A Molecule Away from Madness

November 29, 2021
Neurologist Peskin debuts with an impressive account of the search for cures for a number of neurologic diseases including dementia and psychosis. In vivid prose, Peskin brings to life the scientists who have contributed to the current “molecular” understanding of such conditions as memory loss and sudden personality shifts. There’s Friedrich Miescher, who isolated DNA in the mid–19th century, and Nancy Wexler, who located the gene that causes Huntington’s disease in 1979. Elaborating on recent medical advances, Peskin explains how genetic mutations, autoimmune responses, and vitamin deficiencies have been linked to brain maladies, and describes the intense emotional and physical sufferings of patients and their families: one mother “kept watch over her daughter, hoping one of the always answerless doctors would burst into the room and announce the reason for Lauren’s illness.” Anecdotes run the gamut from depressing to enlightening, the latter exemplified by the story of how Abraham Lincoln’s mood swings were linked to mercury poisoning. The case studies can be heavy, but Peskin finds cause for optimism in modern medicine: “People who would previously have been untreatable—and even undiagnosable—have now become curable. Their minds and lives are saved.” There’s much to savor in this powerful survey.

December 1, 2021
A neurologist looks at how "the very molecules that make our brains work can also co-opt our personalities and destroy our ability to think." Peskin has been a firsthand witness to the suffering of Alzheimer's patients she has been powerless to cure. In this book, she delves into the three known molecular causes of cognitive decline. The first includes DNA mutations, like those present in Huntington's disease. Nancy Wexler, a Huntington's sufferer and medical scientist, was one researcher who worked tirelessly to discover the exact nucleotide sequence of the Huntington's gene. This breakthrough led to an experimental drug that, as of 2018, proved 85% successful in short-circuiting the mechanisms responsible for setting Huntington's in motion in those predisposed to the disease. Peskin then examines how protein molecules that the body creates to defend against infection can attack brain cells, as in the case of a young woman thought to be having a psychotic break. Doctors instead discovered that protein antibodies her own body created were responsible for her cognitive dysfunction. Outside of the body, a group of small molecules Peskin calls "invaders" (which include "environmental toxins, illicit drugs, and pharmaceuticals that are not normally part of the human body") can also wreak havoc, of the kind periodically experienced by Abraham Lincoln. Peskin speculates that his periodic bouts of aggression resulted from ingesting "blue mass," a mercury-based medication. The author further suggests that the key to succeeding against all cognitive disabilities in the future will be to understand the particular kind of molecular abnormality afflicting a given patient rather than assume that brain diseases like dementia function the same way in different people. This readable and well-researched book will undoubtedly satisfy those seeking the nature of neurological dysfunction and the most current research being done in this field, with added appeal for anyone with a loved one suffering from brain disease. Fascinating popular science.

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Starred review from January 1, 2022

As a cognitive neurologist, Peskin (Univ. of Pennsylvania) sees her role as connecting a patient's narrative to "the molecules causing the problem." In this first book, she tells the stories of patients (some her own, others from history) who have been upended by "mutants, rebels, invaders, and evaders"--molecules that hijack the brain and cause diseases that can lead to personality and movement disorders, hallucinations, seizures, memory loss, even death. These illnesses include Huntington's disease, Pick's disease, Creutzfeldt-Jakob disease, multiple neuritis, Alzheimer's and early-onset Alzheimer's, pellagra, and the now-extinct kuru. By exploring the molecular and genetic underpinnings of these diseases, researchers have been able to understand them far better and successfully treat some patients. More needs to be done, including improvements in diagnosis, but Peskin believes that advances are within reach, and that Huntington's and Alzheimer's can be prevented or even cured within our lifetimes. VERDICT A captivating and convincing study that should bring hope and confidence to general readers as well as general practitioners, and to the millions living with neurodegenerative illness and their families. An exemplary work in the relatively new field of narrative medicine.--Marcia G. Welsh

Copyright 2022 Library Journal, LLC Used with permission.

January 1, 2022
"Our brains have an Achilles' heel," neurologist Peskin proclaims. And at that nub of vulnerability contains naughty molecules that can "co-opt the mind" by adversely affecting personality, memory, and thinking. She identifies three categories of havoc-causing, occasionally mind-disintegrating molecules: genetic mutations, problematic proteins, and invaders-evaders. Huntington's disease and familial early-onset Alzheimer's disease are due to deleterious DNA mutations. The troublesome proteins group includes prion disease and autoimmune disorders that trigger an antibody attack on the brain. Prions cause mad cow disease and Creutzfeldt-Jakob disease (an inevitably fatal neurodegenerative disease). Invaders are harmful toxins and drugs; evaders are necessary but missing molecules, as in thiamine or niacin vitamin deficiencies. Peskin includes emotionally charged stories of patients with these conditions, illustrating the misery inflicted by these diseases on individuals and those who love them. For example, a young woman suddenly becomes confused, convinced she's living in the fictional world of TV's The Walking Dead. In conclusion, cognitive neurology, medical history, and clinical anecdotes are effectively enlisted in Peskin's outlook for a bright future for the treatment of dementia and other brain disorders.

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