Dysphagia

The Surprising Benefits of Cannabis for an Active Lifestyle

Dysarthria

Chronic Pain

Perte de cheveux : les boissons sucrées en cause ?

Type 2 diabetes and its impact on the brain

Depression in the elderly

Malnutrition

Dementias associated with extrapyramidal syndrome

Dementia: what are the predictive signs?

Author Archives: Stéphane Bastianetto

  1. Dysphagia

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    Usually, swallowing disorders are caused by neurological or esophageal problems or by medications. They can lead to health problems, such as malnutrition and respiratory complications, and social problems.

    Their frequency is high in the elderly, especially in institutions, but they are probably underestimated and underdiagnosed. It is useful to screen patients with a swallowing test, especially since the symptoms are not always easy to detect.

    It allows us to carry out additional examinations and offer individualized care, in particular on how to eat and stay hydrated.

    Swallowing in three stages

    1. Food or liquids are sucked, chewed, and moved down the throat.
    2. Pharyngeal phase: food passes into the throat. The upper esophageal sphincter, which is the tube that goes from the mouth to the stomach, opens, allowing the bolus to pass into the esophagus. The airways are closed to prevent food or any liquid from entering. Food entering the airways can cause coughing or choking.
    3. The esophageal phase begins after the esophagus is closed and ends with the arrival of the bolus in the stomach. Food may get stuck in the esophagus or you may vomit if there is a problem with the esophagus.

    Esophageal peristalsis includes a first phase triggered during swallowing by receptors in the posterior pharyngeal wall. The second peristaltic phase is triggered by the arrival of the bolus and the dilation of the esophagus.

    Signs of trouble swallowing

    The swallowing disorder is called dysphagia.

    General signs of a swallowing problem can include:

    • A cough during or just after eating or drinking
    • Extra effort or time needed to chew or swallow
    • Food or liquid leaking from the mouth
    • Food stuck in mouth
    • Having trouble breathing after meals
    • Weight loss

    As a result, the person with swallowing difficulties may have:

    • Dehydration or malnutrition.
    • Food or liquid entering the airways.
    • Pneumonia or other lung infection.

    Oropharyngeal dysphagia

    Oropharyngeal dysphagia is a swallowing disorder that is caused by a structural or functional problem.

    Consequences include airway blockage, food transfer into the airways, and aspiration pneumonia.

    These eating issues are often accompanied by significant weight loss and have a psychological impact.

    Causes of swallowing disorders

    Many diseases can cause swallowing problems.

    Medications. It is difficult to chew and swallow some medications that cause a dry mouth. Others cause a sedative effect or a decrease in the activity of the central nervous system. Here is a list:

    • Anxiolytics and some sleeping pills.
    • Certain antibiotics (aminoglycosides, erythromycin), botulinum toxin or penicillamine can block the neuromuscular junction.
    • Corticosteroids, colchicine, or statins can decrease muscle tone.
    • Drugs that lower dopamine levels (antipsychotics, antiemetics or antiparkinsonian drugs that cause undesirable motor effects (e.g. dyskinesias), among others in the mouth and face.
    • All drugs that lower acetylcholine levels such as tricyclic antidepressants and selective serotonin reuptake inhibitors.
    • Opiates or inhaled bronchodilators can also cause xerostomia.
    • NSAIDs can irritate the lining of the esophagus, which is a cause of trouble swallowing.

    Other causes are related to brain or nerve damage by:

    • Cerebrovascular accident (CVA). Strokes are an important cause of dysphagia, particularly when they affect the brain stem or cortical areas involved in swallowing. During the acute phase of stroke, dysphagia is associated with increased mortality and an increased risk of institutionalization.
    • Parkinson disease. The prevalence of dysphagia in Parkinson’s disease varies between 30% and more than 80% depending on the study. Swallowing disorders can occur very early during the disease, or even precede the appearance of other classic motor signs.
    • Dementias. All forms of dementia can be accompanied by swallowing disorders, particularly in the severe stage of the disease, while attention disorders and praxis disorders are more significant. Neuroimaging studies indicate a decrease in activity of cortical areas during swallowing in Alzheimer’s patients.
    • Amyotrophic lateral sclerosis (or Lou Gehrig’s disease). Swallowing disorders are caused by weakness of the various muscles involved in swallowing, resulting in an increased risk of malnutrition.
    • Other neurological disorders or diseases: multiple sclerosis, muscular dystrophy and cerebral palsy, spinal cord injury.
    • Disorders or diseases related to the head or neck, such as certain cancers (mouth, throat, or esophagus).
    • Head or neck injuries.
    • Mouth or neck surgery.
    • Poor dentition, missing teeth or ill-fitting dentures.

    Evaluation of swallowing disorders

    A history and clinical examination are a first step before proceeding to a clinical evaluation or additional examinations.

    The anamnesis

    The doctor inquires about the patient’s history and current illnesses (e.g. neurological), about his complaints (e.g. pain when swallowing), current drug treatments, the social context (entourage, presence or absence of a caregiver ) and the type of power supply usually used.

    Apart from the emergency situation of an obvious aspiration bronchoaspiration, the signs suggestive of dysphagia are often non-specific.

    The clinical examination

    The examination includes a complete neurological and ENT examination, in particular of the oropharyngeal and cervical region. Cough reflex, voice, speech, saliva production and swallowing, oral status, and breathing at rest are also assessed.

    Depending on the cognitive state of the patient, other complementary examinations will be carried out.

    Swallowing test

    Different evaluation methods are available to detect and quantify swallowing disorders.

    Some tests – including the water test – require the patient to swallow a predetermined volume of liquid, usually water.

    Videofluoroscopy. This examination allows a real-time dynamic analysis of the different phases of swallowing, the patient swallowing a barium-based contrast product.

    Flexible nasal endoscopy.  It allows direct visualization of the nasopharynx, pharynx and larynx.

    Pharyngoesophageal manometry. It measures pharyngeal pressure during swallowing.

    There is also a swallowing screening tool: the Eating Assessment Tool (EAT-10)

    Treatments

    Management depends on the causes identified during the assessment.

    A first step is to train the family and caregivers to detect signs of swallowing disorders and to supervise patients at risk at mealtimes.

    It is important to ensure regular oral hygiene.

    Management then includes several components: postural adjustment, learning compensatory maneuvers and changes in the volume and consistency of the bolus.

    Proper positioning of the patient (ideally vertical and symmetrical) at mealtime reduces the risk of choking. The environment in which the meal is taken should be in a calm atmosphere without distraction.

    Rehabilitation based on muscle strengthening of the tongue, respiratory muscles, movements of the lips, cheeks, larynx and vocal cords can improve dysphagia following a stroke.

  2. The Surprising Benefits of Cannabis for an Active Lifestyle

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    Are you interested in learning about the benefits of using marijuana to improve your physical and mental health? From reducing pain and inflammation to promoting relaxation and relieving stress, the therapeutic potential of weed is undeniable. 

    However, how can you ensure you take advantage of weed’s immense healing power? This article will explore three ways weed can help boost your well-being and unlock your inner health. 

    How Can Cannabis Active and Healthy Lifestyle?

    A poll found that four out of every five surveyed consume weed before or after engaging in physical activity. The research was published in the international journal Nature. The fact that people who used cannabis had reduced rates of obesity sparked the inquiry into the topic.

    The following are the three ways weed improves your health:

    Improve Your Quality of Sleep and Relieve Stress

    A healthy lifestyle entails more than just physical activity. Before attempting any type of fitness goal, the body’s basic needs must be met. 

    This involves getting the rest you need for physical and mental recovery. The majority of the body’s basic healing and growth occurs while sleeping.

    Various factors, including stress, anxiety, grief, pain, and disease, can disrupt sleep. Unfortunately, many of these issues are interconnected, all exacerbated by a lack of sleep. 

    This could be a difficult catch for those not getting enough rest and well-being. Moreover, one of the weeds’ primary benefits is their ability to help with sleep issues. Marijuana is well known for improving sleep quality and relieving stress. 

    Furthermore, cannabis improves sleep quality by:

    • Lessening the sensation of pain
    • Body and mind relaxation
    • Enhancing convenience
    • Lowering anxiety

    Smoking is not the healthiest activity for someone with an active lifestyle. However, smoking is not the only way to experience cannabis’s soothing qualities. 

    Weed edibles, such as gummies and chocolate, capsules, and vape pens, are examples of modern marijuana products that offer a smoke-free method to enjoy marijuana’s calming effects. Moreover, edibles come in various shapes, sizes, and flavours that can be used in place of typical snacks and desserts, and you can buy them in any best online weed dispensary.

    Strengthen Your Workouts Drive and Concentration

    Discipline is required to maintain fitness, activity, and health. It is difficult to exercise when the body is willing, but the mind is resistant. A trace amount of marijuana can help the mind overcome stress, lack of desire, and negative thoughts.

    Concentrating and entering the zone is possible by emptying the mind and building a solid mind-body connection. It’s amazing how a minor cannabinoid-induced shift in positive attitude could boost your motivation.

    When you start moving, your body releases endorphins, and you feel great and productive. Cannabis can help you focus and experience your fitness on a deeper and more potent level.

    Before you know it, you’ve completed your workout, whether a run or a class, and you’re ready to move on to the next set of strength-training activities. Additionally, it has been proved that cannabis provides many health benefits, most notably for patients suffering from chronic pain.

    Live resin is an increasingly popular cannabis concentrate known for its strong natural flavour and high cannabinoid content.

    THC, the plant’s major psychoactive component, relieves pain and improves the quality of life for patients suffering from chronic diseases. It has also been shown that the chemical enhances the body’s ability to concentrate and focus.

    Promotes Rapid Recovery From Exercise 

    The maintenance of a lifestyle that is both healthy and active calls for self-discipline and may be challenging. It is far too simple to skip days and then overcompensate by exercising more than necessary out of guilt. The next morning, you will likely feel pain and regret.

    When day-to-day stress enters your life, in addition to the ups and downs that disrupt your normal sleeping habits, it becomes even more challenging to keep a routine. Indeed, there is a serious conflict. The time needed to recuperate from an intense workout may be reduced because of the therapeutic benefits of cannabis.

    Cannabinoids accelerate the rate at which the body recovers from physical exertion by lowering the expression of stress hormones like cortisol and the features associated with inflammatory processes.

    Weeds’ Positive Effects on Healthy, Active People

    Keeping a Balanced Appetite

    If you have an active lifestyle, you know how important it is to eat a diet high in nutrients. Despite this, many individuals are forced to endure hunger daily due to fear, disease, and other factors. Cannabis has been shown to stimulate healthy appetites in anorexic patients, which may benefit patients who have trouble consuming enough food.

    Offering Pain Relief

    Cannabinoids are responsible for the analgesia and greater physical comfort arising from activating the body’s inherent pain-relieving mechanisms.

    The euphoric and intoxicating properties of cannabis contribute to the plant’s soothing effects and enhanced mood; these benefits, along with the plant’s ability to promote sleep, make cannabis an effective medicine.

    Conclusion

    Cannabis may enhance physical and mental health by lowering pain and inflammation, inducing relaxation, and relieving stress. Moreover, adopting cannabis into a healthy lifestyle can uncover additional benefits, including improved sleep, increased exercise drive, and accelerated physical recovery. It is essential to remember that the effects of cannabis might differ from person to person and to begin with a low dose and progress with caution. Cannabis can be a potent tool for increasing general well-being and leading a healthy lifestyle if utilized correctly.

  3. Dysarthria

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    Dysarthria is a speech disorder that is caused by the degeneration of a muscle or certain brain structures.

    These affected structures are the medulla oblongata or the cortex in the latter case.

    Multiple sclerosis (a neurological disease) or a stroke can cause dysrathrias.

    Parkinson’s disease and Huntington’s disease are some of the neurological diseases that lead to dysarthria. Only the expression  is altered.

    It is not caused by damage to the organs of phonation (tongue, lips, palate) and must be differentiated from aphasia, which is an oral and/or written language disorder affecting the expression and understanding of speech. language (aphasia is found in particular in Alzheimer’s disease).

    Patients have weakness, slowness, or incoordination in breathing, articulation, phonation, rate, and/or prosody (loudness and duration of sound).

    The condition is often characterized by slurred or slow speech that can be difficult to understand.

    The different forms of dysarthria

    Here is the classification of dysarthria with the pathologies in parentheses.
    1. Spastic dysarthria (stroke).
    2. Flaccid dysarthria (neuropathy innervating the effector muscles of the face, for example).
    3. Ataxic dysarthria (involvement of the cerebellum).
    4. Hypokinetic (Parkinson’s disease) and hyperkinetic dysarthria (Huntington’s disease).
    5. Mixed dysarthria (head trauma, multiple sclerosis, amyotrophic lateral sclerosis).

    How are dysarthria assessed?

    GBRAS scale

    GRBAS stands for Grade, Breathness, Roughness, Asthenicity and Strain.

    G (for Grade): what is the general impression of the quality of the voice?
    R (for Roughness): is the voice hoarse?.
    B (for Breathness): is a breath audible when the patient speaks?
    A (asthenicity): is there a feeling of asthenia?
    S (strain): is there an impression of the patient?

    These five parameters are rated from 0 (normal voice) to 3 (maximum alteration of the voice). Scoring is relatively easy for hoarseness and breath, but it is difficult for asthenia and forcing.

    Perceptual assessment of dysarthria

    It consists of 32 criteria related to the volume and timbre of the voice, breathing, etc. A scale notes the severity of the criterion (0: no anomaly, 4: severe anomaly).

    Intelligibility measurement

    Several tests translated from English have been developed including the Assessment of Intelligibility in Dysarthric Speakers.

    Additional tests

    There are instruments that perform acoustic and aerodynamic measurements of speech. For example, the Assisted Voice Assessment device records certain physiological parameters of voice and speech (intensity, pitch, airflow, pressure). .

  4. Chronic Pain

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    Chronic pain is one of the costliest health problems. The economic consequences of chronic pain include increased medical expenses, loss of income, loss of productivity, compensation payments, and legal fees.

    • Low back pain is one of the most important health problems. It is a common cause of activity limitation in adults, especially back pain.
    • Cancer pain affects most people with advanced cancer.
    • Approximately 15-20% of the population is affected by arthritis.
    • Headaches affect millions of adults. Migraines and tension headaches are some of the most common types of chronic headache.
    • Neuropathy and other pain disorders affect nerves throughout the body.
    • Pain caused by damage to the central nervous system (the brain and spinal cord) as well as pain without a physical cause.

    What is the source of the pain?

    The pain begins in the receptor nerve cells located under the skin and in the organs of the body. The message is sent along nerve pathways to the spinal cord, which then transmits the message to the brain when you are sick, injured or have a problem. These messages are reduced or blocked by painkillers before they reach the brain.

    The pain can be something bothersome, like a mild headache, or very intense, like chest pain that accompanies a heart attack, or pain due to kidney stones. The pain can be acute, that is to say new, subacute, lasting a few weeks or a few months, and chronic, when it lasts more than 3 months. 

    Are there different types of pain?

    Two types of pain include the following:

    • Acute pain. This pain can be from inflammation, tissue damage, injury, disease, or recent surgery. This usually lasts less than a week or two. The pain usually ends after the underlying cause is treated.
    • Chronic pain. Pain that persists for months or even years.

    What is chronic pain?

    Chronic pain is persistent pain that persists beyond the usual recovery period or occurs alongside a chronic health condition, such as arthritis, Chronic pain can be “on” and “off” or continuous. It can affect people to the point that they can no longer work, eat properly, exercise, or enjoy life.

    Chronic pain is a major medical condition that can and should be treated.

    What is the cause of chronic pain

    There are many causes of chronic pain. You may have experienced an illness or injury that you have recovered from for a long time, but the pain remained. Or there may be an ongoing cause of pain, such as arthritis or cancer. Despite a previous injury or signs of illness, many people experience chronic pain.

    There are usually three causes of chronic pain:

    1. Inflammatory causes: example of rheumatoid arthritis. Peripheral nerve fibers are abnormally sensitive to pain.
    2. Neuropathic causes: Neuropathic pain is the consequence of damage to the nerves and nervous system.
    3. Central pain due to a central abnormality in the pain control system. This includes, for example, tension headaches, fibromyalgia, somatic chest pain or irritable bowel syndrome.

    Pain, sleep and psychological disorders form a triad

    When pain becomes such a problem that it interferes with work and normal life activities, you can become the victim of a vicious cycle. Pain can worry you, depress you, and irritate you. Depression and irritability often lead to insomnia and lassitude, resulting in more irritability, depression, and pain.  The urge to stop the pain can lead some people to become addicted to drugs and can lead others to undergo repeated surgeries or resort to questionable treatments. Family members may find the situation as difficult as the sufferer is.

    How is chronic pain treated?

    The most effective treatment includes symptom relief and support. A multidisciplinary approach is often needed to provide the resources to manage pain.

    • Neurologists and Neurosurgeons
    • Orthopedists and orthopedic surgeons
    • Anesthesiologists
    • Oncologists
    • Nurses
    • Physiotherapists
    • Occupational therapists
    • Psychologists/psychiatrists

    Special pain programs are offered in many hospitals, rehabilitation centers and pain clinics.

    Rehabilitation program to manage pain

    A rehabilitation program for pain management is designed to meet your needs. The schedule will depend on the specific type of pain and disease. Your active participation and that of your family is essential to the success of the program.

    Pain management programs are designed to help you achieve the highest level of functioning and independence possible, while improving your overall quality of life – physically, emotionally and socially. Pain management techniques help reduce your suffering.

    To help achieve these goals, pain management programs may include:

    • Medical management of chronic pain, including drug management:
      • Over-the-counter medications may include nonsteroidal anti-inflammatory drugs, aspirin, or acetaminophen.
      • Prescription painkillers, including opioids, may be needed to relieve pain more strongly than aspirin. However, these drugs are reserved for more severe types of pain, as they have some potential for abuse and can have unpleasant and potentially very dangerous side effects.
      • Prescription antidepressants can help some people. These medications increase the supply of the naturally produced neurotransmitters serotonin and norepinephrine. Serotonin is an important part of a pain control pathway in the brain.
    • Heat and cold treatments to reduce stiffness and pain, especially with joint problems such as arthritis
    • Physiotherapy and occupational therapy such as massages and whirlpool baths
    • Exercise to reduce spasticity, joint contractures, joint inflammation, spinal alignment problems, or weakening and shrinking of muscles to prevent other problems
    • Local electrical stimulation involving the application(s) of brief electrical pulses to nerve endings under the skin to relieve pain
    • Injection therapies, such as epidural steroid injection
    • Emotional and psychological support for pain, which may include the following:
      • Psychotherapy and group therapy
      • Stress management
      • Training on relaxation methods
      • Meditation
      • Hypnosis
      • Biofeedback

    The philosophy common to all of these varied psychological approaches is the belief that you can do something on your own to control pain. This includes changing your attitudes, perception of being a victim, feelings or behaviors associated with pain, or understanding how unconscious forces and past events have contributed to the pain.

    Additionally, treatment may include:

    • Operation. Surgery may be considered for chronic pain. Surgery can relieve pain, but can also destroy other sensations or become the source of new pain. The relief is not necessarily permanent and the pain may return. There are a variety of operations to relieve pain. 
    • Acupuncture. Acupuncture is a 2000-year-old Chinese technique of inserting thin needles under the skin at selected points on the body and has shown promise in treating chronic pain. The needles are manipulated by the practitioner to produce pain relief.

    Common dysfunctional beliefs

    Pain is synonymous with progressive tissue damage rather than the result of a stable problem. This belief leads to more suffering.

    Chronic pain decreases with prolonged rest. This belief encourages passivity

    The pain is inexplicable. This belief leads the patient to minimize his ability to reduce pain.

  5. Perte de cheveux : les boissons sucrées en cause ?

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    La perte de cheveux chez les hommes est la forme la plus courante de perte de cheveux chez les hommes, affectant environ 30 à 50% à l’âge de 50 ans.

    La recherche montre que la nutrition joue un rôle important dans la perte de cheveux chez les hommes. Certaines études montrent que le métabolisme du glucose peut causer la perte de cheveux.

    Récemment, des chercheurs de l’Université Tsinghua, à Beijing, en Chine, ont examiné le lien entre la consommation de boissons sucrées et la perte de cheveux.

    Ils ont constaté qu’une consommation plus élevée de BSR est corrélée à un risque plus élevé de perte de cheveux.

    « Traditionnellement, la plupart des médecins ou des chirurgiens de restauration capillaire comprennent que les nutriments et l’alimentation jouent un rôle clé dans la santé et le bien-être globaux de nos patients », a noté le Dr Williams. « L’exercice, l’évitement des produits du tabac et des drogues illicites, une bonne nutrition et une alimentation équilibrée sont essentiels à la santé et à la longévité de nos patients. »

    Boissons sucrées et perte de cheveux

    Les chercheurs ont recruté 1028 étudiants et enseignants âgés en moyenne de 27,8 ans dans 31 provinces de Chine.

    Les participants ont reçu un sondage dans lequel ils ont rempli des informations sur :

    • Informations sociodémographiques de base
    • État des cheveux
    • Apport alimentaire
    • mode de vie
    • l’état psychologique;

    La consommation de boissons sucrées a été déterminée à partir des réponses à un questionnaire de consommation de boissons de 15 questions, qui examinait leur consommation de boissons au cours du dernier mois. Les boissons sucrées comprenaient :

    • boissons de jus sucrées
    • boissons gazeuses
    • Boissons énergisantes et pour sportifs
    • lait sucré
    • thé et café sucrés

    Dans l’ensemble, 57,6 % des participants ont déclaré une perte de cheveux, alors que les autres n’en ont pas déclaré.

    Les chercheurs ont constaté que les personnes atteintes de perte de cheveux étaient plus susceptibles de :

    • être plus âgé
    • être fumeur actuel ou ancien
    • avoir un niveau d’éducation inférieur
    • faire moins d’activité physique
    • avoir une durée de sommeil plus courte
    • souffrir d’anxiété sévère ou de TSPT
    • avoir des antécédents familiaux positifs de perte de cheveux
    • avoir des maladies liées à la perte de cheveux
    • d’avoir des cheveux teints, décolorés

    Ils ont également constaté que les personnes atteintes de perte de cheveux consommaient plus d’aliments frits, de sucre et de miel, de bonbons et de crème glacée, et moins de légumes que ceux sans la condition.

    Par rapport à ceux qui ne sont pas atteints de la maladie, les personnes atteintes de perte de cheveux chez les hommes consomment en moyenne 4,3 litres de boissons sucrées par semaine.

    Ils ont également constaté que les antécédents de la maladie influençaient le lien entre la prise de boisson sucrée et la perte de cheveux. Ils ont par ailleurs noté un lien entre la fréquence de la consommation de boissons sucrées et du trouble anxieux, et le trouble anxieux et la perte de cheveux chez les hommes.

    Les chercheurs ont noté que l’association entre la consommation de boissons sucrées et la perte de cheveux existait même après la prise en compte des facteurs sociodémographiques, l’apport alimentaire et l’état psychologique.

    L’effet de la consommation de sucre sur les cheveux.

    Les scientifiques suggèrent qu’une consommation plus élevée de sucre augmente la concentration de sucre dans le sang, ce qui déclenche des voies de polyol, qui convertissent le glucose en d’autres sucres.

    Des études montrent que ce processus réduit la quantité de sucre dans les follicules pileux, ce qui peut conduire à une perte de cheveux. Elle a ajouté que la consommation de sucre s’accompagne souvent d’un apport excessif en lipides, qui est également lié à la perte de cheveux.

    Le Dr Zhao a mentionné que des études antérieures ont montré qu’une consommation élevée de sucre est liée à des problèmes de santé mentale. Selon une méta-analyse, ceux qui boivent l’équivalent de trois canettes de cola par jour ont un risque de dépression 25% plus élevé que ceux qui ne le font pas.

    Limites de l’étude

    Comme l’a noté le Dr Zhao, leurs résultats sont limités, car ils se sont appuyés sur des données autodéclarées plutôt que sur des diagnostics cliniques. Les chercheurs ont également noté qu’ils n’avaient pas recueilli de données sur la consommation d’autres produits sucrés et qu’ils ne pouvaient pas distinguer la gravité de la perte de cheveux.

    Le Dr George Cotsarelis, professeur de dermatologie à l’Université de Pennsylvanie et directeur des cliniques capillaires et du cuir chevelu de l’Université de Pennsylvanie, non impliqué dans l’étude, a déclaré :

    « L’étude ne montre qu’une corrélation entre les boissons sucrées et la calvitie. Je doute qu’il s’agisse d’une corrélation réelle, car il est difficile d’imaginer comment les boissons sucrées pourraient avoir un impact sur la calvitie. De plus, parmi les hommes qu’ils ont étudiés, le groupe chauve avait un pourcentage plus élevé d’hommes ayant des antécédents familiaux de calvitie.

    Le Dr Williams a noté que l’étude est détaillée et bien conçue. Cependant, il a ajouté qu’il ne recommande pas nécessairement d’éliminer toutes les boissons contenant du sucre.

    Je recommande de toujours avoir une alimentation équilibrée et de consommer des groupes d’aliments sains et des sources nutritionnelles. Évitez les produits du tabac, les drogues et la consommation excessive d’alcool, a-t-il conclu.

  6. Type 2 diabetes and its impact on the brain

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    Diabetes has detrimental consequences on brain function and mental state in the elderly, since it accelerates cognitive decline and increases the risk of the onset of depressive symptoms and cerebrovascular accidents (CVA) of ischemic origin in the elderly.

    In the general population, diabetes prevalence is around 5% and 10% in subjects over 65, with an increasing proportion as the population ages (25% in those over 75 ).

    However, with the improvement of our lifestyle and the existence of effective preventive measures against stroke, diabetics are able to live longer with fewer major complications.

    Diabetes decreases the faculties of the brain

    There is growing evidence that diabetes impairs brain function.

    Diabetes increases the risk (by about 100%) of seeing decline in cognitive functions, compared to non-diabetics.

    The association between diabetes and arterial hypertension – which is associated with a more pronounced decline in cognitive abilities – being very frequent, it is difficult to assess the exact role of diabetes.

    In 2014, researchers found that people who develop diabetes or hypertension between the ages of 40 and 64 are more likely to have neuronal loss and/or cognitive disorders (memory problems, thought disorders)

    According to one of the study authors (Mayo Clinic), « if we prevent diabetes and hypertension, we can prevent or delay brain damage that occurs decades later ».

    To reach this conclusion, the researchers recruited 1,437 people with an average age of 80 who underwent neuroimaging examinations to detect markers associated with brain damage.

    Results: people with diabetes have an average brain volume 3% smaller than that of non-diabetic subjects. Such a reduction in volume is also observed in patients who suffer from hypertension.

    The researchers conclude that these diseases take decades to produce their deleterious effects on the brain, leading to cognitive impairments that affect memory and thinking.

    In the same year, another group showed that type two diabetes could be associated with premature brain aging, according to a study carried out on 614 patients (average age = 62 years) followed for an average of 10 years.

    This conclusion is in line with previous studies that reported a link between type 2 diabetes and ischemia affecting small vessels, a disease during which the brain does not receive enough oxygenated blood.

    « These patients show less brain tissue, suggesting the presence of cerebral atrophy, » said one of the study’s authors.

    The authors used the magnetic resonance imaging technique to assess the patients’ brain volume. The results further reported a positive association between duration of diabetes and loss of brain volume, particularly in gray matter. More specifically, the results suggest that a person with diabetes for 10 years exhibits premature brain aging (of a period of 2 years) compared to a non-diabetic patient.

    These results are in line with those of previous longitudinal studies, confirming that the cognitive functions of diabetics deteriorate more rapidly.

    In a six-year follow-up study of a group of 9679 women over the age of 65, diabetics whose disease had been evolving for more than 15 years had a 57 to 114% increased risk of presenting with cognitive decline.

    Several hypotheses have been put forward to explain this link:

    • Hyperglycemia affects neurons in the hippocampus, a key brain region involved in learning and remembering events.
    • Diabetes is accompanied by inflammation in the brain – called neuroinflammation  – which also damages neurons.
    • Dysregulation of glucose levels affects neurons in the brain that produce a neurotransmitter called acetylcholine. This neurotransmitter is necessary to obtain a memory.
    • The microalbuminuria (low amounts of albumin in the urine) present in diabetics reflects a dysfunction of the vascular system which prevents poor oxygenation of the brain.

    Research is investigating the possible beneficial effects of treating diabetes with insulin in preventing cognitive decline. This is particularly the case of intranasal insulin injections which would provide protection to the brain.

    Watch out for hypoglycaemia

    The brain is particularly sensitive to changes in blood sugar – especially hypoglycemia. The consequences of hypoglycaemia can be serious in elderly diabetics. Thus, elderly people with diabetes are five times more likely to be hospitalized than younger people due to a greater risk of hypoglycaemia.

    A study suggests that hypoglycemia, which occurs frequently in patients with diabetes, can negatively influence cognitive performance. These cognitive disorders will in turn compromise the management of diabetes and lead to hypoglycemia.

    These are the conclusions of an American study (University of California, San Francisco) involving 783 adults (average age 74 years) with diabetes. After 12 years of follow-up, 8% had a reported episode of hypoglycaemia and 19% developed dementia.

    Patients who had a hypoglycemic event had a twice as high risk of developing dementia compared to those who did not (34% versus 17%).

    In addition, elderly diabetics who have developed dementia have a greater risk of subsequently having an episode of hypoglycemia compared to patients who have not developed dementia (14% versus 6%).

    Obtaining a normal blood sugar level would improve – or at least maintain – his cognitive performance.

    Dementias

    Diabetes: a risk factor for vascular dementia ?

    Diabetes is a risk factor for cerebrovascular accident (CVA) which promotes the development of vascular dementia, with a risk multiplied by 2 to 2.6 according to studies. If the individual has suffered a stroke, this risk can be multiplied by eight. The presence of hypertension in diabetics plays an important role in this increase.

    Alzheimer’s disease

    Diabetes could also be a cardiovascular risk factor in the onset of Alzheimer’s dementia, with an estimated increased risk of between 45% and 90% depending on the studies.

    However, this link is questioned by other studies.

    Better prevention of dementia would be possible thanks to a normalization of blood sugar, in the same way as arterial hypertension.

    The Depression

    Depression can be mistaken for dementia or, conversely, can be one of the first symptoms of Alzheimer’s disease. It is therefore important to detect it, which is often difficult.

    According to scientific data, about 20 to 30% of elderly diabetics suffer from depression, including 10% from major depression. There would be at least one depressive symptom in half of elderly diabetics.

    According to a study conducted in 2015 on people with diabetes (average age = 54 years), they have difficulties with family functioning and a lower quality of life.

    Stroke

    Diabetes is usually considered one of the major risk factors for stroke, with an increased risk of 50% to 100%. The risk of stroke is all the higher when the subject is hypertensive, has atrial fibrillation, carotid stenosis or a history of stroke. In addition, the occurrence of a stroke in a diabetic is strongly associated with a high risk of disability and higher mortality.

    In 2016, researchers showed that type 2 diabetics have a greater risk (+60%) of developing dementia, compared to those without diabetes. Additionally, women with type 2 diabetes have a much higher risk of developing vascular dementia than men with diabetes. Indeed, the risk of vascular dementia is multiplied by 2.3 in women and by 1.7 times in men, compared to those who do not have diabetes. The analysis included data from 14 studies with more than 2.3 million people and more than 100,000 cases of dementia.

    These results suggest that diabetes increases the risk of developing vascular dementia and that women with diabetes are particularly vulnerable. A previous study reported that people with diabetes had a 70% increased risk of dementia. However, these results are limited by the fact that most cases of dementia were reported in people of Asian origin.

    The researchers were unable to analyze the links between the duration of diabetes, glycemic control and dementia. They suggest, however, that treatment differences in diabetes management – ​​particularly poor care for women – may play a role in these results.

    Further physiological studies are needed to examine how blood sugar interacts with the vasculature and whether there are notable gender differences.

    On the other hand, diabetes seems to protect against the occurrence of hemorrhagic strokes, with a risk of stroke of hemorrhagic origin reduced by a factor of 4 to 10.

    Prevention

    Stroke prevention is possible through risk factor control and better blood sugar control. Controlling blood pressure is an essential part of stroke prevention. However, too great a decrease in blood pressure can lead to a stroke through a drop in cerebral circulation.

    The use of statins is also found to be very beneficial. Thus, simvastatin (40 mg) or atorvastatin (10 mg) can reduce strokes by 25% to 50%.

    In addition, antiplatelet drugs are recommended to reduce the risk of stroke. Aspirin is very frequently used in elderly diabetics at high risk of stroke.

    The surgical management of carotid stenosis does not differ from that of non-diabetic subjects. The occurrence of a stroke and the operative risk are higher, but the benefit of an intervention is greater in diabetics. The indication for surgery must therefore be established according to the general condition of the elderly subject and the severity of the stenosis.

     Diabetes increases the risk of heart and brain disease

    The risk of developing cardiovascular disease is almost twice as high in patients who develop type 2 diabetes before age 40, compared to those who develop the disease later. The age of diagnosis of type 2 diabetes is getting younger around the world, mainly due to rising rates of obesity.

    “Given the increasingly frequent onset of type 2 diabetes at an early age, it is hardly surprising that cardiovascular complications also appear earlier and earlier due to an increasingly unfavorable environment. a long time,” explains the lead author of the study.

    The researchers used a large diabetes database, with participation from 630 hospitals and 222,773 patients. The average age of the cohort is 58.3 years. Patients who had early-onset diabetes were on average 34 years old, compared to 55 for those who developed diabetes later in life.

    Early-onset type 2 diabetes was associated with a greater risk (+91%) of diseases associated with the brain and heart system (coronary heart disease and stroke), compared to late-onset diabetes.

    According to some experts, the best way to measure risk in young patients with type 2 diabetes is to identify and treat cardiovascular risk factors. A very high proportion – around 80% – of young people with type 2 diabetes have at least two cardiovascular risk factors.

    Septuagenarians are healthier than their elders

    Americans with diabetes born in the 1940s live longer without major complications and with fewer disabilities than those born 10 years earlier.

    These major complications are heart attack, stroke and amputations.

    The three types of disability were reduced mobility, inability to carry out activities of daily living and total or partial inability to carry out essential activities (use of the telephone, shopping, meal preparation, etc.).

    The messages of the medical authorities aiming to sensitize the individuals to have a better hygiene of life are undoubtedly for something.

    This health improvement also concerns people who are not necessarily diabetic. The data analysis focused on Americans born in the 1930s and 1940s, more than 10% of whom had diabetes.

    However, this improvement may not last in the United States due to rising obesity rates and poorer lifestyles. In this country, the incidence of type 2 diabetes has more than doubled in the last 20 years

    Diabetes and brain disease article references

    Barbagallo M and Dominguez LJ. Type 2 diabetes mellitus and Alzheimer’s disease. World J Diabetes 2014 December 15; 5(6): 889-893

    Bardenheier BH et al. Compression of disability between two birth cohorts of US adults with diabetes, 1992–2012: a prospective longitudinal analysis. The Lancet Diabetes and Endorinology, June, 2016.  

    Bryan RN et al. Effect of diabetes on brain structure: the action to control cardiovascular risk in diabetes MR imaging baseline data. Radiology. July 2014: 210-6.    

    Chatterjee S et al. Type 2 Diabetes as a Risk Factor for Dementia in Women Compared With Men: A Pooled Analysis of 2.3 Million People Comprising More Than 100,000 Cases of Dementia. Diabetes care, December 2015.

    Huo X et al. Risk of non-fatal cardiovascular diseases in early-onset versus late-onset type 2 diabetes in China: a cross-sectional study. The Lancet Diabetes & Endocrinology, Volume 4, No. 2, p115–124, February 2016.

    Roberts RO et al. Association of type 2 diabetes with brain atrophy and cognitive impairment. Neurology, 2014. 

    Saedi E et al. Diabetes mellitus and cognitive impairments. World J Diabetes 2016 September 15; 7(17): 412-422.

    Wang J et al. Depressive Symptoms, Family Functioning and Quality of Life in Chinese Patients with Type 2 Diabetes. Can J Diabetes 39 (2015).

    Yaffe K et al. Association Between Hypoglycemia and Dementia in a Biracial Cohort of Older Adults With Diabetes Mellitus, Hypoglycemia and Dementia in Older Adults With DM. JAMA Internal Medicine, June 2013.

  7. Depression in the elderly

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    Depression in the elderly is different from depression in a young person. Older people have more somatic complaints and minimize their state of sadness. They are often hypochondriac and have an increased risk of chronic diseases.

    Depression is one of the forms of mood disorders that are generally classified as follows:

    1. Depression
    2. Dysthymia
    3.  Bipolar  (or manic-depressive) disorder
    4. Cyclothymia

    Depression includes:

    1. major depression which causes the individual to work normally, sleep well and eat well, concentrate and enjoy the pleasures of life. A person usually has several episodes of major depression;
    2.  dysthymia, with less severe symptoms but lasting longer (at least two years);
    3. minor depression, with symptoms of less severe intensity than in the two previous cases and which are temporary.

    Mood disorders are the most common mental disorders in the elderly. Indeed, old age is a period of vulnerability conducive to the onset of mood disorders.

    Here are some risk factors that may trigger depression in the elderly:

    • Loneliness (or feelings of loneliness) and social isolation.
    • Consequences of retirement (e.g. feeling useless, loss of activity).
    • Interpersonal conflicts.
    • Death of close friends.
    • Anniversary date of the bereavement.
    • Loss of autonomy due to physical illnesses.
    • Hormonal disruption due to dysregulation of melanin or thyroid hormones.
    • To be female.
    • Suffer from a chronic disease (cancer, diabetes, heart disease).
    • Restless sleep.
    • Have a family history of depression.
    • Take certain medications.
    • Consuming too much alcohol.
    • Leading a stressful life (caring for someone with a chronic illness).

    Major depression in the elderly is not properly taken care of because those around you mistakenly believe that it is normal to be sad because you have lost a loved one or because you are losing your autonomy. However, in the case of depression, the sadness persists.

    Prevalence of depression

    The prevalence of depression in people aged 65 and over is estimated at around 1%, while 5% of people over 65 suffer from depressed mood. Here are the prevalence percentages according to age categories.

    PopulationPercentage
    Male (55-75 years old)2.6
    Female (55-75 years old)6.6
    All 15-75 years old7.8

    Etiologies

    Genetic causes : Having a first-degree relative who suffers from recurrent depression increases the risk of suffering from depression by two to four. Studies with homozygous twins confirm the role of heredity, with an increased risk of around 40%.

    Physiological causes : activation of the hypothalamic-pituitary axis associated with an abnormally high level of cortisol is observed in patients with major depression, leading to inhibition of growth factors (including BDNF) and dysregulation of monoaminergic neurotransmitters (noradrenaline, serotonin, and dopamine).

    Psychological causes : A certain view of life (tendency to a negative view of oneself, events and a pessimistic approach to the future)

    Social causes : acute stress caused by different events: job loss, poverty, social exclusion, family conflicts, excessive demands, physical health problems, death of a loved one can be the cause of depression, as well than harmful experiences during childhood or adolescence.

    Diagnostic criteria

    The diagnostic criteria are those taken from the American psychiatry manual DSM IV and the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10, World Health Organization). However, classifications of depression are not entirely suitable for older people because they tend not to express their sadness verbally.

    DSM V Criteria

    • A: at least 5 symptoms during the same 2-week period and represent a change from normal functioning; at least one of the following symptoms: One of the following symptoms:
      1. depressed mood;
      2. anhedonia (loss of interest or pleasure)
      3. significant weight loss or gain (5%) or increased or decreased appetite almost daily;
      4. insomnia or hypersomnia;
      5. psychomotor agitation or retardation;
      6. fatigue or loss of energy;
      7. feeling of worthlessness or excessive or inappropriate guilt;
      8. loss of concentration;
      9. recurrent thoughts of death, suicidal ideation or attempted suicide.
    • B: Symptoms cause significant distress and impairment of daily functioning.
    • C: The symptomatology is not attributable to the physiological effects of a substance or a medical condition.
    • D: the onset of the depressive episode is not explained by schizophrenia or delusional disorder.
    • E: no previous manic or hypomanic episode.

    ICD-10 criteria

    In the ICD-10 manual (2003), mood disorders are divided into seven parts. Most of these disorders tend to be recurrent. The onset of individual episodes can often be related to stressful situations or events. The change in mood is usually accompanied by a change in overall activity level.

    1.  Manic episode
    1.a Hypomania.
    1.b Mania without psychotic symptoms.
    1.c Mania with psychotic symptoms (delusions, hallucinations, agitation, or hyperactivity).

    2.  Bipolar affective disorder
    The mood and level of activity of the subject are profoundly disturbed, sometimes in the sense of elevation (hypomania or mania), sometimes in the direction of depression (depression). 
    2.a Subject is currently hypomanic, and has had at least one other affective episode in the past.
    2.b Subject is currently manic with no psychotic symptoms.
    2.c Subject is currently manic, with psychotic symptoms.
    2.d The subject is currently depressed, such as during a depressive episode of mild or moderate intensity. 2.e The subject is currently depressed, such as during a depressive episode of severe intensity without psychotic symptoms.
    2.f Subject is currently depressed, such as during a depressive episode of severe intensity with psychotic symptoms.
    2.g Simultaneous or alternating presence of manic and depressive symptoms.
    2.h Bipolar affective disorder, currently in remission.

    3.  Depressive episodes
    3.a Mild depressive episode. The subject remains, most often, able to continue most of its activities.
    3.b Moderate depressive episode. The subject experiences considerable difficulty in continuing his or her usual activities.
    3.c Severe depressive episode without psychotic symptoms. Suicidal thoughts and acts are common, and several “somatic” symptoms are usually present.
    3.d Severe depressive episode with psychotic symptoms (hallucinations, delusions) or psychomotor retardation or stupor. Usual social activities are impossible. Risk of suicide, dehydration, or malnutrition.

    4.  Recurrent Depressive Disorder
    4.a A disorder characterized by the repeated occurrence of depressive episodes, the current episode being mild, moderate, or severe in intensity, in the absence of any history of mania and without psychotic symptoms. 4.b Disorder characterized by the repeated occurrence of depressive episodes, the current episode of severe intensity with psychotic symptoms. 4.c Recurrent depressive disorder, currently in remission (F33-4)

    5.  Persistent Mood
    Disorders 5.a Persistent and usually fluctuating mood disorders in which most individual episodes are not severe enough to warrant a diagnosis of hypomanic episode or mild depressive episode.
    5.b Cyclothymia: Persistent instability of mood, including numerous periods of depression or slight elation (F34-0).
    5.c Dysthymia : chronic low mood.

    6.  Other mood disorders

    7.  Mood disorder, unspecified 

    Depression in the elderly is different from depression in a young person. Older people have more somatic complaints and minimize their state of sadness. They are often hypochondriac and have an increased risk of chronic diseases.

    Depression is one of the forms of mood disorders that are generally classified as follows:

    1. Depression
    2. Dysthymia
    3.  Bipolar  (or manic-depressive) disorder
    4. Cyclothymia

    Depression includes:

    1. major depression which causes the individual to work normally, sleep well and eat well, concentrate and enjoy the pleasures of life. A person usually has several episodes of major depression;
    2.  dysthymia, with less severe symptoms but lasting longer (at least two years);
    3. minor depression, with symptoms of less severe intensity than in the two previous cases and which are temporary.

    Mood disorders are the most common mental disorders in the elderly. Indeed, old age is a period of vulnerability conducive to the onset of mood disorders.

    Here are some risk factors that may trigger depression in the elderly:

    • Loneliness (or feelings of loneliness) and social isolation.
    • Consequences of retirement (e.g. feeling useless, loss of activity).
    • Interpersonal conflicts.
    • Death of close friends.
    • Anniversary date of the bereavement.
    • Loss of autonomy due to physical illnesses.
    • Hormonal disruption due to dysregulation of melanin or thyroid hormones.
    • To be female.
    • Suffer from a chronic disease (cancer, diabetes, heart disease).
    • Restless sleep.
    • Have a family history of depression.
    • Take certain medications.
    • Consuming too much alcohol.
    • Leading a stressful life (caring for someone with a chronic illness).

    Major depression in the elderly is not properly taken care of because those around you mistakenly believe that it is normal to be sad because you have lost a loved one or because you are losing your autonomy. However, in the case of depression, the sadness persists.

    Here are some clinical features of depression in the elderly that are sometimes the same as in younger subjects:

    • persistent feelings of sadness and hopelessness.
    • Pessimism.
    • Inability to find a pleasant life as before.
    • Disturbed sleep (sleeps little or not enough).
    • Unexplained crying spells.
    • Change in appetite and weight.
    • Disinterest in sexuality.
    • Fatigue, lack of energy.
    • Clothing or bodily negligence.
    • Feelings of worthlessness and guilt.
    • Psychomotor restlessness or retardation.
    • Loss of interest in things.
    • Suicidal thoughts.
    • Loss of self-esteem.
    • Anxiety which is often the mask of depression.
    • Hypochondriacal and delusional symptoms.
    • Irritability and hostility.
    • Inability to take pleasure in doing an activity, eating, etc. (anhedonia)
    • Difficulty concentrating and remembering.
    • Difficulties making decisions.

    Diagnosis and assessment of severity

    The Geriatric Depression Scale (or GDS): This is a test to diagnose depression in an older person.

    The Hamilton Depression Scale : This is the most widely used test to assess the intensity of depressive symptoms.

    Before starting treatment with an antidepressant, it is important to pay attention to the symptoms, with particular attention to the following:

    • Dysphoric restlessness
    • Suicidal risk
    • Psychotic symptoms
    • Possible comorbidity

    Depression in the elderly associated with certain chronic diseases

    Older people with depression have an increased risk of cardiovascular disease, Parkinson’s disease and Alzheimer’s disease. On the other hand, elderly people suffering from a chronic illness (diabetes, high blood pressure, heart problem) are two to four times more likely to have major depression than others of the same age and in good health.

    Depression and somatic complaints

    Somatic complaints are an integral part of depression in the elderly. Indeed, a depressed person can express his suffering through pain in his body. It is estimated that half to three quarters of depressed people who consult have somatic symptoms such as gastrointestinal disorders, joint pain or cardiovascular symptoms.

    Treatment

    Antidepressants. When the diagnosis of major depression is made in the elderly, studies report that the effectiveness of an antidepressant is recognized compared to a placebo, which is not the case if the depression is minor.

    It is common for older people to try several antidepressants before finding the right drug, leading to a remission rate of over 80%. Combinations of antidepressants are not recommended.

    It is important not to stop treatment without the advice of your doctor. Treatment should be continued for several months even if the beneficial effects are felt.

    Electroconvulsive therapy (ECT) is sometimes used in severe depression in subjects refractory to antidepressants, at the rate of two to three sessions per week under general anesthesia for about a month. ECT is a therapy that involves stimulating the brain directly with electricity, magnets or implants. Some of these treatments are still in the experimental stage. If the depression persists despite medication, or if the depression is so severe that the individual is unable to eat or develops false beliefs (delusions) about their illness, the doctor may recommend ECT as the best option. Although it has been used for almost 80 years, the electroconvulsive therapy remains the most powerful and fastest treatment in severe depression.

    Although ECT is effective and safe in the elderly, many misconceptions remain among patients and healthcare professionals. Admittedly, ECT can cause side effects such as confusion and memory loss that are usually temporary.

  8. Malnutrition

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    Malnutrition that occurs when the body does not receive enough food. 

    Malnutrition results in progressive weight loss. It is common in older people, especially those with Alzheimer’s disease. Depending on whether the person is at home (10%), in an institution (30%), or in the hospital (70%), its prevalence differs.

    A person suffering from undernutrition may be deficient in vitamins, minerals, and other essential substances that the body needs to function.

    Malnutrition can lead to:

    • short-term and long-term health problems
    • slow recovery from injury and illness
    • a higher risk of infection
    • difficulty concentrating at work or school

    Certain deficiencies can trigger specific health problems. 

    For example a lack of vitamin C can lead to scurvy. Although rare in developed countries, it can develop if a person does not eat a varied diet with plenty of fresh fruits and vegetables.

    Older people who drink heavily and people with certain mental health conditions may be particularly at risk. Undernutrition is particularly common in people over 60 years of age. Weight loss in this category approximately doubles the risk of dying.

    Malnutrition symptoms

    Some signs and symptoms of malnutrition include:

    • a lack of appetite or interest in food or drink
    • tiredness and irritability
    • an inability to concentrate
    • always be cold
    • the Depression
    • loss of fat, muscle mass, and body tissue
    • a higher risk of getting sick and taking longer to heal
    • longer healing time
    • a higher risk of complications after surgery

    Eventually, a person may also experience difficulty breathing and heart failure.

    The causes

    Undernutrition can occur for a variety of reasons. 

    Low food intake

    Some people are undernourished because there is not enough food available or because they have difficulty eating or absorbing vitamins and minerals.

    This can happen as a result of:

    • cancer
    • liver disease
    • disorders that cause nausea or make it difficult to eat or swallow
    • taking medications that make it difficult to eat – for example due to nausea

    Mental health problems

    Undernutrition or malnutrition can affect people with:

    • depression
    • dementia
    • schizophrenia
    • anorexia nervosa

    Social and mobility issues

    Factors that can affect a person’s eating habits and potentially lead to undernutrition include:

    • being unable to leave the house or go to a store to buy food
    • find it physically difficult to prepare meals
    • living alone, which can affect a person’s motivation to cook and eat
    • have limited cooking skills
    • not having enough money to buy food

    Digestive disorders

    If the body does not absorb nutrients efficiently, even a healthy diet may not prevent undernutrition.

    Here are examples of digestive and gastric conditions that can cause it:

    • Crohn’s disease
    • celiac disease
    • persistent diarrhea, vomiting, or both

    Alcohol use disorder

    Consuming a lot of alcohol can lead to gastritis or long-term damage to the pancreas. This can make it difficult to digest food, absorb vitamins, and produce hormones that regulate metabolism.

    Alcohol also contains calories, so a person may not feel hungry after drinking. She may therefore not be eating enough healthy foods to provide the body with essential nutrients.

    Malnutrition and Alzheimer’s disease

    Between 20 and 45% of patients with dementia are undernourished and lose weight in the year following the onset of their disease, according to the report entitled “Nutrition and dementia”, from Alzheimer’s Disease International (ADI, February 11, 2014) .

    Energy malnutrition results from an imbalance between the body’s intake and needs, leading to tissue loss (including muscle), which has deleterious functional consequences.

    In addition, 10% of elderly people at home suffer from undernutrition, and this percentage rises to 30% when they are placed in a retirement home. Finally, this is the case for 70% of hospitalized elderly people.

    In people with dementia, malnutrition can be the cause of falls or worsening cognitive impairment.

    The Association even suggests that undernutrition is a triggering factor for certain forms of dementia.

    The report says that certain measures can be taken to improve the nutrition of patients with dementia. These measures include setting nutritional standards, better monitoring the weight of patients, looking at diet and eating habits regularly, and training the family and professional environment.

    This malnutrition may be due to cognitive deficits and loss of autonomy or to an increase in energy expenditure (wandering, hyperactivity).

    Protein-energy malnutrition

    A disorder characterized by a negative balance of protein and energy, leading to loss of weight and muscle mass. Malnutrition can have several causes:

    – Diet that does not meet nutritional needs in protein and energy.

    – Poor intestinal absorption.

    – Increased nutritional needs following an acute or chronic illness.

    – Abnormally large losses caused for example by a nephrotic syndrome or a wound.

    It is often observed in elderly people of fragile constitution, living or not in an institution or hospitalized.

    Protein-energy malnutrition is retained when, among other things, the elderly person:

    – involuntarily loses more than 5 kg.

    – Has a body mass index of less than 21 kg/m2.

    – Has a Mini Nutritional Assessment test result of less than 17.

    The consequences of undernutrition

    The consequences are as follows:

    • weightloss;
    • appearance of bedsores;
    • falls and fractures;
    • lowered immune system;
    • bacterial infections (urinary, bronchopulmonary);
    • hospitalization.

    Evaluation

    It requires:

    • a weight curve;
    • an assessment scale such as the Mini Nutritional Assessment or the Mini Nutritional Assessment Short Form.

  9. Dementias associated with extrapyramidal syndrome

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    Some patients affected by advanced Parkinson’s disease may suffer from cognitive disorders and more generally from a specific form of dementia.

    There are other neurodegenerative diseases that can cause both motor and cognitive impairment: dementia with Lewy bodies, progressive supranuclear palsy, multiple system atrophy and corticobasal degeneration.

    Lewy body dementia

    It is characterized by the existence of lesions called Lewy bodies.

    Progressive supranuclear palsy

    This disease, also called Steele-Richardson-Olszewski disease, usually begins after the age of 40. Its prevalence is 1.4/100,000 versus 100 to 170/100,000. It is characterized by a decline in ocular motor skills (especially vertical gaze), postural instability with frequent falls and akinesia.

    There are differences with Parkinson’s disease:
    – Significant axial stiffness in the neck.
    – Dysarthria (speech disorder linked to neurological impairment).
    – Dysphagia (discomfort in swallowing).
    – Minor tremor.
    – Significant postural problems.
    – Motor disorders do not improve after treatment with L-dopa or a dopaminergic agonist.
    – Cognitive disorders of the frontal type appear during the evolution.

    These disorders are caused by damage to the basal ganglia and brainstem, with the presence of neurofibrillary tangles including the abnormal form of tau protein.

    Multiple system (or multiple system) atrophy

    It is a set of neurodegenerative diseases including:
    – degeneration of the nigrostriatal pathway, with an extrapyramidal syndrome characterized by rigidity and akinesia. The damaged cerebral structures are the substantia nigra and striatum and involved in motricity are affected.
    – Shy-Drager syndrome, with dysautonomia (dysfunction of the autonomic nervous system. 
    – Olivo-pontocerebellar atrophy with cerebellar syndrome. The cerebral structures called pons nuclei and the cerebellum are affected. 

    The occurrence of cognitive disorders can be observed in advanced forms. Levodopa (reference treatment for Parkinson’s disease) only partially responds to the extrapyramidal syndrome.

    Corticobasal degeneration

    It is caused by damage to the frontal and temporal cortex, as well as damage to the basal ganglia. The neurons are said to be ballooned  (ie swollen) and surrounded by glial cells which proliferate (we speak of a phenomenon of gliosis).

    Clinically, the disease is characterized by apraxia and extrapyramidal syndrome.

    Apraxia often begins in one part of the body, causing the inability to perform elaborate movement, despite good understanding and normal muscle strength.

    The extrapyramidal syndrome is asymmetrical, even unilateral and is limited to akinesia and rigidity. However, there may be postural tremor, dystonic disorders usually beginning in the upper limb, myoclonus (rapid, involuntary, low-amplitude muscle contraction) and apraxic disorders.

    The cognitive impairment appears during the evolution with behavioral disorders and signs of frontal dementia. Treatment with levodopa (or L-Dopa) has no effect. Myoclonus can be treated with clonazepam (a benzodiazepine).

  10. Dementia: what are the predictive signs?

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    The signs of dementia – a syndrome whose term appeared at the beginning of the 19th century – are characterized by different disorders:

    • memory ( these are early disorders);
    • other higher functions: orientation, attention, judgment, reasoning;
    • phasic (difficulties reading, speaking, reading, writing or repeating a sentence;
    • praxis (inability to perform motor tasks despite intact motor skills);
    • gnostic (lack of recognition of familiar objects despite intact sensory functions);
    • executive  functions  (loss of sense of abstraction, planning, initiation and organization of tasks).

    These cognitive disorders are generally accompanied by  psychological and behavioral signs and symptoms  (apathy, depression, agitation, aggressiveness, irritability, wandering, insomnia,  delusions, etc.) that can affect activities of daily living.

    The symptoms of dementia have two main characteristics:

    • Symptoms appear in adulthood (mental retardation is not one of them).
    • The symptoms are in most cases progressive and irreversible (confusions  and depressive states of the elderly are not included).

    Signs of cognitive impairment in dementia

    Cognitive disordersExamples
    Inability to learn recent information and events• The subject involuntarily makes the same purchase several times during the day.
    • The subject repeats the same question.
    Loss of orientation (especially temporal)• The subject wanders for several hours in his neighborhood and no longer knows how to get home.
    • He cannot name today’s date.
    Difficulties performing an abstract task• The subject becomes distraught in front of a tax form because he has difficulty performing simple calculations or recognizing numbers.
    • Subject cannot plan a subway trip requiring one or more connections.
    Difficulties finding words• The subject compensates for the omission of words by using other words such as “trick, thing, contraption”.
    • The subject uses phonemic verbal paraphasias (says lion instead of violin).
    • The subject uses sentences that are difficult to understand.
    Misplaced objectsSubject puts dirty clothes in a closet and does not remember where they have been stored.
    Difficulties understanding symbolsSubject no longer recognizes a road sign.
    Forgetting old factsThe subject forgets the name of a famous person, a birthday.
    Poor or impaired judgmentThe subject dresses warmly on a very hot summer day, or goes shopping in a dressing gown
    Difficulty performing familiar tasks• The subject has difficulty using household appliances.
    • Subject has difficulty preparing a meal. He forgets to serve it or to have prepared it.

    Is memory the only one affected in dementia?

    No, these cognitive disorders are accompanied by changes in mood, behavior and a loss of initiative.

    Here are some signs of behavioral dementia:

    • Asocial behavior
      For example: the subject is apathetic, sits idle, remains indifferent, has little interest in others, cuts off all contact with friends, abandons leisure activities.
    • Sadness
    • emotional lability
    • Irascibility or even verbal and physical aggression
    • Suspicion
    • Fearful behaviors
    • Social disinhibition
    • Appearance of excessive familiarity
    • Noisy behaviors
    • Euphoria, boundless energy
    • Episodes of depression and anxiety (the subject becomes aware of his cognitive disorders)
    • Insomnia
    • Paranoia
    • Hallucinations visual, auditory (rare)
    • Slower movement speed

    Signs of dementia that affect daily life

    • Difficulty driving
    • Wandering
    • Forgetting to serve a dish cooked in the oven
    • Negligence (housework, toilets, etc.) or carelessness
    • Difficulties managing expenses
    • Professional errors
    • Difficulties making purchases

    Why does the subject or his entourage ask to be consulted?

    At an early stage, it is usually for memory disorders (appearing gradually) that the subject or most often a member of his or her entourage asks to be consulted (in 75% of cases, memory disorders presage dementia of the Alzheimer type ). Studies have shown that, in 30% to 50% of cases, the cognitive deficit is ignored by the person concerned.

    Rarer are dementias of the Alzheimer type beginning with behavioral disorders. In the case of disorders that are already visible and seem to be getting worse, the request comes from the family and medical environment. It is then a question of behavioral disorders whose appearance or aggravation provoke a crisis in the family care.

    What are the different stages during the consultation?

    Whether or not the doctor makes a diagnosis following:

    • An anamnesis which is a series of information provided by the subject (eg medical history) and confirmed if necessary by those around him. The doctor assesses the subject’s functional abilities (eg ability to carry out physical activities of daily living).
    • Basic exams.
    • A clinical physical examination which assesses in particular the mental faculties of the patient, in particular with the mini-mental state examination, which is the test used.

    If a diagnosis of dementia is made, the next step is to determine the underlying cause.

    The causes may be reversible (depression, delirium, ‘toxic’ side effects of medication, infections, etc.) or irreversible (Alzheimer’s type dementia, vascular dementia, frontotemporal dementia, Lewy body dementia, dementia associated with Parkinson’s disease, etc.).

    Alzheimer’s disease is the most common cause of dementia (about 60% of dementia cases).

    In summary

    Cognitive disorders + emotional and behavioral disorders + disturbances in daily activities:

    => suspected dementia.

    => medical visit.

    => if dementia, search for the reversible or irreversible cause.