The Wisdom Paradox Read online

  Table of Contents

  Title Page

  Copyright Page

  Dedication

  Epigraph

  Introduction

  Chapter 1 - THE LIFE OF YOUR BRAIN

  Chapter 2 - SEASONS OF THE BRAIN

  Chapter 3 - AGING AND POWERFUL MINDS IN HISTORY

  Chapter 4 - WISDOM THROUGHOUT CIVILIZATIONS

  Chapter 5 - PATTERN POWER

  Chapter 6 - ADVENTURES ON MEMORY LANE

  Chapter 7 - MEMORIES THAT DO NOT FADE

  Chapter 8 - MEMORIES, PATTERNS, AND THE MACHINERY OF WISDOM

  Chapter 9 - “UP-FRONT” DECISION-MAKING

  Chapter 10 - NOVELTY, ROUTINES, AND TWO SIDES OF THE BRAIN

  Chapter 11 - BRAIN DUALITY IN ACTION

  Chapter 12 - MAGELLAN ON PROZAC

  Chapter 13 - THE DOG DAYS OF SUMMER

  Chapter 14 - USE YOUR BRAIN AND GET MORE OF IT

  Chapter 15 - PATTERN BOOSTERS

  EPILOGUE

  Acknowledgements

  CHAPTER NOTES

  INDEX

  Praise for The Wisdom Paradox

  “This is an optimistic book. . . . There is even some evidence that a positive mental attitude can help ward off cognitive decline, in which case it might be worth reading the book for its cognitive-enhancement properties alone.”—Laura Spinney, New Scientist (UK)

  “[Goldberg] has found that our intuitive powers grow stronger with every passing year. . . . There is now hope that we can be as mentally alert—if not more so—in our twilight years than we have ever been.”—Jessica Kiddle, The Scotsman (UK)

  “I am now spoiled; I need more essays by opinionated, original, and intellectual contemporary scientists.”

  —Nassim Nicholas Taleb, author of Fooled by Randomness

  “A book of wise reflections on the gains, not the losses, that come to the older human mind. Here is a valuable addition to the literature on aging.”

  —Antonio Damasio, author of Descartes’ Error, The Feeling of What Happens, and Looking for Spinoza

  “A refreshing reprieve from the onslaught of negatives about the aging process. It is both scholarly and a pleasure to read, filled with a multitude of cogent observations on how a host of human endeavors benefit from aging, often in the face of degenerative disease. It is destined to inspire more of our aging population to strive for greatness.”

  —Georg Deutsch, coauthor of Left Brain, Right Brain

  “Goldberg has done a marvelous job in distinguishing between disease and cognitive decline that occurs in normal aging. It is a must-read for people who are interested in preserving and improving their brains.”—Horace Deets, former executive director of AARP

  “The Wisdom Paradox is a delight to read, a splendid review of modern neuroscience. The book is erudite, challenging, and above all, hopeful. I recommend it to all who are interested in keeping their wits about them.”

  —Allan Mirsky, chief, section on clinical and experimental neuropsychology, National Institute of Mental Health

  Elkhonon Goldberg is the author of The Executive Brain and a clinical professor of neurology at New York University School of Medicine. He divides his time between private practice in neuropsychology, research in cognitive neuroscience, and teaching. He lives in New York City.

  ALSO BY ELKHONON GOLDBERG

  The Executive Brain: Frontal Lobes and the Civilized Mind

  GOTHAM BOOKS

  Published by Penguin Group (USA) Inc.

  375 Hudson Street, New York, New York 10014, U.S.A.

  Penguin Group (Canada), 90 Eglinton Avenue East, Suite 700, Toronto, Ontario, Canada M4P 2Y3 (a division of Pearson Penguin Canada Inc.); Penguin Books Ltd, 80 Strand, London WC2R 0RL, England; Penguin Ireland, 25 St Stephen’s Green, Dublin 2, Ireland (a division of Penguin Books Ltd); Penguin Group (Australia), 250 Camberwell Road, Camberwell, Victoria 3124,Australia (a division of Pearson Australia Group Pty Ltd); Penguin Books India Pvt Ltd, 11 Community Centre, Panchsheel Park, New Delhi - 110 017, India; Penguin Group (NZ), Cnr Airborne and Rosedale Roads, Albany, Auckland, New Zealand (a division of Pearson New Zealand Ltd); Penguin Books (South Africa) (Pty) Ltd, 24 Sturdee Avenue, Rosebank, Johannesburg 2196, South Africa

  Penguin Books Ltd, Registered Offices: 80 Strand, London WC2R 0RL, England

  First trade paperback printing, February 2006

  Copyright © 2005 by Elkhonon Goldberg

  All rights reserved

  Gotham Books and the skyscraper logo are trademarks of Penguin Group (USA) Inc.

  Goldberg, Elkhonon.

  The widsom paradox :how your mind can grow stronger

  as your brain grows older / Elkhonon Goldberg.

  p. cm.

  eISBN : 978-1-592-40187-1

  1. Brain—Aging. 2. Neuropsychology. 3. Cognitive neuroscience. I. Title.

  QP356.25.G64 2005

  612.8’2—dc22 2004060695

  Without limiting the rights under copyright reserved above, no part of this publication may be reproduced, stored in or introduced into a retrieval system, or transmitted, in any form, or by any means (electronic, mechanical, photocopying, recording, or otherwise), without the prior written permission of both the copyright owner and the above publisher of this book.

  The scanning, uploading, and distribution of this book via the Internet or via any other means without the permission of the publisher is illegal and punishable by law. Please purchase only authorized electronic editions, and do not participate in or encourage electronic piracy of copyrighted materials. Your support of the author’s rights is appreciated.

  http://us.penguingroup.com

  TO MY FELLOW BABY BOOMERS—

  THE HEADSTRONG GENERATION

  “WISDOM BEGINS IN WONDER.”

  —SOCRATES

  INTRODUCTION

  Ruminations of a Baby Boomer Neuroscientist

  Like Tolstoy’s unhappy families in Anna Karenina, the midlife crisis takes many forms. I first knew that mine was encroaching when halfway through my sixth decade, I began to search for a cathartic experience. An odd sense of temporal symmetry set in. For the first time in my life the past seemed as important as the future, and I felt an urge to examine this more deeply. I felt a sudden need to take stock of my life and to connect its pieces, disjointed by circumstance. For the first time in twenty-six years I visited the country of my birth to seek out old friends with whom I had had no contact in half a lifetime. And I wrote a book, an intellectual memoir of sorts, trying to place my past, my present, and my premonition of the future into a single coherent perspective.

  For reasons existential more than immediate or practical, I also decided to take stock of the physical damage wrought by time. After many years of blatant self-neglect, I had a long overdue comprehensive physical exam. I was delighted to discover that by all objective medical criteria I was in good health, biologically younger than my chronological age. This pleased me but did not particularly surprise me, since I felt fine and my energy level had been undiminished with age.

  With considerable trepidation, I also decided to have an MRI of my brain, a magnetic resonance imaging procedure to visualize the structures inside my aging skull. I had no indication that my mind was beginning to fail me. Quite the contrary, I had good reasons to believe that my cognition was fine: I had just published a reasonably successful book. I was lecturing worldwide and continued to get away with tackling arcane technical matters before demanding audiences without notes. At any given time, I was engaged in a number of parallel activities, usually without dropping the ball. My mental life was rich and full. My private practice in neuropsychology was booming and my career flourishing. And I took occasional mischievous pleasure in teasing my much younger assista
nts and graduate students that I had more physical stamina and mental focus than they did.

  At the same time, I knew that I carried certain genetic baggage. There was no known history of dementia on either side of my family, but my mother had died of a stroke, albeit at the enviable age of ninety-five, and her younger brother, while basically of sound mind, had suffered from a relatively advanced brain vessel condition known as multiinfarct disease. I knew this because I had been the one who diagnosed his condition by reviewing the MRI of his brain.

  More to the point, for many years my lifestyle had followed a rather unhealthy pattern. I grew up in Russia (the former Soviet Union, to be precise) and came to the United States at the age of twenty-seven. Having rejected my old country’s political system, I continued to embrace many aspects of its self-destructive lifestyle. I chain-smoked from my teens until my early forties, when I kicked the habit finally and irreversibly, and for years I drank considerably more than is common among the middle-aged Jewish intellectuals on this side of the Atlantic. In short, I had plenty of neurotoxins in my background to answer for.

  As a cognitive neuroscientist, I am used to regarding the brain dispassionately and abstractly in the laboratory. As a clinical neuropsychologist, I am trained to be exquisitely perceptive about the minute manifestations of brain dysfunction and brain damage—that is, other people’s brain damage. The flip side of having the MRI was that I would be wrenchingly aware of any potential consequences of the condition of my own brain, and the prospect of gaining this knowledge scared me.

  The paradox was not unique to me. In occasional conversations with more than a few friends—world-renowned neuroscientists, neurologists, and psychiatrists among them—they have all said that their curiosity about the condition of their own bodies stopped at the level of the neck. What was in their heads, they simply did not care to know. This agnostic disclaimer was invariably accompanied by a neurotic chuckle, and I could understand why.

  But for me, uncertainty is usually a source of anxiety, while clarity, whatever its content, has always had a mobilizing effect. Among the assorted and often unflattering zoological appellations used by my friends and foes alike to capture my central personality traits, ostrich has never been invoked. I have always prided myself of being a reasonably courageous, head-on type, and now my head was about to be inserted into the brain scanner’s magnetic coil. My neurosurgeon friend Jim Hughes, whom I asked for an MRI referral, first ridiculed the idea and tried to talk me out of it.

  “What if we find a benign tumor?” Jim kept saying. “Your life will be ruined by torment!” He brought up the case of Harvey Cushing, arguably the father of American neurosurgery, who himself had a benign brain tumor.

  To that I fatuously replied that surely I had enough character and inner strength to deal with any such findings rationally, and that, anyway, knowledge was better than ignorance.

  “In that case, my life will be ruined by torment if we find something bad in your brain,” Jim said in exasperation.

  After some argument, we resolved that having Jim’s life ruined by torment was an acceptable price to pay for satisfying my morbid curiosity, and Jim acquiesced.

  As a clinical neuropsychologist and a cognitive neuroscientist, I have been studying the effects of various forms of brain damage on the human mind for thirty-five years, and I have seen and analyzed hundreds of CT and MRI brain scans. For the first time, however, I was about to see the images of my own brain. I knew better than most people how devastating even mild brain damage could be for the mind, and for the soul as well. But in the final analysis I meant every word that I had said to Jim. I believed that I could deal with any news, including bad news, and that knowledge was preferable to ignorance under any circumstances. So on a sunny April day, I walked into the offices of Columbus Circle MRI in midtown Manhattan.

  The report and the films (not usually released to patients but released to me as a colleague) arrived a few days later. What I saw did not look terrible, but it did not particularly please me either. My cortical sulci (the walnut-shaped convolutions on the surface of the brain) and ventricles (spaces inside the brain containing the cerebrospinal fluid that bathes the brain) were declared by the radiologist to be “normal in size.” By my own reckoning, the sulci unequivocally were, but the ventricles looked large to me even allowing for the expected, normal dilation (the technical term for enlargement) with age. This suggested some brain atrophy.

  Furthermore, two tiny areas of increased signal intensity in the white matter (long nerve pathways connecting distant parts of the brain and encased in white fatty tissue called myelin) of the left hemisphere were noted in the report. I could see them also. The meaning of such findings is uncertain. In my case, they most likely reflected ischemic changes, regional death of brain tissue due to poor oxygen supply. They could also mean the loss of myelin in certain areas—probably a less likely explanation. By my own definition of the term, I had mild brain damage.

  The news was not all bad. “Normal flow voids” were present in my internal carotid and basilar arteries, and diffusion images were unremarkable. This meant that my major arteries were clean as a whistle, not occluded, not cluttered with fatty debris, and that my blood vessels were strong. This was consistent with a normal ultrasound Doppler test of my carotid arteries, which I had had as part of my physical a few months earlier. Taken together with my somewhat high but generally normal blood pressure, these findings made the possibility of a sudden, major, catastrophic stroke or aneurysm rupture mercifully remote. The hippocampi (seahorse-shaped brain structures known to be important for memory) appeared normal in size—definitely a good thing, since hippocampal atrophy is a common harbinger of Alzheimer’s disease.

  To lay my apprehensions to rest, I paid a visit to one of New York’s top neurologists, Dr. John Caronna at the famed New York Presbyterian Hospital (where many years ago, barely off the immigrants’ boat, I held my first faculty position in the United States). Dr. Caronna, a genial and gregarious man, examined me carefully, looked at my scans, and showed them to a colleague, the head of neuroradiology at the Cornell University’s Weil Medical School. They both concluded that everything was normal for my age, including the two “punctate” (a fancy way of saying “tiny”) areas of ischemia.

  “It’s just a well-used brain, that’s all,” said Caronna with his characteristically endearing sense of humor.

  Having seen hundreds of scans myself, however, I still felt that my ventricles were larger than those of many other people my age and that the tiny ischemic lesions apparent on my scan were not a sine qua non of aging. To resolve the issue, I showed the scans to an old friend, Dr. Sanford Antin. Sandy is among the most experienced neuroradiologists in New York, and I had collaborated with him in the past on some of the most formative projects of my scientific career.

  Sandy looked at the MRI scans, immediately dismissing one of the two punctate lesions as an artifact, confidently and at length explaining to me how such artifacts happen. He then declared the other punctate lesion “insignificant,” pronounced the sulci and gyri (tiny canyons between the sulci) “normal for any age,” and complimented me on my “beautiful brain.”

  So, I was finally relieved of my personal apprehensions. In retrospect, I found my brain-scanning exercise interesting in two respects: both neurological and neurotic. Neurologically and neuropsychologically speaking, an argument can be made that what I did should become part of a routine physical checkup for people past a certain age, maybe not every year but perhaps every three to five years. We all recognize the utility of prophylactic tests, as well as the fact that our vulnerability to a whole range of afflictions increases with age. Hence the universal acceptance, in fact promotion by the medical establishment, of colonoscopy as a means of combating colon cancer, breast and prostate cancer tests, and so on. But the brain has been traditionally exempt from this prophylactic scrutiny, as if the brain was not of the body. This seems highly illogical, since the incidence of dementia in
the aging population rivals, and often exceeds, the incidence of many other afflictions.

  The Mind, the Brain, and the Body

  Such an illogical and unfortunate state of affairs is probably predicated on two tacit assumptions, one coming from the general public and the other from health professionals. Until recently, the mind was not regarded by most people as part of one’s biological being, subject to medical and quasimedical scrutiny. This, of course, is a misconception, an enduring legacy of Cartesian mind-body dualism. Today the general educated public is increasingly at home with the understanding that the mind is of the brain, and thus of the body. This will be one of the major themes of this book.

  In the eyes of health professionals, the utility of an early diagnosis of the potentially dementing diseases of the brain is often doubted on the grounds that “nothing can be done about it anyway.” To put it in military terms, this type of information is not deemed to be “actionable” and therefore is not useful, merely upsetting to the patient, and the diagnosis without treatment would merely place undue financial burden on society. This tacit and sometimes not-so-tacit assumption, so sadly accurate even a decade ago, is rapidly becoming obsolete, owing to the rapid advent of various pharmacological and nonpharmacological ways of protecting the brain against decay. In plain terms, the assumption that “nothing can be done” is no longer true.