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Addiction Neurocognitive Disorders Neurodegenerative Disorders

What is Alcohol-Related Dementia?

Excessive consumption of alcohol over a long period of time would create a grave risk for anyone of any age or health status. Not only does it make you regret it the next day with a killer hangover, but long-term abuse of alcohol can lead to chronic diseases and other health issues such as liver disease, high blood pressure, heart disease, stroke, digestive problems, and countless more (CDC, 2021). The connection between alcohol and these health problems has been studied by researchers since the last century, but alcohol-related dementia (ARD) has scientists interested in links between alcohol and dementia, along with the connection to Korsakoff’s Syndrome. (Alzheimer’s Association, n.d.). 

As dementia is not a specific disease but more of a collective term for impairment of the mind, (thinking, memory, function in daily life), alcohol-related dementia is defined as brain damage acquired from long-term excessive drinking (Alzheimer’s Society, n.d.) This impairment does not have strict parameters but can involve problems in regular daily life, such as difficulty solving problems, memory lapses, and impaired judgment. 

Measuring and calculating alcohol abuse is not black and white, but knowing when to get help and seek treatment is crucial in combating and avoiding alcohol-related dementia. An occasional cocktail at a party or special occasion can be fine, as moderation is the most important factor, but an excess would be a cause for concern for multiple health problems. “Heavy drinking” is defined by the Centers for Disease Control and Prevention as consuming “eight or more drinks per week” for women and “fifteen or more drinks per week” for men (CDC, 2021). And just as being under the influence can cause a person to lose balance and maybe cause falls due to unsteady feet, alcoholic dementia can bring about a more serious, continual loss of coordination (Alzheimer’s Society, n.d.). The damage to your liver alone should be enough of a deterrent to try and avoid regular excessive drinking, but as there is more research on the mental decline that could be associated with years of abuse, alcohol-related dementia has been brought to people’s attention. 

Conversely, a syndrome of alcohol-related dementia is Wernicke-Korsakoff syndrome. Alcohol does not directly cause the syndrome. However, it is correlated because of the brain damage that occurs due to a deficiency of vitamin B1, or thiamine (VeryWell Mind, n.d.). With a deficiency of vitamin B1, “brain cells do not produce enough energy to function properly,” and so the syndrome commonly afflicts chronic alcoholics who tend to have a deficiency in thiamine due to a poor diet (VeryWell Mind, n.d.). 

The most tragic part of the afflictions of alcohol-related dementia is that in some cases it is preventable and treatable. Alcoholism is a serious disorder just like any other, and to see someone wither away from such a devastating ordeal is difficult, especially as much more research needs to be done to get a complete picture of the effects of this specific type of dementia. Getting help in combating alcoholism and becoming sober is the first step in preventing an otherwise dire predicament. 

 

References

“Drinking Too Much Alcohol Can Harm Your Health. Learn the Facts | CDC.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 23 Feb. 2021.

“Korsakoff Syndrome | Symptoms & Treatments | Alz.Org.” Alzheimer’s Disease and Dementia, Alzheimer’s Association.

“Alcohol-Related ‘Dementia’ | Alzheimer’s Society.” Alzheimer’s Society, https://www.alzheimers.org.uk/about-dementia/types-dementia/alcohol-related-dementia. Accessed 22 Mar. 2021. 

“An Overview of Alcoholic Dementia.” Verywell Mind, https://www.verywellmind.com/alcohol-dementia-62980. Accessed 22 Mar. 2021.

Categories
Neurocognitive Disorders Neurodegenerative Disorders

Living With Alzheimer’s

In most depictions of the media, Alzheimer’s is depicted as a fast-paced tornado. It is shown to be a disease that sweeps a person up within months. But as scientists still have much to discover about the disease and its variability from person to person, it’s important to learn how to approach this diagnosis and have a support network with your physician and loved ones. 

Following a diagnosis, maintaining one’s day-to-day life, focusing on their health, and making adjustments become the main priorities for a person. This prioritization of routine is essential because it’s been found that “up to 40 percent of people with Alzheimer’s disease suffer from significant depression, and research by Rabins and colleagues underscores the importance of evaluating and offering treatment to someone who appears sad, apathetic, and altogether disinterested in life” (Graham, 2017). The loss of routine and improper follow-up on checking for depression and anxiety are big concerns with a diagnosis of Alzheimer’s. Signs of depression may prove more difficult to spot, especially as cognitive functions decline. Indications for depression may be different as it may be “less severe, it may not last as long and symptoms may come and go” (Alzheimer’s Association, n.d.). Following up with a geriatric psychiatrist or therapist would be advisable while noting any problems such as “social withdrawal, irritability, fatigue, sleep disruption, and more” after a diagnosis (Alzheimer’s Association, n.d.). 

Building an effective and nurturing support system needs good communication. Asking for help can be a challenge for anyone and being diagnosed with Alzheimer’s can bring concerns about individuality and independence. Maintaining one’s independence is one of the major concerns for people in the early stages of Alzheimer’s. “You may feel that by asking others for help, you will lose your sense of self or become dependent. While it may seem like a sign of weakness at first, asking for help when you need it may help you maintain your independence and remain in control” (Alzheimer’s Association, n.d.). Having an honest talk with a caretaker or family member can make a huge difference, and can help bridge feelings of helplessness.

On that note, communication is the bedrock of maintaining a semblance of normality and keeping life on track. As impairment increases in severity, continuing to communicate effectively may need to change in perception and practice. “You have to understand that when you have dementia you lose a lot of your natural perceptions of what others are doing” (Graham, 2017). So keeping up clear communication can aid in overcoming any uneasiness or misinterpretations. It is also necessary to “respect autonomy and individuality” because Alzheimer’s is a disease that affects lives deeply, but should not reduce or eclipse the person it affects (Graham, 2017). 

Strategies for caretakers are also necessary for facilitating the rhythm of daily life. “Setting goals, being flexible, anticipating misinterpretation, and enjoying the present” are just some of the focuses that should be done in keeping life coordinated (UCSF Health, 2020). “Many people with Alzheimer’s disease remain physically fit and retain their ability to be comfortable and involved in social situations quite late in the disease. Therefore, they continue to socialize, travel, be physically active, and participate in activities that are enjoyable and creative. Often, familiar activities will continue to be enjoyable for a person with AD and should be encouraged” (UCSF Health, 2020). 

Adjusting and accepting this change in lifestyle can be difficult, but having caretakers and loved ones communicate effectively is critical for staying on track. “Absence of a clear and direct diagnosis means that personal care preferences, pharmacological interventions, and appropriate support mechanisms may be more difficult to put in place” (Beyer, 2019). Therefore, being watchful of one’s health and having the resources to be diagnosed early if needed is vital to being able to organize and prepare for life after a diagnosis.

 

References 

Graham, Judith. “How To Help Alzheimer’s Patients Enjoy Life, Not Just ‘Fade Away.” Kaiser Health News, 14 Sept. 2017, khn.org/news/how-to-help-alzheimers-patients-enjoy-life-not-just-fade-away/. 

“Depression.”9 (n.d.) Alzheimer’s Disease and Dementia, www.alz.org/help-support/caregiving/stages-behaviors/depression. 

“Tips for Daily Life.” (n.d.) Alzheimer’s Disease and Dementia, www.alz.org/help-support/i-have-alz/live-well/tips-for-daily-life. 

UCSF Health. “Coping Strategies for Alzheimer’s Disease Caregivers.” Ucsfhealth.org, UCSF Health, 6 Oct. 2020, www.ucsfhealth.org/education/coping-strategies-for-alzheimers-disease-caregivers. 

Beyer, Anna Lee. “Here’s Why Denying That Your Loved One Has Dementia Can Be Dangerous.” Healthline, 24 Apr. 2019, www.healthline.com/health/mental-health/dementia-denial-dangerous.

Categories
Neurocognitive Disorders Neurodegenerative Disorders

Understanding Alzheimer’s and Dementia Outside the Silver Screen

The Notebook (2004) is probably one of the most recognized classic love stories in the 21st century. Everyone knows the ending of the beloved romantic comedy: two soulmates reunite after seven years and the notebook is their story written by the protagonist Allie, and her husband Noah reads it to her as she battles a type of dementia. This is just one of the more famous portrayals of dementia and Alzheimer’s on TV and in movies. But as these portrayals are plentiful, they may not always be 100% accurate, and these two subjects can often become convoluted. 

Alzheimer’s disease, which affects roughly 5.8 million people in the United States, is a neurological disorder that progresses over time and causes the brain to shrink (atrophy) and brain cells to die (Mayo Clinic). As usually portrayed on TV, Alzheimer’s usually does afflict people over the age of 65, 80% of them being 75 years and older (Mayo Clinic). Where the depictions can get a little muddled is just how fast symptoms can escalate and how it can vary from person to person.

Dementia is not a specific disease like Alzheimer’s. Instead, it is a general term for the impaired ability to think, remember, or make decisions that can impede someone’s everyday life (CDC). In The Notebook, Allie is said to have dementia, but the exact type is never explicitly named. In the movie, she is shown to sometimes have periods of clarity, and sometimes abruptly lose her memory and her bearings. Since signs and symptoms can vary from person to person, these lapses in memory, attention, and communication can worsen at varying degrees and speeds. 

Alzheimer’s can be categorized into five stages: preclinical Alzheimer’s disease, mild cognitive impairment, mild dementia, moderate dementia, and severe dementia due to Alzheimer’s disease (Mayo Clinic). This progression of severity is depicted in the film Still Alice (2014), as we see the protagonist grapple with coming to terms that she and her family have to acknowledge the difference in her behavior and seek help. 

There is still much to learn about Alzheimer’s, and research is prevalent in finding out more on the causes, which are still not well understood. For instance, it’s essential to know that a diagnosis cannot be ruled out entirely to factors such as age, as it’s reported that early-onset Alzheimer’s has arisen as early as 30 years old in about 5% of those afflicted (USC). The genetic and physiological aspects that contribute, as well as investigating any connections it could have with other ailments, are at the forefront of what scientists are looking for. 

The cause of this illness has not yet been discovered, and Alzheimer’s is a disease that still has much to be researched. One of the most important contributions we can make to our loved ones is paying attention to anything outside of the norm. Forgetting your keys while rushing to work is usually just a slip-up that can happen to anyone, but gradual unusual behavior should not be swept under the rug.

 

References

“5 Myths About Alzheimer’s Disease:” Keck Medicine of USC, 8 Nov. 2019, www.keckmedicine.org/5-myths-about-alzheimers-disease/. 

“Alzheimer’s Disease.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 29 Dec. 2020, www.mayoclinic.org/diseases-conditions/alzheimers-disease/symptoms-causes/syc-20350447. 

“What Is Dementia?” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 5 Apr. 2019, www.cdc.gov/aging/dementia/index.html#:~:text=Dementia%20is%20not%20a%20specific,most %20common%20type%20of%20dementia. 

“What to Know about the Stages of Alzheimer’s.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 19 Apr. 2019, www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers-stages/art-200 48448.

Categories
Addiction Neurocognitive Disorders Neurodegenerative Disorders Somatic Symptom and Related Disorders

A General Introduction to Medication-Induced Movement Disorders

For every time we turn on the television, we often land on a commercial involving joyous people while promoting a certain medication and its side effects. In addition, we’re always notified about the side effects such as heart failure, seizures, or death that might potentially happen. As bothersome and even morbid as it may be to hear or think about, side effects like this can happen when you’re on prescribed medications. This is known as medication-induced movement disorders.

According to the DSM-5, the definition of medication-induced movement disorders is included because “the management by medication of mental disorders or other medical conditions and the differential diagnosis of mental disorders (e.g., anxiety disorder versus neuroleptic-induced akathisia; malignant catatonia versus neuroleptic malignant syndrome)” (American Psychiatric Association, 2013 p. 709) According to a study conducted by scholars Stephen R Duma, John Morris, and Victor SC Fung, one of the most common culprits that causes movement disorders is antipsychotics and antiemetics (Duma, Fung, & Morris, 2019). Therapeutic and illicit drugs can potentially cause neurological adverse effects and movement disorders. However, if there is early intervention, there is a probability that these effects can be reversed or prevented.

The DSM-5 has divided the definition of medication-induced movement disorders into multiple sections as it has a myriad of effects on an individual. Furthermore, it is important to emphasize that the following disorders are not mental disorders, but instead are disorders that impact the individual physically.  The following disorders include medication-induced acute dystonia, medication-induced acute akathisia, tardive disorders including dyskinesia, dystonia, and akathisia. While there are a few notable differences in each movement disorder, generally symptoms include irritability, restlessness, excessive and sporadic movements, and the inability to sit or stand still (American Psychiatric Association, 2013 p. 711).

Acute drug-induced movement disorders are one of the common medication-induced movement disorders. It is described to “occur within minutes to days of drug ingestion. They include akathisia, tremor, neuroleptic malignant syndrome, serotonin syndrome, parkinsonism-hyperpyrexia disorder and acute dystonic reactions” (Duma, Fung, & Morris, 2019). According to the DSM-5, medication-induced acute dystonia causes “Abnormal and prolonged contraction of the muscles of the eyes (oculogyric crisis), head, neck (torticollis or retrocollis), limbs, or trunk developing within a few days of starting or raising the dosage of a medication (such as a neuroleptic) or after reducing the dosage of a medication used to treat extrapyramidal symptoms” (American Psychiatric Association, 2013). 

Akathisia is actually a common yet an identifiably difficult medication-induced movement disorder that is the result of experiencing side effects from prescribed antipsychotic or antidepressant medication.When it comes to acute akathisia, an individual would display what the DSM-5 describes as “complaints of restlessness, often accompanied by observed excessive move­ments (e.g., fidgety movements of the legs, rocking from foot to foot, pacing, inability to sit or stand still), developing within a few weeks of starting or raising the dosage of a medi­cation (such as a neuroleptic) or after reducing the dosage of a medication used to treat ex­trapyramidal symptoms” (American Psychiatric Association, 2013). 

Tardive dyskinesia disorder blocks the brain chemical known as dopamine and can cause visible side effects in your limbs. This includes involuntary thrusting, kicking, waving your arms, and tapping your foot. Studies have also shown that a person who is on antipsychotic medication is more likely to experience these symptoms if they are middle aged. The DSM-5 explains that tardive dystonia and akathisia disorders “are distinguished by their late emergence in the course of treatment and their potential persistence for months to years, even in the face of neuroleptic discontinu­ation or dosage reduction” (American Psychiatric Association, 2013). 

Having perpetual tremors would seem exhausting and would get in the way of everyday tasks naturally. As far as treating any of the following disorders would go, it would involve withdrawal from the drugs and adjusting the dosage or being weaned off of it completely. However, there isn’t a specific treatment that exists for movement disorders that were a result from illicit drug use.

 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Duma, S., & Fung, V. (2019, April). Drug-induced movement disorders. Retrieved March 09, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6478951/

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Neurocognitive Disorders Neurodegenerative Disorders Uncategorized

What is Neuropathy?

Neuropathy, or peripheral neuropathy, results from damaged or dysfunctioning nerves. It is also commonly known as peripheral neuropathy because it can damage your peripheral nervous system. The peripheral nervous system is the network of nerves that exist outside of one’s brain and spinal cord. More specifically, neuropathy occurs as a result of damaged or destroyed nerve cells, called neurons, which disrupt synaptic transmission, or the communication of signals within the brain. It can also simultaneously take place in multiple body parts, such as one’s hands or feet  (Neuropathy (Peripheral Neuropathy). 

Neuropathy can be classified as mononeuropathy, the dysfunction of one nerve or nerve type, multifocal neuropathy, the dysfunction of a combination of nerves in a specific area, or polyneuropathy, the dysfunction of many peripheral nerves all throughout the body (Neuropathy (Peripheral Neuropathy) ). Symptoms that span across all classifications of peripheral neuropathy include gradual numbness, tingling in one’s feet or hands, sharp, throbbing, or burning pain, sensitivity to touch, lack of coordination, muscle weakness, and, if motor nerves are affected, paralysis. However, if the autonomic nerves that control blood pressure, heart rate, digestion, and bladder function are affected, symptoms such as heat intolerance, excessive or lack of sweating, digestive problems, and dizziness due to changes in blood pressure can occur as well (Peripheral neuropathy – Symptoms and causes ). 

Although there are three main classifications of neuropathies, there are also different subtypes. A major cause of a certain subtype of neuropathy called distal symmetric polyneuropathy is diabetes. Distal symmetric polyneuropathy is characterized by a loss in sensory function in the lower extremities. At least 50% of diabetics will develop distal symmetric polyneuropathy, making it an epidemic in places such as India. The physiology known so far behind distal symmetric polyneuropathy involves the retraction of the terminal sensory axons in the periphery, while the perikarya, or cell bodies, remain preserved. Experimental evidence has also demonstrated that the entire neuron may be targeted with diabetes, however, this evidence remains to be debated. A study has found that the incidence of distal symmetric polyneuropathy is higher in those with type II diabetes than those with type I diabetes, mainly due to greater glucose control in those with type I diabetes compared to those with type II. When examining trends in the incidence of distal symmetric polyneuropathy, however, one must also consider the duration of diabetes, hemoglobin levels, hypertension, obesity, drug abuse, gender, impaired renal function, and more (Feldman et al., 2019).

 Distal symmetric polyneuropathy is one of many types of neuropathies making diabetes an important risk factor. Other risk factors include alcohol abuse, vitamin B deficiencies, genetics, and certain infections such as Lyme disease, shingles, Epstein-Barr virus, HIV,  and Hepatitis B and C. Although there are many diverse risk factors of neuropathy, there are some beneficial prevention methods, including medications such as antidepressants, anti-seizure medications, topical and narcotic medications, physical therapy, occupational therapy, surgery of resulting conditions such as a herniated disc or carpal tunnel syndrome, and more (Peripheral neuropathy – Symptoms and causes ). 

References

Feldman, E., Callaghan, B., Pop-Busui, R., Zochodne, D., Wright, D., & Bennett, D. et al. (2019). Diabetic neuropathy. Nature Reviews Disease Primers, 5(1). doi: 10.1038/s41572-019-0097-9

Cleveland Clinic. (2019). Neuropathy (Peripheral Neuropathy). https://my.clevelandclinic.org/health/diseases/14737-neuropathy 

Mayo Clinic. (2019). Peripheral Neuropathy-Symptoms and Causes. https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061 

Categories
Neurocognitive Disorders Neurodegenerative Disorders

Amyotrophic Lateral Sclerosis

When some people hear of amyotrophic lateral sclerosis (ALS), they think of the unfortunate passing of theoretical physicist Stephen Hawking in 2018. Hawking’s death was symbolic of prevailing against the unfortunate statistics of significantly shortened longevity amongst those diagnosed with ALS. Hawking was diagnosed with ALS around age 21 and was expected to live no longer than his 25th birthday. However, Hawkings beat all odds and lived a long, inspiring, and successful life till the age of 76. Hawking’s accomplishments regarding his articulation of the black hole and his contributions to other ideas within theoretical physics, such as quantum gravity, are just some of the many elements that make him such an inspiration to the world. Battling and living with ALS for almost 55 years has definitely inspired and given hope to many others around the world, especially those of us living with ALS and those of us who know a loved one with ALS (Harmon, 2020).  

Many know that Hawking unfortunately died of ALS, but what exactly is ALS? Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease that affects motor neurons in the brain and spinal cord, resulting in a loss of muscle control (Amyotrophic lateral sclerosis (ALS) – Symptoms and causes). Specifically, ALS affects both upper and lower motor neurons. This neurodegenerative disease is commonly classified to exist in either a sporadic or familial form. “More than 30 different genes have been linked to the familial form of ALS” (van Es et al., 2017). The familial form of ALS is due to genetic mutations, and approximately 10% of patients are diagnosed with familial ALS. A common mutation that accounts for 30-40% of familial ALS diagnosis is an increase in the G4C2 hexanucleotide repeats on gene C9orf72, beyond the normal repeat range of 30 to several hundred or thousands (Oskarsson, Gendron and Staff, 2018). 

The symptoms of ALS could differ depending on what neurons are specifically affected (Amyotrophic lateral sclerosis (ALS) – Symptoms and causes). If one were to experience the loss of lower motor neurons which extend from the spinal cord to the muscles, symptoms such as muscle weakness, cramps, and fasciculations or muscle twitches could occur. Loss of lower motor neuron features contribute to higher mortality rates compared to symptoms caused by the loss of upper motor neurons in the brain, which include spasticity, clumsiness, brisk reflexes, and functional limitations (Oskarsson, Gendron and Staff, 2018). Overall, the general symptoms someone with ALS may experience include difficulty walking, tripping and falling, leg or feet weakness, slurred speech, trouble swallowing, muscle twitching or cramps that occurs in the arms, tongue, or shoulders, cognitive and behavioral changes, and inappropriate laughing, crying, or yawning (Amyotrophic lateral sclerosis (ALS) – Symptoms and causes). 

There is a lot of variation amongst the various diagnoses of ALS. For instance, some individuals who are known to have “classical ALS” only experience the majority of ALS symptoms impacting motor involvement. However, around half of ALS patients demonstrate some degree of cognitive impairment and behavioral changes, which is also known as executive dysfunction. There are those patients who are diagnosed as having ALS-esi, which is when there is evidence of executive dysfunction, ALS-neci. when there is no executive dysfunction but there is some impairment in memory or other cognitive aspects, and ALS-bi, when only behavioral changes are present. A small fraction of ALS patients (around 5-10% of patients) may also have frontotemporal dementia (FTD) (van Es et al., 2017). Other variations in diagnosis include progressive muscular atrophy (PMA) and primary lateral sclerosis (PLS). PMA is a variation of ALS that is mostly isolated to the lower motor neurons that are impacted, whereas PLA is mostly isolated to the upper motor neurons (Harmon, 2020). This variation in diagnosis of ALS explains how individuals like Hawking can live so long despite the common statistical odds of a lifespan limited to 5 years after being diagnosed (Harmon, 2020). However, the unfortunate reality is that there are very few patients diagnosed with variations of ALS that progress as slowly as it did in Hawking. This means that this variation can be both good news for few and bad news for the majority. Nevertheless, it is better to look at this in a positive light and think of it this way: there is hope for slow progression due to all this variation in diagnosis, so there is hope for beating statistical odds as well.

 

References

Mayo Clinic. 2020. Amyotrophic Lateral Sclerosis (ALS) – Symptoms And Causes. [online] Available at: <https://www.mayoclinic.org/diseases-conditions/amyotrophic-lateral-sclerosis/symptoms-causes/syc-20354022> [Accessed 23 November 2020]. 

van Es, M., Hardiman, O., Chio, A., Al-Chalabi, A., Pasterkamp, R., Veldink, J. and van den Berg, L., 2017. Amyotrophic lateral sclerosis. The Lancet, 390(10107), pp.2084-2098. 

Oskarsson, B., Gendron, T. and Staff, N., 2018. Amyotrophic Lateral Sclerosis: An Update for 2018. Mayo Clinic Proceedings, 93(11), pp.1617-1628. 

Harmon, K., 2020. How Has Stephen Hawking Lived Past 70 With ALS?. [online] Scientific American. Available at: <https://www.scientificamerican.com/article/stephen-hawking-als/> [Accessed 23 November 2020]. 

Categories
Neurocognitive Disorders Neurodegenerative Disorders

What is Spinal Muscular Atrophy?

Approximately one in 10,000 live births have a case of Spinal Muscular Atrophy (SMA) (Lunn & Wang, 2020). Unfortunately, despite being the leading genetic cause of infant deaths, SMA is not well known. SMA is an autosomal recessive disorder, meaning there is a genetic defect in both copies of an autosomal gene (Torgerson & Ochs, 2014). This disorder is a result of deteriorating, or degenerating, motor neurons, which are nerve cells that control voluntary muscle movement located in the spinal cord (Lunn & Wang, 2020 and Spinal Muscular Atrophy (SMA)). This leads to individuals with SMA experiencing atrophy, or the weakening and shrinking of their muscles (Spinal Muscular Atrophy (SMA)). Additionally, individuals with SMA often face hypotonia, or the reduction of tension in their muscles while they stretch, resulting in muscle fatigue and weakness (Lunn & Wang, 2020). SMA normally occurs in children at any age, however, children from infancy to early childhood often experience worsened symptoms of the disorder. It is possible, however, for patients to develop SMA later in childhood, adolescence, and into adulthood, but in these cases individuals tend to have a more positive prognosis (Spinal Muscular Atrophy (SMA)). 

There are four types of SMA that are caused due to a genetic mutation in the survival motor neuron 1 gene (SMN1) located on the fifth chromosome. Type I, or Werdnig-Hoffmann disease, is the most severe and common type. It often occurs before six months of infancy and unfortunately oftentimes results in death within the first two years of the child’s life. Patients diagnosed with type one SMA experience hypotonia, lack of control of head movement, inability to sit up without support, weakened intercostal muscles, and paradoxical breathing. Paradoxical breathing is reverse breathing, so as one breathes in, their chest contracts, and as one breathes out it expands (Lunn & Wang, 2020). 

Type II SMA is of intermediate severity and normally occurs between seven to eighteen months. Patients are able to sit up without support, and some are able to walk with supporting leg braces. Unfortunately, no patients can walk without support, and there may also be difficulty with coughing, fine tremors, as well as kyphoscoliosis. Kyphoscoliosis is when the spine curves in an outward direction (Lunn & Wang, 2020). 

SMA patients with type III, or Kugelberg-Welander disease, tend to have less severe symptoms, and are mostly able to walk independently. Individuals with type III SMA often experience muscle weakness as a result of joint overuse and may develop scoliosis as well. Patients with type IV SMA are often diagnosed in their twenties or thirties and are able to walk independently as adults without experiencing too much motor impairment (Lunn & Wang, 2020). Lastly, other forms of SMA that occur are not caused by the genetic mutation on the SMN1 gene. Some of these types of SMA include “spinal muscular atrophy with respiratory distress (SMARD), spinal and bulbar muscular atrophy (Kennedy’s disease), and distal spinal muscular atrophy” (Lunn & Wang, 2020). 

Unfortunately, there are no current medications or treatments to cure SMA. However, there are supporting methods to lessen the severity of symptomatic pains. For instance, braces and wheelchairs are often used to assist patients in walking or other types of muscle movement. Patients can also receive support for muscle movement through physical and occupational therapy. Lastly, ventilation assistance helps for patients with symptoms such as breathing difficulties (Spinal Muscular Atrophy (SMA)). Although there are no medications and permanent treatments for SMA as of now, there remains hope for further advances in the future as many medications are currently in clinical trials. As more people are educated about SMA, more research advances will be attempted and progress for treatments will be made. 

 

References

Johns Hopkins Medicine. 2020. Spinal Muscular Atrophy (SMA). [online] Available at: <https://www.hopkinsmedicine.org/health/conditions-and-diseases/spinal-muscular-atrophy-sma> [Accessed 11 October 2020]. 

Lunn, M.R. & Wang, C.H., 2008. Spinal muscular atrophy. Lancet, 371, pp. 2120-2133.

Oquendo, C., 2019. Low Angle Shot Of A Child Held by Woman and Man On Each Hand Walking On An Unpaved Pathway Outdoors. [image] Available at: <https://www.pexels.com/photo/low-angle-shot-of-a-child-held-by-woman-and-man-on-on-each-hand-walking-on-an-unpaved-pathway-outdoors-3038455/> [Accessed 11 October 2020]. 

Torgerson, T. & Ochs, H., 2014. Autosomal Recessive Disorders. Stiehm’s Immune Deficiencies 5th Edition.

Categories
Autism Spectrum Disorder Neurocognitive Disorders

Adjusting to Online Learning During the Pandemic for Students with Autism

As of spring 2020, school closures due to the coronavirus pandemic have affected at least 55.1 million students in both public and private schools across the U.S. (Map: Coronavirus and School Closures in 2019-2020). As schools started in the U.S. this fall, many students have engaged in fully remote learning. Life, for elementary school children used to having recess or college undergraduates used to in-person lectures, has completely shifted. While these adjustments have been difficult for all students in terms of education, they have been especially challenging for students who experience Autism Spectrum Disorder. 

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder related to brain development, and impacts an individual’s social and communication skills, as well as behavior (Autism spectrum disorder – Symptoms and causes). Repetitive behaviors, having trouble expressing needs using typical words or motions, having trouble adapting when a routine changes, having trouble relating to others, having trouble understanding other people’s feelings or talking about their own feelings, and avoiding eye contact are some of the symptoms that individuals with ASD may experience. Detection of ASD can occur as early as 18 months. Even though there is currently no cure for ASD, early intervention therapy can assist children with ASD in focusing, walking, talking, and interacting with others (What is Autism Spectrum Disorder?). 

General challenges that many students, parents, and educators have faced during remote learning throughout the pandemic include concerns about technological security, workplace environment, privacy, increasing feelings of isolation, and limitations in engagement throughout remote learning (Online learning concerns that shouldn’t be ignored). However, children and older students with ASD or other learning disabilities couple these concerns with other challenges as well. Specifically, students with ASD that may have trouble communicating in classrooms may find it more difficult to communicate virtually since social engagement is profoundly reduced via remote learning. Many of these students, especially younger children, have aides that assist them in social engagement and attentional issues in classroom environments, and they may not be able to have their aide support them in person with quarantine and social distancing measures in place. Students with ASD who received “related services” or school therapists and behaviorists that monitored and assisted them with behavioral difficulties may no longer receive them (Coronavirus: What happens to students with disabilities when schools close?). Additionally, many students with ASD often process information and learn differently from their peers. For instance, many students with ASD have trouble working independently, struggle with time management, are more likely to have difficulties in tasks  involving language and communication, and experience high levels of anxiety which may be worsened due to the stress of remote learning. Oftentimes, individuals with ASD associate specific tasks with locations, and thus may resist doing school work at home (Webster, 2020).  

Despite such challenges, there are some tips to help students with ASD adjust to remote learning. Some tips include creating a learning space to associate with school work and a routine that allows them to not become overwhelmed with the sudden changes happening. Children with ASD may have trouble engaging in independent tasks, something that has exponentially increased due to limited opportunity for social interaction in remote learning. Therefore, independent tasks such as completing homework may be challenging for students with ASD. However, research has demonstrated that creating a homework plan with clear communication between the parent and educator about which content should be prioritized as the main “takeaway” from lessons makes the individual task less anxiety inducing or overwhelming to the student, while being equally educational and effective. For instance, instead of writing an essay on the story or history of early settlers, students with ASD can use puppets to tell this history since they may have trouble thinking about what goes on in someone’s mind or relating to someone else’s story. Thus, this method would make the individualized tasks less overwhelming, more engaging, and helpful to the student in overcoming any hardships that may exist when it comes to understanding or relating to someone else (Webster, 2020). 

Additionally, there are some positives to remote learning that can benefit students with ASD. Technology can offer students with ASD the opportunity to learn a wide range of academic skills by presenting educational content in a way that better fits the students’ learning style, which is oftentimes visual learning. In particular, apps that are specifically designed to improve language and literacy skills for different learning styles can be of use to students with ASD who often learn and process information differently from their peers (Webster, 2020). The Learning App Guide to Autism and Education is a useful resource for parents, educators, and students with ASD because it contains reviews for learning apps categorized by skill areas and age groups.  For instance, Babnoor, the first Arabic language app, will launch in UAE to help children with ASD and other neurodevelopmental disorders by teaching children how to create sentences using symbols or images (Dawodi et al., 2020). Overall, online learning apps and platforms can be engaging through educational games or presenting learning styles for different types of learners, including students with ASD. 

Coming together and relying on different resources has been helping all students continue to make the best out of the education they receive everyday. Students with ASD may experience additional challenges relating to adjusting to remote learning, but there are many tips, resources, and positives to look forward to. At the end of the day, no one can stop students from learning. In the words of Albert Einstein, “Intellectual growth should commence at birth and cease only at death.”

 

References

Dawodi, A., Alzahrani, S., Almumtin, R., Alshyban, S., Alshabanah, M., Alrajhi, D., Alsmadi, M. and Almarashdeh, I., 2020. Developing and Implementing an Online Learning Platform for Children with Autism. International Journal of Scientific Research in Science and Technology, pp.176-188.

Webster, A.A., 2020. 5 tips to help parents navigate the unique needs of children with autism learning from home. The Conversation, 4, pp.1-5. 

Usatoday.com. 2020. [online] Available at: <https://www.usatoday.com/story/opinion/2020/03/21/coronavirus-what-happens-students-disabilities-when-schools-close-column/2867856001/> [Accessed 4 October 2020].

Strauss, V., 2020. Five Concerns About The Mass Rush To Online Learning That Shouldn’T Be Ignored.. [online] Washingtonpost.com. Available at: <https://www.washingtonpost.com/education/2020/03/30/five-concerns-about-mass-rush-online-learning-that-shouldnt-be-ignored/> [Accessed 4 October 2020]. 

Education Week. 2020. Map: Coronavirus And School Closures In 2019-2020. [online] Available at: <https://www.edweek.org/ew/section/multimedia/map-coronavirus-and-school-closures.html> [Accessed 4 October 2020].

Centers for Disease Control and Prevention. 2020. Basics About Autism Spectrum Disorder (ASD) | NCBDDD | CDC. [online] Available at: <https://www.cdc.gov/ncbddd/autism/facts.html> [Accessed 4 October 2020].

Mayo Clinic. 2020. Autism Spectrum Disorder – Symptoms And Causes. [online] Available at: <https://www.mayoclinic.org/diseases-conditions/autism-spectrum-disorder/symptoms-causes/syc-20352928> [Accessed 4 October 2020].

Cameron, J., 2020. Photo Of Child Sitting At Computer. [image] Available at: <https://www.pexels.com/photo/photo-of-child-sitting-by-the-table-while-looking-at-the-imac-4145153/> [Accessed 27 September 2020]. 

Categories
Neurocognitive Disorders

Mixing up Letters and Numbers- Dyscalculia vs. Dyslexia

Most people have heard of dyslexia, a disorder that causes individuals to have an unexpected difficulty with reading. 5-15% of Americans are dyslexic, meaning it’s highly likely you know someone who has this disorder. Dyslexia can be recognized as early as a child’s preschool years but can have lifelong implications. It can impact an individual’s ability to read fluently, spell, or learn another language. Though the challenges are language based, the implications span beyond just reading and into every subject. However, there is another similar disorder that might be confused for dyslexia, especially when someone struggles with math.

Dyscalculia is another learning disability that causes difficulties specifically with math. While it has a nickname of “math dyslexia”, don’t let this fool you: the two disorders are distinct from one another. Individuals with dyscalculia can have difficulties with manipulating numbers in their head, understanding mathematical concepts like bigger and smaller, or might not be able to apply concepts, even if they understand them. It is currently thought that three- six percent of the population has dyscalculia, but being that this disorder is not well studied, it is likely closer to that of dyslexia.

While there is some overlap in the signs, of these two disorders, it is possible to tell them apart. One of the most obvious ways to figure out whether an individual has dyscalculia or dyslexia is by seeing where an individual’s struggles arise. If they only occur while doing math problems, or if they are an issue in many different areas, can be the first sign of which disorder an individual is dealing with. If someone avoids reading out loud and has issues with spelling and grammar, this would most likely be due to dyslexia, while issues with counting and computation would likely point to dyscalculia. These differences may be due to the way that the disorders impact cognitive functioning. In the case of dyslexia, it has been seen that the underlying issues are actually phonologically based. This is in contrast to dyscalculia, which is has been linked to specific issues with the manipulation of numbers.

In both cases, there is no “cure” for either dyslexia or dyscalculia, but there are ways to help an individual overcome the challenges that come along with the disorders. While there are some accommodations that both types of students can benefit from, such as additional time on tests; however, there are different ways that can help with each individual’s issues more head-on. With a child with dyslexia, using shorter written assignments or testing them in other ways, such as oral reports will help them succeed. For s child with dyscalculia, giving and breaking down math assignments, using games to implement math concepts, and giving them additional help like access to a calculator or math facts, may be more helpful. Overall, both disorders can be manageable, but it is important to treat the correct disorder. By giving a child the proper tools to handle their specific challenges, they will be better equipped to handle the challenges that come with each of these unique disorders.

 

Work Cited:

Dyslexia: What Brain Research Reveals About Reading. (n.d.). Retrieved from http://www.ldonline.org/article/10784/

Landerl, K., Fussenegger, B., Moll, K., & Willburger, E. (2009). Dyslexia and dyscalculia: Two learning disorders with different cognitive profiles. Journal of Experimental Child Psychology,103(3), 309-324. doi:10.1016/j.jecp.2009.03.006

Rosen, P. (n.d.). The Difference Between Dyslexia and Dyscalculia. Retrieved from https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/dyslexia/the-difference-between-dyslexia-and-dyscalculia

Team, U. (n.d.). Understanding Dyscalculia. Retrieved from https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/dyscalculia/understanding-dyscalculia

What is Dyscalculia? (n.d.). Retrieved from http://www.aboutdyscalculia.org/dyscalculiamain.html

What is Dyslexia? (n.d.). Retrieved from https://dyslexia.yale.edu/dyslexia/what-is-dyslexia/

 

Categories
Neurocognitive Disorders

HAND-y Information about HIV Associated Neurocognitive Disorder

HIV. This is a disease that 1.1 million people in the United States are currently living with and is also known for many devastating outcomes. In the early stages, HIV, or human immunodeficiency virus, is commonly associated with fevers, chills, rashes, fatigue and muscle ache. As the disease progresses, the symptoms only worsen, especially after the progression to AIDS (acquired immunodeficiency syndrome). These symptoms include rapid weight loss, night sweats, sores, pneumonia, extreme tiredness, and depression. What many people do not realize is that these are not the only challenges that come along with a diagnosis of HIV. One of the major issues that these individuals face is a complex neurological problem, also known as HIV associated neurological disease.

HIV associated neurological disease, or HAND, describes cognitive impairments that individuals with HIV face, and while it is not one of the more commonly discussed issues, the consequences can be dire. Some of these difficulties include slowed processing, deficits in memory and attention, issues with fine motor control and behavioral changes. The most commonly reported issues and the ones with the most significant impacts are with executive and motor skills, as well as information processing. There are two different classifications of HAND: HIV associated mild neurocognitive disorder (MND), and the more severe HIV associated dementia (HAD). To be diagnosed with MND, an individual must have symptoms that impair their daily functioning, and either they or someone they are close to must have observed reduced mental acuity, and challenges in work, at home, or in social functioning. For a diagnosis of HAD, there must be impairment in at least two different cognitive domains, and these impairments must significantly impact their daily functioning.

One question that you might be having is why do cognitive impairments even occur if HIV infects immune cells? Does it also infect neurons themselves? The reason why HIV is commonly associated with neurological issues is due to the fact that infected immune cells are able to travel across the blood-brain barrier as early as a hours after infection. These infected immune cells release different chemicals that are able to induce neural apoptosis or cell death. This is linked to reduced volume of the hippocampus and frontal lobe, which has been connected to neurocognitive impairment. On top of this, HIV is linked with spinal cord and peripheral nerve pathology that could be linked to these impairments as well.

While this may seem like a very bleak diagnosis, all hope is not lost. There are medicines that can be used to help treat HAND. Most of these treatments are aiming to achieve viral suppression, minimizing the impacts of HIV on the body as a whole, and not specifically the cognitive issues. The benefits that these medicines are expected to have include increased concentration, alertness and memory. In addition to these medicines, there are also non-pharmacological treatments that can be used, the most important method of which is living an all-around healthy lifestyle. This includes a healthy diet, physical activity, and mental and social engagement. It is also very important to make sure that the individual gets a good amount of sleep, as disruptive sleep is known to impact memory and thinking.

References:

Anand, P., Springer, S. A., Copenhaver, M. M., & Altice, F. L. (2010). Neurocognitive Impairment and HIV Risk Factors: A Reciprocal Relationship. AIDS and Behavior, 14(6), 1213-1226.

Content Source: HIV.govDate last updated: May 15, 2017. (2018, September 25). Symptoms of HIV. Retrieved from https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/symptoms-of-hiv

Weill Institute For Neurosciences. (n.d.). A Healthcare Provider’s Guide to HIV-Associated Neurocognitive Disorder (HAND): Diagnosis, pharmacologic management, non-pharmacologic management, and other considerations. Retrieved from https://memory.ucsf.edu/sites/memory.ucsf.edu/files/wysiwyg/UCSF_HIV Dementia_Providers_11-6-17.pdf