MNT Neurological

Question 1

Neurological disorders

Answer 1

1. Epilepsy
2. Stroke/Anuerysm
3. Traumatic brain injuries
4. Progressive Neurodegenerative disorders
   -Parkinson’s disease
   -Multiple sclerosis
   -Dementia/Alzheimer’s
5. Migraine headache

Question 2

Epilepsy and seizure disorder

Answer 2

-Definition: Epilepsy is a disorder characterized by spontaneous, uncontrolled electrical activity among cerebral neurons resulting in a seizure.
-Causes: head trauma, CNS infections, drug and alcohol abuse, CNS tumors, Cerebrovascular disease.
-Single seizure- can also occur as a result of fever, metabolic or electrolyte imbalances including hypo and hyperglycemia.
-Anti-epileptic drugs are quite potent and number of drug-drug, drug-nutrient, drug-food interactions can occur.

Question 3

Stroke and Aneurysm

Answer 3

1. A stroke (cerebrovascular accident) occurs when there is a blockage or interruption of blood flow to the brain, depriving it of nutrients and oxygen and leading to alterations in brain function.
2. Strokes can be categorized into
   a. ischemic stroke (blood vessels to the brain are obstructed)
   b. transient ischemic attacks (TIAs, ischemic episode that is transient with blood flow quickly restored and symptoms resolve in 24 hours)
   c. hemorrhagic stroke (when a blood vessel in the brain ruptures), Result of weakened blood vessel walls as occurs with hypertension or aneurysms.
3. Risk factors- hypertension, smoking, obesity, coronary heart disease, dyslipidemia, diabetes, physical inactivity (all modifiable), genetics (non-modifiable)
4. MNT:
   -Prevention- diet and lifestyle factors
   -person with risk of stroke or had a stroke should be counseled on nutrition therapy to address modifiable risk factors
   - vitamin and mineral supplementation
   -Protective factors against stroke-
   a. daily consumption of fresh fruit
   b. Flavanoid consumption > 4.7 cups of green tea per day
   c. Omega 3 fatty acids (watch for blood thinning meds)
   -Dysphagia- diet consistency from solif food to soft or pureed.

Question 4

Traumatic Brain injury (TBI)

Answer 4

Skull fracture, extraparenchymal hemorrhage-epidural, subdural, subarachinoid or hemorrhage into brain tissue.
-#1 cause: Falls
-#2 cause: Motor vehicle accident
- additional causes: firearms, bicycle accidents, shaken baby syndrome
-Goals of nutrition: oppose hypercatabolism and hypermetabolism associated with inflammation

Initial: Systematic inflammatory response with hyper metabolism, hyperglycemia, insulin resistance, increased gluconeogenesis, lipolysis, protein wasting, as evidenced by nitrogen excretion.
-aggressive nutrition support, enteral nutrition and alternate interventions.
-Protein recommendation are higher than RDA.
-Chronic cases of TBI which may be treated with a number of medical , CAM and nutritional approaches.

Question 5

Alzheimer’s Disease

Answer 5

-Most common form of dementia with varying patterns of cognitive decline
-Early onset- Familal, sporadic,-genetic mutation
-Apo E4 binds to beta-amyloid/involved in transport of cholesterol
-Damage to key mitochondrial components, oxidative stress, impaired insulin signaling, inflammation, elevated homocysteine, low folate, high serum (causal factors)
-Lead, iron, aluminum, copper, zinc- catalyze production of free radicals

Nutrition Support:
-Decrease attention span at meals
-inability to recognize food, motor function, weight loss

A. Frequent snacks, nutrient dense foods.
B. Possible supplements
-Antioxidants
-Omega-3 fats
-Phytochemicals
-phosphatidylcholine

Question 6

Parkinson’s disease

Answer 6

most common neurologic disease
-progressive loss of dopamine producing cells
-substantia nigra of the brain (basal ganglia)
-Etiology (unknown)
-contributing factors: genetics, environmental toxins, oxidative stress,
-Leads to an imbalance between excitatory and inhibitory communication
-clinical manifestations: resting tremor, rigidity, bradykinesia (impaired and slow movement of limbs), stooped posture, shuffling gait, cognitive dysfunction.
-Depression, anxiety, sleep disturbances, sensory abnormalities and pain (present prior to motor symptoms)

_Drug-Nutritent interactions can be a concern
-Check meds for interactions with food and supplements

NUTRITION INTERVENTION
-High protein may interfere with L-dopa levels
-Limit supplement levels of B6 to 15 mg
-Anti-inflammatory- reseratrol, curcumin, apocynin, EGC from green tea.
-Antioxidants
-Vitamin D and omega 3 fats
-closely monitor weight status
-Manage GI symptoms: gastroparesis
-Monitoring and evaluation.

Question 7

Multiple sclerosis (neurodegenerative)

Answer 7

-demylenation within cells of the CNS, inflammation and the development of scar tissue
-destruction of myelin sheath interrupts/leads to changes in nerve transmission.
A. 4 distinct types”
1. relapse remitting
2. primary-progressive
3. secondary-progressive
4. Progressive-relapsing MS

B. Etiology: genetic, autoimmune, infectious, history of cigarette smoking
-symptoms: vary depending on nerve affected: numbness, tingling (paresthesias), loss of coordination (ataxia), weakness, visual problems, dysphagia, constipation, bladder dysfunction, difficulty swallowing.

MNT:
-Drug-nutrient interactions are common
-Supplementation
-Omega-3 fatty acids
-antioxidants
-vitamin D and calcium
-restriction of saturated fat
-Dysphagia- soft food or pureed food
-distribute fluid intake evenly throughout the waking hours.
-weight management , regular exercise
-

Question 8

Migraine headache

Answer 8

-an episode intense, throbbing one sided headache that last from 4 to 72 hours.
-cause: dilation of dural blood vessels and pulsatile blood flow through distended blood vessels. Inflammatory component with mitochondrial dysfunction is also present.

MNT:
-check for food intolerance
-Avoid Tyramine or phenylethylamine rich foods (trigger)
-supplementation: riboflavin, CoQ10, magnesium can be helpful.