Out of sight, out of mind

If you couldn’t see your mashed potatoes,
you probably wouldn’t eat them.

That was the premise that BU biopsychologist Alice Cronin-Golomb and her research partners adopted when they designed the “red plate study.” Their idea was to see whether senior citizens with advanced Alzheimer’s disease would eat more food from red plates than they did from white ones.

The researchers in the Vision & Cognition Lab of the Center for Clinical Biopsychology, which Cronin-Golomb directs, had reason to hope that their experiment would succeed. Nursing home staff often complain that Alzheimer’s patients do not finish the food on their plates even when staff encourages them to do so. Forty percent of individuals with severe Alzheimer’s lose an unhealthy amount of weight. Previous explanations for this phenomenon included depression, inability to concentrate on more than one food at a time, and inability to eat unassisted. Cronin-Golomb and her colleagues took a different approach. They believed this behavior might be explained by the visual-cognitive deficiencies caused by Alzheimer’s. Patients with the disease cannot process visual data—like contrast and depth perception—as well as most other seniors.

So Cronin-Golomb’s team, led by then-BU postdoctoral fellow and current Senior Lecturer in Psychology Tracy Dunne (GRS’92, ’99), tested advanced Alzheimer’s patients’ level of food intake with standard white plates and with bright-red ones. What they found was astonishing—patients eating from red plates consumed 25 percent more food than those eating from white plates.

Since these findings were published in 2004, some nursing homes have made red plates the norm. A private company has even marketed special red plates for seniors with visual impairment.

The CAS researchers’ approach to the problem of decreased functioning was what led to their breakthrough. Whereas many scientists look for drugs to treat degenerative cognitive diseases like Alzheimer’s and Parkinson’s, Cronin-Golomb and her team focus instead on finding visual aids that can improve patients’ quality of life. By assisting Alzheimer’s and Parkinson’s patients with their visual perception, the researchers actually are able to improve the subjects’ mental functioning.

“If the information getting into their brain through their eyes is already degraded, how can you expect them to do much with that?” asks Cronin-Golomb. “If we can enhance how fast they are getting information in, then they can have a better shot at remembering it. For instance, we can improve their reading speed just by enhancing what they see.”

“If the information getting into their brain through their eyes is already degraded, how can you expect them to do much with that?”

It is generally known that memory problems are associated with Alzheimer’s disease, but many people don’t realize that vision problems can plague these patients as much as their mental challenges do.

Cronin-Golomb and her team put subjects through a battery of tests to determine their visual capabilities—visual psychophysics tests to look at contrast sensitivity, color discrimination, and depth perception; neuropsychological tests to examine object recognition, word reading, facial recognition, and pattern completion; and, finally, tests to determine whether the subjects perform better using visual aids, such as measuring cups with larger lettering. Once researchers understand each subject’s abilities, they can then assess how various visual aids improve a patient’s visual perception.

One experiment the team conducted was to test which shades of gray pills were easiest for subjects to pick out. Seniors commonly take multiple daily medications, but pill manufacturers often don’t take into account patients’ vision problems when choosing pill colors. The researchers found that with the right shade of gray, they could help patients more easily locate their medications.

Cronin-Golomb also studies other behaviors caused at least in part by visual impairment. In Parkinson’s patients, for instance, her research suggests that walking through a doorway or experiencing other visual triggers may precipitate a patient’s “freezing,” or being unable to move.

The team’s research lends itself to immediate practical applications, and team members are eager to share their knowledge. They collaborate with colleagues at BU Sargent College, the Boston University Alzheimer’s Disease Center, and the Department of Neurology at the School of Medicine. They also educate local caregivers for the elderly about how to use visual aids to improve patients’ functioning. Many of these caregivers are family members taking care of loved ones. Others are professional caregivers at day programs for Alzheimer’s and Parkinson’s patients, as well as architects designing living spaces for older adults.

Team member and PhD candidate Tom Laudate recalls an encounter following his talk to a local caregiver support group. “A woman came up to me and said that just the week before, her mother had been in the kitchen trying to pour milk into a mug. The mug was white, the milk was white, and the countertop was white. She poured milk all over the place, and it wasn’t until the daughter heard me talk that it clicked in her mind and she understood her mother’s vision problem. It’s a great feeling to be able to give some information to someone that can make a difference. It’s not huge; we are not solving Alzheimer’s, but we are helping people in their daily lives.”

BU biopsychologist Alice Cronin-GolombProfessor of Psychology Alice Cronin-Golomb

Laudate is one of many students entering the field of neuroscience today who will help define its future direction.

“This is a field where a lot of the research hasn’t been done yet,” notes Cronin-Golomb. “Sometimes students ask me questions and I have to offer them my best guess at the answer. I tell them, ‘You could do that research.’”

The study of neuroscience at CAS has grown dramatically over the past two decades. When Cronin-Golomb joined the BU faculty in 1989, after getting her PhD from the California Institute of Technology, there were few students in the field of what was then called biopsychology. She played an instrumental role in cultivating the growing student interest in neuroscience. She developed the undergraduate neuropsychology course, which has become a barometer of the growing student interest in the field. Each year enrollment in the course grew until there were 60 students and a waiting list. The steady growth of interest in this and related courses led CAS to establish a neuroscience major in 2008.

Mentoring the next generation of neuroscientists is a top priority for Cronin-Golomb and her fellow CAS professors connected with the neuroscience major. In the Vision & Cognition Lab, graduate and undergraduate students participate in the leading-edge research.

“The grad students mentor the undergrads,” says Cronin-Golomb. “I love that, and I love the idea of undergraduates doing research.”

Cronin-Golomb’s goal is not only to train others; she is also driven by a personal connection to, and respect for, the elderly. While some people stigmatize Alzheimer’s and Parkinson’s diseases and approach them with a sense of dread, she recognizes that the elderly, including some of her test subjects, are full of vitality.

“I love working with Parkinson’s patients,” she says. “It is probably from my background. My grandma lived upstairs from me. She had all these brothers, sisters, and cousins, and they’d play these really competitive games of pinochle. So they weren’t doting old people. This gave me the idea of old people as very vivacious, and only later did I come across the attitude that old people are slow and frail.”


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