Thursday, November 10, 2011

Can you, or your loved ones, answer these questions?

Caregivers understand that we treat all patients with respect, whether awake, experiencing dementia, aphasic or in coma. Unfortunately, with the furor around right to die, and end-of-life issues, there are those who may want proof that a patient's brain is still functioning.
That said, the prefrontal cortex, which controls higher level brain function, thinking, cognitive functioning, can go awry, yet the lower, older part of the brain functions well.

The reptilian, mammal brain controls respiration, and normal bodily functions. This is why someone, with dementia in the prefrontal cortex, still manages to breathe, digest food, and maintain the body.

People of my generation, or those I have spoken to, have had loved ones on respirators. After a stroke, or other health issues, the respirator continues to allow the body to get oxygen if damage is temporary in that part of the brain. In the news have been many times when family members argue over the 'pulling of the plug.' With this tool, the family can ensure that the cognitive brain is functioning, when communication is impossible, and external measures are being used to keep a loved one alive.

I struggle with this notion. If I am so frail that I cannot breathe on my own, my body is failing, and communication had ceased with family and friends, what is the measure of my life? If I cannot eat, or function at any level of independence, where is my quality of life?

FOr many of the seniors for whom I provide hospice care, they are anxious for the end to come. Restricted to a bed, with bed sores, unable to eat on their own, wearing adult incontinence products. Fighting for breath. Bed sores. Their friends have passed over; their generation, their friends have gone, many wish for the end to come.
This new research provokes more research in the area of ethics, end-of-life, and quality of life. For those with predictable illnesses, they must have these conversations with their family members before the end is nigh.

From the University of Western Ontario: The Brain and Mind Institute
A conclusive study, with a user-friendly version of the fMRI. Functional Magnetic Imaging is a fabulous means by which we can see that goes on in the brain.
During my 25 years teaching we learned so much more about the workings of the brain.
Unfortunately, the fMRI machine is non-portable, and patients had to be taken to the machine.
This device, and we hope it will be even more succinct in future iterations, can be taken to the patient.

The study is the latest report from the lab of Adrian M. Owen, a Canada Excellence Research Chair in Cognitive Neuroscience and Imaging at the University of Western Ontario. Owen, is a pioneer in cognitive neuroscience. He was recruited to Canada in 2010 from the UK.

Here is Dr. Owen himself, with some interesting graphics and images.

The research is described in a paper published online Wednesday in the medical journal The Lancet.

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