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Neck manipulation and stroke ... electrolyte imbalance ... apathy--sign of brain disease?

Q I have heard that manipulation of the neck by a chiropractor or osteopathic doctor might trigger a stroke. Is this true?

A The American Heart Association (AHA) seems to think so. The AHA issued a scientific statement warning about an association between chiropractic manipulation of the neck and heightened risk of stroke in the Aug. 7, 2014 online issue of Stroke. The statement was based on four large studies that have found a link between neck manipulation and increased stroke risk in younger adults. The chiropractic technique usually involves a rotation of the neck and sometimes a forceful thrust that can lead to greater risk for cervical artery dissection, or small tears in the walls of arteries in the neck. Cervical artery dissection may encourage the formation of clots that can travel to the brain and block blood flow to brain tissue. The research suggests that cervical artery dissection may account for as many as 25 percent of strokes in people younger than 45. The AHA statement strongly recommended that chiropractors and osteopathic physicians warn their patients about the stroke/manipulation association before they undergo neck manipulation.

Q My elderly aunt developed confusion and memory loss during a heat wave this summer, but improved after her doctor treated her for an electrolyte imbalance. How does an electrolyte imbalance lead to mental problems?

A The body contains salts known as electrolytes, which are substances that regulate the electric charge and flow of water molecules across cell membranes. An optimal balance of electrolytes--such as sodium, chloride, potassium, magnesium and calcium--helps regulate oxygen delivery and heart muscle activity, and maintain fluid balance in the brain, among other functions. Electrolyte levels in the blood that are higher or lower than normal can cause a variety of adverse effects, and even lead to such severe symptoms as cardiac problems, organ failure, coma or death. Mental symptoms include confusion, short-term memory problems, irritability, disorientation, depression, and inability to concentrate.

Fluid loss from impaired kidney function, diarrhea, vomiting, fever, or chronic laxative abuse heightens risk for electrolyte imbalances, as does unusually hot summer weather, which is often associated in older people with electrolyte imbalance caused by loss of body fluids or dehydration. Common causes of abnormal calcium levels include parathyroid disorders and excessive use of over-the-counter medications such as antacids and calcium supplements.

Q My 76-year-old husband seems happy, but he complains of lack of energy, has quit many of the activities he used to enjoy, and doesn't seem to care much about anything. I have read that apathy is sometimes an indication of brain changes. Can you tell me more?

A A study published April 16, 2014 in Neurology suggests that apathy without signs of depression may be linked to lower brain volume. The researchers scanned the brains of more than 4,000 older adults without dementia and asked them questions designed to identify signs of apathy. Participants who had at least two symptoms of apathy (e.g., lack of interest, decreased energy, lack of emotion, a decline in activities and interests, and an increasing preference for staying at home) were found to have smaller volumes of both gray and white matter in the brain. Controlling for depression did not change the results. Although brain shrinkage is normal with aging, participants with apathy had higher-than-normal levels of shrinkage, a possible indication of brain disease. The findings may help in the identification of at-risk individuals who might benefit from strategies such as exercise, social stimulation, and training programs that might help slow or prevent further cognitive decline.

Editor-in-Chief

Maurizio Fava, MD

Executive Vice Chair, Department of Psychiatry

Massachusetts General Hospital

Director, Clinical Research Program

Slater Family Professor of Psychiatry

Harvard Medical School
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Title Annotation:ASK THE DOCTOR
Author:Fava, Maurizio
Publication:Mind, Mood & Memory
Article Type:Column
Geographic Code:1USA
Date:Nov 1, 2014
Words:616
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