Music can benefit those with Alzheimer’s

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The number of Alzheimer’s patients in India will triple by 2050

New Delhi, 30th May 2018: A study conducted by researchers at the University of Utah Health have come up with the theory that music-based treatments could be used to alleviate anxiety in patients with dementia. Music may help tap into the salience network of the brain that is still relatively functioning. The need of the hour is to create awareness on alternative treatment for Alzheimer’s.

Music activates the brain, causing whole regions to communicate. By listening to the personal soundtrack, the visual network, the salience network, the executive network and the cerebellar and corticocerebellar network pairs all showed significantly higher functional connectivity.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, President, Heart Care Foundation of India, said, “Alzheimer’s causes severe memory recall issues, and progressive damage to their brains impairing other cognitive functions as well. This can lead to a state of anxiety and disorientation in many people but listening to music can prove beneficial. Music can relieve stress, reduce anxiety and depression, and reduce agitation. Apart from aiding memory in those with Alzheimer’s, music can also benefit caregivers by reducing their anxiety and distress. It helps lighten the mood and provides a way to connect with loved ones who have Alzheimer’s disease by easing communication. Music is like an anchor, grounding the patient back in reality.”

India has an ever-growing elderly population, out of which 1.6 million are suffering from Alzheimer’s. This number is only expected to triple by 2050.

Adding further, Dr Aggarwal, who is also the Group Editor of IJCP, said, “It is important that you engage in regular mentally stimulating activities to keep those brain cells up and running. This is particularly beneficial for those who have crossed their 40s. Try doing light brain stimulating tasks like crossword puzzles, quizzes, daily reading or anything similar that interests you. For older individuals, it is advised that they engage their mental reserves through social engagement and exercise.”

Some tips from HCFI

Maintain a healthy weight. Check your waistline.
Eat mindfully. Emphasize colorful, vitamin–packed vegetables and fruits; whole grains; fish, lean poultry, tofu, and beans and other legumes as protein sources plus healthy fats. Cut down on unnecessary calories from sweets, sodas, refined grains like white bread or white rice, unhealthy fats, fried and fast foods, and mindless snacking. Keep a close eye on portion sizes, too.
Exercise regularly. Aim for 2½ to 5 hours weekly of brisk walking (at 4 mph). Or try a vigorous exercise like jogging (at 6 mph) for half that time.
Keep an eye on important health numbers. In addition to watching your weight and waistline, keep a watch on your cholesterol, triglycerides, blood pressure, and blood sugar numbers.
Earlier clinical trials reported in up to date have found that exposing patients to music for 15 to 20 minutes prior to and/or during a procedure reduces anxiety levels in samples of patients undergoing various procedures like colposcopy, cystoscopy and gastrointestinal; cesarean delivery; mastectomy; port catheter placement, day surgery, flexible cystoscopy; and hysteroscopy.
An observational trial in patients awaiting surgery found that patients’ subjective reports of decreased anxiety were consistent with heart rate variability, an objective marker of anxiety.
Music did not show a benefit during endoscopy in a trial of patients under conscious sedation.

WHO Priority Diseases: Lassa fever

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As I had mentioned yesterday in this column, we will be covering about the priority diseases as revised by the World Health Organization (WHO). The first to be covered is Lassa fever.

Here are some salient facts about Lassa fever.

Lassa fever is an acute viral hemorrhagic illness caused by Lassa virus, a member of the Arenavirusfamily of viruses.
Lassa virus is endemic in Benin, Ghana, Guinea, Liberia, Mali, Sierra Leone, and Nigeria and other countries in West Africa.
It is a zoonotic disease. Rodents (multimammate rats) are the animal reservoirs and shed the virus in their urine and feces.
Humans acquire the infection from contact with infected rodents through rodent urine or feces, inhalation of aerosolized rodent excretions, or consumption of infected rodents as a food source.
Person-to-person transmission can occur through direct contact with infectious body fluids (e. g., blood, urine, pharyngeal secretions, vomitus, or other body secretions), unprotected contact with potentially infectious material (e.g., touching vomitus) and mucosal exposure from splashes of body fluids.
Infection does not spread via casual contact such as hugging, shaking hands, or sitting near someone.
Persons with Lassa fever infection are not believed to be contagious prior to symptom onset.
The incubation period of Lassa fever is about 10 days (range 6-21 days).
Clinical picture: Gradual onset of symptoms in most patients. Symptoms are mild to begin with viz. low-grade fever, general weakness, malaise and so may be ignored. These are followed by headache, sore throat, muscle pain, chest pain, nausea, vomiting, diarrhea, cough, and abdominal pain. In severe disease, facial swelling, fluid in the lung cavity, bleeding from the mouth, nose, vagina or gastrointestinal tract and low blood pressure are present. Later stage may be characterized by shock, seizures, tremor, disorientation and coma.
In fatal cases, death usually occurs within 14 days on onset of illness.
The most common complication of Lassa fever is deafness, which may occur following either mild or severe illness.
Lassa fever is difficult to distinguish from other febrile illnesses, including malaria, shigellosis, typhoid fever, yellow fever and other viral hemorrhagic fevers.
The overall case-fatality rate is 1%, while in hospitalized patients, the case-fatality rate is 15%.
Diagnosis is usually supported by a relevant history of exposure along with suggestive signs and symptoms.
Confirmatory test: ELISA to detect IgM and IgG antibodis and Lassa antigen. Serum IgM is detectable 10 to 21 days after symptom onset; serum IgG is detectable approximately 21 days after symptom onset. Serum reverse-transcription polymerase chain reaction is the preferred diagnostic tool but is expensive and requires technical expertise.
Early supportive care with rehydration and symptomatic treatment improves survival
Treatment in confirmed cases: IV ribavirin (Grade 1B); ribavirin may be administered orally, if IV ribavirin is not available.
o IV ribavirin: 30 mg/kg (maximum 2 g) loading dose followed by 15 mg/kg (1 g max) IV 4-6 hourly x 4 days, followed by 7.5 mg/kg IV (500 mg max) 8 hourly x 6 days

o Oral ribavirin: 35 mg/kg (2.5 g max), followed by 15 mg/kg (1 g max) orally 6 hourly x 4 days, followed by 15 mg/kg (1 g max) 8 hourly x 6 days

o Avoiding rodents (multimammate rats).

o Consider all patients as infectious even if signs and symptoms are mild.

o All standard, contact, and droplet precautions as well as correct use of appropriate personal protective equipment should be strictly adhered to.

o Blood and body fluid specimens from patients with suspected Lassa fever infection should be considered highly infectious. Caution should be exercised when handling such material.

o Postexposure prophylaxis with oral ribavirin for contacts with known or suspected Lassa fever infection with risk factors for transmission such as penetrating needle stick injury, exposure of mucous membranes or broken skin to blood or body fluids, and participation in procedures involving exposure to bodily fluids or respiratory secretions without use of personal protective equipment.

There is currently no vaccine that protects against Lassa fever
(Source: Uptodate, WHO)

Dr KK Aggarwal

Padma Shri AwardeeVice President CMAAOGroup Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA