2017, Vol 17, No 4
Intestinal microbiota and nutrients as determinants of nervous system function. Part I. Gastrointestinal microbiota
Aktualn Neurol 2017, 17 (4), p. 181–188
DOI: 10.15557/AN.2017.0020
ABSTRACT

Neuropsychiatric disorders are one of the most common problems in the modern world. In the European Union alone, at least 164 million cases of mental problems were reported in 2016. Despite many years of investigations and enormous resources devoted to scientific research, the causes of some of these diseases have not been clearly identified, and, in the case of others, treatment options are significantly limited. Although the brain weight accounts only for about 2 percent of the body weight, its oxygen consumption accounts for up to 20% of the resting energy metabolism. As opposed to other organs, the brain does not accumulate energy; therefore its functioning depends on the continuous supply of the main energetic substrate, i.e. glucose. At the same time, the physiology of every cell in the human body depends on the availability of regulatory components, including vitamins and trace elements, which are derived from the diet. As evidenced by the basics of cell biology, certain nutrients are essential for proper neuronal functioning and, consequently, nerve signal transmission. Nutrients are also known to be metabolically utilised by intestinal microorganisms, and the neuroactive and immunocompetent products of these transformations pass through the gut–brain axis into the brain and exert their effects on the structure and function of regions responsible for emotions as well as motor and cognitive abilities. The first part of the article presents information regarding intestinal microbiota as a structural and functional nervous system modulator. Particular attention is paid to intestinal dysbiosis in neurodevelopmental and neurodegenerative disorders, which is currently considered to be the cause and/or a factor determining their clinical course. It was also suggested that supporting gut microbiota with probiotic therapy may be an element of nervous system disease prevention and support the primary treatment of these conditions.

Keywords: microbiota, gut–brain axis, probiotics
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Inadequate nutritional status in patients with Alzheimer’s disease
Aktualn Neurol 2017, 17 (4), p. 190–197
DOI: 10.15557/AN.2017.0021
ABSTRACT

Apart from the comprehensively described cognitive disorders or neuropsychiatric symptoms, dementia also leads to progressive wasting in Alzheimer’s disease patients. Malnutrition is a problem affecting up to 25% of patients with dementia. As the disease is mainly found in people over 65 years of age, the patients on the one hand experience changes that are characteristic for the senile age in general, whilst on the other, their nutritional status is affected by the degenerative changes in the central nervous system and the clinical symptoms they produce. The nutritional status has been demonstrated to have a significant impact on the progression of the disease and the patients’ prognosis as well as the incidence of comorbidities, frequency of hospitalisations and overall mortality rate. It is, therefore, important to identify the risk at an early stage, and implement modifications facilitating an adequate nutritional status. Proper education of caregivers is of utmost importance in this respect, and it should be implemented from the earliest stage of the disease. Also, an individual approach must be ensured to adequately address the needs and problems of a given patient, as the required interventions vary depending on the severity of the disease and its current symptoms. Many simple modifications aimed at aiding the adequate nutrition of the patients have been outlined to date, including dietary guidelines and environment adjustments during meals. Also, detailed recommendations have been formulated concerning the intake of oral supplements and medical foods, addressing dietary deficiencies and parenteral nutrition. It should also be pointed out that any decisions concerning treatment must be made in an ethical way, accounting for the patient’s individual preferences.

Keywords: Alzheimer’s disease, dementia, malnutrition, eating behaviour disturbances
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Nutrition in Parkinson’s disease
Aktualn Neurol 2017, 17 (4), p. 199–207
DOI: 10.15557/AN.2017.0022
ABSTRACT

Parkinson’s disease is a chronic neurodegenerative disorder with extensive motor and non-motor symptoms. Several specific dietary components have emerged as being of potential importance in the occurrence and course of Parkinson’s disease. Inappropriate nutrition is likely to aggravate neurodegenerative processes. Conversely, a proper diet can be an element of therapy and a potential neuroprotective factor that slows down the progression of the disease. Even the effectiveness of pharmacological treatment in Parkinson’s disease may be affected by dietary habits. Parkinson’s disease patients have also specific nutritional needs related to non-motor problems resulting from changes occurring in the course of the disease. Adequate nutrition needs also to be considered in the context of barriers posed by the disease in food intake. A proper diet in Parkinson’s disease should ensure the maintenance of normal body weight, meet the demand for proteins, fats, carbohydrates, fibre, vitamins and minerals in accordance with the current standards, aid the effective action of drugs and therapy of the prevalent symptoms, and thus, in the light of current scientific research, facilitate a slower or milder course of the disease. Currently, the Mediterranean diet meets the most expectations in this case. However, it should be emphasized that the nutrition of each Parkinson’s disease patient requires a fully individual approach, taking into consideration the stage and the picture of the disease and comorbidities. A lack of fully effective management concerning dietary pattern is reflected by high rates of malnutrition in this population of patients. The article presents the current views on the dietary problems associated with Parkinson’s disease and the potential for using nutritional guidance to optimise the treatment of Parkinson’s disease patients.

Keywords: Parkinson’s disease, diet, treatment
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Dysphagia due to brain stroke – diagnostic and therapeutic guidelines
Aktualn Neurol 2017, 17 (4), p. 208–212
DOI: 10.15557/AN.2017.0023
ABSTRACT

According to a definition by the World Health Organization from 1980, a brain stroke is described as rapidly developing clinical signs of focal (or global) disturbance of cerebral function, with symptoms lasting 24 hours or longer, of vascular origin. Aside from loss of mobility, it results with speech and swallowing impairment. Neurogenic dysphagia causes difficulties with adequate food intake and contributes to aspiration pneumonia and malnutrition. Dysphagia due to brain stroke occurs suddenly and progresses rapidly, preventing the patient from adapting to the deficits. The role of physicians, speech and language therapists and nursing staff in acute stroke units is to screen for dysphagia, and implement relevant management strategies, including an optimum feeding method (e.g. with a nasogastric tube), prompt therapy and prophylaxis of possible complications. The available dysphagia screens are characterised by high sensitivity and specificity. Management of dysphagia involves the use of various methods aimed at facilitating articulation and restoring the capacity for oral food intake. Texture-modified food, adjusted to the patient’s current condition, is an important element of treatment. Foods and fluids are modified with a thickener. Studies have demonstrated appropriate food consistency to be crucial, allowing oral intake of foods and liquids, whilst preventing aspiration and the associated pneumonia. Food-thickening is an easy management strategy, applicable for a wide range of foods and meals, helping caregivers to follow dietary recommendations in a home setting, and improving the patients’ quality of life.

Keywords: brain stroke, dysphagia, dysphagia assessment, thickeners
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Ketogenic diet for epilepsy
Aktualn Neurol 2017, 17 (4), p. 214–219
DOI: 10.15557/AN.2017.0024
ABSTRACT

Epilepsy is the second most frequent chronic condition neurologists encounter in their day-to-day practice. Suboptimal response to antiepileptic drugs may be due to numerous factors, some of which may be modified. For patients who remain nonresponsive to various combinations of drugs and doses, the therapeutic options include surgery, or vagal nerve stimulation, yet not all patients with drug-resistant epilepsy are eligible for the procedures. Ketogenic diet is one of the available non-pharmacological options in such cases. Many years of experience, dating back to the 1920s, have allowed to identify disorders in which ketogenic diet is the treatment modality of choice. In the case of broadly defined drug-resistant epilepsy in children, and increasingly often in adult patients, ketogenic diet is an established adjunctive treatment. Most of the available data concerns the paediatric population. This paper is a review of literature data regarding ketogenic diet for drug-resistant epilepsy. The diet’s application has been discussed for the management of various neurological disorders such as glucose transporter type 1 deficiency syndrome (GLUT1 deficiency syndrome), Dravet syndrome, tuberous sclerosis, Doose syndrome, Lennox–Gastaut syndrome, Ohtahara syndrome, Landau–Kleffner syndrome and epileptic encephalopathy with continuous spike and wave during sleep. The literature data demonstrate ketogenic diet to be an effective nonpharmacological treatment method. Importantly, however, in many cases instead of being considered a therapy of last resort, it should be offered earlier in the management.

Keywords: epilepsy, treatment, drug-resistant epilepsy, ketogenic diet, epileptic encephalopathies
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Once again on the treatment of nociceptive pain – is it worth to combine diclofenac with B vitamins?
Aktualn Neurol 2017, 17 (4), p. 221–226
DOI: 10.15557/AN.2017.0025
ABSTRACT

Spine pain is a frequent ailment with a complex pathophysiology. The guidelines for treatment oscillate between physiotherapeutic procedure, pharmacotherapy and surgical treatment. It seems that every patient requires an individual approach which is especially important in case of elderly patients – due to multiple morbidities and polytherapy. The article presents the benefits and the limitations of the therapy applying diclofenac and B vitamins in the treatment of pain, mainly osteo-articular pain. Diclofenac belongs to the group of non-steroidal analgesic and anti-inflammatory drugs. It demonstrates high therapeutic efficacy in the scope of nociceptive pain, however, it also causes significant adverse effects including arterial hypertension. The analgesic effect of group B vitamins has not been fully explained; it seems that they may affect the increase of the secretion of serotonin in the central nervous system, regulate afferent conduction in the scope of the spinal cord or – as indicated by some, more optimistic, authors – enhance the release of endogenous opioids. The article includes information referring to combining both drugs in the context of the efficacy and safety of treating nociceptive pain.

Keywords: non-steroidal analgesics, B vitamins, pharmacotherapy of pain
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The effect of a training programme stimulating language functions on Alzheimer-type dementia and maintenance of language skills
Aktualn Neurol 2017, 17 (4), p. 227–244
DOI: 10.15557/AN.2017.0026
ABSTRACT

In dementia of the Alzheimer’s type, memory and language impairments coexist, occur early and aggravate with time. The aim of this study was to assess the effect of our proprietary language function stimulating programme on cognitive functions and the maintenance of language skills in patients with mild-to-moderate Alzheimer-type dementia as well as to evaluate the programme’s effectiveness depending on patients’ age, sex, education, severity of dementia and level of motivation. The intervention group (54 patients) and the control group (34 patients) were divided into subgroups according to the severity of dementia (mild/moderate). Tests such as the Mini-Mental State Examination, the Clock-Drawing Test, the Boston Naming Test and picture description were performed at 1, 3, 6, 9 and 12 months. In the course of 1 year, the Mini-Mental State Examination scores in the intervention group improved on average by 0.87 points, whilst in the control group they declined by 1.32 points over the same period of time. Statistically significant differences in the Clock-Drawing Test were found at 6 and 12 months, with the mean score differing by 0.98 and 1.35 points respectively across the groups. The score difference in the Boston Naming Test grew gradually. At 3 months it was 3.67 points, amounting to as much as 7.96 points at 12 months. For the picture description task, the mean scores at 12 months increased by 1.18 points in the intervention group in the mild dementia subgroup and by 0.66 points in the moderate dementia subgroup. In the control group, the scores decreased. The use of our proprietary training programme, specially designed to stimulate language functions in patients with mild-to-moderate Alzheimer-type dementia, facilitates the maintenance of general cognitive function and improvement of language skills, and its effectiveness increases with the patient’s motivation. This confirms the importance of supplementing non-pharmacological interventions used in Alzheimer-type dementia with language therapy programmes.

Keywords: Alzheimer-type dementia, language exercises, cognitive stimulation, language function
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