Tourette's Syndrome

Definition

Tourette (too-RET) syndrome is a nervous system (neurological) disorder that starts in childhood. It involves unusual repetitive movements or unwanted sounds that can't be controlled (tics). For instance, you may repeatedly blink your eyes, shrug your shoulders or jerk your head. In some cases, you might unintentionally blurt out offensive words.

Signs and symptoms of Tourette syndrome typically show up between ages 2 and 12, with the average being around 7 years of age. Males are about three to four times more likely than females to develop Tourette syndrome.

Although there's no cure, you can live a normal life span with Tourette syndrome, and many people with Tourette syndrome don't need treatment when symptoms aren't troublesome. Symptoms of Tourette syndrome often lessen or become quiet and controlled after the teen years.

Symptoms

Tics — sudden, brief, intermittent movements or sounds — are the hallmark sign of Tourette syndrome. Symptoms range from mild to severe. Severe symptoms may significantly interfere with communication, daily functioning and quality of life.

Tics are classified as either:

• Simple tics, which are sudden, brief and repetitive, involving a limited number of muscle groups
• Complex tics, which are distinct, coordinated patterns of movements that involve several muscle groups

Tics involving movement (motor tics) — often facial tics, such as blinking — usually begin before vocal tics do. But the spectrum of tics that people experience is diverse, and there's no typical case.

Common motor tics seen in Tourette syndrome
Simple tics	Complex tics
Eye blinking	Touching the nose
Head jerking	Touching other people
Shoulder shrugging	Smelling objects
Eye darting	Obscene gesturing
Finger flexing	Flapping the arms
Sticking the tongue out	Hopping
Common vocal tics seen in Tourette syndrome
Simple tics	Complex tics
Hiccuping	Using different tones of voice
Yelling	Repeating one's own words or phrases
Throat clearing	Repeating others' words or phrases
Barking	Using vulgar, obscene or swear words

In addition, if you have Tourette syndrome, your tics may:

• Vary in type, frequency and severity
• Worsen if you're ill, stressed, anxious, tired or excited
• Occur during sleep
• Evolve into different tics over time
• Worsen during teenage years and improve during the transition into adulthood

Before the onset of motor or vocal tics, you'll likely experience an urge called a premonitory urge. A premonitory urge is an uncomfortable bodily sensation, such as an itch, a tingle or tension. Expression of the tic brings relief.

With great effort, some people with Tourette syndrome can temporarily stop a tic or hold back tics until they find a place where it's less disruptive to express them.

Causes

The exact cause of Tourette syndrome isn't known, and there's no known way to prevent it. Tourette is a complex syndrome, likely caused by a combination of genetic and environmental factors. Theories about the causes of Tourette include:

• Genetics. Tourette syndrome may be an inherited disorder. The specific genes involved in Tourette syndrome are still being defined, although one genetic mutation has been identified as a rare cause of Tourette syndrome.
• Brain abnormalities. Certain chemicals in the brain that transmit nerve impulses (neurotransmitters) may play a role, including dopamine and serotonin.

Risk factors

Risk factors for Tourette syndrome include:

• Family history. Having a family history of Tourette syndrome or other tic disorders may increase the risk of developing Tourette syndrome.
• Being male. Males are about three to four times more likely than females to develop Tourette syndrome.

Complications

People with Tourette syndrome have a normal life span and often lead healthy, active lives. However, having Tourette syndrome may increase your risk of learning, behavioral and social challenges, which can harm your self-image.

In addition, having Tourette syndrome means you're likely to have other related conditions, such as:

• Attention-deficit/hyperactivity disorder (ADHD)
• Obsessive-compulsive disorder (OCD)
• Learning disabilities
• Sleep disorders
• Depression
• Anxiety disorders

Treatments and drugs

There's no cure for Tourette syndrome. Treatment is intended to help control tics that interfere with everyday activities and functioning. When tics aren't severe, treatment may be unnecessary.

Medications
No medication is helpful to everyone with Tourette syndrome, none completely eliminates symptoms, and they all have side effects to be weighed against the benefits.

Possible medications to help control or minimize tics or to reduce symptoms of related conditions — such as attention-deficit/hyperactivity disorder (ADHD) or obsessive-compulsive disorder (OCD) — include:

• Drugs that block or deplete the neurotransmitter dopamine in the brain, such as fluphenazine, haloperidol (Haldol) or pimozide (Orap). Used to control tics, these medications may have side effects such as weight gain and a dulling of the mind.
• Botulinum toxin type A (Botox) injections. For simple or vocal tics, an injection into the affected muscle may help relieve the tic.
• Stimulant medications, such as methylphenidate (Concerta, Ritalin, others) and those containing dextroamphetamine (Adderall XR, Dexedrine, others). These are used to help increase attention and concentration for people with ADHD.
• Central adrenergic inhibitors, such as clonidine (Catapres) or guanfacine (Tenex). Typically prescribed for high blood pressure, these drugs may help control behavioral symptoms, such as impulse control problems and rage attacks. Side effects may include sleepiness.
• Antidepressants, such as fluoxetine (Prozac, Sarafem, others). These may help control symptoms of sadness, anxiety and OCD.

Therapies

• Psychotherapy. In addition to helping you cope with Tourette syndrome, psychotherapy or talk therapy can help with accompanying problems, such as ADHD, obsessions, depression or anxiety.
• Behavior therapy. A form of behavior therapy called habit-reversal training may help to reduce tics. With this therapy, you monitor tics and identify premonitory urges — those uncomfortable sensations that occur before the tic. You learn to respond to those urges by voluntarily moving in a way that's incompatible with the tic, which suppresses the tic.
• Deep brain stimulation. For severe tics that don't respond to other treatment, deep brain stimulation (DBS) may help. DBS consists of implanting a battery-operated medical device (neurostimulator) in the brain to deliver electrical stimulation to targeted areas that control movement. More research is needed to determine whether DBS benefits people with Tourette syndrome.

Source : Mayoclinic.com

Mayo is bad for you, but you can never go wrong with Mayoclinic ;)

STROKE??

DEFINITION

A stroke is a condition in which the brain cells suddenly die because of a lack of oxygen. This can be caused by an obstruction in the blood flow, or the rupture of an artery that feeds the brain. The patient may suddenly lose the ability to speak, there may be memory problems, or one side of the body can become paralyzed.

TYPES OF STROKE

SYMPTOMS

Watch for these signs and symptoms if you think you or someone else may be having a stroke. Note when your signs and symptoms begin, because the length of time they have been present may guide your treatment decisions.

• Trouble with walking. You may stumble or experience sudden dizziness, loss of balance or loss of coordination.
• Trouble with speaking and understanding. You may experience confusion. You may slur your words or have difficulty understanding speech.
• Paralysis or numbness of the face, arm or leg. You may develop sudden numbness, weakness or paralysis in your face, arm or leg, especially on one side of your body. Try to raise both your arms over your head at the same time. If one arm begins to fall, you may be having a stroke. Similarly, one side of your mouth may droop when you try to smile.
• Trouble with seeing in one or both eyes. You may suddenly have blurred or blackened vision in one or both eyes, or you may see double.
• Headache. A sudden, severe headache, which may be accompanied by vomiting, dizziness or altered consciousness, may indicate you're having a stroke.

When to see a doctor
Seek immediate medical attention if you notice any signs or symptoms of a stroke, even if they seem to fluctuate or disappear. Call 911 or your local emergency number right away. Every minute counts. Don't wait to see if symptoms go away. The longer a stroke goes untreated, the greater the potential for brain damage and disability. To maximize the effectiveness of evaluation and treatment, you'll need to be treated at a hospital within three hours after your first symptoms appeared. If you're with someone you suspect is having a stroke, watch the person carefully while waiting for emergency assistance.

CAUSES

Ischemic strokes are ultimately caused by a thrombus or embolus that blocks blood flow to the brain. Blood clots (thrombus clots) usually occur in areas of the arteries that have been damaged by atherosclerosis from a buildup of plaques. Embolus type blood clots are often caused by atrial fibrillation - an irregular pattern of heart beat that leads to blood clot formation and poor blood flow. 

Hemorrhage strokes can be caused by uncontrolled high blood pressure, a head injury, oraneurysms. High blood pressure is the most common cause of cerebral hemorrhage, as it causes small arteries inside the brain to burst. This deprives brain cells of blood and dangerously increases pressure on the brain. 

Aneurysms - abnormal blood-filled pouches that balloon out from weak spots in the wall of an artery - are the most common cause of subarachnoid hemorrhage. If an aneurysm ruptures, blood spills into the space between the surfaces of the brain and skull, and blood vessels in the brain may spasm. Aneurysms are often caused or made worse by high blood pressure. 

A less common from of hemorrhage stroke is when an arteriovenous malformation (AVM) ruptures. AVM is an abnormal tangle of thin-walled blood vessels that is present at birth.

A study found that migraines increase stroke risk during pregnancy.

RISK FACTORS

Many factors can increase your risk of a stroke. A number of these factors can also increase your chances of having a heart attack. Stroke risk factors include:

Potentially treatable risk factors

• High blood pressure — risk of stroke begins to increase at blood pressure readings higher than 120/80 millimeters of mercury (mm Hg). Your doctor will help you decide on a target blood pressure based on your age, whether you have diabetes and other factors.
• Cigarette smoking or exposure to secondhand smoke.
• High cholesterol — a total cholesterol level above 200 milligrams per deciliter (mg/dL), or 5.2 millimoles per liter (mmol/L).
• Diabetes.
• Being overweight or obese.
• Physical inactivity.
• Obstructive sleep apnea (a sleep disorder in which the oxygen level intermittently drops during the night).
• Cardiovascular disease, including heart failure, heart defects, heart infection or abnormal heart rhythm.
• Use of some birth control pills or hormone therapies that include estrogen.
• Heavy or binge drinking.
• Use of illicit drugs such as cocaine and methamphetamines.

Other risk factors

• Personal or family history of stroke, heart attack or TIA.
• Being age 55 or older.
• Race — African-Americans have higher risk of stroke than people of other races.
• Gender — Men have a higher risk of stroke than women. Women are usually older when they have strokes, and they are more likely to die of strokes than men.

DIAGNOSIS

A stroke is a medical emergency, and anyone suspected of having a stroke should be taken to a hospital immediately so that tests can be run and the correct treatment can be provided as quickly as possible. 

Physicians have several tools available to screen for stroke risk and diagnose an active stroke. These include:

• Physical assessment - blood pressure tests and blood tests to see cholesterol levels, blood sugar levels, and amino acid levels


• Ultrasound - a wand waved over the carotid arteries in the neck can provide a picture that indicates any narrowing or clotting


• Arteriography - a catheter is inserted into the arteries to inject a dye that can be picked up by X-rays


• Computerized tomography (CT) scan - a scanning device that creates a 3-D image that can show aneurysms, bleeding, or abnormal vessels within the brain


• Magnetic resonance imaging (MRI) - a magnetic field generates a 3-D view of the brain to see tissue damaged by stroke


• CT and MRI with angiography - scans that are aided by a dye that is injected into the blood vessels in order to provide clearer and more detailed images


• Echocardiography - an ultrasound that makes images of the heart to check for embolus


• Eye-movement analyzer may diagnose stroke - researchers from Johns Hopkins University School of Medicine in Baltimore created a device that can help diagnose stroke by expertly analyzing eye movements. They reported their findings in the journal Stroke. The electronic device is a small, portable, video-oculography machine. It detects eye movements that most doctors find hard to notice.

TREATMENT

The primary goal in treating ischemic stroke is to restore blood flow to the brain. This will be attempted using blood clot-busting drugs such as aspirin, heparin, or tissue plasminogen activators that must be administered within three hours of the stroke. In addition, surgical procedures may be performed that can open up or widen arteries. These include carotid endarterectomy (removal of plaque and widening of the carotid artery) and angioplasty (a balloon that widens the cartoid artery and is held open with a metallic mesh tube called a stent).

A study found that cholesterol lowering drugs can prevent stroke recurrence.

Hemorrhagic stroke is treated differently than ischmic stroke. Surgical methods used to treat this stroke variant include aneurysm clipping, aneurysm embolisation, and arteriovenous malformation (AVM) removal. Aneurysm clipping consists of a small clamp placed at the base of the aneurysm that isolates it from the circulation of it's attached artery and keeps the aneurysm from bursting or re-bleeding. Aneurysm embolisation (coiling) uses a catheter inserted into the aneurysm to deposit a tiny coil that coil fills the aneurysm, causing clotting and sealing off the aneurysm off from arteries. AVM removal is a surgical procedure to remove usually smaller AVMs or AMVs that are in more accessible portion of the brain in order to eliminate the risk of rupture. 

US researchers found that patients who had experienced strokes as long as six months earlier were able to regain brain function through the help of a novel robotic device that they squeezed with their hand.

Most stroke victims will require rehabilitation after the event. A person's condition is generally dependent on the area of the brain and the amount of tissue that was damaged. It is common for the rehabilitation process to include speech therapy, occupational therapy, physical therapy, and family education.

A study carried out by researchers at the University of Illinois, Chicago found that Tai Chi helped stroke victims regain balance.

A new study has found that the short window of time to treat stroke pa

tients can be expanded.

A stroke patient was intravenously injected with his own bone marrow stem cells as part of a research trial at The University of Texas Medical School at Houston.

Oxford University researchers say they now know how the human brain protects itself from damage during and after a stroke. In the journal Nature Medicine, they explained how the protein hamartin helped rats' brain cells that were being starved of oxygen and glucose survive.

Astrocytes may repair brain damage from stroke - stem cell researchers from UC Davis in California explained in Nature Communications that astrocytes, neural cells that form the blood-brain barrier, may help limit the spread of damage after ischemic stroke. They may also help regenerate and repair damaged nerve cells.

PREVENTION

One way to prevent a stroke is to notice a transient ischemic attack (TIA) - or mini stroke - that provides symptoms similar to stroke. Knowing the symptoms of stroke can lead to earlier treatment and better recovery. 

Much of stroke prevention is based on living a healthy lifestyle. This includes:

• Knowing and controlling blood pressure
• Finding out if you have atrial fibrillation
• Not smoking
• Lowering cholesterol, sodium, and fat intake
• Following a healthy diet. If you eat plenty of tomatoes, your risk of developing stroke could be reduced significantly. Tomatoes are rich in lycopene, a powerful antioxidant. In a study published in Neurology, October 2012, researchers found that people with high blood concentrations of lycopene had a 59% lower risk of stroke compared to those with the lowest concentrations.
• Drinking alcohol only in moderation
• Treating diabetes properly
• Exercising regularly. Moderate aerobic fitness can reduce stroke risk, a study found.
• Managing stress
• Not using drugs
• A study found that drinking three cups of tea per day reduces the risk of stroke
• Taking preventive medications such as anti-platelet and anticoagulant drugs to prevent blood clots
• Cholesterol lowering drugs can prevent stroke recurrence
• Walking for at least 210 minutes each week was found to reduce the risk of stroke in women, compared to those who did not do much physical activity, researchers from the Murcia Regional Health Authority, Spain, reported in the journal Stroke (January 2013 issue). The same benefit was not found among men.

#you can take a quiz from this link#

have fun :)  http://www.medicinenet.com/stroke_quiz/quiz.htm

*reference from the link :

- http://en.wikipedia.org/wiki/Stroke

- http://www.medicalnewstoday.com/articles/7624.php

- http://www.onhealth.com/stroke/page9.htm#

- http://www.mayoclinic.com/health/stroke/DS00150/DSECTION=

prepared by : IZZATUL ATHIRAH BINTI SHAFIAI (1311170204)

Parkinson's Disease

Parkinson's disease is a progressive disorder of the nervous system that affects your movement. It develops gradually, sometimes starting with a barely noticeable tremor in just one hand. But while tremor may be the most well-known sign of Parkinson's disease, the disorder also commonly causes stiffness or slowing of movement.

In early stages of Parkinson's disease, your face may show little or no expression, or your arms may not swing when you walk. Your speech may become soft or slurred. Parkinson's disease symptoms worsen as your condition progresses over time.

Although Parkinson's disease can't be cured, medications may markedly improve your symptoms. In occasional cases, your doctor may suggest surgery to regulate certain regions of your brain and improve your symptoms.

Symptoms

Parkinson's disease symptoms and signs may vary from person to person. Early signs may be mild and may go unnoticed. Symptoms often begin on one side of your body and usually remain worse on that side, even after symptoms begin to affect both sides. Parkinson's signs and symptoms may include:

• Tremor. Your tremor, or shaking, usually begins in your limb, often your hand or fingers. You may notice a back-and-forth rubbing of your thumb and forefinger, known as a pill-rolling tremor. One characteristic of Parkinson's disease is tremor of your hand when it is relaxed (at rest).
• Slowed movement (bradykinesia). Over time, Parkinson's disease may reduce your ability to move and slow your movement. This may make simple tasks difficult and time-consuming. Your steps may become shorter when you walk, or you may find it difficult to get out of a chair. Also, your feet may stick to the floor as you try to walk, making it difficult to move.
• Rigid muscles. Muscle stiffness may occur in any parts of your body. The stiff muscles can limit your range of motion and cause you pain.
• Impaired posture and balance. Your posture may have become stooped, or you may have balance problems as a result of Parkinson's disease.
• Loss of automatic movement
• s. In Parkinson's disease, you may have a decreased ability to perform unconscious movements, including blinking, smiling or swinging your arms when you walk. You may no longer gesture when talking.
• Speech changes. You often may have speech problems as a result of Parkinson's disease. You may speak softly, quickly, slur or hesitate before talking. Your speech may be more of a monotone, rather than with the usual inflections.
• Writing changes. Writing may appear small and become difficult.
Medications typically markedly reduce many of these symptoms. These 
medications increase or substitute for a specific signaling chemical (neurotransmitter) in your brain: dopamine. People with Parkinson's disease have low brain dopamine concentrations.
When to see a doctorSee your doctor if you have any of the symptoms associated with Parkinson's disease — not only to diagnose your condition but also to rule out other causes for your symptoms.

Causes

The cause of Parkinson's disease is unknown, but several factors appear to play a role, including:
• Your genes. Researchers have identified specific genetic mutations that can cause Parkinson's disease, but these are extremely uncommon, except in rare cases with many family members affected by Parkinson's disease. However, certain gene variations (polymorphisms) appear to increase the risk of Parkinson's disease, but with a relatively small risk of for each of these genetic markers.
• Environmental triggers. Exposure to certain toxins or environmental factors increase the risk of later Parkinson's disease, but the risk is relatively small.
In summary, there is much work to be done to identify the factors causing Parkinson's disease.
Many changes occur in the brains of people with Parkinson's disease, including:
• The presence of Lewy bodies. Clumps of specific substances within brain cells are microscopic markers of Parkinson's disease. These are called Lewy bodies, and researchers believe these Lewy bodies hold an important clue to the cause of Parkinson's disease.


• A-synuclein is found within Lewy bodies. Although many substances are found within Lewy bodies, scientists believe the most important of these is the natural and widespread protein called a-synuclein. It's found in all Lewy bodies in a clumped form that cells can't break down. This is currently an important focus among Parkinson's disease researchers.


Risk factors
Risk factors for Parkinson's disease include:
• Age. Young adults rarely experience Parkinson's disease. It ordinarily begins in middle or late life, and the risk continues to increase with age.
• Heredity. Having a close relative with Parkinson's disease increases the chances that you'll also develop the disease. However, your risks are still small unless you have many relatives in your family with Parkinson's disease.
• Sex. Men are more likely to develop Parkinson's disease than are women.
• Exposure to toxins. Ongoing exposure to herbicides and pesticides may put you at a slightly increased risk of Parkinson's disease.



Complications
Parkinson's disease is often accompanied by these additional problems, which are variably treatable:
• Thinking difficulties. You may experience cognitive problems (dementia) and thinking difficulties, which usually occur in the later stages of Parkinson's disease. Such cognitive problems aren't very responsive to medications.
• Depression and emotional changes. Many people with Parkinson's disease may experience depression. Receiving treatment for depression can make it easier to handle the other challenges of Parkinson's disease. You also may experience other emotional changes, such as fear, anxiety or loss of motivation.
• Sleep problems and sleep disorders. People with Parkinson's disease often may have sleep problems, including waking up frequently throughout the night, waking up early or suddenly falling asleep during the day, or rapid eye movement sleep behavior disorder — acting out your dreams. Medications may help your sleep problems.
• Bladder problems. Parkinson's disease may cause you to experience bladder problems, including being unable to control urine or having difficulty urinating.
• Constipation. Many people with Parkinson's disea
• se develop constipation primarily due to a slower digestive tract.
• Sexual dysfunction. Some people with Parkinson's disease may notice a decrease in sexual desire or performance.
Treatments and drugs


Parkinson's disease can't be cured, but medications can help control your symptoms, often dramatically. In some later cases, surgery may be advised. Your doctor also may recommend lifestyle changes, especially ongoing aerobic exercise. In some cases physical therapy that focuses on balance and stretching also is important.
MedicationsMedications can help you manage problems with walking, movement and tremor by increasing your brain's supply of dopamine. However, dopamine can't be given directly, as it can't enter your brain.
You may have significant improvement of your symptoms after beginning Parkinson's disease treatment. Over time, however, the benefits of drugs frequently diminish or become less consistent, although symptoms usually can continue to be fairly well controlled.
Your doctor may prescribe medications, which may include:
• Carbidopa-levodopa (Parcopa). Levodopa, the most effective Parkinson's disease medication, is a natural chemical that passes into your brain and is converted to dopamine. Levodopa is combined with carbidopa, which protects levodopa from premature conversion to dopamine outside your brain, which prevents nausea. In Europe, levodopa is combined with a similar substance, benserazide (Madopar). Side effects include nausea or a drop in blood pressure when standing (may result in faintness).
  After years, as your disease progresses, the benefit from levodopa may become less stable, with a tendency to wax and wane ("wearing off"). Also, you may experience involuntary movements (dyskinesia) after taking higher doses of levodopa. Your doctor may lessen your dose or adjust the times of your doses to control these effects.
• Dopamine agonists. Unlike levodopa, dopamine agonists don't change into dopamine. Instead, they mimic dopamine effects in your brain. They aren't as effective in treating your symptoms as levodopa. However, they last longer and may be used with levodopa to smooth the sometimes off and on effect of levodopa.
  Dopamine agonists include pramipexole (Mirapex) and ropinirole (Requip). A short-acting injectable dopamine agonist, apomorphine (Apokyn), is used for quick relief.
  The side effects of dopamine agonists are similar to carbidopa-levodopa, but also include hallucinations, swelling, sleepiness or compulsive behaviors such as hypersexuality, gambling and eating. If you're taking these medications and you start behaving in a way that's out of character for you, talk to your doctor.
  Sincerely prepared by, Nurul Izzaty Norazlan

  MEJ03

  Thanks for reading :)

Introduction To Nervous System

What is the nervous system?
     Your nervous system is the control and communication system of the body. Its job is to send and receive messages. Your nervous system controls all your thoughts and movements.

Parts of the nervous system

Neurons
     The cells that make up the nervous system are called neurons. Long, stringy neurons are perfect for carrying the electrical messages that are the "language" of the nervous system.
                              Brain
     The brain is the command center of your entire body. The brain is the body's main information center. It is made of billions of neurons. The brain helps the body respond to the information it receives from the senses. The brain also processes thoughts. When you think, neurons in your brain are working.
     The brain has three main parts. The largest is the cerebrum, which controls vision, touch, and other senses. It also handles movements you have control over. Thinking takes place in the cerebrum. The cerebellum is another section of the brain. The cerebellum helps control balance and coordination. Another part of the brain is called the brain stem. The brain stem is the link to the spinal cord and it also controls digestion, breathing, and heartbeat.
              
Spinal Cord
     The spinal cord is a tube of neurons that runs up the spine and attaches to the brain stem. Information from nerves that branch out to the rest of the body goes to the spinal cord. Some messages are processed by the spinal cord but most information is sent on to the brain.
              

ALZHEIMER'S DISEASE

Alzheimer's is a type of dementia that causes problems with memory, thinking and behavior. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks.

In Alzheimer's disease, the connections between brain cells and the brain cells themselves degenerate and die, causing a steady decline in memory and mental function.

Current Alzheimer's disease medications and management strategies may temporarily improve symptoms. This can sometimes help people with Alzheimer's disease maximize function and maintain independence.

But because there's no cure for Alzheimer's disease, it's important to seek supportive services and tap into your support network as early as possible.

SYMPTOMS 

At first, increasing forgetfulness or mild confusion may be the only symptoms of Alzheimer's disease that you notice. But over time, the disease robs you of more of your memory, especially recent memories. The rate at which symptoms worsen varies from person to person. If you have Alzheimer's, you may be the first to notice that you're having unusual difficulty remembering things and organizing your thoughts. Or you may not recognize that anything is wrong, even when changes are noticeable to your family members, close friends or co-workers.

Brain changes associated with Alzheimer's disease lead to growing trouble with:

MemoryEveryone has occasional memory lapses. It's normal to lose track of where you put your keys or forget the name of an acquaintance. But the memory loss associated with Alzheimer's disease persists and worsens, affecting your ability to function at work and at home. People with Alzheimer's may:

• Repeat statements and questions over and over, not realizing that they've asked the question before
• Forget conversations, appointments or events, and not remember them later
• Routinely misplace possessions, often putting them in illogical locations
• Eventually forget the names of family members and everyday objects

Disorientation and misinterpreting spatial relationshipsPeople with Alzheimer's disease may lose their sense of what day it is, the season, where they are or even their current life circumstances. Alzheimer's may also disrupt your brain's ability to interpret what you see, making it difficult to understand your surroundings. Eventually, these problems may lead to getting lost in familiar places.

Speaking and writingThose with Alzheimer's may have trouble finding the right words to identify objects, express thoughts or take part in conversations. Over time, the ability to read and write also declines.

Thinking and reasoningAlzheimer's disease causes difficulty concentrating and thinking, especially about abstract concepts like numbers. It may be challenging to manage finances, balance checkbooks, and keep track of bills and pay them on time. These difficulties may progress to inability to recognize and deal with numbers.

Making judgments and decisionsResponding effectively to everyday problems, such as food burning on the stove or unexpected driving situations, becomes increasingly challenging.

Planning and performing familiar tasksOnce-routine activities that require sequential steps, such as planning and cooking a meal or playing a favorite game, become a struggle as the disease progresses. Eventually, people with advanced Alzheimer's may forget how to perform basic tasks such as dressing and bathing.

Changes in personality and behaviorBrain changes that occur in Alzheimer's disease can affect the way you act and how you feel. People with Alzheimer's may experience:

• Depression
• Social withdrawal
• Mood swings
• Distrust in others
• Irritability and aggressiveness
• Changes in sleeping habits
• Wandering
• Loss of inhibitions
• Delusions, such as believing something has been stolen

CAUSES

Alzheimer's disease is caused by parts of the brain wasting away (atrophy), which damages the structure of the brain and how it works.

It is not known exactly what causes this process to begin, but people with Alzheimer's disease have been found to have abnormal amounts of protein (amyloid plaques) and fibres (tau tangles) in the brain.

These reduce the effectiveness of healthy neurons (nerve cells that carry messages to and from the brain), gradually destroying them.

Over time, this damage spreads to other areas of the brain, such as the grey matter (responsible for processing thoughts) and the hippocampus (responsible for memory).

Risk factors

Although it is still unknown what causes the deterioration of brain cells, there are several factors that are known to affect the development of Alzheimer's disease. These are described in more detail below.

Age

Age is the greatest factor in the development of Alzheimer's disease. The likelihood of developing the condition doubles every five years after you reach 65 years of age. However, it is not just older people who are at risk of developing Alzheimer's disease.

Family history

Genetic factors contribute to the risk of developing Alzheimer’s disease. Though in most cases, if you have a close family member with the condition, your risk of developing it is only slightly increased.

However, in a few families, Alzheimer’s disease is caused by the inheritance of a single gene, and the risks are much greater. If several of your family members over the generations have developed dementia, it may be appropriate to seek genetic advice and counselling.

The Alzheimer's Society website has more information about genetics and dementia.

Down's syndrome

People with Down's syndrome are at a higher risk of developing Alzheimer's disease.

This is because people with Down's syndrome have an extra copy of chromosome 21, which codes for a protein involved in the cause of Alzheimer's disease. Therefore, people with Down's syndrome produce more abnormal protein, which could contribute to developing Alzheimer's disease.

Whiplash and head injuries

People who have had a severe head injury, or severe whiplash, (a neck injury caused by a sudden movement of the head forwards, backwards or sideways) have been found to be at a higher risk of developing Alzheimer's disease.

Vascular disease

Research shows that several lifestyle factors and conditions associated with vascular disease can increase the risk of Alzheimer’s disease.

These include:

• smoking
• obesity 
• diabetes 
• high blood pressure
• high cholesterol

You can help reduce your risk by quitting smoking, eating a healthy balanced diet and having regular health tests as you get older. It is important to keep as active as possible both mentally and physically to help reduce the risk of Alzheimer’s disease.

TREATMENT 

There is currently no cure for Alzheimer's disease, but there are medications available on prescription that can help delay the condition’s development.

Treatment for Alzheimer’s disease also involves creating a care plan. This identifies the type of assistance that you might need, and focuses on ways of providing this support. 

Medication

Medications that may be prescribed for Alzheimer’s disease include:

• donepezil (brand name Aricept)
• galantamine (brand name Reminyl)
• rivastigmine (brand name Exelon)
• memantine (brand name Ebixa)

Whether these medications are used will depend on the severity of your Alzheimer’s disease.

Donepezil, galantamine and rivastigmine (AChE inhibitors) can be prescribed for people with mild to moderate Alzheimer's disease. Memantine may be prescribed for people with moderate Alzheimer's who cannot take AChE inhibitors or for those with severe Alzheimer's disease.

Medication should be prescribed by specialists such as:

• psychiatrists, including those specialising in learning disabilities
• neurologists
• physicians specialising in the care of older people

If you are caring for someone with Alzheimer's disease, your views should be taken into account when prescribing medication and also at regular assessments. These assessments take place to ensure the medication is having a worthwhile effect. 

Read the full NICE guidance on donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease (PDF: 665Kb).

Side effects

Donepezil, galantamine and rivastigmine (AChE inhibitors) can cause side effects including:

• nausea (feeling sick)
• vomiting
• diarrhoea 
• headache 
• fatigue (extreme tiredness)
• insomnia (difficulty getting to sleep or staying asleep)
• muscle cramps (when your muscles suddenly shorten and cause pain)

For more information about the possible side effects of a particular medication, refer to the patient information leaflet that comes with your medication, or see medicines information. 

Dementia

Alzheimer’s disease is the most common form of dementia. Dementia is a syndrome (a group of symptoms) that is associated with an ongoing decline in mental abilities. The treatment for Alzheimer’s disease will follow the same pattern as treatment for dementia.

If you have been diagnosed with any other conditions as well as Alzheimer’s disease, for example, depression or incontinence (when you unintentionally pass urine or stools), these may be treated separately.

Care assessment 

If you have been diagnosed with Alzheimer's disease, your future health and social care needs will be assessed and a care plan will be drawn up. This will be coordinated by:

• healthcare professionals, such as your GP or psychiatrist
• social care services, which is normally your local council working in conjunction with the NHS

As part of your care assessment your functional capacity will be assessed. This involves identifying areas where you may need some assistance with your day-to-day activities. For example, areas that may be assessed include:

• whether you can drive safely
• whether you can wash, dress and feed yourself
• whether you have a support network, such as family and friends
• whether you need any financial assistance

Following the care assessment, a care plan can be drawn up to arrange support for any areas where you may need to have some help. The kind of care that you will receive may depend on what is available from your local primary care trust (PCT).

Support

The healthcare professionals who are treating you will aim to keep you living as independently as possible. Support can be provided in many different ways. For example:

• grab bars and handrails can be added around your home, for example, to help you to get in and out of the bath
• an occupational therapist can identify problem areas in your everyday life, such as dressing yourself, and help you to work out practical solutions
• cognitive stimulation programmes can be arranged – these involve taking part in activities and exercises to improve your memory, problem-solving skills and language ability

Read more information about how dementia is treated.

You can find Alzheimer's support services in your area and, if necessary, choose a hospital for Alzheimer's disease.

PREVENTION 

As the exact cause of Alzheimer’s disease is still unknown, there is no way to prevent the condition. However, there are some steps that you can take which may help to delay the onset of dementia.

For example, you can help to prevent vascular dementia, as well as cardiovascular diseases such as stroke and heart attacks, by:

• quitting smoking 
• avoid drinking large amounts of alcohol
• eating a healthy balanced diet, including at least five portions of fruit and vegetables every day
• exercising for at least 150 minutes (2 hours and 30 minutes) every week, doing moderate-intensity aerobic activity (such as cycling or fast walking) as this will improve both your physical and mental health
• make sure your blood pressure is checked and controlled through regular health tests
• if you have diabetes, make sure you keep to the diet and take and medicines

Read more information about preventing dementia.

Staying mentally active

There is some evidence suggesting that rates of dementia are lower in people who remain as mentally, physically, and socially active as possible throughout their lives, and also among those who enjoy a wide range of different activities and hobbies.

Some activities that may reduce the risk of developing dementia include:

• reading
• writing for pleasure
• learning foreign languages
• playing musical instruments
• taking part in adult education courses
• playing tennis
• playing golf
• swimming
• group sports, such as bowling
• walking

There is no evidence that playing ‘brain training’ computer games reduces the risk of dementia.

Future research

Research into Alzheimer’s disease is continuing, and as more is revealed about the condition, other ways to treat or prevent it may be found. However, research does not always produce successful results.

You can read more information about ongoing dementia research on the Alzheimer's Research UK website.

The National Institute for Health and Clinical Excellence (NICE) has advised that there is no evidence yet to support the use of the following to prevent dementia:

• statins (cholesterol-lowering medicines)
• hormone replacement therapy (when powerful chemicals are taken to replace those that your body no longer produces)
• vitamin E (found in a variety of foods, such as olive oil, nuts and seeds)
• non-steroidal anti-inflammatory drugs (NSAIDs)

BY : NUR NADHIRAH NAJWA BINTI RUSLI 

MEJ 3 2013