, called dendrites, on other
of the dendrite that receives the contact becomes specialized to
neurons. These target neurons can be located at a considerable
receive and respond to the signal. Special molecules pass between
distance, sometimes at the opposite side of the brain. In the case of
the sending and receiving cells to ensure that the contact is formed
a motor neuron, the axon may travel from the spinal cord all the
properly and that the sending and receiving specializations are
way down to a foot muscle.
precisely matched. These processes ensure that the synapse can
Axon growth is directed by growth cones. These enlargements
transmit signals quickly and effectively. Finally, still other molecules
of the axon’s tip actively explore the environment as they seek out
coordinate the maturation of the synapse after it has formed, so that
their precise destination. Researchers have discovered many special
it can accommodate the changes that occur as our bodies mature
molecules that help guide growth cones. Some molecules lie on the
and our behavior changes. Defects in some of these molecules are
cells that growth cones contact, whereas others are released from
now thought to confer susceptibility to disorders such as autism,
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development
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SPINAL CORD AND NERVES. The mature
central nervous system (CNS) consists of the brain
and spinal cord. The brain sends nerve signals
to specific parts of the body through peripheral
nerves, known as the peripheral nervous system
(PNS). Peripheral nerves in the cervical region
serve the neck and arms; those in the thoracic
region serve the trunk; those in the lumbar region
serve the legs; and those in the sacral region
serve the bowels and bladder. The PNS consists
of the somatic nervous system that connects
voluntary skeletal muscles with cells specialized
to respond to sensations, such as touch and
pain. The autonomic nervous system is made
of neurons connecting the CNS with internal
organs. It is divided into the sympathetic nervous
system, which mobilizes energy and resources
during times of stress and arousal, and the
parasympathetic nervous system, which conserves
energy and resources during relaxed states.
and the loss of others may underlie the degradation of synapses that
the survival of a distinct group of neurons. For example, nerve
occurs during aging.
growth factor is important for sensory neuron survival. Recently, it
Many axons in the brain require a sheath of myelin to enhance
has become clear that apoptosis is maintained into adulthood and
the speed of conduction. The process of wrapping axons in myelin
constantly held in check. On the basis of this idea, researchers have
occurs last and can take years to complete in some areas of the brain.
found that injuries and some neurodegenerative diseases kill neu-
Paring back
After growth, the neural network is pared back to create a
more efficient system. Only about half the neurons generated during development survive to function in the adult. Entire popula-
rons not directly by the damage they inflict but rather by activating
the cells’ own death programs. This discovery — and its implication that death need not follow insult — have led to new avenues
for therapy.
Brain cells also form too many connections at first. For ex-
tions of neurons are removed through apoptosis, programmed cell
ample, in primates, the projections from the two eyes to the brain
death initiated in the cells. Apoptosis is activated if a neuron loses
initially overlap and then sort out to separate territories devoted to
its battle with other neurons to receive life-sustaining chemical
one eye or the other. Furthermore, in the young primate cerebral
signals called trophic factors. These factors are produced in limited
cortex, the connections between neurons are greater in number
quantities by target tissues. Each type of trophic factor supports
than and twice as dense as those in an adult primate. Communica-
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brain development
| Brain Facts
13
tion between neurons with chemical and electrical signals is neces-
Research also shows that enriched environments can bolster
sary to weed out the connections. The connections that are active
brain development. For example, studies show that animals brought
and generating electrical currents survive, whereas those with little
up in toy-filled surroundings have more branches on their neurons
or no activity are lost. Thus, the circuits of the adult brain are
and more connections than isolated animals. In one recent study,
formed, at least in part, by sculpting away incorrect connections to
scientists found that enriched environments resulted in more neu-
leave only the correct ones.
rons in a brain area involved in memory.
Critical periods
with greater proficiency than adults, and recent research suggests
Many people have observed that children can learn languages
Although most of the neuronal cell death occurs in the
that the heightened activity of the critical period may contribute
embryo, the paring down of connections occurs in large part during
to this robust learning. Interestingly, compared with adults, chil-
critical periods in early postnatal life. These are windows of time
dren have an increased incidence of certain disorders that involve
during development when the nervous system must obtain certain
excessive brain activity, such as epilepsy. Many epilepsy syndromes
critical experiences, such as sensory, movement, or emotional
appear during childhood and fade away by adulthood. Brain devel-
input, to develop properly. These periods are characterized by high
opment in people continues into the early 20s — even the brain
learning rates.
of an adolescent is not completely mature. One of the later aspects
After a critical period, connections diminish in number and
of brain development is the completion of myelination of the
are less subject to change, but the ones that remain are stronger,
axons connecting one brain area to another. This process starts
more reliable, and more precise. Injury or deprivation, either
around birth and moves from the back of the brain to the front:
sensory or social, occurring at a certain stage of postnatal life may
The frontal lobes are the last to become “connected” with fastconducting myelinated axons. Major functions of the frontal lobes
are judgment, insight, and impulse control, and so the acquisition
of these attributes becomes the last step in the creation of an adult
human brain.
Scientists hope that new insight
into brain development will lead to
treatments for those with learning
disabilities, brain damage, and
neurodegenerative disorders
and will help us understand aging.
Scientists hope that new insight into brain development
will lead to treatments for those with learning disabilities, brain
damage, and neurodegenerative disorders and will help us understand aging. Research results indicate the need to understand
processes related to normal function of the brain at each of its
major stages and suggest that this information might lead to better
age-specific therapies for brain disorders.
affect one aspect of development, whereas the same injury at a
different period may affect another aspect.
In one example, if a monkey is raised from birth to 6 months
of age with one eyelid closed, the animal permanently loses useful
vision in that eye because of diminished use. This gives cellular
meaning to the saying “use it or lose it.” Loss of vision is caused by
the actual loss of functional connections between that eye and neurons in the visual cortex. This finding has led to earlier and better
treatment for the eye disorders of congenital cataracts and “crossed
eyes” in children.
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Brain Facts | brain
development
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Sensation and Perception
Vision. Our wonderful sense of sight allows us to perceive
scene registers in your left hemisphere. A similar arrangement ap-
the world around us, from the genius of Michelangelo’s Sistine Cha-
plies to movement and touch: Each half of the cerebrum is respon-
pel ceiling to mist-filled vistas of a mountain range. Vision is one
sible for the opposite half of the body and external world.
of our most delicate and complicated senses. It is also the most in-
Scientists know much about the way cells encode visual infor-
tensively studied. About one-fourth of the human brain is involved
mation in the retina, the lateral geniculate nucleus — an intermedi-
in visual processing, more than for any other sense. More is known
ate way station between the retina and visual cortex — and the
about vision than any other vertebrate sensory system, with most of
visual cortex. These studies give us the best knowledge so far about
the information derived from studies of monkeys and cats.
how the brain analyzes and processes sensory information.
Vision begins with light passing through the cornea, which
The retina contains three stages of neurons. The first, the layer
does about three-quarters of the focusing, and then the lens, which
of rods and cones, sends its signals to the middle layer, which relays
adjusts the focus. Both combine to produce a clear image of the
signals to the third layer, which consists of the ganglion cells whose
visual world on the sheet of photoreceptors in the retina. Photorecep-
axons form the optic nerve. Each cell in the middle and third layer
tors absorb light and send electrical signals to nearby neurons lining
typically receives input from many cells in the previous layer, but
the back of the eye.
the number of inputs varies widely across the retina. Near the cen-
As in a camera, the image on the retina is reversed: Objects to
ter of the gaze, where visual acuity is highest, each cell in the third
the right of center project images to the left part of the retina and
layer receives inputs — via the middle layer — from one
vice versa; objects above the center project to the lower part and
cone or, at most, a few, allowing us to resolve very fine details.
vice versa. The size of the pupil, which regulates how much light
Near the margins of the retina, each cell in the third layer receives
enters the eye, is controlled by the iris. The shape of the lens is
signals from a cluster of many rods and cones, explaining why we
altered by the muscles just behind the iris so that near or far objects
cannot see fine details off to either side. Whether large or small,
can be brought into focus on the retina.
the region of visual space providing input to a visual neuron is
Photoreceptors, about 125 million in each human eye, are
neurons specialized to turn light into electrical signals. They oc-
called its receptive field.
About 55 years ago, scientists discovered that the receptive
cur in two forms. Rods are most sensitive to dim light and do not
field of a vision cell is activated when light hits a tiny region in its
convey color.
receptive field center and is inhibited when light hits the part of
Cones work in bright light and are responsible for acute detail,
the receptive field surrounding the center. If light covers the entire
black-and-white vision, and color vision. The human eye contains
receptive field, the cell responds weakly. Thus, the visual process
three types of cones, each sensitive to a different range of colors. Be-
begins by comparing the amount of light striking any small region
cause their sensitivities overlap, cones work in combination to convey
of the retina with the amount of surrounding light.
information about all visible colors. You might be surprised to know
Visual information from the retina is relayed through the
that we can see thousands of colors using only three types of cones,
lateral geniculate nucleus of the thalamus to the primary visual
but computer monitors use a similar process to generate a spectrum of
cortex — a thin sheet of tissue (less than one-tenth of an inch
colors using only three kinds of phosphors: red, green, and blue.
thick) a bit larger than a half-dollar that is located in the occipital
Primates, including humans, have well-developed vision using
lobe in the back of the brain. The primary visual cortex is densely
two eyes, called binocular vision. Visual signals pass from each eye
packed with cells in many layers. In its middle layer, which receives
along the million or so fibers of the optic nerve to the optic chiasm,
messages from the lateral geniculate nucleus, scientists have found
where some nerve fibers cross over, so both sides of the brain receive
responses similar to those observed in the retina and in lateral
signals from both eyes. Consequently, the left halves of both retinas
geniculate cells. Cells above and below this layer respond differ-
project to the left visual cortex and the right halves project to the
ently. They prefer stimuli in the shape of bars or edges and those at
right visual cortex.
a particular angle (orientation). Further studies have shown that
The result is that the left half of the scene you are watching
registers in your right hemisphere. Conversely, the right half of the
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different cells prefer edges at different angles or edges moving in a
particular direction.
sensation and perception
| Brain Facts
15
VISION. The cornea and lens help produce a clear image of the visual world on the retina, the sheet of photoreceptors and neurons lining the back of the eye. As in
a camera, the image on the retina is reversed: Objects to the right of the center project images to the left part of the retina and vice versa. The eye’s 125 million visual
receptors — composed of rods and cones — turn light into electrical signals. Rods are most sensitive to dim light and do not convey the sense of color; cones work in
bright light and are responsible for acute detail, black-and-white vision, and color vision. The human eye contains three types of cones that are sensitive to red, green,
and blue but, in combination, convey information about all visible colors. Rods and cones connect with a middle cell layer and third cell layer (see inset, above). Light
passes through these two layers before reaching the rods and cones. The two layers then receive signals from rods and cones before transmitting the signals onto the
optic nerve, optic chiasm, lateral geniculate nucleus, and, finally, the visual cortex.
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and perception
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Although the process is not yet completely understood, recent
Vision studies also have led to better treatment for visual disor-
findings suggest that visual signals are fed into at least three separate
ders. Information from research in cats and monkeys has improved
processing systems. One system appears to process information mainly
the therapy for strabismus, or squint, a term for cross-eye or walleye.
about shape; a second, mainly about color; and a third, movement,
Children with strabismus initially have good vision in each eye. But
location, and spatial organization. These findings of separate processing
because they cannot fuse the images in the two eyes, they tend to
systems come from anatomical and physiological studies in monkeys.
favor one eye and often lose useful vision in the other. Vision can be
They are supported by human psychological studies showing that the
restored in such cases, but only during infancy or early childhood.
perception of movement, depth, perspective, the relative size of objects,
Beyond the age of 6 or so, the blindness in one eye becomes perma-
the relative movement of objects, shading, and gradations in texture all
nent. Until a few decades ago, ophthalmologists waited until children
depend primarily on contrasts in light intensity rather than on color.
reached the age of 4 before operating to align the eyes or prescribing
Why movement and depth perception should be emphasized by
one processing system may be explained by a school of thought called
Gestalt psychology. Perception requires various elements to be organized so that related ones are grouped together. This stems from the
brain’s ability to group the parts of an image together and also to separate images from one another and from their individual backgrounds.
How do all these systems combine to produce the vivid images
of solid objects that we perceive? This involves extracting biologically
relevant information at each stage and associating firing patterns of
neuronal populations with past experience.
exercises or an eye patch. Now strabismus is corrected very early in
life — before age 4, when normal vision can still be restored.
Hearing
Often considered the most important sense for humans,
hearing allows us to communicate with each other by receiving
sounds and interpreting speech. It also gives us information vital to
survival; for instance, by alerting us to an approaching car.
Like the visual system, our hearing system distinguishes several
qualities in the signals it detects. Our hearing system, however,
HEARING. From the chirping of crickets
to the roar of a rocket engine, sound waves
are collected by the external ear — the pinna
and the external auditory canal — and funneled to the tympanic membrane (eardrum)
to make it vibrate. Attached to the tympanic
membrane, the malleus (hammer) transmits
the vibration to the incus (anvil), which passes
vibration on to the stapes (stirrup). The stapes
pushes on the oval window, which separates
the air-filled middle ear from the fluid-filled
inner ear, to produce pressure waves in the
snail-shaped cochlea of the inner ear. Hair
cells in the cochlea, riding on the vibrating
basilar membrane, have “hair bundles” of
microscopic stereocilia that are deflected by
the overlying tectorial membrane. Hair cells
convert the mechanical vibration to an electrical signal; they, in turn, release chemicals
to excite the 30,000 fibers of the auditory
nerve that carry the signals to the brainstem.
Auditory information is analyzed by multiple
brain centers as it flows to the temporal gyrus
or auditory cortex, the part of the brain
involved in perceiving sound.
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| Brain Facts
17
does not blend different sounds, as the visual system does when two
allow us to distinguish thousands of different flavors. Alone, taste
different wavelengths of light are mixed to produce color. Instead, it
is a relatively focused sense concerned with distinguishing among
separates complex sounds into their component tones or frequen-
sweet, salty, sour, bitter, and umami (Japanese for “savory”). The
cies so that we can follow different voices or instruments as we
interaction between taste and smell explains why loss of the sense
listen to conversations or to music.
of smell causes a serious reduction in the overall taste experience,
Whether from the chirping of crickets or the roar of a rocket
engine, sound waves are collected by the external ear — the pinna
which we call flavor.
Taste is detected within taste buds, special structures embedded
and the external auditory canal — and funneled to the tympanic
within papillae, or protuberances, located mainly on the tongue.
membrane (eardrum) to make it vibrate. Attached to the tympanic
Others are found in the back of the mouth and on the palate. Every
membrane, the malleus (hammer) transmits the vibration to the
incus (anvil), which passes vibration on to the stapes (stirrup). The
stapes pushes on the oval window, which separates the air-filled
middle ear from the fluid-filled inner ear, to produce pressure waves
in the snail-shaped cochlea of the inner ear. The separation of
frequencies occurs in the cochlea, which is tuned along its length
to different frequencies, so that a high note causes one region of
the cochlea’s basilar membrane to vibrate and a lower note causes a
different region to vibrate.
Hair cells in the cochlea, riding on the basilar membrane,
have hair bundles of microscopic hairlike stereocilia that are
deflected by the overlying tectorial membrane. Hair cells convert
the mechanical vibration to an electrical signal; they in turn excite
the 30,000 fibers of the auditory nerve that carry the signals to the
Although different, the two sensory
experiences of taste and smell
are intimately entwined. They are
separate senses with their own receptor organs. However, these two senses
act together to allow us to distinguish
thousands of different flavors.
brainstem. Because each hair cell rides on a different part of the
basilar membrane, each is best excited by a different frequency, and
so each nerve fiber carries information about a different frequency
to the brain. Auditory information is analyzed by multiple brain
person has between 5,000 and 10,000 taste buds. Taste substances
centers as it flows to the temporal gyrus or auditory cortex, the part
stimulate specialized sensory cells, and each taste bud consists of 50
of the brain involved in perceiving sound.
to 100 of these cells.
In the auditory cortex, adjacent neurons tend to respond to
Taste signals in the sensory cells are transferred to the ends of
tones of similar frequency. However, they specialize in different
nerve fibers, which send impulses along cranial nerves to taste regions
combinations of tones. Some respond to pure tones like a flute, and
in the brainstem. From here, the impulses are relayed to the thalamus
some to complex sounds like a violin. Some respond to long sounds
and on to the cerebral cortex for conscious perception of taste.
and some to short, and some to sounds that rise or fall in frequency.
Specialized olfactory receptor cells are located in a small patch
Other neurons might combine information from these specialist
of mucous membrane lining the roof of the nose. Axons of these
neurons to recognize a word or an instrument.
sensory cells pass through perforations in the overlying bone and
Sound is processed in the auditory cortex on both sides of the
enter two elongated olfactory bulbs lying on top of the bone. The
brain. However the left side in most people is specialized for per-
portion of the sensory cell that is exposed to odors possesses hairlike
ceiving and producing speech. Damage to the left auditory cortex,
cilia. These cilia contain the receptor sites that are stimulated by
such as from a stroke, can leave someone able to hear but unable to
airborne odor molecules. These molecules dissolve in the mucous
understand language.
lining in order to stimulate receptor proteins in the cilia to start
the smell response. An odorant acts on many receptors to different
Taste and smell
degrees. Similarly, a receptor interacts with many different odorants
Although different, the two sensory experiences of taste and
smell are intimately entwined. They are separate senses with their
own receptor organs. However, these two senses act together to
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Brain Facts | sensation
and perception
to varying degrees.
The pattern of activity set up in the receptor cells is projected
to the olfactory bulb, where neurons are activated to form a spatial
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TASTE AND SMELL. Specialized
receptors for smell are located in a
patch of mucous membrane lining the
roof of the nose. Each cell has several
fine hairlike cilia containing receptor
proteins, which are stimulated by odor
molecules in the air, and a long fiber
(axon), which passes through perforations in the overlying bone to enter the
olfactory bulb. Stimulated cells give rise
to impulses in the fibers, which set up
patterns in the olfactory bulb that are
relayed to the primary olfactory cortex
at the back of the brain’s frontal lobe
to give rise to smell perception, and
to the limbic system to elicit emotional
responses. Tastes are detected by special
structures, taste buds, of which every
human has some 5,000 to 10,000. Taste
buds are embedded within papillae
(protuberances) mainly on the tongue,
with a few located in the back of the
mouth and on the palate. Each taste
bud consists of about 100 receptors
that respond to stimuli — sweet, salty,
“image” of the odor. Impulses created by this stimulation pass to the primary olfactory cortex at the back
sour, bitter, and umami — from which
of the underside (or orbital) part of the frontal lobe. Olfactory information then passes to adjacent parts
all tastes are formed. A substance is
of the orbital cortex where it is combined with taste information to form flavor.
tasted when chemicals in foods dissolve
in saliva, enter the pores on the tongue,
Touch and pain
and come in contact with taste buds.
Touch is the sense by which we determine the characteristics of objects: size, shape, and texture.
Here they stimulate hairs projecting from
We do this through touch receptors in the skin. In hairy skin areas, some receptors consist of webs of
the receptor cells and cause signals to
sensory nerve cell endings wrapped around the base of hairs. The nerve endings are remarkably sensi-
be sent from the cells, via synapses, to
tive, being triggered by slight movement of the hairs.
cranial nerves and taste centers in the
Signals from touch receptors pass via sensory nerves to the spinal cord, where they synapse (make
brain. Taste and smell information come
contact) with other nerve cells, which in turn send the information to the thalamus and sensory cortex.
together to form flavor in the caudal
The transmission of this information is highly topographic, meaning that the body is represented in an
(back) part of the orbital cortex.
orderly fashion at different levels of the nervous system. Larger areas of the cortex are devoted to sensations from the hands and lips; much smaller cortical regions represent less sensitive parts of the body.
Different parts of the body vary in their sensitivity to tactile and painful stimuli according to the
number and distribution of receptors. The cornea is several hundred times more sensitive to painful
stimuli than are the soles of the feet. The fingertips are good at touch discrimination, but the torso is
not: You don’t try to figure out what coin is in your pocket by rubbing it on your back.
Neurologists measure sensitivity by determining the patient’s two-point threshold. This method
involves touching the skin with calipers at two points. The two-point threshold is the distance between
the two points that is necessary for the individual to distinguish two distinct stimuli from one. Not sur-
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sensation and perception
| Brain Facts
19
prisingly, acuity is greatest in the most densely nerve-packed areas
of the body. The threshold is lowest on the fingers and lips.
Until recently, pain was thought to represent a simple message
In the ascending system, impulses are relayed from the spinal
cord to several brain structures, including the thalamus and cerebral
cortex, which is involved in the process by which pain messages
resulting from neurons sending electrical impulses from a site of
become a conscious experience. The experience of pain is not just a
injury directly to the brain. We now know that the process is far
function of the magnitude of the injury or even the intensity of the
more complicated. Nerve impulses from sites of injury can persist
impulse activity generated by the injury. The setting in which the
for hours, days, or longer. Moreover, persistent injury can lead to
injury occurs (e.g., the pain of childbirth or that produced in a car
changes in the nervous system that amplify and prolong the “pain”
accident) and the emotional component of the experience are also
signal. The result is a state of hypersensitivity in which pain persists
major contributors to the overall experience.
and can even be evoked by normally innocuous stimuli. Persistent
Pain messages can be suppressed by systems of neurons that
pain is in many respects a disease of the nervous system, not merely
originate within the gray matter in the brainstem. These descend-
a symptom of some other disease process.
ing systems suppress the transmission of pain signals from the dorsal
The sensory fibers that respond to stimuli that damage tissue
and can cause pain are called nociceptors. Different nociceptor
horn of the spinal cord to higher brain centers. Some of these
descending systems use naturally occurring chemicals, the endogenous opioids, or endorphins, which are functionally similar to
morphine. The endorphins act at multiple opioid receptors in the
brain and spinal cord, a discovery that has had important implica-
Until recently, pain was thought to
represent a simple message resulting
from neurons sending electrical impulses
from a site of injury directly to the
brain. We now know that the process
is far more complicated.
tions for pain therapy. For example, scientists began studying the
spinal delivery of opioids when they discovered a dense distribution
of opioid receptors in the spinal cord horn. Such treatments were
begun in humans after the method was successfully used in animals;
the technique is now common in treating pain after surgery.
Modern imaging tools are now used to monitor brain activity
when pain is experienced. One finding is that no single area in the
brain generates pain; rather, emotional and sensory components
together constitute a mosaic of activity leading to pain. Interestingly, when people are hypnotized so that a painful stimulus is not
experienced as unpleasant, activity in only some areas of the brain
is suppressed. The stimulus is still experienced, but it doesn’t hurt
anymore. As such techniques for brain study improve, it should
subsets express molecules that are responsible for the response to
be possible to better monitor the changes in the brain that occur
noxious (i.e., painful) thermal, mechanical, or chemical stimula-
in people with persistent pain and to better evaluate the different
tion. Interestingly, these same molecules respond to plant-derived
painkilling drugs being developed.
chemicals that can produce pain, such as capsaicin, garlic, and
wasabi. Tissue injury also causes the release of numerous chemicals
at the site of damage and inflammation. For example, prostaglandins
enhance the sensitivity of receptors to tissue damage and ultimately
can induce more intense pain sensations. Prostaglandins also contribute to the clinical condition of allodynia, in which innocuous
stimuli can produce pain (as with sunburned skin).
Pain messages are transmitted to the spinal cord via small,
myelinated fibers and C fibers — very small unmyelinated fibers.
The small, myelinated, pain-sensitive nerve fibers probably evoke
the sharp, fast pain that is produced by, for example, a pinprick. C
fiber-induced pain, by contrast, is generally slower in onset, dull,
and more diffuse.
20
Brain Facts | sensation
and perception
Society for Neuroscience
PAIN. Messages about tissue damage are picked up by receptors and transmitted to the spinal cord via small myelinated fibers and very small unmyelinated fibers.
From the spinal cord, the impulses are carried to the brainstem, thalamus, and cerebral cortex and ultimately perceived as pain. These messages can be suppressed
by a system of neurons that originates in the gray matter of the midbrain. This descending pathway sends messages to the spinal cord where it suppresses the
transmission of tissue damage signals to the higher brain centers. Some of these descending pathways use naturally occurring, opiatelike chemicals called endorphins.
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sensation and perception
| Brain Facts
21
L earning , M emory ,
Learning and MemorY. A major break-
and
L anguage
Distinct areas within the prefrontal cortex support executive
through in understanding how the brain accomplishes learning and
functions, such as selection, rehearsal, and monitoring of informa-
memory began with the study of a person known by his initials,
tion being retrieved from long-term memory. To serve these func-
H.M. As a child, H.M. developed a severe and intractable epilepsy,
tions, the prefrontal cortex also interacts with a large network of
and an experimental surgical treatment involving removal of the
posterior cortical areas that encode, maintain, and retrieve specific
medial regions of his temporal lobes greatly alleviated the seizures.
types of information, such as visual images, sounds, and words, as
However, the surgery left H.M. with severe amnesia. He can re-
well as where important events occurred and much more.
member recent events for only a few minutes and is unable to form
Semantic memory is a form of declarative knowledge that in-
explicit memories of new experiences. Talk with him awhile, and
cludes general facts and data. Although scientists are just beginning
then leave the room. When you return, he has no recollection of
to understand the nature and organization of cortical areas involved
ever having seen you.
in semantic memory, it appears that different cortical networks are
Despite his inability to remember new information, H.M.
specialized for processing particular kinds of information, such as
remembers his childhood very well. From these observations,
faces, houses, tools, actions, language, and many other categories of
researchers concluded that the parts of H.M.’s medial temporal lobe
knowledge. Studies using functional imaging of normal humans have
that were removed, including the hippocampus and parahippocampal
revealed zones within a large cortical expanse that selectively process
region, play critical roles in converting memories of experiences
different categories of information, such as animals, faces, or words.
from short-term memories to long-term, permanent memories. The
Our memories of specific personal experiences that happened
fact that H.M. retains some memories for events that occurred long
at a particular place and time are called episodic memories. It is gen-
before his surgery indicates that the medial temporal region is not
erally believed that the medial temporal lobe areas serve a critical
the site of permanent storage but instead plays a role in the organi-
role in the initial processing and storage of these memories. Studies
zation and permanent storage of memories elsewhere in the brain.
The medial temporal region is richly connected to widespread
areas of the cerebral cortex, including the regions responsible for
thinking and language. Whereas the medial temporal region is
important for forming, organizing, consolidating, and retrieving
memory, cortical areas are important for the long-term storage of
knowledge about facts and events and for how this knowledge is
used in everyday situations.
Our ability to learn and consciously remember everyday facts
and events is called declarative memory. Studies using functional
brain imaging have identified a large network of areas in the
cerebral cortex that work together to support declarative memory.
How exactly are memories
stored in brain cells? After years
of study, much evidence supports
the idea that memory involves a
persistent change in synapses, the
connections between neurons.
These cortical areas play a distinct role in complex aspects of perception, movement, emotion, and cognition.
When we have new experiences, information initially enters
working memory, a transient form of declarative memory. Working
memory depends on the prefrontal cortex as well as other cerebral
have shown that different parts of the parahippocampal region play
cortical areas. Studies on animals have shown that neurons in the
distinct roles in processing “what,” “where,” and “when” informa-
prefrontal cortex maintain relevant information during working
tion about specific events. The hippocampus links these elements
memory and can combine different kinds of sensory information
of an episodic memory. The linkages are then integrated back into
when required. In humans, the prefrontal cortex is highly activated
the various cortical areas that represent the details of each type
when people maintain and manipulate memories.
of information.
22
Brain Facts | learning,
memory, and language
Society for Neuroscience
LEARNING AND MEMORY. Different brain areas
and systems mediate distinct forms of memory. The
hippocampus, parahippocampal region, and areas of the
cerebral cortex (including prefrontal cortex) compose a system
that supports declarative, or cognitive, memory. Different forms
of nondeclarative, or behavioral, memory are supported by
the amygdala, striatum, and cerebellum.
The fact that H.M. and other people with amnesia show
Another important model for the study of memory is the
deficits in some types of memories and not others indicates that
phenomenon of long-term potentiation (LTP), a long-lasting increase
the brain has multiple memory systems supported by distinct brain
in the strength of a synaptic response following stimulation. LTP
regions. Nondeclarative knowledge, the knowledge of how to do
occurs prominently in the hippocampus, as well as in the cerebral
something, is expressed in skilled behavior and learned habits and
cortex and other brain areas involved in various forms of memory.
requires processing by the basal ganglia and cerebellum. The cer-
LTP occurs through changes in the strength of synapses at contacts
ebellum is specifically involved in motor tasks that are time-depen-
involving N-methyl-d-aspartate (NMDA) receptors.
dent. The amygdala appears to play an important role in emotional
Subsequently, a series of molecular reactions plays a vital
aspects of memory attaching emotional significance to otherwise
role in stabilizing the changes in synaptic function that occur in
neutral stimuli and events. The expression of emotional memories
LTP. These molecular events begin with the entry of calcium ions
involves the hypothalamus and sympathetic nervous system, which
into the synapse, which activates the cyclic adenosine monophos-
support emotional reactions and feelings. Thus, the brain appears to
phate (cAMP) molecule. This molecule activates several kinds of
process different kinds of information in separate ways.
enzymes, some of which increase the number of synaptic receptors,
How exactly are memories stored in brain cells? After years
making the synapse more sensitive to neurotransmitters. In addi-
of study, much evidence supports the idea that memory involves a
tion, cAMP activates another molecule, called cAMP-response ele-
persistent change in synapses, the connections between neurons. In
ment binding protein (CREB). CREB operates within the nucleus
animal studies, researchers found that this occurs in the short term
of the neuron to activate a series of genes, many of which direct
through bio­chemical events that affect the strength of the relevant
protein synthesis. Among the proteins produced are neurotrophins,
synapses. Turning on certain genes may lead to modifications within
which activate growth of the synapse and increase the neuron’s
neurons that change the strength and number of synapses, stabilizing
responsiveness to stimulation.
new memories. Researchers studying the sea slug Aplysia californica, for
Many studies have shown that the molecular cascade lead-
example, can correlate specific chemical and structural changes in rel­
ing to protein synthesis is not essential to initial learning or to
evant cells with several simple forms of memory that the animal shows.
maintaining short-term memory; however, this cascade is essential
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learning, memory, and language
| Brain Facts
23
for long-term memory. In addition, studies using genetically modi-
is a strongly left-dominant function that relies on frontal lobe areas
fied mice have shown that alterations in specific genes for NMDA
but also involves posterior brain regions in the left temporal lobe.
receptors or CREB can dramatically affect the capacity for LTP in
These appear to be important for accessing appropriate words and
particular brain areas, and the same studies have shown that these
speech sounds.
molecules are critical to memory.
Recently, functional imaging methods have identified new
The many kinds of studies of human and animal memory have
structures involved in language. For example, systems involved in
led scientists to conclude that no single brain center stores memory.
accessing the meaning of words appear to be located (in part) in the
It most likely is stored in distributed collections of cortical process-
middle and inferior portions of the temporal lobe. In addition, the
ing systems that are also involved in the perception, processing, and
anterior temporal lobe is under intense investigation as a site that
analysis of the material being learned. In short, each part of the brain
may participate in some aspect of sentence-level comprehension.
most likely contributes differently to permanent memory storage.
Recent work has also identified a sensory-motor circuit for
speech in the left posterior temporal lobe, which is thought to
Language
translate between speech recognition and speech production sys-
One of the most prominent human abilities is language, a
complex system involving many components, including sensorymotor functions and memory systems. Although the neural basis of
tems. This circuit is involved in speech development and is thought
to support verbal short-term memory.
Although the understanding of how language is implemented
language is not fully understood, scientists have learned a great deal
in the brain is far from complete, there are now several techniques
about this function of the brain from studies of patients who have
that may be used to gain important insights into this critical aspect
lost speech and language abilities owing to stroke, and from brain
of brain function.
imaging studies of normal people.
It has long been known that damage to different regions within
the left hemisphere produce different kinds of language disorders,
or aphasias. Damage to the left frontal lobe can produce nonfluent
aphasias, such as Broca’s aphasia, a syndrome in which speech production abilities are impaired. Speech output is slow and halting, requires
effort, and often lacks complexity in word or sentence structure.
By comparison, comprehension of heard speech is spared, although
structurally complex sentences may be poorly understood.
Damage to the left temporal lobe can produce fluent aphasia,
such as Wernicke’s aphasia, in which comprehension of heard speech
is impaired. Speech output, although of normal fluency and speed,
is often riddled with errors in sound and word selection and tends
to be unintelligible gibberish.
Damage to the superior temporal lobes in both hemispheres
can produce word deafness, a profound inability to comprehend
auditory speech on any level. Whereas Wernicke’s aphasics can
often comprehend bits and pieces of a spoken utterance and can
comprehend isolated words, patients with word deafness are functionally deaf for speech, lacking the ability to comprehend even
single words, despite being able to hear sound and even identify the
emotional quality of speech or the gender of the speaker.
Research on aphasia has led to several conclusions regarding
the neural basis of language. Researchers once believed that all
aspects of language ability were governed only by the left hemisphere. Recognition of speech sounds and words, however, involves
both left and right temporal lobes. In contrast, speech production
24
Brain Facts | learning,
memory, and language
Society for Neuroscience
Movement
From the stands, we marvel at the
particular stimuli, such as the sudden withdrawal of the foot when
perfectly placed serves of professional tennis players and the light-
you step on a sharp object or the slight extension of the leg when a
ning-fast double plays executed by big league baseball infielders. But
physician taps your knee with a small rubber hammer. All reflexes
in fact, each of us in our daily activities performs a host of complex,
involve the activation of small sensory receptors in the skin, the
skilled movements — such as walking upright, speaking, and writ-
joints, or even in the muscles themselves. For example, the knee
ing — that are just as remarkable. This is made possible by a finely
movement referred to above is produced by a slight stretch of the
tuned and highly complex central nervous system, which controls the
knee extensor muscles when the physician taps the muscle tendon
actions of hundreds of muscles. Through learning, the nervous system
at the knee. This slight muscle stretch is “sensed” by receptors in
can adapt to changing movement requirements to accomplish these
the muscle called muscle spindles. Innervated by sensory fibers, the
everyday marvels and to perform them more skillfully with practice.
spindles send information to the spinal cord and brain about the
To understand how the nervous system performs such tricks,
length and speed of the shortening or lengthening of a muscle.
we have to start with the muscles, for these are the body parts that
This information is used in reflex control of the joint at which the
produce movement under the control of the brain and spinal cord.
muscle acts and also for control of voluntary movements.
Most muscles attach to points on the skeleton and cross one or
A sudden muscle stretch sends a barrage of impulses into the
more joints, so they are called skeletal muscles. Activation of a given
spinal cord along the muscle spindle sensory fibers. In turn, these fi-
muscle can open or close the joints that it spans, depending upon
bers activate motor neurons in the stretched muscle, causing a con-
whether it is a joint flexor (closer) or extensor (opener).
traction called the stretch reflex. The same sensory stimulus causes
In addition, if flexors and extensors at the same joint are
inactivation, or inhibition, of the motor neurons of the antagonist
activated together, they can “stiffen” a joint, thus maintaining limb
muscles through connecting neurons, called inhibitory interneurons,
position in the face of unpredictable external forces that would oth-
within the spinal cord. Thus, even the simplest of reflexes involves
erwise displace the limb. Muscles that move a joint in an intended
a coordination of activity across motor neurons that control agonist
direction are called agonists, and those that oppose this direction
and antagonist muscles.
of movement are antagonists. Skilled movements at high speed are
The brain can control not only the actions of motor neurons
started by agonists and stopped by antagonists, thus placing the joint
and muscles but, even more amazing, the nature of the feedback
or limb at a desired position.
that it receives from sensory receptors in the muscles as movements
Some muscles act on soft tissue, such as the muscles that
occur. For example, the sensitivity of the muscle spindle organs is
move the eyes and tongue and those that control facial expression.
controlled by the brain through a separate set of gamma motor neu-
These muscles also are under control of the central nervous system,
rons that control the specialized muscle fibers and allow the brain to
and their principles of operation are similar to those that attach
fine-tune the system for different movement tasks.
to bone.
Each skeletal muscle is made up of thousands of individual
In addition to such exquisite sensing and control of muscle
length by muscle spindles, other specialized sense organs in muscle
muscle fibers, and each muscle fiber is controlled by one alpha motor
tendons — the golgi tendon organs — detect the force applied by
neuron in either the brain or the spinal cord. On the other hand,
a contracting muscle, allowing the brain to sense and control the
each single alpha motor neuron controls many muscle fibers (rang-
muscular force exerted during movement.
ing from a few to 100 or more); an alpha motor neuron and
We now know that these complex systems are coordinated and
all the muscle fibers it contains form a functional unit referred to
organized to respond differently for tasks that require precise control
as a motor unit. These motor units are the critical link between the
of position, such as holding a full teacup, than for those requiring
brain and muscles. If the motor neurons die, which can happen in
rapid, strong movement, such as throwing a ball. You can experi-
certain diseases, a person is no longer able to move, either volun-
ence such changes in motor strategy when you compare walking
tarily or through reflexes.
down an illuminated staircase with the same task done in the dark.
Perhaps the simplest and most fundamental movements are
reflexes. These are relatively fixed, automatic muscle responses to
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Another useful reflex is the flexion withdrawal that occurs if
your bare foot encounters a sharp object. Your leg is immediately
movement
| Brain Facts
25
lifted from the source of potential injury (flexion), but the opposite
axons to the spinal cord. Scientists know that the basal ganglia and
leg responds with increased extension in order to maintain your
thalamus have widespread connections with motor and sensory
balance. The latter event is called the crossed extension reflex.
areas of the cerebral cortex.
These responses occur very rapidly and without your atten-
Dysfunction of the basal ganglia can lead to serious movement
tion because they are built into systems of neurons that are located
disorders. For example, the depletion of the neurotransmitter dop-
within the spinal cord itself. It seems likely that the same systems
amine from specific portions of the basal ganglia results in the tremor,
of spinal neurons also participate in controlling the alternating
rigidity, and akinesia of Parkinson’s disease. Dopamine is supplied to
action of the legs during normal walking. In fact, the basic patterns
the basal ganglia by the axons of neurons located in the substantia
of muscle activation that produce coordinated walking can be
nigra, a midbrain cell group. Dopamine is depleted during Parkinson’s
generated in four-footed animals within the spinal cord itself. These
disease because of the degeneration of the nigral neurons.
spinal mechanisms, which evolved in primitive vertebrates, are
likely still present in the human spinal cord.
The most complex movements that we perform, including
Another brain region that is crucial for coordinating and
adjusting skilled movement is the cerebellum. A disturbance of
cerebellar function leads to poor coordination of muscle control,
voluntary ones that require conscious planning, involve control
disorders of balance and reaching, and even difficulties in speech,
of these basic spinal mechanisms by the brain. Scientists are only
one of the most intricate forms of movement control.
beginning to understand the complex interactions that take place
The cerebellum receives direct and powerful information from
among different brain regions during voluntary movements, mostly
all the sensory receptors in the head and the limbs and from most
through careful experiments on animals.
areas of the cerebral cortex. The cerebellum apparently acts to inte-
One important brain area in the control of voluntary move-
grate all this information to ensure smooth coordination of muscle
ment is the motor cortex, which exerts powerful control over the
action, enabling us to perform skilled movements more or less
spinal cord, in part through direct control of its alpha motor neurons.
automatically. Considerable evidence indicates that the cerebellum
Some neurons in the motor cortex appear to specify the coordinated
helps us adjust motor output to deal with changing conditions, such
action of many muscles to produce the organized movement of a limb
as growth, disability, changes in weight, and aging. It tunes motor
to a particular place in space. Others appear to control only two or
output to be appropriate to the specific requirements of each new
task: Our ability to adjust when picking up a cup of coffee that is
empty or full depends on the cerebellum. Evidence suggests that as
we learn to walk, speak, or play a musical instrument, the necessary,
Scientists are only beginning
to understand the complex
interactions that take place among
different brain regions during
voluntary movements, mostly through
careful experiments on animals.
detailed control information is stored within the cerebellum, where
it can be called upon by commands from the cerebral cortex.
three functionally related muscles, such as those of the hand or arm,
that are important for finely tuned, skilled movement.
In addition to the motor cortex, movement control involves
the interaction of many other brain regions, including the basal
ganglia, thalamus, cerebellum, and a large number of neuron groups
located within the midbrain and brainstem — regions that send
26
Brain Facts | movement
Society for Neuroscience
MOVEMENT. The
stretch reflex (top) occurs
when a doctor taps a
muscle tendon to test your
reflexes. This sends a barrage of impulses into the
spinal cord along muscle
spindle sensory fibers and
activates motor neurons
to the stretched muscle
to cause contraction
(stretch reflex). The same
sensory stimulus causes
inactivation, or inhibition,
of the motor neurons to
the antagonist muscles
through connection
neurons, called inhibitory
neurons, within the spinal
cord. Afferent nerves
carry messages from
sense organs to the spinal
cord; efferent nerves carry
motor commands from the
quote goes here for placement only
color changes to match chapters colors,
spinal cord to muscles.
Flexion withdrawal
(bottom) can occur when
your bare foot encounters a sharp object. Your
leg is immediately lifted
(flexion) from the source
of potential injury, but
the opposite leg responds
with increased extension in order to maintain
your balance. The latter
event is called the crossed
extension reflex. These
responses occur very
rapidly and without your
attention because they
are built into systems of
neurons located within the
spinal cord itself.
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movement
| Brain Facts
27
Sleep
Sleep remains one of the great
sources of disease, disability, and even death, costing an estimated
mysteries of modern neuroscience. We spend nearly one-third of our
$100 billion annually in lost productivity, medical bills, and industrial
lives asleep, but the function of sleep still is not known. Fortunately,
accidents. Research holds promise for devising new treatments to al-
over the past few years, researchers have made great headway in un-
low millions of people to get a good night’s sleep.
derstanding some of the brain circuitry that controls wake-sleep states.
Scientists now recognize that sleep consists of several different
stages; that the choreography of a night’s sleep involves the inter-
Brain activity during sleep
Although sleep appears to be a passive and restful time, it
play of these stages, a process that depends upon a complex switch-
actually involves a highly active and well-scripted interplay of brain
ing mechanism; and that the sleep stages are accompanied by daily
circuits to produce its various stages.
rhythms in hormones, body temperature, and other functions.
Sleep is crucial for concentration, memory, and coordination.
The stages of sleep were discovered in the 1950s in experiments using electroencephalography (EEG) to examine human
Without enough sleep, people have trouble focusing and responding
brain waves during sleep. Researchers also measured movements of
quickly — in fact, sleep loss can have as big an effect on performance
the eyes and the limbs. They found that over the course of the first
as drinking alcohol. It is also important for our emotional health. And
hour or so of sleep each night, the brain progresses through a series
growing evidence suggests that a lack of sleep increases the risk of a
of stages during which the brain waves slow down. This period of
variety of health problems, including diabetes, cardiovascular disease
slow wave sleep is accompanied by relaxation of the muscles and
and heart attacks, stroke, depression, high blood pressure, obesity, and
the eyes. Heart rate, blood pressure, and body temperature all
infections.
fall. If awakened at this time, most people recall only fragmented
Disorders of sleep are among the nation’s most common health
problems, affecting up to 70 million people, most of whom are undiagnosed and untreated. These disorders are one of the least recognized
thoughts, not an active dream.
Over the next half hour or so, brain activity alters drastically
from deep slow wave sleep to generate neocortical EEG waves that
SLEEP PATTERNS. During a night of sleep, the brain waves of a young adult recorded by the electroencephalogram (EEG) gradually slow down and become larger as
the individual passes into deeper stages of slow wave sleep. After about an hour, the brain re-emerges through the same series of stages, and there is usually a brief period of REM sleep (on dark areas of graph), during which the EEG is similar to wakefulness. The body is completely relaxed; the person is deeply unresponsive and usually
is dreaming. The cycle repeats over the course of the night, with more REM sleep, and less time spent in the deeper stages of slow wave sleep as the night progresses.
28
Brain Facts | sleep
Society for Neuroscience
are similar to those observed during waking. Paradoxically, the fast,
cause arousal from sleep. Other people have episodes in which their
waking-like EEG activity is accompanied by atonia, or paralysis
muscles fail to become paralyzed during REM sleep, and they act out
of the body’s muscles (only the muscles that allow breathing and
their dreams. This REM behavior disorder also can be very disruptive
control eye movements remain active). This state is often called
to a normal night’s sleep. Both disorders are more common in people
rapid eye movement (REM) sleep. During REM sleep, there is active
with Parkinson’s disease, and both can be treated with drugs for
dreaming. Heart rate, blood pressure, and body temperature become
Parkinson’s or with a benzodiazepine called clonazepam.
much more variable. Men often have erections during this stage of
sleep. The first REM period usually lasts 10 to 15 minutes.
During the night, these cycles of slow wave and REM sleep
Narcolepsy is a relatively uncommon condition — only one
case per 2,500 people — in which the switching mechanisms
controlling the transitions into sleep, particularly REM sleep, do
alternate, with the slow wave sleep becoming less deep and the
not work properly. This problem is due to the loss of nerve cells in
REM periods more prolonged until waking occurs. Over the course
the lateral hypothalamus containing the neurotransmitter orexin
of a lifetime, the pattern of sleep cycles changes. Infants sleep up
(also known as hypocretin). Narcoleptics have sleep attacks during
to 18 hours per day, and they spend much more time in deep slow
the day, in which they suddenly fall asleep. This is socially disrup-
wave sleep. As children mature, they spend less time asleep and
tive, as well as dangerous — for example, if it strikes while they are
less time in deep slow wave sleep. Older adults may sleep only six
driving. They tend to enter REM sleep very quickly as well and may
to seven hours per night, often complain of early waking that they
even enter a dreaming state while still partially awake, a condition
cannot avoid, and spend very little time in slow wave sleep.
known as hypnagogic hallucination. They also have attacks during
Sleep disorders
The most common sleep disorder, and the one most people
are familiar with, is insomnia. Some people have difficulty falling
asleep initially, but other people fall asleep and then awaken partway
which they lose muscle tone — similar to what occurs during REM
sleep but while they are awake. These attacks of paralysis, known as
cataplexy, can be triggered by emotional experiences, even by hearing a funny joke.
Recently, studies into the mechanism of narcolepsy have given
through the night and cannot fall asleep again. Although a variety
researchers major insight into the processes that control these
of short-acting sedatives and sedating antidepressant drugs are avail-
mysterious transitions between waking, slow wave sleep, and REM
able to help, none produces a truly natural and restful sleep state
sleep states.
because they tend to suppress the deeper stages of slow wave sleep.
Excessive daytime sleepiness may have many causes. The most
common are disorders that disrupt sleep and result in inadequate
amounts of sleep, particularly of the deeper stages.
How is sleep regulated?
During wakefulness, the brain is kept in an active or aroused
state by the actions of two major systems of nerve cells that use
In obstructive sleep apnea, as sleep deepens, the airway muscles
either acetylcholine or monoamines, such as norepinephrine, sero-
in the throat relax to the point of collapse, closing the airway. This
tonin, dopamine, and histamine, as their neurotransmitters. Nerve
prevents breathing, which causes arousal from sleep and prevents
cells in the upper part of the pons and in the midbrain that mainly
the sufferer from entering the deeper stages of slow wave sleep.
contain acetylcholine send inputs to activate the thalamus. When
This condition also can cause high blood pressure and may increase
the thalamus is activated, it in turn provides information from the
the risk of heart attack. Increased daytime sleepiness leads to an
sensory systems about the world around us to the cerebral cortex.
increased risk of daytime accidents, especially automobile accidents.
Other nerve cells in the upper brainstem, largely containing nor-
Treatment may include a variety of attempts to reduce airway col-
epinephrine, serotonin, and dopamine, send their outputs directly
lapse during sleep. Whereas simple things like losing weight, avoid-
to the hypothalamus, the basal forebrain, and the cerebral cortex.
ing alcohol and sedating drugs prior to sleep, and avoiding sleeping
They are joined by nerve cells in the hypothalamus containing the
on one’s back can sometimes help, most people with sleep apnea
neurotransmitter orexin and another group containing histamine,
require devices that induce continuous positive airway pressure to
and neurons in the basal forebrain containing acetylcholine or
keep the airway open. This can be accomplished by fitting a small
GABA, all of which also send outputs directly to the cortex. This
mask over the nose that provides an airstream under pressure during
activates the cerebral cortex so that input from the thalamus is
sleep. In some cases, surgery is needed to correct the airway anatomy.
interpreted accurately during wakefulness.
Periodic limb movements of sleep are intermittent jerks of the legs
or arms that occur as the individual enters slow wave sleep and can
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During REM sleep, the cholinergic nerve cells activate the
thalamus, producing an EEG pattern that is similar to wakefulness,
sleep
| Brain Facts
29
THE WAKING AND SLEEPING BRAIN. Wakefulness is
maintained by activity in two systems of neurons. Neurons that make the
neurotransmitter acetylcholine are located in two main arousal centers,
one in the brainstem (green pathways) and one in the forebrain (red
pathway). The brainstem arousal center supplies the acetylcholine for
the thalamus and brainstem, and the forebrain arousal center supplies
that for the cerebral cortex. Activation of these centers alone can create
rapid eye movement sleep. Activation of other neurons that make
monoamine neurotransmitters such as norepinephrine, serotonin, and
histamine (blue pathways) is needed for waking.
but the monoamine pathway from the upper brainstem directly
to the cerebral cortex is quiet. As a result, the input from the
thalamus to the cerebral cortex is perceived as dreams. When
the nerve cells containing the monoamine neurotransmitters
are active, they suppress the occurrence of REM sleep.
The brainstem cell groups that control arousal from sleep
of wakefulness followed by rest and sleep. Several mechanisms for
are, in turn, influenced by two groups of nerve cells in the hypo-
the signal of accumulating sleep have been suggested. Evidence
thalamus, the part of the brain that controls basic body cycles. One
suggests that levels of a chemical called adenosine, which is linked
group of nerve cells, in the ventrolateral preoptic nucleus, contains
to brain energy and activity homeostasis, increase in the brain
the inhibitory neurotransmitters galanin and GABA. When the
during prolonged wakefulness and that these levels modulate sleep
ventrolateral preoptic neurons fire, they are thought to turn off the
homeostasis. Interestingly, the drug caffeine, which is widely used
arousal systems, causing sleep. Damage to the ventrolateral preoptic
to prevent sleepiness, acts as an adenosine blocker.
nucleus produces irreversible insomnia.
A second group of nerve cells in the lateral hypothalamus
If an individual does not get enough sleep, the sleep debt
progressively accumulates and leads to a degradation of mental
promotes wakefulness and suppresses REM sleep. They contain
function. When the opportunity to sleep comes again, the individ-
the neurotransmitter orexin, which provides an excitatory signal
ual will sleep much more, to “repay” the debt. The slow wave sleep
to the arousal system, particularly to the monoamine neurons. In
debt is usually “paid off” first.
experiments in which the gene for the neurotransmitter orexin was
The other major influence on sleep cycles is the brain’s circa-
experimentally removed in mice, the animals became narcoleptic.
dian timing system. The suprachiasmatic nucleus is a small group of
Similarly, in two dog species with naturally occurring narcolepsy, an
nerve cells in the hypothalamus that acts as a master clock. These
abnormality was discovered in the gene for the type 2 orexin recep-
cells express clock proteins, which go through a biochemical cycle
tor. Although humans with narcolepsy rarely have genetic defects
of about 24 hours, setting the pace for daily cycles of activity, sleep,
in orexin signaling, most develop the disorder in their teens or 20s
hormone release, and other bodily functions. The suprachiasmatic
because of the loss of orexin nerve cells. Recent studies show that
nucleus also receives input directly from the retina, and the clock
in humans with narcolepsy, the orexin levels in the brain and spinal
can be reset by light so that it remains linked to the outside world’s
fluid are abnormally low. Thus, orexin appears to play a critical role
day-night cycle. The suprachiasmatic nucleus provides signals to an
in activating the monoamine system and in preventing abnormal
adjacent brain area, called the subparaventricular nucleus, which in
transitions, particularly into REM sleep.
turn contacts the dorsomedial nucleus of the hypothalamus. The dor-
Two main signals control our need for sleep and its circuitry.
First is homeostasis, or the body’s need to seek a natural equilibrium
30
Brain Facts | sleep
somedial nucleus in turn contacts the ventrolateral preoptic nucleus
and the orexin neurons that directly regulate sleep and arousal.
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Stress
The ability to react in response to threatening events has been with us since the time of our ancient ancestors.
The immediate response
A stressful situation activates three major communication
In response to impending danger, muscles are primed, attention is
systems in the brain that regulate bodily functions. Scientists have
focused, and nerves are readied for action — “fight or flight.” In to-
come to understand these complex systems through experiments
day’s complex and fast-paced world, stressors are more consistently
primarily with rats, mice, and nonhuman primates, such as mon-
psychological or socially based, and we face them with less reprieve.
keys. Scientists then verified the action of these systems in humans.
The continued stimulation of the systems that respond to threat
The first of these systems is the voluntary nervous system, which
or danger may contribute to heart disease, obesity, arthritis, and
sends messages to muscles so that we may respond to sensory infor-
depression, as well as accelerating the aging process.
mation. For example, the sight of a shark in the water may prompt
Nearly two-thirds of ailments seen in doctors’ offices are
adversely affected by stress; indeed, stress can both cause diseases
you to run from the beach as quickly as possible.
The second communication system is the autonomic nervous
and exacerbate existing ones. Surveys indicate that 60 percent of
system. It combines the sympathetic branch and the parasympathetic
Americans feel they are under a great deal of stress at least once a
branch. The sympathetic nervous system gets us going in emergen-
week. Costs due to stress from absenteeism, medical expenses, and
cies, while the parasympathetic nervous system keeps the body’s
lost productivity are estimated at $300 billion annually.
maintenance systems, such as digestion, in order and calms the
Stress is difficult to define because its effects vary with each
individual. Specialists now define stress as any external stimulus
body’s responses to the emergency branch.
Each of these systems has a specific task. The sympathetic
that threatens homeostasis — the normal equilibrium of body
branch causes arteries supplying blood to the muscles to relax in
function. Stress also can be induced by the belief that homeostasis
order to deliver more blood, allowing greater capacity to act. At
might soon be disrupted. Among the most powerful stressors are
the same time, blood flow to the skin, kidneys, and digestive tract is
psychological and psychosocial stressors that exist between mem-
reduced, and supply to the muscles increases. In contrast, the para-
bers of the same species. Lack or loss of control is a particu-
sympathetic branch helps to regulate bodily functions and soothe
larly important feature of severe psychological stress that can
the body once the stressor has passed, preventing the body from
have physiological consequences. Most harmful are the chronic
remaining too long in a state of mobilization. If these functions are
aspects of stress.
left mobilized and unchecked, disease can develop. Some actions
During the past several decades, researchers have found that
stress both helps and harms the body. When confronted with a
crucial physical challenge, properly controlled stress responses can
of the calming branch appear to reduce the harmful effects of the
emergency branch’s response to stress.
The brain’s third major communication process is the neuroen-
provide the extra strength and energy needed to cope. Moreover,
docrine system, which also maintains the body’s internal function-
the acute physiological response to stress protects the body and
ing. Various stress hormones travel through the blood and stimulate
brain and helps to re-establish or maintain homeostasis. But stress
the release of other hormones, which affect bodily processes such as
that continues for prolonged periods can repeatedly elevate physi-
metabolic rate and sexual function.
ological stress responses or fail to shut them off when they are not
The major stress hormones are epinephrine (also known as adren-
needed. When this occurs, the same physiological mechanisms can
aline) and cortisol. When the body is exposed to stressors, epineph-
badly upset the body’s biochemical balance and accelerate disease.
rine, which combines elements of hormones and neurotransmitters, is
Scientists also believe that the individual variation in responding to stress is somewhat dependent on a person’s perception of
external events. This perception ultimately shapes his or her inter-
quickly released into the bloodstream to put the body into a general
state of arousal and enable it to cope with a challenge.
The adrenal glands secrete glucocorticoids, which are hor-
nal physiological response. Thus, by controlling your perception
mones that produce an array of effects in response to stress. These
of events, you can do much to avoid the harmful consequences
include mobilizing energy into the bloodstream from storage sites
of the sorts of mild to moderate stressors that typically afflict
in the body, increasing cardiovascular tone, and delaying long-term
modern humans.
processes in the body that are not essential during a crisis, such as
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stress
| Brain Facts
31
feeding, digestion, growth, and reproduction. In primates, the main
and atherosclerosis (hardening of the arteries). Epinephrine also
glucocorticoid is cortisol (hydrocortisone), whereas in rodents, it
increases the activity of body chemicals that contribute to inflam-
is corticosterone. Some of the actions of glucocorticoids help to
mation, and these chemicals add to the burden of chronic stress,
mediate the stress response, while some of the other, slower actions
potentially leading to arthritis and possibly aging of the brain.
counteract the primary response to stress and help re-establish
Stress also can contribute to sleep loss. Elevated levels of
homeostasis. Over the short run, epinephrine mobilizes energy and
glucocorticoids can delay the onset of sleep, and sleep deprivation
delivers it to muscles for the body’s response. Cortisol promotes
raises glucocorticoid levels, setting off a vicious cycle.
energy replenishment and efficient cardiovascular function.
Glucocorticoids also affect food intake during the sleep-wake
Scientists have identified a variety of stress-related disorders,
including colitis, high blood pressure, clogged arteries, impotency
cycle. Cortisol levels, which vary naturally over a 24-hour period,
and loss of sex drive in males, irregular menstrual cycles in females,
peak in the body in the early-morning hours just before waking.
and adult-onset diabetes. Aging rats show impairment of neuronal
This hormone acts as a wake-up signal and helps turn on appetite
function in the hippocampus — an area of the brain important
and physical activity. This effect of glucocorticoids may help to
for learning, memory, and emotion — as a result of glucocorticoid
explain disorders such as jet lag, which results when the light-dark
secretion throughout their lifetimes.
cycle is altered by travel over long distances, causing the body’s
Overexposure to glucocorticoids also increases the number of
biological clock to reset itself more slowly. Until that clock is reset,
neurons damaged by stroke. Moreover, prolonged exposure before
cortisol secretion and hunger, as well as sleepiness and wakefulness,
or immediately after birth can cause a decrease in the normal num-
occur at inappropriate times of day in the new location.
ber of brain neurons and smaller brain size.
Acute stress also enhances memory of threatening situations
The immune system, which receives messages from the nervous
and events, increases activity of the immune system, and helps pro-
system, also is sensitive to many of the circulating hormones of the
tect the body from pathogens. Cortisol and epinephrine facilitate
body, including stress hormones. Although acute elevations of stress
the movement of immune cells from the bloodstream and storage
hormones actually facilitate immune function, sustained exposure
organs such as the spleen into tissue where they are needed to
to moderate to high levels of glucocorticoids acts to suppress im-
defend against infection.
mune function.
Glucocorticoids do more than help the body respond to stress.
While acute, stress-induced immunoenhancement can be
In fact, they are an integral part of daily life and the adaptation to
protective against disease pathogens, glucocorticoid-induced
environmental change. The adrenal glands help protect us from
immunosuppression also can be beneficial. Normally, the gluco-
stress and are essential for survival.
corticoids help reverse the immunoenhancement brought about
Chronic stress
When glucocorticoids or epinephrine are secreted in response
by stress. Without this reversal, there is an increased chance of
diseases of overactive immunity and inflammation, such as autoimmune disorders, which occur when the body’s immune defenses turn
to the prolonged psychological stress commonly encountered by
against body tissue. Synthetic glucocorticoids like hydrocortisone
modern humans, the results are not ideal. Normally, bodily systems
and prednisone suppress the immune system and therefore are used
gear up under stress and release hormones to improve memory,
often to treat autoimmune and inflammatory diseases.
increase immune function, enhance muscular activity, and restore
One important determinant of resistance or susceptibility
homeostasis. If you are not fighting or fleeing but standing frus-
to disease may be a person’s sense of control as opposed to a feeling
trated in a supermarket checkout line or sitting in a traffic jam, you
of helplessness. This phenomenon may help explain large individu-
are not engaging in muscular exercise. Yet these systems continue
al variations in response to disease. Scientists are trying to identify
to be stimulated, and when they are stimulated chronically, the
how the perception of control or helplessness influences physiologi-
consequences are different: Memory is impaired, immune function
cal responses to stress, including the regulation of immune function.
is suppressed, and energy is stored as fat.
Overexposure to cortisol also can lead to weakened muscles
The cardiovascular system receives many messages from the
autonomic nervous system, and stressful experiences have an imme-
and can chip away at the mechanisms that keep our body systems
diate and direct effect on heart rate and blood pressure. In the short
in a healthy balance. Elevated epinephrine release increases blood
run, these changes help in response to stressors. But when stressors
pressure. Together, elevated cortisol and epinephrine can contribute
are chronic and psychological, the effect can be harmful and result
to chronic hypertension (high blood pressure), abdominal obesity,
in accelerated atherosclerosis and increased risk for heart attack.
32
Brain Facts | stress
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THE STRESS REACTION. When stress
occurs, the sympathetic nervous system is triggered. Norepinephrine is released by nerves,
and epinephrine is secreted by the adrenal
glands. By activating receptors in blood vessels
and other structures, these substances ready
the heart and working muscles for action.
Acetylcholine is released in the parasympathetic nervous system, producing calming
effects. The digestive tract is stimulated to
digest a meal, the heart rate slows, and the
pupils of the eyes become smaller. The neuroendocrine system also maintains the body’s
normal internal functioning. Corticotrophinreleasing hormone (CRH), a peptide
formed by chains of amino acids, is
released from the hypothalamus, a
collection of cells at the base of the
brain that acts as a control center
for the neuroendocrine system.
CRH travels to the pituitary gland,
where it triggers the release of adrenocorticotropic hormone (ACTH). ACTH travels
in the blood to the adrenal glands, where it
stimulates the release of cortisol.
Research supports the idea that people holding jobs that carry high
finding confirmed that hostility scores do not predict the biological
demands and low control, such as telephone operators, waiters, and
response to simple mental tasks.
cashiers, have higher rates of heart disease than people who can dictate
the pace and style of their working lives.
Behavioral type affects a person’s susceptibility to heart attack.
Then the researchers added harassment to the test by leading the
subjects to believe that their performances were being unfairly criticized. Men with high hostility scores showed much larger increases in
People at greatest risk are hostile, irritated by trivial things, and
muscle blood flow and blood pressure and showed slower recovery than
exhibit signs of struggle against time and other challenges. Research-
those with low hostility scores. Scientists found that harassed men with
ers found that two groups of men — one with high hostility scores and
high hostility scores had larger increases in levels of stress hormones.
the other with low hostility scores — exhibited similar increases in
Thus, if you have personality traits of hostility, learning to reduce or
blood pressure and muscle blood flow when performing a lab test. This
avoid anger could be important to avoid cardiovascular damage.
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stress
| Brain Facts
33
Aging
Neuroscientists believe that the brain
All human behavior is determined by how well the brain’s
can remain relatively healthy and fully functioning as it ages and
communication systems work. Often a failure in the cascade of one
that diseases cause the most severe decline in memory, intelligence,
of these systems results in a disturbance of normal function. Such a
verbal fluency, and other tasks. Researchers are investigating both
failure may be caused by an abnormal biochemical process or a loss
the abnormal and normal changes that occur over time and their
of connections between neurons.
effect on reasoning and other intellectual activities.
The effects of age on brain function are subtle and very selective.
The cause of normal brain aging remains a mystery. Dozens of
theories abound. One says that specific “aging genes” are switched
Almost everyone gets a bit forgetful in old age, particularly in forming
on at a certain time of life. Another points to genetic mutations
memories of recent events. For example, once you reach your 70s, you
or deletions. Other theories implicate hormonal influences, an im-
may start to forget names, phone numbers, or where you parked your
mune system gone awry, and the accumulation of damage caused by
car, or you might respond more slowly to conflicting information.
free radicals, cell byproducts that destroy fats and proteins vital to
This is not disease. Some individuals, however, develop senile demen-
normal cell function.
tia, the progressive and severe impairment in mental function that
interferes with daily living. The senile dementias include Alzheimer’s
and cerebrovascular diseases and affect about 1 percent of people
Aging neurons
The brain reaches its maximum weight near age 20; subtle
younger than age 65, with the incidence possibly increasing to nearly
changes in the chemistry and structure of the brain begin at
50 percent in those older than 85. In a small, third group, mental
midlife for most people. During a lifetime, the brain is at risk for
functioning seems relatively unaffected by age. Many people do well
losing some of its neurons, but normal aging does not result in
throughout life and continue to do well even when old, at least until
widespread neuron loss as occurs in Alzheimer’s disease or after
shortly before death. The wisdom and experience of older people
a stroke. Brain tissue can respond to damage or loss of neurons
often make up for deficits in performance. The oldest human, Jeanne
by expanding dendrites and fine-tuning connections between
Calment, kept her wits throughout her 122-year life span.
neurons. A damaged brain neuron can readjust to damage only
The belief that pronounced and progressive mental decline is
if its cell body remains intact. If it does, regrowth can occur in
inevitable was and still is popular for several reasons. For one, until
dendrites and axons. When neurons are destroyed, nearby surviv-
the 20th century, few people lived past 65. In 1900, when average
ing neurons can compensate, in part, by growing new dendrites and
life expectancy was about 47 years, 3 million people, or 4 percent
connections. Physical exercise also can improve neuronal functions
of the population, were older than age 65 and typically were ill. In
at later ages.
2003, when life expectancy was more than 77 years, nearly 36 million
people, or more than 12 percent of the population, were older than
Intellectual capacity
age 65. A generation ago, frailty was seen among people in their
From the first large studies to monitor the same group of healthy
60s; today it is more typical among those in their 80s. Moreover,
humans for many years, scientists have uncovered unexpected results.
few people challenged the notion that aging meant inevitable brain
They report declines in some mental functions and improvements
decline because scientists knew little about the brain or the aging pro-
in others. In several studies, the speed of carrying out certain tasks
cess. Today’s understanding of how the normal brain ages comes from
becomes slower, but vocabulary improves. Other findings demonstrate
studies of the nervous system that began decades ago and are just now
less severe declines in the type of intelligence relying on learned or
bearing results. Modern technologies now make it possible to explore
stored information compared with the type that uses the ability to
the structure and function of the brain in more depth than ever before
deal with new information.
and to ask questions about what actually happens in its aging cells.
Thus, neuroscientists are increasingly able to distinguish
This research is supported by animal studies in which scientists
find that changes in mental function are subtle. For example, in
between the processes of normal aging and disease. Although some
rodents and primates in which only minor brain abnormalities can be
changes do occur in normal aging, they are not as severe as scien-
detected, certain spatial tasks, such as navigating to find food, tend to
tists once thought and certainly do not include widespread cell loss.
become more difficult with age.
34
Brain Facts | aging
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THE AGING BRAIN.
Studies of people who have
died contradict the popular belief
that adults lose an enormous
number of neurons every day.
In fact, many areas of the brain,
primarily in the cortex, maintain
most of their neurons. Examples
include the parietal cortex, which
plays a role in sensory processes
and language, and the striate
cortex, which processes visual
information. The connectivity
between neurons changes with
aging, so that the brain is constantly capable of being modified
or improved.
The aging brain is only as resilient as its circuitry. Scientists
motor learning generates new synapses. Physical exercise, however,
debate whether this circuitry is changed only by neuron atrophy
improved blood circulation in the brain. Aerobic exercise can also
or whether some neuron loss over time also is inevitable. In any
improve cognitive performance in humans.
event, when the circuitry begins to break down, remaining neurons
Although much has been learned about the aging brain, many
can adapt by expanding their roles, and larger portions of the brain
questions remain. For instance, does the production of proteins
can be recruited in older people to accomplish performance levels
decline with age in all brain neurons? In a given neuron, does
similar to those of younger adults.
atrophy lead to a higher likelihood of death? How does aging affect
Learning conditions may dictate what happens to brain cells.
gene expression in the brain — the organ with the greatest number
Studies of rats shed light on some of the changes that occur in
of active genes? Do hormonal changes at menopause contribute to
brain cells when the animals live in challenging and stimulating
gender differences in brain aging?
environments. Middle-aged rats exposed to such environments
Neuroscientists speculate that certain genes may be linked to
formed more and longer dendrite branches in the cerebral cortex
events leading to cell death in the nervous system. By understand-
than did rats housed in isolated conditions. In response to enriched
ing the biology of the proteins produced by genes, scientists hope to
environments, older rats tend to form new dendrite outgrowths and
be able to influence the survival and function of neurons.
synapses, just as younger animals do. But the response is more sluggish and not as large. Compared with younger rats, older rats have
less growth of the new blood vessels that nourish neurons.
Another study showed that brain cells in rats given acrobatic
training had more synapses per cell than rats given only physical
exercise or rats that were inactive. The scientists concluded that
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aging
| Brain Facts
35
Neural Disorders:
Advances and Challenges
In
this
n Addiction
n Alzheimer’s Disease
n Amyotrophic Lateral Sclerosis
n Anxiety Disorders
n Attention
36
Chapter —
Addiction
Drug abuse is one of the nation’s most serious health problems.
Indeed, 9 percent of Americans, more than 22 million people,
abuse drugs on a regular basis. Recent estimates show that the abuse
Deficit Hyperactivity Disorder
of drugs, including alcohol and nicotine, costs the nation more
than $276 billion each year.
If continued long enough, drug abuse — often defined as
harmful drug use — can eventually alter the very structure and
chemical makeup of the brain, producing a true brain disorder. This
disorder is called drug addiction or drug dependence. Drug addiction
is characterized by a pathological desire for drugs, such that drugseeking and drug-taking behaviors occupy an inordinate amount of
n Autism
n Bipolar Disorder
n Brain Tumors
and terminating use, despite a stated desire to do so.
n Down Syndrome
reasons, one of which is that most drugs of abuse produce feelings of
n Dyslexia
n Huntington’s Disease
activating a specific network of neurons called the brain reward sys-
n Major Depression
ing that helps us to stay alive. It evolved to mediate the pleasurable
n Multiple Sclerosis
are hungry or drinking when we are thirsty. Indeed, when a reward
n Neurological AIDS
n Neurological Trauma
n Pain
abuse affect neurons to exert their influence. Abused drugs alter the
n Parkinson’s Disease
Some drugs mimic neurotransmitters, whereas others block them.
n Schizophrenia
vated. Ultimately, in all cases, the brain reward system is activated
n Seizures and Epilepsy
n Stroke
n Tourette Syndrome
Brain Facts |
an individual’s time and thoughts, at the expense of other activities,
and these behaviors persist despite many adverse consequences. Addiction is also characterized by difficulty controlling frequency of use
People initially experiment with drugs for many different
pleasure or remove feelings of stress and emotional pain. Neuroscientists have found that almost all abused drugs produce pleasure by
tem. The circuit is normally involved in an important type of learnand motivating effects of natural rewards, such as eating when we
produces feelings of pleasure, we learn to repeat the actions that got
us the reward in the first place. Drugs can activate this same system
and therefore can also promote continued drug use.
Neuroscientists have learned a great deal about how drugs of
ways neurotransmitters carry their messages from neuron to neuron.
Still others alter the way neurotransmitters are released or inactiinappropriately because drugs alter the chemical messages sent
among neurons in this circuit.
Finally, neuroscientists have learned that addiction requires
more than the activation of the brain reward system. Over the past
neural disorders: advances and challenges
20 years or so, research has indicated that the drugs themselves
change the brain of susceptible individuals in complex ways, leading
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to symptoms of addiction. The brain regions that are changed by
drugs include the brain reward system as well as brain regions involved in executive functions and judgment. These latter brain systems are important in inhibiting behavior and in decision-making.
The process of becoming addicted is influenced by many factors that scientists are only beginning to understand. Motivation for
drug use is an important one. For example, people who take opioids
to get high may get addicted, but people who use them properly to
relieve pain rarely do. Genetic susceptibility and environmental
factors, such as stress, also alter the way that people respond to
drugs. The characteristics of the drugs themselves, such as how
quickly they enter the brain, also play a role in addiction. In addition, the development of tolerance — the progressive need for a
higher drug dose to achieve the same effect — varies in different
people, as does drug dependence — the adaptive physiological state
that results in withdrawal symptoms when drug use stops. Tolerance
and dependence are standard responses of the brain and body to
the presence of drugs. However, addiction requires that these occur
while a motivational form of dependence — the feeling that a person
can’t live without a drug — also is developing.
An important question for addiction research is to understand
how these many factors interact to predispose individuals to addiction and, conversely, how to protect them. The knowledge and
insight into abuse and addiction arising from this research will lead
to new therapies.
Alcohol Although legal, alcohol is addictive. Alcohol abuse and
alcohol addiction — sometimes referred to as alcoholism or alcohol
dependence — together are one of the nation’s major health problems.
Nearly 14 million people abuse alcohol or are alcoholic. Fetal alcohol syndrome, affecting about 0.5 to 3 of every 1,000 babies born in
the United States, is the leading preventable cause of mental retarda-
BRAIN DRUG REWARD SYSTEMS. Scientists are not certain about all
tion. Cirrhosis, the main chronic health problem associated with
the structures involved in the human brain reward system. However, studies of
alcohol addiction, and other chronic liver diseases are responsible for
rat and monkey brains, and brain imaging studies in humans, have provided
more than 25,000 deaths each year. The annual cost of alcohol abuse
many clues. These illustrations show what areas are most likely part of the re-
and addiction is estimated at $185 billion.
ward systems in the human brain. A central group of structures is common to the
Genetic and environmental factors contribute to alcoholism,
actions of all drugs. These structures include a collection of dopamine-containing
but no single factor or combination of factors enables doctors to
neurons found in the ventral tegmental area. These neurons are connected to
predict who will become an alcoholic.
the nucleus accumbens and other areas, such as the prefrontal cortex. Cocaine
Alcohol activates the endogenous opioid system so that sus-
exerts its effects mainly through this system. Opiates act in this system and many
ceptible individuals may feel an opioidlike euphoria from their own
other brain regions, including the amygdala, that normally use opioid peptides.
endorphins when they drink. Based on animal research showing
Opioids are naturally occurring brain chemicals that induce the same actions as
that opiate receptors were involved in the dopamine-reward activa-
drugs, such as heroin and morphine. Alcohol activates the core reward system
tion of alcohol, naltrexone, a medication developed for heroin ad-
and additional structures throughout the brain because it acts where GABA
diction, was used to treat alcoholics. Clinical trials began in 1983,
and glutamate are used as neurotransmitters. GABA and glutamate are widely
and in 1995, naltrexone was approved by the U.S. Food and Drug
distributed in the brain, including in the cortex, hippocampus, amygdala, and
Administration (FDA) for the treatment of alcoholism.
nucleus accumbens.
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neural disorders: advances and challenges
| Brain Facts
37
Ethanol, the active ingredient in alcoholic beverages, reduces
anxiety, tension, and inhibitions. In low doses, it may act as a
stimulant, whereas at higher doses, it acts as a depressant. In both
to unexpected adverse reactions and even death after high doses.
Physical exhaustion also can enhance some toxicities and problems.
Marijuana This drug distorts perception and alters the sense
cases, it significantly alters mood and behavior. It can also cause
of time, space, and self. In certain situations, marijuana can produce
heat loss and dehydration.
intense anxiety.
The drug, which is easily absorbed into the bloodstream and
In radioactive tracing studies, scientists found that tetrahy-
the brain, affects several neurotransmitter systems. For example,
drocannabinol (THC), the active ingredient in marijuana, binds
alcohol’s interaction with the gamma-aminobutyric acid (GABA)
to specific receptors, many of which coordinate movement. This
receptor can calm anxiety, impair muscle control, and delay reac-
may explain why people who drive after they smoke marijuana are
tion time. At higher doses, alcohol also decreases the function
impaired. The hippocampus, a structure involved with memory
of N-methyl-d-aspartate (NMDA) receptors that recognize the
storage and learning, also contains many receptors for THC. This
neurotransmitter glutamate. This interaction can cloud thinking
may explain why heavy users or those intoxicated on marijuana
and eventually lead to coma.
have poor short-term memory and problems processing complex
Club drugs Ecstasy, herbal ecstasy, Rohypnol (“roofies”),
information. Scientists recently discovered that these receptors nor-
GHB (gamma hydroxy-butyrate), and ketamine are among the
mally bind to natural internal chemicals termed endocannabinoids,
drugs used by some teens and young adults as part of raves and
one of which is called anandamide. A large effort is now addressing
trances. These drugs are rumored to increase stamina and to pro-
the development of medications that target the endogenous can-
duce intoxicating highs that are said to deepen the rave or trance
nabinoid system, with the hope that these will prove beneficial in
experience. Recent research, however, is uncovering the serious
treating a number of different brain disorders, including addiction,
damage that can occur in several parts of the brain from use of some
anxiety, and depression.
Nicotine In 2003, more than 70 million people smoked, at
of these drugs.
MDMA, called “Adam,” “ecstasy,” or “XTC” on the street, is a
least occasionally, making nicotine one of the most widely abused
synthetic psychoactive drug with hallucinogenic and amphetamine-
substances. Tobacco kills more than 430,000 U.S. citizens each
like properties. Users encounter problems similar to those found
year — more than alcohol, cocaine, heroin, homicide, suicide, car
with the use of amphetamines and cocaine. Recent research also
accidents, fire, and AIDS combined. Tobacco use is the leading
links chronic ecstasy use to long-term changes in those parts of the
preventable cause of death in the United States. Smoking is respon-
brain critical to thought, memory, and pleasure.
sible for approximately 7 percent of total U.S. health-care costs,
Rohypnol, GHB, and ketamine are predominantly central nervous system depressants. Because they are often colorless, tasteless,
and odorless, they can be added easily to beverages and ingested
an estimated $80 billion each year. The direct and indirect costs of
smoking are estimated at more than $138 billion per year.
Nicotine, the addicting substance in tobacco, acts through
unknowingly. These drugs have emerged as the so-called date-
the well-known cholinergic nicotinic receptor. This drug can act
rape drugs. When mixed with alcohol, Rohypnol can incapacitate
as both a stimulant and a sedative. Nicotine stimulates the adrenal
victims and prevent them from resisting sexual assault. Rohypnol
glands, and the resulting discharge of epinephrine causes a “kick”: a
may be lethal when mixed with alcohol and other depressants.
sudden release of glucose paired with an increase in blood pressure,
Since about 1990 in the United States, GHB has been abused for
respiration, and heart rate. Nicotine also suppresses insulin output
its euphoric, sedative, and anabolic (body-building) effects. It, too,
from the pancreas, which means that smokers are always slightly
has been associated with sexual assault. Ketamine is another central
hyperglycemic. In addition, nicotine releases dopamine in the brain
nervous system depressant abused as a date-rape drug. Ketamine,
regions that control motivation, which is one reason that people
or “Special K,” is a fast-acting general anesthetic. It has sedative,
continue to smoke.
hypnotic, analgesic, and hallucinogenic properties. It is marketed
Much better understanding of addiction, coupled with the
in the United States and a number of foreign countries as a general
identification of nicotine as an addictive drug, has been instrumen-
anesthetic — a drug that brings about a reversible loss of conscious-
tal in the development of treatments. Nicotine gum, the transder-
ness — in both human and veterinary medical practice.
mal patch, nasal spray, and inhalers are equally effective in treating
Many users tend to experiment with a variety of club drugs in
the more than one million people addicted to nicotine. These
combination. This practice creates a larger problem, because com-
techniques are used to relieve withdrawal symptoms and produce
binations of any of these drugs, particularly with alcohol, can lead
less severe physiological alterations than tobacco-based systems.
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They generally provide users with lower overall nicotine levels than
A standard treatment for opiate addiction involves methadone,
they receive with tobacco and totally eliminate exposure to smoke
a long-acting oral opioid that helps keep craving, withdrawal, and
and its deadly contents. The first non-nicotine prescription drug,
relapse under control. Methadone helps opiate addicts rehabilitate
bupropion, an antidepressant, has been approved for use as a phar-
themselves by preventing withdrawal symptoms that can moti-
macological treatment for nicotine addiction. An exciting advance
vate continued drug use. Naloxone and naltrexone are available
is the use of varenicline for smoking cessation, which directly inter-
medications that act as antagonists at opioid receptors; in other
acts with the cholinergic nicotinic receptor in a key component of
words, they can curb the allure of opiates by blocking the opiate
the brain’s reward circuitry and prevents nicotine from activating
receptors so that opiates produce no pleasurable effects when they
this circuit. The development of varenicline is a prime example
are taken. The blockers alone are sometimes useful for addicts who
of how basic science research can lead to the production of novel
are highly motivated to quit. In addition, scientists are developing a
medications. Behavioral treatments also are important in help-
long-lasting version of naltrexone that needs to be taken only once
ing an individual learn coping skills for both short- and long-term
a month.
prevention of relapse.
Another medication to treat heroin addiction, buprenorphine,
causes a weaker effect on the receptors than methadone and creates
only a limited high, which deters an addict from abusing the medication itself. Buprenorphine has been prescribed for over 500,000
Tobacco kills more than
430,000 U.S. citizens each year —
more than alcohol, cocaine, heroin,
homicide, suicide, car accidents,
fire, and AIDS combined.
patients in the United States.
Psychostimulants This class of drugs includes cocaine and
amphetamines. In 2003, there were an estimated 2.3 million
chronic cocaine users and 5.9 million occasional cocaine users in
the United States. A popular, chemically altered form of cocaine,
crack, is smoked. It enters the brain in seconds, producing a rush
of euphoria and feelings of power and self-confidence. A smokable form of methamphetamine, “crystal meth,” also has become
popular. The key biochemical factor that underlies the reinforcing
effects of psychostimulant drugs is their ability to greatly elevate
the brain chemical dopamine in specific brain regions, such as the
nucleus accumbens, and repeated use of these drugs progressively
Opiates Humans have used opiate drugs, such as morphine,
increases their ability to activate brain dopamine systems. This is
for thousands of years. Monkeys and rats readily self-administer heroin
thought to result in a progressively increasing motivation to take
or morphine and, like humans, will become tolerant and physically de-
the drugs, eventually leading to addiction.
pendent with unlimited access. Withdrawal symptoms range from mild,
Cocaine users often go on binges, consuming a large amount
flulike discomfort to severe muscle pain, stomach cramps, diarrhea, and
of the drug in just a few days. A crash occurs after this period of
unpleasant mood.
intense drug-taking and includes symptoms of emotional and
Opiates increase the amount of dopamine released in the brain
physical exhaustion and depression. These symptoms may result
reward system and mimic the effects of endogenous opioids. Heroin
from an actual crash in dopamine and serotonin function as well as
injected into a vein reaches the brain in 15 to 20 seconds and binds
an increased response of the brain systems that react to stress. Vac-
to opiate receptors found in many brain regions, including the reward
cines to produce antibodies to cocaine in the bloodstream are
system. Activation of the receptors in the reward circuits causes a brief
in clinical trials.
rush of intense euphoria, followed by a couple of hours of a relaxed,
contented state.
Opiates create effects like those elicited by the naturally occurring
Alzheimer’s disease
One of the most frightening and devastating of all neurological
opioid peptides. They relieve pain, depress breathing, cause nausea and
disorders is the dementia that occurs in the elderly. The most com-
vomiting, and stop diarrhea — important medical uses. In large doses,
mon cause of this illness is Alzheimer’s disease (AD). Rare before
heroin can make breathing shallow or stop altogether — the cause of
age 60 but increasingly prevalent in each decade thereafter, AD
death in thousands of people who have died of heroin overdose.
affects more than 40 percent of those age 85 and over and nearly
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39
HOW CRACK COCAINE AFFECTS THE BRAIN. Crack cocaine takes the same route as nicotine by entering the bloodstream through the lungs. Within seconds,
it is carried by the blood to the brain. The basis for increased pleasure occurs at the gap where the impulses that represent neural messages are passed from one neuron
to another. This gap is called a synapse. Dopamine-containing neurons normally relay their signals by releasing dopamine into many synapses. Dopamine crosses the
synapse and fits into receptors on the surface of the receiving cell. This triggers an electrical signal that is relayed through the receiver. Then, to end the signal, dopamine
molecules break away from the receptors and are pumped back into the nerve terminals that released them. Cocaine molecules block the pump or “transporter,” causing
more dopamine to accumulate in the synapse. Pleasure circuits are stimulated again and again, producing euphoria.
20 percent of those ages 75 to 84. As many as 5 million Americans
2005 was reported to have killed 72,000 Americans, is the seventh
have AD. The disease is predicted to affect approximately 14 mil-
leading cause of death in the United States.
lion individuals in the United States by the year 2040.
The earliest symptoms of AD include forgetfulness; disorienta-
In the earliest stages, the clinical diagnosis of possible or
probable AD can be made with greater than 80 percent accuracy.
tion to time or place; and difficulty with concentration, calcula-
As the course of the disease progresses, the accuracy of diagnosis
tion, language, and judgment. As the disease progresses, some
at Alzheimer’s research centers exceeds 90 percent. The diagnosis
patients have severe behavioral disturbances and may even become
depends on medical history, physical and neurological examina-
psychotic. In the final stages, the affected individual is incapable of
tions, psychological testing, laboratory tests, and brain imaging
self-care and becomes bed-bound. Patients usually die from pneu-
studies. New brain imaging strategies promise to enable doctors to
monia or some other complication of immobility. AD, which in
visualize AD neuropathology during life. At present, however, final
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confirmation of the diagnosis requires examination of brain tissue,
ate caution must be taken. Experimental therapies in models of
usually obtained at autopsy.
other neurodegenerative diseases — amyotrophic lateral sclerosis,
The causes and mechanisms of the brain abnormalities underlying AD are not yet fully understood, but great progress has been
made through genetics, biochemistry, cell biology, and experimental
for example — have been effective in mice but not in humans with
the disease.
Researchers have begun to modulate the actions of genes that
treatments. Reductions occur in levels of markers for many neu-
play critical roles in the production of amyloid in animal models.
rotransmitters, including acetylcholine, somatostatin, monoamines,
These genes encode the amyloid-producing enzymes beta and
and glutamate, that allow cells to communicate with one another.
gamma secretases, which cleave amyloid peptide from the precur-
Damage to these neural systems, which are critical for attention,
sor. The amyloid peptide is then released from the neuron into the
memory, learning, and higher cognitive abilities, is believed to
extracellular space, where it can accumulate and form AD plaques.
cause the clinical symptoms.
Amyloid-destroying enzymes, known as alpha secretases, break up
Microscopic examination of AD brain tissue shows abnormal
the amyloid peptide, preventing amyloid accumulation. Anti-
accumulations of a small fibrillar peptide, termed beta amyloid, in
amyloid therapies for AD aim either to remove existing amyloid or
the spaces around synapses (neuritic plaques) and abnormal ac-
decrease production of new amyloid.
cumulations of a modified form of the protein tau in the cell bodies
Within the past three to five years, greater appreciation has
of neurons (neurofibrillary tangles). In all forms of AD, plaques and
developed for the surprisingly important roles that diet and lifestyle
tangles mostly develop in brain regions important for memory and
play in determining risk for AD. Cognitive activity, physical activ-
intellectual functions. New brain imaging strategies show amyloid
ity, and heart-healthy diets lower the risk for AD, while obesity,
plaques and tau tangles labeled by a mildly radioactive chemical
high blood pressure, high cholesterol, metabolic syndrome, and
marker in living people.
diabetes raise the risk. Some evidence indicates that successful
Early-onset AD is a rare, dominantly inherited form of the disease. Recently, scientists have identified AD-associated mutations.
The gene encoding the amyloid precursor protein (APP) is on chromosome 21. In other families with early-onset AD, mutations have
been identified in the presenilin 1 and 2 genes. Genes that cause
management of these cardiovascular risks can delay the onset or
slow the progression of dementia.
Amyotrophic lateral sclerosis
This progressive disorder strikes more than 5,000 Americans
dominant Alzheimer’s appear to do so by causing beta amyloid
annually, with an average survival time of just three to five years
plaques to accumulate. Apolipoprotein E (apoE), which influences
from symptom onset. It is the most common disorder within a group
susceptibility in late life, exists in three forms. The variant known
of diseases affecting motor neurons and costs Americans some $300
as APOE epsilon 4 is clearly associated with enhanced risk.
million annually.
Currently approved treatments do not modify the course of
Commonly known as Lou Gehrig’s disease, amyotrophic lateral
the disease and offer only temporary mitigation of some symptoms
sclerosis (ALS) affects neurons that control voluntary muscle
of AD, such as agitation, anxiety, unpredictable behavior, sleep
movements such as walking. For reasons that are not completely
disturbances, and depression. Five drugs have been approved by the
understood, motor neurons in the brain and spinal cord begin to
FDA to treat AD. Four prevent the breakdown of acetylcholine, a
disintegrate. Because signals from the brain are not carried by these
brain chemical important for memory and thinking. The fifth regu-
damaged nerves to the body, the muscles begin to weaken and dete-
lates glutamate, a brain chemical that may cause brain cell death
riorate from the lack of stimulation and resulting disuse.
when produced in large amounts. These agents improve memory
The first signs of progressive paralysis are usually seen in
deficits temporarily and provide some symptomatic relief but do not
the hands and feet. They include weakness in the legs, difficulty
prevent progression of the disease. Several other approaches, such
walking, and clumsiness of the hands when washing and dressing.
as antioxidants, are being tested.
Eventually, almost all muscles under voluntary control, including
An exciting area of research is the introduction of AD-
those of the respiratory system, are affected. Despite the paralysis,
causing genes in mice. These mice, carrying mutant genes linked
however, the mind and the senses remain intact. Death is usually
to inherited AD, develop behavioral abnormalities and some of the
caused by respiratory failure or pneumonia.
microscopic changes in tissue structure that occur in humans. It is
No specific test identifies ALS, but muscle biopsies, blood
hoped that these mouse models will prove useful for studying the
studies, electrical tests of muscle activity, computed tomography
mechanisms of AD and testing novel therapies, although appropri-
(CT) and magnetic resonance imaging (MRI) scans, and X-rays
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41
of the spinal cord help identify the disease and rule out other
compulsive licking, respond to the serotonergic antidepressant
disorders. Still, diagnosis is often difficult because the causes of ALS
clomipramine, which was the first effective treatment developed for
remain unknown. Potential causes or contributors to the disease
OCD in people. This and other serotonergic antidepressants and
include glutamate toxicity, oxidative stress, environmental factors,
the selective serotonin reuptake inhibitors (SSRIs), such as sertra-
and an autoimmune response in which the body’s defenses turn
line and paroxetine, are effective in treating OCD. A specialized
against body tissue.
type of behavioral intervention, exposure and response prevention,
In more than 90 percent of cases, ALS is sporadic, arising in
individuals with no known family history of the disorder. In the
also is effective in many patients.
Panic disorder, with a lifetime prevalence rate of 1.7 to 3.5
other 5 to 10 percent of cases, ALS is familial — transmitted to fam-
percent in the United States, usually starts “out of the blue.”
ily members because of a gene defect.
Patients experience an overwhelming sense of impending doom,
Scientists have now identified several genes that are respon-
accompanied by sweating, weakness, dizziness, and shortness of
sible for some forms of ALS. The most common and well studied of
breath. With repeated attacks, patients may develop anxiety in
these are mutations in the gene that codes for superoxide dismutase.
anticipation of another attack and avoid public settings where at-
Scientists believe that whatever they learn from studying this gene
tacks might occur. If these patients are untreated, they may develop
and others will have relevance for understanding the more common
agoraphobia and become virtually housebound. Antidepressants,
sporadic form of motor neuron disease.
including SSRIs, are effective, as is cognitive behavioral therapy.
Once ALS is diagnosed, physical therapy and rehabilitation
Phobia is an intense, irrational fear of a particular object or
methods can help strengthen unused muscles. Various drugs can
situation. Individuals can develop phobias of almost anything,
ease specific problems, such as twitching and muscle weakness,
including dogs, dating, blood, snakes, spiders, or driving over
but there is no cure. An anti-glutamate drug moderately slows
bridges. Exposure to the feared object or situation can trigger an
the disease. Additional drugs are now under study. Protecting or
extreme fear reaction that may include a pounding heart, short-
regenerating motor neurons using nerve growth factors, other more
ness of breath, and sweating. Cognitive behavioral therapy is an
potent drugs, and stem cells may someday provide additional hope
effective treatment.
Extreme stressors such as trauma in combat, being a victim of as-
for patients.
Anxiety disorders
The most widespread mental illnesses, anxiety disorders an-
sault or sexual abuse, or experiencing or witnessing a crime can lead to
a form of stress that can last a lifetime. Termed PTSD, the lifetime prevalence rate in the United States for this disorder is 6.8 percent (9.7 per-
nually affect an estimated 12.6 percent of the adult population,
cent in women and 1.8 percent in men). It is characterized by intense
or 24.8 million Americans. They include obsessive-compulsive
fear, helplessness or horror, intrusive recollections of the traumatic
disorder (OCD); panic disorder; phobias, such as fear of heights,
event, avoidance and numbing, and hyperarousal. In addition, PTSD
agoraphobia (fear of open spaces), and social anxiety disorder;
is associated with dysregulation of the hypothalamic-pituitary-adrenal
generalized anxiety disorder; and post-traumatic stress disorder
axis, disordered sleep, and major depressive disorder. Military personnel
(PTSD). Some can keep people completely housebound. Anxiety
are at elevated risk for exposure to trauma and not surprisingly have
disorders often occur together with depression, and individuals
higher prevalence rates when compared to the general population.
doubly afflicted are at a high risk of suicide.
In OCD, people become trapped, often for many years, in re-
Scientists have learned that very high levels of norepinephrine
are released in the brain during stress and that patients with PTSD
petitive thoughts and behaviors, which they recognize as groundless
have heightened levels of this chemical long after the traumatic event
but cannot stop. Such behavior includes repeatedly washing hands
has passed. High levels of norepinephrine strengthen the primitive
or checking that doors are locked or stoves turned off. The illness
emotional reactions of the amygdala, the fear center of the brain, while
is estimated to affect 5 to 6 million Americans annually. Environ-
weakening the rational functions of the prefrontal cortex, which quiets
mental factors and genetics probably play a role in the development
the amygdala. Very high levels of norepinephrine release can strengthen
of the disorder. Positron emission tomography (PET) scans reveal
the consolidation of emotional memories and strengthen fear responses
abnormalities in both cortical and deep areas of the brain, implicat-
through the stimulation of alpha-1 and beta receptors in the amygdala.
ing central nervous system changes in OCD patients.
In contrast, stimulation of alpha-1 receptors in the prefrontal cortex
Scientists have recently discovered that certain breeds of
large dogs that develop acral lick syndrome, severely sore paws from
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neural disorders: advances and challenges
takes this higher brain region “offline.” The prefrontal cortex normally
allows us to suppress troubling memories and thoughts, and inhibits
Society for Neuroscience
the amygdala to let us know that we are safe (the extinction of the fear
brain volume or function. Smaller volume and reduced activity
response). Imaging studies show that patients with PTSD have weaker
are often observed in prefrontal cortical-striatal-cerebellar circuits,
prefrontal function and stronger amygdala activation, consistent with
particularly in the right hemisphere. Recent studies show a delay in
their symptoms.
cortical development in some children with ADHD, speculated to
New successful medications for PTSD have arisen from this basic
research. The alpha-1 blocker, prazosin, a drug used to lower blood
pressure for more than 20 years, is now used to treat nightmares experi-
represent the subgroup who “grow out” of the disorder.
Recent imaging studies are consistent with reduced catecholamine transmission in at least some patients with this disorder.
enced with PTSD; those treated with prazosin include people with very
long-standing illness, such as Holocaust survivors. Beta-blockers such as
propranolol also are being tested in individuals exposed to trauma, but
these agents must be administered close in time after the trauma, before
PTSD has been established, which brings up complex ethical issues.
The discovery of brain receptors for the benzodiazepine antianxiety drugs has sparked research to identify the brain’s own antianxiety
chemical messengers. The benzodiazepine receptors are a component
of the GABA receptor and enhance the responsiveness to endogenous
GABA, the major inhibitory neurotransmitter in the brain. Indeed,
recent studies have revealed alterations in certain GABA receptors in
Characterized by excessively
inattentive, hyperactive, or impulsive
behaviors, ADHD affects an estimated
2 million children in the United States,
or 3 to 5 percent of children.
the central nervous system of patients with PTSD. This finding may
lead to ways to regulate this brain system and correct its possible defects
in anxiety disorders.
PTSD also is treated with antidepressant and atypical antipsychotic medications and with psychotherapies such as cognitive behavioral
As prefrontal circuits require an optimal level of catecholamine
therapy or eye movement desensitization and reprocessing therapy.
stimulation, reduced catecholamine transmission could lead to
Attention deficit hyperactivity disorder
Attention deficit hyperactivity disorder (ADHD) was first
weakened prefrontal cortical regulation of attention and behavior
and symptoms of ADHD.
ADHD is commonly treated with medications such as
described more than 100 years ago. Characterized by excessively
stimulants (e.g., methylphenidate) and newer, nonstimulant drugs.
inattentive, hyperactive, or impulsive behaviors, ADHD affects an
These agents all act by enhancing catecholamine transmission in
estimated 2 million children in the United States, or 3 to 5 percent
the prefrontal cortex. Despite the widespread use of stimulants,
of children. Studies show that 30 percent to 70 percent of these
concerns about their risks linger. Thus, parents and clinicians have
children will continue to experience ADHD symptoms as adults.
to balance the benefits of a child with better attention and behav-
By definition, symptoms of ADHD appear before age 7, last for
six months or longer, and impair normal functioning in at least two
types of settings — at school, among friends, at home, or at work, in
the case of adults. Currently, no objective diagnostic test for ADHD
exists. Diagnosis requires a comprehensive evaluation, including a
ioral regulation on one hand, and the uncertainty about the risks of
exposing children to psychotropic drugs on the other.
Autism
An autism spectrum disorder (ASD) is diagnosed in 1 of every
clinical interview, parent and teacher ratings, and, sometimes, learn-
150 babies born in the United States (approximately 1.7 million
ing disorder or psychological testing. Multiple evaluation techniques
Americans), an incidence far greater than in the 1970s owing
are required because healthy children occasionally show similar
mainly to changes in diagnostic criteria, grouping of multiple
behavior, and other conditions, disorders, or environmental triggers
disorders into one spectrum, and enhanced clinician referral based
— such as stress — may be associated with the same behaviors.
on greater awareness. ASD is characterized by communication
Twin and family studies show that ADHD has a strong genetic
difficulties; absent, delayed, or abnormal language; impaired social
influence, and genes encoding components of dopamine and
skills; and narrow, obsessive interests or repetitive behaviors. Com-
norepinephrine transmission have been implicated. Studies increas-
mon associated symptoms include mental retardation, seizures, and
ingly are finding correlations between ADHD and differences in
behavioral abnormalities.
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Currently, ASD is diagnosed in 3- to 5-year-olds based on behav-
Other useful medications include certain anticonvulsants, such
ioral symptoms. New research indicates that very sensitive measures
as valproate or carbamazepine, which can have mood-stabilizing
of social engagement and interaction can detect differences in the first
effects and may be especially useful for difficult-to-treat bipolar
year of life, a time when many affected children exhibit accelerated
episodes. Newer anticonvulsant medications are being studied to
growth of the brain. This abnormal growth is a potential marker for
determine how well they work in stabilizing mood cycles.
early evaluation that may also indicate that development has gone
awry.
Brain tumors
Studies of brain neurophysiology, tissue, and imaging indicate
Although brain tumors are not always malignant — a condition
that ASD is a disorder that disrupts basic developmental processes
that spreads and becomes potentially lethal — these growths always
that occur both before and after birth, potentially including neural cell
are serious because they can interfere with normal brain activity.
proliferation, migration, survival, axon and dendrite extension, and
Primary brain tumors arise within the brain, whereas metastat-
synapse formation. Specific brain regions involved in language, cogni-
ic (also called secondary) brain tumors spread from other parts of
tion, and social communication, or the connections among them, may
the body through the bloodstream. The incidence of primary brain
be formed abnormally. Research also indicates that genetic factors are
tumors is about 15 per population of 100,000. About 44,000 new
major contributors to ASD (10 to 20 percent of cases have identified
cases occur in the United States annually.
genetic causes), with potential involvement of environmental factors.
Although no cure exists, many affected children respond well
Symptoms vary according to location and size, but seizures
and headache are among the most common. To expand, gliomas,
to highly structured environments and specialized education and lan-
typically malignant brain tumors, release the neurotransmitter
guage programs, with earlier interventions leading to better outcomes.
glutamate at toxic concentrations. This kills off neurons in their
Associated symptoms respond to medications.
vicinity, making room for the tumor’s expansion. The released
Knowledge of specific functional deficits in social and cogni-
glutamate explains seizures originating from tissue surrounding the
tive circuits is leading to distinct clinical training to improve brain
tumor. An expanding tumor can increase pressure within the skull,
activity and behavioral outcomes, whereas genetic findings may allow
causing headache, vomiting, visual disturbances, and impaired
new targeted therapies at the molecular level. One day, genetic tests
mental functioning. Brain tumors are diagnosed with MRI and
may complement behavioral indicators to allow earlier diagnosis and
CT scanning.
intervention as well as the means to overcome and possibly prevent
Treatment options for primary brain tumors are limited. Surgery
is generally the first step if the tumor is accessible and vital structures
ASD symptoms.
Bipolar disorder
Patients with bipolar disorder, previously known as manicdepressive illness, usually experience episodes of deep depression
and manic highs, with a return to relatively normal functioning in
will not be disturbed. Radiation is used to stop a tumor’s growth or
cause it to shrink. Chemotherapy destroys tumor cells that may remain
after surgery and radiation but is not very effective for gliomas. Steroid
drugs relieve brain swelling, and antiepileptic drugs control seizures.
New therapies for brain tumors are developed in organized
between. They also have an increased risk of suicide. Bipolar disorder
studies called clinical trials. Many of these trials focus on targeted
annually affects 1.2 percent of Americans age 18 or older, or 2.2 mil-
therapy — treatment aimed at biologic characteristics of tumors.
lion individuals. Approximately equal numbers of men and women
Targeted therapies include vaccines created from the patient’s own
suffer from this disorder.
tumor combined with substances that boost the immune system or
Bipolar disorder tends to be chronic, and episodes can become
kill tumor cells; monoclonal antibodies, which home in on receptors
more frequent without treatment. As bipolar disorder runs in fami-
on the surface of the tumor cells; anti-angiogenic therapy, in which
lies, efforts are underway to identify the responsible gene or genes.
the tumor’s blood supply is restricted; immunotherapy, which uses the
Bipolar patients can benefit from a broad array of treatments.
body’s own immune system against the tumor; gene therapy, in which
One of these is lithium. During the 1940s, researchers showed that
bioengineered genes are delivered to the cancer cells to kill them;
lithium injections into guinea pigs made them placid, which implied
and several approaches for a targeted delivery of antibodies, toxins,
mood-stabilizing effects. When given to manic patients, lithium
or growth-inhibiting molecules that attach specifically to the tumor
calmed them and enabled them to return to work and live relatively
cells and interfere with their growth. A scorpion-derived toxin called
normal lives. Regarded as both safe and effective, lithium is often
chlorotoxin that interferes with tumor spread has shown promise in
used to prevent recurrent episodes.
clinical studies where it extended life expectancy significantly.
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Researchers are exploring the role of stem cells in the origin
Once this mystery is understood, they hope to decode the bio-
of brain tumors. Epidemiologists, or scientists studying disease in hu-
chemical processes that occur in Down syndrome and learn to treat
man populations, also are looking into tumor genetics and patients’
or cure this disorder.
lifestyle, environment, occupation, and medical history for clues as
to the causes of these tumors. International efforts are underway to
increase awareness of brain tumors, encourage research collaboration, and explore new and innovative therapies.
Down syndrome
Down syndrome, the most frequently occurring chromosomal
condition, appears in 1 of every 732 babies. It typically occurs when
an extra copy of chromosome 21 — or part of its long arm — is pres-
Dyslexia
An estimated 15 to 20 percent of the population, as many
as 60 million Americans, has some form of learning disability
involving difficulties in the acquisition and use of listening,
speaking, reading, writing, reasoning, or mathematical abilities.
These challenges often occur in people with normal or even
high intelligence.
Dyslexia, or specific reading disability, is the most common
ent in the egg or, less commonly, in the sperm, at the time of con-
and most carefully studied of the learning disabilities. It affects
ception. It is not known why this error occurs, and the error has not
80 percent of all those identified as learning-disabled. Dyslexia is
been linked to any environmental or behavioral factors, either be-
characterized by an unexpected difficulty in reading in children
fore or during pregnancy, but the risk is markedly increased with the
and adults who otherwise possess the intelligence, motivation, and
age of the mother. At age 35, the risk is about 1 in 365 births; at age
schooling considered necessary for accurate and fluent reading.
40, it is 1 in 110. Because of higher fertility rates in younger women,
Studies indicate that although there can be improvement, dyslexia
80 percent of children with Down syndrome are born to women un-
is a persistent, chronic condition.
der 35 years of age. Prenatal screening tests, such as the Triple and
Quadruple Screens, can accurately detect Down syndrome in about
There is now a strong consensus that the central difficulty in
most forms of dyslexia reflects a deficit within the language system
70 percent of fetuses. Definitive prenatal diagnoses can be obtained
with either chorionic villus sampling or amniocentesis.
Down syndrome is associated with approximately 50 physical and developmental characteristics. An individual with Down
syndrome is likely to possess, to various degrees, some of these characteristics: mild to moderate intellectual disabilities; low muscle
tone; an upward slant to the eyes; a flat facial profile; an enlarged
tongue; and an increased risk of congenital heart defects, respiratory
problems, and digestive tract obstruction. Nearly all people with
Down syndrome show some neuropathological changes like those
seen in Alzheimer’s disease by age 40, and most show cognitive
decline by age 60.
Babies with Down syndrome develop much as typical children
do but at a somewhat slower rate. They learn to sit, walk, talk, and
toilet train, just like their peers. Early intervention programs can
An estimated 15 to 20 percent of the
population, as many as 60 million
Americans, has some form of learning
disability involving difficulties in
the acquisition and use of listening,
speaking, reading, writing, reasoning,
or mathematical abilities.
begin shortly after birth and can help foster an infant’s development.
Thanks to medical advances and a greater understanding
of the potential of those with this condition, people with Down
syndrome have been able to have longer and fuller lives. They
are being educated in their neighborhood schools, participating
— and more specifically, in a component of the language system
in community activities, and finding rewarding employment
called phonology. This results in difficulty transforming the letters
and relationships.
on the page to the sounds of language.
Although there is no cure for or means of preventing Down
As children approach adolescence, one manifestation of dys-
syndrome, scientists are moving closer to understanding the role
lexia may be a very slow reading rate. Children may learn to read
that the genes on chromosome 21 play in a person’s development.
words accurately, but their reading will not be fluent or automatic,
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reflecting the lingering effects of a phonologic deficit. Because
ability to walk, talk, think, and reason. HD usually appears between
they can read words accurately — albeit very slowly — dyslexic
the ages of 30 and 50. It affects both the basal ganglia, which con-
adolescents and young adults may mistakenly be assumed to have
trol coordination, and the brain cortex, which serves as the center
“outgrown” their dyslexia. The ability to read aloud accurately,
for thought, perception, and memory.
rapidly, and with good expression, as well as facility with spelling,
The most recognizable symptoms include involuntary jerk-
may be most useful clinically in distinguishing students who are
ing movements of the limbs, torso, and facial muscles. These
average from those who are poor readers. In some languages that are
are often accompanied by mood swings, depression, irritability,
more consistent in the relationship between letters and sounds, for
slurred speech, and clumsiness. As the disease progresses, common
instance Finnish and Italian, slow reading may be the only manifes-
symptoms include difficulty swallowing, unsteady gait, loss of bal-
tation of dyslexia at any age.
ance, impaired reasoning, and memory problems. Eventually, the
A range of investigations indicates that there are differences in
brain regions between dyslexic and nonimpaired readers involving
three important left hemisphere neural systems, two posteriorly
individual becomes totally dependent on others for care, with death
often due to pneumonia, heart failure, or another complication.
Diagnosis consists of a detailed clinical examination and
(parieto-temporal, occipito-temporal) and one anteriorly around
family history. Brain scans may be helpful. The identification in
the left inferior frontal region (Broca’s area). Converging evidence
1993 of the gene that causes HD has simplified genetic testing,
using functional brain imaging indicates that dyslexic readers dem-
which can be used to help confirm a diagnosis. HD researchers and
onstrate a functional disruption in an extensive system in the posterior portion of the brain. The disruption occurs within the neural
systems linking visual representations of letters to the phonologic
structures they represent, and the resulting brain images are referred
to as the neural signature of dyslexia.
It is clear that dyslexia runs in families, and research has
advanced understanding of its genetic basis. Following the gradual
identification over the past 20 years of sites on the human genome
that are associated with an increased risk for developing dyslexia, in
the past four years, six candidate dyslexia susceptibility genes have
been reported, and multiple studies have confirmed some of these
Affecting some 30,000 Americans
and placing 200,000 more at
risk, Huntington’s disease is now
considered one of the most common
hereditary brain disorders.
candidates. These risk alleles, the term given to gene variants that
increase the risk of developing a condition or illness, have been
shown to play important roles in the development of the brain during fetal life, and some of them may eventually be confirmed to play
genetic counselors, however, have established specific protocols for
a role in dyslexia.
Interventions to help children with dyslexia focus on teaching
predictive testing to ensure that the psychological and social con-
the child that words can be segmented into smaller units of sound
sequences of a positive or negative result are understood. Predictive
and that these sounds are linked with specific letter patterns. In
testing is available only for adults, though children under 18 may be
addition, children with dyslexia require practice in reading stories,
tested to confirm a diagnosis of juvenile-onset HD. Prenatal testing
both to allow them to apply their newly acquired decoding skills
may be performed. The ethical issues of testing must be considered,
to reading words in context and to experience reading for meaning
and the individual must be adequately informed, because there is
and enjoyment.
no effective treatment or cure.
Huntington’s disease
gene — a kind of molecular stutter in the DNA. This abnormal
The HD mutation is an expanded triplet repeat in the HD
Affecting some 30,000 Americans and placing 200,000 more
gene codes for an abnormal version of the protein called Hun-
at risk, Huntington’s disease (HD) is now considered one of the
tingtin. The Huntingtin protein, whose normal function is still
most common hereditary brain disorders. The disease, which killed
unknown, is widely distributed in the brain and appears to be
folk singer Woody Guthrie in 1967, progresses slowly over a 10- to
associated with proteins involved in transcription, protein turnover,
20-year period and eventually robs the affected individual of the
and energy production. The cause of HD probably involves the gain
46
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of a new and toxic function. Cell and animal models can replicate
tricyclic antidepressants but act selectively on the serotonin system
many features of the disease and are now being used to test new
and have much less toxicity. Several newer antidepressants, such as
theories and therapies. Although currently no effective treatments
bupropion, are also very effective but may affect the synaptic levels
for slowing disease progression exist, clinical and observational tri-
of dopamine.
als are being conducted. Any of these may yield an effective treatment that would slow the progression or delay onset of the disease
while researchers continue working toward a cure.
Major depression
This condition, with its harrowing feelings of sadness, hope-
Multiple sclerosis
The most common central nervous system disease of young
adults after epilepsy, multiple sclerosis (MS) is a lifelong ailment
of unknown origin that affects more than 400,000 Americans. MS
is diagnosed mainly in individuals between the ages of 20 and 50,
lessness, pessimism, loss of interest in life, and reduced emotional
with 2 of 3 cases occurring in women. The disease results in earning
well-being, is one of the most common and debilitating mental
losses of about $10.6 billion annually for U.S. families with MS.
disorders. Depression is as disabling as heart disease or arthritis.
Although a cause has yet to be found, MS is thought to be
Depressed individuals are 18 times more likely to attempt suicide
an autoimmune disease in which the body’s natural defenses act
than people with no mental illness.
against the myelin and nerve fibers in the central nervous system
Annually, major depression affects 5 percent of the population,
as though they were foreign tissue. Some nerve fibers are actually
or 9.8 million Americans, aged 18 years and older. Fortunately, 80
cut in association with the loss of myelin. In MS, when brain tissue
percent of patients respond to drugs, psychotherapy, or a combina-
is destroyed, it is either repaired or replaced by scars of hardened
tion of the two. Some severely depressed patients can be helped
sclerotic patches of tissue. Areas of disease activity are called lesions
with electroconvulsive therapy.
or plaques and appear in multiple places within the central nervous
Depression arises from many causes: biological (including
system. These effects are comparable to the loss of insulating mate-
genetic), psychological, environmental, or a combination of these.
rial around an electrical wire, or cutting of the wire itself, which
Stroke, hormonal disorders, antihypertensives, and birth control
interferes with the transmission of signals.
pills also can play a part.
Physical symptoms — disturbances of sleep, sex drive, energy
Siblings of people with MS are 10 to 15 times more likely
than the general population to be diagnosed with the disorder,
level, appetite, and digestion — are common. Some of these
whereas the risk for disease concordance for identical twins is about
symptoms may reflect the fact that the disorder affects the delicate
30 percent. In addition, the disease is as much as five times more
hormonal feedback system linking the hypothalamus, the pituitary
prevalent in temperate zones, such as the northern United States
gland, and the adrenal glands. For example, many depressed pa-
and northern Europe, than it is in the tropics. Caucasians are more
tients secrete excess cortisol, a stress hormone, and do not respond
susceptible than other races. Women are at a higher risk than
appropriately to a hormone that should counter cortisol secretion.
men. Thus, both genetic and environmental factors are probably
When tested in sleep laboratories, depressed patients’ electroen-
involved in the cause. Previous studies had suggested that MS sus-
cephalograms often exhibit abnormalities in their sleep patterns.
ceptibility peaked before age 15; more recent, larger studies suggest
The modern era of drug treatment for depression began in the
late 1950s. Most antidepressants affect norepinephrine or serotonin
that there is no exact age cutoff.
The most common symptoms of MS are numbness, fatigue,
in the brain, apparently by correcting the abnormal signals that
blurred vision, and clumsiness. These can occur singly or in com-
control mood, thoughts, and other sensations. The tricyclic antidepres-
bination, vary in intensity, and last from several weeks to months
sants primarily block the reuptake and inactivation of serotonin and
or may remain permanent symptoms. In some patients, symptoms
norepinephrine to varying degrees. Another class of antidepressant
include slurred speech, weakness, loss of coordination, pain, uncon-
medications is the monoamine oxidase inhibitors (MAOIs). These
trollable tremors, loss of bladder control, memory and other cogni-
agents inhibit monoamine oxidase, an enzyme that breaks down sero-
tive problems, depression, and paralysis (rarely). Muscle spasticity
tonin and norepinephrine, allowing these chemicals to remain active.
can affect balance and coordination, causing stiffness and involun-
The popular medication fluoxetine is the first of a class of
tary jerking movement — and, if untreated, can create contractures,
drugs called selective serotonin reuptake inhibitors, or SSRIs. SSRIs
or the “freezing” of a joint that prevents movement.
block the reuptake and inactivation of serotonin and keep it active
MS cannot be cured at present, but several medications help
in certain brain circuits. Hence, they are functionally similar to the
control forms of MS where attacks or relapses occur. A wide range
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47
of medications and therapies are available to control symptoms
subcortical areas. Neurons in the cortex also may be altered or lost.
such as spasticity, pain, fatigue, and mood swings, as well as blad-
Recent studies indicate that highly active combination
der, bowel, or sexual dysfunctions. Steroids, which have been used
antiretroviral treatment — cocktails of three or more drugs active
to treat MS for more than three decades, may effectively shorten
against HIV — is effective in reducing the incidence of AIDS
attacks and speed recovery from MS-related acute attacks. Many
dementia. Such treatment also can effectively reverse but not elimi-
promising new agents to control MS or to alleviate its symptoms
nate the cognitive abnormalities attributed to brain HIV infection.
are in clinical trials. Treatments given early in the disease are the
most effective.
Peripheral neuropathy, nerve death in extremities that causes
severe pain, is also a major neurological problem commonly seen in
Neurological AIDS
In 2007, about 2.5 million people worldwide became infected
HIV patients. It is believed that the virus triggers a distal sensory
neuropathy through neurotoxic mechanisms. This has often been
unmasked or exacerbated by certain antiretroviral drugs that have
with human immunodeficiency virus (HIV); 33 million are now
mitochondrial toxicity and tend to make the neuropathies more
living with HIV. Advanced HIV infection is known as acquired
frequent and serious. More than half of advanced patients have
immunodeficiency syndrome, or AIDS. The epidemic is still the
neuropathy, making it a major area for preventive and symptomatic
most intense in sub-Saharan Africa but is gaining speed in Asia
therapeutic trials.
and Eastern Europe. The impact of AIDS in the United States has
Despite remarkable advances toward new therapies, some
been muted because of life-prolonging drugs, but in developing
patients develop these neurological problems and fail to respond to
countries only 2 million of the 6 million people who need therapy
treatment, thus requiring additional approaches to prevention and
are receiving such treatment. Women now represent half of all
treatment of the symptoms. In addition, because of immunodefi-
cases worldwide.
ciency in HIV patients, otherwise rare opportunistic infections and
Although the principal target of HIV is the immune system,
the nervous system may be profoundly affected. Some 20 to 40
percent of untreated patients with full-blown AIDS also develop
clinically significant dementia that includes movement impairment,
malignancies are relatively common.
Neurological trauma
Some 1.4 million people suffer traumatic head injuries each
with a smaller percentage still suffering from an overt dementia.
year in the United States, of whom roughly 50,000 die. Those who
Those affected have mental problems ranging from mild difficulty
survive face a lifetime of disability, and economic costs approach
with concentration or coordination to progressive, fatal dementia.
$60 billion annually.
Despite advances in treating other aspects of the disease,
No magic bullet has yet been found, but doctors have dis-
AIDS dementia remains incompletely understood. Most current
covered several methods to stave off severe neurological damage
hypotheses center on an indirect effect of HIV infection related
caused by head and spinal cord injuries and to improve neurologi-
to secreted viral products or cell-coded signal molecules called
cal function following trauma. These treatments include better
cytokines. Convincing evidence also exists that some proteins of
imaging techniques, methods to understand and improve the
the virus itself are neurotoxic and may play a role in the ongoing
brain’s ability to regenerate and repair itself, and improved rehabili-
damage that occurs during infection. The viral Tat, released by
tation techniques.
infected cells, has been among the proteins suspected of neurotox-
Greater access to and use of CT and MRI offer physicians the
icity. In any case, HIV infection appears to be the prime mover in
opportunity to diagnose the extent of trauma and to avoid second-
this disorder because antiviral treatment may prevent or reverse this
ary injury related to edema, or swelling, and a reduction in blood
condition in many patients.
flow to the brain (ischemia).
Experts believe that serious neurologic symptoms are uncom-
In general, patients who arrive in the emergency room and
mon early in HIV infection. Later, however, patients develop
are diagnosed with a severe head injury are monitored for pressure
difficulty with concentration and memory and experience general
on the brain from bleeding or swelling. Treatments for increases
slowing of their mental processes. At the same time, patients may
in intracranial pressure include the removal of cerebrospinal fluid,
develop leg weakness and a loss of balance. Imaging techniques,
moderate hyperventilation to decrease blood volume, and the
such as CT and MRI, show that the brains in these patients have
administration of drugs to reduce cellular metabolism or to remove
undergone some shrinkage. The examination of brain cells under
water from the injured tissue. No drug for improving outcomes
a microscope suggests that abnormalities are present principally in
of traumatic brain injury has yet been approved. A recent pilot
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clinical trial for patients with moderate to severe closed head injury
or progenitor cells — to areas of brain injury to facilitate regenera-
found that the hormone progesterone cut the number of deaths in
tion and repair.
severely injured patients by 50 percent, and those in the moderately
These and other recent discoveries are pointing the way toward
injured group had improved functional recovery 30 days after in-
new therapies to promote nerve regeneration after brain and spinal
jury. Treatments for the injury-induced reduction of cerebral blood
cord injury. Although these new therapies have not yet reached the
flow include the administration of drugs that increase mean arterial
clinic, several approaches are on the path to clinical trials.
blood pressure. In combination with the reduction in intracranial
pressure, this results in an increase in blood flow, allowing more
blood to reach vital areas.
In addition to helping the physician avoid cerebral edema and
Pain
If there is a universal experience, pain is it. Each year, more
than 97 million Americans suffer chronic, debilitating headaches or
reductions in cerebral blood flow following traumatic brain injury,
a bout with a bad back or the pain of arthritis — all at a total cost
imaging can reveal mass lesions produced by the initial injury.
of some $100 billion. But it need not be that way. New discoveries
These mass lesions can consist of bleeding on the surface or within
about how chemicals in the body transmit and regulate pain mes-
the brain as well as the formation of contusions (bruises). Once
sages have paved the way for new treatments for both chronic and
blood leaks from vessels and comes into direct contact with brain
acute pain.
tissue, it can add focal pressure, thereby reducing cerebral blood
Local anesthesia, or loss of sensation in a limited area of a
flow, or can by itself be toxic to brain cells. As a consequence, it
person’s body, is used to prevent pain during diagnostic procedures,
may be removed surgically. Contusions can be troubling because
labor, and surgical operations. Local anesthetics temporarily inter-
they can increase pressure as well as contribute to the develop-
rupt the action of all nerve fibers, including pain-carrying ones, by
ment of post-traumatic epilepsy. As a last resort to reduce increased
interfering with the actions of sodium channels. Historically, the
intracranial pressure, part of the skull may be removed to allow the
most familiar of these agents was Novocain, which was used by
brain to swell, a procedure known as a craniotomy.
dentists. Lidocaine is more popular today.
An estimated 250,000 individuals are living with spinal cord
Analgesia refers to the loss of pain sensation. The four main
injury in the United States. Some 11,000 new injuries are reported
types of analgesics are nonopioids (aspirin and related nonsteroidal
annually and are caused mostly by motor vehicle accidents, sports in-
anti-inflammatory drugs, or NSAIDs, such as ibuprofen and naprox-
juries, violence, and falls. Economic costs approach $10 billion a year.
en), opioids (morphine, codeine), antiepileptic agents (gabapentin,
Researchers have found that people who suffer spinal cord
pregabalin), and antidepressants (amitriptyline). NSAIDs are useful
injuries may become less severely impaired if they receive high
for treating mild or moderate pain, such as headache, sprains, or
intravenous doses of a commonly used steroid drug, methylpredniso-
toothache. Because NSAIDs are anti-inflammatory, they also are
lone, within eight hours of the injury. Building on these clues and
useful in treating injuries or conditions such as arthritis. NSAIDS
insight into precisely how and why spinal cord cells die after injury,
inhibit the cyclo-oxygenase (COX) enzymes that make the inflam-
researchers hope to develop new therapies to reduce the extent of
matory and pain-producing chemical prostaglandin. Acetamino-
spinal cord damage after trauma.
phen has analgesic properties but does not reduce inflammation.
Scientists have known that, after a spinal cord injury, animals
Often moderate pain is treated by combining a mild opioid, such
can regain the ability to bear their weight and walk at various
as codeine, with aspirin or an NSAID. Opioids are the most potent
speeds on a treadmill belt. More recently, scientists have recognized
painkillers and are used for severe pain. Opioids, however, have a
that the level of this recovery depends to a large degree on whether
high abuse potential and can affect breathing.
these tasks are practiced — that is, trained for — after injury. People with spinal cord injury also respond to training interventions.
Scientists have discovered that new nerve cells can be born
The antiepileptic and antidepressant drugs are useful primarily
for neuropathic pain, pain due to injury to the nervous system, which
includes the pain of diabetic neuropathy, post-herpetic neuralgia,
in the adult brain, but these new cells do not seem capable of
phantom limb pain, and post-stroke pain. The best results have
helping the injured brain regenerate. Studies are underway to
been reported with antidepressants that regulate both serotonin and
determine how to “jump-start” the pathway that stimulates
norepinephrine. Interestingly, SSRIs are not effective for neuro-
neurogenesis, the birth of new nerve cells. Researchers are trying
pathic pain. Topical lidocaine may be effective for the treatment of
to decipher how certain environmental cues can be used or
some neuropathic pain conditions where light touch of the skin can
overcome to attract these new cells — or transplanted stem
produce severe pain.
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tors in the gut), new analgesics
that target only the nociceptor
may have a better side-effect
profile. Among the many nociceptor targets are specialized
receptor channels (one of which
is activated by capsaicin, the
pungent ingredient in hot peppers,
and another by mustard oil) and a
variety of acid-sensing sodium and
calcium ion channels.
Blocking the activity of many
of these molecules has proven
effective in animal studies, suggesting that the development of
drugs that target these molecules
in humans may have great value
for the treatment of acute and
persistent pain.
However, it should be emphasized that pain experience is the
product of brain function.
HOW PAINKILLERS WORK. At the site of injury, the body produces prostaglandins that increase pain sensitivity.
The pain is in the brain, not in
Aspirin, which acts primarily in the periphery, prevents the production of prostaglandins. Acetaminophen is believed
the nociceptors that respond to
to block pain impulses in the brain itself. Local anesthetics intercept pain signals traveling up the nerve. Opiate drugs,
the injury. In addition to the
which act primarily in the central nervous system, block the transfer of pain signals from the spinal cord to the brain.
sensory-discriminative aspects,
pain involves emotional factors
Studies of the body’s own pain-control system not only
and the meaning of previous painful experiences, which need
demonstrated the existence of naturally occurring opioids (the
to be addressed concurrently in order to treat pain. The fact that
endorphins) but also identified the receptors through which opioids
placebos and hypnosis can significantly reduce pain clearly
exert their effects. The finding that opiate receptors are concen-
illustrates the importance of these psychological factors. New
trated in the spinal cord led to the use of injections of morphine
targets for the treatment of pain also include approaches that
and other opioids into the cerebrospinal fluid (in which the spinal
identify molecules in the brain associated with the elaboration
cord is bathed) without causing paralysis, numbness, or other severe
of persistent pain.
side effects. This technique came about through experiments with
animals that first showed that injecting opioids into the spinal cord
could produce profound pain control. It is now commonly used in
Parkinson’s disease
This neurologic disorder afflicts 1 million individuals in the
humans to treat pain after surgery and in some patients to treat
United States, most of whom are older than 50. Parkinson’s disease
chronic pain using an implanted pump.
is characterized by symptoms of slowness of movement, muscular
New targets are on the horizon. Molecular biology and genetic
approaches have identified many molecules (ion channels and
rigidity, tremor, and postural instability.
The discovery in the late 1950s that the level of dopamine was
receptors) that are predominantly, if not exclusively, expressed by
decreased in the brains of Parkinson’s patients was followed in the
the nociceptor, the peripheral nerve fiber that initially responds to
1960s by the successful treatment of this disorder by administration
the injury stimulus. Because adverse side effects of drugs arise from
of the drug levodopa, which is converted to dopamine in the brain.
the widespread location of the molecules targeted by analgesics
The successful treatment of Parkinson’s by replacement therapy is
(e.g., constipation results from morphine’s action on opioid recep-
one of the greatest success stories in neurology.
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Levodopa is now combined with another drug, carbidopa,
that reduces the peripheral breakdown of levodopa, thus allowing
greater levels to reach the brain and reducing side effects. Also
On a given day, these patients occupy up to 100,000 hospital beds.
Annual costs total about $32.5 billion.
Schizophrenia is thought to reflect changes in the brain, pos-
playing an important role are newer drugs, such as inhibitors of
sibly caused by disruption of neurodevelopment through genetic
dopamine breakdown and dopamine agonists.
predisposition, which may be exacerbated by environmental factors
Genetic studies have demonstrated several heritable gene
abnormalities in certain families, but most cases of Parkinson’s
such as maternal infections or direct brain trauma. Brain scans
and postmortem studies show abnormalities in some people with
occur sporadically. It is believed, however, that hereditary factors
may render some individuals more vulnerable to environmental
factors, such as pesticides. The discovery in the late 1970s that a
chemical substance, MPTP, can cause parkinsonism in drug addicts
stimulated intensive research on the causes of the disorder. MPTP
was accidentally synthesized by illicit drug designers seeking to
produce a heroinlike compound. MPTP was found to be converted
in the brain to a substance that destroys dopamine neurons. Parkinson’s continues to be studied intensively in both rodent and primate
MPTP models.
In the past several decades, scientists have shown in primate
models of Parkinson’s that specific regions in the basal ganglia,
a group of cellular structures deep in the brain, are abnormally
overactive. Most important, they found that surgical deactiva-
Schizophrenia is thought to reflect
changes in the brain, possibly caused
by disruption of neurodevelopment
through genetic predisposition,
which may be exacerbated by
environmental factors such as maternal
infections or direct brain trauma.
tion or destruction of these overactive nuclei — the pallidum
and subthalamic nucleus — can greatly reduce symptoms of
Parkinson’s disease.
The past decade has witnessed a resurgence in this surgical
schizophrenia, such as enlarged ventricles (fluid-filled spaces) and
procedure, pallidotomy, and more recently chronic deep-brain
reduced size of certain brain regions. Functional neuroimaging
stimulation. These techniques are highly successful for treating
scans such as PET and functional magnetic resonance imaging
patients who have experienced significant worsening of symptoms
(fMRI) taken while individuals perform cognitive tasks, particularly
and are troubled by the development of drug-related involuntary
those involving memory and attention, show abnormal function-
movements. The past decade has also seen further attempts to treat
ing in specific brain areas of people with this illness. Brain systems
such patients with surgical implantation of cells, such as fetal cells,
using the chemicals dopamine, glutamate, and GABA appear to be
capable of producing dopamine. Replacement therapy with stem
particularly involved in the pathogenesis of the disorder. Recently,
cells also is being explored. More recently, gene transfer of trophic
several genes involved in controlling nerve cell communication
factors has been studied in animal models and is being tested in
have been identified that appear to increase the risk of developing
clinical trials. Lastly, four clinical trials are currently underway
schizophrenia.
testing the hypothesis that gene therapy can provide symptomatic
The disorder usually is diagnosed between the ages of 15 and 25.
(in some cases) or neuroprotective (in others) benefit to patients
Few patients recover fully following treatment, and most continue
with Parkinson’s.
to have moderate or severe symptoms that may be exacerbated by
Schizophrenia
Marked by disturbances in thinking, emotional reactions, and
life stressors. About 15 percent of patients return to a productive
life after a single episode, 60 percent will have intermittent episodes
throughout their lives, and an additional 25 percent will not recover
social behavior, schizophrenia usually results in chronic illness and
their ability to live as independent adults. Deficits in cognition are
personality change. Delusions, hallucinations, and thought disorder
frequent, lifelong manifestations in most patients, even those who
are common.
show good recovery from more acute positive symptoms. The nega-
Affecting about 1 percent of the population, or 2 million
Americans each year, schizophrenia is disabling and costly.
Society for Neuroscience
tive symptoms may be the most debilitating in terms of leading a
productive life and generally are resistant to drug treatment.
neural disorders: advances and challenges
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51
The first antipsychotic drug, chlorpromazine, serendipitously
nately, partial epilepsies are generally more difficult to treat. Often,
was discovered to reduce symptoms of schizophrenia in the 1950s.
they can be controlled with a single antiepileptic that prevents
Clinical trials demonstrated that chlorpromazine was more effective
seizures or lessens their frequency, but sometimes a combination of
than placebo or a sedative. Subsequently, more than 20 effective
these drugs is necessary. Identification of the mutated genes under-
antipsychotic drugs were developed. Antipsychotics act by block-
lying epilepsy may provide new targets for the next generation of
ing certain dopamine receptors. This action accounts for the high
antiseizure drugs.
prevalence of parkinsonian side effects associated with the use of
Surgery is an excellent option for patients with specific types
the first generation of antipsychotics and the risk of developing an
of partial seizures who do not respond to antiepileptic drugs.
irreversible movement disorder, tardive dyskinesia.
Surgery requires the precise location and removal of the brain
The second generation of antipsychotic medications, devel-
area from which the partial seizures originate. After surgery, most
oped to be more effective in treating the positive symptoms of
properly selected patients experience improvement or complete
schizophrenia, can lead to debilitating side effects such as very large
remission of seizures for at least several years.
weight gain, blood disorders, and muscle pain and dysfunction.
Safer drugs are being sought.
Seizures and epilepsy
Seizures are due to sudden, disorderly discharges of interconnected neurons in the brain that temporarily alter one or more brain
functions. Epilepsy is a chronic neurological disorder characterized
by the occurrence of unprovoked seizures. In developed countries,
epilepsy affects approximately 50 of every 100,000 people. It affects
three to four times that number in developing countries.
Many different types of epilepsy have been recognized. Epilep-
A new form of epilepsy treatment, electrical stimulation therapy, was introduced as another option for hard-to-control partial
seizures. An implantable pacemakerlike device delivers small bursts
of electrical energy to the brain via the vagus nerve on the side of
the neck. While not curative, vagal nerve stimulation has been
shown to reduce the frequency of partial seizures in many patients.
Stroke
A stroke occurs when a blood vessel bringing oxygen and
nutrients to the brain bursts or is clogged by a blood clot or some
other particle. This deprives the brain of blood, causing the death
sy can start at any age and can be idiopathic (having an uncertain
of neurons within minutes. Depending on its location, a stroke can
cause) or symptomatic (having a known or presumed cause). Most
cause many permanent disorders, such as paralysis on one side of
idiopathic epilepsies probably are due to the inheritance of one or
the body and loss of speech.
more mutant genes, often a mutant ion channel gene. Symptomatic
Until recently, if you or a loved one had a stroke, your doctor
epilepsies result from a wide variety of brain diseases or injuries, in-
would tell your family there was no treatment. In all likelihood, the
cluding birth trauma, head injury, neurodegenerative disease, brain
patient would live out the remaining months or years with severe
infection, brain tumor, or stroke.
neurological impairment.
Epilepsies are of two types, generalized and partial. General-
This dismal scenario is now brightening. For one, use of the clot-
ized seizures typically result in loss of consciousness and can cause
dissolving bioengineered drug, tissue plasminogen activator (tPA), is
a range of behavioral changes, including convulsions or sudden
now a standard treatment in many hospitals. This approach rapidly
changes in muscle tone. They arise when there is simultaneous
opens blocked vessels to restore circulation before oxygen loss causes
excessive electrical activity over a wide area of the brain, often
permanent damage. Given within three hours of a stroke, it often can
involving the thalamus and cerebral cortex. In partial epilepsies,
help in limiting the ensuing brain damage. Also, attitudes about the
seizures typically occur with maintained consciousness or with
nation’s third leading cause of death are changing rapidly. Much of
altered awareness and behavioral changes. Partial seizures can
this has come from new and better understanding of the mechanisms
produce localized visual, auditory, and skin sensory disturbances; re-
that lead to the death of neurons following stroke and from devising
petitive uncontrolled movements; or confused, automatic behaviors.
ways to protect these neurons.
Such seizures arise from excessive electrical activity in one area of
the brain, such as a restricted cortical or hippocampal area.
Many antiepileptic drugs are available. Their principal targets
Stroke affects roughly 700,000 Americans a year — 150,000 of
whom die; total annual costs are estimated at $51.2 billion. Stroke often occurs in individuals over 65 years of age, yet a third are younger.
are either ion channels or neurotransmitter receptors. Generalized
Stroke tends to occur more in males and African Americans and in
epilepsies often are readily controlled by antiepileptic drugs, with
those with risk factors such as diabetes, high blood pressure, heart
up to 80 percent of patients seizure-free with treatment. Unfortu-
disease, obesity, high cholesterol, and a family history of stroke.
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STROKE. A stroke occurs when a blood vessel bringing oxygen and nutrients to the brain bursts or is clogged by a blood clot (1). This lack of blood leads to a cascade of neurochemical abnormalities that can cause cell death within minutes. Free radicals are released, causing damage to endothelial cells (2) and the mitochondria (3) of neurons. Normally the body readily disarms free radicals (4), but in stroke, endothelial cell damage allows many more than can be controlled to move into
brain tissue. Depending on its location, a stroke can have different symptoms such as paralysis on one side of the body or a loss of speech.
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Controlling risk factors with diet, exercise, and certain drugs
can help prevent stroke. Other specific treatments involving surgery
or arterial stents can clear clogs in the arteries of the neck region;
development or excesses in certain chemicals, including the
neuro-transmitter dopamine.
The majority of people with TS are not significantly disabled
these and treatments targeting heart disease can help prevent a
by symptoms, and therefore do not require medication. However,
cutoff of blood supply. Anticoagulant drugs can reduce the likeli-
antipsychotics and SSRIs, as well as drugs to control tics, nausea,
hood of clots forming, traveling to the brain, and causing a stroke.
high blood pressure, seizures, or anxiety, are available to help
Other experimental therapies under investigation may lead to
control symptoms when they interfere with functioning. Stimulant
even bigger payoffs for patients in the future. Some strategies target
medications, such as methylphenidate and dextroamphetamine,
mechanisms inside the neuron. In this way, the vicious cycle of
local damage followed by a widening fringe of biochemical-induced
neuronal death can be slowed. A number of classes of drugs have
been shown to be effective in animal studies.
Emerging clinical evidence suggests that, following a stroke
affecting movement in one arm, encouraging use of the weakened
arm by temporarily restricting use of the unaffected arm can aid
functional recovery. Another promising possibility for improving
recovery after stroke is through the use of neural stem cells. Some
animal studies have shown that an injection of stem cells aids
recovery even if administered several days after the injury. Administration of growth factors may further enhance the benefits of stem
One of the most common and
least understood neurobiological
disorders, Tourette syndrome
is an inherited disorder that
affects about 1 in 200 Americans.
cell transplantation.
Tourette syndrome
One of the most common and least understood neurobiological
disorders, Tourette syndrome (TS) is an inherited disorder that
affects about 1 in 200 Americans. Males are affected three to four
that are prescribed for attention deficit hyperactivity disorder
times as often as females.
(ADHD) have been reported to improve attention and decrease
Symptoms usually appear between the ages of 4 and 8, but
tics in TS. For obsessive-compulsive symptoms that interfere signifi-
in rare cases may emerge in the late teenage years. The symptoms
cantly with daily functioning, SSRIs, antidepressants, and related
include motor and vocal tics — repetitive, involuntary movements
medications may be prescribed.
or utterances that are rapid and sudden and persist for more
Medication dosages that achieve maximum control of symptoms
than one year. The types of tics may change frequently and
vary for each patient and must be gauged carefully by a doctor. The
increase or decrease in severity over time. In roughly one-half
medicine is administered in small doses with gradual increases to the
of individuals, this disorder lasts a lifetime, but the remaining
point where there is maximum alleviation of symptoms with minimal
patients may experience a remission or decrease in symptoms as
side effects. Some of the undesirable reactions to medications are
they get older.
weight gain, muscular rigidity, fatigue, motor restlessness, and social
A high percentage of people with TS also have associated
withdrawal, most of which can be reduced with specific medications.
conditions such as problems with learning, difficulties with atten-
Some side effects such as depression and cognitive impairment can
tion, and obsessive thoughts and compulsive rituals. Often these
be alleviated with dosage reduction or a change of medication.
manifestations are more troublesome to individuals than the tics
Other types of therapy also may be helpful. Psychotherapy and
themselves, so physicians must consider them when choosing a
counseling can assist people with TS and help their families cope,
treatment regimen.
and some behavior therapies can be very effective in reducing the
TS is inherited and seems to result from abnormal activity in
severity of both tics and compulsions.
a brain system called the basal ganglia. Research suggests that
genes associated with TS, perhaps together with in utero or early
environmental conditions, cause abnormalities in basal ganglia
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New Diagnostic Methods
Many of the recent advances
neurotransmitters, which can be used to understand the relation-
in understanding the brain are due to the development of techniques
ship between a particular neurotransmitter and a behavior or cogni-
that allow scientists to directly monitor neurons throughout the body.
tive process. Within the next few years, PET could enable scientists
Electrophysiological recordings, for example, the recording of
to identify the biochemical nature of neurological and mental
auditory brainstem responses to assess hearing function in infants,
disorders and to determine how well therapy is working in patients.
trace brain electrical activity in response to a specific external
For example, PET has revealed marked changes in the depressed
stimulus. In this method, electrodes placed in specific parts of the
brain. Knowing the location of these changes helps researchers
brain — which vary depending on which sensory system is being
understand the causes of depression and monitor the effectiveness
tested — make recordings that are then processed by a computer.
of specific treatments.
The computer makes an analysis based on the time lapse between
Another technique, single photon emission computed tomography
stimulus and response. It then extracts this information from back-
(SPECT), is similar to PET, but its pictures are not as detailed.
ground activity.
SPECT is much less expensive than PET because the tracers it uses
Following the discovery that material is transported within
neurons, methods have been developed to visualize activity and
precisely track fiber connections within the nervous system. This
have a longer half-life and do not require a nearby particle accelerator, typical of those used in nuclear physics, to produce them.
Magnetic resonance imaging (MRI) Providing a high-
can be done by injecting a radioactive amino acid into the brain of
quality, three-dimensional image of organs and structures inside the
an experimental animal; the animal is sacrificed a few hours later,
body without X-rays or other radiation (noninvasive), MRIs are
and then the presence of radioactive cells is visualized on film.
unsurpassed in anatomical detail and may reveal minute changes
In another technique, the enzyme horseradish peroxidase is in-
that occur over time.
jected and taken up by nerve fibers that later can be identified
under a microscope.
These and other methods have resulted in many advances in
knowledge about the workings of the nervous system and are still
useful today. New methods, safely applicable to humans, promise to
give even more precise information.
Imaging techniques
Positron emission tomography (PET) PET is one of the most
MRIs tell scientists when structural abnormalities first appear
in the course of a disease, how they affect subsequent development,
and precisely how their progression correlates with mental and
emotional aspects of a disorder.
During the 15-minute MRI procedure, a patient lies inside
a massive, hollow, cylindrical magnet and is exposed to a powerful, steady magnetic field. Different atoms in the brain resonate
to different frequencies of magnetic fields. In MRI, a background
magnetic field lines up all the atoms in the brain. A second mag-
important techniques for measuring blood flow or energy consump-
netic field, oriented differently from the background field, is turned
tion in the brain. This method of measuring brain function is based
on and off many times a second; at certain pulse rates, particular
on the detection of radioactivity emitted when positrons, positively
atoms resonate and line up with this second field. When the second
charged particles, undergo radioactive decay in the brain. Small
field is turned off, the atoms that were lined up with it swing back
amounts of a radioisotope are introduced into the blood, which is
to align with the background field. As they swing back, they create
then taken up into different brain areas in proportion to how hard
a signal that can be picked up and converted into an image. Tissue
the neurons are working. Computers build three-dimensional im-
that contains a lot of water and fat produces a bright image; tissue
ages of the changes in blood flow based on the amount of radiation
that contains little or no water, such as bone, appears black.
emitted in these different brain regions.
PET studies have helped scientists understand more about how
A different MRI procedure can also assess the path of fiber
tracts in the brain, that is, the connectivity between regions. This
drugs affect the brain and what happens during various behaviors,
technology, referred to as diffusion tensor imaging, or DTI, takes
such as learning and using language, and in certain brain disorders
advantage of diffusion rates of water, which tend to be higher along
— such as stroke, depression, and Parkinson’s disease. For example,
fiber tracts, to produce high-resolution images of how areas may
PET allows scientists to measure changes in the release of some
connect in the brain.
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new diagnostic methods
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CHROMOSOMES, GENES, AND PROTEINS. Every trait and chemical process in the body is controlled by a gene or group of genes on 23 paired chromosomes in the nucleus of every cell (1). Each gene is a discrete segment along the two tightly coiled strands of DNA that make up these chromosomes. DNA strands bear
four different types of coding molecules — adenine (A), cytosine (C), guanine (G), and thymine (T) — the sequence of which contains the instructions for making all
the proteins necessary for life (2). During protein production, a gene uses a molecule called mRNA to send a message with instructions for the amino acids needed to
manufacture a protein (3).
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MRI images can be constructed in any plane, and the tech-
Optical imaging techniques Optical imaging relies on shin-
nique is particularly valuable in studying the brain and spinal cord.
ing weak lasers through the skull to visualize brain activity. These
It reveals the precise extent of tumors rapidly and vividly, and it
techniques are inexpensive and relatively portable. They are also
provides early evidence of potential damage from stroke, allowing
silent and safe: Because only extremely weak lasers are used, these
physicians to administer proper treatments early.
methods can be used to study even infants. In a technique called
Magnetic resonance spectroscopy (MRS) MRS, a technique
related to MRI, uses the same machinery but measures the concentra-
near infrared spectroscopy (NIRS), technicians shine lasers through
the skull at near infrared frequencies, which renders the skull
tion of specific chemicals — such as neurotransmitters — in different
parts of the brain instead of blood flow. MRS also holds great promise: By measuring the molecular and metabolic changes that occur in
the brain, this technique has already provided new information on
brain development and aging, Alzheimer’s disease, schizophrenia, autism, and stroke. Because it is noninvasive, MRS is ideal for studying
the natural course of a disease or its response to treatment.
Functional magnetic resonance imaging (fMRI) Among the
most popular neuroimaging techniques today is fMRI. This technique compares brain activity under resting and active conditions.
It combines the high-spatial-resolution, noninvasive imaging of
brain anatomy offered by standard MRI with a strategy for detecting increases in blood oxygen levels when brain activity brings
fresh blood to a particular area of the brain, which is a correlate for
One of the most exciting
developments in imaging is the
combined use of information from
fMRI and MEG. Together, this
information leads to a much more
precise understanding of how the
brain works in health and disease.
neuronal activity. This technique allows for more detailed maps
of brain areas underlying human mental activities in health and
disease. To date, fMRI has been applied to the study of various
functions of the brain, ranging from primary sensory responses to
cognitive activities. Given fMRI’s temporal and spatial resolution,
transparent. Blood with oxygen in it absorbs different frequencies
and its noninvasive nature, this technique is often preferred for
of light from blood in which the oxygen has been consumed. By ob-
studies investigating dynamic cognitive and behavioral changes.
serving how much light is reflected back from the brain at each fre-
Magnetoencephalography (MEG) MEG is a recently
quency, researchers can track blood flow. Diffuse optical tomography
developed technique that reveals the source of weak magnetic fields
is then used to create maps of brain activity. A similar technique,
emitted by neurons. An array of cylinder-shaped sensors monitors
the event-related optical signal, records how light scatters in response
the magnetic field pattern near the patient’s head to determine the
to rapid cellular changes that arise when neurons fire and poten-
position and strength of activity in various regions of the brain. In
tially can assess neural activity lasting milliseconds. Transcranial
contrast with other imaging techniques, MEG can characterize rap-
magnetic stimulation (TMS) works by inducing electrical impulses in
idly changing patterns of neural activity — down to millisecond res-
the brain by modulating magnetic fields — an electromagnetic coil
olution — and can provide a quantitative measure of the strength of
that emits powerful magnetic pulses is held against the scalp. Re-
this activity in individual subjects. Moreover, by presenting stimuli
petitive TMS is being used to investigate the role of specific brain
at various rates, scientists can determine how long neural activation
regions during behavior and can be combined with other neuroim-
is sustained in the diverse brain areas that respond.
aging techniques; for example, with fMRI, to establish a functional
One of the most exciting developments in imaging is the
combined use of information from fMRI and MEG. The former
provides detailed information about the areas of brain activity in a
particular task, whereas MEG tells researchers and physicians when
correlation between a region and a behavior.
Gene diagnosis
The inherited blueprint for all human characteristics, genes
certain areas become active. Together, this information leads to a
consist of short sections of deoxyribonucleic acid (DNA) sequence
much more precise understanding of how the brain works in health
scattered throughout the long, spiraling, double-helix structure found
and disease.
on the 23 pairs of chromosomes in the nucleus of every human cell.
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new diagnostic methods
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57
New hereditary linkage studies have made it possible to find
abnormalities found on the X chromosome in patients with Duch-
the chromosomal location of genes responsible for neurologic and
enne muscular dystrophy and on chromosome 13 in patients with
psychiatric diseases and to identify structural changes in these
inherited retinoblastoma, a rare, highly malignant childhood eye
genes that are responsible for causing disease. This information is
tumor that can lead to blindness and death.
useful for identifying individuals who carry faulty genes and thereby
Gene mapping has led to the localization on chromosome 21
improving diagnosis, for understanding the precise cause of diseases
of the gene coding for the beta amyloid precursor protein that is
in order to improve methods of prevention and treatment, and for
abnormally cut to form the smaller peptide, beta amyloid. It is this
peptide that accumulates in the senile plaques that clog the brains
of patients with Alzheimer’s disease. This discovery shed light on
why individuals with Down syndrome with three copies of chromosome 21 (trisomy 21) invariably accumulate amyloid deposits; they
New hereditary linkage studies
have made it possible to find the
chromosomal location of genes
responsible for neurologic and
psychiatric diseases and to identify
structural changes in these genes that
are responsible for causing disease.
make too much amyloid because they have an extra copy of this
gene. Mutations in this gene have been shown to underlie
Alzheimer’s in another subset of these patients.
Gene mapping has enabled doctors to diagnose fragile X mental
retardation, the most common cause of inherited mental retardation
in males. Some scientists have now identified this gene, FMR1,
which is found on the X chromosome and is important for neuronal communication. Other groups of scientists are investigating
whether genetic components to schizophrenia, bipolar disorder, and
alcoholism exist, but their findings are not yet conclusive.
Overall, the characterizations of the structure and function of
individual genes causing diseases of the brain and nervous system
are in the early stages. Factors that determine variations in the genetic expression of a single-gene abnormality — such as what con-
evaluating the malignancy of certain tumors and people’s suscepti-
tributes to the early or late start or severity of a disorder or prevents
bility to them.
its occurrence in a mutant gene carrier — are still largely unknown.
So far, scientists have found the chromosomal location of
Scientists also are studying the genes in mitochondria, structures
defective genes for more than 100 neurological disorders and have
found outside the cell nucleus that have their own DNA and are
identified the defect in up to 50. Prenatal or carrier tests exist for
responsible for the production of energy used by the cell. Recently,
many of the most prevalent of these illnesses.
mutations in mitochondrial genes were found to cause several rare
For example, scientists have tracked down the gene that
neurological disorders. Some scientists speculate that an inheritable
goes awry in Huntington’s patients. The defect is an expansion
variation in mitochondrial DNA may play a role in diseases such
of a CAG repeat. CAG is the genetic code for the amino acid
as Alzheimer’s, Parkinson’s, and some childhood diseases of the
glutamine, and the expanded repeat results in a long string of glu-
nervous system.
tamines within the protein. This expansion appears to alter the protein’s function. Scientists have found that the size of the expanded
repeat in an individual is predictive of susceptibility to and severity
of Huntington’s disease. Several other neurodegenerative disorders
have been attributed to expanded CAG repeats in other genes. The
mechanisms by which these expansions cause adult-onset neurodegeneration are the focus of intense research.
Sometimes patients with single-gene disorders are found to
have a chromosomal abnormality — a deletion or break in the
DNA sequence of the gene — that can lead scientists to a more
accurate position of the disease gene. This is the case with some
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Potential Therapies
New drugs. Most medicines used today were
aged rats. NGF, which slows the destruction of neurons that use
developed using trial-and-error techniques, which often do not
acetylcholine, also holds promise for slowing the memory deficits
reveal why a drug produces a particular effect. But the expanding
associated with normal aging.
knowledge gained from the new methods of molecular biology —
Recently, several new factors have been identified. They are
the ability to determine the structure of receptors or other proteins
potentially useful for therapy, but scientists must first understand
— makes it possible to design safer and more effective drugs.
how they may influence neurons. Alzheimer’s disease, Parkinson’s
In a test tube, the potency of an agent can be determined by how
well it attaches to a receptor or other protein target. A scientist then
can vary the drug’s structure to enhance its action on the desired tar-
disease, and amyotrophic lateral sclerosis (ALS) may be treated in
the future with trophic factors or their genes.
In an interesting twist on growth factor therapy, research-
get. Thus, subsequent generations of drugs can be designed to interact
ers demonstrated that neutralization of inhibitory molecules can
more selectively with the target or, in many cases, specific subtypes of
help repair damaged nerve fiber tracts in the spinal cord. Using
the target, producing better therapeutic effects and fewer side effects.
While this rational drug design holds promise for developing
drugs for conditions ranging from stroke and migraine headaches to
depression and anxiety, it will take considerable effort to clarify the
role of the different potential drug targets in these disorders.
Other promising candidates for drug therapies include trophic
factors, antibodies engineered to modify the interactions and
toxicity of misfolded proteins, small molecules that take advantage
of specific biochemical pathways, interfering RNAs (RNAi) that
reduce toxic levels of individual proteins, and stem cells that could
replace dead or dying neurons.
Trophic factors
One result of basic neuroscience
research is the discovery of
numerous growth factors or
trophic factors, which control
the development and survival
of specific groups of neurons.
One result of basic neuroscience research is the discovery of
numerous growth factors or trophic factors, which control the development and survival of specific groups of neurons. Once the specific
actions of these molecules and their receptors are identified and
their genes cloned, procedures can be developed to modify trophic
antibodies to Nogo-A, a protein that inhibits nerve regeneration,
factor-regulated functions in ways that might be useful in the treat-
Swiss researchers succeeded in getting some nerves of damaged
ment of neurological disorders.
spinal cords to regrow in rats and monkeys. Treated animals of both
Once a trophic factor for a particular cell is found, copies of
the factor might be genetically targeted to the area of the brain
where this type of cell has died. The treatment may not cure a disease but could improve symptoms or delay the disease’s progression.
Already, researchers have demonstrated the possible value of
at least one of these factors, nerve growth factor (NGF). Infused into
the brains of rats, NGF prevented cell death and stimulated the
regeneration and sprouting of damaged neurons that are known to
species showed large improvements in their ability to walk and use
their forepaw digits after spinal cord damage.
This research has been translated to a clinical setting where
recently injured spinal cord injury patients are being treated with
anti-Nogo-A antibodies in a clinical trial.
Engineered antibodies
The immune system has evolved to very specifically identify
die in Alzheimer’s disease. When aged animals with learning and
and modify factors both inside and outside of cells. It is sometimes
memory impairments were treated with NGF, scientists found that
possible to trick the body into attacking proteins that cause neu-
these animals were able to remember a maze task as well as healthy
rological diseases by “vaccinating” patients against these proteins.
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potential therapies
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CELL AND GENE THERAPY.
In potential therapy techniques,
scientists plan to insert genetic
material for a beneficial neurotransmitter or trophic factor into
stem cells or a virus. The cells or
virus are then put into a syringe
and injected into the patient
where they will produce the beneficial molecule and, it is hoped,
improve symptoms.
This approach has shown some promise in Alzheimer’s disease,
disease (vCJD), known as prion diseases. vCJD has been linked
although it also carries risks, such as increased inflammation when
to bovine spongiform encephalopathy, or “mad cow” disease. For
the brain reacts to the antibodies against its proteins. Another
example, fruit flies (Drosophila) that get HD because they have
new approach combines genetic engineering with immunology to
been modified to carry the mutant human gene are generally too
engineer antibodies or fragments of antibodies that can bind to and
weak and uncoordinated to break out of their pupal case the way
alter the disease characteristics of specific proteins. These therapies
normal insects do. However, when they also express the gene for
could be delivered either as proteins or as genes.
an anti-HD antibody, all of them emerge as young adults. Further-
Promising preliminary results have been obtained for Hun-
more, these treated flies live longer than the untreated ones that
tington’s (HD), Parkinson’s (PD), and Alzheimer’s (AD) diseases
do manage to emerge, and the treated ones show less pathology in
and neurodegenerative disorders such as variant Creutzfeld-Jakob
their brains.
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therapies
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Small molecules and RNAs
Clarifying the processes that underlie brain damage will open
up the potential to use small-molecule drugs to alter these processes.
Some success has occurred in developing animal models using approaches based on known mechanisms of drugs. Examples include
drugs such as antibiotics and anti-tumor drugs, which appear to
reduce the neuronal damage in ALS, HD, and PD. Thousands of
small molecule drug candidates can be tested using high-throughput
screening to alter a cellular property that represents an important
part of a disease process. Because many neurodegenerative diseases
involve proteins that misfold and clump abnormally, lasers are used
to measure whether proteins are clumped inside cells that have been
robotically distributed into tiny wells, along with the small molecules
to be tested. A machine then scans the wells and reports whether
particular drugs have changed the protein clumping, so that these
drugs can be tested further. New leads for drugs to treat AD and
prion diseases have recently been described using these methods.
worked out in animals and cannot be considered therapies for
humans at this time.
Scientists have identified embryonic neuronal stem cells — unspecialized cells that give rise to cells with specific functions — in
the brain and spinal cord of embryonic and adult mice. Stem cells
can continuously produce all three major cell types of the brain:
neurons; astrocytes, the cells that nourish and protect neurons; and
oligodendrocytes, the cells that surround axons and allow them to
conduct their signals efficiently. The production abilities of stem
cells may someday be useful for replacing brain cells lost to disease.
A more limited type of stem cell also has been discovered in the
adult nervous system in various kinds of tissue, raising the possibility that these adult stem cells might be pharmacologically directed
to replace damaged neurons.
In other work, researchers are studying a variety of viruses that
may ultimately be used as “Trojan horses,” carrying therapeutic
genes to the brain to correct nervous system diseases. Adeno-associated virus (AAV) and human or equine lentivirus seem to be the
safest and most efficient at this time. AAV and equine lentivirus
are being used in clinical trials in patients with PD. Herpes simplex
virus and adenovirus vectors also have been evaluated in early-stage
Thousands of small molecule
drug candidates can be tested
using high-throughput screening
to alter a cellular property that
represents an important part
of a disease process.
human trials for treating brain tumors.
Several neurodegenerative diseases are caused by the accumulation of abnormal proteins. If the cells made much less of such proteins to begin with, then presumably the disease would progress much
more slowly. A new class of potential drugs is based on removing the
RNAs that code for the proteins that are causing damage. Mouse
models of HD and ALS appear to have responded positively to such
treatments, which are delivered via gene therapies.
Cell and gene therapy
Researchers throughout the world are pursuing a variety of
new ways to repair or replace neurons and other cells in the brain.
For the most part, these experimental approaches are still being
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potential therapies
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Neuroethics
Breaking a confidence. Going along to
havior. These discoveries will place traditional questions of personal
get along. Telling a “white lie” to protect a friend. Everyone faces
responsibility in a new light. Our understanding of the brain as the
ethical dilemmas — in school, at home, and nearly everywhere
control center for all decisions and actions comes into direct contact
in everyday life. This is no different for neuroscientists. With the
with concepts of free will as the basis for personal responsibility. If the
tremendous advances in the field, scientists and nonscientists alike
brain is the source of all action, when the brain is damaged, do we
have sensed a critical turning point. Advancing knowledge about
hold the person less responsible for his or her action? Does antisocial
how the brain enables normal behavior; how injury, drugs, or dis-
behavior itself provide evidence for a maladapted or miswired brain,
ease affect it; and how diagnoses and treatments could change brain
or do we need physical evidence of trauma or disease? Neuroscience
function raises serious and novel ethical questions.
is interested in these questions about criminal behavior but also in
For example, some recent brain imaging studies have sought to
the questions of how “normal” members of society create and enforce
define areas responsible for phenomena such as deception. The post-
the laws that criminals violate. Some commentators think that in-
9/11 era has created much interest in lie detection for security pur-
creasing neuroscience knowledge may seriously challenge fundamen-
poses in screening immigrants. How should privacy be balanced with
tal tenets of criminal law, while others foresee incremental changes
national security? Is the technology accurate enough to provide useful
that may lead to more just, accurate, and fair judgments. Neuroethics
data upon which to base decisions? Pursuing these lines of scientific
can help society think about how knowledge of the brain basis of
inquiry in a responsible way requires neuroscientists to examine how
behavior may affect our ideas of the way society should be.
what they do affects the world beyond the laboratory or clinic.
This self-examination makes up a field known as neuroethics.
Scientists and ethicists are beginning to reflect on the implica-
Diagnosis, treatment, and enhancement
Neuroscience already has given rise to drugs and devices, de-
tions of neuroscience in areas of behavioral research such as moral
veloped for the treatment of illness, that permit healthy people to
reasoning and decision-making, as well as the implications of new
improve their cognitive performance or alter their emotional states.
neuroscience technologies such as brain scanning, brain stimula-
In the future, drugs may be developed that enhance memory or alter
tion, and pharmaceuticals to manipulate cognition. While many
social behaviors. It is critical that scientists engage policy-makers
questions and methods within neuroethics are similar to those in
and society at large in discussions about the extension of treatments
biomedical ethics, neuroethics deals with brain-specific issues that
from the realm of illness to the realm of enhancement. Neuroethi-
touch no other area of science — our sense of self, our personalities,
cal issues in medicine arise where gaps exist between diagnosis and
and our behavior. What’s more, brain science is developing inter-
treatment, where treatments may offer tradeoffs in personality or
ventions that can change the way our brains function. Neuroethics
cognitive changes, and where drugs or devices that can help unwell
links the descriptive science — what can we do — with the ques-
patients also can boost performance of normal people. When diag-
tion of what should we do, which is guided by individual and shared
nostic tests exist for brain-based diseases that have no cure, such as
value systems.
Alzheimer’s, how should this capability be used? Should emergency
Neuroethics is the subject of a growing body of literature and an
rooms administer memory-altering drugs to patients who have suf-
increasing number of meetings and conferences that have attracted
fered a trauma and may be at risk for post-traumatic stress disorder?
a wide range of thinkers, students, basic and clinical neuroscientists,
If drugs that are effective for treating attention deficit hyperactivity
economists, philosophers, journalists, sociologists, lawyers, judges,
disorder also improve work or classroom performance of normal
and others. Some major topics include the subjects listed below.
people, do we need to regulate access, and do we consider such use
Personal responsibility and punishment
Neuroscience is teaching us about the neural substrates of human characteristics, such as anger, impulse control, and conscience.
to be cheating?
Social behavior
The neurobiological basis of social interaction is now an excit-
It is also giving us insight into the brain mechanisms of conditions
ing topic of research. While a major goal of such research is the
such as addiction and other disorders that impair the control of be-
treatment of disabling conditions such as autism spectrum disorders,
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Society for Neuroscience
the knowledge gleaned may also permit us to delve into other kinds
of social behavior. Already it is possible to use brain imaging to
observe emotional responses to pictures of minority groups within
a society. What are we to make of such information? Will it help
us understand prejudice, or could it be used to influence decisions
about individuals? It is critical that scientists explain the limitations
of current technologies and help formulate policies to minimize the
chances of misuse.
Prediction
Neuroimaging and genetic screening may enable us to predict
behavior, personality, and disease with greater accuracy than ever
before. Neuroimaging technology is also being researched and marketed for lie detection, with consumer targets including national
security, employment screening, the legal system, and personal
relationships. As individuals and members of groups, people have
long been interested in predicting someone else’s behavior or detecting whether or not they are truthful. Our approximately 20,000
genes are very distant from our behavior, however, and appear to
act in extremely complex combinations in contributing to neural
function. Neuroscience technologies that enable more accurate
assessment also raise important concerns about privacy and fairness
that go beyond those in bioethics. Will we be able to use imaging to
measure intelligence? Empathy? Risk for violence? What degree of
privacy do we expect to have over our thoughts? If someone has not
yet committed a crime but shows brain-based reactions to inappropriate stimuli, such as pictures of children, would we require further
monitoring or even preventive detention? The neuroimaging detection of lying has the potential for a major impact on society but will
require careful controls and years of research. People lie for different
reasons under different circumstances, not all lies cause harm, and
even brain correlates of deception will never give us an objective
determination of “truth.” Predicting individual behavior and determining truthfulness will be major areas of research in neuroimaging
and behavioral neuroscience in the coming years, and neuroethics
will face many challenges as technologies evolve.
Effective and ethical science communication
and commercial enterprise
Neuroethics will draw from the experience of bioethics in
handling scientific communication with the media and responsible
transfer of knowledge from basic science to profit-driven venture.
A major concern for neuroethicists is the degree to which the
media and the public fascination with neuroscience can lead to
overstatements and inaccuracies in media communication. Early
studies have shown that neuroscience information and pictures of
brain images lend excessive credibility to scientific statements in
the media, which may underscore “neurorealism” — the idea that
anything neuroscientific must be definitive and true. The powerful allure of neuroscience may also entice commercialization of
neurotechnologies before full understandings of the risks, benefits,
and limitations of the science are in hand. Neuroethics has a critical role in protecting the integrity of neuroscience by promoting
responsible and accurate scientific communication in the media,
appropriate oversight of commercialized neurotechnologies including accurate advertising, and proactive communication in the
popular media to promote public discussion of ethical, social, and
legal issues arising from neuroscience knowledge and technology.
At this stage, the field of neuroethics raises more questions
than answers. It poses challenges to scientists, ethicists, lawyers,
policy-makers, and the public to work through the social implications
of new discoveries. The issues are too broad-based to expect that
scientists alone will supply the answers. But neuroscientists are well
positioned to help shape and contribute to the debate and discussion.
One of the hallmarks of neuroscience has been the drive
toward integrating information from disparate fields and specializations to increase knowledge. Sorting through the complex issues
captured under the umbrella of neuroethics provides an important
opportunity for informed and rich discussions among scientists
and with the public. Continuing study of neuroethics will help all
segments of society deal with the challenges posed by emerging
technologies that investigate the brain and how it works.
Informed consent in research
Special care must be taken when scientists seek consent to
conduct research and throughout experiments, when individuals
have thinking or emotional impairments that might affect their decision-making capacity. Consent is an ongoing process that should
involve education of the potential research participant and, when
appropriate, family members. Researchers are discussing potential
needs to exercise greater scrutiny, ensure safeguards, and enhance
participants’ grasp of a study, including risks and benefits.
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G l o s s a ry
ACETYLCHOLINE A neurotransmitter active both in the brain,
APOPTOSIS Programmed cell death induced by specialized bio-
where it regulates memory, and in the peripheral nervous system,
chemical pathways, often serving a specific purpose in the develop-
where it controls the actions of skeletal and smooth muscle.
ment of the animal.
ACTION POTENTIAL An electrical charge that travels along the
AUDITORY NERVE A bundle of nerve fibers extending from the
axon to the neuron’s terminal, where it triggers the release of a
cochlea of the ear to the brain that contains two branches: the co-
neurotransmitter. This occurs when a neuron is activated and tem-
chlear nerve, which transmits sound information, and the vestibu-
porarily reverses the electrical state of its interior membrane from
lar nerve, which relays information related to balance.
negative to positive.
AUTONOMIC NERVOUS SYSTEM A part of the peripheral ner-
ADRENAL CORTEX An endocrine organ that secretes steroid hor-
vous system responsible for regulating the activity of internal organs.
mones for metabolic functions; for example, in response to stress.
It includes the sympathetic and parasympathetic nervous systems.
ADRENAL MEDULLA An endocrine organ that secretes epineph-
AXON The fiberlike extension of a neuron by which it sends infor-
rine and norepinephrine in concert with the activation of the
mation to target cells.
sympathetic nervous system; for example, in response to stress.
BASAL GANGLIA Structures located deep in the brain that play
AGONIST 1.) A neurotransmitter, drug, or other molecule that
an important role in the initiation of movements. These clusters of
stimulates receptors to produce a desired reaction. 2.) A muscle
neurons include the caudate nucleus, putamen, globus pallidus, and
that moves a joint in an intended direction.
substantia nigra. Cell death in the substantia nigra contributes to
ALZHEIMER’S DISEASE A major cause of dementia in the elderly,
Parkinson’s disease.
this neurodegenerative disorder is characterized by the death of neu-
BRAINSTEM The major route by which the forebrain sends
rons in the hippocampus, cerebral cortex, and other brain regions.
information to and receives information from the spinal cord and
AMINO ACID TRANSMITTERS The most prevalent neurotransmitters in the brain, these include glutamate and aspartate, which have
peripheral nerves. The brainstem controls, among other things,
respiration and the regulation of heart rhythms.
excitatory actions on nerve cells, and glycine and gamma-amino
BROCA’S AREA The brain region located in the frontal lobe of the
butyric acid (GABA), which have inhibitory actions on nerve cells.
left hemisphere that is important for the production of speech.
AMYGDALA A structure in the forebrain that is an important com-
CATECHOLAMINES The neurotransmitters dopamine, epineph-
ponent of the limbic system and plays a central role in emotional
rine, and norepinephrine, which are active in both the brain and
learning, particularly within the context of fear.
the peripheral sympathetic nervous system. These three molecules
ANDROGENS Sex steroid hormones, including testosterone, found
in higher levels in males than females. They are responsible for
male sexual maturation.
ANTAGONIST 1.) A drug or other molecule that blocks receptors.
Antagonists inhibit the effects of agonists. 2.) A muscle that moves
a joint in opposition to an intended direction.
APHASIA Disturbance in language comprehension or production,
often as a result of a stroke.
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Brain Facts | glossary
have certain structural similarities and are part of a larger class of
neurotransmitters known as monoamines.
CEREBELLUM A large structure located at the roof of the hindbrain
that helps control the coordination of movement by making connections to the pons, medulla, spinal cord, and thalamus. It also
may be involved in aspects of motor learning.
CEREBRAL CORTEX The outermost layer of the cerebral hemispheres of the brain. It is largely responsible for all forms of conscious
experience, including perception, emotion, thought, and planning.
Society for Neuroscience
CEREBRAL HEMISPHERES The two specialized halves of the brain.
DOPAMINE A catecholamine neurotransmitter known to have
For example, in right-handed people, the left hemisphere is special-
varied functions depending on where it acts. Dopamine-containing
ized for speech, writing, language, and calculation; the right hemi-
neurons in the substantia nigra of the brainstem project to the cau-
sphere is specialized for spatial abilities, visual face recognition, and
date nucleus and are destroyed in Parkinson’s victims. Dopamine
some aspects of music perception and production.
is thought to regulate key emotional responses and plays a role in
CEREBROSPINAL FLUID A liquid found within the ventricles of
the brain and the central canal of the spinal cord.
CIRCADIAN RHYTHM A cycle of behavior or physiological change
lasting approximately 24 hours.
CLASSICAL CONDITIONING Learning in which a stimulus that
naturally produces a specific response (unconditioned stimulus) is
schizophrenia and drug abuse.
DORSAL HORN An area of the spinal cord where many nerve
fibers from peripheral sensory receptors meet other ascending and
descending nerve fibers.
DRUG ADDICTION Loss of control over drug intake or compulsive
seeking and taking of drugs, despite adverse consequences.
repeatedly paired with a neutral stimulus (conditioned stimulus).
ENDOCRINE ORGAN An organ that secretes a hormone direct-
As a result, the conditioned stimulus can come to evoke a response
ly into the bloodstream to regulate cellular activity of certain
similar to that of the unconditioned stimulus.
other organs.
COCHLEA A snail-shaped, fluid-filled organ of the inner ear re-
ENDORPHINS Neurotransmitters produced in the brain that gener-
sponsible for converting sound into electrical potentials to produce
ate cellular and behavioral effects like those of morphine.
an auditory sensation.
EPILEPSY A disorder characterized by repeated seizures, which are
COGNITION The process or processes by which an organism gains
caused by abnormal excitation of large groups of neurons in various
knowledge or becomes aware of events or objects in its environment
brain regions. Epilepsy can be treated with many types of anticon-
and uses that knowledge for comprehension and problem-solving.
vulsant medications.
CONE A primary receptor cell for vision located in the retina. It is
EPINEPHRINE A hormone, released by the adrenal medulla and
sensitive to color and is used primarily for daytime vision.
specialized sites in the brain, that acts with norepinephrine to affect
CORPUS CALLOSUM The large bundle of nerve fibers linking the
left and right cerebral hemispheres.
CORTISOL A hormone manufactured by the adrenal cortex. In
humans, cortisol is secreted in the greatest quantities before dawn,
readying the body for the activities of the coming day.
CRANIAL NERVE A nerve that carries sensory input and motor
output for the head and neck region. There are 12 cranial nerves.
the sympathetic division of the autonomic nervous system. Sometimes called adrenaline.
ESTROGENS A group of sex hormones found more abundantly in
females than males. They are responsible for female sexual maturation and other functions.
EVOKED POTENTIAL A measure of the brain’s electrical activity in
response to sensory stimuli. This is obtained by placing electrodes
on the surface of the scalp (or more rarely, inside the head), repeat-
DEPRESSION A mental disorder characterized by sadness, hopeless-
edly administering a stimulus, and then using a computer to average
ness, pessimism, loss of interest in life, reduced emotional well-
the results.
being, and abnormalities in sleep, appetite, and energy level.
DENDRITE A treelike extension of the neuron cell body. The dendrite is the primary site for receiving and integrating information
from other neurons.
EXCITATION A change in the electrical state of a neuron that is
associated with an enhanced probability of action potentials.
FOLLICLE-STIMULATING HORMONE A hormone released
by the pituitary gland that stimulates the production of sperm in
the male and growth of the follicle (which produces the egg) in
the female.
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glossary
| Brain Facts
65
FOREBRAIN The largest part of the brain, which includes the
HUNTINGTON’S DISEASE A movement disorder caused by the
cerebral cortex and basal ganglia. The forebrain is credited with the
death of neurons in the basal ganglia and other brain regions. It is
highest intellectual functions.
characterized by abnormal movements called chorea — sudden,
FOVEA The centermost part of the eye located in the center of the
retina and that contains only cone photoreceptors.
FRONTAL LOBE One of the four subdivisions of the cerebral cortex.
The frontal lobe has a role in controlling movement and in the
planning and coordinating of behavior.
GAMMA-AMINO BUTYRIC ACID (GABA) An amino acid transmitter in the brain whose primary function is to inhibit the firing of
nerve cells.
GLIA Specialized cells that nourish and support neurons.
GLUTAMATE An amino acid neurotransmitter that acts to excite
jerky movements without purpose.
HYPOTHALAMUS A complex brain structure composed of many
nuclei with various functions, including regulating the activities
of internal organs, monitoring information from the autonomic
nervous system, controlling the pituitary gland, and regulating sleep
and appetite.
INTERNEURON A neuron that exclusively signals another neuron.
INHIBITION A synaptic message that prevents a recipient neuron
from firing.
IONS Electrically charged atoms or molecules.
neurons. Glutamate stimulates N-methyl-d-aspartate (NMDA)
LIMBIC SYSTEM A group of brain structures — including the
and alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid
amygdala, hippocampus, septum, basal ganglia, and others — that
(AMPA). AMPA receptors have been implicated in activities rang-
help regulate the expression of emotion and emotional memory.
ing from learning and memory to development and specification
of nerve contacts in developing animals. Stimulation of NMDA
receptors may promote beneficial changes, whereas overstimula-
LONG-TERM MEMORY The final phase of memory, in which
information storage may last from hours to a lifetime.
tion may be a cause of nerve cell damage or death in neurological
MANIA A mental disorder characterized by excessive excitement,
trauma and stroke.
exalted feelings, elevated mood, psychomotor overactivity, and
GONAD Primary sex gland: testis in the male and ovary in
the female.
GROWTH CONE A distinctive structure at the growing end of
most axons. It is the site where new material is added to the axon.
HAIR CELLS Sensory receptors in the cochlea that convert mechanical vibration to an electrical signal; they in turn excite
the 30,000 fibers of the auditory nerve that carry the signals to
the brainstem.
HIPPOCAMPUS A seahorse-shaped structure located within the
brain and considered an important part of the limbic system. One
of the most studied areas of the brain, it functions in learning,
memory, and emotion.
HOMEOSTASIS The normal equilibrium of body function.
HORMONES Chemical messengers secreted by endocrine glands
to regulate the activity of target cells. They play a role in sexual
development, calcium and bone metabolism, growth, and many
other activities.
overproduction of ideas. It may be associated with psychosis; for
example, delusions of grandeur.
MEMORY CONSOLIDATION The physical and psychological
changes that take place as the brain organizes and restructures
information to make it a permanent part of memory.
METABOLISM The sum of all physical and chemical changes that
take place within an organism and all energy transformations that
occur within living cells.
MIDBRAIN The most anterior segment of the brainstem. With the
pons and medulla, the midbrain is involved in many functions,
including regulation of heart rate, respiration, pain perception,
and movement.
MITOCHONDRIA Small cylindrical organelles inside cells that provide energy for the cell by converting sugar and oxygen into special
energy molecules, called adenosine triphosphate (ATP).
MONOAMINE OXIDASE (MAO) The brain and liver enzyme
that normally breaks down the catecholamines norepinephrine,
dopamine, and epinephrine, as well as other monoamines such
as serotonin.
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MOTOR NEURON A neuron that carries information from the
OLFACTORY BULB A round, knoblike structure of the brain
central nervous system to muscle.
responsible for processing the sense of smell. Specialized olfactory
MYASTHENIA GRAVIS A disease in which acetylcholine receptors
on muscle cells are destroyed so that muscles can no longer respond
to the acetylcholine signal to contract. Symptoms include muscular
weakness and progressively more common bouts of fatigue. The
receptor cells are located in a small patch of mucous membrane lining the roof of the nose. Axons of these sensory cells pass through
perforations in the overlying bone and enter two elongated olfactory bulbs lying on top of the bone.
disease’s cause is unknown but is more common in females than in
ORGANELLES Small structures within a cell that maintain the cell
males; it usually strikes between the ages of 20 and 50.
and do the cell’s work.
MYELIN Compact fatty material that surrounds and insulates the
PARASYMPATHETIC NERVOUS SYSTEM A branch of the au-
axons of some neurons.
tonomic nervous system concerned with the conservation of the
NMDA RECEPTORS N-methyl-d-aspartate (NMDA) receptors,
body’s energy and resources during relaxed states.
one of three major classes of glutamate receptors, which have been
PARIETAL LOBE One of the four subdivisions of the cerebral cortex.
implicated in activities ranging from learning and memory to devel-
The parietal lobe plays a role in sensory processes, attention, and
opment and specification of nerve contacts in a developing animal.
language.
NECROSIS Cell death due to external factors, such as lack of
PARKINSON’S DISEASE A movement disorder caused by death of
oxygen or physical damage, that disrupt the normal biochemical
dopamine neurons in the substantia nigra, located in the midbrain.
processes in the cell.
Symptoms include tremor, shuffling gait, and general reduction in
NERVE GROWTH FACTOR A substance whose role is to guide
movement.
neuronal growth during embryonic development, especially in the
PEPTIDES Chains of amino acids that can function as neurotrans-
peripheral nervous system. Nerve growth factor also probably helps
mitters or hormones.
sustain neurons in the adult.
NEURON A nerve cell specialized for the transmission of information and characterized by long, fibrous projections called axons and
shorter, branchlike projections called dendrites.
PERIPHERAL NERVOUS SYSTEM A division of the nervous system
consisting of all nerves that are not part of the brain or spinal cord.
PHOSPHORYLATION Transfer of a phosphate molecule from adenosine triphosphate (ATP) to a protein (ion channel, neurotrans-
NEUROPLASTICITY A general term used to describe the adaptive
mitter receptor, or other regulatory protein), resulting in activation
changes in the structure or function of nerve cells or groups of
or inactivation of the protein. Phosphorylation is believed to be
nerve cells in response to injuries to the nervous system or altera-
a necessary step in allowing some neurotransmitters to act and is
tions in patterns of their use and disuse.
often the result of second-messenger activity.
NEUROTRANSMITTER A chemical released by neurons at a syn-
PHOTORECEPTOR A nerve ending, cell, or group of cells special-
apse for the purpose of relaying information to other neurons
ized to sense or receive light.
via receptors.
PITUITARY GLAND An endocrine organ closely linked with the
NOCICEPTORS In animals, nerve endings that signal the sensation
hypothalamus. In humans, the pituitary gland is composed of two
of pain. In humans, they are called pain receptors.
lobes and secretes several different hormones that regulate the
NOREPINEPHRINE A catecholamine neurotransmitter, produced
activity of other endocrine organs throughout the body.
both in the brain and in the peripheral nervous system. Norepi-
PONS A part of the hindbrain that, with other brain structures,
nephrine is involved in arousal and in regulation of sleep, mood,
controls respiration and regulates heart rhythms. The pons is a ma-
and blood pressure.
jor route by which the forebrain sends information to and receives
OCCIPITAL LOBE One of the four subdivisions of the cerebral cor-
information from the spinal cord and peripheral nervous system.
tex. The occipital lobe plays a role in processing visual information.
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glossary
| Brain Facts
67
PSYCHOSIS A severe symptom of mental disorders characterized
STROKE A block in the brain’s blood supply. A stroke can be
by an inability to perceive reality. Psychosis can occur in many
caused by the rupture of a blood vessel, a clot, or pressure on a blood
conditions, including schizophrenia, mania, depression, and drug-
vessel (as by a tumor). Without oxygen, neurons in the affected
induced states.
area die and the part of the body controlled by those cells cannot
RECEPTOR CELL A specialized sensory cell, designed to pick up and
transmit sensory information.
RECEPTOR MOLECULE A specific protein on the surface of or
inside a cell with a characteristic chemical and physical structure.
function. A stroke can result in loss of consciousness and death.
SYMPATHETIC NERVOUS SYSTEM A branch of the autonomic
nervous system responsible for mobilizing the body’s energy and
resources during times of stress and arousal.
Many neurotransmitters and hormones exert their effects by bind-
SYNAPSE A physical gap between two neurons that functions as
ing to receptors on cells.
the site of information transfer from one neuron to another.
RETINA A multilayered sensory tissue that lines the back of the eye
TASTE BUD A sensory organ found on the tongue.
and contains the receptor cells to detect light.
TEMPORAL LOBE One of the four major subdivisions of each
REUPTAKE A process by which released neurotransmitters are
hemisphere of the cerebral cortex. The temporal lobe functions in
absorbed for later reuse.
auditory perception, speech, and complex visual perceptions.
ROD A sensory neuron located in the periphery of the retina. The
THALAMUS A structure consisting of two egg-shaped masses of
rod is sensitive to light of low intensity and is specialized for night-
nerve tissue, each about the size of a walnut, deep within the brain.
time vision.
The key relay station for sensory information flowing into the
SCHIZOPHRENIA A chronic mental disorder characterized by
psychosis (e.g., hallucinations and delusions), flattened emotions,
and impaired cognitive function.
SECOND MESSENGERS Substances that trigger communications
among different parts of a neuron. These chemicals play a role in
the manufacture and release of neurotransmitters, intracellular
brain, the thalamus filters out information of particular importance
from the mass of signals entering the brain.
VENTRICLES Comparatively large spaces filled with cerebrospinal
fluid. Of the four ventricles, three are located in the forebrain and
one in the brainstem. The lateral ventricles, the two largest, are
symmetrically placed above the brainstem, one in each hemisphere.
movements, carbohydrate metabolism, and processes of growth and
WERNICKE’S AREA A brain region responsible for the compre-
development. The messengers’ direct effects on the genetic mate-
hension of language and the production of meaningful speech.
rial of cells may lead to long-term alterations of behavior, such as
memory and drug addiction.
SEROTONIN A monoamine neurotransmitter believed to play
WHITE MATTER The part of the brain that contains myelinated
nerve fibers. The white matter is white because it is the color of
myelin, the insulation covering the nerve fibers.
many roles, including but not limited to temperature regulation,
sensory perception, and the onset of sleep. Neurons using serotonin
as a transmitter are found in the brain and gut. Several antidepressant drugs are targeted to brain serotonin systems.
SHORT-TERM MEMORY A phase of memory in which a limited
amount of information may be held for several seconds or minutes.
STEM CELL Unspecialized cells that renew themselves for long
periods through cell division.
STIMULUS An environmental event capable of being detected by
sensory receptors.
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Index
Numbers in bold refer to illustrations.
Acetaminophen 49, 50
Acetylcholine (ACh) 6
and Alzheimer’s disease 41, 59
and brain development 11
and sleep regulation 29, 30
and stress 33
Acquired immunodeficiency syndrome
(AIDS) 48
Action potential 6
“Adam” (drug) 38
Addiction 36–39, 37, 51
Adenosine 30
Adenosine triphosphate (ATP) 9
Adenylyl cyclase 9
Adrenal glands 8, 33, 38
Adrenal medulla 8
Adrenocorticotropic hormone
(ACTH) 33
Afferent nerves 27
Aging 13, 34–35, 35, 59
see also Alzheimer’s disease
Agonists (muscles) 25
Agoraphobia 42
AIDS 48
Alcohol 12, 37
Alcoholism 8, 37–38, 57
Allodynia 20
Alpha motor neurons 25, 26, 27
Alpha secretases 41
Alzheimer’s disease 39–41
and aging 34
annual costs 5
diagnosis 40–41
early-onset 41
genetic basis 57
norepinephrine deficiency 8
potential treatments 59, 60, 61
prevalence 5, 39–40
risk factors 41
symptoms 40, 41
treatment 6, 41
Amino acids 6–7, 56
Amnesia 22, 23
Amphetamines 37, 39
Amygdala 5, 23, 23, 37, 42–43
Amyloid peptide 41
Amyloid plaques 41
Amyloid precursor protein (APP) 41
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Amyotrophic lateral sclerosis (ALS)
41–42, 59, 61
Analgesia 49
Anandamide 38
Androgens 8, 9
Anesthesia 49, 50
Antagonists (muscles) 25
Anterior temporal lobes 24
Antibodies, engineered 59–60
Anticonvulsants 44
Antidepressants 42, 47, 49, 54
Antiepileptic agents 49, 52
Antipsychotic drugs 52, 54
Antiretroviral treatment 48
Anvil 17, 18
Anxiety disorders 42–43
Aphasia 24
Apnea 29
Apolipoprotein E (apoE) 41
Apoptosis 13
Ascending system 20
Aspartate 7
Aspirin 49, 50
Astrocytes 61
Atonia 29
Attention deficit hyperactivity disorder
(ADHD) 43, 54, 62
Auditory system 17, 18–19
Autism spectrum disorders (ASD) 10,
12–13, 43–44
Autoimmune disorders 32, 47–48
Autonomic nervous system 5, 13, 31,
32, 33
Axons 6, 7, 12–13, 14
Balance 27
Basal forebrain 29, 35
Basal ganglia 23, 26, 46, 51, 54
Benzodiazepines 7, 29, 43
Beta amyloid 41, 57
Beta secretases 41
Binocular vision 15
Biological clocks 8, 32
see also Circadian rhythm
Bipolar disorder 44, 57
Blindness 17
Blood clots 53
Blood pressure 8, 32
Brain
development 4, 10, 10–14
parts and functions 5
plasticity 4
reward system 36–37, 37, 39
weight 4
Brain tumors 44–45, 57, 61
Brainstem 18, 21, 26, 29–30, 30
Broca’s aphasia 24
Broca’s area 46
Buprenorphine 39
Bupropion 39, 47
C fibers 8, 20
Caffeine 30
CAMP-response element binding protein
(CREB) 23–24
Cancer see Brain tumors
Capsaicin 8, 50
Carbon monoxide 9
Cardiovascular system 32–33
Cataplexy 29
Catecholamines 7–8, 43
Caudal orbital cortex 19
Cell bodies 6, 7
Cell therapy 60, 61
Central nervous system 8, 13, 25, 47, 50
Cerebellum 5, 22, 23, 23, 26
Cerebral artery 53
Cerebral cortex
and addiction 37
development 12, 13
and environment 35
and Huntington’s disease 46
and learning and memory 22, 23,
23–24
and movement 26
and pain 20, 21, 50
parts and functions 5
and seizures 52
and sleep regulation 29–30, 30
and taste 18
Cerebrovascular diseases 34
Cerebrum 5, 9
Chlorpromazine 52
Cholinergic nerve cells 29
Cholinergic nicotinic receptors 38, 39
Chromosomal conditions 45, 57–58
Chromosomes 56
Circadian rhythm 30
see also Biological clocks
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Clomipramine 42
Clonazepam 29
Cocaine 12, 37, 39, 40
Cochlea 17, 18
Colliculi 5
Cones 15, 16
Contractures 47
Convolutions 10
Cornea 15, 16, 19
Corticotrophin-releasing hormone
(CRH) 33
Cortisol 9, 31, 32, 33, 47
Crack cocaine 39, 40
Craniotomy 49
Creutzfeld-Jakob disease (vCJD) 60
Criminology 62
Cross-eye 17
“Crystal meth” 39
Cyclic adenosine monophosphate
(cAMP) 9, 23–24
Cyclic GMP 9
Cytokines 48
Date-rape drugs 38
Dementia 34, 39, 48
see also Alzheimer’s disease
Dendrites 6, 7, 12
Deoxyribonucleic acid (DNA) 56, 57
Depression 5, 8, 42, 47, 55
Depth perception 17
Descending systems 20, 21
Diagnostic methods 55–58, 62
Diffuse optical tomography 57
Diffusion tensor imaging (DTI) 55
Dopamine
and alcoholism 37
and antidepressants 47
and attention deficit hyperactivity
disorder (ADHD) 43
and cocaine use 40
and cognition and emotion 7
and endocrine system 7
and movement 7, 26
and opiate drug use 39
and Parkinson’s disease 7, 50, 51
and psychostimulants 39
and schizophrenia 7, 51, 52
and sleep regulation 29
and smoking 38
and Tourette syndrome 54
Dorsal horn 20, 21, 50
Dorsomedial nucleus 30
Down syndrome 45, 57
Dreaming 28, 29, 30
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Drug abuse 36, 38, 39
see also Addiction
Drug addiction see Addiction
Drugs see Neuropharmacology
Duchenne muscular dystrophy 57
Dyslexia 45–46
Ears 17, 18
Ecstasy (drug) 38
Ectoderm 11
Edema 48
Efferent nerves 27
Electrical stimulation therapy 52
Electroconvulsive therapy 47
Electroencephalogram (EEG) 28, 28–30
Embryonic neuronal stem cells 61
Endocannabinoids 38
Endocrine system 7, 8
Endorphins
and alcoholism 37
mimicry 39
and pain 8, 20, 21, 50
and sleep 8
Engineered antibodies 59–60
Enkephalin 8
Epidemiologists 45
Epilepsy 12, 14, 22, 49, 52
Epinephrine 31, 32, 33, 38
Estrogens 8, 9
Ethanol 38
Ethics 62–63
Event-related optical signal 57
Extensor muscles 25, 27
Eye 10, 10, 13, 14
Fetal alcohol syndrome 37
Flexion withdrawal 25–26, 27
Fluoxetine 8, 47
Follicle-stimulating hormone (FSH) 9
Forebrain 5, 10, 10, 30
Fragile X mental retardation 58
Free radicals 53
Frontal cortex 35
Frontal lobe 5, 14, 19, 24
Functional magnetic resonance imaging
(fMRI) 57
Galanin 30
Gamma-aminobutyric acid (GABA)
and alcohol 38
and Huntington’s disease 7
as neurotransmitter 6–7, 37
and post-traumatic stress disorder
(PTSD) 43
and schizophrenia 51
and sleep 29–30
Gamma hydroxy-butyrate 38
Gamma motor neurons 25
Gamma secretases 41
Gases (neurotransmitters) 9
Gender differentiation 9, 35
Gene 56
in brain development 11, 12
diagnosis 57–58, 63
disorders 12, 41–44, 46–47, 54
recent discoveries 4
therapies 44, 51, 60, 60, 61
Glial fibers 11
Gliomas 44
Glucocorticoids 8, 9, 31–32
Glutamate
activating NMDA receptors 7
and alcohol use 37
and Alzheimer’s disease 41
and brain tumors 44
and schizophrenia 51
and stroke 9
Glycine 6–7
Golgi tendon organs 25
Gonadotropin-releasing hormone
(GnRH) 9
Growth factor therapy 59
Head injuries 5, 48–49, 62
Hearing 5, 17, 17–18
Heart rhythm 5, 6, 8, 32–33
Hemispheres 10, 24, 46
Herbal ecstasy (drug) 38
Heroin see Opiate drugs
Hindbrain 5, 5, 10, 10
Hippocampus 5
and addiction 37
and learning and memory 5, 22, 23,
23–24
and marijuana 38
and stress 32
Histamine 29, 30
HIV/AIDS 48
Homeostasis 30, 31
Hormones 8–9, 31–32
Human immunodeficiency virus (HIV) 48
Huntington’s disease 46–47
annual costs 5
definition 7
genetic basis 46, 57
potential treatments 60, 61
prevalence 5, 46
Hydrocortisone see Cortisol
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Hypersensitivity 20
Hypnagogic hallucination 29
Hypnosis 20, 50
Hypocretin see Orexin
Hypothalamic-pituitary-adrenal axis
42, 47
Hypothalamus 5
functions 5
hormone production 7, 9
and learning and memory 23
and sleep regulation 29–30
and stress 33
Imaging techniques 4, 55, 57, 63
Immune system 32, 33, 48, 59–60
Incus 17, 18
Informed consent 63
Inhibitory neurons 25, 27
Inner ear 17, 18
Insomnia 29, 30
Insulin 8, 38
Interfering RNAs (RNAi) 59
Interneurons 11, 12, 25
Ion channels 6
Iris 15, 16
Ischemia 48, 53
Jet lag 32
Ketamine 38
Korsakoff’s syndrome 8
Language 14, 24
Lateral geniculate nucleus 15, 16
Lateral hypothalamus 29, 30
Learning 9, 22–24, 23, 36
Learning disabilities see Dyslexia
Lens 15, 16
Levodopa 7, 50–51
Long-term potentiation (LTP) 23–24
Lou Gehrig’s disease see Amyotrophic
lateral sclerosis (ALS)
Luteinizing hormone (LH) 9
Magnetic resonance imaging (MRI)
55, 57
Magnetic resonance spectroscopy
(MRS) 57
Magnetoencephalography (MEG) 57
Malleus 17, 18
Manic-depressive illness see Bipolar
disorder
Marijuana 38
MDMA 38
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Medial temporal lobe 22
Medulla 5, 5, 19
Memory 22–24, 23, 62
Mental retardation 10, 12, 37, 43, 58
Mesoderm 11
Messenger RNA (mRNA) 56
Methadone 39
Methamphetamine 39
Methylprednisolone 49
Midbrain 5, 10, 10, 26, 29
Middle ear 17, 18
Mineralocorticoids 8
Mitochondria 53, 57
Monamine oxidase inhibitors
(MAOIs) 47
Monamines 29–30, 30, 41
Morphine see Opiate drugs
Motor cortex 5, 26
Motor neurons 11, 25, 27, 41
Movement 5, 15, 25–26, 27
MPTP 51
Multiple sclerosis 5, 47–48
Muscle spindles 25, 27
Muscles 6, 13, 21, 25, 41
Muscular dystrophy 57
Myasthenia gravis 6
Myelin 6, 7, 13, 20, 47
N-methyl-d-aspartate (NMDA) 7,
23–24, 38
Naloxone 39
Naltrexone 37, 39
Narcolepsy 29, 30
Near infrared spectroscopy (NIRS) 57
Nerve growth factor (NGF) 59
Nervous system 10, 11, 48
Neural disorders 4, 5, 36–54, 57
Neural plate 10
Neural tube 10, 10, 12
Neuritic plaques 41
Neurodegenerative disorders 57, 60, 61
Neuroendocrine system 31, 33
Neuroethics 62–63
Neurofibrillary tangles 41
Neurogenesis 49
Neuromodulators 6–9
Neurons 6–9, 7
aging 34
development 4, 10–14
migration 11, 12
signaling 6, 7, 11
Neuropharmacology 4, 6, 7, 59–61
Neurotransmitters 6–9, 7, 11, 41
Neurotrophins 23
Nicotine addiction 38–39
Nitric oxide 9
NMDA see N-methyl-d-aspartate
(NMDA)
Nociceptors 20, 21, 50
Nondeclarative knowledge 23
Nonopioids 49
Nonsteroidal anti-inflammatory drugs
(NSAIDs) 49
Norepinephrine
and neural disorders 8, 42, 43, 47
and pain 49
production 8, 11
and sleep 29, 30
and stress 8, 33, 42
Nucleus accumbens 37, 39
Obsessive-compulsive disorder (OCD) 8,
42, 54
Obstructive sleep apnea 29
Occipital lobe 5, 11, 15
Occipito-temporal neural system 46
Olfactory bulbs 18–19, 19
Olfactory cortex 19, 19
Olfactory receptors 18
Olfactory tract 19
Oligodendrocytes 6, 61
Opiate drugs 37, 37, 39, 49, 50
Opiate receptors 8, 20, 39, 50
Opioid peptides 8, 39
Opioids, endogenous see Endorphins
Optic chiasm 15, 16
Optic nerve 15, 16
Optic vesicle 10
Optical imaging techniques 57
Orbital cortex 19
Orexin 29, 30
Ovaries 9
Pain 8, 19–20, 21, 49–50, 50
Pallidum nucleus 51
Panic disorder 42
Papillae 18
Parahippocampal region 22, 23
Parasympathetic nervous system 13,
31, 33
Parietal cortex 35
Parietal lobe 5
Parieto-temporal neural system 46
Parkinson’s disease 50–51
annual costs 5
dopamine deficiency 7, 26
index
| Brain Facts
71
norepinephrine deficiency 8
potential treatments 59, 60, 61
prevalence 5, 50
symptoms 7, 26, 29, 50
treatment 7, 29, 50–51
Perception 15–22
Peripheral nervous system 13
Peripheral neuropathy 48
Phobias 42
Phonology disorders 45–46
Photoreceptors 15, 16
Physical exercise 34, 35
Pinna 17, 18
Pituitary gland 5, 7, 8, 9, 33
Pons 5, 5, 29, 30
Positron emission tomography (PET) 55
Post-traumatic stress disorder (PTSD)
42, 62
Prefrontal cortex 22, 23, 37, 42–43
Prion diseases 60
Progesterone 9, 49
Progestins 8
Prostaglandins 20, 49, 50
Proteins 12, 56, 61
Psychostimulants 39
Pupil 15, 16
Radiation 12
Rapid eye movement (REM) sleep 28,
29–30, 30
Rational drug design 59
Reflexes 25–26, 27
Reproduction 8, 9
Retina 15, 16, 30
Retinoblastoma 57
Rods 15, 16
Rohypnol (“roofies”) 38
Schizophrenia 5, 7, 10, 51–52, 57
Schwann cells 6
Second messengers 9
Seizures 44, 52
Selective serotonin reuptake inhibitors
(SSRIs) 42, 47, 54
Senile dementia 34, 39
Sensation 15–22
Sensory cortex 5, 19
Sensory neurons 27
Serotonin
and cocaine use 39
and depression 8, 47
functions 8
and pain relief 49
72
Brain Facts | index
and sleep 29, 30
Sexual differentiation 9, 35
Sight see Vision
Single photon emission computed
tomography (SPECT) 55
Skeletal muscles 25
Skin 21
Sleep 28–30
brain activity 28, 28–29
disorders 5, 28–30, 32, 42, 47
regulation 29–30, 30
REM sleep 28, 29–30, 30
slow wave 28, 28, 29
stages 28, 28, 28–29
Small-molecule drugs 61
Smell 18–19, 19
Smoking 38–39
Somatic nervous system 13
Somatostatin 41
Sonic hedgehog (protein) 11
“Special K” 38
Speech 18, 24
Spinal cord 5, 13
development 10, 11
injuries 5, 49, 59
and movement 26, 27
and pain 20, 21, 50, 50
and sleep 30
and touch 19
Stapes 17, 18
Stem cells
potential therapies 4, 49, 51,
54, 60, 61
and tumor growth 45
Steroid hormones 8
Steroids 48, 49
Stirrup 17, 18
Strabismus 17
Stress 8–9, 31–33, 33
Stress hormones 9, 47
Stretch reflex 25, 27
Striate cortex 35
Striatum 23
Stroke 52, 53, 54
costs 5, 52
damage caused by 9, 18, 32
diagnosis 57
prevalence 5, 52
treatment 52, 54
Subparaventricular nucleus 30
Substance P 8
Substantia nigra 26
Subthalamic nucleus 51
Superior temporal lobes 24
Superoxide dismutase 42
Suprachiasmatic nucleus 30
Sympathetic nervous system 8, 13, 23,
31, 33
Synapses 7
and cocaine use 40
definition 6
development 12–13, 23–24, 35
Tardive dyskinesia 52
Taste 18–19, 19
Tau tangles 41
Tectorial membrane 18
Temporal lobe 5, 22, 24
Testes 9
Testosterone 9
Tetrahydrocannabinol (THC) 38
Thalamus 5
and movement 26
and pain 20, 21, 50
and seizures 52
and sensation 15, 18, 19, 19
and sleep 29–30, 30
Thymine (T) 56
Thymus 8, 33
Touch 15, 19–20
Tourette syndrome 54
Transcranial magnetic stimulation
(TMS) 57
Traumatic brain injury 5, 48–49, 62
Tricyclic antidepressants 47
Trophic factors 8, 13, 59, 60
Tumors 44–45, 57, 61
Two-point threshold 19–20
Tympanic membrane 17, 18
Vagal nerve stimulation 52
Varenicline 39
Ventral tegmental area 37
Ventrolateral preoptic neurons 30
Viruses 60, 61
Vision 15–17, 16
Visual cortex 14, 15, 16
Vitamin D 8
Voluntary nervous system 31
Wakefulness 29–30, 30
Walleye 17
Wernicke’s aphasia 24
Word deafness 24
XTC (drug) 38
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Neuroscience Partner
Organizations
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National Center for Research Resources
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www.nccam.nih.gov
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www.nidcr.nih.gov
National Institute on Drug Abuse
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www.nida.nih.gov
U.S. National Science Foundation
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www.nsf.gov
World Health Organization
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www.who.int
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| Brain Facts
73
Copyright © 2008 Society for Neuroscience
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Washington, DC 20005 USA
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All rights reserved. No portion of this publication may be reproduced, stored in a retrieval
system, or transmitted in any form or by any means, electronic, mechanical, photocopying,
recording, or otherwise without permission of the Society for Neuroscience (SfN).
Statistics for diseases and conditions were obtained from the Centers for Disease Control
and Prevention, National Institutes of Health, and voluntary organizations.
Brain Facts is produced as part of SfN’s commitment to advance public education and
information about the brain and nervous system. For more information or to download a free
copy, please go to www.sfn.org/brainfacts.
The Society gratefully acknowledges the invaluable assistance of more than 120 neuroscientists
who volunteered their time, expertise, and guidance in the development of this book. In
particular, SfN recognizes the assistance of its Public Education and Communication Committee
and especially the Publications Subcommittee: Nicholas Spitzer, PhD, Committee Chair; David
B. Parfitt, PhD, Subcommittee Chair; Patricia Camp, PhD; Emanuel M. DiCicco-Bloom, MD;
Howard Eichenbaum, PhD; Janet L. Fitzakerley, PhD; Alan G. Gittis, PhD; Mark Tuszynski,
MD, PhD; Lu-Yang Wang, PhD. SfN also wishes to recognize Joseph Carey, founding editor of
the Brain Facts series, for his enduring contributions to this and previous editions.
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Executive Editor: Mona Miller, Senior Director, Communications and Public Affairs
Contributing Editors: Todd Bentsen, DeeDee Clendenning, Sara Harris
Science Writer/Editor: Debra Speert
Indexer: Connie Binder
Design: Society for Neuroscience
Illustrators: Lydia V. Kibiuk, Baltimore, Maryland; Devon Stuart, Washington, DC
Printed and bound in the United States of America
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