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Pietro Biagio Carrieri è specialista in Neurologia, in Medicina Legale e in Psichiatria e attualmente è docente a contratto presso il Dipartimento di Neuroscienze della Università “Federico II” di Napoli. Ha pubblicato numerosi articoli su riviste internazionali ed è autore di monografie e di capitoli di libri su vari argomenti di Neurologia. Si occupa anche di corsi di aggiornamento ECM, in particolare in campo di Malattia di Alzheimer, Sclerosi Multipla e Malattia di Parkinson.

Cannabis as medicine for neurological and psychiatric diseases

26 February 20246 January 2024 by pcarrieri

Commonly referred to as a “mild drug” because of its sweetened effects on the central nervous system; in fact, it is a real drug that has long been used not only for “recreational” purposes, but also for medical and religious purposes. We are talking about cannabis (or hemp), an angiosperm plant native to Afghanistan that is widely cultivated in Asia, Europe and Africa. Cannabis comes in various forms, including “hash,” the resinous part, and “marijuana,” consisting of the dried and shredded leaves and stems of the plant.

History

The use of cannabis as medicine dates back at least 2,500 years and was described in the first treatise on pharmacology written in China. In Europe, the widespread use of cannabis is mainly related to its use in textiles, but in the 17th and 18th centuries it was also used in medicine as an analgesic and sedative. Numerous famous writers and poets made use of it, including Verlaine, Rimbaud, Mallarmé, Dumas, Baudelaire, Balzac, Hugo, and Shakespeare. In Italy, it was Raffaele Valieri, a physician at the Incurabili Hospital in Naples, who introduced the properties of cannabis in the medical field. Since 2015, the cultivation of cannabis plants for use in the preparation of medicines has been legalized in our country. However, cannabis is still not considered a true therapy, but a supportive treatment to standard ones when the latter have not produced the desired effects or have resulted in non-tolerable side effects.

Use in medicine

Cannabis is currently the most widely used drug in the world due to both the sharp increase in volutary use and medical use, especially for the treatment of neurological and psychiatric diseases, such as amyotrophic lateral sclerosis, multiple sclerosis, Alzheimer’s, Parkinson’s, epilepsy, bipolar disorder, and schizophrenia.
Let’s take Parkinson’s disease. Very recent scientific studies (2014 and 2015) of patients treated with cannabis extracts have shown significant improvements in the main symptoms of the disease, such as tremor, rigidity and slowness of movement, but also in non-motor disorders, such as alterations in sleep-wake rhythm and pain.
Regarding its use in pain, cannabis is capable of improving mood and quality of life in HIV-infected individuals. In addition, in cancer patients, cannabis can combat chemotherapy-induced anorexia, nausea, and vomiting, as well as chronic pain,insomnia, and mood depression.

The negative aspects

Having ascertained its medicinal qualities, cannabis is still a drug and, as such, it causes negative, serious and lasting effects especially in young people, particularly those who began taking cannabis in their teens.
Addiction, respiratory disorders, memory deficits, reduced attention and concentration, behavioral disorders, and accentuation of depressive, anxious, or psychotic disorders are among the most frequent adverse events.
Despite the difficulties in the therapeutic use of cannabis, numerous studies on its medical use continue to be conducted around the world. However, often the conclusions of such research do not seem appropriate or properly applicable in the public health field. Indeed, studies conducted often lack data to support a favorable risk-benefit ratio. Hence the difficulties in drafting appropriate regulations or procedures for the use of cannabis in the medical field.

By Pietro Biagio Carrieri, Andrea Di Cesare, Massimo Persia

Cell phone is not responsible for the occurrence of brain tumors

21 February 20246 January 2024 by pcarrieri

Since the mid-1980s, a time when the cell phone spread rapidly throughout the world, there has been speculation about a possible cell phone-brain tumor relationship as a result of brain exposure to high levels of radio frequency.

Some epidemiological, case-control studies had shown a significant increase in brain tumors related to cell phone use and, in particular, glioma, while no association was found with brain meningiomas(INTERPHONE Study Group, 2010; Hardell et al, 2011) .

Precisely as a result of these studies, the International Agency for Research on Cancer (IARC) classified radio frequencies as possibly carcinogenic (Baan et al., 2011)

In Italy, where research is sometimes carried out in the courtrooms, the 2017 decision of the Ivrea Court of Law, which for the first time in Italy recognized a causal link between cell phone use and a brain tumor, which was otherwise benign (it was in fact a neurinoma) and not on the brain, but rather on a nerve, has remained historic.

In a very recent studio conducted in Australia by a number of Australian and New Zealand universities, coordinated by Ken Karipidis, examined the trend of brain tumor incidence in three separate time periods, in order to assess both the influence of improved diagnostic techniques in this field, but especially the relationship with the increasing use of cell phones.

The authors examined the incidence of primary brain tumors during the periods 1982-1992, 1993-2002 and 2003-2013, in subjects aged 20-59 years, taken from national cancer registries. A total of 16,825 cases of brain tumors meeting the study characteristics were identified, of which 10,083 were males and 6742 were females. These data were then compared with the incidence of cell phone use during 2003-2013.

Rates of primary brain tumors remained constant in all three periods. There was only an increase in glioblastoma in 1993-2002, compared with the previous period (1982-1992), which the authors put in reaction with the improvement in diagnosis related to the increased use of MRI.

In contrast, no increase was observed for any type of brain tumor, including glioma and glioblastoma, during 2003-2013, a period there was a significant increase in cell phone use. Notably, the authors of the article report no increase in gliomas in the temporal lobe, which is the site most exposed to cell phone use.

The conclusions of the study are that there is no demonstrable relationship between brain tumors and cell phones, let alone a particular brain location attributable to cell phones.

Bibliography

Baan R, Grosse Y, Lauby-Secretan B, et al. Carcinogenicity of radiofrequency electromagnetic fields. Lancet Oncol 2011;12:624-6

Hardell L, Carlberg M, Hansson Mild K. Pooled analysis of case control studies on malignant brain tumors and the use of mobile and cordless phones including living and deceased subjects. Int J Oncol 2011;38:1465-74).

INTERPHONE Study Group. Brain tumor risk in relation to mobile telephone use: results of the INTERPHONE international case-control study. Int J Epidemiol 2010;39:675-94.

Source

Ken Karipidis et al. Mobile phone use and incidence of brain tumor histological types, grading or anatomical location: a population-based ecological study. BMJ Open 2018;8:e024489. doi:10.1136/bmjopen-2018-024489

Narrative Medicine: a new way of relating to the patient

26 February 20246 January 2024 by pcarrieri

We live in a society that is now considered by many to be “postmodern” and in which an exclusively technical approach to medical care is no longer considered sufficient. Twenty-first-century patients seek a different approach to their health problems than in the past, and in particular demand a deeper dialogue with their physicians (Shapiro, 2011; Greaves, 2004).

Medicine can no longer be limited to collecting a medical history (anamnesis), performing an objective examination, and implementing a diagnostic procedure with a final discussion of therapeutic intervention strategies (Johna et Dehal, 2013). Medicine especially needs physicians capable of establishing narrative connections and more intense contact with the person asking for help (Charon , 2001). Narrative medicine aims to deal with patients comprehensively and to recognize and interpret their stories of illness by integrating education, medicine and the humanities (Frank A, 1995). The goal is to strengthen the doctor-patient relationship by providing more humane and ethical care.

The narrative

With narrative medicine, we seek to understand the patient-physician relationship through the collection and analysis of narratives, told from the perspectives of the different stakeholders, patient, civil society, health care facilities, physicians and family members (Charon, 2012). This practice uses methods aimed at obtaining information about how a person experiences his or her illness, in an effort to consider the many facets of the care journey: narratives allow health professionals to gather information about the patient’s perceived needs on how to cope with problems related to his or her health.

Empathy

Although objectivity and medical care always retain their importance, a good deal of empathy is asked of the physician that will be rewarded by greater patient satisfaction and better clinical outcomes. What is empathy? It has been defined as a psychological process that enables an individual to have feelings that are more congruent with others as well as himself: it is basically the ability to understand and share others’ feelings. Empathy can be distinguished into cognitive, which is the ability to understand how another person feels, and affective, which is experiencing the same emotions that the other person feels (Hoffman, 2000; McDonald et al. 2015).

The negative aspects of the traditional approach

At present, the doctor-patient relationship is overwhelmingly based on scientific aspects, a position corroborated by the biomedical innovations that have occurred over time, from antibiotics to organ transplants, and which have made it possible to solve many health problems. Medical examinations tend to be always and only “scientific”: diagnosis is based on objective parameters, treatment centered on clinical protocols closely related to scientific research, and consequently the patient’s “well-being” will be linked only to the achievement of certain standard goals.

All this fails to consider that medical practice is above all a human endeavor and that each patient is his or her own case. The patient’s history, the so-called anamnesis, is reduced to repetitive, routine sentences, whereas the human case should be the focus of clinical practice. (Montgomery, 2006). Narrative medicine makes it possible to view individual subjects as persons rather than clinical cases, to understand the world in which they live, and to tailor drug treatment to their needs. Both the patient and all caregivers, including caregivers, will be taken into account.

The goal: to improve patient care by enhancing both medical science and human aspects. Only in this way can the person be assisted as a whole and in a more meaningful way (Franke RJ, 2016). Narrative medicine fosters empathy and trust between patients and patients and between patients and physicians by improving communication with effect a therapeutic on patients. It is used in individuals with cancer, AIDS, stroke, and generally chronic diseases, but also in seemingly more mundane conditions, such as chronic spontaneous urticaria (Cappuccio et al, 2017). Another area of application is palliative care, treatment given to people at the end of their lives.

BIBLIOGRAPHY

Short-term and long-term memory

26 February 20246 January 2024 by pcarrieri

Memory is a function of the central nervous system that enables all animal beings to be able to make the best use of knowledge from experience: thus, old and new difficulties or problems from the outside world can be dealt with in an increasingly appropriate way.
In humankind in particular, memory has assumed a fundamental value both in the dissemination of language and in the development of culture.
The basis of memory is first and foremost learning, the ability to acquire new information from the outside world. This information, stored in particular brain areas, can be retrieved and used.
The three different moments underlying mnemonic processes are:
1 – the acquisition of new information or experiences from the outside world;
2 – the consolidation and preservation of information;
3 – the recall and use of archived information.
One of the most important aspects of memory is the consolidation of acquired information, which takes place through formation of new proteins, activation of genes, and changes in synapses and dendrites.

VARIOUS FORMS OF MEMORY
Based on how long information is stored in brain structures, two different forms of memory can be distinguished:
1 – short-term memory
2 – long-term memory
In short-term memory, information is retained only for a short period of time, seconds or minutes; in long-term memory, information is also available for long intervals of time, even years.

SHORT-TERM MEMORY

Short-term memory is the ability to retain and recall a memory acquired shortly before for only a very short time interval (thirty seconds to two minutes). Within short-term memory, there is what is known as immediate memory or working memory, which allows information to be stored and used only to implement a particular task.

LONG-TERM MEMORY

It is the process of learning that is completed with the preservation and subsequent consolidation of the acquired information. This process can occur actively with the individual’s personal commitment, but also without direct participation. It is also worth noting the distinction of long-term memory into implicit and explicit.
Implicit memory, also called procedural memory, is that related to the performance of activities, such as swimming, riding a bicycle or playing a musical instrument. It is closely related to training and is recalled to mind unconsciously. Explicit memory, also called declarative memory, is related to events, people, situations, places or objects. It is called to mind consciously and always needs awareness. It is the memory of spoken language or related to previous experiences. Forms of explicit memory are:
– episodic or autobiographical memory, which is about personal experiences or events in one’s life;
– semantic memory, which refers to notions, concepts or general cultural knowledge. However, not all memories are stored. Proper memorization requires a selection of information, which is based both on the subject’s interest in a particular topic or event and on his or her ability to pay attention and concentrate. Long-term memory, as opposed to short-term memory, involves a whole series of changes to neurons, synapses and dendrites. Processes of neurogenesis, with formations of new neurons, are probably also involved in a particular encephalic structure called the hippocampus, which, contrary to common belief, continues to produce new neurons throughout life.

The decalogue of tips for living with a person with a disability or serious illness

24 February 20246 January 2024 by pcarrieri

Living with a disabled person with physical and/or mental problems can often be difficult and frustrating for both the sick person and those whose job it is to care for him or her. The difficulties are diverse and varied in nature and, if not handled appropriately, can lead to stressful and unpleasant situations making life anything but easy. So here are some great tips for living with peace of mind with a person with a severe disability.

The decalogue of advice

Ensure a quiet, orderly, comfortable and safe home environment for the sick person.

To help the sick person in carrying out his or her activities unhurriedly and trying to maintain his or her autonomy for as long as possible.

Use comfortable and simple clothing, avoiding buttons and shoelaces.

Abituate him to perform his physiological needs at fixed times, supervising him discreetly.

A caution him often, talk to him calmly and gently and reassure him by looking into his eyes; if necessary, communicate nonverbally through touch and smiles.

Use short, simple, clear and concrete sentences; communicate one message at a time

Be patient, even if the affected person repeats the same things over and over again: … he has already forgotten that he said them just before.

Don’t
point out his mistakes, never scold him out loud … he suffers from it, even if he can’t tell you.

Make him listen to
music and songs from his youth and other things he likes.

Assist him, always respecting his modesty and dignity.

Other useful information

When living with a person with a disability, it is highly recommended that youorganize your medical knowledge so that you are constantly up-to-date with the affected person’s illness and Learning how to communicate effectively with physicians. It is also necessary to keep all documentation pertaining to the patient and his or her illness in order at all times so that it is immediately available in case of emergencies. Also remember. that the effort put in is hard work, so there is a need for moments of rest.

Here are three other useful tips:

Seeking and Accepting Help from Other People: remembering that you don’t have to be alone
Taking care of one’s health as well: one needs to be strong enough to take care of a sick person
Pay attention to signs of depression that may also occur in the caregiver and do not delay in seeking professional help when needed

Transient ischemic attacks

24 February 20246 January 2024 by pcarrieri

Transient ischemic attack, or transient ischemia, (TIA) is defined as an episode of neurological deficit caused by focal cerebral ischemia with complete recovery within 24 hours. On average, the duration of a TIA is about 10 minutes.

The cause of TIAs is usually atherothrombotic in nature and is due, in particular, to the presence of platelet microemboli or fibrin-platelet material from atheromasic plaques. This material can temporarily interrupt blood flow within an artery. The resumption of blood circulation and, consequently, the disappearance of the neurological deficit may be due to the Rapid dissolution of emboli. It is also possible that functional recovery is due to the rapid establishment of a
anastomotic compensation circle.
.

In the case of TIA affecting the
vertebro-basilar system
mechanisms may be invoked hemodynamic type such as abrupt head movements, which in subjects with cervical spondylarthrosis result in a momentary reduction in cerebral blood flow by compression on the vertebral arteries.

The numbers

The annual incidence of TIAs is around
120 cases per 100,000 population
, but hard data do not exist because such manifestations are not often reported to the physician or do not always prompt the subject to go to the
emergency room
. Episodes of TIA may instead be reported to the physician during the course of the medical history after cerebral ischemia. The TIA is in fact a risk factor important short-term risk factor for ischemic stroke. The possibility of an ischemic stroke after a TIA is estimated to be approximately between 3-10% after two days, around 5% after 7 days and between 9 and 17% after 3 months.

Also in the case of TIAs, symptomatology is related to the arterial district affected and can be distinguished, depending on whether the
carotid territory
or the
vertebrobasilar
.

Symptoms

Major complaints include loss of strength in a limb or a right or left hemilateral, difficulty speaking (aphasia, dysarthria), dizziness, drop-attack (sudden fall to the ground due to failure of the lower limbs with preservation of consciousness), short-term memory impairment (Transient global amnesia).

It is necessary to be
great care
in advancing the
suspicion of TIA
, because the symptomatology reported by the patient could be confused with other conditions such as syncopal episodes, seizures partial, migraine with hemiplegia

I would like to emphasize again that TIA is a
neurological deficit without loss of consciousness:
therefore the affected person remembers the episode very well and is able to report it in great detail, as opposed to during epileptic seizure.

On the other hand, one cannot confuse a TIA with a cerebral stroke, even of modest magnitude, because in the case of a stroke the neurological deficits are of more than 24 hours’ duration: moreover, an ischemic brain lesion can be evidenced on CT (Computed Tomography) or MRI (Magnetic Resonance Imaging) brain.

Parkinson’s disease: Symptoms, causes and treatment

24 February 20246 January 2024 by pcarrieri

Parkinson’s disease is a chronic progressive disease; it was first described by James Parkinson in 1817. After dementias, it is the most common neurodegenerative disease.

EPIDEMIOLOGY

The condition is equally prevalent worldwide; the average age of onset is between
55 and 60 years of age
and affects
1-2% of the entire population over 65 years of age; 5% of those affected are under 40 years of age.

In Italy there are about
220 thousand people affected.

ETIOPATHOGENESIS

Various risk factors for Parkinson’s disease have been identified, including age, family history, male gender, environmental exposure to herbicides, pesticides, metals (manganese, iron), well water, residence rural, mental and physical trauma, emotional stresses.

A protective factor, on the other hand, is cigarette smoking.
.

The cause of the disease is unknown, but it is probably the result of an interaction between environmental toxins, genetic susceptibility, and senescence.
Mitochondrial dysfunction and oxidative stress
are now considered among the main mechanisms underlying the disease.

In a .small percentage
of the cases a genetic cause
. Major mutations include those affecting genes coding for
alpha-synuclein
and for
parkin
.

The
pathogenesis
is related to the
degeneration of most of the dopaminergic neurons in the black substance
(nerve structure located at the level of the midbrain). This results in the reduced production of
dopamine
, a key neurotransmitter in the
regulation of movement
. Symptoms of the disease become apparent
When more than 70 percent
of dopaminergic neurons were lost.

The main alterations involve the
black substance
which appears paler than normal; within it there is a reduction in the number of neurons and in surviving neurons inclusions of a substance called
alpha-synuclein:
are the so-called
Lewy bodies
, which are not specific to Parkinson’s disease, as they can also be found in
Lewy body dementia
and in
Alzheimer’s dementia.

SYMPTOMATOLOGY

The onset is sneaky
with tremor in one hand
, but also often with
joint pain, depression of mood, easy fatigability.

The cardinal symptoms are
resting tremor
, the
slowness of movement
, also called bradykinesia,

and the
rigidity
. To these symptoms must be added postural instability. PD is a
asymmetric pathology
in that, especially in the early stages, it affects one half of the body more than the other .

Let us go on to illustrate the basic symptoms.

The resting tremor, present in about 70% of cases, has a frequency of 4-6 shocks per second and at onset affects only one hand and, in particular, the first three fingers, giving the impression of “count coins“; tremor is accentuated under conditions of emotional tension, fatigue, o When the subject feels observed, while it is absent during sleep.

The
rigidity
is characterized by an
increased muscle tone
with
constant resistance
to mobilization. There may be the so-called
cogwheel phenomenon
, in that the presence of resistance to passive mobilization is alternated with
sudden failures
, brings to mind the
clicks of a gear
.

The
slowness of movement
(bradykinesia) is the third cardinal sign of the disease, also accompanied by reduced motility. During the march, the subject with PD gives the impression of having the
upper limbs attached to the body
without the characteristic
pendular movements
.

Also observed are
difficulties such as using a knife or fork, buttoning up or
unbuttoning, shave. The writing becomes trembling and uncertain and you shrinks (microgra phy), the facial expressions is reduced (amimia) (Figure 8). The subject, over time, assumes a prone posture with
Head flexed forward and knees and elbows flexed
.

Postural instability
is the difficulty in maintaining upright station in response to external thrusts; it can be the cause of disastrous falls and is present in about 40% of cases.

NON-MOTOR SYMPTOMS

Autonomic nervous system involvement is characterized by the presence of
orthostatic hypotension, constipation, sialorrhea, seborrhea, increased sweating
At the level of the head and neck. Urinary disorders may be present such as urinary urgency
and increased
urinary frequencyI.

The
cognitive impairment, usually moderate, is present in up to 60 percent of cases; there may be impairment of attention, concentration and memory and slowness in performing executive tasks. Unfortunately in some cases until the
in 20%
may be present a
frank dementia
subcortical type

The
depression of mood tone
is often present but under-diagnosed and under-treated. I sleep-wake rhythm disorders are very common being able to affect up to 90% of people with PD. They can consist of
excessive daytime sleepiness
or in
difficulty in initiating or maintaining sleep
, or in
poor sleep quality with frequent awakenings
and reductions in stages III and IV sleep and REM sleep.

DIAGNOSIS

It is mainly based on the recognition of the three main signs
, resting tremor, rigidity and bradykinesia with unilateral onset, and the response to L-DOPA.

CT or MRI scans of the brain are normal or at most can demonstrate the presence of some degree of brain atrophy, which is otherwise highly variable.

The following can be used to assess presynaptic dopaminergic pathways
the SPET-DaT SCAN, which s
erve to show alteration of dopaminergic pathways, but is not always superior to clinical diagnosis.

To assess the degree of disability, the use of Rating Scales is useful. The most widely used are the UPDRS and the Hoehn and Yahr Scale.

THERAPY

Initially there is a good drug response; later, as the disease worsens, the response to drugs worsens and fluctuations appear especially in the area of motor symptoms. These include the on-off phenomenon, sudden lack of response to medication with no relation to the timing of intake; wearing-off, predictable reappearance of parkinsonian symptoms after a number of years due to the shorter duration of response to medication; and freezing of gait or simply freezing, sudden motor blockage that occurs at the onset of walking, or in crossing narrow passages, or in changes of walking direction; in the latter case, the subject reports having his or her feet as if glued to the floor.

Measuring blood pressure correctly, two methods compared

19 February 20246 January 2024 by pcarrieri

High blood pressure is the most important risk factor for very frequent and disabling diseases, such as myocardial infarction and stroke. It is important, for these reasons, to provide good criteria for accurate blood pressure (BP) measurement in order, if necessary, to institute appropriate pharmacological treatment. The same criteria can also be used to rule out masked forms of hypertension or those that appear only during a visit within a physician’s office, so-called white-coat hypertension.

In a recent article by the American Heart Association, useful tips for proper blood pressure measurement are given in this regard. Until now, blood pressure measurement with a sphygmomanometer(so-called cuff) and phonendoscope has been considered the best technique. More recently, the market introduction of oscillometric instruments has allowed, as reported in the article, “accurate and multiple BP measurements through the push of a button, with the added benefit of reducing human errors associated with the auscultatory approach.” In fact, these are electronic automated devices that make use of a pressure sensor inside the cuff and are capable of more frequent BP readings, even in the absence of the operator, and more accurate than traditional measurement. The article also points out the advantage of taking the BP measurement in one’s own home and, therefore, even during hours when the doctor’s office is closed, consequently making the BP measurement more closely aligned with reality and eliminating the “white coat” effect.

Finally, I would like to remind you of the possibility of connecting these new devices to your computer and, through specific applications that are very easy to download online, preparing pressure diagrams, which will then be presented to your doctor. This will enable the medical professional to judge, more appropriately, the effect of the current drug treatment and any therapeutic changes to be made.

Source: Paul Muntner et al. Measurement of Blood Pressure in Humans: A Scientific Statement From the American Heart Association. Hypertension. 2019 Mar 4:HYP000000000087. doi: 10.1161/HYP. 0000000000000087.

Some drugs used in Parkinson’s disease stimulate creativity

19 February 20246 January 2024 by pcarrieri

In individuals with Parkinson’s disease, the use of dopaminergic drugs that can stimulate receptors for dopamine, a deficient neurotransmitter in this disease, can result in side effects characterized by poor impulse control: these include pathological gambling, hypersexuality, and compulsive shopping. However, the same drug treatment has stimulated increased creativity and the acquisition of new artistic skills in some individuals with Parkinson’s disease.

While poor impulse control, such as especially pathological gambling, is well recognized in the literature, creativity remains underestimated, probably because it is an often-appreciated event and as such not likely to create distress, either in patients or their families. In a recent study, researchers evaluated about 20 subjects with Parkinson’s disease who exhibited greater artistic creativity after dopaminergic treatment than before. Among the artistic activities found in first place is painting, but also the development of poetic skills(Schrag and Trimble 2001; Walker et al, 2006).

There is no doubt that a stimulating family environment could bring out creative aspects more frequently during Parkinson’s disease treated with dopaminergic drugs. But a not insignificant aspect is that the same patients in whom there is the appearance of artistic activities also report a state of well-being and a loss of awareness of the disease and even of disease-related physical limitations(Chatterjee et al, 2006).

Source: Garcia-Ruiz PJ, Martinez Castrillo JC, Desojo LV. Creativity related to dopaminergic treatment: A multicenter study. Parkinsonism Relat Disord. 2019 Feb 22. pii: S1353-8020(19)30056-2.

Bibliography

Chatterjee A, Hamilton RH, Amorapanth PX: Art produced by a patient with Parkinson’s disease. Behav Neurol 2006;17:105-108

Schrag A, Trimble M: Poetic talent unmasked by treatment of Parkinson’s disease. Mov Disord 2001;16:1175-1176

Walker RH, Warwick R, Cercy SP: Augmentation of artistic productivity in Parkinson’s disease. Mov Disord 2006;21:285-286.

Is it possible to stop the progressive worsening of Parkinson’s disease?

19 February 20246 January 2024 by pcarrieri

The
Parkinson’s disease
is a degenerative disease of the central nervous system, first described in 1817 by an English physician, James Parkinson. It is characterized by three main symptoms: slowness of movement, rigidity and tremor. The causes are related to degeneration of certain structures in the central nervous system, where dopamine, the main neurotransmitter essential for controlling bodily movements, is produced. Treatment of the disease still relies on drugs that can either supply the deficient dopamine through its precursor, L-DOPA, or stimulate the cells on which this transmitter acts, the dopaminergic cells. Unfortunately, due to the processes of neuro-degeneration, inherent in Parkinson’s disease, these drugs gradually lose their effectiveness over time.

A pioneering program involving an experimental and innovative drug treatment to be applied directly to the brains of people with the disease was published in the latest issue of the Journal of Parkinson’s Disease in February 2019.

The hope: to restore cells damaged in the course of the disease.

The study is based on providing Parkinson’s disease-compromised brains with increased levels of a naturally occurring growth factor, glial cell line-derived neurotrophic factor (GDNF), which has been shown to be able to regenerate the brain cells impaired dopaminergic pathways in individuals with this condition.

Six patients took part in the initial pilot study that mainly evaluated the safety of the treatment approach. Another 35 people then participated in the actual study, which was carried out in a double-blind manner for the duration of nine months: half of the randomly selected subjects received monthly infusions of GDNF, while the other half were treated with placebo infusions.

A specially designed delivery system using robot-assisted neurosurgery was implanted in each subject to carry out the monthly infusions. This delivery system made it possible to deliver high-dose infusions of GDNF every four weeks directly to disease-affected brain areas with pinpoint accuracy through a transcutaneous port mounted on the skull behind the ear. The high compliance rate (99.1%) in participants recruited throughout the United Kingdom demonstrated that the drug delivery system, by repeated cerebral infusion, is feasible and tolerable.

After 18 months of therapy, all of the patients who had received GDNF showed improvement in disease-affected brain areas and related symptoms with a moderate to major rating from the researchers compared with the initial condition. This improvement was also observed in those subjects who were initially placed in the placebo group and then switched to GDNF treatment. GDNF administration proved to be safe throughout the study period.

The study’s principal investigator, Dr. Alan L. Whone of Bristol Medical School at the University of Bristol, UK, stated that: “ In GDNF-treated subjects The improvement in disease-affected areas went beyond what has ever been seen before” and then added that: “High doses of GDNF are able to awaken and restore dopaminergic brain cells, which are progressively impaired in the course of Parkinson’s disease.”.

Even in light of the neurodegenerative process underlying Parkinson’s disease, the drugs currently in use are likely to gradually lose their effectiveness. Therefore, there is no doubt that this study, if confirmed by subsequent evaluations, represents a decisive breakthrough in the treatment of Parkinson’s disease.

Source: Alan L. Whone et al:“Extended Treatment with Glial Cell Line-Derived Neurotrophic Factor in Parkinson’s Disease” published online in the Journal of Parkinson’s Disease, in advance of Volume 9, Issue 2 (April 2019) by IOS Press

Could mushroom consumption be effective against cognitive decline?

19 February 20246 January 2024 by pcarrieri

Despite the large number of scientific studies conducted on cognitive decline, which is generally age-related but can also begin even before age 65 and dramatically result in irreversible diseases such as Alzheimer‘ s disease, no effective treatment has been identified at present.

In a recent study conducted at the National University of Singapore by a team of researchers coordinated by Lei Feng, a possible association between mushroom consumption and reduced risk of experiencing cognitive decline was examined. The study was carried out on nearly 700 people over the age of 60, comparing subjects who consumed a portion of mushrooms (about 300 grams) less than once a week, compared with subjects in whom mushroom consumption was present more than twice a week. In people in the latter group, the authors found a reduced risk of presenting cognitive decline: this association was, among other things, independent of age, gender, cigarette and alcohol consumption, physical activity, social relationships, and the presence of diseases such as high blood pressure, stroke, or cardiovascular disorders.

This effect is probably related to a substance found in mushrooms, ergothioneine, which has antioxidant properties and prevents the degradation of polyunsaturated fatty acids (Pahila et al, 2019). The authors conclude that mushrooms would have an active function against neuro-degeneration.

Could it be that an elixir against brain aging has finally been identified in mushrooms?

Bibliographical References

Lei Feng et al. The Association between Mushroom Consumption and Mild Cognitive Impairment: A Community-Based Cross-Sectional Study in Singapore. J Alzheimers Dis. 2019 Feb 11. doi: 10.3233/JAD-180959.

Pahila J, Ishikawa Y, Ohshima T. Effects of Ergothioneine-Rich Mushroom Extract on the Oxidative Stability of Astaxanthin in Liposomes. Agric Food Chem. 2019 Mar 6. doi: 10.1021/acs.jafc.9b00485.

Isolating oneself, setting oneself apart, a new psychic pathology: Hikikomori

18 February 20246 January 2024 by pcarrieri

In recent years, a particular form of severe and prolonged social withdrawal, called
hikikomori
, has attracted attention mainly because of its impact on society. Hikikomori is a term of Japanese origin meaning “toisolate oneself, to set oneself apart.” Although there is no real consensus on the diagnosis of this condition at present, hikikomori is defined as a condition of social withdrawal accompanied by a refusal to take on responsibilities in education, work and friendships.

This kind of behavior undoubtedly poses a threat to the labor market from people who, for no apparent reason, drop out of school or are unable to maintain employment. Initially described in Japan, in the last decade thehikikomori has attracted global attention, with cases described in North America, Europe and Asia. Epidemiological surveys have been carried out that have shown a prevalence of this disorder in the population between 1 and 2 percent.

Still little known in Italy and not reported in the latest edition of DSM V, thehikikomori exits in adolescents or young adults, usually male, and mostly occurs in the presence of difficulties in school or problems within the family or psychosocial stresses, with the end result that the subject is forced to spend most of his or her time in isolation in his or her bedroom.(Teo, 2010)

In some conditions this disorder is accompanied by mood depression or phobias, including selfisophobia, fear of getting dirty, or anthropophobia, fear of social counts. In other cases, no concomitant psychiatric conditions are present. (Teo AR, et al 2015; ; Kato T et Kanba 2017; Malagón-Amoret al, 2018)

In order to better assess this condition and estimate its frequency in different populations, partly due to the lack of objective criteria or laboratory investigations, the development of an appropriate questionnaire was considered. In a recent study on this topic, the following were evaluated. 399 subjects through a series of 25 questions concerning mainly socialization and isolation. Among the questions: I prefer to be away from other people; I spend most of my time at home; other people annoy me; I much prefer to be alone than with others; I spend most of my time alone; there are few people with whom to discuss important matters; I do not like social relationships.

According to the Authors of the article, belonging to the Department of Psychiatry, University of Oregon, Portland, USA: “The proposed questionnaire represents a potentially useful self-administration tool in the assessment of a relatively new mental health problem. As concern about social withdrawal increases, particularly in more economically developed parts of the Western and Eastern worlds, this scale offers an important new tool in order to better study and understand people at risk for hikikomori.”

Source

Teo AR et al. Development and validation of the 25-item Hikikomori Questionnaire (HQ-25). Psychiatry Clin Neurosci. 2018 Oct;72(10):780-788. doi: 10.1111/pcn.12691. Epub 2018 Jul 27.

Bibliography

Teo AR. A. Int. J. Soc. Psychiatry 2010; 56: 178-185.

Kato TA, et al. Soc. Psychiatry Psychiatr. Epidemiol. 2012; 47: 1061-1075.

Teo AR, et al. Psychiatry Res. 2015; 228: 182-183.

Kato T, Kanba S. Am. J. Psychiatry 2017; 174: 1051-1053.

Malagón-Amor Á1 et al. Psychiatry Res. 2018 Dec;270:1039-1046.

Fibromyalgia, a real puzzle of modern medicine

17 February 20246 January 2024 by pcarrieri

Fibromyalgia syndrome, more commonly known as fibromyalgia, represents a real enigma, as recently pointed out by some authors (Häuser et al, 2019). Over the past three decades, the acceptance, although not always unanimous, of the diagnosis of fibromyalgia has led to an unwarranted increase in the number of cases; in fact, guidelines accepted by the international scientific community are necessary for a correct diagnosis.

The most important complaint is chronic widespread pain along with two so-called major symptoms, fatigue and unrestorative sleep. In the 2016 review (Wolfe et al, 2016), in addition to the above criteria, the need for the patient to undergo careful medical examinations, including a history and objective assessment, was noted. Specifically, this revision combines medical criteria with those on patient-administered questionnaires, minimizes misclassification of regional pain disorders, and eliminates previous confusing recommendations regarding diagnostic exclusions. The importance of self-assessment forms in the clinical diagnosis of the individual patient, on which the previous criteria were based, is also reduced.

Although at present there are no specific laboratory tests for the diagnosis of this syndrome, careful medical examinations, especially in the fields of rheumatology and neurology, and the performance of instrumental and laboratory investigations are essential to rule out other pathologies.

Bibliography

Häuser W et al. Fibromyalgia syndrome: under-, over- and misdiagnosis, Clin Exp Rheumatol 2019; 37 (Suppl. 116): S90-S97

Wolfe F et al. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum, 2016; 46: 319-329.

Correlation between cold sores and Alzheimer’s disease

18 February 20246 January 2024 by pcarrieri

The herpes simplex virus 1 often alters the face, putting those who are unfortunately affected in an uncomfortable condition. There is a tendency to hide one’s mouth, especially if one is in public places. There is no definitive cure to eradicate the virus from the body, so subsequent to infection you will be subject throughout your life to developing cold sores more or less frequently.

Educate You was among the very first in the country to report the results of an epidemiological study conducted in Taiwan by Dr. Ruth Itzhaki on a possible correlation between the disease of
Alzheimer’s disease
and the herpes simplex 1 virus, the very one responsible for the very annoying bubbles on the lips.

Confirmation now comes from a study conducted on experimental animals by Italian researchers, with Dr. Giovanna De Chiara of the National Research Council in Rome as the first name.

A model of recurrent herpes simplex virus 1 infections in mice that were subjected to repeated cycles of viral reactivation was used in this study. In the course of the study, a spread of the herpes simplex virus 1 also in different brain areas that resulted in the appearance in the brains of animals of some typical features of Alzheimer’s disease, including, most importantly, the protein-beta amyloid constantly present in the brains of people with Alzheimer’s disease. According to the authors, in mice infected with herpes simplex virus 1 The progressive accumulation of typical molecular changes in certain brain areas, including the cortex and hippocampus, correlates with the appearance and increase of cognitive deficits which become irreversible after seven cycles of virus reactivation. The authors conclude that repeated herpes simplex 1 infections could be considered as a risk factor for Alzheimer’s disease.

Source

De Chiara G et al. Recurrent herpes simplex virus-1 infection induces hallmarks of neurodegeneration and cognitive deficits in mice. PLoS Pathog. 2019 Mar 14;15(3):e1007617. doi: 10.1371/journal.ppat.1007617. eCollection 2019 Mar.

Female brain ages less than male brain

15 February 20246 January 2024 by pcarrieri

The aging of the human brain varies greatly from subject to subject: some individuals experience rapid cognitive decline, while others maintain their cognitive abilities intact even in old age. According to some studies, brain aging would be linked primarily to impaired brain metabolism, particularly glucose metabolism, and not only to neurodegenerative phenomena, which is the currently most accepted thesis.

In this line of research is a recent paper, published in a prestigious American journal, which aimed to show that sex differences are able to influence the morphology and physiology of the brain during development and aging.

Through the use of data acquired by brain PET scan from 205 normal adult subjects, aged 20 to 82 years, it was found that throughout adult life the female brain, compared with the male brain, has a persistently lower metabolic brain age than the chronological brain age.

According to the authors of the article, belonging to the Washington University School of Medicine. St. Louis, sexual differences would be able to influence brain aging, in favor of women, the whose brains, with the same age of birth, would be a few years younger than The male one.

SOURCE

Manu S. Goyal et al. Persistent metabolic youth in the aging female brain. PNAS February 19, 2019 116 (8) 3251-3255.

Pasta, precious nourishment

29 January 20246 January 2024 by pcarrieri

One recognition of the nutritional capabilities of pasta comes from Canada. In a recent paper, author, Yanni Papanikolaou of Nutritional Strategies Inc, Paris, ON, Canada evaluated the relationship between pasta consumption and diet quality in both children and adults.
The pasta was wheat-based and egg-free, and the comparison was with people who did not consume pasta.

The study found that pasta consumption was significantly associated with better diet quality than subjects who did not consume pasta.
Particularly in pasta consumers there was a reduction in intake of added sugars and saturated fat, while there were no differences in levels of sodium, potassium, calcium, and vitamins A and D.
It is also interesting to note that in women, aged 19 to 50 years, there was a reduction in body mass index, waist circumference and body weight, compared with those who did not consume pasta.

Pasta consumption was found to be associated with better diet quality and higher intakes of several nutrients, including folate, iron, magnesium, and dietary fiber.
Pasta consumers also had lower daily intake of saturated fat and added sugars than non-pasta consumers, with no differences in total daily calories and sodium intake.

In conclusion, the study author suggests that pasta should be consistently included in diets dedicated to both children and adults in order to increase its nutritional quality.

Mental disorders after lockdown

29 January 20246 January 2024 by pcarrieri

The coronavirus pandemic has forced the Italian population into forced isolation within their homes, and there is no doubt that this quarantine has caused conditions of psychological distress.

Why has the isolation, now known to all as lockdown, resulted in a state of mental illness?

The reason is related to theimportance ofsocial relationships in human beings.
Social relationships are indeed the basis of the evolution to an increasingly complex society, such as the present one: the sudden and totally unexpected deprivation of interpersonal relationships has deprived human beings of the most meaningful aspects of their lives.

Restrictions assumed by various national governments in order to contain the spread of the pandemic have caused people to be unable to meet with friends and relatives or to have access to venues such as theaters or restaurants.
Instinctive manifestations, such as simply “shaking hands,” came to be missing.Social distancing itself was felt to be a barrier to the individual’s freedom.

Mental health problems are a common response to pandemic COVID-19; symptoms such as anxiety and depression increased from 16 percent to 28 percent, while stress conditions were found in 10 percent of cases.
Also related to stress are sleep-wake rhythm disturbances with frequent night waking and poor sleep.
Among the most at-risk groups are the elderly, pregnant women, people with pre-existing conditions including mental illness, out-of-home students, the homeless, and migrants.

Psychological stress can manifest itself, in addition to sleep-wake rhythm disturbances, in different forms, which may include:

concern for their own health and that of their loved ones, including the unpredictability and severity of the illness;
Fear of losing the security acquired over time (work, affections, friendships etc.);
Attention and concentration deficits;
feeling of loneliness and boredom;
Increased use of alcohol, tobacco and other psychotropic substances;
Worsening of any pre-existing chronic diseases.

Theeconomic impact related to COVID-19 and the anxiety of losing available resources also contribute to the malaise.

How to deal with this state of malaise?

The following is a list of strategies aimed at reducing epidemic-related stress:

accurate information to the public in order to minimize responses such as“panic” about the disease and its transmission; for example, the use of specific preventive measures, such as handwashing, has partly mitigated the occurrence of mental disorders;
Improving social support;
maintaining as normal a life as possible, even in the presence of security measures;
Use of available psychosocial services, particularly online services;
training of teams of qualified specialists to deal with emotional distress and the need for adequate training of health personnel;
Use of online surveys to assess the extent of mental health problems;
provision of online counseling and self-help services, and in particular seek to bring mental health services online;
Development of telemedicine services for diagnostic and counseling purposes;
Improving linkages between community and hospital services.

Such strategies offer the hope that mental health services can be provided in a more easily accessible way without any increased risk of infection. However, the above strategies are crucially dependent on the availability of adequate personnel and infrastructure.

In a very recent study (Banerjee et al, 2020), the central figure of the psychiatrist is particularly emphasized, with six key roles attributed to him or her:

(a) educate the public on the most common psychological effects of a pandemic;
(b) motivate the public to adopt strategies for disease prevention and health promotion;
(c) integrate the services of Mental Health Departments with available health care;
(d) teach problem-solving strategies to cope with the current crisis;
(e) Empower patients with COVID-19 and their caregivers;
(f) provide mental health care for health care workers.

Finally, some simple tips for dealing with the symptoms of stress:

Try to respect the usual sleep-wake rhythms by going to rest and feeding at the usual times;
Continue taking medication for any other conditions;
Keeping one’s home in order;
Avoid the use of alcohol and drugs;
Try to get some physical activity even if it is simply by moving around inside your home;
try to do activities that keep one’s brain engaged such as reading, crosswording, cooking, etc;
maintain contact with their friends and relatives, trying not to talk exclusively about pandemic issues;
if physical complaints arise, such as alterations in sleep-wake rhythm, feelings of apathy or disinterest in surroundings, or anxious state, contact your doctor.

Headache and Covid 19

12 March 20246 January 2024 by pcarrieri

It is now well known to all that COVID 19, identified as a global pandemicby theWorld Health Organization in March 2020, is a disease characterized by a severe acute respiratory syndrome caused by a coronavirus called SARS-Cov2.
This virus has unfortunately been shown to be lethal, acting mainly on the lungs, but with pathological effects on other organs as well including, in particular, the renal, hematological, and nervous systems.

In fact, patients with COVID 19 may present with various neurological symptoms, and among these, one of the most common is headaches.

However, the worsening of headache during COVID-19 in many subjects who were already suffering from it is also significant.
The causes lie in the fact that many headache sufferers have been forced to forego medical checkups, and in particular taking medications dispensed at specialized centers, precisely because of the physical distancing, put in place to limit the spread of infection.

Other causes of the worsening of a pre-existing headache are related to the significant increase in stressors, including, in particular, forced changes in activities of daily living and giving up one’s activities, which have been a trigger for headaches through the onset of anxiety and depression.

In some neurological centers, the use of alternative options has been possible in order to minimize difficulties in physician-patient contact.
In this regard, one of the most interesting approaches is Telemedicine, which is a real-time interactive audio/video relationship between patient and physician, with also very high satisfaction rates.
However, some qualms have hindered a wider diffusion of this method: among them, the lack of technological capabilities on the part of the users, aspects related to patients’ privacy, or the impossibility of performing a valid neurological objective examination especially during the first visit.