CLINICAL NUTRITION AND MULTIMODAL NEUROREHABILITATION PROGRAM IMPROVE SYMPTOMS OF PRIMARY PROGRESSIVE APHASIA IN 61 YEAR OLD WOMAN
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1
Carrick Institute, United States
Background:
A 61-year-old female presented by her spouse for evaluation of symptoms due to chief diagnosis of primary progressive aphasia. The patient had "decreased speech fluency." She was unable to find words during conversation, had difficulty making decisions or making plans, and had difficulty doing math and paying bills. Sometimes she would appear slow and forget what came next in a sequence (ex. putting the leash on the dog before taking it out to walk). Symptoms began 4 years prior to presentation. Two years prior to presentation she stopped working due to memory lapses and difficulty finding words. She began having headaches and experiencing faster decline in her speech and memory. MRI showed atrophy of the left frontal lobe. She was finally diagnosed two months before presentation with Progressive Primary Aphasia.
At presentation she was taking a variety of supplements.
Methods:
Neurological examination revealed a score of 5 on the Montreal Cognitive Assessment (MoCA) version 7.1. She demonstrated some aspects of receptive aphasia and apraxia. Gait analysis showed freezing when she attempted to dual-task by saying the months of the year in reverse order. Fist-making and finger-tapping tests from the Unified Parkinson's Disease Rating Scale (UPDRS) were normal unless she was asked to dual-task at the same time, in which case she would freeze. Pursuits at bedside showed consistent large intrusion from left to right at about 5 degrees to the left of midline. Saccadometry revealed slower and more latent rightward saccades, as well as hypermetria to the left and hypometria to the right. She demonstrated significant apraxia with vertical vs. horizontal visually guided saccades. Cerebellar function tests were normal.
Blood chemistry was unremarkable except for elevated Sodium (146), LDH (235), Cholesterol (248), LDL (112)
clinically significantly high ferritin (126 ng/ml), clinically significantly low Vitamin D (39.1)
Initially, her treatment plan included intermittent fasting (up to 18 hours of uninterrupted fasting per day) as well as therapeutic amounts of turmeric, resveratrol and vitamin D. After two weeks of this treatment, the patient began more initiative, as evidenced by deciding spontaneously to set up and decorate their Christmas tree.
Three weeks later, she was enrolled in a four day multimodal rehabilitation program consisting of Interactive Metronome® training, gaze stabilization activities--both active and reinforced with head movements, non-linear complex movements of the right arm, saccade and pursuit exercises for the left hemisphere, and the FitLight® trainer.
She continued the Intermittent Fasting and supplement protocol.
Results:
Two weeks after the conclusion of the four day program, her spouse reported that the patient was able to engage fully in conversation with a friend, and had been completing an extensive to-do list on a daily basis (cleaning, journal writing, playing piano). Re-examination showed moderate improvement in her oculomotor apraxia, ability to dual-task, as well as in improvement in her Interactive Metronome millisecond average scores, despite the fact that the patient had not trained in two weeks. Her score on the MocA version 7.2 was an 8.
Four weeks later, the patient's spouse reported that the patient had spontaneously decided to drive to the drugstore to buy chocolates for Valentine's Day. The patient had also begun to take short drives again in her car for the first time in several months. Her spouse also reported that the patient decided unprompted to grocery shopping and the outing was successful.
On re-examination, she displayed no oculomotor apraxia but still had some difficulty with direct verbal examination. Again, her Interactive Metronome millisecond average scores improved over previous despite her not having trained at all in the intervening weeks.
She was directed to continue the Intermittent Fasting and supplement protocol. Additional rehabilitation using the same modalities was recommended. The MoCA version 7.3 will be administered again for objective assessment.
Conclusion:
The author suggests further investigation into the use of clinical nutrition combined with multimodal neurorehabilitation in treatment of patients with Primary Progressive Aphasia.
Keywords:
primary progressive aphasia,
Neurorehabilitation,
intermittent fasting,
turmeric,
resveratrol,
Vitamin D
Conference:
International Symposium on Clinical Neuroscience 2018, Orlando, Florida, United States, 24 May - 26 May, 2018.
Presentation Type:
Poster
Topic:
Clinical Applications in health, disease, and injury to the nervous system
Citation:
Clark
DJ
(2018). CLINICAL NUTRITION AND MULTIMODAL NEUROREHABILITATION PROGRAM IMPROVE SYMPTOMS OF PRIMARY PROGRESSIVE APHASIA IN 61 YEAR OLD WOMAN.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience 2018.
doi: 10.3389/conf.fneur.2018.60.00008
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Received:
24 Feb 2018;
Published Online:
14 Dec 2018.
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Correspondence:
Dr. David J Clark, Carrick Institute, Cape Canaveral, United States, mail@doctordavidclark.com