[tt] NYT: Nancy C. Andreasen, a Neuroscientist and Psychiatrist, Uses Imaging to Look at Changes in the Brain

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Nancy C. Andreasen, a Neuroscientist and Psychiatrist, Uses Imaging to 
Look at Changes in the Brain
http://www.nytimes.com/2008/09/16/health/research/16conv.html

A Conversation With Nancy C. Andreasen
Using Imaging to Look at Changes in the Brain
By CLAUDIA DREIFUS

Dr. Nancy C. Andreasen concentrates on the big questions. A
neuroscientist and psychiatrist at the University of Iowa, she uses
M.R.I. to ask questions like: How do the nervous systems of
extremely creative people differ from those of the rest of us? How
is the brain physiology of the mentally ill different from that of
normal people? For nearly two decades, she has been conducting a
study that tracks long-term changes in the brain. We spoke this
summer when she visited New York City. An edited version of a
three-hour conversation follows:

Q. HOW DID YOU BECOME A PSYCHIATRIST?

A. I was an English professor in the early 1960s. I'd done a book on
John Donne. Then, in 1964, I gave birth to my first child and nearly
died from a postpartum infection -- the very thing that had killed
millions of birthing women in the centuries before antibiotics. As I
recovered, I realized I had been given back my life, and that caused
me to rethink everything in it. I decided to quit literature studies
and go back to school to become a doctor.

> From the outset, I knew I wanted to do research and patient care.
Because I relish complexity, I chose psychiatry -- it's more
complicated than neurology. And I chose brain research because the
brain is the most complicated organ in the body. I wanted to do
something as important as the discovery of penicillin, the thing
that had saved me.

Q. YOU PIONEERED THE USE OF IMAGING TECHNOLOGY FOR LEARNING ABOUT
THE PHYSIOLOGY OF THE BRAIN. HOW DID THE IDEA OF USING CAT SCANS AND
M.R.I.'S AS A RESEARCH TOOL COME TO YOU?

A. My first patient was a schizophrenic. After working with him, I
wanted to understand how this terrible disease developed, how to
stop it and to find better treatments. Right away, I began searching
for new tests to assay brain activities. With the technology we had
at that time, you couldn't see brain differences easily. A lot of
our information came from autopsies done on patients, but that was
of limited use because you had nothing to compare it to.

But then, in the early 1970s, CT scans came along. They got pictures
of the inside of a living patient's brain. I recognized the
potential immediately. The problem was convincing my colleagues. CT
scans involved exposing patients to radiation. When I went to the
human experimentation committee at my medical school, they went, "We
don't want you subjecting patients to radiation. Besides, you're not
going to find anything that way, anyway." It took a long time to
convince them.

Q. TODAY, IMAGING STUDIES ARE ONE OF THE MAINSTAYS OF NEUROSCIENCE.
WHEN DID ATTITUDES CHANGE?

A. In the early 1980s, when magnetic resonance imaging came on line.
M.R.I.'s did not expose patients to radiation, and you could see
brain structures in exquisite detail. I decided to use it for a
longitudinal study of brain changes over a long period of time.
We're asking: Is schizophrenia a neurodegenerative disease like
Alzheimer's?

In 1989, I began to collect subjects -- some with schizophrenia and
some not -- and began taking pictures of their brains. With the
schizophrenics, we began seeing them at the first onset of their
disease, which is usually at around age 24. We recruited about 538
people with schizophrenia. Eighteen years later, we're still
following 305.

Q. AND WHAT HAVE YOU FOUND?

A. I haven't published this yet. But I have spoken about it in
public lectures. The big finding is that people with schizophrenia
are losing brain tissue at a more rapid rate than healthy people of
comparable age. Some are losing as much as 1 percent per year.
That's an awful lot over an 18-year period. And then we're trying to
figure out why. Another thing we've discovered is that the more
drugs you've been given, the more brain tissue you lose.

Q. WHY DO YOU THINK THIS IS HAPPENING?

A. Well, what exactly do these drugs do? They block basal ganglia
activity. The prefrontal cortex doesn't get the input it needs and
is being shut down by drugs. That reduces the psychotic symptoms. It
also causes the prefrontal cortex to slowly atrophy.

If I were developing new drugs, I'd switch targets. Till now it's
been chemically formulated targets. I believe we should be thinking
more anatomically and asking, "With schizophrenics, which brain
regions are functioning abnormally?"

Q. ARE YOU WORRIED YOUR FINDINGS MIGHT BE MISUSED?

A. The reason I sat on these findings for a couple of years was that
I just wanted to be absolutely sure it was true. My biggest fear is
that people who need the drugs will stop taking them.

Q. WHAT ARE THE POLICY IMPLICATIONS OF THIS FINDING?

A. Implication 1: that these drugs have to be used at the lowest
possible dose, which often doesn't happen now. There's huge economic
pressure to medicate patients very rapidly and to get them out of
the hospital right away. Implication 2: we need to find other drugs
that work on other systems and parts of the brain. Implication 3:
whatever medications we use need to be combined with more
nonmedication-oriented treatments, like cognitive or social
therapies.

Q. IN YOUR LONGITUDINAL STUDY, ARE YOU ALSO LOOKING AT HOW THE
NORMAL BRAIN AGES?

A. Yes. I've been asking, "At what point is human brain maturation
complete and at what point do our brains naturally decline and lose
tissue?" The answer is: the human brain continues to mature till
about 25. At about 25, it plateaus for about 20 years, and at about
45, we start to lose brain tissue.

But it's interesting: we lose brain tissue, but we don't necessarily
lose cognitive capacities. A lot of people at 50, 60, 70 or 80 are
quite sharp. I can quantify their brain tissue and see they've lost
quite a bit from what would be normal for a 45-year-old, but their
cognitive abilities are not at all impaired.