Neurodegeneration

“ For healthy and efficient action, the brain should be primarily sound; as this organ is subject to the same general laws as other parts of the body. If the brain of the child is free from defects at birth, and acquires no improper impressions in infancy, it will not easily become diseased in after life. But, if the brain has inherited defects, or has acquired a proneness to disease by mismanagement in early life, it will more easily yield to influences that cause diseased action. The hereditary tendency to disease is one of the most powerful causes that produce nervous and mental affections. ”

“ The process of dissolution progresses from the highest most complex, least stable functions, memory, intelligence, will and so on, to the lower, less complex and more stable functions, reading, writing, playing, etc., finally reaching to the very lowest, to the simplest co-ordination of movements, mastication, swallowing, etc. A post-mortem examination of the brain uniformly reveals a profound degeneration of the brain cells. In the various forms of epilepsy and in most cases of chronic insanity, ending in dementia, we find on examination as a rule, some degeneration of the brain cells. ”

“ Nervous diseases may be hereditary, and pass directly from father to son; examples of such are locomotor ataxy, epilepsy, and hysteria; but indirect and dissimilar heredity, as in psychopathies, is more usually observed. Family connections between diseases from lesions of the nervous system and nervous affections are proved by frequent coincidences among relatives, and also by their manifestations in the same person, either at the same time or in different periods of his life. Not rarely, further, are mental and neuropathic troubles met with in the history of the same person ”

“ The treatment of all degenerates, and consequently their preservation from the evils that threaten them, ought to begin in their earliest infancy. First avoid exaggerating hereditary predisposition when serious neurosis has occurred in the parental line. Too often such a conclusion is adopted, and hope of recovery in the descendants is abandoned because one of the parents or the grandparents was affected with insanity by reason of organic disease of the brain. Preliminary examination of the neurotic needs to be made before one is enabled to judge as to the effects of heredity. ”

“ As the brain is the last acquirement in vertebrates, considered from the standpoint of necessity, while the face (also a late acquirement) is much less complex, the last, obviously, will present the derangements from degeneration in shape, while the former will show these in shape and function. Furthermore, during the embryonic period the development of the brain will, of necessity, be more immediately affected by degeneracy than the face, which will gain in evolution at its expense. ”

“ In the condition known as neurasthenia, which is often taken as a type of a functional disease, the basal and intrinsic cause is activity of the nervous system with the using up of material which is not compensated for by the renewal which comes in repose and sleep. Neurasthenia is one of the common conditions of our civilization, found among children and adults, the poor and rich, the idle and the factory worker; it is rife in the scholastic professions and among those who earn their living by brain work. ”

“ One illustration, and a very striking one, of the influence of degeneracy on the brain is the durencephalous child which so often appears in degenerate families. Here the cerebral hemispheres and everything but the medulla and pons may be absent, while the rest of the body is in a comparatively normal state of development. Starting with such an extreme expression of degeneracy in the brain, a wide but closely linked range of deficiencies may be found in the brain of degenerates, involving even in some almost normal individuals more than simple deficiency. ”

“ Such mental changes are commonly found in those undergoing degenerative physical changes, not only in the very aged, but in those passing into premature decay; in fact, mental impairment and decay are but the evidences or outcomes of the implications of brain-tissue in the general degeneration. We are, of course, most familiar with such changes in the very old, in whom we regard them as almost normal. The mental grasp is imperfect and illusive; petulance and caprice are the characteristics, especially of those in whom the intellect was never very strong. ”

“ Since we know that the basis of many nervous diseases is an obliteration of certain cells of the brain or of the spinal cord, or certain tracts of the central nervous system through which impulses must pass if they are to be effective as motion, sensation or function in some other form, we realize that we cannot recreate these portions of highly organized tissue and that therefore organic nervous diseases are beyond the action of any remedies we now know or may even hope to discover. ”

“ The varying degrees in which the various portions of the cortex, medullary portion, and different ganglia of the brain may be involved in the morbid process naturally give rise to a great variety in the symptoms, mental and physical, sensory and motor, emotional and intellectual, and in the relative preponderance of one or another in individual cases. The usual symptoms of any form of mental disease may for a time obscure the dementia which sooner or later must appear in general paralysis, and which, as has already been said, is the only mental symptom universally present in all cases. ”

“ Thus in man birth finds some parts of the nervous system and the most important ones, when the light of relation is regarded in full development. It is therefore easily comprehensible that evolutionary disorders of the nervous system due to morbid heredity or provoked by influences of the medium may exist without external morbid aberrations. Furthermore, many lesions of the centers met with in neuropathic families in which no external deformities have been found have been attributed to evolutionary troubles of the nervous system. ”

“ Alzheimer's disease, a major brain disorder, results in the progressive loss of mental faculties, often beginning with impairment of memory, learning, attention, and judgment. While some types of dementia are curable, Alzheimer's disease is not. In time, it erodes thought, feeling, and behavior and leads to death. ”

“ Each day, these efforts yield new knowledge about the functions of the brain and its disorders. New imaging techniques have disclosed that Alzheimer's disease does not affect the entire brain, as previously thought, but instead destroys specific areas. Scientists can now target future research more precisely on these areas and on certain brain chemicals that appear to play a role in the disease. Much about Alzheimer's disease remains to be learned, but through research we hope to find a way to overcome what we now know is a disease and not "senility" or a normal consequence of aging. ”

“ A broad and deep development of the middle lobe of the brain, shown by a fullness under the chin, and of the adjacent portion of the neck, denotes tendencies to somnambulism, delirium, and insanity. If such characteristics of the organization do not culminate in mental derangement, they exhibit childishness, helplessness, and great dependence. Age abates the vigor of the executive faculties, and old people manifest not only bodily infirmities, but the relaxing and enfeebling influences proceeding from the lower portions of the brain. ”

“ Every study of the psychosis of regression and age must start from this fact and we must seek to distinguish the forms of weakness of old age due to central tissues from those that have their cause in the primary weakness of the blood vessels. For sclerotic senile dementia anatomy has already more or less basis. For the various forms of brain sclerosis it is now possible to propose an anatomical diagnosis, although it is impossible to have a very definite clinical picture of what takes place. ”

“ The question of therapeutic optimism versus pessimism is forced upon attention in the fourth great group of neurosyphilitic diseases which we have chosen to distinguish, namely, the group of paretic neurosyphilis including the disease formerly known as general paresis, paralytic dementia, softening of the brain and the like. ”

“ But all this has caused a much greater expenditure of nerve-energy. The brain has to bear a much greater strain, and is worn out earlier, the body is more stimulated and overworked than it was a hundred years ago. Many diseases of modern civilization are making appalling progress; neurasthenia, especially, and other diseases of the nerves, carry off more victims every year. Our asylums grow bigger and more numerous every year, and we have sanatoria on every side in which the baited victim of modern civilization seeks refuge from his evils. ”

“ And it is hardly possible that nervous diseases and insanity, incident to the pressure of civilisation, can be eliminated. But certainly the alleviations of all but the last, and even of that except in its extreme expression as total dementia, will have advanced to a high standard. We shall no doubt, for instance, have discovered means of so acting on the sensory system that we shall be able innocuously and temporarily to paralyse at any desired spot the nerves which transmit pain. ”

“ Such consideration is, however, without the sphere of the present paper, which deals with cerebral manifestations in relation to ordinary disease, and not with those ailments which belong to the province of the alienist physician. To one form of disorder of the cerebral cells alone may reference be made here, and that is as to the effects of mental over-strain. Brain-tissue can be developed by exercise, and worn out by overwork. When this latter condition has been induced, there exists that irritability which forms part of the early stage of the exhaustion of nerve-matter. ”

“ It is late to begin when the brain symptoms show brain involvement. For this there must be radical and careful treatment with mercury and iodide of potash; with tonics and general building up treatment, and then even if the patient lives he may be a nuisance to himself and others.
GENERAL PARESIS. (Paretic dementia. General Paralysis of the Insane. Softening of the Brain) .—This belongs under diseases of the mind, but there are so many cases that a description of this disease may be instructive and interesting. ”

“ Looking backward to our Civil War, one is strongly impressed with the fact that the present volume, one of the earliest works of its kind to appear in book form, deals largely with psychiatry and functional nervous diseases, whereas during and after the American conflict the most important contributions to neurology related to organic disease, especially as illustrated by the work of Weir Mitchell and his collaborators on injuries of nerves. ”

“ A very important point relating to the prevention of mental disorders and the modern nervous diseases is, that the growth of mental function is as gradual as that of bodily power, and that brain-tissue degenerations and mental diseases may be separated by long Intervals of time from the too premature and intense stimulation of the brain in school-children which causes these nervous diseases. ”

“ Hampton, you have my word. In Alzheimer's, tissue responsible for the production of certain neurotransmitters dies. What we're doing here is enabling your brain to regrow healthy, long‐lived tissue to replace what has become damaged and destroyed by an excess of the wrong . . . Let's just say we're not trying to salvage damaged tissue. We're actually replacing the dysfunctional tissue in the cortical and hippocampal regions of the brain, so we're working with the body. And you're responding wonderfully." He turned back to Ally. "I've got to get back to the lab now. ”

“ It is true a large proportion of them do have organic disorders in connection with their neuroses. We find that most of them do have functional disorders originating purely in their mind, or because of some constitutional nervous defect and that the real fundamental condition from which they are suffering is not an organic condition but is nervous or mental and must be approached along lines of psycho-therapy. ”

“ Early involvement of the germ is shown by the fact that the somatic malformations of the hereditary forms of insanity often involve the body elsewhere than in the [Pg 69] nervous axis. The stigmata of heredity—defective development of the uro-genital system, deformities of the face and skull, irregular development of the teeth, misshapen ears and limbs—owe their grave significance to this fact. Like deformities of the brain, these anomalies are also more marked and constant with the lower forms of the hereditarily based systematised perversions of the mind than the higher. ”

“ If the neuroglia cells, whose end plates are attached to blood-vessel walls, become over-contracted or lose their power of relaxation or of contraction, many of the curious phenomena of over-tiredness in neurotic conditions, and the lack of the power of concentration, and sufficient attention to things, can be readily understood. In a word, the theory enables us to translate many expressions that are vague and indefinite, from terms of mind into terms of the physical basis of mind—the anatomy and physiology of the brain. ”