Behind the Scenes of The Brain Show

by Zeev Nitsan

  When people are unaware of their existence, the failures related to brain activity are sometimes perceived as “wrinkles in the texture of reality” that cast a shadow and make it difficult to see the horizon beyond them—as mountains that block their sight line.

  “Losing Myself”—Alzheimer’s Disease

  On November 25, 1901, a fifty-one-year-old patient, Auguste Deter, was examined by Dr. Alois Alzheimer at a psychiatric hospital in Frankfurt. The words of the first documented Alzheimer’s patient are moving due to their frankness and the porthole they open to the essence of the inner being of the ones who suffer from the disease. The patient said, “I lost myself….” The sense of loss of the self, which gradually evaporates, turns the patient into a spectator who is compelled to watch a horror play that takes place at the theater located inside his skull.

  A person who loses his grip on his brain is in a situation in which the organ that is in charge of dealing with the challenges of life gradually retires from coping.

  The outline of Alzheimer’s disease sometimes resembles a nightmare without awakening. The sick person is dealing with an obstinate process that brings about the loss of lifetime memories.

  The shades of the mental view that is reflected in the eyes of the brain fade away. The view that is reflected from the rearview mirror of the life coach is grim, and the front lights are unable to penetrate the fog.

  Dementia is like an inverted loom; instead of weaving the threads of wisdom in our brain, it unweaves them.

  If we are unlucky and toward the end of our life our brain sinks into the dump of dementia, the end of our life will get a totally different meaning out of the ruins of our brain. Our life will no longer be full of bright consciousness facing the forthcoming eternal silence, but a life of fragments of shattered consciousness that is looking at reality through turbid lenses, to a point that the magic touch of wisdom is lost.

  When the brain fails and abandons its owner when he is still alive, and when the lens of consciousness becomes turbid and the brain becomes a wilderness, the brains’ lucidity vanishes and is replaced by welcomed and unwelcomed visitors from the land of hallucinations. In such a case we ask ourselves a blunt question: is this a life worth living? If the road to destruction winds through this twilight zone, the transition from life to death is no longer sharp.

  When the number of people who suffer from dementia is always on the rise, foggy consciousness—a not-rare mode of existence on the spectrum between bright consciousness and turbid, shattered consciousness—becomes a common mode of human existence.

  The destruction topography of Alzheimer’s disease, which is the most common source of dementia, is characterized by rapid degeneracy in certain brain areas. In Alzheimer’s disease, the function of the hippocampus and the temporal and occipital cortex is damaged at a more rapid pace compared to the function of the frontal lobes. This is the inverted version of the degeneracy pattern that takes place in a slow, gradual manner in cases of normal aging.

  In structural brain scans of Alzheimer’s patients can be observed, at an early stage, a degeneracy of tissue (atrophy) at the medial, temporal areas (the areas of the inner temporal lobe including the hippocampus). In functional imaging scans that reflect the activity at various brain areas, we witness a decrease in metabolism (hypometabolism) at parieto-temporal areas.

  In normal cases, our brain first identifies the essential aspects of a stimulation, prior to complete identification, and responds to them. For instance, a long, cylindrical shape will trigger an emotional response even before our brain identifies it as a snake, a pipe, or some other entity. Later on, brain processing moves from general identification to specific identification of the phenomenon, according to the circumstances.

  Atavism (backwards evolution) of brain skills characterizes the pattern of cognitive withdrawal among those who suffer from Alzheimer’s disease.

  One of the functional withdrawal signs among Alzheimer’s patients at an early stage is the tendency to define phenomena in general terms and not to continue the processing that will enable them to identify the unique features of a phenomenon. For example, they might refer to all the animals that walk on four limbs as dogs, even when they meet a deer. It seems that brain processing gets “stuck” at the general phase, which defines fundamental aspects of a phenomenon but does not go any deeper. Alzheimer’s patients withdraw toward generalization.

  The atavism in the conceptual capabilities and information retrieval resembles an inverted mirror image of the development of such capabilities in the brain of a human infant. Remaining at the general definition stage is typical of infants as well when they get to know the world and might refer to all animals with wings as birds. Later on, however, a process of information conceptualization and retrieval is formed among infants; it’s in an inverted pattern compared to the process that takes place in the brain of Alzheimer’s patients: infants develop the ability to distinguish and differentiate between various details, which enables them to identify one flying entity as a stork and the other as a raven. This ability, on the other hand, is lost forever in the case of Alzheimer’s patients, who withdraw toward the phase in which all will be defined only as birds.

  The Pharaonic Pyramid of Memory

  Our brain generalizes and differentiates, during childhood, the layers of the pyramid of memory, which are built from the bottom upwards—from the pattern of generalization toward the details. The same process takes place in the brain of an expert. On the other hand, in the case of dementia, a gradual destruction of the layers takes place, and the pattern of wear starts from the high downward toward the low—from the level of conceptualizing nuances toward the level of raw conceptualization. The number of remaining layers is in correlation with the severity of dementia.

  In a normal, young brain, the memory pyramid is built from the generalizing basis toward the layers that are built upward on top of each other, in which unique details are embedded. The level of memory uniqueness rises gradually until it reaches its exclusive features. It seems that, at the time of assimilating new information in the brain of Alzheimer’s patients, the upper layers of the specific memory that encode its unique features are not built, and only the basic layers that include the very general features of the event are built. It is also true with respect to information retrieval—its availability among Alzheimer’s patients is limited to the basic layers that store general information. They seem to lose the ability to differentiate information at the time of assimilation and to retrieve unique information.

  Love at First Sight—at a Second Sight

  A known convention is that our first love is always the last. It is so, in the sense of a virginal experience that we will not experience again as its definition. But, due to the (too-) short refresh time of the screen of consciousness among those who suffer from advanced Alzheimer’s disease, which erases the traces of perception recordings prior to their preservation, Alzheimer’s patients live in a sort of perpetual present. In such a situation, there is a tendency to be captured by the first love for the second and third time, and the patient enjoys the heady scent of a flower he comes across again and again as if it were the first time. The perception recordings exist within a brief present that vanishes without leaving a trace.

  The pleasant scent and the rich shades of the flower the patient comes across numerous times wash over the field of consciousness as if it were the first encounter. The intensity of its presence does not dim, even when it becomes familiar according to standard definitions, but this supposedly romantic aspect cannot dim the tragic consequences of this disease.

  “Upside-Down Childhood”

  When the children of Alzheimer’s patients, with children of their own, have to take care of their parents they face a new responsibility. Contrary to a child that acquires capabilities, the patient loses capabilities. The imaginary encounter between the capabilities of the child, who develops rapidly, on the one hand, and the parent who sinks in a swamp of dementia,
on the other hand, takes place when each of them comes from an opposite direction on the spectrum of abilities.

  Alzheimer’s disease sometimes seems like “reversed childhood,” since, in many senses, it is like a mirror image of the stages of child development. The understandable emotional difficulty of the patient’s family members sometimes derives from comparing their elderly loved one to a child, but sometimes it cannot be avoided if we want to create reality-compatible expectations among family members who take care of the patients.

  The Safe Harbor of Mother Tongue

  Studies that were conducted in countries with multiple immigrants show that in people who immigrated as adults to a country where the common language is not their mother tongue and who have become proficient in that language, and whose brain is affected by dementia in old age, the wall of second-language proficiency becomes cracked; these people retreat to the haven of their mother tongue. This language constitutes a more solid defense line against the attack of linguistic fading.

  First language, like first love, is usually unforgettable. We use our first language to create most linguistic patterns. Thus, our scope of expression is wider in this language. With respect to a second language, we are usually equipped with a more limited repertoire of patterns, and using this language requires more mental energy and effort compared to our first language.

  It might constitute a plausible explanation for the fact that people who speak two languages and suffer from dementia first lose their mastery of the second language and preserve their mother tongue better.

  Insulin: Not Just for Treating Diabetes?

  Insulin plays a role in memory and learning. A study shows that taking insulin improves memory performance soon after the intake. The number of insulin receptors in the brain areas that have an important role in memory and learning functions is significantly higher in the brains of healthy people compared to the brains of Alzheimer’s patients. Diabetes patients who are not balanced might be at a higher risk of Alzheimer’s disease compared to people who do not suffer from diabetes. That is another reason to keep a strict balance of glucose levels in the blood. It was found that inhaling insulin out of an inhaler improved memory performance among healthy subjects, and it might lead to developing such a treatment with respect to memory disorders.

  So What Shall We Do with It?

  Some medical practitioners doubt the efficiency of early detection of the process of dementia due to the unfortunate fact that the reversibility component, with regard to these syndromes, is relatively minor. A common assumption is that 10 percent of the disorders generating dementia are curable nowadays, such as lack of vitamins, malfunction of the thyroid gland, and problems in the liver and kidneys. Although there is no cure, treatment that might improve the quality of life of the patients, their family members, and the people who take care of them is of great importance, however.

  Disruption of Internal Insinuation

  The faces of people who suffer from the Parkinson’s disease wear an involuntary mask due to physiological disruption in innervations. The lack of dopamine causes weakness in the muscles of facial expression.

  With regard to people who suffer from Parkinson’s disease, the hands of the time clock slow down in several senses; in addition to the slow movements, called “bradykinesia,” and the slow pace of thinking, called “bradyphrenia,” the personal sense of time slows down as if enchanted, in accordance with the slowing down of movement and thought. Often the patient does not experience his actions and movements as slower than usual, and when he measures himself against an external time pacer—another person or a standard clock—it often seems to him that they act more quickly than usual.

  Self-regulation directed by the “internal insinuation” mechanism is disrupted among Parkinson’s patients. In order for their speech to be clearer, they are required to recalibrate the volume of their voice and the fluency of their speech not according to their inner sense but, rather, in accordance with external measurements. It is similar to the recommendation given to pilots at a state of vertigo—to change from flight mode based on senses and intuition to flight mode based on devices and external information.

  Behavioral Effects of Frontal Lobe Injury

  Injury at the lateral areas of the frontal lobes induces a state of mind that is characterized by apathy and lack of initiation. Injury at the central or orbito-frontal areas reduces or even eliminates inhibitions with regard to primeval urges and raw thoughts that have not been processed through the filter of discretion. In such a case, the injured person tends to exhibit judgeless, impulsive and shameless behavior that is inconsiderate toward others.

  Single Impressions That Do not Become Unified

  A stroke might induce, as a rare phenomenon, a condition called simultanagnosia—difficulty in perceiving various aspects of sensory experience simultaneously. Thus, for example, vocal simultanagnosia might be formed as a result of damage to the centers of auditory-input processing, an injury that does not affect the ability to perceive the pitch and the rhythm separately but affects the ability to perceive them as combined into a melody.

  Visual simultanagnosia might be formed as a result of an injury at the meeting areas between the parietal lobes and the occipital lobes on both sides of the brain. Its outcome is Balint’s syndrome, which is expressed, inter alia, in difficulty in seeing the overall visual picture, and seeing the objects that compose the global picture as single entities detached from the surrounding context.

  The Profile of Stroke

  Stroke at the area called fusiform gyrus might severely damage the ability to recognize human faces. A person might not recognize his parents, his children, and even his own reflection in the mirror.

  From a Lover to an Impostor

  Tragic failure in the perceptual field of vision combined with a normal sensory field of vision is reflected in the rare Capgras delusion, which results from brain injury. In this syndrome, the patient believes that a family member or a loved acquaintance was replaced by an impostor. The sensory input is identical, but its interpretation changes. The person who has the syndrome sees the face of his acquaintances impeccably but is convinced that a talented impostor, and not the real person, stands in front of him.

  When Consciousness Roars and the Voice is Mute

  A painful and moving illustration of a rare syndrome that might be caused by stroke was described in the French movie The Diving Bell and the Butterfly. The movie tells the story of Jean-Dominique Bauby, the editor of a fashion magazine, who had a stroke in December 1995. Due to the unique pattern of brain damage at the brain stem caused by the stroke, Bauby was unable to talk or to move his body except for his eyes—although the sharpness of his brain and his comprehension were not damaged at all.

  He had a syndrome called “Locked-in Syndrome.” People who suffer from this syndrome live a full life with regard to their soul, but they are locked inside a paralyzed body that cannot communicate with the world (except for moving the eyes). Bauby passed away in 1997.

  The Trees That Conceal the Forest

  Brain syndromes such as Balint’s syndrome, Williams syndrome, and autism have unique characteristics. Their causes vary, and the way they are reflected also depends on the unique personality of the person who suffers from them. Nevertheless, they are all characterized by a difficulty in seeing the overall picture, as if the trees conceal the forest—the essence is drowned in the sea of details.

  Hyperphysiological Conditions of the Brain

  A brain tissue whose function was disrupted might turn into a source of arbitrary signals that might jam the lines of communication in the brain and prevent well-timed signals of a healthy brain tissue from reaching their destination.

  Patterns of overarousal of certain brain areas, which disrupt normal functioning, can be found in conditions such as epilepsy, which is caused by an electrical storm that takes place in the brain and might induce involuntary movements and disruption of consciousness. Other examples are the mania t
hat induces hyperactivity, emotional tide, and disturbance in the course of thinking; and dyskinesia—movement spasm as a reflection of motor automation, which mostly affects people who suffer from Parkinson’s as a side effect of the drugs they are treated with.

  To the Depth of the Matters

  The depth dimension in eyesight (the stereoscopic dimension) relies, as an important, though not exclusive, source of information, on a spatial-horizontal gap that is customarily measured between the two pupils and whose average length is six centimeters.

  Even in the case of monovision, the brain manages to create a sense of depth, though not as clearly as in two-eyed vision. It does so by relying on environmental clues, such as movement shifts (changing of the input during movement and changing of the angle of view that derives from it), perspective, and concealing.

  In this case, brain processing “adds a dimension” to the visual perception recordings of each of the eyes separately. The carpet of the retina is almost two-dimensional (although there are several cell layers). It is very thin, and it sends raw, two-dimensional impressions of world manifestations from each of the eyes to the brain. Brain processing, which weaves together the input coming from each of the eyes, is the main contributor to experiencing the depth dimension.

  Voluntary neck movements of low amplitude might assist people who rely on monovision to sample the vision input from angles that are a bit different, which will improve the ability of the brain to produce the depth dimension out of this information. Neck movement can also help people with one-ear hearing to sample the sounds from directions that are a bit different and, by that, to add the depth dimension.