Functional neurological rehabilitation of a 68 year-old male with symptoms consistent with early-mid stage Alzheimer’s disease
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1
Southwest Brain Performance Centers, United States
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2
Life University, United States
Background:
A 68 year-old male with an incidence of heavy metal poisoning 10 years prior, presented to a functional neurology clinic having a chief complaint of short-term memory loss with concomitant “brain fog” and forgetfulness and depression. He also complained of back pain and intermittent, bilateral leg aches and numbness. The patient is concerned that his symptoms may be early onset Alzheimer’s disease.
Methods:
Manual muscle testing and subjectively rated strength tests were performed on some of the major muscle groups of the upper and/ or lower extremities. Reflex examinations of the biceps, triceps, brachioradialis, patellar, and Achilles tendons elicited normal responses. The plantar reflex elicited no response. Romberg’s test was negative but elicited immediate truncal ataxia. Finger-to-nose testing was positive and worse on patient’s left side than right, heel-to-toe tandem walking test was negative, and heel-to-shin testing revealed ataxic movements on the left. Normal amplitude throughout finger tapping test and normal amplitude for the open-closed fist tests were noted. While preforming a gait examination with dual tasking, bilateral arm swing showed greater than five hesitations and two freezes. Convergence testing revealed decreased right constriction and convergence with weakness of the right medial rectus muscle. Saccadic testing revealed dysmetric and hypometric saccades horizontally and vertically. The patient had a 75% accuracy failure bilaterally when doing anti-saccades. Optokinetic (OPK) testing created vertical compensatory head titubation (in a yes-yes direction). C3 Logix Graded Symptom Checklist (GSC) severity was a 44/138. Standard Assessment of Cognition (SAC) was scored 21/30. Trails A (TA) had a score of 33.6 seconds. Processing Speed (PS) score was 24/80. Choice Reaction Time (cRT) latency was 529 milliseconds. A five-day, multi-modal program of neurological rehabilitation was administered two to three times per day. Each session consisted of somatosensory evoked potential stimulation, pulsed electromagnetic field therapy, low level laser therapy and neuromuscular rehabilitation. Treatment also included the performance of gaze stabilization exercise, by keeping his eyes fixed on a target while shaking his head yes and no. This was done using the “Focus Builder” application saccade program. Three repetitions of three sets of this exercise were performed. Passive complex figure eight movements of the left upper and lower extremities moving in opposite directions were given. These movements were performed ten times each set for three sets. Three sets of supine vertical OPK stimulation was performed in an up, down, up sequence. A Neurosensory Integrator was used on the proactive setting. Somatosensory evoked potential simulations without recording electrodes were performed three times on the mandibular branch of the trigeminal nerve, bilaterally. Low level laser therapy using the Erchonia FX 635 was applied to increase Interleukin 10 (anti-inflammatory hormone), increase ATP production from the mitochondria, to increase blood flow and reduce inflammation of the involved areas. This therapy was performed for ten minutes on the frontal lobes, temporal lobes and cerebellum. Gait therapy was preformed such that the patient had to navigate around five obstacles while performing numerical computations by increments of the number three as a form of dual mental tasking. He was also instructed to make full left turns around the end obstacles, up and back ten times. Lastly, he received transcutaneous nerve stimulation using High Volt Galvanic at 3 microamperes to the tragus of the left ear for twenty five minutes.
Results:
At the end of five days of treatment there were measurable improvements of symptoms; Graded Symptom Checklist (GSC) severity decreased from 44 to 19. SAC score increased from 21 to 24, TA time increased from 33.6 to 37.6 seconds, PS score increased from 24 to 29, cRT latency increased from 529 to 562 milliseconds. Both the patient and his spouse stated improvements in remembering and carrying out daily activities/responsibilities as well as significant positive changes in mood and mental well-being. His back pain and leg numbness improved to a level that the patient was able to resume heavy lifting labor tasks. The patient’s weakest area that persisted after five days of treatment was his short term memory.
Conclusion:
Short duration, multi-modal, intensive programs of neurological rehabilitation may be a viable method to improve neurological integrity and performance in individuals with some symptoms consistent with early on-set Alzheimer’s Disease. Further research is suggested with these positive findings.
Keywords:
Alzheimer's disease,
Heavy Metal Poisoning, Nervous System,
brain fog,
chiropractic neurology,
Neurorehabilitation
Conference:
International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function, Orlando, United States, 7 Oct - 9 Oct, 2016.
Presentation Type:
Poster Presentation
Topic:
Abstracts ISCN 2016
Citation:
Pendleton
MA,
Pratt
E and
Esposito
SE
(2016). Functional neurological rehabilitation of a 68 year-old male with symptoms consistent with early-mid stage Alzheimer’s disease.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function.
doi: 10.3389/conf.fneur.2016.59.00043
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Received:
29 Aug 2016;
Published Online:
07 Sep 2016.
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Correspondence:
Dr. Susan E Esposito, Life University, Marietta, United States, susanesposito@gmail.com