Carmela Tartaglia

Is that 'midlife crisis' really Alzheimer's disease?

noreen.rasbach — Wed, 12 Sep 2018 18:51:43 +0000

Is that 'midlife crisis' really Alzheimer's disease?

noreen.rasbach Wed, 09/12/2018 - 14:51

Cutline

Early-onset Alzheimer’s disease presents unique challenges, when a patient is still working or parenting children. The film Still Alice, starring Julianne Moore, tackled the issue (photo of Gregg DeGuire/Wire Image)

Carmela Tartaglia

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Neurology

Research & Innovation

The Conversation

Imagine you tell your 55-year-old mom you’re going to get married and she’s too disorganized to help you with the wedding preparations. Or you put your kids on the bus to elementary school and the 57-year-old driver forgets the route.

These are real scenarios, drawn from my clinical work with patients who have young-onset Alzheimer’s disease.

This is the other face of dementia – no white hair or wrinkles. And it is relatively common. Approximately five per cent of Alzheimer’s patients are younger than 65.

While the underlying pathology of both young-onset and late-onset Alzheimer’s is the same – the abnormal accumulation of proteins called amyloid and tau in the brain – there are significant differences in how the two diseases are experienced.

Patients who are under 65, for example, often have difficulties with language, visual processing and organizing and planning. They have less of the classic memory complaints.

There is also accumulating evidence that young-onset Alzheimer’s progresses faster.

Dementia confused with depression

The path to a diagnosis of Alzheimer’s or other dementia is often long, meandering and riddled with misdiagnosis.

A correct diagnosis is essential for every patient but especially important for younger people. They are often still working and at risk of losing their jobs. They may have young children. When they tell people that something isn’t quite right, they are told they are depressed or must be going through a midlife crisis.

Anne Hunt looks to her husband, Bruce, to be reminded if she already added sugar or not to her dough in their home in Chicago in July 13. Diagnosed with Alzheimer’s in 2016, Anne, who once ran a Chicago cooking school, now has to separate the ingredients into two different sections of the kitchen to prevent errors (photo by Annie Rice/AP)

Many times, younger patients will notice changes in their cognition at very early stages. They may notice increased difficulty in organization or planning. They may forget how to do complex tasks or forget appointments. Cognitive impairment is more obvious when completing highly demanding tasks at work or co-ordinating family logistics.

When a young person goes to see their doctor and reports such changes in cognition, the “d” word brought up is usually depression and not dementia.

Until the correct diagnosis is made, there can be many misinterpretations of their changes in thinking – resulting in conflicts with family, friends and colleagues.

Divorce before diagnosis

Initially, a change in personality can be misinterpreted by the partner as indifference, as a midlife crisis or as something else.

There can be a changing of roles within a couple and it is not uncommon for separation or divorce to occur before a diagnosis is even made.

If young children are involved, it can be difficult for them to understand the change in their parent’s personality.

Getting services for young-onset Alzheiner’s can be especially challenging. There are very few programs that cater to people with dementia under the age of 65.

Support for caregivers and family members of these patients is also lacking. There is a dire need for specialized programs and long-term care facilities that can accommodate those under 65.

‘Use it or lose it’

Although we have no cure for any patients with Alzheimer’s, there are clinical trials that are targeting the abnormal proteins that build up during the disease.

There is symptomatic medication – such as acetylcholinesterase inhibitors – that can help memory.

We also promote a healthy lifestyle that includes aerobic exercise because evidence shows this can slow neurodegeneration. We want people to remain cognitively active and go on learning to help their brain reserve.

Although patients with young-onset Alzheiner’s are impaired in some activities, there are many other activities that they can participate in. “Use it or lose it” is the motto we should live by when it comes to the brain and preserving its function.

Young-onset Alzheimer’s is not the only dementia that typically affects the young. Frontotemporal dementia also strikes young people. And although there are differences in presentation in these two illnesses, many of the challenges facing patients are the same.

Ongoing research is required to better understand this disease. While we search for a cure, we need to appreciate the special needs of this population. We need to target research and services to better serve patients and their families.

Carmela Tartaglia is a clinician-scientist at University Health Network and associate professor at the University of Toronto.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

This Mother's Day, know the symptoms of concussion

noreen.rasbach — Thu, 10 May 2018 14:42:37 +0000

This Mother's Day, know the symptoms of concussion noreen.rasbach Thu, 05/10/2018 - 10:42

Cutline

The changes in the brain from a concussion do not appear on conventional imaging tests such as CT scans or MRIs, nor are there any other tests to diagnose a concussion (photo by Shutterstock)

Topic

Research & Innovation

The Conversation

Subheadline

The Conversation with U of T's Carmela Tartaglia, a cognitive neurologist and concussion researcher

A bump on the head. And then another. That’s all there was to it. Yet, Mother’s Day 2013 would change one mother’s life. Her daughter Rowan Stringer, a high school rugby player with her whole life ahead of her, died after sustaining multiple concussions in the span of a few days.

Second-impact syndrome, the cause of Rowan’s death, is rare. However, persisting symptoms after concussion – also known as post-concussion syndrome – are more common and can have devastating effects on people’s lives.

Rowan’s parents envisioned a world where this happens to no other family. They petitioned for more education on concussions, for better surveillance and for improved return-to-learn and return-to-play practices.

On March 7, concussion safety legislation known as Rowan’s Law was passed by the Ontario legislature, compelling sport organizations across the province to take concussions seriously.

As a cognitive neurologist and concussion researcher with the Canadian Concussion Centre at Toronto Western Hospital who sees people with brain diseases, I believe Rowan’s Law is a necessary, important step that will help protect the young athletes of Ontario.

However, all its recommendations highlight the need for better understanding, detection and management of concussions. We must admit there is a lot we do not know.

This law should also have more widespread ramifications. People of all ages can suffer concussions. Many do happen in the context of sport. But many are the consequence of motor vehicle accidents, trauma, domestic violence and falls.

Symptoms of a brain injury

Until recently, concussions were considered trivial incidents, not worthy of medical attention. We now know that the symptoms that accompany concussions are the result of a brain injury.

The changes in the brain from a concussion do not appear on conventional imaging tests such as CT scans or MRIs; nor are there any other tests to diagnose a concussion.

But we know that these changes can cause symptoms such as headache, dizziness and unsteadiness, as well as changes in mood, concentration and memory.

Concussions: 10 things you may not know

Although most people recover from a concussion, 10 to 15 per cent can develop persistent symptoms lasting months or years.

This can have profound effects on school, work and relationships. These consequences from head injury can make return to one’s life difficult, and in some cases impossible, as not everyone recovers.

I am always amazed that most people realize that memory, attention, language, movement and such activities are functions of the brain but don’t understand it is also responsible for mood, love, judgment and the like.

The idea that someone who has been concussed is in the best position to know whether they should continue to play or not reflects our poor understanding of brain function. A concussion that causes headache or poor memory is also likely to impair other aspects of behaviour.

The long-term effects of multiple concussions and the long-term risk of developing a neurodegenerative disease in the form of chronic traumatic encephalopathy (CTE), is now being recognized by the medical community.

Mandatory concussion education

Rowan’s Law imposes requirements on sports organizations. These are all geared towards recognizing a concussion and avoiding repeat concussion while an individual is still recovering.

Rowan’s Law, Concussion Legislation requires:

Medical clearance of a concussed athlete before they return to play.
Mandatory concussion education for young athletes, parents and coaches.
The immediate removal of a young athlete from play if a concussion is suspected.
Strict adherence to return-to-learn and return-to-play protocols for youth athletes with concussions.

Thanks to the Stringers’ tireless advocacy, it will not be up to the athletes to decide whether to pull themselves out, or put themselves back, into a game after a concussion.

The law mandates that coaches and others responsible for young athletes are educated about concussion and take action when they suspect one has occurred.

You only have one brain

Currently, we have no methods to detect concussions. There is no marker of persistent concussion symptoms and so we have no way to predict the length of recovery. And we do not know what predisposes someone to persistent concussion symptoms.

We also have no treatments that are specific for concussion and so we borrow ideas from other areas without much evidence.

We still do not even know what happens to the brain to cause a concussion and all its symptoms. Answering this last question is essential to move us toward treatments.

Although Rowan’s Law focuses on young athletes, people of all ages can suffer concussions. These can occur as a result of motor vehicle accidents, trauma, falls, domestic abuse and many other types of incident. Many concussions happen outside the context of sport.

Protecting one’s brain from concussion, appropriate treatment of concussion and importantly, prevention of further concussions, should be on everyone’s agenda.

You only have one brain, it defines who you are – when it changes you change. Multiple concussions can permanently change the brain and result in grave consequences for you, those around you and, most of all, your loved ones.

Carmela Tartaglia is a clinician-scientist at the University Health Network and an associate professor at the University of Toronto

This article was originally published on The Conversation. Read the original article.