Don't ignore Alzheimer's

By Nilma DOLE

Growing old gracefully is what we hope in our retirement, spending time with our grandchildren and having a peaceful retirement life. But what happens when we are afflicted with a disease that would make us forget our own loved ones? Ignoring early symptoms would lead to consequences later.

Ten symptoms of dementia and Alzheimer’s Disease: Memory loss Difficulty in performing familiar tasks Problems with speech and language Disorientation in time and place Poor judgement Problems with keeping track of things Misplacing things Changes in mood and behaviour Changes in personality Loss of initiative.

"In dementia, the common cause is old age (senile dementia) which affects the individual at the 75 plus age. It affects people who were previously very intelligent so it is a very dangerous disease," said Consultant Neurologist, Dr. Githanjan Mendis.

Other causes include brain disease, stress and anxiety.

Complaints

"Alzheimer's Disease is also caused by alcoholism, drug abuse, heavy smoking, overwork, family problems," said the doctor.

In Alzheimer's Disease, dementia is characterised by gradual loss of memory with later involvement of the motor system.

The normal presentation is that of an elderly men (less common in women) who has been gentle-mannered and soft-spoken in the past, whom the family will say that they have changed in personality. "Complaints such as 'He has lost interest in life', 'He shouts all the time', 'He is argumentative and aggressive' or 'He tends to be lost even at home' are what family members say about the person affected by this condition," said Dr. Mendis. Usually, such patients have no idea about time, neglects basic hygiene, washes again after using the toilet and keeps wandering out of the house and is unable to find their way back.

Behaviour

"They usually don't know about their own behaviour and don't know that they are affected by Alzheimer's Disease which makes it difficult for loved ones to understand why they are doing this," said the doctor. It is often sad for loved ones to know that their grandfather or father is affected by dementia and Alzheimer's Disease. "There are four common types of dementia and Alzheimer's Disease is the most common. Other types are vascular dementia (second most common condition), dementia with lewy bodies and secondary dementia," he said.

A history of diabetes, hypertension, smoking or hyper-cholesterolemia, minor strokes or full-blown strokes can be the result of vascular dementia. "Dementia with lewy bodies might come in the form of visual hallucinations and recurrent falls which are common. Secondary dementia is due to the deficiency of hormones such as hypo-thyroidism, vitamins such as B12, brain tumours and other brain damage such as sub-dural haemorrhage following a fall or falls," said the doctor.

The main symptoms of dementia are loss of memory, behavioural problems leading to violence, difficulty in carrying out day-to-day activities, disturbance in speech and use of bad language, difficulty in recognising familiar objects and inability to read the clock and tell the time. "It is important to know the history of the patient when you diagnose dementia and Alzheimer's Disease.

The most reliable history is given by the patient himself or a close relative, or a close associate or the patients carer," said the doctor. He said that things have to be recorded such as when the memory loss started and how did it evolve and form? "In the Western world, such patients tend to be taken into care and soon it becomes a big problem to the carers especially in elderly people's homes," he said.

In the East, where the family usually looks after the patient, this abnormal behaviour is tolerated to a large extent. "Even in Sri Lanka, more families are now seeking help for early dementia," he said. There are myths surrounding Alzheimer's Disease which are untrue. "According to the Lanka Alzheimer's Foundation, one such myth is that dementia is an acceptable cause of growing old but it is not true because more than 80 percent of people over 80 years have no dementia", said Dr. Mendis. He said that only a small amount of memory loss and impairement of mental function is due to old age.

"Dementia which interferes with everyday life activities is not part of the process of growing old," he said. Another myth is that there is no treatment for dementia and nothing can be done to cure it but it is not true. "There are new drugs that can be used to treat dementia and a lot of advice and encouragement can be given," said the doctor. Management of dementia is done by pharmacological and non-pharmacological treatment.

Cure

In pharmacological treatment, there are three main drugs that are used to cure mild to moderate Alzheimer's Disease. In non-pharmacological treatment or environmental modification, 'reality orientation' is done where everything is marked correctly for the patient to remember. "Investigations such as a full blood count, urine check, fasting blood sugar, TSH, T3, T4, B12 and serum folic acid levels, serum calcium, a CT and MRI scan can be done to check the patient to see if they have dementia and Alzheimer's Disease," said Dr. Mendis. Only one or two people should be allowed to help the patient with their daily routine and needs.

"This will reduce the incidence of bad behaviour, aggression, violence, inattentiveness and prevents them from using offensive language," said the doctor. Acupuncture treatment such as DU 11 (Shentao) is the main point in treating dementia and Alzheimer's Disease. There are sedative and tonification points which when applied the correct way, can lead to a proper cure to combat the condition.

They should be encouraged to have their main meals with the rest of the family whenever possible and spend time with their children and play with their grandchildren. This will lead to the path of curing dementia and Alzheimer's Disease as it is upto their loved ones to accept them with open arms in spite of their condition.

Courtesy Lanka Alzheimer's Foundation

Understanding mindfulness meditation

In times of stress, we're often encouraged to pause for a moment and simply be in the 'now.' This kind of mindfulness, an essential part of Buddhist and Indian Yoga traditions, has entered the mainstream as people try to find ways to combat stress and improve their quality of life. And research suggests that mindfulness meditation can have benefits for health and performance, including improved immune function, reduced blood pressure, and enhanced cognitive function. But how is it that a single practice can have such wide-ranging effects on well-being? A new article published in the latest issue of Perspectives on Psychological Science, a journal of the Association for Psychological Science, draws on the existing scientific literature to build a framework that can explain these positive effects. The goal of this work, is to "unveil the conceptual and mechanistic complexity of mindfulness, providing the 'big picture' by arranging many findings like the pieces of a mosaic." By using a framework approach to understand the mechanisms of mindfulness, Hölzel and her co-authors point out that what we think of as mindfulness is not actually a single skill. Rather, it is a multi-faceted mental practice that encompasses several mechanisms.

The authors specifically identify four key components of mindfulness that may account for its effects: attention regulation, body awareness, emotion regulation, and sense of self. Together, these components help us attend to and deal with the mental and physiological effects of stress in ways that are non-judgemental.

Although these components are theoretically distinct, they are closely intertwined. Improvement in attention regulation, for example, may directly facilitate our awareness of our physiological state. Body awareness, in turn, helps us to recognize the emotions we are experiencing. Understanding the relationships between these components, and the brain mechanisms that underlie them, will allow clinicians to better tailor mindfulness interventions for their patients, says Hölzel. On the most fundamental level, this framework underscores the point that mindfulness is not a vague cure-all. Effective mindfulness meditation requires training and practice and it has distinct measurable effects on our subjective experiences, our behaviour, and our brain function.

The authors hope that further research on this topic will "enable a much broader spectrum of individuals to utilize mindfulness meditation as a versatile tool to facilitate change - both in psychotherapy and in everyday life."

 - MNT

New vaccine to combat malaria

by Dr. Saman Gunaherath

Researchers, officials express measured optimism about a malaria vaccine candidate that has produced positive results in trials involving more than 15,000 children across 11 sites in seven countries in Africa, where the disease primarily causes the death.

It has been confirmed that a new vaccine can offer sustained protection against malaria which affects millions of people.

Preliminary data of a recently conducted study indicated the vaccination can reduce the risk of malaria in children by half for a period of 12 months after vaccination.

The vaccine is known as RTS.S and it has provided ''young African children with significant protection against clinical and severe malaria with an acceptable safety and tolerability profile'' according to the press announcement made by the Malaria Vaccine Initiative (MVI) and GlaxoSmithKline (GSK), two of the main partner organisations that conducted the trial.

The vaccine reacts by prompting the body's immune system to defend itself against Plasmodium falciparum, the fatal malaria parasite carried by mosquitoes. Researchers collected data on the first 6,000 children 12 months after they received three doses of the vaccine.

Those aged 5 to 17 months were shown to have reduced risk of clinical malaria, marked by fever and chills by 56 percent. Children had a 47 percent lower risk of contracting severe malaria, which becomes a medical emergency with a patient exhibiting coma, severe anemia, respiratory distress and potential organ damage.

The vaccine was first developed at GSK biological headquarters in Belgium and was successfully tested on US adult volunteers.

The current trail results from a proposal by MVI that RTS.S could be useful in protecting African children, who make up about 90 percent of the some 800,000 fatalities caused by malaria each year.

Rajive Shah U.S. Agency for International Development Administrator, welcomed the initial evidence for the vaccine, ''the vaccine as a new addition to our present package of malaria control interventions, could result in further major reduction in severe malaria cases and deaths'' Shah said in a press statement.

Unlike other vaccines developed to protect human life, from bacteria and viruses, this is the first to offer immunity against the parasite. This provides possibilities that the same or similar breakthroughs should help in development of new vaccines to protect against other human parasitic infections.

Obesity and depression increase health costs

Obesity and depression both dramatically increase health care costs, but they mainly act separately, according to a study published in the November 2011 Journal of General Internal Medicine by Group Health Research Institute scientists. Gregory Simon, MD, MPH, a Group Health psychiatrist and Group Health Research Institute senior investigator, led the research.

"Previous research shows that both depression and obesity are associated with higher health care costs," he said. "But depression and obesity often occur together, so it was important to know if the relationship between obesity and cost is really due to depression - or vice versa." Simon and his colleagues tested whether depression confounds the increase in health care use that is associated with obesity. Confounding means an apparent connection - such as the link between increased health care costs and obesity - is influenced or even caused by a third factor. In this study, the authors tested if depression confounds the increase in health care seen in obese patients. The study used telephone interviews to determine obesity and depression, and Group Health's extensive medical records to calculate health care costs for 4,462 women aged 40-65. All were enrolled in Group Health Cooperative, a nonprofit health care system in Washington and northern Idaho. Obesity was measured as body mass index (BMI), a standard obesity measure that is calculated from height and weight.

A BMI below 25 is considered normal weight, 25-30 considered overweight, and over 30 is considered obese. Depression was measured with a 9-item American Psychiatric Association questionnaire.

The researchers found: In middle-aged women, health care costs increased with obesity. Specifically, costs increased 65 percent in women with a BMI of 30-35, and 157 percent in women with a BMI higher than 35, compared to women of normal weight.

The trend was similar for all types of health care that the researchers examined: primary care, outpatient prescriptions, specialist visits, inpatient care, and mental health care. Health care costs increased with higher depression scores, but depression was a not a major confounder of the obesity results.

Even accounting for depression, health costs increased with every rise in BMI category. The study concluded that in this population of women, obesity is associated with higher health care costs, but not because of co-occurring depression. Similarly, depression is associated with higher costs, but not because of co-occurring obesity. These higher costs have an economic impact.

Increased costs associated with depression were spread across all types of health care, not just mental health care.

Courtesy: Science Daily

Leg fatigue should be targeted in heart failure

Doctors should not only treat the heart muscle in chronic heart failure patients, but also their leg muscles through exercise, say researchers in a major new study.

Heart failure causes breathlessness and fatigue that severely limits normal daily activities such as walking. The University of Leeds research team has, for the first time, shown that leg muscle dysfunction is related to the severity of symptoms in heart failure patients. These findings suggest that daily activity in patients with severe heart failure may not simply be limited by the failing heart, but also by an impairment in the leg muscles themselves.

In a series of experiments with chronic heart failure patients, the research team measured responses of the heart, lungs and leg muscles following a moderate exercise warm-up. Using a near-infrared laser to measure the oxygenation of the leg muscles, they found that warm-up exercise increased the activity of skeletal muscle enzymes that control energy production. However, this adaptation was less in patients with the most severe symptoms, showing that the heart failure condition had a negative impact on the normal function of the leg muscles.

Dr Harry Rossiter, of the University's Faculty of Biological Sciences says: "Many chronic heart failure patients complain of leg fatigue during exercise and this can prevent them from being active. Our study shows that by warming up properly, patients can improve the oxygenation and performance of their leg muscles, which is beneficial in promoting exercise tolerance."

"When your muscles don't use oxygen well, it causes an uncomfortable burning sensation during activity," says Dr Klaus Witte, the Cardiologist on the research team. "The effect of a warm up is to direct oxygen to the places that are going to need it, and make the muscles ready to use it when you start exercising."

Dr Rossiter says the next stage of this research will be to see whether training of the skeletal muscles can improve long-term overall outcomes for patients with chronic heart failure, and to discover more about the pathological changes in the leg muscles that may be a contributing factor in limiting exercise.

"Our main message is that exercise is safe and beneficial in patients with heart failure. By warming up the leg muscles properly, the exercise can be more comfortable and sustained for longer - affording great benefits for these patients," he says.

Courtesy: Sciencenewsline

Male breast cancer rare though aggressive

Men get diagnosed with breast cancer at less than one percent the rate of women, according to a new analysis of cancer rates from six cities and countries. But when they did get breast cancer, men were caught with more advanced disease, on average, and were more likely to die from it. "It's not surprising that men with breast cancer present with later stages," said Dr. Susan Dent, from the Ottawa Hospital Cancer Center in Canada, who was not involved in the new study.

"That's just because the awareness of the fact that breast cancer can occur in men is not as acute," she told Reuters Health. "Men aren't as likely to think of it, and health care providers aren't as likely to think of men having breast cancer." Men are most commonly in their 60s or 70s when diagnosed with breast cancer, according to the National Cancer Institute.

Radiation exposure and diseases that increase oestrogen levels - such as liver cirrhosis or Klinefelter syndrome, a genetic disorder - are among factors that raise a man's risk. Dent added that men should be particularly aware of breast cancer - and possibly consider getting screened for the disease - if they have a family history of it, including a predisposition to cancer caused by mutations in the BRCA1 and BRCA2 genes, which are well-known to raise women's risk of breast and ovarian cancers.

But men with no family history should not be screened, experts agreed. Researchers combined cancer registries from Denmark, Finland, Norway, Sweden, Singapore and Geneva, Switzerland, with cases dating back to 1970.

That included about 460,000 women diagnosed with breast cancer and about 2,700 men. Men were more likely to have disease that had spread beyond the breast by the time they were diagnosed. In treatment, they also had less surgery and radiation compared to women, but similar rates of chemotherapy and hormone therapy.

Over the entire time period, men had a 72 percent chance of surviving breast cancer in the five years after a diagnosis - compared to 78 percent in women. But researchers led by Dr. Mikael Hartman of the National University of Singapore found that when their cancer was spotted at the same stage and they got recommended treatment, men had a better chance than women of surviving a breast cancer diagnosis. Hartman's team also noted in the Journal of Clinical Oncology that previous studies have shown it typically takes a few months from when men start getting symptoms until they are diagnosed with breast cancer. "Men who develop a breast lump delay seeing their doctor longer than a comparable woman would with similar symptoms," Hartman wrote in an email to Reuters Health.

SOURCE: Journal of Clinical Oncology.