Category: Neurocognitive Disorders

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/

“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. 

Parkinson’s disorder is a neurodegenerative disorder that primarily affects movement. However, this neurodegenerative disorder is rare in young adults, and normally appears in adults aged 60 or older. Symptoms of Parkinson’s disorder often occur gradually, and different symptoms may appear in different people. Regardless, these symptoms progressively worsen overtime. Symptoms of Parkinson’s disorder may include tremors that usually occur or begin in the limb area or fingers and hands, slowed movement, also called bradykinesia, rigid or stiff muscles, impaired posture and balance, loss of automatic or unconscious movements, changes in speech, and difficulty writing. Early signs and symptoms of Parkinson’s disorder may go unnoticed since they can be mild to detect, and symptoms usually begin on one side of the body and continue to worsen on that side, even after symptoms begin to affect both sides (Parkinson’s disease – Symptoms and causes). 

Typically, Parkinson’s disorder occurs in stages ranging from one to five. Stage one consists of mild symptoms that do not interfere with daily activities as much, and these include tremors or other movement symptoms that typically occur on one side of the body. Additionally, stage one consists of changes in posture, facial expressions, and walking that are often mild. Stage two consists of worsened tremors, rigidity in muscles, and movement symptoms that affect both sides of the body. During stage two, daily tasks start to become more difficult to perform and take longer to do so. Stage three consists of a loss of balance, bradykinesia, and an increase in falls. Throughout stage three, the individual can still live independently and perform tasks independently. However, symptoms tend to make daily tasks such as dressing and eating a bit more difficult. Stage four consists of limiting and severe symptoms to an extent where the individual may require a walker, and the individual needs assistance with daily activities of living, so the individual cannot live independently. Lastly, stage five consists of stiffness in the legs that make it impossible to stand or walk, hallucinations or delusions, and the individual may be bedridden or require a wheelchair. Stage five normally requires consistent nursing care (Treatment).

Parkinson’s disorder is caused by the gradual breakdown or death of neurons, which are known to produce a chemical neurotransmitter called dopamine. This decrease in dopamine levels results in abnormal brain activity that leads to impaired movement as well as the non-motor symptoms of Parkinson’s disorder (Parkinson’s disease – Symptoms and causes). The specific neurons that are lost are called dopaminergic neurons (Tysnes and Storstein, 2017). Although the exact cause of this loss in neurons is unknown, there are many factors that seem to play a role in their loss, including genetic mutations, exposure to environmental toxins, the presence of lewy bodies, and alpha-synuclein found in lewy bodies (Parkinson’s disease – Symptoms and causes). Researchers believe that clumps called lewy bodies, especially those filled with the protein alpha synuclein, are markers of Parksinson’s disorder (Tysnes and Storstein, 2017). 

The cure for Parkinson’s disorder is unfortunately unknown. Additionally, treatment for Parkinson’s varies based on the symptoms the individual experiences. For instance, some people may benefit and alleviate some symptoms through lifestyle changes such as exercise and more rest, whereas others may be recommended medication or surgical therapy (Treatment). Luckily, advances in Parkinson’s research are being made and may improve future course of treatments. 

References

Tysnes, O. and Storstein, A., 2017. Epidemiology of Parkinson’s disease. Journal of Neural Transmission, 124(8), pp.901-905.

Mayo Clinic. n.d. Parkinson’s disease – Symptoms and causes. [online] Available at: <https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/symptoms-causes/syc-20376055> [Accessed 26 April 2021].

Parkinson’s Foundation. n.d. Treatment. [online] Available at: <https://www.parkinson.org/Understanding-Parkinsons/Treatment> [Accessed 26 April 2021].

When thinking about neurocognitive diseases, the most common examples that arise are usually dementia, Alzheimer’s disease, and cognitive dysfunction brought upon by traumatic brain injury. A more unknown neurocognitive affliction is Creutzfeldt-Jakob Disease, a disease in which there are only about 350 known cases in the United States per year, and affects about one in a million people per year worldwide, making it pretty rare (National Institute of Neurological Disorders and Stroke, n.d). Though rare, the disease works rapidly and degenerates brain capability to be fatal in a relatively short amount of time (National Institute of Neurological Disorders and Stroke, n.d). 

Creutzfeldt-Jakob Disease is more common in the age range of sixty years old and above and is so severe that almost seventy percent of those afflicted die within the span of a year (National Institute of Neurological Disorders and Stroke, n.d). This destruction is caused by “prions which are misfolded prion proteins that build up in the brain and cause other prion proteins to misfold as well,” (NHS Choices, n.d.). In an article in Global Genes, a woman writes of her husband who was at first misdiagnosed with severe onset Alzheimer’s, and later found out that he was in fact battling Creutzfeldt-Jakob Disease. She says “I do believe there is hope, hope for all affected by these rare diseases but we must be diligent, passionate and willing to do anything we can to help those affected and their families,” after sharing her family’s story of caring for her husband.

With stories like that and with the quick statistics one can find on the disease, Creutzfeldt-Jakob Disease seems daunting and catastrophic. And while research on the disease is still in its infancy and there is no cure to date, scientists are working on how to combat and learn more about this disastrous disease. In News for Medical and Life Sciences, it was reported from a scientific journal that “National Institutes of Health scientists have used human skin cells to create what they believe is the first cerebral organoid system, or “mini-brain,” for studying sporadic Creutzfeldt-Jakob disease,” and with research like this, they expect to be able to find more ways to examine and create new therapeutics to treat Creutzfeldt-Jakob disease (Ives, 2019). The NIH also shared that “Researchers are examining and characterizing the prions associated with CJD and trying to discover factors that influence prion infectivity and transmission, and how the disorder damages the brain” (National Institute of Neurological Disorders and Stroke, n.d). New scientific strategies like this could open up many more methods of learning about neurodegenerative diseases. 

References

“Creutzfeldt-Jakob Disease Fact Sheet.” National Institute of Neurological Disorders and Stroke, U.S. Department of Health and Human Services, www.ninds.nih.gov/disorders/patient-caregiver-education/fact-sheets/creutzfeldt-jakob-disease-fact-sheet. 

NHS Choices, NHS, www.nhs.uk/conditions/creutzfeldt-jakob-disease-cjd/causes/. “A Shattered Life: The Last Days With Creutzfeldt-Jakob Disease.” Global Genes, 16 June 2016, globalgenes.org/2016/06/16/a-shattered-life-the-last-days-with-creutzfeldt-jakob-disease. 

Ives, Reviewed by James. “Scientists Create ‘Mini-Brain’ for Studying Sporadic Creutzfeldt-Jakob Disease.” News, 16 June 2019, www.news-medical.net/news/20190616/Scientists-create-mini-brain-for-studying-sporadic-Creut zfeldt-Jakob-disease.aspx.

Finding changes from day to day can be a difficult task, especially when noticing a significant difference in someone close to you. How silly that grandma seemed to confuse your birthday with your brother’s, or forgot the last digits of her phone number at dinner last night? She must have been tired. This could be the case- but after too many incidences, it might be best to take your loved one to a doctor. Getting an early diagnosis can help alleviate obstacles and anxieties not only for them but for you and the rest of their support network. Looking at how to get help may be one of the first concerns after getting diagnosed, and with so much material information out on the web, it could be difficult to navigate. Being able to get a diagnosis relatively early is crucial in being able to sort “legal, financial, and long-term planning” to allow fewer anxieties and a better focus on how life goes on (Alzheimer’s Association, n.d.). It is also crucial because it can mean the difference between being able to participate in clinical trials or any other currently available treatments (Alzheimer’s Association, n.d.). Planning will ultimately help everyone involved know how to navigate this new normal. 

In maintaining daily life, the most important course of action is to maintain a daily routine, maybe one similar to before, but adjusted to allow the space for time with a network of those closest to them and other necessities. As a caretaker or family member, it is best to have a clear understanding of what you can do to help at any given time. Whether it be dealing with anxieties or stress, or maybe normal duties like grocery shopping, having honest communication is the key to keeping a routine.  

It is important to establish mutual respect in communication, and showing that asking for help is not something to be ashamed of, or to shy away from. It is encouraged for the caretaker to seek this ease and honesty because a person with Alzheimer’s may have some feelings of helplessness, and it is important to be on the same page in which it is alright on both sides. Providing choices for things such as the types of long-term care they feel comfortable with, or choosing to participate in clinical trials helps in respecting their autonomy and sense of self (National Institute on Aging, n.d.). There are many resources available for seeking guidance and help, and that can start with speaking to a doctor early in order to have more choices, and more time to plan.

References 

“Early-Stage Caregiving.” Alzheimer’s Disease and Dementia, www.alz.org/help-support/caregiving/stages-behaviors/early-stage.

“Getting Help with Alzheimer’s Caregiving.” National Institute on Aging, U.S. Department of Health and Human Services, www.nia.nih.gov/health/getting-help-alzheimers-caregiving.

Lewy body dementia (LBD) is the second most common form of dementia after Alzheimer’s disease dementia (Lewy body dementia – Symptoms and causes ). LBG specifically results from a deposit of protein alpha-synuclein in the brain in abnormal quantities.These deposits are known as lewy bodies. Alpha-synuclein plays important roles in the functioning of a healthy brain, especially within neurons and synapses. However, as a result of alpha-synuclein clumping in the neurons of areas of the brain that control memory and movement, neuronal death can eventually occur. Additionally, lewy bodies affects multiple brain regions such as the cerebral cortex, limbic cortex, hippocampus, midbrain and basal ganglia, as well as the brain stem. As a result, LBD can result in problems that involve thinking, movement, behavior, and mood (LBD ). 

The exact cause of LBD is unknown, however there has been research focused on its biology and genetics to learn more about the precise causes. Lewy body accumulation results in neuronal death of certain neurons that are often involved in the production of two neurotransmitters. One of these neurotransmitters is acetylcholine, which is important for memory and learning. Other information researchers have gathered regarding the possible risk factors for LBD include age, Parkinson’s disorder, REM sleep behavior disorder, and even genetics. Individuals over the age of 50 tend to be at a higher risk for onset of LBD. Although LBD is not a genetic disease, variants in the genes APOE, SNCA, and GBA have been linked to having an increased risk for LBD (LBD ).  Additionally, it has been shown that males are more likely to be affected by LBD than females (Lewy body dementia – Symptoms and causes ). 

There are two diagnoses of LBD, including dementia with lewy bodies (9DLB) and Parkinson’s disease dementia (PDD) (LBD). Both DLB and PDD have similar symptoms, and have the same biological changes in the brain, however they differ in the early signs of onset. LBD results in cognitive impairments in attention and executive and visuo-perceptual abilities. Patients with LBD present with a variety of neuropsychiatric symptoms, such as visual hallucinations, systematised delusions, apathy, aggression, anxiety and depression. Other symptoms that many DLB patients experience include motor difficulties (Taylor, McKeith and Burn, 2019). 

Due to the variation in the types of symptoms LBD patients may experience, LBD treatment and care can involve a variety of care takers, especially because LBD cannot be prevented or cured. For instance, physical therapists can assist with motor difficulties, speech therapists can assist with swallowing difficulties or voice projection, occupational therapists can assist in carrying out everyday activities such as eating and bathing, music or art therapists can assist by providing therapeutic activities that can help patients overcome anxiety and depression, and mental health counselors can help patients with neuropsychiatric symptoms as well (LBD ). Other than relying on support provided by healthcare workers and care takers, certain symptoms can be treated utilizing prescribed medication. Studies have shown that the cholinesterase inhibitors (ChEI) donepezil and rivastigmine medications were similarly effective in both DLB and PDD for improving cognition (Taylor, McKeith and Burn, 2019). From medications to having a support team, there are many hopes in assisting patients with LBD so that they can better manage their symptoms.

References

Mayo Clinic. n.d. Lewy body dementia – Symptoms and causes.

National Institute on Aging. n.d. What Is Lewy Body Dementia?.

Taylor, J., McKeith, I. and Burn, D., 2019. New evidence on the management of Lewy body dementia. Lancet Neurology, [online] pp.1-9.