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BABY , IT ' S COLD OUTSIDE
Mary G . Barry , MD
Louisville Medicine Editor editor @ glms . org
I
’ ve been reading about brain plasticity , and how to preserve it . According to researchers at Mass General and Northeastern University , as described by Dr . Lisa Feldman Barrett in the New Year ’ s Eve New York Times , this requires “ the yuck factor .” Dr . Barrett , the Distinguished Professor of Psychology at Northeastern and author of a forthcoming book about emotions and the brain , quoted the U . S . Marine motto , “ Pain is weakness leaving the body .”
In her article about “ Superagers ,” she reported that the most brilliant and liveliest 88-year-olds have been lifelong fitness buffs who don ’ t just stroll , but regularly exert near-maximum effort in exercise , both mental and physical . Functional MR imaging showed that crucial regions of their brains were indistinguishable from those of young adults . These regions in the brain cortex that she called “ hub regions ” were thicker than in those of similar age who had lost mental and physical capacity : the thicker that cortex , the better the person performed on tests of memory and attention . Those with thinner , more atrophied cortical regions did worse .
How to get “ thick in the head ?” Dr . Barrett said , work hard at something . “ Many labs have observed that these critical brain regions show increased activity when we perform difficult tasks , whether the effort is physical or mental .” However , when activity in these parts of the cortex increases , people also report that “ they feel bad in the moment .” The old adage , “ No pain no gain ,” applies fully here ; to keep our brains smart and supple we have to push hard , to work at something till it hurts , till we are used up , till we are worn out . No lollygaggers need apply .
She pointed out that this does not mean just doing the Sunday crossword puzzle . She means doing something intellectually challenging , regularly , with more intensive exercise like interval training , not strolling around the block with the dog . I ’ ve also been reading Seveneves , by Neal Stephenson , who has written many long and highly imaginative science fiction / techie novels ( vacation over , so I still haven ’ t finished it ). This one actually qualifies for the Barrett Yuck Factor intellectual division , since the author indulges in long aerospace engineering treatises on orbital mechanics , asteroid mining and unimaginable interplanetary distances . Later , he explores genetics and epigenetics in great detail , and I cannot but wonder what I will have to comprehend and absorb during the last third of the book .
His space travelers who die are kept on the ISS in the deep freezer ; reading this while at 38,000 feet over the North Atlantic , where the outside temperature is -50 C , definitely induces severe internal shivering . Yet , freezing each other on purpose to save a life – and a brain – is something humans do every day . Ever since the groundbreaking research in
Toronto from Dr . W . G . “ Bill ” Bigelow et al , beginning in 1946 ( he points out that he was inspired by an episode of frostbite ), we have cooled the human heart for open heart surgery . We have done enough studies on cooling the whole person after cardiac arrest to recommend it strongly , even for out of hospital cardiac arrest , spurred by stories of miraculous survival when children are pulled from frozen ponds and awaken mentally intact over the next 24 hours . In the Jan . 2016 issue of Resuscitation , Dr . Daniel Howes and multiple other authors reported on the Canadian guidelines for the use of targeted temperature management ( TTM ) also known as therapeutic hypothermia . This was the report of a large working group that issued a joint statement from the Canadian Critical Care society , the Canadian Neurocritical Care Society and the Canadian Critical Care Trials Group .
They reviewed all available evidence , reviewing some original research and all articles since 2002 , relating to the preservation of brain and bodily function by intentional immediate freezing of the patient . They then issued recommendations for the safe and effective use of TTM . The strongest recommendations rested on what we Americans call " Level A evidence ." Any evidence they felt not quite so worthy was given a suggestion for treatment as opposed
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