September 30, 2016
Mini Medical School is back in session this fall semester. The University of Alabama College of Community Health Sciences kicked off its second semester of the lecture series for UA’s OLLI program that has been put on by faculty and resident physicians at CCHS. Mini Medical School lets adults and community learners explore trends in medicine and health, and the lectures by CCHS faculty and residents provide information about issues and advances in medicine and research. OLLI, short for Osher Lifelong Learning Institute, is a member-led program catering to those aged 50 years and older and offers education courses as well as field trips, socials, special events and travel. Parkinsonism — Dr. Catherine Ikard Many people think of Parkinson’s disease as a single disorder, but it is actually more complicated than that, said Dr. Catherine Ikard, a neurologist at University Medical Center and assistant professor of Internal Medicine and Psychiatry and Behavioral Health for the College. Parkinsonism is a syndrome characterized by decreased movement and is associated with tremors and a loss of balance, Ikard said at her lecture, titled “Parkinsonism and Parkinson’s Disease,” which she presented as part of the Mini Medical School series on Sept. 15. Parkinsonism can appear in an array of disorders, some even as a result of repeated head trauma or medication, but the most common one—the one most people refer to when they think of Parkinson’s Disease—is Idiopathic Parkinson’s Disease. Idiopathic Parkinson’s Disease is the progressive loss of dopamine-producing cells in the brain. The disease is slow and degenerative. “We don’t know why this happens,” Ikard said. There are motor symptoms, which include shaking, smaller and slower movements, becoming stiff and losing balance more easily. Motor symptoms usually start on one side of the body. Tremors can worsen when the patient is at rest, and they are suppressible by concentration. Non-motor symptoms include affective disorders, such as depression, orthostatic hypotension (when blood pressure falls significantly when standing up too quickly), memory impairment, fatigue, constipation and sleep disturbances. There is no test for Idiopathic Parkinson’s Disease, Ikard said. The diagnosis is clinical. “We often have to watch a tremor over time—months, sometimes years,” Ikard said. Medication and therapy can help treat symptoms, Ikard said. The most common medication is Levodopa, and physical and speech therapy can help improve lifestyle. “I cannot emphasize enough how important therapy is for patients with Parkinsonism,” said Ikard. Exercise improves symptoms, too, she said. There are clues that the disorder might not be traditional Idiopathic Parkinson’s Disease, Ikard said. Some of these include: rapid progression of the disease, absence of tremors, frequent falls early in the disease, abnormal eye movement and poor response to Levodopa. If that is the case, the Parkinsonism could be tied to another disorder. Grandchildren and ADHD — Dr. Brian Gannon Children are very active from the ages of 2 to 5, but that busyness should decrease over time, said Dr. Brian Gannon, a pediatrician at University Medical Center and an assistant professor of Pediatrics for the College. But as children get older and if they are easily distracted, can’t stick with a task for a reasonable amount of time and their activity level is not appropriate for their age, they could suffer from ADHD, or attention deficit hyperactivity disorder. “ADHD is defined as an activity level that is inappropriate for age, that interferes with school work, that causes trouble in dealing with adults,” Gannon said during a lecture on Sept. 22, titled “Grandparents and ADHD.” Gannon said about 5 percent of the general population in the US qualifies for an ADHD diagnosis. He said sometimes the markers of what appears to be ADHD are actually caused by other medical issues. He said hearing, vision and speech problems can cause some of the same symptoms of ADHD, as can developmental delays, autism and sensory processing disorder. “We want to look at medical issues because they may cause similar issues to ADHD,” Gannon said. A child’s living situation – unstable home environment, varying and inconsistent rules and food insecurity – is also a factor. “My job as a physician is to advocate for the child and help parents problem solve. We don’t want to just throw medicine at a child.” Gannon said medication can help and should be part of efforts to manage ADHD, but is only part of the answer. “Children still need to follow the rules, and do their work. With medication, they can do it without your help.” Geriatric Depression — Dr. John Burkhardt Older adults are at risk for depression. One reason: The more medical burdens one has, the higher the risk of depression, said Dr. John Burkhardt, a clinical psychologist with University Medical Center-Northport. “Chronic pain conditions can be managed, but you never get a break from them. Heart problems can precipitate depressive episodes, and then you have to eat differently, go to physical therapy and deal with a chronic condition. What does that do to your mood?” said Burkhardt, also an assistant professor of Psychiatry and Behavioral medicine for UA’s College of Community Health Sciences, which operates UMC-Northport. His remarks came in a lecture titled “Geriatric Depression” that he provided on Sept. 29 as part of the Mini Medical School lecture series. Burkhardt said changes in previous functioning, pain and sleep disruption, significant weight gain or loss, a loss of interest in activities, a sad and depressed mood, a feeling of being a burden – and if those conditions and feelings go on for two weeks or more – could signal possible depression. “A lot of people go through sad times. But when it starts to impact your functioning, that could be depression.” With older couples, depression can also be “contagious,” Burkhardt said. “If one spouse is depressed, the other spouse is at an increased risk of depression.” Late-life depression, which happens after the age of 60, can carry added risk because it can transition to dementia, Burkhardt said. He stressed that depression needs to be treated, particularly in the elderly, who might not seek care because of an associated perceived stigma. He noted that suicide is the 17th leading cause of death in those aged 65 and older. “When you’re depressed, you’re not good at coping with your physical conditions. Depression impacts the person who is experiencing it, and their families. Who wants to visit people when they aren’t happy? Then they’re alone.” Burkhardt recommended that people watch for changes in behavior, thoughts, appetite, sleep and whether they lose interest in activities once important to them. “See a provider if you suspect depression. Don’t let stigma keep you from getting help. Don’t isolate yourself. Be social, stay active and have a daily structure.”
