Alexithymia is the difficulty of expressing emotions or feelings. The person does not have the words to express his emotions.
It is a term created by the American professor Sifneos of Harvard University.
This disorder often appears in older people with depressive symptoms.
How is alexithymia expressed?
It is characterized by an inability to recognize one’s emotions and to communicate one’s feelings.
It also results in a limitation of the imaginary life, a tendency to resort to action, a tendency to dependence or a preference for solitude.
People with alexithymia complain of inner tension, irritability, feelings of boredom and emptiness as well as nervousness. They tend to somatize their emotional problems.
Possible causes of alexithymia
Some psychologists think that alexithymia helps people deal with traumatic situations. It would depend on the existence of early childhood trauma.
Neurobiologists believe that alexithymia is caused by abnormalities in the connections between the limbic system and the neocortex, a part of the brain associated with perceptions.
It is also unclear whether alexithymia is determined at birth (genetic origin) or whether it results from an environmental factor.
Forms of alexithymia
There are two forms of alexithymia:
the primary form, which refers to a factor predisposing to the onset of somatic disorders;
the secondary form, which results in a mechanism of adaptation to specific traumas.
Alexithymia would predict the appearance of somatic symptoms that are not clinically explained, such as asthma, chromium disease, certain migraines, or gastrointestinal disorders.
There would be depressive disorders in alexithymic patients. There would be depressive disorders that are often undiagnosed in these people because of their weak verbalization skills and who find it difficult to recognize themselves as depressed.
Therapy
The best medical attitude is to screen patients as early as possible because there is a risk of developing a somatic disorder, depression, or even dementia.
Psychotherapy is indicated for patients wishing to find the origin of their psychological disorders.
Individual care is complex because there is no actual demand. Group support is often indicated.
Relaxation is also a good indication. The relaxant is lying down, and the caregiver talks to him about his body. This sometimes makes him feel good and sometimes makes him feel bad, and he will be able to talk about it after the session.
Screening
To detect this disease, there is a questionnaire called the French scale for evaluating alexithymia.
Akinesia is a symptom that causes a person to lose the ability to move their muscles. Occasionally, a person’s body seems “frozen.”
Doctors usually associate this disease with an advanced stage of Parkinson’s disease, which results in a loss of control of his movements. However, there are other medical causes related to akinesia.
Babies in the womb can suffer from akinesia, which can have a detrimental impact on their development.
What are the symptoms?
Symptoms can include difficulty starting to walk and muscle stiffness in the legs.
Some of the symptoms include:
Difficulty when a person begins to walk.
Muscle stiffness, usually starting in the neck and legs. Facial muscles may become stiff.
A sudden inability to move the feet properly, especially when changing direction.
A person with Parkinson’s disease may have some or all of the symptoms of the disease. However, according to one study, nearly half of people with Parkinson’s disease reported akinesia.
Furthermore, It is possible that a person may have akinesia alone without any underlying signs of Parkinson’s disease. Such a case is known as « pure » akinesia and is not accompanied by the other symptoms of Parkinson’s disease: tremors at rest, generalized slower movements, or rigidity.
Akinesia refers to the loss of the ability to move one’s muscles voluntarily, and it is most commonly described as a symptom of Parkinson’s disease.
Difference Between Akinesia and Dyskinesia
Akinesia and dyskinesia are two symptoms that describe movement disorders.
Akinesia is a lack of movement, whereas a person with dyskinesia or difficulty moving has muscles that move involuntarily and unexpectedly. Examples may include shaking or twitching movements.
Both symptoms can occur when a person has Parkinson’s disease.
Causes of Akinesia
In adults, some of the causes associated with this condition include:
Parkinson’s disease: A reduction in the amounts of dopamine produced in the brain affects a person’s ability to control their muscles.
Drug-induced Parkinson’s-like symptoms: when a person takes too much of a drug that inhibits dopamine.
Progressive supranuclear palsy: A disease that usually first impacts balance during walking.
Hypothyroidism or deficient levels of thyroid hormone.
In people with Parkinson’s disease, men are more likely to suffer from akinesia than women. Those with resting tremors as the predominant symptom of their Parkinson’s disease are less likely to suffer from akinesia than others.
Risk factors
Risk factors include:
a history of bradykinesia or slowed muscle movement;
have had Parkinson’s disease for a long time;
postural instability;
muscle stiffness problems.
Genetic causes
Doctors have also isolated two genetic mutations associated with increased risks of fetal akinesia.
A person with a family history or a baby with the condition can see a genetics specialist. She can be tested for DOK7 and RAPSN gene mutations associated with akinesia.
Treatments
Treatment depends on the cause of the symptoms.
Medication-Related Symptoms
For example, drug-related akinesia can be treated by stopping the drug causing the problem.
Symptoms related to Parkinson’s disease
Treatments for Parkinson’s disease-related akinesia can be more complicated. Doctors often prescribe drugs that increase the amount of the neurotransmitter dopamine in the body.
These symptoms may help, as reduced levels of dopamine cause the motor symptoms associated with Parkinson’s disease.
These drugs include levodopa, carbidopa, MAO-B inhibitors, and dopamine agonists.
Ageusia is a disorder in which the tongue loses its sense of detecting different tastes, such as sweet, sour, bitter, and salty.
Ageusia can affect people of all ages but is particularly common in people over 50.
The recent coronavirus pandemic has also listed loss of taste in some patients who tested positive for COVID-19.
When symptoms of ageusia are recognized, prompt medical treatment is needed to ensure a full recovery.
Various factors can cause ageusia, and a dry mouth is the most common cause. Smoking (especially pipe smoking), allergies, and certain medications, including certain antibiotics, blood pressure medications, antihistamines, and antidepressants, can all contribute to iritis.
The causes of ageusia
Many infections can affect the taste, such as:
common cold;
flu;
sinus infections;
Infections of the throat, including angina and pharyngitis.
Salivary gland infections.
Other causes of altered taste include:
cigarette smoking;
inflammation of the gums, such as gingivitis or periodontal disease ;
medications, including lithium, thyroid medications, and cancer treatments;
Sjögren’s syndrome, an autoimmune disease that causes dry mouth and dry eyes;
head or ear injuries;
nutritional deficiencies, especially vitamin B-12 and zinc.
Symptoms
Common symptoms of ageusia are:
Distinguishing the taste of food is difficult.
High blood pressure;
The underlying signs of diabetes
Teeth, gum, and tongue problems;
Allergies and nasal congestion.
Diagnosis and treatment
An otolaryngologist can diagnose taste and smell disorders, which can determine the extent of the taste disorder. It is possible to compare the tastes of different substances or note how the intensity of a flavor increases with the concentration of food.
Treating the underlying condition causing the taste alteration can help restore taste. Bacterial sinusitis, salivary glands, and throat infections can be treated with antibiotics.
Symptoms of colds, flu, and allergic rhinitis that impact taste can be relieved with decongestants or antihistamines. When the symptoms subside, your sense of taste will likely return.
The doctor may prescribe medications to minimize the effects of a nervous system disorder or autoimmune disease that causes taste disturbance.
More often than not, lifestyle changes are all one needs to improve the sense of taste. Stopping the consumption of cigarettes or other substances can make it possible to taste food thoroughly, and Ex-smokers begin to regain their sense of taste quickly.
Good dental hygiene can also reverse ageusia.
Brushing and flossing can remove plaque from the mouth, protect teeth from disease and cavities, and help fight ageusia.
Anosmia, ageusia and COVID-19
Anosmia and ageusia are the first symptoms in patients with COVID-19, especially if the patient has very few symptoms. A study published in 2021 aimed to determine the profile demographics of patients with anosmia, the prevalence of anosmia, and the time to recovery in COVID-19-positive patients treated in hospitals.
Of the study population of 1000 patients, 742 had a smell disorder of some form. There was a correlation between disease severity and smoking history. The prevalence of smell disorders in COVID-19 patients in this study was 74.2%, while most smokers had the moderate disease. The average resolution time for olfactory disorders was ten days.
In conclusion, anosmia and ageusia may be the only symptoms in patients with COVID-19. They are completely reversible and can be used as early predictors of infection.
Agoraphobia is a form of anxiety disorder in which you fear and avoid places that could cause you to panic and be trapped.
Anxiety is caused by the fear that there is no easy way to escape or get help if the tension escalates.
Most people with agoraphobia develop it after having one or more panic attacks, which causes them to worry about having another attack.
People with agoraphobia often have trouble feeling safe in any public place, especially where crowds gather.
Treating agoraphobia can be difficult because it usually means facing your fears. But with psychotherapy and medication, you can escape the trap of agoraphobia and live a more enjoyable life.
Symptoms
Typical symptoms of agoraphobia include fear of:
Stand in line
Closed spaces, such as cinemas, elevators, or small shops
Open areas, such as parking lots, bridges, or shopping malls
Use public transport (bus, plane, or train).
These situations cause anxiety because you worry that you won’t be able to escape or that you won’t find help if you start to feel panicked.
In addition:
Fear or anxiety almost always results from exposure to the situation
Your fear or anxiety is out of proportion to the real danger of the situation
You avoid the case, you need a companion to accompany you, or you put up with the problem, but you feel distressed
Your phobia and avoidance usually last six months or more
Example of agoraphobia
A person is afraid to leave home and must be accompanied to go further than their condition allows. She can call a relative to let her know she is leaving alone. This avoidance has a deleterious impact on professional functioning.
The causes
Biology, stress, and learning experiences can all play a role in developing agoraphobia.
Risk factors
Agoraphobia can start in childhood but usually in late adolescence or early adulthood – usually before age 35. Older adults can also develop it, and women are diagnosed with agoraphobia more often than men.
Risk factors for agoraphobia include:
Having panic disorder or other phobias
Respond to panic attacks with excessive fear and avoidance
Experiencing stressful life events, such as abuse, death of a parent, or assault.
Having an anxious or nervous temperament
Having a parent with agoraphobia
Complications
Agoraphobia can significantly limit the activities of your life. If your agoraphobia is severe, you may not even be able to leave your home.
Without treatment, some people remain housebound for years.
You may not be able to visit family and friends, go to school or work, run errands, or participate in other normal daily activities.
Agoraphobia can also cause or be associated with:
Depression
Alcohol or drug abuse
Other mental health disorders, including other anxiety disorders or personality disorders
Prevention
There is no sure way to prevent agoraphobia. However, anxiety tends to increase as you avoid situations you fear.
If you start to have mild fears about going to safe places, try to practice going there again and again before your anxiety becomes overwhelming.
If it’s too difficult to do it yourself, ask a family member or friend to go with you, or seek professional help.
If you feel anxious or have panic attacks, get treatment as soon as possible. Get help early to prevent symptoms from getting worse. Anxiety, like many other mental health issues, can be harder to deal with if you wait.
Diagnostic
Agoraphobia is diagnosed based on the following:
Signs and symptoms
In-depth interview with your doctor or a mental health professional
Physical examination to rule out other conditions that could be causing your symptoms
Criteria for agoraphobia are listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association
Treatment
Treatment for agoraphobia usually includes both psychotherapy and medication. It may take some time, but treatment can help you get better.
Psychotherapy
Psychotherapy involves working with a therapist to set goals and learn practical skills to reduce anxiety symptoms. Cognitive-behavioral therapy is one of the most effective psychotherapies for anxiety disorders, including agoraphobia.
Medications
Certain types of antidepressants are often prescribed to treat agoraphobia, and sometimes benzodiazepines are used on a limited basis.
Medications can take weeks to relieve symptoms.
Alternative medicine
Some dietary and herbal supplements claim to have calming and anti-anxiety benefits. Before taking these drugs for agoraphobia, please speak with your doctor.
Although these supplements are available without a prescription, they are not without health risks.
Agnosia is a loss of the ability to recognize objects we see (visual agnosia) or noises we hear (auditory agnosia). At the same time, sensory functions (vision, hearing, touch, etc.) are standard.
Clinical studies show that people suffering from neurodegenerative diseases have gnostic disorders – the inability to recognize objects, shapes, and faces. Face recognition is particularly impaired in frontotemporal and Alzheimer’s -type dementia, as well as in Parkinson’s disease. These gnostic disorders would explain the appearance of behavioral and psychological disorders.
Agnosia and Alzheimer’s disease
Alzheimer’s disease is primarily characterized by progressive degeneration of the hippocampus and entorhinal cortex, resulting in impaired episodic memory and learning, making it challenging to learn new faces.
A loss of semantic memory is subsequently observed as the disease progresses: the patient has more difficulty retaining information related to people from their face. He hardly perceives the relative as familiar and no longer recognizes him.
Patients have difficulty interpreting negative facial expressions expressing fear and sadness. Delusional-type behavioral disorders appear as the disease worsens, resulting in the belief that the loved one has been replaced by a look-alike (Capgras syndrome). These disorders hinder communication, generate inappropriate behaviors and affect the relational life of patients.
In the severe stage of the disease, the patient no longer recognizes himself in a mirror. Faced with his image, the patient presents different attitudes: hesitation, indifference, or avoidance.
Neuroimaging studies have reported lesions of neurons located in the temporal and prefrontal cortex’s limbic regions (e.g., the amygdala), undoubtedly at the origin of these gnostic disorders.
Agnosia and frontotemporal dementia
Frontotemporal dementias (FTD) are a group of neurodegenerative diseases characterized by behavioral and language disorders associated with intellectual deterioration.
Patients are often anosognosic (anosognosia: neuropsychological disorder defined by the individual’s lack of knowledge of his illness). They can recognize familiar faces and extract features unrelated to emotions (i.e., age, sex) but have more difficulty identifying negative facial emotions, such as fear, anger, and disgust. Recognition of positive emotions may also be affected.
These deficits would explain the appearance of specific behavioral and psychological disorders (inappropriate behavior in society, empathy). They would be linked to progressive damage to the amygdala, the frontal lobe, then the temporal lobe.
When the temporal lobe is affected, the patient has difficulty identifying famous people, which is more akin to semantic dementia or primary progressive aphasia, which are two subtypes of FTD where language disorders predominate.
Semantic dementia is characterized by early behavioral disturbances, impaired word comprehension, altered social functioning, and a lack of empathy. The patient loses the notion of concepts in connection with temporal lobe degeneration.
The patient can no longer put a name to a famous or familiar face. The inability to recognize faces can be associative (the patient identifies the person from their nature and not their face) or semantic (the patient cannot remember the person).
In addition, patients have difficulty identifying facial expressions evoking fear, anger, or sadness. This deficit is correlated with atrophy of the temporal lobe, the amygdala, and the frontal cortex.
Parkinson’s disease
Although motor symptoms predominate in the disease, the existence of cognitive, psychological, and behavioral disorders (anxiety, depression, apathy) would be associated with degeneration of the cerebral regions located in the basal ganglia.
Early impairment of emotion processing (recognition of facial expressions of disgust and fear) has been observed in Parkinson’s patients. In contrast, the ability to recognize positive expressions (expressions of joy) is preserved. The involvement of the basal ganglia and the amygdala would be at the origin of this deficit in emotion processing.
Aggressive behavior in the elderly is not synonymous with psychomotor agitation.
Agitation is a behavioral disorder characterized by exaggeration and abnormal psychomotor activity, leading to a loss of control of thoughts and actions. It is a behavioral disorder that originates in suffering.
It does not necessarily justify hospitalization, which must most often be avoided (except in the case of somatic illness or serious psychiatric disorder). The possible causes are multiple and sometimes interdependent.
Agitation can be verbal, physical, and associated with aggression or not
It can have severe consequences for the elderly subject and others around him. Approximately 15% of elderly subjects hospitalized in psychiatry are hospitalized for aggressive agitation.
The subject does not stay in place; he wanders and gesticulates. He can scream and cling to others.
He can sometimes have violent gestures accompanied by falls and traumatism.
Their comments may be abusive or repetitive, and he can refuse to cooperate. Agitation may be permanent or intermittent, alternating with prostration.
The causes of psychomotor agitation
Confusion
This common syndrome in the elderly can lead to behavioral disorders such as agitation.
Anxiety
It can cause more or less confused agitation in the elderly. Chronic anxiety can lead to ambulation, insomnia, and irritability, accompanied by bodily manifestations: oppression, tremors, palpitations, and abdominal pain.
Hypomania
The elderly subject presents a state of hypomanic excitement that is euphoric and satisfied but sometimes suspicious, even aggressive. A toxic cause or a brain tumor should be sought if there is no history of manic-depressive disorders.
Depression
Certain depressions in the elderly may include phases of agitation with anxiety disorders. The person is in a sad mood and has a loss of interest and a feeling of emptiness.
Late delirium
Settling gradually can lead to behavioral disorders marked by agitation.
The subject feels persecuted and is experiencing emotional reactions.
Hallucinations
In certain dementias, they can be distressing.
Dementia
Behavioral disorders related to dementia are potentially dangerous manifestations for the person or others.
These behaviors are frequently added to the cognitive symptoms observed in dementia.
Agitation and aggression in dementia of Alzheimer’s may occur in approximately half of the patients depending on the care setting.
A crisis
A relational crisis within a family or the entourage can generate psychomotor agitation in the elderly.
Mourning
The mourning of a loved one, the loss of an animal, or money can trigger agitation.
Medical and surgical causes
Hypoglycemia
Hyperthyroidism
fecal impaction
Urinary retention
Hyponatremia
Pulmonary, urinary, or dental infection
Meningitis
Iatrogenic pathologies: drugs that can cause confusion (e.g., anticholinergics), diuretics, corticosteroids, caffeine, etc.
Drug withdrawal (especially benzodiazepine)
Alcoholic withdrawal
The appearance of a heart rhythm disorder
Hemodynamic disorder
Subdural hematoma after a fall on the buttocks gone unnoticed or minimized
Cerebrovascular or tumor pathology
Diagnostic
It is done by contacting the person, who can sometimes play down the situation. It is also necessary to inquire about the patient’s entourage.
The circumstances that provoked the psychomotor agitation must be specified, as well as the possible pathological history and the previous treatments.
Suppose the cause is not a psychiatric origin. In that case, the doctor must have the patient undergo a clinical examination to look for somatic reasons: blood test, blood sugar, creatinine, calcium, sodium, blood pressure and temperature, cardiovascular, pulmonary, abdominal, and skin condition (search for bruises, for example). Spatial and temporal orientation and signs of hemiparesis are also checked.
Treatment
The doctor’s presence can sometimes have a soothing sedative effect.
If this is not the case, sedative therapy may be necessary:
Antipsychotic for urgent action.
Benzodiazepine with a short half-life.
Mood stabilizer (e.g., Depamide).
An antidepressant
Sensory capture is a technique of the Gineste-Marescotti care methodology to prevent restless behavior.
Tinnitus is the perception of noise or ringing in the ears, affecting about 15 to 20% of people.
Tinnitus is not a condition in itself – it is a symptom of an underlying condition, such as age-related hearing loss, ear injury, or circulatory system disorder.
Although bothersome, tinnitus is generally not something serious.
Although it can get worse with age, for many people, tinnitus can get better after treatment.
Treating the identified underlying cause sometimes helps. Other treatments reduce or mask noise, making tinnitus less noticeable.
Symptoms
Tinnitus involves the sensation of hearing sound in the absence of external sound. Tinnitus symptoms can include phantom noises in the ears, such as:
A ring
A buzz
A roar
A click
A whistle
Phantom noise can range from a low-pitched roar to a high-pitched squeal, which can be heard in one or both ears. In some cases, the sound may be so loud that it may interfere with the ability to concentrate or hear external sound. Tinnitus can be present all the time or intermittently.
There are two types of tinnitus.
Subjective tinnitus is the most common type of tinnitus. Ear problems in the outer, middle, or inner part can cause it. Disorders with the auditory (auditory) nerves or the amount of your brain that interprets nerve signals as sound (auditory pathways) can cause issues.
Objective tinnitus is tinnitus that your doctor can hear during an exam. A blood vessel disturbance, a bone condition in the middle ear, or muscle twitching can cause this rare tinnitus.
Not confused with auditory hallucinations.
Tinnitus Diagnosis
The doctor examines the ears, head, and neck to look for possible causes of tinnitus. The tests include:
· Hearing test (audiological). The patient sits in a soundproof room with headphones. It indicates when he can hear the sound, and the results are compared to those considered normal for his age. This test can help rule out or identify possible causes of tinnitus.
· Movement. The doctor may ask to move the eyes, clench the jaw, or move the neck, arms, and legs. If the tinnitus changes or worsens, it can help identify an underlying disorder that needs treatment.
· Imaging tests. Depending on the suspected cause of the tinnitus, the patient may need imaging tests (CT scans or MRIs).
The sounds heard can help the doctor identify a possible underlying cause.
· Clicks. Muscle contractions in and around the ear can cause sharp clicks to be heard in bursts. They can last from a few seconds to a few minutes.
· Humming. These sound fluctuations are generally of vascular origin and occur, for example, when exercising or changing position, for example, when lying down or getting up.
· Heartbeat. Blood vessel problems, such as high blood pressure, aneurysm or tumor, and blockage of the ear canal or eustachian tube, can amplify the heartbeat sound in the ears.
· Low ringtone. Conditions that can cause severe ringing in one ear include Ménière’s disease. Tinnitus can become very loud before an attack of vertigo – a feeling that the environment is spinning or moving.
· High-pitched ringing. Exposure to loud noise or a knock in the ear can cause a high-pitched ringing or buzzing sound that usually subsides after a few hours. However, tinnitus may be permanent if there is also hearing loss. Long-term noise exposure, age-related hearing loss, or medication can cause continuous, high-pitched ringing in both ears. Acoustic neuroma, also called vestibular schwannoma, can cause constant, high-pitched ringing in one ear.
· Other sounds. Stiff bones in the inner ear (otosclerosis) can cause severe tinnitus that may be continuous or come and go. Earwax, foreign bodies, or hair in the ear canal can rub against the eardrum, causing a variety of sounds.
Often, it is challenging to determine the cause of tinnitus.
Brain abscesses are caused by bacteria entering the bloodstream through a break in the skin. They usually form when there is an injury to the head, neck, face, or teeth.
This allows bacteria to enter the blood stream and travel to the brain. Once inside the brain, the bacteria multiply and cause swelling.
This causes pressure on nearby nerves and may lead to seizures.
Brain abscess is more likely to affect adult males under the age of 30.
In children, they most often develop in those between 4 and 7 years old. Vaccination programs have reduced the incidence of brain abscesses in young children.
Brain Abscess Symptoms
Brain abscess symptoms include headache, fever, nausea, vomiting, stiff neck, confusion, seizures, loss of consciousness, coma, and death.
The most common cause of brain abscesses is bacterial infection. Other causes include fungal infections, trauma, tumors, and autoimmune diseases.
If the headache suddenly gets worse, the abscess may have burst.
In two-thirds of cases, symptoms last up to 2 weeks. On average, doctors diagnose the disease 8 days after the onset of symptoms.
The causes of brain abscess
Brain abscesses are caused by bacteria, fungi, or amoebae that enter the brain.
Brain abscesses are caused by bacteria, fungi, or amoebae that enter the brain. The most common cause is bacterial meningitis.
Brain abscesses can also be caused by tuberculosis or fungal infections of the sinuses or ear.
As the cells accumulate, a wall or membrane develops around the abscess. This isolates the infection and prevents it from spreading to healthy tissue.
If an abscess swells, it puts increasing pressure on surrounding brain tissue.
How the infection enters the brain
Brain infections are quite rare for several reasons.
One reason is the blood-brain barrier, a protective network of blood vessels and cells. It blocks certain components of blood flowing to the brain.
Sometimes an infection can cross the blood-brain barrier. This can happen when inflammation damages the barrier.
The infection enters the brain through three main routes.
It could:
by blood;
from a neighboring site, for example the ear;
result from traumatic injury or surgery
Infection from another area of the body
If an infection occurs elsewhere in the body, infectious organisms can bypass the blood-brain barrier and enter and infect the brain.
Many bacterial brain abscesses arise from a lesion in the body.
A person with a weakened immune system (for example caused by chemotherapy or an organ transplant) has a higher risk of developing a brain abscess as a result of a blood-borne infection.
The most common infections known to cause brain abscesses are:
endocarditis, an infection of the heart valve
pneumonia, bronchiectasis and other lung infections
an abdominal infection such as peritonitis,
cystitis or inflammation of the bladder.
Direct contagion
An untreated middle ear infection can lead to a brain abscess. If an infection starts inside the skull, for example in the nose or ear, it can spread to the brain.
Infections that can trigger a brain abscess include:
ear infection;
sinusitis;
mastoiditis, an infection of the bone behind the ear.
The location of the abscess may depend on the site and type of the original infection.
Direct trauma
A brain abscess can result from neurological surgery or brain injury.
An abscess can result from:
a blow to the head that causes a skull fracture,
a complication of surgery, in rare cases.
Diagnosis of brain abscess
To diagnose a brain abscess, the doctor will assess the signs and symptoms and review the patient’s medical history and recent movements.
Symptoms can be similar to those of other illnesses and conditions, so confirming a diagnosis can take time. The diagnosis will be easier if the doctor can determine exactly when the symptoms started and how they progressed.
Tests may include:
a blood test to check for high levels of white blood cells, which may indicate an infection
imaging scans, such as an MRI or CT scan,
biopsy which consists of taking a sample of pus for analysis.
The number of deaths from brain abscess has declined over the past decades, due to the increasingly common use of neuroimaging.
Brain abscess treatment
Treatment usually involves surgical drainage of the pus through an incision into the skull (craniotomy). Antibiotics should also be given intravenously to fight any infection that might have caused the abscess in the first place. After the infection is eliminated, a long-acting antibiotic may be given orally to help prevent future recurrences.
If tests show an infection is viral rather than bacterial, the doctor will change treatment accordingly.
The effectiveness of the treatment will depend on:
the size of the abscess
number of abscesses
the cause of the abscess
how the person is healthy
Surgery
A person may need surgery if:
the pressure in the brain continues to rise
the abscess does not respond to medication
there is a risk that the abscess will burst
A craniotomy is a procedure in which the surgeon makes an opening in the skull.
Medication
A short course of high-dose corticosteroids can help with increased intracranial pressure and risk of complications, such as meningitis.
However, doctors do not routinely prescribe corticosteroids.
A doctor can prescribe anticonvulsants to prevent seizures. A person who has had a brain abscess may need to take anticonvulsants for up to 5 years.
Wandering is a common behavior among patients suffering from Alzheimer’s disease.
The wandering may occur during the day or night, and it may be triggered by external stimuli, such as noise, light, or smells. It may also be caused by internal factors, such as sleep disorders, depression, or anxiety.
The wandering Alzheimer syndrome is a condition where patients lose their sense of direction and wander off without knowing why.
This happens when there is damage to the hippocampus, a part of the brain responsible for spatial navigation. Patients may become lost and disoriented, unable to find their way back home.
Wandering becomes a complicated situation for the family and professional environment.
Indeed, the elderly person can be in danger if the entourage or the police do not find him quickly.
Running away or wandering?
It is difficult to know whether a patient leaves voluntarily or by chance, especially since the memory problems from which he suffers make it difficult to distinguish.
Moreover, the patient does not have all his faculties of judgment, which does not make it possible to know if the act is voluntary or not.
The main forms of running away are:
Running away due to orientation disorders. The patient is happy to be found.
Running away due to behavioral problems. The patient does not realize he is at home (confusion) or thinks he is still working or has a dependent child (delusions).
The reactive fugue. The patient does not find his bearings in the establishment he has just joined.
Running away due to a hostile environment. The patient does not feel included in the health care establishment in which he does not feels, comfortable, or thinks that the nursing staff will harm him.
Trompe l’oeil murals to improve the quality of life of patients
The idea behind trompe l’oeils is to trick your brain into thinking there’s something real when there isn’t. This technique is used in architecture, painting, sculpture, and even in medical treatments. It’s often used to create illusions of depth, which can help people who suffer from conditions like dementia.
In 2019, the Anna-Laberge Foundation obtained a donation that allowed it to install trompe-l’oeil murals in a residential center, in order to improve the quality of life of patients with Alzheimer’s disease.
The murals, made up of different images, make it possible in particular to camouflage the elevator and exit doors of the unit, which, among other things, reduces attempts to run away and the interventions of the staff to counter them.
A box to help the person in the event of a runaway
In Belgium, an original solution has been found to find them as quickly as possible. In the event of a worrying disappearance, the investigators inspect a box which is in the fridge in the middle of the food.
The fridge is indeed the only piece of furniture that is the easiest to find in a house.
In this box is a booklet in which we find the basic information on the missing person: his photo, the addresses where the person is likely to go, the people to warn.
The Wandering Alzheimer Project
The Wandering Alzheimer Project is a project designed to provide a box which will allow people who suffer from Alzheimer’s disease to wander safely. This box contains a GPS tracker, a panic button, and a mobile phone charger. It also includes a map of the area where the user lives, so that if they get lost, someone can find them.
Optical illusions to reduce runaways in long-term care centers
More and more accommodation and long-term care centers (CHSLD; equivalent of EPHAD in France) are using trompe-l’oeil murals that allow elevators and exits to be camouflaged.
This technique aims to reduce runaways and anxiety in people with Alzheimer’s disease.
It is currently used in a CHSLD in Montreal. Thus, the elevator or the exit door are replaced by a sideboard, a table or a general store.
« We try to use paints that encourage the recall of old memories », comments the head of unit.
An anti-fugue sensor in a sock
A 15-year-old New Yorker has developed a device that allows him to prevent people suffering from Alzheimer’s from running away. This idea came to him following the runaways of his grandfather suffering from the disease.
The principle is as follows: when the Alzheimer’s person gets up at night, a wireless pressure sensor attached to the sock sends an audible alert to a smartphone. This device has been tested 437 times on his grandfather, with 100% success.
The young Kenneth Shinozuka hopes to be able to quickly provide hundreds of copies to caregivers. According to him, this tool will protect patients and reduce the stress of caregivers. Kenneth Shinozuka won the 2014 Google Science Fair prize worth $50,000.
Two studies found that people with Alzheimer’s disease and taking opioid painkillers were twice as likely to develop side effects like constipation, nausea, vomiting, dizziness, confusion, hallucinations, and sleep problems. They also identified a mechanism that could explain why this happens.
In a randomized controlled trial of 162 Norwegian nursing home residents, researchers from the University of Exeter, King’s College London and the University of Bergen found a significant increase in side effects such as changes in personality changes, confusion and sedation, which can have a serious impact on the lives of people with dementia.
The team wants studies to be carried out to look at the appropriate dosage of painkillers (e.g. buprenorphine) for people with dementia.
About half of people with dementia who live in nursing homes experience pain.
Previous research has recognized that pain is often under diagnosed and poorly managed in people with dementia, impacting quality of life.
After paracetamol, opioid painkillers are frequently the second choice of treatment for clinicians in people with dementia and are prescribed to nearly 40% of people with dementia living in care homes.
They provide effective pain relief, but current recommendations do not consider that people with dementia get noticeable pain relief from doses lower than those usually prescribed, and are particularly susceptible to adverse effects.
The team studied 162 people from 47 Norwegian nursing homes who suffered from dementia and depression. In those given buprenorphine as part of their treatment, harmful side effects more than tripled. The researchers also found that those taking buprenorphine were significantly less active during the day.
According to Clive Ballard, a professor at the University of Exeter Medical School:
Pain is a symptom that can cause enormous distress, and it is important that we can provide relief to people with dementia. When we try to relieve their pain, we need more research in this area, and we need to find the right treatment. We need to establish the best course of treatment and consider the appropriate dosage for people with dementia.
Importantly, research conducted by Professor Ballard’s team and presented at the 2018 Alzheimer’s Disease International Conference (AAIC) sheds light on why people with dementia are more sensitive to opioid painkillers, suggesting that they overproduce the body’s natural opioids.
A second study in an Alzheimer’s mouse model revealed increased sensitivity to morphine (an opioid painkiller) compared to healthy mice. People with Alzheimer’s disease responded to a much lower dose for pain relief and experienced more adverse effects when the dose was increased to a normal level. Looking further, the study found that the Alzheimer’s mice produced more endorphins (the body’s natural endogenous opioids).
