When we moved into our neighborhood I looked around at the other houses and said to my wife, “If we want to fit in here, then we’re going to need a pickup truck.” One day while we were out driving through our town I told the kids to count all of the pickup trucks that they saw. There were about fifty of them in three miles. This is a town that knows trucks, that lives and breathes and drives pickup trucks.
If trucks are near the top of the list of things that most people around here really understand, then neuroscience is probably near the bottom. I aim to change that, one conversation at a time.
One day in clinic I was seeing a woman with Alzheimer disease. “She got a lot worse last month,” her son told me. “She was getting lost inside the house, and couldn’t hardly feed herself.”
“Was she sick?” I asked.
“Yeah, they gave her some antibiotics for a bladder infection,” he said. “I don’t know if she really had one — she couldn’t have told you. But she didn’t have any symptoms.”
“Has she gotten better since taking the antibiotics?”
“Yeah, she’s just about back to normal — I mean, normal for her.”
“I see this all the time,” I said. “It was the UTI that caused her cognitive symptoms to worsen.”
He tilted his head sideways. “Really? How does that work?”
“When the system is under stress, the weakest part fails,” I said. “It’s pretty common.”
He looked a little perplexed. Time for an analogy.
“Let me explain it this way,” I said. “Imagine you have an old pickup truck that doesn’t fire on all of its cylinders. This truck is fine to drive around the farm, moving a couple of hay bails or something, but if you hitch up a trailer and try to haul a load up the canyon, it’s not going to make it. You’re gonna be spitting out black smoke and going 15 miles per hour.”
The man looked at me with rapt attention, and nodded his head several times.
“A diseased brain is the same way. A person with mild dementia may be fine for most of the day-to-day stuff, but when you put the system under stress, you don’t get the same performance out of the brain. The stress can be anything: an illness, sleep deprivation, family arguments, you name it. So when your mom had a urinary tract infection, it put a strain on her system. Her brain function doesn’t have any reserve, so under those conditions it started to fail. Does that make sense?”
“That makes total sense,” he said. “You really explained that well.”
The same thing can happen with any kind of brain disease. When I was a neurology resident I got called down to the Emergency Department one night to see an older man who was having stroke symptoms.
“This is just how he was when he first came to the hospital three months ago,” his daughter said. “He’s not speaking, he’s not moving his arm, and his mouth is crooked again. Everything he has gained in rehab he has lost in the last 24 hours. He’s having another stroke!”
Well, it turns out that he wasn’t. We took him to the MRI scanner, and all we saw was an old stroke from three months earlier. But on his chest X-ray we found that he had pneumonia.
A return or worsening of old stroke symptoms caused by some other illness is called post-stroke recrudescence. The same phenomenon in patients with multiple sclerosis is called pseudoexacerbation.
Now use this same analogy to imagine what can happen when your faith is weak or damaged. What if you neglect the small daily habits that keep up your relationship with God, like prayer and scripture study? Or what if there is some misdeed in your past that you have been procrastinating your repentance of? These things are like diseases of the spirit, like scars on the soul. When your faith isn’t firing on all of its cylinders, you won’t have the spiritual power to pull the load through the trials that are surely coming your way. You may be fine for the day-to-day things, but what will happen when the soul-crushing experiences of life test your faith to its limits?
In the recent General Conference President Russell M. Nelson encouraged us to work on this:
“My dear brothers and sisters, my call to you this Easter morning is to start today to increase your faith. Through your faith, Jesus Christ will increase your ability to move the mountains in your life, even though your personal challenges may loom as large as Mount Everest. […]
“Your growing faith in Him will move mountains—not the mountains of rock that beautify the earth but the mountains of misery in your lives. Your flourishing faith will help you turn challenges into unparalleled growth and opportunity” (April 2021 General Conference).
You maintain your faith so that you can make it through life’s hardest pulls, over the highest mountain passes. The time to build your faith is now, not after the trailer is hitched up and your engine is struggling to turn over.
If you want to haul a heavy load, then you need a truck in good working condition. If you want to function at your highest level, then you need a healthy brain. And if you want to make it through life’s greatest challenges, then you need to continually build your faith in Jesus Christ. All three things require a lot of maintenance, but if the outcome is important to you, then the work is well worth it. You don’t want your truck, or your brain, or your faith to fail when you need them the most.
Alan B. Sanderson, MD is a member of The Church of Jesus Christ of Latter-day Saints and is a practicing neurologist.
One reply to “Your Brain is an Old Truck”
Interesting idea and a fun way to explain the difficult to understand.