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Dementia (Part 1)
- Written by: Healthysport
- Hits: 54
When we think of Dementia, we think of an old person that is forgetful and confused. The keyword here is ‘old’. It makes sense. As we age, everything in our bodies declines. Skin gets wrinkled, the joints become arthritic, the heart acquires abnormal rhythms; vision and hearing become impaired, teeth fall off and we start needing high maintenance medications (whether for heart or blood pressure or diabetes etc) because just like a car, we have already used up our warranties and we need to check it under the hood frequently and immediately address its problems before it breaks down in the middle of the road. Obviously, the brain also declines. Most of us get by with occasional forgetfulness with funny anecdotes of looking for your eyeglasses while wearing them or looking for keys that you are holding in your hands. I do have those ‘senior moments’ but they don’t automatically mean dementia. Dementia is far more damaging than simple forgetfulness. It gets worse when it progresses to Alzheimer’s disease. There is a joke about how to differentiate Dementia from Alzheimer’s. Dementia is driving to a mall to do your shopping and after shopping you cannot remember where you parked your car. Alzhemier’s is driving to a mall to do shopping and once you’re done, you flag a taxi or take the bus without knowing where your address is.
It may sound funny to many of us, and we laugh at this with a nervous laugh because we all know this could happen to any of us who are now stepping into our 60s.
What is dementia? It is simply memory loss. In Rehab parlance, it is cognitive loss.
And it can be manifested by these symptoms:
- Difficulty performing ‘normal’ tasks
- Language problems (aphasia)
- Decline in judgment (poor safety awareness)
- Poor abstract thinking (decline in complex mental processes)
- Misplacing things frequently (I am guilty of this)
- Moodiness, abrupt changes in behavior
- Change of personality (confident to insecure, brave to fearful etc)
- Loss of motivation or initiative or purpose in life
It has been suggested that neurological changes in the brain occur years prior to the manifestation of the symptoms described above.
What are the categories of Dementia?
Reversible Dementia are those temporary memory losses and confusion brought about by brain tumors, brain bleeding, hydrocephalus (water in the brain), metabolic disorders such as vitamin B12 deficiency, low thyroid hormones, psychiatric problems like depression, and major infection or sepsis. Once these conditions are resolved, Dementia can possibly resolve as well.
In clinical settings reversible dementia can also be caused by Acute Respiratory Distress Syndrome(ARDS) which basically means failure of the lungs (breathing) that requires ventilation in an ICU setting. Though reversible, 78 percent of people who suffered ARDS show cognitive deficits (mental decline) one year after being discharged from hospital, 50 percent may still show the mental decline 2 years after discharge, for those with associated severe sepsis or infection, the mental decline can persist up to 5 years. Prolonged hospitalization causes severe mental decline. However there is still a big chance to reverse it though it might take time.
Non-Reversible Dementia is the one that we classically deal with when it comes to managing patients with dementia.
Parkinson’s Disease is the most common cause of Dementia. 50-80 percent of people with Parkinson's Disease will experience Dementia around 10 years after being diagnosed. Some neurological hallmarks for this include presence of a protein “Lewy bodies” and beta-amyloid plaques and neurofibrillary tangles. (this is more on the domain of Neuro specialists).
Everybody is familiar with Parkinson’s Disease - the person’s movements are slow, body is rigid, their posture is bent, especially the head, their walking are short and shuffling, they drool, they ‘freeze’ when they change directions while walking, they don’t have normal facial expressions, and they don’t sleep well.
The second most common cause of Dementia is Multi-Infarct (Vascular) Dementia. This type of dementia is caused by reduced blood or blockage in the flow of blood in the brain, which could have resulted from stroke or mini-stroke and especially strokes that occur multiple times. This is very common among men between 55 - 75 years old. It does co-exists with Alzhimer’s. Sadly, there is no cure for this, the damage is non-reversible.
People with strokes have a high risk of developing dementia. Other medical conditions that increase one’s risk for Dementia include diabetes, atherosclerosis or hardening of arteries prevalent to smokers and alcoholics, poor diet and no exercise. Once Vascular dementia occurs to these types of people, they show difficulty doing things that used to be easy to do for them, they get lost all the time, they could not easily find the words they want to say, they lose interest in tasks they used to enjoy doing (like hobbies), their faces are blank and flat, they misplace things, they have poor dealing with people (as opposed to them being sociable before), they get easily agitated, they have poor short term memory, meaning they may not remember what they just did 5 minutes ago.
There is a special condition among the Vascular Dementia worth mentioning here. It is called front-temporal Dementia. It involves the front and side parts of the brain where blood flow is restricted. It could be a result of a stroke or bleeding in the brain due to injury like a fall and bumping the head. The reason this is special is because the involved part of the brain is the seat of Reason, Logic, Self-Control and Judgment.
Their family members are shocked by the sudden changes in the personality of ones with this type of Dementia. Oftentimes families come to me saying their father (or mother) is a total stranger to them. These patients appear possessed by another being. A very decent Pastor starts cursing, a retired Doctor starts swinging his arms to punch everyone that gets close to him, a beloved parent is aggressively getting out of the room to go ‘to my house; or ‘to my parents’(who are most likely dead for decades) or they call on old friends or lovers or children or relatives to come help them because they need to go to the bathroom. They are highly obsessed to escape where they are, causing extreme stress to their family or caregivers. Some of them become amorous, suddenly hitting on everyone and looking for a new sexual partner all the time. They have propensity to make indecent proposals, taking off their clothes in public spaces. Patients with Fronto-Temporal Dementia show marked changes in personality and mood, communication is highly altered for the worse, they are very impulsive, they get easily bored and apathetic(they don’t care about anybody except what they feel), very inappropriate in social behavior (they have sudden flaring up of temper, saying things that are not said in normal conversations, can become suspicious, they call you names etc) Surprisingly, their memories remain largely intact.
Finally, the third most common type of Dementia is called Lewy Body Dementia. It is very similar to Parkinson’s with or without the neuro plaques and tangles, a common diagnostic include abnormal proteins that develop inside nerve cells of the brain. These patients move like Parkinson’s, their eyes fixed on the floor and mumbling all the time. This type of Dementia is often underdiagnosed and lumped up with the other forms.
There is another form of Dementia, Korsakoff syndrome, which is very common among people with a history of alcohol abuse especially binge drinkers. 1 in 8 people with alcoholism will develop this type of Dementia.
… to continue
Osteoporosis, Balance and Falls (part 1)
- Written by: Healthysport
- Hits: 68
First off, I am getting crazy over apps Instagram, FB and YouTube because of videos, reels and what-have-you features, which for a social media-latecomer like me is a wonderful learning experience but time consuming. One of the established health recommendations is - physical and mental exercise go hand in hand in living a good quality life. A lot of seniors abandon their mental sharpness because they feel like they have done all the heavy mental lifting already. That is a misconception. As long as we are alive, the brain needs to sharpen its neurons, make new axonal connections and form new patterns of neuronal networks to prevent it from deteriorating. An idle brain is susceptible to dementia which progresses to Alzheimer's. A lot of dementia is obviously genetic, just like every other disease, but it still pays to minimize and delay its progression.
Now ack to my current topic.
Imagine yourself having had a fracture, say of a hip or a knee or pelvis. You went through surgery. ‘Ok’, the surgeon says after the successful operation, ‘you can get out of bed, but your leg should be non-weight bearing.’ So, you get up with the PT. He brings in a walker for your use. He tells you to sit on the edge of bed. You feel all the unimaginable pain bearing down on you. You realize it is hard to move the operated/fractured leg. You summon all your body strength - both arms and core and the normal leg to help you move on bed. It helps that the PT holds your operated leg as he maneuvers it to the edge of bed and 1-2-3 up, you finally get yourself sitting on the edge of bed.
But that is only the first step. Besides the pain you feel slightly dizzy. You also want to use the bathroom. How?
The PT hands you the walker. Again, he reminds you of the non-weight bearing precaution of the operated leg. The walker helps. But the degree of your ability to use only one leg and both arms to help you stand and walk poses an existential crisis.
In my experience with patients, there is usually a big advantage for one who is more active, strong, and at normal weight when it comes to recovering from injuries (and surgeries) like leg or back fractures. And fractures are easy to get. It takes only one or two seconds to fracture a bone leading to months of painful recovery.
I have seen it all - a frail woman walking her dog with a leash as it leaps towards another dog across the street dragging the poor woman until she falls breaking her hip. A man trying to change a light bulb while standing on a stool and, losing balance, he falls and breaks his knee. These are risky but with advanced medical management, easy to recover from. The worst kinds are the life-threatening falls that hit the head, whether it is the sink or the bathtub or the floor which can lead to brain trauma that range from subarachnoid bleed to subdural hematoma if not treated immediately. And then there are spinal fractures that can require surgery or months of bracing or worse, paralysis depending on the extent of trauma.
As I am turning into a senior citizen myself, I often find myself wondering about what I could do if I were one of these fractured patients. Can I stand on one leg without falling? Can I hold my injured leg up for at least walking around the house?
Can I avoid these falls and strengthen my bones to reduce the intensity of the injury? Yes, there are steps to do that proactively but still, there are a few things in the Laws of Nature that are immutably designed by our Creator. Everything deteriorates, declines, weakens, becomes chaotic because of the Second Law of thermodynamics otherwise known as entropy. Humans, in the course of time, were able to delay this human entropy by adding more years to life. In ancient times, people were considered old in their twenties, dead before 40. Today, we are full of baby boomers on their way to century old years. There is a difference between adding mere years versus having quality life through those years. Unless you have lived under a rock in the last 100 years, you and everyone else know these life-prolonging measures that will give us long and good quality lives: exercise, diet, minimal stress, vice-free lifestyle and more recently, protecting oneself from infections such as during pandemics.
I am limiting this blog to exercise right now. That includes mobility and strength as the necessary components of independent functions. What are the potential health problems that can affect these?
Osteoporosis is the weakening of bones through the erosion of its main building blocks that include protein, calcium and Vitamin D. The main component of bone is collagen which is cemented by calcium. And for the body to absorb calcium it needs Vitamin D. A good source of vitamin D is the sun. Diet is important for bones. So is gravity.
Osteoporosis is caused by a decrease in bone density, which makes bones more fragile and easier to break. There are many causes of osteoporosis, including aging, estrogen or androgen hormone deficiency, medications (especially corticosteroids), an overactive thyroid gland or excessive thyroid medication, cancer, a sedentary lifestyle, poor nutrition, low calcium consumption or poor calcium absorption. Other risk factors for osteoporosis include being a postmenopausal female, low body weight or having a chronic inflammatory condition (such as rheumatoid arthritis or Crohn’s disease). Smoking or drinking excessive alcohol are also potential contributors to osteoporosis. (from google)
Simply put, the older we get, both men and women are susceptible to decalcification, demineralization, and erosion of bones (due to medical conditions) that render us all susceptible to osteoporosis. Although most of us are educated about osteoporosis and how to manage it, it is worth reviewing what are evidence-based solutions:
- Proper nutrition, remember proteins and calcium. And vitamin D (Spending time in sunlight because the sun is one of the best sources of Vitamin D, consuming fatty fish and seafood, eating mushrooms rich in minerals, having egg yolks, fortified foods and supplements etc. )
- Weight bearing, such as walking, triggers the formation of new bone cells. This has been established among the astronauts who lingered in space. Although negligible, their bone densities were reduced upon return to earth. They were back to normal once ‘earthly’ mobility resumed.
- Strength training improves the bone-forming cells through nudging and pushing (similar to other weight bearing exercises).
- Obviously, you can have diseases that may reduce bone density, so it is important to work with your physician on proper medications and supplements to minimize their impact on bone strength.
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