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Remember the lakes and streams representing the nervous system? Well the vascular system (arteries and veins) is like a bunch of hoses. The biggest hoses are closest to the heart and taper smaller as they proceed farther from the heart. Normally, the blood flows through the hose unimpeded. But, like with your garden hoses, certain conditions can cause the flow to change. Hypertension (HTN) occurs when the hoses are constricted more than necessary. That restriction causes the heart to have to beat harder and will eventually cause heart muscle changes and could lead to a stroke (CVA).
At times, the hose lumen (artery) is narrowed due to plaque buildup. That build up causes arteriosclerosis or atherosclerosis, big words for plaque buildup. This is the reason the AMA highly recommends lipid management, both through the use of a statin medication and dietary modification. There are two main types of stroke: ischemic, due to a lack of oxygen, and the most common; and hemorrhagic (bleeding in the brain). If there is a buildup in the hose, there is a risk of part of that plaque breaking off, traveling through the vessel, and clogging elsewhere. If that situation occurs in the brain, the end result is an ischemic or embolic stroke (CVA). The brain suffers from lack of oxygen in that specific area. The symptoms will indicate where the ischemic area is located in the brain. Each hemisphere of the brain controls the opposite side of the body, so if there is weakness on the right side, it is due to a L sided stroke (and conversely). If the ischemia occurs in the area of speech, speech will be garbled, slurred or non-existent. A severe stroke may leave “residual” damage, that is, deficits that remain long after rehab has concluded. A mild stroke with very little damage will result in a complete recovery. Understandably, a stroke that seriously affects the dominant hand will have a more difficult and probably longer rehabilitation. Residual damage will of course affect activities of daily living, and even cognition so will ultimately decrease the life expectancy. The second type of stroke is from a leak in the hose. The leak can be caused by chronic HTN weakening the artery, aneurysm (weakness or bubble in the hose), and bleeding disorders, to name a few. Hemorrhagic strokes are more serious, as in addition to the area of ischemia, the excess blood in the brain will have to be evacuated either through surgery or resorbed by the body (slow process). Again, recovery depends on amount of damage done and the location of the bleeding. A “mini-stroke” is termed transient ischemic attack (TIA). A temporary block of blood flow occurs without permanent damage. Symptoms may include numbness, tingling, weakness, speech or vision difficulty, and/or difficulty understanding others. As the damage is not permanent, the TIA does not show on imaging. Symptoms typically resolve within 24 hours. The takeaway for you, your family and your business: surviving a severe stroke results in a complete lifestyle change and permanent impairments; minor strokes and TIAs are survivable and should require lifestyle modification (diet, stress, etc).
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The definition of dementia: a group of thinking and social symptoms that interferes with daily functioning. Memory loss is at the forefront of symptoms. There are several kinds of dementia, but the most common in Life Settlements includes frontotemporal dementia and ALZ. ALZ causes about 60-80% of dementia cases. Both are caused by damage to brain cells and affect communication, thinking, behavior and feelings. ALZ is currently felt to result from deposits of amyloid material (proteins), disrupting the brain signals. Some of the earliest symptoms are getting lost while driving in familiar places and loss of the ability to keep track of complex matters such as finances. Later stages report the loss of understanding in using everyday items such as cell phones, microwaves, and the remote controller. New information becomes difficult to retain and in late stages, impossible to retain.
Medical doctors utilize simple in office screening such as the MMSE (mini-mental state examination), SLUMS (St. Louis university mental status exam) and MoCA (Montreal cognitive assessment). Each test asks the patient to do specific tasks, such as word recall, two stage commands, spelling a word or counting backwards or serial counting, and often drawing a clock. These tests are helpful in discerning loss of cognitive function, but not always accurate on indicating the severity of loss. Neuropsychological evaluation can accurately identify dementia versus ALZ type dementia, or the likelihood of development. Treatment centers around safety and security; medication and brain exercises (puzzles, games, etc) are often helpful. Mild cognitive impairment demonstrates forgetfulness that does not interfere with ADLs. Per the Mayo clinic website, it is the stage between the expected cognitive decline of normal aging and the more serious decline of dementia. Forgetfulness, word finding delays, focus problems, struggle with complex tasks (bill paying) are common symptoms. Mild cognitive impairment may or may not progress to a more serious impairment. Depression may contribute to both dementia and mild cognitive impairment. Facts found on the alzheimers.net website indicate ALZ is the sixth leading cause of death in the states. It is estimated 1 in 10 persons over age 65 has ALZ. Shockingly 1 in 3 seniors will die of some sort of dementia. There was an increase of ALZ deaths between 2000 and 2014 by a staggering 89%. ALZ and dementia are not going away, they will continue to increase and contribute a large part in the Life Settlement Industry. 5/5/2020 1 Comment Streams and RiversThe central nervous system (CNS) consists of the brain and the spinal cord. If the cardiac system is like a car, the central nervous system is like a mountain lake with lots of run-off rivers and streams. The CNS runs the body, voluntarily like when we take in a deep breath and involuntarily, like how we breathe while we are sleeping, or how respiration continues during loss of consciousness. There are 12 cranial nerves, designated as CN with a Roman numeral listed to depict the specific nerve. They are the rivers that extend from the base of the brain (midbrain, pons, medulla). These nerves connect the brain to the eyes, mouth, ears and other parts of the head, providing motor, as in movement of the eyes and tongue (CNIII, IV, VI), sensory as in smelling (CNI), or a combination of both motor: for chewing and sensory for the sensations in the face (CNV). Trigeminal neuralgia is a chronic condition causing intense pain in the face often stimulated by chewing; it is a disorder of CNV. Bell’s Palsy is a painless distortion of the face due to CNVII involvement.
There are many more CNS disorders than the two mentioned above. As the rivers and streams travel away from the brain and spinal cord, the flow of water (nerve conduction) may be obstructed. The decrease in the flow may be progressive, caused by a loss of structure or function of nerve cells, and therefore, degenerative. Motor neuron disease is one type of disruption, and as you may have guessed, it involves motor function. The neurons (nerve cells) generate and die and slowly the muscles become weaker, eventually leading to paralysis. These diseases are incurable and most often affect the older population. Amyotrophic lateral sclerosis or Lou Gehrig’s disease (ALS, 2 in 100k) and Parkinson’s disease (1,900 in 100k (>80 yrs)) are in this category. ALS is the most common lower motor neuron disease. Progressive and degenerative, ALS will lead to respiratory failure (due to paralysis) and require ventilatory support. The ALS Association lists average survival times at three years, with 5-year survival at 20%, 10-year at 10% and 5% will live 20 years or longer. Longevity will depend on the speed of disease progression. Atypical cases generally have slower disease progression and thus longer life expectancy. Many of the cases I have seen through Life Settlements have a slower progression. Parkinson's disease often begins with a tremor, evidencing loss of motor control. Characteristic progression includes lack of facial expression (flat affect), slowness, and balance problems with frequent falls. Dementia may also occur. Ultimately, the disease will leave a person confined to a wheelchair or bed bound. Treatment consists of medications and at times brain stimulator implants. Longevity depends on the rate of progression and treatment response. Slow progression can occur over twenty plus years. |
AuthorRita Loy, Managing Director and Chief Underwriter here at Polaris Underwriting Technologies. Archives
August 2020
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