Saturday, November 17, 2012

The Importance of Regular Mental Health Checkups -

EVERYONE is familiar with the concept of a periodic medical checkup — some sort of scheduled doctor's visit to check your blood pressure, weight and other physical benchmarks.

Ideally, doctors should ask patients about their moods as part of a regular wellness visit, Dr. Borenstein said — there doesn't necessarily need to be a special visit to gauge mental health. But if the doctor doesn't bring it up, patients can educate themselves and start the conversation with their physicians.

Jeffrey Cain, president of the American Academy of Family Physicians, said family doctors were trained to spot symptoms of mental illness, like depression, and he encouraged patients to bring in questions or concerns for discussion. But people don't necessarily go to their family doctor and say they are depressed, he said. Rather, they say they're tired, or that they lack energy, that they're having trouble concentrating or that their body aches — all of which can be symptoms of depression or anxiety.

There are some well-known screening tools that patients can use as a starting point to assess themselves, to help prompt a conversation with their doctor. Dr. Borenstein mentioned a common tool used by doctors to assess patients for depression: a "P.H.Q.," for "patient health questionnaire" He cautioned that the idea here was not to self-diagnose using such forms — there are several versions, varying by number of questions — but rather to self-assess, and then discuss your concerns with a professional.

The P.H.Q.-9, which asks nine questions, was developed by researchers at Columbia University and Indiana University, with help from a grant from Pfizer Inc. The form is available on several Web sites, including (

It asks about the patient's outlook and health habits over the previous two weeks. The first question, for instance, asks patients whether they have had "little interest or pleasure" in doing things and asks them to check a box ranging from "not at all," which scores a zero, to "nearly every day," which scores a 3. A professional computes a total score, which gives more weight to frequent symptoms; the higher the score, the greater the likelihood of significant depression.

Another set of screening tools for depression and other mental health disorders were developed by Screening for Mental Health, a Boston-area nonprofit that creates assessment tools for use by health plans, colleges, the military and the general public. Founded by Douglas Jacobs, an associate clinical professor of psychiatry at Harvard Medical School, the organization grew out of the first National Depression Screening Day, which is held annually each October during Mental Illness Awareness Week.

Mental illnesses have specific signs and symptoms, much as a disease like diabetes does, Dr. Jacobs said, and those symptoms can be identified and treated. Take depression, again, as an example. It's normal to be sad for a while after a personal loss or a traumatic event. But when the effects linger and begin to affect your self-esteem, or interfere with your ability to do your job or handle other responsibilities, he said, you may want to consider if you are suffering from a more serious depression that should be treated professionally — with behavioral therapy, medication or both.

At the site, which is sponsored by Screening for Mental Health, you can find locations near you that offer mental health services. Or, you can use a free online screening tool that can help you gauge if you might be at risk for various illnesses including depression, anxiety, bipolar disordereating disorders and post-traumatic stress disorder.

You can choose a specific screening or answer questions to help narrow your choice. For instance, the tool asks you to complete the sentence "I have been..." with phrases like "feeling sad or empty," or "drinking more than planned."

The depression screening tool asks questions about how you have been feeling during the last two weeks, like whether you have been "blaming yourself for things" some of the time, all of the time, or most of the time.

The questionnaire concludes with a finding based on your answers. For instance, it might tell you that "Your screening results are consistent with symptoms of an eating disorder," along with a recommendation to seek a professional evaluation. Gina N. Duncan, an assistant professor of psychiatry at the Medical College of Georgia at Georgia Health Sciences University in Augusta, who has blogged about the notion of a personal mental health checkup, said sleep disruptions were often a sign of stress. If you're sleeping much more or less than usual, or having difficulty falling asleep, that can be a warning signal.

Many large employers include mental health coverage as part of their health benefits packages, and recent federal rules on benefits "parity" mean such benefits at large plans should not have higher have co-payments and deductibles or stricter limits on treatment than benefits for other medical or surgical needs. Also, most large companies currently offer employee assistance plans, which provide counseling and referrals — both over the phone and in person — to workers and members of their families who are suffering from personal crises.

Helen B. Darling, president of the National Business Group on Health, a consortium of large employers, said employee assistance plans were an important way to screen for mental health problems. Help through them is generally provided free of charge outside of the main health insurance plan, so using the service does not generate an insurance claim.

Over all, however, 15 percent of employers in the United States do not offer mental health coverage to employees, according to the Society for Human Resource Management. Such benefits may become more widely available in 2014, when many provisions of the Affordable Care Act take effect. Mental health benefits will be part of the "essential package" that must be offered by many insurance plans, including the new state-sponsored insurance exchanges.

Can Housework Help You Live Longer? -

It's well known by now that active people typically live longer than those who are sedentary. But precisely what types or amounts of exercise most affect life span has not been clear. Several new studies, though, are beginning to provide some clarity, suggesting that certain activities may be better than others in terms of affecting mortality risk.

Perhaps the most memorable of the new studies was conducted by researchers in Europe who turned to a large database of health informationabout middle-aged British civil servants. The workers, ages 35 to 55 at the start, were followed for a decade or so, during which time they filled out repeated health questionnaires.

The topics included each man or woman's physical activity during the previous month. Specifically, the questionnaires asked about the number of hours that the volunteers had spent walking, gardening, performing housework, playing sports (swimming, cycling, golf or soccer) and puttering around the house completing yardwork and do-it-yourself repair projects.

Each activity was designated as "mild," like washing the dishes and cooking; "moderate," encompassing weeding and brisk walking; or "vigorous," which here included swimming and mowing the yard. (Riding mowers apparently didn't factor in.)

The researchers also checked death records for the civil servants.

They found that in general, physical activity of any kind was associated with longer life. But the association was much stronger among those people whose activities were relatively intense. Those who regularly painted and repaired their houses or walked briskly enjoyed more protection against premature death than those who washed dishes, even if people spent more overall hours engaged in "mild" activities.

That finding agrees with those of a study published this year in The European Journal of Preventive Cardiology, in which scientists in Copenhagen followed 5,106 adult recreational cyclists for about 18 years, asking their volunteers to occasionally report how many hours and how strenuously they were riding their bikes.

The researchers also tracked deaths among the group.

It turned out that the men and women who reported riding relatively hard (although none were racers) lived longer than those who rode at an easy pace, even if they weren't pedaling for as many hours. On average, cyclists who regularly rode hard lived about four or five years longer than those who went at a more leisurely pace.

"Our general recommendations to all adults would be that brisk cycling is preferable to slow," the authors conclude.

But not all researchers are convinced that intense exercise is essential, if your goal is a longer life. The general consensus among most researchers studying exercise and longevity "is that it is the total amount of energy expended that is important," and not whether you huff and strain during that expenditure, says Dr. I-Min Lee, a professor of medicine at Harvard Medical School, an author of a major new examination of exercise and life expectancy.

In that study, published last week in PLoS Medicine, Dr. Lee and colleagues from the National Cancer Institute and other institutions compiled physical activity, body mass and mortality data for more than 650,000 American adults who'd participated in National Cancer Institute studies over the years.

The researchers compared the volunteers' activity levels against the current governmental recommendation of 150 minutes of moderate activity (like brisk walking) per week. They found that those who met the recommendation lived on average 3.4 years longer than people who didn't exercise. Those who ambitiously doubled the recommended amount of weekly exercise enjoyed additional gains in life span, but at a noticeably diminishing rate, typically living 10 months or so longer than those who just met the guidelines.

Even people who were overweight or obese lived longer if they exercised moderately, whether or not they lost weight during the study period.

Interestingly, the association between physical activity and longer life held true also for those volunteers who reported exercising only occasionally. "A very low level of activity, equivalent to 10 minutes per day of walking, was associated with a gain of almost two years of life expectancy," says Steven Moore, a research fellow with the National Cancer Institute, who led the study.

In fact, he says, "maximum longevity was reached at a physical activity level equivalent to 65 minutes per day of walking, with no evidence for gains above this level of activity."

What all of this suggests, Dr. Lee says, is "that physical activity, even at a modest level, can increase life expectancy."

But it's also probable, although not yet definitively proven, she continues, that "intense exercise gives additional benefit above the risk reduction afforded by energy expenditure alone."

In other words, pushing yourself during your next walk, bike ride or home-repair project might amplify the activity's longevity-enhancing benefits, Dr. Lee says. But if you don't wish to or cannot increase the intensity of your exercise, don't sweat it.

The largest gain in terms of adding years to someone's life, she says, comes in that space between "doing nothing to achieving the lower end of the activity scale," which makes even the usually tedious prospect of washing this morning's breakfast dishes more palatable.

Friday, November 16, 2012

Dr. Sanjay Gupta: The truth about prescription medication addiction – The Chart - Blogs

Whenever I hand a prescription for pain pills to a patient, I tell them, "Remember not to drink any alcohol when taking these medications."

For years, we in the medical community thought that simple message was getting through. It turns out we were wrong.

Every 19 minutes someone dies because of misuse of prescription medications. Sometimes it is because they take too much. Many times it is because they forget or ignore the warning their doctor gave about combining the medications with alcohol. And tens of thousands of people die every year as a result.

As much attention as we pay to illicit drugs such as cocaine or heroin, the truth is prescription medications kill more people in this country than those illicit drugs combined. Perhaps it is a perception issue: "It came from a pharmacy, therefore, it must be safe."

They certainly can be safe, but they can also be incredibly addictive, with more than 1.9 million Americans hooked on prescription pain medications alone.

These painkillers are particularly dangerous because they depress the central nervous system, slowing down breathing and the brain stem's responsiveness to CO2 to the point where someone abusing these medications can simply stop breathing. Combine these painkillers with alcohol, another depressant, and you've got a recipe for disaster.

Researchers are racing to find something that can help, and there are a few promising things in development. A recent study, the first large-scale trial aimed at painkiller dependence, offered some hope.

Almost half of those addicted to painkillers - 49% - were able to reduce their drug abuse when taking Suboxone for at least 12 weeks. The drug works by reducing withdrawal symptoms and relieving cravings.

Unfortunately, the success rate dropped to less than 10% [8.6%] once patients stopped taking the drug. In the study, patients receiving intensive addiction counseling did no better than those who didn't.

Naltrexone – sold under the brand names Revia and Vivitrol, an injectable, long-acting formulation – has also been used for prescription painkiller abuse. But naltrexone only has the potential to work in patients who are already off the painkillers long enough that the drugs are out of their system.

Truth is most of the researchers I have interviewed over the last decade all seem to agree on one thing: addiction is a brain disease. The latest science shows how the dependence on drugs or alcohol can change the brain chemistry, altering pain and reward centers. As a result of this latest science, the idea of therapy alone to treat addiction is waning.

I should point out that millions of patients use prescription pain medications every year safely, without becoming addicted, and certainly without dying. For nearly 30,000 people a year though, they pay the price with their lives.

As a doctor, I will look my patients in the eye every time I hand them a prescription to tell them the concerns about the pills they will take. It won't just be a casual reminder about not taking the medications with alcohol, but a forceful warning backed up with scary but forceful statistics. I will remind them that they could become addicted, and they could die. That is our jobs as doctors, and it is one way to save thousands of lives.

Thursday, November 15, 2012

Pop Warner football: Kids should not be allowed to put on helmets and knock each other in the head. - Slate Magazine

Last week, I took part in a roundtable discussion in Washington on the future of youth football.Robert Cantu, the CTE (chronic traumatic encephalopathy) researcher and NFL adviser, was there. So were Chris Nowinski, the Harvard defensive tackle turned pro wrestler turned brain-injury activist; neurosurgeon Julian Bailes, who has advised the NFL Players Association, the NCAA, and Pop Warner football; and DeMaurice Smith, the head of the NFLPA. An NFL executive attended, as did various youth-football organizations. There was an ex-Jet/Jaguar/Redskin, a plaintiffs' lawyer, a school board member, the head of a sporting goods trade group, academics, and a bunch of journalists like me.
The event was organized by the Aspen Institute and moderated by ESPN reporter Tom Farrey. His topic question: "How can football serve children, communities, and public health?" Three hours of talk yielded, for me anyway, an unsurprising answer: Tackle football can best serve children, communities, and public health by disappearing.
I know that Matt Chaney, who wrote for the roundtable this week about the tackling technique that won't make football safer, is on board with the idea that tackle football is simply too dangerous for the brains of children, and that a distinction needs to be made between what adult men choose to do professionally and what kids are permitted or often pushed to do by parents and other adults. In his new book, Concussions and Our Kids, co-written with journalist Mark Hyman, Cantu proposes barring tackle football before age 14, or the start of high school. The cutoff is arbitrary, Cantu said at the Washington panel. The more important consideration is an individual child's physical development: If he's skeletally immature, if he hasn't developed axillary hair, he shouldn't play tackle football.
"Youngsters are not miniature adults," Cantu said. For starters, he explained, their brains are not fully myelinated, meaning their nerve cells lack the complete coating that offers protection. That makes them more susceptible to concussions and means they recover more slowly from them than adults. Cantu said children have big heads relative to the rest of their bodies and weak necks, creating a "bobblehead-doll effect" that elevates the risk of concussion. They typically play in the oldest equipment, with the least educated coaches, and with little or no available medical care. They are allowed to hit each other in practice—up to 40 minutes per session in Pop Warner football, under new guidelines—to a greater extent than NFL players are in season. And finally, kids are unable to provide meaningful informed consent. "Rarely do they really understand the risk they're taking," Cantu said.
That brief presentation was a devastating synopsis of the perils of football for small children. (How small? Pop Warner, the formal name of which is, I joke not, Pop Warner Little Scholars Inc., is open to children as young as 5 years old and as light as 35 pounds.) And none of it was refuted by the representatives of children's football who participated in the event. Instead, what emerged was the playbook for the youth-football-industrial complex—3 million players and tens of millions of dollars in revenue, backed by the NFL, college football, equipment manufacturers, and other sports businesses—in what will be a long battle against the forces of science, medicine, and common sense.
First is the rhetoric. Scott Hallenbeck, the executive director of USA Football, the governing body/trade group funded by the NFL and NFLPA, thanked Cantu for raising "important issues," declared that a "healthy debate" was necessary, and reminded us that "we're all in this together." Our goal? "A better and safer environment for parents and players." Indeed, "safety" is the key word in the kids' tackle football PR effort; it's all over the websites of organizations like Pop WarnerAmerican Youth Football, and USA Football. Who's against safety?
The words are buttressed by limited, practical changes, like USA Football's "Heads Up" program and Pop Warner's limits on head contact and hitting in practice. Better than nothing, sure. But Matt and ex-NFL player Nate Jackson have already debunked the notion that football can always be played with the head up. And kids aren't usually capable, physically or mentally, of implementing precise technique, as five minutes on the sideline of any youth sports game will demonstrate. As for rules, well, Pop Warner's concussion-prevention guidelines call for "no full speed head-on blocking or tackling drills in which the players line up more than 3 yards apart." You can bet some suburban Belichick is lining up his players exactly three yards apart and instructing them to go at 90 percent speed, or ignoring the rules entirely.
Which leads to part two of the youth-football change mantra: better coaching. Hallenbeck said USA Football has "trained" almost 100,000 coaches in the last five years. It also has "looked at the concept" of a national accreditation program with "15 chapters" and "15 quizzes" with a passing grade of 80. "So you could argue there's 80 percent competency in a program like that," he said. Or you could argue that the numbers are a way to conceal the reality that youth sports coaches are mostly amateur volunteers, usually parents, with little knowledge about sports or coaching or injuries but lots of preconceived ideas gleaned from years of watching the pros. How else to explain that Pop Warner mismatch in Massachusetts in which five kids suffered concussions?
"The coaches that coach this game ... for whatever reason don't embrace change very well," former NFL linebacker Eddie Mason told the panel. "That's the issue. ... Pop Warner, USA Football can implement all the things that they want to. You can implement rules, you can implement changes, but until the football community embraces the reality of the sport, the reality of concussion, the reality of the damage that comes along with it if you start at an early age, that's the problem."
Youth football officials are aware their coaching problem goes beyond education. Hallenbeck's answer was another "concept": installing a player-safety monitor in every youth league to ensure that coaches are teaching "proper" tackling and using sanctioned practice plans, and who also reassure concerned parents that football is getting safer. "Parents are literally looking at us and saying, 'Thank you, you're making us feel more comfortable,' " Hallenbeck said.
The third and most critical component of the youth-football defense wouldn't be out of place at a debate over climate change: The science just doesn't exist to justify banning youth football at any age level. Over and over, Hallenbeck cited the lack of "evidence-based" data. And while Cantu and others agreed that more research is needed, there's already data that shows the effect of tackle football on undeveloped brains, like a study released this year by researchers at Virginia Tech and Wake Forest that found that 7-year-old players absorb impacts on par with those in college football.
Even that sort of science is used to defend kids' football. Brooke de Lench, who founded the youth sports website MomsTEAM, said her business outfitted the helmets of an Oklahoma high-school team with accelerometers to track and measure the impact of hits. (She's making a documentary about the project.) "The kids want the accelerometers, either in their helmet or as an earbud or a mouthpiece," de Lench told the panel. "They want that responsibility"—of determining when they might have suffered a head injury—"taken away from themselves."
To sum up: The defenders of youth football envision a sport in which players must be outfitted with expensive electronic sensors to determine when they have suffered brain injury; in which coaches have to pass 15-part examinations in order to be certified; and even after doing that, in which safety watchdogs must be deployed on the sidelines of every practice and game to supervise the performance of coaches. "Burning down the village to save it," sportswriter Patrick Hruby said after the Washington event.
It's not as if there aren't alternatives. Maybe have kids play flag football wearing no pads until they're 10, then with shoulder pads until 13. At 14 or 15, if they are determined to be physically mature, players can don helmets and wrap up opponents to bring them to ground. Any blow to the head or leading with the head is an automatic ejection. Full hitting can start on high-school varsities. Tackling can be taught over time—flag football teaches the proper entry point for contact, around the hips; rugby-style tackling might be instructive—to prepare kids for full contact when their bodies are ready, or at least readier, for it.
None of this is likely, at least anytime soon. Science or no science, the real reason 5- and 6-year-olds will keep padding up and hitting is consumer demand. If Pop Warner offered only flag football, its executive director, John Butler, candidly told the panel, "90 to 95 percent of our members would drop out" and play for independent teams "because whether it be kids or parents, they want to play tackle football."
Of course they do. They watch it on Sundays. It's fun. But as Eddie Mason responded, "Sometimes you have to take the decisions out of the hands of the parents and you have to just make the change. You say, well, we don't offer tackle at this age, we offer flag, and these are the reasons why." Mason said he isn't letting his 8-year-old son play tackle football.

A Young Reporter Chronicles Her 'Brain On Fire' | WBUR & NPR

In 2009, Susannah Cahalan was a healthy 24-year-old reporter for the New York Post, when she began to experience numbness, paranoia, sensitivity to light and erratic behavior. Grasping for an answer, Cahalan asked herself as it was happening, "Am I just bad at my job — is that why? Is the pressure of it getting to me? Is it a new relationship?"

But Cahalan only got worse — she began to experience seizures, hallucinations, increasingly psychotic behavior and even catatonia. Her symptoms frightened family members and baffled a series of doctors.

After a monthlong hospital stay and $1 million worth of blood tests and brain scans that proved inconclusive, Cahalan was seen by Dr. Souhel Najjar, who asked her to draw a clock on a piece of paper. "I drew a circle, and I drew the numbers 1 to 12 all on the right-hand side of the clock, so the left-hand side was blank, completely blank," she tells Fresh Air's Dave Davies, "which showed him that I was experiencing left-side spatial neglect and, likely, the right side of my brain responsible for the left field of vision was inflamed."

As Najjar put it to her parents, "her brain was on fire." This discovery led to her eventual diagnosis and treatment for anti-NMDA receptor encephalitis, a rare autoimmune disease that can attack the brain. Cahalan says that doctors think the illness may account for cases of "demonic possession" throughout history.

Cahalan's new memoir is called Brain on Fire: My Month of Madness.

Interview Highlights:

On the moment when Cahalan lost her sanity

"I don't remember anything from this experience. This was all told to me after the fact. [My boyfriend] Stephen heard guttural sounds coming from me. He thought maybe I was just angry because I hadn't slept for days, and he knew that it was really frustrating. And so he thought, 'Maybe she's just venting her frustration.' But the grunts were very unnatural sounding, so he turned and looked at me. And he saw that my eyes were wide open but completely unseeing, and at that point he tried to shake me and say, 'Are you OK, Sue? What's going on?' And at that point, my arms whipped out, and I had a grand mal seizure, and I was convulsing. And I bit my tongue so that blood and kind of a combination of blood and foam was coming out of my mouth. And he had the presence of mind — and I think this is incredible — to know that this was a seizure because I had never had a seizure before. And so he turned me on my side and he called 911. And [that's, for me] ... the difference between sanity and insanity ... that moment where kind of my memory goes dark."

On some of the symptoms she exhibited at the hospital

"I slurred my words. I drooled. I didn't have proper control over my swallowing ... I kept my arms out in unnatural poses. At one point, I was like the Bride of Frankenstein — I kept my arms out rigidly. I was slow. I could hardly walk, and when I did, I needed to be supported ... I started [acting] very psychotic. I believed that I could age people with my mind. If I looked at them, wrinkles would form, and if I looked away, they would suddenly, magically get younger. And I believed that my father had murdered my stepmother. I believed all these incredibly paranoid — a huge, extreme example of persecution complex. And then as the days went on, I stopped being as psychotic, and I started entering into a catatonic stage, which was characterized by just complete lack of emotion, inability to relate, or to read, or hardly to be able to speak."

On being supported by her parents and boyfriend

"Without them, I wouldn't be here right now, especially with my mom. She was a bulldog. I mean she would not take 'no' for an answer, especially in the beginning when they were saying it was alcohol withdrawal and partying. She refused to see that as an answer, and so she did her own research. She asked questions. At home, after a day at the hospital, she'd make a list of all the different terminology they used, and she'd look it up and, you know, not everyone is capable of doing that. ... I was so lucky to have someone there for me that could do that. ... If everyone could have someone like that, it would just be a better world."

On the possible connection between her rare immune disease and cases of "demonic possession" throughout history

"When you think about the symptoms — in my case alone, this grandiosity, this violence. In a lot of children, you see hypersexuality. Even my grunts and these guttural sounds that came from me sounded superhuman to someone who might be inclined to think that way. ... When you see videos of people — in fact, when I see videos of myself — demonic possession is not far from your mind. It wasn't far from Stephen's mind when he first saw that seizure. And I've talked to many people who've had this disease, and one woman I spoke to actually asked for a priest because she said, 'The devil is inside of me. I need it out.' A little girl was grunting — they had a monitor in her room — and she was grunting so unnaturally that her parents looked at each other and said, 'Is she, is she possessed?' They actually said that about a little girl. You can see throughout history why people would believe this."


Shortly before her thirtieth birthday, cartoonist Ellen Forney was diagnosed with bipolar disorder. Flagrantly manic and terrified that medications would cause her to lose creativity and her livelihood, she began a years-long struggle to find mental stability while retaining her passion and creativity.

Searching to make sense of the popular concept of the crazy artist, she finds inspiration from the lives and work of other artists and writers who suffered from mood disorders, including Vincent van Gogh, Georgia O'Keeffe, William Styron, and Sylvia Plath. She analyzes the clinical aspects of bipolar disorder as she struggles with the strengths and limitations of a parade of medications and treatments.

Darkly funny, intensely personal, and visually dynamic, Forney's graphic memoir provides a visceral glimpse into the effects of a mood disorder on the artist's work. Her story seeks the answer to this question: if there's a correlation between creativity and mood disorders, is an artist's bipolar disorder a curse, or a gift?

Tuesday, November 13, 2012

BBC News - Vegetative patient Scott Routley says 'I'm not in pain'

A Canadian man who was believed to have been in a vegetative state for more than a decade, has been able to tell scientists that he is not in any pain.

It's the first time an uncommunicative, severely brain-injured patient has been able to give answers clinically relevant to their care.

Scott Routley, 39, was asked questions while having his brain activity scanned in an fMRI machine.

His doctor says the discovery means medical textbooks will need rewriting.

Vegetative patients emerge from a coma into a condition where they have periods awake, with their eyes open, but have no perception of themselves or the outside world.

Mr Routley suffered a severe brain injury in a car accident 12 years ago.

None of his physical assessments since then have shown any sign of awareness, or ability to communicate.

But the British neuroscientist Prof Adrian Owen - who led the team at the Brain and Mind Institute, University of Western Ontario - said Mr Routley was clearly not vegetative.

"Scott has been able to show he has a conscious, thinking mind. We have scanned him several times and his pattern of brain activity shows he is clearly choosing to answer our questions. We believe he knows who and where he is."

Prof Owen said it was a groundbreaking moment.

"Asking a patient something important to them has been our aim for many years. In future we could ask what we could do to improve their quality of life. It could be simple things like the entertainment we provide or the times of day they are washed and fed."

Scott Routley's parents say they always thought he was conscious and could communicate by lifting a thumb or moving his eyes. But this has never been accepted by medical staff.

Prof Bryan Young at University Hospital, London - Mr Routley's neurologist for a decade - said the scan results overturned all the behavioural assessments that had been made over the years.

"I was impressed and amazed that he was able to show these cognitive responses. He had the clinical picture of a typical vegetative patient and showed no spontaneous movements that looked meaningful."

Observational assessments of Mr Routley since he responded in the scanner have continued to suggest he is vegetative. Prof Young said medical textbooks would need to be updated to include Prof Owen's techniques.

The BBC's Panorama programme followed several vegetative and minimally-conscious patients in Britain and Canada for more than a year.

Another Canadian patient, Steven Graham, was able to demonstrate that he had laid down new memories since his brain injury. Mr Graham answers yes when asked whether his sister has a daughter. His niece was born after his car accident five years ago.

The Panorama team also followed three patients at the Royal Hospital for Neuro-disability (RHN) in Putney, which specialises in the rehabilitation of brain-injured patients.

It collaborates with a team of Cambridge University neuroscientists at the Wolfson Brain Imaging Centre at Addenbrooke's hospital, Cambridge.

A second patient, who was not able to be fully assessed by the RHN because of repeated sickness, is later shown to have some limited awareness in brain scans.

High Blood Pressure Tied to Brain Changes -

High blood pressure may cause harmful brain changes in people as young as 40, a study suggests.
In the report, published online Nov. 2 in Lancet Neurology, researchers measured blood pressure in 579 men and women whose average age was 39, then examined their brains with magnetic resonance imaging. After adjusting for smoking, hypertension treatment and total cranial volume, they found that higher systolic blood pressure - the most common form of hypertension - was associated with decreases in gray matter volume and significant injury to white matter. Moreover, there was a dose-response relationship: The higher the blood pressure, the greater the visible changes.
These changes also occur in people over 55 with high blood pressure and are associated with decreased cognitive performance. Essentially, these young people with high blood pressure had brains that were older than their chronological age.
The authors acknowledge that their sample was mostly healthy, white volunteers, and that the study represents a snapshot, not a long-term picture.
The senior author, Dr. Charles DeCarli, a neurologist at the University of California, Davis, urged caution. "Most people at this age have no symptoms at all, even if they have high blood pressure," he said. "Get your blood pressure measured when you're young, and treated if necessary."