Parkinsons And Multiple Sclerosis Case Study: Virginia
One recent case illustrating the power of water to combat problems related to major conditions involves a 67-year-old patient diagnosed with both Multiple Sclerosis and Parkinsons who sought treatment at a senior living campus. The woman, Virginia, has been wheelchair bound due to her illnesses, but was particularly concerned because her body had begun to lean to the left to the point where she could not easily read the newspaper, play the piano or easily put on her slacks.
Virginia was determined not to allow her conditions to stop her from having a good quality of life. Therefore, she turned to water therapy twice a week. When she began her rehabilitation, it was very difficult for her to bear any weight until she was significantly submerged and the buoyancy could prevent her from falling. After three months, she improved her core strength to the point where she could sit and stand upright, and could exercise in water depths that were lower than before.
As Virginias physical therapist now notes, she has improved to the point where she can stand against currents created by resistance jets. Additionally, her posture is much better. Most exciting of all from Virginias perspective was when she had a check-up with her neurologist who was amazed at the results. Now, Virginia plays the piano for up to 45 minutes at a time without leaning to the left, and can feel the positive effects of being stronger and more stable.
Cognitive Dysfunction In Multiple Sclerosis
There has been a lot of recent research into changes in cognition due to MS and it is now evident that such changes do occur and that they are more common than was previously thought. Cognition is about our abilities in thinking things through and how well our memory works.
Cognition is also about how to focus and to maintain our attention; the way we learn and remember new things; how we think reason and solve problems. It also concerns how we plan and carry out our activities; the way we understand and use language and how well we recognise objects, assemble things together and judge distances.
The brain damage in MS is different to that in e.g. Alzheimers type dementia and so the problems shown are different. Although the problems may not amount to full dementia they can cause significant disruption to the lives of patients. In studies of MS patients with and without cognitive dysfunction, those with have been shown to be more significantly impaired with respect to work, sexual and social functioning and basic activities of daily living.
Symptoms and course
Carer problems
The person may express anger about what is happening to them and take this out on the carer. Similarly the carer may also be angry or depressed about he person and possibly become irritable and withdrawn.
Causes and risk factors
Diagnostic procedures
Care and treatment
Ongoing research/Clinical trials
The Roles Of Depression And Physical Disability
Inflammation, neuronal degeneration, and lesion formation are likely among the causes of cognitive impairment in people with MS. Gray matter loss in the brain, specifically in the cerebral cortex and the thalamus , correlates with cognitive impairment.14 However, some patients with extensive brain lesions remain cognitively intact, while others with a low lesion load experience cognitive impairment. Additionally, the patterns of deficits in patients affected by cognitive impairment vary widely. For example, some patients experience relatively subtle cognitive problems, such as word-finding difficulty, while others are so debilitated that they cannot navigate roads in their own neighborhood or remember important phone numbers that used to be familiar to them. While the exact causes of cognitive impairment in MS are unknown, two factors often further impair cognitive performance in patients with the disease: depression and physical disability.
Depression is predominantly caused by inflammation in the brain, which is a hallmark of MS.15 Although researchers do not fully understand the pathogenesis of MS, they think inflammation precedes neuron death and myelin loss. One might hypothesize that depression would arise due to early inflammation, to be followed by degeneration of neurons and lesion development, leading to cognitive impairment.
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The Similarity Of Myelin Damage In Multiple Sclerosis And Ad
Multiple sclerosis is one of the most frequent demyelinating disorders, which, like AD, is accompanied by impaired cognition . Cognitive impairment affects 4370% of MS patients . Multiple data from neuropathological and neuroimaging studies confirm myelin damage in the brains of MS patients . It is also known that myelin damage in MS contributes to cognitive decline . What is more interesting, there exists evidence that spatial memory impairment and working memory impairment are especially connected with demyelination of the CNS . The data from MS research suggest that myelin damage may directly lead to cognitive decline and memory deficits.
Myelin damage is also typical of the normal aging brain, and research shows that it is this damage that contributes to the cognitive decline in elderly people . Age-related cognitive decline is mainly due to marked demyelination and loss of oligodendrocytes . Additionally, there is evidence that memory training may increase the integrity of the white matter and improve memory both in MS patients and elderly people .
Both MS and AD are accompanied by an inflammatory process and both are neurodegenerative disorders. Inflammation may contribute to myelin damage. Both activated microglia and inflammatory cytokines may be involved in myelin impairment. Demyelination may, in turn, contribute to the dysfunction of neurons, which forms a kind of vicious circle both in AD and in MS, and may promote further progression of these diseases.
Signs Of Impaired Thinking In Ms
The clues that you have fuzzy thinking are often subtle. You might not notice them until a friend, co-worker, or family member points them out. You may:
- Struggle to find the right words to say
- Forget things you need to do or tasks already done
- Find it hard to plan ahead or set priorities
- Have trouble concentrating, especially when two things are happening at once.
MS usually does not hurt your intelligence or long-term memory. It won’t change your ability to read and carry on a conversation.
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Neurofibrillary Tangles And Senile Plaques
Plaques are dense, mostly insoluble deposits of protein and cellular material outside and around the neurons. Plaques are made of beta-amyloid , a protein fragment snipped from a larger protein called amyloid precursor protein . These fragments clump together and are mixed with other molecules, neurons, and non-nerve cells .
In AD, plaques develop in the hippocampus, a structure deep in the brain that helps to encode memories, and in other areas of the cerebral cortex that are used in thinking and making decisions. Plaques may begin to develop as early as the fifth decade of life. Whether Ab plaques themselves cause AD or whether they are a by-product of the AD process is still unknown. It is known that changes in APP structure can cause a rare, inherited form of AD.
Tangles are insoluble twisted fibers that build up inside the nerve cell. Although many older people develop some plaques and tangles, the brains of people with AD have them to a greater extent, especially in certain regions of the brain that are important in memory. There are likely to be significant age-related differences in the extent to which the presence of plaques and tangles are indicative of the presence of dementia.
SPs also accumulate primarily in association cortices and in the hippocampus. Plaques and tangles have relatively discrete and stereotypical patterns of laminar distribution in the cerebral cortex, which indicate predominant involvement of corticocortical connections.
Are Multiple Sclerosis And Osteoarthritis Connected
by Patient Advocate
People living with multiple sclerosis often experience impaired balance, difficulty walking, mild to severe muscle weakness, and sensory disturbances. Each of these symptoms can put extra strain on the body as patients struggle to stay mobile and active.
Osteoarthritis is the most common joint disorder that causes symptoms in the United States. It affects approximately 10 percent of men and 13 percent of women aged 60 years or older.
Pain and disability caused by osteoarthritis can make climbing stairs and walking difficult. Increased risk factors include older age, female gender, obesity, knee injury, repetitive use of joints, muscle weakness, and joint looseness. Radiographic signs of OA include osteophytes , joint space narrowing, and breakdown of cartilage.
Although OA is generally considered to be a wear and tear condition affecting older adults, it can also affect individuals in their 40s and 50s. I was first diagnosed with knee osteoarthritis in my early 40s, several years after being diagnosed with MS in my mid-30s. My case of OA is tricompartmental, meaning that it affects each of three joint areas where the thigh bone and lower leg come together and behind the kneecap. Eventually I will need total knee replacement on both my left and right knees.
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The Cause Of Myelin Damage In Ad
Aging is an obvious risk factor for myelin damage, as well as for AD. The number of oligodendrocytes decreases with age by 27% from adolescence until the age of 90 and the volume of the white matter also decreases by 28% within this time. Thus the rate of oligodendrocyte death and myelin damage is faster than the rate of neuronal death . The aging of oligodendrocytes leads to a decrease in the quality and amount of myelin.
Oligodendrocytes originate from oligodendrocyte progenitor cells , which have the capacity to clear A through the process of phagocytosis and autophagy . In AD, the number of OPCs and oligodendrocytes becomes smaller, which hinders A cleavage from the brain. As mentioned above, oligodendrocytes are also involved in the neurodegenerative process, which also decreases their number in the course of AD.
It is worth noting that there exists a relationship between the presence of the ApoE4 allele and the level of myelin damage in AD. ApoE, a confirmed risk factor for the disease, plays an important role in the transportation of endogenously produced brain lipids and recycling of these lipids, which is crucial for the production of myelin, its maintenance, and its repair . It has been proven that apoE4 allele carriers have lower levels of ApoE molecules in serum and the brain tissue than non-carriers . The Apo E4 allele decreases the formation of myelin in the human brain and promotes age-related myelin damage .
What Types Of Exercise Are Best For Someone With Knee Problems
Three types of exercise are best for people with arthritis:
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Range-of-motion exercises to help maintain or increase flexibility and relieve stiffness in the knee;
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Strengthening exercises to help maintain or increase muscle strength that will in turn support and protect joints with arthritis; and
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Aerobic or endurance exercises to improve heart function and blood circulation, help with weight control, and reduce swelling in some joints.
For my own knee osteoarthritis, I have received corticosteroid injections, physical therapy, and hyaluronate viscosupplementation injections which are designed to help improve lubrication and cushioning inside the joint. I also ride my bicycle for exercise and follow strengthening and flexibility exercises prescribed by my physical therapist.
Researchers do not have clear answers as to why people with MS may have earlier and more significant cartilage degeneration compared to healthy individuals. However, more recent studies have indicated that the immune system plays a role in the development of OA. I look forward to researchers continuing to look for answers.
Eroglu S, Inal EE, et al. Ultrasound detection of knee joint degeneration in patients with multiple sclerosis. J Rehabil Med. 2016;48:604-8. doi: 10.2340/16501977-2099.
Orlowsky EW, Kraus VB. The Role of Innate Immunity in Osteoarthritis: When Our First Line of Defense Goes on the Offensive. The Journal of Rheumatology. 2015;42:363-371. doi:10.3899/jrheum.140382.
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Sexual Differences In Incidence
Some studies have reported a higher risk of AD in women than in men; other studies, however, including the Aging, Demographics, and Memory Study, found no difference in risk between men and women. Almost two thirds of Americans with AD are women. Among AD patients overall, any sexual disparity may simply reflect womens higher life expectancy. Among those who are heterozygous for the APOE E4 allele, however, Payami et al found a twofold increased risk in women.
Granulovacuolar Degeneration And Neuropil Threads
Granulovacuolar degeneration occurs almost exclusively in the hippocampus. Neuropil threads are an array of dystrophic neurites diffusely distributed in the cortical neuropil, more or less independently of plaques and tangles. This lesion suggests neuropil alterations beyond those merely due to NFTs and SPs and indicates an even more widespread insult to the cortical circuitry than that visualized by studying only plaques and tangles.
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When To Seek Medical Care For Als
In ALS, most people are aware of problems with physical strength and weakness in their hands, arms or legs. People with dementia do not always realize that they are having problems with their thinking. Because dementia is not a common feature associated with ALS, and can have many causes, it is important to see your health care provider if you develop any changes in personality, behavior, language comprehension, or memory.
Multiple Sclerosis Dementia Like Symptoms
What is Multiple Sclerosis Dementia?;
Multiple sclerosis is a medical condition in which there is an inflammatory process that affects the myelin sheaths of the nerves and brain.;The myelin sheaths are a covering that protects the nerves and allows the nerve cells to communicate between the brain and the spinal cord. In Multiple Sclerosis an inflammation process the body attacks the coverings around the axons of the spinal cord and brain that leads to scarring and loss of the covering, known as demyelination.
The loss of the myelin sheath affects the nerves ability to efficiently communicate information because scarring occurs in the white matter of the brain and spinal cord. The scarring causes a buildup of plaque resulting in a variety of different neurological symptoms.
Multiple sclerosis is a progressive disease. There are several different forms ranging from a condition that has periods of remission followed by a period of relapse to a progressive form that occurs over time.;Symptoms that appear during a relapse may go away, leaving permanent neurological deficits.; The symptoms may range from muscle weakness, loss of balance, problems with swallowing, visual disturbances, changes in mood, and problems with memory concentration.
A change in cognitive abilities is usually subtle in most individuals with MS and a few behavioral changes may be developed to compensate for those changes.
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How Do You Treat Osteoarthritis
According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases , common treatments for osteoarthritis include:
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Medicines to reduce pain, such as aspirin and acetaminophen;
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Medicines to reduce swelling and inflammation, such as ibuprofen and nonsteroidal anti-inflammatory drugs ;
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Exercises to improve movement and strength; and
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Weight loss.
Cognitive Impairment In Multiple Sclerosis
A Forgotten Disability Remembered
Physicians first noted the presence of cognitive impairment in patients with multiple sclerosis more than 160 years ago, yet it took clinicians until 2001 to codify a standard test to measure cognitive function. We now know that cognitive impairment occurs in up to 65 percent of people with MS and usually lessens their ability to remember previously learned information. So far, trials of drugs formulated to treat cognitive impairment have failed, but the authors remain optimistic that new approaches to diagnosis and drug development could lead to effective therapies in the future.
Depending on the extent and location of damage in the CNS, patients with MS may experience a wide variety of symptoms. The most commonly reported symptoms at the time of diagnosis are blurred vision, tingling and/or numbness, and loss of coordination. As the disease progresses, usually with a series of acute immune attacks and a late-stage steady march of function loss, patients with MS commonly experience fatigue, spasticity, difficulty walking, and cognitive impairment. Before 1993 there were no approved treatments of MS. Today, eight of the nine FDA-approved disease-modifying treatments are designed to reduce the frequency of clinical exacerbations in MS, and one is approved to improve walking ability. None, however, target the cognitive impairment often seen in people who have MS.
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Multiple Sclerosis And Alzheimer Disease Through The Looking Glass Of Mr Imaging
MR imaging has led to a profound shift of perspective in many central nervous system conditions. In epilepsy, quantitative evidence of hippocampal volume loss by MR imaging has been highly correlated with seizure onset in medial temporal structures ; in stroke, it has enabled detection of the earliest structural changes and targeting of patients for thrombolysis ; and in brain tumors, it has allowed unprecedented, accurate preoperative work-up . The field in which MR imaging has contributed most to shape current knowledge about the mechanisms leading to irreversible disability and, as a consequence, the identification of effective treatment, however, is perhaps multiple sclerosis and allied white matter diseases.
Contribution of MR imaging to understanding the pathophysiology of multiple sclerosis and Alzheimer disease
Do Ms Symptoms Lead To Osteoarthritis
One of the more complex risk factors for knee OA is muscle weakness, particularly in the quadriceps. MS can be associated with weak thigh muscles. Researchers examining potential associations between MS and osteoarthritis hypothesized that the knee joint in people with MS might be more greatly affected due to problems with balance and muscle weakness and may result in earlier joint degeneration.
To test this theory, researchers used ultrasound to investigate whether there is a correlation between the breakdown of femoral cartilage the cartilage that covers the end of the thigh bone and MS-related disease parameters.
Researchers recruited 79 people with MS and 60 healthy age- and sex-matched controls. Several outcomes, including disability, physical functioning, pain, and balance, were measured in the study. Ultrasound was used to evaluate the sharpness, clarity, and thickness of cartilage.
Scores for pain, stiffness, and physical function were significantly worse in the MS group compared to those of the control group. Members of the MS group had more impaired balance. Researchers found that the femoral cartilages of patients with MS were significantly more degenerated compared with healthy controls. Also, members of the MS group had more effusion swelling or water on the knee than did controls. Results of the study were published in the Journal of Rehabilitation Medicine.
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