MCI Symposium: What Do Autopsy Studies Tell Us?

Summary: The symptoms associated with Mild Cognitive Impairment (MCI) vary from person to person. The same can be said of the pathologies found in the brains of people with MCI. Pathologists often find some level of the plaques and tangles associated with Alzheimer’s disease, but other abnormalities are common. It’s not yet clear how much each pathology might contribute to memory loss, or how those pathologies might interact.

Two presentations at the 7th Annual Mild Cognitive Impairment (MCI) Symposium detailed the complexities of making a definitive diagnosis based on pathologies found in the brains of people who had MCI.

During an autopsy, a pathologist looks at various sections of the brain, and assesses the types and level of brain pathologies, or abnormalities. For patients who had dementia, pathologists look for evidence of structural abnormalities including infarcts (areas damaged by stroke), tumors and demyelinating disease (multiple sclerosis, for example). They also look for the presence of specific degenerative changes in vulnerable brain regions.

Dr. Joseph Parisi, Professor of Laboratory Medicine and Pathology at Mayo Clinic, started his presentation at the MCI Symposium with an overview of these degenerative changes. Neurodegenerative diseases are diverse, he said, but all are associated with aging and involve abnormal protein interactions that form the deposits that serve as the defining features of a specific neurodegenerative disease. These abnormal protein deposits include:

• Beta amyloid
• Tau
• Alpha-synuclein
• TDP-43.

Mixed pathologies in the brains of older people with Amnestic MCI
In a study of the brains of fifteen people with Amnestic MCI (average age 89 years), Dr. Parisi and his colleagues found evidence of medial temporal lobe pathology in all. [The medial temporal lobe is an area of the brain associated with memory function.] The brains were not normal, and showed a variety of pathologies. Many had mixed pathologies.

Most of the brains in the study had features of early Alzheimer’s disease. Plaques and tangles – the hallmarks of Alzheimer’s – were present, but were fewer in number than needed for a diagnosis of Alzheimer’s. The plaques and tangles in these MCI brains were confined to the medial temporal area, instead of distributed widely throughout the brain as they would be in Alzheimer’s, Dr. Parisi said.

In addition to plaques and tangles, the brains in this study had a variety of other pathologies. Of the fifteen brains, there were:

• Seven with argyrophilic grain disease
• Five with infarcts, or signs of stroke
• Three with loss of neurons in a specific part of the medial temporal lobe called the hippocampus
• Two with tangles but no plaques
• One with alpha-synuclein deposits characteristic of Lewy body disease/dementia.

This was a small study with older patients, so the results may not be representative of all patients with MCI.

The limits of autopsy studies

You might have read that the only way to be 100 percent sure of what caused someone’s memory loss is to conduct an autopsy. Many of the things we think we know about dementia are over-simplified, though, and the idea that an autopsy can accurately capture all the processes that caused a person’s memory loss is no exception.

First, an autopsy captures a pathologic process at one point in time, providing a “snap-shot” of the disease process at the time of death. This means the disease process as seen at autopsy is often end-stage. Also, as people age, there may be multiple pathological events going on at the same time, each at different rates. Research suggests that these different pathologies may interact with each other in a synergistic manner. Finally, the presence of the plaques and tangles associated with Alzheimer’s doesn’t always mean the person had problems with memory and thinking.

“Although in general, the number of plaques and tangles correlates with the degree of cognitive impairment, this is not always the case,” Dr. Parisi explained in an email after the conference. “Some patients can compensate for high plaque and tangle burdens, and remain cognitively normal. This may be due to factors such as education, activity or life experience.”

Despite these cautionary notes, this study and related research add to the data about what causes Mild Cognitive Impairment.

Related studies at Mayo Clinic

Researchers at Mayo Clinic are also studying the brains of people with Non-Amnestic MCI. About half of these brains don’t show the level of medial temporal lobe pathology found in the brains of people with Amnestic MCI, and about half show some degree of Alzheimer’s pathology, Dr. Parisi said.

He and his colleagues also examined the brains of 34 people who had been diagnosed with Amnestic MCI and then progressed to dementia before death. He said the majority (71 percent) of patients progressing through MCI to dementia showed pathologic Alzheimer’s at autopsy, confirming final clinical diagnoses. A significant minority (29 percent), however, showed other pathologies including Lewy body disease, loss of neurons in the hippocampus, nonspecific tauopathy, argyrophilic grain disease, frontotemporal dementia with hippocampal sclerosis, and progressive supranuclear palsy.

Mixed pathologies increase the likelihood of cognitive problems

In the second presentation, Dr.Julie Schneider, Assistant Professor of Neurology and Neuropathology at Rush University Medical Center, talked about autopsy results for 134 people from the Religious Orders Study and from Rush’s Memory and Aging Project who were diagnosed with MCI.

Mixed pathologies were common in these brains, with 55 percent meeting criteria for Alzheimer’s, 33 percent meeting the criteria for stroke or vascular disease and 16 percent meeting criteria for Lewy body disease. On average, the amount of these pathologies was higher than in the brains of people with no cognitive impairment, but lower than in those of people with probable Alzheimer’s. When there were infarcts or Lewy bodies in addition to Alzheimer’s pathology, it increased the likelihood of cognitive impairment.

Previously published research has suggested that Alzheimer’s pathology underlies Amnestic MCI, while vascular pathology underlies Non-Amnestic MCI, Dr. Schneider said. However, she and her colleagues found that in the brains they studied, Alzheimer’s was the most common pathology in both Amnestic (59 percent) and Non-Amnestic MCI (49 percent). In brains with only a single pathology, vascular pathology was somewhat higher in Non-Amnestic MCI, though (17 percent vs. 11 percent in Amnestic MCI).

Interestingly, 22 percent of the MCI brains they studied had no Alzheimer’s or Lewy body pathologies, and no signs of stroke.

The role of vascular disease

Dr. Schneider and her colleagues at Rush have started new research into the role of vascular disease in memory loss. They are investigating whether very small infarcts, previously thought to be harmless, are related to poor cognitive function. In studies so far, the cerebral amyloid angiopathy (CAA) my father had was present in 94 percent of the brains of people with dementia, but also in 77 percent of those without dementia. Even in people with no memory loss, CAA was associated with a worsening of perceptual speed in these studies.

Alzheimer's caregivers overlooked by policy-makers

November 21, 2009
By DENISE M. BONILLA
Nassau County New York
denise.bonilla@newsday.com

Quick Summary

The job of caregiver is one of endless struggle, and those who work with Alzheimer's caregivers say it is a struggle that is too often ignored by policy-makers.
Karen Henley sits by here

Alzheimer's on Long Island: The caregivers

The job of caregiver is one of endless struggle, and those who work with Alzheimer's caregivers say it is a struggle that is too often ignored by policy-makers. Now, with experts predicting a surge in the number of Alzheimer's cases in the coming decades, advocates worry that the needs of patients and caregivers could overwhelm the health care system.

"We don't have enough infrastructure right now to handle what we have," said Eric Hall, president and chief executive of the Alzheimer's Foundation of America. "If we're not ready for what we've got . . . when do we start building an infrastructure for what we know is coming?"

The six families profiled in Newsday's recent Alzheimer's series represent only a tiny fraction of those struggling against the disease while grappling with government services and the health care system.

There are about 5.3 million Americans with Alzheimer's - 55,000 on Long Island - and nearly 10 million caregivers. Estimates are that by 2050, Alzheimer's cases will surge to as much as 16 million.

Alzheimer's is a degenerative, fatal disease and the most common cause of dementia. It is most prevalent in those over 85 - where it may strike 1 out of 2 people - but 5 percent to 10 percent of all cases occur in those under 65 in what is called early- or young-onset Alzheimer's.

There is no cure but researchers hope in the next 10 to 15 years to find new ways to stave off the disease's progression.

"What are we going to do for the next 15 years or more?" asked Hall. "How do we support those people [caregivers]?"


Change from ground up connections

* Barack Obama
* Taliban
* Hillary Rodham Clinton
* U.S. House of Representatives
* White House

Those in the field want to see change from the ground up, starting with physicians.

"The field has now reached about 7,000 certified geriatricians for a country that needs at least 14,000 and will need in excess of 30,000 within the next two or three decades," said Dr. Gisele Wolf-Klein, director of geriatric education for the North Shore-LIJ health system.

To that end, Wolf-Klein said many geriatricians are acting as mentors to other doctors, teaching them about elder care. Hall said his group is also creating an advisory board to make curriculum recommendations to medical schools.

Mary Ann Malack-Ragona, head of the Long Island chapter of the Alzheimer's Association in Ronkonkoma, is working with the New York State Department of Health to examine a possible additional level of care for dementia patients. Right now, hospitals and facilities such as nursing homes are unable to care for a dementia patient who exhibits aggression. Instead they are often sent to psychiatric wards.

Malack-Ragona is also part of the state's Alzheimer's disease coordinating council. The council was formed in response to town-hall forums held by the state Department of Health last year to assess caregivers' needs. Some issues they are looking into include: increased home health care training, mandated cognitive testing as part of a physical exam, and streamlining the process of Medicaid assistance.

The Alzheimer's Association estimates 9.9 million people in the United States are unpaid caregivers providing care valued at $94 billion. For families, the cost of caregiving can be devastating. Assisted living and nursing facilities cost $6,000 to $14,000 a month on Long Island.

Keeping a patient at home can run tens of thousands of dollars a year. Medicare pays for limited home services after hospitalization, and many families earn too much to qualify for Medicaid coverage.

Slow response so far

Advocates say response to the Alzheimer's crisis on both federal and state levels has been slow. Long-term care and cognitive issues were largely absent from the debates over health care reform, experts say. One of the more ambitious bills that has not been acted on would create an Office of National Alzheimer's Project within the White House, coordinating research and care.

On Long Island, Malack-Ragona is trying to raise money to create an Alzheimer's resource center. The center would include a cafe, recreation area and classroom space for training programs. She hopes to have doctors, lawyers and social workers available. Malack-Ragona said the association has raised $1 million but still needs another $2.5 million.

Fragmented network

The eldercare network is still extremely fragmented, said Fred Jenny, executive director of the Long Island Alzheimer's Foundation in Port Washington. Caregivers remain isolated, he said, and often wait for a crisis before reaching out for help.

"What ultimately happens is the family member can't cope and the person needs to be placed," Jenny said. "We don't have enough nursing home beds and assisted-living beds to take care of everyone who's going to need that care. So we're going to have to put a lot more emphasis on being supportive of the family caregiver and giving them assistance in maintaining their loved one in the community."

The GOP's no-exit strategy

By E.J. Dionne Jr.
Thursday, November 19, 2009

Normal human beings -- let's call them real Americans -- cannot understand why, 10 months after President Obama's inauguration, Congress is still tied down in a procedural torture chamber trying to pass the health-care bill Obama promised in his campaign.

Last year, the voters gave him the largest popular-vote margin won by a presidential candidate in 20 years. They gave Democrats their largest Senate majority since 1976 and their largest House majority since 1992.

Obama didn't just offer bromides about hope and change. He made specific pledges.

You'd think that the newly empowered Democrats would want to deliver quickly.

ut what do real Americans see? On health care, they read about this or that Democratic senator prepared to bring action to a screeching halt out of displeasure with some aspect of the proposal. They first hear that a bill will pass by Thanksgiving and then learn it might not get a final vote until after the new year.

Is it any wonder that Congress has miserable approval ratings? Is it surprising that independents, who want their government to solve a few problems, are becoming impatient with the current majority?

Democrats in the Senate -- the House is not the problem -- need to have a long chat with themselves and decide whether they want to engage in an act of collective suicide.

But it's also time to start paying attention to how Republicans, with Machiavellian brilliance, have hit upon what might be called the Beltway-at-Rush-Hour Strategy, aimed at snarling legislative traffic to a standstill so Democrats have no hope of reaching the next exit.

We know what happens when drivers just sit there when they're supposed to be moving.

They get grumpy, irascible and start turning on each other, which is exactly what the Democrats are doing.

Republicans know one other thing: Practically nobody is noticing their delay-to-kill strategy. Who wants to discuss legislative procedure when there's so much fun and profit in psychoanalyzing Sarah Palin?

Yet there was a small break in the Curtain of Obstruction this week when Republican senators unashamedly ate every word they had spoken when George W. Bush was in power about the horrors of filibustering nominees for federal judgeships. On Tuesday, a majority of Republicans tried to block a vote on the appointment of David F.

Hamilton, a rather moderate jurist, to a federal appeals court.

Sen. Jeff Sessions of Alabama explained the GOP's about-face by saying: "I think the rules have changed."

That was actually a helpful comment, because the Republicans have changed the rules on Senate action up and down the line. Hamilton's case is just the one instance that finally got a little play.

Thankfully, this filibuster failed because some Republicans were embarrassed by it.

But Republican delaying tactics have made Obama far too wary about judicial nominations for fear of controversy. He is well behind his predecessor in filling vacancies, a shameful capitulation to obstruction. There's also the fact that the nomination of Christopher Schroeder as head of the Justice Department's Office of Legal Policy, which helps to vet judges, is snarled -- guess where? -- in the Senate.

Republicans are using the filibuster to stall action even on bills that most of them support. Remember: The rule is to keep Democrats from ever reaching the exit.

As of last Monday, the Senate majority had filed 58 cloture motions requiring 32 recorded votes. One of the more outrageous cases involved an extension in unemployment benefits, a no-brainer in light of the dismal economy. The bill ultimately cleared the Senate this month by 98 to 0.

The vote came only after the Republicans launched three filibusters against the bill and tried to lard it with unrelated amendments, delaying passage by nearly a month.

And you wonder why it's so hard to pass health care?

Defenders of the Senate always say the Founders envisioned it as a deliberative body that would cool the passions of the House. But Sessions unintentionally blew the whistle on how what's happening now has nothing to do with the Founders' design.

The rules have changed. The extra-constitutional filibuster is being used by the minority, with extraordinary success, to make the majority look foolish, ineffectual and incompetent. By using Republican obstructionism as a vehicle for forcing through their own narrow agendas, supposedly moderate Democratic senators will only make themselves complicit in this humiliation.

ejdionne@washpost.com

The GOP's no-exit strategy

By E.J. Dionne Jr.
Thursday, November 19, 2009

Normal human beings -- let's call them real Americans -- cannot understand why, 10 months after President Obama's inauguration, Congress is still tied down in a procedural torture chamber trying to pass the health-care bill Obama promised in his campaign.

Last year, the voters gave him the largest popular-vote margin won by a presidential candidate in 20 years. They gave Democrats their largest Senate majority since 1976 and their largest House majority since 1992.

Obama didn't just offer bromides about hope and change. He made specific pledges. You'd think that the newly empowered Democrats would want to deliver quickly.
But what do real Americans see? On health care, they read about this or that Democratic senator prepared to bring action to a screeching halt out of displeasure with some aspect of the proposal. They first hear that a bill will pass by Thanksgiving and then learn it might not get a final vote until after the new year.
Is it any wonder that Congress has miserable approval ratings? Is it surprising that independents, who want their government to solve a few problems, are becoming impatient with the current majority?

Democrats in the Senate -- the House is not the problem -- need to have a long chat with themselves and decide whether they want to engage in an act of collective suicide.

But it's also time to start paying attention to how Republicans, with Machiavellian brilliance, have hit upon what might be called the Beltway-at-Rush-Hour Strategy, aimed at snarling legislative traffic to a standstill so Democrats have no hope of reaching the next exit.

We know what happens when drivers just sit there when they're supposed to be moving. They get grumpy, irascible and start turning on each other, which is exactly what the Democrats are doing.

Republicans know one other thing: Practically nobody is noticing their delay-to-kill strategy. Who wants to discuss legislative procedure when there's so much fun and profit in psychoanalyzing Sarah Palin?

Yet there was a small break in the Curtain of Obstruction this week when Republican senators unashamedly ate every word they had spoken when George W. Bush was in power about the horrors of filibustering nominees for federal judgeships. On Tuesday, a majority of Republicans tried to block a vote on the appointment of David F. Hamilton, a rather moderate jurist, to a federal appeals court.

Sen. Jeff Sessions of Alabama explained the GOP's about-face by saying: "I think the rules have changed."

That was actually a helpful comment, because the Republicans have changed the rules on Senate action up and down the line. Hamilton's case is just the one instance that finally got a little play.

Thankfully, this filibuster failed because some Republicans were embarrassed by it. But Republican delaying tactics have made Obama far too wary about judicial nominations for fear of controversy. He is well behind his predecessor in filling vacancies, a shameful capitulation to obstruction. There's also the fact that the nomination of Christopher Schroeder as head of the Justice Department's Office of Legal Policy, which helps to vet judges, is snarled -- guess where? -- in the Senate.

Republicans are using the filibuster to stall action even on bills that most of them support. Remember: The rule is to keep Democrats from ever reaching the exit.

As of last Monday, the Senate majority had filed 58 cloture motions requiring 32 recorded votes. One of the more outrageous cases involved an extension in unemployment benefits, a no-brainer in light of the dismal economy. The bill ultimately cleared the Senate this month by 98 to 0.

The vote came only after the Republicans launched three filibusters against the bill and tried to lard it with unrelated amendments, delaying passage by nearly a month. And you wonder why it's so hard to pass health care?

Defenders of the Senate always say the Founders envisioned it as a deliberative body that would cool the passions of the House. But Sessions unintentionally blew the whistle on how what's happening now has nothing to do with the Founders' design.
The rules have changed. The extra-constitutional filibuster is being used by the minority, with extraordinary success, to make the majority look foolish, ineffectual and incompetent. By using Republican obstructionism as a vehicle for forcing through their own narrow agendas, supposedly moderate Democratic senators will only make themselves complicit in this humiliation.

ejdionne@washpost.com

The GOP's no-exit strategy

By E.J. Dionne Jr.
Thursday, November 19, 2009

Normal human beings -- let's call them real Americans -- cannot understand why, 10 months after President Obama's inauguration, Congress is still tied down in a procedural torture chamber trying to pass the health-care bill Obama promised in his campaign.

Last year, the voters gave him the largest popular-vote margin won by a presidential candidate in 20 years. They gave Democrats their largest Senate majority since 1976 and their largest House majority since 1992.

Obama didn't just offer bromides about hope and change. He made specific pledges. You'd think that the newly empowered Democrats would want to deliver quickly.
But what do real Americans see? On health care, they read about this or that Democratic senator prepared to bring action to a screeching halt out of displeasure with some aspect of the proposal. They first hear that a bill will pass by Thanksgiving and then learn it might not get a final vote until after the new year.
Is it any wonder that Congress has miserable approval ratings? Is it surprising that independents, who want their government to solve a few problems, are becoming impatient with the current majority?

Democrats in the Senate -- the House is not the problem -- need to have a long chat with themselves and decide whether they want to engage in an act of collective suicide.

But it's also time to start paying attention to how Republicans, with Machiavellian brilliance, have hit upon what might be called the Beltway-at-Rush-Hour Strategy, aimed at snarling legislative traffic to a standstill so Democrats have no hope of reaching the next exit.

We know what happens when drivers just sit there when they're supposed to be moving. They get grumpy, irascible and start turning on each other, which is exactly what the Democrats are doing.

Republicans know one other thing: Practically nobody is noticing their delay-to-kill strategy. Who wants to discuss legislative procedure when there's so much fun and profit in psychoanalyzing Sarah Palin?

Yet there was a small break in the Curtain of Obstruction this week when Republican senators unashamedly ate every word they had spoken when George W. Bush was in power about the horrors of filibustering nominees for federal judgeships. On Tuesday, a majority of Republicans tried to block a vote on the appointment of David F. Hamilton, a rather moderate jurist, to a federal appeals court.

Sen. Jeff Sessions of Alabama explained the GOP's about-face by saying: "I think the rules have changed."

That was actually a helpful comment, because the Republicans have changed the rules on Senate action up and down the line. Hamilton's case is just the one instance that finally got a little play.

Thankfully, this filibuster failed because some Republicans were embarrassed by it. But Republican delaying tactics have made Obama far too wary about judicial nominations for fear of controversy. He is well behind his predecessor in filling vacancies, a shameful capitulation to obstruction. There's also the fact that the nomination of Christopher Schroeder as head of the Justice Department's Office of Legal Policy, which helps to vet judges, is snarled -- guess where? -- in the Senate.

Republicans are using the filibuster to stall action even on bills that most of them support. Remember: The rule is to keep Democrats from ever reaching the exit.
As of last Monday, the Senate majority had filed 58 cloture motions requiring 32 recorded votes. One of the more outrageous cases involved an extension in unemployment benefits, a no-brainer in light of the dismal economy. The bill ultimately cleared the Senate this month by 98 to 0.

The vote came only after the Republicans launched three filibusters against the bill and tried to lard it with unrelated amendments, delaying passage by nearly a month. And you wonder why it's so hard to pass health care?

Defenders of the Senate always say the Founders envisioned it as a deliberative body that would cool the passions of the House. But Sessions unintentionally blew the whistle on how what's happening now has nothing to do with the Founders' design.
The rules have changed. The extra-constitutional filibuster is being used by the minority, with extraordinary success, to make the majority look foolish, ineffectual and incompetent. By using Republican obstructionism as a vehicle for forcing through their own narrow agendas, supposedly moderate Democratic senators will only make themselves complicit in this humiliation.

ejdionne@washpost.com

Why Aren't We All in This Together?

Deepak Chopra
Author, Sirius/XM radio host
Posted: November 16, 2009 01:26 PM

This is a country where the haves help the have-nots. The House's passage of sweeping health care reform proved that such a spirit is still alive, as it is during wars and depressions. But the massive holdouts in the House vote show that the last thirty years of reactionary policies have weakened the altruism of America. How could over 200 Congressmen act exactly like their blinkered forebearers who voted against Social Security and Medicare when those reforms were passed?

The answer is that "greed is good" has gone from being a satirical phrase in a Hollywood movie to a general philosophy among the well-to-do. Far from feeling obliged to help the have-nots, the haves in this country are racing to widen the gap between them. Urban and suburban housing remains shamefully segregated. Incomes for CEOs are at an outrageous proportion compared to workers' salaries, not to mention the immoral bonuses given to bankers using public money that was given to them as an outright gift. This remains true even when CEOs, fund managers, and traders lose billions of their shareholders' and clients' money.

In short, we aren't all in this together. President Obama repeatedly calls for bipartisanship and national unity, but it falls upon deaf ears. Or should we say cynical ears? Wall Street traders and Washington power brokers who are in the pocket of special interests have become used to a moral laxity that in former years would amount to corruption. Influence peddling used to be a felony. Now it's business as usual, and government officials justify their low wages (by the standards of the rich) while in office by planning for huge windfalls when they retire from government and sell themselves on the open market.

When you also consider that fewer than half of 1% of the population bears the burden of military service with its risks and sacrifices, the picture of an unequal society cannot be swept under the rug. It used to be considered a scandal in aristocratic Britain when about 2% of the population owned 90% of the wealth. Shift the focus to modern day America, and the figure is 1%. The income of average workers remained unchanged during the Bush years while the wealthiest Americans enjoyed enormous gains, abetted by grossly unfair tax breaks.

If this trend toward inequality continues, what will a future America look like? It will be more segregated, with workers being robbed of the fruits of their productivity (even though American workers' productivity is the highest in the world and growing), corporations running free in their immoral tactics while writing their own regulations in Washington, and influence peddling totally out of control. I mention this sad litany because the House's health care bill is a sign that altruism and a sense of social fairness do exist. We aren't as passionate as in the Great Depression or World War II, but Barack Obama is reminding a younger generation that we really are all in this together. Those aren't empty words. They are the basic idea that keeps a society functioning, building its ideals, and enjoying a collective identity with justice at its core.

Published in the San Francisco Chronicle

Life After Death: The View From The Edge

Dinesh D'Souza
Posted: November 5, 2009 04:10 PM Huffington Post

Read more at: http://www.huffingtonpost.com/dinesh-dsouza/life-after-death-the-view_b_347412.html&cp

The best empirical evidence for life after death comes from people who have had "near death experiences" (NDEs). These are people who have gone to the edge and come back with a report. Certainly they haven't crossed over; in that sense, death remains, as Shakespeare put it, the undiscovered country. But so-called NDEs give us the best chance to make at least an initial map of that unknown territory.

NDEs were first publicized in 1975 by physician Raymond Moody in Life After Life. Moody described 150 cases of people very near death, or pronounced clinically dead, who reported experiences of moving through dark tunnels, seeing themselves from outside their bodies, encountering the spirits of dead relatives and friends, seeing celestial beings, being dazzled by a bright light, reviewing their whole life in an instant, and then reaching an impassable barrier before being returned to their earthly bodies.

Recognizing that his reports would sound fantastic to many, Moody cited numerous examples from history to show that NDEs were not uncommon. Plato reports one in the last pages of his Republic. The eighth-century monk Bede gives a similar account in his history of the English people. The Tibetan Book of the Dead instructs dying people to prepare to give an account of their lives as they go through the darkness into the radiant light of pure reality. Even the atheist philosopher A.J. Ayer wrote of a near death experience in which he found himself in a realm where "the laws of nature had ceased to function" and where he was "confronted by a red light, exceedingly bright."

Gallup surveys and studies around the world have subsequently shown that such experiences occur frequently. The stunning implication is that consciousness can survive the termination of bodily functions -- that death may not be "final exit."
Recognizing the implications of NDEs, atheists have labored hard to refute them. One explanation, favored by Carl Sagan in Broca's Brain, is that at the end of life we, in a sense, return to the womb and once again experience the original birth process. An ingenious idea: it would account for several features of NDEs, such as the tunnel, the sensation of floating, the movement from darkness to light.

But Sagan's hypothesis has been largely discredited by the work of philosopher Carl Becker, who draws on research in the field of infant perception to show that newborns cannot see anything as they emerge from the womb. Even if they could, newborns don't have developed mental faculties and cannot be expected to have recollections of the birth process. In any case, the birth canal is not like a tunnel through which a child gracefully floats; it is a tight, compressed passage from which a newborn emerges, typically head first and sometimes chafed or bruised.

A second explanation is that NDEs reflect distorted brain states. Psychologist Ron Siegel suggests they are dreamlike experiences of a kind that people have when they take hallucinogenic or mind-altering drugs. Those who take recreational drugs do experience a range of perceptions from wild colors to soaring sensations to drowsiness to decreased vision. During this time however, most of them know they are on drugs. Also they don't have anything like the coherence of the near death experience. Finally people who have NDEs aren't typically on recreational drugs -- many aren't even on anesthetics, narcotics or painkillers.

Neuroscientist Michael Persinger claims he can simulate the NDE by placing a helmet on subjects and electrically stimulating parts of their brains. Persinger's helmet is a hit-or-miss device; atheist Richard Dawkins tried it, and it had no effect on him. Others have a spiritual feeling but not the particular features of the NDE. The bigger problem is that this is an artificially induced state. If I tell you that I am being blinded by the sun, you cannot prove this is a mental illusion by showing me that you can also blind me with a flashlight. NDEs not only occur with no external inducement; they also happen to people whose hearts and in some cases brains have stopped functioning altogether.

Perhaps the most plausible explanation for NDEs is given by psychologist Susan Blackmore, who seeks to account for them through her "dying brain hypothesis."

Blackmore suggests that when the brain breaks down, its mechanisms of pattern recognition continue to generate images. In other words, the brain attempts to reconstruct a memory model of reality that seems perfectly real, even though it does not reflect anything outside the brain itself.

The strength of Blackmore's theory is that it explains important features of the NDE. The tunnel is the result of constriction in the visual pathways. The lights are a kind of special effect generated by a brain cortex that is deprived of oxygen. A breakdown in body image and the brain's model of reality can account for the feeling of being outside one's body. The life review is a consequence of the brain's memory systems trying to organize themselves as they fail and falter. The same memory systems conjure up images of deceased relatives and friends. Finally, the impression of timelessness is fostered by a self that is disintegrating and relinquishing all experiential notions of time and place.

The only problem is that Blackmore offers no empirical evidence that dying brains actually generate all these experiences. It seems obvious that they don't, because if they did, then virtually everyone who is dying would have an NDE! Moreover, as those who have watched a loved one die can easily testify, dying brains tend to produce faded recollections, incoherence and disorientation. These symptoms are radically different from the perceptual clarity and bliss of the typical NDE.

If NDEs are the result of a dying brain, then a breakdown of mental faculties has already taken place, but in fact most people who report NDEs are now living normal lives. So how have their brains reversed the dissolution and gotten all their normal perceptual faculties back? This reversal defies medical explanation and Blackmore provides none.

The bottom line is that near death experiences have so far withstood all efforts at refutation. The critics continue to speculate -- it may be this and it may be that -- but on balance NDEs suggest that consciousness can and sometimes does survive the cessation of heart and even brain functions. True, NDEs don't tell us much about what the afterlife is really like. Nor do they indicate how long this postmortem awareness continues: "survival" is not the same thing as "immortality." Near death experiences do seem to show, however, that death is not always the end; there may be something more.

Dinesh D'Souza's new book Life After Death: The Evidence is published by Regnery.

License to Wonder

November 3, 2009, 9:30 pm New York Times
License to Wonder
By Olivia Judson

In the wake of my column last week about how the faces you make when speaking different languages might affect your mood, several people wrote and accused me of speculating. I admit it! Indeed, I said as much in the piece.

One of my favorite things to do is to take a set of facts and use them to imagine how the world might work. In writing about some of these ideas, my aim is not to be correct — how can I be, when the answer isn’t known? — but to be thought-provoking, to ask questions, to make people wonder.

I mention this because science is usually presented as a body of knowledge — facts to be memorized, equations to be solved, concepts to be understood, discoveries to be applauded. But this approach can give students two misleading impressions.

One is that science is about what we know. One colleague told me that when he was studying science at school, the relentless focus on the known gave him the impression that almost everything had already been discovered. But in fact, science — as the physicist Richard Feynman once wrote — creates an “expanding frontier of ignorance,” where most discoveries lead to more questions. (This frontier — this peering into the unknown — is what I especially like to write about.) Moreover, insofar as science is a body of knowledge, that body is provisional: much of what we thought we knew in the past has turned out to be incomplete, or plain wrong.

The second misconception that comes from this “facts, facts, facts” method of teaching science is the impression that scientific discovery progresses as an orderly, logical “creep”; that each new discovery points more or less unambiguously to the next. But in reality, while some scientific work does involve the plodding, brick-by-brick accumulation of evidence, much of it requires leaps of imagination and daring speculation. (This raises the interesting question of when speculation is more likely to generate productive lines of enquiry than deductive creep. I don’t know the answer — I’d have to speculate.)

There are plenty of (probably) apocryphal tales about what inspired a great discovery, from Archimedes in his bathtub, to Newton and his apple. But there are also many well-documented accounts of inspiration — or lack of it — in the history of science. Among the most famous is the story of Rosalind Franklin and her non-discovery of the structure of DNA.

Franklin was an expert at getting x-ray diagrams from crystals of molecules. The idea is that the array of spots in the diagram will reveal how the atoms in the crystal are arranged. When Franklin started working on DNA, she obtained superb x-ray diagrams; one of her contemporaries described them as among the most beautiful of any substance ever taken. Indeed, it was from one of her diagrams that James Watson and Francis Crick deduced what the correct structure of DNA must be. (The picture was shown to Watson without Franklin’s knowledge.)

She had the data. Why didn’t she reach the solution? There are several answers to this; but one is that she had a fixed idea about how the problem should be solved. Namely, she wanted to work out the structure using the methods she had been taught. These methods are intricate, abstract, and mathematical, and difficult to use on a molecule as complex as DNA. Watson and Crick, meanwhile, were building physical models of what the diagram suggested the structure should be like — an approach that Franklin scorned. What’s more, their first model was ludicrously wrong, something that Franklin spotted immediately. But they were willing to play; she wasn’t. In other words, she wouldn’t, or couldn’t, adopt a more intuitive, speculative approach.

Our ability to make scientific discoveries is limited in a number of fundamental ways. One is time: it’s hard to do good experiments that last for more than a few weeks. Experiments that run for years are rare; as a result, we know relatively little about long, slow processes. Another constraint is money (no surprise there); a third is ethics (some experiments that would be interesting to do are ethically impossible). Some questions remain uninvestigated because no one stands to profit from the answers. Still others are neglected because they have no obvious bearing on human health or welfare, the areas of research are unfashionable, or the appropriate tools haven’t been invented yet. Some problems are just overwhelmingly complex.

But there’s one way in which we should not be limited: imagination. As Einstein put it, “Imagination is more important than knowledge. Knowledge is limited. Imagination encircles the world.”

Happy Ending ???

November 2, 2009, 8:25 pm
Happy Ending
By Todd May

In the spring of 2004 I took a flight from my home near Greenville, S.C., to New York to visit my dying step-grandmother. We had been close, and it would be one of the last times I would get to see her. As the flight was about to land, it abruptly ascended and headed toward the Empire State Building. The passengers on the plane became quiet; the aura of 9/11 was hanging in the air.

We flew over the Empire State Building (but too close to the antenna for my comfort) and circled back to La Guardia. As it turned out, a small commuter plane had decided to land without taking account of our aircraft, so the pilot had had to make a quick move. But in those moments when it seemed I was aboard another human missile, I revisited my life. I realized, almost to my surprise, that I would not have traded it in for another life. There had been disappointments, to be sure, but my life appeared to me to have been a meaningful one, a life I did not regret. This is not to say that I was not nearly paralyzed with fear. I was. At the same time, strangely, my life appeared to me as worth having lived.

There are two lessons here. The first, and most obvious one, is that death is terrifying. Here in the United States, we have the technology to defer death, so we often pretend it will never really happen to us. There is always another procedure, always a cure in sight if not in hand. But in our sober moments we recognize that we will indeed die, and that we have precious little control over when it will happen.

The harm of death goes to the heart of who we are as human beings. We are, in essence, forward-looking creatures. We create our lives prospectively. We build relationships, careers, and projects that are not solely of the moment but that have a future in our vision of them. One of the reasons Eastern philosophies have developed techniques to train us to be in the moment is that that is not our natural state. We are pulled toward the future, and see the meaning of what we do now in its light.

Death extinguishes that light. And because we know that we will die, and yet we don’t know when, the darkness that is ultimately ahead of each of us is with us at every moment. There is, we might say, a tunnel at the end of this light. And since we are creatures of the future, the darkness of death offends us in our very being.

We may come to terms with it when we grow old, but unless our lives have become a burden to us coming to terms is the best we can hope for.

The second, less obvious lesson of this moment of facing death is that in order for our lives to have a shape, in order that they not become formless, we need to die.

This will strike some as counterintuitive, even a little ridiculous. But in order to recognize its truth, we should reflect a bit on what immortality might mean.

Immortality lasts a long time. It is not for nothing that in his story “The Immortal” Jorge Luis Borges pictures the immortal characters as unconcerned with their lives or their surroundings. Once you’ve followed your passion — playing the saxophone, loving men or women, traveling, writing poetry — for, say, 10,000, it will likely begin to lose its grip. There may be more to say or to do than anyone can ever accomplish. But each of us develops particular interests, engages in particular pursuits. When we have been at them long enough, we are likely to find ourselves just filling time. In the case of immortality, an inexhaustible period of time.

And when there is always time for everything, there is no urgency for anything. It may well be that life is not long enough. But it is equally true that a life without limits would lose the beauty of its moments. It would become boring, but more deeply it would become shapeless. Just one damn thing after another.

This is the paradox death imposes upon us: it grants us the possibility of a meaningful life even as it takes it away. It gives us the promise of each moment, even as it threatens to steal that moment, or at least reminds us that some time our moments will be gone. It allows each moment to insist upon itself, because there are only a limited number of them. And none of us knows how many.

I prefer to think that the paradox of death is the source not of despair but instead of the limited hope that is allotted to us as human beings. We cannot live forever, to be sure, but neither would we want to. We ought not to mind the fact that we will die, although we really would rather that it not be today. Probably not tomorrow either. But it is precisely because we cannot control when we will die, and know only that we will, that we can look upon our lives with the seriousness they merit.

Death takes away from us no more than it has conferred: lives whose significance lies in the fact they are not always with us.

Our happiness lies in being able to inhabit that fact.