About Dr. Sara Manning Peskin 

Dr. Sara Manning Peskin received her undergraduate degree in biochemistry from Harvard University, where she graduated magna cum laude prior to moving to Philadelphia. She received her doctor of medicine, along with a master’s degree in cellular and molecular biology, from the University of Pennsylvania. She went on to complete residency and fellowship in neurology at the Hospital of the University of Pennsylvania, where she now works both in the Penn Memory Center and the Penn Frontotemporal Dementia Center. She’s particularly interested in narrative medicine and teaching the lay public about neurologic afflictions. She has published work in The New York Times and The Boston Globe Magazine. In 2022, her book “A Molecule Away From Madness: Tales of the Hijacked Brain” was published.

Steve Martorano
The Behavioral Corner is produced in partnership with Retreat Behavioral Health -- where healing happens.

The Behavioral Corner
Hi, and welcome. I'm Steve Martorano and this is the Behavioral Corner; you're invited to hang with us, as we've discussed the ways we live today, the choices we make, the things we do, and how they affect our health and wellbeing. So you're on the corner, the Behavioral Corner, please hang around a while. 

Steve Martorano
Hi, everybody. Welcome to the Behavioral Corner. Here I am again, hanging out. Steve Martorano. What do we do on the Corner? Well, we wait for really interesting people to bump into us and they share their stories with us. We hope you're finding that to be the case because we certainly enjoy the people we run into on the Behavioral Corner. So underwritten by our partners Retreat Behavioral Health, you'll hear more about them later on. I'm really excited about today for a number of reasons. But as I prepare for the interview with our guest, it began to occur to me that what we were going to talk about today, it's really a detective story. And the crimes, if you allow me, that are under investigation in this book, don't occur in the library. And they weren't committed by Colonel Mustard. But instead, the events we're going to talk about -- the crimes as I call them, occur in our brains. In our heads. It's an amazing story told by our guest, who has described the brain, very early on in her book, "as the most complex machine known to mankind." I hear that our guest is Sara Manning Peskin. Right? Peskin?

Sara Manning Peskin
Exactly. 

Steve Martorano
Yes. Sara is the author of a book called A Molecule Away from Madness: Tales of the Hijacked Brain. And it is a dandy read. I'm telling you, friends. Sara is very accomplished, she's a medical doctor. She's an Assistant Professor of Clinical neurology at the University of Pennsylvania. She got her undergrad degree at Harvard, then she moved to Philadelphia, a good move, attended medical school, and got her master's degree in cellular and molecular biology at the University of Pennsylvania. And that I mentioned she is also a Professor of Clinical neurology at that university. So Sara, thanks for joining us, and welcome to the Behavioral Corner.

Sara Manning Peskin
Thanks so much for having me, Steve.

Steve Martorano
By the way, I'd be remiss if I didn't point out this book can be scary as you're reading it, the conclusion of which is hopeful because we're learning more and more. Boy, there are some stories here that made me sit up and go, "Wow, this is crazy." The Hijacking of the Brain what a wonderful title for the book, before we get to the nitty-gritty of the, of what you're describing here, about the, you know, our nervous system, what attracted you to the field of neurology in the first place?

Sara Manning Peskin
I think I was always interested in cases in medical school where you go in and meet someone and their...their sort of identity has been changed. And that you can there are diseases of the brain that there are diseases of that, you know, the liver that can alter someone's cognition, you know, you can have heart disease, and it can cause some changes in cognition. But when you have essential brain diseases, they really change someone's selfhood. And I think there's this idea that we go through life with where it's like, you know, my gallbladder might go, my kidneys might go, but I'm still myself, I am my identity. And we don't really realize that actually, our entire identities are still actually sort of hanging tenuously from a single organ that can self-destruct the same way as all of our other organs can do that.

Steve Martorano
It's surprising given its complexity, that it doesn't do it more often. I mean, kidneys and heart and lungs seem to fail at a greater rate than our brain, which is I suppose the good news and bad news is you said, it's amazing, it's an amazing story. And you tell it so brilliantly. So it's so accessible, you tell it but basically, through the stories of people that have undergone these just horrible transformations. Why did you choose that? I think I know you wanted to personalize that, give us a story about it. But Is that why you did it, you were drawn to the personal story?

Sara Manning Peskin
When I first started writing about the book, actually, initially, I wasn't going to write anything about sort of medical history, I was just going to write about patient stories. And I sort of a lot of these diseases are sort of wild and out there. And I used to come home and my husband who's not in medicine would say, like, how do people not know about this? These stories are so outlandish. So initially, the idea was just to share the stories that I talked about when I got home. And then...then when I went actually to write about them, I realized, you know, on one level, you could say, Okay, here's this person going along in their life and something happens to them. And surprise, this is the disease. But that doesn't really make it that accessible. And then I realized what I needed to do actually was tell the story of the disease as a narrative. And that's what I ended up with. It's sort of the story of patients, and then also the story of the diseases that they have, and how most of the diseases that I write about actually are treatable, and a lot of them are curable. And ultimately, the sort of as you hopefully felt is, the goal is to strike a hopeful tone and to say, "You know what, there are so many things that go wrong, but actually, when you look around, most of us are doing pretty damn well."

Steve Martorano
Yeah, well, as I said, at the outset, here, it's, you know, it's a miracle you know, we get up in the morning, put our shoes on, and, you know, remember where the refrigerator is, these are stories that are unbelievable, it's particularly powerful. When you tell it from the perspective of individuals that you have either seen or heard about. This is a difficult topic for a lay person. I mean, you know, the central nervous system is everything. The brain is, as you say, "incredibly complex." To discuss it from a purely technical way I think would lose people, when you take what's ever going on with them, and show us what happens to their personality, their behavior, their life, then you go, I start paying attention to this. It's...it's extraordinary. I remember the first time I really understood what can happen to your cognition. Would that syndrome be where people believe their loved ones or acquaintances, or not them they are..

Sara Manning Peskin
Imposters. Yeah, Capgras Delusions. They're wild. They're horribly traumatic. It's often directed at it, you know, a spouse, and it's just horribly traumatic for spouses.

Steve Martorano
Yeah, that was the first time that years ago when I read about that, I thought...I thought of that movie, The Invasion of the Body Snatchers, where people keep going around, though that's not my husband. What are you talking about is your husband and I'm thinking, actually, there are people that have this problem. All of this is caused by the malfunction of our brains. I guess in terms of brain disease, or disorder, the most common one, the one that's most available to people on a mainstream basis is dementia. In general, and Alzheimer's, of course, tell us about that.

Sara Manning Peskin
The most common question we get in the clinic is what's the difference between dementia and Alzheimer's disease? And so dementia really just describes what it looks like when someone moves about the world. It describes someone who can't do what's called particularly complex things like they can't do you know, driving grocery shopping, cooking, because of memory and thinking problems, and because of a problem that's progressive. Alzheimer's disease describes what's going on under a microscope. So when I give someone a diagnosis of Alzheimer's disease, what I tell them is, what I'm really saying is if I took a piece of your brain out, and I looked at it under a microscope, this is what I think would see. And they...I actually tell them about the story of the original Doctor Alzheimers I wrote about in the book. And he was this German neuropsychiatrist in the early 1900s. And he actually was sort of a boisterous guy. He had written his PhD on the cellular life of earwax, they'd also gotten the citation for disturbing the peace in training. So he was this sort of very social and super smart guy, and he is working in this asylum in Frankfort. And he meets this 51-year-old woman named Monica Deter. And she's been dropped off by her husband, because her husband's like, "I can't manage her at home anymore. She's gone crazy." He starts studying her and realizes that she's had this profound loss of memory. So he can go talk with her. He can show her objects, and at least initially, she can name them. She knows what they are. And then he shows up a few minutes later, and she has no concept, but he was just there. And he asked her to write her name. And she writes Mrs. Auguste, and then she, for sure, it's Mrs. I think, and then she forgets what the task is. And he's interested. So he follows her for a time at this asylum. And then he actually had been moving away after a little bit less than two years. But he basically calls dibs on her brain. So everyone knows that like when this patient dies, they have to call Dr. Alzheimer in Munich and let him know. And so she passes away, and they call him up and they say, like, you want us to send you her brain. So this is a totally different system of sharing medical information than now. But and he said, Sure, you know, send it over. They send over her brain in a box along with her entire medical record. They send it over to Munich, and Alzheimer ends up taking pieces of the brain slicing them up, and he looks under a microscope. And he sees these two structures under a microscope look sort of like a spray-painted spot. And we know now that's made of a protein called amyloid, and the other looks sort of like spaghetti inside of neurons. And we know now that's made of a protein called tau. And it's that when we say someone has Alzheimer's disease, we mean, under a microscope, we think they have amyloid and tau that's. That's what it means and Alzheimer himself, it turns out, makes this finding and decides, you know, maybe I've discovered a new disease goes to this meeting and presents it and nobody cares at all. There's complete silence in the out in the audience, and the moderator says, "Well, it seems like there's no desire for discussion, please have a seat."

Steve Martorano
Why do you suppose that was? Was it so startling and so novel that it didn't resonate?

Sara Manning Peskin
So people had known about these structures before in older people and senile dementia. But Alzheimer's point was, you know, we used to think these were just random structures you'd see in, you know, dementia, but in this young patient, maybe these are pathologic, these are causing the problem. And I think it was sort of so outlandish that people didn't seem to believe it. Later, at the same conference, actually, there was a presentation about excessive masturbation and people love that presentation. There's an incredible conversation, it's the highlight of the meeting. And here, this guy has just discovered this disease that's going to affect millions and millions of people, and nobody cares at all.

Steve Martorano
Well, it helps to know your audience is

Sara Manning Peskin
Exactly. Maybe you should have chosen a different meeting.

Steve Martorano
It helps to know what they all have in common. That's interesting you mentioned that his startling discovery -- 100 years ago, did you say how long ago? 

Sara Manning Peskin
We say nineteen oh...I have to say it was the 1906 presentation in 1909, that the term Alzheimer's disease ultimately is sort of coined.

Steve Martorano
Lots of the discoveries vis-à-vis how the brain works and what's going on were almost always no...not...not always but very often ignored. And then, later on, another inquiry would be put on top of that, and then we begin to get a better picture. When did that process begin for real? Because of the things you described in the book, the personality disruptions, the violence, the strange behavior. Historically, were just assigned to bedlam. These people were lunatics. When did we begin to go wait a minute, there's something else going on here?

Sara Manning Peskin
It's actually interesting that you use the term "bedlam" as part of the research in the book. One thing that came up is that the term bedlam is actually from Bethlem Hospital in London, which I may be that's common knowledge I hadn't noticed before.

Steve Martorano
I know the Boris Karloff movie. So...

Sara Manning Peskin
So essentially, when did we get that shift? I mean, in some ways, we're still doing the same shift I imagined 20 years from now, there are people who are sitting in inpatients like facilities who otherwise you know, 20 years from now, they would be on a neurology floor getting treated, but we don't yet know what they have. And you could say, when one of the diseases I write about in the book, is a cause this woman who she was highly successful. And she essentially very quickly started thinking that she was living in The Walking Dead in the show, and she became acutely psychotic. And 30 years ago, she 100% would have been admitted to a psych facility, and that would have been it, she probably would never have gotten back to normal. And now she's treated.

Steve Martorano
That was your first story it was, it sounds like the plot of a novel or a movie. She thought she was in a zombie apocalypse, and grew violent over it and uncontrollable that immediately they must think she's having a psychotic episode, or they thought she was on Angel Dust, right?

Sara Manning Peskin
Exactly. She was on PCT. And actually, the disease works the same as PCP. Except that if you take PCP it wears off eventually, but the disease doesn't wear off unless you treat it.

Steve Martorano
What other behaviors are altered by a neurological problem in the brain? You describe so many. Give me another couple of examples.

Sara Manning Peskin
So there are some that are sort of behavioral outbursts like psychosis like that. And then some of them are a little bit less, less, sort of aggressive. There are things like, you know, I write about early-onset Alzheimer's disease in this family where it's caused by a genetic mutation. And they're the primary symptom is this...this incredibly pervasive severe...severe memory loss in people who are in the middle of their working careers. And then there are some of the conditions that cause movement changes, like Huntington's disease causes these sort of rising dance-like movements, almost like if you imagine an electrical current going through the body, and how that would pick up the lens.

Steve Martorano
Your story...your story of that, that a woman and her daughter is some people get more than their share to bear. And she certainly did the worst part of that for her and Huntington's disease, and tell me how many other these ailments are also hereditary. That's what she was worried about. Are all these neurological problems of the brain hereditary or not?

Sara Manning Peskin
It's a great question. So the first section of it the book is about diseases that are hereditary, but the other two sections are all you know, not hereditary. And even if it takes something like Alzheimer's disease, a very, very small minority of people will have a single gene causing the disease where if I look at their genetics, I can see if they have a mutation, I can say you're essentially 100% going to get the disease. That's extraordinarily rare. With Alzheimer's disease, most cases people will have, you know, they can have some risk genes there, you know, 30, 50, 60 genes where, depending on the version of the gene, your risk of the disease may be a little higher or a little bit lower. But it's not a single gene, which is surprising to a lot of people.

Steve Martorano
Yeah. leads me into diagnosis, because I've been reading about early-onset Alzheimer's, which is rare. It's this is not pervasive, but it's out there. And the article made the point that one of the problems has been misdiagnosing these things. How is the diagnosis done for neurological problems? Brain problems? Is it imaging? Is it blood work? How do you do that?

Sara Manning Peskin
Yeah, so it's a combination. So when someone comes to our clinic, there's sort of a few steps that we do. So the first thing is hearing from the person but also hearing from a friend or family member that they come with because that history is often just as important as what the person themselves tells. And because we're even normal people, we're pretty bad at judging our own cognition. We all think that we have sort of better processing speed and better dexterity than we do. And so we a lot of it at the beginning is getting the story to what was the first symptom? How did things change over time? Did it start with a memory problem? Did it start with inappropriate behavior? Did it start with hallucinations? And the very those early symptoms often are sort of the key to unlocking what's going on. And then we do essentially brain games. And the goal is to figure out which parts of cognition someone has difficulty with it, do they have a problem with visual-spatial function? They have a problem with executive function, which is sort of organization and judgment? Do they have a problem with memory? So they have a problem with language? So we use tests to try to figure out what are they good at? And what are they not good at. And that can often point us in the right direction,

Steve Martorano
But they get to you at a very late stage in this thing, right? I mean, it's not like if your back starts bothering you, or any human or other part of your body, you can generally get out a little ahead of it, say what's going on, by the time some of the other people that you write about in the book, present they got a big problem already. 

Sara Manning Peskin
Yeah, that's totally true. A lot of them have gone, most of them, I would say, especially young people, at least once they've gone to their primary doctor and said, I think something's wrong. And he's been told, you're totally fine, stop worrying. And they've gone back, and they've been told to go this is ADD or depression or you know, stress, or, you know, bad medications or something like that. So most people have some other diagnosis before they get to us.

Steve Martorano
Yeah, and most of the time, it's treated, I guess, with drugs, which may or may not be the right...the right thing to do there. Let's...let's talk about memory loss. And younger people suffered, as I said, misdiagnosed, as well. It's brain fog and the stresses of your life and you're trying to do too many things. Is that just sort of a standard narrative for somebody that age, when they present that way to go, "Well, it can't be this?"

Sara Manning Peskin
I think that's often what happened. And is that sort of standard answer? On the other hand, you know, I could say, how would we not see this coming? But I see people exactly as you said, they're a lot more severe. It's clearly something's wrong. But as you know, primary care doctor, you probably have 100 people, you know, one hundred 60-year-olds coming saying, I'm having memory problems, it's really hard to pick out the one that's more significant because the symptoms at the beginning are really subtle.

Steve Martorano
That's why it's important to bring someone in with them to talk about what's going on, because they...they're sort of the objective observer to this thing. What do we know about the causes of is there one cause to these problems? Or is it a multitude of things that can go wrong?

Sara Manning Peskin
We think it's a lot of different things. So there's, you know, dementia itself is, it's not that useful of a word, it describes what someone is...how they function in the everyday world. But as far as what causes it under a microscope, there are a ton of different causes. Alzheimer's disease is the most common cause. And but there are things like Frontotemporal dementia, which causes very different symptoms. They're usually there's Lewy body dementia, which causes people to have these well-formed hallucinations. They'll say, you know, "Why is that person sitting on the end of my bed?" Or, "Why are those people in the yard there." when there's no one there?

Steve Martorano
I read that in the book. And I, you know, why are you staring at that rabbit? I think or why is the rabbit staring at us? So if you had that experience in your life, that out of nowhere, your wife or husband says, you know, "Why is that person in our room?" What should your reaction to that be? Because maybe they're dreaming, you know, or you're dreaming, go back to bed. When you get alarmed when you go, "Wait a minute, what's going on here?"

Sara Manning Peskin
A lot of people I think, don't tell anyone at the beginning because they think, you know, "Oh, I must be crazy." 

Steve Martorano
Oh, they let the hallucination just go away. 

Sara Manning Peskin
Is it possible? This is would be, I'm sure wild conjecture on your part. So if you don't want to answer don't, is it possible that some of what goes on in the brain that we now view as problematic? Before it was diagnoseable could it account for genius, great creative genius? Wouldn't it be great if you could study Michelangelo's brain? He had the same brain, everybody at that period of time had his work differently.

Sara Manning Peskin
And I think a lot of them just keep it to themselves. And then eventually, you know, they tell close people with Lewy body disease, actually, the hallucinations tend not to be threatening. So people tend to know that they're not real, but they're very vivid. And so it's not the same as you know, some of the other diseases that I read about in the book where they, you know, the woman who was hallucinating that she was in The Walking Dead. Those were scary. She was really scared of it. With Lewy body disease, oftentimes the things that people see, and they don't find scary. They're just, you know, they know they're not there and they're very vivid.

Sara Manning Peskin
Yeah, it's a great question. You know, I have no idea. The only thing that comes to mind is and I don't know if this is true, but I've always had the story that the person who designed the Epcot...

Steve Martorano
Epcot Center in Flordia?

Sara Manning Peskin
...and he had vision problems, and that maybe that accounted for some of it. I don't know if that's true or not. I've always heard.

Steve Martorano
They used to explain impressionism that way. Well, they were all nearsighted. Our guest is Dr. Manning Peskin. She is a molecular biologist or a neurologist? How do you describe...

Sara Manning Peskin
Neurologist. Yeah, I tried to be a molecular biologist, and I quit my Ph.D. So I think I no longer married any title like that anymore.

Steve Martorano
Okay, well, neurology...neurologist is good enough. For those who might not be I mean, I've heard the term, neurology is a study of the nervous system, right? 

Sara Manning Peskin
Mmmm hmmm.

Steve Martorano
Okay, what's the nervous system?

Sara Manning Peskin
So the nervous system is the brain which you could guess and then it goes into the spinal cord. And then there are all the nerves that go out to the tips of your thumb, and fingers, the tips of your toes?

Steve Martorano
Clearly, there is nothing that we do, from the simplest thing to tying our shoes or writing a novel or whatever. All are directed by our brain. Is that true?

Sara Manning Peskin
I would say, but maybe I'm biased because that's why I chose. There's that debate between the brain and the heart, you notice it? Does the desire just exist to pump blood to the brain, or...?

Steve Martorano
Oh, I see. Yeah. Well, and then there's the other the evidence, and it seems like, you know, there's no brain activity and some people. So how could that be a factor? But it seems clear to me that we are how our brains is functioning. By the way, I just have a question I've always wanted to ask, it's the dumbest question, I'm sure. What's the difference between the mind and the brain?

Sara Manning Peskin
It's a great question. I don't think there's a good definition. We usually use "brain" more as sort of an anatomic term. 

Steve Martorano
Do you do as a physician?

Sara Manning Peskin
Yeah, I think more and more people say like, how could you ever separate that? Anything that happens in the brain is happening in the mind.

Steve Martorano
I wonder whether there was a sharp distinction in your field? No, no...

Sara Manning Peskin
There isn't. I will say we don't usually use the term "mind." We usually use the term "brain." So maybe it's sort of medically speaking, mostly, we use the brain term.

Steve Martorano
I've always felt and I know you're, you're gonna read I think life is tough sometimes things happen to you, that you have to overcome one way or another. Organic diseases...disease. But it's always occurred to me that if you have cancer or diabetes, or whatever it is, your mind is a tremendous tool to help you deal with this. When your mind is having trouble. You know, your liver doesn't help, right? Your lungs don't help. It must terrify people, your patients, it must terrify them to think there's something wrong with their brain.

Sara Manning Peskin
Yeah, and I think you bring up a really good point, which is we have a problem with your brain, it's really hard to take care of the rest of your body. So we have you know, you have people who have Alzheimer's disease, and then you can't remember to take your medications for your diabetes, and it really invades everything.

Steve Martorano
And when you lose the ability to think clearly, you can't use the tool that's supposed to allow you to do that, "well, I only...I have this thing." That doesn't work, particularly if your memory is shot. What are the causes of some of that -- there is a multitude of causes. Can head injury create these problems? Or is it all or organic?

Sara Manning Peskin
There is an association between that concussion and going on to have a neurodegenerative disease. But it's not at least as far as we know. It's not causative because there are lots of people who've had concussions who don't go on to have, you know, dementia, and there are lots of people who have dementia and have never had a concussion. But there is an association. Ultimately, for most of these cases, we have no idea what causes it. There are some diseases where there's a specific gene and we can say, hey, there's a mutation in your DNA, and that's what causes your problem. But a lot of these can we have no idea why it happens to one person or another.

Steve Martorano
The advance in this field has been spectacular, over the decades, but I think you said at some point or alluded to the fact that it lags behind other specialties in oncology. We've made greater strides against cancer than we have against neurological diseases. Is that because of the complexity that we're dealing with?

Sara Manning Peskin
Part of it is that it's hard to study these diseases. And how did we do so well, in cancer? Right now, if you develop cancer, you go to your doctor. And ideally, they take out a piece of cancer, they look at it, and they look at what molecules this cancer has. And then they pull out medications from the shelf that target those specific molecules. It's very directed therapy. So if you take someone with breast cancer, and another person with breast cancer, they're not getting the train, same treatment. Diseases of the brain and it's much more complicated, very complicated to study for several reasons. So one is, a lot of the diseases are slow. Alzheimer's disease progresses over a decade. So if you want to study treatment, it's going to take you years to figure out if it does anything. There are also a lot of variabilities. We could have five people with Alzheimer's disease, one person may progress over the course of three years. One person may stay the same for a while and progress eight years later. And so when you give someone medication, we have no idea if they would have always progressed slowly, or did the medication actually do something. It's really hard to figure out. And the last piece is, if the last of many is, it's really hard for us to actually figure out who to include in these trials. So actually, it turned out that we do research trials for Alzheimer's disease until pretty recently, about 20% of people that we would enroll to not actually turn out to have Alzheimer's disease. So you can imagine if you want to know if a drug works for a disease, and you're studying it on people who don't actually have it, you're not gonna get a good result.

Steve Martorano
No, no, not at all. Where are we, with regard to, if not a cure for Alzheimer's?

Sara Manning Peskin
So we're in sort of a precarious place. So until now, the main idea has been what's called the amyloid theory. So, you know, we know that Alzheimer's is defined by amyloid and tau proteins aggregating in the brain. And it turns out amyloid builds up about 10 to 15 years before symptoms ever start. So if someone has Alzheimer's disease starting in their 50s, they probably had amyloid all over their brain a decade earlier. Tau tends to build up more sort of along the timeline of the actual symptoms. And for that reason, and a few other reasons, a lot of people have thought for a long time that if we could just get rid of amyloid, you could sort of preventing the horse from leaving the barn, you could cut the disease off in its tracks. And we've spent an enormous, enormous amount of money on drugs that target amyloid. Most of them didn't do it that effectively. And although lately, we have medications that actually do seem to clean up amyloid really effectively, we haven't yet proven that that method works. So the big thing in the news that people have been reading about is a medication called Aducanumab that's made by a company called Biogen and Aducanumab, at least it used to be with sort of the most powerful amyloid cleaner around. It really did a good job of getting rid of amyloid. And so this company did two huge phases three trials of more than 1000 people each. And they did an analysis partway and said, "Oh, actually, you know, the medication isn't working, stop the trials." But you can imagine, these are huge studies. So it takes a few months for the trials to really grind to a halt. So it takes about three months or so the trial stops. And then they go back and analyze the data again. And they say, "Oh, actually, the drug worked." And the reason why they said that is they said, "Well, you know, in one of these two studies, it didn't work. But if you look at the other one, and you get rid of the people who were progressing really fast, and you only look at people who got a really high dose of the drug, then there's a little bit of a signal." So it was sort of a now hindsight, 20/20. It should have been used to create a new theory that they would test. Instead, the company went to the FDA looking for approval. And the advisory committee said, "You know, this is not ready for primetime." But actually, the FDA approved it. And then they were sort of uproar. People are not, you know, from an anecdotal perspective, people aren't really prescribing it. And then Medicare actually said they're not going to pay for it.

Steve Martorano
Yeah, took care of that. Yeah, that's the most recent story. They got a little ahead of themselves. Yeah, got everybody excited. We have an aging population, and Alzheimer's is not going to diminish by itself. So it must be some pretty exciting work out there. Although very frustrating. I can imagine. Tell me about brain imaging. Is it effective at all in your work?

Sara Manning Peskin
So it's actually it's gotten pretty advanced. So CT scans are the that's the quick and dirty way to do brain imaging. Those are okay. MRI scans are even better. They give you a sense of you know, what's big and what's small. And we know that in particular diseases, some structures tend to get small and some structures don't. And then what's the neatest in terms of Alzheimer's disease are these particularly called PET scans. So you know, we were talking about these amyloid and tau proteins. We now can have someone come into our office, come into the radiology suite, and give them a tracer. It goes through an IV and get a tracer that sticks to the amyloid. And then you take a picture of their brain and you can see where the amyloid aggregates are. And if if someone has them, so you could actually take a picture and you can figure out if someone has amyloid aggregates in their brain. And the same thing with tau. So you could give them a tracer, it sticks to tau in their brain, and then you take a picture of where the tracer is. Which is pretty remarkable. So now when we enroll trials and people, when we enroll trials for Alzheimer's disease drugs, we're able to actually figure out in living people with a really high...with a really high sort of conviction rate that whether or not they have amyloid tabs. We can be much more particular about who we enroll. 

Steve Martorano
Sara Manning Peskin is our guest. She has written a book called A Molecule Away from Madness: Tales of the Hijacked Brain. You break down these rogue molecules into four categories. Can you give us a brief description of those four? 

Sara Manning Peskin
So I call them mutants, rebels, invaders, and evaders. And mutants are diseases that are caused by DNA mutations that things as Huntington's disease, and particular forms of Alzheimer's disease. And then the rebels were diseases that are caused by proteins that take aim at the brain. And two of them are stories of people whose immune systems essentially attack their brains and attack their spinal cords. One of those is the story of that woman who started to believe she was in The Walking Dead. And then the invaders are things that aren't supposed to be in the brain, but we bring them into our bodies, and they get into the break something like a medication. And then the evaders are things that actually we need and we're missing them. Something like a vitamin

Steve Martorano
Are any of them caused by...by the environment that we're living in?

Sara Manning Peskin
So certainly the... invaders... So that the story that I chose in the invader section is actually about Abraham Lincoln. Who used a...we think that he used a medication called Blue Mass. And the main ingredient of Blue Mass is mercury. And so there are some folks who have this idea that he actually suffered from the effects of mercury toxicity. And then it cost him to be very volatile. And there's a quote from a colleague of his, that he apparently Lincoln told him, that he was using Blue Mass. And then he had to stop after he got elected president because it was making him cross. And so that's the story. They tell him a book. But environmental toxins would be in the same category. It's sort of things that are around us that get into the brain, and they wreak havoc because they're not supposed to be there.

Steve Martorano
Yeah. The schizophrenia fit into what...what we're talking about here?

Sara Manning Peskin
It's funny you ask. I'd say after I published the book, that the biggest question that I get in terms of psychiatry, is, what about schizophrenia? Where are we? It's not my expertise. I have no idea where we are. And in terms of, you know, how close are we to a molecular idea...

Steve Martorano
We're not even looking at schizophrenia on a molecular level to find out...

Sara Manning Peskin
So I'm sure we are and I wouldn't say it's totally its sort of a little peripheral to my field. So I totally not up to date on the literature about it. 

Steve Martorano
Yeah and I guess, in a kind of final sense, here now, you don't study mental illness? Do you? Your field is something different than mental illness, isn't it?

Sara Manning Peskin
So, you know, I often think of it you know, a lot of what I do is, is sort of, essentially therapy techniques. Yeah, so much of what I do is couples therapy, when people come in and one person has a neurodegenerative disease, and the other person doesn't, and, you know, watching it play out in a partnership, or a sort of family therapy watching it. You know, we have a 50-year-old with dementia, what does it look like with their kids? There's a lot of therapy...

Steve Martorano
Yeah, Sara, who are you trying to help in that situation. The person who's not suffering from this so they can deal with it?

Sara Manning Peskin
But it has to be both. I mean, these are...these diseases are not only affecting one person. And I think part of the issue is, you know, this isn't a broken arm. You have to treat families. Yeah. And it'll...it will...it will be better for the patient. If things are better for the family.

Steve Martorano
Yeah, what's devastating about this thing is the impact on everybody. In fact, in terms of severe dementia, or Alzheimer's disease, the sufferer of the disease is cut off from the suffering.

Sara Manning Peskin
Yeah, 100%. A lot of times, it's the people who are around them that are suffering more,

Steve Martorano
Everybody else is actually the victim of Alzheimer's disease. The book is called A Molecule Away from Madness: Tales of the Hijacked Brain. I don't...whenever a reviewer refers to something as a slim novel, I don't know whether there is a slim, slim book. I don't know whether they're praising or not. But it's a great read, Sara, this is you really can...it's just a great read. You write so brilliantly. You're talking about something, you know, which is beneficial to all of us. So you got some time, folks, I'm telling you, I don't generally make a rule of recommending books. I think it's presumptuous to do that. Who knows what somebody wants to sit down and spend their time reading. I can recommend this one. It's a terrific read. Not for the faint of heart, but it's hopeful. I mean, they're looking...they're looking in the right place. How long have you been in Philadelphia, incidentally?

Sara Manning Peskin
Now, I guess 12 years. 

Steve Martorano
So I'm Where are you from?

Sara Manning Peskin
I grew up in Boston. But now I feel like a Philadelphian. I think that maybe I've lived here long enough.

Steve Martorano
I lived and worked in Boston for a bunch of years, and I'm a native Philadelphian. I'll leave you with this. Since we've got that in common. Someone wants to describe the difference between Bostonians and Philadelphians, as in Philadelphia, and it's got to do with a Quaker underpinning. You don't draw attention, and everybody's comfortable being part of the tribe. And in Boston, everyone insists that they're the chief. Anyway, welcome to Philadelphia. You're a Philadelphian now. 12 years makes it official. And the book is terrific. And I thank you so much for your time. 

Sara Manning Peskin
Thanks so much for having me. This is great. 

Steve Martorano
Appreciate a lot. Thank you guys for your time as well. You know where to find us, Facebook, all those other places. Push the subscribe button, push the like button, and you'll make my day. See you next time on The Behavioral Corner.

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