Meetings with experts, clarifications and updates. Neurological diseases at the center of attention: diagnosis, prevention, care throughout life
From March 14 to March 20, Brain Week takes place all over the world. For the occasion, the Italian Society of Neurology (Sin) has prepared, as every year, occasions for public meetings both online and live where the experts will make themselves available to all for pre-arranged in-depth studies via videoconference, webinar, YouTube direct or to respond to person to people’s questions. For information on the program and the meetings you can consult the Sin website. The theme chosen this year for Brain Week are neurological diseases throughout the course of life because they go hand in hand with the development of the nervous system which is not born ready and ready, but continues to evolve and change throughout life, being affected along the way by internal influences (hormonal, metabolic , endocrine) and external agents (infectious agents, even psychic traumas, lifestyles, eating habits, environmental toxic substances) which can shape their development giving rise to different pathologies. Moreover the manifestations of the same disease are different according to agebecause the body’s responses change over the years.
Two different types of stroke
For example you recover earlier and better from a stroke at 40 than at 70 (age in which it occurs most often), both because in the young adult the mechanisms of compensation and recovery are better, and because the type of stroke is different: hemorrhagic in the early, ischemic in the elderly. In recent years, the pre-age cases are increasing due to increasingly widespread abusive behaviors (alcohol and smoking), as well as the growing overweight among young people due to poor eating habits. At the presentation of the Brain Week, professor Mauro SilvestriniDean of the Faculty of Medicine of the University of Marche, showed a photo that can become the emblem of this disease and which represents the three great ones of the Yalta treaty of ’45: Winston Churchill, Franklin Delano Roosevelt e Iosif Stalin. All three died of strokes. American Roosevelt, then 63, a few months later. He would have had a first episode right in Yalta and the fact that he has an inert arm resting on his leg could be proof of this. Churchill twenty years later, at 91, and Stalin 8 years later, at 71. The youngest, the American, had a hemorrhagic stroke, while the other two had an ischemic stroke. In fact, the type of stroke changes at different ages which most often affects us: ischemic, that is, from obstruction of a blood vessel in the elderly, hemorrhagic, that is, from rupture of a vessel in the younger ones.
Symptoms and time to intervene
For everyone, the same rule always applies: time is brainthat is brain time, as soon as the first symptoms appear you must hurry because the minutes are golden, in fact we are talking about golden hours. What are the warning symptoms? Difficulty articulating or understanding words, sudden numbness or weakness of the muscles of the face, arm, or leg on one side, mental and visual blurring, often in one eye. The Anglo-Saxons summarize everything in the acronym FAST, a word that means fast and carries with it the idea of running to the emergency room to be sent to Stroke Unit, the specialized departments for stroke where a thrombolysis treatment done on time avoids a lot of trouble and often saves life. But FAST also summarizes all these concepts because the acronym comes from Facethat is, face, Arm ie arm, Speech nal e Time that is time. In the photo of Yalta there is also another important clue why smoking in this disease is a fundamental risk factor: two smoke, Churchill the cigar and Roosevelt the cigarette, Stalin was a well-known pipe smoker, but on that occasion he had not lit it.
Parkinson’s disease
While different hydromechanical and coagulability factors play a role in the risk of stroke, in Parkinson’s more complex genetic, toxic-environmental, hormonal and even dietary factors come into play. After Alzheimer’s disease, Parkinson’s is the most widespread neurodegenerative disease that affects about half a million people in Italy. Both genetic and environmental characteristics influence its development
(e.g. exposure to pesticides). The classic age of onset 58-60 years. There are forms genetically designed to start after 85 (3-5%), there are others that start earlier, the so-called Juvenile Parkinson’s which affects around the age of 40 (5% of cases). How to judge this variability? A concept to always keep in mind – says the professor Alfredo Berardelli of the University La Sapienza of Rome and President of the Sin – that the nervous system has an extraordinary capacity of adaptation, that is of neuro-plasticity which, unlike what was believed in the past, is maintained even in old age and justifies its usefulness to always keep the mind and body trained, even in old age.
The role of correct lifestyles
A habit that is also valid for Alzheimer’s disease. In fact, if plasticity is helped above all by correct lifestyles such as physical and mental exercise and by proper nutrition, it is also possible to counteract and slow down diseases associated with old age such as neurodegenerative ones.. In Parkinson’s age, all phenomena of degeneration of the dopaminergic systems that regulate movement above all occur – continues Professor Berardelli -. But why doesn’t everyone get sick? Because our physiological deterioration can be both slowed and accelerated by factors that increase risk or act as protection.
Parkinson’s Symptoms
This disease has three cardinal symptoms: bradykinesia (motor slowdown), rigidity and tremor leading to postural instability, associated to a variable extent with other non-motor signs, namely cognitive, behavioral (depression), sensory (loss of smell). Above all if not otherwise justifiable, other signs must also be kept in mind, even when the classic symptomatological triad has not yet appeared: persistent stubborn constipation for over 2 years; hyperhidrosis (profuse sweating); restless sleep (restless legs syndrome); dyspepsia (difficulty digesting); orthostatic hypotension (lowering of blood pressure when standing up); deficit of executive functions (ie inability to complete a task); a minor sign la micrografia, that is, the fact that the size of the handwriting continues to shrink. Many of these symptoms come well before the actual onset of the disease and in 2016 the American Academy of Neurology drew up a sort of temporal decalogue of the warning signs.
Warning signs
Six years before Parkinson’s diagnosis problems related to normal daily activities may appear, especially in those in which he has to perform a specific task that involves both motor and non-motor activities such as moving and traveling. Between six and five years ago the first signs of hypokinesia, bradykinesia or tremor appear. Three years ago approximately, these problems extend to basic daily activities such as eating. A few years earlier, stiffness and postural alterations appear and patients have significantly lower scores on neuropsychological tests such as Mini-Mental State Examination. They also start using laxatives much more often than average. The year before of diagnosis have more anxious and depressive symptoms than average.
The characteristics of tremor
Finally, a final clarification on the symbolic symptom of this disease: tremor. The appearance of only tremorit must not immediately make us think of Parkinson’s because there are many causes that can cause it, however, also related to the different ages of life. First of all the tremor of Parkinson’s disease, which initially affects mostly hands or feet and in about 30% of cases it can also be missing, classically a tremor at restthat is, it is reduced by grasping an object, such as a glass.
Tremor not related to Parkinson’s
The opposite occurs in the so-called essential tremor that For example, it prevents you from drinking a coffee without spilling it on yourself and a movement disorder more frequent than Parkinson’s, with which it is confused in 30-50% of cases. About 4% of adults aged 40 and over suffer from it, but it can appear even earlier, especially in anxious or depressed individuals. For example due to hyperthyroidism: If you are losing weight without a diet, have rapid heartbeat or problems falling asleep, the tremor could result from excessive thyroid activity, a condition that prefers women between the ages of 55 and 64 5 to 10 times more often than males. Also drinking too much coffee can lead to tremor. If on one hand caffeine appears protective towards true Parkinson’s
, on the other hand, exceeding 2 or 3 cups a day can induce tremor: many over-the-counter pain relievers, chocolate, coca-cola or other drinks such as energy drinks contain caffeine which is added to that of coffee. This type of abuse is especially typical of young adults. The abuse of alcoholic beverages is also implicated in tremor and usually begins about 10 hours after the last sip and can then last even weeks, so much so that detoxification programs also include drugs to counteract this tremor. Also to be considered the smoke: Too much nicotine causes rapid heartbeat resulting in anxiety, a cocktail that can induce tremor. The incidence of this vice is also increasing in the young age groups. The stressful situationslike having to speak in public at a convention, can make your hands shake.
Wilson’s disease
Among the causes of tremor there is also a rare genetic pathology called Wilson’s disease which affects between 5 and 40 years, in which there is a toxic accumulation of copper especially in the liver: in addition to tremor it causes a series of motor disorders that affect speech and coordination of movements. The sclera of the eye characteristically appears auburn-yellow. The catecholamines, that is adrenaline and noradrenaline they are two hormones secreted by the adrenal gland and some nerve endings: they increase heart pressure and contraction in preparation for a muscular effort and activate the metabolism to cope with stress. A benign tumor of the adrenal glands called pheochromocytomawhich can appear at any age but especially between 20 and 40 years, determines an excessive production of catecholamines and this, in addition to the obvious hypertensive peaks, induce tremore.
Medicines that can cause tremor
Plus many drugs can make you tremble: anti-depressants, anti-comitials, antihistamines, anti-migraines or anti-asthmatics. They are drugs used at all ages and therefore it is difficult to define a season of life for this type of tremor. Hands shake even if vitamin B12 is missing, which is important for the integrity of the nervous system. In addition to being consumed by some of the drugs listed above, B12 is in short supply when you don’t eat certain foods: eggs, liver, caviar, oysters, mushrooms, rabbit, ham, tuna, cod, sardines, mackerel, mussels, or if you don’t drink milk. L’hypoglycemia it can cause tremor because sugars are the main energy source of the muscles. Values of glycated hemoglobin lower than 7% in young people and 8% in the elderly should lead to suspicion that the tremor derives from hypoglycemia. So it could not be Parkinson’s, but diabetes, a disease that affects every age group and increasingly also young ones.
March 13, 2022 (change March 13, 2022 | 15:11)
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