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Developmental Disabilities: a group of conditions due to an impairment in physical learning, language, or behavior areas that begin during the developmental period (CDC, 2018).

Intellectual Disability: a disability originating before the age of 18, characterized by significant limitations in both intellectual functioning and in adaptive behavior, which covers many everyday social and practical skills (AAIDD, 2018).

ASD: a developmental disorder that affects communication and behavior. There is a wide variation in the type and severity of symptoms people experience (NIH, 2018).

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-There are no exact causes of ASD
-development can be affected and lead to ASD by certain genes that are influenced being influenced by the environment
-Risk factors:
* Having a sibling with ASD
* Having older parents
* Very low birth weight
* Certain genetic conditions like Down Syndrome, fragile X syndrome, and Rett syndrome

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National Institute of Mental Health (NIMH)

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What is ASD?

Autism spectrum disorder (ASD) is a neurological and developmental disorder that affects how people interact with others, communicate, learn, and behave. Although autism can be diagnosed at any age, it is described as a "developmental disorder" because symptoms generally appear in the first 2 years of life.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a guide created by the American Psychiatric Association that health care providers use to diagnose mental disorders, people with ASD often have:

Difficulty with communication and interaction with other people

Restricted interests and repetitive behaviors

Symptoms that affect their ability to function in school, work, and other areas of life

Autism is known as a "spectrum" disorder because there is wide variation in the type and severity of symptoms people experience.

People of all genders, races, ethnicities, and economic backgrounds can be diagnosed with ASD. Although ASD can be a lifelong disorder, treatments and services can improve a person's symptoms and daily functioning. The American Academy of Pediatrics recommends that all children receive screening for autism. Caregivers should talk to their child's health care provider about ASD screening or evaluation.

What are the signs and symptoms of ASD?

What are the causes and risk factors for ASD?

How is ASD diagnosed?

What treatment options are available for ASD?

How can I find a clinical trial for ASD?

Where can I learn more about ASD?

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Learn about autism spectrum disorder, including signs and symptoms, causes, how it is diagnosed, and potential treatments.

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-Mitochondrial system: some people with ASD have mitochondria that do not function to their full ability (not enough ATP produced for energy and not enough calcium signaled for the SR).
-Immune system: imbalances of immune system cells (lower levels of lymphocytes) and cytokines (more cytokines IL-1, IL5, IL8 and IL-12, the more severe the stereotypical behaviors). The immune system can affect the mitochondria negatively.
-Gastrointestinal system: symptoms of abdominal pain, chronic diarrhea and or constipation, and gastro esophageal reflux disease were common in people with ASD.
Neurological system: there are anatomical differences in the cerebellum and amygdala.  There are motor delays repetitive behaviors shown in people with ASD.

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Background

Autism is the fastest rising developmental disorder in the world today. In the US the rates of autism have risen from 1 in 2500 in the 1970 [ 1] to 1 in 88 today [ 2]. Autism is defined behaviorally, and is characterized by impairments in social behavior, stereotypic movements and difficulties in communicating [ 3]. Autism presents a burden upon both families and society as a whole. The estimated total lifetime societal cost of caring for one individual with autism is $3.2 million US dollars. This includes direct costs such as medical, therapeutic, educational and child and adult care. This figure also includes indirect costs such as loss of productivity of both the individual with autism and their caregivers [ 4].

In the past autism was considered purely a psychological [ 5] or neurological disorder [ 6]. There is increasing evidence that it is a highly diverse disease affecting multiple systems of the body. Some systems with strong evidence of involvement are metabolic, gastrointestinal, immunological, mitochondrial, and neurological [ 7, 8]. Identification and modeling of these systems may lead to new treatments. It is hard to predict the all new treatments that would result from a systems approach, but the first would be better targeting of treatments. At present, physicians often rely on therapeutic trials and on psychotropic drugs not approved for autism [ 9].

One of the difficulties in describing the biology of autism is that it appears to have multiple etiologies. Some children have gastrointestinal disease, while others do not [ 10]. Some children have frank immune disorders, while others appear healthy [ 11]. Some show signs of autism from birth, while others appear to have a period of normal development, and then regress [ 12]. In addition to the difficulties this presents for modeling autism, the complex etiology can be a confounding factor in many autism studies as the different subgroups are not apparent using just the defining behavioral characteristics.

Currently those going in for autism evaluation do not get a comprehensive workup. These patients cannot articulate their problems or have the cognition to request an evaluation, so we need better lab workups. Many of these patients present with behavioral challenges, so the testing procedures should be all-encompassing and as less invasive as possible. So this whole body approach to modeling could potentially generate the parameters for a comprehensive evaluation or intake that would best guide treatment.

Another difficulty in understanding autism is that the various systems involved interact in complex and highly interdependent ways. This complexity points to a new paradigm in autism research using systems biology. In addition, autism poses particular difficulties as the scale of information to be modeled varies widely, from molecular level to anatomical. The diverse systems involved in autism and its complex etiology, makes the development of new techniques to model autism and mine its data, imperative. This paper will first review the systems that are altered in people with autism, and then present some of the challenges autism presents to system biologists.

Genetics, metabolism and oxidative stress

Several genetic variants have been associated with increased risk for autism. The variants found so far are mostly associated with differences in the metabolism, rather than in brain structure. The MET promoter variant rs1858830 allele "C", found at increased rates in autism, is associated with neuronal growth and development, but also is involved in immune function and gastrointestinal repair [ 19, 20]. The fact that this genetic variant is present in 47% of the general population gives credence to the assertion that there is an environmental component to the development of autism. Many of the genetic variants at increased prevalence in autism are associated with the folic acid, transmethylation and transsulfuration metabolic pathways. Some of these genes are MTHFR, COMT, GST, RFC and TCN2. As with the MET variant, these are common in the general population. These variants decrease the activity of enzymes and decrease the efficiency of the body's ability to resolve oxidative stress, methylate genes and detoxify exogenous and endogenous toxins [ 21].

Oxidative stress occurs when production of Reactive Oxygen Species (ROS) and Reactive Nitrogen Species (RNS) exceeds the body's ability to neutralize them. ROS/RNS are free radicals, highly reactive molecules which can damage many parts of the cell. ROS/RNS occur through the energy production process in the mitochondria and through environmental sources. The mitochondrion is the main source of ROS/RNS and has evolved a system to neutralize the oxidants. The most important among these defences is glutathione (GSH). If the mitochondrial GSH pool is low, increased mitochondrial ROS production can occur. GSH is also the main antioxidant for extra-mitochondrial parts of the cell. GSH is produced by the sulfuration pathway as shown in Figure . The sulfuration pathway is linked to the methylation and folic acid pathways and any perturbation of those pathways will affect the production of GSH.

The activity of MS also determines the proportion of homocysteine shunted into the sulfuration pathway to make GSH. As the MS cofactor cobalamin is easily oxidized, oxidative stress will cause more homocysteine to be turned into GSH. In a properly functioning system this additional GSH would resolve the oxidative stress. But in autism there is evidence of continued oxidative stress [ 25].

These interacting cycles are of great importance in autism as they have the potential for therapeutic intervention. Defects in MTHFR enzyme can be bypassed by supplementing the 5-CH3THF form of folic acid. Supplemental cobalamin can increase the efficiency of MS [ 36]. Supplements of other enzyme cofactors might also be of benefit [ 7].

Mitochondrial system

Mitochondria are the organelles responsible for the energy production in most eukaryotic cells. They convert the energy from carbohydrates and fats into adenosine triphosphate (ATP) through the process of cellular respiration. ATP is used to power most cellular functions. Mitochondria are also involved in signalling, cellular differentiation, and apoptosis, as well as the control of the cell cycle and cell growth [ 24].

The mitochondrion utilizes a complex series of chemical reactions to produce the ATP. During this process free radicals, including the particularly damaging super oxide, are produced. Since free radicals are so destructive, the mitochondrion has a series of defences to reduce the free radicals. If, due to genetic defects or acquired dysfunction, more free radicals are produced than the defences can reduce, oxidative stress can occur [ 39]. Mitochondrial disease occurs when there are mutations in the mitochondrial DNA. Mitochondrial disease is associated with a multitude of disorders including hypotonia, mitochondrial encephalomyopathy, cardiomyopathy and a range of endocrine, hepatic or renal tubular dysfunctions, myoclonic epilepsy and mitochondrial myopathy and developmental delay among others. Mitochondrial disease has many different presentations as a child can inherit a mixture of normal and mutated mitochondria from the mother [ 40].

In addition to producing ATP, mitochondria perform the important function of sequestering calcium. Calcium is also used as a biologic signal between the mitochondria and the endoplasmic reticulum. Neuronal calcium signalling causes the release of neurotransmitters and can affect the speed of signals. Diseases with defects in the mitochondrial calcium pathways have a high Co-morbid occurrence of autism [ 55]. Post mortem studies of autistic brains show alterations in calcium homeostasis. This study also showed a possible connection between ionized calcium levels and the immune system [ 56].

Immune system

There is strong evidence of immune dysfunction in children with autism. Relatives of children with autism have increased rates of autoimmune diseases [ 62]. Imbalances of immune system cells and cytokines are found in many different parts of the immune system of people with autism.

Total levels of lymphocytes are reduced [ 63, 64]. The serum immunoglobulin subtypes show abnormal patterns. In particular there is often a skewed Th1-Th2 helper ratio, with most people with autism showing a Th2 predomination [ 64, 65]. T2 skewing results in increased antibodies which can induce allergies and autoimmune reactions. Food allergies are common in children with autism [ 66]. Th2 skewing also makes chronic viral infections more likely. Skewing also occurs in the serum immunoglobulin subtypes. Immunoglobulins are antibodies formed by the B cells to create humoral, persistant immunity. Immunoglobulins IgM, IgA, and total IgG are depressed while IgG subtypes IgG2 and IgG4, and total IgE are increased [ 67- 70]. Increases of pro-inflammatory cytokines along with reductions of regulatory cytokines have been found [ 71].

The immune system has the ability to affect the mitochondria. Cytokines such as TNF α and IL6 can facilitate calcium influx and contribute to mitochondrial dysfunction possibly contributing to the deficits of autism through the mitochondrial system [ 72]. Extracellular mitochondrial DNA and anti-mitochondrial antibodies have been found in the serum of children with autism [ 73].

There are several avenues for the immune system to induce autistic behaviors. Immune dysregulation could result in generalized inflammation in the brain [ 74]. Inflammation in the brain has been linked to a number of psychiatric diseases including schizophrenia, [ 75] bipolar [ 76] Alzheimer's disease [ 77] and depression [ 78]. Multiple studies have found a correlation between abnormal levels of immune factors and core autistic deficits such as speech, mood and social deficits [ 79- 84]. Another study found that the more the levels of the cytokines IL-1, IL5, IL-8 and IL-12p40 deviated from the norm, the more severe the stereotypical behaviors [ 85].

The interaction between the immune system and the brain can present in several variations. Neuropeptides can modulate the immune system by recruitment of the innate immune system and chemotaxis [ 11]. In mouse models, decreased lymphocytes result in impaired learning and memory [ 89]. Autoimmunity is present in some cases. Anti-brain antibodies have been found in children with autism, though no evidence of demyelination has been found [ 11]. A study of 93 children with autism found that 75% had autoantibodies to the folate receptors in the central nervous system (CNS). Impairments of these receptors can lead to reduced levels of folate in the CNS and Cerebral Folate Deficiency (CFD). The levels of folate receiver antibodies were highly correlated with cerebrospinal fluid 5-methyltetrahydrofolate concentrations, thus indicating possible CFD in the tested children. There are structural similarities between the folate receptors and proteins found in milk [ 90]. A milk free diet, in addition to high dose folinic acid supplementation has been found to decrease the autoantibody titer and improve functioning in younger patients [ 91, 92]. These immunological differences point to treatment options. Replacement of deficient lymphocytes in mice resolved the learning and memory difficulties [ 89]. Treatment of allergies often results in improvement in autistic behaviors such as hyperactivity and irritability [ 66]. An early study found that treatment with intravenous immune globulin in ten children with autism resulted in better speech, eye contact, focus and awareness of surroundings [ 93].

Gastrointestinal system

There is evidence of increased intestinal permeability in people with autism [ 99- 103]. Increased intestinal permeability was even found in 43% of children with autism without clinical signs of bowel dysfunction [ 101]. Intestinal permeability allows larger molecules that would normally stay in the gut to cross into the bloodstream. Plasma and urinary concentrations of oxalate were greatly elevated in children with autism, which may be a result of increased intestinal absorption [ 104]. Increased permeability can lead to allergy and autoimmune processes. There appear to be multiple reasons for the increased permeability. The dietary protein gluten can bind to the CXCR3 receptor, resulting in increased zonulin levels. Zonulin regulates the opening of the tight junctions in the gut [ 105]. Ingested toxins such as Polychlorinated Biphenyls can also open the tight junctions in the gut [ 106].

There are anecdotal reports of improvement of autistic behavior on restricted diets. Some experimental studies have reported improvements reported include socialization, speech, strange and unusual behavior [ 108, 109], stereotyped behaviors, attention/hyperactivity [ 110] and physiological symptoms [ 109] One study of the casein/gluten free diet considered children with and without GI symptoms separately. They found greater improvent in autistic behaviors in children with gastrointestinal symptoms compared to those without [ 109]. The reported improvements may be due to several reasons. Removal of allergens may result in lessened autoimmune reactions [ 66]. Removal of gluten may reduce intestinal permeability [ 103, 105]. Removal of dietary proteins for which there is insufficient enzymic activity may reduce dysbiosis [ 111].

The brain has the potential to directly effect the functioning of the gut. Stress has been implicated in Irritable Bowel Syndrome with alterations of the intestinal barrier function, altered balance in enteric microflora, exaggerated stress response and visceral hypersensitivity [ 112]. Antidepressants [ 113] and therapy [ 114] have been found to be effective treatments for irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). There is also a finding that the brains of patients with IBS have increased hypothalamic gray matter compared with controls, though it is unknown whether the brain changes result from long term IBS or are preexisting [ 115].

Neurological system

Brain hypoperfusion has been noted in several studies of subjects with autism. Interestingly, the region affected can vary widely. Hypoperfusion can result from structural abnormalities or from global effects such as oxidative stress [ 7]. Seizures are present in 30% of people with autism [ 128]. In addition, subclinical seizures are often present and treatment with anti-epileptics can result in mental improvement [ 129, 130].

Modeling autism

All of the systems described above interact in highly complex ways. To date, little research exists in autism modeling outside of the genetic and neurological systems. Finding commonalities between autism and other conditions may lead to new treatments. Rzhetsky used statistical models to find genetic overlaps between autism, bipolar disorder and schizophrenia [ 131]. Individual subsystems of importance in autism have been modeled [ 132, 133], but work needs to be done in modeling combinations of systems. It is clear that autism poses a challenging problem for modeling due to the high level of interactions between the different elements [ 134]. The probably incomplete Figure shows some potential interactions between the systems discussed in this paper. For example, an analysis of children with both autism and mitochondrial disease found that a high proportion, 70%, regressed during a fever [ 135]. This illustrates just one example of an intersystem interaction between the mitochondrial, immune and neurological systems.

The dotted lines in Figure indicate how even the environment might be effected by the presence of autism. For example, food allergies or special diets would change the environment through different food choices. Fecal incontinence in older children would change the activities the child would be exposed to. Energy deficits from mitochondrial dysfunction could affect school activities. And being oversensitive to sensory input would change activities and family dynamics.

Much work has been done investigating the genetic basis of autism. Additional work needs to be done to find and cluster the genes involved in autism. Modeling autism will require an integration of both systems and scales. A few potential research areas are presented below.

Hierarchical modeling

A hierarchical approach allows for separation of development of models for subsystems, but global effects of different substances and conditions need to be considered too. Studies of trans-organ and system effects of substances is a relatively unexplored field of study. For example, oxidative stress affects the mitochondria directly [ 24], but also the larger systems such as the brain [ 47]. Mitochondrial stress may also affect the brain indirectly. Dysregulation of mitochondrial dynamics has been implicated in Parkinson's disease [ 139]. Mitochondrial stress may lead to lipid peroxidation leading to reactive aldehyde generation in the liver, and finally to microglial activation and neuronal death [ 61].

Inflammation can affect many body systems. Inflammation can also be part of a feedback mechanism where inflammation creates conditions which create or perpetuate inflammation [ 140]. Xenobiotic substances must be taken into account. Many exogenous substances are not typically included in existing models. Toxins such as PCBs, pesticides and heavy metals can affect the efficiency of enzymes often deficient in autism and need to be considered as a potential causative element [ 18, 38]. In addition, the effect of toxins in combination may not be the same as the effect of the toxins in isolation [ 141- 143]. The microbiome, the complex ecosystem of intestinal flora, may have an impact on many systems in the body either through immunological effects, or through the microbial metabolites such as the proprionic acid produced by clostridium [ 144]. Special diets and supplements used by many on the autism spectrum may affect the composition of the microbiome in addition to possibly changing the function of enzymes [ 145, 146].

Identifying subgroups

The benefits of subgrouping are as follows. Subgrouping the population might result in subgroups that have distinctive symptoms and pathology that are already familiar in the medical literature, and can draw upon treatments that work in existing treatable conditions. For example, if one subgroup is a variant of a known syndrome, we can possibly benefit from the treatments known in the context of that syndrome. Subtyping would reduce the use of therapeutic trials, allowing a more targeted treatment. Another benefit that accrues from subgrouping is in prevention. If we know the sequelae of another similar condition, we can take appropriate action to include appropriate preventive measures in the treatment protocol. For example, if seizures are a symptom of the similar known syndrome or condition, potentially a periodic EEG evaluation could be included in the treatment protocol.

- Genetics. This can include genetic panels such as mitochondrial or results of microarray testing.

- Lab test results, such as the above mentioned metabolic, immunologic and proteomic biomarkers.

- Symptoms and severity as a function of time. These could be "hard" symptoms such as the presence and type of epilepsy, or "soft" symptoms such as parent reports of sociability.

- Treatments and their effectiveness. The treatments could include steps to address some of the disease markers discussed above, such as methycobalamin and folinic acid [ 36] for methylation issues and carnitine [ 61] for mitochondrial issues.

The feature vector would be a vector with both specific values and binary numbers as markers such as a 1 for the presence of a polymorphism or other hard symptom and a 0 for none. For example, a child with the MTHFR 677 genotype, a tGSH: GSSG ratio of 8.6 and no epilepsy could be represented by the feature vector [1, 8.6, 0]. Once in numerical form, a variety of pattern recognition techniques can be used.

One popular clustering technique is the K-means [ 155]. The k-means algorithm is essentially a density finder. It assigns each input vector using an indicator function to a cluster defined by a prototype vector. The algorithm then minimizes the global average squared Euclidean distance from each input vector to the prototype. This optimization changes the position of the prototype vector to reflect Euclidean density patterns. The prototype center is the average of the input vectors assigned to it and thus potentially representative of a subgroup.

One weakness of the k-means is that it performs a hard assignment of each input vector to a cluster. An input vector is either entirely in a cluster or not at all. This would not match situations where there might be an overlap of symptoms. Fuzzy techniques would be of value in these cases. Fuzzy set theory allows intermediate levels, between 0 and 1, of belonging to member sets. The fuzzy c-means (FCM) is a fuzzy generalization of the k-means algorithm to allow input vectors to belong to more than one prototype [ 156]. The FCM also does not suffer from the stability problems that sometimes occur in the k-means when an input vector will switch back and forth between two prototypes, and thus changing the prototypes in the process.

An important issue with clustering algorithms is the number and validity of clusters. The k-means and FCM algorithms will find the number of clusters specified during program initialization, regardless of the actual number of clusters. Some clustering algorithms can produce clusters that are empty or degenerate. Many practitioners will heuristically try different numbers of clusters and asses the fit. There are also various methods to attempt to quantify the validity of clusters [ 157]. The Self Organizing Map (SOM) maintains a proximity relationship between clusters and can be useful for visualization [ 158].

The above techniques are unsupervised. Unsupervised techniques relay wholly on the input data to find clusters or groupings in the data. Supervised techniques incorporate additional knowledge about the expected groupings to guide the cluster development process. This additional information, if available, can aid in complex and high dimensional problems. Support Vector Machines [ 159, 160] and a variety of Neural Network algorithms can be used to find patterns in the data [ 161]. Although supervised algorithms can, in general, outperform unsupervised algorithms, additional "ground truth" data is often unavailable. This ground truth can be information such as genes already associated with a phenotype or reaction to an intervention. It could also be symptoms that could also be used as inputs, such as the before mentioned presence of epilepsy.

Most of the algorithms mentioned above measure similarity based on the Euclidean distance metric. Euclidean and other Minkowski lp norms such as the "city block" distance measures will represent hyperspherical patterns well. Other distance measures are possible such as various correlation measures [ 162] and non-spherical distance measures such as the Mahalanobis distance [ 161]. Another issue is the scale of the data. Expected results in lab tests may vary by several orders of magnitude. Therefore, it is usually advisable to normalize the data before using in an algorithm.

Perhaps the most critical issue is the "Curse of Dimensionality". The curse of dimensionality refers to the somewhat counterintuitive properties of high dimensional spaces whereby additional information can result in a lessening of discernment. The simplest of the implications of high dimensional space is that the amount of data required to adequately cover a volume increases exponentially with dimension. It can be shown geometrically that most of the volume of a high dimensional Gaussian is contained in its tails, rather than at its center. This has obvious implications to distance based algorithms. The distance from a center of a cluster to any point is concentrated in a small interval and the relative differences from various data points to the prototype become essentially the same. Thus discriminatory power can decrease with added information, even if that additional information has discriminatory power in of itself [ 163, 164]. That has implications for finding subgroups in a complicated disease such as autism that might require a large number of features. Feature selection will alleviate the curse of dimensionality but may exclude features needed to find less prevalent subgroups. The curse of dimensionality may also be avoided by using subspace methods or hierarchical clustering.

Another issue prevalent in autism data is the abundance of missing data. One cause of missing data would be different protocols for different studies resulting in similar but not identical feature vectors. When utilizing clinical data, physicians will not perform all tests on all patients, resulting in missing data when patients are combined. Therefore techniques need to be utilized to make the most of the data that is present [ 165, 166].

Numerical data in autism research has particular challenges. The data can refer to disparate body systems. Data can be problematic to integrate across studies and research centers. For example, studies can have different selection criteria, experimental conditions, and goals. Research centers can have different testing procedures which can lead to varying results. Data is often not precise. Fuzzy techniques should be incorporated, as many of the data considered will not be easily quantifiable, such as parent reports of behavior. Also, what might be considered outlier data may in fact be important. It may be representative of the extreme values that are evident in autism data [ 167]. There are a myriad of information that might be useful in determining autism phenotypes. As mentioned before, it might include items such as genotype information and lab results. It also might include items such as parent ratings of diarrhea odor. It is obvious that a value of '1' in these three categories would have very different meanings, although numerically they would be the same.

Incorporating domain knowledge into the identification of subgroups will alleviate many of the problems noted above. As shown in the preceding sections, there is much qualitative information about autism contained in the medical literature. Most of it is single system studies. Techniques need to be discovered to integrate this information together. One way to incorporate domain knowledge is to embed causal information into the solution [ 168].

Some preliminary, simple subgrouping has already shown promise. An analysis of the gluten and casein elimination diet showed greater improvement in symptoms in children with gastrointestinal symptoms compared to those without [ 109]. This information can help practitioners decide whether to recommend restrictive diets. It has been proposed that there may be a mitochondrial [ 58], intestinal permeability [ 103] and immune subgroups [ 11] in autism, but it is probably more complex than that as many children may belong to multiple subgroups. Thus it is imperative to develop subgroups that have clinical significance for treating the symptoms of autism, not just statistical validity.

For example, one could, possibly discover a subtype of autism that presents with clinical or subclinical seizures of a certain characteristic type. The treatment of seizures being a well-studied area, by itself, we could potentially establish a treatment protocol for patients in this subgroup, using treatment studies of drugs used for seizures in these patients also presenting with autism. This would result in a new treatment for those with autism, in contrast to using a seizure medication as an off-label drug without clear evidence of efficacy in this population.

Time dependent modeling

Another issue of importance is the time scales involved. Autism is a developmental, not a static disease. Disease progression might start prenatally and extend throughout childhood. And of course, the child's body is growing and changing. Modeling incorporating time progression has been primarily on the genetic or cellular level. Frameworks have been developed for parameter adjustments during phenotype transitions [ 169]. Molecular connectivity maps incorporating differentially expressed genes have been used to investigate the relationship of aging to neurological and psychiatric diseases [ 170].

Another source of time-dependence is that the brain itself is a state machine, in the sense that future characteristics depend on past characteristics, the various interventions employed or not employed at a certain time, etc. Simplified modeling with reasonable assumptions can be potentially employed to answer questions of generic value. An example would be "Are outcomes better for children with regression, who were treated with anti-epileptic medications prior to puberty, compared to children who received such treatment later, after puberty?" Another example would be "Do children who exhibit conditions such as gastro-intestinal abnormalities or seizures generally tend to lose these symptoms after a certain age?" If so, did these children receive a certain therapy, either medical, educational or behavioral, at a certain age? In summary, a time-dependent model will throw more light into brain plasticity and its contribution to the outcomes that we see in this population.

In order to introduce this complexity, we propose enhancing our models using Dynamic Time Warping (DTW) [ 178] or a more complex model with state information, similar to hidden Markov models where the body is assumed to be in a state where it produces certain symptoms or observations and transitions to other states based on the model. Estimating these models and predicting outcomes would be the most complex of the techniques proposed in this article, and would be the goal for modeling such a complex time-varying system.

Discussion and conclusions

This paper contains, of necessity, an incomplete review of the issues involved in autism. Research is exploding in this area and new findings are being published every month.

It is clear that the complexity of autism presents a both challenge and an opportunity for systems biologists. Modeling autism requires new techniques to be developed to harness and tame the complexity of interactions. For example, a possible interaction would be impairment of the detoxification system could allow toxins to accumulate and cause mitochondrial dysfunction [ 48, 49], which could cause immune dysfunction [ 179, 180], which could cause gastrointestinal dysfunction which could then affect the brain [ 181]. This is not to imply that this relation is the cause of autism. In fact, the whole relation could go the other way, with stress inducing bowel dysfunction [ 112]. The bowel dysfunction could, through opening of tight junctions, induce immune activation [ 182], which could contribute to mitochondrial dysfunction [ 72], and finally the resultant oxidative stress can cause more resources to be used in the production of GSH, perturbing the metabolic pathways [ 183]. And in fact, the chain is not ordered. Gastrointestinal dysfunction could impair mitochondrial function directly through the clostridial production of proprionic acid [ 8]. These interactions are a purely hypothetical thought experiment and are not to be represented as causes. But even so, it is apparent that the number of possible interactions of systems in autism is almost exponential. This necessitates a system approach.

Autism could be considered a model for other complex diseases. The probable interplay between genetic and environmental factors is suspected as a factor in many diseases such as cancer and diabetes. Since many of the genetic variants that predispose children to autism are common in the general population, findings in autism may have much broader implications for the population in general.

Autism is the most rapidly increasing developmental disability with enormous costs to individuals and to society. The importance of modeling autism research cannot be overstated. In summary, the goal of a systems approach to modeling autism, can potentially lead to the following concrete benefits. First, having a comprehensive evolving digital data model for autism gives us a platform to capture the on-going research in an analysable format. The model itself can "learn" as results are incorporated as training data, into the system. Second, immediate tools such as a detailed hierarchical Intake or Follow up questionnaire could result from the system, based on its knowledge of subtypes and interconnections, leading to better clinical care for this population. Third, the system can be used for hypothesis generation, suggesting possible research topics for clinical trials.

Autism research findings need to be mined, integrated and modeled to help not just future generations, but also to improve the outcomes for the current generation of people with autism.

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Wolowczuk I, Verwaerde C, Viltart O, Delanoye A, Delacre M, Pot B, Grangette C. Feeding Our Immune System: Impact on Metabolism. Clin Dev Immunol. 2008. [PMC free article]

Duda RO, Hart PE, Stork DG. Pattern Classification. 2. John Wiley & Sons; 2001.

Bezdek JC. Pattern Recognition with Fuzzy Objective Function Algorithms. Kluwer Academic Publishers; 1981.

Kohonen T. Self-organizing maps. Springer; 2000.

Bishop CM. Pattern Recognition and Machine Learning. Springer; 2006.

Verleysen M, François D. In: The Curse of Dimensionality in Data Mining and Time Series Prediction Computational Intelligence and Bioinspired Systems. Cabestany J, Prieto A, Sandoval F, editor. Heidelberg: Springer Berlin; 2005. pp. 85-125. (Lecture Notes in Computer Science).

Little RJ, Rubin DB. Statistical Analysis with Missing Data. 2. NJ: Wiley-Interscience, Hoboken; 2002.

Randolph-Gips M. Seventh International Conference on Machine Learning and Applications; Dec. 11-13. CA USA: San Diego; 2008. A New Neural Network to Process Missing Data without Imputation; pp. 756-762.

James SJ, Zimmerman AW. Oxidative Stress and the Metabolic Pathology of Autism. NJ: Humana Press, Totowa; 2008. (Autism).

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Modeling autism: a systems biology approach

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Autism is the fastest growing developmental disorder in the world today. The prevalence of autism in the US has risen from 1 in 2500 in 1970 to 1 in 88 children today. People with autism present with repetitive movements and with social and communication ...

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-ADHD
-Autoimmune diseases
-Crohn's disease
-Dyslexia
-Motor coordination disorder
-Epilepsy
-Fragile X syndrome
-Dyskinesia

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-Behavior and communication therapy (can reduce problem behaviors or teach new skills)
-Educational therapies: highly structured educational programs that include a team of specialists and a wide range of actives to improve social skills, communication, and behavior.
-Speech, occupational, or physical therapy: communication, activites of daily living, and improving movement and balance respectively.
-Medications: they cannot improve the core signs of ASD, but they can help control symptoms

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Diagnosis

Your child's doctor will look for signs of developmental delays at regular checkups. If your child shows any symptoms of autism spectrum disorder, you'll likely be referred to a specialist who treats children with autism spectrum disorder, such as a child psychiatrist or psychologist, pediatric neurologist, or developmental pediatrician, for an evaluation.

Because autism spectrum disorder varies widely in symptoms and severity, making a diagnosis may be difficult. There isn't a specific medical test to determine the disorder. Instead, a specialist may:

Observe your child and ask how your child's social interactions, communication skills and behavior have developed and changed over time

Give your child tests covering hearing, speech, language, developmental level, and social and behavioral issues

Present structured social and communication interactions to your child and score the performance

Use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Include other specialists in determining a diagnosis

Recommend genetic testing to identify whether your child has a genetic disorder such as Rett syndrome or fragile X syndrome

Treatment

No cure exists for autism spectrum disorder, and there is no one-size-fits-all treatment. The goal of treatment is to maximize your child's ability to function by reducing autism spectrum disorder symptoms and supporting development and learning. Early intervention during the preschool years can help your child learn critical social, communication, functional and behavioral skills.

The range of home-based and school-based treatments and interventions for autism spectrum disorder can be overwhelming, and your child's needs may change over time. Your health care provider can recommend options and help identify resources in your area.

If your child is diagnosed with autism spectrum disorder, talk to experts about creating a treatment strategy and build a team of professionals to meet your child's needs.

Treatment options may include:

Behavior and communication therapies. Many programs address the range of social, language and behavioral difficulties associated with autism spectrum disorder. Some programs focus on reducing problem behaviors and teaching new skills. Other programs focus on teaching children how to act in social situations or communicate better with others. Applied behavior analysis (ABA) can help children learn new skills and generalize these skills to multiple situations through a reward-based motivation system.

Educational therapies. Children with autism spectrum disorder often respond well to highly structured educational programs. Successful programs typically include a team of specialists and a variety of activities to improve social skills, communication and behavior. Preschool children who receive intensive, individualized behavioral interventions often show good progress.

Family therapies. Parents and other family members can learn how to play and interact with their children in ways that promote social interaction skills, manage problem behaviors, and teach daily living skills and communication.

Other therapies. Depending on your child's needs, speech therapy to improve communication skills, occupational therapy to teach activities of daily living, and physical therapy to improve movement and balance may be beneficial. A psychologist can recommend ways to address problem behavior.

Medications. No medication can improve the core signs of autism spectrum disorder, but specific medications can help control symptoms. For example, certain medications may be prescribed if your child is hyperactive; antipsychotic drugs are sometimes used to treat severe behavioral problems; and antidepressants may be prescribed for anxiety. Keep all health care providers updated on any medications or supplements your child is taking. Some medications and supplements can interact, causing dangerous side effects.

Managing other medical and mental health conditions

In addition to autism spectrum disorder, children, teens and adults can also experience:

Planning for the future

Children with autism spectrum disorder typically continue to learn and compensate for problems throughout life, but most will continue to require some level of support. Planning for your child's future opportunities, such as employment, college, living situation, independence and the services required for support can make this process smoother.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Alternative medicine

Because autism spectrum disorder can't be cured, many parents seek alternative or complementary therapies, but these treatments have little or no research to show that they're effective. You could, unintentionally, reinforce negative behaviors. And some alternative treatments are potentially dangerous.

Talk with your child's doctor about the scientific evidence of any therapy that you're considering for your child.

Examples of complementary and alternative therapies that may offer some benefit when used in combination with evidence-based treatments include:

Creative therapies. Some parents choose to supplement educational and medical intervention with art therapy or music therapy, which focuses on reducing a child's sensitivity to touch or sound. These therapies may offer some benefit when used along with other treatments.

Sensory-based therapies. These therapies are based on the unproven theory that people with autism spectrum disorder have a sensory processing disorder that causes problems tolerating or processing sensory information, such as touch, balance and hearing. Therapists use brushes, squeeze toys, trampolines and other materials to stimulate these senses. Research has not shown these therapies to be effective, but it's possible they may offer some benefit when used along with other treatments.

Massage. While massage may be relaxing, there isn't enough evidence to determine if it improves symptoms of autism spectrum disorder.

Pet or horse therapy. Pets can provide companionship and recreation, but more research is needed to determine whether interaction with animals improves symptoms of autism spectrum disorder.

Some complementary and alternative therapies may not be harmful, but there's no evidence that they're helpful. Some may also include significant financial cost and be difficult to implement. Examples of these therapies include:

Some complementary and alternative treatments do not have evidence that they are beneficial and they're potentially dangerous. Examples of complementary and alternative treatments that are not recommended for autism spectrum disorder include:

Coping and support

Raising a child with autism spectrum disorder can be physically exhausting and emotionally draining. These suggestions may help:

Find a team of trusted professionals. A team, coordinated by your doctor, may include social workers, teachers, therapists, and a case manager or service coordinator. These professionals can help identify and evaluate the resources in your area and explain financial services and state and federal programs for children and adults with disabilities.

Keep records of visits with service providers. Your child may have visits, evaluations and meetings with many people involved in his or her care. Keep an organized file of these meetings and reports to help you decide about treatment options and monitor progress.

Learn about the disorder. There are many myths and misconceptions about autism spectrum disorder. Learning the truth can help you better understand your child and his or her attempts to communicate.

Take time for yourself and other family members. Caring for a child with autism spectrum disorder can put stress on your personal relationships and your family. To avoid burnout, take time out to relax, exercise or enjoy your favorite activities. Try to schedule one-on-one time with your other children and plan date nights with your spouse or partner - even if it's just watching a movie together after the children go to bed.

Seek out other families of children with autism spectrum disorder. Other families struggling with the challenges of autism spectrum disorder may have useful advice. Some communities have support groups for parents and siblings of children with the disorder.

Ask your doctor about new technologies and therapies. Researchers continue to explore new approaches to help children with autism spectrum disorder. See the Centers for Disease Control and Prevention website on autism spectrum disorders for helpful materials and links to resources.

Preparing for your appointment

Your child's health care provider will look for developmental problems at regular checkups. Mention any concerns you have during your appointment. If your child shows any signs of autism spectrum disorder, you'll likely be referred to a specialist who treats children with the disorder for an evaluation.

Bring a family member or friend with you to the appointment, if possible, to help you remember information and for emotional support.

Here's some information to help you prepare for your appointment.

What you can do

Before your child's appointment, make a list of:

Any medications, including vitamins, herbs and over-the-counter medicines that your child is taking, and their dosages.

Any concerns you have about your child's development and behavior.

When your child began talking and reaching developmental milestones. If your child has siblings, also share information about when they reached their milestones.

A description of how your child plays and interacts with other children, siblings and parents.

Questions to ask your child's doctor to make the most of your time.

In addition, it may be helpful to bring:

Questions to ask your child's doctor may include:

Why do you think my child does (or doesn't) have autism spectrum disorder?

Is there a way to confirm the diagnosis?

If my child does have autism spectrum disorder, is there a way to tell how severe it is?

What changes can I expect to see in my child over time?

What kind of special therapies or care do children with autism spectrum disorder need?

How much and what kinds of regular medical care will my child need?

What kind of support is available to families of children with autism spectrum disorder?

How can I learn more about autism spectrum disorder?

Don't hesitate to ask other questions during your appointment.

What to expect from your child's doctor

Your child's doctor is likely to ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on. Your doctor may ask:

What specific behaviors prompted your visit today?

When did you first notice these signs in your child? Have others noticed signs?

Have these behaviors been continuous or occasional?

Does your child have any other symptoms that might seem unrelated to autism spectrum disorder, such as stomach problems?

Does anything seem to improve your child's symptoms?

What, if anything, appears to worsen symptoms?

When did your child first crawl? Walk? Say his or her first word?

What are some of your child's favorite activities?

How does your child interact with you, siblings and other children? Does your child show interest in others, make eye contact, smile or want to play with others?

Does your child have a family history of autism spectrum disorder, language delay, Rett syndrome, obsessive-compulsive disorder, or anxiety or other mood disorders?

What is your child's education plan? What services does he or she receive through school?

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Autism spectrum disorder is a serious condition related to brain development that impairs the ability to communicate and interact with others.

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- Infections that are present at birth or occur after birth
- Chromosomal abnormalities (Down syndrome)
-Environmental factors
-Metabolic (hyperbilirubinemia or very high bilirubin levels in babies)
- Malnutrition
- Intrauterine exposure to alcohol, amphetamines, and other 🤬
- Trauma
-Unexplained reasons

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Effective Recreational Therapy interventions for Intellectual Disability

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Effective Recreational Therapy interventions for Intellectual Disability

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- Functional skills: The RT could play frisbee or a board game that involves fine motor skills.  This could help with better coordination and everyday activites
- Cognitive skills: To improve cognitive skills, a RT could play memory card games. The client might not even realize they are exercising their mind while play the game.
- Social skills: Individuals with ID could learn from modeling of your behavior. They could also learn by being put in a group setting and being taught how to appropriately communicate with their peers.  For example, you could have them join a baseball game or go bowling.
**It is important to remember that each client will have different hobbies and interests. People with ID are also not at the same skill levels.

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Importance of timing of diagnosis of a sensory impairment (congenital vs. acquired)

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Importance of timing of diagnosis of a sensory impairment (congenital vs. acquired)

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*It is important to have infants and children go into the doctor for regular testing. If the baby is born with a sensory impairment, it is known as a congenital diagnosis. Health professionals need to be able to diagnose the infant with the specific impairment, so the parents can get the baby needed help. Most neural connections are formed within the first three years of life and without vision or hearing, there can be developmental delays. For example, babies are able to form connections by seeing their parents and hearing their voice. They might also miss out on important cues in social environments. With interventions and proper help, the child will be able to learn in an adapted way. *For children or even adults diagnosed with a sensory impairment, it is important they get the support needed. Acquired diagnoses occur over the course of someone's life. If an individual gets diagnosed with a visual or hearing impairment, it can be very tough. They need support and therapy to help them go through major life changes.

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Early Identification of Hearing and Vision Loss is Critical to a Child's Development

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vision and hearing loss, early identification, warning signs

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-Inherited hearing loss: From a genetic trait passed down from a parent that can be conductive, sensorineural or mixed
*Waardenburg syndrome
*Branchiootorenal syndrome
*Usher syndrome
*Pendred syndrome
-Age-related hearing loss: gradual loss of hearing that occurs over time
-Noise-induced hearing loss: caused by prolonged exposure to loud noise including traffic, construction work, noisy office environments, and loud music.
-Illness-related hearing loss: diseases that result in loss in hearing
*Otosclerosis
*Meniere's disease
-Unilateral hearing loss (Single Sided Deafness):  hearing loss that occurs in just one ear
* causes include..trauma to the ear, autoimmune ear diseases, excessive noise exposure to one ear, genetics, illnesses or infections
-Ototoxic medication including aminoglycoside antibiotics, aspirin, and chemotherapy 🤬 have been linked to permanent hearing loss
-Head trauma and tumors

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The National Institutes of Health (NIH) estimates that approximately 37.5 million American adults have a significant hearing loss making it one of the most common health concerns people face. While most causes of hearing loss are well-understood, researchers are still studying all the possible causes, methods for prevention and treatment options.

Inherited hearing loss

Hereditary factors account for many
cases of hearing loss.

Hereditary hearing loss can be conductive, sensorineural or mixed and is the result of a genetic trait passed down from a parent. A study performed by the University of Washington, Seattle reports there are more than 400 known genetic syndromes that include hearing loss.

Some of these include:

Waardenburg syndrome

Branchiootorenal syndrome

Stickler syndrome

Usher syndrome

Pendred syndrome

Alport syndrome

While many hereditary hearing losses are congenital (present at birth), some of these conditions develop slowly over time.

Age-related hearing loss

Age-related hearing loss, or presbycusis, is the gradual loss of hearing that occurs over time. This type of loss is permanent and is generally greater for higher-pitched tones, such as birds chirping or the ringing of a telephone.

The main symptoms of age-related hearing loss include: difficulty understanding conversations especially in noisy situations, the perception that others are mumbling instead of speaking clearly, certain sounds seeming annoying or too loud and tinnitus (ringing in the ears).

Because presbycusis is a type of sensorineural hearing loss, it commonly occurs from changes in the inner ear as a person ages. It also can be the result of changes in the middle ear or along the nerve pathways leading to the brain. Changes in the blood supply to the ear from heart disease, high blood pressure or vascular conditions may also contribute to age-related hearing loss.

Presbycusis usually affects both ears equally and gradually. Because it develops slowly over time, you may not realize it's happening until your symptoms become severe or someone else notices you're having trouble.

What are the signs of hearing loss?

Noise-induced hearing loss

Noise-induced hearing loss is caused by prolonged exposure to loud noise. The culmination of constant exposure to every day sounds like traffic, construction work, noisy office environments or loud music can negatively impact your hearing. While noise-induced hearing loss is generally temporary in nature, repeated overexposure to loud noise makes it harder for the ears to recover between events. The noise damages inner ear hair cells, causing hearing loss to deteriorate over time and become permanent.

Remember: noise-induced hearing loss is largely preventable.

The Center for Disease Control and Prevention estimates that more than one out of 10 people aged 6-19 has already suffered permanent damage to their hearing from excessive exposure to loud noise. Culprits of exposure include: loud music from headphones, stereos and concerts, in addition to construction and other work equipment noises.

You can significantly lower your risk of hearing loss by limiting exposure to loud noises, using earplugs in noisy environments, turning down the volume of music or sound on personal music devices and using a volume-limiter device when using personal audio equipment.

Illness-related hearing loss

There are numerous illnesses and disorders which contribute to hearing loss including:

Otosclerosis - This disease affects the movement of the tiny bones in the middle ear causing a conductive hearing loss that is usually treated with surgery.

Meniere's disease - The cause of this disease is unknown, but symptoms usually include fluctuating hearing loss, vertigo and tinnitus (ringing in the ears).

Unilateral hearing loss

Some tests can detect malfunction of the
middle ear, a cause of hearing loss.

Unilateral hearing loss (UHL), sometimes referred to as Single Sided Deafness (SSD), is hearing loss that occurs in just one ear. It can cause difficulty hearing speech on the affected side and locating the source of sounds.

Causes of unilateral hearing loss include:

trauma to the ear/head.

autoimmune ear diseases.

excessive noise exposure to one ear (shooting long guns is common).

genetic or hereditary conditions.

specific syndromes.

illnesses and infections.

Unilateral hearing loss should be evaluated by an otolaryngologist or other physician. If it is due to a cause that is not medically treatable, specialized hearing aids called CROS (Contralateral Routing of Signal) aids or bone-anchored hearing aids should be considered.

Ototoxic medication

There are numerous types of medications that have been linked to permanent hearing loss. These include:

aminoglycoside antiobiotics.

aspirin and non-steroidal anti-inflammatory drugs (NSAIDs).

chemotherapy drugs.

Generally, you must consume large quantities of these types of drugs to notice effects of hearing loss, but research is still being conducted to further understand the effects of specific dosages and medications.

Head trauma and tumors

Another cause for hearing loss is from tumors such as an acoustic neuroma. Tumor-related hearing loss might also include tinnitus (ringing in the ears), or you might have a sensation of fullness in one or both ears. Tumors are usually treated either medically or surgically and normal hearing may or may not be restored.

Head trauma can damage inner ear structures causing a temporary or permanent hearing loss. Any injury sustained to the head should be evaluated by a doctor immediately. The medical evaluation will likely include both a hearing and eye examination.

Cause determines proper treatment

There are so many potential causes of hearing loss. Hearing healthcare professionals are trained to use many diagnostic tests to help get to the bottom of your concerns. Once they determine the cause, they can find the best course of treatment. If you have hearing loss and are unsure of the cause, visit a qualified clinic near you from our consumer-reviewed directory.

Brande Plotnick holds a master's degree and MBA from the University of Louisville. Her career in hearing care spans sales, marketing and content creation and she enjoys helping people with hearing loss seek help and be their own advocates.

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Learn about the many causes of hearing loss

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The National Institutes of Health (NIH) estimates that approximately 37.5 million American adults have a significant hearing loss making it one of the most common health concerns people face. While most causes of hearing loss are well-understood, researchers are still studying all the possible causes, methods for prevention and treatment options.

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Types of hearing loss:

Auditory processing disorders- brain cannot process the information contained in sound

Conductive hearing loss- happens when their is a problem with the Outer or Middle Ear so the sound cannot be passed to the Inner Ear

Sensorineural Hearing Loss- occurs when the Cochlea and/or auditory never is damaged or malfunctions making it unable to accurately send the electrical information to the brain

Mixed Hearing Loss- occurs when both Conductive Hearing Loss and Sensorineural Hearing Loss are present

Degrees of Hearing Loss:

Mild (26-40 dB HL threshold)- difficult to hear soft speech or distinguish sounds when there is background noise

Moderate (41-70 dB HL threshold)- difficult to hear conversations, especially when there is background noise

Severe (71-90 dB HL threshold)- normal conversations are not audible.

Profound (91 dB HL or higher threshold)- may have difficulty understanding even amplified speech

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There are four types of hearing loss:

HEARnet Online's Interactive Ear provides a quick and easy visual guide to explanation the different types of hearing loss and the range of technologies available to help manage it.

Auditory Processing Disorders

Auditory Processing Disorders occur when the brain has problems processing the information contained in sound, such as understanding speech and working out where sounds are coming from.

Conductive Hearing Loss

Conductive Hearing Loss occurs when there is a problem with the Outer or Middle Ear which interferes with the passing sound to the Inner Ear. It can be caused by such things as too much earwax, Ear Infections, a punctured eardrum, a fluid build-up, or abnormal bone growth in the Middle Ear such as Otosclerosis. It is more common in children and indigenous populations.

Surgery and some types of hearing technologies can be used to treat Conductive Hearing Loss such as Bone Conduction Hearing Aids, Bone Anchored Hearing Devices and Middle Ear Implants.

Sensorineural Hearing Loss

Sensorineural Hearing Loss occurs when the hearing organ, the Cochlea, and/or the auditory nerve is damaged or malfunctions so it is unable to accurately send the electrical information to the brain. Sensorineural Hearing Loss is almost always permanent.

It can be genetic or caused by the natural aging process, diseases, accidents or exposure to loud noises such as Noise-induced Hearing Loss and certain kinds of chemicals and medications. Auditory Neuropathy is another form where the nerves that carry sound information to the brain are damaged or malfunction.

Technologies such as Hearing Aids, Cochlear Implants and Hybrid Cochlear Implants can help reduce the effects of having Sensorineural Hearing Loss.

Mixed Hearing Loss

A Mixed Hearing Loss occurs when both Conductive Hearing Loss and Sensorineural Hearing Loss are present. The sensorineural component is permanent, while the conductive component can either be permanent or temporary. For example, a Mixed Hearing Loss can occur when a person with Presbycusis also has an Ear Infection.

More Information

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There are four types of hearing loss: HEARnet Online's Interactive Ear provides a quick and easy visual guide to explanation the different types of hearing loss and the range of technologies available to help manage it. Auditory Processing Disorders occur when the brain has problems processing the information contained in sound, such as understanding speech and working out where sounds are coming from.

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Visual Acuity- sharpness of vision, measured by the ability to discern letters or numbers at a given distance according to a fixed standard.  It is how well you can see details.  An example of visual acuity would be the vision tests the doctor gives a patient to test their vision.  Below is one example of a visual acuity exam.  If the patient can read up to a certain line at a certain distance, their visual acuity is said to be very high.
Here is another example of a visual acuity test.

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-Injury to the eyes while playing or at work due to accidents
-inherited conditions of blindness and vision impairment (Retinitis pigmentosa)
-infections of the eyes like Trachoma
-Amblyopia which is impaired vision in one eye due to lack of use in childhood
-Cataract is clouding of part or the entire lens of the eye
-Diabetic retinopathy is a diabetes affecting the small blood vessels in the retina
-Glaucoma is due to raised pressure in the eyes that damages the optic nerve
-Age related Macular degeneration is a progressive loss of visual acuity due to damage to the macula

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RT interventions for hearing loss and visual impairments

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RT interventions for hearing loss and visual impairments

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Functional skills: The RT could play catch with a larger ball for a person with a visual impairment. They could also use games that involve textures and sounds for those with visual impairments.  The games could focus on gross motor skills and coordination. For clients with hearing impairments, the RT could kick a soccer ball back and forth, being cautious of games that require the client to hear certain sounds or voices.
Social Skills: The RT should try to focus on ways that the client is comfortable going out in public. They could introduce the client to recreational places in the community that offer support to those with sensory impairments.  They could simply act as another support system for the client by listening and understanding what they are saying.

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Information regarding Duchenne's Muscular Dystrophy (DMD)

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Information regarding Duchenne's Muscular Dystrophy (DMD)

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-DMD is a genetic disorder that involves progressive muscle degeneration and weakness (one of nine types of muscular dystrophy)
-caused by an absence of a protein, dystrophin, which helps keep muscle cells intact
-symptom onset is usually between ages 3 and 5, primarily affecting boys
-there is a steady decline in muscle strength between ages 6 to 11.  By age 10, braces may be needed for walking and by age 13, most boys are using a wheelchair.
-diagnosis can be made by taking a blood test, doing molecular genetic testing, or an electromyography
-there is no cure for DMD, but treatment includes gentle exercise and steroids (Prednisone, Deflazacort, and Oxandrolone)

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Duchenne Muscular Dystrophy (DMD)

What is Duchenne muscular dystrophy?

Duchenne muscular dystrophy (DMD) is a genetic disorder characterized by progressive muscle degeneration and weakness due to the alterations of a protein called dystrophin that helps keep muscle cells intact. DMD is one of four conditions known as dystrophinopathies. The other three diseases that belong to this group are Becker Muscular dystrophy (BMD, a mild form of DMD); an intermediate clinical presentation between DMD and BMD; and DMD-associated dilated cardiomyopathy (heart-disease) with little or no clinical skeletal, or voluntary, muscle disease.

DMD symptom onset is in early childhood, usually between ages 2 and 3. The disease primarily affects boys, but in rare cases it can affect girls.

In Europe and North America, the prevalence of DMD is approximately 6 per 100,000 individuals. 1,2,3,4

What are the symptoms of DMD?

Muscle weakness is the principal symptom of DMD. It can begin as early as age 2 or 3, first affecting the proximal muscles (those close to the core of the body) and later affecting the distal limb muscles (those close to the extremities). Usually, the lower external muscles are affected before the upper external muscles. The affected child might have difficulty jumping, running, and walking. Other symptoms include enlargement of the calves, a waddling gait, and lumbar lordosis (an inward curve of the spine). Later on, the heart and respiratory muscles are affected as well. Progressive weakness and scoliosis result in impaired pulmonary function, which can eventually cause acute respiratory failure. For more about DMD symptoms, see Signs and Symptoms.

Becker muscular dystrophy (BMD) is a similar to DMD, but with onset usually in the teens or early adulthood. The disease course for BMD is slower and less predictable compared to DMD.

What causes DMD?

DMD was first described by the French neurologist Guillaume Benjamin Amand Duchenne in the 1860s, but until the 1980s, little was known about the cause of any kind of muscular dystrophy. In 1986, MDA-supported researchers identified a particular gene on the X chromosome that, when flawed (mutated), leads to DMD. In 1987, the protein associated with this gene was identified and named dystrophin. Lack of the dystrophin protein in muscle cells causes them to be fragile and easily damaged.

DMD has an X-linked recessive inheritance pattern and is passed on by the mother, who is referred to as a carrier. For more about the way gene mutations cause DMD, see Causes/Inheritance.

What are DMD "carriers"?

DMD carriers are females who have a normal dystrophin gene on one X chromosome and an abnormal dystrophin gene on the other X chromosome. Most carriers of DMD do not themselves have signs and symptoms of the disease, but a minority do. Symptoms can range from mild skeletal muscle weakness or cardiac involvement to severe weakness or cardiac effects and can begin in childhood or adulthood. For more, read Females and DMD in Causes/Inheritance.

What is the life expectancy in DMD?

Until relatively recently, boys with DMD usually did not survive much beyond their teen years. Thanks to advances in cardiac and respiratory care, life expectancy is increasing and many young adults with DMD attend college, have careers, get married, and have children. Survival into the early 30s is becoming more common than before. For more about living with DMD, see Medical Management.

What is the status of DMD research?

MDA-supported researchers are actively pursuing several exciting strategies in DMD, such as gene therapy, exon skipping, stop codon read-through and gene repair. Human clinical trials are underway for some of these strategies. For an overview of DMD research strategies and the latest research news, see Research.

On Sept. 19, 2016, the U.S. Food and Drug Administration (FDA) granted accelerated approval to eteplirsen (brand name Exondys 51) as the first disease-modifying drug for DMD. For more, see Top 5 FAQs: Eteplirsen (Exondys 51) for DMD Treatment.

On Feb. 9, 2017, the FDA approved deflazacort (brand name Emflaza) to treat DMD. For more, see FDA Approves Emflaza for Treatment of Duchenne Muscular Dystrophy.

In December 2019, Vyondys 53, an "exon skipping" drug that targets a section of DNA called exon 53 was approved by the FDA for treatment of individuals who have a confirmed mutation of the DMD gene that is amenable to a therapeutic strategy called exon 53 skipping and may help up to 8% of individuals with DMD. For more, see https://www.mda.org/press-releases/mda-celebrates-fda-approval-vyondys-53-treatment-dmd-amenable-exon-53-skipping.

In August 2020, Viltepso, an "exon skipping" drug that targets a section of DNA called exon 53. was approved by the FDA for treatment of individuals who have a confirmed mutation of the DMD gene that is amenable to a therapeutic strategy called exon 53 skipping and may help up to 8% of individuals with DMD. For more, see https://strongly.mda.org/fda-approves-ns-pharmas-viltepso-for-treatment-of-dmd-amenable-to-exon-53-skipping
For stories of families living with DMD, see our Download our Duchenne Muscular Dystrophy (DMD) Fact Sheet Learn about MDA's COVID-19 response DMD stories on Strongly, the MDA blog
References

1. Understanding Neuromuscular Disease Care. IQVIA Institute. Parsippany, NJ. (2018).

2. Ryder, S. et al. The burden, epidemiology, costs and treatment for Duchenne muscular dystrophy: An evidence review. Orphanet Journal of Rare Diseases (2017). doi:10.1186/s13023-017-0631-3

3. Moat, S. J., Bradley, D. M., Salmon, R., Clarke, A. & Hartley, L. Newborn bloodspot screening for Duchenne Muscular Dystrophy: 21 years experience in Wales (UK). Eur. J. Hum. Genet. (2013). doi:10.1038/ejhg.2012.301

4. Romitti, P. A. et al. Prevalence of Duchenne and Becker Muscular Dystrophies in the United. Pediatrics (2015). doi:10.1542/peds.2014-2044

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Duchenne Muscular Dystrophy (DMD) - Diseases | Muscular Dystrophy Association

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What is Duchenne muscular dystrophy? Duchenne muscular dystrophy (DMD) is a genetic disorder characterized by progressive muscle degeneration and weakness due to the alterations of a protein called dystrophin that helps keep muscle cells intact. DMD is one of four conditions known as dystrophinopathies.

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Information regarding Cerebral Palsy (CP)

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Information regarding Cerebral Palsy (CP)

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-CP is a disorder of movement, muscle tone or posture that is caused by damage that occurs to the immature, developing brain (most often before birth)
-may have problems swallowing and commonly have eye muscle imbalance
-can also suffer reduced range of motion at various joints of their bodies due to muscle stiffness
-can use tests like MRI, ultrasound and EEG to diagnose
-treatment includes having medical teams (therapists, social worker, and special education teacher, etc.). Some medications can lessen the tightness of muscles that can improve functional abilities

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Symptoms
-variations in muscle tone (too stiff or too floppy)
-stiff muscles and exaggerated reflexes
-lack of muscle coordination
-tremors or involuntary movements
-slow, writhing movements
-seizures
-favoring one side of the body and delays in reaching motor skills milestones
-difficulty with sucking or eating
Causes
-mutations in genes that lead to abnormal brain development
-maternal infections that affect the developing fetus
-fetal stroke, a disruption of blood supply to the developing brain
-infant infections that cause inflammation in or around the brain
-traumatic head injury to an infant from a motor vehicle accident or fall
-lack of oxygen to the brain related to difficult labor or deliver

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Learn about this group of conditions that affect movement. It’s caused by damage to the developing brain, usually before birth.

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-Brain abnormalities associated with CP may contribute to other neurological problems
*difficulty with vision and hearing
*intellectual disabilities
*seizures
*abnormal touch or pain perceptions
*oral diseases
*mental health (psychiatric) conditions
*urinary incontinence

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Recreational Therapy Interventions for CP

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Recreational Therapy Interventions for CP

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-There have been advantages in recreation opportunities in sports like rugby, soccer, and tennis for people in wheelchairs. This can help a child develop interests and enhance a child's self-concept and self-confidence.  It can also be a way to get the child active and ultimately healthier.  Simply playing a group sport can help social skills and decrease anger and anxiety.
-Children can use softer clay for ceramic pots which can improve fine motor skills.
-organized painting instruction using vibrant colors can help children with neurological connection

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Recreation therapy, also known as therapeutic recreation, focuses on designing ways in which an individual can fully participate in recreational activities of their choice. Recreation therapists work to identify the interest level, capabilities, adaptive approaches, and in some cases modified processes required to successfully complete. Inclusion in life-enhancing activities improves a child's physical, mental and social experiences.
What is recreational therapy?

We all have pastimes that we enjoy. For children affected by Cerebral Palsy, this should be no different. Our activities, whether it be swimming or playing basketball, or nurturing a love for painting or dancing, provide us with hours of pleasant leisure. Recreation enhances our ability to relate to others and engage in the environment around us.

Therefore, recreation therapy - also known as therapeutic recreation - is an important step in helping an individual with Cerebral Palsy become a well-rounded individual afforded the benefits that physical, mental, and social experiences provide. Recreation therapy focuses on inclusion, not exclusion, by allowing the individual to participate in and be an integral part of activities they enjoy and learn from.

However, recreation therapy also has another purpose - to enhance the ability of a child with Cerebral Palsy to plan, strategize and perform tasks in an effort to achieve improved physical functioning and encourage emotional well-being by facilitating inclusion into activities they benefit by and enjoy. This provides quality of life.

Recreation therapy is a treatment that helps children with Cerebral Palsy develop and expand physical and cognitive capabilities while participating in recreational activities. Though a child may participate in other therapies that specifically address physical function need, recreation therapy is specifically designed to allow children to partake in leisure pursuits by eliminating the roadblocks that impede the pursuit of sports, arts, crafts, games and other life-enhancing activities.

The 'Where there is a will, there is a way' mantra applies to recreation therapy. When children with impairment are presented with an obstacle to perform a life-enhancing activity, recreation therapists work to identify the interest level, capabilities, adaptive approaches, and in some cases modified processes required to complete the activity successfully.

Recreation opportunities have advanced through the years. Sports like rugby, soccer and tennis have been modified for individuals in wheelchairs. Hockey can be played using an innovative, custom-designed sled and extreme sports, such as modified downhill bike racing, prove that those with impairment have more sporting options - and fewer limits - than ever before.

Recreation therapy also addresses arts and cultural pursuits. Children with compromised fine motor hand strength can use softer than average clay to make ceramic pots. Organized painting instruction using vibrant colors can help children build crucial neurological connections. Artwork can be created by using specialized applications and assistive equipment. Children are participating in dance recitals using adaptive equipment, modified movements and accepted grace.

The goals of recreation therapy include:

What are the benefits of recreation therapy?

Recreation therapy has numerous benefits for children with Cerebral Palsy - it can improve physical functionality, improve neurological connections associated with processing activities, and provide opportunities for inclusion. Children involved with recreation therapy benefit within both group or solitary environments. The time spent within activities of interest decreases opportunities for depression, loneliness and frustration. In fact, recreation therapy provides a greater sense of self-worth and accomplishment.

Another benefit that a child will enjoy is the ability to take part in activities with his or her family, neighborhood children, school mates and others with like interests. When an individual is accepted into a group, other members of that group are exposed to the ever-increasing capabilities of those with impairment. Often siblings, friends, and co-workers would like to interact with individuals with Cerebral Palsy, but are discouraged by their ability to know how. Those trained in recreation that participate in activities often become examples of human possibility, understanding and inspiration for those with and without impairment.

Physical benefits of recreation therapy include:

Improved physical adeptness

Increased strength and flexibility

Improved physical fitness and health

Improved athletic prowess

Improved coordination

Psychological benefits of recreation therapy include:

Cognitive benefits of recreation therapy include:

Improved behavior

Increased analytical and decision-making skills

Improved confidence

Increased organization

Increased perception

When is recreation therapy advised?

Recreation therapy is advised by professionals in a special education setting at the child's school; through behavioral counselors that are working to build the child's self-esteem; or by concerned parents looking for enhanced opportunities for their child.

There is no specific age in which recreation therapy begins, or ends. However, recreational modalities that are introduced should always be age appropriate. Toddlers and young children will likely be introduced to light sports, playground activities, games and arts. As children get older, more organized recreational approaches, team sports, and complex creative activities such as drama and music can be introduced.

When in teen years, children may wish to participate in an area of interest such as golf, swimming, diving, dance, school plays, talent shows, or debate competitions. When adult, interests and opportunities present which may interest in the individual with impairment. The focus is on expanding interests and the ability to know opportunities once thought unavailable can be modified to accommodate. This can be empowering.

A child's medical team will assist a recreational therapist in devising recreation interventions that meet the child's treatment needs and satisfies his or her interests.

How is recreation therapy performed?

Recreation therapy makes use of activity-based interventions that are rooted in functional performance, communication, behavior, adaptation and modification to physical conditions and cognitive processes.

Plans of treatment are highly-individualized; techniques that work on one child may not easily translate to another. Recreation therapists must systematically identify any physical and emotional roadblocks; they explore adaptations and, when required, modifications. Adaptations are distinctly different from modifications in that adaptations may require the assistance of orthotics, adaptive equipment or assistive technologies, while modifications are alternate methods for a child to perform an activity. The desired result can render a limitation manageable or nonexistent, thus allowing full participation and successful inclusion opportunities.

Taking the step into recreational activities can be stressful for children with Cerebral Palsy; many of the techniques used by therapists are designed to motivate children; it's the therapist's job to instill confidence in the child. It can be frustrating for the child to learn new ways to perform or overcome obstacles. However, when the child experiences the benefit of being accepted and included into areas of their own interest, children often quickly accept and learn, especially if the learning environment is positive and supportive.

Interventions that are used include:

Where is recreation therapy performed?

Recreation therapy is performed at several locations, many of which are clinical settings. However, because recreation therapy is based on the child's capabilities and interests, therapy can take place indoors or outdoors, or any place where the individual is to engage in activities that provide pleasure and leisure.

Therapists will also instruct family members on how to engage in recreational pursuits with their child at home, or in public. At times, the recreational therapist may be on hand to assist others in learning how to include and embrace the efforts of the child with impairments, such as classrooms, gyms and community programs. In some cases, the child is enrolled in programs specifically designed for others with like impairment, thus once trained they are integrated with others who have also overcome their obstacles to participate.

Indoor locations include:

Outdoor locations include:

Who provides recreational therapy?

Recreation therapy is provided by trained, often-certified professionals that are dedicated to empowering and enabling disabled children. Most therapists earn a bachelor's degree in recreation therapy, but others receive degrees in other health-related fields of study. Therapists will most likely have also completed an on-site internship as part of their education.

Required coursework for recreations therapists include:

Certification is not required in all states; however, it's considered desirable by employers, especially those in a clinical setting. For more information, contact your state's medical licensing board.

Certification is obtained through the National Council for Therapeutic Recreation Certification, which offers the Certified Therapeutic Recreation Specialist credential. Applicants must have completed a bachelor's degree from an approved degree program, pass the CTRC written exam, and successfully complete a 480-hour internship.

Additionally, therapists may obtain specialty licensure in specific areas of practice, including behavioral health, physical rehabilitation, or developmental disabilities, to name a few. Certified therapists are required to reapply every five years, and as part of the process must show additional professional work experience or education, or take the national exam.

What happens during recreational therapy?

Parents are typically relieved to learn there are so many opportunities for their child to participate. Children are empowered by the possibilities, particularly if they can socialize with their peers.

For a child - typically one with more severe physical impairment - to be included, an evaluation is made of the child's capabilities, interests, temperament and adaptive needs by a therapist. Therapists consult with the child's primary care physician to coordinate treatment plans. They also consult with the child's physical and occupational therapists to ascertain ability levels already achieved. Therapists also analyze the child's support team, daily routines and social skills.

A recreation therapist will then fully analyze the physical and cognitive functioning required to perform the activities of interest, including the physical demands of mobility and function, the cognitive process of learning, processing and decision-making, as well as the emotional demand of performance, interaction and competition. Adaptation and modification methods may be incorporated, if needed.

Evaluation may include:

Review of medical records

Observation in a clinical setting

Standardized tests

Collaboration with other medical team members

A therapist will then outline a plan of treatment. Before a plan is implemented, a therapist must determine several factors, including:

Whether the plan meets a child's interests and goals

How a child's body mechanics enhance, or impede, an activity

What, if any, assistive and adaptive equipment is needed

If a child needs additional coping strategies

If a child requires enhanced social skills for group activities

How to incorporate positive support systems during therapy

The treatment plan may employ several strategies to help a child develop solutions to physical, cognitive and social gaps. For instance, a child that is shy, or uncomfortable in social situations might be placed in more group activities so that he or she has an opportunity to build socials skills along with mastering the activity.

Therapists will also teach children how to use any specialized equipment that is required for activities, and will teach children alternate methods to engage in activities. This may include teaching a child how to properly position himself or herself for specific activities, how to pace for physically taxing activities like sports, and how to breathe throughout the process.

Therapists must also identify and inform children and caregivers of local community resources programs and transportation that could further their opportunities for recreation beyond therapeutic and school settings. They may have access to funding sources that may be required to cover expenses beyond that which the health insurance may cover.

Therapists also show parents and caregivers how to maintain and properly clean the equipment. In some activities, equipment must be worn and used in a manner that does not harm the child. Safety guidelines are provided.

Throughout therapy, the recreation therapist will continually assess a child's level of participation and progress, and will make changes to a child's treatment plan as they are required.

Are there special considerations or risks to recreational therapy?

As with all activities - especially sports - a certain level of risk is involved. However, when a child is being treated by a qualified therapist that has implemented a well-thought out treatment plan, the risk is minimized and continually supervised and monitored until safety levels are obtained.

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Recreation therapy, also known as therapeutic recreation, focuses on designing ways in which an individual can fully participate in recreational activities of their choice. Recreation therapists work to identify the interest level, capabilities, adaptive approaches, and in some cases modified processes required to successfully complete.

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diplegia: paralysis of corresponding parts on both sides of the body, typically affecting the legs more severely than the arms
hemiplegia: paralysis of one side of the body
quadriplegia: paralysis of all four limbs or of the entire body below the neck
ataxia: loss of coordination of the muscles, especially of the extremities
dysarthria: any of certain disorders of articulation, as stammering or stuttering, caused by a nerve defect
spasticity: pertaining to, of the nature of, or characterized by spasm, especially tonic spasm
contractures: a shortening or distortion of muscular or connective tissue due to spasm, scar, or paralysis of the antagonist of the contracting muscle
osteopenia: a condition of bone in which there is a generalized reduction in bone mass that is less severe than that in osteoporosis, caused by the resorption of bone at a rate that exceeds bone synthesis

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Basic information regarding Spinal Cord Injury (SCI)

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Basic information regarding Spinal Cord Injury (SCI)

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-SCI is damage to any part of the spinal cord or nerves at the end of the spinal canal.  It often causes permanent changes in strength, sensation, and other body below the site of injury
-symptoms
*loss of movements
*loss of altered sensation
*exaggerated reflex activites or spasms
*pain or intense stinging sensation
*difficulty breathing, coughing or clearing secretions from your lungs
-Causes
*motor vehicle accidents, falls, acts of violence, sports and recreation injuries, alcohol, diseases
-Diagnosis
*Can use tests like X-rays, CT scans, and MRIs
-Treatment
*There's no way to reverse damage to the spinal cord, but prostheses and medications are available.

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-Grade A: complete sensory or motor function loss below the level of injury
-Grade B: sensation is persevered below the level of injury, but motor function is lost
-Grade C: motor function below the level of injury is preserved, with more than half of the main muscles receiving a less than 3 grade on the ASIA motor score
-Grade D: motor function below the level of injury is preserved, with more than half of the main muscles receiving at least 3 or greater grade on he ASIA motor score
Grade E: normal sensation and motor function

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Spine specialists who diagnose and treat traumatic spinal cord injuries (SCI) utilize a classification system to evaluate and grade a patient's injury in terms of severity. Classification can be likened to a universal language all SCI specialists speak. The grading of an injury improves communication across different medical specialties.

Furthermore, classifying the type and severity of SCI can help patients better understand the extent of their functional and neurological injury and potential for improvement.

How Doctors Classify Spinal Cord Injury

Doctors all over the world classify SCI using a method developed by the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). If your doctor suspects an SCI, he or she may conduct the ISNCSCI exam shortly after you arrive in the hospital.

The ISNCSCI is based on 3 scores:

1. American Spinal Injury Association (ASIA) motor score, which grades muscle strength and movement.

2. The ASIA sensory score, which grades light touch and pinprick feeling.

3. The ASIA Impairment Scale grade, which determines whether the injury is complete or incomplete.

More about the ASIA Impairment Scale
The ASIA Impairment Scale assigns the SCI a grade based on its severity. Grades range from A to E, with A being the most severe injury and E being the least severe.

Grade A
Complete sensory or motor function loss below the level of injury.

Grade B
Sensation is preserved below the level of injury, but motor function is lost.

Grade C
Motor function below the level of injury is preserved, with more than half of the main muscles receiving a less than 3 grade on the ASIA motor score.

Grade D
Motor function below the level of injury is preserved, with more than half of the main muscles receiving at least a 3 or greater grade on the ASIA motor score.

Grade E
Normal sensation and motor function.

Complete and Incomplete Spinal Cord Injuries
The ASIA Impairment Scale determines the category of SCI, which typically is complete or incomplete. A third, less common category- discomplete -refers to complete injuries that show some signs of brain-muscle connectivity.

Complete SCI occurs when there's a total loss of function (motor) and feeling (sensory) below the injury level. For example, a thoracic injury may start at the torso and arms level, but it will also affect the low back, pelvis, groin, tailbone, legs, and toes. Complete SCI affects both sides of the body equally.

With incomplete SCI, some function and feeling remain below the injury level. Typically, one side of the body has more function or feeling than the other side. There are different types, or syndromes, of incomplete SCI, including central cord syndrome, Brown-Séquard syndrome, anterior cord syndrome, and posterior cord syndrome.

Spinal Cord Injury Syndromes

Central cord syndrome
Central cord syndrome is the most common incomplete SCI syndrome, occurring in 15-25% of traumatic SCIs. Central cord syndrome is common in elderly patients with a history of cervical spondylosis and spinal stenosis who suffer a SCI from a traumatic fall. As the name suggests, this syndrome affects the central part of the spinal cord. The central spinal cord contains large nerve fibers that exchange information between the spinal cord and the cerebral cortex. The cerebral cortex is important to personality, interpreting sensation (feeling), and motor function. The central spinal cord is important for hand and arm function, such as fine motor control (eg, writing), although the lower body may also be affected (eg, loss of bladder control).
Brown-Séquard syndrome
Brown-Séquard syndrome most often occurs in patients who suffered a penetrating traumatic SCI, such as a bullet or knife wound. This syndrome affects either the left or right side of the spinal cord, but symptoms can affect both sides of the body. It is characterized by partial loss of function or impaired function, a vibrating sensation on the same side of the injury, and pain and temperature loss on the opposite side of the injury.

Anterior and posterior cord syndromes
The anterior spinal cord is the front section of the structure, and the posterior spinal cord is the back. These syndromes are most common in people with non-traumatic SCI as opposed to traumatic SCI. Anterior cord syndrome causes complete loss of movement, and pain and temperature loss, but it preserves light touch sensations. Posterior cord syndrome produces the opposite effect: It causes loss of light touch sensation, but it preserves movement, and pain and temperature sensation.

Early Classification Leads to the Right Treatment at the Right Time

The ability for spine doctors worldwide to uniformly classify spinal cord injury allows them quickly to understand the SCI's severity, including the associated SCI syndromes. With traumatic injury-and certainly spinal cord injury-time plays a critical role in outcomes. Having a standard SCI classification system helps patients get the right treatment earlier.

Suggested Additional Reading
A special issue of theGlobal Spine Journal set forth guidelines for the Management of Degenerative Myelopathy and Acute Spinal Cord Injury, which is summarized on SpineUniverse in Summary of the Clinical Practice Guidelines for the Management of Degenerative Cervical Myelopathy and Traumatic Spinal Cord Injury.

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Michael G. Fehlings, MD, PhD, FRCSC, FACS

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Spinal Cord Injury Classification and Syndromes

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Spine specialists who diagnose and treat traumatic spinal cord injuries (SCI) utilize a classification system to evaluate and grade a patient's injury in terms of severity. Classification can be likened to a universal language all SCI specialists speak. The grading of an injury improves communication across different medical specialties.

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Cervical injuries- (C1-C7) is at the top of the spine and forms the neck. Spinal cord damage in the vertebrae within the cervical spine is the most serious because it can result in loss of function to all areas below the neck
-Thoracic injuries: (T1 to T12) forms the upper portion of the backbone.  This type of injury typically affects the middle of the body and the legs, potentially resulting in paraplegia.
-lumbar injuries- (L1-L5) are the five vertebrae below the thoracic section.  Spinal cord damage here can lead to loss of function at or below the hips and legs.
Sacral injuries- (S1-S5) form the base of the spine or tailbone. Can cause some loss of function at or below the hips and legs.

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Spinal cord injuries are severe instances of damage to the spine which require immediate medical attention. The higher up in the spinal cord the injury occurs..

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-Bladder and bowel control: brain may not be able to control your bladder and bowel as well because of damage to message carrier
-skin sensation: below the injury, you may have lost part or all skin sensations which means you will not know when you are injured by prolonged pressure, heat, or cold.
Circulatory control: may be low blood pressure when you rise to swelling of your extremities.  Can increase your risk of developing blood clots.
-Respiratory system: may make it more difficult to breathe and cough if your abdominal and chest muscles are affected.
-Muscle tone: Can experience uncontrolled tightening or motion in the muscles or soft and limp muscles lacking muscle tone
-Fitness and wellness: weight loss and muscle atrophy due to limited mobility .  This can put you at risk for obesity, cardiovascular disease, and diabetes.
- Sexual health: sexuality, fertility, and sexual function may be affected by SCI.
-Pain: muscle or joint pain for overuse of a particular muscle groups.  Also may experience nerve pain.
Depression: coping with changes from a SCI can be difficult

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Spinal cord injury - Symptoms and causes

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Learn what may happen after the spinal cord has been damaged.

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tetraplegia: paralysis caused by illness or injury that results in the partial or total loss of use of all four limbs and torso
paraplegia: paralysis of the legs and lower body, typically caused by spinal injury or disease
complete vs. incomplete injury: complete spinal cord injuries refer to an injury that results in the complete loss of function below the point of injury. While an incomplete
injury refers to a spinal cord injury in which some feeling or movement is still evident below the point of injury
autonomic dysreflexia: a condition where your involuntary nervous system overreacts to external or bodily stimuli causing a dangerous spike in blood pressure
pressure ulcer: localized damage to the skin and/or underlying tissue that usually occur over a bony prominence as a result of pressure or pressure in combination with shear or friction

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pressure ulcer: pressure injuries are localized damage to the skin and/or underlying tissue that usually occur over a bony prominence as a result of pressure or pressure in combination with shear and/or friction.
incontinence: lack of voluntary control over urination or defecation
delirium: serious disturbance in mental abilities that results in confused thinking and reduced awareness of the environment
dementia: a chronic or persistent disorder of the mental processes caused by brain disease or injury and marked by memory disorders, personality changes, and impaired reasoning.

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predominant age: Increasing gage is the greatest risk factor for Alzheimer's.  The majority of people with Alzheimer's are 65 and older.  There can be people that have early-onset Alzheimer's which occurs before the age of 65.
Causes: a combination of genetic, lifestyle, and environmental factors that affect the brain over time.   The causes of Alzheimer’s Disease are not yet understood, but its effect on the brain is clear.  The disease damages and kills brain cells.  There are fewer connections among neurons in a person’s brain that has Alzheimer’s Disease. The collection of beta-amyloid protein outside of brain cells interferes with cell-to-cell communication.  Another protein, tau, twist into abnormal tangles inside brain cells causing a failure of the transport system.
Risk Factors:

-Age

-family history and genetics

-down syndrome

-women are more likely to develop the disease

-People with mild cognitive impairment

-past head trauma

-lifestyle and heart health

Systems affected:
Central Nervous System: brain abnormalities have been identified in patients with the disease. As the disease progresses, problems with memory and learning occur

Digestive System: swallowing difficulties occur with people with Alzheimer Disease.  They can also have difficulty eating without chocking.  Pneumonia remains a common cause of death among people with Alzheimer’s disease.

Neuromuscular System: People with advance Alzheimer’s Disease lose the ability to use their muscles in purposeful ways.  They can lose the ability to maintain posture and even walk.

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Alzheimer’s disease - Symptoms and causes

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Understand more about this brain disorder that’s the most common cause of dementia. Also learn about new tests and medicines on the market.

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Define Lewy Body Neurocognitive Disorders (NCD): Protein deposits, called Lewy bodies, develop in nerve cells in the brain regions involved in thinking, memory, and movement. It causes a progressive decline in mental abilities because people with NCD can experience visual hallucinations, and changes in alertness and attention.
Two related diagnoses:
-Parkinson's Disease: A progressive nervous system disorder that affects movement.  In the early stages of the disease, the individual’s face may show little or no expression, their arms may not swing when they walk, and their speech may become soft or slowed.
-Huntington's Disease: An inherited disease that causes the progressive breakdown of nerve cells in the brain.  It has a big impact on a person’s functional abilities and usually results in movement, thinking and psychiatric disorders.

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Lewy body dementia - Symptoms and causes

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This common dementia is caused by a buildup of proteins in the brain. It affects thinking, memory and movement.

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-It is important to understand that people with NCD progress at different rates and their strengths and challenges are all different.

-Communication with family members can be crucial to see what the individual’s hobbies are if they can no longer recall.

-sometimes joy can be rediscovered by participating in the interests the person had before the disorder progressed

-making goals and reviewing them regularly with the client is also beneficial.  It can improve their mood if they know they are improving and growing.

-doing activites in groups can also be beneficial socially for the client

-active games involving gross motor skills might be useful to keep their muscles active and stronger

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Neurocognitive Disorders affecting the family

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Neurocognitive Disorders affecting the family

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-can be a 24/7 job because the family member might need help doing daily tasks (bathe and dress)

-caregiver might need to manage medications or talking to doctors

-taking care of household chores, meals, or bills

-it can be difficult to watch an important member of family lose his/her attitudes and cognitive capacities.

-when providing care for a loved one, sometimes the caregiver can neglect their own needs

-often times the role of caregiver is unexpected, undesirable, and underappreciated so it can take a tole on the caregiver’s health

-can cause stress because the caregiver feels scared, frustrated, angry and depressed

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Ph.D. Program in Behavioral Neuroscience, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy

*Corresponding Author:

Iacobacci C
Ph.D. Program in Behavioral Neuroscience
Sapienza University of Rome
Via dei Marsi 78, 00185 Rome, Italy
Tel: + 3335476405
E-mail: [email protected]

Received date: July 12, 2017; Accepted date: July 20, 2017; Published date: July 27, 2017

Citation: Iacobacci C (2017) Neurocognitive Disorder as a Family Illness. Clin Exp Psychol 3: 158. doi: 10.4172/2471-2701.1000158

Copyright: © 2017 Iacobacci C. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Visit for more related articles at Clinical and Experimental Psychology

Abstract

Becoming a caregiver for members of their own family with neurocognitive disorder or dementia like Alzheimer's disease, frontotemporal dementia or dementia with Lewy bodies means take a new and unexpected role.

Neurocognitive Disorder

Becoming a caregiver for members of their own family with neurocognitive disorder or dementia like Alzheimer's disease, frontotemporal dementia or dementia with Lewy bodies means take a new and unexpected role.

A caregiver can be defined as an unpaid person who helps another individual who has a chronic physical or psychological impairment and takes responsibility for him.

Typical duties of a caregiver might include managing medications or talking to doctors on someone's behalf; helping to bathe or dress someone; or taking care of household chores, meals, or bills for someone who cannot do these things alone. Becoming a caregiver for members of their own family means to take care of an adult person which cares of us in every moment.

We thought that the neurocognitive disorders were characteristic of aging and people over 65 years of age would have more risk to be affected by them. Instead today more people younger than 65 years receive a diagnosis of dementia (early-onset dementia or EOD). EOD is often misdiagnosed or its diagnosis is delayed because it has a more varied differential diagnosis than late-onset dementia. In case of EOD, often, the first symptoms are changes in personality or mood, confused with a mood disorder. For this reason, for the specialist get accurate diagnosis and treatment promptly are more difficult. EOD affects individuals at the height of their career and productivity and produces devastating consequences and financial loss for the patient's family as well as society [ 1].

It is heartbreaking and painful to watch an important member of family lose his attitudes and his cognitive capacities. For example, it is heartbreaking to see a mother lose their ability to care for her house and to go grocery shopping. It is painful to see a mother that can't cook anymore. It is heartbreaking to see a father that can't no longer walk the dog or go to the bank. In this case the major role of mother and father, or husband or wife can be lost within the family. The loved one can lose the ability to take care of himself and of the other members of family.

The neurocognitive disorder, when diagnosed, distresses all members of the family not only the person affected but all members of the family. The family members have to change their role becoming a caregiver in addition to being a son, a daughter, a father, a wife and a husband. The role of caregiver is an unexpected, undesirable, underappreciated role. No one could have expected that the loved one lost his abilities, so we are not prepared to become a caregiver. Moreover, when providing care for a loved one, caregivers can often neglect their own needs. This neglect, over time, can exact a heavy toll on the overall well-being of a caregiver. Became a caregiver means taking on a new role. It's a job.

It requires training and an attitude that allows you to take care of yourself as well as your own. It's not simple. Caregiving can affect the psychological and physical state, the relationship, the productivity of labor. Caregiving can lead to stress and can be dangerous for the caregiver. Prolonged periods of stress can lead to the situation called "burn-out". The burn-out is a severe condition that affects humor. A caregiver in "burn-out" can feel exhausted, listless, and unable to cope. This condition might affect the relation with loved one [ 2- 4].

It's more difficult to become the caregiver of a young person. Sometimes we think that his difficulties are questions of will. We think that the abnormal behavior is spiteful of us. It's relatively easy to accept the difficulties in older people than in younger.

The caregivers passes through a lot of emotions. They may feel scared, frustrated, angry, depressed, resigned because it is difficult to accept the disease of the loved one. To prevent the burn-out of caregivers it is of vital importance to seek professional help. It's of vital importance to know as much as we can about the illness. A professional can try to teach the manner to support the loved one. It's important to be able to talk about our concerns. The caregiver must put his self to the level of the loved one. The worst attitude is to persevere in a behavior without realizing that the situation in the family has changed.

The education about the disease reveals to caregivers the ways in which these diseases gradually erode the person's ability to use normal intellectual potential, the difficulty to maintain emotional balance, the difficulty to plan and to carry out daily actions. Education can help the caregiver to communicate with the loved one when he is not able to do, to attract his attention, to understand the memory loss. We aren't born knowing how to communicate with a person with neurocognitive disease but we can learn. To learn we need a change of mood and acceptance. I think that the complete acceptance of the neurocognitive disease is very difficult for the family members.

Despite therapeutic journey in which the caregiver learns modalities to interact with the loved one, the acceptance is "incomplete". We learn to understand the disease and live together with. But every day we feel the loss in the heart.

In this case, we, psychologists play a very important role. We must be able to support the family members, we must listen to the concerns without judgment. We must be able to help the caregiver find the best way to interact with the loved one. We must help to face challenges and the emotions that change depending on the needs of the moment.

Initially the caregiver will get attention to the worries, to the changes in his life. In time, improving caregivers skills will help make caregiving less stressful and will likely improve the quality of the relationship with loved one.

The caregivers must learn to be empathic, patient, flexible and supportive.

In fact, caregiver's awareness of the disease is crucial because it facilitates the understanding of the needs of the patient and therefore facilitates the care. With the right information, resources and tips on caregiving the caregiver can become expert at both caring for your charge and taking care of himself.

References

1. Fadil H, Borazanci A, Ait Ben Haddou E, Yahyaoui M, Korniychuk E, et al. (2009) Early onset dementia. Int Rev Neurobiol 84: 245-62.

2. Annerstedt L, Elmstahl S, Ingvad B, Samuelsson SM (2000) Family caregiving in dementia - An analysis of the caregiver's burden and the "breaking-point" when home care becomes inadequate. Scand J Public Health 28: 23-31.

3. Hepburn K, Lewis M, Tornatore J, Sherman CW, Dolloff J (2008) Caregiver's manual. Training program for assistance to people with dementia.

4. Wood FG (1991) The meaning of caregiving rehabilitation nursing.

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Neurocognitive Disorder as a Family Illness

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Ph.D. Program in Behavioral Neuroscience, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy *Corresponding Author: Iacobacci C Ph.D. Program in Behavioral Neuroscience Sapienza University of Rome Via dei Marsi 78, 00185 Rome, Italy Tel: + 3335476405 E-mail: [email protected] Received date: July 12, 2017; Accepted date: July 20, 2017; Published date: July 27, 2017 Citation: Iacobacci C (2017) Neurocognitive Disorder as a Family Illness.

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Define PTSD and some of its possible causes

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Define PTSD and some of its possible causes

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Post-traumatic stress disorder (PTSD): a mental health condition that's triggered by a terrifying event, either experiencing it or witnessing it. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.

Causes:

-PTSD can develop when an individual goes through, sees, or learns about an event involving actual or threatened death, serious injury, or sexual violation

-stressful experiences (amount of severity of trauma you’ve gone through in your life)

-childhood abuse

-having a job that increases your risk of being exposed to traumatic events, like first responders or military personnel

-having other mental health problems, such as anxiety or depression

-having problems with substance misuse

-lack of good support system of family and friends

-having blood relatives with mental health problems

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Overview

Post-traumatic stress disorder (PTSD) is a mental health condition that's triggered by a terrifying event - either experiencing it or witnessing it. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.

Most people who go through traumatic events may have temporary difficulty adjusting and coping, but with time and good self-care, they usually get better. If the symptoms get worse, last for months or even years, and interfere with your day-to-day functioning, you may have PTSD.

Getting effective treatment after PTSD symptoms develop can be critical to reduce symptoms and improve function.

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Symptoms

Post-traumatic stress disorder symptoms may start within one month of a traumatic event, but sometimes symptoms may not appear until years after the event. These symptoms cause significant problems in social or work situations and in relationships. They can also interfere with your ability to go about your normal daily tasks.

PTSD symptoms are generally grouped into four types: intrusive memories, avoidance, negative changes in thinking and mood, and changes in physical and emotional reactions. Symptoms can vary over time or vary from person to person.
Intrusive memories
Symptoms of intrusive memories may include:

Recurrent, unwanted distressing memories of the traumatic event

Reliving the traumatic event as if it were happening again (flashbacks)

Upsetting dreams or nightmares about the traumatic event

Severe emotional distress or physical reactions to something that reminds you of the traumatic event

Avoidance
Symptoms of avoidance may include:

Trying to avoid thinking or talking about the traumatic event

Avoiding places, activities or people that remind you of the traumatic event

Negative changes in thinking and mood
Symptoms of negative changes in thinking and mood may include:

Negative thoughts about yourself, other people or the world

Hopelessness about the future

Memory problems, including not remembering important aspects of the traumatic event

Difficulty maintaining close relationships

Feeling detached from family and friends

Lack of interest in activities you once enjoyed

Difficulty experiencing positive emotions

Feeling emotionally numb

Changes in physical and emotional reactions
Symptoms of changes in physical and emotional reactions (also called arousal symptoms) may include:

Being easily startled or frightened

Always being on guard for danger

Self-destructive behavior, such as drinking too much or driving too fast

Trouble sleeping

Trouble concentrating

Irritability, angry outbursts or aggressive behavior

Overwhelming guilt or shame

For children 6 years old and younger, signs and symptoms may also include:

Re-enacting the traumatic event or aspects of the traumatic event through play

Frightening dreams that may or may not include aspects of the traumatic event

Intensity of symptoms
PTSD symptoms can vary in intensity over time. You may have more PTSD symptoms when you're stressed in general, or when you come across reminders of what you went through. For example, you may hear a car backfire and relive combat experiences. Or you may see a report on the news about a sexual assault and feel overcome by memories of your own assault.
When to see a doctor
If you have disturbing thoughts and feelings about a traumatic event for more than a month, if they're severe, or if you feel you're having trouble getting your life back under control, talk to your doctor or a mental health professional. Getting treatment as soon as possible can help prevent PTSD symptoms from getting worse.
If you have suicidal thoughts
If you or someone you know has suicidal thoughts, get help right away through one or more of these resources:

Reach out to a close friend or loved one.

Contact a minister, a spiritual leader or someone in your faith community.

Contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential.

Make an appointment with your doctor or a mental health professional.

When to get emergency help
If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately.

If you know someone who's in danger of attempting suicide or has made a suicide attempt, make sure someone stays with that person to keep him or her safe. Call 911 or your local emergency number immediately. Or, if you can do so safely, take the person to the nearest hospital emergency room.

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Causes

You can develop post-traumatic stress disorder when you go through, see or learn about an event involving actual or threatened death, serious injury or sexual violation.

Doctors aren't sure why some people get PTSD. As with most mental health problems, PTSD is probably caused by a complex mix of:

Stressful experiences, including the amount and severity of trauma you've gone through in your life

Inherited mental health risks, such as a family history of anxiety and depression

Inherited features of your personality - often called your temperament

The way your brain regulates the chemicals and hormones your body releases in response to stress

Risk factors

People of all ages can have post-traumatic stress disorder. However, some factors may make you more likely to develop PTSD after a traumatic event, such as:

Experiencing intense or long-lasting trauma

Having experienced other trauma earlier in life, such as childhood abuse

Having a job that increases your risk of being exposed to traumatic events, such as military personnel and first responders

Having other mental health problems, such as anxiety or depression

Having problems with substance misuse, such as excess drinking or drug use

Lacking a good support system of family and friends

Having blood relatives with mental health problems, including anxiety or depression

Kinds of traumatic events
The most common events leading to the development of PTSD include:

Combat exposure

Childhood physical abuse

Sexual violence

Physical assault

Being threatened with a weapon

An accident

Many other traumatic events also can lead to PTSD, such as fire, natural disaster, mugging, robbery, plane crash, torture, kidnapping, life-threatening medical diagnosis, terrorist attack, and other extreme or life-threatening events.

Complications

Post-traumatic stress disorder can disrupt your whole life - your job, your relationships, your health and your enjoyment of everyday activities.

Having PTSD may also increase your risk of other mental health problems, such as:

Depression and anxiety

Issues with drugs or alcohol use

Eating disorders

Suicidal thoughts and actions

Prevention

After surviving a traumatic event, many people have PTSD-like symptoms at first, such as being unable to stop thinking about what's happened. Fear, anxiety, anger, depression, guilt - all are common reactions to trauma. However, the majority of people exposed to trauma do not develop long-term post-traumatic stress disorder.

Getting timely help and support may prevent normal stress reactions from getting worse and developing into PTSD. This may mean turning to family and friends who will listen and offer comfort. It may mean seeking out a mental health professional for a brief course of therapy. Some people may also find it helpful to turn to their faith community.

Support from others also may help prevent you from turning to unhealthy coping methods, such as misuse of alcohol or drugs.

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Post-traumatic stress disorder (PTSD) - Symptoms and causes

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Post-traumatic stress disorder (PTSD) is a mental health condition triggered by a terrifying event, causing flashbacks, nightmares and severe anxiety.

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Endocrine system: hormonal disruption (produce less of primary stress hormone cortisol, as bodies have learned to adapt to ongoing stress) Also can be diagnosed with depression and anxiety too.

Nervous system: the parts of the brain responsible for activating the stress response become more efficient.  Brain structures that handle memory, learning, and cognitive processing shrink.  EEG analysis from the brains of veterans have difficulty coordinating information from multiple sensory channels.  Insomnia is common for people with PTSD.

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Our understanding of human development has been enriched over the past four decades by an "awful gift" in the form of research into posttraumatic stress disorder (PTSD). I have been the primary investigator in many studies of PTSD published in peer-reviewed journals, and trained thousands of medical and mental health professionals, as well as life coaches, in effective treatments.

The work of these dedicated professionals in places like Fort Hood, the largest US Army base, has shown that PTSD isn't just a psychological disorder; it's a physical one too. PTSD affects the body as well as the mind, and the link was apparent to doctors as early as the American Civil War.

When writing a recent scientific review entitled Psychological Trauma: Healing Its Roots in Brain, Body, and Memory (Church, 2015), I was struck by how many physical changes PTSD can produce. When normal human development is interrupted by shattering events, profound disruption is produced in both brain and body.

I'd like to share five of the physical signs of PTSD with you, because you may recognize them in yourself, your loved ones, or your friends. You might have noticed these characteristics in others without realizing they may be linked to trauma.

Among them are are hormonal disruption, adverse brain remodeling, physical coordination problems, insomnia, and disease. Let's look at each of these in turn.

Hormonal Disruption. A 20-year longitudinal study of women who were sexually molested as children showed profound physical and mental changes (Trickett et al., 2011). Their hormonal cycles were disrupted and they entered puberty an average of 18 months earlier.

Androstenedione and testosterone, hormones that stimulate libido, were three to five times higher than normal. When stressed, they produced less of the primary stress hormone cortisol, as their bodies had learned to adapt to ongoing stress. They had high levels of obesity, major illness, depression, dissociation, and self-mutilation.

Another study followed abused children for 30 years, all the way into adulthood (Sroufe et al., 2010). The investigators found that by late adolescence, half of them had been diagnosed with mental health disorders such as anxiety, depression, and PTSD. They were unable to form healthy emotional bonds with teachers, peers, and caregivers.

Brain Remodeling. Our brains are constantly building new neural pathways, a process known as "neurogenesis." When we're learning to play the oboe, improve our golf swing, court a new lover, or learn French, this works to our advantage. We build new neural capacity as we practice, and we quickly improve our abilities.

Yet there's a dark side to neurogenesis. When we're chronically stressed, we increase the signaling capabilities of the neural circuits that carry those signals, at the expense of healthy brain function. In people suffering from PTSD, the parts of the brain responsible for activating the stress response become more efficient, while brain structures that handle memory, learning, and cognitive processing actually shrink (Vasterling & Brewin, 2005).

The eyes are extensions of the brain. During WWII, a British ophthalmologist named Harry Moss Traquair observed abnormalities in the eye movements of traumatized veterans (Traquair, 1944). His work was forgotten after the war until the 2000s when new studies of EMDR and EFT demonstrated the link between eye movements and PTSD. Research shows that these therapies, both of which utilize eye movements, cure most cases of PTSD in 4-10 treatment sessions (Bisson et al., 2013; Karatzias et al., 2011).

Physical Coordination Problems. Clinicians working with veterans with PTSD have been struck by their lack of physical coordination. Bessel van der Kolk, a psychiatrist formerly in charge of the physical exercise program at a Harvard hospital, found that veterans who moved with graceful assurance before combat had trouble coordinating the movement of their limbs afterward (van der Kolk, 2014). Electroencephalograph (EEG) analysis shows that the brains of veterans have difficulty coordinating information from multiple sensory channels into a coherent unified picture (Church, 2015).

Insomnia. People with PTSD have high levels of insomnia. During a randomized controlled trial of 59 veterans that I conducted with a group of colleagues, their insomnia scores were 19 on a scale on which 15 indicates severe clinical symptoms. That's typical, and nightmares often interrupt their sleep. After six treatment sessions using EFT, however, PTSD symptoms had normalized in over 80% of the participants, and their insomnia scores had dropped to 11 (Church, Hawk, et al., 2013).

Disease. Veterans need the services of doctors and hospitals much more often than average, and have high rates of cancer, heart disease, and other major illnesses.

From the list above, you'll see that although the profession of psychology classifies PTSD as a mental health condition, like anxiety or depression, it is actually rooted in the physical body as well as the mind. It compromises sleep, digestion, neural function, hormone levels, and immunity. It promotes inflammation and many different types of physical disease. Besides its immense cost in suffering, it costs a great deal of money, with the national bill for treating PTSD in veterans estimated to top a trillion dollars (Church, 2014).

The physical disease, inflammation, brain rewiring, and hormonal disruption caused by PTSD can be avoided by appropriate mental health intervention. Recent studies show that evidence-based treatments like EFT and EMDR are able to reduce or eliminate most symptoms in six or fewer therapy sessions.

So if you've noticed the symptoms of PTSD in yourself or a loved one, it's worth seeking help. Both the physical and psychological effects can be treated successfully, and there's no need to repeat the suffering of earlier generations.

Traquair, H. M. (1944). An Introduction to Clinical Perimetry (4th ed.). St. Louis, MO: C. V. Mosby.

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PTSD Affects the Body as Well as the Mind

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Our understanding of human development has been enriched over the past four decades by an "awful gift" in the form of research into posttraumatic stress disorder (PTSD). I have been the primary investigator in many studies of PTSD published in peer-reviewed journals, and trained thousands of medical and mental health professionals, as well as life coaches, in effective treatments.

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People with PTSD are more likely to experience:

-arthritis

-heart-related problems and disease

-respiratory system

-digestive problems and disease

-reproductive system

-diabetes

-pain

-substance misuse involving alcohol, 🤬, caffeine, or nicotine to cope with symptoms

-depression, including the risk of suicide

-anxiety, such as panic disorder, that can lead to additional restrictions because they avoid the trigger

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This guideline is concerned with the diagnosis, early identification and treatment of post-traumatic stress disorder (PTSD) as defined in ICD-10 (World Health Organization, 1992), code number F43.1. This disorder is one that people may develop in response to one or more traumatic events such as deliberate acts of interpersonal violence, severe accidents, disasters or military action.

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Five categories of symptoms for Schizophrenia

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Five categories of symptoms for Schizophrenia

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Delusions. These are false beliefs that are not based in reality. For example, you think that you're being harmed or harassed; certain gestures or comments are directed at you; you have exceptional ability or fame; another person is in love with you; or a major catastrophe is about to occur
Hallucinations. These usually involve seeing or hearing things that don't exist. Can be in any of the senses, but hearing voices is the most common hallucination.
Disorganized thinking (speech). Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated.
Negative symptoms. This refers to reduced or lack of ability to function normally. For example, the person may neglect personal hygiene or appear to lack emotion

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This severe mental disorder can result in hallucinations, delusions, and extremely disordered thinking and behavior that interfere with daily living.

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-no known cause for schizophrenia, but researchers believe it is a combination of genetics, brain chemistry, and environment

-problems with brain chemical like dopamine and glutamate

-different brain and central nervous system structures

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Explain the systems affected by Schizophrenia

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Explain the systems affected by Schizophrenia

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Nervous system: Schizophrenia mainly affects the nervous system because it is a disorder in which people interpret reality abnormally.  It can include hallucinations, delusions, and extremely disordered thinking and behavior that impairs daily functioning, and can be disabling

*can lead to suicide, self-injury, anxiety and OCD, depression, abuse of alcohol and other 🤬, inability to attend work or school, legal and financial problems and homelessness, social isolation, health and medical problems due to poor hygiene, being victimized, and aggressive behavior

Immune system: it has been found that before a person is on medication, they can have an overactive immune system

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Schizophrenia is considered a disorder of the mind, influencing the way a person thinks, feels and behaves. But our latest research shows that organs, other than the brain, also change at the onset of the disease.

Scientists have known for a long time that people with schizophrenia have much higher rates of physical illness compared with the general population, and this contributes to startlingly high rates of premature death. People with the disorder die 15 to 20 years earlier than the average person.

This poor physical health has often been seen as a secondary effect of illness. Antipsychotic drugs, for example, are associated with an increased risk of weight gain and type 2 diabetes. Lifestyle factors have been thought to play a part, too. A person with debilitating mental symptoms is more likely to forgo exercise and have a poor diet.

However, in recent years, scientists have observed that people who have recently been diagnosed with schizophrenia and who aren't on any medication yet show evidence of physiological changes, such as an overactive immune system. Could it be that schizophrenia is in fact a body-wide disorder?

My colleagues and I examined evidence of physiological changes around the body at the onset of schizophrenia and compared it with evidence of changes within the brain in the same group of people. We pooled data from multiple studies, examining markers of inflammation, hormone levels and heart disease risk factors, including glucose and cholesterol levels. We also pooled data from studies examining brain structure, levels of different chemicals within the brain, and markers of brain activity.

We showed that compared with the general population, early schizophrenia is associated with changes in brain structure and function. We also showed that early schizophrenia is associated with various changes around the body. We calculated the magnitude of these changes using a statistical measure known as the effect size. At the onset of schizophrenia, we observed that there was no difference in the effect size for changes within the brain compared with the effect size for changes around the body, suggesting that schizophrenia might indeed be a whole-body disorder, and one that should be treated as such.
Three possible explanations
There are three theories that might explain how alterations within the brain might be associated with alterations around the body in schizophrenia.

First, dysfunction around the body may cause changes in the brain, ultimately leading to schizophrenia. This process has been seen in certain rare cancers that produce antibodies that target the brain and trigger psychosis. If the tumour is removed, the psychotic experiences improve.

Second, symptoms of schizophrenia may result in physical health disorders. An example of this is the stress of psychosis resulting in raised levels of the steroid hormone cortisol. High levels of cortisol are associated with weight gain, diabetes and raised blood pressure.

Third, symptoms of schizophrenia and physical health disorders may arise via different mechanisms but from a common risk factor. An example of this is how famine experienced by a pregnant mother increases the chances of her child developing both diabetes and schizophrenia in adult life. The increased risk of schizophrenia may be due to impaired development of the child's brain as a result of the mother's malnutrition. The increased risk of diabetes may be due to changes in the child's ability to metabolise glucose, again a result of the mother's malnutrition.
Work still to be done
We need to do more work to figure out whether changes around the body are a cause or a consequence of schizophrenia. One approach is to look at those people who are at risk of developing schizophrenia to see how changes around the body evolve in the ones who develop schizophrenia compared with those who don't. More work is also needed to see how changes around the body respond to changes in the severity of symptoms of schizophrenia.

Finally, most premature deaths seen in schizophrenia are due to cardiovascular disease. Life expectancy in schizophrenia has failed to improve over recent decades. Studies are needed to determine if addressing physical health early on will reduce mortality in schizophrenia.
Toby Pillinger is a doctor and clinical researcher at King's College London. This article was first published in The Conversation ( theconversation.com )

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Schizophrenia affects your body, not just your brain

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Schizophrenia is considered a disorder of the mind, influencing the way a person thinks, feels and behaves. But our latest research shows that organs, other than the brain, also change at the onset of the disease.

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Hallucination: A profound distortion in a person's perception of reality, typically accompanied by a powerful sense of reality. An hallucination may be a sensory experience in which a person can see, hear, smell, taste, or feel something that is not there
Delusion: A false personal belief that is not subject to reason or contradictory evidence and is not explained by a person's usual cultural and religious concepts
Psychosis: losing touch with reality and seeing, hearing, or believing things that aren’t real
Anhedonia: a psychological condition characterized by inability to experience pleasure in normally pleasurable acts

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Define Major Depressive Disorder and its symptoms

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Define Major Depressive Disorder and its symptoms

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MDD: a mood disorder that causes a persistent feeling of sadness and loss of interest. It affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn't worth living.
Symptoms:

Feelings of sadness, tearfulness, emptiness or hopelessness

Angry outbursts, irritability or frustration, even over small matters

Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports

Sleep disturbances, including insomnia or sleeping too much

Tiredness and lack of energy, so even small tasks take extra effort

Reduced appetite and weight loss or increased cravings for food and weight gain

Anxiety, agitation or restlessness

Slowed thinking, speaking or body movements

Feelings of worthlessness or guilt, fixating on past failures or self-blame

Trouble thinking, concentrating, making decisions and remembering things

Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide

Unexplained physical problems, such as back pain or headaches

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Overview

What is depression? A Mayo Clinic expert explains.

Learn more about depression from Craig Sawchuk, Ph.D., L.P., clinical psychologist at Mayo Clinic.

Hi, I'm Dr. Craig Sawchuk, a clinical psychologist at Mayo Clinic. And I'm here to talk with you about depression. Whether you're looking for answers for yourself, a friend, or loved one, understanding the basics of depression can help you take the next step.

What is depression?

Depression is a mood disorder that causes feelings of sadness that won't go away. Unfortunately, there's a lot of stigma around depression. Depression isn't a weakness or a character flaw. It's not about being in a bad mood, and people who experience depression can't just snap out of it. Depression is a common, serious, and treatable condition. If you're experiencing depression, you're not alone. It honestly affects people of all ages and races and biological sexes, income levels and educational backgrounds. Approximately one in six people will experience a major depressive episode at some point in their lifetime, while up to 16 million adults each year suffer from clinical depression. There are many types of symptoms that make up depression. Emotionally, you may feel sad or down or irritable or even apathetic. Physically, the body really slows down. You feel tired. Your sleep is often disrupted. It's really hard to get yourself motivated. Your thinking also changes. It can just be hard to concentrate. Your thoughts tend to be much more negative. You can be really hard on yourself, feel hopeless and helpless about things. And even in some cases, have thoughts of not wanting to live. Behaviorally, you just want to pull back and withdraw from others, activities, and day-to-day responsibilities. These symptoms all work together to keep you trapped in a cycle of depression. Symptoms of depression are different for everyone. Some symptoms may be a sign of another disorder or medical condition. That's why it's important to get an accurate diagnosis.

What causes depression?

While there's no single cause of depression, most experts believe there's a combination of biological, social, and psychological factors that contribute to depression risk. Biologically, we think about genetics or a family history of depression, health conditions such as diabetes, heart disease or thyroid disorders, and even hormonal changes that happen over the lifespan, such as pregnancy and menopause. Changes in brain chemistry, especially disruptions in neurotransmitters like serotonin, that play an important role in regulating many bodily functions, including mood, sleep, and appetite, are thought to play a particularly important role in depression. Socially stressful and traumatic life events, limited access to resources such as food, housing, and health care, and a lack of social support all contribute to depression risk. Psychologically, we think of how negative thoughts and problematic coping behaviors, such as avoidance and substance use, increase our vulnerability to depression.

The good news is that treatment helps. Effective treatments for depression exist and you do have options to see what works best for you. Lifestyle changes that improve sleep habits, exercise, and address underlying health conditions can be an important first step. Medications such as antidepressants can be helpful in alleviating depressive symptoms. Therapy, especially cognitive behavioral therapy, teaches skills to better manage negative thoughts and improve coping behaviors to help break you out of cycles of depression. Whatever the cause, remember that depression is not your fault and it can be treated.

To help diagnose depression, your health care provider may use a physical exam, lab tests, or a mental health evaluation. These results will help identify various treatment options that best fit your situation.

Help is available. You don't have to deal with depression by yourself. Take the next step and reach out. If you're hesitant to talk to a health care provider, talk to a friend or loved one about how to get help. Living with depression isn't easy and you're not alone in your struggles. Always remember that effective treatments and supports are available to help you start feeling better. Want to learn more about depression? Visit mayoclinic.org. Do take care.

Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn't worth living.

More than just a bout of the blues, depression isn't a weakness and you can't simply "snap out" of it. Depression may require long-term treatment. But don't get discouraged. Most people with depression feel better with medication, psychotherapy or both.
Depression care at Mayo Clinic
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Symptoms

Although depression may occur only once during your life, people typically have multiple episodes. During these episodes, symptoms occur most of the day, nearly every day and may include:

Feelings of sadness, tearfulness, emptiness or hopelessness

Angry outbursts, irritability or frustration, even over small matters

Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports

Sleep disturbances, including insomnia or sleeping too much

Tiredness and lack of energy, so even small tasks take extra effort

Reduced appetite and weight loss or increased cravings for food and weight gain

Anxiety, agitation or restlessness

Slowed thinking, speaking or body movements

Feelings of worthlessness or guilt, fixating on past failures or self-blame

Trouble thinking, concentrating, making decisions and remembering things

Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide

Unexplained physical problems, such as back pain or headaches

For many people with depression, symptoms usually are severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others. Some people may feel generally miserable or unhappy without really knowing why.

Depression symptoms in children and teens

Common signs and symptoms of depression in children and teenagers are similar to those of adults, but there can be some differences.

In younger children, symptoms of depression may include sadness, irritability, clinginess, worry, aches and pains, refusing to go to school, or being underweight.

In teens, symptoms may include sadness, irritability, feeling negative and worthless, anger, poor performance or poor attendance at school, feeling misunderstood and extremely sensitive, using recreational drugs or alcohol, eating or sleeping too much, self-harm, loss of interest in normal activities, and avoidance of social interaction.

Depression symptoms in older adults

Depression is not a normal part of growing older, and it should never be taken lightly. Unfortunately, depression often goes undiagnosed and untreated in older adults, and they may feel reluctant to seek help. Symptoms of depression may be different or less obvious in older adults, such as:

Memory difficulties or personality changes

Physical aches or pain

Fatigue, loss of appetite, sleep problems or loss of interest in sex - not caused by a medical condition or medication

Often wanting to stay at home, rather than going out to socialize or doing new things

Suicidal thinking or feelings, especially in older men

When to see a doctor

If you feel depressed, make an appointment to see your doctor or mental health professional as soon as you can. If you're reluctant to seek treatment, talk to a friend or loved one, any health care professional, a faith leader, or someone else you trust.

When to get emergency help

If you think you may hurt yourself or attempt suicide, call 911 in the U.S. or your local emergency number immediately.

Also consider these options if you're having suicidal thoughts:

Call your doctor or mental health professional.

Contact a suicide hotline.

In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential.

U.S. veterans or service members who are in crisis can call 988 and then press "1" for the Veterans Crisis Line. Or text 838255. Or chat online.

The Suicide & Crisis Lifeline in the U.S. has a Spanish language phone line at 1-888-628-9454 (toll-free).

Reach out to a close friend or loved one.

Contact a minister, spiritual leader or someone else in your faith community.

If you have a loved one who is in danger of suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.

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Causes

It's not known exactly what causes depression. As with many mental disorders, a variety of factors may be involved, such as:

Biological differences. People with depression appear to have physical changes in their brains. The significance of these changes is still uncertain, but may eventually help pinpoint causes.

Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters and how they interact with neurocircuits involved in maintaining mood stability may play a significant role in depression and its treatment.

Hormones. Changes in the body's balance of hormones may be involved in causing or triggering depression. Hormone changes can result with pregnancy and during the weeks or months after delivery (postpartum) and from thyroid problems, menopause or a number of other conditions.

Inherited traits. Depression is more common in people whose blood relatives also have this condition. Researchers are trying to find genes that may be involved in causing depression.

Risk factors

Depression often begins in the teens, 20s or 30s, but it can happen at any age. More women than men are diagnosed with depression, but this may be due in part because women are more likely to seek treatment.

Factors that seem to increase the risk of developing or triggering depression include:

Certain personality traits, such as low self-esteem and being too dependent, self-critical or pessimistic

Traumatic or stressful events, such as physical or sexual abuse, the death or loss of a loved one, a difficult relationship, or financial problems

Blood relatives with a history of depression, bipolar disorder, alcoholism or suicide

Being lesbian, gay, bisexual or transgender, or having variations in the development of genital organs that aren't clearly male or female (intersex) in an unsupportive situation

History of other mental health disorders, such as anxiety disorder, eating disorders or post-traumatic stress disorder

Abuse of alcohol or recreational drugs

Serious or chronic illness, including cancer, stroke, chronic pain or heart disease

Certain medications, such as some high blood pressure medications or sleeping pills (talk to your doctor before stopping any medication)

Complications

Depression is a serious disorder that can take a terrible toll on you and your family. Depression often gets worse if it isn't treated, resulting in emotional, behavioral and health problems that affect every area of your life.

Examples of complications associated with depression include:

Excess weight or obesity, which can lead to heart disease and diabetes

Pain or physical illness

Alcohol or drug misuse

Anxiety, panic disorder or social phobia

Family conflicts, relationship difficulties, and work or school problems

Social isolation

Suicidal feelings, suicide attempts or suicide

Self-mutilation, such as cutting

Premature death from medical conditions

Prevention

There's no sure way to prevent depression. However, these strategies may help.

Take steps to control stress, to increase your resilience and boost your self-esteem.

Reach out to family and friends, especially in times of crisis, to help you weather rough spells.

Get treatment at the earliest sign of a problem to help prevent depression from worsening.

Consider getting long-term maintenance treatment to help prevent a relapse of symptoms.

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Depression (major depressive disorder) - Symptoms and causes

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Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest and can interfere with your daily functioning.

# data[].attributes.body
Nervous system: feelings of sadness and loneliness, insomnia, trouble with memory or decisions, and preoccupation with death

Cardiovascular system: risk of heart attack by causing blood vessels to constrict, weakened immune system so your ability to fight off disease lessens

*Untreated depression can wipe out your energy levels during the day.  Daytime fatigue may also occur from nighttime insomnia

*increased pain sensitivity including headache and other aches

*weight fluctuations because depression can lead to overeating or appetite loss

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Depression is one of the most common mental health illnesses in the United States, affecting about 26 percent of adults. Depression is technically a mental disorder, but it also affects your physical health and well-being. Learn more about some of the most common symptoms of depression, as well as how depression can affect your entire body, especially if left untreated.

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Feeling sad or anxious at times is a normal part of life, but if these feelings last more than two weeks they could be symptoms of depression. It's estimated that each year 17 million American adults will experience depression. However, clinical depression, especially left untreated, can interrupt your day-to-day life and cause a ripple effect of additional symptoms.

Depression affects how you feel and can also cause changes in your body. Major depression (a more advanced form of depression) is considered a serious medical condition that may have a dramatic effect on your quality of life.

Central nervous system

Depression can cause a lot of symptoms within the central nervous system, many of which are easy to dismiss or ignore.

Older adults may also have difficulty identifying cognitive changes because it's easy to dismiss the signs of depression as related to "getting older." According to the American Psychological Association, older adults with depression have more difficulties with memory loss and reaction time during everyday activities compared with younger adults with depression.

Symptoms of depression include overwhelming sadness, grief, and a sense of guilt. It may be described as a feeling of emptiness or hopelessness. Some people may find it difficult to put these feelings into words. It may also be difficult for them to understand as symptoms can manifest and cause physical reactions. Frequent episodes of crying may be a symptom of depression, although not everyone who is depressed cries.

You may also feel tired all the time or have trouble sleeping at night. Other symptoms include: irritability, anger, and loss of interest in things that used to bring pleasure, including sex. Depression can cause headaches, chronic body aches, and pain that may not respond to medication. It's also sometimes an effect of certain neurological diseases, such as Alzheimer's disease, epilepsy, and multiple sclerosis.

People with depression may have trouble maintaining a normal work schedule or fulfilling social obligations. This could be due to symptoms such as an inability to concentrate, memory problems, and difficulty making decisions.

Some people who are depressed may turn to alcohol or drugs, which may increase instances of reckless or abusive behavior. Someone with depression may consciously avoid talking about it or try to mask the problem. People experiencing depression may also find themselves preoccupied with thoughts of death or hurting themselves.

While there's a 25 times greater risk of suicide, even during the recovery process, the American Association of Suicidology reports that treatment for depression is effective 60 to 80 percent of time.

Symptoms in children

Depression may be more difficult to detect in children who can't articulate their symptoms. Behaviors you may want to look out for include persistent clinginess, worry, and unwillingness to attend school without improvement over time. Children may also be excessively irritable and negative.

Digestive system

While depression is often thought of as a mental illness, it also plays a heavy role in appetite and nutrition. Some people cope by overeating or bingeing. This can lead to weight gain and obesity-related illnesses, such as type 2 diabetes.

You may even lose your appetite entirely, or fail to eat the right amount of nutritious food. A sudden loss of interest in eating in older adults can lead to a condition called geriatric anorexia.

Eating problems can lead to symptoms that include:

stomachaches

cramps

constipation

malnutrition

These symptoms may not improve with medication if a person doesn't eat the correct diet. Sweets and foods high in carbohydrates may provide immediate relief, but the effects are often temporary.

It's important to maintain a healthy diet when experiencing depression. Nutrients are essential to making sure the body's neurotransmitters are firing right. According to a study, the most common vitamin and nutritional deficiencies are.

omega-3 fatty acids

B vitamins

minerals

amino acids

Cardiovascular and immune systems

Depression and stress are closely related. Stress hormones speed heart rate and make blood vessels tighten, putting your body in a prolonged state of emergency. Over time, this can lead to heart disease.

Recurrence of cardiovascular problems is linked more closely to depression than to other conditions like:

smoking

diabetes

high blood pressure

high cholesterol

Untreated, depression raises the risk of dying after a heart attack. Heart disease is also a trigger for depression. The Cleveland Clinic estimates that about 15 percent of people with heart disease also develop major depression.

Depression and stress may have a negative impact on the immune system, making you more vulnerable to infections and diseases. One review looked at studies and found that there seemed to be a relationship between inflammation and depression, although the exact connection is unclear. Inflammation is linked to many illnesses, such as stress. Some anti-inflammatory agents have shown to benefit some people with depression.

Suicide prevention

If you think someone is at immediate risk of self-harm or hurting another person:

Call 911 or your local emergency number.

Stay with the person until help arrives.

Remove any guns, knives, medications, or other things that may cause harm.

Listen, but don't judge, argue, threaten, or yell.

If you think someone is considering suicide, get help from a crisis or suicide prevention hotline. Try the National Suicide Prevention Lifeline at 800-273-8255.

Sources: National Suicide Prevention Lifeline - Substance Abuse and Mental Health Services Administration

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Depression is one of the most common mental health illnesses in the United States, affecting about 26 percent of adults. Depression is technically a mental disorder, but it also affects your physical health and well-being. Learn more about some of the most common symptoms of depression, as well as how depression can affect your entire body, especially if left untreated.

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Excess weight or obesity, which can lead to heart disease and diabetes

Pain or physical illness

Alcohol or drug misuse

Anxiety, panic disorder or social phobia

Family conflicts, relationship difficulties, and work or school problems

Social isolation

Suicidal feelings, suicide attempts or suicide

Self-mutilation, such as cutting

Premature death from medical conditions

# data[].attributes.body
Excessive, ongoing anxiety and worry that are difficult to control and interfere with day-to-day activities may be a sign of generalized anxiety disorder
Symptoms:

Persistent worrying or anxiety about a number of areas that are out of proportion to the impact of the events

Overthinking plans and solutions to all possible worst-case outcomes

Perceiving situations and events as threatening, even when they aren't

Difficulty handling uncertainty

Indecisiveness and fear of making the wrong decision

Inability to set aside or let go of a worry

Inability to relax, feeling restless, and feeling keyed up or on edge

Difficulty concentrating, or the feeling that your mind "goes blank"

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*People with GAD may anticipate disaster and may be overly concerned about money, health, family, work, or other issues. Individuals with GAD find it difficult to control their worry.
Nervous system: anxiety can cause frequent feelings of impending doom, panic attacks, depression, headaches, and irritability

Respiratory system: can cause rapid, shallow breathing, especially when having a panic attack

Cardiovascular system: heart rate increases in pace and intensity, especially when having a panic attack, increase in blood pressure

*can have an upset stomach accompanied by nausea and diarrhea

*extreme fatigue throughout the day and also problems sleeping at night

*muscle aches and other pains from worrying so often

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Overview

Everyone has anxiety from time to time, but chronic anxiety can interfere with your quality of life. While perhaps most recognized for behavioral changes, anxiety can also have serious consequences on your physical health.

Read on to learn more about the major effects anxiety has on your body.

The effects of anxiety on the body

Anxiety is a normal part of life. For example, you may have felt anxiety before addressing a group or in a job interview.

In the short term, anxiety increases your breathing and heart rate, concentrating blood flow to your brain, where you need it. This very physical response is preparing you to face an intense situation.

If it gets too intense, however, you might start to feel lightheaded and nauseous. An excessive or persistent state of anxiety can have a devastating effect on your physical and mental health.

Anxiety disorders can happen at any stage of life, but they usually begin by middle age. Women are more likely to have an anxiety disorder than men, says the National Institute of Mental Health (NIMH).

Stressful life experiences may increase your risk for an anxiety disorder, too. Symptoms may begin immediately or years later. Having a serious medical condition or a substance use disorder can also lead to an anxiety disorder.

There are several types of anxiety disorders. They include:

Generalized anxiety disorder (GAD)

GAD is marked by excessive anxiety for no logical reason. The Anxiety and Depression Association of America (ADAA) estimates GAD affects about 6.8 million American adults a year.

GAD is diagnosed when extreme worry about a variety of things lasts six months or longer. If you have a mild case, you're probably able to complete your normal day-to-day activities. More severe cases may have a profound impact on your life.

Social anxiety disorder

This disorder involves a paralyzing fear of social situations and of being judged or humiliated by others. This severe social phobia can leave one feeling ashamed and alone.

About 15 million American adults live with social anxiety disorder, notes the ADAA. The typical age at onset is around 13. More than one-third of people with social anxiety disorder wait a decade or more before pursuing help.

Post-traumatic stress disorder (PTSD)

PTSD develops after witnessing or experiencing something traumatic. Symptoms can begin immediately or be delayed for years. Common causes include war, natural disasters, or a physical attack. PTSD episodes may be triggered without warning.

Obsessive-compulsive disorder (OCD)

People with OCD may feel overwhelmed with the desire to perform particular rituals (compulsions) over and over again, or experience intrusive and unwanted thoughts that can be distressing (obsessions).

Common compulsions include habitual hand-washing, counting, or checking something. Common obsessions include concerns about cleanliness, aggressive impulses, and need for symmetry.

Phobias

These include fear of tight spaces (claustrophobia), fear of heights (acrophobia), and many others. You may have a powerful urge to avoid the feared object or situation.

Panic disorder

This causes panic attacks, spontaneous feelings of anxiety, terror, or impending doom. Physical symptoms include heart palpitations, chest pain, and shortness of breath.

These attacks may occur at any time. You can also have another type of anxiety disorder along with panic disorder.

Central nervous system

Long-term anxiety and panic attacks can cause your brain to release stress hormones on a regular basis. This can increase the frequency of symptoms such as headaches, dizziness, and depression.

When you feel anxious and stressed, your brain floods your nervous system with hormones and chemicals designed to help you respond to a threat. Adrenaline and cortisol are two examples.

While helpful for the occasional high-stress event, long-term exposure to stress hormones can be more harmful to your physical health in the long run. For example, long-term exposure to cortisol can contribute to weight gain.

Cardiovascular system

Anxiety disorders can cause rapid heart rate, palpitations, and chest pain. You may also be at an increased risk of high blood pressure and heart disease. If you already have heart disease, anxiety disorders may raise the risk of coronary events.

Excretory and digestive systems

Anxiety also affects your excretory and digestive systems. You may have stomachaches, nausea, diarrhea, and other digestive issues. Loss of appetite can also occur.

There may be a connection between anxiety disorders and the development of irritable bowel syndrome (IBS) after a bowel infection. IBS can cause vomiting, diarrhea, or constipation.

Immune system

Anxiety can trigger your flight-or-fight stress response and release a flood of chemicals and hormones, like adrenaline, into your system.

In the short term, this increases your pulse and breathing rate, so your brain can get more oxygen. This prepares you to respond appropriately to an intense situation. Your immune system may even get a brief boost. With occasional stress, your body returns to normal functioning when the stress passes.

But if you repeatedly feel anxious and stressed or it lasts a long time, your body never gets the signal to return to normal functioning. This can weaken your immune system, leaving you more vulnerable to viral infections and frequent illnesses. Also, your regular vaccines may not work as well if you have anxiety.

Respiratory system

Anxiety causes rapid, shallow breathing. If you have chronic obstructive pulmonary disease (COPD), you may be at an increased risk of hospitalization from anxiety-related complications. Anxiety can also make asthma symptoms worse.

Other effects

Anxiety disorder can cause other symptoms, including:

headaches

muscle tension

insomnia

depression

social isolation

If you have PTSD, you may experience flashbacks, reliving a traumatic experience over and over. You might get angry or startle easily, and perhaps become emotionally withdrawn. Other symptoms include nightmares, insomnia, and sadness.

# data[].attributes.attachment_link.description
Everyone has anxiety from time to time, but chronic anxiety can interfere with your quality of life. While perhaps most recognized for behavioral changes, anxiety can also have serious consequences on your physical health. Read on to learn more about the major effects anxiety has on your body.

# data[].attributes.body
-uncontrollable urge to keep gambling despite the toll it takes on your life.  It stimulates the brain's reward system much like 🤬 or alcohol can, leading to addiction
-in the DSM-5, the condition has been re-classified as an addictive disorder.  There is data that suggests a closer relationship between gambling disorder and substance use disorders than between gambling disorder and obsessive compulsive disorder.
-Ex) Most primary substance use disorders seek to activate the brain's reward meanisms while the behaviors characterizing OCD are prompted by overactive and misplaced signals from the brain's fear mechanisms

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Overview

Compulsive gambling, also called gambling disorder, is the uncontrollable urge to keep gambling despite the toll it takes on your life. Gambling means that you're willing to risk something you value in the hope of getting something of even greater value.

Gambling can stimulate the brain's reward system much like drugs or alcohol can, leading to addiction. If you have a problem with compulsive gambling, you may continually chase bets that lead to losses, use up savings and create debt. You may hide your behavior and even turn to theft or fraud to support your addiction.

Compulsive gambling is a serious condition that can destroy lives. Although treating compulsive gambling can be challenging, many people who struggle with compulsive gambling have found help through professional treatment.

Products & Services

Symptoms

Signs and symptoms of compulsive gambling (gambling disorder) can include:

Being preoccupied with gambling, such as constantly planning gambling activities and how to get more gambling money

Needing to gamble with increasing amounts of money to get the same thrill

Trying to control, cut back or stop gambling, without success

Feeling restless or irritable when you try to cut down on gambling

Gambling to escape problems or relieve feelings of helplessness, guilt, anxiety or depression

Trying to get back lost money by gambling more (chasing losses)

Lying to family members or others to hide the extent of your gambling

Risking or losing important relationships, a job, or school or work opportunities because of gambling

Asking others to bail you out of financial trouble because you gambled money away

Most casual gamblers stop when losing or set a limit on how much they're willing to lose. But people with a compulsive gambling problem are compelled to keep playing to recover their money - a pattern that becomes increasingly destructive over time. Some people may turn to theft or fraud to get gambling money.

Some people with a compulsive gambling problem may have periods of remission - a length of time where they gamble less or not at all. But without treatment, the remission usually isn't permanent.

When to see a doctor or mental health professional

Have family members, friends or co-workers expressed concern about your gambling? If so, listen to their worries. Because denial is almost always a feature of compulsive or addictive behavior, it may be difficult for you to realize that you have a problem.

Causes

Exactly what causes someone to gamble compulsively isn't well understood. Like many problems, compulsive gambling may result from a combination of biological, genetic and environmental factors.

Risk factors

Although most people who play cards or wager never develop a gambling problem, certain factors are more often associated with compulsive gambling:

Mental health issues. People who gamble compulsively often have substance misuse problems, personality disorders, depression or anxiety. Compulsive gambling may also be associated with bipolar disorder, obsessive-compulsive disorder (OCD) or attention-deficit/hyperactivity disorder (ADHD).

Age. Compulsive gambling is more common in younger and middle-aged people. Gambling during childhood or the teenage years increases the risk of developing compulsive gambling. But compulsive gambling in the older adult population can also be a problem.

Sex. Compulsive gambling is more common in men than women. Women who gamble typically start later in life and may become addicted more quickly. But gambling patterns among men and women have become increasingly similar.

Family or friend influence. If your family members or friends have a gambling problem, the chances are greater that you will, too.

Medications used to treat Parkinson's disease and restless legs syndrome. Drugs called dopamine agonists have a rare side effect that may result in compulsive behaviors, including gambling, in some people.

Certain personality characteristics. Being highly competitive, a workaholic, impulsive, restless or easily bored may increase your risk of compulsive gambling.

Complications

Compulsive gambling can have profound and long-lasting consequences for your life, such as:

Relationship problems

Financial problems, including bankruptcy

Legal problems or imprisonment

Poor work performance or job loss

Poor general health

Suicide, suicide attempts or suicidal thoughts

Prevention

Although there's no proven way to prevent a gambling problem, educational programs that target individuals and groups at increased risk may be helpful.

If you have risk factors for compulsive gambling, consider avoiding gambling in any form, people who gamble and places where gambling occurs. Get treatment at the earliest sign of a problem to help prevent gambling from becoming worse.

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Compulsive gambling - Symptoms and causes

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Compulsive gambling, also called gambling disorder, is the uncontrollable urge to keep gambling despite the toll it takes on your life. Gambling means that you're willing to risk something you value in the hope of getting something of even greater value. Gambling can stimulate the brain's reward system much like drugs or alcohol can, leading to addiction.

# data[].attributes.body
-The cause is not well-understood, but it could result from a combination of biological, genetic, and environmental factors.
Risk Factors include:
-individuals with other mental health disorders like depression, anxiety, and personality disorders
-more common in younger and middle-aged people
-more common in men than women
-friend or family influence
-certain personality characteristics like being highly competitive, a workaholic, impulsive, restless, or easily bored
-🤬 called dopamine agonists have a rare side effect that may result in compulsive behaviors

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Systems affected by Gambling Disorder and secondary problems

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Systems affected by Gambling Disorder and secondary problems

# data[].attributes.body
Nervous system: Ventral striatum, located in the brain, is the brain's reward center, and it has been implicated in reward processing as well as substance abuse. People with gambling disorders have lower activation in reward pathways, so they are drawn to ways that stimulate their pathways like highs of gambling.
*Can lead to loss of sleep, social isolation and bad hygiene but mainly affects the brain
Secondary Problems:
-relationship problems
-financial problems, including bankruptcy
-legal problems or imprisonment
-poor work performance or job loss
-poor general health
-suicide, suicide attempts or suicidal thoughts

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Anorexia nervosa: eating disorder characterized by an abnormally low body weight, an intense fear of gaining weight and a distorted perception of weight
Bulimia nervosa: serious, potentially life- threatening eating disorder where people secretly binge (eat large amounts of food with a loss of control over the eating) and then purge, trying to get rid of the extra calories in an unhealthy way
Binge-eating disorder: eating disorder which you frequently consume unusually large amounts of food and feel unable to stop eating. Excessive overeating that feels out of control and becomes a regular occurrence
Pica: eating disorder defined as the persistent ingestion of non-nutritive substances for at least 1 month at an age where the behavior is developmentally inappropriate (persistent eating of substances such as dirt or paint that have no nutritional value

# data[].attributes.body
*Exact cause of eating disorders is unknown
-genetics and biology: brain chemicals and certain genes can increase their risk
-psychological and emotional health: people with eating disorders may have low self-esteem, perfectionism, impulsive behavior, and troubled relationships

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Anorexia, bulimia and binge-eating disorder affect physical and mental health. Learn about symptoms, causes, risk factors, diagnosis and treatment options.

# data[].attributes.body
Cardiovascular system: due to severe calorie restrictions, the body does not receive adequate energy through food, so its processes slow down.  Low blood pressure and irregular heart rhythms occur
Endocrine system: women often stop menstruating, and the body has a difficult time regulating its temperature
Bone density decreases causing premature osteoporosis and increasing the risk of bone fractures
Circulatory system: low white blood cells count, so low immunity
Urinary system: kidneys suffer damage due to prolonged dehydration and kidney failure is a possibility
Esophagus can become raw and inflamed in people with bulimia
Nervous system: depression can occur with an eating disorder

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Long Term Side Effects of Anorexia, Bulimia and Eating Disorders

# data[].attributes.attachment_link.description
Eating disorders are complex mental health disorders that occur in many different forms, including anorexia, bulimia, binge eating disorder and eating disorders not otherwise specified. While each type of eating disorder has its own set of associated symptoms, all types of eating disorders have the potential to cause long-term damage to the body's organs.

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-serious health problems since the body is not getting the necessary nutrients
-depression and anxiety
-suicidal thoughts or behavior
-problems with growth and development
-social and relationship problems
work and school issues
-death

# data[].attributes.body
-several factors contribute to the development of drug addiction
Environment: family's beliefs and attitudes and exposure to a peer group that encourages drug use, seem to play a role in initial drug use
Genetics: once starting using the drug, the development into addiction can be influenced by inherited traits, which may delay or speed up the disease progression
Risk Factors:
-family history of addiction
-mental health disorder
-peer pressure
-lack of family involvement
-early use
-taking a highly addictive drug

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Drug addiction (substance use disorder) - Symptoms and causes

# data[].attributes.attachment_link.description
Drug addiction affects your brain and behavior to the point where you can’t control your use of legal or illegal drugs, even when you know they cause harm.

# data[].attributes.headline
Systems affected by Substance Related Disorders

# data[].attributes.subject
Systems affected by Substance Related Disorders

# data[].attributes.body
-Respiratory System: could get lung cancer from inhaling 🤬
-Find it hard to sleep, think, reason, remember, and solve problems
-The 🤬 can harm every system in your body, depending on the substance.  Throat, stomach, lungs, liver, pancreas, heart, brain, and nervous system
-Immune system: more likely to engage in risk-taking behaviors and sharing needles
-Circulatory system: needle marks and collapsed veins
-Acne, or skin lesions
-baldness or male pattern hair growth in women
-jaw and teeth issues due to clenching and grinding your teeth
-mood swings and erratic behavior

# data[].attributes.attachment_link.readable_text
Different types of drugs affect your body in different ways, and the effects associated with drugs can vary from person to person. How a drug effects an individual is dependent on a variety of factors including body size, general health, the amount and strength of the drug, and whether any other drugs are in the system at the same time. It is important to remember that illegal drugs are not controlled substances, and therefore the quality and strength may differ from one batch to another.

Drugs can have short-term and long-term effects. These effects can be physical and psychological, and can include dependency.

You may act differently, feel differently and think differently if you have taken drugs. And you may struggle to control your actions and thoughts.

You might begin to use drugs without thinking about any harm to your body. You might think drugs won't become a problem because you are only a casual user. The more you take a drug, the more likely you are to build up a tolerance to its effects. This can lead to the need to take larger doses to obtain the effects of the drug. For this reason, evidence suggests that after prolonged use, many drugs can cause dependence. Drug dependence can quickly begin to affect your psychological and physical health, and can also affect your work and social life.

It is important to remember that there is no safe level of drug use. Be careful when taking any kind of drug.

Different drugs, different effects

Drugs affect your body's central nervous system. They affect how you think, feel and behave. The three main types are depressants, hallucinogens and stimulants:

Depressants slow or 'depress' the function of the central nervous system. They slow the messages going to and from your brain. In small quantities depressants can cause a person to feel relaxed and less inhibited. In large amounts they may cause vomiting, unconsciousness and death. Depressants affect your concentration and coordination, and slow your ability to respond to situations. It is important to not operate heavy machinery while taking depressants. Alcohol, cannabis, GHB, opiates (heroin, morphine, codeine) and benzodiazepines (minor tranquillisers) are examples of depressants.

Hallucinogens distort your sense of reality. You may see or hear things that are not really there, or see things in a distorted way. Other effects can include emotional and psychological euphoria, jaw clenching, panic, paranoia, gastric upset and nausea. Ketamine, LSD, PCP, 'magic mushrooms' and cannabis are examples of hallucinogens.

Stimulants speed or 'stimulate' the central nervous system. They speed up messaging to and from the brain, making you feel more alert and confident. This can cause increased heart rate, blood pressure and body temperature, reduced appetite, agitation and sleeplessness. In large amounts stimulants may cause anxiety, panic, seizures, stomach cramps and paranoia. Caffeine, nicotine, amphetamines (speed and Ice), cocaine and ecstasy (MDMA) are examples of stimulants.

The effects of a drug, and how long they last, depend on a number of factors:

the type and strength of drugs that you use

how the drug was made -- substances manufactured in home labs may contain bacteria, dangerous chemicals and other unsafe substances, and have an unknown strength. Even one dose may cause an overdose that leads to brain damage or death

your physical characteristics (including height, weight, age, body fat and metabolism)

the dose that you take

how often and for how long you have been using drugs

how you ingest the drug (by inhalation, by injection or orally). Compared with swallowing a drug, inhalation and injection are more likely to lead to overdose and dependence. If you are injecting drugs, sharing injecting equipment will increase your risk of contracting serious diseases such as hepatitis and HIV. It will also increase your risk of serious infection

your mental health, mood and environment (that is, whether you are in a secure, happy place or an unsafe place) can affect the experience you have when taking drugs. If you have a mental health condition, drugs may exacerbate or complicate the symptoms of that condition

whether you mix drugs, including alcohol. In particular, alcohol use may lead to high risk behaviour (such as drink driving) which can result in the serious injury or death of yourself or others.

Physical harms from drug use

Drug use can affect short- and long-term health outcomes. Some of these health outcomes can be serious, and possibly irreversible.

Drug use can lead to risky or out of character behaviour. When affected by drugs:

You are more likely to have an accident (at home, in a car, or wherever you are).

You may be vulnerable to sexual assault or you may engage in unprotected sex. Either of these could lead to pregnancy and sexually transmitted infection.

You could commit a sexual assault or other violent act.

You may find it hard to sleep, think, reason, remember and solve problems.

Drug use can also result in long-term health outcomes that include:

harm to organs and systems in your body, such as your throat, stomach, lungs, liver, pancreas, heart, brain, nervous system

cancer (such as lung cancer from inhaling drugs)

infectious disease, from shared injecting equipment and increased incidence of risk-taking behaviors

harm to your baby, if you are pregnant

acne, or skin lesions if the drug you are taking causes you to pick or scratch at your skin

needle marks and collapsed veins, if you inject regularly

baldness

male pattern hair growth in women, such as facial hair

jaw and teeth issues due to clenching and grinding your teeth; or

mood swings and erratic behavior

addiction

psychosis (losing touch with reality)

accidental overdose

higher risk of mental illness, depression, suicide and death.

Effects of common drugs

Cannabis (hash, pot, dope, weed, grass, skunk, marijuana)

may cause relaxation and altered perception

can lead to increased heart rate and low blood pressure

can make you feel relaxed and happy, but can also cause lethargy, anxiety, paranoia, and psychosis in extreme cases. A history or family history of mental illness may increase the possibility of more extreme psychotic reactions

is linked to mental health problems such as schizophrenia and, when smoked, to lung diseases such as asthma, chronic bronchitis and lung, throat, mouth and tongue cancer

affects how your brain works. Regular use can make it hard for you to concentrate, learn and retain information

reduces your fertility

when mixed with tobacco, is likely to increase the risk of heart disease and lung cancer.

Cocaine (powder cocaine, coke, blow, Charlie, crack)

gives you increased energy

makes you feel happy, awake, confident and less inhibited, but has a nasty 'come down' that makes you feel depressed and unwell. (Using depressant drugs to help with the severity of come downs can increase the chances of the development of negative cycles of dependence.)

can overstimulate the heart and nervous system and lead to a seizure, brain haemorrhage, stroke or heart attack (people have died from cocaine-induced heart failure)

reduces your pain perception and may result in injury

carries greater risk if mixed with alcohol or other stimulants, especially if you have high blood pressure or if you have an existing heart condition

can harm your baby during pregnancy, and may cause miscarriage

can increase the risk of mental health issues such a s anxiety, paranoia and psychosis

if snorted, can cause damage to the lining of the nasal passage and nose

if injected, can cause vein collapse and increased risk of HIV and hepatitis infection.

Mephedrone (meow meow, m-cat, plant food, bubble, meph)

can induce feelings of happiness, euphoria and confidence, but can also cause anxiety and paranoia

causes vomiting, sweating and headaches in some users

can overstimulate your heart and nervous system

can cause periods of insomnia

can lead to fits and agitated and hallucinatory states

if used in large amounts, can cause tingling of the hands and feet, seizure and respiratory failure

has been linked to a number of deaths

if injected, can cause vein collapse and increases the risk of HIV and hepatitis infection.

Ecstasy (MDMA, pills, E, eckies)

can make you feel alert, warm and chatty

can make sounds and colours seem more intense

may cause anxiety, confusion, paranoia and even psychosis

is linked (in cases of long-term use) to memory loss, depression and anxiety

can lead to overheating and dehydration

tends to stop your body producing enough urine, so your body retains fluid.

Speed (amphetamine, billy, whizz)

can make you feel alert, confident and energetic

can reduce appetite

may make you agitated and aggressive

may cause confusion, paranoia and even psychosis

can make you very depressed and lethargic for hours or days, when used a lot

can cause high blood pressure and heart attacks

is more risky if mixed with alcohol, or if you have blood pressure or heart problems

puts you at risk of overdose, vein and tissue damage, and infectious disease (such as hepatitis C and HIV), if you inject speed.

Ice (crystal meth, shabu, crystal, glass, shard, P):

may create feelings of pleasure and confidence

can make you feel alert and energetic

can cause you to repeat simple things like itching and scratching

can cause enlarged or dilated pupils and a dry mouth

may make you grind your teeth

can cause excessive sweat

can increase your heart rate and breathing

may reduce your appetite

may increase your sex drive

puts you at risk of infectious diseases (such as hepatitis B, hepatitis C and HIV) if you inject it

can damage your nasal passages and cause nose bleeds if you snort it.

The Alcohol and Drug Foundation has a .

Effects of a 'come down'

A 'come down' is your body's reaction to the substances that you have taken, after the initial reaction. In other words, it is the after effect.

How long it lasts, and how bad it is, depends on the type of drug (stimulant or depressant) and your age, sex and tolerance.

Common after effects are flatness, depression and exhaustion. Or you may feel:

shaky, dizzy, sweaty

headachey

nauseous

fatigued

not hungry

sleepy or unable to sleep.

ReachOut provides information on how to .

Where to get help

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Different types of drugs affect your body in different ways, and the effects associated with drugs can vary from person to person. How a drug effects an individual is dependent on a variety of factors including body size, general health, the amount and strength of the drug, and whether any other drugs are in the system at the same time.

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Secondary problems of Substance Related Disorders

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Secondary problems of Substance Related Disorders

# data[].attributes.body
-Getting a communicable disease (HIV for example through unsafe sex or by sharing needles)
-other health problems (ranging from short term and long term mental and physical problems)
-Accidents (doing dangerous activities like driving while under the influence
-Suicide
-Family problems
-Work issues

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A stroke is loss of blood flow to part of the brain. Brain cells die because they are deprived of oxygen. Depending on the area that is not receiving blood, a person may experience loss of memory, movement, speech, or other disabilities. If blood flow is restored or pressure is relieved quickly, the brain can fully recover.
Ischemic stroke: occurs when a blood clot blocks the flow of blood to the brain.  Medications that dissolve a clot can prevent severe damage if given quickly after stroke symptoms appear.
Hemorrhagic stroke: occurs when a blood vessel in the brain breaks or leaks due to weakness in the vessel wall.  Blood then flows into or around the brain and creates swelling and pressure

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F: ask the person to smile.  Does one side of the face droop?
A: ask the person to raise both arms.  Does one arm drift downward?
S: Ask the person to repeat a simple phrase.  Is their speech slurred or strange?
T: If you observe any of these symptoms, call 911 immediately. Time is crucial to regain blood flow or release pressure

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FAST is an easy way to remember and identify the most common symptoms of a stroke. Recognition of stroke and calling 9-1-1 will determine how quickly someone will receive help and treatment. Getting to a hospital rapidly will more likely lead to a better recovery.

Use FAST to Remember the Warning Signs of a Stroke
Call 9-1-1 immediately if you observe any of these symptoms. Note the time of the first symptom.
This information is important and can affect treatment decisions.

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FAST is an easy way to remember and identify the most common symptoms of a stroke. Recognition of stroke and calling 9-1-1 will determine how quickly someone will receive help and treatment. Getting to a hospital rapidly will more likely lead to a better recovery.

# data[].attributes.body
Left-Brain Stroke: affects the right side of the body
-trouble speaking or understanding words said or written
-slow, careful movements
-not able to see things on the right side of the body
-facial weakness, unclear speech, or problems with swallowing
Right-Brain Stroke
-trouble knowing how far or near an object is to the body
-neglect of left side of the body, or not able to see things to the left of the body
-poor decision making, lack of insight into the changes in ability since the stoke, leading to safety concerns
-impulsiveness
-short attention span and slowed learning of new things
-facial weakness, unclear speech, or problems swallowing

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The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

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University of Wisconsin Hospitals and Clinics Authority

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Stroke | Location of Strokes - Left-brain vs. Right-brain Stroke

# data[].attributes.attachment_link.description
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

# data[].attributes.body
Ischemic Stroke
-Thrombotic stoke: occurs when a blood clot forms in one of the arteries that supply blood to your brain.   May be caused by plaque build up in arteries and cause reduced blood flow or other artery conditions
-Embolic stroke: occurs when a blood clot or other debris forms away from your brain (commonly in your heart) and is swept through bloodstream to lodge in narrower brain arteries. Can form from air bubbles, fat, or plaque from an artery wall
Hemorrhagic stroke: occurs when a blood vessel in your brain leaks or ruptures. Can be caused by uncontrolled high blood pressure, overtreatment with anticoagulants (blood thinners), or weak spots in your blood vessel walls

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Overview

What is a stroke? A Mayo Clinic expert explains

Learn more from neurologist Robert D. Brown, Jr. M.D., M.P.H.

I'm Dr. Robert Brown, neurologist at Mayo Clinic. In this video, we'll cover the basics of a stroke. What is it, who it happens to, the symptoms, diagnosis, and treatment. Whether you're looking for answers for yourself or someone you love, we're here to give you the best information available. You've likely heard the term stroke before. They affect about 800,000 people in the United States each year. Strokes happen in two ways. In the first, a blocked artery can cut off blood to an area of the brain. And this is known as an ischemic stroke. 85% of strokes are of this type. The second type of stroke happens when a blood vessel can leak or burst. So the blood spills into the brain tissue or surrounding the brain. And this is called a hemorrhagic stroke. Prompt treatment can reduce brain damage and the likelihood of death or disability. So if you or someone you know is experiencing a stroke, you should call 911 and seek emergency medical care right away.

Anyone can have a stroke, but some things put you at higher risk. And some things can lower your risk. If you're 55 and older, if you're African-American, if you're a man, or if you have a family history of strokes or heart attacks, your chances of having a stroke are higher. Being overweight, physically inactive, drinking alcohol heavily, recreational drug use. Those who smoke, have high blood pressure or high cholesterol, have poorly controlled diabetes, suffer from obstructive sleep apnea, or have certain forms of heart disease are at greater risk as well.

Look for these signs and symptoms if you think you or someone you know is having a stroke: Sudden trouble speaking and understanding what others are saying. Paralysis or numbness of the face, arm or leg on one side of the body. Problems seeing in one or both eyes, trouble walking, and a loss of balance. Now many strokes are not associated with headache, but a sudden and severe headache can sometimes occur with some types of stroke. If you notice any of these, even if they come and go or disappear completely, seek emergency medical attention or call 911. Don't wait to see if symptoms stop, for every minute counts.

Once you get to the hospital, your emergency team will review your symptoms and complete a physical exam. They will use several tests to help them figure out what type of stroke you're having and determine the best treatment for the stroke. This could include a CT scan or MRI scan, which are pictures of the brain and arteries, a carotid ultrasound, which is a soundwave test of the carotid arteries which provide blood flow to the front parts of the brain, and blood tests.

Once your doctors can determine if you're having an ischemic or hemorrhagic stroke, they'll be able to figure out the best treatment. If you're suffering an ischemic stroke, it's important to restore blood flow to your brain as quickly as possible, providing the oxygen and other nutrients your brain cells need to survive. To do this, doctors may use an intravenous clot buster medicine, dissolving the clot that is obstructing the blood flow or they may perform an emergency endovascular procedure. This involves advancing a tiny plastic tube called a catheter up into the brain arteries, allowing the blockage in the artery to be removed directly. Unlike ischemic strokes, the goal for treating a hemorrhagic stroke is to control the bleeding and reduce pressure in the brain. Doctors may use emergency medicines to lower the blood pressure, prevent blood vessel spasms, encourage clotting and prevent seizures. Or, if the bleeding is severe, surgery may be performed to remove the blood that is in the brain.

Every stroke is different, and so every person's road to recovery is different. Management of a stroke often involves a care team with several specialties. This may include a neurologist and a physical medicine and rehabilitation physician, among others. Now, in the end, our goal is to help you recover as much function as possible so that you can live independently. A stroke is a life-changing event that can affect you emotionally as much as it can physically. You may feel helpless, frustrated, or depressed. So look for help and support from friends and family. Accept that recovery will take hard work and most of all time. Strive for a new normal and remember to celebrate your progress. If you'd like to learn even more about strokes, watch our other related videos or visit mayoclinic.org. We wish you all the best.

An ischemic stroke occurs when the blood supply to part of the brain is blocked or reduced. This prevents brain tissue from getting oxygen and nutrients. Brain cells begin to die in minutes. Another type of stroke is a hemorrhagic stroke. It occurs when a blood vessel in the brain leaks or bursts and causes bleeding in the brain. The blood increases pressure on brain cells and damages them.

A stroke is a medical emergency. It's crucial to get medical treatment right away. Getting emergency medical help quickly can reduce brain damage and other stroke complications.

The good news is that fewer Americans die of stroke now than in the past. Effective treatments also can help prevent disability from stroke.

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Symptoms

If you or someone you're with may be having a stroke, pay attention to the time the symptoms began. Some treatments are most effective when given soon after a stroke begins.

Symptoms of stroke include:

Trouble speaking and understanding what others are saying. A person having a stroke may be confused, slur words or may not be able to understand speech.

Numbness, weakness or paralysis in the face, arm or leg. This often affects just one side of the body. The person can try to raise both arms over the head. If one arm begins to fall, it may be a sign of a stroke. Also, one side of the mouth may droop when trying to smile.

Problems seeing in one or both eyes. The person may suddenly have blurred or blackened vision in one or both eyes. Or the person may see double.

Headache. A sudden, severe headache may be a symptom of a stroke. Vomiting, dizziness and a change in consciousness may occur with the headache.

Trouble walking. Someone having a stroke may stumble or lose balance or coordination.

When to see a doctor

Seek immediate medical attention if you notice any symptoms of a stroke, even if they seem to come and go or they disappear completely. Think "FAST" and do the following:

Face. Ask the person to smile. Does one side of the face droop?

Arms. Ask the person to raise both arms. Does one arm drift downward? Or is one arm unable to rise?

Speech. Ask the person to repeat a simple phrase. Is the person's speech slurred or different from usual?

Time. If you see any of these signs, call 911 or emergency medical help right away.

Call 911 or your local emergency number immediately. Don't wait to see if symptoms stop. Every minute counts. The longer a stroke goes untreated, the greater the potential for brain damage and disability.

If you're with someone you suspect is having a stroke, watch the person carefully while waiting for emergency assistance.

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Causes

There are two main causes of stroke. An ischemic stroke is caused by a blocked artery in the brain. A hemorrhagic stroke is caused by leaking or bursting of a blood vessel in the brain. Some people may have only a temporary disruption of blood flow to the brain, known as a transient ischemic attack (TIA). A TIA doesn't cause lasting symptoms.

Ischemic stroke

This is the most common type of stroke. It happens when the brain's blood vessels become narrowed or blocked. This causes reduced blood flow, known as ischemia. Blocked or narrowed blood vessels can be caused by fatty deposits that build up in blood vessels. Or they can be caused by blood clots or other debris that travel through the bloodstream, most often from the heart. An ischemic stroke occurs when fatty deposits, blood clots or other debris become lodged in the blood vessels in the brain.

Some early research shows that COVID-19 infection may increase the risk of ischemic stroke, but more study is needed.

Hemorrhagic stroke

Hemorrhagic stroke occurs when a blood vessel in the brain leaks or ruptures. Bleeding inside the brain, known as a brain hemorrhage, can result from many conditions that affect the blood vessels. Factors related to hemorrhagic stroke include:

High blood pressure that's not under control.

Overtreatment with blood thinners, also known as anticoagulants.

Bulges at weak spots in the blood vessel walls, known as aneurysms.

Head trauma, such as from a car accident.

Protein deposits in blood vessel walls that lead to weakness in the vessel wall. This is known as cerebral amyloid angiopathy.

Ischemic stroke that leads to a brain hemorrhage.

A less common cause of bleeding in the brain is the rupture of an arteriovenous malformation (AVM). An AVM is an irregular tangle of thin-walled blood vessels.

Transient ischemic attack

A transient ischemic attack (TIA) is a temporary period of symptoms similar to those of a stroke. But a TIA doesn't cause permanent damage. A TIA is caused by a temporary decrease in blood supply to part of the brain. The decrease may last as little as five minutes. A transient ischemic attack is sometimes known as a ministroke.

A TIA occurs when a blood clot or fatty deposit reduces or blocks blood flow to part of the nervous system.

Seek emergency care even if you think you've had a TIA. It's not possible to tell if you're having a stroke or TIA based only on the symptoms. If you've had a TIA, it means you may have a partially blocked or narrowed artery leading to the brain. Having a TIA increases your risk of having a stroke later.

Risk factors

Many factors can increase the risk of stroke. Potentially treatable stroke risk factors include:

Lifestyle risk factors

Being overweight or obese.

Physical inactivity.

Heavy or binge drinking.

Use of illegal drugs such as cocaine and methamphetamine.

Medical risk factors

High blood pressure.

Cigarette smoking or secondhand smoke exposure.

High cholesterol.

Diabetes.

Obstructive sleep apnea.

Cardiovascular disease, including heart failure, heart defects, heart infection or irregular heart rhythm, such as atrial fibrillation.

Personal or family history of stroke, heart attack or transient ischemic attack.

COVID-19 infection.

Other factors associated with a higher risk of stroke include:

Age - People age 55 or older have a higher risk of stroke than do younger people.

Race or ethnicity - African American and Hispanic people have a higher risk of stroke than do people of other races or ethnicities.

Sex - Men have a higher risk of stroke than do women. Women are usually older when they have strokes, and they're more likely to die of strokes than are men.

Hormones - Taking birth control pills or hormone therapies that include estrogen can increase risk.

Complications

A stroke can sometimes cause temporary or permanent disabilities. Complications depend on how long the brain lacks blood flow and which part is affected. Complications may include:

Loss of muscle movement, known as paralysis. You may become paralyzed on one side of the body. Or you may lose control of certain muscles, such as those on one side of the face or one arm.

Trouble talking or swallowing. A stroke might affect the muscles in the mouth and throat. This can make it hard to talk clearly, swallow or eat. You also may have trouble with language, including speaking or understanding speech, reading or writing.

Memory loss or trouble thinking. Many people who have had strokes experience some memory loss. Others may have trouble thinking, reasoning, making judgments and understanding concepts.

Emotional symptoms. People who have had strokes may have more trouble controlling their emotions. Or they may develop depression.

Pain. Pain, numbness or other feelings may occur in the parts of the body affected by stroke. If a stroke causes you to lose feeling in the left arm, you may develop a tingling sensation in that arm.

Changes in behavior and self-care. People who have had strokes may become more withdrawn. They also may need help with grooming and daily chores.

Prevention

You can take steps to prevent a stroke. It's important to know your stroke risk factors and follow the advice of your healthcare professional about healthy lifestyle strategies. If you've had a stroke, these measures might help prevent another stroke. If you have had a transient ischemic attack (TIA), these steps can help lower your risk of a stroke. The follow-up care you receive in the hospital and afterward also may play a role.

Many stroke prevention strategies are the same as strategies to prevent heart disease. In general, healthy lifestyle recommendations include:

Control high blood pressure, known as hypertension. This is one of the most important things you can do to reduce your stroke risk. If you've had a stroke, lowering your blood pressure can help prevent a TIA or stroke in the future. Healthy lifestyle changes and medicines often are used to treat high blood pressure.

Lower the amount of cholesterol and saturated fat in your diet. Eating less cholesterol and fat, especially saturated fats and trans fats, may reduce buildup in the arteries. If you can't control your cholesterol through dietary changes alone, you may need a cholesterol-lowering medicine.

Quit tobacco use. Smoking raises the risk of stroke for smokers and nonsmokers exposed to secondhand smoke. Quitting lowers your risk of stroke.

Manage diabetes. Diet, exercise and losing weight can help you keep your blood sugar in a healthy range. If lifestyle factors aren't enough to control blood sugar, you may be prescribed diabetes medicine.

Maintain a healthy weight. Being overweight contributes to other stroke risk factors, such as high blood pressure, cardiovascular disease and diabetes.

Eat a diet rich in fruits and vegetables. Eating five or more servings of fruits or vegetables every day may reduce the risk of stroke. The Mediterranean diet, which emphasizes olive oil, fruit, nuts, vegetables and whole grains, may be helpful.

Exercise regularly. Aerobic exercise reduces the risk of stroke in many ways. Exercise can lower blood pressure, increase the levels of good cholesterol, and improve the overall health of the blood vessels and heart. It also helps you lose weight, control diabetes and reduce stress. Gradually work up to at least 30 minutes of moderate physical activity on most or all days of the week. The American Heart association recommends getting 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous aerobic activity a week. Moderate intensity activities can include walking, jogging, swimming and bicycling.

Drink alcohol in moderation, if at all. Drinking large amounts of alcohol increases the risk of high blood pressure, ischemic strokes and hemorrhagic strokes. Alcohol also may interact with other medicines you're taking. However, drinking small to moderate amounts of alcohol may help prevent ischemic stroke and decrease the blood's clotting tendency. A small to moderate amount is about one drink a day. Talk to your healthcare professional about what's appropriate for you.

Treat obstructive sleep apnea (OSA). OSA is a sleep disorder that causes you to stop breathing for short periods several times during sleep. Your healthcare professional may recommend a sleep study if you have symptoms of OSA. Treatment includes a device that delivers positive airway pressure through a mask to keep the airway open while you sleep.

Don't use illicit drugs. Certain illicit drugs such as cocaine and methamphetamine are established risk factors for a TIA or a stroke.

Preventive medicines

If you have had an ischemic stroke, you may need medicines to help lower your risk of having another stroke. If you have had a TIA, medicines can lower your risk of having a stroke in the future. These medicines may include:

Anti-platelet drugs. Platelets are cells in the blood that form clots. Anti-platelet medicines make these cells less sticky and less likely to clot. The most commonly used anti-platelet medicine is aspirin. Your healthcare professional can recommend the right dose of aspirin for you.

If you've had a TIA or minor stroke, you may take both an aspirin and an anti-platelet medicine such as clopidogrel (Plavix). These medicines may be prescribed for a period of time to reduce the risk of another stroke. If you can't take aspirin, you may be prescribed clopidogrel alone. Ticagrelor (Brilinta) is another anti-platelet medicine that can be used for stroke prevention.

Blooding-thinning medicines, known as anticoagulants. These medicines reduce blood clotting. Heparin is a fast-acting anticoagulant that may be used short-term in the hospital.

Slower acting warfarin (Jantoven) may be used over a longer term. Warfarin is a powerful blood-thinning medicine, so you need to take it exactly as directed and watch for side effects. You also need regular blood tests to monitor warfarin's effects.

Several newer blood-thinning medicines are available to prevent strokes in people who have a high risk. These medicines include dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis) and edoxaban (Savaysa). They work faster than warfarin and usually don't require regular blood tests or monitoring by your healthcare professional. These medicines also are associated with a lower risk of bleeding complications compared to warfarin.

Stroke care at Mayo Clinic

Show references

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17. Papadakis MA, et al., eds. Quick Medical Diagnosis & Treatment 2023. McGraw Hill; 2023. https://accessmedicine.mhmedical.com. Accessed Sept. 13, 2023.

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# data[].attributes.attachment_link.description
Promptly spotting stroke symptoms leads to faster treatment and less damage to the brain.

# data[].attributes.body
Nervous system: memory problems, visual problems (losing ability to judge space and depth, or trouble seeing clearly), less emotional control, poor hand-eye coordination difficulty making decisions, nerves are not communicating properly
Respiratory system: problems speaking or communicating could mean damage to left side of the brain, difficulty breathing or infections in the lungs
Digestive system: eating and swallowing may be difficult, loss of control of the bowels and bladder
Circulatory system: body temperature control, fatigue and low endurance
Movement and sensation may be lost on either the right or left side, depending on the stroke

# data[].attributes.attachment_link.readable_text
A stroke happens when blood carrying oxygen is unable to get to part of the brain. Brain cells get damaged and can die if left without oxygen even for a few minutes. A stroke requires immediate medical care, is potentially deadly, and can affect several parts of the body well after the event is over.

The best chance of reducing damage caused by a stroke is to get medical treatment as fast as possible. Long-term symptoms and recovery time will depend on what areas of the brain were affected.

Damage to the area of your brain that controls eating and swallowing can cause you to have trouble with these functions. This is called dysphagia. It is a common symptom following a stroke, but often improves with time.

If the muscles in your throat, tongue, or mouth aren't able to direct food down the esophagus, food and liquid can get into the airway and settle in the lungs. This can cause serious complications, like infection and pneumonia.

A stroke that happens in the brain stem, where your body's vital functions - like breathing, heartbeat, and body temperature - are controlled can also cause breathing problems. This type of stroke is more likely to result in coma or death.

The nervous system is made up of the brain, spinal cord, and a network of nerves throughout the body. This system sends signals back and forth from the body to the brain. When the brain is damaged, it doesn't receive these messages correctly.

You may feel pain more than normal, or when doing regular activities that weren't painful before the stroke. This change in perception is because the brain might not understand the sensations, like warmth or cold, the way it used to.

Changes in vision can happen if the parts of the brain that communicate with the eyes get damaged. These issues can include loss of vision, losing one side or parts of the field of vision, and problems moving the eyes. There may also be processing issues, meaning the brain isn't getting the right information from the eyes.

Foot drop is a common type of weakness or paralysis that makes it difficult to lift the front part of the foot. It can cause you to drag your toes along the ground while walking, or bend at the knee to lift the foot higher to keep it from dragging. The problem is usually caused by nerve damage and may improve with rehabilitation. A brace might also be helpful.

There is some overlap between the areas of the brain and their function.

Damage to the front part of the brain may cause changes in intelligence, movement, logic, personality traits, and thinking patterns. If this area is affected following a stroke it may also make planning difficult.

Damage to the right side of the brain can cause loss of attention span, focus and memory issues, and trouble recognizing faces or objects even if they're familiar. It can also result in behavior changes, like impulsiveness, inappropriateness, and depression.

Damage to the left side of the brain can cause difficulty speaking and understanding language, memory problems, trouble reasoning, organizing, thinking mathematically/analytically, and behavior changes.

Following a stroke, you're also at a higher risk of having a seizure. This often depends on the size of the stroke, the location, and its severity. One study showed 1 in 10 individuals can develop seizures after a stroke.

A stroke is often caused by existing issues within the circulatory system that build up over time. These are often due to complications related to high cholesterol, high blood pressure, smoking, and diabetes. A stroke can be caused by bleeding, known as a hemorrhagic stroke, or blocked blood flow called an ischemic stroke. A clot typically causes blocked blood flow strokes. These are the most common, causing nearly 90 percent of all strokes.

If you've had a stroke, you are at a higher risk of having a second stroke or heart attack. To prevent another stroke, your doctor will recommend lifestyle changes, like eating healthy and being more physically active. They may also prescribe medications.

Your doctor will also recommend getting better control of any ongoing health problems like high cholesterol, high blood pressure, or diabetes. If you smoke, you will be encouraged to quit.

Depending on which area of the brain is damaged, a stroke can have an effect on a variety of different muscle groups. These changes can range from major to minor, and will usually require rehabilitation to improve.

A stroke normally effects one side of the brain. The left side of the brain controls the right side of the body and the right side of the brain controls the left side of the body. If there's a lot of damage to the left side of the brain, you may experience paralysis on the right side of the body.

When messages can't travel properly from the brain to the body's muscles, this can cause paralysis and muscle weakness. Weak muscles have trouble supporting the body, which tends to add to movement and balance problems.

Feeling more tired than usual is a common symptom after a stroke. It's called post-stroke fatigue. You may need to take more breaks between activities and rehabilitation.

During early stroke recovery, you're typically not as active as usual. You may also be taking different medications. Constipation is a common side effect of some pain medications, not drinking enough liquids, or not being as physically active.

It's also possible for the stroke to affect the part of your brain that controls your bowels. This can cause incontinence, meaning the loss of control over bowel function. It's more common in the early recovery stages and often improves over time.

Damage from a stroke can cause a breakdown in communication between the brain and the muscles that control your bladder. When this happens, you may need to go to the bathroom more often, or you may urinate in your sleep, or while coughing or laughing. Like bowel incontinence, this is usually an early symptom that improves with time.

Having a stroke doesn't directly change how your reproductive system works, but it can change how you experience sex and how you feel about your body. Depression, a decreased ability to communicate, and certain medications may also decrease your desire for sexual activity.

One physical issue that can affect your sex life is paralysis. It's still possible to engage in sexual activity, but you and your partner will likely need to make adjustments.

There are different types of strokes. Symptoms and rehabilitation can vary based on the type of stroke and its severity. Learn more about strokes, risk factors, prevention, and recovery time.

# data[].attributes.attachment_link.description
A stroke happens when blood carrying oxygen is unable to get to part of the brain. Brain cells get damaged and can die if left without oxygen even for a few minutes. A stroke requires immediate medical care, is potentially deadly, and can affect several parts of the body well after the event is over.

# data[].attributes.headline
Secondary problems associated with stroke

# data[].attributes.subject
Secondary problems associated with stroke

# data[].attributes.body
Brain edema: swelling of the brain after a stroke
Pneumonia: occurs because the patient was not able to move as the result of the stroke.  Swallowing problems can also lead to pneumonia
Urinary tract infection: result from having a foley catheter placed
Seizures: abnormal electrical activity in the brain causing convulsions
Depression: causes unwanted emotional and physical reactions to changes and losses.
Bedsores: pressure ulcers that result from decreased ability to move and pressure on areas of the body because of immobility
Limb contractures: shortened muscles in an arm or leg from reduced ability to move the affected limb or lack of exercise
Shoulder pain: from lack of support of an arm due to weakness or paralysis
Deep venous thrombosis: blood clots form in veins of legs because of immobility from stroke

# data[].attributes.body
-disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head, or penetrating head injury
-everyone is at risk for a TBI, especially children and older adults
-usually results from a violent blow or jolt to the head or body. An object that reaches brain tissue, like a bullet or shattered piece of skull, can also cause a TBI

# data[].attributes.attachment_link.description
Centers for Disease Control and Prevention. CDC twenty four seven. Saving Lives, Protecting People

# data[].attributes.body
Mild TBI
-structural imaging: normal
-loss of consciousness: less than 30 mins
-alteration of consciousness/mental state: a moment to 24 hours
-Post-traumatic Amnesia: 0-1 day
-Glasgow Coma Scale: 13-15
Moderate TBI
-structural imaging: normal or abnormal
-loss of consciousness: 30 minutes to 24 hours
-alteration of consciousness/mental state: greater than 24 hours
-Post-traumatic Amnesia: 1-7 days
-Glasgow Coma Scale: 9-12
Severe TBI
-structural imaging: normal or abnormal
-loss of consciousness: greater than 24 hours
-alteration of consciousness/mental state: greater than 24 hours
-Post-traumatic Amnesia: greater than 7 days
-Glasgow Coma Scale: 3-8

# data[].attributes.attachment_link.title
Table 1, Criteria used to classify TBI severity - Multidisciplinary Postacute Rehabilitation for Moderate to Severe Traumatic Brain Injury in Adults - NCBI Bookshelf

# data[].attributes.attachment_link.description
Brasure M, Lamberty GJ, Sayer NA, et al. Multidisciplinary Postacute Rehabilitation for Moderate to Severe Traumatic Brain Injury in Adults [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Jun. (Comparative Effectiveness Reviews, No. 72.)

# data[].attributes.body
Nervous system: loss of consciousness, persistent headache, seizures, weakness or numbness in fingers and toes, lack of coordination, memory loss, mood changes, feeling depressed or anxious, fatigue or drowsiness, loss of balance, problems with speech
Digestive system: nausea or vomiting
Endocrine system: Both the hypothalamus and pituitary gland can be impacted when brain injury occurs. The hypothalamus controls the release of hormones from the pituitary gland and the pituitary gland tells the other glands when and how to make other hormones. Hormonal imbalances can effect sexual development, growth, metabolism, and the impacts of illness.

# data[].attributes.attachment_link.readable_text
Traumatic Brain Injury, or TBI, affects more than the brain and nervous system. There is clear evidence that TBI affects the endocrine system, significantly impacting the body's hormones. Approximately 40% of patients with moderate to severe TBI will suffer from post-TBI pituitary hormonal insufficiency. Brain injury can cause hormonal issues immediately-but in many cases, hormonal problems won't be clinically evident or diagnosed until months or even years after the injury.
The Endocrine System
The human endocrine system is comprised of organs that make and release hormones-body chemicals that help the organs and systems work properly. Hormones control sexual development, growth, metabolism, and the impacts of illness. Hormonal balance is important in one's overall health and wellness.
How TBI Affects the Endocrine System
Specifically, TBI can impact two key components of the endocrine system. Both the hypothalamus and pituitary gland are located in or near the brain and can be impacted when brain injury occurs. The hypothalamus controls the release of hormones from the pituitary gland and the pituitary gland tells the other glands when and how to make other hormones.

Adrenal insufficiency, a rare type of diabetes, or a salt and water imbalance known as hyponatremia can result from hormonal imbalances after TBI. These issues tend to occur soon after the injury occurs. Other issues that may not present until later include hypothyroidism, hypogonadism, growth hormone deficiency, or hyperprolactinemia as a result of pituitary dysfunction.
Diagnosing and Treating TBI-related Hormonal Problems
In cases of brain injury, the physician will likely ask about a patient's medical history and perform a physical evaluation that includes blood tests to check hormone levels. The physician may also request an MRI to look at the pituitary gland and check the surrounding area for tumors or cysts.

Hormone therapy (also called hormone replacement therapy) is a fairly common prescription in cases of hormone problems related to brain injury. In some cases, treatment could be as simple as prescribing a hormone supplement designed to replace what's missing. Additional steps might include reducing fluid intake to combat hyponatremia, or receiving an IV treatment to replenish missing salt.

In many cases, simple but long-term therapies can help the injured person recover from brain injury and hormonal problems. Hormone therapy can relieve symptoms, restore overall health, and significantly improve quality of life. In severe cases, hormone therapy can be lifesaving.

Paradigm Outcomes is always ready to assist with complex medical cases. For more information on our full-service offerings or to find out more about catastrophic care management, please contact us through our website or call (888) 621-6602. We also invite you to join our social communities on LinkedIn, Twitter, YouTube and Facebook.

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Traumatic Brain Injury and the Endocrine System - Outlook on Outcomes

# data[].attributes.attachment_link.description
Traumatic Brain Injury, or TBI, affects more than the brain and nervous system. There is clear evidence that TBI affects the endocrine system, significantly impacting the body's hormones. Approximately 40% of patients with moderate to severe TBI will suffer from post-TBI pituitary hormonal insufficiency. Brain injury can cause hormonal issues immediately-but in many cases, hormonal ...

# data[].attributes.body
Altered consciousness
-coma (unconscious, unaware of anything)
-vegetative state (unaware of surroundings, can open eyes, make sounds, respond to reflexes, or move)
-minimally conscious state
-brain death
Physical complications
-seizures
-fluid buildup in the brain causing swelling and increased pressure in the brain
-infections of the meninges
-blood vessel damage
-headaches
-vertigo
-hearing loss, loss of sense of smell, loss of sense of taste, vision loss
Intellectual problems
-memory, learning, reasoning, judgement, attention or concentration, organization, planning, multitasking, problem-solving
Communication problems
-difficulty understanding speech or writing, difficulty speaking or writing, inability to organize thoughts
-trouble making conversation, difficulty understanding nonverbal signals
Behavioral changes
-lack of awareness of abilities, difficulty in social situations, verbal or physical outbursts
Emotional changes
-depression, anxiety, mood swings, irritability, anger, insomnia
Sensory problems
-ringing in ears, difficulty recognizing objects, impaired hand-eye coordination, double vision, skin tingling, trouble with balance
Degenerative brain diseases
-repeated or severe TBI's might increase risk of degenerative brain diseases like Alzheimer's disease, Parkinson's disease, and Dementia pugilistica

# data[].attributes.attachment_link.title
Traumatic brain injury-Traumatic brain injury - Symptoms & causes - Mayo Clinic

# data[].attributes.attachment_link.description
If a head injury causes a mild traumatic brain injury, long-term problems are rare. But a severe injury can mean significant problems.

# data[].attributes.body
Type 1 Diabetes: chronic condition in which the pancreas produce little or no insulin.  Insulin is a hormone needed to allow sugar to enter cells to produce energy.  It usually appears in childhood or adolescence, but can appear in adults.
Type 2 Diabetes: chronic condition that affects the way your body metabolizes sugar, an important fuel.  The body resists the effects of insulin or does not produce enough insulin to maintain a normal glucose level. Usually because of environmental factors like excess weight and inactivity.

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Overview

What is type 1 diabetes? A Mayo Clinic expert explains

Learn more about type 1 diabetes from endocrinologist Yogish Kudva, M.B.B.S.

I'm Dr. Yogish C. Kudva an endocrinologist at Mayo Clinic. In this video, we'll cover the basics of type 1 diabetes. What is it? Who gets it? The symptoms, diagnosis, and treatment. Whether you're looking for answers for yourself or someone you love. We are here to give you the best information available. Type 1 diabetes is a chronic condition that affects the insulin making cells of the pancreas. It's estimated that about 1.25 million Americans live with it. People with type 1 diabetes don't make enough insulin. An important hormone produced by the pancreas. Insulin allows your cells to store sugar or glucose and fat and produce energy. Unfortunately, there is no known cure. But treatment can prevent complications and also improve everyday life for patients with type 1 diabetes. Lots of people with type 1 diabetes live a full life. And the more we learn and develop treatment for the disorder, the better the outcome.

We don't know what exactly causes type 1 diabetes. We believe that it is an auto-immune disorder where the body mistakenly destroys insulin producing cells in the pancreas. Typically, the pancreas secretes insulin into the bloodstream. The insulin circulates, letting sugar enter your cells. This sugar or glucose, is the main source of energy for cells in the brain, muscle cells, and other tissues. However, once most insulin producing cells are destroyed, the pancreas can't produce enough insulin, meaning the glucose can't enter the cells, resulting in an excess of blood sugar floating in the bloodstream. This can cause life-threatening complications. And this condition is called diabetic ketoacidosis. Although we don't know what causes it, we do know certain factors can contribute to the onset of type 1 diabetes. Family history. Anyone with a parent or sibling with type 1 diabetes has a slightly increased risk of developing it. Genetics. The presence of certain genes can also indicate an increased risk. Geography. Type 1 diabetes becomes more common as you travel away from the equator. Age, although it can occur at any age there are two noticeable peaks. The first occurs in children between four and seven years of age and the second is between 10 and 14 years old.

Signs and symptoms of type 1 diabetes can appear rather suddenly, especially in children. They may include increased thirst, frequent urination, bed wetting in children who previously didn't wet the bed. Extreme hunger, unintended weight loss, fatigue and weakness, blurred vision, irritability, and other mood changes. If you or your child are experiencing any of these symptoms, you should talk to your doctor.

The best way to determine if you have type 1 diabetes is a blood test. There are different methods such as an A1C test, a random blood sugar test, or a fasting blood sugar test. They are all effective and your doctor can help determine what's appropriate for you. If you are diagnosed with diabetes, your doctor may order additional tests to check for antibodies that are common in type 1 diabetes in the test called C-peptide, which measures the amount of insulin produced when checked simultaneously with a fasting glucose. These tests can help distinguish between type 1 and type 2 diabetes when a diagnosis is uncertain.

If you have been diagnosed with type 1 diabetes, you may be wondering what treatment looks like. It could mean taking insulin, counting carbohydrates, fat protein, and monitoring your glucose frequently, eating healthy foods, and exercising regularly to maintain a healthy weight. Generally, those with type 1 diabetes will need lifelong insulin therapy. There are many different types of insulin and more are being developed that are more efficient. And what you may take may change. Again, your doctor will help you navigate what's right for you. A significant advance in treatment from the last several years has been the development and availability of continuous glucose monitoring and insulin pumps that automatically adjust insulin working with the continuous glucose monitor. This type of treatment is the best treatment at this time for type 1 diabetes. This is an exciting time for patients and for physicians that are keen to develop, prescribe such therapies. Surgery is another option. A successful pancreas transplant can erase the need for additional insulin. However, transplants aren't always available, not successful and the procedure can pose serious risks. Sometimes it may outweigh the dangers of diabetes itself. So transplants are often reserved for those with very difficult to manage conditions. A successful transplant can bring life transforming results. However, surgery is always a serious endeavor and requires ample research and concentration from you, your family, and your medical team.

The fact that we don't know what causes type 1 diabetes can be alarming. The fact that we don't have a cure for it even more so. But with the right doctor, medical team and treatment, type 1 diabetes can be managed. So those who live with it can get on living. If you would like to learn even more about type 1 diabetes, watch our other related videos or visit mayoclinic.org. We wish you well.

Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition. In this condition, the pancreas makes little or no insulin. Insulin is a hormone the body uses to allow sugar (glucose) to enter cells to produce energy.

Different factors, such as genetics and some viruses, may cause type 1 diabetes. Although type 1 diabetes usually appears during childhood or adolescence, it can develop in adults.

Even after a lot of research, type 1 diabetes has no cure. Treatment is directed toward managing the amount of sugar in the blood using insulin, diet and lifestyle to prevent complications.

Symptoms

Type 1 diabetes symptoms can appear suddenly and may include:

Feeling more thirsty than usual

Urinating a lot

Bed-wetting in children who have never wet the bed during the night

Feeling very hungry

Losing weight without trying

Feeling irritable or having other mood changes

Feeling tired and weak

Having blurry vision

When to see a doctor

Talk to your health care provider if you notice any of the above symptoms in you or your child.

Causes

The exact cause of type 1 diabetes is unknown. Usually, the body's own immune system - which normally fights harmful bacteria and viruses - destroys the insulin-producing (islet) cells in the pancreas. Other possible causes include:

Genetics

Exposure to viruses and other environmental factors

The role of insulin

Once a large number of islet cells are destroyed, the body will produce little or no insulin. Insulin is a hormone that comes from a gland behind and below the stomach (pancreas).

The pancreas puts insulin into the bloodstream.

Insulin travels through the body, allowing sugar to enter the cells.

Insulin lowers the amount of sugar in the bloodstream.

As the blood sugar level drops, the pancreas puts less insulin into the bloodstream.

The role of glucose

Glucose - a sugar - is a main source of energy for the cells that make up muscles and other tissues.

Glucose comes from two major sources: food and the liver.

Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin.

The liver stores glucose in the form of glycogen.

When glucose levels are low, such as when you haven't eaten in a while, the liver breaks down the stored glycogen into glucose. This keeps glucose levels within a typical range.

In type 1 diabetes, there's no insulin to let glucose into the cells. Because of this, sugar builds up in the bloodstream. This can cause life-threatening complications.

Risk factors

Some factors that can raise your risk for type 1 diabetes include:

Family history. Anyone with a parent or sibling with type 1 diabetes has a slightly higher risk of developing the condition.

Genetics. Having certain genes increases the risk of developing type 1 diabetes.

Geography. The number of people who have type 1 diabetes tends to be higher as you travel away from the equator.

Age. Type 1 diabetes can appear at any age, but it appears at two noticeable peaks. The first peak occurs in children between 4 and 7 years old. The second is in children between 10 and 14 years old.

Complications

Over time, type 1 diabetes complications can affect major organs in the body. These organs include the heart, blood vessels, nerves, eyes and kidneys. Having a normal blood sugar level can lower the risk of many complications.

Diabetes complications can lead to disabilities or even threaten your life.

Heart and blood vessel disease. Diabetes increases the risk of some problems with the heart and blood vessels. These include coronary artery disease with chest pain (angina), heart attack, stroke, narrowing of the arteries (atherosclerosis) and high blood pressure.

Nerve damage (neuropathy). Too much sugar in the blood can injure the walls of the tiny blood vessels (capillaries) that feed the nerves. This is especially true in the legs. This can cause tingling, numbness, burning or pain. This usually begins at the tips of the toes or fingers and spreads upward. Poorly controlled blood sugar could cause you to lose all sense of feeling in the affected limbs over time.

Damage to the nerves that affect the digestive system can cause problems with nausea, vomiting, diarrhea or constipation. For men, erectile dysfunction may be an issue.

Kidney damage (nephropathy). The kidneys have millions of tiny blood vessels that keep waste from entering the blood. Diabetes can damage this system. Severe damage can lead to kidney failure or end-stage kidney disease that can't be reversed. End-stage kidney disease needs to be treated with mechanical filtering of the kidneys (dialysis) or a kidney transplant.

Eye damage. Diabetes can damage the blood vessels in the retina (part of the eye that senses light) (diabetic retinopathy). This could cause blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.

Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of some foot complications. Left untreated, cuts and blisters can become serious infections. These infections may need to be treated with toe, foot or leg removal (amputation).

Skin and mouth conditions. Diabetes may leave you more prone to infections of the skin and mouth. These include bacterial and fungal infections. Gum disease and dry mouth also are more likely.

Pregnancy complications. High blood sugar levels can be dangerous for both the parent and the baby. The risk of miscarriage, stillbirth and birth defects increases when diabetes isn't well-controlled. For the parent, diabetes increases the risk of diabetic ketoacidosis, diabetic eye problems (retinopathy), pregnancy-induced high blood pressure and preeclampsia.

Prevention

There's no known way to prevent type 1 diabetes. But researchers are working on preventing the disease or further damage of the islet cells in people who are newly diagnosed.

Ask your provider if you might be eligible for one of these clinical trials. It is important to carefully weigh the risks and benefits of any treatment available in a trial.

Show references

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4. Levitsky LL, et al. Epidemiology, presentation, and diagnosis of type 1 diabetes mellitus in children and adolescents. https://www.uptodate.com/contents/search. Accessed May 4, 2022.

5. Diabetes mellitus (DM). Merck Manual Professional Version. https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/diabetes-mellitus-dm. Accessed May 4, 2022.

6. AskMayoExpert. Type 1 diabetes mellitus. Mayo Clinic; 2021.

7. Robertson RP. Pancreas and islet transplantation in diabetes mellitus. https://www.uptodate.com/contents/search. Accessed May 4, 2022.

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11. Insulin resistance & prediabetes. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance. Accessed May 4, 2022.

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13. Inzucchi SE, et al. Glycemic control and vascular complications in type 1 diabetes. https://www.uptodate.com/contents/search. Accessed May 4, 2022.

14. Diabetes and oral health. American Diabetes Association. https://www.diabetes.org/diabetes/keeping-your-mouth-healthy. Accessed May 4, 2022.

15. Drug treatment of diabetes mellitus. Merck Manual Professional Version. https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/drug-treatment-of-diabetes-mellitus. Accessed May 4, 2022.

16. Weinstock DK, et al. Management of blood glucose in adults with type 1 diabetes mellitus. https://www.uptodate.com/contents/search. Accessed May 7, 2022.

17. FDA proves first automated insulin delivery device for type 1 diabetes. U.S. Food and Drug Administration. https://www.fda.gov/news-events/press-announcements/fda-approves-first-automated-insulin-delivery-device-type-1-diabetes. Accessed May 4, 2022.

18. Boughton CK, et al. Advances in artificial pancreas systems. Science Translational Medicine. 2019; doi:10.1126/scitranslmed.aaw4949.

19. Hypoglycemia (low blood sugar). American Diabetes Association. https://www.diabetes.org/healthy-living/medication-treatments/blood-glucose-testing-and-control/hypoglycemia. Accessed May 4, 2022.

20. Diabetes in the workplace and the ADA. U.S. Equal Opportunity Employment Commission. https://www.eeoc.gov/laws/guidance/diabetes-workplace-and-ada. Accessed May 4, 2022.

21. Cardiovascular disease and risk management: Standards of medical care in diabetes - 2022. Diabetes Care. 2022; doi:10.2337/dc22-S010.

22. Diabetes technology. Standards of Medical Care in Diabetes - 2022. 2022; doi:10.2337/dc22-S007.

23. FDA authorizes a second artificial pancreas system. JDRF. https://www.jdrf.org/blog/2019/12/13/jdrf-reports-fda-authorizes-second-artificial-pancreas-system/. Accessed May 4, 2022.

24. Classification and diagnosis of diabetes: Standards of medical care in diabetes - 2022. Diabetes Care. 2022; doi:10.2337/dc22-S002.

25. Retinopathy, neuropathy, and foot care: Standards of medical care in diabetes - 2022. Diabetes Care. 2022; doi:10.2337/dc22-S012.

26. Glycemic targets: Standards of medical care in diabetes - 2022. Diabetes Care. 2022; doi:10.2337/dc22-S012.

27. Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes - 2022. Diabetes Care. 2022; doi:10.2337/dc22-S009.

28. Facilitating behavior change and well-being to improve health outcomes: Standards of medical care in diabetes - 2022. Diabetes Care. 2022; doi:10.2337/dc22-S005.

29. Centers for Disease Control and Prevention. Use of hepatitis B vaccination for adults with diabetes mellitus: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report. 2011;60:1709.

30. Management of diabetes in pregnancy: Standards of medical care in diabetes - 2022. Diabetes Care. 2022; doi:10.2337/dc22-S015.

31. Older adults: Standards of medical care in diabetes - 2022. Diabetes Care. 2022; doi:10.2337/dc22-S013.

32. FDA approves first-of-its-kind automated insulin delivery and monitoring system for use in young pediatric patients. U.S. Food and Drug Administration. https://www.fda.gov/news-events/press-announcements/fda-approves-first-its-kind-automated-insulin-delivery-and-monitoring-system-use-young-pediatric#:~:text=Today, the U.S. Food and,by individuals aged 2 to. Accessed May 8, 2022.

33. What you need to know: Getting a COVID-19 vaccine. American Diabetes Association. https://www.diabetes.org/coronavirus-covid-19/vaccination-guide. Accessed June 1, 2022.

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Learn about the symptoms, causes, treatment of this chronic condition in which the pancreas produces little or no insulin.

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Type 1: Usually the body's own immune system (fights harmful bacteria and viruses) mistakenly destroys the insulin-producing cells in the pancreas. Other causes could be genetics and exposure to viruses and other environmental factors. Some risk factors are ages between 4-7 years old and 10-14 years old, and living farther from the equator.
Type 2: The exact reason the body becomes resistant to insulin is unknown, but genetics and environmental factors like excess weight and inactivity play a role. Certain risk factors are fat distribution primarily in the abdomen, people of specific races-African Americans, Hispanics, American Indians, and Asian-Americans-, older age, having prediabetes, having gestational diabetes while pregnant, and having polycystic ovarian syndrome in women.

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Overview

Type 2 diabetes is a condition that happens because of a problem in the way the body regulates and uses sugar as a fuel. That sugar also is called glucose. This long-term condition results in too much sugar circulating in the blood. Eventually, high blood sugar levels can lead to disorders of the circulatory, nervous and immune systems.

In type 2 diabetes, there are primarily two problems. The pancreas does not produce enough insulin - a hormone that regulates the movement of sugar into the cells. And cells respond poorly to insulin and take in less sugar.

Type 2 diabetes used to be known as adult-onset diabetes, but both type 1 and type 2 diabetes can begin during childhood and adulthood. Type 2 is more common in older adults. But the increase in the number of children with obesity has led to more cases of type 2 diabetes in younger people.

There's no cure for type 2 diabetes. Losing weight, eating well and exercising can help manage the disease. If diet and exercise aren't enough to control blood sugar, diabetes medications or insulin therapy may be recommended.

Symptoms

Symptoms of type 2 diabetes often develop slowly. In fact, you can be living with type 2 diabetes for years and not know it. When symptoms are present, they may include:

Increased thirst.

Frequent urination.

Increased hunger.

Unintended weight loss.

Fatigue.

Blurred vision.

Slow-healing sores.

Frequent infections.

Numbness or tingling in the hands or feet.

Areas of darkened skin, usually in the armpits and neck.

When to see a doctor

See your health care provider if you notice any symptoms of type 2 diabetes.

Causes

Type 2 diabetes is mainly the result of two problems:

Cells in muscle, fat and the liver become resistant to insulin As a result, the cells don't take in enough sugar.

The pancreas can't make enough insulin to keep blood sugar levels within a healthy range.

Exactly why this happens is not known. Being overweight and inactive are key contributing factors.

How insulin works

Insulin is a hormone that comes from the pancreas - a gland located behind and below the stomach. Insulin controls how the body uses sugar in the following ways:

Sugar in the bloodstream triggers the pancreas to release insulin.

Insulin circulates in the bloodstream, enabling sugar to enter the cells.

The amount of sugar in the bloodstream drops.

In response to this drop, the pancreas releases less insulin.

The role of glucose

Glucose - a sugar - is a main source of energy for the cells that make up muscles and other tissues. The use and regulation of glucose includes the following:

Glucose comes from two major sources: food and the liver.

Glucose is absorbed into the bloodstream, where it enters cells with the help of insulin.

The liver stores and makes glucose.

When glucose levels are low, the liver breaks down stored glycogen into glucose to keep the body's glucose level within a healthy range.

In type 2 diabetes, this process doesn't work well. Instead of moving into the cells, sugar builds up in the blood. As blood sugar levels rise, the pancreas releases more insulin. Eventually the cells in the pancreas that make insulin become damaged and can't make enough insulin to meet the body's needs.

Risk factors

Factors that may increase the risk of type 2 diabetes include:

Weight. Being overweight or obese is a main risk.

Fat distribution. Storing fat mainly in the abdomen - rather than the hips and thighs - indicates a greater risk. The risk of type 2 diabetes is higher in men with a waist circumference above 40 inches (101.6 centimeters) and in women with a waist measurement above 35 inches (88.9 centimeters).

Inactivity. The less active a person is, the greater the risk. Physical activity helps control weight, uses up glucose as energy and makes cells more sensitive to insulin.

Family history. An individual's risk of type 2 diabetes increases if a parent or sibling has type 2 diabetes.

Race and ethnicity. Although it's unclear why, people of certain races and ethnicities - including Black, Hispanic, Native American and Asian people, and Pacific Islanders - are more likely to develop type 2 diabetes than white people are.

Blood lipid levels. An increased risk is associated with low levels of high-density lipoprotein (HDL) cholesterol - the "good" cholesterol - and high levels of triglycerides.

Age. The risk of type 2 diabetes increases with age, especially after age 35.

Prediabetes. Prediabetes is a condition in which the blood sugar level is higher than normal, but not high enough to be classified as diabetes. Left untreated, prediabetes often progresses to type 2 diabetes.

Pregnancy-related risks. The risk of developing type 2 diabetes is higher in people who had gestational diabetes when they were pregnant and in those who gave birth to a baby weighing more than 9 pounds (4 kilograms).

Polycystic ovary syndrome. Having polycystic ovary syndrome - a condition characterized by irregular menstrual periods, excess hair growth and obesity - increases the risk of diabetes.

Complications

Type 2 diabetes affects many major organs, including the heart, blood vessels, nerves, eyes and kidneys. Also, factors that increase the risk of diabetes are risk factors for other serious diseases. Managing diabetes and controlling blood sugar can lower the risk for these complications and other medical conditions, including:

Heart and blood vessel disease. Diabetes is associated with an increased risk of heart disease, stroke, high blood pressure and narrowing of blood vessels, a condition called atherosclerosis.

Nerve damage in limbs. This condition is called neuropathy. High blood sugar over time can damage or destroy nerves. That may result in tingling, numbness, burning, pain or eventual loss of feeling that usually begins at the tips of the toes or fingers and gradually spreads upward.

Other nerve damage. Damage to nerves of the heart can contribute to irregular heart rhythms. Nerve damage in the digestive system can cause problems with nausea, vomiting, diarrhea or constipation. Nerve damage also may cause erectile dysfunction.

Kidney disease. Diabetes may lead to chronic kidney disease or end-stage kidney disease that can't be reversed. That may require dialysis or a kidney transplant.

Eye damage. Diabetes increases the risk of serious eye diseases, such as cataracts and glaucoma, and may damage the blood vessels of the retina, potentially leading to blindness.

Skin conditions. Diabetes may raise the risk of some skin problems, including bacterial and fungal infections.

Slow healing. Left untreated, cuts and blisters can become serious infections, which may heal poorly. Severe damage might require toe, foot or leg amputation.

Hearing impairment. Hearing problems are more common in people with diabetes.

Sleep apnea. Obstructive sleep apnea is common in people living with type 2 diabetes. Obesity may be the main contributing factor to both conditions.

Dementia. Type 2 diabetes seems to increase the risk of Alzheimer's disease and other disorders that cause dementia. Poor control of blood sugar is linked to a more rapid decline in memory and other thinking skills.

Prevention

Healthy lifestyle choices can help prevent type 2 diabetes. If you've received a diagnosis of prediabetes, lifestyle changes may slow or stop the progression to diabetes.

A healthy lifestyle includes:

Eating healthy foods. Choose foods lower in fat and calories and higher in fiber. Focus on fruits, vegetables and whole grains.

Getting active. Aim for 150 or more minutes a week of moderate to vigorous aerobic activity, such as a brisk walk, bicycling, running or swimming.

Losing weight. If you are overweight, losing a modest amount of weight and keeping it off may delay the progression from prediabetes to type 2 diabetes. If you have prediabetes, losing 7% to 10% of your body weight may reduce the risk of diabetes.

Avoiding long stretches of inactivity. Sitting still for long periods of time can increase the risk of type 2 diabetes. Try to get up every 30 minutes and move around for at least a few minutes.

For people with prediabetes, metformin (Fortamet, Glumetza, others), a diabetes medication, may be prescribed to reduce the risk of type 2 diabetes. This is usually prescribed for older adults who are obese and unable to lower blood sugar levels with lifestyle changes.

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High blood sugar levels are the main problem in diabetes. Learn about lifestyle changes to lower the risk and treatments to manage type 2 diabetes.

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1. Foot complications because of nerve damage called neuropathy. It can lessen ability to feel pain, heat, and cold. This can lead to a foot injury because you can not feel a blister form.  Blood circulation is also decreased, so infections might not heal very well.
2. With diabetes, you are 1.5 more times higher to have a stroke.  A stroke can damage brain tissue which can cause movement problems, pain, numbness and problems with thinking , remembering, and speaking.
3. Hypertension which makes your heart work harder, increasing the risk for heart disease.
4. Nephropathy can affect the body's ability to remove waste products from the blood. Diabetes can damage the kidneys because high levels of blood glucose make the kidneys filter too much blood.  This excess filtering is hard on the filters so eventually they start to leak and useful proteins are lost in urine.
5.  Diabetic ketoacidosis is a condition that can lead to diabetic coma or even death. If cells do not get enough glucose, the body begins to burn fat for energy which produces ketones. High levels of ketones can poison the body because it raises the acidity level of the blood.

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Diabetic ketoacidosis (DKA) is a serious condition that can lead to diabetic coma (passing out for a long time) or even death.

When your cells don't get the glucose they need for energy, your body begins to burn fat for energy, which produces ketones. Ketones are chemicals that the body creates when it breaks down fat to use for energy. The body does this when it doesn't have enough insulin to use glucose, the body's normal source of energy. When ketones build up in the blood, they make it more acidic. They are a warning sign that your diabetes is out of control or that you are getting sick.

High levels of ketones can poison the body. When levels get too high, you can develop DKA. DKA may happen to anyone with diabetes, though it is rare in people with type 2.

Treatment for DKA usually takes place in the hospital. But you can help prevent it by learning the warning signs and checking your urine and blood regularly.

What are the Warning Signs of DKA?

DKA usually develops slowly. But when vomiting occurs, this life-threatening condition can develop in a few hours. Early symptoms include the following:

Thirst or a very dry mouth

Frequent urination

High blood glucose (blood sugar) levels

High levels of ketones in the urine

Then, other symptoms appear:

Constantly feeling tired

Dry or flushed skin

Nausea, vomiting, or abdominal pain
(Vomiting can be caused by many illnesses, not just ketoacidosis. If vomiting continues for more than 2 hours, contact your health care provider.)

Difficulty breathing

Fruity odor on breath

A hard time paying attention, or confusion

Ketoacidosis (DKA) is dangerous and serious. If you have any of the above symptoms, contact your health care provider IMMEDIATELY, or go to the nearest emergency room of your local hospital.
How Do I Check for Ketones?

You can detect ketones with a simple urine test using a test strip, similar to a blood testing strip. Ask your health care provider when and how you should test for ketones. Many experts advise to check your urine for ketones when your blood glucose is more than 240 mg/dl.

When you are ill (when you have a cold or the flu, for example), check for ketones every 4 to 6 hours. And check every 4 to 6 hours when your blood glucose is more than 240 mg/dl.

Also, check for ketones when you have any symptoms of DKA.

What If I Find Higher-than-normal Levels of Ketones?

If your health care provider has not told you what levels of ketones are dangerous, then call when you find moderate amounts after more than one test. Often, your health care provider can tell you what to do over the phone.

Call your health care provider at once if you experience the following conditions:

Your urine tests show high levels of ketones.

Your urine tests show high levels of ketones and your blood glucose level is high.

Your urine tests show high levels of ketones and you have vomited more than twice in four hours.

Do NOT exercise when your urine tests show ketones and your blood glucose is high. High levels of ketones and high blood glucose levels can mean your diabetes is out of control. Check with your health care provider about how to handle this situation.

What Causes DKA?

Here are three basic reasons for moderate or large amounts of ketones:

Not enough insulin
Maybe you did not inject enough insulin. Or your body could need more insulin than usual because of illness.

Not enough food
When you're sick, you often don't feel like eating, sometimes resulting in high ketone levels. High levels may also occur when you miss a meal.

Insulin reaction (low blood glucose)
If testing shows high ketone levels in the morning, you may have had an insulin reaction while asleep.

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Diabetic ketoacidosis (DKA) is a serious condition that can lead to diabetic coma (passing out for a long time) or even death. When your cells don't get the glucose they need for energy, your body begins to burn fat for energy, which produces ketones.

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MS: involves an immune-mediated process where an abnormal response of the body's immune system is directed against the CNS.
Role of myelin (fatty substance that surrounds and insulates the nerve fibers): if myelin is damaged messages within the CNS are altered or stopped completely. It is the protective coating around the nerve fibers in the CNS. Damage resulting from myelin destruction can cause a variety of neurological symptoms and lead to development of scar tissue.

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Multiple Sclerosis (MS) involves an immune-mediated process in which an abnormal response of the body's immune system is directed against the central nervous system.

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1. Clinically Isolated Syndrome: first episode of neurological symptoms caused by inflammation and demyelination in the central nervous system.  May not go on to have MS.
2. Relapsing-remitting MS: attacks of new or increasing neurological symptoms.  It can be characterized a active or not active.
3. Secondary progressive MS: follows an initial relapsing-remitting course.  Most people that have been diagnosed with RRMS will eventually get SPMS that progressively gets worse.
4. Primary progressive MS: characterized by worsening neurologic function from the onset of symptoms with no relapse or remissions.

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Clinically Isolated Syndrome (CIS)

Clinically isolated syndrome (CIS) refers to a first episode of neurologic symptoms caused by inflammation and demyelination in the central nervous system. Symptoms of CIS vary from person to person but commonly include:

Vision problems (optic neuritis)

Vertigo

Loss of sensation in the face

Weakness in the arms and legs, with one side of the body affected more than the other

Difficulty with coordination, balance, walking, speaking and swallowing (ataxia)

Bladder problems

To meet the definition of CIS, the episode must last at least 24 hours. Though an episode like this is typical of MS, not all people who have CIS go on to develop MS.
A person with CIS has a high likelihood of a second episode of neurologic symptoms and a diagnosis of relapsing-remitting MS if an MRI ( magnetic resonance imaging) shows brain lesions that are similar to those seen in MS. Without those lesions, the likelihood of an MS diagnosis is much lower.

According to the 2017 diagnostic criteria for MS, a person with CIS may be diagnosed with MS if a brain MRI shows:

Specific signs of an earlier episode of damage in a different location and

Active inflammation in a region other than the one causing the current symptoms

As MRI technology improves, diagnosing MS will be quicker and easier. In the meantime, people with CIS who are considered at high risk for developing MS may be treated with a disease-modifying therapy with approval for that purpose from the U.S. Food and Drug Administration (FDA). Studies show that early treatment of CIS delays the onset of MS.

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Four disease courses have been identified in multiple sclerosis: clinically isolated syndrome (CIS), relapsing-remitting MS (RRMS), primary progressive MS (PPMS) and secondary progressive MS (SPMS).

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-Nervous system:  difficulty thinking, forgetfulness, confusion, and other cognitive changes, depression, frustration, and stress
-Respiratory system: difficulty swallowing because of nerve damage to muscles, vocal changes like slurring, volume or pitch control. Difficulty breathing because of weakened muscles and nerve damage along the spinal cord.
Immune system: weakens so there is a risk of pneumonia, nutrient deficiencies, and inflammatory conditions.
Cardiac system: increased cardiovascular risk such as stroke and heart disease
*There can be vision problems like blurring, eye pain, double vision, and poor contrast
There is also weak bladder control and increase occurrence of bladder infections.
Nerve damage can lead to difficulty with hand-eye coordination
Balance difficulties, muscle weakness, and brittle bones also are secondary problems of S

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Multiple sclerosis causes a breakdown of the protective cover around nerves in the brain and spinal cord. This can affect various body systems, resulting in difficulties with thinking, vision, mood, and movement, among other symptoms.

Multiple sclerosis (MS) is an episodic or progressive and demyelinating immune condition. It's caused by a breakdown of the protective cover (myelin sheath) around the nerves in the brain and spinal cord. This interferes with nerve messages in the brain and spinal cord, making it hard for the brain and spinal cord to send and receive messages with each other and the rest of the body.

The exact cause of MS is still unknown, and there's no cure. The resulting symptoms and their severity can vary from person to person.

Read on to learn more about the effects of MS on the body.

Early MS symptoms tend to appear in adults ages . People assigned female at birth are more likely to develop MS than people assigned male at birth.

The exact cause of MS is unknown, and there's currently no cure. But treatments help manage the symptoms, reduce the number of relapses, and delay the disease progressing (worsening).

MS directly affects the nervous system as the body's immune cells attack myelin in the brain and spinal cord. The symptoms can impact other body systems and cause nervous system symptoms, such as pain and weakness.

Primary symptoms of MS are those that occur due to damage to the myelin sheath and the nerves within. Doctors may treat these symptoms with medications to prevent MS attacks and slow demyelination. This can include:

vision loss

weakness

sensory changes

trouble concentrating

Secondary symptoms of MS are complications that arise due to the direct effects of MS. Examples include urinary tract infections that result from weak bladder muscles and a loss of muscle tone that results from an inability to walk. Doctors may treat secondary symptoms with medication and other therapies.

In some cases, slowing the progression of MS can prevent secondary symptoms.

As the immune system damages the myelin sheath, nerves are exposed. If the nerves become damaged, scar tissue known as plaques may form in the central nervous system.

The result is that the nerves within the brain do not communicate efficiently with each other. This can cause nervous system symptoms that include:

dizziness

vertigo

confusion

memory problems

mood or personality changes

People may also experience depression as a result of MS or from the difficulty of coping with the disease.

Though less common, in advanced cases, MS can cause tremors, seizures, and cognitive problems that closely resemble other neurodegenerative conditions such as dementia.

The impaired nerve signaling between the brain and the organs, muscles, tissues, and cells served by the damaged nerves affects many body systems.

Vision and hearing loss

For many people, vision problems are the first sign of MS and can begin suddenly, affecting one or both eyes. They can include:

double vision (diplopia)

blurriness or dimness

pain

loss of color vision

shaking of the eyes (nystagmus)

These vision problems are usually temporary and likely result from nerve inflammation or eye muscle fatigue.

Although some people with MS experience permanent vision problems, most can be effectively treated with steroids and other short-term treatments, such as special lenses.

Though rare, some people with MS may experience hearing loss or deafness caused by damage to the brainstem. These types of hearing problems usually resolve when the MS flare improves. But they can be permanent in some cases.

Speaking, swallowing, and breathing

According to the National MS Society (NMSS), 25%-40% of people with MS experience speech problems at some point. These can include:

slurring words, or difficulty articulating

disrupted speech pattern

trouble with volume control

stuttering

changes in pitch

nasal voice

hoarseness or breathiness

These effects often occur during relapses or times of fatigue. Treatment may include speech therapy.

People with MS can develop breathing difficulties brought on by demyelination that can impact nerves that control muscles in the chest. Difficulty controlling these muscles can begin early in the disease and worsen as it progresses. Difficulty breathing is a dangerous yet uncommon complication of MS. It often can be improved through work with a respiratory therapist.

Swallowing problems (dysphagia) can also develop. If demyelination weakens the muscles involved in swallowing or hinders the body's ability to control them, it can cause swallowing problems. When proper swallowing is disrupted, food or drink can be inhaled into the lungs, increasing the risk of infections like pneumonia.

Coughing and choking when eating and drinking may occur if you have swallowing problems and should be evaluated immediately. Speech or language therapists can often help with trouble swallowing.

Muscle weakness and balance issues

Demyelination in areas of the brain and spinal cord that control sensation, movement, or balance results in weakness or balance impairment of the limbs or trunk. This may occur when the brain has trouble sending signals to the nerves and muscles. Symptoms can include:

pain

tingling

numbness

trouble with hand-eye coordination

muscle weakness

balance issues

walking difficulties

These effects may start gradually and worsen as demyelination progresses. Many people with MS first feel "pins and needles" and have difficulty with coordination or fine motor skills.

Over time, limb control and ease of walking may be disrupted. In these cases, canes, wheelchairs, and other assistive technologies can aid in muscle control and strength.

People with MS are at higher risk of developing low bone density (osteoporosis) due to common MS treatments (steroids) and inactivity. Weakened bones can make individuals with MS susceptible to fractures and breaks, which can add risk if you also have balance and coordination problems.

Osteoporosis can be prevented or slowed through:

suggests that vitamin D deficiencies may play an important role in the development of MS. Although its exact effect on individuals with MS isn't yet well understood, vitamin D is vital to skeletal health and immune system health. More studies are needed to determine whether and how much vitamin D supplements may benefit people with MS.

MS is thought to be an immune-mediated disease. This means that the body's immune system mistakenly damages healthy nerve tissue, causing damage to the myelin sheath. Immune system activity seems to result in the inflammation responsible for many MS symptoms. Some symptoms may flare up during an MS attack and resolve when the episode ends.

Some MS treatments involve medications and infusions that affect immune cells to help slow the progression of the disease. However, drugs that suppress the immune system may make people more vulnerable to infection.

Problems with bladder and bowel functions commonly occur with MS. This can include:

In some cases, diet and physical therapy or self-care strategies can reduce the impact of these problems on daily life. Other times, medications or other interventions may be necessary.

This is because nerve damage affects how much urine those with MS can comfortably hold in the bladder. MS can cause:

difficulty holding in urine (incontinence)

difficulty urination when you want to (retention)

voluntary or involuntary release of small amounts of urine (spasticity)

This can result in complications such as:

spastic bladder infections

urinary tract infections (UTIs)

kidney infections

These problems can make urination painful and very frequent, even overnight or when there's little urine in the bladder. The use of a catheter may occasionally be necessary.

Doctors can help people with MS effectively manage bladder and bowel problems and avoid complications. But if untreated or unmanaged, they can result in serious infections.

MS can cause an increased risk of infertility in people assigned and female at birth.

MS doesn't increase the risk of pregnancy complications compared to people without MS.

Pregnant people with MS may experience fewer relapses during the second and third trimesters of pregnancy. The NMSS also notes that exclusive breastfeeding may protect against postpartum relapses.

However, sexual dysfunction, such as difficulty experiencing arousal or orgasm, with MS. This can result from demyelination or other MS symptoms, such as fatigue, pain, or depression.

MS symptoms can sometimes make sexual intimacy feel awkward. But, in many cases, sexual problems can be managed successfully through medication, over-the-counter aids, or counseling.

People with MS may have a greater risk for cardiovascular disease, according to a 2022 review of research. This can include:

coronary artery disease

heart attack (myocardial infarction)

heart failure

atrial fibrillation

Treatment to manage MS symptoms, along with heart-healthy behaviors, such as eating a balanced diet and getting regular physical activity, can reduce an individual's risk.

The following includes common questions about the effect of MS on the body.

What happens to your body when you have MS?

When you have MS, your immune system damages the protective covering around nerves in your brain or spinal cord. This inflammation causes demyelination, which may result in nerve damage and symptoms that affect different body systems.

These symptoms can include tingling and numbness, vision changes, muscle cramping and weakness, and problems with bladder and bowel function.

What is the life expectancy of a person with MS?

MS significantly alter a person's life expectancy, according to the National Institute of Neurological Disorders and Stroke (NINDS).

The NMSS notes that life expectancy may be 7 years less than people without MS due to complications that can potentially be prevented or managed and other health conditions. Depending on the type of MS you have and the severity of your symptoms, you may experience some disability.

What part of the body does MS affect first?

MS directly affects the nervous system as the body's immune cells attack the myelin in the brain and spinal cord. The impaired nerve activity can impact different body systems, causing symptoms such as muscle weakness, loss of bladder control, and vision changes.

While there's no cure for multiple sclerosis, a wide variety of treatment options can manage symptoms and modify the disease by preventing its progression and overall effects on your body.

MS affects everyone differently. Each person has a unique set of symptoms and responses to treatments.

You can work with a doctor or healthcare team to customize a treatment plan that addresses your symptoms and helps prevent relapses and disease progression. This can make MS more manageable.

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The Effects of Multiple Sclerosis on Your Body

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When the protective sheath around your nerves breaks down, you can experience nerve damage, which can result in a wide range of symptoms. Learn what to expect.

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Heart disease: conditions that involve narrowed or block blood vessels that can lead to a heart attack, chest pain, or stroke
blood vessel diseases: disease of the arteries and veins of circulatory system of the body
heart arrhythmia: occur when the electrical impulses that coordinate your heartbeats do not work correctly, making the heart beat either too fast or too slow, or irregularly.
congenital heart defect: malformation of the heart, aorta, or other large blood vessels. (Most frequent form of major birth defect in newborns)
cardiomyopathy: a chronic disease of the heart muscle
heart infections: Endocarditis is an infection of the endocardium (inner lining of the heart chambers and valves).
valvular heart disease: damage to or a defect in one of the fours heart valves.

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Secondary problems related to heart disease

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Secondary problems related to heart disease

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-heart failure (heart can't pump enough blood to meet the body's needs
-heart attack (a blood clot blocking the blood flow through a blood vessel) can damage pr destroy part of the heart muscle
-stroke can occur where brain tissue begins to die.  This can lead to numerous central nervous system problems.
-Aneurysm (bulge in the wall of your artery that if it bursts can lead to internal bleeding
-Peripheral artery disease (extremities don't receive enough blood flow which can cause pain when walking or using your arms).
-Sudden cardiac arrest where you can lose heart function, breathing, and consciousness

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Overview

Heart disease describes a range of conditions that affect the heart. Heart diseases include:

Blood vessel disease, such as coronary artery disease

Irregular heartbeats (arrhythmias)

Heart problems you're born with (congenital heart defects)

Disease of the heart muscle

Heart valve disease

Many forms of heart disease can be prevented or treated with healthy lifestyle choices.

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Symptoms

Heart disease symptoms depend on the type of heart disease.

Symptoms of heart disease in the blood vessels

Coronary artery disease is a common heart condition that affects the major blood vessels that supply the heart muscle. Cholesterol deposits (plaques) in the heart arteries are usually the cause of coronary artery disease. The buildup of these plaques is called atherosclerosis (ath-ur-o-skluh-ROE-sis). Atherosclerosis reduces blood flow to the heart and other parts of the body. It can lead to a heart attack, chest pain (angina) or stroke.

Coronary artery disease symptoms may be different for men and women. For instance, men are more likely to have chest pain. Women are more likely to have other symptoms along with chest discomfort, such as shortness of breath, nausea and extreme fatigue.

Symptoms of coronary artery disease can include:

Chest pain, chest tightness, chest pressure and chest discomfort (angina)

Shortness of breath

Pain in the neck, jaw, throat, upper belly area or back

Pain, numbness, weakness or coldness in the legs or arms if the blood vessels in those body areas are narrowed

You might not be diagnosed with coronary artery disease until you have a heart attack, angina, stroke or heart failure. It's important to watch for heart symptoms and discuss concerns with your health care provider. Heart (cardiovascular) disease can sometimes be found early with regular health checkups.

What is coronary artery disease? A Mayo Clinic cardiologist explains.

Stephen Kopecky, M.D., talks about the risk factors, symptoms and treatment of coronary artery disease (CAD). Learn how lifestyle changes can lower your risk.
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Stephen Kopecky, M.D., Cardiovascular Disease, Mayo Clinic: I'm Dr. Stephen Kopecky, a cardiologist at Mayo Clinic. In this video, we'll cover the basics of coronary artery disease. What is it? Who gets it? The symptoms, diagnosis and treatment. Whether you're looking for answers for yourself or someone you love, we're here to give you the best information available.

Coronary artery disease, also called CAD, is a condition that affects your heart. It is the most common heart disease in the United States. CAD happens when coronary arteries struggle to supply the heart with enough blood, oxygen and nutrients. Cholesterol deposits, or plaques, are almost always to blame. These buildups narrow your arteries, decreasing blood flow to your heart. This can cause chest pain, shortness of breath or even a heart attack. CAD typically takes a long time to develop. So often, patients don't know that they have it until there's a problem. But there are ways to prevent coronary artery disease, and ways to know if you're at risk and ways to treat it.

Who gets it?

Anyone can develop CAD. It begins when fats, cholesterols and other substances gather along the walls of your arteries. This process is called atherosclerosis. It's typically no cause for concern. However, too much buildup can lead to a blockage, obstructing blood flow. There are a number of risk factors, common red flags, that can contribute to this and ultimately lead to coronary artery disease. First, getting older can mean more damaged and narrowed arteries. Second, men are generally at a greater risk. But the risk for women increases after menopause. Existing health conditions matter, too. High blood pressure can thicken your arteries, narrowing your blood flow. High cholesterol levels can increase the rate of plaque buildup. Diabetes is also associated with higher risk, as is being overweight. Your lifestyle plays a large role as well. Physical inactivity, long periods of unrelieved stress in your life, an unhealthy diet and smoking can all increase your risk. And finally, family history. If a close relative was diagnosed at an early age with heart disease, you're at a greater risk. All these factors together can paint a picture of your risk for developing CAD.

What are the symptoms?

When coronary arteries become narrow, the heart doesn't get enough oxygen-rich blood. Remember, unlike most pumps, the heart has to pump its own energy supply. It's working harder with less. And you may begin to notice these signs and symptoms of pressure or tightness in your chest. This pain is called angina. It may feel like somebody is standing on your chest. When your heart can't pump enough blood to meet your body's needs, you might develop shortness of breath or extreme fatigue during activities. And if an artery becomes totally blocked, it leads to a heart attack. Classic signs and symptoms of a heart attack include crushing, substernal chest pain, pain in your shoulders or arms, shortness of breath, and sweating. However, many heart attacks have minimal or no symptoms and are found later during routine testing.

How is it diagnosed?

Diagnosing CAD starts by talking to your doctor. They'll be able to look at your medical history, do a physical exam and order routine blood work. Depending on that, they may suggest one or more of the following tests: an electrocardiogram or ECG, an echocardiogram or soundwave test of the heart, stress test, cardiac catheterization and angiogram, or a cardiac CT scan.

How is it treated?

Treating coronary artery disease usually means making changes to your lifestyle. This might be eating healthier foods, exercising regularly, losing excess weight, reducing stress or quitting smoking. The good news is these changes can do a lot to improve your outlook. Living a healthier life translates to having healthier arteries. When necessary, treatment could involve drugs like aspirin, cholesterol-modifying medications, beta-blockers, or certain medical procedures like angioplasty or coronary artery bypass surgery.

What now?

Discovering you have coronary artery disease can be overwhelming. But be encouraged. There are things you can do to manage and live with this condition. Reducing cholesterol, lowering blood pressure, quitting tobacco, eating healthier, exercising and managing your stress can make a world of difference. Better heart health starts by educating yourself. So don't be afraid to seek out information and ask your doctors about coronary artery disease. If you'd like to learn even more about this condition, watch our other related videos or visit Mayoclinic.org. We wish you well.

Heart disease symptoms caused by irregular heartbeats (heart arrhythmias)

The heart may beat too quickly, too slowly or irregularly. Heart arrhythmia symptoms can include:

Chest pain or discomfort

Dizziness

Fainting (syncope) or near fainting

Fluttering in the chest

Lightheadedness

Racing heartbeat (tachycardia)

Shortness of breath

Slow heartbeat (bradycardia)

Heart disease symptoms caused by congenital heart defects

Serious congenital heart defects usually are noticed soon after birth. Congenital heart defect symptoms in children could include:

Pale gray or blue skin or lips (cyanosis)

Swelling in the legs, belly area or areas around the eyes

In an infant, shortness of breath during feedings, leading to poor weight gain

Less-serious congenital heart defects are often not diagnosed until later in childhood or during adulthood. Symptoms of congenital heart defects that usually aren't immediately life-threatening include:

Easily getting short of breath during exercise or activity

Easily tiring during exercise or activity

Swelling of the hands, ankles or feet

Heart disease symptoms caused by diseased heart muscle (cardiomyopathy)

Early stages of cardiomyopathy may not cause noticeable symptoms. As the condition worsens, symptoms may include:

Dizziness, lightheadedness and fainting

Fatigue

Feeling short of breath during activity or at rest

Feeling short of breath at night when trying to sleep or waking up short of breath

Irregular heartbeats that feel rapid, pounding or fluttering

Swollen legs, ankles or feet

Heart disease symptoms caused by heart valve problems (valvular heart disease)

The heart has four valves - the aortic, mitral, pulmonary and tricuspid valves. They open and close to move blood through the heart. Many things can damage the heart valves. A heart valve may become narrowed (stenosis), leaky (regurgitation or insufficiency) or close improperly (prolapse).

Valvular heart disease is also called heart valve disease. Depending on which valve isn't working properly, heart valve disease symptoms generally include:

Chest pain

Fainting (syncope)

Fatigue

Irregular heartbeat

Shortness of breath

Swollen feet or ankles

Endocarditis is an infection that affects the heart valves and inner lining of the heart chambers and heart valves (endocardium). Endocarditis symptoms can include:

Dry or persistent cough

Fever

Heartbeat changes

Shortness of breath

Skin rashes or unusual spots

Swelling of the legs or belly area

Weakness or fatigue

When to see a doctor

Seek emergency medical care if you have these heart disease symptoms:

Always call 911 or emergency medical help if you think you might be having a heart attack.

Heart disease is easier to treat when detected early. Talk to your health care provider if you have any concerns about your heart health. Together, you and your provider can discuss ways to reduce your heart disease risk. This is especially important if you have a family history of heart disease.

If you think you may symptoms of heart disease, make an appointment to see your provider.

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Causes

Heart disease causes depend on the specific type of heart disease. There are many different types of heart disease.

How the heart works

To understand the causes of heart disease, it may help to understand how the heart works.

The heart is divided into chambers - two upper chambers (atria) and two lower chambers (ventricles).

The right side of the heart moves blood to the lungs through blood vessels (pulmonary arteries).

In the lungs, blood picks up oxygen and then returns to the left side of the heart through the pulmonary veins.

The left side of the heart then pumps the blood through the aorta and out to the rest of the body.

Heart valves

Four heart valves - the aortic, mitral, pulmonary and tricuspid - keep the blood moving the right way. The valves open only one way and only when they need to. Valves must open all the way and close tightly so there's no leakage.

Heartbeats

A beating heart squeezes (contracts) and relaxes in a continuous cycle.

During contraction (systole), the lower heart chambers (ventricles) squeeze tight. This action forces blood to the lungs and the rest of the body.

During relaxation (diastole), the ventricles fill with blood from the upper heart chambers (atria).

Electrical system

The heart's electrical system keeps it beating. The heartbeat controls the continuous exchange of oxygen-rich blood with oxygen-poor blood. This exchange keeps you alive.

Electrical signals start in the upper right chamber (right atrium).

The signals travel through specialized pathways to the lower heart chambers (ventricles). This tells the heart to pump.

Causes of coronary artery disease

A buildup of fatty plaques in the arteries (atherosclerosis) is the most common cause of coronary artery disease. Risk factors include a poor diet, lack of exercise, obesity and smoking. Healthy lifestyle choices can help lower the risk of atherosclerosis.

Causes of irregular heartbeats (arrhythmias)

Common causes of arrhythmias or conditions that can lead to them include:

Cardiomyopathy

Coronary artery disease

Diabetes

Drug misuse

Emotional stress

Excessive use of alcohol or caffeine

Heart problem present at birth (congenital heart defects)

High blood pressure

Smoking

Heart valve disease

Use of certain medications, including those bought without a prescription, and herbs and supplements

Causes of congenital heart defects

A congenital heart defect develops while a baby is growing in the womb. A congenital heart defect forms as the baby's heart develops, about a month after conception. Congenital heart defects change the flow of blood in the heart. Some medical conditions, medications and genes increase the risk of congenital heart defects.

Causes of a thickened or enlarged heart muscle (cardiomyopathy)

The cause of cardiomyopathy depends on the type:

Dilated cardiomyopathy. The cause of this most common type of cardiomyopathy often is unknown. It may be passed down through families (inherited). Dilated cardiomyopathy typically starts in the heart's main pumping chamber (left ventricle). Many things can cause damage to the left ventricle, including heart attacks, infections, toxins and some drugs, including cancer medicines.

Hypertrophic cardiomyopathy. This type is usually passed down through families (inherited).

Restrictive cardiomyopathy. This is the least common type of cardiomyopathy. It can occur for no known reason. Sometimes it's caused by a buildup of protein called amyloid in the heart (cardiac amyloidosis) or connective tissue disorders.

Causes of heart infection

A heart infection, such as endocarditis, occurs when germs reach the heart or heart valves. The most common causes of heart infections are:

Causes of heart valve disease

Many things can cause diseases of the heart valves. Some people are born with heart valve disease (congenital heart valve disease). Heart valve disease may also be caused by conditions such as:

Rheumatic fever

Infections (infectious endocarditis)

Connective tissue disorders

Risk factors

Risk factors for heart disease include:

Age. Growing older increases the risk of damaged and narrowed arteries and a weakened or thickened heart muscle.

Sex. Men are generally at greater risk of heart disease. The risk for women increases after menopause.

Family history. A family history of heart disease increases the risk of coronary artery disease, especially if a parent developed it at an early age (before age 55 for a male relative, such as your brother or father, and 65 for a female relative, such as your mother or sister).

Smoking. If you smoke, quit. Substances in tobacco smoke damage the arteries. Heart attacks are more common in smokers than in nonsmokers. If you need help quitting, talk to your health care provider about strategies that can help.

Unhealthy diet. Diets high in fat, salt, sugar and cholesterol have been linked to heart disease.

High blood pressure. Uncontrolled high blood pressure can cause the arteries to become hard and thick. These changes interrupt blood flow to the heart and body.

High cholesterol. Having high cholesterol increases the risk of atherosclerosis. Atherosclerosis has been linked to heart attacks and strokes.

Diabetes. Diabetes increases the risk of heart disease. Obesity and high blood pressure increase the risk of diabetes and heart disease.

Obesity. Excess weight typically worsens other heart disease risk factors.

Lack of exercises. Being inactive (sedentary lifestyle) is associated with many forms of heart disease and some of its risk factors, too.

Stress. Unrelieved stress may damage the arteries and worsen other risk factors for heart disease.

Poor dental health. It's important to brush and floss your teeth and gums often. Also get regular dental checkups. Unhealthy teeth and gums makes it easier for germs to enter the bloodstream and travel to the heart. This can cause endocarditis.

Complications

Complications of heart disease include:

Heart failure. This is one of the most common complications of heart disease. Heart failure occurs when the heart can't pump enough blood to meet the body's needs.

Heart attack. A heart attack may occur if a blood clot is stuck in a blood vessel that goes to the heart.

Stroke. The risk factors that lead to heart disease can also lead to an ischemic stroke. This type of stroke happens when the arteries to the brain are narrowed or blocked. Too little blood reaches the brain. A stroke is a medical emergency - brain tissue begins to die within just a few minutes of a stroke.

Aneurysm. An aneurysm is a bulge in the wall of an artery. If an aneurysm bursts, you may have life-threatening internal bleeding.

Peripheral artery disease. In this condition, the arms or legs - usually the legs - don't get enough blood. This causes symptoms, most notably leg pain when walking (claudication). Atherosclerosis can lead to peripheral artery disease.

Sudden cardiac arrest. Sudden cardiac arrest is the sudden loss of heart function, breathing and consciousness. It's usually due to a problem with the heart's electrical system. Sudden cardiac arrest is a medical emergency. If not treated immediately, it results in sudden cardiac death.

Prevention

The same lifestyle changes used to manage heart disease may also help prevent it. Try these heart-healthy tips:

Don't smoke.

Eat a diet that's low in salt and saturated fat.

Exercise at least 30 minutes a day on most days of the week.

Maintain a healthy weight.

Reduce and manage stress.

Control high blood pressure, high cholesterol and diabetes.

Get good sleep. Adults should aim for 7 to 9 hours daily.

More Information

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Learn about symptoms, causes and treatment of cardiovascular disease, a term describing a wide range of conditions that can affect the heart.

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Secondary problems related to cancer treatment

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Secondary problems related to cancer treatment

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Anemia

Appetite loss

Bleeding and bruising

Constipation

Delirium

Diarrhea

Edema

Fatigue

Fertility Issues

Hair Loss

Infection and Neutropenia

Lymphedema

Sleep problems

Urinary problems

Nausea and vomiting

Memory and nerve problems

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Side effects are problems that occur when cancer treatment affects healthy tissues or organs. Learn about side effects caused by cancer treatment. Know what signs and symptoms to call your doctor about. Learn about treatments for side effects.

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Cancer: disease caused by an uncontrolled division of abnormal cells in a part of the body (malignant growth or tumor forms)
How is cancer named?
It begins in your cells when their are mutations or old cells don't die when they should. There are more than 100 different types of cancer that are named after where they originate. For example, lung cancer starts in the lungs, and brain cancer starts in the brain. The spread of cancer from one part of the body to another is called metastasis.

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If you or someone you love has been diagnosed with cancer, learn about diagnosis, treatment, risk factors, and much more.

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Carcinoma in situ (stage 0): there is a group of abnormal cells in an area of the body and could develop into cancer at some point in the future
Stage 1: cancer is relatively small and contained within the organ it started
Stage 2: tumor is larger than in stage 1, but the cancer has not started to spread into the surrounding tissues
Stage 3: cancer is larger and has stated to spread to the surrounding tissues.  There are cancer cells in the lymph nodes in the area
Stage 4: cancer has spread from where it started to another body organ (also called secondary or metastatic cancer).

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This page tells you about the stages of a cancer. There is information about

What cancer staging is

Staging is a way of describing the size of a cancer and how far it has grown. When doctors first diagnose a cancer, they carry out tests to check how big the cancer is and whether it has spread into surrounding tissues. They also check to see whether it has spread to other parts of the body.

Cancer staging may sometimes include the grading of the cancer. This describes how similar a cancer cell is to a normal cell.

Why staging is important

Staging is important because it helps your treatment team to know which treatments you need.

Doctors may recommend a local treatment, such as surgery or radiotherapy, if your cancer is just in one place. This could be enough to get rid of the cancer completely. A local treatment treats only an area of the body.

But you may need treatment that circulates throughout the whole body if your cancer has spread. These are called systemic treatments and include:

chemotherapy

hormone therapy

targeted cancer drugs

You can read more about the different types of cancer treatment.

Cancer spread in the lymph nodes

Sometimes doctors aren't sure if a cancer has spread to another part of the body or not. So they look for cancer cells in the lymph nodes near the cancer.

Cancer cells in these nodes is a sign that the cancer has begun to spread. This is often called as having positive lymph nodes. It means that the cells have broken away from the original cancer and got trapped in the lymph nodes. But it isn't always possible to tell if they have gone anywhere else.

Adjuvant treatment

Doctors usually suggest adjuvant treatment if you have cancer cells in the lymph nodes. This means having treatment in addition to the main treatment for the primary tumour. An example of this is having chemotherapy after surgery.

The aim of adjuvant treatment is to kill any cancer cells that have broken away from the primary tumour.

Types of staging systems

There are 2 main types of staging systems for cancer. These are the TNM system and the number system.

The systems mean that:

doctors have a common language to describe the size and spread of cancers

treatment results can be accurately compared between research studies

different hospitals and clinics have standard treatment guidelines

Some blood cancers or lymph system cancers have their own staging systems.

The TNM staging system

TNM stands for Tumour, Node, Metastasis. This system describes the size of the initial cancer (the primary tumour), whether the cancer has spread to the lymph nodes, and whether it has spread to a different part of the body (metastasised). The system uses letters and numbers to describe the cancer:

T refers to the size of the cancer and how far it has spread into nearby tissue - it can be 1, 2, 3 or 4, with 1 being small and 4 large

N refers to whether the cancer has spread to the lymph nodes - it can be between 0 (no lymph nodes containing cancer cells) and 3 (lots of lymph nodes containing cancer cells)

M refers to whether the cancer has spread to another part of the body - it can either be 0 (the cancer hasn't spread) or 1 (the cancer has spread)

So for example, a small cancer that has spread to the lymph nodes but not to anywhere else in the body may be T2 N1 M0. Or a more advanced cancer that has spread may be T4 N3 M1.

Sometimes doctors use the letters a, b or c to further divide the categories. For example, stage M1a lung cancer is a cancer that has spread to the other lung. Stage M1b lung cancer has spread to other parts of the body.

The letter p is sometimes used before the letters TNM. For example, pT4. This stands for pathological stage. It means that doctors based the staging on examining cancer cells in the lab, after surgery to remove a cancer.

The letter c is sometimes used before the letters TNM. For example, cT2. This stands for clinical stage. It means that the stage is based on what the doctor knows about the cancer before surgery. Doctors may look at your tests results and use the clinical information from examining you.

Number staging systems

Number staging systems usually use the TNM system to divide cancers into stages. Most types of cancer have 4 stages, numbered from 1 to 4. Often doctors write the stage down in Roman numerals. So you may see stage 4 written down as stage IV.

Here is a brief summary of what the stages mean for most types of cancer:

Stage 1 usually means that a cancer is relatively small and contained within the organ it started in

Stage 2 usually means that the tumour is larger than in stage 1, but the cancer has not started to spread into the surrounding tissues. Sometimes stage 2 means that cancer cells have spread into lymph nodes close to the tumour. This depends on the particular type of cancer

Stage 3 usually means the cancer is larger. It may have started to spread into surrounding tissues and there are cancer cells in the lymph nodes in the area

Stage 4 means the cancer has spread from where it started to another body organ. This is also called secondary or metastatic cancer

Sometimes doctors use the letters A, B or C to further divide the number categories. For example, stage 3B cervical cancer.

Carcinoma in situ

Carcinoma in situ is sometimes called stage 0 cancer or 'in situ neoplasm'. It means that there is a group of abnormal cells in an area of the body. The cells may develop into cancer at some time in the future. The changes in the cells are called dysplasia. The number of abnormal cells is too small to form a tumour.

Some doctors and researchers call these cell changes 'precancerous changes' or 'non invasive cancer'. But many areas of carcinoma in situ will never develop into cancer. So some doctors feel that these terms are inaccurate and they don't use them.

Because these areas of abnormal cells are still so small they are usually not found unless they are somewhere easy to spot, for example in the skin. A carcinoma in situ in an internal organ is usually too small to show up on a scan. But tests used in cancer screening programmes can pick up carcinomas in situ in the breast or the neck of the womb (cervix).

Related information

You can read our information about
Cancer grading Cancer treatments
Specific staging systems for different types of cancer

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COPD: chronic inflammatory lung disease that causes obstructed airflow from the lungs
Chronic bronchitis: a disease of the lungs where there is a persisting infection and inflammation of the bronchi. Chronic cough and daily mucus production for at least 3 months of two or more consecutive years.
Emphysema: lung condition that causes shortness of breath because the air sacs in the lungs are damaged. The surface area of the lungs decreases because the air sacs weaken and rupture.

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Overview

Emphysema is a lung condition that causes shortness of breath. In people with emphysema, the air sacs in the lungs (alveoli) are damaged. Over time, the inner walls of the air sacs weaken and rupture - creating larger air spaces instead of many small ones. This reduces the surface area of the lungs and, in turn, the amount of oxygen that reaches your bloodstream.

When you exhale, the damaged alveoli don't work properly and old air becomes trapped, leaving no room for fresh, oxygen-rich air to enter.

Most people with emphysema also have chronic bronchitis. Chronic bronchitis is inflammation of the tubes that carry air to your lungs (bronchial tubes), which leads to a persistent cough.

Emphysema and chronic bronchitis are two conditions that make up chronic obstructive pulmonary disease (COPD). Smoking is the leading cause of COPD. Treatment may slow the progression of COPD, but it can't reverse the damage.

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Symptoms

You can have emphysema for many years without noticing any signs or symptoms. The main symptom of emphysema is shortness of breath, which usually begins gradually.

You may start avoiding activities that cause you to be short of breath, so the symptom doesn't become a problem until it starts interfering with daily tasks. Emphysema eventually causes shortness of breath even while you're at rest.

When to see a doctor

See your doctor if you've had unexplained shortness of breath for several months, especially if it's getting worse or it's interfering with your daily activities. Don't ignore it by telling yourself it's because you're aging or out of shape. Seek immediate medical attention if:

You're so short of breath, you can't climb stairs

Your lips or fingernails turn blue or gray with exertion

You're not mentally alert

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Causes

The main cause of emphysema is long-term exposure to airborne irritants, including:

Tobacco smoke

Marijuana smoke

Air pollution

Chemical fumes and dust

Rarely, emphysema is caused by an inherited deficiency of a protein that protects the elastic structures in the lungs. It's called alpha-1-antitrypsin deficiency emphysema.

Risk factors

Factors that increase your risk of developing emphysema include:

Smoking. Emphysema is most likely to develop in cigarette smokers, but cigar and pipe smokers also are susceptible. The risk for all types of smokers increases with the number of years and amount of tobacco smoked.

Age. Although the lung damage that occurs in emphysema develops gradually, most people with tobacco-related emphysema begin to experience symptoms of the disease between the ages of 40 and 60.

Exposure to secondhand smoke. Secondhand smoke, also known as passive or environmental tobacco smoke, is smoke that you inadvertently inhale from someone else's cigarette, pipe or cigar. Being around secondhand smoke increases your risk of emphysema.

Occupational exposure to fumes or dust. If you breathe fumes from certain chemicals or dust from grain, cotton, wood or mining products, you're more likely to develop emphysema. This risk is even greater if you smoke.

Exposure to indoor and outdoor pollution. Breathing indoor pollutants, such as fumes from heating fuel, as well as outdoor pollutants - car exhaust, for instance - increases your risk of emphysema.

Complications

People who have emphysema are also more likely to develop:

Collapsed lung (pneumothorax). A collapsed lung can be life-threatening in people who have severe emphysema, because the function of their lungs is already so compromised. This is uncommon but serious when it occurs.

Heart problems. Emphysema can increase the pressure in the arteries that connect the heart and lungs. This can cause a condition called cor pulmonale, in which a section of the heart expands and weakens.

Large holes in the lungs (bullae). Some people with emphysema develop empty spaces in the lungs called bullae. They can be as large as half the lung. In addition to reducing the amount of space available for the lung to expand, giant bullae can increase your risk of pneumothorax.

Prevention

To prevent emphysema, don't smoke and avoid breathing secondhand smoke. Wear a mask to protect your lungs if you work with chemical fumes or dust.

Show references

1. What is COPD? National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health/health-topics/topics/copd/#. Accessed Jan. 9, 2017.

2. Mason RJ, et al. COPD: Pathogenesis and natural history. In: Murray and Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. http://www.clinicalkey.com. Accessed Jan. 11, 2017.

3. Goldman L, et al., eds. Chronic obstructive pulmonary disease. In: Goldman-Cecil Medicine. 25th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. http://www.clinicalkey.com. Accessed Jan. 12, 2017.

4. AskMayoExpert. Chronic obstructive pulmonary disease. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2016.

5. Longo DL, et al., eds. Chronic obstructive pulmonary disease. In: Harrison's Principles of Internal Medicine. 19th ed. New York, N.Y.: McGraw-Hill Education; 2015. http://www.accessmedicine.com. Accessed Jan. 11, 2017.

6. Weiss ST. Chronic obstructive pulmonary disease: Risk factors and risk reduction. http://www.uptodate.com/home. Accessed Jan. 11, 2017.

7. Han MK, et al. Chronic obstructive pulmonary disease: Definition, clinical manifestations, diagnosis, and staging. http://www.uptodate.com/home. Accessed Jan. 11, 2017.

8. Ferguson GT, et al. Management of stable chronic obstructive pulmonary disease. http://www.uptodate.com/home. Accessed Jan. 11, 2017.

9. What is bronchitis? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/brnchi. Accessed Jan. 9, 2017.

10. Jong EC, et al. Travel with chronic medical conditions. In: Travel and Tropical Medicine Manual. 4th ed. Philadelphia, Pa.: Saunders Elsevier; 2008.

11. Gautret P, et al. Travel-associated illness in older adults (>60 y). Journal of Travel Medicine. 2012;19:169.

12. Fishwick D, et al. Occupational chronic obstructive pulmonary disease: A standard of care. Occupational Medicine. 2015;65:270.

13. Support and community. American Lung Association. http://www.lung.org/support-and-community/. Accessed Jan. 23, 2017.

14. COPD treatment options. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health/educational/copd/breathing-better/treatment-options.htm. Accessed Jan. 23, 2017.

# data[].attributes.attachment_link.description
Emphysema is a lung problem that makes it hard to catch your breath. It's one of the conditions that make up chronic obstructive pulmonary disease (COPD).

# data[].attributes.body
-tobacco smoking
-fumes from burning fuel for cooking and heating in poorly ventilated homes
-genetic susceptibility to the disease
-air pollution, pipe smoke, cigar smoke, secondhand smoke, and workplace exposure to dust, smoke, or fumes
-COPD develops slowly over years, so older age

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Overview

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus (sputum) production and wheezing. It's typically caused by long-term exposure to irritating gases or particulate matter, most often from cigarette smoke. People with COPD are at increased risk of developing heart disease, lung cancer and a variety of other conditions.

Emphysema and chronic bronchitis are the two most common conditions that contribute to COPD. These two conditions usually occur together and can vary in severity among individuals with COPD.

Chronic bronchitis is inflammation of the lining of the bronchial tubes, which carry air to and from the air sacs (alveoli) of the lungs. It's characterized by daily cough and mucus (sputum) production.

Emphysema is a condition in which the alveoli at the end of the smallest air passages (bronchioles) of the lungs are destroyed as a result of damaging exposure to cigarette smoke and other irritating gases and particulate matter.

Although COPD is a progressive disease that gets worse over time, COPD is treatable. With proper management, most people with COPD can achieve good symptom control and quality of life, as well as reduced risk of other associated conditions.

Symptoms

COPD symptoms often don't appear until significant lung damage has occurred, and they usually worsen over time, particularly if smoking exposure continues.

Signs and symptoms of COPD may include:

Shortness of breath, especially during physical activities

Wheezing

Chest tightness

A chronic cough that may produce mucus (sputum) that may be clear, white, yellow or greenish

Frequent respiratory infections

Lack of energy

Unintended weight loss (in later stages)

Swelling in ankles, feet or legs

People with COPD are also likely to experience episodes called exacerbations, during which their symptoms become worse than the usual day-to-day variation and persist for at least several days.

When to see a doctor

Talk to your doctor if your symptoms are not improving with treatment or getting worse, or if you notice symptoms of an infection, such as fever or a change in sputum.

Seek immediate medical care if you can't catch your breath, if you experience severe blueness of your lips or fingernail beds (cyanosis) or a rapid heartbeat, or if you feel foggy and have trouble concentrating.

Causes

The main cause of COPD in developed countries is tobacco smoking. In the developing world, COPD often occurs in people exposed to fumes from burning fuel for cooking and heating in poorly ventilated homes.

Only some chronic smokers develop clinically apparent COPD, although many smokers with long smoking histories may develop reduced lung function. Some smokers develop less common lung conditions. They may be misdiagnosed as having COPD until a more thorough evaluation is performed.

How your lungs are affected

Air travels down your windpipe (trachea) and into your lungs through two large tubes (bronchi). Inside your lungs, these tubes divide many times - like the branches of a tree - into many smaller tubes (bronchioles) that end in clusters of tiny air sacs (alveoli).

The air sacs have very thin walls full of tiny blood vessels (capillaries). The oxygen in the air you inhale passes into these blood vessels and enters your bloodstream. At the same time, carbon dioxide - a gas that is a waste product of metabolism - is exhaled.

Your lungs rely on the natural elasticity of the bronchial tubes and air sacs to force air out of your body. COPD causes them to lose their elasticity and over-expand, which leaves some air trapped in your lungs when you exhale.

Causes of airway obstruction

Causes of airway obstruction include:

Emphysema. This lung disease causes destruction of the fragile walls and elastic fibers of the alveoli. Small airways collapse when you exhale, impairing airflow out of your lungs.

Chronic bronchitis. In this condition, your bronchial tubes become inflamed and narrowed and your lungs produce more mucus, which can further block the narrowed tubes. You develop a chronic cough trying to clear your airways.

Cigarette smoke and other irritants

In the vast majority of people with COPD, the lung damage that leads to COPD is caused by long-term cigarette smoking. But there are likely other factors at play in the development of COPD, such as a genetic susceptibility to the disease, because not all smokers develop COPD.

Other irritants can cause COPD, including cigar smoke, secondhand smoke, pipe smoke, air pollution, and workplace exposure to dust, smoke or fumes.

Alpha-1-antitrypsin deficiency

In about 1% of people with COPD, the disease results from a genetic disorder that causes low levels of a protein called alpha-1-antitrypsin (AAt). AAt is made in the liver and secreted into the bloodstream to help protect the lungs. Alpha-1-antitrypsin deficiency can cause liver disease, lung disease or both.

For adults with COPD related to AAt deficiency, treatment options include those used for people with more-common types of COPD. In addition, some people can be treated by replacing the missing AAt protein, which may prevent further damage to the lungs.

Risk factors

Risk factors for COPD include:

Exposure to tobacco smoke. The most significant risk factor for COPD is long-term cigarette smoking. The more years you smoke and the more packs you smoke, the greater your risk. Pipe smokers, cigar smokers and marijuana smokers also may be at risk, as well as people exposed to large amounts of secondhand smoke.

People with asthma. Asthma, a chronic inflammatory airway disease, may be a risk factor for developing COPD. The combination of asthma and smoking increases the risk of COPD even more.

Occupational exposure to dusts and chemicals. Long-term exposure to chemical fumes, vapors and dusts in the workplace can irritate and inflame your lungs.

Exposure to fumes from burning fuel. In the developing world, people exposed to fumes from burning fuel for cooking and heating in poorly ventilated homes are at higher risk of developing COPD.

Genetics. The uncommon genetic disorder alpha-1-antitrypsin deficiency is the cause of some cases of COPD. Other genetic factors likely make certain smokers more susceptible to the disease.

Complications

COPD can cause many complications, including:

Respiratory infections. People with COPD are more likely to catch colds, the flu and pneumonia. Any respiratory infection can make it much more difficult to breathe and could cause further damage to lung tissue.

Heart problems. For reasons that aren't fully understood, COPD can increase your risk of heart disease, including heart attack

Lung cancer. People with COPD have a higher risk of developing lung cancer.

High blood pressure in lung arteries. COPD may cause high blood pressure in the arteries that bring blood to your lungs (pulmonary hypertension).

Depression. Difficulty breathing can keep you from doing activities that you enjoy. And dealing with serious illness can contribute to the development of depression.

Prevention

Unlike some diseases, COPD typically has a clear cause and a clear path of prevention, and there are ways to slow the progression of the disease. The majority of cases are directly related to cigarette smoking, and the best way to prevent COPD is to never smoke - or to stop smoking now.

If you're a longtime smoker, these simple statements may not seem so simple, especially if you've tried quitting - once, twice or many times before. But keep trying to quit. It's critical to find a tobacco cessation program that can help you quit for good. It's your best chance for reducing damage to your lungs.

Occupational exposure to chemical fumes and dusts is another risk factor for COPD. If you work with these types of lung irritants, talk to your supervisor about the best ways to protect yourself, such as using respiratory protective equipment.

Here are some steps you can take to help prevent complications associated with COPD:

Quit smoking to help reduce your risk of heart disease and lung cancer.

Get an annual flu vaccination and regular vaccination against pneumococcal pneumonia to reduce your risk of or prevent some infections.

Talk to your doctor if you feel sad or helpless or think that you may be experiencing depression.

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This chronic inflammatory lung disease causes obstructed airflow from the lungs, resulting in breathing difficulty, cough, mucus production and wheezing.

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-respiratory infections: more likely to catch colds, the flu and pneumonia
-heart problems: COPD have a higher risk of developing heart disease, including heart attacks
-lung cancer: can develop, especially if the individual smokes
-high blood pressure in lung arteries: pulmonary hypertension
-depression:difficulty breathing can keep you from doing activities that you enjoy
-osteoporosis: issues related to COPD like inactivity, inflammation, vitamin D deficiency, and corticosteroid use can lead to bone density loss

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1. Wedzicha JA, Donaldson GC. Exacerbations of Chronic Obstructive Pulmonary Disease. Respiratory Care. December 2003.

2. Finkelstein J, Cha E, Scharf SM. Chronic Obstructive Pulmonary Disease as an Independent Risk Factor for Cardiovascular Morbidity. International Journal of Chronic Obstructive Pulmonary Disease. September 24, 2009.

3. Weitzenblum W. Chronic Cor Pulmonale. . February 2003.

4. Annangi S, Foreman MG, et al. Chronic Obstructive Pulmonary Disease and Heart Failure. American Journal of Respiratory and Critical Care Medicine. May 2014.

5. Lam S. Increased Risk for Lung Cancer in COPD. Journal of Thoracic Oncology. January 2017.

6. Raviv S, Hawkins KA, DeCamp MM Jr., Kalhan R. Lung Cancer in Chronic Obstructive Pulmonary Disease Enhancing Surgical Options and Outcomes. American Journal of Respiratory and Critical Care Medicine. May 1, 2011.

7. Fettal N, Taleb A. Pneumothorax Secondary to Chronic Obstructive Pulmonary Disease. European Respiratory Journal. September 1, 2012.

8. Kim J, Lee JH, Kim Y, et al. Association Between Chronic Obstructive Pulmonary Disease and Gastroesophageal Reflux Disease: A National Cross-Sectional Cohort Study. BMC Pulmonary Medicine. August 9, 2013.

9. Jorgensen NR, Schwarz P, Holme I, et al. The Prevalence of Osteoporosis in Patients With Chronic Obstructive Pulmonary Disease: A Cross-Sectional Study. Respiratory Medicine. January 2007.

10. Itoh M, Tsuji T, Nemoto K, et al. Undernutrition in Patients with COPD and Its Treatment. . April 2013.

11. Budhiraja R, Parthasarathy S, Budhiraja P, et al. Insomnia in Patients With COPD. . March 1, 2012.

12. Stage KB, Middelboe T, Stage TB, et al. Depression in COPD - Management and Quality of Life Considerations. International Journal of Chronic Obstructive Pulmonary Disease. September 2006.

13. Vogele C, von Leupoldt A. Mental Disorders in Chronic Obstructive Pulmonary Disease (COPD). Respiratory Medicine. May 2008.

Sources

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What Are the Complications of COPD? | Everyday Health

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Wedzicha JA, Donaldson GC. Exacerbations of Chronic Obstructive Pulmonary Disease. Respiratory Care . December 2003. Finkelstein J, Cha E, Scharf SM. Chronic Obstructive Pulmonary Disease as an Independent Risk Factor for Cardiovascular Morbidity. International Journal of Chronic Obstructive Pulmonary Disease . September 24, 2009. Weitzenblum W. Chronic Cor Pulmonale. .

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RA: chronic progressive disease causing inflammation in the joints which leads to painful deformities and immobility. Most commonly in the fingers, wrists, feet, and ankles.
Stage 1 (early): initial inflammation in the  joint capsule and swelling of synovial tissue. There is swelling that causes joint pain and stiffness.
Stage 2 (moderate): inflammation of the synovial tissue becomes severe enough that it creates cartilage damage. There is loss of mobility and decreased joint range of motion
Stage 3 (severe): inflammation in the synovial tissue is now destroying cartilage and the bone. There is increased pain and swelling and ma decrease in mobility and muscle strength
Stage 4: End stage of RA where the inflammatory process ends and joints just stop functioning altogether

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Jennifer Freeman, MD

If you suspect you have rheumatoid arthritis (RA) or have been recently diagnosed with RA, you will likely have lots of questions and be feeling uncertain about what this disease means for your future. What is the normal RA progression? Will my symptoms get worse? How can I manage the disease? Do I have to have a surgery?

These (and more) are all frequent questions asked by RA sufferers. The reality though is that each patient will experience a unique progression of this disease. RA progression depends on multiple unpredictable variables. Because it is still unclear exactly what triggers RA, it can be nearly impossible to predict an exact outcome.

Below is some general information about what to expect as well as the different stages of RA including the advanced condition known as progressive rheumatoid arthritis.

What to Expect

RA sets in motion many unpredictable symptoms that create a unique disease pattern in each patient. Here is an overview of potential outcomes that can occur while living with RA:

* Symptoms may come and go over the course of the disease
* Intensity and severity of symptoms may change over time
* Symptoms may get better
* Symptoms may worsen
* Pain can be managed and long remission periods can be achieved
* Flare-ups can become more frequent or more prolonged
* Symptoms can stay relatively consistent throughout the course of the disease

In some cases, joint inflammation may continue or worsen despite treatment. It may not necessarily lead to a full progressive state of RA, but it may become more difficult to maintain your mobility and range of motion.

RA Progression Factors

While it is impossible to know the exact progression of each patient, your physician can help you assess your specific case. The progression of your unique condition of RA will depend on many factors including (but not limited to) the following:

* Whether or not you have a family history of the disease
* The age at which you were diagnosed
* What the potential triggers of the disease are as discussed with your physician
* Whether you have the presence of rheumatoid factor or anti-CCP in your blood tests
* The stage at which your condition was diagnosed

Stages of RA

There are four distinct stages of RA progression, and each has their own treatment courses.

Stage 1: This is early stage RA. This stage involves the initial inflammation in the joint capsule and swelling of synovial tissue. The swelling causes the symptoms of joint pain, swelling, and stiffness.

Stage 2: In the moderate stage of RA, the inflammation of the synovial tissue becomes severe enough that it creates cartilage damage. In this stage, symptoms of loss of mobility and decreased joint range of motion become more frequent.

Stage 3: Once the disease has progressed to stage three, it is considered severe RA. Inflammation in the synovium is now destroying not only the cartilage of the joint but the bone as well. Potential symptoms of this stage include increased pain and swelling and a further decrease in mobility and even muscle strength. Physical deformities of the joint may start to develop as well.

Stage 4: In the end stage of RA, the inflammatory process ceases and joints stop functioning altogether. Pain, swelling, stiffness and loss of mobility are still the primary symptoms in this stage.

Early Detection and Diagnosis

As with most diseases, early detection and diagnosis are crucial for being able to treat symptoms, manage pain, and slow progression. An early diagnosis of RA can help you and your team of physicians and specialists put together an individualized treatment plan so that you can continue living a high quality of life.

Early on, you will want to discuss your case with a rheumatologist or RA specialist who can provide you with the treatment you need to delay the disease's progression. Generally, early diagnosis treatment is aggressive and targeted to properly manage the disease and prevent it from progressing.

If your RA was diagnosed in the early stage when symptoms first appeared, your chances of achieving longer periods of remission typically increase drastically. That's not to say you won't experience flare-ups. Early diagnosis simply helps manage the disease and cannot guarantee the complete elimination of symptoms.

Progressive Rheumatoid Arthritis

Progressive rheumatoid arthritis is the condition that occurs when advancing through the disease stages. This advancing condition is characterized by more frequent bouts of inflammation and worsening chronic pain. Additional symptoms that never occurred before can also start to develop in patients who have progressive rheumatoid arthritis.

Progressive rheumatoid arthritis requires a deliberate treatment plan provided by a team of physicians and specialists. This plan should be tailored specifically to your individual symptoms and history of the disease.

Keep in mind that what works for some patients may not work for you. Your response to treatment is largely dependent on the potential factors that triggered your RA, including genetic background.

Symptoms of Progressive Rheumatoid Arthritis

Here are some general warning signs and symptoms that you may have developed progressive rheumatoid arthritis:

* The "active" state of the disease is becoming more frequent
* Flare-ups are occurring regularly and lasting for longer periods of time
* Your pain and swelling are becoming more intense, spreading throughout other areas of your body
* Your diagnosis occurred early on, and so the disease has had a long time to develop
* You are beginning to develop rheumatoid nodules that you didn't have before
* Your blood tests show high levels of Rheumatoid Factor (RF) or anti-CCP

If you suspect that your rheumatoid arthritis has become progressive, consult your rheumatologist to determine the changes in your condition and discuss potential adjustments to your treatment plan.

When to Seek Treatment

The following are general guidelines of when to seek treatment for your RA progression:

* When you first suspect symptoms
* Regularly during the first few years of diagnosis
* If you suspect you are experiencing progressive rheumatoid arthritis
* If you feel your condition is worsening in any way or new symptoms appear

Prevention

While it is difficult to prevent the disease itself due to its unknown causes, RA progression can be managed. The ultimate goal is to stop symptoms from worsening and to prevent the disease from advancing through its stages.

If you undergo individualized, targeted and aggressive treatment early in your disease process, you are more likely to delay and possibly prevent the progression of RA. Working closely with your physician to determine the specific stage of your condition will help to create a unique treatment plan for you for each stage.

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RA Progression: What are the Stages of Rheumatoid Arthritis Progression?

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Jennifer Freeman, MD If you suspect you have rheumatoid arthritis (RA) or have been recently diagnosed with RA, you will likely have lots of questions and be feeling uncertain about what this disease means for your future. What is the normal RA progression? Will my symptoms get worse?

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-unknown what starts the process of the immune system attacking the synovial fluid, but genes play a role if certain environmental factors are present
-Women are more likely to develop the condition
-most commonly occurs at ages 40-60
-there is an increased frisk of the disease if a family member has it
-cigarette smoking
-exposure to dust from building collapses and exposure to asbestos or silica
-people who are overweight or obese

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Rheumatoid arthritis - Symptoms and causes

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This chronic inflammatory disorder can affect more than just your joints. It can also damage your skin, eyes, lungs, heart and blood vessels.

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Systems affected by Rheumatoid Arthritis

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Systems affected by Rheumatoid Arthritis

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-respiratory system: chest pain if lungs get damaged from long-term inflammation, dry mouth, difficulty breathing
-integumentary system: hardened bumps (nodules) form on arms, especially around elbows
-skeletal system: shoulder pain, finger pain and redness, weakness in the knees, uneven stance in your ankles, claw toes and bunions can form
-nervous system: numbness in the wrist from the inflammation of the joints

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Overview

Rheumatoid arthritis (RA) is more than just joint pain. This chronic inflammatory autoimmune disease causes your body to mistakenly attack healthy joints and leads to widespread inflammation.

While RA is notorious for causing joint pain and inflammation, it can also cause other symptoms throughout the body. Read on to learn more about the possible symptoms of RA and its overall effects on the body.

The effects of rheumatoid arthritis on the body

RA is a progressive autoimmune disease that mainly affects your joints. According to Arthritis Foundation, about 1.5 million U.S. people live with RA.

Anyone can get RA, but it generally begins between the ages of 30 and 60. It also tends to affect women nearly three times more than men.

The exact cause of RA is unknown, but genetics, infections, or hormonal changes may play a role. Disease-modifying medications can help slow the progression of RA. Other medications, combined with lifestyle changes, can help manage the effects and in turn improve your overall quality of life.

Skeletal system

One of the first signs of RA is inflammation of the smaller joints in the hands and feet. Most of the time, symptoms affect both sides of the body at once.

Common symptoms include pain, swelling, tenderness, and stiffness, which is more pronounced in the morning. Morning RA pain can last for 30 minutes or longer.

RA can also cause tingling or burning sensations in the joints. Symptoms can come and go in "flares" followed by a period of remission, but the initial stages can last at least six weeks.

RA can also result in:

As the disease progresses, cartilage and bone are damaged and destroyed. Eventually, supporting tendons, ligaments, and muscles weaken. This can lead to a limited range of motion or difficulty moving the joints properly. In the long term, joints can become deformed.

Having RA also puts you at greater risk of developing osteoporosis, a weakening of the bones. This in turn can increase your risk of bone fractures and breaks.

Chronic inflammation of the wrists can lead to carpal tunnel syndrome, making it difficult to use your wrists and hands. Weakened or damaged bones in the neck or cervical spine can cause chronic pain.

Your doctor may order X-rays to investigate the extent of joint and bone damage from RA.

Circulatory system

RA can affect the system responsible for making and transporting blood throughout your body, too.

A simple blood test can reveal the presence of an antibody called the rheumatoid factor. Not all people with the antibody develop RA, but it's one of many clues doctors use to diagnose this condition.

RA increases your risk for anemia. This is due to a decreased production of red blood cells. You may also have a higher risk of blocked or hardened arteries.

In rare cases, RA can lead to inflammation of the sac around the heart (pericarditis), the heart muscle ( myocarditis), or even congestive heart failure.

A rare but serious complication of RA is inflammation of the blood vessels ( rheumatoid vasculitis, or RA rash). Inflamed blood vessels weaken and expand or narrow, interfering with blood flow. This can lead to problems with the nerves, skin, heart, and brain.

Skin, eyes, and mouth

Rheumatoid nodules are hard lumps caused by inflammation that appear under the skin, usually near joints. They can be bothersome, but usually aren't painful.

As many as 4 million U.S. people have an inflammatory disease called Sjogren's syndrome, according to the Sjogren's Syndrome Foundation. About half of these individuals also have RA or a similar autoimmune disease. When the two diseases are present, it's called secondary Sjogren's syndrome.

Sjogren's causes severe dryness - especially of the eyes. You may notice a burning or gritty feeling. Prolonged dry eyes increases the risk of eye infection or corneal damage. Though it's rare, RA can also cause inflammation of the eye.

Sjogren's can also cause a dry mouth and throat, making it difficult to eat or swallow, especially dry foods. Chronic dry mouth can lead to:

You may also experience swollen glands in the face and neck, dry nasal passages, and dry skin. Women may also feel vaginal dryness.

Respiratory system

RA increases the risk of inflammation or scarring of the linings of the lungs ( pleurisy) and damage to lung tissue (rheumatoid lung). Other problems include:

Although RA can damage the respiratory system, not everyone has symptoms. Those who do may experience shortness of breath, coughing, and chest pains.

Immune system

Your immune system acts as an army, protecting you from harmful substances like viruses, bacteria, and toxins. It does this by producing antibodies to attack these invaders.

Occasionally, the immune system mistakenly identifies a healthy part of the body as a foreign invader. When that happens, antibodies attack healthy tissues.

In RA, your immune system attacks your joints. The result is intermittent or chronic inflammation throughout the body.

Autoimmune diseases are chronic, and treatment focuses on slowing progression and easing symptoms. It's also possible to have more than one autoimmune disorder.

Other systems

The pain and discomfort of RA can make it difficult to sleep. RA may lead to extreme fatigue and a lack of energy. In some cases, RA flare-ups can cause flu-like symptoms such as:

short-term fever

sweating

lack of appetite

Early diagnosis and treatment may help slow the progression of RA. Disease-modifying medications, symptom relievers, and lifestyle changes can also greatly improve your quality of life.

It's important to keep your doctor informed of any changes in symptoms you experience with your RA, so you can adjust your treatment plan as necessary.

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11 Effects of Rheumatoid Arthritis on the Body

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Rheumatoid arthritis (RA) is a progressive autoimmune disease that mainly affects your joints. The exact cause of RA is unknown, but genetics, infections, or hormonal changes may play a role. Here, we explain all about its symptoms, as well as RA's overall effects on the body. Learn more with our infographic.

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Secondary problems of Rheumatoid Arthritis

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Secondary problems of Rheumatoid Arthritis

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-increase risk for osteoporosis
-formation of rheumatoid nodules that can form anywhere in the body, especially the lungs
-dry eyes and mouth
-increased infections since the immune system is impaired
-proportion of fat compared to lean mass is often higher for people with RA
-Carpal tunnel syndrome
-increased risk of inflammation and scarring of the lung tissue
-Lymphoma is a concern for people with RA

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Epilepsy: central nervous system disorder where brain activity becomes abnormal, causing seizures or periods of unusual behavior, sensations, and/or a loss of awareness
Seizure: sudden, uncontrolled electrical disturbance in the brain that can cause changes in behavior, movements or feelings, and in levels of consciousness.
Relationship between them: Symptom of epilepsy are seizures (a person with epilepsy will typically have the same type of seizure each episode)

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Learn about this condition that causes seizures. Find out which symptoms are associated with different types of seizures and how they’re treated.

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Focal seizures: seizures that appear from abnormal activity in just one area of the brain. They fall into 2 categories, focal seizures with impaired awareness and focal seizures without loss of consciousness
Generalized seizures: seizures that involve all areas of the brain. They include absence seizures, tonic seizures, atonic seizures, clonic seizures, myoclonic seizures, tonic-clonic seizures

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Status Epilepticus: occurs when a seizure lasts longer than 5 minutes or when seizures occur close together and the person has not adequately recovered
-Convulsive status epilepticus: needs emergency treatment in a hospital because it can be life-threatening
-Nonconvulsive status epilepticus: describes long or repeated absence or focal impaired awareness seizures

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Safety concerns for people with Epilepsy participating in yoga

Sources:
https://www.youtube.com/watch?v=qrlh5Oot5QY

https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/epilepsy-and-exercise

https://www.healthline.com/health/seizure-precautions#exercise

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-genetic disorder caused when there is an abnormal cell division which causes either an extra or partial chromosome 21.
-The syndrome varies with individuals by causing different intellectual disabilities and developmental disabilities.
-With the disorder, an individual might also have heart and gastrointestinal disorders as well

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There are three genetic variations that can cause Down syndrome. It is important to note that human cells contain 23 pairs of chromosomes and Down syndrome results from the abnormal cell division of chromosome 21 dividing an extra time. This extra chromosome causes the characteristic features and developmental delays in people with Down syndrome.
-Trisomy 21 (person has 3 copies of chromosome 21 instead of 2) This occurs during the development of the sperm cell or egg cell.
-Mosaic Down syndrome (person has only some cells with an extra copy of chromosome 21.  It occurs by an abnormal cell division after fertilization has happened.
-Translocation Down syndrome (occurs when a portion of chromosome 21 is attached to another chromosome. This can happen before or at conception. They have the usual two copies of the chromosome, but also have more genetic information from chromosome 21 on other chromosomes.

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-Flattened face
-smaller head
-protruding tongue
-poor muscle tone
-relatively short fingers and small hands and feet
-excessive flexibility
-short height
-infants with Down syndrome are typically average size, but they often grow slowly and remain shorter
-children with Down syndrome have mild to moderate cognitive impairment
-language is delayed
-short and long-term memory can be affected

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-treatment varies between individuals, as each person with down syndrome is unique.
-usually there is a team effort with professionals including, but not limited to, a pediatric cardiologist, pediatric endocrinologist, audiologist, speech pathologist, physical therapist, and an occupational therapist
-medical care and finding ways to help the child adapt to get the best quality of life are important management techniques
-Certain coping and support options available are to learn about early intervention programs, educational options for schools, support groups, participating in social and leisure activities, encourage independence, and preparing for the transition to adulthood.

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-Advancing maternal age
-Being a carrier of the genetic translocation for Down syndrome
-Having a child with Down syndrome already

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-congenital heart defects that can cause life-threatening problems and require surgery
-GI abnormalities, including problems with the intestines, esophagus, trachea, and 🤬.
-Immune disorders meaning people with Down syndrome are more likely to develop autoimmune disorders, some forms of cancer, and infectious diseases
-sleep apnea due to soft tissue and skeletal changes
-Obesity
-Misalignment of the top two vertebrae in the neck can cause spinal problems
-Increased risk to develop Leukemia
-Dementia
-Can have other problems including endocrine problems, dental problems, seizures, ear infections, and hearing and vision problems

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Mayo Clinic Staff. (2018, March 08). Down syndrome. Retrieved from https://www.mayoclinic.org/diseases-conditions/down-syndrome/symptoms-causes/syc-20355977

National Down Syndrome Society. (2018). What is Down Syndrome? | National Down Syndrome Society. Retrieved from https://www.ndss.org/about-down-syndrome/down-syndrome/

Miller, P. (2016). Down syndrome. New York: Cavendish Square.