Alzheimer's disease: An alternative approach

Alzheimer's disease (AD) is the most common neurodegenerative cortical dementia. It starts with memory loss, spatial disorientation in people above the age of 65 yr with a preference to females. Its incidence is expected to increase threefold by 2050. It affects almost one out of ten persons above the age of 65 years. Majority of patients are sporadic, but a very small percentage is autosomal dominant. The pathomechanisms postulated include amyloid cascade hypothesis according to which mutation in amyloid precursor protein causes Aβ aggregation. The next hypothesis is signal transducer and activation of transcription 3 (STAT3) causing aberration in intracellular signalling pathways. Senile plaques and neurofibrillary tangles are other important pathological changes reported. It is observed that dementia research has not yielded the expected result world over, and therefore, the pitfalls with reference to known facts about diagnosis, clinical features, pathogenic mechanisms, assessment of progression, biomarkers, treatment and prevention, as well as brief information on our experiments with relatively inexpensive methods of differentiating the most common types of dementia AD and frontotemporal dementia are discussed

Battered woman syndrome: An unusual presentation of pseudodystonia

Pseudodystonia is the term used to define abnormal postures, which are not due to the disorders of the basal ganglia and is encountered very rarely in clinical practice and often difficult to distinguish from true dystonia syndromes. We report a rare case of a battered woman who was managed as restricted resistant dystonia with pharmacotherapy and intrathecal baclofen and referred for considering deep brain stimulation (DBS). The patient turned out to be a case of pseudodystonia due to bilateral hip dislocation. This was due to assault by a close relative and the history was masked by the patient for more than one and a half years. In a patient with late onset dystonia, who is resistant to the recommended treatment for dystonia along with atypical clinical features and electrophysiological parameters, pseudodystonia should always be considered as a possible diagnosis and evaluated for causes of the same

"A lady of few words": Review of literature and report of a case of progressive nonfluent aphasia type of frontotemporal dementia

Frontotemporal dementia (FTD) is a clinically and pathologically heterogeneous syndrome. It can be classified into three clinical syndromes depending on the early and predominant symptoms: A behavioral variant FTD and two language variants namely, semantic dementia, and progressive nonfluent aphasia (PNFA) which are very rare and elude diagnosis. We report the case of an elderly homemaker who came to our institute with features of cognitive decline and behavioral problems with language deficits in the form of nonfluent speech, impaired vocabulary to three pairs of words, agrammatism, and impaired single sentence comprehension with corroborative magnetic resonance imaging findings. PNFA is a rare clinical variant of FTD and often underdiagnosed. It should be considered in elderly patients who apart from having cognitive decline, behavioral problems, and absent insight also develop limited vocabulary, especially using a set of nouns to express themselves. Speech therapy and behavioral therapy in the initial stages can be of utility

New onset psychosis as the first manifestation of neuro-psychiatric lupus. A situation causing diagnostic dilemma

First episode of psychosis can occur at any age and it can be primarily psychiatric or secondary to other occult diseases. It is of great therapeutic relevance to be cautious about organic etiology as early diagnosis can help in early initiation of disease modifying treatments. To study patients who presented with first episode of psychosis and later turned out to be due to lupus erythematosus with varying periods of delay. Details of patients who were considered as treatment unresponsive psychosis and later turned out to be due to vasculitis were entered in excel sheet and analyzed. The details of patients including neuropsychological features, apparent soft signs which were initially ignored, lab data and signs during follow-up were tabulated and warning signs analysed. All our patients were highly intelligent young females and there were stressors in all of them. They presented with panic, followed by psychotic symptoms which was resistant to regular psychiatric treatment and therefore possibility of organicity explored. All of them had history of transient symptoms referable to other systems which were treated as such and patients did not volunteer the same unless questioned. During follow-up full-fledged features of SLE came up in all patients. When a young female with no past or family history of mental illness presents with psychotic features, unprovoked panic, and limbic symptoms always ask for minor or transient symptoms and signs referable to the other systems which might give valuable clues

Self-mutilation in neurodegeneration with brain iron accumulation

Neurodegeneration with brain iron accumulation (NBIA) is the term applied to a heterogeneous group of disorders resulting in iron deposition in the basal ganglia. Well-known phenotypic features are progressive regression with extra pyramidal involvement and a variable course. A 10-year-old child born to consanguineous parents presented with progressive generalized opisthotonic dystonia, retrocollis, oromandibular dyskinesias, apraxia for swallowing, optic atrophy and severe self-mutilation of lips. MR imaging showed brain iron accumulation. Other causes of self-mutilation were excluded. Early infantile onset, ophisthotonic dystonia with oromandibular dyskinesias and characteristic MR images are suggestive of NBIA. There is only one case reported in the literature of self-mutilation in this condition

Psychoneuroimmunological mechanisms in pain management and healing: Illustrative case series

Background: Phantom pains with no painful lesion, war wounds which are painless, and spiritual practices such as fire walking are examples of painful stimuli and pleasurable experience. Why frontal leukotomy reduces pain and not parietal lobe are questions indicating it is not the sensations that hurts. Aim and Settings: The aim of the study was to discuss the course of illness of a series of exceptional patients. Patients and Methods: Exceptional patients who astonishingly handled their pain and healed themselves are described. The first patient, a woodcutter, carried his bowel in a bag for 4 months, the second patient had a large fungating tumor in breast, the third patient repaired his palatal cleft with paper and lived several years, and two swamijis who dissociated themselves from their malignancy. Results and Conclusions: The quality of life of these patients was excellent in spite of serious disorders which indicates “The doctor” within is the most powerful and cheapest healer