Thursday, 20 July 2017

TBI and Dementia?

TBI and dementia: Link or no link?

Published Today Published Today

By Yella Hewings-Martin, PhD

Researchers are using population studies and animal models to investigate how TBIs might lead to progressive neurodegeneration in some patients.

Whether or not traumatic brain injury predisposes individuals to dementia has long been under investigation, and the results of different studies are often conflicting. But evidence is mounting that traumatic brain injury can cause long-term damage to the brain.

Traumatic brain injuries (TBIs) disrupt the normal function of the brain. They occur as a result of a blow or jolt to the head, or an injury that penetrates it, according to the Centers for Disease Control and Prevention (CDC).

In 2013, 2.8 million people in the U.S. sustained TBI, of which approximately 56,000 resulted in death. The age groups most affected by TBI were small children up to the age of 4, teenagers and young adults between 14 and 25 years, and those over 75 years of age. The most common causes of TBI were falls, being struck by an object, and car accidents.

The immediate symptoms can range from headaches and blurry vision to slurred speech and short-term memory problems. TBIs can also have long-term effects on health, with an increased risk of seizures and infections sometimes following.

Research has suggested a link between TBI and several forms of progressive neurodegeneration - such as dementia, Alzheimer's disease, amyotrophic lateral sclerosis (ALS), and Parkinson's disease - but there is conflicting evidence.

Why is it so difficult to find conclusive evidence? And what are the long-term predictions for TBI patients?

The latest findings

Last week, Medical News Today reported on a study by Finnish researchers, which was published in the journal PLOS Medicine. Using the Finnish Care Register for Health Care, the team compared the medical notes of working-age individuals under the age of 65 with mild or moderate to severe TBI, all of whom had subsequently developed dementia, Parkinson's disease, or ALS.

They found a link between moderate to severe TBI and dementia, but no links with Parkinson's disease or ALS were discovered.

Importantly, they found that the incidence rate of dementia in moderate to severe TBI patients was similar to that found in the general population. But dementia occurs mostly in the elderly, highlighting that TBI shifts the risk from old age to working age.

The dataset used in this study was comprehensive; Finland has a tax-funded healthcare system. According to the authors, all acute TBI cases are treated at public hospitals and would therefore have been included in the study.

Yet data were only available for TBI patients who had subsequently been admitted to the hospital with neurodegenerative symptoms. The authors explain that it is possible that other patients with a diagnosis of neurodegeneration may have been missed if they had not been hospitalized at the time.

The results of the Finnish study concurred with data published last year in the Asian Pacific Journal of Public Health. Here, rates of dementia were higher among Taiwanese TBI patients than among those who had not sustained TBI.

Another study, published recently in the Journal of Alzheimer's Disease, failed to establish a link between TBI and Alzheimer's disease.

The authors compared 706 U.S. seniors with and without TBI and found that cognitive decline in participants was not affected by having experienced TBI. But in this study, TBI was self-reported by the study participants rather than assessed in their medical notes, meaning that data may not have been accurate.

A systematic review published earlier this year in Annals of Physical & Rehabilitation Medicine struggled to find a meaningful connection between TBI and Alzheimer's disease.

The review included 18 studies, but the authors were unable to classify TBI by severity. By grouping mild and moderate to severe TBI into the same category, it may not have been possible to establish a connection between TBI and Alzheimer's disease.

Other studies, however, have found clear links between TBI and Alzheimer's disease and Parkinson's disease.

TBI, neurodegeneration link supported

In an Alzheimer's disease patient cohort, those with histories of moderate to severe TBI began to experience symptoms and received their diagnosis by an average of 2.5 years earlier than non-TBI patients, according to a recent study published in the journal The Clinical Neuropsychologist. But again, TBI was self-reported in this study.
A paper published last year in JAMA Neurology found that while there was no link between TBI and dementia or Alzheimer's disease, there was a connection with Parkinson's disease.
Some of the study participants had consented to brain autopsies after their death. Both mild and moderate to severe TBI patients showed signs of Lewy bodies, a hallmark of Parkinson's disease, in their brains, while moderate to severe TBI patients also had signs of cerebral microinfarcts.
Importantly, while study participants were aged 65 and over, a third of mild and nearly half of moderate to severe TBI patients were age 25 years or younger when they sustained their TBI. This demonstrates that TBI could have long-term neurodegenerative effects.
The problem with this type of study is that they mostly rely on measures of association. This means that researchers establish whether or not there is a link between TBI and neurodegeneration in a particular study population based on the data they are using.
However, it is not possible to establish cause and effect in these studies, meaning that there could be other biological mechanisms involved in causing neurodegeneration in these patients.
To study what happens in the brain after TBI, researchers turn to animals. Here, the events following TBI are beginning to be unraveled.

How can TBI cause neurodegeneration?

A recent article in Reviews in the Neurosciences summarized what is known, to date, about the neurological damage following TBI.
The initial injury damages blood vessels, neurons, and other cell types. As a secondary effect, neurons become overstimulated, resulting in oxidative stress and cell death. Water metabolism is also affected, causing swelling in the brain.
The blood-brain barrier, which is normally impenetrable to most substances, becomes disrupted, allowing immune cells to infiltrate the damaged brain.
The combination of oxidative damage, neuroinflammation, edema, and damaged blood flow can cause significant and long-term damage to the brain.
Using a mouse model of brain injury, a recent study published in The Journal of Neuroscience set out to investigate the long-term effects of TBI in more detail.
Damage to the regions surrounding the injury site was immediate. Crucially, long-term damage was observed in distant regions in the brain and was attributed to chronic neuroinflammation.
In a mouse model of Alzheimer's disease, long-term effects were also observed after TBI in a study reported in Neuroscience Letters. Interestingly, there were no immediate differences in the brains of aged mice that had experienced TBI and those that had not.
Both injured and uninjured mice developed senile plaques, a hallmark of Alzheimer's disease, at the same rate for the first week of the study. However, at 28 days after the TBI, significantly more plaques were present in the mice. This was accompanied by impaired spatial learning.
The researchers interpreted this to mean that TBI accelerates Alzheimer's disease symptoms.
For patients who have experienced TBI, what do these data mean?

The need for long-term monitoring

While it is possible to study the cellular events that follow TBI in model systems, it is more difficult to confidently apply these results to human patients.
Many studies point to long-term effects of TBI on the brains of animals and humans, but the extent of the damage and the precise implications remain unclear.
Regardless of their results, what most studies agree on is the need for long-term monitoring for TBI patients, especially those who have experienced moderate to severe TBI. There is also a call for more accurate diagnostic criteria that would allow physicians to spot the onset of TBI-associated neurodegeneration earlier.
This would enable physicians to closely monitor patients and start treatments or interventions early on, with the aim of slowing the progression of cognitive decline.
It is clear that more studies are needed, specifically those that investigate cause and effect and that can link the results to large-scale, accurate population data.
It is also important to remember that not all of those who have sustained TBI will definitely go on to develop progressive neurodegeneration.
In the Finnish study, 1.6 percent of those with a history of mild TBI went on to develop dementia. Even though those with moderate to severe TBI were 90 percent more likely to receive a dementia diagnosis, this still only equates to a rate of 3.5 percent.
While there is strong evidence to suggest a risk of long-term damage to the brain after sustaining TBI, questions remain on why some patients go on to develop progressive neurodegeneration and how many are likely to be affected.

Monday, 17 July 2017

Right to die with dignity

People on television are discussing the rights and wrongs of ending life when you have a terminal illness.

While I am not in this position, of living with a terminal illness, I do in all honesty think that there is far too much red tape connected with this along with far too many so called gooders getting involved

If someone has something like motor neuron disease or rapid form of cancer etc, and there bodies are failing, I don't understand why they should not be allowed to die with dignity, rather than fighting to the bitter end.

In all honesty, we would be prosecuted if we allowed an animal to suffer in similar conditions, yet humans are expected to carry on struggling.

I do feel that the guidelines stop unnecessary premature deaths, yet many people think it's wrong to stop fighting an illness.

I know that there are Christian groups linked with stopping people from dying early when they have had enough, and to be honest it's time they allowed people to make up their own minds.

Many of us have set up guidelines for the end of our lives, and I see nothing wrong with that at all because it was discussed between my wife and I.

To be honest there is no way that I want to be left living in a cabbage state, and if it came to it, I may want to look at alternatives if the chips were down

So let us hope that common sense steps in and people can die with the dignity they deserve

Saturday, 15 July 2017

Depression in Dementia etc

A lot has been written over the last few months about depression, yet it seems to appear in many illnesses like Parkinson and Dementia, to name only two.

Many doctors don't look at the cause of the depression, and simply want to issue sedatives etc, "but is this the real answer.".
Surely they should be looking for the true cause, rather than using drugs,

I know that there are times now when my brain goes, and I am no longer able to think or plan things as I was used to, and this is upsetting, because it's very hard to accept or understand.

I have often been accused of frowning these days, yet there are times when I have no real idea when I am smiling, unless I can look into a mirror.
Facial expressions don't mean a lot to me anymore.

It's not easy when you are not I control of these things, and sometimes it's embarrassing.

Things like reading and understanding letters and documents can be an experience, because I don't always understand what I am reading or seeing.

I often misunderstand what people are saying these days, and this in turn causes upset, until it's all explained properly. But I think this is my brain working things out wrongly

This causes mistrust between people, but unless you to have been there you would never understand it.

These days it takes me longer to work to things out, or try to carry on doing normal things, and have to resort to items such as voice activated software on my computer, so that I can write my blogs etc.

But I guess over the years we have all said, that we feel totally depressed, but it's only when things go wrong and you cannot workout how to correct them.

It's a phrase which can cause a lot of trouble these days, especially if you say it to the wrong person, like an uncaring doctor

When I was first aware that things were going wrong, and had not been diagnosed with Lewy Body Dementia, all I got from the family doctors was that it was depression

Yet the job I was in, there was not enough time to get depressed, as I worked 24 hours a day doing breakdowns.

Yes it was hectic from what I can remember, but it was a job I loved.

I did not always get a full nights sleep, but my employers always said, that when the chips were down, I stepped up a gear to get the breakdowns or power failures sorted out.

Perhaps other people would have simply become stressed or depressed, but I enjoyed my life, until I could not do my Job anymore.

I guess that because I could not remember how to do estimates and electrical work anymore, and ended up counting on my fingers, which was distressing

But in this case who wouldn't be depressed, it was because I was losing control over my brain and thought that I was going mad.

I do feel that life has been turned on it's head, in more ways than one, and things are no longer what they seem, and this causes me at times to feel depressed, but as with memory problems etc, I have to fight it for my families sake.

But I do feel that we need more support for depression or the symptoms of this illness to stop it getting any worse

I don't remember in all honesty hearing about so many suicides as we have these days, but if we are honest there is not the support out there, that we should have.
We also have Government who don't care about anyone but themselves and that does not help.

Let us hope that in the future we get more support for those in need, before it's too late.

While I openly admit to getting depressed at times, I do have ways of trying to deal with it, and turn things around.

Yes it's to do with losing control over my brain, but that's life and I have to hang on to that and help others wherever I can.

I realise that I am starting to lose control of my photography quite a lot these days, but I will just have to find something else to do and be positive

I have my family and grandchildren and they are more important to me.

Friday, 14 July 2017

Brain training app reduces symptoms of pre-dementia

Marco Ricci

July 5, 2017

Brain training apps can help ward off early signs of dementia, according to a new study.

The study, jointly carried out by Cambridge University and University of East Anglia researchers, and partly funded by Janssen, found that an app called Game Show improved the memory of patients with amnestic mild cognitive impairment – a precursor for dementia.

The game involves associating geometric patterns with locations. Its difficulty increases each time a player guesses correctly.

Half of the patients used the app for two hours per week over four weeks. The other played no games at all.

The app specifically improved ‘episodic’ memory by around 40%. This type of memory is based on autobiographical events like past locations they have visited. Better episodic memory therefore helps with day-to-day activities, for example remembering where a car has been parked.

“Game Show could hold some benefit for people with mild memory problems,” said Dr Carol Routledge from Alzheimer’s Research UK, speaking to The Telegraph.

“But without more research we can’t tell if the same benefits could be achieved with any other electronic game.”
Larger trials investigating the game’s use have been planned.

An alternative to medicine?

Numerous studies have indicated the benefits of regularly using brain training apps. However, more, longer-term studies need to be conducted to understand whether they can help with symptoms or prolong disease onset.

In the pharmaceutical world, no company has so far developed a cure for dementia, although some drugs can control symptoms.

In the US, Roivant Sciences spinout Axovant recently received FDA fast track designation for its pipeline drug nelotanserin. The drug treats visual hallucinations associated with dementia with Lewy bodies.

The firm’s lead candidate, intepirdine, is currently in a phase 3 trial for the treatment of Alzheimer’s disease. It is being tested in combination with current standard therapy of donepezil in its ability to improve patient cognition.

Other, larger companies have developed candidates in the past which have unfortunately proved unsuccessful. One of the more notable examples is Eli Lilly’s solanezumab, which failed in a phase 3 study involving patients with early stage disease late last year.

Thursday, 13 July 2017

Lewy Body Dementia

Lewy body dementia: Thousands 'at risk of injury or death' due to inappropriate prescription of antipsychotics

Prescription of these drugs often worsens symptoms and has been found to increase the risk of death fourfold

Katie Forster Health Correspondent
@katieforster
Thursday 6 July 2017 11:58 BST

The Independent Online

Around 120,000 people are estimated to suffer from Lewy Body Dementia in the UK Getty

Thousands of people in the UK with a commonly misdiagnosed form of dementia are at increased risk of injury or death because they are being prescribed potentially harmful antipsychotic medication, experts have warned.

The symptoms of Lewy body dementia include hallucinations, motor problems, fainting spells and disturbed sleep in which people appear to “act out” their dreams, as well as the cognitive decline associated with other forms of the disease.

Dementia with Lewy bodies is the second most common form of the disease after Alzheimer's and is estimated to account for 10 to 15 per cent of all dementia cases.
However, up to 60,000 people in Britain may be unaware they have the condition, which is missed or misdiagnosed in up to 50 per cent of cases, said Professor Clive Ballard, a leading researcher of the disease at the University of Exeter.

Antipsychotic drugs given to dementia sufferers to treat behavioural disturbances has been found to increase the risk of death for people with Lewy body dementia fourfold, compared to one and a half times in people with Alzheimer’s disease, he warned.

These medicines, prescribed to around 15 per cent of people with dementia overall, can worsen symptoms of Parkinson’s disease commonly seen in Lewy body dementia sufferers, leading to risky falls.
They can also trigger a potentially fatal syndrome known as a “neurolaptic sensitivity reaction”, described by Professor Ballard as “a very acute syndrome which can come on within one or two hours of taking an antipsychotic drug, or increasing the dose”.

“When people have these reactions they develop very severe Parkinson’s symptoms and become very confused. You also get a breakdown of muscle cells which can lead to renal failure; there’s quite a high mortality rate acutely associated to these reactions.

Professor Ballard said around a quarter of people diagnosed with Lewy body dementia will have such a reaction when given the wrong medication.

Even if people do not die as a result of the syndrome, they may experience a steep decline in their condition “which they usually do not recover from”, he added.

A new set of diagnosis guidelines have been introduced by the Dementia with Lewy bodies consortium in the hope that better diagnosis rates will reduce the risk of patients being given drugs that may harm them.

“Getting the diagnosis right is very important, particularly for the treatment of the psychiatric symptoms those people may have,” said Professor Ballard.

The vast majority of Lewy body dementia patients – 80 per cent – experience a very high frequency of distressing psychotic symptoms, he added.

“If they’re misdiagnosed there’s a very high likelihood those individuals will be given an antipsychotic drug, which could be very damaging for that individual.”

In total, around 120,000 people are estimated to suffer from Lewy body dementia in the UK. The NHS says “more than 100,000” may have the condition.

Monday, 10 July 2017

Lewy Body Dementia and Parkinsons Dementia

Lewy body dementia, an umbrella term for both Parkinson’s disease dementia and dementia with Lewy bodies

By: Mohan Garikiparithi | Brain Function |

Lewy body dementia (LBD) is an umbrella term referring to both Parkinson’s disease dementia and dementia with Lewy bodies. In dementia with Lewy bodies, cognitive symptoms interfering with daily living present themselves before or within one year of Parkinson’s-like movement problems. In Parkinson’s disease dementia, cognitive symptoms usually don’t appear until after a year of the onset of movement problems.

Researcher Howard I. Hurtig explained, “An early and accurate diagnosis may be lifesaving. The avoidance of medications that can worsen the symptoms of LBD cannot be overemphasized. Every patient with LBD and their caregiver(s) should memorize the list of acceptable and forbidden drugs.”

Lewy body dementia is characterized by an abnormal buildup of Lewy bodies in areas of the brain responsible for memory, behavior, movement, and personality. Parkinson’s disease symptoms primarily affect mobility and motor abilities. Diagnosis can be difficult because more than one cognitive disorder can be causing changes in the brain. For proper diagnosis and differentiation between dementia and Parkinson’s disease, it’s best to consult with a neurologist or geriatric physician.

Signs and symptoms of dementia with Lewy bodies and Parkinson’s disease dementia

Parkinson’s disease dementia

· Changes in memory, concentration, or judgement

· Trouble interpreting visual information

· Muffled speech

· Visual hallucinations

· Delusions, paranoid thoughts

· Depression

· Irritability and anxiety

· Sleep disturbances

· Loss of decision-making ability

· Disorientation in familiar surroundings

· Trouble learning new material

· Difficulty using complex language

Dementia with Lewy bodies

· Changes in thinking and reasoning

· Confusion and alertness that varies significantly

· Parkinson’s symptoms

· Visual hallucinations

· Delusions

· Trouble interpreting visual information

· Acting out dreams

· Memory loss

As you can see, Parkinson’s disease dementia and dementia with Lewy bodies share many signs and symptoms. It’s important that a specialist reviews the patient’s specific symptoms to establish a proper diagnosis and recommend an appropriate mode of treatment.

Wednesday, 5 July 2017

What is Lewy Body Disease

What Lewy Body Disease Is

On this page:

Lewy body disease is a kind of dementia

Lewy body disease is a kind of dementia. Dementia is a general decline in cognitive abilities (thinking, memory, language, etc.) usually due to degeneration of the brain. There are many kinds of dementia. The most common and best known kind is Alzheimer's disease. Lewy body disease is thought to be the second most common kind of dementia. It causes cognitive problems similar to those seen in Alzheimer's disease and motor problems like those in Parkinson's. Like Alzheimer's disease, Lewy body disease is currently incurable and it gets worse with time. It should be noted that there are some kinds of dementia (for example, those caused by a thyroid problem or a deficiency in vitamin B-12) that can be reversed. That's why it's important to have a full work-up done when dementia is suspected.

Lewy body disease is also referred to as dementia with Lewy bodies, Lewy body dementia, diffuse Lewy body disease, senile dementia of Lewy body type, and Lewy body variant of Alzheimer's disease.

Despite its prevalence, Lewy body disease is not well known. Every year, it seems that Newsweek and other popular magazines run a feature article on the progress made against Alzheimer's disease, and any new information about Alzheimer's is big news. In these articles there's never a mention of Lewy body disease. In our experience many health professionals (physical therapists, nurses, and even some doctors) aren't well informed about Lewy body disease.

What are Lewy bodies?

In 1912, while Frederick Lewy was examining the brains of people with Parkinson's disease, he discovered irregularities in the cells in the mid-brain region. These abnormal structures (microscopic protein deposits found in deteriorating nerve cells) became known as Lewy bodies. Since that time, the presence of Lewy bodies in the mid-brain has been recognized as a hallmark of Parkinson's disease. In the 1960s, researchers found Lewy bodies in the cortex (the outer layer of gray matter) of the brains of some people who had dementia. Lewy bodies in the cortex are known as cortical Lewy bodies or diffuse Lewy bodies. (That's why Lewy body disease is sometimes called cortical Lewy body disease or diffuse Lewy body disease.) Cortical Lewy bodies were thought to be rare, until the 1980s when improved methodologies showed that Lewy body disease was more common than previously realized.

People with Lewy body disease have Lewy bodies in the mid-brain region (like those with Parkinson's disease) and in the cortex of the brain. It's believed that they usually also have the "plaques and tangles" of the brain that characterize Alzheimer's disease. Conversely, it's believed that many people with Alzheimer's disease also have cortical Lewy bodies. Because of the overlap, it's likely that many people with Lewy body disease are misdiagnosed (at least initially) as having either Parkinson's disease or Alzheimer's disease. A big factor in the misdiagnosis might be that Lewy body disease is relatively unknown.

Symptoms of Lewy body disease

People with Lewy body disease have cognitive problems (problems with thinking, memory, language, etc.) similar to those that occur in Alzheimer's disease. Therefore, it can be hard to distinguish the two. Some doctors think there are three distinguishing features and the presence of two of them makes the diagnosis of Lewy body disease probable:

Motor problems typical of Parkinson's disease but usually not so severe as to warrant a diagnosis of Parkinson's. Of these problems, an impairment in walking (a shuffling gait) might be the most common one. Also common would be muscle stiffness and a tendency to fall. Tremor would be less common.
Fluctuations in cognitive function with varying levels of alertness and attention. Periods of being alert and coherent alternate with periods of being confused and unresponsive to questions.
Visual hallucinations, usually occurring early on. Delusions may be common too.

It's possible that people with Lewy body disease are better able to form new memories than those with Alzheimer's disease. Compared with Alzheimer's, Lewy body disease may affect speed of thinking, attention and concentration, and visual-spatial abilities more severely than memory and language. Depression may be a typical symptom too.

Treatment

Right now, doctors prescribe drugs to treat four major features found in Lewy body disease (also see the medication section of our Information page):

Cognitive problems. Usually, a drug like Aricept is prescribed. This is the same drug that is commonly prescribed for Alzheimer's disease. In some people, it seems to slow the progression of the disease.
Motor problems. Levodopa/carbidopa (Sinemet) is frequently prescribed to deal with the motor problems. This medication can worsen hallucinations, though.
Hallucinations. An antipsychotic medication, such as Zyprexa, might be prescribed. This kind of medication can worsen motor problems, though. Also note the FDA warning.
Depression. In cases of depression, an antidepressant, such as Zoloft or Prozac, might be prescribed.