You Forget Where You’ve Put Things
Its not unusual to occasionally forget where you stashed your keys. But if you find that youre doing this regularly, leaving the stove burner on or frequently forgetting recent events and conversations, this could be a warning sign. Commonly, says Hsiung, people with this type of memory loss will ask loved ones the same questions over and over again.
Families can help a lot in recognizing these early symptoms, because if the persons memory is poor, they wont remember the problems they have in remembering, he says.
This sign is one that often points to Alzheimers disease. In this type of dementia, the hippocampusthe brain area involved in forming, storing and retrieving memoriesmay be affected first. In fact, short-term memory loss is the most common symptom among people with Alzheimers disease, whereas its less often an early sign in vascular dementia and Lewy body dementia, and rarely in FTD.
Medications and depression can also affect memory, so its important to check with your doctor, who might recommend a screening test, such as the Montreal Cognitive Assessment30 questions which quickly identify abnormal brain function.
Brain Health Lifestyle Treatments
There are several things that you can do to keep your brain as healthy as possible, including:
- learning some ways to manage stress MS can cause stress because of its unpredictable nature, but stress in turn can increase your risk of a relapse.
If you have an intolerance or sensitivity to cold or heat that worsens your symptoms, it can be managed by adopting various strategies talk to your MS healthcare team.
Multiple Sclerosis Is A Form Of Dementia
Professor Giavannoni has put the cat amongst the pigeons by saying that MS is a form of dementia.
The definition of dementia is
Dementia is a loss of mental ability severe enough to interfere with normal activities of daily living, lasting more than six months, not present since birth, and not associated with a loss or alteration of consciousness.
Multiple Sclerosis is a Form of Dementia
Or to put it more simply the brain cells are being irrepairably damaged and as a result the cognitive functions such as memory, reasoning, planning, and behaviour are becoming impaired doesnt this this sound like progressive multiple sclerosis? I know there is loss of short term and that is not just because Im getting older.
He goes on to say that a huge number of MS sufferers with aggressive MS are young people.
The current figures show
- 50% of MS sufferers are unemployed within 10 years of disease onset
- 50% of MS sufferers are unemployed at an EDSS of 3.5 a level of disability that is not associated with physically disability
Those figures are frightening. I stopped work, more to the point, no one would hire me. My level of disability on the EDSS scale was between 5.0 and 5.5. Was I lucky, well who knows?
MS is measured on the EDSS scale. 0 is normal and 10 is dead. Assume we have 8 functional systems as listed below
This is very thought provoking, what do you think? Please write and let me know.
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Living With Cognitive Problems
Problems with thinking or memory might sound trivial, but they can have a big impact on the day-to-day experience of living with MS. It can be frustrating to find that your cognitive issues go un-noticed by those around you. Your experience might not look as bad to the outside world as it feels to you. Other people dont see the extra, invisible effort you are putting in to get the same result.
You may need to explain your cognitive symptoms to friends, family or work colleagues in order to get understanding or appropriate support. It is worth remembering that in most cases you have not lost the skills you used to have, they just take a little longer to express. With the right support and plans in place you can continue to do things as you choose.
The longer you have had MS the more likely cognitive problems are to occur. Research suggests that cognitive symptoms usually stay the same over several years, or only very gradually worsen. You have time to develop strategies to compensate for any difficulties, or train your brain to slow down any cognitive decline.
Dementia With Lewy Bodies
Initial symptoms: Dementia with Lewy bodies is a type of Lewy body dementia. Dementia with Lewy bodies involves both body symptoms such as motor and muscle weakness and rigidity, as well as brain symptoms like making decisions, memory impairment, and attention span.
In dementia with Lewy bodies, the brain symptoms develop before the body symptoms, at the same time or less than a year after the body symptoms present.
Progression: Dementia with Lewy bodies can vary quite a bit, even from day to day. However, in general the disease starts slowly and worsens gradually.
Prognosis: Average life expectancy depends on many factors but is estimated to be approximately 5 to 8 years after diagnosis.
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Nature Of Cognitive Impairment
Cognitive functioning is typically characterized into one of 5 domains: 1) learning and memory, 2) language, 3) visuo-spatial, 4) executive and 5) psychomotor. These domains have a rough correspondence with their cerebral localization. For a diagnosis of MCI, only one of these areas must be impaired in order to make a diagnosis, whereas more than one domain must be impaired to make a diagnosis of dementia. Evidence for involvement of individual domains can be obtained from the history, a brief mental status examination or neuropsychological testing.
Non-amnestic cognitive impairments are nearly as common as the amnestic forms. Non-amnestic impairment can involve word finding and speech difficulties, impaired geographic orientation, visual perception problems and impaired mental agility. When there is dysfunction in more than one cognitive domain in persons with MCI, referred to as multidomain MCI, the risk for decline to dementia is much higher than when there are isolated memory problems or word finding problems, .
Medical Treatment For Dementia
There are no cures for degenerative or irreversible dementias, so medical treatments focus on maximizing the individualâs cognitive and functional abilities. Specific treatments for dementia vary depending on the cause of the dementia. For patients with Alzheimerâs disease and Lewy body disease, for example, medications are available to slow the rate of decline and improve memory function. These medications are known as cholinesterase inhibitors and seem to be effective for some patients. For patients with Alzheimerâs disease, a newer medication, which prevents the buildup of chemicals thought to contribute to memory loss, has also been developed. Treatment for vascular dementia includes controlling risk factors such as high blood pressure and high cholesterol. Additional medications are available to manage other symptoms associated with dementia, including sleep disorders, movement problems, depression, or behavioral symptoms such as irritability or agitation. Because treatments vary depending on the cause of dementia, an accurate diagnosis is critical.
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You See Things That Aren’t There
Recurring visual hallucinations may be an early symptom of Lewy body or Parkinsons disease dementia, although people with Alzheimers disease can experience them, too. These can be as simple as seeing flashing lights or as elaborate as encountering animals and people that arent real.
Sometimes the hallucinations are quite frightening, like seeing a wolf or a bear trying to break through the window, says Hsiung. Other times theyre more positive, like a grandmother who looks out the window and sees her grandchildren playing in the playground, but no one is there.
Researchers believe that visual hallucinations may be caused by damage to the brains visual-processing system, in combination with the diseases disruption of the sleep cycleso that the visions might actually be dreams breaking into waking consciousness.
Tests And Diagnosis For Impaired Thinking
If you think you have cognitive problems, talk with your neurologist or family doctor. Fuzzy thinking can have many causes.
Once you have any health problems fully treated, the next step is usually testing. Your doctor may refer you to a neuropsychologist, speech pathologist, or occupational therapist.
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What Are The Signs And Symptoms Of Dementia
Individuals with dementia may be prone to forgetting things, like where they live or how to cook something they have cooked for years. If the disease affects the frontal temporal lobe, they can lose control of their decision-making skills and language abilities. Some patients are also prone to aggression.
Common Forms Of Dementia
There are many different forms of dementia. Alzheimer’s disease is the most common form and may contribute to 6070% of cases. Other major forms include vascular dementia, dementia with Lewy bodies , and a group of diseases that contribute to frontotemporal dementia . The boundaries between different forms of dementia are indistinct and mixed forms often co-exist.
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Dementia Associated With Corticobasal Degeneration
Corticobasal degeneration , sometimes referred to as corticobasal ganglionic degeneration, is considered to be a part of the spectrum of Frontotemporal dementia . It is characterized by nerve cell death and atrophy or shrinkage of multiple areas of the brain, including the cerebral cortex and basal ganglia. CBD typically occurs in individuals between the ages of 45-70. Rarely, there is a family history of dementia, psychiatric problems or a movement disorder.
Signs & Symptoms: Individuals with CBD usually present with either a movement disorder or cognitive deficits. As the disease progresses, they can go on to develop both types of symptoms.
The movement symptoms can be very similar to Parkinsons disease, with slowness, and rigidity, but tremor is less common. These symptoms do not respond to Parkinsons disease medications. Many individuals with CBD experience a subtle change in sensation or an inability to make the affected limb follow commands. They may have difficulties completing some specific tasks such as brushing teeth, opening a door or using tools such as a can opener. When it affects the legs, a person can have difficulty dancing or may show an increased tendency to trip and fall. Other symptoms include involuntary stiffening, twisting or contraction , or uncontrolled movement of the affected limb .
UCSF Memory and Aging Center
For more information, visit the National Institute of Neurological Disorders and Stroke:
Your Vision Is Patchy
Problems with spatial awareness can be caused by cataracts or glaucoma, but theyre also one of the early signs of dementia. This was the case with Chow, whose first Alzheimers symptoms were caused by a shrinkage of the area of the brain crucial to his ability to accurately perceive the world three-dimensionally.
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A patient with posterior cortical atrophy may see the world in a patchy visual field, explains Hsiung. If the person is focusing in front while driving, he cant see things off to the side. And if hes changing lanes, he cant see other cars beside him. Meanwhile, when Chow made mistakes typing, he was having trouble seeing the whole keyboard.
Tartaglia notes that visual-spatial processing problems are especially prevalent as an early sign of Lewy body dementia, which can affect a similar area of the brain.
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You Struggle With Vocabulary
Word-finding difficulties are a common early sign of dementia. You might have trouble finding the right words during conversations or when naming objects, sometimes substituting the wrong word. People affected in this way pause while speaking, use filler words and frequently rely on it or they instead of specific names for things. Researchers at the University of Wisconsin-Madison found that these word-finding problems increased significantly in the span of just two years for people developing dementia.
Language can, in fact, be affected before memory problems emerge. An Arizona State University study analyzed former U.S. President Ronald Reagans press conferences and found speech changes more than a decade before he was diagnosed with Alzheimers.
To assess whether your word-finding challenges are related to a shrinkage in the language areas of your brain, pay attention to when and how often this happens. It could simply be a result of being tired or stressedand can be caused by anxiety, depression, stroke and delirium, as well.
How Is Ms Treated
There are no medications to cure MS, rather they are used to modify the course of the disease. At present there are a total of 16 disease modifying treatments registered for use in Australia, including treatments for RRMS, several for SPMS and one for PPMS. Most are covered by the Pharmaceutical Benefits Scheme . For RRMS, MS treatment aims to:
- minimise relapses
- prevent the formation of new lesions
- minimise brain atrophy
- restore function
- minimise the impact of symptoms on your day-to-day life.
The DMTs can be administered in various ways, by injection, orally by tablet/capsule and intravenously at various time points. There can be significant side effects associated with some of the DMTs, for this reason specialist MS healthcare teams usually manage the DMTs and provide important safety guidance and treatment monitoring for people living with MS and their local health care teams. Studies have shown that early diagnosis and commencement of DMTs can lead to better health outcomes in people living with MS.
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You’re Suddenly Bad With Money
A pattern of uncharacteristically poor financial decisions should set off alarm bells. When you have frontal-lobe damage, you lose judgment and can make rash, impulsive financial decisions, says Tartaglia. A frugal person starts giving away more money or buying things they dont needlike a furnace from a door-to-door salesperson. Shes seen patients who did significant damage to their families finances, as well as CEOs of companies who lost millions because nobody noticed the signs.
A combination of declining decision-making skills and memory can also lead to financial lapses. A 2020 JAMA Internal Medicine study found that people with dementia started missing bill payments up to six years before they were diagnosed.
Cognitive Impairment In Ms: An Overview
Although Jean-Martin Charcot is credited with providing a comprehensive description of MS, reports of both MS and comorbid cognitive impairment precede Charcots 1868 lectures. Dr. Friedrich von Frerichs first cited MS-related cognitive impairment in 1849, 25 years after the diseases initial clinical description. Despite multiple early accounts of MS as a disease affecting cognition, reports on the incidence of cognitive impairment in patients with MS were mixed over the following century. While some late 19th and early 20th century physicians recognized deterioration of cognitive faculties in more than half of their MS patients, others reported that only two percent of their patients with MS experienced blunted intellectual function.1 Discrepancies in these figures are probably due to the fact that the majority of neurologists did not ask patients with MS about their cognitive function, and those neurologists who did inquire had inconsistent means of measuring cognitive function.
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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.
Myelin Sheath And The Role It Plays In Ms
Moreover, the disease can cause atrophy and shrinkage in certain parts of the brain and spinal cord, including the corpus callosum, which connects the right and left sides of the brain.
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Complementary Therapies And Ms
Medications and physical therapies can be complemented by other therapies. Be cautious when investigating a complementary therapy and be sceptical of miracle cure claims. Always ask your MS healthcare team for advice before starting any complementary treatment, as some complementary treatments may have negative interactions with medications you may be taking.
How Healthcare Professionals Can Help:
Healthcare professionals who work with dementia patients know that compassion and patience can go a long way in improving a patients day-to-day life.
These three strategies can help you minimize negative experiences for your patients and provide an exceptional level of care:
1. Stay calm. Some patients tend to have high anxiety, especially when they are exposed to new activities, changes in their routine or noise. Its not always easy to recognize when patients are feeling anxious because they may not be able to verbalize their feelings. They may act out aggressively towards their caregivers.
Its important to remember that patients can sense your stress and frustration. If you are visibly stressed, you patient may become more upset. Watch your patients body language for signals of stress and stay calm when you address a patient who is having difficulty coping with a new situation.
2. Patience is key. You might not be able to calm an upset patient right way. Sometimes patients get into a funk and cannot find a way to listen sometimes they might not want to listen. A new face and voice can sometimes help put an upset patient at ease, so ask a colleague to assist you if you cannot help a patient on your own.
It also helps to use simple directives. Repeat instructions calmly and clearly until your patients can understand and respond. Do not end your instruction with okay? because patients may become combative and respond with no.
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