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Autism Spectrum Disorder -Autism Spectrum Disorder is a neurodevelopmental disorder that is diagnosed on behavioral and developmental characteristics rather than medical, anatomic, or specific genetic markers. There is no single behavior that is always seen in ASD, nor is there a single behavior that can disqualify an individual from being diagnosed with ASD. There is a wide spectrum of functionality in ASD ranging from requires support to requires very substantial support.

Intellectual Disability- This is the most common type of disability. To be diagnosed with an intellectual disability a person must exhibit significant sub-average intellectual functioning, along with deficits in adaptive behavior during a developmental period (under 18 years of age).

Developmental Disability- A group of disables, that are chronic and long term. They occur during a child's developmental period (under the age of 18). They can be physical or mental delays, that are long term.

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Causes of Autism Spectrum Disorder (ASD)

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Causes of Autism Spectrum Disorder (ASD)

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The etiology of ASD is unknown. The research to find the causes of ASD is still ongoing. The three broad areas of research to explain ASD are genetics, neurological structure and development, and environmental factors.

Genetics- It was found that identical twins are more likely to share autism than fraternal twins, this leads scientists to believe it is genetically based. The specific genes involved have not yet been discovered.

Neurological Structure and Development- There is a strong link that children with autism are more likely to develop epilepsy than typically developing children It was also found that EEGs of about half of children with autism are abnormal. This proves that there is a difference in development between children with ASD and typically developing children. Children with ASD also have less densely packed cells in their limbic system.

Environmental Factors- There is little evidence for environmental factors being the cause of ASD. There are theories that pesticides and immunizations cause autism, but they have not been proven true.

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The characteristic behaviors of autism spectrum disorder may be apparent in infancy (18 to 24 months), but they usually become clearer during early childhood (24 months to 6 years).

As part of a well-baby or well-child visit, your child's doctor should perform a "developmental screening," asking specific questions about your baby's progress. The National Institute of Child Health and Human Development (NICHD) lists five behaviors that warrant further evaluation:

Does not babble or coo by 12 months

Does not gesture (point, wave, grasp) by 12 months

Does not say single words by 16 months

Does not say two-word phrases on his or her own by 24 months

Has any loss of any language or social skill at any age

Any of these five "red flags" does not mean your child has autism. But because the disorder's symptoms vary so widely, a child showing these behaviors should be evaluated by a multidisciplinary team. This team might include a neurologist, psychologist, developmental pediatrician, speech/language therapist, learning consultant or other professionals who are knowledgeable about autism.

For more information, visit the Infants and Toddlers page or the CDC's "Learn the Signs. Act Early" program.

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The characteristic behaviors of autism spectrum disorder may be apparent in infancy (18 to 24 months), but they usually become clearer during early childhood (24 months to 6 years). As part of a well-baby or well-child visit, your child's doctor should perform a "developmental screening," asking specific questions about your baby's progress.

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ASD affects social interactions the ability of the person to accept change. There are five diagnostic criteria and three levels of severity.

Five Diagnostic Criteria

1) Persistent deficits in social communication and interaction in three areas: social-emotional reciprocity, nonverbal communication, and maintaining, understanding, and creating relationships.

2) Restricted often repetitive behaviors, interests, and activities in at least two of the following areas: repetitive motor movements, use of objects, or speech; must follow a routine, ritualized patterns of behavior, and hyper or hypersensitivity to sensory input.

3)Symptoms must be present during childhood or adolescence

4) The symptoms must cause significant functional impairment.

5) Must be able to rule out any other possible causes for symptoms.

Three Severity Levels

1) Requires support, deficits in social communication is noticeable and adherence to
routine.

2) Requires substantial support, apparent deficits in social communication and obvious repetitive behaviors.

3) Requires very substantial support, severe deficits in social communication and extremely repetitive behaviors.

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Today's blog is written by Ben Moore. Ben, age 26, recently shared his insights about life with autism at Seattle Children's Autism 200 class in November and we couldn't get enough of his honest, heartfelt answers. Today he shares a little more.
What is it like as an adult living with autism?

Like, how do I even answer this? Let's see... It's hard at times. Sometimes there's too much loud noises. Sometimes people speak too fast - their language gets scrambled and jumbled when I hear it. When I speak, often times what I intend to say is not what comes out of my mouth. Most times it's hard to sustain my attention for prolonged periods. I can be blunt and easily hurt others' feelings (I try really hard not to).

How do you explain your diagnosis to people?

Okay, first off, I don't bring it up hardly ever unless people specifically ask. Instead, if I'm having issues with sensory stuff, I politely ask people to turn down whatever stimuli is bothering me (light brightness, sound volumes, etc.) I try to amend/ameliorate my situation/surroundings. If that doesn't work, I'll cover my ears. It's as if I'm ashamed of being autistic. I know I shouldn't be - there's nothing to be ashamed of, but stigma is a powerful thing.

What do you want people to know about autism?

Please don't see autism and autistic people as a burden, or defective, or diseased, or people who need to be cured. It is said by some so-called "professionals" that we lack empathy. This is just not true! We may not show it like you, and we may struggle at times to put a label on what we're feeling, but believe me when I say that we feel every emotion that you do. Heck, sometimes I think we even feel emotions more profoundly than the average person!

What are you hopes and aspirations?

I want to make the world a better place for autistic people. One where every autistic person feels loved and valued, and get accommodations so that they can be as proactive a member of society as possible. As for career goals, I like hospitals, so doing something medical or at least in a hospital setting would be cool.

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What Is It Like to Live With Autism? | The Autism Blog

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Today's blog is written by Ben Moore. Ben, age 26, recently shared his insights about life with autism at Seattle Children's Autism 200 class in November and we couldn't get enough of his honest, heartfelt answers. Today he shares a little more. Like, how do I even answer this? Let's see...

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Common secondary conditions in ASD include, epilepsy, sleep disorders, hyperactivity, anxiety, and depression. There is also the possibility for sensory processing dysfunctions, cognitive impairment, and self-injurious behavior. Some sensory processing dysfunctions would be:
Sensory over-responsivity, these individuals often have "melt-downs" because they can't control how their brain responds to stimuli.
Sensory under-responsivity, individuals with ASD may react less intensely to stimuli than those without ASD.
Sensory seeking individual is child who needs more intense  sensory input than a typically developing child.

Some cognitive impairments that children with ASD may process information more slowly and have  a strength in visual processing. Some individuals with ASD exhibit self-injurious behaviors (SIB). These behaviors are self-inflicted and cause physical injury to the individual.

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1) Behavioral package- This intervention is used to reduce problem behaviors and to teach functional alternative behaviors or skills.

2) Modeling - An adult peer provides a demonstration of the target behavior either live or videotaped. This type of treatment is often used with other methods.

3) Schedules- This intervention uses lists to complete tasks and activities. The tasks or sequence can be verbal or written.

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There are five categories of causes:

1) Genetic Condition- Abnormalities of genetic material from parents such as chromosomes, errors in genes, and damage to genetic material from X-ray during pregnancy.

2) Problems During Pregnancy- The use of 🤬 or alcohol, malnutrition, and illness such as rubella, syphilis, toxoplasmosis, and 🤬 during pregnancy.

3) Problems at Birth- Any problems during delivery that cause oxygen deprivation or birth injuries.

4) Problems After Birth- Lead or mercury poisoning, near drowning, head injuries, cerebrovascular accidents in children, shaken baby syndrome, meningitis and encephalitis.

5) Poverty and Cultural Deprivation- Growing up in impoverished and malnourished increases the risk of intellectual disabilities

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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- A recreational therapist uses interventions that teach the client about recreation, while teaching them functional skills. An example of this would be  playing a game of tag that involves communication allowing the client to involve themselves in leisure while working on communication in a social setting.

Education, Training, and Counseling- Individuals with intellectual disabilities should be empowered to develop leisure skills that involve their interests, wishes, and aspirations. The recreational therapists will use guided discovery to help involve the client in activities they are interested in. This intervention may also include skills of daily living to increase the client's independence.

3) Community Integration- The recreational therapist helps the client gain knowledge of recreational resources in their community. The recreational therapist helps the client through all the steps of becoming involved in the community.
4) Health Promotion - The recreational therapist helps the individual with an ID to become involved in community programming such as the Special Olympics. The recreational therapist also helps to motivate the client to participate in exercise, healthy eating, and mindfulness.

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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 diagnose a sensory impairment early on or shortly after it happens so a therapeutic intervention can begin. For people with congenital sensory impairments, they were born with that impairment. It is important to figure that out early on so that a child may begin to learn in a way that is adapted to them rather than being mistaken for having a learning disability. It is also important to recognize acquired sensory impairments as soon as they happen. It is important to immediately create support network for this person due to a rapid and traumatic life change. They had this sense previously and suddenly they no longer have it so they have to learn to communicate and go about daily life without it. Apposed to a person who was born with a sensory impairment who considers it part of their life and they have never really experienced that sense.

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Hearing loss can be caused by many things such as noise, aging, disease, and heredity. Also some illnesses and medications can cause hearing loss.
Hearing loss as a baby can be caused during pregnancy, due to an infection. It also can be caused by head trauma, during or after birth.
Hearing loss is also associated with Usher's Syndrome which is a combination of retinitis pigmentosa and hearing loss.

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Usher syndrome is a condition characterized by partial or total hearing loss and vision loss that worsens over time. The hearing loss is classified as sensorineural, which means that it is caused by abnormalities of the .

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Types of Hearing Loss and Degrees of Hearing Loss 

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Types of Hearing Loss and Degrees of Hearing Loss 

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Four Types of Hearing Loss:

1) Conduction Hearing Loss - This is caused by something blocking sound from reaching the outer or middle ear, it can be treated medically.
2) Sensorineural Hearing Loss- There is a problem in the inner ear or hearing nerve that causes this impairment.
3) Mixed Hearing Loss- Hearing loss that includes both conductive and sensorineural impairments.
4) Auditory Neuropathy Spectrum Disorder - There is damage to the inner ear that causes sound to be disorganized, causing the brain to not understand it.

Four Degrees of Hearing Loss:

1) Mild Hearing Loss- Can hear some some speech sounds, but soft sounds are hard to hear.
2) Moderate Hearing Loss - May hear almost no speech when a person is talking at a normal level.
3) Severe Hearing Loss- This person can hear almost no speech when a person is talking at a normal level and only some loud sounds.
4) Profound Hearing Loss- This person can not hear any speech and only very loud sounds.

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Normal visual acuity is how well someone can see normal details from about twenty feet away giving them 20/20 vision. It is also defined as the clearity and sharpness of vision. This 20/20 vision can change such as a person who has 20/30 vision. This person can see at 20 feet away what a person can normally see from 30 feet away. In the United States visual impairment is a visual acuity of 20/40 or less with some correction. Legal blindness is a visual acuity of 20/200, meaning this person at twenty feet away can see what most people see 200 feet away.

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No. 15/15 vision means normal sharpness of vision at 15 feet, just as 20/20 indicates normal sharpness of vision at 20 feet. For consistency, optometrists in the United States use 20 feet as the standard for measuring sharpness of vision. Other countries express visual acuity in their own way.

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Common Eye Diseases that Cause Visual Impairment:

1) Refractive Errors- The most frequent errors include near-nearsightedness ( myopia), farsightedness (hyperopia), and astigmatism.
2)Age-Related Macular Degeneration (AMD)-  is an eye disease associated with aging, where the sharp and central vision are impacted. It can be considered wet or dry. Wet meaning there is blood and fluid leakage in the eye. Dry means the macula had thinned over time resulting in blurry vision.
3)Cataract- It is the clouding of the eye lens it can occur at any age.
4)Diabetic Retinopathy (DR)- It is the leading cause of blindness in the United States. It is caused by damage to the blood vessels of the retina and to the light sensitive tissue in the back of the eye.
5)Glaucoma- It is caused by normal pressure in the eye or a rise in fluid pressure, which results in damage to the optic nerve. There are two types open angle which is a slow onset, and closed angle which is rapid and painful.
6)Amablyopia- It is often referred to as "lazy eye" it occurs when the brain and eye don't work together. This lack of communication between the eye and brain causes visual impairments.
7)Strabismus- This is an imbalance in the positioning of the two eyes that causes a lack of coordination between the two eyes.
8)Diplopia (Double Vision)- There are twp types of diplopia, monocular and binocular. Monocular is caused by a optical aberration, so an image persists even when the eye is covered. Binocular is caused by the misalignment of the eyes resulting in an image not persisting when the eye is covered.
9) Visual Field Impairments- This includes visual neglect such as lack of awareness on one side of the environment or loss of vision in a portion of the field.
10)Quality of Visual  Impairments- These are impairments that affect the quality of vision such as night blindness, photophobia, color blindness, floaters, stray light, and seeing stars or flashes.

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TR Interventions for Hearing Loss and Visual Impairments

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TR Interventions for Hearing Loss and Visual Impairments

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TR Interventions for Visual Impairments:

Functional Skills- A CTRS focuses on problem solving for a person living with a visual impairment. They focus on improving their orientation and mobility, how to move around effectively and safely. They will also focus on improving a clients self-care, communication, reading, and leisure skills. It is essentially a intervention that helps a client do the things they need to and want to do in a way that caters to them.
Community Integration- In this intervention a CTRS teaches a client how to function and move around in the community environment. This means teaching them how to use transportation, educating them about safety, and teaching them to use any equipment such as a cane if necessary.

TR Interventions for Hearing Loss:

Community Integration- As a CTRS it is important to educate the client about community resources that are available. An example would be in Florida, there is the National Deaf Academy, that provides education and resources to those with hearing loss. It is also important to educate and help clients work through barriers they may encounter such as going to the movie theater and not being to hear the dialog. This would be an opportunity to teach your client about subtitles.

Education, Training, and Counseling- A client with a hearing loss may need guidance in domestic and life skills. This may involve teaching a client how to effectively communicate with friends and family. This also may include an assessment of a client's support system, and helping to create one for them. It also also educating them on job skills, leisure skills, and daily living skills. It is teaching them things like cooking, and the importance of a proper nutrition.

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Centers for Disease Control and Prevention

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No single treatment or intervention is the answer for every child or family. Good intervention plans will include close monitoring, follow-ups and any changes needed along the way. There are many different options for children with hearing loss and their families.

Some of the treatment and intervention options include:

Working with a professional (or team) who can help a child and family learn to communicate.

Getting a hearing device, such as a hearing aid.

Joining support groups.

Taking advantage of other resources available to children with a hearing loss and their families.

Early Intervention and Special Education

Early Intervention (0-3 years)

Hearing loss can affect a child's ability to develop speech, language, and social skills. The earlier a child who is deaf or hard-of-hearing starts getting services, the more likely the child's speech, language, and social skills will reach their full potential.

Early intervention program services help young children with hearing loss learn language skills and other important skills. Research shows that early intervention services can greatly improve a child's development.

Babies that are diagnosed with hearing loss should begin to get intervention services as soon as possible, but no later than 6 months of age.

There are many services available through the Individuals with Disabilities Education Improvement Act 2004 (IDEA 2004). Services for children from birth through 36 months of age are called Early Intervention or Part C services. Even if your child has not been diagnosed with a hearing loss, he or she may be eligible for early intervention treatment services. The IDEA 2004 says that children under the age of 3 years (36 months) who are at risk of having developmental delays may be eligible for services. These services are provided through an early intervention system in your state. Through this system, you can ask for an evaluation.

Special Education (3-22 years)

Special education is instruction specifically designed to address the educational and related developmental needs of older children with disabilities, or those who are experiencing developmental delays. Services for these children are provided through the public school system. These services are available through the Individuals with Disabilities Education Improvement Act 2004 (IDEA 2004), Part B.

Early Hearing Detection and Intervention (EHDI) Program

Every state has an Early Hearing Detection and Intervention (EHDI) program. EHDI works to identify infants and children with hearing loss. EHDI also promotes timely follow-up testing and services or interventions for any family whose child has a hearing loss. If your child has a hearing loss or if you have any concerns about your child's hearing, call toll free 1-800-CDC-INFO or contact your local EHDI Program coordinator to find available services in your state.

Technology

Many people who are deaf or hard-of-hearing have some hearing. The amount of hearing a deaf or hard-of-hearing person has is called "residual hearing". Technology does not "cure" hearing loss, but may help a child with hearing loss to make the most of their residual hearing. For those parents who choose to have their child use technology, there are many options, including:

Hearing aids

Cochlear or brainstem implants

Bone-anchored hearing aids

Other assistive devices

Hearing Aids

Hearing aids make sounds louder. They can be worn by people of any age, including infants. Babies with hearing loss may understand sounds better using hearing aids. This may give them the chance to learn speech skills at a young age.

There are many styles of hearing aids. They can help many types of hearing losses. A young child is usually fitted with behind-the-ear style hearing aids because they are better suited to growing ears.

Cochlear and Auditory Brainstem Implants

A cochlear implant may help many children with severe to profound hearing loss - even very young children. It gives that child a way to hear when a hearing aid is not enough. Unlike a hearing aid, cochlear implants do not make sounds louder. A cochlear implant sends sound signals directly to the hearing nerve.

Persons with severe to profound hearing loss due to an absent or very small hearing nerve or severely abnormal inner ear (cochlea), may not benefit from a hearing aid or cochlear implant. Instead an auditory brainstem implant may provide some hearing. An auditory brainstem implant directly stimulates the hearing pathways in the brainstem, bypassing the inner ear and hearing nerve.

Both cochlear and brainstem implants have two main parts. There are the parts that are placed inside the inner ear, the cochlea, or base of the brain, the brainstem during surgery; and the parts outside the ear that send sounds to the parts inside the ear.

Bone-Anchored Hearing Aids

This type of hearing aid can be considered when a child has either a conductive, mixed or unilateral hearing loss and is specifically suitable for children who cannot otherwise wear 'in the ear' or 'behind the ear' hearing aids.

Other Assistive Devices

Besides hearing aids, there are other devices that help people with hearing loss. Following are some examples of other assistive devices:

FM System
An FM system is a kind of device that helps people with hearing loss hear in background noise. FM stands forfrequency modulation. It is the same type of signal used for radios. FM systems send sound from a microphone used by someone speaking to a person wearing the receiver. This system is sometimes used with hearing aids. An extra piece is attached to the hearing aid that works with the FM system.

Captioning
Many television programs, videos, and DVDs are captioned. Television sets made after 1993 are made to show the captioning. You don't have to buy anything special. Captions show the conversation spoken in soundtrack of a program on the bottom of the television screen.

Other devices
There are many other devices available for children with hearing loss. Some of these include:

Text messaging

Telephone amplifiers

Flashing and vibrating alarms

Audio loop systems

Infrared listening devices

Portable sound amplifiers

TTY (Text Telephone or teletypewriter)

Medical and Surgical

Medications or surgery may also help make the most of a person's hearing. This is especially true for a conductive hearing loss, or one that involves a part of the outer or middle ear that is not working in the usual way.

One type of conductive hearing loss can be caused by a chronic ear infection. A chronic ear infection is a build-up of fluid behind the eardrum in the middle ear space. Most ear infections are managed with medication or careful monitoring. Infections that don't go away with medication can be treated with a simple surgery that involves putting a tiny tube into the eardrum to drain the fluid out.

Another type of conductive hearing loss is caused by either the outer and or middle ear not forming correctly while the baby was growing in the mother's womb. Both the outer and middle ear need to work together in order for sound to be sent correctly to the inner ear. If any of these parts did not form correctly, there might be a hearing loss in that ear. This problem may be improved and perhaps even corrected with surgery. An ear, nose, and throat doctor (otolaryngologist) is the health care professional who usually takes care of this problem.

Placing a cochlear implant, auditory brainstem implant, or bone-anchored hearing aid will also require a surgery.

Learning Language

Without extra help, children with hearing loss have problems learning language. These children can then be at risk for other delays. Families who have children with hearing loss often need to change their communication habits or learn special skills (such as sign language) to help their children learn language. These skills can be used together with hearing aids, cochlear or auditory brainstem implants, and other devices that help children hear.
Read about learning language
Family Support Services

For many parents, their child's hearing loss is unexpected. Parents sometimes need time and support to adapt to the child's hearing loss.

Parents of children with recently identified hearing loss can seek different kinds of support. Support is anything that helps a family and may include advice, information, having the chance to get to know other parents that have a child with hearing loss, locating a deaf mentor, finding childcare or transportation, giving parents time for personal relaxation or just a supportive listener.

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early hearing detection and intervention

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Hearing Loss Treatment and Intervention Services | CDC

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No single treatment or intervention is the answer for every child or family. Good intervention plans will include close monitoring, follow-ups and any changes needed along the way.

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It is a group of diseases caused by a defect in a person's genes ( it often runs in families). It is the weakening of muscles over time to the point of where it is hard to perform daily tasks. There are many specific types that affect different muscle groups, but Dechenne/ Becker effects the upper arms and legs. It than can progress to the Brain, throat, heart, diaphragm/chest muscles, stomach, intestines, spine. It primarily effects males between the ages of 5-24.

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I was diagnosed with Duchenne Muscular Dystrophy when I was six years old.

I didn't have the same stamina as other kids on my soccer team, and my parents knew something was wrong. We finally realized that I had a rare genetic disease that affects my muscles after a trip to the doctor's office.

At that point I really didn't know what that meant, only that I couldn't keep up with my classmates anymore. I wouldn't grow up to be the football player I had always dreamed of.

Duchenne Muscular Dystrophy is a degenerative, genetic muscle disease that leaves sufferers with an average life expectancy of 25. It is a sex-linked genetic disease only affecting boys, hindering the production of a protein in your muscle cells that holds together your cellular membrane. In many cases, boys are left wheelchair bound after losing the ability to create that protein entirely.

My body still produces a small amount and I've stuck closely to a regime of stretching and resting. As a result, I am fortunately not yet at that stage.

Any strenuous exercise (running, lifting, even just stair-climbing) is enough to tear the cellular membrane, leading to my muscles breaking down and never being able to repair themselves. So coping with the disease is a combination of conserving energy, taking supplements and steroids that help reduce inflammation and retain muscle strength.

When I was diagnosed it came as a shock to us all, and at the time there were no real treatment options. It was scary, but my parents tell me I was more peaceful now I finally understood why I couldn't keep up with the other kids. W henever someone asked, I told them that I had "leg problems," without knowing the full extent of the disease I had.

My little blue scooter drew everyone towards me throughout elementary school and middle school. Everyone wanted a ride because they thought it was the coolest thing they'd ever laid their eyes on. I remember being so frustrated when asked why I needed my scooter - being able to walk didn't qual not needing a chair, and I wanted to be treated like a normal person.

At the time, there was a lack of work being done on the disease and no one really knew about it. My parents started their foundation, CureDuchenne, to try to jump start research for a cure.

There are numerous examples of parents helped me through my childhood when physical activity was too much. On the final eighth grade trip to Yosemite, my dad fashioned a backpack to carry me in up part of Half Dome. My mom was as equally as committed to helping me through my disease because she helped grow my faith both in God and myself. Even though Boy Scouts is a thought of a outdoors physical activity, I took to my dad's shoulders for long hikes and during my Eagle Scout project, I organized the physical labor without having to do any of it.

As I transitioned from lower school into high school, I became more involved in my parents foundation, speaking at fundraising events and accompanying my parents to network with the community.

High school was both easier and harder. For example, I was really into football at that time, so I became part of the team as a statistician and a "motivator". I loved being able to travel with the team - to games and got to know some of the players.

That said, I still felt left out. Some friends thought I wouldn't be able to participate in activities that they'd planned. At times I felt like being around them made extra work for them, helping me up and down stairs and the small physical things.

This lead to me being afraid of asking for help - I wanted to be able to do everything else on my own.

My dad was there again to help me through the physical challenges that came with international trips. He carried me through the Ho Chi Minh Mausoleum in Vietnam, they thought my scooter was a safety risk. In Argentina he carried me down the side of a cliff for a waterfall boat ride.

Since arriving at USC, I've had to learn to manage on my own.

When I was living at home my parents were always there. They made sure I took my medicine, took on anything around the house I wasn't able to do and they stretched me every night, to name a few things. It's not just one little pill everyday either.

I take around 10-15 pills in the morning, in the afternoon and night. Those range from a steroid that reduces inflammation, which also hampers my growth and maturity (I had to take human growth hormone for a couple of years), multivitamins, supplements that help strengthen muscle cells (some of the same ones you see bodybuilders downing), and general vitamins like D-3.

I'm now in charge of everything. I was able to coordinate with the USC Physical Therapy school to get stretched every day and I've been able to find alternatives with day to day exertions, butI have had to constantly remind myself to take my medicine.

USC has done it's best to accommodate my needs: giving me extra time, the use of a word processor on exams, a room which I can fit my power chair, stretching table and scooter and accessible facilities, but there's still a lot they can do to retrofit their old buildings to be wheelchair accessible. For example, m any of the doors on campus are not accessible via a push plate and some buildings don't have elevators to every floor.

Balancing all of my work and health has been an additional struggle for me. I need rest and cannot pull all nighters so I am constantly figuring out ways to manage my time better and unfortunately cut social activities that would interfere with the amount of sleep that I need. Even with that, I am doing as much as possible to take advantage of the countless opportunities there are at USC.

I am a part of the Navigators at USC, a Christian club that has a weekly service on campus and has semester retreats. Recently I drove up to the San Bernadino mountains with my friends to spend time in worship and prayer and have fun together. I am writing for the Daily Trojan and I was a Deputy News Editor last year, which I was still able to do with all of the other things I have to worry about. I am also writing for the Tab and working at the Annenberg Media center on Monday and Wednesday. Even though I am completely busy at USC, I wouldn't have it any other way.

Years ago, the future for boys with Duchenne like me was grim. The life expectancy was very low and many were wheelchair bound from an early age. Now, with the approval of a drug called Eteplirsen which treats 13 percent of the population, the odds are stacked in the favor of kids with the disease. 13 percent may not seem like a lot put its approval by the FDA has laid the groundwork for the development of other drugs that can treat different mutations.

Living with Duchenne has given me the chance to participate in groundbreaking biological research. I was poked and prodded and my cells were grown in a petri dish to further research the disease. I made two trips to the Netherlands, the original country of my ancestors, to give my body to science with the hopes that it would accelerate the research in Duchenne. I was almost selected to participate in a research trial in Italy, which unfortunately ended up falling through. Obviously there were countless other boys and families who sacrificed parts of their lives to jumpstart the research as well and I am also forever grateful for them.

This drug isn't an outright cure per se either; it won't reverse the effects of the disease and the only hope is that it will stop the progression. The drug works by skipping over an exon that produces the protein dystrophin so that instead of producing nothing, the cell produces a protein that acts the same way as dystrophin would. That's one part of the cure because the disease affects all parts of the body.

In order to stop the progression of the disease, scientists must employ medicine that targets each part of the body that the exon skipping drug doesn't affect - sort of like a drug cocktail. There's already been development in stem cell therapy with the heart and there's bound to be so much more.

With the way science is progressing today nothing is impossible, even curing a disease like mine.

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Living with Duchenne Muscular Dystrophy is frustrating and humbling

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I was diagnosed with Duchenne Muscular Dystrophy when I was six years old. I didn't have the same stamina as other kids on my soccer team, and my parents knew something was wrong. We finally realized that I had a rare genetic disease that affects my muscles after a trip to the doctor's office.

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It is commonly referred to as CP, it is a group of symptoms and neurological disorders that appear in early childhood and infancy. It is caused by non-progressive damage to the areas of the brain that control motor movement. This ultimately affects muscle tone, endurance, strength, and speech. Some people with Cerebral Palsy may also experience some cognitive impairments.

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The General Symptoms of CP:
-Ataxia (poor muscle coordination)
-Poor muscle control
-Spasticity or tight muscles
-Atypical gait (scissoring particularly with spastic CP)
-Drooling
-Swallowing and/or eating difficulties
-Speech impairments in clarity and articulation
-Difficulty with fine motor tasks
-Toe walking
-Atypical muscle tone (too high or too low)
-Involuntary movements or tremors

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Walk at home, school, outdoors and in the community.

Able to climb curbs and stairs without physical assistance or a railing.

Can run and jump but speed, balance and coordination are limited.

Walk in most settings but environmental factors and personal choice influence mobility choices.

Might require a hand-held mobility device for safety at school or work and climb stairs holding onto a railing.

Might use wheeled mobility when traveling long distances outdoors and in the community.

Capable of walking using a hand-held mobility device.

Might climb stairs holding onto a railing with supervision or assistance.

Might self-propel a manual wheelchair or use powered mobility at school.

Use powered mobility or be transported in a wheelchair outdoors and in the community.

Use wheeled mobility in most settings.

Require physical assistance from one to two people for transfers

Might walk short distances indoors with physical assistance; use wheeled mobility or a body-support walker when positioned.

Might operate a powered chair, otherwise are transported in a manual wheelchair.

Are transported in a manual wheelchair in all settings.

Limited in ability to maintain antigravity head and trunk postures and control leg and arm movements.

Self-mobility is severely limited, even with the use of assistive technology.

Visit CanChild Centre for Childhood Disability Research for more information about the GMFCS.

Handles objects easily and successfully.

Experiences limitation in performing manual tasks requiring speed and accuracy. (These limitations don't interfere with independence in daily activities.)

Handles most objects, but with a reduced quality and/or speed in achieving tasks and activities.

Struggles with some activities; might need alternative ways of doing tasks. (These limitations usually don't interfere with independence in daily activities.)

Handles objects with difficulty.

Needs help to prepare or adapt activities.

Does tasks slowly.

Experiences limited success regarding quality and quantity of tasks and activities.

Performs activities independently only if they have been set up or adapted.

Handles a limited selection of easily managed objects in adapted situations.

Performs only parts of activities with effort and limited success.

Requires continuous assistance and/or adapted equipment to attempt an activity.

Cannot handle objects.

Experiences severely limited ability to perform even simple actions.

Requires total assistance.

Visit the MACS online resource site for more information.

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Cerebral Palsy Symptoms and Effects | Gillette Children's Specialty Healthcare

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Walk at home, school, outdoors and in the community. Able to climb curbs and stairs without physical assistance or a railing. Can run and jump but speed, balance and coordination are limited. Walk in most settings but environmental factors and personal choice influence mobility choices.

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- Intellectual Disability
- Epilepsy or Seizures
- Both Intellectual Disability and Seizure Disorder
- Behavioral Problems
- Learning Disabilities
- Sensory Impairments
- Feeding Difficulties and/or Malnutrition
- Lung Problems
- Chronic Pain
- Autism
- Inadequate or Low Levels of Physical Fitness
- Balance Issues
- Fatigue and Cardiovascular Disease
- Musculoskeletal Problems - weakness, arthritis, scoliosis, etc.
- Difficulty Processing Sensory Stimulation
- Incontinence
- Speech Difficulties
- Drooling
- Breathing Difficulties
- Skin Breakdown
- Decreased Spatial Awareness
- Depression or Distress

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Recreational Therapy Interventions for CP

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Recreational Therapy Interventions for CP

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Functional Skills:
-Exercise/ Stretching/ Fitness
-Aquatic Therapy
-Hippotherapy: it is the use of a horse as a therapy animal.
-Therapeutic Horseback Riding
-Therapeutic Massage: this can help to reduce pain and anxiety in clients with CP.

Education, Training, and Counseling:
-Adaptive Sports
-Community Integration Skills: Accessibility, Advocacy, and Removal of Barriers
-Mobile Devices as Adaptive Equipment: use of iPad and other technologies as a mean of therapy.
-Leisure and Health Education: teaching the client the importance of leisure to prevent secondary disability.
-Relaxation and Coping Skills

Community Integration and Inclusion
-Social Skills and Inclusion: Work with clients to be able to work and play with others.
-Participation and Inclusion: promoting community integration and independence.
-Advocacy Skills

Health Promotion
-Adaptive sports
-Animal Assisted Therapy
-Volunteerism: clients participate in meaningful work to promote their psychological well being.
-Therapeutic Recreation Camping Program

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Horses are essential in hippotherapy, a form of neuromuscular therapy that can improve the posture and coordination of a child with disabilities.

Horses are special animals and their healing powers have been recognized for thousands of years. Hippos is the Greek word for horse and hippotherapy means the therapeutic use of horses. But hippotherapy shouldn't be confused with therapeutic riding -- hippotherapy is a medically based treatment tool, whereas therapeutic riding involves teaching people with disabilities equestrian skills. Although Hippocrates first mentioned using horses therapeutically in his ancient Greek writings around 400 B.C., it wasn't until the 1960s that physical therapists (PTs) in Europe began using horses to help patients with neuromuscular disorders such as cerebral palsy or brain injury. Physical therapists believed that the horse's movement created neurological changes that helped improve a person's postural control, strength, and coordination.

American and Canadian physical therapists trained in Europe brought their expertise back to North America in the 1980s and formed the American Hippotherapy Association (AHA) for those specialized in the field. The original focus of hippotherapy was treating physical disabilities, but today it's also used by occupational therapists (OTs) and speech and language pathologists (SLPs). "A horse is powerful motivation, and this enthusiasm can be leveraged into teaching communication, social, fine motor, or any target skill" says Lois Brady, speech and language pathologist and author of Apps for Autism. "Children may feel more comfortable communicating with a horse than a human. Luckily, therapists can help children direct their horse friends by using all modalities of communication, including sign, vocalizations, and picture exchange."

Signs Your Child Needs Hippotherapy

If a child has a disability that qualifies him for therapy (occupational, physical, or speech and language), hippotherapy is an option, particularly if the child loves horses and has grown frustrated with the traditional school or clinical setting. Parents may consider hippotherapy if their child:

leans against surfaces, slides out of chairs, and bumps into things, indicating poor body awareness and postural control

seeks a lot of intense movement and avoids sitting long enough to manipulate objects such as crayons or puzzles

has difficulty following directions and communicating with words, pictures, or gestures.

How Hippotherapy Works

One can say that simply being on a horse is therapeutic. Through hippotherapy, a child can experience many different types of beneficial sensory stimulation -- muscles and joints receive deep pressure stimulation from bouncing and holding positions (like kneeling or standing on the horse), and the brain receives vestibular stimulation (to sense movement and balance) as the horse moves (in circles, up and down hills) and changes speeds. "Hippotherapy provides the sensory stimulation that helps a child organize his body for complex tasks," says Melanie Potock, a speech and language pathologist in Longmont, Colorado, and author of Happy Mealtimes with Happy Kids. "For some children, this may be as simple as being able to produce voice or vocalizing; for others it may be using multisyllabic words or even telling a short story." Also, because a horse walks with a gait that's similar to the human gait -- variable, rhythmic, and repetitive -- a child who has never walked or who has an abnormal gait can sit on a horse and experience what "normal" feels like. The therapist is always in control of the horse's movement, choosing activities that will help achieve specific outcomes. Some examples include:

Reducing muscle tone (e.g., spasticity) with slow, rhythmic movement

Improving attention and postural control with fast, erratic movements

Decreasing sensory defensiveness or sensitivities with full-body contact (when the child pets or hugs the horse).

Improving right and left coordination by steering the reins

Developing visual-motor skills with hiding puzzle pieces along a trail that need to be found

How to Choose a Therapist

Parents may ask therapists at their child's early intervention program or school whether the child is a good candidate for hippotherapy and if they have recommendations for licensed therapists. Unfortunately, there are a limited number of facilities and trained therapists available, and only licensed OTs, PTs, and SLPs utilize hippotherapy as a treatment tool. Some (but not all) early intervention programs and health insurance companies will cover the costs of hippotherapy as they would for therapy in other clinical settings. But insurance companies typically require that treatment be provided by a therapist with credentials in the same discipline that the child needs. In other words, if the insurance company agrees that a child qualifies for PT services to improve gait, it will pay only for hippotherapy provided by a PT.

Of course, parents who pay out of pocket have the option of choosing any type of therapist. They can also opt to include therapeutic riding instructors who are trained and are certified to teach people with disabilities how to ride a horse -- to steer, trot, or jump over poles -- but health insurance companies do not typically pay for therapeutic riding lessons.

To find a therapist with advanced certification training in hippotherapy, visit The American Hippotherapy Association, which has a directory of therapists: americanhippotherapyassociation.org/hippotherapy/find-a-therapist/

Copyright © 2014 Meredith Corporation.

All content on this Web site, including medical opinion and any other health-related information, is for informational purposes only and should not be considered to be a specific diagnosis or treatment plan for any individual situation. Use of this site and the information contained herein does not create a doctor-patient relationship. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.

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Horses are essential in hippotherapy, a form of neuromuscular therapy that can improve the posture and coordination of a child with disabilities. Horses are special animals and their healing powers have been recognized for thousands of years. Hippos is the Greek word for horse and hippotherapy means the therapeutic use of horses.

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Dyplegia - only the legs of a person are impacted in a person who has CP.
Hemiplegia - only half of the body is impacted, usually one side of the body in both extremities.
Quadriplegia - both upper and lower extremities are impacted; may also include facial and trunk muscles.
Ataxia - unsteady wide-based gait, poor coordination, and loss of control of bodily movements.
Dysarthria - difficult or unclear articulation of speech.
Spasticity - A condition where muscles are continuously contracted causing stiffness and tightness of muscles.
Contractures - a condition of shortening and hardening of muscles, or other tissues. This often leads to deformity and rigidity of joints.
Osteopenia - a condition where bones are weaker than normal, but have not broken down.

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A spinal cord injury (SCI) occurs when the spinal cord is injured due to trauma, disease, or disorder. When the spinal cord is damaged, the signals it carries can become interrupted causing temporary or permanent loss of movement and/or sensation. The spinal cord is part of the bodies central nervous system. Its responsibility to convey and receive sensory and motor information to the body. When this is disrupted a functional impairment occurs. Some of the causes for SCIs are trauma, tumor, Tranverse Myelitis, and Guillain-Barre syndrome.

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At the core of the matter

The facts

An SCI, or spinal cord injury, is sustained damage to the spinal cord at any part of it, or the nerves at the end of the spinal canal. This can permanently affect many physiological areas, such as sensations, strength, motor ability and any other functions. A spinal cord injury can impact a person's life and lifestyle. An SCI can either be complete or incomplete.

What is the spinal cord?

The spinal cord is a thick bundle of nerves that runs through the vertebrae (backbones) in your spine. This nerve bundle is about 18 inches long, starting at the base of your brain and ending at your buttocks. The spinal cord acts as a superhighway between your brain and the rest of your body. Want to take a step, or wriggle a finger? The message is normally sent through the spinal cord to these body parts, in the form of nerve impulses. The highway runs in both directions: stub a toe or touch something sharp, and those pain or pressure signals speed back up along the spinal cord to your brain faster than you can say "ow."

What happens when a spinal cord is injured?

Certain neurological diseases or an accident that causes your vertebrae to break can damage your spinal cord. And when the spinal cord is damaged, the highway is essentially closed. Nerve impulses can't get through. This results in paralysis - loss of mobility and sensation - below the level of injury.

What's an incomplete SCI?

Not all spinal cord injuries cause complete paralysis. In the case of an incomplete spinal cord injury, a small stream of highway traffic still gets through. Someone with an incomplete SCI may have a certain amount of feeling or movement below the level of injury. Often, in the case of an incomplete SCI, one side of the body has more function than the other. Thanks to new medical treatments at the time of injury, incomplete spinal cord injuries are more common than they used to be. These same injuries might have been complete if they'd happened a couple of decades earlier.

Why is level of injury important?

The site of your injury will determine what parts of your body are paralyzed. The higher the injury, the more body parts that are affected. For instance, a spinal cord injury in the upper, or cervical, region of your spine will affect your arms as well as your trunk, legs and pelvic area (including bowel and bladder). Someone with this level of injury is considered to be quadriplegic. But an injury lower down, in the thoracic or lumbar region, won't affect your arms. Someone with a spinal cord injury in either of these regions is considered to be paraplegic. About half of all people with SCI are quadriplegic, and half are paraplegic.

Assumptions

In some cases, you may assume someone is paraplegic, rather than quadriplegic, because they are using their arms and hands, but that may not be the case. Their injury could be in the upper, cervical region, and they may have some use of their arms and hands but it could be limited to varying degrees. This is good reason to never assume the degree of movement of someone you first meet - and, if it's important to know, ask the person with an SCI for clarification.

Looking to learn more? Check out Living with an SCI, or ask a question from anywhere in Ontario using the Ask Us! Form on the side tab of this page or email info@sciontario.org or call 416-422-5644, ext. 213 (toll-free 1-877-422-1112).

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Spinal Cord Injury Ontario | What is an SCI

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An SCI, or spinal cord injury, is sustained damage to the spinal cord at any part of it, or the nerves at the end of the spinal canal. This can permanently affect many physiological areas, such as sensations, strength, motor ability and any other functions.

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Classifications of SCIs are classified by the level and type of injury:

Level of Injury
The spinal cord is made up of five segments cervical, thoracic, lumbar, sacral, and coccygeal. The spinal cord runs through these five different levels of vertebrae. To identify the level of injury several tests are performed (x-rays, CT scan, etc.) and the injury is identified by its corresponding vertebrae. So if the spinal cord is damaged near the cervical region, than it may be identified as a C4 injury. There is also a test that is given to clients called the Manual Muscle Exam that helps to identify the level of motor function in a person that has aSCI.

Type of Injury

In addition to determining the level of injury the extent of the injury is also evaluated. The injury can be determined to be
either complete or incomplete. A complete injury means that there is no motor or sensory functioning below the site of injury. An incomplete SCI is where a client would display some sensory and motor functioning below the site of injury. There is also another method of evaluating type of injury called the ASIA Impairment Scale. This scale includes five impairment grades that differ in sensory and motor function to better help evaluate the client's function.

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Tetraplegia (C1-C8) Can be Complete or Incomplete
-C1-C8 injury causes limited neck flexion, extension, and rotation. May have to use a ventilator or phrenic pacer for breathing if SCI is at C3. May be dependent for activities of daily living but can verbalize and direct care.
-C4 SCI has increased control of the neck flexion, extension, and rotation; shoulder shrug (scapula elevation), inspiration. May need a ventilator or phrenic pacer for breathing, but often can begin to breathe on their own. Dependent for daily living but can directly direct their own care.
-C5 SCI can flex and bend arms at  elbows face up, increased shoulder control, including shoulder flexion, abduction, extension, and scapular abduction and adduction. Can breathe on their own and directly communicate care. Can also do some basic tasks of daily living.
-C6 SCI has increases strength and coordination of upper extremities, including scapular protraction and elevation, forearm supination, radial wrist extension; tendoesis resulting in thumb and index finger natural opposition with flexion. Have increased in dependency and can often do most tasks of daily living on their own.
-C7-C8: SCI have radial and ulnar wrist extension, elbow extension, partial finger extension and thumb abduction, partial finger flexors with C8 SCI. Often can be very independent with adaptive equipment that helps them complete daily tasks.

Paraplegia (T1-S5) Complete or Incomplete
-T1-T7 SCI have upper extremity muscle function intact; some truck control and stability. Independent to modified independent with ADLs. They also  have greater participation in recreational activities.
-T8-L1 SCI have improved trunk flexion, extension, and rotation. They are independent to modified independent.
-L2-S5 SCI have partial to full control of lower extremities as hip flexors, knee extenders, ankle dorsiflexors, and plantar flexors return with each level of SCI. Increased standing and ambulation with each level with each level of recovery.

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-Autonomic Dysreflexia or Hyperflexia (AD) : ID is a life threatening rise in blood pressure  that can occur in individuals with a LOI at or above T6 when there is a negative stimulus within or outside the body below the level of injury. Symptoms include high blood pressure, head ache, stuffy nose, blurred vision, and sweating. This condition only occurs in individuals with SCI.
-Pressure Ulcers (decubitus ulcers, skin sores) : Pressure ulcers are spots on the skin that have too much pressure on them. This causes blood flow to stop and the skin begins to die. An individual with an SCI may not feel sensations of too much pressure on the skin and this causes them to stay in the same position. By staying in the same position skin ulcers can occur. If this is not caught it can cause breakdown of the muscle and eventually the bone.
-Respiratory Complications : Injuries to the upper thoracic and cervical spinal cord impact the respiratory muscles causing to be harder for an individual with an SCI to cough or take a deep breath.
-Spasticity or Spastic Hypertonia : The interruption of messages to the reflex center of the brain may result in over compensation of the spinal cord reflex system, leading to spasticity or the stiffness of muscles.
-Temperature Regulation : Individuals with SCIs above T6 will be impacted, due to the interruption to the bodies sympathetic nervous system. This leads to the bodies inability to regulate temperature, such as creating sweat to cool down.
-Heterotopic Ossification: This is the growth of new bones in soft tissues. It is most likely to occur in the hips, knees, and shoulders. Symptoms include redness and warmth, joint and muscle pain, reduced range of motion, and a low fever.
-Deep Vein Thrombosis: These often form in the lower extremities. If it is not caught it can break free and travel to the heart and/or lungs causing a life threatening situation. It is important to monitor possible symptoms such as skin tenderness, discoloration, swelling, and skin temperature.
-Orthostatic (Postural) Hypotension: This is a change in systolic blood pressure by 20 mm HG or in diastolic blood pressure by 10 mm HG when changing from supine to upright. This causes lightheadedness, fainting, fatigue, headache, nausea, numbness, and blurred vision. This is caused by blood pooling in the lower extremities, or lower abdomen.

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Secondary conditions - Living with Paralysis

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Information on common issues related to paralysis, including autonomic dysreflexia, bladder & bowel issues, respiratory health, skin care, sepsis, pain, and DVT.

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Tetraplegia: SCI in C1-C8 that causes paralysis of all four limbs.

Paraplegia: SCI in T1-S5 that causes paralysis of legs and the lower body.

Complete vs. Incomplete Injury: A complete SCI is where a client displays no motor or sensory function below the level of injury. An incomplete SCI is a bruise or increased pressure to the spinal cord that causes decreased sensory and motor function.

Autonomic Dysreflexia: This is a condition where the autonomic nervous system overreacts to external stimuli, and this cause a dangerous rise in blood pressure.

Pressure Ulcer: This is what occurs when too much pressure builds up on the skin in a particular area causing flow of blood to this area to be disrupted. When blood flow is disrupted this causes the skin in this area to die. If not caught in the early stages it can also cause the bone and muscle in this area to also die. This can be prevented through movement such as exercise, or changing body positions.

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Pressure Ulcer - Also known as bed sores are a common wound in nursing homes. They are caused by constant pressure applied to one part of the skin. They occur on bony prominences such as a person's elbows. They are categorized by the depth of damage to soft tissue (stages 1-4). These stages range from redness of the skin or a blister to exposed bone or muscle. This is a serious and common wound among the geriatric population in the U.S.
Incontinence - Or a cognitive deficit is a decline in a person's mental abilities. This is most commonly an acquired change in abilities among the geriatric population. This change in abilities can be caused by disease or injury.
Delirium - It has a very rapid onset and often occurs in coordination with other health problems. This is a deficit in attention and develops over a short period of time. Delirium can fluctuate in severity day to day.
Dementia - This term is often replaced with neurocognitive disorder, this term better encompasses what a client has. This is an umbrella term that overall describes a decline in memory and other thinking skills. It is characterized by memory loss, communication difficulty, decline in the ability to focus, and a decline in visual perception.

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Alzheimer's Disease is a type of dementia that causes changes in abilities such as in memory, thinking, and behavior. Alzheimer's is most common among those 85 years and older. The onset of Alzheimer's is around 65 years and older. There is also the possibility for an early onset is before the age of 65 but this is fairly uncommon.
Alzheimer's is caused by plaques forming in the brain. These plaques can occur due to lifestyle choices such as smoking, genetics, and other medical conditions. These plaques destroy brain cells, creating progressive deterioration in memory, problem solving, and thinking. This is a progressive disease that leads to the inability to complete tasks of daily living.
The systems affected by Alzheimer's are:
-Complex Attention: A client with this might take longer than they normally do to complete daily tasks. They find thinking easier when there are fewer tasks to think about. There is some memory impairments such as a client may forget a phone number.
-Executive Function: This is when there is increased effort to complete a multistage project. It may take extra effort to plan, organize, and make decisions. An example would be this person may not like large social gatherings due to following conversation from many people may require an increased effort.
-Learning and Memory: This is a change in the ability to recall events. This person may make more lists, and have trouble remembering recent events.
-Language: There is word difficulty and often general terms are used over specific ones. Recalling family and friend names can also become a challenge.
-Perceptual-Motor Abilities: This is the increased use of maps and directions to get places. There is often confusion about using tools and going to familiar places.
-Social Cognition: There may be mild changes in personality, behaviors, or attitudes. There may be an inability to recognize facial expressions. This can also be characterized with insensitivity to dress, religion, and sexual behaviors.
-Other ICF Consequences: Sleep functions may be impacted, sequencing of complicated movements, urination, and work skills can all be impacted.

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Alzheimer's is a type of dementia that affects memory, thinking and behavior. Symptoms eventually grow severe enough to interfere with daily tasks.

Subscribe to E-News to learn how you can help those affected by Alzheimer's.

Understanding Alzheimer's and dementia

Alzheimer's is the most common cause of dementia, a general term for memory loss and other cognitive abilities serious enough to interfere with daily life. Alzheimer's disease accounts for 60-80% of dementia cases.

Learn more: What is the Difference Between Dementia and Alzheimer's?, What is Dementia, Research and Progress

Alzheimer's is not a normal part of aging. The greatest known risk factor is increasing age, and the majority of people with Alzheimer's are 65 and older. Alzheimer's disease is considered to be younger-onset Alzheimer's if it affects a person under 65. Younger-onset can also be referred to as early-onset Alzheimer's. People with younger-onset Alzheimer's can be in the early, middle or late stage of the disease.

Learn more: Younger/Early-Onset Alzheimer's, Risk Factors
​
Alzheimer's worsens over time. Alzheimer's is a progressive disease, where dementia symptoms gradually worsen over a number of years. In its early stages, memory loss is mild, but with late-stage Alzheimer's, individuals lose the ability to carry on a conversation and respond to their environment. On average, a person with Alzheimer's lives 4 to 8 years after diagnosis but can live as long as 20 years, depending on other factors.

Learn more: 10 Warning Signs, Stages of Alzheimer's Disease

Alzheimer's as a Continuum

Alzheimer's disease progresses in stages, with the severity of symptoms increasing over time.

Select a stage to learn more.

Asymptomatic

Mild Cognitive Impairment (MCI) due to Alzheimer's Disease

Mild Dementia

Moderate Dementia

Severe Dementia

Alzheimer's has no cure, but two treatments - aducanumab (Aduhelm™) and lecanemab (Leqembi®) - demonstrate that removing beta-amyloid, one of the hallmarks of Alzheimer's disease, from the brain reduces cognitive and functional decline in people living with early Alzheimer's. Other treatments can temporarily slow the worsening of dementia symptoms and improve quality of life for those with Alzheimer's and their caregivers. Today, there is a worldwide effort underway to find better ways to treat the disease, delay its onset and prevent it from developing.

Learn more: Treatments, Treatment Horizon, Prevention, Clinical Trials

Symptoms of Alzheimer's

The most common early symptom of Alzheimer's is difficulty remembering newly learned information.

Just like the rest of our bodies, our brains change as we age. Most of us eventually notice some slowed thinking and occasional problems with remembering certain things. However, serious memory loss, confusion and other major changes in the way our minds work may be a sign that brain cells are failing.

Alzheimer's changes typically begin in the part of the brain that affects learning. As Alzheimer's advances through the brain it leads to increasingly severe symptoms, including disorientation, mood and behavior changes; deepening confusion about events, time and place; unfounded suspicions about family, friends and professional caregivers; more serious memory loss and behavior changes; and difficulty speaking, swallowing and walking.

People with memory loss or other possible signs of Alzheimer's may find it hard to recognize they have a problem. Signs of dementia may be more obvious to family members or friends. Anyone experiencing dementia-like symptoms should see a doctor as soon as possible. If you need assistance finding a doctor with experience evaluating memory problems, your local Alzheimer's Association can help. Earlier diagnosis and intervention methods are improving dramatically, and treatment options and sources of support can improve quality of life. Two helpful support resources you can tap into are ALZConnected, our message boards and online social networking community, and Alzheimer's Navigator, a web tool that creates customized action plans, based on answers you provide through short, online surveys.

Take our free, online education courses: Understanding Alzheimer's and Dementia and Know the 10 Signs: Early Detection Matters

Help is available

If you or someone you know has been diagnosed with Alzheimer's or another dementia, you are not alone. The Alzheimer's Association is the trusted resource for reliable information, education, referral and support to millions of people affected by the disease.

Alzheimer's is not the only cause of memory loss

Many people have trouble with memory - this does NOT mean they have Alzheimer's. There are many different causes of memory loss. If you or someone you know is experiencing symptoms of dementia, it is best to visit a doctor so the cause can be determined.

Alzheimer's and the brain

Microscopic changes in the brain begin long before the first signs of memory loss.

The brain has 100 billion nerve cells (neurons). Each nerve cell connects with many others to form communication networks. Groups of nerve cells have special jobs. Some are involved in thinking, learning and remembering. Others help us see, hear and smell.

To do their work, brain cells operate like tiny factories. They receive supplies, generate energy, construct equipment and get rid of waste. Cells also process and store information and communicate with other cells. Keeping everything running requires coordination as well as large amounts of fuel and oxygen.

Scientists believe Alzheimer's disease prevents parts of a cell's factory from running well. They are not sure where the trouble starts. But just like a real factory, backups and breakdowns in one system cause problems in other areas. As damage spreads, cells lose their ability to do their jobs and, eventually die, causing irreversible changes in the brain.

The role of plaques and tangles

Two abnormal structures called plaques and tangles are prime suspects in damaging and killing nerve cells.

1. Plaquesare deposits of a protein fragment called beta-amyloid (BAY-tuh AM-uh-loyd) that build up in the spaces between nerve cells.

2. Tangles are twisted fibers of another protein called tau (rhymes with "wow") that build up inside cells.

Though autopsy studies show that most people develop some plaques and tangles as they age, those with Alzheimer's tend to develop far more and in a predictable pattern, beginning in the areas important for memory before spreading to other regions.

Scientists do not know exactly what role plaques and tangles play in Alzheimer's disease. Most experts believe they somehow play a critical role in blocking communication among nerve cells and disrupting processes that cells need to survive.

It's the destruction and death of nerve cells that causes memory failure, personality changes, problems carrying out daily activities and other symptoms of Alzheimer's disease.

Learn More: Take the Brain Tour

Research and progress

In 1906, German physician Dr. Alois Alzheimer first described "a peculiar disease" - one of profound memory loss and microscopic brain changes - a disease we now know as Alzheimer's.

Today, Alzheimer's is at the forefront of biomedical research. Researchers are working to uncover as many aspects of Alzheimer's disease and other dementias as possible. Some of the most remarkable progress has shed light on how Alzheimer's affects the brain. The hope is this better understanding will lead to new treatments. Many potential approaches are currently under investigation worldwide. Sign up for our weekly E-News to receive updates about Alzheimer's and dementia care and research.

Learn more: Research and Progress

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Alzheimer's information - learn about signs, symptoms, causes, diagnosis, risks and treatments and the difference between Alzheimer's disease and dementia.

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 Lewy Body Neurocognitive Disorders (NCD)

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 Lewy Body Neurocognitive Disorders (NCD)

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Lewy Body Neurocognitive Disorders (NCD) is an umbrella term used to describe both Parkinson's Disease NCD and NCD with Lewy bodies. These two diseases have the same underlying biological changes in the brain.
-Parkinson's Disease NCD: Parkinson's has a insidious and onset and gradual progression. It is characterized by a major or minor NCD. It must also be associated with established Parkinson's Disease.
-Lewy Bodies: This also requires a major or mild NCD and an insidious onset and gradual progression. This is characterized by fluctuating cognition, recurring visual hallucinations, spontaneous features of parkinsonsim, after the onset of cognitive decline, sleep disorders, and neuroleptic sensitivity.

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Recreational Therapy Approaches for Neurocognitive Disorders (NCD)

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Recreational Therapy Approaches for Neurocognitive Disorders (NCD)

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Meaningful activities for people with NCDs promote well-being and prevent excessive disability. Most adults with NCDs will benefit from self-selected activities it promotes a sense of self expression. To increase involvement in this self expressed leisure the Farrington Leisure Interest Inventory is used to consider past and current leisure interests. This allows a CTRS to match current physical ability to an activity that interests the client. It is important to take a client's personality style into account when placing them in an activity. By doing this the client may become more active and social, enhancing their overall enjoyment.
When Designing a program for a client with a NCD, the Neurodevelopmental Sequencing Program (NDSP) is used. The NDSP describes the design, framework, and programs to be used when working with a client with a NCD. The purpose of the NDSP is to enhance the quality of life of individuals with NCDs through enhancement of physical and psychosocial abilities in relation to recreation participation. Goals are set based upon a client's physical and cognitive functioning.

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How Neurocognitive Disorders (NCD) Affect Families

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How Neurocognitive Disorders (NCD) Affect Families

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Neurocognitive Disorders (NCD) can be difficult for families to handle. Depending on the severity of their loved one's NCD they may require full time care. This puts strain on the family in that someone now has to take on a caregiver role. This can be frustratin and emotionally draining that a family member has to care for someone who may have had no impairments previously. The loved one with an NCD may also forget who family members are causing alarm to the person with the NCD. They can experience hallucinations and depression. These things would be hard for a family to see a loved one go through and possibly would put strain on relationships. There is also strain on the family trying to cover the cost of medical treatment for their loved one.

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Synopsis

Clinicians can diagnose the syndromes of dementia (major neurocognitive disorder) and mild cognitive impairment (mild neurocognitive disorder) based on history, examination, and appropriate objective assessments, using standard criteria such as DSM-5. They can then diagnose the etiological subtypes of these syndromes using standard criteria for each of them. Brain imaging and biomarkers are gaining ground for the differential diagnoses among the different disorders. Treatments for the most part are still symptomatic.

Keywords: Neurocognitive disorder, Mild Cognitive Impairment (MCI), Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), National Institute on Aging- Alzheimer's Association (NIA-AA) Guidelines, diagnosis, risk factors, biomarkers, Alzheimer's disease

INTRODUCTION

When older patients and their families report symptoms of "memory loss," experienced clinicians know that these concerns refer to a range of cognitive abilities or to general cognitive decline, and not just memory. However, some degree of cognitive slowing is typical of normal aging.

The clinician's first challenge, therefore, is to identify the cognitive changes that are clinically significant. Dementia is typically diagnosed when acquired cognitive impairment has become severe enough to compromise social and/or occupational functioning. Mild cognitive impairment (MCI) is a state intermediate between normal cognition and dementia, with essentially preserved functional abilities.

We will describe these entities and their diagnoses using the framework of the recently published fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-5) (). Briefly, the DSM-5 diagnosis of Major Neurocognitive Disorder, which corresponds to dementia, requires substantial impairment to be present in one or (usually) more cognitive domains. The impairment must be sufficient to interfere with independence in everyday activities. The diagnosis of Mild Neurocognitive Disorder, corresponding to MCI, is made when there is modest impairment in one or more cognitive domains. The individual is still independent in everyday activities, albeit with greater effort. The impairment must represent a decline from a previously higher level and should be documented both by history and by objective assessment. Further, the cognitive deficits must not occur exclusively in the context of a delirium or be better explained by another mental disorder.

Table 1

Diagnostic
Criteria

Major Neurocognitive Disorder/Dementia

Major Neurocognitive Disorder/Dementia

A

Significant cognitive decline in one or more cognitive domains, based on:

Modest cognitive decline in one or more cognitive domains, based on:

1.

Concern about significant decline, expressed by individual or reliable informant, or observed by clinician.

1.

Concern about mild decline, expressed by individual or reliable informant, or observed by clinician.

2.

Substantial impairment, documented by objective cognitive assessment.

2.

Modest impairment, documented by objective cognitive assessment.

B

Interference with independence in everyday activities.

No interference with independence in everyday activities, although these activities may require more time and effort, accommodation, or compensatory strategies

C

Not exclusively during delirium.

D

Not better explained by another mental disorder.

E

Specify one or more etiologic subtypes, "due to"

Cerebrovascular disease (Vascular Neurocognitive Disorder)

Frontotemporal Lobar Degeneration (Frontotemporal Neurocognitive Disorder)

Dementia with Lewy Bodies (Neurocognitive Disorder with Lewy Bodies)

Another medical condition

The clinician's second challenge is to determine the cause(s) of the cognitive impairment, i.e., to identify the underlying etiology. DSM-5 also provides diagnostic criteria for the most common etiologic subtypes of the neurocognitive disorders in all age groups. Here we focus on the neurocognitive disorders of older adults.

Impact of Dementia

Neurocognitive disorders, particularly major neurocognitive disorders (dementias), have tremendous consequences for individuals, their families, the healthcare system, and the economy. In the United States, Alzheimer's disease (AD) is a leading cause of death, hospital admissions, skilled nursing facility admissions, and home health care. The costs of health services and the informal costs of unpaid caregiving for individuals with dementia are high and growing. Family caregivers also experience increased emotional stress, depression, and health problems. In absolute numbers, 35.6 million people worldwide were estimated to be living with dementia in 2010, a number expected to reach 115.4 million people by 2050.

Dementia in the Population

Prevalence, defined as the proportion of people with an illness in a given population at a given time, is an index of the burden of disease in the population. Incidence is the rate at which new disease occurs in a given population, i.e., the proportion of new cases in that population over a given period of time. Incidence is therefore an index of the risk of disease in that population. Prevalence is a function of both incidence and duration. Since most dementias are not curable, their duration reflects how long individuals live with their dementia. Thus, the public health burden of dementia depends both on the development of new cases and on the survival of those cases after onset; holding incidence constant, groups with longer life expectancy will have higher prevalence.

Prevalence

Prevalence of dementia increases exponentially with increasing age, and doubles every five years of age after age 65. In higher income countries, prevalence is 5-10% in those aged 65+ years, usually greater among women than among men, in large part because women live longer than men. Within the US, higher prevalence has been reported in African American and Latino/Hispanic populations than in White nonHispanic populations. Global systematic reviews and meta-analyses suggest that prevalence of dementia is lower in sub-Saharan Africa and higher in Latin America than in the rest of the world []. The prevalence of MCI is at present difficult to pin down as it depends on the precise definitions and subtypes of MCI being studied.

Table 2

Life expectancy is increasing across the planet, with population aging rising the most rapidly in the low- and middle-income countries, where the prevalence of dementia is therefore expected to increase. Emerging studies suggest that prevalence may be leveling off or even decreasing in the high-income countries.

Incidence

The incidence of dementia increases steadily until age 85 or 90, and then continues to rise but less rapidly. It is either similar in men and women or slightly higher in women. Annual age-specific rates ranged from 0.1% at age 60-64 to 8.6% at age 95.

Risk and Protective Factors

Risk factors are factors associated with an elevated incidence rate of disease, higher odds of developing disease, or earlier onset of disease, depending on the type of statistical analysis that is performed. Protective factors represent the converse. An observed risk factor does not necessarily cause disease; a protective factor does not necessarily prevent disease and almost certainly will not treat the disease. The observed effects can potentially reflect selection or survival bias or confounding, or sometimes reverse causality. They may also depend on the timing and duration of exposure to the factor, with mid-life often being the critical period.

Demographic risk factors

Increasing age is not only the strongest risk factor for dementia, but also the only risk factor consistently identified after the eighth decade of life. While prevalence is consistently higher among women, incidence is not; thus, the higher prevalence may largely be a function of longer life-expectancy in women. Lower educational levels have been found associated with higher prevalence. Within the US, prevalence has been reported as elevated in African American and Latino populations; some authors have attributed these findings to lower education and higher cardiovascular morbidity in those populations.

Genetic factors

Few dementias are caused by deterministic autosomal dominant genes; these are discussed later under the specific disorders. While several genes have been identified as increasing susceptibility for Alzheimer's disease, the best-established is the Apolipoprotein E ( APOE) polymorphism on Chromosome 19. The APOE*4 allele, associated with higher risks of hypercholesterolemia and heart disease, is also associated with dementia due to Alzheimer's and Parkinson's diseases, Dementia with Lewy Bodies, vascular dementia, and frontotemporal dementia in men. Individuals homozygous for APOE*4 are at greater risk of dementia than those who are heterozygous. The APOE*2 appears to have a protective effect. APOE*4 is a risk factor, not a diagnostic marker for Alzheimer's disease. It is neither necessary nor sufficient for diagnosis, and its effect on risk appears to wear off by the eighth decade, i.e. individuals who are older than 80 years, APOE*4 positive, and do not yet have dementia, are at no greater risk of developing dementia than those who are APOE*4 negative.

Medical risk factors

Cardiovascular disease is increasingly recognized as not just a risk factor for vascular dementia but also for degenerative dementias, particularly AD. Heart disease has been associated with both dementia of the Alzheimer's type, and vascular dementia. Risk factors in midlife, including hypertension, high cholesterol, high body mass index (BMI), and diabetes mellitus are associated with increased risk of dementia in late life, demonstrating the importance of risk exposures decades earlier. Heart failure and atrial fibrillation are risk factors for cognitive impairment and dementia. Cardiac disease can cause or worsen cerebral hypoperfusion, creating a cellular energy crisis setting off a cascade of events leading to the production of toxic proteins. In cognitively normal older adults, elevated pulse pressure has recently been found associated with alterations in biomarkers suggestive of AD.

Inflammation and alterations in inflammatory markers [interleukins, cytokines, C-reactive protein] have been reported in Alzheimer's and vascular dementias. Multiple mechanisms have been proposed for the role played by inflammation in the neuropathology of AD.

Obstructive sleep apnea, associated with hypertension, heart disease, stroke risk and white matter change, is also associated with an increased risk of dementia.

Psychiatric risk factors

Depression has a complex and likely bi-directional association with dementia. Recurrent major depression in earlier adulthood appears to increase risk of dementia in later life. Depression with late life onset is believed to be an early sign of the vascular or degenerative disease causing the dementia. Late-life anxiety is associated with cognitive impairment and decline. Post-traumatic stress disorder has been reported as increasing risk of dementia. Lifelong traits of harm avoidance and lesser sense of purpose have been reported as harbingers of AD.

Head injury

Head injury is associated with increased risk of dementia, in particular AD, and the severity of injury appears to heighten this risk. Neurocognitive disorders can occur immediately after a traumatic brain injury or after the recovery of consciousness at any age. However, chronic traumatic encephalopathy (previously termed dementia pugilistica) is diagnosed years after repeated concussive or subconcussive blows to the head, with a clinical presentation similar to AD or frontotemporal lobar degeneration.

Lifestyle and environmental risk factors

Many environmental and occupational exposures have shown varying associations with neurodegenerative diseases. Smoking has been associated with an elevated risk of dementia; although some studies have found an apparentprotective effect which could reflect survival bias (competing risks) or possibly cholinergic action as also seen in Parkinson's disease. Heavy consumption of alcohol increases odds of developing dementia. Parkinson's disease risk is associated with exposure to pesticides, for which a molecular mechanism has been established.

Protective Factors

Protective factors are those associated with a reduced incidence rate or reduced odds of dementia, or with delayed onset of dementia.

The concept of "reserve" was proposed to explain why some individuals remain cognitively intact despite the presence of neuropathology typically associated with dementia. Brain reserve refers to structural capacity and integrity of the brain (e.g. brain mass, preserved large neurons), whereas cognitive reserve refers to its functional capacity, specifically the ability to utilize alternative neural networks and compensatory strategies.

Education and cognitive activity

Where educational opportunities are universal, higher education may reflect innate reserve; the process of education may also promote the development of reserve through mechanisms such as increased dendritic branching. Education may also reflect general socioeconomic status and thus also represent quality of environmental factors like nutrition, or health care. Regardless of mechanism, higher education is associated with lower prevalence of dementia.

Bilingualism has been associated with delayed onset of dementia, independent of education, and may specifically protect against declines in attention and executive functioning.

Cognitive activity: Lifelong occupations that do not require higher education or skilled vocational training appear to be associated with a higher risk of dementia. Several popular leisure activities have been found associated with lower risk of dementia. Cognitively stimulating activities appear to have both protective and enhancing effects on cognition.

Pharmacological factors

Several therapies for other conditions have been found in long-term observational studies to be associated with a reduced risk of dementia. However, in clinical trials, these drugs have not been found to prevent dementia. Timing and duration of the exposure might partly explain these discrepancies, as the protective effects were seen with prolonged use multiple years before dementia onset. While some studies have found a protective relationship with the use of non-steroidal anti-inflammatory drugs ( NSAIDs), a 2005 meta-analysis determined that many of the positive results seen in the 25 studies reviewed were due to various forms of bias. Despite mixed reports of the effects of the lipid-lowering HMG Co-A reductase inhibitors (" statins "), pooled results in a recent review as well as in a 2013 meta-analysis indicate a protective effect against dementia.

As regards estrogen therapy, the WHIMS trial in older women showed no protection and possibly an increased risk from combination hormone therapy. A 2013 meta-analysis of any use versus no use concluded that hormones had no effect on dementia. However, a long-term observational study suggests that the timing of hormone therapy, at menopause, may be the critical factor.

Lifestyle factors

As with cardiovascular disease, population based studies have found that mild to moderate alcohol consumption is associated with reduced risk of cognitive impairment and dementia. Adherence to a Mediterranean diet was associated with better cognitive functioning, lower rates of cognitive decline and a reduced risk of AD. High physical activity levels are associated with reduced risk of neurodegenerative diseases. Smoking shows a consistently protective effect against Parkinson's disease, potentially involving nicotine effects on cholinergic receptors.

Elderly women with larger social networks, and who participate in mental, social or productive activities, have shown lower incidence of dementia. Social, mental and physical lifestyle components appear important, although reverse causality cannot be ruled out, given that the neuropathology often begins decades before symptom onset.

CLINICAL ASSESSMENT

Assessment is easier for the clinician when patients themselves and/or their family members or other caregivers spontaneously express concern about cognitive difficulties. In other cases, neither patient nor caregiver report concerns but may acknowledge them if asked. Alternatively, the patient denies any difficulty, and there is no reliable informant, but the clinician observes cognitive impairment, this being more likely when the clinician knows the patient well. Sometimes the clinician, or a member of the clinic staff, is tipped off by a patient forgetting to keep appointments or fill prescriptions, or being confused by simple instructions. Experienced clinicians also recognize vagueness and evasiveness in patient's responses, or catastrophizing of minor problems, as clues to failing cognition. Occasionally, the initial complaint will not be of cognitive loss but of changes in mood or behavior, such as apathy, anxiety, or depression.

Subjective assessment

Whenever possible, history should be obtained both from the patient and also from a family member, caregiver, or other reliable informant. In some mild cases, the patient is more aware of the deficits than the relative. The clinician should focus on changes in cognitive functioning as manifested in everyday activities. Early deficits are frequently noted in managing finances and medications. Over-learned, routine activities may be preserved but problems may be occurring in problem-solving, multi-tasking, and dealing with new situations. lists the cognitive domains recognized by DSM-5 and everyday activities that tap those domains.

Table 3

Cognitive domain

Examples of changes in everyday activities

Complex attention

Normal tasks take longer, especially when there are competing stimuli; easily distracted; tasks need to be simplified; difficulty holding information in mind to do mental calculations or dial a phone number

Executive functioning

Difficulty with multi-stage tasks, planning, organizing, multi-tasking, following directions, keeping up with shifting conversations

Learning and memory

Difficulty recalling recent events, repeating self, misplacing objects, losing track of actions already performed, increasing reliance on lists, reminders

Language

Word-finding difficulty, use of general phrases or wrong words, grammatical errors, difficulty with comprehension of others' language or written material

Perceptual-motor/visuospatial function

Getting lost in familiar places, more use of notes and maps, difficulty using familiar tools and appliances

Social cognition

Disinhibition or apathy, loss of empathy, inappropriate behavior, loss of judgment

Many patients and families accept cognitive decline as part of normal aging, and will declare themselves normal on the grounds that they are no worse than others their age. Others may magnify the significance of relatively minor changes and express fears of developing AD. Despite the value of systematic and disciplined clinical observations, clinicians' impressions can be clouded by personal expectations of what is normal for a given patient. Subjective concerns alone are therefore insufficient for diagnosis.

Objective assessment

The objective assessment requires the administration of one or more standardized tests. Neuropsychological assessment of specific cognitive domains is preferred both for detecting mild impairments and for differential diagnosis (). Details of such assessments are beyond the scope of this chapter but are readily available from other sources. If neuropsychological assessment is unavailable, objective testing can consist of a global screening scale, such as the well-known Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), or the Mini-Cog. Such tests are usually sensitive enough to detect dementia but not necessarily MCI. It is critically important that a patient's test performance be interpreted in accordance with norms for that patient's age and educational level, and preferably for his/her cultural/linguistic group and region as well.

Table 4

Complex Attention

Maintenance of attention, e.g., press a button every time a tone is heard, over a period of time.
Selective attention, e.g., hear numbers and letters, but count only the letters.
Divided attention, e.g., tap rapidly while learning a story.
Processing speed: carry out any timed task.

Executive Functioning

Planning: e.g., maze puzzles, interpret sequential pictures or arrange objects in sequence.
Decision making with competing alternatives, e.g., simulated gambling.
Working memory: hold information for a brief period and manipulate it, e.g. repeat a list of numbers backward.
Feedback utilization: Use feedback on errors to infer rules to carry out tasks.
Inhibition: Override habits; choose the correct but more complex and less obvious solution, e.g., read printed names of colors rather than naming the color in which they are printed.
Cognitive flexibility: Shift between sets, concepts, tasks, rules, e.g., alternate between numbers and letters.

Learning and Memory

Immediate memory: Repeat a list of words or digits.
Recent memory:

Free recall: recall as many items as possible from, e.g., a list of words, or a story, or a diagram.

Cued recall: with examiner providing cues, e.g., "recall as many food items as you can from the list."

Recognition: with examiner asking, e.g., "was there an apple on the list?"

Semantic memory: recall well-known facts.
Autobiographical memory: recall personal events.
Implicit (procedural) memory: recall skills to carry out procedures.

Language

Expressive language: confrontation naming of e.g., objects or pictures; fluency for words in a given category (e.g. animals) or beginning with a given letter, as many as possible in one minute.
Grammar and syntax: omitting or incorrectly using articles, prepositions, helper verbs.
Receptive language: comprehend /define words, carry out simple commands.

Perceptuomotor functioning

Visuoconstructional: e.g., Draw, copy, assemble blocks.
Perceptuomotor: e.g., Insert blocks or pegs into appropriate slots.
Praxis: Mime gestures such as "salute" or actions such as "use hammer."
Gnosis: e.g., recognize faces and colors.

Social cognition

Recognize emotions: Identify pictures showing e.g., happy, sad, scared, angry faces.
Theory of mind: Consider another person's thoughts, intentions when looking at story cards, e.g., "why is the boy sad?"

Additional assessments

A general physical and neurological examination, and appropriate laboratory investigations, should be performed both to rule out treatable causes of cognitive impairment (even if they only partially explain the impairment) and to aid in differential diagnosis.

We present here the etiologic subtypes most likely to be seen in geriatric psychiatry settings.

Alzheimer's Disease

Alzheimer's disease (AD) is the single most common neurodegenerative disease, characterized by progressive loss of synapses and neurons, with the accumulation of amyloid plaques, and neurofibrillary tangles, and prominent cholinergic deficits. It is typically diagnosed in the eighth or ninth decades of life, but early onset forms of the disease may be diagnosed as early as the fifth decade. Average duration of survival is about 10 years after the onset of dementia, but varies widely depending on the age of onset, the severity of cognitive impairment, the presence of comorbid diseases, and other factors.

In DSM-5, AD is listed an etiologic subtype of both Major and Mild Neurocognitive disorders. Criteria for this subtype harmonize with the latest expert guidelines for Dementia and MCI due to AD, as published by the National Institute on Aging - Alzheimer Association (NIA-AA) Work Group. Unlike the NIA-AA guidelines, the DSM-5 criteria are intended primarily for clinical rather than research use, and do not include pre-clinical AD. The diagnosis of Dementia (Major NCD) in Alzheimer's disease requires evidence of decline to the level of substantial impairment in at least two cognitive domains, one of which must be memory. To diagnose MCI (Mild NCD) in Alzheimer's disease, decline to the level of modest impairment must be observed in memory and potentially in additional domains as well. The cognitive decline should be of insidious onset with gradual and steady progression. Impairments in memory and executive functions typically develop earlier in the disease course, while impairments in visuoconstructional/ perceptual- motor functions, language functions, and social cognition occur later. However, non-amnestic presentations also do occur. Depression and apathy may occur throughout the clinical spectrum. In the middle to later stages, psychotic features, irritability, agitation, combativeness and wandering may occur, and very late in the illness, gait disturbances, dysphagia, incontinence, myoclonus and seizures may be evident.

For neurocognitive disorders to be attributed to Probable AD, there should either be evidence of autosomal dominant familial AD, or no evidence of mixed etiology, i.e., no other contributing neurological, psychiatric, or systemic disorder that could explain the cognitive decline. Otherwise, the diagnosis of Possible AD is appropriate.

Genetics of AD

Autosomal dominant mutations which cause rare cases of early onset familial AD are the amyloid precursor protein (APP) gene on Chromosome 21, the Presenilin 1 (PS1) gene on Chromosome 14, and the Presenilin 2 (PS2) gene on Chromosome 1. Individuals with Down's Syndrome, caused by Trisomy 21, inevitably develop Alzheimer's neuropathology if they live long enough. The APOE*4 gene, as noted under Risk Factors, increases risk of dementia but is not diagnostic.

Biomarkers for AD

Evidence of cerebral amyloid deposition, such as positron emission tomographic (PET) brain scans with amyloid tracers, and reduced levels of amyloid beta 42 in the cerebrospinal fluid (CSF), have been proposed as research biomarkers. Evidence of neuronal injury, such as hippocampal atrophy on magnetic resonance imaging (MRI) brain scan, temporoparietal hypometabolism on fluorodeoxyglucose (FDG) PET scans, and elevated total tau and phospho-tau levels in CSF, are less specific to AD but have also been proposed as research biomarkers. They have not been officially validated or approved for clinical diagnostic use.

Unlike DSM-5, the NIA-AA guidelines also describe a stage of asymptomatic preclinical Alzheimer's disease, in which the pathology of the disease is present as evidenced by biomarkers and subclinical cognitive decline detectable only by objective testing.

Vascular Dementia (Vascular Neurocognitive Disorder)

In Major and Mild Vascular Neurocognitive Disorders, the cognitive deficits are principally attributed to cerebrovascular disease. Variously referred to as arteriosclerotic dementia, multi-infarct dementia, vascular cognitive impairment and vascular cognitive disorder, it is the second most common cause of dementia and is frequently present in combination with AD ("mixed dementia"). It can result from both large and small vessel disease, with the location of the lesions more important than the volume of destruction. Given the variability of lesions and locations, the presenting symptoms and time course are often variable. The progression of the neurocognitive decline can be in an acute stepwise pattern, show a more gradual pattern, or can be fluctuating or rapid in its course.

To diagnose vascular neurocognitive disorder, there should either be a clear history of stroke or transient ischemic attacks temporally related to the cognitive decline, or neurological deficits consistent with sequelae of previous strokes. Cognitive decline is usually seen in the domains of complex attention and executive functions. Gait disturbance, urinary symptoms, and personality or mood changes (including emotional lability) are common. The depression associated with vascular neurocognitive disorder may have a late-life presentation and be coupled with psychomotor slowing and executive dysfunction, the so called vascular depression.

Neuroimaging

Neuroimaging (CT or MRI) evidence of significant parenchymal injury attributable to cerebrovascular disease can include one or more large vessel infarcts, a single large or strategically located infarct or hemorrhage, extensive lacunar infarcts outside the brainstem, or extensive white matter lesions.

Genetics

There are rare autosomal dominant cerebrovascular disorders, such as CADASIL (cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy), which is a form of hereditary stroke caused by Notch-3 mutations on Chromosome 19.

Frontotemporal lobar degeneration (Fronto-temporal Dementia)

Frontotemporal dementia (FTD), the third most prevalent degenerative dementia, is characterized by prominent atrophy of the frontal and temporal lobes, with the predominant neuropathological proteins containing inclusions of hyperphosphorylated tau or ubiquitin protein.

With mean onset in the sixth decade, FTD is a common cause of early-onset dementia although 20-25% of individuals with this disorder are over age 65. The duration of survival is 6-11 years after symptom onset, and 3-4 years after diagnosis. With insidious onset and gradual progression, the clinical subtypes (behavioral and language variants) of FTD correspond to specific areas of brain atrophy.

In the Behavioral Variant, changes in personality and behavior are most prominent, with loss of interest in personal affairs and responsibilities, social withdrawal, loss of awareness of personal hygiene, and socially disinhibited behavior. Perseverative or compulsive motor behaviors, as well as hyperorality and dietary changes may also be evident. These patients are often initially seen in psychiatric settings and can be misdiagnosed as major depressive or bipolar disorder. In addition to the Behavioral Variant, there are three Language Variants: (i) the Semantic type which appears as a fluent aphasia with impoverished content and paraphasic errors, with intact syntax and prosody; emotional blunting, loss of empathy, and rigid behaviors may also be seen, (ii) Progressive Nonfluent Aphasia, and (iii) the Logopenic subtype.

Genetics

In familial FTD, mutations have been associated with genes encoding proteins affecting a number of fundamental cellular functions, including microtubule-associated protein tau (MAPT), granulin (GRN), C9ORF72, transactive response DNA- binding protein of 43 kDa, valosin-containing protein, chromatin modifying protein 2B, and fused in sarcoma protein.

Neuroimaging

Structural MRI or CT can show distinct patterns of regional cortical atrophy which correlate with the clinical variants of FTD.

Dementia with Lewy Bodies

Dementia with Lewy bodies (DLB) is the second most common neurodegenerative dementia. The underlying disease is primarily characterized by alpha-synuclein misfolding and aggregation within the pathognomonic Lewy bodies, which are also found in Parkinson's disease. Onset of symptoms is between the sixth and ninth decades, and average survival is 5-7 years.

With insidious onset and gradual progression, the cognitive deficits are most prominent in the domains of attention, visuospatial and executive functioning. Additional core features include fluctuating cognition, recurrent visual hallucinations, and parkinsonism. The key distinction between DLB and dementia of Parkinson's disease is based on the temporal sequence of the cognitive impairment and the movement disorder. In DLB, cognitive impairment precedes the onset of parkinsonism, while in the latter, the cognitive impairment occurs in the context of established Parkinson's disease.

Suggestive features of DLB include REM sleep behavior disorder and severe neuroleptic sensitivity. Low dopamine transporter (DaT) uptake in basal ganglia demonstrated by SPECT or PET imaging has been proposed as a suggestive feature. Supportive clinical features include repeated falls and syncope, transient and unexplained loss of consciousness, severe autonomic dysfunction, hallucinations in other modalities, systematized delusions and depression.

Neuroimaging

To help differentiate Lewy-body related dementias (DLB and Dementia in Parkinson's disease) from other dementias, dopamine transporter (DaT) PET scans may be useful. Generalized low uptake on SPECT and fluorodeoxyglucose PET with reduced occipital activity also suggests DLB. Additional testing supportive of DLB include low uptake MIBG myocardial scintigraphy, suggesting synaptic denervation, as well as prominent slow wave activity on EEG with temporal lobe transient sharp waves.

Neurocognitive Disorders due to Parkinson's Disease

These disorders are diagnosed when there is gradual cognitive decline in the presence of a well-established diagnosis of Parkinson's disease. Over the course of their disease, approximately 75% of individuals with Parkinson's disease will develop a major neurocognitive disorder. The pattern of cognitive deficits is variable but often affects the executive, memory, and visuospatial domains, with a slowing of information processing that suggests a "subcortical" picture. Associated features include psychiatric symptoms such as depressed or anxious mood, apathy, hallucinations, delusions, or personality change, as well as rapid eye movement sleep behavior disorder and excessive daytime sleepiness.

Neurocognitive Disorder due to Huntington's Disease

Huntington's disease is a neurodegenerative disease caused by an autosomal dominant mutation consisting of CAG repeats on Chromosome 4. The neurotoxic Huntingtin (HTT) protein begins by damaging the striatum of the basal ganglia but eventually affects the entire brain. Although adult onset Huntington's disease usually manifests in the fourth or fifth decades, patients have a median survival of 15 -20 years after diagnosis, and can thus present to geriatric services. A few patients develop their first symptoms at older ages in the absence of a family history. Progressive cognitive impairment to eventual dementia is inevitable. Although cognitive deficits (executive function) and behavioral symptoms (depression, anxiety, apathy, obsessive-compulsive symptoms, and psychosis) often emerge before the motor abnormalities (bradykinesia and chorea), clinical diagnosis is rarely made on the basis of cognitive symptoms alone. A family history of the disease should alert clinicians to the possibility, and genetic testing for the HTT mutation is diagnostic.

Neurocognitive Disorder due to Prion Disease

These are neurocognitive disorders due to spongiform encephalopathies caused by transmissible misfolded protein particles called prions. The human prion disorders include kuru, sporadic Creutzfeldt-Jacob disease (CJD), familial CJD, iatrogenic CJD, Gerstmann-Stäussler-Scheinker disease, fatal insomnia, and new variant CJD. Human transmission has been reported due to infected growth hormone injection and corneal transplantation; cross-species transmission is exemplified by bovine spongiform encephalopathy ("mad cow disease.") These illnesses progress rapidly and combine neurocognitive decline and motor features such as myoclonus and ataxia. Variant CJD may present with low mood, withdrawal, and anxiety. Individuals are typically diagnosed in their seventh and eighth decades, and the course is rapidly progressive, with survival typically under one year. Diagnosis can only be confirmed by biopsy or autopsy. However, MRI scanning with diffusion weighted imaging or fluid-attenuated inversion recovery may show multifocal gray matter hyperintensities in the subcortical and cortical areas. Tau or 14-3-3 protein may be found in the cerebrospinal fluid; characteristic triphasic waves may be seen on the electro-encephalogram. Genetic testing may be useful in the 15% of cases who have a family history suggesting an autosomal dominant mutation.

TREATMENT

Etiology-specific treatment

If a neurocognitive disorder is diagnosed as wholly or partly due to a treatable condition, treatment specific to that condition is clearly the first line of defense. At this time, no disease-modifying therapies are available for any of the neurodegenerative diseases. However, symptomatic and supportive treatments are usually of value.

Symptomatic Treatment

Cholinesterase inhibitors increase cholinergic transmission at the synaptic cleft, potentially benefiting patients with cholinergic deficits as in AD. Three such drugs are currently available in the US: donepezil, rivastigmine, and galantamine. For dementia due to AD, a systematic review determined that all three drugs are comparable in efficacy and, on average, provide modest improvements in cognitive function and everyday activities and behavior in Alzheimer's disease. Although approved for use in severe dementia, many practitioners question its value in advanced disease. Evidence is mixed on the effects of these drugs on long-term outcomes, e.g., slowing of the rate of decline in everyday functions, and delay of institutionalization.

Rivastigmine is also approved for dementia in Parkinson's disease. A large double-blind placebo-controlled trial of rivastigmine showed meaningful improvements in cognition and everyday functioning.

While there is expert consensus that cholinesterase inhibitors are more effective in DLB than in AD, for both cognitive and behavioral effects, evidence from large controlled trials is lacking.

In vascular dementia, evidence is mixed for the cholinesterase inhibitors. They are often prescribed in vascular dementia because of the frequent co-occurrence of cerebrovascular and neurodegenerative disease.

In frontotemporal dementia, there is no convincing evidence of benefits from these drugs, and there are reports that they worsen behavior symptoms.

There is inadequate evidence on the use of cholinesterase inhibitors in other neurocognitive disorders.

In contrast, a systematic review has found minimal evidence of benefit from these drugs in mild cognitive impairment, either with symptom relief or delay in progression to dementia. Further, this weak evidence was overwhelmed by the risk of adverse effects, particularly gastrointestinal effects.

NMDA receptor antagonist

One such agent, memantine, is approved for the treatment of moderate to severe dementia due to Alzheimer's disease. It is believed to be neuroprotective against excitoxicity in the cortex and hippocampus. An advantage of memantine is that it is well tolerated.

A systematic review showed that memantine had a small beneficial effect on cognition at six months in moderate to severe AD, marginal effect on mild to moderate AD, and a small but clinically undetectable effect in mild to moderate vascular dementia.

In frontotemporal dementia, memantine has shown mixed results. There is preliminary evidence of benefits in DLB and Dementia in Parkinson's disease; however, there have been reports of worsening delusions and hallucinations in DLB.

Serotonergic agents

SSRI antidepressants can produce benefits for behavioral /psychiatric symptoms in frontotemporal dementia, without concomitant improvements in cognition.

Dopamine blocking agents

Neuroleptic (antipsychotic) drugs should be prescribed in dementia with due attention to the risk of adverse cerebrovascular events. They should be avoided or used with extreme caution in patients with DLB, given their sensitivity to these agents. When necessary the second-generation antipsychotics are preferred. If the patient is taking a dopaminergic (anti-parkinsonian) drug, lowering its dose would be the preferred first step before introducing a dopamine-blocking agent.

Benzodiazepines

In general, benzodiazepines are to be avoided in the neurocognitive disorders because of the risk of paradoxical agitation as well as of falls and further diminished cognition. An exception may be the treatment of REM Sleep Behavior Disorder in DLB.

Further discussion of the pharmacologic, psychosocial, and environmental management of neurocognitive disorders is provided elsewhere in this volume.

SUMMARY

Clinicians should be knowledgeable about the various neurocognitive disorders which are common and devastating in older adults. Diagnosis requires careful history-taking and skilled clinical assessment, followed by appropriate laboratory investigations. Diagnostic imaging can be useful when interpreted by experts familiar with these conditions. Biomarkers for most of these disorders are still being validated and are not yet recommended for clinical use. Referral to specialists can be valuable for specific purposes, e.g., neuropsychologists for objective cognitive testing and interpretation; neurologists for diagnosis, particularly of the less common disorders; geriatric psychiatrists when there are psychological or behavioral challenges. Drug treatments at present provide symptomatic relief. Psychosocial and other supportive therapies are essential.

​

1. Clinicians should be knowledgeable about the various neurocognitive disorders which are common and devastating in older adults.

2. Diagnosis requires careful history-taking and skilled clinical assessment, followed by appropriate laboratory investigations.

3. Diagnostic imaging can be useful when interpreted by experts familiar with these conditions.

4. Biomarkers for most of these disorders are still being validated and are not yet recommended for clinical use.

5. Referral to specialists can be valuable for specific purposes, e.g., neuropsychologists for objective cognitive testing and interpretation; neurologists for diagnosis, particularly of the less common disorders; geriatric psychiatrists when there are psychological or behavioral challenges.

6. Drug treatments at present provide symptomatic relief. Psychosocial and other supportive therapies are essential.

Footnotes

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

References

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. Arlington, VA: American Psychiatric Association; 2013.

7. Prince M, Prina M, Guerchet Alzheimer's Disease International. World Alzheimer Report 2013 Journey of Caring: An analysis of long term care for dementia. [Accessed on-line December 17, 2013]; Available at: http://www.alz.co.uk/research/world-report-2013.

30. de la Torre JC. Cardiovascular risk factors promote brain hypoperfusion leading to cognitive decline and dementia. Cardiovasc Psychiatry and Neurol. 2012 Article ID 367516, 15 pages. [ PMC free article]

77. O'Brien J, Jackson JW, Grodstein F, Blacker D, Weuve J. Postmenopausal hormone therapy is not associated with risk of all-cause dementia and Alzheimer's Disease. Epidemiol Rev. first published online September 15, 2013.

101. Press D, Alexander M. Cholinesterase inhibitors in the treatment of dementia. In: Basow DS, editor. UpToDate. Waltham, MA: UpToDate; [Accessed on December 17, 2013].

105. Wright CB. Treatment and prevention of vascular dementia. In: Basow DS, editor. UpToDate. Waltham, MA: UpToDate; [Accessed on December 17, 2013].

106. Miller BL, Lee SE. Frontotemporal dementia: treatment. In: Basow DS, editor. UpToDate. Waltham, MA: UpToDate; [Accessed on December 17, 2013].

# data[].attributes.attachment_link.title
Dementia and Cognitive Impairment: Epidemiology, Diagnosis, and Treatment

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Clinicians can diagnose the syndromes of dementia (major neurocognitive disorder) and mild cognitive impairment (mild neurocognitive disorder) based on history, examination, and appropriate objective assessments, using standard criteria such as DSM-5. They can then diagnose the etiological subtypes of these syndromes using standard criteria for each of them.

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Post-Traumatic Stress Disorder(PTSD) and its Causes 

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Post-Traumatic Stress Disorder(PTSD) and its Causes 

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PTSD is considered a trauma and stress-related disorder. The essential feature of this disorder is the development of characteristic symptoms following exposure to one or more traumatic events. These events may include rape, abuse, natural disaster, being in a war zone, or exposure to terrorist attack. There are many more causes that would fall under threatening or physically threatening. A person with PTSD may avoid anything that associated with their specific trauma. They also may feel emotionally numb, and can experience events again through dreams or flashbacks.

Causes:
Causes of PTSD may include the experience of rape, abuse, natural disaster, being in a war zone, or exposure to terrorist attack. Other events that can cause PTSD are any event where a person feels threatened or is physically assaulted. Resilience factors also influence a person's rick of PTSD. If a person experiences a threat and doesn't have a good social support system they are more likely to develop PTSD.

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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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PTSD affects a person's mood and ability to cope effectively with ongoing stressful events, even events that most people wouldn't consider stressful. The experience of negativity towards the future, and feeling separate from others. The experience of recurring dreams and thoughts. It can also affect a person's social functioning, in that they may detach from people and avoid certain places. Finally there are cognitive difficulties that are loss of focus and concentration, emotional learning, and emotional regulation.

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PTSD causes there to be a higher risk for agoraphobia, obsessive-compulsive disorder, social phobia, specific phobias, major depressive disorder, somatization disorder, and substance-related disorders. People with PTSD are 80% more likely to have symptoms that meet the criteria for at least one other mental disorder. There is also a higher risk for panic disorders, suicidal thoughts and feelings.

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Other examples that may be secondary are: If you have a rated hip condition and it affects your back, you may want to file for the back pain as a secondary condition. If you take medications for service connected PTSD, you may be eligible to file for erectile dysfunction.

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Five Categories of Symptoms:

1) Delusions: They are the beliefs that client holds and will not change even if they are contradicted by evidence in a situation. Delusions are considered bizarre and implausible. There are different types of delusions:
-Persecution: belief that someone or an organization is out to harm the client.
-Referential: the belief that environmental cues or gestures around them have secret messages given to them by a character in a TV show.
-Grandiose: the client believes they have exceptional abilities.
-Erotomanic: incorrect belief that someone is in love with him/her.
-Nihilistic: belief of impeding destruction.
-Somatic: inaccurate beliefs about health.

2) Hallucinations: They are what seem to be vivid perceptions of something that occurred in the real world, even though nothing in the environment caused the perception. Auditory hallucinations are the most common type. When waking or falling asleep hallucinations are considered normal.

3) Disordered Thinking and Speech: Disordered thinking is usually determined by observations of disorder speech. For speech to be considered disordered it needs to be enough disordered to substantially impair communication. An example would be quickly switching topics so a listener can't follow. There are also memory deficits, delayed recall, difficulty assessing vocabulary, difficulty organizing information, and problems with multiple tasks.

4) Motor Behavior: Problems with motor behavior are diagnosed when the behavior interferes with goals or other goal directed behaviors. Catatonia is the resistance to directions, rigid postures, and lack of response.

5) Negative Symptoms: A negative symptom is when something is missing in a person who has SSD. There can be diminished emotional expression and avolition.  This can include less empathetic facial expressions, lack of intonation speech, less eye contact, and fewer physical movements while communicating. There can be alogia (poverty of speech), asociality (decreased desire to interact with others), and anhedonia  (inability to experience pleasure).

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-Structure and chemical composition of the brain. Individuals with SSD are more likely to have enlarged ventricles, possibly related to tissue degeneration and less activity in the frontal cortex. There also can be chemical imbalances of dopamine in the brain.
-Environmental factors such as living in environmentally stressful settings. An example would be urban settings, particularly in impoverished neighborhoods.
-Psychosocial factors, include that individuals may not develop a sense of self. Families can also have a genetic predisposition that can be triggered by stressful situations.

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-Cognitive Functioning: The symptoms of delusions, and disordered thinking and speech are cognitive issues. Individuals with SSD experience difficulty with receiving, processing, and initiating conversation, planning, problem solving, initiating tasks, managing tasks, and organizing information. Structurally in the brain there is decreased activity of the frontal lobe. This affects speech fluency, language use, and executive function.
-Emotional Functioning: Symptoms include blunted or flattened affect, and anhedonia (inability to experience pleasure).
-Social Functioning: Asociality is a negative symptom that affects the individual's ability to empathize with others. This affects the individual's communication and motivation.

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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.

Read more: The concept of schizophrenia is coming to an end - here's why

Three possible explanations

There are three theories which 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.

DONOT6_STUDIO/Shutterstock.com

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.

Read more: Schizophrenia may cause type 2 diabetes, new study finds

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.

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Schizophrenia affects your body, not just your brain - new study

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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.

# data[].attributes.body
-Hallucination: It is a vivid perception of something that is occurring in the real world, even though nothing in the environment is causing the perception.
-Delusion: Beliefs that the individual will not change even though they are contradicted by evidence on the current situation.
-Psychosis: Thoughts and emotions are impaired to the point where the individual loses contact with external reality.
-Anhedonia: The inability to experience pleasure.

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Major Depression Disorder (MDD) and Symptoms 

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Major Depression Disorder (MDD) and Symptoms 

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Major depressive disorder is different from mild sadness or brief response to external stressors. MDD lasts at least two weeks while manifesting at least five of the following symptoms that significantly impair functioning:
- Depressed mood most of the day, nearly everyday
-Diminished interest or pleasure in most or all activities, nearly every day
-Significant unintentional increase or decrease in weight or appetite
-Lack of sleep or sleeping excessively, nearly everyday
- Psychomotor changes noticed by others (agitation or sluggishness), nearly every day
-Fatigue and/or loss of energy, nearly everyday
-Feelings of guilt and/or worthlessness, nearly everyday
-Diminished cognitive abilities, nearly everyday
-Recurrent thoughts of death

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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.

More Information

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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.

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MDD has a pervasive and holistic impact on a person often it significantly diminishes quality of life, loss of work productivity, cognitive and emotional impairments, and is the leading cause of years lived with disability. MDD can negatively impact long and short term relationships. There is a decrease in energy that affects daily activities. Basic self-care can be neglected. Weight gain can also be a result of MDD.

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MDD often occurs with many physical and mental health conditions. MDD is seen at higher rates among persons with chronic pain, illness, and disability, and cardiovascular disorders are more common among persons with chronic MDD. MDD often occurs with anxiety, substance abuse, eating disorders, dementia, and personality disorders.

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GAD is characterized by excessive and uncontrollable worry about everyday things more days than not for at least six months. The intense duration and frequency of the worry disproportionate to the issue, and interfere with the performance of daily tasks. Anxiety can manifest in physical symptoms including muscle tension, sweating, nausea, gastrointestinal problems, jumpiness, fidgeting, trembling, inability, to relax, being easily startled, trouble sleeping, and feeling on edge. There are three types of anxiety:
-Mild anxiety: Sharpens the senses and expands the perceptual field, preparing us for action. Learning and problem-solving skills are enhanced.
-Moderate anxiety: Decreases the perceptual field. Sight, hearing, touch, taste, and smell are limited and the ability to think is impaired. Problem solving and the ability to mobilize resources can be hindered.
-Severe anxiety: Constricts the perceptual field so that an individual's focus is limited to one specific detail. Completing a task or processing new information is compromised, and behavior and attention are directed toward the anxiety.

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GAD affects the mental functions of the client including mood, cognition (trouble concentrating, difficulty learning new information and behaviors, misperception of the events and situations, poor short term memory, difficulty with abstract thinking), and social functioning. When anxiety is resolved or minimized, systems typically recover. Anxiety affects the client's motor functioning by shakiness, restless, and headaches; the gastrointestinal system with diarrhea, constipation, pain, nausea, feeling of "butterflies in the stomach", heart palpitations, shortness of breath, and excessive sweating.

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For many adults gambling can be a social and non-problematic activity. For those with a Gambling Disorder they continue to gambling despite negative consequences or desire to stop, it can become a compulsion. Gambling Disorder is an addictive disorder in that even after losing people still feel the need to pursue gambling. It is addictive in that it affects the reward system of the brain in similar ways as substance abuse. Gambling Disorder is also treating with a 12-step program similar to recovery programs, like Alcoholic Anonymous or Narcotics Anonymous.

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Many people enjoy playing a game of chance every now and then. The risk versus reward element gives players a small rush of excitement, even if they don't win, and more often than not it's enjoyed as a social activity - whether it's betting on a sport like racing or playing poker with a few friends.

But as is the case with many substances and experiences that make us feel good - like eating, shopping, or drinking alcohol - going overboard can transform what should be an occasional source of enjoyment into a mental dependence.

The brain becomes conditioned into wanting more and more to trigger its reward system, to the point where its mental wiring becomes significantly altered, and getting it back to normal requires undoing weeks, months, or potentially even years of negative impact.

When a person reaches this stage, gambling has become more than just a problem of burning through their wallet too quickly: it has become an addiction. And it's only recently that we've begun to identify excessive gambling as such.

In 2013, the substance-related and addictive disorders section of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was updated. Pathological gambling used to be regarded as a compulsion, motivated by the need to relieve anxiety.
But now it's recognised as an addiction akin to substance addiction.
What Exactly Makes Gambling Addictive?

The answer to this isn't as simple as 'people love making money and love winning it even more, so they go overboard'.

Gambling excessively can lead to dramatic alterations in the way the brain sends chemical messages, and gamblers often have genetic or psychological dispositions that make them prone to gambling too much. These factors can initiate a person's downward spiral into addiction.

What happens to the brain?

Understanding gambling addiction requires understanding a little bit about how the brain naturally works when we engage in enjoyable activities.

Our brain has a series of circuits known as the reward system. They are connected to various regions throughout the brain, notably the pleasure and motivation centres.

Rewarding experiences - such as receiving a compliment, having sex, accomplishing a task, or winning a game - cause our brain to send signals via neurotransmitters: chemical messengers that either stimulate or depress neurons in the brain.

The main neurotransmitter in the reward system is known as dopamine. When enough dopamine is released due to stimulating, enjoyable activities, we experience euphoria and pleasure, and feel motivated (particularly to do that same activity again).

When drugs are taken, they create a high by increasing the dopamine that's released in the reward system up to 10 times more than the amount natural rewarding experiences would generate. This also happens when gambling.

Research and studies into gambling's effect on the brain indicates that it activates the brain's reward system similarly to how drugs do: by releasing a higher amount of dopamine.

This is why people are initially attracted to gambling: it's a highly rewarding experience.

But the thing is: most people easily walk away after playing a few rounds of poker or putting a dozen or so coins in a slot machine, having enjoyed the fun while it lasted. Others can't: namely, those who eventually become gambling addicts. Why? When an individual continues gambling, several other factors might be in play, and things get complicated. First of all:

Some people are more inherently prone.

Research shows that problem gamblers and drug addicts often have genetic predispositions for reward-seeking behaviours and impulsivity. The two main ones are:

An underactive brain reward system.

Less activation of the prefrontal cortex.

Having an underactive brain reward system means that the individual doesn't experience the same level of euphoria and pleasure from naturally-rewarding experiences as the average person does. They are therefore drawn to activities that stimulate reward pathways more than usual; ones that are enough to make them feel a satisfactory amount of euphoria and pleasure - for example, the high that taking drugs or gambling creates.

The prefrontal cortex is an area of our brain involved in decision-making, controlling impulses, and cognitive control, and studies have revealed that problem gamblers and drug addicts had less activation of the prefrontal cortex than the average person.

Thus, controlling their impulse to throw the dice or pull the lever of a slot machine just one more time is significantly harder for them. Impulsivity is in their nature and they have difficulty making decisions that assess the long-term impact of their short-term actions.

These predispositions make it highly likely that the individual keeps gambling once they've started and experienced their first win or a series of wins. They've activated their reward system and got a kick of dopamine that they're not used to getting, so they keep going on impulse to experience the euphoria again.

This is when the brain starts physically changing in terms of how its reward system responds to stimulation.

The individual builds up a tolerance.

Have you ever played a game on your phone that was really entertaining at first, but after several play sessions stopped being fun? Although this isn't exactly the same as how a tolerance in gambling or drug addiction works, the principle is similar and gives you an idea of how the brain changes.

To put it simply: the brain 'gets used' to it and is not stimulated by the activity nearly as much as it was initially.

To put it scientifically: when the brain is being overstimulated by excessive drug use or gambling, the brain boosts its defensive reaction which makes the reward system less efficient. The number of dopamine receptors is reduced; less dopamine goes through the brain and therefore the level of pleasure the individual experiences is reduced.

After isolated instances, such as taking a drug once or twice, the brain eventually returns back to normal without difficulty. However, repeated, excessive stimulation leads to the brain developing a stronger, longer-lasting resistance to the stimulant.

When a person gambles excessively, they are often trying to get that same dopamine kick they got in the early days of gambling. But no matter how much they keep gambling, it won't return, because they've built up a tolerance.

At this stage, the individual becomes addicted to gambling because of the way the brain's function has been altered long-term.

Addiction occurs because gambling is the new norm.

Dopamine receptors continue to reduce and eventually the dopamine circuit becomes blunted. This dopamine deficit means that when the stimulant is absent, withdrawal and depression occurs: unpleasant side effects of the brain attempting to reconfigure itself and get back to normal.

Thus, the individual gets stuck in a limbo: they have to keep gambling to stay out of withdrawal and depression, but because of tolerance they don't experience any dopamine-generated euphoria anymore. Excessive gambling is now necessary to stay in their 'new normal'.

This is all assuming that the individual keeps gambling long enough for dopamine receptors to reach such a stage. Surely a person will recognise after a while that they aren't going to win and it's best to quit before they spend all their money, right? Well, people prone to gambling addiction don't quite see this logic.

Firstly: as an addiction develops, the neural pathways to the prefrontal cortex weaken, which as we learned earlier controls decision-making, controlling impulses, and cognitive control. The weakened pathways make impulses and cravings even harder to fight, thus they get continuously pulled downward. Secondly:

Psychological factors compel them to keep playing.

There are five psychological factors that could affect an at-risk gambler and compel them to keep playing to the point where it becomes an addiction:

Partial reinforcement.

Availability heuristic.

Gambler's fallacy.

Illusion of control.

Loss aversion.

Partial reinforcement

Partial reinforcement refers to when the actions a person takes aren't rewarded 100% of the time, nor do they cause a negative outcome 100% of the time. This is why gambling makes people keep playing: the player realises they have a chance of anywhere between 0% and 100% to win. In their mind, a loss or a string of losses are just part of the process and they need to keep going to eventually win. They expect to be reinforced some of the time, and this expectation motivates them to keep playing.

Availability heuristic

This refers to when people overestimate the probability that something will happen because their mind can produce immediate examples of when it did happen. In the case of gambling, this might be when the individual saw stories on the news of people winning the lottery or when they saw people nearby in the casino win big. It might even be because they can recall a time when they had a lucky string of wins themselves. Thus, they think their chances of winning are larger than they actually are.

Gambler's fallacy

Gamblers commonly think that the chances of winning increase with each loss, but this is completely untrue.

The chance of winning neither 'increases' nor 'decreases' when gambling. Chance does not work by shuffling through a pre-determined number of losses or wins. Each turn is a new, isolated event and has the exact same chance of winning or losing as the previous one.

Think of it like flipping a coin. If it comes up with tails 7 times in a row, that doesn't suddenly make the chance of getting heads higher than 50%. Each new flip is always 50%. Our brains just try to rationalise the unlikeliness of getting 7 tails in a row by saying it'll 'balance' out with a heads next.

Chance has no methodology, but gamblers often think it does. They believe that their next hand of cards is 'due' to be good because all their previous ones have been so lousy or that the machine they're playing on is 'due' to pay out, and this flawed mentality urges them to keep playing.

Illusion of control

Many gamblers also falsely believe that they have some influence over chance. This might be reinforced depending on the type of game they're playing - one where there is some level of control due to choices (such as what number/colour to bet on and what cards to discard/pick) but where chance is primarily the driving force in whether someone wins or loses.

Humans want to feel in control - it's within our nature - so the frustration of how unpredictable gambling is can lead to a person convincing themselves that they can gain some control over it. For example: throwing dice in a particular way, sitting in a certain spot, or wearing a 'lucky' item of clothing.

Loss Aversion

People are more sensitive to losses than gains of equal value. For example, losing a £10 note generates a more prominent emotional reaction than finding £10. This is why many gamblers endlessly invest time and money to try 'win' back previous losses or alleviate the feeling of disappointment or frustration by gaining a win. At this point, winning becomes less about excitement and more about 'making up' for losses, so they get stuck in a vicious cycle.
These psychological factors, combined with genetic predispositions, mean a person can very easily fall down a slippery slope into addiction when gambling.
It also makes it incredibly difficult for a person to know when they have a problem. Having a gambling addiction is often accompanied with denial and an unrealistic views of things.

Fortunately, there's tonnes of information online about identifying a problem gambler and there is help for them. Have a read of our author Louise Petty's article on 10 ways to help someone with a gambling problem. If you ever suspect someone might have a gambling addiction, do seek advice and support. Any addiction can be overcome.

Further Resources:

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Why Gambling is Addictive | Understanding the Science

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Gambling addiction is more common than you think, and it can destroy individuals and ruin relationships - so what makes it so addictive?

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-Behaviorally Conditioned Problem Gamblers: Gamblers are unable to remember their big win and get caught in a cycle of "chasing loses" trying to win their money back. This cycle continues and often the gambler believes that they are in control of the outcome. Gamblers in this group often experience anxiety, depression, and substance use and abuse. This group is most likely to comply with treatment.

-Emotionally Vulnerable Problem Gamblers: This group is behaviorally conditioned by environmental and psychological factors. This group has preexisting anxiety, depression, poor coping, problem solving, and negative family and life events. Gambling allows them to cope with these types of emotional states. They are less likely to respond to treatment.

-Antisocial, Impulsive Gamblers: This group is more likely to have predisposed psychological and biological factors contributing to problematic gambling. They also have features of impassivity, attention deficit disorder and antisocial personality. Clients in this group are more likely to have parents with antisocial and substance abuse problems. Clients in this group are unlikely to seek out treatment and follow it.

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Compulsive gambling - Diagnosis and treatment - Mayo Clinic

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Compulsive gambling is an addictive disorder - the uncontrollable urge to keep gambling despite the toll it takes on your life.

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Systems Affected By Gambling Disorder and Secondary Problems 

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Systems Affected By Gambling Disorder and Secondary Problems 

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Systems Affected:

Gambling Disorder interferes with occupational and social functioning. Gamblers often participate in "chasing", betting larger sums of money or taking greater risks trying to make up for previous losses. People with GD often feel as if they are in control of gambling outcomes. People with GD also may become preoccupied with thoughts of gambling. This impacts many domains such as self, family, and work. The biggest impact is on relationships, due to distrust forming between individuals. Finally a person with GD may experience emotional difficulties such as depression and substance misuse.

Secondary Problems:
Secondary problems associated with GD are relationship difficulties, including separation and divorce, occupational difficulties, criminal behavior, antisocial behavior, financial troubles, substance-related disorders, and suicide.

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-Anorexia Nervosa: It is the refusal to maintain body weight at or above a minimally normal weight for height, body type, age, and activity level. There is an intense fear of weight gain or being fat. There is an extreme concern with body weight and shape, and often loss of menstrual periods. Warning signs are extreme dieting, food rituals, hair loss, dry skin, and brittle nails.
-Bulimia Nervosa: Primary symptoms are recurrent episodes of eating large quantities of food in a short period of time, often secretly, past the point of fullness. Following these binges there is a purge or compensatory behavior to make up for excessive calories. These can involve vomiting, laxative abuse, fasting, and compulsive exercise. Waring signs include disappearance of large amounts of food, frequent bathroom trips after meals, calluses on knuckles from induced vomiting and swollen face.
-Binge-Eating Disorder: This is similar to Bulimia Nervosa in that there is large intake of food in a short period of time without the regard of fullness. The difference is that there is no purge following the binge. Warning signs are sudden weight gain and disappearance to large amounts of food.
-Pica: The persistent eating of nonfood or non-nutritive substances that is developmentally inappropriate and is not supported by any particular cultural or social practice.

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-Genetics: Eating Disorders tend to run in families; therefore genetics play a role.
-Biological Issues: Serotonin may have an impact on eating disorders. The behaviors of restricting food intake, binging, and purging have been shown to alter brain structure, metabolism, and neurochemistery in ways that make it difficult for individuals to discontinue the behavior.
-Psychological or Interpersonal Issues: Eating disorders can be the result of searching for control, coping with stress or trauma, personality factors, family issues, low self-esteem, feelings of inadequacy or lack of control in life, depression, anxiety, anger, stress, loneliness, troubled personal relationships, difficulty expressing emotions and feelings, history of being teased about weight, and history of physical or sexual abuse. People who have an eating disorder also may have preexisting low self-esteem, perfectionism, impulsive behavior, and troubled relationships. Eating disorders are used as a way to cope and often suppress feelings.
-Social/Societal Issues: Today's culture often promotes and reinforces a desire to be thin. Peer pressure and media fuel the desire to be thin mainly among young girls. There is an unrealistic expectation of the "perfect" body. These media images can lead to girls having a negative body image about themselves. This negative body image can lead to unhealthy behaviors.
-Cultural Issues: Cultures that glorify "thinness" or muscularity place a high value on obtaining the "perfect body". Cultures that value people more on their physical appearances rather than their inner qualities and strengths.
-Obesity Prevention Programs: Children who participated in a school-based childhood obesity prevention programs are more likely to develop an eating disorder.

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Eating disorders affect an individual socially, emotionally, cognitively, and physically. Individuals with eating disorders may become withdrawn and socially isolated due to eating disorders being practiced in private. Individuals may also have nutritional issues, due to reducing intake and avoiding certain foods. Cognitive issues that may arise are denial of illness, distorted body image, perfectionism, and avoidance. Emotionally individuals may experience anxiety, depression, decreased self-esteem and self-worth, and inability to cope. Physically individuals may experience dehydration, low blood pressure, osteoporosis, digestive complications, arrhythmias, and tearing of the esophagus.

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Eating Disorders can cause severe medical issues including cardiac arrhythmia, cardiac arrest, brain damage, osteoporosis, infertility, and death. Women who have an eating disorder during pregnancy can cause premature labor, low birth weight, cardiac irregularities, still birth, gestational diabetes, miscarriage, respiratory difficulties, abnormal fetal growth, postpartum depression etc. Medical conditions that can occur with eating disorders are bone loss, difficulty regulating body temperature, loss of menstrual periods, electrolytes imbalance, esophageal ulcers, tooth decay, substance use, low heart rate, low blood pressure, anxiety, depression, social isolation, and perfectionism.

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Eating Disorders rank among the most serious public health concerns in the United States and have the highest mortality rate of any mental illness. Despite the risks, only about 10% of those affected get the treatment they need. At the Center for Eating Disorders, treatment involves a specially trained interdisciplinary team of professionals and close monitoring of patients' physical health and safety.

Eating disorders are complex illnesses that can have harmful consequences for an individual's social and emotional well-being but also greatly impact physical health. In fact, eating disorders can compromise every regulatory system in the body including the immune system, digestive system, skeletal system, cardiovascular system and the reproductive system. Common symptoms one might notice include dizziness/fainting, heart palpitations, hair loss, menstrual irregularities, fatigue and energy loss. The effects on physical health can occur rapidly or may deteriorate over a longer period of time. Some medical complications resolve quickly as a person recovers from their eating disorder and others, such as osteoporosis, can have lasting impacts.

The earlier a person with an eating disorder seeks treatment, the more likely they are to begin healing emotionally and physically. Click on each of the links below to explores the signs, symptoms and health consequences associated with each diagnosis.

Eating Disorders & Suicide

In addition to medical causes like cardiac failure, its important to be aware that suicide accounts for as many as 1/3 of the deaths related to eating disorders ( source: Academy for Eating Disorders). In general, individuals struggling with eating disorders are more likely than those without eating disorders to think about and attempt suicide; their risk for suicide is approximately 23 times higher than the in the general population of the same age (Harris and Barraclough, 1997). One particular study found the suicide rate for women with eating disorders was 58 times greater than those without (Herzog et al, 2000). If you are suffering, do not struggle alone. Ask for help.

"But my eating disorder isn't really that bad"

Commonly, if a person's symptoms don't fit into the diagnostic categories listed above they may feel that there is little to worry about with regards to medical complications or that their symptoms don't warrant the same level of concern. This is a dangerous misconception. In reality, most people with eating disorders will fall into the diagnostic category called Other Specified Feeding and Eating Disorders (formerly referred to as Eating Disorder Not Otherwise Specified or EDNOS). This diagnosis does not indicate an eating disorder of lesser severity or the absence of serious medical consequences. In fact, recent research revealed that the elevated mortality risks for EDNOS were similar to those for anorexia nervosa. The bottom line? All eating disorders have the potential to impact health and can have long-term medical consequences.
The health risks associated with eating disorders increase over time with the duration of the illness. However, even individuals in the early stages of illness and those who look and feel well are still at risk. Normal blood work and lab results should not completely alleviate or minimize concerns about medical risk for any patient with an eating disorder. If you are experiencing health complications of your eating disorder do not wait to seek help. Call (410) 938-5252 to find out about treatment options at The Center for Eating Disorders at Sheppard Pratt.
If you are a physician or medical practitioner with questions about the medical monitoring of patients with eating disorders, please visit our For Professionals page or email our Co-Director, Steven Crawford, M.D. at scrawford@sheppardpratt.org.

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Medical Complications | The Center for Eating Disorders | Baltimore, Maryland

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Eating disorders are real, complex and destructive illnesses that can have serious consequences for an individual's emotional well-being and physical health. Find a list of potential medical complications here and get help today.

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There are five areas that have been identified as causes of Substance Abuse:

1) Familial, Social, or Cultural Factors: Problems with substance use is more likely when a person's  primary family, social, and/or cultural tolerances, approves, and/or models substance abuse and related behaviors.

2) Personality Factors: Substance use is more likely in those experiencing depression, high levels of stress, challenges in self-regulating behavior, and those who have poor coping skills.

3) Cognitive Factors: Substance use produces a positive effect that reinforces the continued or increased use of substances. Particularly if the individual has positive expectancies related to the effects of the substance.

4) Genetic Factors: A person who has a parent with a substance use problem is at a greater risk for developing a substance use problem even when social factors are controlled. Individuals may inherit a greater sensitivity to psychopharmacological effects of substances.

5) Biological Factors: Neurotransmitters including dopamine and serotonin affecting the reward pathways of the brain are influenced by substances. This makes it harder for the reward system of the brain to be normally stimulated without the use of substances.

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Drug and Substance Abuse

Causes & Symptoms

As you get older, your body changes and you may find that you are less able to handle the same amount of medications or alcohol. For example, you may have a lower tolerance for alcohol, because it breaks down more slowly in your body as you age. If you have been smoking for a long time, health problems related to smoking are likely to begin to appear.

Older people are also more likely to suffer from at least one chronic illness-and maybe more-as the years go by. Because of this, they tend to take more prescription drugs and over-the-counter remedies compared to younger people. These medicines often do not mix well, or they may alter the amount of each drug in your body-even leading to overdoses when you are actually taking exactly what was prescribed.

When you drink alcohol with some medications, the alcohol can make the effect of the medication dangerously strong. For example, taking alcohol with pills for sleeping, pain, anxiety, or depressioncan produce harmful effects. In particular, you should avoid alcohol if you take:

benzodiazepines (sedatives)

sleeping pills

pain medications

anti-seizure or anti-psychotic medications

antihistamines

anti-depressants

For some older adults, abuse of alcohol, drugs, or a smoking habit is the continuation of a pattern that began earlier in life. But for other older people, abusing alcohol may be an attempt to cope with the stresses that come with normal aging. Unfortunately, alcohol and drug abuse tend to worsen any problems that come with getting older.

Risk Factors

Older people have extra stresses and changes in how their bodies function that increase the likelihood for alcohol or substance abuse. The following risk factors increase the chance for developing a problem with alcohol or substance abuse:

family member with an alcohol problem (family history)

male sex

living alone

single status (separated or divorced)

mental health issues, including depressionor other chronic mental health problems

substance abuse in earlier life

chronic pain

sleep problems

life stresses (financial difficulties, retirement, loss of a spouse or family member, moving to a new home, new illness)

being in the hospital

living in a long-term care facility

long-term tobacco habit

misunderstanding about how to take your medications

over-prescription of drugs that affect mood (especially for older women)

not reporting unwanted medication side effects

disability

boredom

Mental Health Problems

If you are addicted to a medication or other substance, your likelihood of having some type of mental illness is higher. In addition, the illness may be worse and harder to treat. Older adults who abuse alcohol are nearly three times more likely to be diagnosed with a mental illness. The risk of dementia, suicide, depression, anxiety, and sleep problems is much greater in older people who are dependent on alcohol. Quitting alcohol can slow down or even reverse many of these conditions.
Memory impairment, such as dementia from chronic alcoholism, in older adults can improve as long as you stop drinking.
Symptoms and Warning Signs of Alcohol or Substance Abuse

Your healthcare provider may not realize that you are having problems with alcohol or substance abuse unless you or a close friend or family member reports that there is a problem. Your substance abuse may also be covered up by symptoms from another condition such as depression, memory problems, or physical disability. Some healthcare professionals may not consider substance abuse in an older person. They may mistake the symptoms for normal signs of aging, or for Alzheimer's disease or other dementia.

The first signs of misuse of a medication or of alcohol in an older person may include:

increased confusion or memory impairment

mood changes (e.g., agitation, depression, irritability)

sleep problems (including apnea) and daytime sleepiness

dizziness

changes in blood pressure

anemia (low blood counts)

fatigue or weakness

altered liver function and other abnormal blood results

a fall

Long-term alcohol abuse can cause severe nerve damage, confusion, clumsiness, muscle problems, dementia, and coma. Other mental disorders that commonly appear along with alcohol abuse are depression, anxiety, and sleep problems.

If you have been smoking for many years, lung troubles may become more apparent as you get older. You may have more infections or take longer to recover from them and you may find yourself short of breath or wheezing more often.

Withdrawal Symptoms

An addiction to alcohol or other substances can put you at risk of severe, even life-threatening withdrawal symptoms if you try to stop using these substances suddenly. Depending on the substance, withdrawal symptoms may include: shaking, sweating, feeling hot or cold, delirium, seizures, or sudden heart problems. For this reason, you must inform your healthcare provider so you can get help withdrawing from your addiction safely and help you create a plan to avoid the addiction in the future.

Updated: November 2016
Posted: March 2012

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Causes & Symptoms > Drug And Substance Abuse > Aging & Health A To Z > Health in Aging

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As you get older, your body changes and you may find that you are less able to handle the same amount of medications or alcohol. For example, you may have a lower tolerance for alcohol, because it breaks down more slowly in your body as you age.

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Systems Affected by Substance Related Disorders

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Systems Affected by Substance Related Disorders

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Substance abuse exists on a continuum and the hazards and consequences of use are not universal. Harmful involvement with one substance does not necessarily lead to harmful involvement with another. The type, quantity, frequency, and routine of administration of a substance has an affect on those using it. Substances can have an impact on a person's relationships, employment, and personal health practices. Physical health is impacted in that individuals may experience illness, injuries, hyperactivity of the autonomic nervous system, and damage to the body. Substances impact mental health in that they can cause anxiety, depression, loss of motivation, anger agitation, and irritability. Social health concerns are strained or unhappy relationships with the possibility of breakdowns. Cognitive health concerns are short term confusion, learning problems, and memory loss. Substances can also cause also cause lifestyle issues including financial instability, unemployment, homelessness, traffic accidents. conflict with the law, food insecurity, poor nutritional intake, and poor dental hygiene.

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Secondary Problems of Substance Related Disorders

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Secondary Problems of Substance Related Disorders

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-Others Affected: A person's substance abuse may impact those around them such as family, friends, co-workers, and classmates. They may experience isolation, social life restrictions, dissatisfying relationships, public embarrassment, disruption to family events, feelings of shame, anger and resentment, depression, guilt or responsibility, financial instability, and violence.

-Concurrent Disorder or Dual Diagnosis: It is common for people with substance abuse to also experience metal illness.

-Other Disorders Associated with Substance use: People with anxiety are at a higher risk for substance use problems, same for people with ADHD. Mood disorders and substance use have a strong correlation: as does psychosis. Substance use in people with psychosis can actually worsen psychosis symptoms.

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A cerebrovascular accident or stroke occurs when a blood vessel carrying oxygen and nutrients to the brain is blocked or ruptures. When this happens parts of the brain are not receiving the amount of blood needed. Due to the lack of oxygen, parts of the brain begin to die and cause neurological impairments. The neurological impairments depends on what part of the brain is affected. Treatment should be sought right away, a delay in treatment can cause major problems.

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A stroke is a "brain attack". It can happen to anyone at any time. It occurs when blood flow to an area of brain is cut off. When this happens, brain cells are deprived of oxygen and begin to die. When brain cells die during a stroke, abilities controlled by that area of the brain such as memory and muscle control are lost.

How a person is affected by their stroke depends on where the stroke occurs in the brain and how much the brain is damaged. For example, someone who had a small stroke may only have minor problems such as temporary weakness of an arm or leg. People who have larger strokes may be permanently paralyzed on one side of their body or lose their ability to speak. Some people recover completely from strokes, but more than 2/3 of survivors will have some type of disability.

Stroke By The Numbers

Each year nearly 800,000 people experience a new or recurrent stroke.

A stroke happens every 40 seconds.

Stroke is the fifth leading cause of death in the U.S.

Every 4 minutes someone dies from stroke.

Up to 80 percent of strokes can be prevented.

Stroke is the leading cause of adult disability in the U.S.

Hemorrhagic Stroke

A brain aneurysm burst or a weakened blood vessel leak (hemorrhagic) is one of two types of stroke. While the least common of the two types of stroke it most often results in death.
More about Hemorrhagic Stroke
Ischemic Stroke

A blood vessel carrying blood to the brain is blocked by a blood clot (ischemic) is one type of stroke. Learn more about the types of ischemic stroke.
More about Ischemic Stroke
What Is TIA?

When blood flow to part of the brain stops for a short period of time, also called transient ischemic attack (TIA), it can mimic stroke-like symptoms. These appear and last less than 24 hours before disappearing. Learn more about the signs, your risk, and TIA management.
More about TIA
Stroke Facts

Although stroke is the fifth leading cause of death in America and a leading cause of adult disability, many myths surround this disease. Test how much you know about stroke today
Learn Stroke Facts

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A stroke is a "brain attack". It can happen to anyone at any time. It occurs when blood flow to an area of brain is cut off. When this happens, brain cells are deprived of oxygen and begin to die.

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The American Stroke Association has created an acronym F.A.S.T. to remember the sudden signs and symptoms of CVA.

-Face Dropping: If one side of a person's face is numb or droops, the person may be having a stroke. The only way to determine if a person's face is drooping is to have them smile and make observations about asymmetries.
-Arm Weakness: If one arm is weak or numb an individual may be having a stroke. If the person cannot raise both arms without having one of them drift down than the person may be having a stroke.
-Speech Difficulty: If the person is having slurred speech or is unable to speech, they may be having a stroke. Ask the person to repeat a simple sentence like "the grass is green."
-Time to Call 911: If the person is exhibiting any of these signs, call 911 and get the person to the hospital right away.

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CVAs can be classified by the side of the brain affected, the major cerebral vessel involved, and the reason for the interruption of blood flow. The following are arteries affected by CVA:

Right CVA: left hemiplegia, visual deficits, quick and impulsive behavior style.
Left CVA: right hemiplegia, language deficits, slow and cautious behavior style.

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The Society for Cardiovascular Angiography and Interventions

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Strokes happen for two different reasons. The most common cause is blood stops flowing to the brain. The flow of blood is blocked by a clot or a buildup of a fatty substance called plaque in an artery leading to the brain-a process called atherosclerosis, or more generally, cardiovascular disease. Strokes caused by blockage of blood flow to the brain are called ischemic strokes. More than 85 percent of strokes are ischemic.

Ischemic strokes (sometimes called "brain attacks"), like heart attacks, are preventable because they are caused by cardiovascular disease. And cardiovascular disease can be prevented by living a healthy lifestyle that includes eating right, exercising and not smoking.

The other 15 percent of strokes are caused by blood leaking into the brain or between the brain and the skull. These are hemorrhagic strokes. These strokes happen when an artery leading to the brain bursts because it is weak or damaged from aging or from years of high blood pressure. It's important for you and your healthcare team to know the cause of the stroke to determine the best treatment.

If you are relatively young and have no obvious risk factors for stroke, your doctor may want to check for patent foramen ovale (PFO), commonly known as a hole in the heart. We are all born with this hole between the left and right upper chambers of the heart, but the hole usually closes soon after birth. If you are among the 20 percent of people whose PFO never closed, then you may not know it or have any symptoms, but it may increase your risk of stroke and migraines.

TIA (Mini-Stroke)

A transient ischemic stroke (TIA) or mini-stroke is an ischemic stroke that passes quickly. It is caused by a blood clot or piece of plaque blocking or restricting blood from flowing through an artery to the brain. In a mini-stroke, whatever was blocking the artery breaks loose and moves along, allowing blood to once more flow freely to the brain. And you feel better-for now.

You may or may not notice if you've had a mini-stroke, but if you think you are having a stroke of any kind, the best thing to do is call 911. Mini-strokes are often a warning that a full-blown ischemic strokes will happen next.
If you discover that you've had a mini-stroke, check with your doctor about steps to prevent another stroke.
Silent Stroke

It is possible to have a stroke and not know it. A test taken for some unrelated purpose may show lesions on your brain. Those lesions are evidence of damage to the brain tissue caused by a stroke. At that point, you can't really repair the damage, but it is important to know that you are at greater risk for stroke than you may have realized. Talk with your doctor about what you can do to reduce your risk of having another stroke in the future.

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Strokes happen for two different reasons. The most common cause is blood stops flowing to the brain. The flow of blood is blocked by a clot or a buildup of a fatty substance called plaque in an artery leading to the brain-a process called atherosclerosis, or more generally, cardiovascular disease.

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A stroke can be caused by a blood clot that develops in the brain and blocks blood flow. This is called a thrombosis and is the main cause of ischemic strokes. Strokes can also be caused by a clot formed somewhere else in the body other than the brain and travels in the vascular system to the brain, where it becomes logged and prevents blood flow. This is called an embolism. The final cause is a ruptured or broken blood vessel and increased blood pressure. Hemorrhages are the causes of intracerebral hemorrhagic strokes and subarachnoid hemorrhage strokes.

Some factors that increase the risk of stroke are hypertension, high cholesterol, heart disease, sleep apnea, smoking, alcohol use, heart rhythm disorders, drug use and Body Mass Index (BMI).

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A stroke affects many cerebral functions. However a stroke primarily affects an individual's motor, sensory, cognitive, language, and visual functions.

-Motor Impairments: hemiplegia, motor planning, muscle power, muscle tone, reflexes, balance, gait, apraxia, and coordination. These are some of the most common impairments seen after a stroke. They are often seen in the face, arm, or leg.
-Sensory Impairments: decreased sensory awareness, numbness, tingling, astereognosis, agraphia, and processing problems.
-Cognitive Impairments: decreases in consciousness functions, calculation abilities, attention, concentration, problem solving, organizing, perception, orientation, time management, planning, judgement, and safety.
-Language Impairments: dysphasia in comprehension, reading, and writing, and a decrease in expression and reception of language.
-Visual Impairments: double vision depth perception problems, and field cuts.
-Other Impairments: emotions, personality, sexual function, as well bowel and bladder function. The severity of dysfunction depends on the severity and location of brain damage.

The effects of a stroke also depend on the person's age and gender, the type and location of the stroke, and how fast they are provided medical care.

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Secondary Conditions Associated with Stroke

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Secondary Conditions Associated with Stroke

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Some common secondary conditions associated with stroke are limitations including inactivity, lack of independence and participation, post-stroke depression, and emotional lability. Inactivity may be the result from a lack of mobility, poor coping mechanisms, loss of function, and barriers to recreation and leisure choices. Inactivity can affect an individual's work performance, academic performance, community involvement, and social relationships. After strokes individuals may experience a decrease in independence, participation, and ability to complete tasks of daily living (basic self-care). There is also an increase for the number and severity of falls. There is also a burden put on caregivers that are caring for individuals who have had a stroke. These caregivers must perform many activities of daily living and instrumental activities of daily living for the individual who has had a stroke. After a person has a stroke they often are depressed, irritable, have trouble sleeping, have low self-esteem, fatigue, and are withdrawn.

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The Society for Cardiovascular Angiography and Interventions

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TBI is a form of acquired brain injury that results from a direct trauma to the brain. It can be caused by a blow or jolt to the head or a penetrating injury, such as a gun shot wound that causes damage to the brain.

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Traumatic brain injury-Traumatic brain injury - Symptoms & causes - Mayo Clinic

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If a head injury causes a mild traumatic brain injury, long-term problems are rare. But a severe injury can mean significant problems.

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TBIs can be classified as mild, moderate, or severe depending on the extent of damage to the brain.
-Mild TBI (concussion or minor brain injury): This type of TBI occurs when there is a forceful motion of the head that causes a brief alteration of mental status, loss of memory of events before or after the TBI, and brief loss of consciousness. These individuals have a Glasgow Coma Scale score of 13-15 and have the following symptoms: headache, fatigue, sleep disturbance, irritability, sensitivity to noise or light, balance problems, decreased concentration or attention, decreased speed of thinking, memory problems, nausea, blurry vision, dizziness, depression, anxiety, emotional mood swings and/or seizures.

-Moderate TBI: Individuals with a moderate TBI experience loss of consciousness, along with persistent confusion and functional impairments in one or more of the cognitive, physical, emotional, or behavioral domains, along with a GCS score of 8-12.

-Severe TBI: Individuals with severe TBIs have prolonged unconscious state or coma with a GCS score less than 8.

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The Glasgow structured approach to assessment of the Glasgow Coma Scale

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The Glasgow Coma Scale was described in 1974 by Graham Teasdale and Bryan Jennett as a way to communicate about the level of consciousness of patients with an acute brain injury.

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The primary system affected is the structure of the brain. Any part of the brain can be affected including brain controls of voluntary and involuntary functions. These dysfunctions are on a wide spectrum.
-Physical Changes: These may include weakness, muscle tone and coordination problems, full or partial paralysis, balance difficulties, and/or fatigue.
-Cognitive Changes: These may include impairment to attention and arousal, initiation, and memory.  Problem solving and the whole set of higher level functions such as judgement, organization and planning, time management, abstract reasoning, and insight may be impacted. Other cognitive changes in reading, writing, language and communication, new learning and/or confabulation may be impacted.

-Emotional and Behavioral Changes:  These may include difficulty with social skills, such as the inability to empathize with others or poor pragmatics, inappropriate or self-centered behavior, disinhibited behavior, and other emotional-behavioral issues such as irritability, agitation, frustration, flat affect, depression, and/or anxiety.

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Secondary problems of a traumatic brain injury include several that cause further damage to the structure of the brain.

-Anoxic Injury: An injury that results from an absence of oxygen in the brain.
-Hypoxic Injury: An injury that results from a decrease of oxygen in the brain.
-Cranial Nerve Dysfunction: There are twelve pairs of cranial nerves that emerge from the brain. Injury to one or more of the cranial nerves can result in impairments in taste, smell, vision, auditory and vestibular functions.
-Edema: Sweelling and excess fluid in the brain.
-Hematomas: A collecting or pooling of blood that can increase intracranial pressure (ICP). There are three types of hematomas:
1) Subdural hematoma where blood vessels rupture between the brain and the dura (membrane that covers the brain).
2) Epidural or extradural hematoma where blood vessels rupture between the dura and the skull.
3) Intracerebral or intraparenchymal hematoma, which is bleeding within the brain itself.
-Hydrocephalus: This occurs when the cerebral spinal fluid (CSF) accumulates in the brain causing dilation of cerebral ventricles and an increase in intracranial pressure. Symptoms include: incontinence, gait disorder, and dementia.
-Heterotopic Ossification: This is a formation of bone in soft tissues where bone normally isn't present. It predominately occurs in the joints of the upper and lower extremities. Symptoms include: pain, warmth, swelling, and contracture formation.
-Seizures: Post-traumatic seizures, recurrent seizures and epilepsy are known complications of TBI. Seizures usually develop within one day to one week after the injury. The greatest risk for new seizures is within two years after the TBI.

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Many medical issues may arise during the treatment of someone with a brain injury. This briefly discusses some of the most commonly encountered complications. Please check with your health care team for additional information.

Fever and Infection

Infections are very common after a brain injury. Usually the first evidence is a fever. The most common locations of infections are the lungs (pneumonia) and the bladder. That is why when a patient has a fever, the physician will often order tests of the urine, known as a urinalysis and culture, as well as an x-ray of the chest. Once the location of the infection is discovered, antibiotics are used for treatment.

Conditions other than infections can cause fevers. These include blood clots and heterotopic bone, which are discussed later. Sometimes the fever can be a result of the brain injury itself and not the result of an infection. This happens when the part of the brain that controls body temperature is damaged. These conditions require other types of treatment.

Blood Clots (Deep Venous Thrombosis - DVT)

DVT refers to clots that form in the legs or arms, not the brain. These clots are very common; they occur in approximately 40 percent of patients with brain injuries. Clots are serious because they can break off from the blood vessels of the leg and travel to the lungs causing damage or even death. Signs of a DVT may include swelling, redness, or pain in the area of the clot.

Patients with brain injury are watched closely for DVT and are sometimes given blood thinning medicines to reduce their risk. If the physician suspects that a blood clot has formed, a Doppler or blood flow test may be indicated. If a clot in the lung is suspected, a CT scan may be ordered. If a blood clot is discovered, a strong blood thinner or filters placed in the veins can be used for treatment.

Seizures (Epilepsy)

The risk of seizures depends on the type of injury. In people with a closed head injury, about five percent will develop seizures. In those with a penetrating injury, the percentage can approach 50 percent. A seizure occurs when a part of the brain becomes active on its own. The symptoms of the seizure depend on which area of the brain that is involved. For instance, if the area of the brain that controls movement of the arm is affected, the seizure would involve twitching or shaking of that arm. Not all seizures involve movement. They can also cause an abnormal sensation in the body or a change in mental function. Usually, however, seizure in people with brain injuries can cause a loss of consciousness and shaking of the whole body.

Physicians sometimes decide to use anti-seizure (anticonvulsant or anti-epileptic) medicines for preventive purposes. This decision is based on issues such as the risk of someone having a seizure and the possible side effects of the medication. Sometimes, an EEG test may be used to help make the decision.

If a patient has already had one or more seizures, especially if occurring one week after the injury, anti-epileptic medicines are often used. Most likely, these medications will be needed for six months to one year.

Hydrocephalus

This condition occurs when there is a build up of fluid in the hollow spaces of the brain (ventricles). The extra fluid can squeeze the rest of the brain and cause symptoms. The symptoms are not very specific, however. Often, the first signs may be a subtle change in a patient's level of arousal or a slowing of recovery. Of course many other factors can cause these changes. The physician may order a CT scan if hydrocephalus is suspected.

If the CT scan shows hydrocephalus, then a decision will be made in consultation with the neurosurgeon about the type of hydrocephalus and if it would improve with the placement of a shunt. Hydrocephalus is thought to occur in about five percent of people with brain injuries. The percentage is higher in those people with severe brain injuries.

Heterotopic Ossification

This refers to formation of extra bone in the body and occurs in about 10-20 percent of people with brain injury. The extra bone most often forms in the large joints of the body such as the hip or the shoulder. It can cause pain, swelling, inflammation and tightening of the joint. No one yet knows for certain why this happens.

If heterotopic ossification is suspected, x-rays or a bone scan may be order to help with the diagnosis. Treatment for heterotopic ossification can include range of motion exercises, bracing or splinting, medications, or even surgery.

Fractures and Nerve Injuries

Because most people with brain injuries have been involved in trauma, for instance an automobile collision, they are likely to have other injuries as well. Approximately 30 percent of people with brain injuries have fractures and the same number have injuries to the nerves of the arms and legs. Sometimes these injuries are not discovered until the person is in rehabilitation for several reasons. During the initial hospitalization, the focus is on life threatening conditions. Other problems are not yet a priority. Also, many fractures and nerve injuries are extremely difficult to diagnose when someone is comatose or minimally conscious because the primary symptoms of these injuries are pain and difficulty moving. As a person becomes more alert, however, the team may order additional tests, such as x-rays or an EMG, to assist with diagnosis.

High Blood Pressure (Hypertension)

Some patients (less than ten percent) will have high blood pressure after a brain injury. This is usually because of damage to the part of the brain that controls blood pressure. Patients with high blood pressure are treated with medications called anti-hypertensives.

Spasticity

This is one of the most common problems faced by people with brain injuries. Certain muscles of the body become tight or hypertonic because they cannot fully relax. For instance, the elbow can be bent almost completely, so that the hand is almost at the shoulder. If one tried to straighten the elbow out, it would be extremely difficult because of the tightness. Spasticity prevents use of the body part and is painful. It can also interfere with the ability of a helper to assist with dressing or other care.

Therapies play a crucial role in the treatment of spasticity through interventions including range of motion and stretching exercises, splinting or bracing, and serial casting. Medicines may also be used to relax the muscles. Other options are nerve block, baclofen pump, botulinum toxin injections, and surgery.

Other Problems

Problems with respiratory care including tracheostomies; feeding and nutrition including feeding tubes; swallowing problems including aspiration; bowel and bladder management; and skin breakdown are other effects of brain injury.
This content is for informational purposes only. It does not replace the advice of a physician or other health care professional. Reliance on this site's content is solely at your own risk. Shirley Ryan AbilityLab disclaims any liability for injury or damages resulting from the use of any site content.

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Brain Injury: Complications and Medical Problems | BrainLine

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Many medical issues may arise during the treatment of someone with a brain injury. This briefly discusses some of the most commonly encountered complications. Please check with your health care team for additional information. Infections are very common after a brain injury. Usually the first evidence is a fever.

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-Diabetes mellitus (DM): is a complex disease that occurs when insulin production is too low (or lacking entirely) or when the body is unable to effectively use the insulin it produces due to deficits in the insulin receptors. The results can be problematic in that the body cannot metabolize carbohydrates, proteins, or fat correctly, left untreated this can lead to death.

-Type 1 Diabetes (T1D): Insulin dependent and juvenile-onset diabetes are now called T1D. T1D develops when the body's immune system destroys the pancreatic beta cells that make insulin. It primarily occurs in children and young adults.

-Type 2 Diabetes (T2D): Non-insulin dependent diabetes mellitus (NIDDM) and adult-onset diabetes are now T2D. It is the most common type of diabetes and occurs when the body can not produce enough insulin or when the cells cannot use the insulin properly. This causes a build up of glucose in the bloodstream. If glucose levels are not reduced damage can occur to many systems in the body including: eyes, kidneys, nerves, and the heart. T2D is associated with older age, obesity, family history, impaired glucose tolerance, physical inactivity, and race. T2D can be controlled with lifestyle changes, diet, and medication.

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Type 1 diabetes

Type 1 diabetes can occur at any age, but is most commonly diagnosed from infancy to the late 30s. With this type of diabetes, a person's pancreas produces no insulin. It occurs when the body's own defence system (the immune system) attacks and destroys the insulin-producing cells in the pancreas. What causes the immune system to do this is not yet completely understood, but we are funding world-class research to find out.

The only treatment for type 1 diabetes is insulin, which is usually injected or infused via a pump.

Type 2 diabetes

Type 2 diabetes is by far the most common type of diabetes - in the UK over 90 per cent of people with diabetes have type 2. Type 2 diabetes usually affects those over 40, or 25 if you're of South Asian descent. However, it is becoming more common among young people due to lifestyle. The symptoms of type 2 diabetes are not always obvious and, unlike with type 1, they can take a long time to develop.

People with type 2 diabetes either don't make enough insulin or don't make insulin that the body can use properly. The cells in the body become resistant to insulin, making a greater amount of insulin necessary to keep blood glucose levels within a normal range. Eventually, the pancreas can wear out from producing extra insulin, and it may start making less and less.

Type 2 can usually be managed through diet, exercise, and self-monitoring blood glucose, at least in the first few years following diagnosis. However, type 2 diabetes is a progressive condition, and most people will need to take tablets and/or inject insulin after living with it for five to 10 years.

Gestational diabetes

Gestational diabetes usually only affects women during pregnancy. This type of diabetes affects about two to five per cent of pregnant women.

Pregnant women produce large amounts of hormones, which can cause the body to become resistant to the effects of insulin. By the time a woman reaches the end of the third trimester, her insulin requirements have tripled. If the pancreas is unable to match this increased demand, blood-glucose levels start to rise.

In most cases, blood glucose returns to normal after pregnancy. However, women who have had gestational diabetes have a higher risk of eventually developing type 2 diabetes.

LADA

Up to a third of people who were initially diagnosed as having type 2 diabetes actually have latent autoimmune diabetes of adults (LADA), sometimes refer to as type 1.5. People with LADA have features of both type 1 and type 2 diabetes - their immune system attacks the cells of the pancreas that produce insulin, but they may also develop insulin resistance.

The destruction of the insulin producing cells is much slower in LADA than in type 1 diabetes. A blood test is needed to tell the difference between type 2 diabetes and LADA.

Some people can manage LADA on diet, exercise and tablets in the initial months or years following diagnosis. However, most with move onto insulin therapy at some point.

MODY - Maturity Onset Diabetes of the Young

MODY is a rare form of diabetes (3% of those diagnosed under the age of 30) that is caused by a change in a single gene. This means there is a 1 in 2 chance of inheriting MODY from an affected parent, and it runs strongly in families. The most common genes that cause MODY are HNF1A, HNF4A, HNF1B and glucokinase, and the condition presents differently depending on which gene specifically is affected.

A genetic test can be used to confirm MODY and work out which gene is affected. It is important to know which gene is causing MODY, as treatment varies accordingly. Some forms of MODY may require insulin injections, while others are treated using drugs to boost insulin production in the pancreas. One form of MODY requires no treatment at all.

MODY is typically diagnosed under the age of 25, often with a family history of diabetes.

Neonatal diabetes

Neonatal diabetes is a rare form of diabetes that develops in babies under 6 months old. This type of diabetes is caused by a change in a single gene. Treatment for neonatal diabetes varies depending on which gene is affected.

Neonatal diabetes may either be transient or permanent. Transient neonatal diabetes typically disappears during infancy, but may reappear during adolescence. Permanent neonatal diabetes is a lifelong condition.

A genetic test can be used to confirm neonatal diabetes, and work out which gene is affected. It is important to know which gene is causing neonatal diabetes, as treatment varies accordingly. Some forms of neonatal diabetes may require insulin injections, while others are treated using drugs to boost insulin production in the pancreas.
N.B. Because it's very rare, babies with neonatal diabetes may mistakenly be diagnosed with type 1 diabetes. Evidence suggests however that type 1 diabetes is not found in babies under 6 months old. If you or your child were diagnosed with diabetes under the age of 6 months, speak to your healthcare team. Genetic testing can be used to identify cases of neonatal diabetes.

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Difference Between Type 1 and Type 2 Diabetes - JDRF, the type 1 charity

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Type 1 diabetes can occur at any age, but is most commonly diagnosed from infancy to the late 30s. With this type of diabetes, a person's pancreas produces no insulin. It occurs when the body's own defence system (the immune system) attacks and destroys the insulin-producing cells in the pancreas.

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Causes of Type 1 Diabetes:
It is caused by an autoimmune disease, predominant hereditary, that attacks and destroys beta cells in the pancreas. Environmental factors such as viruses, infections, and foods are thought to trigger the autoimmune reaction.

Causes of Type 2 Diabetes:
T2D is caused by a combination of factors that include, genetics, personal and environmental factors. Heredity plays a role. African Americans, Alaska Natives, American Indians, Pacific Islanders of American decent, and  Hispanic/Latinos have a higher risk. Having a parent or sibling with T2D increases an individual's risk. Personal factors also increase a person's risk include: obesity, being middle-ages, physical inactivity, high blood pressure, bad cholesterol levels, polycystic ovary syndrome, prediabetes, acanthosis (a dark rash around the neck or armpits), and a history of cardiovascular disease. Women who give birth to a baby over nine pounds also have an increased risk of T2D.

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1. Hypertension: Approximately two-thirds of adults with diabetes have high blood pressure.

2. Kidney Disease: Diabetes is the leading cause of kidney failure, accounting for about 45% of all new kidney failure cases.

3. Hyperglycemia: This is when blood glucose levels become too high. This can be caused by too little insulin or when the body is not using insulin effectively. The signs and symptoms are: high levels of sugar in urine, frequent urination, and increased thirst. This condition can often be controlled with exercise to help lower blood sugar.

4. Ketoacidosis: This is a serious condition where excess ketones and acidosis develop because of faulty carbohydrate metabolism. When carbohydrates can't be used as fuel, the body metabolizes proteins instead. The waste product includes so many ketones that the body can't get rid of all of them in the urine. The condition develops slowly, but can develop in a few hours when vomiting occurs. The first symptoms include: thirst or very dry mouth, frequent urination, high glucose levels, high levels of ketones in the urine. The next symptoms to occur are constantly feeling tired, dry or flushed skin, nausea, vomiting, abdominal pain, difficulty breathing, a fruity odor on the breath, a hard time paying attention or confusion. This condition can be life threatening and should be treated right away.

5. Nervous System Disease: Approximately 60-70% of adults with diabetes have mild to severe nervous system damage. This includes an impaired sensation or pain in hands or feet, slowed digestion, carpel tunnel syndrome, and erectile dysfunction. Adults with impaired sensation in feet, is a contributing factor to lower extremity amputations.

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Multiple Sclerosis is an autoimmune disease that causes chronic inflammation of the central nervous system. The bodies own defense system attacks that myelin that surrounds and protects the nerve fibers of the brain, optic nerve, and spinal cord. As the damage occurs, the myelin covering of the nerves becomes inflamed, swollen, and detached from the fibers. Eventually the myelin is destroyed. Scar tissue, also called a lesion or sclerosis, forms over the nerve fibers in place of the myelin. Nerve impulses do not travel as fast or as accurately across the scarred areas, so impulses are blocked or delayed from traveling to or from the brain. When some impulses are sent incorrectly it can lead to an array of uncomfortable sensations in addition to sensory loss and loss of motor control. Ultimately the disease leads to the degeneration of the nerves themselves which causes permanent disability.

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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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Possible Disease Courses of Multiple Sclerosis

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Possible Disease Courses of Multiple Sclerosis

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-Relapsing-remitting (RRMS): This is the most common type of MS. Symptoms flare up and then subside. Flare ups usually last several days to several weeks. The person may have total or only partial recovery between flare ups. Most people with MS initially begin on this course.

-Secondary-Progressive (SPMS): When exacerbations (flare ups) become steadily progressive and only partial recoveries are achieved with each exacerbation, the course of the disease is described as SPMS. Before disease-modifying 🤬 became available, more than 50% of those who started with RRMS developed SPMS within 10 years, and 90% within 25 years. It still may happen, but percentages are lower now.

-Primary-progressive (PPMS): PPMS is a steady progression of symptoms without signs of remitting, and occurs in about 10% of individuals with MS.

-Progressive-relapsing (PRMS): A steady progression of symptoms with obvious acute attacks. Only about fiver percent of people with MS have PRMS.

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MS is a disease of the central nervous system; therefore any system that is directly related to the CNS is possibly affected. Symptoms and the severity of symptoms can vary from person to person. The primary symptoms are directly related to demyelination: weakness, numbness, tingling, tremor, visual problems, pain, paralysis, poor balance, bowel and bladder dysfunction, slurred speech, decline in cognitive functioning, including reasoning, memory, and processing, and dysphagia.
MS can also be aggravated by external variables such as heat, fatigue, and stress.
-Heat: Any warm environment such as a sunbathing or a hot tub can worsen MS symptoms. Heat and humidity causes the myelin sheath to move signals less efficiently. The most common symptom is blurry vision which subsides when the heat stimulus is taken away.
-Fatigue: This is one of the major complaints of MS making it both a symptom and something that worsens other symptoms. This is an extreme type of fatigue that affects motivation and the ability to perform daily activities. This type of fatigue is unique to MS and worsens as the day goes on.
-Stress: Stressful events and poorly controlled stress levels can lead to exacerbations in MS symptoms.

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Read our article and learn more on MedlinePlus: Multiple sclerosis

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-Heart Disease: This is an umbrella term that includes a range of medical conditions that involve the heart in one way or another.
-Blood Vessel Diseases: narrowed , blocked, or stiffened blood vessels that impair circulation. Symptoms include agnia (chest pain), shortness of breath, pain, numbness, weakness, and/or feelings of cold extremities.
-Heart Arrhythmias: An abnormal heartbeats, which can be quick, slow, or irregular. Symptoms include fluttering in chest, tachycardia (racing heart beat) bradycardia (slow heart beat), angina, shortness of breath, vertigo, feeling lightheaded, and syncope (fainting).
-Congenital Heart Defect: Structural problems of the heart or major blood vessels there are 18 types of defects. These defects are usually seen in babies. Symptoms may vary depending upon the defect or abnormality. Common symptoms are pale gray or blue color skin, swelling in hands, feet, ankles, abdomen, or other areas around eyes, shortness of breath, tiring easily, and excessive fluid in the heart or lungs.
-Cardiomyopathy: Thickening and stiffening of the heart muscle. Symptoms may include shortness of breath, swelling in legs, ankle, or feet, bloating of abdomen, fatigue, irregular heartbeats that feel rapid or pounding, vertigo, feeling of lightheadedness and syncope.
-Heart Infections: There are three types of heart infections:
Pericarditis: infection of the tissue surrounding the heart.
Myocarditis: infection of the muscular middle layer of the heart walls.
Edocarditis: infection of the inner membrane that separates the heart chambers and heart valves.
Symptoms include fever, shortness of breath, fatigue, weakness, swelling, heart rhythm changes, a dry persistent cough or rash.
-Valvular Heart Disease: Functions of one or more heart valves are damaged leading to stenosis (narrowing), regurgitating (leaking), or prolapse (improper closing). Symptoms are fatigue, shortness of breath, irregular heartbeat or heart murmur, swollen feet of ankles, angina, and syncope.

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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

Show more related 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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Most secondary problems depend on the type of heart disease a person has.
-About 20-30% of individuals with a heart defect have other physical, developmental, or cognitive disorders.
-Five to 10% of people with cardiac problems also have anxiety disorders, panic attacks and phobias.
-10-15% have mood disorders, depressive episodes, minor depression or dysthymia.
-People with heart disease and diabetes are at a higher risk of developing depression.
-Sexual activity can be impacted due to the increased stress on the cardiovascular system.
-A secondary condition related to lifestyle is back problems due to inactivity or weight.

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Cancer is the generic term given to a group of more than 100 diseases where abnormal cells divide and grow out of control. As cancer advances, cancer cells can invade other parts of the body spreading to nearby tissue or moving through the blood or lymphatic system. Symptoms include unexplained weight loss, fever, fatigue, pain, skin changes. Specific types of cancer have other symptoms.

How Cancer is Named: Cancer is named based off the location where cancer originates in the body. Even if it spreads to other parts of the body it is still named after where it originated.

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Secondary Problems Related to Cancer Treatment 

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Secondary Problems Related to Cancer Treatment 

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Side effect from cancer treatment vary widely due to a multitude of factors including the treatment chosen, the client's age and health, and the individual's response to a specific treatment. The three most invasive treatments are surgery, chemotherapy, and radiation. Surgery complications include pain, a partially collapsed lung, blood clots, fatigue, muscle atrophy, anesthesia effects, confusion or delirium, and infection. Chemotherapy effects include nausea, vomiting, loss of appetite, hair loss, mouth sores, and low blood cell counts that increase risk for infection, bleeding, bruising, and anemia. Radiation effects include skin irritation and fatigue. Individuals with advanced cancer often experience a greater number of physical, emotional, and spiritual symptoms. These include pain, dyspnea, constipation, fatigue, poor sleep, anxiety, depression, and grief.

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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 staging is used as a way to determine the appropriate treatment for a client. Most types of cancer have specific stages based upon the number of cancer cells and the local in the body. In the U.S. the National Cancer Institute manages the Surveillance, Epidemiology, and End Results Program (SEER) to help identify the most promising treatment protocols. Data is collected using a staging scale that uses five levels
-In situ: early cancer only located in the layer of cells in which it began.
-Localized: Cancer is limited to the organ in which it began, without evidence of spreading.
-Regional: Cancer that has spread beyond original site to nearby organs, lymph nodes, or tissue.
-Distant: Cancer that has spread from primary site to distant organs or lymph nodes.
-Unknown: cases where there is not enough information to indicate a stage.
Cancer Stages:
-Cancer Stage 0: Carcinoma in situ
-Cancer stages 1-3: Higher numbers indicate more extensive disease, as seen by larger tumor size and spread of cancer beyond the organ in which it first developed to nearby lymph nodes and/or tissues or organs adjacent to the location of the primary tumor.
-Cancer Stage 4: The cancer has spread to distant tissues or organs.

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After a colorectal cancer diagnosis, you likely experience a range of emotions. Allow yourself to be present with all your emotions, and communicate with your support network (family, friends, or mental health professional) to help you manage this unexpected event. You may have a desire to begin treatment immediately, but know that before beginning treatment you must go through the steps of cancer staging to learn more about your cancer and how to treat it.

It is important that you take the time to learn about your colon cancer or rectal cancer diagnosis because your diagnosis determines the treatment you will receive. Once your doctor tells you that you have colon or rectal cancer, your healthcare team will work together to determine what stage of diagnosis you have. Learn as much as you can about your diagnosis before making cancer treatment decisions. If there is any uncertainty about your diagnosis or treatment choices, you'll benefit from a second opinion.

Call our Patient Resources Line for help with your colorectal cancer diagnosis or to get resources for colorectal cancer patients. Also, if you're stage III or stage IV, download Your Guide in the Fight.

STEPS TO CANCER STAGING

Step 1

First, you will have blood tests (to look for certain enzymes), diagnostic scans (to show where the cancer is located), and a physical exam:

A computed tomography (CT) scan is an imaging method that uses x-rays to create pictures of cross-sections of the body.

A positron emission tomography (PET) scan is an imaging test that uses a radioactive substance called a tracer that creates 3-D images to look for disease in the body.

Need more information about your radiology exam? Visit RadiologyInfo.org.

Step 2

Surgery may be the next step. Doctors may want to conduct a biopsyto remove cells from the tumor and have a pathologist examine them to determine whether they appear normal (called cell differentiation).

Your tumor should be tested for biomarkers. This can help guide treatment recommendations and decisions.

Step 3

Your cancer is finally classified according to the TNM system (tumor, node, metastasis) developed by the American Joint Committee on Cancer (AJCC).

>Tumor: How far the tumor extends from the inner lining of the colon or rectum through the layers of its walls

Nodes: Whether cancer cells are found in the lymph nodes by the colon

Metastasis: Whether cancer has spread beyond the colon and its adjacent tissues to organs like the lungs or liver

Step 4

After doctors classify a tumor with the TNM system, an overall stage is assigned, ranging from stage 0 (no cancer found) to stage IV (cancer spread to organs beyond the colon or rectum).

Colorectal Cancer Diagnosis & Biomarkers

You'll want to have your tumor tested for Biomarkers at the time of rectal or colon cancer diagnosis. Biomarkers play a key role in developing individualized treatment plans. Getting your tumor tested for biomarkers could help you choose a treatment plan that best matches your tumor type so you may you may experience fewer side effects and improved health.

Here is a list of known biomarkers that impact colorectal cancer patients. For more information about their implications, visit the Biomarked website.

KRAS and NRAS

BRAF

PIK3CA

Carcinoembryonic Antigen (CEA)

Microsatellite Instability High (MSI-H)

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Colorectal Cancer Diagnosis | Fight Colorectal Cancer

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After a colorectal cancer diagnosis, you likely experience a range of emotions. Allow yourself to be present with all your emotions, and communicate with your support network (family, friends, or mental health professional) to help you manage this unexpected event.

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The primary cause of COPD is smoking it accounts for 85-90% of COPD cases. This includes all smoked tobacco products: cigarettes, pipes, and cigar. There is only a small number people that develop COPD from other sources such as fumes, chemical, and secondhand smoke. In rare cases COPD can be caused by aplpha 1 antitrypin deficiency, which is a gene disorder.

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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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Chronic Obstructive Pulmonary Disease (COPD)- This is a condition that makes it hard to breathe. There are two types of COPD that interfere with the normal functioning of the breathing system.

1. Chronic Bronchitis: It is caused by the chronic inflammation of bronchial tubes due to increased mucus. The mucus obstructs the bronchioles, making it hard to breathe in and out. The person coughs to try and clear the mucus and becomes short of breath with exertion. Chronic Bronchitis is associated with prolonged exposure to bronchial irritants such as smoking.

2. Emphysema: In this condition the walls of the alveoli begin to break down and the lung loses its elasticity. So instead of having many small alveoli only a few large air sacs remain. Less alveoli and bigger air sacs cause a problem. There is less surface area for the exchange of oxygen and carbon dioxide. When combined with the loss of lung elasticity this can lead to air being trapped in the lungs. Air trapped in the lungs causes poor exchange and shortness of breath.

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COPD may limit an individual's work ability, physical ability, household chores, social activities, sleeping, and family activities. Individuals with COPD are also more susceptible to respiratory infections, pulmonary hypertension, heart problems, lung cancer, and depression. People with COPD may also have poor nutrition, poor muscle strength and endurance, skeletal disease (decreased bone density), anxiety, learned helplessness, loss of internal locus control, and sensory problems. Many of these are due to frequent hospital visits, decreased activity level, deconditioning, medications, lack of oxygen, and poor adjustment and coping skills.

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COPD can affect more than just your breathing. It can also affect your sleep. Learn more about COPD and what you can do to sleep better.

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Rheumatoid Arthritis (RA): is a chronic disease that involves the inflammation of the lining of joints, causing joint damage, chronic pain, loss of function, and possibly permanent disability. RA is considered an autoimmune disorder, which occurs when the immune system attacks the bodies own tissues. RA can also cause fevers and fatigue.

Three Stages of RA:

1. The first stage is swelling of the joint lining, causing pain, warmth, stiffness, redness, and swelling around the joint.
2. The second stage is rapid division and growth of cells, which causes the joint lining to thicken.
3. In the third stage the inflamed cells release enzymes that may digest bone and cartilage, often causing the involved joint to lose its shape and alignment leading to increased pain and loss of movement.

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Rheumatoid arthritis is an autoimmune disease in which the body's immune system - which normally protects its health by attacking foreign substances like bacteria and viruses - mistakenly attacks the joints.

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It is not known what the exact cause for the immune system to turn against itself in RA, but the following factors have been identified:
Genetic Factors: Specific genes may play a role in whether a person develops RA and how severe the disease will become. However some people with these genes never develop RA, whiles others without these genes develop RA. Therefore ones genetics only play part of the role.
Environmental Factors: It is believed that environmental factors such as a virus, bacterium, or mycobacterium may trigger the disease process.
Hormones: Deficiencies or changes in certain hormones may promote the development of RA in genetically susceptible clients who have been exposed to an environmental trigger agent.

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Systems Affected by Rheumatoid Arthritis

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Systems Affected by Rheumatoid Arthritis

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RA predominantly Affects the musculoskeletal system, though sensory changes, involvement of other organs, lower energy levels and psychological issues may also be present. RA primarily affects wrist joints and finger joints closer to the hand; however it can affect the neck, shoulders, elbows, hips, knees, ankles, and feet. It presents in a symmetrical pattern, meaning that it affects the same joints on the right and left sides. Clients typically complain of feeling pain and stiffness that lasts for more than 30 minutes upon awakening. Joints can become red, swollen, and painful during and after excessive use. Some additional symptoms and problems a client with RA may experience are:
-Anemia: A decrease in the normal number of red blood cells. This is due to proteins released from the inflamed tissue interferes with the bodies ability to make red blood cells.
-Depression
-Fatigue: Can be caused by the increased time it takes to complete tasks.
-Functional Limitations: Clients with RA may find some tasks of daily living very hard or they cannot do them.
-Impaired Range of Motion
-Inflammation: The joint lining thickening causes swelling near the joint.
-Joint Deformity
-Neck Pain
-Rheumatoid Nodules: Bumps under the skin that form close to the joint.
-Fever
-Dry eyes and mouth

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Secondary Problems of Rheumatoid Arthritis

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Secondary Problems of Rheumatoid Arthritis

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-Bone Loss: Women with RA are at an increased risk of developing bone loss, fracture and/or osteoporosis in RA affected joints.  This can be caused by medications used to fight RA, and lack of physical activity. Women are two to three times more likely to have RA than men.
-Cardiopulmonary Endurance: Decreased involvement in cardiopulmonary conditioning due to pain, stiffness, limited range of motion, fatigue and depression often compromise endurance.
-Muscle Atrophy: Loss of muscle strength due to decreased physical activity.
-Life Tasks: Joints become tender and painful during and after excessive use impacting the client's ability to complete perform life tasks.
-Psychological Changes: Depression, anxiety, and feelings of helplessness are common in clients who live with chronic disease.
-Sexual Dysfunction: Pain, limited range of motion, resultant inflammation from activity, limited endurance, and psychological changes can affect the client's desire to participate in sexual activity.

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A medical condition is referred to as comorbid when it occurs simultaneously with another condition considered to be the primary illness. So, diseases that tend to occur along with RA are said to be comorbid conditions.

There are a number of comorbid conditions that tend to appear with RA. Sometimes these conditions may also be called extra-articular (this means they appear outside of the joint) complications or manifestations of RA, when they occur as a result of the disease process involved in RA.

Overview of RA comorbidities and complications

RA is associated with numerous comorbidities and complications, affecting a wide range of organs and organ systems, including blood vessels, bones, the brain and nerves, the cardiovascular system, kidney, liver, eyes, and lungs. ¹⁻⁴

Some of the main comorbidities associated with RA include cardiovascular disease, osteoporosis and bone loss, and infections.

Comorbidities and extra-articular manifestations of RA

Insulin resistance, sarcopenia

Cardiovascular disease

Cardiovascular disease is one of the more common comorbidities associated with RA. The prevalence of a range of cardiovascular conditions is increased in patients with RA, including myocardial infarction (MI or heart attack), stroke, congestive heart failure, ischemic heart disease, and vascular disease. ³

For example, results from the Nurses Health Study, a study that included over 100,000 participants, showed that women who had had RA for 10 years had 3 times the risk for MI compared with women without RA. ⁵

Osteoporosis and fracture

Osteoporosis, with increased risk of fracture, commonly affects women with RA. This is especially true as women reach menopause and during the post-menopausal years. In the general population, the period shortly before menopause (1.5 years before) and the period following menopause are associated with loss of bone, with bone density decreasing on average at a rate of 2.5% yearly during peri-menopause and at a slower rate (about 1%) after menopause. Among post-menopausal Caucasian women in the general population, 35% will develop osteoporosis, with increased fracture risk. ⁶

Women with RA, who already face a risk of bone loss associated with chronic inflammation, face additional increased risk of osteoporosis from menopause. This means that they are at extremely high risk for fractures and other complications associated with continued bone loss. ⁶

Osteoporosis and bone loss can affect women with RA well before they reach menopause. Results from a study of 394 female RA patients ranging in ages from 20 to 70 years found that bone mineral density was reduced throughout the study population and that osteoporosis occurred at double the rate for the entire group of female RA patients compared with a healthy control group of females without RA. ⁷

Infection

RA patients face increased risk for infections, mainly affecting joints and bones, but also affecting the skin, soft tissues, and respiratory tract. One study conducted in Rochester, Minnesota, found that RA patients faced a 10-fold increased risk for osteomyelitis (an infection of the bone or bone marrow) and a 15-fold increased risk for septic arthritis (an infection of the joint) compared with the general population. Overall, the risk for developing infections was around 50% higher in RA patients compared with the general population. ⁸

The cause behind increased risk for infection among RA patients is unclear. There are several factors that may contribute to this increased risk, including the immune system malfunction that is part of RA, as well as use of drugs that suppress the immune system. Corticosteroids have been shown to increase risk of both mild and serious infections. Selected DMARDs with immunosuppressive potential (azathioprine, cyclosporine, cyclophosphamide, and leflunomide) have been shown to increase the risk of infection. Notably, methotrexate is not associated with increased infection risk. Newer biologic treatments are also associated with increased risk for infection. ³

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Medical Conditions Occuring along with RA - RheumatoidArthritis.net

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A medical condition is referred to as comorbid when it occurs simultaneously with another condition considered to be the primary illness. So, diseases that tend to occur along with RA are said to be comorbid conditions. There are a number of comorbid conditions that tend to appear with RA.

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Epilepsy is a medical condition that affects the brain neurons and causes abnormal signals. These abnormal signals may be caused by an imbalance of neurotransmitters or defects in the connections between neurons in the brain. When the abnormal signals causes a brief strong surge of electrical activity that affects a portion of the brain, it is called a seizure. Seizures can last from a few seconds to a few minutes. Having a seizure does't necessarily mean the person has epilepsy. Only when a person has two or more unprovoked seizures are they diagnosed with epilepsy.

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Epilepsy is the fourth most common neurological disorder and affects people of all ages.

Epilepsy means the same thing as "seizure disorders."

Epilepsy is characterized by unpredictable seizures and can cause other health problems.

Epilepsy is a spectrum condition with a wide range of seizure types and control varying from person-to-person.

Public misunderstandings of epilepsy cause challenges that are often worse than the seizures.

Join our mailing list to stay to date about programs, events, and news about epilepsy.

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The human brain is the source of human epilepsy.

Epilepsy is a chronic disorder, the hallmark of which is recurrent, unprovoked seizures. A person is diagnosed with epilepsy if they have two unprovoked seizures (or one unprovoked seizure with the likelihood of more) that were not caused by some known and reversible medical condition like alcohol withdrawal or extremely low blood sugar.

The seizures in epilepsy may be related to a brain injury or a family tendency, but often the cause is completely unknown. The word "epilepsy" does not indicate anything about the cause of the person's seizures or their severity.

Many people with epilepsy have more than one type of seizure and may have other symptoms of neurological problems as well. Sometimes EEG (electroencephalogram) testing, clinical history, family history, and outlook are similar among a group of people with epilepsy. In these situations, their condition can be defined as a specific epilepsy syndrome.
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Essentially, anything the brain can do, it can do in the form of a seizure.

Although the symptoms of a seizure may affect any part of the body, the electrical events that produce the symptoms occur in the brain. The location of that event, how it spreads, how much of the brain is affected, and how long it lasts all have profound effects. These factors determine the character of a seizure and its impact on the individual.

Having seizures and epilepsy can affect one's safety, relationships, work, driving, and so much more. Public perception and treatment of people with epilepsy are often bigger problems than actual seizures.

Are you new to epilepsy and seizures?
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The mission of the Epilepsy Foundation is to lead the fight to overcome the challenges of living with epilepsy and to accelerate therapies to stop seizures, find cures, and save lives.

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Epilepsy is the fourth most common neurological disorder and affects people of all ages. Epilepsy means the same thing as "seizure disorders." Epilepsy is characterized by unpredictable seizures and can cause other health problems. Epilepsy is a spectrum condition with a wide range of seizure types and control varying from person-to-person.

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Focal Seizures: Also called partial seizures, these begin in a localized area of the brain. They are frequently labeled by the area of the brain in which they originate.
-Simple Focal Seizures: Individuals remain conscious but experience unusual feelings or sensations. They can experience sudden and unexplainable emotions. They may also have unrealistic heightening of their senses.
-Complex Focal Seizures: Individuals experience an altered state of consciousness, in which they may experience a dreamlike experience that lasts a few seconds. They may display repetitive behaviors such as blinks, twitches, mouth movements, experience auras.

Generalized Seizures: are a result of abnormal neurological activity that occurs in more than one area of the brain. These seizures may cause loss of consciousness, falls, or muscle spasms.
-Absence Seizures: A momentary loss of consciousness of just a few seconds usually with no other  symptoms. Muscles seem to jerk or twitch, and at times the individual seem to stare into space. Individuals may no know they have a seizure.
-Tonic Seizures: These seizures cause stiffening of the back, leg, and arm muscles.
-Clonic Seizures: Seizures of these type cause repetitive, rhythmic jerks that involve both sides of the body at the same time.
-Myoclonic Seizures: Jerks or twitches of the upper body, arms, or legs are typical of these seizures.
-Atonic Seizures: These seizures cause a loss of normal muscle tone, which results in a fall.
-Tonic-Clonic Seizures: A typical symptom of these seizures includes stiffening of the body and repeated jerks of the arms and/or legs as well as loss of consciousness. These are referred to as grand mal seizures.

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Status epilepticus is a potentially life-threatening condition in which a person either has an abnormaly prolonged seizure or does not fully regain consciousness between seizures. A prolonged seizure is one lasting longer than five minutes.

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My Video:
https://www.youtube.com/watch?v=v1wiqn-GwUM
Additional Resources:
https://www.epilepsy.com/learn/seizure-first-aid-and-safety/staying-safe

https://www.epilepsysociety.org.uk/toms-story#.XAHz52hKjIU

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Down Syndrome is a genetic disorder that is caused by abnormal cell division that results in an extra copy of chromosome 21. This change causes developmental and physical changes in the developing fetus. The severity ranges from person to person but overall results in lifelong intellectual and developmental delays. Intellectual and developmental problems can range from mild to severe.

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Down Syndrome is the result of extra genetic material when chromosome 21 divides. This creates an extra full or partial chromosome 21. This extra chromosome is responsible for the symptoms of Down Syndrome. There are three genetic variations that cause Down Syndrome:

1. Trisomy 21: an individual with three copies of chromosome 21.

2. Mosaic Down Syndrome: This is a rare form of Down Syndrome and is caused by abnormal cells.

3. Translocation Down Syndrome: This occurs when a portion of chromosome 21 becomes attached to another chromosome.

Although Down Syndrome is genetic it isn't inherited from the parent.

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Each individual experience with Down Syndrome is unique. Such as some individuals are healthy while others have significant health conditions such as heart problems. Children and adults with Down Syndrome have distinct facial features. Some common features include:
-Flatten Face
-Small Head
-Short Neck
-Protruding Tongue
-Upward Slanted Eyes
-Small Ears
-Poor Muscle Tone
-Broad Short Hands
-Short Fingers
-Small Hands and Feet
-Excessive Flexibility
-Short Height
-Hyperflexibility
-Scoliosis
Most children and some adults with Down Syndrome have mild to moderate cognitive impairment. There can be language delay and both long and short term memory can be impacted.

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Down Syndrome is not something that is cured individual's have it for a lifetime. Early detection is important to help with an individual's management with Down Syndrome. Some of the management techniques that are used are speech therapy, occupational therapy and exercise to help improve motor skills. Usually a team of providers work together to provide the best care for the individual. This care team consists of:
-Primary physician who is in charge of general health and vaccinations.
-Other health providers depending if an individual has any secondary conditions.
-Speech therapist to work on communication skills
-Physical therapist to work on motor skills and build strength
-Occupational therapist to work on fine motor skills and tasks of daily living.
-Behavioral therapy for the emotional challenges of Down Syndrome.

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Secondary conditions associated with Down Syndrome become more prevalent the older the individual is. Some common secondary conditions are:
-Heart Defects
-Gastrointestinal Defects
-Immune Disorders
-Sleep Apnea
-Obesity
-Spinal Problems
-Leukemia
-Dementia
-Endocrine Problems
-Dental Problems
-Seizures
-Ear Infections
-Hearing Problems
-Vision Problems
-Autism

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-Down Syndrome is the most common chromosomal condition every one in 700 babies in the United States is born with it.
-The life expectancy for individuals with Down Syndrome has risen drastically from 25 in 1983 to 60 today.
-Down Syndrome occurs in people of all races and economic status.

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Cleveland Clinic. Down Syndrome Management and Treatment. Retrieved December 11, 2018, from https://my.clevelandclinic.org/health/diseases/17818-down-syndrome/management-and-treatment

Mayo Clinic. Down Syndrome. Retrieved December 11, 2018, from https://www.mayoclinic.org/diseases-conditions/down-syndrome/symptoms-causes/syc-20355977

National Down Syndrome Society. Down Syndrome Facts. Retrieved December 11, 2018, from https://www.ndss.org/about-down-syndrome/down-syndrome-facts/

Porter H. R. (2015) Recreational Therapy for Specific Diagnoses and Conditions. Enumclaw, WA: Idyll Arbor Inc.