The sensitive topic of brain donation

Brain donor program coordinator Lauren Bartley says while it can be difficult to talk to people about brain donation, it’s for a very important cause.

When I first began recruiting to the brain donor program at NeuRA and the Sydney Brain Bank, I found it difficult to broach such a sensitive topic with the participant and their family members. After all, how do you ask someone you have met just briefly if you can have access to their brain tissue after they pass away?

This is a discussion I’ve had to have with all our research participants – and one that I no longer shy away from. I know that every brain is valuable and have seen firsthand that every donation brings us closer to understanding more about dementia.

Sometimes there can be confusion over whether the tissue we collect will be transplanted into another human (which it’s not); other times, I’ve found that participants think their brains won’t be useful because of their cognitive impairments.

Lauren Bartley is a brain donor program coordinator at NeuRA.

It’s actually brain tissue from people with these very impairments that is helping scientists at NeuRA understand why proteins that cause dementia begin to deposit in some people’s brains and not others, and how this occurs.

In some cases, it’s difficult for a neurologist to determine if the patient is suffering from early onset Alzheimer’s disease (AD) or frontotemporal dementia (FTD). While clinically these dementia syndromes can appear similar, the brain tissue pathology is quite different. Looking at brain tissue has been essential for understanding the differences in pathology between AD and FTD.

Thanks to people who have donated their brain tissue in the past, we now know that the brain tissue of people with Alzheimer’s disease is marked with plaques formed by the beta-amyloid protein and tangled accumulations of the tau protein.

The tau protein also accumulates in frontotemporal dementia, depositing not in tangles but as inclusions inside brain cells called Pick bodies (FTD is also known as Pick’s disease). Some people with FTD also have pathological inclusions of other proteins such as TDP-43 or FUS.

“This is at the heart of what’s driving our research: we need to come up with new ways of accurately diagnosing dementia while a person is still living.”

Because of the heterogeneity of pathology in FTD, it’s impossible to predict which protein is responsible for the illness with the clinical tools we currently have at our disposal.

I can recall many times when participants were only found to have evidence of motor neurone disease (in addition to their dementia) during the autopsy process. There have been instances where we found participants who had been diagnosed with FTD actually had Alzheimer’s disease pathology and vice versa.

If we had known the true cause of their illness during life, they may have been able to access therapies or medicine to reduce the impact of their symptoms. This will become increasingly important as new therapies for dementia syndromes become available.

This is at the heart of what’s driving our research: we need to come up with new ways of accurately diagnosing dementia while a person is still living.

Helping us improve diagnosis during life is one of the reasons why brain donation is invaluable, and it’s why I’d like to thank each and every brain donor who I’ve had the privilege of working with at NeuRA.

 

More information about brain donation

While I am not able to accept brain donations from the general public, we do accept brain donations for AD and FTD research from people who have participated in research at our clinic. There are also circumstances where people who we have not seen in our clinic but have had a diagnosis from a neurologist/geriatrician and previous brain imaging (preferably MRI) can also be enrolled.

After the Sydney Brain Bank at NeuRA has finalised the report identifying the protein that caused the dementia, I send this report to the families and clinicians. The tissue donation is then used in ethically approved projects performed by medical researchers across Australia and the world.

If you are interested in finding out more about brain donation for medical research into AD and FTD, please contact me at frontierbiomarkers@neura.edu.au

Books For Brains

The NeuRA Foundation is looking to raise funds to support brain research via ‘Books for Brains’, which kicks off in October.

Sometimes an idea just ‘feels right’, and so it was when we conceived the idea for NeuRA’s Books for Brains event.

From the outset, it was clear to us that people who enjoy reading intuitively know that reading is good for their brains. And so the idea that people in book clubs would take a lively interest in the frontiers of knowledge about the brain, and how it works, was not a stretch.

Books for Brains is a NeuRA initiative calling on book clubs around Australia to put their heads together in the month of October and read a book with a focus on the brain and mind.

NeuRA’s Judy Dixon

The concept has received praise from a number of bestselling authors.

Norman Doidge, author of this year’s featured book, The Brain that Changes Itself, says:

“At this moment, while Australian neuroscience researchers are ‘punching well above their weight’ and making huge breakthroughs, so many Australians display an open-minded wonder about the brain. That’s why NeuRA’s initiative, Books for Brains, is such a wonderful idea. What could be more enlivening than digesting the meaning of new findings, which can so illuminate our lives, by getting together and discussing them within your book club – with the helpful, up-to-date comments on offer through Books for Brains from leading Australian researchers at NeuRA.

Ruby Wax, comedian and author of 2013’s bestseller, Sane New World, a story about what is it like to live with depression, says:

“The problem is in us; in our brains. The conflict is within ourselves. It’s those voices battering us and we project it out on the world. Inside our heads there is always war. I totally support NeuRA’s Books for Brains – unless we learn what’s in our heads, we will never resolve our own issues and the world’s.”

Peter FitzSimons, much-loved Australian author and social commentator, says:

 “Books for Brains is a wonderful initiative to raise awareness about an issue growing in importance with every passing year. Once, while playing rugby in France, I was so badly eye-gouged I actually saw my own brain, and was satisfied it was big. But as time has gone on, I have become aware that none of us can take brain health for granted, and I fully support all efforts to make Australians aware of that very fact.”

Through NeuRA’s Books for Brains, we hope to encourage your book club to think about the importance of brain research. We want to encourage you to discuss one of our suggested books and hope that you find it stimulating, uplifting, funny or even moving.

To register and access this year’s book list, visit us here.

Brain Injury Awareness Week

This week is Brain Injury Awareness Week. More than 500,000 Australians have an acquired brain injury, so what can we do reduce the numbers? In this blog post, NeuRA’s Professor Lynne Bilston explains that prevention is key in cutting the numbers of those affected each year.

Lynne Bilston

Traumatic brain injury occurs when an impact to the head causes damage to the brain tissue. It’s very common – about 2500 serious brain injuries occur each year in Australia, and many more that are less serious. Even apparently minor injuries often have ongoing effects on people’s lives, and repeated minor trauma can predispose people to dementia later in life. Brain injury has enormous social and financial costs, profoundly affecting the lives of not only those with the brain injury but also their families. The lifetime cost of looking after people who acquire a brain injury in Australia in a typical year is estimated to be approximately $8.6 billion[i], much of that cost falls on individuals and families, not just on our health system.

So what can we do?

Improvements in emergency care after trauma have helped more people survive, but there are no drug treatments that make significant differences in function once a traumatic brain injury happens. Rehabilitation is a long and arduous road, with often only small improvements resulting.

Prevention of traumatic brain injury is therefore paramount.

To prevent brain injuries, we must understand how they happen and from there,  design effective prevention strategies, whether these are engineering design solutions such as improvements to car safety features and restraints, public education programs, or clearer regulations. These methods all help.

Research done together with my colleague Dr Julie Brown into injuries in car crashes – the leading cause of brain injury, details how these injuries are sustained in crashes, and what  factors contribute to brain injury. In children, we have shown that the most serious injuries can be prevented entirely if children are correctly strapped into the right type of child restraint for their size. This apparently simple approach works because the right restraint used properly stops the child’s head from hitting hard objects in a crash. If there’s no head impact, then the head can come to a stop relatively slowly. This minimises the acceleration forces on the head and prevents the brain from ‘sloshing around’ inside the skull, which in turn, dramatically reduces the risk of serious head injury.

Our research has led to new national child restraint laws, which require children to use the right type of car seat for their age. But our research shows that the laws alone are not enough. We must also help parents use the restraints correctly, otherwise they won’t work properly.

We have shown that better restraint labels make it easier for parents to choose the right restraint for their child’s size. Getting restraints checked by a professional can also reduce mistakes in how they are used. We’ve shown that education programs in preschools can help kids understand how to use restraints correctly.

The fact is, preventing brain injury is not only possible but vital, and needs the ongoing cooperation of neuroscientists, engineers, public health experts, teachers, and governments.

Welcome to the new Margarete Ainsworth Building

After many months of construction, not to mention anticipation, we have officially opened the new Margarete Ainsworth Building at NeuRA (Neuroscience Research Australia).

Jillian Skinner MP (left) and Tanya Plibersek MP (right) congratulate philanthropist Margarete Ainsworth (centre) on the opening of the Margarete Ainsworth Building at NeuRA

We were lucky enough to host Federal Minister for Health and Minister for Medical Research, Tanya Plibersek MP and NSW State Minister for Health and Minister for Medical Research, Jillian Skinner MP, as well as philanthropist Margarete Ainsworth.

As NeuRA chairman Paul Brassil said in his speech, Margarete Ainsworth has been exceptionally generous to NeuRA and “we thank her most sincerely for her trust and confidence in NeuRA’s research capacity”.

The official opening of the Margarete Ainsworth Building at NeuRA

Lucille Bloch, whose husband Keith had frontotemporal dementia and was a research participant at NeuRA, reminded us in her speech what this new building is all about: the power of research to find answers to devastating diseases of the brain. I’ve pasted a copy of Lucille’s speech below for those who couldn’t make it to our opening.

Here’s to a new era of discoveries at NeuRA.

Lucille Bloch, a carer and research participant at NeuRA, participates in a demonstration of using illusion to relieve pain.

Lucille Bloch’s speech

My husband Keith was always an easy person. We had a very good relationship; we shared everything, we respected each other.

In the year 2000, we decided to pack up our life in Israel and move to Australia to be with our three sons. It was around this time that I noticed changes in Keith’s behaviour.

What stood out for me was his inability to pack up his beloved hobby workshop before emigration. Eventually I had to do it myself. I’d never held a spanner in my life, and here I was dismantling everything, with Keith just watching. This was totally out of character for him.

I said to myself, why is Keith so different? And as I said ‘different’, I stopped. I felt very concerned, because I remembered what my father, a GP, had said about my mother when he suspected she had Alzheimer’s disease; that her behaviour was different somehow to what it had always been.

Shortly afterwards, I spoke to our GP, but he brushed aside my concerns. The next three years were heartbreaking and very difficult as I watched Keith behave in ways that were so out of character for the man I knew. Finally, a neurologist sent him for tests and gave us a diagnosis: Keith had frontotemporal dementia.

There is this over-riding grief when the person you love has dementia. You can only stand by watching as the person you love loses skills and abilities, one by one.

When we first arrived in Australia, Keith still loved to tinker in his workshop, but it became evident quite quickly that it was becoming dangerous. He had lost physical coordination and the ability to forward plan, so there was no more sawing, no more using his electric tools.

I had to just follow Keith’s deterioration, trying to accommodate it. Initially I would lay out his clothes for him in the morning. When he could no longer easily manage, I thought of ways of folding and tying his clothes to help him dress himself for just that little bit longer.

Keith’s deterioration was rapid. He had many falls. I managed most times to pick him up, but about a year after diagnosis, he needed a wheelchair. I was determined to care for Keith at home. It was difficult, but somehow if you want to, you do it.

He attended day centres, I took him to the Art Gallery, out for coffee and had our children and grandchildren share meals with us. After dinner I changed and settled Keith using a hoist to lift and move him.

He never lost his memory or his ability to feel and understand emotions. At the day centre, Keith would write cards to me. They were mostly illegible, but the staff asked him what he had written and told me.

I have one of the cards here with me today, and it says: “Dear Lucille, thank you for being the Mother of my children. Love, Your Husband”.

As you can see, he may have lost many things, but he was still the same loving husband.

During this time, I attended a presentation by Professor John Hodges from Neuroscience Research Australia about the need for brain donation and the great value it has for research. The idea grabbed me.

I went home that night and discussed it with Keith, suggesting we could both donate our brains. Keith agreed immediately. He said, ‘We’ve got four children, your mother had it, now I’ve got it. Let’s do it and let’s help other people.’ We discussed it with our children, they agreed, and thus our bond with NeuRA began.

I brought Keith regularly to NeuRA for cognitive tests and MRI scans. At all times, Keith was treated with dignity and respect. I too have been attending this amazing research institute for regular tests.

When I felt that he was going, I gathered all my four children. Even two of the grandchildren were there, aged just nine and six. The grandchildren always knew that gramps had dementia; we didn’t want to hide anything.

That last night, we put him to bed and I sat beside him and said, let’s talk about our life, and you squeeze my hand if you remember. So we’d talk about where we had lived, our children, and he kept squeezing my hand.

Keith passed away at home, with me at his bedside holding his hand. We called the Sydney Brain Bank and, with great dignity and sensitivity, they took my Keith and arranged for his brain donation without any disruption to the funeral plans.

Afterwards, Professor Hodges and his team told me that Keith had suffered from both frontotemporal dementia and also, unexpectedly, from Alzheimer’s disease. It is rare for these two diseases to occur together, and they said they would learn a tremendous amount from studying his case.

My dream was to have Keith’s dementia reversed. Realistically, however, both Keith and I would be well rewarded if participation in research here at NeuRA, together with our brain donations, advances knowledge about this horrible disease.

My vision for the future is a world where there is a cure for dementia in all its forms or at least medication that will arrest it.

I want those people who will unfortunately follow my husband Keith down the same path of dementia to have hope.

Thank you.

Could immunological mechanisms trigger neurodegeneration in frontotemporal dementia?

Dr James Burrell researches frontotemporal dementia. One of the symptoms of this type of dementia is forgetting language and words, which can be tested by asking a volunteer to name toy animals.

Frontotemporal dementia (FTD)  is the second most common degenerative disease causing dementia in younger adults, with onset typically occurring in the 50s or 60s. In FTD, damage to brain cells begins in the frontal and/or temporal lobes of the brain, which often results in personality and behavioural changes or losing the ability to speak or understand language.

When conveying a new diagnosis of frontotemporal dementia the clinician almost invariably encounters the following questions “Why has this happened?” “Is there any treatment?” and “Will our children get it?”.

Recent discoveries of genetic causes in familial FTD have given us a much firmer handle on the last question, and have undoubtedly shed light on the cellular processes leading to the death of brain cells in people with familial FTD. Nonetheless, we still know little about causation in non-familial FTD, which accounts for around 90% of cases. Without a clear understanding of these processes it is hard to visualise the development of an effective treatment for this devastating disease.

One potential avenue of exploration is the role of inflammation and the immune system.(2) Recently, Miller et al (3) reported the prevalence of autoimmune disease in two FTD subtypes in which the underlying pathology is quite predictable. The authors reviewed cases files seeking evidence of autoimmune diseases in these two FTD subtypes. A history of non-thyroid autoimmune disease was roughly 3-4 times more common in the FTD disease groups compared to controls or patients with Alzheimer’s disease. A second aspect of the study involved the measurement of an inflammatory marker in the blood, which was found to be elevated in both groups compared to controls, reinforcing the apparent association of neurodegeneration and immune disease. A wide variety of non-thyroid autoimmune diseases contributed to the elevated prevalence in the two groups. Why were only non-thyroid autoimmune diseases more common in the FTD subtypes? The answer may be found in examining so-called “clusters” of autoimmune disease, which may partly represent the expression of certain genetic factors.(4)

The study offers a tantalising clue but much remains to be understood. Is this apparent increase in autoimmune disease only true for one of the pathological processes that underlie FTD? If so, could measuring inflammatory blood markers help identify individuals with that pathology in other FTD subtypes, where the pathology is more varied? What is main determinant in non-familial disease: autoimmunity or systemic inflammation more generally? What is the relationship between FTD pathology and autoimmunity: which is the chicken and which the egg? Could immune modulation offer a route to disease modification? We hope that this important paper opens the way to a more complete understanding of the processes underlying neurodegeneration in FTD and the development of new therapies, which are needed desperately to halt the progression of this dreadful disease.

“Sundowner”…play explores the relationships of memory and of family.

I attended the opening of “Sundowner” at Parramatta Riverside Theatre last night. Directed by Kate Denborough and starring Helen Morse, its the story of a writer in her late 50s who has young onset dementia. A strong and compelling performance with moments of raw emotion and of tender poignance, the play explores the relationships of memory and of family. What was unexpected for me, and particularly impressive, was the use of modern dance and its choreography brought by KAGE. It brought a whole new dimension to the exploration of issues of memory and dementia.
Commencing a national tour with performances in many towns in all states (details at http://www.kage.com.au/project/sundowner/book-tickets1 ) I highly recommend this.

Credit or savings?

When I tell people I manage a Brain Bank they usually look quizzical and joke about making deposits and withdrawals. The reality is, they’re not so far from the truth. People make the decision to donate their brain for medical research every day and when they do, a Brain Bank is where their brain goes. Continue reading