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EEG

EEG or Electroencephalography is a diagnostic test that measures the brain's electrical activity. This non-invasive test is used to detect any abnormality in the brain's electrical impulses. Nearly 16 - 25 electrodes are placed over different areas of your head and they record electrical activity. A study of the pattern of these electrical activities of the brain help in detecting any abnormality. Electroencephalography helps in detecting causes of seizures, epilepsy or degenerative diseases.

It helps in evaluating head injury, tumor or infections. But an EEG cannot help diagnose mental illness. Sleep disorders such as narcolepsy can be evaluated with the help of EEG. An EEG helps confirm brain death in comatose patients. Brain tumors, encephalitis, meningitis, Parkinson's disease or cerebral infarct can be detected with EEG test.


The patient will need to lie down with eyes closed during the EEG test. Sometimes the doctor may ask the patient to breathe deeply or look at bright flickering lights. Sometimes the patient may also be asked to go to sleep. The patient must not consume caffeine, tea, cola or chocolate for about 8 hours prior to the EEG test. The hair must be free of oils, creams or sprays. Medications such as tranquilizers, muscle relaxants and anti-epilepsy medicines might need to be discontinued for a short period.

Prion Disease

Prion diseases are Transmissible Spongiform Encephalopathies or TSE that affect humans and animals. In humans, they cause neurological disorders that are progressively degenerative. A prion is an abnormal pathogen that affects proteins found in the brain causing them to fold and clump unnaturally. This then leads to brain damage that is progressive. Prion diseases may occur spontaneously, may be inherited or may be acquired from contaminated material.


The most common form of prion disease is Creutzfeldt Jakob Disease or CJD. A variant of CJD is the 'mad cow disease'. The infection passes on to humans through contaminated meat. The most common pathologic feature of CJD is the formation of vacuoles (fluid filled spaces) in the brain giving rise to sponge-like appearance. CJD is one of several spongiform encephalopathies. Others include Kuru and Gerstmann Straussler Scheinker Syndrome.


Typical symptoms of prion disease include muscle stiffness, dementia, hallucinations, ataxia and fatigue. There is a change in the personality and behavior of the person. Diagnostic tests such as brain MRI, Spinal tap, EEG and blood tests are done to understand the condition. Brain tissue biopsy helps to confirm the disease. With rapid progression of the disease, the patient needs help in taking care of himself and might need to be moved to assisted care.


Kuru is another degenerative human spongiform encephalopathy disease that afflicted the Fore people from Papua, New Guinea due to ritual cannibalism.

GSS or Gerstmann Straussler Scheinker Syndrome is a rare neurological disorder due to brain degeneration. It is mostly inherited and sets in middle age. Initially the patient suffers cerebellar ataxia (lack of muscular coordination) and gradually deteriorates to dementia. There might be Nystagmus (rapid involuntary eye movements) and visual problems. There is a possibility of developing Parkinsons disease too. With rapid progression of the disease, the patient needs help in taking care of himself and might need to be moved to assisted care.


FFI or Fatal Familial Insomnia is a type of prion disease where the patient has difficulty in walking and falling asleep. There might be weight loss and excessive tears in the eye. It rapidly deteriorates to loss of consciousness and death. Initially the patient suffers insomnia that later worsens to include panic attacks, phobia and hallucinations. There might be weight loss and incontinence. After this, the patient might suffer dementia and sudden death.



Pick's Complex

This is a less common form of dementia, more prominent in those under the age 65. Frequently misdiagnosed as Alzheimer's disease, Pick's patients initially exhibit marked personality and behavioral changes. And gradually the ability to speak coherently declines.


Although there is no cure for Pick's complex presently, it can however be managed well and the quality of life improved. According to Arnold Pick, who first described the disease in 1892, Pick's disease causes an irreversible decline in a person's functioning for several years. Pick's affects adults between the ages of 40 and 60 and is more common in women than men.


Causes

The frontal and temporal lobes of the brain control a person's speech and personality. Excess protein build-up in these parts causes slow atrophy in these regions. The cause for this build-up of protein is unknown. Other than causing speech and behavioral changes, Pick's disease can also cause memory loss quite like those with Alzheimer's as well as socially inappropriate behavior, poor decision making, progressing to severe impairment in intellect, speech and memory. Some opine that Pick's disease may have a genetic or heredity component although not all family members are affected.


Symptoms of Pick's disease

The first sign of Pick's complex is personality changes and decline of basic functioning. Pick's can occur in an age earlier than Alzheimer's and memory loss need not be a predominant early sign of Pick's disease. Although there could be reports of Pick's occurring as young as 20 years of age, the progression is slower in Pick's disease. However, there are cases where symptoms could worsen over time and brain cells degenerate. More severe symptoms appear at later stages of Pick's. Some noticeable behavioral symptoms of Pick's disease are poor judgment, extreme restlessness especially in the early stages, overeating or drinking, lack of personal hygiene, sexual exhibitionism, decreased interest in daily activities and obsessive behavior.

Mood swings, lack of empathy, apathy, rudeness, impatience and aggression, easy distraction and being unaware of strange behavior and memory loss are some of the prominent emotional symptoms of Pick's disease. Loss of vocabulary, difficulty in speaking and understanding, uncoordinated speech and decrease in the ability to speak and write are some serious signs of Pick's.


Diagnosis of Pick's Complex

Other than careful symptomatic evaluation, brain scans and EEG, three of the following five characteristics are found to be present in the early stages. They include:


    Onset before age 65
    Personality changes
    Lack of normal behavior / Loss of control
    Lack of inhibition
    Roaming behavior
    When compared to Alzheimer's, memory loss and mental impairment occur later in Pick's.

Diet and activity

There should be a restriction on foods with high sugar content. There could be carbohydrate cravings in some. While in Alzheimer's and Parkinsons, a diet relatively high in fat and protein and low in carbohydrates is necessary, it is unclear if the same is recommended for Pick's complex. It is better to get a doctor's opinion on an appropriate heart-healthy diet. A regimen of therapeutic exercises such as brisk walking can help to regulate the patient's mood and benefit on cognitive function.


Treatment

Pick's disease, like any other dementia progresses rapidly and life gets shortened about six to eight years, although some do live for as long as twenty years. As currently there is no cure for Pick's like Alzheimer's, the aim is to maximize quality of life by way of medications to manage particular symptoms, regular supervision, and assistance.

Emotional and substantive support is an important aspect of the treatment. The family of the affected may help with the following control symptoms:


  • Eyeglasses and hearing aids to bolster the failing senses.
  • Positive behavior when symptoms set in by creating a calm and soothing atmosphere so that the patient feels safe and less anxious.
  • Speech therapy or any other physical therapy that can improve communication and movement.
  • Selective antidepressants that can provide some relief from apathy and depression and help reduce food cravings, impulse control and compulsive activity.
  • Treatment for other disorders such as anemia, thyroid disorders and kidney or liver diseases.
  • Stopping medications like paracetamol, NSAIDS, anti-cholergenics or changing them under medical guidance.

Tips for coping with Pick's complex

Being diagnosed with Pick's complex can be overwhelming especially when it involves any form of dementia. It is good to learn more about Pick's disease and frontotemporal dementia. In this way, more control can be exhibited and they will be better prepared to manage symptoms.


  • Music therapy, meditation, deep breathing exercises can help control stress and anxiety.
  • Pet therapy and visits from specially trained animals can help relieve stress and improve mood.
  • Treating depression can make it easier to handle other challenges of the disease.
  • Reaching out to family and friends for emotional support can help avoid isolation. A support group of similar patients can help overcome feelings of depression and isolation and provide a wealth of coping tips. Staying socially active will lighten the load and increase patient comfort.
  • Playing cards and word games such as scrabble, crossword and Sudoku puzzles can exercise the brain and help slow cognitive decline.
  • It would be wise for a Pick's patient to avoid medical, financial and legal confusion and instead create a design plan and discuss and document end-of-life preferences with doctors and family members.

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Collection of Pages - Last revised Date: September 23, 2018