Silent Stroke

A silent stroke (also called asymptomatic cerebral infarction) is a type of stroke that displays no outward or evident symptoms. Usually, the patient who suffers such stroke attacks is not aware of it or cannot remember any symptoms experienced. Therefore, silent stroke victims may not have obvious or associated impairments like slurred speech, feeling of numbness and difficulties of movement of body parts.

Like ischemic strokes, silent strokes are caused when blood supply is disrupted to the brain. But in this case, the portion of the brain affected may not hamper speech or movement as in the case of a typical patient with stroke symptoms. That makes it extremely difficult to know whether a stroke has occurred or not. However, the stroke effects are cumulative and may result in permanent damage to neurological functions in the long run. So patients may witness slight memory problems in recollecting events or face difficulties in paying attention.

Since silent stroke is usually unanticipated, potentially understanding stroke risk is important so that preventive measures may be taken to proactively avoid the attack itself. Some of the risk factors likely to cause this stroke are:

•  Presence of blood clots
•  Prevailing health conditions and chronic ailments like high blood pressure(hypertension) and     diabetes
•  Narrowing of blood arteries
•  Unregulated blood lipid profile(especially high cholesterol)

Some Subtle Changes to be noticed after Silent Stroke

• Memory issues
• Emotional instability and loss of control(for example laughing or crying at inappropriate times)
• Changes to the prevailing style of walking
• Getting lost in known places
• Difficulty in making decisions
• Loss of bowel and bladder control

Detection of Silent Stroke

Patients may have mild memory problems or face difficulties in moving around. Many people without apparent symptoms may suffer about ten percent of brain damage. Physicians are capable of identifying the effects of silent stroke even without detailed tests. The non-functioning brain cells may be seen as lesions or white spots through imaging tests.

Treatment for Silent Stroke 

Intervention through appropriate therapy and medications are beneficial in stimulating brain portions so that lost abilities may be regained. The various therapists who assist in silent stroke recovery are physical therapists or physiotherapists, speech pathologists, occupational therapists, psychologists and sociologists. Doctors may also prescribe some Alzheimer’s medications for treating memory-related issues.

Some of the remedies that help to overcome impaired cognitive problems and memory issues are:

• Practice consistent routines by scheduling tasks at specific times of the day.
• Make a habit of putting things at appropriate places or slots so that you may not face trouble searching for it.
• To remember complicated tasks and schedules, you may use checklists, reminders, to-do lists and sequenced instruction lists.
• Keep better track of medications using labeled pill containers.
• Play memory games to sharpen your mind skills and retain your cognitive capabilities.
• Utilize the services of online payments for paying your bills so that due dates and deadlines may not be missed.
• Make it a point to diligently do stroke recovery exercises like walking, swimming, jogging, stretching, aerobics and also try relaxation techniques and meditation. 

Stroke Support Programs are particularly beneficial in the overall rehabilitation of patients as they adopt a holistic treatment approach and focus on improving the independent capabilities and quality of life. 

  

Prevention of Silent Stroke

• Monitor your blood pressure periodically if you are prone to risk and keep it under control by following healthy diets and taking medicines if required.
• Ensure that the blood sugar levels are maintained.
• Quit the habit of smoking.
• Maintain a healthy weight and avoid obesity.
• Reduce saturated fats and excessive salt and sugar in your meals.
• Eat a healthy and balanced diet that contains plenty of fresh fruits, vegetables and whole-grain  foods.
• Remain physically active by doing household chores, exercises, gardening and other activities that help in strengthening your affected limbs.

Screening for Down Syndrome

Every year, the 10th of October is celebrated as World Mental Health Day. This day is exclusively marked as an International Day for promoting global mental health education, awareness and advocacy against social stigma. The objective is to raise the consciousness of mental health problems worldwide and the efforts which are mobilized for supporting mental health.

One such healthcare initiative of Mental Health Day is the Screening of Down Syndrome. This is an optional test for all pregnant women irrespective of age. It includes both Screening and Diagnostic tests for determining the likelihood of the unborn baby having Down Syndrome. If the baby has an increased risk of having it, further investigation tests may be done to have a definitive diagnosis.

Screening Test - Usually, this test is offered as part of the routine prenatal care. Screening predominantly only identifies the potential risk of having a baby with Down Syndrome. It also helps the parents-to-be to make decisions about certain diagnostic procedures to be undertaken for confirming this. Screening tests are mostly safe and do not cause miscarriages. The tests that are included in this package are-

• The combined first-trimester test - This two-step procedure involves

1. Blood test - Here the levels of Pregnancy Associated Plasma Protein-A (PAPP-A) and a pregnancy hormone Human Chorionic Gonadotropin (HCG) are tested. Abnormal levels of any of these are indicative of problems in the unborn child.
2. Nuchal translucency screening test - An ultrasound scan is used to measure a specific portion on the back of the neck in the foetus. In case of abnormalities, there is likely to be an accumulation of tissue fluid thereby making the baby’s neck bigger.

In combination with the mother’s age, the results of these tests forecast the risk of Down Syndrome. Further, diagnostic tests may be done (optionally) to confirm the prognosis.

• Non-Invasive Pre-Natal testing (NIPT) - This is one of the latest and sophisticated forms of screening. A simple blood test is done to analyze the baby’s DNA that has been released into the mother’s bloodstream. The test results make predictions with nearly 99% accuracy and are normally after ten weeks of pregnancy. NIPT tests are usually done at private health centres and maternity hospitals.

• Second-trimester Maternal Serum Screening (MSS) - These tests are conducted between the fourteenth and eighteenth weeks of pregnancy. Pregnant ladies who have missed the combined first trimester tests can undergo this screening. Here again, a blood test is done to check the hormonal levels for detecting Down Syndrome in the unborn child. Additionally, ultrasound scans may also be done to detect neural tube defects (abnormalities in the baby’s spinal cord or brain). A morphology or anomaly scan may also be recommended to examine the baby’s growth and pregnancy progress.

• Diagnostic Tests - These tests are promising routes to determine definitively whether the foetus has Down Syndrome or not. Such tests can result in miscarriages and are hence more recommended only to those women who are prone to increased risk, have a family medical history of genetic conditions or have already delivered children with genetic defects. Confirmation tests include- 

1. Chorionic Villus Sampling (CVS) - The mother’s placental cells are examined for the presence of extra, abnormal or missing chromosomes. This is an invasive process done by inserting an ultrasound-guided needle into the abdomen and is done between the eleventh and fourteenth weeks of pregnancy.
2. Amniocentesis - This is another invasive procedure wherein the mother’s amniotic fluid is tested for chromosomal irregularities. It is conducted between the fifteenth and eighteenth weeks of pregnancy. 

Both these tests are not painful and last for about twenty minutes. The results may be obtained after a few days.

If the test results are positive, the parents are offered counselling by qualified healthcare practitioners. They provide guidance and relevant information to help the parents decide whether to continue the pregnancy or not and register the baby for adoption.

All expectant mothers are advised to undergo Down Syndrome Screening if medically required to ensure the mental well-being of their babies.

Significance of Family Activities For Parkinson's

One of a disease that comes into life uncalled for is Parkinson's disease (PD). A person who might have been the star in a party, or someone who was known for their touches of humour sense - Parkinson's changes it all. It comes along with tremors and stiff expressions. But, it is not a life-threatening disease. It can be managed and improved through exercises and therapies. A social support circle enforces individuals with PD to be strong and optimistic towards life.  

Role of Family in Parkinson's 

Parkinson's is a type of a disease which would affect the individuals both mentally and physically. Even though the progression of the condition takes place slowly, there would be setbacks to certain activities. But, it is not something for which one should lose hope. Parkinson's opens doors to other possibilities where one can rediscover oneself. 

When a person comes to know that they have Parkinson's, the only immediate support they turn to is FAMILY. 

The close-knit group of loved ones who understand the feelings of others and render support during happy and hard times is Family. The unmeasurable support which this group provides, promises a safe and secure emotional quotient for the individuals with PD. 

Spending time with the dear ones can make an individual feel happy and content. So, planning family activities is important. These are some of the activities one can do as a family: 

Go on a Picnic - Slowing down would be very much needed for a person with Parkinson's. Take a moment to smell the flowers around. The family would have to learn to take a slow pace in certain activities. They may need to get used to stiff expressions. Even though people with Parkinson's would want to express many things, it may not be possible for them. A picnic is a great opportunity to understand one another better. And be sure to carry enough of food for the hungry hearts! 

Teamwork in Daily Chores - PD individuals will face difficulty in doing daily tasks such as cleaning, cooking, washing and shopping. Family members can step in and assist in their everyday activities. Going on errands, taking them for medical check-ups, preparing meals and checking whether the medicines are taken on time. But, there should be at least certain things where they are given the freedom to do things by themselves.  

Parkinson's support programs would have an array of activities and exercises for Parkinson's disease. It is a great way to keep the tremors at bay and reduce the progression of Parkinson's. 

Game fun With Family - Playing games brings in enjoyment for those with Parkinson's. Sometimes, games could be challenging. It may require to socialize and make use of the memory. Stick to games which are easy to follow and have simple rules. Jigsaw puzzle, painting and playing musical instruments are some of the fun activities in which families can express their support. 

Once the family starts doing various activities with their loved ones who have Parkinson's - they can find their favourite pastime. It is the most practical way to understand the problems and challenges faced by them while doing these activities with the family. It is important to make individuals with PD feel as normal as possible to reduce anxiety caused by the condition. Indulging in quality time with family would close the doors of anxiety and depression. 

Link Between Osteoporosis and Parkinson

Osteoporosis is a bone disease caused by the reduction of bone mass and deterioration of bone tissue, resulting in fractures.  Parkinson's disease is a neurodegenerative disorder with loss of motor control. Patients with Parkinson's disease are at higher risk of developing osteoporosis due to their limited activity, lower muscle strength an bone mass.

A research paper submitted at the American Academy of Neurology in 2006 clearly highlights the danger of osteoporosis in PD patients. Of the 166 Parkinson's patients studied, nearly 51 % of the females and 29% of the men had osteoporosis. A number of them also had osteopenia or lowered bone mass- 45% of the women and 48% of the men. This firmly establishes the link between osteoporosis and Parkinson's disease.

Parkinson's disease symptoms that may lead to osteoporosis

• Tremors

Incessant shaking or tremors are the first and early sign of Parkinson's. This uncontrollable shaking is due to loss of nerve control and it severely affects Parkinson's patients. It also hampers the free movement and routine activities of the PD patients, resulting in the quick onset of osteoporosis.

• Reduced movement

Patient's with Parkinson's find it difficult to move freely as they have poor posture, balance and  reduced bone and muscle strength. All this prevents them from leading an active life with ample movement. This reduced movement and lack of mobile activity lead to osteoporosis.

• Slow gait

Parkinson's patients exhibit slow gait due to loss of motor function. They lack control of their movements and body balance and hence move in a stumbling manner. This slow gait may lead due to loss of bone mass and osteoporosis.

• Bradykinesia

Bradykinesia or slow movement is another Parkinson's disease symptom that may lead to osteoporosis. Poor nerve and muscular strength and coordination is the reason for the slowed movement in PD patients. This lethargic movement may cause osteoporosis if not attended to immediately.

• Akinesia

The rigidity of muscles or akinesia is another PD symptom that increases the risk of osteoporosis. Caused due to muscular stiffness due to impaired movement, akinesia may reduce muscle and bone strength and cause osteoporosis.

• Vitamin D deficiency

Due to decreased activity and exposure to sunlight, Vitamin D deficiency occurs in PD patients. this reduces bone mass and density leading to osteoporosis.

All the above Parkinson's disease symptoms may accelerate the risk and incidence of osteoporosis in PD patients but can be effectively controlled and cured with regular exercise and  the right medication.

Osteoporosis medications for PD patients

Parkinson's patients are treated with Levodopa as a form of medication. This Levodopa treatment is found to increase the level of homocysteine in the blood and this may further on lead to osteoporosis in PD patients. This condition called "hyperhomocysteinemia" is peculiar to PD patients and causes osteopenia or lowered bone mass which is the first among osteoporosis disease stages.

The only way to arrest this medical problem in PD patients taking Levodopa is to give them additional B12 and Folic acid supplementation to reduce elevated homocysteine levels, thereby preventing osteoporosis.

PD patients also consume SSRI antidepressants to prevent depression. These antipsychotic drugs can increase the risk of hip fractures. Instead, tricyclic anti depressants can be used for such depressed D patients as they do not increase the risk of osteoporotic fractures.

In addition, PD patients have to be treated for reduced bone mass density, calcium and Vitamin D deficiency. A dietary intake of 1200-1500 mg of calcium is a must for PD patients along with enough Vitamin D for its bone absorption.

Biphosphonates like alendronate or risedronate are best recommended to treat osteoporosis in PD patients. Use of these osteoporosis medications can help them combat osteoporosis effectively and completely.

Parkinson's disease is not a singular disease but it is accompanied by a host of other associated medical ailments like osteoporosis. Osteoporosis in PD patients must be addressed immediately with awareness, exercise and medication.

The Similarities Between Parkinson's and Alzheimer's Diseases

September 21st is celebrated as World Alzheimer's Day, across the world. There is a significant need for the increased awareness on this neurodegenerative disorder. There are many scientific researches have found link between Parkinson's and Alzheimer's, however concrete proofs need to be established on this. According to the medical journal Acta Neuropathologica medical a few found biological mechanisms that connect Parkinson's disease to Alzheimer's.

What is Parkinson's Disease (PD)?

Parkinson's disease was first discovered by Dr. James Parkinson. Parkinson's disease is diagnosed based on the three symptoms - slowed body movement, rigid muscles and shakes and tremors. These are the initial recognizable symptoms. A few patients also show other symptoms that include slurred speech, difficulty in getting up from a chair, losing control over body parts and expressionless face.

What is Alzheimer's Disease (AD)?

Alzheimer's can be defined as a type of dementia that affects memory, thinking and other cognitive abilities of the brain. The prolonged systems lead to reduced quality of life. The person may find it difficult to even remember the names of their family members. Alzheimer's is the most common cause of dementia, a state of memory loss.

Similarities Between Parkinson's and Alzheimer's Diseases

As both diseases are considered as the neurodegenerative disorders, they share a few similarities. The cognitive impairment similarities between PD and AD are almost similar. Based on the location of the disease occurrence in the brain, PD is referred as subcortical and AD as cortical. This is the reason why the symptoms of PD are more related to movement and AD symptoms more on the cognitive side.

• Depression

Both the diseases show the symptoms of depression but the influence of it could be seen on the higher side in AD than in PD. The depression in a PD case is more responsive to the antidepressant treatment compared to the AD.

• Psychotic Symptoms

Psychotic symptoms can be seen in both AD and PD. Delusions, hallucination and a state of paranoid are among the common psychotic symptoms in the advanced conditions. The development of these symptoms occurs at a higher rate in AD context, compared to PD. However, the medications used to treat the motor conditions in PD, depending on the dose, can lead to paranoid ideas.

• Anxiety

Anxiety is another common symptom in these two disorders. And, it is common to use antidepressant and antianxiety medications to treat the conditions but it is important to keep the side-effects of medications. The excessive use of medications for anxiety will lead to major health issues that affect the overall health quality. Behavioral treatment for Parkinson's and Alzheimer's is a better treatment approach than the medications.

• Deterred Quality of Sleep

It is another common symptom that could be observed in both these neurodegenerative disorders. Additionally, in Parkinson's disease, the issue termed as REM (rapid eye movement) causes more disturbance during the sleep. In AD too, the depression associated with anxiety will become the major obstacles for a quality sleep.

• Changed Personality

Seniors experience various cognitive and physical impairments in these conditions and their overall personality will get affected. Undergoing the treatment and all the medications will have a severe effect on their typical characteristics. The movement disorders in PD will reduce their outgoing and social life; AD will have the same impact by reducing the cognitive ability of a person.

It is important to know that medications that are used in one condition may show a negative impact on another condition. For instance, most of the medications prescribed to treat AD will show a negative impact on PD, due to its typical movement disorders. Identifying the cognitive and behavioral similarities and distinguishing the conditions in a better way. This helps in the diagnosis process as well as in better treatment approach.

6 Techniques to Sleep Better After a Stroke

Sleep is an integral part of human life and is essential for a healthy brain. Brain, the most significant organ that uses almost 20% of the total oxygen consumption, needs a sufficient amount of rest and medical support in order to recover especially after a major health condition like a stroke.

Disrupted sleep is one of the common post-stroke effects faced by many stroke survivors. Due to lack of sleep, the brain feels tired after a stroke. Doctors recommend at least 9 to 10 hours of sleep for stroke patients as sleep is the key to a speedy recovery. Making the recovery difficult, sleep disruptions affect many individuals after a stroke.

Lack of sleep not only causes depression and stress but also increases the intensity of the other symptoms such as memory loss, fatigue and nausea. Sleep helps the brain to clean after itself while flushing out the toxins. Sleeplessness may build-up the toxic substances in the brain, further damaging it on top of the stroke.

If you are a stroke survivor who is experiencing excessive sleep, feel blessed and continue to sleep for a sufficient amount of time. If you are a person facing difficulty in getting adequate sleep, seek doctor help. In addition, the following tips and simple lifestyle changes could help you in getting better sleep.

• Relax the Stressed Mind - A stressful mind could never be relaxed and it is next to impossible to make it sleep. Practice various stress relieving activities such as simple physical activities like jogging and walking.
• Meditation and Yoga - Make meditation and yoga as part of your regular life. Especially, yoga shows an enormous effect on sleep disorders as it works as the best medicine to relax the body and mind. Practice meditation and pranayama as they are proven to be best solutions for sleeplessness.
• Air Flow Improvement Using Medications - The breathing patterns may get affected due to the side-effects of a stroke. Check for the blocks and signs of sleep apnea and other breathing disorders to help the individual to have a better sleep. Sleep gets disrupted if the person is facing any breathing issues.
• Develop and Stick to a Daily Sleeping Routine - It is the common sleep tip that could work wonders. Train your body and brain by going to bed at a particular time every day. After a certain point of time, the brain starts feeling sleepy as soon as the clocks tick that time.
• Avoid Sleeping During Day - If you are finding it difficult to sleep at night, never take the naps during the daytime, irrespective of their small tenure. If you just include moderate physical activity (based on the body support), your body drives you to the bed as the time arrives.
• Use the Bright Light Therapy - Stroke may leave your biological cycles disrupted and it may require some effort to catch the rhythm again. Use the Bright Light Therapy technique that helps people to readjust their inner clocks. This is a simple practice that is performed in the bright light of the morning for 30 minutes. This activity also helps in getting vitamin D which helps in better sleep. 

In addition, ensure your bedroom is dimly lit, the pillow and mattress are comfortable. Few people respond better to the aroma and music therapy. Try them to see if they are working for you. Keep the room temperature at the suitable levels. 

Sleep plays a significant role in the recovery of the people who have survived a stroke. Use these techniques along with medical help for a quality sleep during the recovery stages of a stroke.

The Relationship Between Iron and Parkinson

"Eat a lot of green vegetables, they are full of iron" - this is what our mothers used to lecture us every day.  Iron is good for health but excess iron can be harmful as in the case of  Parkinson's disease. Surprising but true, brain iron levels have been found to be high in patients with Parkinson's disease.

Parkinson's disease is a neurodegenerative disorder that affects the dopaminergic neurons in the substantia nigra region of the midbrain. Hallgren and Sourander state that there is no iron in the brain at birth but the brain iron levels accumulate rapidly during adolescence and early adulthood. In patients with Parkinson's disease, abnormal iron concentration has been found in the globus pallidus and substantia nigra.  This has led to a discussion on the relationship between iron and Parkinson's disease.

How can excess brain iron levels affect patients with Parkinson's disease?

Excess iron is found in the brains of patients with Parkinson's disease. This excess iron in the neurons has been found to impair cellular recycling causing toxic oxidative stress. This oxidative stress plays a major role in the death of neurons in patients with Parkinson's disease.

Research from the Anderson Lab at the Buck Institute of Research on Ageing in California has revealed that iron reduces the ability of neurons to perform cellular recycling. The excess iron damages the lysosomes within the cells, thereby affecting their ability to recycle damaged proteins.

 It is the function of the lysosomes to store iron in the cell in such a way that it does not participate in oxidative reactions. Since the lysosomes are damaged,  the excess iron enters the neurons causing their death.  With age, the ability of the lysosomes to recycle proteins diminishes, thereby creating more protein garbage. One such abnormal protein aggregate present in patients with Parkinson's disease is the Lewy bodies which are responsible for this ailment.

All this is due to the excess iron present in the basal ganglia of patients with Parkinson's disease.

University of Washington's research scientists revealed that people who consumed higher quantities of iron are more likely to be prone to Parkinson's disease and their risk is doubled.

The only way to combat this ailment is to adopt the right Parkinson disease diet.

Parkinson Disease Diet

Consume

• Fibre-rich food like whole grains, broccoli, peas, beans
• Tree nuts like hazelnuts, walnuts, pistachios
• Berries like blueberries, cranberries, goji berries and elderberries
• Bland food like saltine crackers or plain bread
• Lots of water- 8 cups daily
• Levodopa which is the best medication for Parkinson's disease on an empty stomach half an hour before meals as per doctor's advice

Reduce

• Sugar
• Salt
• Dairy products
• Ice-cold drinks
• Orange, grapefruit or acidic beverages

Dos and don'ts

• Sip all liquids slowly. Drink a little water or juice after each bite of food to help you swallow.
• Dunk bread or crackers in milk to swallow them easily.
• Mix all foods with gravies or sauces to swallow easily
• Consume liquids between meals.
• Eat small portions of meals  frequently
• Avoid oily, fried, sugary or greasy foods.
• Avoid coffee, tea, chocolate or soda
• Avoid mouthwashes
• Don't mix hot and cold foods. Have food at room temperature

Foods that patients with Parkinson's disease can have

• Ice cream and custard
• Sandwiches and nachos with cheese
• Greek yoghurt
• Eggs
• Granola bars
• Crackers with peanut butter
• Cereals 

Parkinson's support programs must discuss the use of Parkinson's disease diet in order to create awareness about the disease, its relationship with iron and the right foods to be consumed.