What are the signs of early-onset Alzheimer's?

Timothy J. Legg, PhD, CRNP      Fri 22 June 2018

Alzheimer's disease is a type of dementia typically associated with older adults. However, early-onset Alzheimer's disease occurs before the age of 65.

Alzheimer's causes memory problems and a variety of related symptoms. It is a degenerative disease, which means the symptoms will get worse over time.

According to the Alzheimer's Association, Alzheimer's is the most common form of dementia, accounting for 60 to 80 percent of all known dementia cases.

Though there is no cure, there are some treatments available to ease symptoms and slow the disease's progression.

Signs and symptoms

There are several distinct signs and symptoms of memory loss that may indicate Alzheimer's. If a person experiences one or more of the following signs or symptoms, they should speak to their doctor.

1. Memory loss that impedes daily activities

Reliance on memory aids may be a sign of early-onset Alzheimer's.

The most common symptom of Alzheimer's is memory loss. A person experiencing memory loss may:

•forget recently learned information

•ask for same information repeatedly

•have a higher reliance on memory aids, such as calendars and notes

•forget important events or dates

As a person ages, it is not uncommon to forget things from time to time. Typical, non-Alzheimer's memory loss may include forgetting an acquaintance's name but remembering it later on.

A person with early-onset Alzheimer's will have more noticeable memory loss and may repeatedly forget the same information.

2. Trouble completing everyday tasks

Another common early sign of Alzheimer's is when a person has difficulty completing an otherwise familiar task.

A person with early-onset Alzheimer's may:

•forget how to get to a grocery store, restaurant, or place of employment

•have problems balancing a home or work budget

•forget the rules of a familiar game

Sometimes, natural aging may cause a person to need help with new or unfamiliar things. For example, helping an older loved one figure out the settings on their new phone is not uncommon and does not necessarily indicate a problem.

By contrast, if a person has used the same phone for years and suddenly cannot remember how to make a phone call, they may be experiencing Alzheimer's-related memory loss.

3. Problem-solving or planning difficulties

Some people with early-onset Alzheimer's find they have trouble following directions, solving problems, and focusing.

It may be hard for a person to follow a recipe or directions written on a product. They may also have trouble keeping track of monthly bills or expenses.

4. Problems with vision and spatial awareness

Alzheimer's can sometimes cause vision problems, which may make it difficult for a person to judge distances between objects.

It may also cause a person to have difficulty distinguishing contrast and colors. These vision problems combined can make it difficult or impossible to drive.

Normal aging also affects eyesight, so it is essential to have regular checkups with an eye doctor.

5. Confusion about location and time

Another common sign of early-onset Alzheimer's is getting confused about places or time. A person may have trouble keeping track of seasons, months, or time of day.

A person may occasionally be unable to recognize where they are or have no memory of how they got there.

6. Frequently misplacing items and not being able to retrace steps

Most people will lose items at some time but are usually able to locate them again by searching in logical locations and retracing their steps.

A person with Alzheimer's may forget where they placed an item, especially if they put it in an unusual place.

Alzheimer's also makes it difficult for a person to retrace their steps to find the missing item. This can be distressing and may cause the person to believe someone is stealing from them.

7. Problems writing or speaking

A person may have trouble keeping up in a conversation or may repeat themselves. A person may also have trouble writing down their thoughts.

The person may stop in the middle of a conversation, unable to figure out what to say next. They may struggle to find the right word or label things incorrectly.

It is not uncommon for a person to occasionally struggle to find the right word. Typically, they eventually remember it and do not experience the problem frequently.

8. Showing signs of poor judgment

Everyone makes bad decisions at times. People with early-onset Alzheimer's, however, may display a marked change in their ability to make good decisions.

Signs of poor judgment include:

• spending too much on unnecessary items
• showing inattention to personal grooming
• not showering or cleaning themselves regularly

9. Mood or personality changes

A person with Alzheimer's may start to become confused, anxious, suspicious, or depressed. They may show these signs in a variety of settings, including at work, at home, and in unfamiliar places.

They may become frustrated with their symptoms or feel unable to understand the changes taking place. This may present as aggression or irritability towards others.

10. Stepping away from social or work activities

As Alzheimer's develops, a person may stop participating in the social or work activities they used to enjoy.

Risk factors

According to the Alzheimer's Association, age is the primary risk factor for developing Alzheimer's.

From the age of 65, the risk of developing Alzheimer's doubles every 5 years. By age 85, a person has a 50 percent chance of developing Alzheimer's.

Another risk factor is family history or genetics. A person is more likely to develop Alzheimer's if they have an immediate family member with the disease. If more than one person in the family has had Alzheimer's, the genetic risk increases.

Researchers are still unsure why Alzheimer's develops at an early age in some people. However, they have identified rare genes in some people who experience Alzheimer's in their 30s, 40s, and 50s.

Diagnosis

If a person experiences one or more of the symptoms listed above, they should speak to their doctor as soon as possible. Early diagnosis might help slow the progression of the disease.

There is no standard test to diagnose Alzheimer's, so a doctor will make a diagnosis based on several factors.

A doctor will ask a person about the symptoms and concerns. The doctor will also review a person's family history, specifically looking for a history of Alzheimer's and dementia. It may help to bring a loved one to the doctor's office for support.

After an initial review of the person's symptoms and family history, a doctor may order medical tests, including a neurological exam and brain imaging.

Treatment

Treatment focuses on managing symptoms, as there is still no cure for Alzheimer's disease.

There are some medications available that may help with memory loss. These are most effective if started early on in the disease's progression.

Doctors can also provide recommendations and medications to help a person who is experiencing related health issues, such as insomnia, which may be contributing to memory problems.

A person may also benefit from talking to a counselor about any behavioral changes they experience. Also, some medications are available to help with symptoms of depression or anxiety.

Researchers are still looking for better treatment options.

Supporting a loved one

A person can support a loved one diagnosed with Alzheimer's in many different ways. Some recommendations include:

• Learning about Alzheimer's disease to understand the symptoms better.
• Participating in activities with the person as often as possible.
• Discussing the changing relationship with a counselor or other trusted person.
• Talking to the person about concrete ways to help, such as by preparing meals or driving them to appointments.
• Connecting with other people through support networks.

Outlook

There is currently no cure for Alzheimer's disease, but treatment can help in some ways.

Early detection may help slow the progression of the disease but will not prevent it.

A person is most at risk of developing Alzheimer's as they age, especially if they have a family history of the disease.

If a person suspects they or a loved one is developing Alzheimer's, they should speak to a doctor.

https://www.medicalnewstoday.com/articles/322240.php?utm_source=newsletter&utm_medium=email&utm_country=US&utm_hcp=no&utm_campaign=MNT%20Daily%20Full%20%28non-HCP%20US%29%20-%20OLD%20STYLE%202018-06-23&utm_term=MNT%20Daily%20News%20%28non-HCP%20US%29

Sex and gender both shape your health, in different ways

June 22, 2018 by Lisa F. Carver, The Conversation

There are now many gender categorizations, from the traditional ‘masculine’ and ‘feminine’ to ‘gender fluid’ and ‘undifferentiatied.’ Health researchers can work with these to gain a more accurate understanding of disease susceptibilities. Credit: Shutterstock

When you think about gender, what comes to mind? Is it anatomy or the way someone dresses or acts? Do you think of gender as binary —male or female? Do you think it predicts sexual orientation?

Gender is often equated with sex —by researchers as well as those they research, especially in the health arena. Recently I searched a database for health-related research articles with "gender" in the title. Of the 10 articles that came up first in the list, every single one used "gender" as a synonym for sex.

Although gender can be related to sex, it is a very different concept. Gender is generally understood to be socially constructed, and can differ depending on society and culture. Sex, on the other hand, is defined by chromosomes and anatomy —labelled male or female. It also includes intersex people whose bodies are not typically male or female, often with characteristics of both sexes.

Researchers often assume that all biologically female people will be more similar to each other than to those who are biologically male, and group them together in their studies. They do not consider the various sex- and gender-linked social roles and constraints that can also affect their health. This results in policies and treatment plans that are homogenous.

'Masculine?' 'Cisgender?' 'Gender fluid?'

The term "gender" was originally developed to describe people who did not identify with their biological sex. John Money, a pioneering gender researcher, explained: "Gender identity is your own sense or conviction of maleness or femaleness; and gender role is the cultural stereotype of what is masculine and feminine." 

There are now many terms used to describe gender —some of the earliest ones in use are "feminine," "masculine" and "androgynous" (a combination of masculine and feminine characteristics). 

Research shows that gender, as well as sex, can influence vulnerability to disease. (Shutterstock)

More recent gender definitions include: "Bigender" (expressing two distinct gender identities), "gender fluid" (moving between gendered behaviour that is feminine and masculine depending on the situation) and "agender" or "undifferentiated" (someone who does not identify with a particular gender or is genderless).

If a person's gender is consistent with their sex (e.g. a biologically female person is feminine) they are referred to as "cisgender." 

Gender does not tell us about sexual orientation. For example, a feminine (her gender) woman (her sex) may define herself as straight or anywhere in the LGBTQIA (lesbian, gay, bisexual, transgender, queer or questioning, intersex and asexual or allied) spectrum. The same goes for a feminine man.

Femininity can affect your heart

When gender has actually been measured in health-related research, the labels “masculine,” “feminine” and “androgynous” have traditionally been used. 

Research shows that health outcomes are not homogeneous for the sexes, meaning all biological females do not have the same vulnerabilities to illnesses and diseases and nor do all biological males. 

Gender is one of the things that can influence these differences. For example, when the gender of participants is considered, “higher femininity scores among men, for example, are associated with lower incidence of coronary artery disease…(and) female well-being may suffer when women adopt workplace behaviours traditionally seen as masculine.” 

In another study, quality of life was better for androgynous men and women with Parkinson’s disease. In cardiovascular research, more masculine people have a greater risk of cardiovascular disease than those who are more feminine. And research with cancer patients found that both patients and their caregivers who were feminine or androgynous were at lower risk of depression-related symptoms as compared to those who were masculine and undifferentiated.

However, as mentioned earlier, many health researchers do not measure gender, despite the existence of tools and strategies for doing so. They may try to guess gender based on sex and/or what someone looks like. But it is rare that they ask people. 

A tool for researchers

The self-report gender measure (SR-Gender) I developed, and first used in a study of aging, is one simple tool that was developed specifically for health research. 

The SR-Gender asks a simple question: “Most of the time would you say you are…?” and offers the following answer choices: “Very feminine,” “mostly feminine,” “a mix of masculine and feminine,” “neither masculine or feminine,” “mostly masculine,” “very masculine” or “other.”

Self-report gender tool. (Lisa Carver), Author provided

The option to answer “other” is important and reflects the constant evolution of gender. As “other” genders are shared, the self-report gender measure can be adapted to reflect these different categorizations.

It’s also important to note that the SR-Gender is not meant for in-depth gender research, but for health and/or medical studies, where it can be used in addition to, or instead of, sex. 

Using gender when describing sex just muddies the waters. Including the actual gender of research participants, as well as their sex, in health-related studies will enrich our understanding of illness.

By asking people to tell us their sex and gender, health researchers may be able to understand why people experience illness and disease differently.

http://theconversation.com/sex-and-gender-both-shape-your-health-in-different-ways-98293

What causes internal vibrations? Last reviewed 21 June 2018 By Cathleen Crichton-Stuart

21 June 2018       By Cathleen Crichton-Stuart

Internal vibrations, also known as internal tremors, are symptoms that occur most commonly in people with Parkinson's disease, multiple sclerosis, or essential tremor. Internal tremors are not harmful, but they be can be worrying and may interfere with a person's daily life.

Internal tremors are shaking sensations felt inside the body. They occur without visible movement, which external tremors produce.

A person may experience internal tremors in the trunk, arms, legs, or internal organs.

In this article, we look at the causes and treatment of internal tremors.

Causes

People with Parkinson's disease(PD), multiple sclerosis (MS), or essential tremor (ET) may experience internal and external tremors.

The causes of internal tremors are not well understood, and current research is limited. However, doctors tend to believe that these tremors are produced by the same neurological causes of external tremors.

Authors of a recent study proposed a connection between the onset of internal tremors and anxiety. Some researchers have also suggested that internal tremors may produce physical movement too slight to be detected.

Authors of a 2016 study have suggested that internal tremors are early, unusual symptoms of movement disorders, such as PD. Other researchers have proposed that anyone can experience internal tremors and that they are more pronounced in people with PD, MS, and ET.

Below, find more information about PD, MS, and ET, the three most common causes of internal tremors.

Parkinson's disease

PD is a neurological disease that results from the loss of dopamine-producing brain cells. It usually occurs in people over 60 years old.

People with PD may experience some of the following symptoms:

• slowness of movement
• external tremors, including visible trembling in the hands, limbs, face, and jaw
• internal tremors
• stiffness of the arms, legs, and trunk
• poor coordination and balance

These symptoms may progress quickly or slowly, and they can make daily activities difficult. Tremors are not always the most evident symptom of PD, though many people with the condition have tremors.

Initially, a person may only experience a tremor in one limb. As the condition progresses, the tremor can spread to both sides of the body. Strong emotions and stress can make tremors worse.

Treatments for PD

There is no cure for PD. It is a chronic condition that progresses over time. However, there are several treatment options.

A doctor may prescribe a combination of levodopa and carbidopa to replenish the brain's dopamine supply. This can help to treat advanced PD.

Other drug-related options include bromocriptine, pramipexole, and ropinirole.

A doctor may recommend surgery for people who do not respond to medication. The primary type is called deep brain stimulation (DBS).

During the procedure, a surgeon implants electrodes in a person's brain. These stimulate targeted areas to alleviate some symptoms of PD. DBS can also reduce the need for certain drugs, and this may especially benefit people experiencing unpleasant side effects.

Multiple sclerosis

MS is a chronic condition that affects the central nervous system. Many experts believe that in a person with MS, the immune system attacks and damages the body's nerves. The condition can have a significant impact on a person's quality of life.

Symptoms of MS usually develop between the ages of 20 and 40. They can include:

• blurred or double vision
• color blindness
• blindness in one eye
• muscle weakness
• poor coordination and balance
• a sensation of numbness or pins and needles
• pain
• speech difficulties
• internal and external tremors
• dizziness

Around half of the people with MS also experience difficulty with:

• memory
• attention
• concentration
• judgment

Treatment of MS

There is currently no cure for MS, and its severity varies from person to person. Many people can manage without treatment, though a doctor will continue to monitor the condition. Other people need steroids and other drugs to alleviate symptoms.

A doctor may prescribe muscle relaxers or tranquilizers for people with sustained muscle stiffness and spasticity. Some people also benefit from exercise and physical therapy.

However, it is important for a person with MS to avoid excessive exercise and high temperatures, to avoid fatigue.

Essential tremor

ET is the most common type of abnormal tremor.

The condition is sometimes associated with mild degeneration of some of the cerebellum. This is the part of the brain that receives information needed to regulate the quality of a person's movements. The cerebellum receives this information from other parts of the brain, the spinal cord, and the body's sensory systems.

People with ET may experience unintentional, rhythmic movements, most commonly a hand tremor. The tremor may also affect the head, tongue, limbs, trunk, and the ability to speak.

Symptoms can develop at any age, but they usually become noticeable in people over the age of 40. Triggers of ET can include:

• stress and anxiety
• heightened emotions
• fever
• feeling physically tired
• low blood sugar

The tremor usually appears on both sides of the body, but it is often more noticeable in the dominant hand.

Treatment of ET

While there is no cure for ET, medications can help to reduce symptoms. These can include beta-blockers or anticonvulsants.

Some people with ET find physical, occupational therapy, and DBS helpful. Treatment plans often involve reducing triggers, such as caffeine and other stimulants.

Treatment

There are currently no diagnostic tests for internal tremors. However, anyone experiencing a tingling sensation, shaking, muscle weakness, or poor coordination should speak with a doctor.

For people with internal tremors, doctors may recommend treatments similar to those for other movement or neurological disorders.

However, the severity of internal tremors can vary from person to person, and some may find that no treatment is necessary.

When PD, MS, or ET is responsible for internal tremors, doctors will aim to treat the underlying condition.

Treatments for internal tremors can include:

• reducing anxiety and stress
• avoiding dietary stimulants, such as caffeine
• avoiding intense exercise and heat

For some people, doctors may recommend DBS or medications similar to those for PD, MS, and ET.

Outlook

While internal tremors are not harmful, they can be disconcerting and may interfere with daily activities.

PD, MS, and ET are the most common causes of internal tremors. For many people, treatments for tremors will be similar to treatments for these neurological conditions.

Avoiding known triggers, such as stress or stimulants, can also help.

https://www.medicalnewstoday.com/articles/322217.php 

Long-term DBS Linked to Less Psychosis, Falls in Parkinson's

 Pauline Anderson   June 21, 2018

LISBON, Portugal — Patients with Parkinson's disease (PD) have less risk for psychosis and falls 10 years after undergoing deep-brain stimulation (DBS) compared with controls not receiving this intervention, a new study has found.

However, DBS had no benefit in terms of survival, development of dementia, or placement in a nursing home, the researchers report.

"We found that the risk of falls and psychosis was reduced after DBS," which has not been shown before, said Philipp Mahlknecht, resident, Department of Neurology, Innsbruck Medical University, Austria.

"We think that DBS would be beneficial in terms of these outcomes, in addition to what has already been shown in terms of motor outcomes," said Mahlknecht. "We don't actually think DBS is disease-modifying, but may modify the disease course."

The study was presented at the Congress of the European Academy of Neurology (EAN) 2018.

Proven Effective

Subthalamic DBS (STN-DBS) has been used for more than 20 years in PD. Previous randomized controlled trials showed various levels of improvement following this intervention in terms of motor symptoms, off time, dyskinesia severity, levodopa equivalent dose, and quality of life. For this reason, professional groups have determined that STN-DBS is effective for severe motor fluctuations and/or dyskinesia.

There have also been longer-term studies, but for the key disability milestones of psychosis, falls, dementia, nursing home placement, and death, all such studies to date have been uncontrolled, Mahlknecht told congress delegates. "So it remains unclear whether DBS can actually reduce the frequency of these important outcomes."

The new study included 53 patients with PD who underwent STN-DBS at Mahlknecht's center from 1999 to 2007. Most were male, and the mean age was 62.8 years. The study also included 52 control patients who did not undergo DBS and were followed in a registry study that was performed in 2003-2004.

The two groups were similar in terms of age, sex, disease duration, and number of comorbidities.

The levodopa equivalent dose was significantly higher in the DBS group (1.550 mg at baseline compared with 780 mg in controls) but dropped significantly to 566 mg 2 to 4 months after the DBS surgery.

The total number of medications was slightly higher in the stimulation group (5 vs 4.5), but this difference was not statistically significant.

Over time, 25% of the DBS patients and 52% of control patients developed hallucinations or delusions (hazard ratio [HR] for stimulated vs control group, 0.43; 95% confidence interval [CI], 0.19 - 0.98; P = .044).

Close to three quarters of patients in both groups had recurrent falls, but the number was significantly lower in the treatment group (HR, 0.62; 95% CI, 0.39 - 0.99; P = .048).

About a third of patients — 38% in the treatment and 33% in the control group — developed dementia, but there was no significant between-group difference in risk (HR, 1.19; P = .64).

In the DBS group, 23% of patients needed to enter a nursing home, as did 27% in the control group, with a nonsignificant difference between the groups (HR, 0.68; P = .21).

Forty-seven percent of stimulated patients and 42% of controls died, but, again, there was no statistical difference here (HR, 1.23; P = .49).

The researchers also looked at the progression on the Hoehn and Yahr scale. In the stimulation group, the score at baseline (2.3) dropped slightly at 2 to 4 months, but then picked up to 3.3 at the last follow-up, for an incremental increase of 1 point. In controls, the score went from 2.0 to 3.5 at the last follow-up, representing an incremental increase of 1.5 points.

Some session attendees wondered about selection bias. Mahlknecht noted that the researchers made every effort to "balance out" the two groups, but he also stressed that because it was a retrospective study,  these new results "must be taken with a grain of caution."  

One delegate wondered whether there was a correlation between the levodopa reduction after surgery and clinical outcome. Mahlknecht said he has not yet analyzed all the data; however, the reduction in psychosis among treated patients was "striking," he added. "Of course, one obvious thing you think about is maybe the levodopa dose is responsible for that effect."

One of the session chairs, Patricia Canhao, MD, PhD, Faculty of Medicine, University of Lisbon, Portugal, wondered whether the researchers expected DBS patients to have a positive outcome and whether the control group used in the study "was appropriate to show that."

Mahlknecht reiterated that "we think we have two well-balanced groups."

He noted that animal studies suggest that DBS may be neuroprotective but that this has not been found in humans.

The investigators have disclosed no relevant financial relationships.

Congress of the European Academy of Neurology (EAN) 2018. Oral session TCLIN05. Presented June 18, 2018.

https://www.medscape.com/viewarticle/898369#vp_2