Categories
Neurocognitive Disorders

A Deep Dive into Epilepsy and it’s (Not-So) Shocking Ramifications on Global Health

Epilepsy is a neurological condition characterized by a recurrent onset of seizures (Mayo Clinic, 2021). Seizures are abnormal electrical activity in the brain which can be divided into two categories: focal and generalized. Focal seizures originate from one area of the brain, whereas a generalized seizure involves all areas. Seizures are often short-lived events, lasting 30 seconds to two minutes; however, they may classify as a medical emergency if prolonged for a longer duration (Mayo Clinic, 2021). Because seizures may affect any location of the brain, symptoms vary considerably, ranging from temporary loss of awareness to physical twitches or disturbances in sensations. Not all seizures can be classified under epilepsy. As at least two unprovoked seizures, within a 24-hour timeframe, are usually needed for a complete diagnosis (Mayo Clinic, 2021). As individuals with epilepsy may experience seizures at a higher frequency, they consequently may experience more severe symptoms such as muscle spasms, injuries, behavioral changes, or psychological conditions such as anxiety. 

The causes and mechanism of action for epilepsy are widely unknown for about 50% of all cases (World Health Organization, 2022). Epilepsy can result from genetic, structural (physical abnormality/ injury), infectious, or immune causes. Some examples include oxygen deprivation during one’s prenatal stage, stroke, genetic conditions relating to brain malformations, or head trauma (World Health Organization, 2022). While treating the underlying cause of epilepsy is generally not feasible, treating the symptoms of seizures is largely an attainable goal for many patients. Medications, such as antiepileptic drugs (AEDs), are considered initial options for treatment plans because they treat seizures by reducing excessive electrical signals sent by neural cells (American Association of Neurological Surgeons, 2021). With numerous AEDs available on the market, individuals have more options to choose the right medication for them based on their physical and social needs. Treatment plans may also include prescribed diet modifications, such as a ketogenic diet, for children who do not benefit from medications (American Association of Neurological Surgeons, 2021). A ketogenic diet is high in fats and low in carbohydrates, which are believed to reduce glutamate concentrations in the brain and increase gamma-Aminobutyric acid (GABA) synthesis. These are excitatory and inhibitory neurotransmitters respectively which result in reduced electrical signaling between neighboring neural cells (Wnuk, 2018). While surgery is considered a final option for treatment, some individuals with epilepsy may greatly benefit from surgical options if they respond poorly to AEDs (American Association of Neurological Surgeons, 2021). 

With the increasing treatment options, epilepsy is increasingly becoming a manageable condition for most. Of patients with recorded epilepsy, 70% report no seizures largely due to the help of AEDs. When considering epilepsy and its effects, one must consider the global context for the condition as the rate of incidence falls higher in low and middle-income countries. Of all individuals with epilepsy, 80% reside in such countries where preventable health and accessible care are likely to be lacking (World Health Organization, 2022). Therefore, individuals in low and middle-income countries are more susceptible to an increased risk of infectious conditions or birth-related injuries. Further, treatment barriers exist for around 75% of these individuals where they do not have access to medications (World Health Organization, 2022). Thus, it is crucial to see the varying support levels provided to low and middle-income countries to assist in this global health issue which inevitably pushes individuals towards a greater inequitable fate. 

 

References

American Association of Neurological Surgeons. (2021). Epilepsy. https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Epilepsy

Mayo Clinic. (2021, February 24). Seizures. https://www.mayoclinic.org/diseases-conditions/seizure/symptoms-causes/syc-20365711

Mayo Clinic. (2021, October 7). Epilepsy. https://www.mayoclinic.org/diseases-conditions/epilepsy/symptoms-causes/syc-20350093

Wnuk, A. (2018, August 14). How Do Ketogenic Diets Help People With Epilepsy? BrainFacts. http://www.brainfacts.org/diseases-and-disorders/epilepsy/2018/how-do-ketogenic-diets-help-people-with-epilepsy-081418

World Health Organization. (2022, February 9). Epilepsy. https://www.who.int/news-room/fact-sheets/detail/epilepsy

Categories
Neurocognitive Disorders Neurodegenerative Disorders

Disparities in Access and Utilization of Neurological Health Care

You were just diagnosed with a neurological disorder, what’s next? Of course it depends on what disorder exactly, but more often than not these diagnoses are accompanied with a discussion about a prognosis, or long-term timeline of that disorder. Along with that, the healthcare professional will most likely detail a schedule of follow ups and possible treatment options to either treat the symptoms or ease a patient as best as they can into the end stage of the disorder. This aspect of healthcare is crucial  because when creating these timelines, medical professionals are trying to think of the best way to keep a person out of the emergency room and hospital. Ultimately, hoping to keep the person comfortable and not accruing too much debt in medical expenses. Unfortunately this goal is not often met throughout the entire population, as this part of healthcare is riddled with racial and socioeconomic inequalities. 

One large scale study of about 279,103 respondents, looked at three groups in terms of the disparities in access and utilization of neurological health care: Non-Hispanic white, Non-Hispanic black, and Hispanic people. The data showed that black participants were nearly 30% and Hispanic participants nearly 40% less likely to see an outpatient neurologist when compared to the whtie participants. Additionally, this study also found that Non-Hispanic black participants had the highest # of encounters for a neurological diagnosis in terms of Emergency department visits and Hospital inpatient discharges. Leading to an overall per capita cost of care of about 1,485$, which is almost triple the per capita cost for Non-Hispanic white and Hispanic participants. The study goes on to discuss how these racial/ethnic disparities are multifactorial. Two of which can be a distrust in the healthcare system or a low density of neurologists in necessary locations. For example, California has less than half the number of neurologists per 100,000 residents than Massachusetts, despite being more racially and ethnically diverse. (Saadi, 2017). 

The socioeconomic disparity is quite clear on what exactly causes it and it boils down to costs. This may seem like an obvious statement, and you would think that programs such as Medicaid (state/federal program which provides health coverage for low income individuals) and Medicare (federal program which provides health coverage to 65+ year olds or 65 and under individuals with a disability) exist so why is there much of a disparity? In the outpatient setting, practices are not forced to take patients who are on these health care coverage plans. According to MACPAC, about 71% of providers took Medicaid and 85% took Medicare. This is in comparison to about 90% of providers accepting private insurance (Masterson, 2019). Well, this shouldn’t really make that much of a difference, right? The percentage is not 0, so there has to be some provider relatively close to people who will take their insurance, right? One study showed that 1 in every 11 insured adults either delayed medical care or did not seek medical care in 2020 due to costs which include copays and travel (Ortaliza, 2022). This mindset of “someone will take care of this patient” is counterintuitive to what healthcare is supposed to be and continues to push away whole populations of people. 

In spite of the cause of the disparity in access and utilization of neurological healthcare, there should not be any reason for the healthcare system to fall into the same trap as other institutions which are too afraid to change and hide behind a veil of “where do we even begin”. I believe two major aspects that lend to such disparities discussed previously, is that the emergency room is 24/7 and cannot deny a patient any services. This is an issue, not only within the neurological side of medicine, but in all fields. Outpatient hours are not really conducive to people who also work a 9-5, nor are they inclined to accept medicaid. As the insurance side of this problem has been a battle for many years, the extended outpatient hours is a much more feasible goal. Some offices do have late night hours, but these offices are few and far between meaning if such an office is too far out of the way for a patient, they might feel more inclined to go to the emergency room. The main way I could see more practices including late night hours, would be to entice them with tax breaks or other benefits. 

 

References

Saadi, A., Himmelstein, D. U., Woolhandler, S., & Mejia, N. I. (2017). Racial disparities in neurologic health care access and utilization in the United States. Neurology, 88(24), 2268–2275. https://doi.org/10.1212/wnl.0000000000004025 

Masterson, L. (2019, January 28). Doctors less likely to accept Medicaid than other insurance. Healthcare Dive. https://www.healthcaredive.com/news/doctors-less-likely-to-accept-medicaid-than-other-insurance/546941/ 

Ortaliza, J., Fox, L. How does cost affect access to care? (2022, January 14). Peterson-KFF Health System Tracker. https://www.healthsystemtracker.org/chart-collection/cost-affect-access-care/

Categories
Dissociative Disorders

A Break from the Oneself (and Maybe the World): Examining Depersonalization-Derealization Disorder

*Top image is part of a comic drawn by a community member, with the account name as Planetmclulu, on Bored Panda. The individual’s name is Lulu, and they drew this comic to display what it is like to have depersonalization/derealization disorder. They are cited in the reference section; however, one may go on their account to view more of their illustrations.*

 

Dissociative disorders are characterized by an absence of connectivity between one’s perceptions, emotions, and understanding of self. The dissociation, defined by these types of disorders, usually results from prior experiences with trauma, and is thought to allow the individual to cope with their reality that is a result of situations associated with a painful or sorrowful memory or sentiment (Mayo Clinic, 2017). Depersonalization/derealization disorder (DPDR) is one type of dissociative disorder categorized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Within DPDR, one may experience significant aspects of depersonalization and/or derealization that are strongly likely to interfere with the routine functioning of daily life (Mayo Clinic, 2017). 

The depersonalization element of DPDR is defined by detachment from one’s self in terms of mind and body (2017). With this, an individual can feel that they are viewing themselves from a third-person perspective. Alexithymia may arise as a symptom in which one cannot identify or properly explain their emotions. Additionally, one may experience a physical loss of sensation or ability to control movement which can be further exacerbated by an idea that one’s limbs are disfigured (Fritscher, 2020). The derealization element of DPDR is defined by detachment from one’s environment and other people within one’s surroundings (2020). With this type of dissociation, an individual can feel separate and isolated from their surroundings to the point where they may feel objects and people near them are fabricated (2020). Hence, one’s senses of vision and hearing, which make up memory, may be warped (2020). A person experiencing derealization may have symptoms of hyper-awareness of their environment and visualizing objects in the nearby vicinity to be manipulated into two-dimensional, colorless, or cartoonish configurations (Fritscher, 2020).  

Whether an individual experiences both depersonalization and derealization aspects or just one, it is apparent that this disorder has strong potential to severely impact one’s behavior and capacity in daily function. An individual with DPDR is likely to experience initial symptoms and episodes of the disorder in their mid-teenage years to young adulthood (American Psychiatric Association, 2018). Although most episodes are not chronic, the respective episodes can persist over hours, days, weeks, and even months. The symptoms can also periodically return over several years (Fritscher, 2020). To be diagnosed as an individual with DPDR, along with identifying the presence of the depersonalization/derealization symptoms, it is also important to identify if the disorder is causing social or personal disturbance to the individual and if the individual recognizes that the dissociation they experience is not real (2020). To recognize that one’s reality is not the dissociation experience is a crucial criterion for a DPDR diagnosis, as it rules out other psychotic disorders (Fritscher, 2020).  

While there is no distinct cause for DPDR, it is possible for certain situations or predispositions, such as genetic or environmental causes, to pose a higher risk for individuals to be more susceptible to the disorder. Most often, individuals with DPDR have experienced or witnessed a past trauma such as emotional, physical, or sexual childhood abuse. In early years, a child is more readily able to learn how to view traumatic events from a third-person perspective as personal identity is still under development. Thus, it is possible for dissociation to unknowingly be a coping mechanism for later years of life (Fritscher, 2020). For treatment purposes, it is usually most effective for individuals with DPDR to undergo psychotherapy, such as cognitive-behavioral therapy (CBT). CBT serves to help an individual to reconnect with their emotions, mind, and body, so they may block out false perceptions of themselves and their surroundings. The second form of therapy, eye movement desensitization and reprocessing (EDMR), may also be used, in which an individual is trained to shift their negative thoughts and memories with a series of bilateral (side-to-side) eye movements (Fritscher, 2020). Through this therapy, it is hoped for the individual to focus on a specific memory or thought until it does not cause distress to the individual (Gotter & Raypole, 2022). 

 

References

American Psychiatric Association. (2018, August). What are dissociative disorders? https://www.psychiatry.org/patients-families/dissociative-disorders/what-are-dissociative-disorders

Fritscher, L. (2020, December 4). What Is Depersonalization/Derealization Disorder (DPDR)? Verywell Mind. https://www.verywellmind.com/derealization-2671582

Gotter, A., & Raypole, C. (2022, January 11). Considering EMDR Therapy? What to Expect. Healthline. https://www.healthline.com/health/emdr-therapy

Mayo Clinic. (2017, November 17). Dissociative disorders. https://www.mayoclinic.org/diseases-conditions/dissociative-disorders/symptoms-causes/syc-20355215#:~:text=Dissociative%20disorders%20are%20mental%20disorders,with%20functioning%20in%20everyday%20life

Planetmclulu. (2019). I’ve been suffering from DPDR for over 3 years now, and I want people to know what it’s like (10 comics) [Illustration]. Bored Panda. https://www.boredpanda.com/comics-life-with-depersonalization-derealisation-disorder-planetmclulu/?

Categories
Tic Disorders

Increase in Tic Disorders during the COVID-19 Pandemic

The COVID-19 pandemic and quarantine was a massive paradigm shift in how many people carried about their day to day lives. As with any large or small change to someone’s habits and routines, there is a level of stress associated with this. This stress alongside prolonged negative emotions such as loneliness and powerlessness drove the occurrence of the initial episodes of mental illnesses to occur in people or worsened them (Chatterjee & Chauhan, 2020). One section of the population where this trend was observed was children. More specifically, pediatricians and child mental health professionals in the United Kingdom noted an increase in tic symptoms in children and adolescents already diagnosed with tic disorders and an increase in presentations of sudden onset severe tics and “tic-like attacks” (Heyman, Liang, and Hedderly, 2021).

Tics are classified as “sudden, uncontrollable twitches, movements, or sounds that people do repeatedly”(CDC, 2021). There are currently three tic disorders that are included in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The three disorders are Tourette’s disorder, Chronic motor or vocal tic disorder, and Provisional tic disorder (DSM-5). One of the main factors that distinguishes the three disorders is the length of time that people have had tics, as well as the number of motor and/or vocal tics they perform (CDC, 2021). Tourette’s is the most involved diagnosis, as it is diagnosed in people who have two more motor tics and at least one vocal tic for at least a year. In comparison to the other two disorders, which vary in the length of time with symptoms and number of tics. 

Medical professionals postulate that tic-like attacks are primarily caused by underlying built-up anxiety in adolescents, but this cannot be used as a blanket explanation because previous studies have shown that the stress-tic relationship is not a linear one (NHS Choices, 2022). In one study that looked at a sample of children with co-occurring tic and anxiety disorders, the data suggested that tic frequencies may not change or change in implausible ways during acute periods of stress (Conelea et al., 2014). The main gripe with this study, though, comes in the form of the researchers not properly defining their definition of “acute”, as the quarantine was certainly not a 1 or 2 week event (2014). Therefore, anxiety may not be entirely the cause of tic disorders. 

The initial rise in tic-like symptoms during quarantine alarmed health care professionals in the United Kingdom, where this rising trend in tic disorders and tic-like attacks were observed, for three reasons. Firstly, the rate at which child mental health professionals received referrals for sudden tic-like attacks between 2020 and 2021 was double the rate in years prior (Heyman et al., 2021). Secondly, the onset of symptoms included a mix of both motor and vocal tics in adolescents, which is seen in individuals with Tourette’s. However, what has been generally seen in the past with non-Tourette’s tic disorders, is the normal onset of symptoms is mainly motor tics (Heyman et al., 2021). Thirdly, the main population of new adolescents who were affected by these sudden tic-like attacks were girls, a drastic contrast to the usual 4:1 ratio of tic-like symptoms present in boys as opposed to girls (Heyman et al., 2021). At the time the original study was conducted, the time frame between the onset of symptoms and the end of the study was less than a year, so the psychologists could not officially diagnose the new wave of people with new tic-like behavior with Tourette’s. Furthermore, when the adolescents were examined, there was no other neurological reason that could be found to explain the sudden onset of tic-like attacks, which coincided with the medical professionals believing the children developed some form of a tic disorder (Heyman et al., 2021).

The consensus belief held by the medical professionals involved in the care of these children, is that the children all had some form of underlying anxiety which could have unearthed their predisposition to tics and other neurodevelopmental impairments such as ADHD and autism (Heyman et al., 2021). Additionally, the sudden nature of the tic-like attacks, as opposed to a steady wind up of episodes, coincides with the sudden halt of their regular daily routines because of quarantine. Moreover, another confounding factor found by the professionals was the increased consumption of social media by these adolescents as a result of being stuck at home all day. More specifically, it is the consumption of content made by creators who have tic disorders, such as Tourette’s. Adolescents who presented with a sudden onset of tic-like attacks told medical professionals that posting videos and discussions about their symptoms to peers, gave the adolescents a sense of support and belonging (Heyman et al., 2021).  The medical professionals believe that as a result of this echo chamber of support, and a lack of proper therapeutic intervention, such as Cognitive Behavioral Intervention, the adolescents weren’t attempting to improve their tics. Cognitive Behavioral Intervention works to establish three things in people with tics: tics can improve and worsen on their own, tics are often done in response to a feeling or urge, and tics can be stopped, at the minimum for a short time (Cincinnati’s Children, 2021). Further research into this phenomenon is being heavily pushed by the medical professionals to try and definitely see a correlation between social media and an unintentional reinforcement of tic-like symptoms (Heyman et al., 2021).

Given the small sample size and the already non-consensual data on stress-tic relationships, there can be no definitive answer as to whether social media or pandemic anxiety played a role in the seemingly subsequent rise in tic-like attacks in children. However, it will definitely be something to keep an eye on for child mental health care professionals moving forward as the world returns to a state post-quarantine, but in the advent of social media’s continued growth. 

 

References

fancycrave1. 2015. “Hands Ipad Tablet – Free Photo on Pixabay.” Pixabay.com. June 25, 2015. https://pixabay.com/photos/hands-ipad-tablet-technology-820272/.

CDC. 2021. “Diagnosing Tic Disorders.” Centers for Disease Control and Prevention. April 15, 2021. https://www.cdc.gov/ncbddd/tourette/diagnosis.html#:~:text=Tics%20are%20sudden%20twitches%2C%20movements,make%20a%20grunting%20sound%20unwillingly.. 

Heyman, Isobel, Holan Liang, and Tammy Hedderly. 2021. “COVID-19 Related Increase in Childhood Tics and Tic-like Attacks.” Archives of Disease in Childhood 106 (5): 420–21. https://doi.org/10.1136/archdischild-2021-321748. 

Conelea, Christine A., Krishnapriya Ramanujam, Michael R. Walther, Jennifer B. Freeman, and Abbe M. Garcia. 2014. “Is There a Relationship between Tic Frequency and Physiological Arousal? Examination in a Sample of Children with Co-Occurring Tic and Anxiety Disorders.” Behavior Modification 38 (2): 217–34. https://doi.org/10.1177/0145445514528239. 

Chatterjee, Kaushik, and V.S. Chauhan. 2020. “Epidemics, Quarantine and Mental Health.” Medical Journal Armed Forces India 76 (2): 125–27. https://doi.org/10.1016/j.mjafi.2020.03.017.

NHS Choices. 2022. “Overview – Tics.” 2022. https://www.nhs.uk/conditions/tics/#:~:text=Tics%20can%20happen%20randomly%20and,talked%20about%20or%20focused%20on.. 

Cincinnati Children’s. “Cognitive Behavioral Intervention for Tics (CBIT).” 2021. Cincinnatichildrens.org. 2021. https://www.cincinnatichildrens.org/health/t/tic-intervention. 

Categories
Neurodegenerative Disorders

What is Multiple System Atrophy?

Multiple System Atrophy (MSA) is a progressive, neurodegenerative disorder characterized by the suspension of the standard function of the autonomic nervous system with a presentation of symptoms usually arising in the 50s or 60s of one’s adulthood (Mayo Clinic, 2020). The autonomic division of the nervous system regulates involuntary movements of an organism’s internal organs in response to environmental stimuli such as breathing patterns, heart rate, digestion, and metabolism (Kandola, 2020). An individual with MSA most commonly experiences frequent fluctuations in blood pressure, such as low blood pressure when one stands or sits up (orthostatic hypotension) or high blood pressure when lying down (supine hypertension) (2020). One may additionally experience a loss of urinary or bowel control, dysfunction in body temperature regulation due to reduced sweat production, and difficulty maintaining sexual function with a loss of libido (Mayo Clinic, 2020). 

MSA is divided into two categories: MSA-P, parkinsonian, and MSA-C, cerebellar (MedlinePlus, 2016). The most common form, MSA-P, is grouped by movement abnormalities such as rigid muscles, slow movement, trouble bending arms and legs, and difficulty keeping the body in a sustained, balanced position (2016). MSA-C is defined by cerebellar ataxia in which an individual faces complications with muscle coordination (2016). This may present as speech slurring, trouble focusing one’s eyes, or difficulty swallowing or chewing (Mayo Clinic, 2020). 

As of right now, there is no conclusive reasoning for why MSA occurs in the population; however, it is thought for the cause of the disorder to be a conglomerate of genetic and environmental elements (2020). By examining the brain and spinal cord of those who were impacted by MSA, researchers saw a significant shrinkage of the cerebellum, basal ganglia, and brainstem (Mayo Clinic, 2020). All three structures are crucial in their involvement for motor learning, balance, and coordination of body movements (Johns Hopkins Medicine, n.d.). Affected brain tissue has been revealed for neurons in the brain and spinal cord to be composed of an abnormal amount of alpha-synuclein protein, which form clumps, or inclusions, throughout the nervous system (n.d.). Accumulations of alpha-synuclein protein over nerve cells can block proper cell signaling, leading to a progressive loss of control in coordination and motor functions (n.d.). Studies suggest that variations in the SNCA gene, which encodes for the alpha-synuclein protein, have been associated with a greater risk of MSA (MedlinePlus, 2016). 

Unfortunately, no cure has been found for MSA. Although all individuals with MSA experience varying levels of the disorder throughout their years, the symptoms do not decrease in severity. The progression of the condition leads to a greater degree of difficulty in maintaining daily activities with further secondary complications (Mayo Clinic, 2020). 

 

References

Johns Hopkins Medicine. (n.d.). Brain anatomy and how the brain works. https://www.hopkinsmedicine.org/health/conditions-and-diseases/anatomy-of-the-brain

Kandola, A. (2020, January 10). What is the autonomic nervous system? Medical News Today. https://www.medicalnewstoday.com/articles/327450#function

Mayo Clinic. (2020, May 21). Multiple system atrophy (MSA). https://www.mayoclinic.org/diseases-conditions/multiple-system-atrophy/symptoms-causes/syc-20356153

MedlinePlus. (2016, July 1). Multiple system atrophy. National Library of Medicine. https://medlineplus.gov/genetics/condition/multiple-system-atrophy/

Categories
Neurocognitive Disorders Neurodegenerative Disorders

What is Mild Cognitive Impairment?

“I literally had my phone just a second ago…. Where could it have gone?” Most humans have this exact thought play out countless times with a various number of items throughout their lives. The act of forgetting is one thing all humans do, intentionally or unintentionally, and for the most part, it is a daily occurrence. People don’t often pay much attention to what they forget, because for the things they must remember, they try to put a special mental emphasis on it so that it won’t slip their minds. Still, there’s a section of the population, who no matter how much mental emphasis they place on remembering something, they just can’t. Depending on what exactly they cannot remember, those people may have mild cognitive impairment, MCI, and they may have to seek out professional help to assist them in handling the symptoms that impact their way of life (Mayo Clinic, 2020).  

Mild cognitive impairment, MCI, is classified as the “area between the expected cognitive decline of normal aging and a more serious decline of dementia” (2020). An important note is that people with MCI can stay in this intermediary zone and not progress to dementia (2020).  MCI is characterized by an abnormal increase in issues with memory, language, thinking or judgment and those with MCI are aware and conscious that they have some sort of decline (2020). There really are no other specific symptoms, other than a decline in the areas previously discussed. For individuals with MCI, there is a level of understandable anxiety that stems from this decline because when or if the decline will stop, can be uncertain  (2020).

The main difference between MCI and Alzheimers or other dementia-like disorders is that the decline does not progress to the point where the individual cannot carry out daily activities without additional help (Memory and Aging Center, 2022). People with MCI use written reminders and notes to help pick up the parts of their memory that are lacking (Memory and Aging Center, 2022). Additional help is seen as the need for home health aids or care providers to help someone function in their daily lives, which people with MCI do not need. 

While MCI is associated with aging and usually not extremely intrusive to functioning, it is necessary to seek the help from a medical professional when you or a loved one begin to exhibit some neurological decline. The reason being that there may be an underlying greater cause of MCI-like symptoms that can be more severe in nature if untreated. For example, some of these underlying causes are sleep apnea and a Vitamin B12 deficiency (Hamilton, 2022). For those who may be unfamiliar with sleep apnea, it is defined as the “repeated stop and start of breathing while sleeping” (Mayo Clinic, 2020). Sleep apnea can lead to a similar neurological decline in individuals with MCI.  Luckily, these causes when uncovered are easily treatable, with the use of Continuous positive airway pressure machines, CPAP, for sleep apnea or Vitamin B12 supplementation for the deficiency (Hamilton, 2022). However, another possible cause of MCI-like symptoms is Alzheimer’s disease. Alzherimer’s disease is classified as a “brain disease which causes a continuous decline in thinking, behavioral and social skills that affects a person’s ability to function independently” (Mayo Clinic, 2022). Around a third of the patients who are diagnosed with MCI, will be diagnosed with Alzheimer’s disease later on in life (Hamilton, 2022). One saving grace is that if caught early that someone’s MCI can be attributed to early stage Alzheimer’s disease, there are treatment plans that can try to delay the continued abnormal deterioration of that person’s memory and overall ability to be independent in caring for themselves (Hamilton 2022). 

The act of forgetting is something people of all ages do. The quality of one’s memory varies greatly from person to person, where not much attention is paid if one may have a slightly worse or better memory than another. Fortunately, many people with MCI can function and carry out their daily activities with a reliance on written reminders and notes, but it is important to see a medical professional if one believes they or their loved ones may have MCI. A couple of tests in a medical office will ensure that the MCI is not a symptom for a greater underlying cause. 

 

References

Clker-Free-Vector-Images. 2012. “Thinker Thinking Person – Free Vector Graphic on Pixabay.” Pixabay.com. April 11, 2012. https://pixabay.com/vectors/thinker-thinking-person-idea-28741/. 

“Mild Cognitive Impairment – Symptoms and Causes.” 2020. Mayo Clinic. 2020. https://www.mayoclinic.org/diseases-conditions/mild-cognitive-impairment/symptoms-causes/syc-20354578. 

“Mild Cognitive Impairment.” 2022. Memory and Aging Center. 2022. https://memory.ucsf.edu/dementia/mild-cognitive-impairment. 

Hamilton, Jon. “This Form of Memory Loss Is Common — but Most Americans Don’t Know about It.” 2022. NPR.org. March 18, 2022. https://www.npr.org/sections/health-shots/2022/03/18/1087042353/mild-cognitive-impairment-dementia-alzheimers-association-report. 

“Sleep Apnea – Symptoms and Causes.” 2020. Mayo Clinic. 2020. https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631. 

“Alzheimer’s Disease – Symptoms and Causes.” 2022. Mayo Clinic. 2022. https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/symptoms-causes/syc-20350447. 

Categories
Uncategorized

Companionship During Quarantine

The impact pets have on the lives of their owners is no secret, supporting them through both joyous moments and difficult times. This has remained true throughout the Covid-19 pandemic, with pet adoptions skyrocketing as people are forced to stay home (Hedgpeth, 2021). However, do pets truly impact our mental health in the way that we assume they do? A study focused on human-pet interactions in Malaysia wanted to test how pets can be used to treat mental health and general well being problems during prolonged periods of social isolation, as was the case with Covid-19 (Grajfoner et al., 2021).

The adverse effects of isolation in response to Covid-19 have been well documented over the past year or so, with many people reporting feeling anxious, depressed, bored, or lonely. In order to combat this feeling, many decided to turn to pet companionship when human interactions were not possible. In studying the effect that this decision had on the humans, especially when compared to those who did not have pets, Malaysia was chosen as the area of focus because there is relatively little data about human-animal interactions in Southeast Asia in general. The information gathered would be providing a new outlook into a certain idea, one potentially affected by social and cultural norms in that region.

From a total pool of 920 responses, 224 pet owners and 224 non-pet owners were chosen (Grajfoner et al., 2021). Of the pet owner’s, 122 were dog owners and 80 were cat owners. It should be noted that the sample is inconsistent with the actual ratio of types of pets owned, as of the 50% of Malasians households that owned pets, 71% of them had cats while less than 1.3% owned dogs (Grajfoner et al., 2021). That inconsistency aside, the individuals were from all over Malaysia and of varying ages, genders, marital status, education, etc., representing a diverse group of people.

The study had these individuals fill out various surveys rating their mental health and general wellbeing. The results reported that there were statistically significant differences between pet owners and non-pet owners, especially when it came to coping, self-efficacy, positive emotions, and psychological well-being, leaning in favor of pet owners (Grajfoner et al., 2021). The difference wasn’t large, but they did show that having pets improved the owner’s life in various areas of life, at least to a certain degree. Certain groups, such as those 65 and older, had to be removed from the study due to not having enough data to form a reliable conclusion from their responses. The outcome, however, remains the same, with pets improving daily life in certain aspects, although interaction with them did not result in a noticeable decrease in mental illnesses such as anxiety and depression. In fact, the prevalence of those illnesses within both sample groups remained roughly the same.

Interestingly enough, the studies done within groups focusing on pet owners and the different types of pets showed the most variations when it came to general wellbeing. Studies done in the UK and the United States claimed that owning dogs would result in the greatest benefit, as the physical act of walking a dog and other associated acts would lead to an improvement in wellbeing overall. This study done in Malaysia, however, found the opposite to be true, with the few cat owners present in this study reporting greater psychological wellbeing than the numerous dog owners (Grajfoner et al., 2021). The authors theorized that the act of feeding the cats, petting them, and overall engaging with them on an emotional level held more benefits for their owners than the physical activity that a dog could provide for its owner. Regardless, isolation during this pandemic has been difficult, and any form of respite, whether it be a walk with your dog or napping with your cat, is welcome.

 

References

Grajfoner, Ke, G. N., & Wong, R. M. M. (2021). The Effect of Pets on Human Mental Health and Wellbeing during COVID-19 Lockdown in Malaysia. Animals (Basel), 11(9), 2689–. https://doi.org/10.3390/ani11092689

Hedgpeth, D. (2021, January 7). So many pets have been adopted during the pandemic that shelters are running out. The Washington Post. Retrieved December 1, 2021, from https://www.washingtonpost.com/dc-md-va/2021/01/06/animal-shelters- coronavirus-pandemic/. 

Categories
Neurodegenerative Disorders

Neurodegenerative Disease of Unknown Source

Over the past year, a cluster of forty-eight cases of a distinct neurodegenerative disease arose in New Brunswick, Canada. The disease runs its course quickly, killing the individual in just a matter of months. In identified cases, there is an even split between women and men, and ages range from as old as 85 to as young as 18 (Murphy, 2021). Symptoms ranged from memory problems and muscle spasms to balance issues, vision deterioration, hallucinations, and extreme weight loss without any other underlying cause. Some individuals also experienced marked changes in behavior and pain in their limbs (Government of New Brunswick, 2021). 

Initially, this phenomenon was assumed to be Creutzfeldt-Jakob disease (CJD). Although CJD can be genetic in origin, some cases are iatrogenic, meaning the disease is transmitted surgically via direct contact with brain or nervous system tissue. It can also be contracted by eating meat from cattle infected by bovine spongiform encephalopathy (BSE), colloquially referred to as “mad cow disease”. Both CJD and BSE belong to a family of diseases called transmissible spongiform encephalopathies (TSEs), which are caused by misfolded proteins called prions. The word “spongiform” is used because the brains acquire numerous holes, taking on sponge-like appearances. CJD can present as symptoms of dizziness, loss of coordination, impaired memory and cognition, vision problems, and hallucinations, which is largely consistent with the New Brunswick cases (US Department of Health). 

To diagnose CJD or rule out any other diseases, physicians typically conduct spinal fluid tests, looking for specific polypeptide markers in the cerebrospinal fluid. However, upon examining spinal tap results, none of the New Brunswick cases had such proteins. Autopsies of the nine deceased individuals in the cluster also revealed no signs of CJD. Since this discovery, scientists have been searching for the source of the New Brunswick outbreak to no avail. Thus, the disease has been termed NBNSUC (New Brunswick Neurological Syndrome of Unknown Cause). 

Substantial evidence has now been accumulated for doctors to reach the consensus that this is a novel condition. While almost all the people studied in the cluster ate seafood like lobster, this is probably trivial and there is no evidence linking the symptoms to any particular food. Now scientists have directed their attention to neurotoxic environmental exposures, which they suspect are the culprit due to the geographical localization of the cases. Eight individuals reported that they may have been exposed to harmful algal blooms (Murphy, 2021). Blue-green algae, or cyanobacteria, are of particular concern, since they are known to produce four types of toxins,and neurotoxins are the rarest. When they do produce neurotoxins, it is often anatoxin-a, but all of them interfere with neuronal functioning at the synapse between nerve cells, causing symptoms like muscular paralysis (Hoff, 2007). However, there is no current evidence indicating the exposures in these cases elicited NBNSUC symptoms. 

Twenty-five individuals have also reported industrial exposures in their home or workplace, and twelve said they had possible indirect exposure to herbicides or pesticides. Interestingly, more than half of those surveyed said they regularly spent time gardening in the two years before the onset of their symptoms, and at least two people handled pesticides directly (Murphy, 2021). It would not be surprising if pesticides were to blame, as there is an abundance of literature supporting their neurotoxicity. Many pesticides are not highly selective, so in addition to targeting the nervous systems of organisms that pose a threat to crops, they can have unintentional effects on people. While insecticides target ion channels and have more of an acute, reversible toxicity, other pesticides have been associated with the development of chronic neurodegenerative disorders like Parkinson’s disease (Costa, 2007). However, since there is no concrete evidence to support this hypothesis either, for now, the root of this remains elusive (Government of New Brunswick, 2021).

 

References

Costa, L. G. (2008). Neurotoxicity of pesticides: A brief review. Frontiers in Bioscience, 13(13), 1240. https://doi.org/10.2741/2758 

Government of New Brunswick, C. (2021). New Brunswick cluster of neurological syndrome of unknown cause. Government of New Brunswick, Canada. https://www2.gnb.ca/content/gnb/en/departments/ocmoh/cdc/neuro_cluster.html. 

Hoff, B., Thomson, G., & Graham, K. (2007). Neurotoxic cyanobacterium (blue-green alga) toxicosis in Ontario. The Canadian veterinary journal = La revue veterinaire canadienne. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1780230/. 

Murphy, J. (2021). Doctors investigate Mystery Brain Disease in Canada. BBC News. Retrieved from https://www.bbc.com/news/world-us-canada-56910393. 

U.S. Department of Health and Human Services. (n.d.). Creutzfeldt-Jakob Disease Fact Sheet. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Creutzfeldt-Jakob-Disease-Fact-Sheet. 

Categories
Uncategorized

Queer and Here: Mental Illness with the LGBTQ+ Community

Mental health issues are widespread in this day and age, but within minorities, these issues are more prevalent, with members having higher rates of mental illness than seen in the general population. This remains true when examining the LGBTQ+ community, which has been marginalized for centuries. Studies involving queer or questioning individuals, both on their own and in comparison to their heterosexual counterparts, have shown this to be true.

A large part of the difference in the rates in mental illness stems from stigma and discrimination based on sexual orientation and gender identity, as the LGBTQ+ community has been clearly designated as “other” in the eyes of society (Veltman & Chaimowitz, 2014). This outsider status leads to fear and concern for safety, as individuals can experience verbal taunts, exclusion, and sometimes violence in very public areas such as parks, colleges, and restaurants (Vaccaro & Mena, 2011). All of this can lead to the presence of a wide range of mental illnesses, the most common among them being depression and anxiety.

Potential stressors aren’t located just outside the individual’s communities, however.  Individuals who identify as both queer and as people of color have stated that when it comes to racism, they feel well supported by their communities, with a support system in place if something were to ever happen (Vaccaro & Mena, 2011). However, although they can turn to others when it comes to racial issues, they do not have the same support exploring their sexual and gender identities and the problems that could arise if they were to freely attempt to express them. Part of this may be due to cultural and religious beliefs that being queer is a sin, or simply attempts to conform to societal standards as a minority group, one that faces threats of its own (Vaccaro & Mena, 2011).

Whatever the case may be, this leaves queer individuals of color without proper rolemodels, people who can guide them through what they are going through and provide advice specific to their experience as both a queer individual and a person of color, as the general experiences of the LGBTQ+ community does not factor in specific cultures and nationalities. These experiences, added on top of the strugge to figuring out your identity and undergoingthe process of living life, ultimately build up the stress queer individuals face. 

With this in mind, it’s no surprise that 26% of queer students report severe psychological distress, as opposed to 18% of non-queer students, and were 1.87 times more likely to use the mental health resources offered by their college than other students (Dunbar et. al, 2017). It is also interesting to note that different racial groups responded differently to the issues arising from mental health, with their coping strategies different from one another. In this particular study, queer black students reported more engagement in religious activities, while queer Latino students had higher levels of social activity (Vaccaro & Mena, 2011). What remained the same, however, was the importance of a social support system in handling mental illness, especially as an individual belonging to multiple marginalized groups.

 

References

Dunbar, Sontag-Padilla, L., Ramchand, R., Seelam, R., & Stein, B. D. (2017). Mental Health Service Utilization Among Lesbian, Gay, Bisexual, and Questioning or Queer College Students. Journal of Adolescent Health, 61(3), 294–301. https://doi.org/10.1016/ j.jadohealth.2017.03.008

Vaccaro, & Mena, J. A. (2011). It’s Not Burnout, It’s More: Queer College Activists of Color and Mental Health. Journal of Gay & Lesbian Mental Health, 15(4), 339–367. https://doi.org/ 10.1080/19359705.2011.600656

Veltman, & Chaimowitz, G. (2014). mental health care for people who identify as lesbian, gay, bisexual, transgender, and (or) queer. Canadian Journal of Psychiatry, 59(11), 1–8.

Categories
Neurocognitive Disorders Neurodegenerative Disorders Uncategorized

Neurogenesis: Remembering or Forgetting

Neurogenesis refers to the process of developing new nerve cells from multipotent neural stem cells, and it is essential during embryonic and infant brain development. While it also occurs throughout adulthood, it is restricted to specific parts of the brain as we age. These areas include the ventricular-subventricular zone (V-SVZ) and the subgranular zone (SGZ) of the dentate gyrus, a hippocampal structure important for episodic memory formation.  Episodic memories are long-term memories characterized by conscious recollection of past events and experiences.

As we learn from experiences throughout life, our brains are predominantly developing through the formation of new synaptic connections rather than increasing in number of neurons. In healthy brains, old connections are also pruned over time to ensure proper brain functioning if they are no longer necessary. However, the number of neurons becomes pertinent when we take neurodegenerative conditions such as Alzheimer’s and dementia into consideration, wherein abnormally configured beta amyloid proteins accumulate in the brain. This forms sticky plaques which are thought to contribute to brain atrophy by disrupting synaptic transmission, eventually eliciting cell death. In simpler terms, conditions that involve neuronal cell death highlight the importance of processes that increase the number of neuronal cells. Thus, studying adulthood neurogenesis in brain areas related to memory in order to see what promotes this proliferation may provide insight into how we can maximize brain and memory maintenance. 

Some studies done on mice suggest that exercise, and particularly aerobic exercise results in the incorporation of new neurons into hippocampal pathways. A molecule called brain derived neurotrophic factor, or BDNF, plays an integral role in this process. As exercise duration and intensity increase, so does BDNF concentration. Periodic moderate exercise over prolonged periods of time was determined to be optimal for increasing neurogenesis (Liu, 2018). 

Since exercise and neurogenesis appear to promote brain health, one would assume they protect against episodic memory deterioration as well. However, the opposite is true: neurogenesis also plays a key role in forgetting, and studies involving infantile amnesia showcase this interesting phenomenon. Contrary to Sigmund Freud’s reasoning that we have repressed early childhood memories because they are unacceptable or traumatic, one study posits that the formation of new neuronal cells during infancy is the reason why most of us can’t remember anything from that period of our lives. In the study, both adult and infant mice were trained and then tested to assess the maintenance of their memory. Under baseline conditions, the infants appeared to retain the memory of the training experience for a short time, but that memory was not maintained over a longer duration, as opposed to the adult mice which had no problems with their recall. However, when the adult mice were provided with exercise wheels, increased neurogenesis created weaker, shorter-lasting memories of the training experience (Ackers, 2014).

A group of infant mice were then treated with a drug called temozolomide (TMZ) which is known to prevent neurogenesis by preventing mitotic cell division. Surely enough, blocking neurogenesis in the infant mice resulted in stronger memories, essentially undermining infantile amnesia. Like humans, when mice are born they are unable to remember anything without such a treatment. However, there are similar rodent species that are precocial, meaning they are born more developed. Thus, for instance, when guinea pigs were tested, there was no difference between memory maintenance in adults and infants, as both groups had already completed most of their neurogenesis. Also as expected, exercise decreased their memory maintenance and induced infantile amnesia by promoting neurogenesis. This converging evidence therefore suggests that neurogenesis can also play a role in forgetting under certain conditions. The fact that neurogenesis may be involved in both remembering and forgetting processes may seem counterintuitive, but it does link neurogenesis to infantile amnesia, despite its long-standing association with memory promotion (Ackers, 2014).

 

References

Akers, K. G., Martinez-Canabal, A., Restivo, L., Yiu, A. P., De Cristofaro, A., Hsiang, H.-L. (L., et al. (2014). Hippocampal neurogenesis regulates forgetting during adulthood and infancy. Science, 344(6184), 598–602. doi:10.1126/science.1248903 

Josselyn, S. A., & Frankland, P. W. (2012). Infantile amnesia: A neurogenic hypothesis. Learning & Memory, 19(9), 423–433. doi:10.1101/lm.021311.110 

Liu, P. Z., & Nusslock, R. (2018). Exercise-mediated neurogenesis in the hippocampus via BDNF. Frontiers in Neuroscience, 12(7). doi:10.3389/fnins.2018.00052