Alzheimer’s disease, while one of humanity’s most ubiquitous afflictions, is also a mystery to many. This is why Dr. Naheed Ali has written a fantastic book about the disease that provides invaluable knowledge and guidance. My review of his book, Understanding Alzheimer’s: An Introduction for Patients and Caregivers:
Understanding Alzheimer’s: An Introduction for Patients and Caregivers is a remarkably-organized and astoundingly well-researched guidebook for one of the world’s foremost growing concerns. Dr. Ali has presented us with a tome that is a road map of hope for patients as well as all types of caregivers of patients afflicted with Alzheimer’s. His realistic, practical approaches in dealing with this initially frightening diagnosis should bring a degree of peace and solace to all of us. He includes a wealth of information about alternative approaches, new treatments, and the most up-to-date research available.
This book is a great read even if you are not a patient or caregiver; the writing is elegant and the content is essential. You can find the book in the Kindle store, as well as at Amazon.com.
I was recently interviewed for an article about foot drop on AdvancedWeb.com. Foot drop is when the front of one’s foot hangs lower than it should due to a weakened or damaged nerve or muscle in the lower part of the leg. Individuals with foot drop will drag their toes along the group or will bend their knees in order to not drag their feet. In this article Danielle Bullen discusses how doctors and hospitals use exercises, as well as convectional and alternative treatments to ensure those with foot drop walk safely again.
Foot Drop Conditions
From exercise to medications to modalities, clinicians have a lot of tools at their disposal to treat foot drop. Just as its causes are many, so are the treatments. While the same approach may not work for each patient, trial and error can help doctors and physical therapists figure out the best possible outcomes.
Foot drop is not a disease itself, but rather a symptom that develops as a result of various neurological, muscular or anatomical problems. Patients who suffer have difficulty lifting the front part of their foot due to muscle weakness or paralysis. Sometimes they drag their toes along the floor as they walk.
Finding the Cause
Some of the common reasons patients present with foot drop include stroke, spinal cord injury or injury to the peroneal nerve on the outside of the fibula, below the knee. ALS (Lou Gehrig’s disease), Parkinson’s disease and multiple sclerosis can also lead to foot drop. Patients who have had a total knee replacement can also present with foot drop, although that is less likely. Moshe Lewis, MD, MPH, chief of the department of physical medicine and rehabilitation, California Pacific Medical Center, San Francisco, described one unique case where a surfing accident lacerated someone’s peroneal nerve, causing foot drop.
The Old and The New
Other than exercise, clinicians have other options to treat foot drop. “We’re seeing a blend of the old and the new,” said Dr. Moshe regarding treatment. He cited vitamin therapy, particularly B6, as helpful. Nerve medications, which are relatively new on the scene, decrease pain and improve nerve function without peripheral swelling. Topical pain medications are another new development but Dr. Moshe advised his fellow physicians to use them wisely.
I recently had the chance to talk face to face with Dr. Jerome Lisk, an esteemed colleague, about Parkinson's disease. Some of my patients have this movement disorder. Visit this article to read a summary of our discussion on the movement disorder. Here is a summary of our discussion:
1. What’s the one big thing about the disease that we should be more aware of?
Parkinson's Disease is often misdiagnosed and can be confused with other disorders that have the same physical symptoms as Parkinson's Disease but are secondary causes of Parkinson's. These chameleons of Parkinson's Disease can mislead general neurologists, primary care physicians and even sometimes the inexperienced movement disorder specialists.
Secondary Parkinson Disease usually does not respond to medication as well as Idiopathic (Primary Parkinson's Disease) and can be caused by medications, Multi-System Atrophy, Progressive Supranuclear Palsy, Corticobasal Ganglionic Degeneration, Diffuse Lewy Body Disease, Essential Tremor and other secondary causes.
2. How have Michael J. Fox and other famous people with Parkinson’s helped shape Parkinson’s disease awareness?
It has been a blessing to have people such as Michael J. Fox and Muhammad Ali contribute the millions of dollars to research, public awareness and be such a champion for fundraising for a cure. Over the years there have been many famous and wealthy people with Parkinson's Disease, but none that have been advocates for the disease such as these two individuals. Many people where shocked about how physically disabling Parkinson's Disease can be and at the same time are able to see those such as Michael J Fox still be able to continue his career. Those famous people with Parkinson's Disease have brought a disease that was rarely mentioned by the public not to the forefront of communities and made the public much more aware of this devastating disease.
3. Who’s at risk for Parkinson’s disease?
Those who are at risk of Parkinson's Disease are those over the age of 65, those with a family history (even more if they are young onset), Caucasian, blonde hair, exposure to environmental toxins (Pesticides), certain occupations such as agriculture or welding increase risk, Men have a slightly higher risk than women. Interestingly, the state of Nebraska (329.2/100,000) has the largest incidence of Parkinson's Disease in the USA because of its large agriculture industry and use of pesticides. The Amish Community, who is also largely agricultural based, has the highest incidence of Parkinson's Disease at 970/100,000. Those exposed to Manganese are also at high risk of developing secondary Parkinson's Disease. Also living in the United States has the highest risk of developing Parkinson's Disease while living in Korea or Ethiopia gives the lowest risk in the world.
4. Many people know that Parkinson’s disease symptoms include tremors and movement problems. What are some of the more surprising symptoms of Parkinson’s?
It is now known from pathological studies of brains of Parkinson's patients, that Parkinson's Disease starts usually 3- 20 years before the first physical sign. These are called Non-Motor Signs of Parkinson's Disease. They include constipation, decrease sense of smell, REM Behavior Sleep Disorder (acting out dreams), etc. Other symptoms that occur in Parkinson's Disease are rigidity, loss of postural anticipatory reflexes, drooling (beginning at night), development of a poker face, depression, anxiety, smaller hand writing and difficulty with thinking. Compulsive Gambling, Hyper-sexuality, Compulsive shopping or eating can be caused by certain Parkinson's medications especially if there is a previous history of impulsivity. Symptoms occurring later in the disease can include persecutory delusions, visual hallucinations, dementia, Autonomic Nervous System dysfunction (urinary incontinence and Orthostatic Hypotension)
For more helpful information on Parkinson's Diesease and other movement Disorders check out Dr. Lisk's educational resources page.