Monday 11 December 2023
The Excessive TV-Watching will cause Dementia, Depression and Parkinson’s Disease
Monday 31 July 2023
Snoring Could Be Harming Your Brain
Monday 12 June 2023
The Role of Multivitamins in Memory Boost and Slowing Cognitive Aging
Wednesday 22 March 2023
Parkinson Disease
Parkinson disease (PD) is one of the most common neurologic disorders, affecting approximately 1% of individuals older than 60 years and causing progressive disability that can be slowed, but not halted, by treatment. The 2 major neuropathologic findings in Parkinson disease are loss of pigmented dopaminergic neurons of the substantia nigra pars compacta and the presence of Lewy bodies and Lewy neurites.
Signs and symptoms
Initial clinical symptoms of Parkinson disease include the following:
- Tremor
- Subtle decrease in dexterity
- Decreased arm swing on the first-involved side
- Soft voice
- Decreased facial expression
- Sleep disturbances
- Rapid eye movement (REM) behavior disorder (RBD; a loss of normal atonia during REM sleep)
- Decreased sense of smell
- Symptoms of autonomic dysfunction (eg, constipation, sweating abnormalities, sexual dysfunction, seborrheic dermatitis)
- A general feeling of weakness, malaise, or lassitude
- Depression or anhedonia
- Slowness in thinkin
Onset of motor signs include the following:
- Typically asymmetric
- The most common initial finding is a resting tremor in an upper extremity
- Over time, patients experience progressive bradykinesia, rigidity, and gait difficulty
- Axial posture becomes progressively flexed and strides become shorter
- Postural instability (balance impairment) is a late phenomenon
Nonmotor symptoms
Nonmotor symptoms are common in early Parkinson disease. Recognition of the combination of nonmotor and motor symptoms can promote early diagnosis and thus early intervention, which often results in a better quality of life.
Diagnosis
Parkinson disease is a clinical diagnosis. No laboratory biomarkers exist for the condition, and findings on routine magnetic resonance imaging and computed tomography scans are unremarkable.
Clinical diagnosis requires the presence of 2 of 3 cardinal signs:
- Resting tremor
- Rigidity
- Bradykinesia
Management
The goal of medical management of Parkinson disease is to provide control of signs and symptoms for as long as possible while minimizing adverse effects.
Symptomatic drug therapy
- Usually provides good control of motor signs of Parkinson disease for 4-6 years
- Levodopa/carbidopa: The gold standard of symptomatic treatment
- Monoamine oxidase (MAO)–B inhibitors: Can be considered for initial treatment of early disease
- Other dopamine agonists (eg, ropinirole, pramipexole): Monotherapy in early disease and adjunctive therapy in moderate to advanced disease
- Anticholinergic agents (eg, trihexyphenidyl, benztropine): Second-line drugs for tremor only
Treatment for nonmotor symptoms
- Sildenafil citrate (Viagra): For erectile dysfunction
- Polyethylene glycol: For constipation
- Modafinil: For excessive daytime somnolence
- Methylphenidate: For fatigue (potential for abuse and addiction)
Deep brain stimulation
- Surgical procedure of choice for Parkinson disease
- Does not involve destruction of brain tissue
- Reversible
- Can be adjusted as the disease progresses or adverse events occur
- Bilateral procedures can be performed without a significant increase in adverse events
Prognosis
Before the introduction of levodopa, Parkinson disease caused severe disability or death in 25% of patients within 5 years of onset, 65% within 10 years, and 89% within 15 years. The mortality rate from Parkinson disease was 3 times that of the general population matched for age, sex, and racial origin. With the introduction of levodopa, the mortality rate dropped approximately 50%, and longevity was extended by many years. This is thought to be due to the symptomatic effects of levodopa, as no clear evidence suggests that levodopa stems the progressive nature of the disease.
The American Academy of Neurology notes that the following clinical features may help predict the rate of progression of Parkinson disease :
Older age at onset and initial rigidity/hypokinesia can be used to predict (1) a more rapid rate of motor progression in those with newly diagnosed Parkinson disease and (2) earlier development of cognitive decline and dementia; however, initially presenting with tremor may predict a more benign disease course and longer therapeutic benefit from levodopa
A faster rate of motor progression may also be predicted if the patient is male, has associated comorbidities, and has postural instability/gait difficulty (PIGD)
Older age at onset, dementia, and decreased responsiveness to dopaminergic therapy may predict earlier nursing home placement and decreased survival
Patient Education
Patients with Parkinson disease should be encouraged to participate in decision making regarding their condition. In addition, individuals and their caregivers should be provided with information that is appropriate for their disease state and expected or ongoing challenges. Psychosocial support and concerns should be addressed and/or referred to a social worker or psychologist as needed.
Prevention of falls should be discussed. The UK National Institute for Health and Clinical Excellence has several guidance documents including those for patients and caregivers.
Other issues that commonly need to be addressed at appropriate times in the disease course include cognitive decline, personality changes, depression, dysphagia, sleepiness and fatigue, and impulse control disorders. Additional information is also often needed for financial planning, insurance issues, disability application, and placement (assisted living facility, nursing home).
Tuesday 18 June 2019
Magic Mushrooms could replace Anti-depressants!
I started reading this article in the Indepedent with a curious mind! Interest in the potential medical uses for psychedelics, such as “magic mushrooms” and LSD, has rapidly increased in recent years, leading to the opening of the world’s first formal center for psychedelics research in April — and the center’s leader is already prepared to make a bold prediction about the future of psychedelics in medicine. The ideas are bloomed since the cannabis oil became a prescribed medicine recently.
Emotional Release
Carhart-Harris is currently leading a Centre for Psychedelic Research trial to compare the ability of psilocybin, or “magic,” mushrooms and leading antidepressants to treat depression.
He told The Independent that so far, participants are reporting that the psilocybin leaves them feeling like they’ve experienced an emotional “release,” while patients often criticize antidepressants for making them feel like their emotions are “blunted.”
Wishful Thinking
Given the ‘positive’ feedback from study participants and psilocybin mushrooms’ extremely low risk for overdose or addiction, it’s not hard to see why Carhart-Harris is optimistic that doctors will soon be able to use psychedelics to treat patients. Although, we know that the ‘magic’ mushrooms are abundantly available in the streets and self medicating is not uncommon in UK.
Another psychedelics researcher, James Rucker from King’s College London, isn’t so sure about Carhart-Harris’ timeline (which I’m not comfortable either), telling The Independent that five years is “possible… but only if everything goes to plan, and you know what they say about best-laid plans.”
So next time when you travel through M1, look out for majestic magic mushroom fields!
READ MORE: Magic mushrooms could replace antidepressants within five years, says new psychedelic research centre [The Independent]