Atypical Parkinsonism

Atypical parkinsonisms are conditions in which an individual experiences some of the signs and symptoms of Parkinson's disease (PD) -- tremor, slowness, rigidity (stiffness), and/or walking and balance problems -- but does not have PD. Atypical parkinsonism can be due to certain medications (some anti-nausea and antipsychotic drugs), other brain disorders (repeated head injury or multiple small strokes) or neurodegenerative diseases.

Parkinson's Plus

The neurodegenerative diseases, which cause damage or death of brain cells, include corticobasal degeneration, Lewy body dementia, multiple system atrophy and progressive supranuclear palsy. These conditions are often referred to as "Parkinson's plus" because they mimic PD but have extra associated symptoms (the "plus"). They can be misdiagnosed as Parkinson's disease because no blood or imaging test can, on its own, make a definitive diagnosis. (As with PD, the diagnosis is based on a person's medical history and physical examination.) Early in the course, people with Parkinson's plus syndromes also may get some benefit from levodopa, the drug most commonly used to treat PD. A poor response to levodopa, development of additional symptoms and more rapid progression of disease may eventually differentiate Parkinson's plus from PD, although it can take years for these differences to emerge. As with PD, no disease-modifying therapy has been discovered for any of the neurodegenerative atypical parkinsonisms so treatment is symptomatic and supportive.

Learn more:

• Ask the MD: FAQs on Lewy Body Dementia
• Webinar on Parkinson's and Lewy Body Dementia
• Insight into Lewy Body Dementia Hallucinations
• Dementia with Lewy Bodies: In the News and in the Clinic

Corticobasal Degeneration (CBD)

Corticobasal degeneration (CBD) leads primarily to motor and cognitive (memory/thinking) symptoms. Motor symptoms mainly affect one arm and/or hand and include:

• slowness,
• stiffness,
• myoclonus (rapid muscle jerks), and
• dystonia (an abnormal, fixed posture).

The dystonic posture may cause the arm to be held close to the body and bent at the elbow and the wrist and fingers to be flexed toward the palm. Dystonia can cause pain and palm sores and interfere with regular daily activities (such as brushing teeth or preparing meals). Cognitive problems can affect speech, memory and/or behavior. Brain-processing difficulties can make performing complex motions, such as combing hair or turning a key in a lock, challenging or impossible. People with CBD may also experience "alien limb phenomenon," which is involuntary activity of a limb and a feeling that the limb is foreign or has a will of its own. (An alien hand could take one's eyeglasses off after the other hand has put them on, for example.)

Lewy Body Dementia (LBD)

Multiple system atrophy (MSA) patients may experience:

• parkinsonism -- usually slowness, stiffness and walking/balance difficulties (rather than tremor);
• cerebellar symptoms -- incoordination, imbalance and/or slurred speech; and
• autonomic nervous system dysfunction -- problems with the body's automatic activities such as blood pressure regulation, bladder emptying and sexual functions.

Other features of MSA include abnormal postures (head and neck tilted forward, hand held in a grasping position, or foot and ankle turned inward); speech and swallowing problems; episodes of uncontrolled laughter or crying (pseudobulbar palsy); cognitive (memory/thinking) problems; and sleep disturbances, including REM sleep behavior disorder (acting out one's dreams) or sleep apnea (breathing pauses during sleep).

Progressive Supranuclear Palsy (PSP)

Progressive supranuclear palsy (PSP) causes imbalance, gait difficulties and a tendency to fall backwards. It also restricts normal eye movements, which can lead to reading difficulties, falls when walking down stairs and visual disturbances (blurred or double vision, or light sensitivity). Involuntary eyelid closure (called blepharospasm); memory and behavior changes (such as decreased motivation and emotional fluctuations); and speech and swallowing problems also may occur.

Management of Parkinson's Plus

These diseases are complex conditions that progress over time. As ongoing symptoms worsen and new symptoms arise, a person's needs will change and caregivers' roles and responsibilities will evolve. A team approach involving the person with disease, caregivers, family members and multiple medical professionals, is necessary to address the multitude of symptoms. As with PD, no disease-modifying therapy has been discovered for the neurodegenerative atypical parkinsonisms. Treatment relies on medications to lessen symptoms, allied health care services, assistive devices (canes or walkers) when necessary and caregiver support. Palliative care specialists can be especially helpful consultants for managing symptoms and coordinating goals of care.

Levodopa is usually the initial therapy for motor symptoms, although most people do not get a significant or long-term response. Other Parkinson's medications are sometimes used in conjunction with or instead of levodopa, but in general these are not very effective either. For dystonia, Botox injections can be helpful, and for associated non-motor symptoms (such as memory, behavioral or sleep disturbances), doctors may prescribe a variety of other medications.

Physical and occupational therapy are beneficial, specifically for dystonia, gait and balance problems, and falls. In earlier stages of disease, therapists can develop programs aimed at maintaining mobility, preventing falls or falling in ways to minimize injury. They can also assess the need for a cane or walker. In advancing disease, therapists can teach exercises to maintain joint range of motion, evaluate the home for safety and suggest modifications or adaptive equipment (such as shower grab bars or a raised toilet seat), and determine the appropriate type of wheelchair if one is necessary.

Speech therapists can recommend language exercises for speech disturbances and dietary and/or mealtime adjustments for swallowing problems. If swallowing problems are particularly severe (leading to weight loss, choking or pneumonia), your therapist or doctor may discuss starting a feeding tube. While not always required, it's worth thinking about this possibility early on so that a person (and their caregiver's) thoughts can be taken into full consideration.

Throughout the course, social workers can provide educational resources, link to support groups and assist with finding in-home care services or alternative living situations. Palliative care providers can be consulted at any point for help with managing symptoms and determining goals of current and future care. In conjunction with a person's movement disorder specialist, palliative care experts can aid in optimizing medical therapy while lending extra emotional and spiritual support, and coordinating communication among the patient, family and medical providers.

Source: michaeljfox

Is India a racist country?

April 07, 2017 00:15 IST
Updated: April 07, 2017 01:07 IST

LEFT

The Indian government must acknowledge there is deep-rooted prejudice

Samuel Jack

Samuel Jack is president of the Association of African Students in India

In India, racism is practised in some quarters and by some Indians. This is evident in the manner in which we are treated when we seek extension for our visas, in the problems we face in getting accommodation in the country, and in the general treatment of viewing us with suspicion. The prejudice and stereotypes are all too apparent. When we seek accommodation, most landlords come out with an emphatic ‘no’ without offering any explanation. We are left with little choice and make do with what we get. We are faced with a situation where we cannot even communicate with our neighbours in case of an emergency. How do we talk with each other with so many stigmas attached to us? How do we even begin to counter the prejudices?

Bias linked to caste system

To an outsider like myself, when I begin to process this blatantly discriminatory attitude, I find that this racism is linked to the prevalent caste system which is very hierarchical. Black people, Dalits and untouchables somehow seem to be linked to this caste system which is discriminatory and excludes people. Indian kids smoke in public places. Yet when we smoke, we are always supposedly smoking marijuana or weed, when there are many Indians who smoke the same. How can Africans playing loud music be an excuse to beat them up and complain to the police when Indians do the same? I am not saying black people don’t smoke weed or don’t do drugs but isn’t that true of others too? So, why single us out? Why do people here become aggressive when they see us on the streets? Students from the Northeast face the same problems like us.

Is Punjab’s drug problem because of us? The State is reeling under a drug crisis affecting many young men. In Goa, the drug problem is largely due to Europeans and Russians who, along with local leaders, peddle drugs, but will India discriminate against them? They give some donations to NGOs and nobody dares speak against them.

The Class XII student who passed away in Greater Noida recently unfortunately died of a drug overdose. He was an addict. You will be amazed to see what Indian school children are smoking. Unfortunately, Africa becomes a binary for most Indians. The impression is that we hail from a backward continent, which is simply not true. Some African countries have better human development indicators than India and have a robust democracy. Indians went as indentured labour to the African continent and elsewhere. If that is an acknowledged fact, how do Indians reconcile with their racist attitude towards us? If Indians went as indentured labour and Africans were treated like slaves, isn’t there a common history of discrimination that binds the two?

The wrong colour?

Right from when we land here, our colour becomes an excuse for Indians to display all their prejudices. An extension of our visas which should not take more than seven days takes at least three months for us. Police verification becomes an excuse for extortion. Policemen keep calling at odd hours.

We are deeply disappointed and hurt that the Government of India has not condemned the attacks against us. The government must say this is wrong and that it will deal with it in an appropriate manner. The government has to acknowledge there is a deep-rooted prejudice first. It is only after you acknowledge the problem that you can address it.

But the Government of India appears to be in denial. Due to the hostility of some Indians, the number of African students coming to study in India may come down.

RIGHT

What we are witnessing is the conflict of cultures which is a law and order problem, not racism

Rakesh Sinha

Rakesh Sinha teaches political science at Delhi University and is president of the RSS-affiliated India Policy Foundation

Some sporadic incidents cannot, and should not, lead one to brand any society as racist. Of course, one cannot deny that there has been some violence against people of African origin in some parts of the country. But a majority of these incidents have not been motivated by the colour of the nationalities involved. The reasons are sex, drug trafficking and behaviorial patterns which unsettle the structured values cherished by locals. A society’s multi-culturalism depends on the blending of empathy and reason. Chances of conflicts are higher when empathy and reason diminish. What we are witnessing is the conflict of cultures which is a law and order problem, not racism.

The case of Western societies

Racism is a negative value of life which is not a part of the Indian psyche. That said, no society or nation can claim to have achieved a completely ideal stage where its citizens are on their best behaviour. Whether a society is racist or becoming racist can be judged only by the collective consciousness of larger masses. Unprovoked incidents against Indians or Asian nationals in the form of violent attacks in Canada, the U.S., Australia, New Zealand tell us that all is not well with the melting pot of Western societies either.

The notion of the Other is historically rooted in the Western civilisation trajectory which erupts whenever societies face an economic or political crisis. While the notion of egalitarianism rests easily with elites there, this feeling does not find resonance with the masses. There is a huge disconnect between academic discourse on egalitarianism and social realities.

India’s history and the psychology of its masses have remained unchanged for as long as one can remember. During the anti-colonial movement, leaders of the freedom movement wisely secularised the struggle against colonial forces. Indians had no problem when two westerners, George Yule (1888) and William Wedderburn (1889) became presidents of the Indian National Congress (INC). Acceptance is the norm in Indian society.

There is an interesting observation in the 1911 Census report that Indians had no problems stating their religion. However, what mattered to most surveyed was social status. Historically, India has welcomed people of different races and creeds. The INC participated in the anti-apartheid conference in 1927 in Brussels.

We are one family

It is this credo of Vasudhaiva Kutumbakam (the whole universe is one family) which led Indians to embrace victims of religious or racist persecutions. In 1931, as the Census data revealed, there were 24,000 Jews and 109,754 Parsis in India. They played a significant role in our freedom movement and in economic activities that shaped India. In the first session of the INC, there were nine Parsi delegates, and two each from the Muslim and Christian communities, of a total of 72. Their representation kept swelling in successive Congress sessions. Moreover, there has been consensus for Anglo-Indian representation in Parliament. The fundamental rationale underpinning this has been one of cherishing diversities.

However, in India there have been clashes between Dalits and upper castes and some violent incidents against students from the Northeast. But drawing a parallel with racism would not be correct. Racism is based on hatred which makes conciliation between people of different groups virtually impossible. Spiritual democracy is the basis of our secularism and our multi-culturalism negates perpetuation of conflicts. These have little to do with race.

CENTRE

Early education is an important field for providing the basis for independent and critical thought

Sanjay Srivastava

Sanjay Srivastava is professor of sociology at the Institute of Economic Growth

The remarkable 1952 novel Invisible Man by Ralph Ellison is about the experience of being black in the U.S. Its opening paragraph has the following lines: “I am a man of substance, of flesh and bone, fiber and liquids — and I might even be said to possess a mind. I am invisible, understand, simply because people refuse to see me”.

The novel’s protagonist goes on to say that “the invisibility to which I refer occurs because of a peculiar disposition of the eyes of those with who I come in contact”.

What is the peculiarity of the Indian eye that makes blackness such an invisible – that is, insignificant – thing as to take an axe to it when it seeks normal, human visibility, expressing the same desires and anxieties as those who think of themselves if not as completely white then at least something like possessing whiteness?

Confront the ‘messy’ present

We could, for a start, begin with history. There are, by now, a number of books and exhibitions about an Indian past that was apparently far more tolerant of blackness. Historians speak of an easy intermingling between Indians and people of African origin, with Indian noblewomen taking African men as lovers, and slaves being raised to the status of rulers.

But to invoke history is to only add to the problem of Ellison’s protagonist’s invisibility in the Indian present. History is easy. It is the present that is messy. A certain kind of, albeit well-meaning, history has convinced us that we were, in fact, good and tolerant in the past and hence that goodness must lie somewhere submerged among us, only needing minor prodding to emerge as joyful guiding light of the present. Indians love history because it allows an exit route to not having to deal with the present.

To the extent that 20th century racism has been addressed in the West, it is not through constant references to the Black Madonna in Christian iconography and Shakespeare’s Othello in literature. No. It has been done through addressing the root causes and reasons for intolerance in the present.

We in India refuse to deal with our present because history is such everlasting comfort.

Strategies for the present

What of the present, then? We could begin with school education. This crucial realm is one where ideas of the false basis of race and racism are almost never touched upon. While it is more difficult to influence attitudes in the domestic sphere, early education is an important field for providing the basis for independent and critical thought. But our social science school books continue to deal with ‘tribes’ – a category that flows on to blackness in general – in terms of their proximity to ‘civilisation’. The term itself – its bloody history, for example – is hardly ever examined. We are willing to put up with the ‘uncivilised’ as long as they know their place. We might also consider another strategy for the present. Our cities are now places where we increasingly have declining tolerance for strangers. We primarily extend courtesies to those we know, and exhibit hostility to those outside our circles of familiarity. Do we not need an education on how to live with strangers? Accounts of the past – fascinating and important in themselves – are about the past. The past is, actually, another planet and cannot be a guide to what is to be done now.

As told to Anuradha Raman

Source: thehindu

Obama’s Parting Gift: The Power Not to Fear White Racism

By Carvell Wallace

January 19, 2017

 
Growing up, I wondered whether I had any power or beauty within me. With Barack and Michelle in the White House, I knew I did.PHOTOGRAPH BY CHARLES OMMANNEY / GETTY 

The only Inauguration I have attended, and probably the only one I ever will attend, was Barack Obama’s first, eight years ago. My wife and I were nearly broke, but we gathered money from the life insurance left by my mother, who had died of lung cancer six weeks before the election. We wrapped our California kids, ages five and three, in a million layers of clothing and hats, filled thermoses with soup and hot chocolate, shared hand-warmers among us, and packed as though we were braving the Arctic tundra. The temperature in Washington was in the twenties, and we were outside for eight hours. It must have been uncomfortable. Our kids must have suffered. Their mom and I must have bickered. But I don’t remember it that way. I remember laughing a lot and holding gloved hands. I remember taking turns hoisting our children on our shoulders, and our son waving a flag with Michelle’s and Barack’s faces on it. I remember the Metro car, packed with the bodies of strangers, breaking out into impromptu choruses of “We Shall Overcome.”

We felt hope that day. But that hope was the flip side of the terror, anguish, and frustration we had felt every single day before, living in a country that, for centuries, systematically abused many of its people, and then punished those people for trying to regain their humanity. To be black in America is a wild and endless assault on the senses. You can spend every day fighting off your spiritual and intellectual extinction.

For much of my childhood, I lived in a small, mostly white town along Appalachia, in the Rust Belt. By seventh grade, I spent days fighting with kids who called me nigger and nights secretly wishing I was white so that I wouldn’t have to. The message arrived early that blackness was, for some reason, something bad, something that made people hate me, something that made people angry. When I was twelve, a white man drove by in a car and threw a milkshake at me as I rode a skateboard. Blackness, I learned, was so hateful that it made adults assault random children. It was as if I had a disease that made other people want to hurt me.

And so I grew up afraid of racists. Even when I was safely at home, there was an unspoken idea that just outside the door there were men made of fire and hate who would laugh to see me suffer. When white friends talked road trips, I made up excuses. When race became the topic, I waited quietly for it to change. This is how racism is designed to work, of course: it’s a form of terrorism and mind control that seeks to will you into subservience, to make you afraid to advocate for your own humanity.

When we attended Obama’s Inauguration, we were high on the hope that there might be an end to all of this. We had always more or less trusted our government to protect us from foreign threats. Now it seemed that we might trust it to protect us from domestic ones, too.

And then we watched as Obama, in the early days of his Administration, treaded delicately in the thorny bramble of race, taking steps that pierced his flesh and drew blood. After the Harvard professor Henry Louis Gates, Jr., was arrested for trying to break into his own home, Obama chided the Cambridge police; his approval ratings, particularly among white voters, dipped severely. It would not be the last time he would wrongly calibrate the fervor of white America’s sensitivity around race. For eight years, we watched him trying to thread the impossible needle, searching for a message that would resonate evenly with a nation of people who seemed increasingly estranged from one another. The deaths of Trayvon Martin, Eric Garner, John Crawford, Tamir Rice, Rekia Boyd, Sandra Bland, and others bubbled up into a movement of protests. Soon, the idea that black lives mattered was branded by some as a terrorist threat; talk of race wars slithered to daylight from the damp crevices of American consciousness.

During the Obama years, many Americans became angrier, more defensive, and more afraid. The rise of Donald Trump, built on the message that there are barbarians at the gate, is a testament to that. But for me these eight years have had the opposite effect. I was more afraid at the beginning. My joy at Obama’s Inauguration could only exist because white racism had terrified me for decades, and I hoped that Obama would be my protector.

He couldn’t be. America’s illness is bigger than him. Nonetheless, his Presidency had a surprising effect on me: it changed my sense of what racism is. Obama was impeccable as a President and a politician: deeply informed, thoroughly prepared, intelligent, and forthright. He treated his job with a seriousness befitting the office. I did not agree with many of his policy decisions. But I believed that he undertook them with integrity, and with a conviction that they would yield the greatest good for the greatest number of people.

And still he was called names and branded by the opposition as a failure. His citizenship and religion were called into question. Republicans in the House and Senate preferred to nearly tank the country rather than appear to be in league with him. Newscasters vociferously questioned his fitness for the job. These reactions moved beyond the terrifying and into the cartoonish. White racism, which I used to take so seriously, came, more and more, to seem childish and pitiful to me.

Meanwhile, Barack and Michelle Obama—cool, collected, fiercely loyal to each other—have reflected back to me my own capacities. Representation does, in fact, matter. When I was alone among white kids, I wondered if I had any power or beauty within me. With Michelle and Barack in the White House, I knew I did.

I still consider my own destruction daily. I think about doomsday scenarios and potential horrors to come. But I do not fear them. I am clear on what my worth is and what the worth of each person is. I no longer hope to avoid arousing the demons of racism—I know that such an awakening is an unavoidable result of affirming my own humanity. And there is no longer a scenario, under any President, or any Administration, in which I would refuse to do that. I have a family whom I love, and I know the difference between right and wrong.

When Barack Obama first campaigned for President, he ran on hope. But hope, I have come to feel, is only needed by the fearful. What his Presidency left me with is power.

Carvell Wallace is a writer in Oakland.

Source: newyorker

శ్రీ కౌముది ఏప్రిల్ 2017