Alzheimer's & Dementia

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Did you know dementia not only has effects on memory? In severe cases, it may cause hospital Emergency Departments to have to use chemical or mechanical restraint. A study from Royal Melbourne Hospital recently published by Australian Doctor online showed:

  1. One in five patients needed prescription restraints (i.e. antipsychotics or benzodiazepines)
  2. Some patients also needed mechanical restraint, 40% due to agitation.


Alzheimer's and Dementia may be mentally crippling conditions where memory is lost and loved ones may not even be able to recognize family and friends.

 

Washington University School of Medicine have discovered that even one night of disrupted sleep is enough to raise levels of the brain protein amyloid beta which is linked with Alzheimer's disease. When this clumps together it can stop neuronal brain cells talking with each other which can destroy neurons and erase memory.


In Australia, more than 1 in 3 adults complain of significant sleep issues, with even more saying they "do not feel refreshed when they wake in the morning". Dr Justin Lim says "Lack of sleep impacts your concentration, you may become forgetful and display irritation. Your cognition deteriorates and even a mild cognitive impairment can be a warning sign for Alzheimer's disease".


Research reported in the Medical Journal of Australia from an international study involving Germany, the US and the UK suggested that lack of navigational skills may be an early sign of Alzheimer's disease. 


With a variety of factors contributing to our mental and emotioanl state, Professor Yoland Lim Health Care works in conjunction with fellow medical practitioners and specialists with a general medical holistic patient centered approach to help co-ordinate and integrate care of the patient, including, but not limted to, wellbeing, stress, and mental health.

Anosmia

Anosmia is a disorder characterised by the inability to smell. The first cranial nerve known as the Olfactory nerve transports the messages from the nose to the brain. Anosmia is caused by the dysfunction of this olfactory system[1]. Various factors contribute to this such as:

  • hormonal disturbances
  • chemicals
  • diseases of the nervous system
  • head injuries
  • numerous medications 


Due to the unique ability of olfactory neuron being able to regenerate after injury, the incidence of anosmia may be temporary1. Despite this, losing the sense of smell can have a severe impact on not just health but also on the quality of life[2]. For example, as the sense of smell is closely intertwined with the sense of taste, losing the ability to smell can result in food tasting bland. This can make it hard to eat and drink (decreased appetite) and can affect enjoyment of life revolving around meals[3]. 


Other difficulties experienced as a result of anosmia include challenges with maintaining personal hygiene and social relationships, feeling less safe and fear of hazardous events such as smoke and gas[2]. 


Specific treatment for anosmia depends on the underlying cause with studies highlightingthe successful treatment of anosmia cases with acupuncture whereby patients regained the sense of smell following acupuncture sessions[4][5].

    

References

[1] Better Health Channel (2014, August). Anosmia – loss of smell. betterhealth.vic.gov.au/health/conditionsandtreatments/anosmia-loss-of-smell

[2] Boesveldt (2017, September). Anosmia – A Clinical Review. Chem Senses Vol 42 (7) 513-523

[3] Health Direct (2018, April). Anosmia (loss of smell) healthdirect.gov.au/anosmia-loss-of-smell

[4] Michael (2003, December). Anosmia treated with acupuncture. Acupunct Med Vol 21 (4) 153-4. 

[5] Dai et al (2015) Recovery of Olfactory Function in Postviral Olfactory Dysfunction Patients after Acupuncture Treatment. Evidence-Based Complementary and Alternative Medicine  

Bell’s Palsy

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Bell’s Palsy is a sudden weakness or paralysis on one side of the face. It is caused by damage to the facial nerve through a virus infection. For unknown reasons, it is often seen more in young adults of either gender[1]. It has been reported that between 11 and 40 per 100 000 people are affected by the disease worldwide[2].


The inflammation caused by the infection puts pressure on the nerve that controls the facial muscles which ultimately results in paralysis of the face. Some of the most common symptoms include droopy appearance around affected side of the face, eye and mouth, as well as overall numbness.

Some may suffer long-term effects. 


A study published in the JAMA Otolaryngology Head Neck Surgery illustrated the factors associated with improved facial function are[3]:

  • younger age
  • lower degree of facial nerve paralysis (as measured using the House-Brackmann grade)
  • good electromyography result (absence of pathological spontaneous fibrillation activity)
  • absence of diabetes, and 
  • good control of hypertension

    

According to The Copenhagen Facial Nerve Study, approximately 13% are left with ongoing slight weakness and 4% with severe weakness that often result in major facial dysfunctions. 


References

[1] betterhealth.vic.gov.au/health/conditionsandtreatments/bells-palsy

[2] nps.org.au/australian-prescriber/articles/management-of-bells-palsy

[3] Yoo MC, Soh Y, Chon J, Lee JH, Jung J, Kim SS, et al. Evaluation of Factors Associated With Favorable Outcomes in Adults With Bell Palsy. JAMA Otolaryngology Head Neck Surg. 2020 Jan 23. DOI: 10.1001/jamaoto.2019.4312. 

Dementia

Dementia is a group of conditions/symptoms that affects the brain resulting in a progressive decline in day-to-day functioning. There are multiple causes of dementia such as neurodegenerative diseases like Alzheimer’s disease (accounting for 50-70% of cases), traumatic brain injury and brain tumours. 


In Australia, dementia is the second leading cause of death with 1 in 10 people over the age of 65 affected[1]. However, it is important to note, although the risk of being affected by dementia increases with age, anybody can be affected[2].


Some of the most common symptoms include[3]: 

  • memory loss 
  • apathy and withdrawal
  • sleep disturbances and 
  • personality and behavioural changes


To date, physicians and researchers have highlighted evaluation and diagnosis of dementia to include four elements[4]: 

1) Thorough clinical history

2) Neurological examination

3) Metabolic and physiologic abnormalities, and 

4) Structural brain scan


Although there are medications to reduce some symptoms of dementia, there is no current cure. As dementia can be a result of multiple health factors, current emphasis is placed on initial evaluation and early diagnosis. 


References

[1] Dementia Australia. What is dementia? https://www.dementia.org.au/about-dementia/what-is-dementia

[2] Kuruppu, D, Matthews, B (2013) Young-onset dementia. Seminars in Neurology Vol 33 (4) 365-385. doi: 10.1055/s-0033-1359320
[3] Gale et al (2018, October) Dementia. The American Journal of Medicine Vol 131 (10) 1161-1169 

[4] Better Health Channel (2016, May) Dementia explained. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/dementia

Functional Neurological Disorders (FND)

Functional neurological disorders (FND) previously known as conversion disorder is a disorder characterised by the dysfunction of the nervous system and how the brain receives and sends signals[1]. For a long time, FND was termed as conversion disorder as it was thought psychological distress was being converted to physical symptoms[2]. 


Symptoms of FND include[3]:

  • Motor dysfunction 
  • Seizures
  • Vision impairments 
  • Speech difficulties 
  • Paralysis 


The exact cause of FND is unknown but it is thought there are predisposing factors that can make individuals more susceptible to FND such as[4]:

  • Having another neurological condition
  • Chronic pain
  • Fatigue
  • Stress


As FND encompasses a variety of symptoms, it is treated using a multidisciplinary approach. Management strategies can include any of the following in combination with each other: 

  • cognitive behavioural therapy
  • physiotherapy
  • speech therapy and 
  • occupational therapy. 

There are no known prescription medicines to treat FND directly but some medications may relieve other symptoms present in FND[2]. Acupuncture has also been shown to show positive benefits[5]. 


References  

[1] Cock (2018) Functional neurological disorders: acute presentations and management.doi: 10.7861/clinmedicine.18-5-414

[2] Harvard Medical School (2019, March) Conversion Disorder (Functional Neurological Symptom Disorder) health.harvard.edu/a_to_z/conversion-disorder-functional-neurological-symptom-disorder-a-to-z

[3] SANE Australia (2018, April) Functional neurological disorder: the silent illness sane.org/information-stories/the-sane-blog/mental-illness/functional-neurological-disorder-the-silent-illness

[4] National Organisation of Rare Disorders. Functional Neurological Disorder. rarediseases.org/rare-diseases/fnd/

[5] Functional Neurological Disorder. FND Treatments fndhope.org/fnd-guide/treatment/#

Headaches

Throughout life, most people will experience headache pains around the head, neck or face area at some stage during their lifetime.  Around 15% of Australians are taking pain relief medication for headaches at any given time[1]. 


There are more than 300 different types of headaches[2]. 


Headaches can be classified into two broad categories[3]:

1. Primary headaches. These headaches are the most common and include tension headaches, migraines and cluster headaches. In most cases, primary headaches are caused by a variety of factors such as stress, dehydration, lack of sleep, eye strain and poor posture. 

2. Secondary headaches. Secondary headaches are caused by an underlying health condition such as in head injury cases and concussions. 


Generally, headaches can be treated by[4]:

  • Drinking plenty of fluids 
  • Using pain relief medication as directed
  • Maintaining good posture
  • Reducing stress such as engaging in yoga, meditation or massage


References

[1] Better Health Victoria (2015, June) Headache betterhealth.vic.gov.au/health/conditionsandtreatments/headache

[2] Migraine and Headache Australia. Headache types headacheaustralia.org.au/types-of-headaches/

[3] Health Direct (2017, October) Headaches healthdirect.gov.au/headaches

[4] Healthy WA – Department of Health. Headache healthywa.wa.gov.au/Articles/F_I/Headache

Memory loss

Memory loss or forgetfulness is a common worry in our lives. It is normal to forget things from time to time and also as you age. It is important to note that not all memory loss or forgetfulness is the first sign of a serious underlying health condition such as Alzheimer’s disease[1]. 


However, when there are significant pronounced changes in memory loss, investigation by a medical practitioner should be considered. This will enable early diagnosis that will be helpful as it will allow early access to preventative measures, support and information[2].


Possible causes of reversible memory loss include[3]:

  • Prescription Medications alone, or in combination with others 
  • Minor head trauma or injury, even without losing consciousness — this may cause memory problems.
  • Emotional Stress, anxiety or depression
  • Alcoholism, especially chronic alcoholism
  • Vitamin B-12 deficiency as Vitamin B-12 normally helps maintain healthy nerve cells and red blood cells
  • Hypothyroidism- underactive thyroid
  • Brain diseases such as a tumor or infection in the brain

    

References

[1] U.S. Department of Health and Human Services (2018, January) Do Memory Problems Always Mean Alzheimer’s Disease? nia.nih.gov/health/do-memory-problems-always-mean-alzheimers-disease

[2] Health Direct (2018, October) Worried about your memory? healthdirect.gov.au/worried-about-your-memory

[3] Mayo Clinic “Memory loss: When to seek help”

mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/memory-loss/art-20046326

Meniere’s Disease

Meniere’s Disease is a disorder of the ear characterised by a change in the volume of fluid in the labyrinth found in the inner ear. As the inner ear is primarily responsible for our balance and hearing, individuals who have Meniere’s Disease typically experience sensations of the world spinning around them known as vertigo causing a:

  • loss of balance
  • hearing hissing
  • roaring or ringing noises in the ear known as tinnitus
  • loss of the ability to hear and 
  • heightened sensitivity to noise[1]


In many cases, Meniere’s disease is confined to one ear and symptoms persist as episodes last on average between two to four hours[2]. 


The exact cause of Meniere’s Disease is unknown but it is thought a combination of these factors play a role in its onset[3]:

  • Constriction of blood vessels 
  • A consequence of viral infections, allergies or autoimmune reactions
  • A result of genes 


There are currently no strategies to cure Meniere’s Disease. However, there are multiple treatment strategies available to help manage and treat it including[2]:

  • Changes to diet with the aim to restrict salt, water, caffeine and alcohol intake
  • Nutritional supplements 
  • Prescription medications that reduce fluids (diuretics) 
  • Surgical procedures involving draining fluid procedures from the inner ear or removal of the balance nerve 


References

[1] Better Health Victoria (2017, July) Ears – Meniere’s disease betterhealth.vic.gov.au/health/conditionsandtreatments/ears-menieres-disease

[2] Brain Foundation Australia. Meniere’s disease brainfoundation.org.au/disorders/menieres-disease/

[3] National Institute on Deafness and Other Communication Disorders (NIDCD) (2017, February) Meniere’s disease nidcd.nih.gov/health/menieres-disease#2

Migraines

Migraines can be a very debilitating condition. Not only are they painful, they also can cause nausea and vomiting, sensitivity to light and noise, weird visual auras and sensations, problems concentrating and missing many days off work and school. For some it can be a problem for over 20 to 30 years and impacts all aspects of life and severely affecting on ones social, family and work life.


Harvard Medical School[1] announced that a 2012 medical study involving approximately 18,000 individual patients over 23 high-quality randomized controlled trials of acupuncture showed that acupuncture is beneficial for headache, along with low back pain and osteoarthritis.


Additionally, the safety profile of acupuncture is excellent, without drugs, without side effects. Other potential benefits include lowering blood pressure to long-lasting improvements in brain function. Acupuncture has emerged as an important non-drug option that may help chronic pain patients avoid the use of potentially harmful medications, especially opiates with their serious risk of substance use disorder.


References

[1] health.harvard.edu/blog/acupuncture-for-headache-2018012513146 

Multiple Sclerosis (MS)

Multiple Sclerosis (MS) is a disease of the central nervous system that disrupts the communication between the brain and other parts of the body. It affects up to 25,600 people in Australia, with over 2 million diagnosed worldwide[1]. The national MS society estimates that MS is two to three times more common in women than men[2]. While most are diagnosed between the ages of 20-40 years, MS affects both the young and the old alike. 


As symptoms vary greatly from one person to another, MS can be difficult to diagnose. Symptoms may range from mildly disabling to very significant. According to a 2017 report by The European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) an average diagnosis of MS takes approximately five visits to healthcare professionals. Over one-fifth of those surveyed were initially misdiagnosed with a different illness[3].


Early intervention is critical as not seeking immediate treatment may cause the delay of definitive diagnosis of MS which can impact the longer-term course of disease as well as quality of life.

Some of the common symptoms associated with MS are problems with motor control such as muscular spasms, difficulty with functioning of arms and legs, sexual dysfunctions as well as fatigue, depression and other neurological problems such as double vision and vertigo. 


A 2013 study performed by Global Advances in Health and Medicine has shown that acupuncture can be an effective treatment for MS[4]. Acupuncture has also been proven to relieve some of the common MS symptoms such as pain, spasticity and numbness[5].


References

[1] msaustralia.org.au/what-ms

[2] nationalmssociety.org/Chapters

[3] ectrims-congress.eu/2017.html

[4] ncbi.nlm.nih.gov/pmc/articles/PMC3833581/

[5] nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Brochures/Brochure-Acupuncture-in-MS.pdf

Motor Neuron Disease (MND)

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MND encompasses various conditions such as:

  • Amyotrophic Lateral Sclerosis (ALS)
  • Progressive Muscular Atrophy (PMA)
  • Progressive Bulbar Palsy (PBP) and 
  • Primary Lateral Sclerosis (PLS). 

  

In the USA MND is commonly known as Lou Gehrig's disease, after a famous baseball player who died of the disease[1]. In Australia, prominent ex-Essendon AFL footballer Neal Daniher also has this. ALS affects men more frequently than women, and in 10% of all ALS patients it is thought to be due to a mutation in the gene for an enzyme called copper/zinc superoxide dismutase-1 (SOD1)[2].


What is MND?

Neurones (nerve cells) descend from the brain down the spinal cord, which then control and activate the lower motor neurones which innervate (supply neurological messages) to the muscles all around our body. This control of muscles allows us to direct the human body’s basic needs of muscle movement, speech, respiration (breathing) and deglutition (swallowing). MND is the name of the group of diseases in which these neurones fail to work normally. Muscles then gradually weaken and waste, as neurones degenerate and die[3].


What causes MND?

The cause of MND is currently not known, but viruses, exposure to certain toxins and chemicals, genetic factors, inflammation and damage to neurons due to an immune system response suspected to be contributing.


Symptoms[1]

MND often begins with weakness of the muscles in the hands, feet or voice, although it can start in different areas of the body and progress in different patterns and at different rates. Commonly:

  • muscle aches, cramps, twitching
  • clumsiness, stumbling
  • weakness or changes in upper and lower limbs 
  • changes to voice, slurred speech, swallowing or chewing difficulty
  • fatigue
  • muscle wasting, weight loss
  • being more emotional
  • cognitive change (changes in thinking processes)
  • respiratory changes


Prognosis

MND patients become increasingly disabled. Life expectancy after diagnosis is one to five years, with 10 per cent of people with MND living 10 years or more3. The needs of MND patients are complex and vary from person to person.


References    

[1] Better Health Channel (2018, November) Motor neurone disease (MND). betterhealth.vic.gov.au/health/conditionsandtreatments/motor-neurone-disease

[2] Mayo Clinic (2019, August) Amyotrophic lateral sclerosis (ALS). mayoclinic.org/diseases-conditions/amyotrophic-lateral-sclerosis/symptoms-causes/syc-20354022

[3] MND Australia. What is motor neurone disease (MND)? mndaust.asn.au/Get-informed/What-is-MND.aspx

Parkinson’s disease

Parkinson’s disease is a progressive neurological condition of the nervous system primarily affecting movement. Symptoms of Parkinson’s disease include:

  • hand tremors
  • shuffling gait
  • fatigue
  • sleep disturbance
  • freezing (of movement)
  • bradykinesia (slowness of movement)
  • muscle stiffness and 
  • apathy[1]


These symptoms begin when a sub population of nerve cells in the brain stop working properly and gradually expire[2]. The cause of Parkinson’s disease is unknown with plausible factors such as genes and toxins in the environment playing a role[3]. 


Of the 4 in 1,000 people in Australia affected with Parkinson’s disease, treatment and severity of symptoms varies1. Unfortunately there are no traditional western medical treatments to slow the progression of Parkinson’s. However, there are a number of therapies which can help alleviate and manage movement problems[4]. These treatments include restoring dopamine levels in the brain, deep brain stimulation and continuous drug infusions. 


References

[1] Better Health Channel (2017, April) Parkinson’s disease. betterhealth.vic.gov.au/health/conditionsandtreatments/parkinsons-disease

[2] Brain Foundation Australia. Parkinson’s Disease. brainfoundation.org.au/disorders/parkinsons-disease/

[3] Health Direct (2018, November) Parkinson’s disease. healthdirect.gov.au/parkinsons-disease

[4] The Florey Institute of Neuroscience and Mental Health. Parkinson’s disease. florey.edu.au/diseases-disorders/parkinsons-disease

Peripheral neuropathy

Peripheral neuropathy is a condition in which damage is seen in the communication network of our body that is responsible for sending signals to the brain. When peripheral nerves stop working, it results in the disruption of functions of our entire body; of which there are 2 main types: 

  1. Sensory (i.e. touch, taste, smell, hearing) motor (i.e. walking, running)
  2. Autonomic (i.e. digestion, sweating and balance)[1] 


Some of the common causes include:

  • heavy alcohol intake
  • diabetes
  • nerve damage and 
  • chronic diseases such as cancer, liver disease and kidney disease.


The symptoms can range from mild to disabling depending on the severity of damage and the affected nerves[2]. Common symptoms include aching, weakness, numbness or cramping in the affected area which are often worse at night. The disease could develop over weeks or even years.


References

[1] Health Direct (2017, November) Peripheral neuropathy. healthdirect.gov.au/peripheral-neuropathy

[2] National Institute of Neurological Disorders and Stroke. Peripheral Neuropathy Fact Sheet. ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Peripheral-Neuropathy-Fact-Sheet

Sleep

Dr Justin Lim Professor Yoland Lim Best Acupuncture Melbourne Cosmetic Laser Acupuncture Weight Loss

 There are 3 fundamental adult human instincts:

1) Eating

2) Intimacy, and 

3) Sleep. 


Good sleep is important for restoring physical and mental health. When one is not sleeping well, it can impact a lot of other aspects of one's life.


Sleeping disorders may be a sign that the body's normal sleep wake cycle rhythms are not functioning properly. According to the Chinese Yellow Emperor classic of Internal Medicine, an "imbalance of energy flow can upset the brain". This in turn can cause sleep disorders. These may result in an inability to have a sound, restful sleep, or an inability to 'switch off' resulting in sleeplessness.  Symptoms of sleep deprivation include:

  • fatigue
  • poor concentration and memory
  • mood disturbances
  • impaired judgement and reaction time, and 
  • poor physical coordination.


The body’s circadian rhythm (internal clock) regulates when and how we sleep depending on our exposure to light. When the day turns into night, your brain releases hormones to make you sleepy. In the morning, exposure to daylight suppresses these hormones and releases brain chemicals to keep you awake. 

Do you get enough sleep?


We should be aiming for at least 7 hours of sleep per night. Sleep deprivation is common in western society, with the average adult sleeping for only six or seven hours each night. 
Studies show that sleep may be disturbed from [1]:

  • mobile phone use- internet and social media
  • being a new parent can lead us to lose approximately 1.5-2 hours of sleep every night. The accumulation of this over time can have severe effects on our life.
  • shiftwork (Eg working in the Emergency Departments in hospital)
  • travel across time zones
  • illness
  • poor sleeping habits 
  • some medications.


Sleep disorders


There are many common conditions that can affect a person’s sleep. These include:

  • insomnia
  • bad sleep habits and routine
  • nightmares, sleep walking and night terrors
  • jet lag and shiftwork sleep disorder
  • narcolepsy
  • restless legs syndrome (periodic limb movement)
  • snoring and obstructive sleep apnoea.


Professor Yoland Lim Health Care's sleep management may include advice regarding:

  • waking up at consistent times each day. This 'routine' helps ‘set’ your body clock, and helps you get sleepy at around the same time every night.
  • Not ignoring tiredness. Sleep when your body tells you to.
  • Maximising early morning sunshine during early morning helps set your body clock.


"No drugs, No Side Effects"


Professor Yoland Lim's famous mantra fittingly applies to sleep issues. Some people misleadingly seek out medications, and other vices trying to cope with lack of sleep by using:

  • Cigarettes – Nicotine is a stimulant. It does not help with sleep. Side effects such as increased heart rate and blood pressure, are likely to keep you awake for longer.
  • Alcohol – this slows the workings of the nervous system and may leave you not feeling refreshed in the morning. 
  • Sleeping pills – drawbacks include daytime sleepiness, failure to address the causes of sleeping problems, and the ‘rebound’ effect – after a stint of using sleeping pills, falling asleep without them tends to be even harder. 


Holistic approach Insomnia is often caused by stress and worry[2]. Our medical approach is to work in conjunction with fellow medical practitioners and specialists with a general medical holistic patient centered approach to help co-ordinate and integrate care, including wellbeing, stress, and mental health in addition to acupuncture Management may involve guided meditation and relaxation with binaural therapy. Relaxation 'Si Ba Si' exercises may also be advised.  


References

[1] betterhealth.vic.gov.au/health/conditionsandtreatments/sleep 

[2] ncbi.nlm.nih.gov/pmc/articles/PMC3156618