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Memory and brain function

Maintaining brain function - Dr. Nir Giladi: summary of Dr. Giladi's lecture which was held at the association's branch in Tel Aviv on November 16.11.2004, XNUMX

The subject: maintaining brain function beyond Parkinson's disease

Parkinson's is not just a disease that boils down to movement problems. The most difficult problems are mainly disorders in the autonomic system, problems in the feeling system, mental-mood problems, depression, anxiety, concentration, difficulties in dealing with complicated tasks. The non-motor problems appear long before the movement problems. When the tremors come, those with the disease tend to forget about the other problems. The primary impairment of a Parkinson's patient is the sense of smell. Digestive problems sometimes begin about 10 years before the appearance of movement problems. Depression usually appears up to 10 years before the appearance of the movement problems themselves. Initiative problems, a decrease in the desire to do things are also phenomena that precede the motor problems. The trend today is to make sure that as the disease progresses, it will not get worse. Memory problems - usually, as age increases, it is difficult to perform several tasks at the same time, and the distribution of attention is impaired. Not least Parkinson's patients who contracted the disease at a relatively old age, the ability to do several things at the same time is particularly impaired.

The main causes of memory loss:

1. Problems with blood vessels in the brain - small events that may cause damage to blood vessels in the brain and damage to memory. The scars in the blood vessels in the brain develop at the age of 40-50.

The main causes: hypertension, excess cholesterol. Parkinson's patients should be especially careful about their blood pressure and cholesterol levels. A blood pressure of 120/80, which used to be considered normal, is today defined as high blood pressure.
Cholesterol - Cholesterol levels above 200 are considered high levels today. If you do not take care to correct these levels, it can cause brain damage. According to studies done, almost 50% of the population suffers from cholesterol problems, while 70% of the population is overweight, which, among other things, can cause the onset of Alzheimer's disease.

In conclusion, a balance of:
A. over-weight
B. Excess cholesterol
third. high blood pressure

Inflammations - chronic inflammations of any kind can cause damage to the blood vessels in the brain which can cause damage to memory as well as create conditions for the onset of Alzheimer's disease.
The most common inflammation is gingivitis. Failure to treat such inflammation can be fatal.
Chronic bladder infections and arthritis which are not properly treated. What all of these have in common is that due to the inflammation, a large amount of antibodies are created in the blood which damage the blood vessels and cause irreversible damage.

Persistent depression is one of the causes of the first signs of Parkinson's disease. Nervousness on an emotional level causes biochemical phenomena in the brain that cause injury.

A high level of homocysteine ​​in the blood is one of the main causes of arteriosclerosis and damage to brain cells.

In people who take drugs based on dopa, homocysteine ​​will be found in high levels in the blood. The best treatment for lowering homocysteine ​​levels is the use of folic acid.

In the United States today it is even customary to add folic acid to various food products.

Memory and orientation problems in Parkinson's patients who have been sick for 15-10 years are not only due to the disease itself and the drugs, but also due to changes that occur in the brain. The phenomenon is called:

Double Hit - for example, both Parkinson's and vascular damage, or both Parkinson's and Alzheimer's, etc.

It is advisable already at the age of 45-50 to start preventive treatment against brain function drains:

The most important preventive action is maintaining a healthy weight.

The damage to brain function can be repaired even in old age. During brain training, the intercellular connection improves and new connections are formed between the cells.

To improve the intercellular connection it is advisable to practice:

Movement - during movement, more connections are formed between the movement cells.

Mental stimulation - creates new connections between brain cells and improves function. For this purpose, it is advisable to increase reading books, listening to the radio, lectures, mental games such as bridge and chess, listening to music and especially movement therapy. Anything where it is necessary to exercise the head improves the connections between the brain cells and prevents long-term damage. It is known that a lack of mental stimulation, for example, can cause the onset of Alzheimer's disease.

Mental function should be treated like motor function. The mental stimulation is the part that ensures that the situation will not deteriorate.

In Parkinson's, the ability to "initiate" is impaired over time. If brain stimulation is not initiated regularly, mental ability is lost and there is a sharp decrease in function.

Physical activity causes a significant improvement in memory functions and even prevents deterioration in the general condition.

Dr. Nir Giladi answers questions in the audience:

Question: Can excessive initiative hurt?
Answer: Excessive initiative such as an increased urge for physical activity, shopping, sexual activity, excessive sitting in front of the computer screen, obsessive internet browsing, gambling addiction and any other type of urge for excessive activity may increase the symptoms of Parkinson's disease.
A lack of initiative is one side and an excess of initiative is another and both may cause the disease to increase.

Question: Are antidepressants advisable to take at an early stage of the disease?
Answer: Depression in Parkinson's disease is different from what is defined as depression in general medicine. It is not a cause of weight loss and sleep problems. There is sadness, distress and an unpleasant feeling and this is a precursor to the appearance of the first signs of Parkinson's disease. This is not a psychological problem, but chemical changes that are caused in the brain. Giladi: "As a doctor, I give antidepressants, but each case is individual."

Question: Is there a connection between Parkinson's and decreased vision in the evening?
Answer: There is damage to the ability to focus and damage to eye motility. Double vision especially in the evening.

Question: What is the connection between protein consumption and Parkinson's disease?
Answer: In the early stage of the disease there is no connection between the food and the medicine. In later stages when the disease becomes more severe and the activity of the stomach is affected, partial paralysis of the digestive organs sometimes occurs. Proteins and fats + dopa weaken the absorption capacity in the intestines.
The absorption efficiency of the drugs and their effect increase when the efficiency of the stomach activity increases.
His stomach will also be in a similar state. When a Parkinson's patient is in the OFF state, it takes about an hour and a half from the moment the medication is taken until the patient's condition returns to the ON state.

Question: Do all medications have side effects?
Answer: All drugs have side effects. The trick is to find the right dose.

Question: Is it advisable to take medicine on an empty stomach?
Answer: Generally yes, but sometimes this can cause nausea. In such a situation it is advisable to eat something while taking the pill. It is recommended to take a pill about an hour before eating or two hours after eating.

Question: What do we do against the uncontrolled saliva excess?
Answer: The problem is swallowing and not excess saliva production, so it is desirable to find a way to improve the level of swallowing. It is known that this ability is impaired in Parkinson's disease. The amount of saliva produced can be reduced by drugs to dry the mouth, anti-tremor drugs, but usually these damage the memory. In the pharmaceutical market there is a special sticker known as "Skokolemi" but currently it cannot be purchased in Israel. It can be obtained abroad. Taking drops of atropine causes the secretions to dry up. Likewise, an injection of a substance called "botulinum" into the salivary glands.

Advice from a Parkinson's patient from the audience:
"You can hold a candy in your mouth, which requires increased swallowing and then the amount of saliva secreted is reduced."

Question: Is it possible to take medications to stabilize the thyroid gland, such as Androxin, together with the anti-Parkinson medications?
Answer: Yes!

A new approach to Parkinson's disease among the medical authorities in Israel
The new approach in the medical authorities in Israel today is to treat Parkinson's disease as a disease that can be rehabilitated. This means that "it is not possible to return to the state that existed before the onset of the disease, but the potential for improving function and leading a normal life can be increased."
In the past, Parkinson's disease was included in the list of diseases that cannot be rehabilitated. The new approach is rehabilitation therapy!!!
A new project at Reut Hospital includes rehabilitation hospitalization for those with the disease (Parkinson Rehabilitation Department).
The rehabilitation department is managed by Prof. Uri.

The rehabilitation department at Reot Hospital combines rehabilitation personnel (who come from Reot) and neurology (who come from the neurology department/Ichilov's movement disorders unit). The rehabilitation process lasts about two weeks and the hospitalization is for rest!!

You can be hospitalized through the HMO using Form 17 or privately at a cost of approximately $150 per day of hospitalization.

As part of the hospitalization, physiotherapy treatments are provided twice a day, treatments for movement problems, psychological and sexological counseling are provided. (The treatment is by a multi-professional team)

Information about new drugs that are in trial
There is a new drug that helps dyskinesia problems - involuntary movements. The drug is extremely effective and is being tested today on groups of patients. There is a drug called Recoip, an old drug that is given to Parkinson's patients and whose main effect is on the "restless legs" phenomenon. The company that produces the drug has proven its effectiveness over the years, but this drug exists today on the market under a different name and is intended for the same purpose.

There is a new drug for Parkinson's patients which is supplied as a patch and whose side effects are known to be extremely small, due to its rapid absorption and bypassing the liver. The patch is called retigotine and is currently being tested on groups of patients.
Dr. Oren Cohen, Parkinson's and Movement Disorders Clinic, Sheba Medical Center, Tel Hashomer:

Damage to memory and other higher functions can appear in some Parkinson's patients, usually in an advanced disease stage.

Today there are drug treatments that can improve memory, and it is recommended to contact the attending physician in order to receive a referral for examination, to assess the severity of the impairment and advice regarding the possibility of treatment.