Author Archives: Stéphane Bastianetto

1. Anemia

   3 décembre 2022 9 h 56 min Leave a Comment

   Anemia is a disorder in which the number of red blood cells or the hemoglobin concentration in red blood cells is lower than normal. 

   Hemoglobin is needed to carry oxygen. If you have too few red blood cells or not enough hemoglobin, there will be a decrease in the blood’s ability to carry oxygen to the tissues of the body.  

   Anemia can be temporary or long-term, ranging from mild to severe. 

   Anemic patients may appear pale, feel cold, fatigue, tire quickly, have weakness, dizziness, or lightheadedness, impaired balance and increased risk of falling, develop rapid heartbeats, and become short of breath. 

   Anemia is associated with decreased walking speed or the ability to get up from a chair, impaired mental abilities such as thinking, memory, and learning (cognitive performance), depressive symptoms, and diminished quality of life. 

   Anemia is a common condition in older people, although it is not caused by normal aging. 

   It has many causes, some of which you can control. For example, in the elderly, a poor diet can lead to anemia.

   Anemia is more common in women than men, but from age 65, it occurs more often in men. It is diagnosed in about 20% of men and 15% of women over 80.

   Types of anemia

   iron deficiency

   Iron is one of the main building blocks for producing red blood cells. Iron levels in the body may be too low if your body does not absorb iron from your food, if you do not eat enough iron-containing foods, or if you bleed and lose iron faster than you expect. You can consume it. Low iron is a prevalent cause of a low red blood cell count.

   Anemia associated with chronic diseases

   Anemia associated with chronic diseases is the result of chronic inflammation caused by ongoing infections, tissue damage, various forms of arthritis, benign or malignant tumors, or a variety of chronic medical conditions.  

   Pernicious anemia

   It occurs when you don’t have enough vitamin B12 or folic acid. 

   hemolytic anemia

   This type of anemia occurs when a disease destroys your red blood cells.

   The causes

   The three main reasons why anemia can occur are described below. In the elderly, anemia is often the result of several conditions simultaneously. These conditions may include the following:

   • Decreased red blood cell production caused by:
     • Bone marrow function problems
     • Chronic diseases or inflammation, such as cancer or infections
     • Hormonal problems
     • kidney disease
     • Malnutrition and dietary deficiencies of iron, vitamin B12, or folic acid (folate)
     • Hereditary disorders
     • Medications
     • Alcohol addiction
   • Blood loss due to:
     • stomach irritation caused by drugs, alcohol, or an ulcer
     • polyps or tumors in the intestines
     • kidney stones or tumors
     • cancer
     • surgery 
   • Increased destruction of red blood cells caused by:
     • Medications
     • A hereditary disorder
     • A disease of your immune system
     • Heart valve problems (which damage your red blood cells)
     • A tumor
     • Infections

   Symptoms

   Symptoms of anemia may include

   • Fatigue
   • weakness
   • Shortness of breath
   • Dizziness
   • Pale skin color
   • Be cold
   • Behavioral changes, such as lack of interest, confusion, agitation, or depression
   • If you have heart disease and anemia, you may notice increased chest pain or swelling in your ankles.

   Diagnosis and tests

   The cause(s) of anemia in the elderly can be challenging to diagnose. Many conditions can cause anemia in older people, and several can co-occur. 

   Even with a thorough evaluation, in 20% of cases, the underlying cause of anemia is not found. If you have symptoms of anemia, your healthcare professional will perform a complete history and physical exam and take a blood sample for a total blood count.

   Anemia is diagnosed if the amount of hemoglobin (the part of the blood cell that carries oxygen) is lower than usual (less than 13 g/dL in men and less than 12 g/dL in women ). Your healthcare professional may also test your blood to measure your iron, vitamin B12, and folate levels and recommend special blood tests to determine how well your body stores and uses iron.

   Your healthcare professional may perform additional tests to determine if you have any underlying disease or problems, such as ulcers or polyps, which could be causing chronic internal bleeding. These tests may include the following:

   • Additional blood tests
   • X-rays
   • endoscopy.
   • Bone marrow biopsy.

   Care and treatment of anemia

   Treatment for anemia will depend on the type you have been diagnosed with.

   If you are diagnosed with iron deficiency anemia, your healthcare professional may prescribe oral iron supplements (usually ferrous sulfate or ferrous gluconate). Treatment may need to continue for six months or more. A typical treatment schedule is 325 mg ferrous sulfate 1-2 times daily, 1 hour before or 2 hours after a meal. Orange juice or oral vitamin C supplements can help you absorb iron. Antacids, H2 receptor blockers, proton pump inhibitors, calcium supplements, and some antibiotics (tetracycline, quinolones) can interfere with iron absorption.

   Oral iron supplements’ most common side effects are indigestion, nausea and vomiting, constipation, diarrhea, and dark stools. If you experience uncomfortable side effects, your healthcare professional may suggest a lower dosage or frequency, or you can try a different formulation. There is no significant difference between oral iron preparations, but one preparation may be better tolerated than another by an individual patient. Liquid iron drops may be better absorbed, but their side effects are similar to those of iron tablets.

   Suppose you are diagnosed with anemia due to vitamin B12 or folate deficiency. In that case, your healthcare provider may prescribe periodic injections or oral supplements of vitamin B12 or folic acid (the synthetic version of folate).

   If you have hemolytic anemia, your healthcare provider might prescribe steroids or even recommend surgery to remove your spleen if it’s enlarged.

   Anemia caused by kidney disease or chemotherapy may require injection treatments (called erythropoietin-stimulating agents) to increase the production of red blood cells in the bone marrow.

   You may need a blood transfusion if your blood count is meager or you have severe anemia symptoms.

   Lifestyle and management

   Some types of anemia can be managed with a healthy, balanced diet rich in iron, vitamin B12, folic acid, and vitamin C, which helps your body absorb iron. Because meat is a primary source of some of these nutrients, strict vegetarians should have periodic blood tests and discuss the need for supplements with their healthcare provider.  

   • Iron is found in red meat, poultry, and fish (like salmon, tuna, and shrimp). Other iron-rich foods include beans, lentils, dark green leafy vegetables, dried fruits, nuts, soy, and iron-fortified cereals and bread.
   • Folate is found in fortified cereals, meat, spinach, beans, citrus fruits and juices, cantaloupe, papaya, and bananas.
   • Vitamin B12   is most abundant in meat, fish, dairy products, and fortified cereals.
   • Vitamin C   is found in citrus fruits, melons, berries, bell peppers, broccoli, Brussels sprouts, and kale.

2. Cardiac amyloidosis

   9 h 28 min Leave a Comment

   Cardiac amyloidosis is a clinical disorder caused by the deposition of insoluble by-products from proteins called amyloid, which are approximately 10 nanometers wide.

   Amyloid deposits form on the outside of cells in the heart muscle, affecting its ability to pump blood.

   These abnormalities result in amyloid fibrils and can manifest as primary, secondary, familial, or senile amyloidosis. 

   Amyloidosis can affect multiple organs (e.g., heart, liver, kidney, skin, eyes, lungs, nervous system), resulting in various clinical manifestations.

   Cardiac involvement is a progressive disorder resulting in early death due to congestive heart failure and arrhythmias. Cardiac involvement can occur as part of a systemic disease or a localized phenomenon.

   Cardiac amyloidosis symptoms

   Symptoms of cardiac amyloidosis mimic those of heart failure, including:

   • Thickened and less flexible heart tissue
   • Shortness of breath
   • Fatigue
   • Leg swelling
   • Heart palpitations
   • Dizziness

   Diagnosis of cardiac amyloidosis

   To confirm a diagnosis of cardiac amyloidosis, you will need a heart biopsy or a technetium pyrophosphate scan.

   A heart biopsy is a minor surgical procedure in which a small sample of heart tissue is removed and examined under a microscope by a doctor.

   A technetium pyrophosphate scan is similar to an MRI and gives an image of the heart. A dye is injected before the scan and will cause the ‘brightening’ of transthyretin amyloidosis (ATTR). If any tests indicate transthyretin amyloidosis (ATTR), genetic testing is recommended to confirm the subtype.

   • Light chain (AL) amyloidosis and transthyretin (ATTR) are most likely to damage the heart.
   • Treatment depends on the specific subtype of amyloidosis. These can include drugs, chemotherapy, and stem cell transplantation.

   Other tests that might be recommended:

   • Electrocardiogram (ECG)
   • echocardiogram
   • Blood analyses
   • Urine analysis

   Cardiac amyloidosis treatment

   Cardiac amyloidosis is a severe disease that requires a multidisciplinary approach. Although the disease cannot be cured, treatment can slow the progression of amyloid deposits and treat damage to the heart.

   Treatment depends on the subtype and may involve a combination of these approaches:

   • Drug to stabilize transthyretin protein.
   • A medical approach to inhibit the transthyretin gene and prevent the body from producing the transthyretin protein.
   • Medicines to reduce swelling or control irregular heartbeats
   • A pacemaker to regulate the heartbeat
   • Chemotherapy.
   • Automatic stem cell transplant.
   • Participation in clinical trials to test new therapies.

3. Amaurosis fugax

   2 décembre 2022 20 h 30 min Leave a Comment

   Amaurosis fugax is a condition in which a person’s eyes do not get enough blood flow, and they cannot see out of one or both eyes. 

   The disease is a symptom of an underlying problem, such as a blood clot or insufficient blood flow to the blood vessels that supply the eye. 

   Amaurosis fugax is also called transient monocular blindness, transient monocular visual loss, or temporary vision loss.

   What are the symptoms of fleeting amaurosis?

   When a person has fleeting amaurosis, their vision may suddenly appear clouding. This temporary effect can last from a few seconds to several minutes. 

   Often, fleeting amaurosis is a symptom of transient ischemic attack (TIA). 

   Other symptoms associated with transient ischemic attacks include temporary blindness, difficulty speaking, drooping on one side of the face, and sudden weakness on one side of the body.

   The causes

   Amaurosis occurs when blood flow is blocked to the central retinal artery that supplies blood to the eyes. A common cause of fleeting amaurosis is a blockage of blood flow to the eye by a piece of atherosclerotic plaque or a blood clot.

   Risk factors include a history of heart disease, high blood pressure, high cholesterol, smoking, or alcohol or cocaine abuse.

   Other underlying causes of the disease include:

   • brain tumor
   • head injury
   • history of multiple sclerosis
   • history of lupus erythematosus
   • migraine
   • optic neuritis, which is inflammation of the optic nerve

   Transient amaurosis can be caused by diseases that affect the nervous system and blood flow to the head. Other possible causes include temporary blindness due to vasospasm, in which the blood vessels in the eye suddenly constrict, restricting blood flow. Strenuous exercise, running, and sexual intercourse can all cause vasospasm.

   What are the treatments?

   Treatment for amaurosis fugax involves identifying and treating the underlying medical condition. If the disease is linked to high cholesterol levels or blood clots, this indicates that a person is at increased risk for stroke. 

   Treatments include:

   • Blood thinners, such as aspirin or warfarin (Coumadin);
   • surgery is known as carotid endarterectomy, in which a doctor will ‘clean out’ plaque potentially blocking the carotid arteries;
   • medicines to lower blood pressure.

   In addition to these medical treatments, a doctor will recommend non-drug treatments:

   • abstain from eating foods high in fat, such as fried, processed, or fast foods,
   • stop smoking;
   • exercise at least 30 minutes a day most days of the week;
   • manage chronic diseases like diabetes, high blood pressure, or high cholesterol.

   How is amaurosis diagnosed?

   Your doctor will then perform a physical exam, including an eye exam. Your doctor may also order tests, which may include:

   • imaging scans to identify blockages or damage to blood vessels in your eyes;
   • blood tests to determine your cholesterol level as well as the likelihood of blood clotting;
   • an electrocardiogram to identify irregularities in your heartbeat that could lead to fleeting amaurosis.

   A doctor will consider your symptoms, age, and general health when diagnosing amaurosis and temporary vision loss.

   What are the complications of amaurosis?

   Although amaurosis is a short-lived condition that causes symptoms that last from a few minutes to an hour, it is often a worrying indicator of an underlying disease. 

   This includes an increased risk of stroke, which can be fatal. If people ignore these signs, they are at risk for more severe complications.

   What is the prognosis of amaurosis?

   Amaurosis is a concerning symptom, as it may indicate a high likelihood of a person having a stroke.

   In the case of transient ischemic attack, the earlier the disease is treated, the fewer serious complications there will be.

4. Alzheimer’s: how to announce the diagnosis

   20 h 17 min Leave a Comment

   What should be said to the patient when delivering a diagnosis of Alzheimer’s disease? Some doctors may be afraid of the patient’s reaction and avoid using the words ‘dementia’ or ‘Alzheimer’s.’

   What to say to the patient during a diagnosis?

   When the diagnosis of Alzheimer’s is announced, it is possible to be frank, but it is better to speak of neurodegenerative disease or degenerative neurological disease instead of dementia or Alzheimer’s if the patient does not ask questions.

   If the patient asks if he has Alzheimer’s disease, the doctor replies that the diagnosis is likely or possible.

   It should be explained to the patient that it is important to ensure that the decline in cognitive functions cannot be explained by another illness (e.g. trauma)

   Second visit, confirming or not the diagnosis of Alzheimer’s

   The doctor reveals the additional examinations, which confirm the hypothesis of a diagnosis of Alzheimer’s disease.

   He directs the patient and his loved one to resources (e.g., France Alzheimer) and discusses drug treatments (e.g. donepezil) and non-drug approaches.

   Subsequent visits

   The doctor discusses the possible side effects of the medications and assesses possible changes to lifestyle and day-to-day activities.

   Cognitive performance is usually reassessed (e.g. with the MMSE).

   The doctor questions the patient and his family during subsequent visits about possible behavioral problems (such as aggressiveness, wandering, anxiety, or confusion) and addresses the issue of driving.

   Other questions must then follow over the visits: questions of safety (fugues, fire, bad medication), legal (putting under guardianship or curatorship, will), the role of the natural caregiver, etc.

   Practical case

   A 55-year-old woman consults at the request of her husband because he realizes that she has been presenting a progressive decline in her cognitive functions for 2 years.

   The first symptoms are as follows: loss of memory, forgetting conversations, tendency to repeat oneself, and asking the same question over a short period of time.

   She worked in the financial sector for 20 years and was made redundant 18 months ago. She then took up another less demanding position, which she left 7 months ago. Her husband points out that she had difficulty remembering the password she uses every day to access her computer.

   The patient had difficulty remembering the names of characters from TV shows she watches regularly. She can no longer write checks, and her husband has taken over the management of the finances of the house.
   She continues to be in relatively good spirits, but has episodes of severe anxiety.

   On physical examination, the patient is alert. His blood pressure is normal (121/70 mm Hg), and his pulse is regular (70 beats/min). His body mass index is 20.6 kg/m2. She has fluent and coherent speech.

   General and neurological examination results are normal. The result on the mini-mental state examination is 24/30, with a low score on the orientation test. She also had difficulty performing the clock test. Her score on the Geriatric Depression Scale (short 4-item version) is 2. Brain imaging reveals greater than normal hippocampal atrophy and white matter abnormality.

   What is the diagnosis?
   1. Degeneration of the frontotemporal lobe
   2. Limbic encephalitis
   3. Primary progressive form of multiple sclerosis
   4. Alzheimer’s disease or
   5. Corticobasal degeneration

   Diagnosis
   A diagnosis of Alzheimer’s disease (mild stage) was made based on the following observations:
   Progressive memory loss (difficulty remembering recent events or things recently learned).
   Disorders of several other cognitive functions (including visuospatial abilities)
   Daily functioning is below what it was before the symptoms.

   However, tests have been undertaken to rule out other causes (e.g., encephalopathy) due to his age (symptoms of Alzheimer’s disease generally appear after age 65, i.e., 10 years later than his age). The hypothesis of frontotemporal dementia was ruled out because the patient presented neither personality nor language disorders nor frontal lobe atrophy.

   Measurement of amyloid protein and tau protein levels in cerebrospinal fluid supports the hypothesis of Alzheimer’s disease.

   Finally, the fact that her parents did not develop Alzheimer’s disease excludes the possibility that the patient has one of the 3 gene mutations responsible for the familial form of the disease (these mutations affect the amyloid precursor genes and presenilin 1 and 2).

   Alzheimer’s: Diagnosis disclosure is low in the United States

   Less than half (45%) of people with Alzheimer’s disease (or those close to them) are made aware of their doctor’s diagnosis of Alzheimer’s, according to a report by the American Alzheimer’s Association published in April 2015.

   This percentage is slightly higher than that reported by the American Centre for Disease Control (35%).

   « This is unacceptable, said Beth Kallmyer, one of the association’s leaders.  Patients have the right to know. Disclosure of diagnosis is a practice that should be common. »

   “This surprisingly low disclosure rate in Alzheimer’s disease is reminiscent of that seen for cancer in the 1950s and 60s, when the word cancer was taboo,” she added in her statement.

   Read more on the Otitti.net website.

5. Alexithymia

   20 h 01 min Leave a Comment

   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.

6. Akinesia

   18 h 43 min Leave a Comment

   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.

7. Ageusia

   18 h 32 min Leave a Comment

   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. 

8. Agoraphobia

   18 h 13 min Leave a Comment

   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.

9. Agnosia

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   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.

10. Psychomotor agitation

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    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.