Degenerative Conditions

Dementia is a category of brain diseases that result in memory loss and deterioration of speech, motor skills and cognitive functioning as it progresses.

It is estimated that there are up to 459,000 Australians with dementia (AIHW, 2018), and impacting on a much greater number of family, friends and carers. Research shows that people who have acquired a brain injury are more likely to develop dementia in old age than the general population. Fortunately, there are a number of changes that can be made in our own lives to reduce our risk of dementia.

What is dementia?

Dementia is a broad term used to describe a range of symptoms, the most well-known of these being a gradual loss of a person’s memory. Other symptoms can include gradual deterioration in speech, motor skills, thinking and planning, and the ability to carry out daily tasks. People with dementia can lose the ability to control their behaviour and may at times act socially inappropriate or unaware.

The disease is progressive, meaning that symptoms become worse over time. Towards the later stages of the disease, people require full-time care from family or staff, sometimes in residential aged care. Dementia is a terminal disease, and despite the best efforts of our medical researchers, there is currently no cure.

There are a number of different types of dementia, the most common being Alzheimer’s disease, and others including vascular dementia (usually related to stroke), Parkinson’s disease dementia, alcohol-related dementia, and Lewy Body Syndrome. While the risk of dementia increases with age, it is not a normal or natural part of ageing. Although rare, people in their 50s, 40s and even 30s can be diagnosed with ‘younger onset’ dementia.

How are dementia & brain injury related?

Research shows that people who have had a moderate to severe brain injury are more likely to develop dementia in later life. The pattern of changes seen in the brain following a moderate to severe brain injury can appear similar to those changes seen in Alzheimer’s disease.

Reducing your risk of dementia

Researchers at the World Health Organisation (WHO) have found that a person is more likely to develop Alzheimer’s disease if they have diabetes, high blood pressure or depression. A person is also at greater risk if they are obese, don’t exercise regularly, if they smoke, or if they have low levels of education. Other types of dementia have other risk factors: for example, heavy drinkers are more likely to develop alcohol-related dementia.

Based on these risk factors, there are five important steps that we can take to reduce our risk of dementia:

1. Look after your heart – Have your blood pressure, cholesterol, blood sugar levels and weight checked regularly by your doctor. Avoid smoking.

2. Be physically active – At least 30 minutes of moderate- intensity exercise such as walking, dancing, swimming or cycling is recommended daily.

3. Mentally challenge your brain – Learn a new skill, enrol in an educational course, read about interesting or novel topics, or have a regular, engaging hobby.

4. Follow a healthy diet – Eat a variety of foods, including two serves of fruit and five serves of vegetables per Limit your alcohol consumption to no more than two standard drinks per day.

5. Enjoy a social activity – Help to keep your brain active by organising regular social outings with friends and family, joining a community or volunteer group or having a regular social leisure activity.

Concerned about your memory?

If you are concerned about your memory or that of someone close to you, it is important to speak to a doctor. A doctor will be able to listen to your concerns and investigate a range of possible causes of memory difficulties. An early diagnosis of dementia ensures that a person has access to support, information and treatment options. It also gives people the opportunity to help plan their future care, including financial and lifestyle wishes. When visiting your doctor, it is helpful to write down your concerns before the appointment and consider bringing along a close friend or family member for support.

More information on how to maintain brain, heart and body health can be found at www.yourbrainmatters.org.au or call us on 1800 673 074.

REFERENCES:
Australian Institute of Health and Welfare (2018).
Dementia in Australia. AIHW: Canberra.
www.aihw.gov.au/reports/australias-health/dementia

Parkinson’s disease (PD) affects a person’s ability to control muscle movement.

It is a neurodegenerative condition that occurs when nerve cells die in certain parts of the brain and in particular, the substantia nigra where dopamine is created.

Motor symptoms

Dopamine is the chemical messenger responsible for the planning and smooth coordination of movement. When levels are low, the four main signs of Parkinson’s disease start to appear:

• tremor – shaking that usually starts in the finger and thumb while a person is at rest
• body kinesia – movements become slower
• muscle rigidity and
• postural instability.

If a person experiences all four motor symptoms, then a diagnosis can be made.

Non-motor symptoms

There are also many non-motor symptoms that a person with Parkinson’s might experience:

• anosmia – loss of sense of smell
• anxiety
• constipation
• brodyphrenia – slow thought
• depression – due to neurotransmitter imbalances
• fatigue
• festination of speech (involuntarily speaking faster)
• impotence
• micrographia (abnormally small handwriting)
• microphonia (abnormally weak voice)
• postural hypotension (low blood pressure upon standing up)
• sialorrhea (excessive salivation)
• sleep disturbance
• swallowing changes
• sweating.

Who is affected?

Around 100,000 Australians live with Parkinson’s disease. It mainly affects older people but around one fifth of those affected have young onset Parkinson’s and are between the age of 21 and 50.

Causes

There are two forms of Parkinson’s disease, familial (a genetically inherited form), and sporadic or idiopathic (believed to develop from gene-environment interactions). The familial form accounts for approximately 10–15% of cases. There have been many studies looking at the role of various environmental toxins, however, the results have been inconsistent, indicating that the cause, as well as the symptoms, of PD are very individual.

Age remains the greatest risk factor, although the condition is in no way part of the normal ageing process.

Treatment

While there is no cure, there are several treatments available to control symptoms.

Medication: is used to raise the level of dopamine in the brain and help its uptake. Levodopa (L-Dopa) is the most common medication and it is usually taken with carbidopa. Other medications that are used include dopamine agonists, MAOB inhibitors, COMT inhibitors, anticholinergics, and amantadine (See the Mayo Clinic for details https://www.mayoclinic.org/diseases-conditions/ parkinsons-disease/diagnosis-treatment/drc-20376062)

Deep brain stimulation (DBS): is an option when the disease affects a person’s quality of life and medication alone does not work, or the side effects cannot be tolerated. DBS involves reversible surgery to help control stiffness, slowness and tremor. Electrodes are implanted into the areas of the brain that control movement. They are programmed to send electrical pulses to the brain using a neurostimulator, which is also implanted during surgery.

Focused Ultrasound: is a non-surgical option using an MRI machine to target abnormal brain cells and destroy them without affecting healthy tissue. It is used to ease the motor symptoms of Parkinson’s but can only be performed on one side of the body and is not reversible.

Treatments will differ depending on a person’s symptoms and how they respond to medication. Because Parkinson’s is a degenerative condition with symptoms getting worse over time, treatments will need to change accordingly.

Therapies such as occupational, speech and physiotherapy can also be beneficial, along with exercising and staying active as much as possible.

Further information
Shake It Up Australia: https://shakeitup.org.au

Huntington’s disease (HD) is a rare neurodegenerative condition that affects movement, thought, emotions, and behaviour.

Huntington’s disease is caused by the inheritance of an altered Huntingtin gene on chromosome 4. The altered gene causes an excessive build-up of the Huntingtin protein, which damages the neurons in certain parts of the brain, primarily the basal ganglia and the frontal cortex. These parts of the brain are responsible for motor movement control and coordination, cognition, personality and emotion.

HD is a slow, progressive condition that affects people differently. Usually, symptoms first appear when people are in their 30s and 40s, however, there have been cases of onset as early as childhood. There is no confirmed order for the onset of symptoms, and each person experiences the disease’s progression differently. On average, life expectancy is between 10 and 30 years from the time symptoms appear.

A child born to a person with Huntington’s has a 50% chance of inheriting the gene and developing the disease. If the child does not inherit the gene, she or he will not develop the disease, and will not pass it future generations.

Symptoms in adults

Huntington’s disease affects people differently, but symptoms include:

• chorea – uncontrollable jerking movements that begin as twitches, usually in the finger and toes
• difficulty with coordination – leading to problems walking, swallowing and speaking
• difficulty planning, making decisions, insight and short-term memory changes in mood and personality – irritability and depression.

Treatment

While there is no cure, the physical and psychiatric symptoms of the disease are managed with medication, alongside physio, speech and occupational therapies.

Further information:
Huntington’s Disease, Health Direct
www.healthdirect.gov.au/huntingtons-disease