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Delirium is an under-reported condition that may affect up to 56% of older individuals after surgery, patients that have been heavily sedated for a length of time, burn, cancer, and patients on ventilators for long periods. Patients experience vivid hallucinations that may be part of a vicious cycle if doctors attempt to control the delusions with larger amounts of sedatives; the medications may disorient and confuse the patient even more.

The delusions and accompanying cognitive issues can persist for months after patients leave the hospital and can lead to a misdiagnosis of dementia, rather than delirium. [Dementia develops gradually and gradually worsens, while delirium may be of sudden onset.]

Delirium is associated with excessive inflammation in the brain resulting from triggering specialized immune cells the microglia. If stimulated over a long time, the cells release inflammatory cytokines, molecules that damage nerve cells and contribute to damage and break down of the capillaries in the brain, the blood-brain barrier.

C-reactive protein, CRP, is one measure of inflammation. CRP levels were measured in elderly surgical patients who had ended up with complications such as delirium, cardiovascular issues, or infection. The levels of CRP in their blood were predictive as to how fully they recovered.

A recent study measured the levels of 12 different inflammatory and anti-inflammatory cytokines in older patients undergoing surgery. Those having episodes of delirium had consistently high levels of inflammatory cytokines as compared to patients that did not have high levels of cytokines. Similar results were seen in patients that developed delirium after procedures such as open-heart surgery and hip fracture repair.

Conclusion

In order for the body to heal after it is hurt, or to fight an infection successfully, a delicate balance of cytokines, immune messages are required. Too little of an inflammatory response and the individual may not survive an infection. Too much of an inflammatory response and healthy tissue is destroyed. Homeostasis, balance, is what the body strives for every moment.

Dr. Hellen would be pleased to provide guidance to helping enhance your quality of life.  She may be contacted by using this form or at: 302.265.3870 (ET, USA).

 

www.theatlantic.com/health/archive/2015/06/the-overlooked-danger-of-delirium-in-hospitals/394829/
www.mayoclinic.org/diseases-conditions/delirium/basics/definition/con-20033982
www.ncbi.nlm.nih.gov/pmc/articles/PMC2911011
intl-biomedgerontology.oxfordjournals.org/content/early/2015/07/24/gerona.glv083.full
www.sciencedirect.com/science/article/pii/S2210833511000773
www.ncbi.nlm.nih.gov/pubmed/17504139

 

 

The brain, being the “control center” of the body is cushioned by fluid, and is protected by bone and layers of membranes that support blood vessels that feed the brain.

Concussions
Direct or indirect mechanical impact to the brain may result from sports activities or workplace accidents. These may result in trauma to the brain. Rapid acceleration or deceleration, e.g., motor vehicle accidents or intense changes in pressure, e.g., blast exposures can also lead to brain damage.

The term “concussion” is commonly used to refer to a brain injury resulting from the head being hit with a great deal of force. Shaking the upper body and head violently can also cause brain damage.

Concussions alter the way the brain functions. The effects are usually short-lived, but may include being dazed, headaches, and problems with concentration, memory, balance, and coordination.

Brain injuries may result in loss of consciousness, but since the majority of cases do not end in “blackouts”, concussions often occur without the individual realizing they have had damage. The impact may seem relatively mild, and the individual may appear only to be dazed and with time and rest they may heal properly.

Serious untreated concussions can result in long-term brain damage and may even end in death.
Repetitive head injuries are a major issue especially when an individual sustains additional head injuries before the damage from the prior injury has been completely resolved.

The effects are cumulative. Cumulative sports concussions increase the likelihood of permanent neurologic disability. Complete recovery from an initial trauma can take from 6-18 months, and multiple concussions over time may result in long-term problems, including neurological deterioration, dementia-like symptoms, memory disturbances, behavioral, and personality changes, Parkinsonism, and speech and gait abnormalities.

In a minority of cases, additional trauma to the brain, even occurring from days to weeks following a prior event, can lead to collapse and death within minutes.

How quickly and completely one heals, depends on a number of factors including one’s genetic makeup. (This would be expected since genes determine a cell’s ability to withstand mechanical stress, regenerate, and heal.)

Inflammation and Concussions
For years it was thought that the membranes around the brain acted as a blood-brain barrier which stopped the brain from responding with inflammatory responses when it was confronted by infection. However, it has now been shown that concussions and other brain injuries, or infection or disease, will trigger inflammatory responses.

The types of immune cells found throughout the body are also found in the brain, but additionally, the brain has unique immune cells. When activated, brain-specific microglia and astrocytes, produce inflammatory cytokines that remain localized in the brain.

In response to brain injury, the immune system releases a tidal wave of pro- and anti-inflammatory cytokines, molecules that trigger and/or stop an inflammatory response depending on what is needed.

In small amounts, these cytokines help protect the brain and heal it. However, prolonged exposure to inflammatory cytokines, or too high a level of these proteins, will result in damage that accumulates after injury. High levels of inflammatory cytokines are localized at the injury site, and may be found on the opposite side of the head from the side that was hit.

There is increasing evidence suggesting that much of the neurological damage that occurs after the brain is injured is the result of a delayed inflammatory response that lasts hours, days, or even for months after the injury. This chronic inflammatory response may cause more damage to the brain tissue than the mechanical impact itself.

Immune Homeostasis, Immune Balance is the Key
Unfortunately, pharmaceutical treatments known to reduce inflammation appear to interfere with the brain’s natural repair mechanisms. Therefore it is necessary for the body to control its inflammatory responses. It has to produce enough of a response to help brain tissue heal, but not an overly exaggerated inflammatory response which may cause more damage after injury.

In order for the brain to heal after trauma, the immune system must generate the proper balance, and types, of pro-inflammatory and inflammatory cytokines. For those with brain injuries, maintaining immune homeostasis, immune balance, may be the best way to minimize damage.

 

Dr. Hellen is available at 302.265.3870 for discussion on the role of inflammation and immune homeostasis in our health.  She may be contacted at: drhellen@drhellengreenblatt.info, or use the contact form.  Thank you.

emedicine.medscape.com/article/92189-overview#a0107
www.ncbi.nlm.nih.gov/pmc/articles/PMC2945234/
emedicine.medscape.com/article/92189-overview
www.headcasecompany.com/concussion_info/stats_on_concussions_sports
www.ncbi.nlm.nih.gov/pmc/articles/PMC3520152/

 

When I ask people for their typical dietary intake, many people “shamefully” tell me that they drink coffee.  It  surprises them when I ask “what is wrong with that”?  Coffee is a healthy addition to one’s diet because it can help the body regulate its  immune inflammatory responses.

Studies have shown that coffee consumption reduces the risk of conditions such as diabetes, neurological diseases, cardiovascular disease, certain cancers, depression,and back and neck pain to mention a few.

 Diabetes
Phytonutrients, plant compounds, other than caffeine, found in coffee, are reported to reduce blood sugar levels, and decrease the way the body stores carbohydrates and fats.  Data from over 450,000 people found that every additional cup per day of caffeinated or decaffeinated coffee lowers the risk of diabetes by 5 to 10%.  Heavy consumers of coffee, 12 cups/day, have a 67%  lower risk of getting diabetes.  The effect is not due to the caffeine found in coffee, but to other compounds in coffee.

 Parkinson’s Disease
In Parkinson’s disease, caffeinated coffee may protect nerve cells from destruction, decrease the incidence of Parkinson’s, and the improve mobility of individuals with Parkinson’s disease. In the case of Parkinson’s, the caffeine in coffee is the “magic ingredient”, since decaffeinated coffee does not have the same affect.  Women with Parkinson’s Disease, that were on hormonal replacement therapy, showed less benefit from coffee.  

Alzheimer’s and Dementia
As mentioned above, caffeine may help the body protect nerve cells. Consuming caffeinated coffee over a long period appears to decrease the risk of dementia or Alzheimer’s.

Heart Disease
In other studies, although coffee may raise blood pressure for a brief time, after two months of daily coffee consumption, blood pressure is reduced. It also lowers the risk of heart disease and reduces stroke incidents.

Cancer
Drinking one cup of coffee a day has been associated with a 42% lower risk of liver cancer.  Women that drank two or more cups of coffee per day had a delayed onset of a hard-to-treat cancer.  Individuals drinking three cups of coffee a day had a 40% lower risk of developing pharyngeal, esophageal, and oral cancers. Men who drank over six cups of caffeinated or non-caffeinated coffee a da,y had an 18% lower risk of prostate cancer, and a 40% lower risk of aggressive prostate cancer. Individuals that were heavy coffee drinkers had a 30% lower risk of colorectal cancer.

 Depression
A study of over 50,000 women, found that 4 cups of coffee daily lowered their risk of depression by 20%.

Coffee and Pain Responses
Subjects who consume coffee while working at the computer, report less pain in their back and necks than those that abstain from drinking coffee

Inflammatory Responses  and Coffee:
Regular coffee consumption affects the production of cytokines, such as IL-1 and IL-10 that regulate immune inflammatory responses. The data suggests that the benefits of coffee consumption are due to the phytonutrients, plant nutrients, and caffeine found in coffee. The adage that “coffee is not good for you”, should be re-examined.

 

Reach out to Dr. Hellen Greenblatt for simple steps to help the body balance inflammatory responses. 


http://www.lef.org/magazine/mag2012/jan2012_Discovering-Coffees-Unique-Health-Benefits_02.htm
http://www.ncbi.nlm.nih.gov/pubmed/22955949
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Alzheimer’s and IVIG Rx
Last week John Gever, Senior Editor, MedPage Today brought attention to the results of a small study presented at the 2012 Alzheimer’s Association International Conference held in Vancouver, British Columbia.  In this study, patients with mild to moderate Alzheimer’s were given antibody preparations, immunoglobulin preparations, which were obtained by pooling plasma from numerous blood donors.  This sterile, medical product, IVIG, intravenous immunoglobulin, consists mostly of immunoglobulins, antibodies,  and is administered intravenously (IV). 

After receiving IVIG twice a month for three years, patient’s ‘ ability to function or think, their mood, or memory did not worsen over the three years. [Untreated Alzheimer’s disease patients typically show measurable declines in 3 to 6 months.]

The FDA, The U.S. Food and Drug Administration, has approved the use of IVIG for only six conditions.  However, it has been used “off-label”, to try and treat about 50 other conditions, including infectious diseases, a wide-range of autoimmune conditions, organ transplant and cancer patients, blood, and neurological conditions to mention a few.

When practitioners are asked how s/he thinks IVIG works, the response is typically, except for infectious diseases, “we are not sure”.

 IVIG Contains Immunoglobulins and Smaller Immune Factors
IVIG contains antibodies to organisms such as streptococcus, hepatitis, measles, polio, etc., that can specifically neutralize infectious agents.  Other immunoglobulins may be directed  against specific immunological factors. 

However, viewing reported results in chronically ill populations, I have always been of the opinion that IVIG also contains cytokines, or cytokine-like immune molecules, with potent immune system-modulating properties, which help the body return to immune homeostasis, immune balance. 

 I suggest that the reason that Alzheimer’s patients receiving IVIG saw a stabilization of their symptoms, is that IVIG limited inflammatory responses and thus slowed the progression of disease.

 Alzheimer’s and Inflammatory Cytokine Levels
This supposition is further supported by the fact that animal models suggest that excessive production of inflammatory cytokines, inflammatory messages, are implicated in Alzheimer’s disease. These animals have a condition similar to human Alzheimer’s, and also have higher levels of inflammatory cytokines in their blood.  When a drug was administered that inhibited the cytokines, there was less damage to nerve cells and neurological outcomes in the animals improved.  

 The scientists suggest that blocking production of high amounts of inflammatory cytokines may be beneficial for any number of brain conditions, such as “Alzheimer’s and Parkinson’s disease, multiple sclerosis (MS), motor neurone disease, frontotemporal dementia, and complications from traumatic brain injury.” (1)

 Immune Homeostasis, Immune Balance the Key to Health
Thus improvements, or at least delay in the onset of Alzheimer’s, or other brain –associated conditions, may be associated with the body achieving immune homeostasis.  A body in inflammatory balance controls the immune system’s  inappropriate inflammatory responses which otherwise may lead to damage of bystander tissues.

Feel free to contact Dr. Hellen at DrHellen@DrHellenGreenblatt.info with questions or to consult with her. A message may also be left at: 1.302-265.3870 or click on: http://drhellengreenblatt.info/contact-dr-hellen/.

 


www.medpagetoday.com/MeetingCoverage/AAIC/33780
http://emedicine.medscape.com/article/210367-overview#aw2aab6b3
www.alz.org/aaic/tues_1030amct_ivig_trial.asp
www.jneurosci.org/content/32/30/10201.abstract?sid=349221d1-e12f-411a-80a6-80285ed5db54
www.ncbi.nlm.nih.gov/pubmed/22806462

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