Category: Brain

Jul 05

Brain Training and Memory: What to Know

Brain Training and Memory: What To Know Brain training games have gained popularity as a means to improve cognitive abilities and maintain mental sharpness. However, the effectiveness of these games has been a subject of debate. Research has shown that supervised group training with brain games can lead to improvements in memory and mood among older adults experiencing mild cognitive decline. It is important to note that the research findings predominantly apply to supervised group training sessions rather than individuals playing these games at home. The benefits observed in the studies may not necessarily translate to the same extent for those using brain training games independently. Furthermore, it is worth mentioning that brain training games have not been found to be beneficial for individuals who have already been diagnosed with dementia. In such cases, other interventions and treatments are typically recommended to manage the condition. While brain training games may offer some benefits for memory and mood in certain contexts, it is essential to approach their usage with realistic expectations. It is advisable to consider them as one component of a comprehensive approach to cognitive health, which may also include maintaining a healthy lifestyle, engaging in stimulating activities, and seeking appropriate medical care when necessary. What Is Brain Training? Brain training refers to the practice of engaging in mentally challenging exercises or tasks, often presented in the form of video games, with the aim of enhancing memory and cognitive abilities. The concept gained popularity as a means to improve cognitive function and prevent cognitive decline. While some studies have shown potential benefits of brain training for specific groups, such as individuals with depression or Parkinson’s disease, the overall effectiveness and generalizability of brain training have been subjects of debate. Some software programs and websites marketed for brain training have faced criticism and legal action for making exaggerated claims about their benefits. Research has indicated that brain training often leads to improvements in the specific tasks or exercises that individuals are trained on. However, these benefits typically do not extend to other cognitive domains or real-life situations. For example, individuals may show improved performance and reaction times on trained tasks, but these gains do not necessarily transfer to skills such as reasoning, verbal memory, digit-span, or executive functions. Furthermore, concerns have been raised regarding the placebo effect and the limited impact of brain training on general cognition. Some studies suggest that any cognitive improvements observed may be primarily due to participants’ expectations or belief in the effectiveness of the training rather than the training itself. A review in Trends in Cognitive Sciences concluded that research consistently finds little evidence supporting the effectiveness of brain training for improving overall cognitive abilities. Overall, while brain training may offer some benefits in specific contexts and for specific groups, the broader impact and practical significance of brain training on cognitive function and real-life outcomes remain uncertai Other Insights Into Brain Training A meta-analysis conducted by researchers from the University of Sydney’s Brain and Mind Centre combined data from multiple studies to assess the effectiveness of brain training. The analysis included studies with participants who had mild cognitive impairment (MCI) and dementia. When focusing on individuals with MCI, the findings showed that brain training led to improvements in global cognition, memory, learning and attention, mood, and self-perceived quality of life. This suggests that brain training can be beneficial in reducing early symptoms of memory loss and cognitive decline in this population. However, when data from studies involving individuals with dementia were included, the association between brain training and cognitive improvements disappeared. This suggests that brain training may not have the same impact on individuals with more advanced cognitive decline. Lead author Amit Lampit emphasized that brain training can be an effective and inexpensive treatment for maintaining or improving cognitive skills in older individuals at high risk of cognitive decline. However, most large trials have been conducted in supervised settings, and it remains unclear whether online programs used at home would yield the same effects. A previous meta-analysis from 2014 also compared the effects of computerized brain training in supervised group settings versus at-home settings. The results indicated that significant benefits were observed when exercises were done in a group with a trainer, but not when done at home independently. Overall, while supervised brain training has shown promise in improving cognitive abilities in individuals with MCI, further research is needed to determine the effectiveness of at-home brain training programs and their ability to produce similar results. The Possible Benefit of Supervised Brain Training While the effectiveness of brain training in general is still debated, supervised brain training appears to hold more potential than at-home training. According to Amit Lampit, supervised training allows individuals to persevere with their program, customize exercises to their needs, and address challenges in real-time. This could contribute to achieving better results compared to independent at-home training. Lampit suggests that establishing group facilities in community centers and involving clinicians could be a more effective approach. This way, individuals can benefit from the support and guidance provided in supervised settings, similar to how joining a gym or attending fitness classes can enhance fitness outcomes compared to exercising at home. Michael Valenzuela, a leader in the field, highlights the importance of upcoming technology in making brain training more accessible. The focus is on developing methods that maintain training gains over the long term and enable individuals to engage in effective brain training in their own homes. As research and technological advancements progress, the aim is to refine and expand the availability of brain training programs, ensuring their effectiveness and feasibility for a broader population. More Considerations About Brain Training and Memory While research shows that memory exercises can improve memory-related tasks, it remains challenging to determine if these gains translate into noticeable improvements in real-life symptoms. Amit Lampit emphasizes that objective and sensitive outcome measures are lacking to detect functional changes in individuals without dementia. Although several outcome tools are available for research trials on

Jul 04

15 Possible Causes of Brain Fogginess

15 Possible Causes of Brain Fogginess Many of us have experienced the phenomenon known as "brain fog," which refers to a feeling of mental cloudiness, difficulty focusing, fatigue, forgetfulness, or making errors. However, the severity of brain fog can vary, and for some individuals, it can be a persistent and debilitating part of their daily life. Brain fog can be associated with factors such as stress, inadequate sleep, or excessive physical or mental exertion. In these cases, making lifestyle adjustments, such as managing stress, improving sleep habits, and taking breaks when needed, may help alleviate symptoms. However, if brain fog persists, significantly interferes with your daily functioning, or has a negative impact on your mental well-being, it is advisable to consult with a healthcare provider. There could be an underlying cause contributing to your symptoms that requires medical attention and appropriate treatment. It is important to recognize that brain fog is not a normal state and should not be ignored if it is significantly impacting your quality of life. Seeking professional guidance can help identify any underlying issues and guide you towards appropriate interventions to address and manage brain fog effectively. Lyme Disease Lyme disease, which is transmitted through the bite of an infected tick, can give rise to various symptoms, including brain fog. The initial manifestation of the disease often involves the appearance of a distinctive "bulls-eye" rash. As the infection progresses, individuals may experience mental fogginess or difficulty with cognitive functions. Brain fog associated with Lyme disease can occur at any time following the infection and may manifest as challenges in engaging in conversations, retaining information, or experiencing difficulty in finding the right words. If you are experiencing brain fog and have a history of tick bite, it is crucial to seek medical assistance promptly. Similarly, if you notice the presence of a bulls-eye rash, medical attention should be sought immediately. Early diagnosis and treatment, typically involving the administration of antibiotics, can lead to successful recovery for most individuals. Lupus Lupus is a chronic autoimmune disease characterized by the immune system mistakenly attacking the body’s healthy cells, resulting in inflammation and pain. The exact cause of systemic lupus erythematosus (SLE), the most common form of lupus, is unknown. According to the CDC, SLE affects approximately 200,000 adults in the United States. Within the lupus community, "lupus fog" is a term used to describe the cognitive symptoms experienced by individuals with lupus. This brain fog can manifest as memory lapses, difficulty concentrating, and confusion. People with lupus-related brain fog may struggle with familiar tasks, recalling names, maintaining a schedule, and processing thoughts. For some individuals, these symptoms can significantly interfere with daily life. It’s important to discuss your symptoms with a healthcare provider who can provide appropriate lupus treatments to address your specific needs and offer strategies to cope with memory issues. The National Resource Center on Lupus suggests engaging in activities such as reading books, doing puzzles, and using planners or color-coded calendars as ways to manage lupus-related brain fog. These activities can help improve cognitive function and organization skills. Multiple Sclerosis Multiple sclerosis (MS) is a chronic inflammatory disease that can lead to the development of lesions on the central nervous system, affecting various aspects such as motor function, emotions, cognition, and clarity of thinking. Individuals with MS often refer to their experience of brain fog as "cog fog," which stands for "cognitive fog." Cognitive fog in MS typically impacts information processing speed and memory recall. Individuals may struggle with tasks that require quick thinking or remembering information. Finding the right words, remembering how to perform certain tasks, and making decisions can be challenging. Research has also shown a connection between multiple sclerosis and sleep disorders, indicating that lack of sleep or restless sleep can worsen brain fog symptoms. During MS flares, brain fog may become more pronounced, and environmental factors such as heat can exacerbate the symptoms. For example, brain fog may worsen on hot days, in hot rooms, or when a person has a fever. It is important to address brain fog symptoms with a healthcare provider to explore potential medication options and rule out other factors like depression or medications for other symptoms that may contribute to cognitive difficulties. Developing strategies to work around brain fog can also be helpful, such as tackling mentally challenging tasks earlier in the day if brain fog tends to worsen later in the day. Chronic Fatigue Syndrome (CFS) Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), is characterized by persistent physical and cognitive fatigue lasting more than six months. Rest does not alleviate the fatigue, and it is not necessarily triggered by exertion. In addition to physical fatigue, individuals with CFS often experience brain fog, which is described as sluggish or hazy thinking, difficulty focusing and concentrating, and forgetfulness. The exact cause of CFS is still unknown, but research suggests that neuroinflammation may play a role. A study published in the Journal of Nuclear Medicine in 2014 found evidence of "widespread" neuroinflammation in individuals with CFS, highlighting the potential importance of this factor in developing diagnostic criteria and treatment approaches. People with CFS often face stigma and disbelief, which can be challenging and exacerbate the impact of their symptoms. The brain fog associated with CFS may interfere with work and social activities, leading to frustration, anxiety, and depression. It is important for individuals with CFS to seek understanding and support from healthcare providers and to connect with others who have similar experiences. Managing symptoms and finding coping strategies, both for physical fatigue and cognitive difficulties like brain fog, can be an ongoing process that requires a multidisciplinary approach and support from a healthcare team. Celiac Disease Celiac disease is an example of a condition that primarily affects the gut but can manifest with symptoms throughout the body. In individuals with celiac disease, the consumption of gluten triggers an immune response that leads to inflammation and damage to the small intestine. This results in

Jul 03

9 Facts About Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a neurodevelopmental illness that influences a person’s ability to understand and connect with others. The disease is best understood as a “spectrum,” spanning a wide range of symptom intensity and encompassing a wide range of previously distinct medical disorders. According to the Centers for Disease Control and Prevention (CDC), around 1% of the world’s population, or 75 million individuals, have ASD. Despite how common ASD is, many common myths persist regarding it. Here are nine things regarding autism spectrum disorder (ASD) that you might not know. This includes symptoms, diagnosis, and treatment options for children. 1. Children Can Be Very Young When Diagnosed Children can receive a diagnosis of autism spectrum disorder (ASD) as early as 18 months, although most diagnoses occur at 24 months or older when the diagnosis is considered more reliable, as stated by MedlinePlus. Prior to that age, children with autism may exhibit social communication deficits that are appropriate for their developmental stage. ASD is diagnosed based on behavioral observations and assessments since there are no medical or blood tests specifically for ASD. Healthcare providers typically conduct developmental screenings and comprehensive evaluations to assess a child’s behavior. This evaluation may include assessments of hearing, vision, and neurological function. In some cases, a follow-up visit to a specialist, such as a developmental pediatrician, may be recommended for further evaluation and support. 2. There’s a Wide Range of Symptoms The symptoms of autism spectrum disorder (ASD) can vary greatly from person to person, with some individuals experiencing mild symptoms while others have more pronounced ones. In general, ASD symptoms often involve difficulties in communication and social interaction. People with ASD may struggle to understand and respond to others’ emotions and intentions, exhibit challenges in making eye contact, and have difficulty with social interactions and relationships. Repetitive behaviors and restricted interests are common among individuals with ASD. These may manifest as repetitive movements or actions, a strong focus on specific topics or objects, or the need for routine and sameness in daily activities. While some individuals with ASD may have difficulty with verbal communication, it is important to note that not all individuals with ASD are nonverbal. Approximately 40% of people with autism are nonverbal, according to Autism Speaks, but this varies among individuals. Other potential signs of ASD in children can include heightened sensitivity to sensory stimuli, intense tantrums or meltdowns, lack of response to their name being called, limited or absent pointing or gestures by 18 months of age, and a lack of engagement in pretend play activities. It is crucial to remember that these symptoms can vary and that an accurate diagnosis should be made by qualified healthcare professionals through comprehensive assessments and evaluations. 3. Prevalence Seems to Be Growing The prevalence of autism spectrum disorder (ASD) has shown a significant increase over the years. According to a 2021 report from the MMWR Surveillance Summaries, the prevalence has risen from 1 in 150 children being diagnosed to 1 in 44 since 2000. However, there is ongoing debate among experts regarding the reasons behind this increase. One factor that contributes to the rise in ASD prevalence is increased awareness and improved screening methods. As awareness about ASD has grown, more children are being identified and diagnosed with the disorder. Healthcare providers and educators are better equipped to recognize the signs and symptoms of ASD, leading to more accurate and timely diagnoses. Changes in diagnostic criteria also play a role in the increased prevalence. The criteria for diagnosing ASD have evolved over time, resulting in broader definitions and more inclusive criteria. This expansion has allowed for the identification of individuals who may have previously gone undiagnosed. However, it is important to note that the exact causes of the increased prevalence are still not fully understood. Some experts suggest that there may be underlying environmental or genetic factors contributing to the rise in ASD cases. Further research is needed to explore these factors and gain a better understanding of the true drivers behind the increased prevalence. Ultimately, the increase in ASD prevalence can be attributed to a combination of improved awareness, changes in diagnostic criteria, and potentially other factors. Ongoing research and collaboration among professionals in the field will help shed light on the causes and provide better insights into ASD. 4. Boys Are More Likely to Be Diagnosed Autism spectrum disorders (ASD) are more commonly diagnosed in boys than in girls, with a prevalence rate of about four times higher in boys compared to girls. According to Autism Speaks, approximately 1 in 27 boys and 1 in 116 girls are reported to have ASD. Boys tend to be diagnosed with ASD earlier and more frequently than girls. However, there is growing evidence that girls with ASD may be underdiagnosed. Research suggests that girls often exhibit different patterns of ASD symptoms and may present with camouflaged symptoms that are missed during evaluations, contributing to the underdiagnosis. A study published in the Journal of Autism and Developmental Disorders in May 2018 explored sex-based differences in ASD presentation among girls. The researchers highlighted the diagnosis gap between girls and boys and emphasized the need to recognize and understand the unique characteristics and challenges faced by girls with ASD. Underdiagnosis of ASD in girls may be attributed to fewer screenings and a lack of awareness about the diverse ways ASD can manifest in females. Societal expectations and stereotypes may also play a role. Girls with ASD may be perceived as shy or introverted, and their preference for solitary play or differences in social interactions may be overlooked or attributed to normal variations in behavior. In contrast, boys are often expected to exhibit more extroverted and social behaviors, making deviations from these expectations more noticeable. It is crucial to increase awareness and understanding of the unique presentation of ASD in girls. By addressing the gender disparities in ASD diagnosis, healthcare professionals can improve identification and provide appropriate support for girls with ASD. 5. Autism May Begin Before

Jul 02

Steroids Commonly Used for Asthma and Allergies Linked to Changes in Brain Structure, Study Shows

The white matter of the brain and cognitive impairment have been linked to glucocorticoids, a common steroid used to treat inflammation related to asthma and allergies. The latest study, published in BMJ Open, indicated that both inhaled and orally administered glucocorticoids had similar effects on brain structure. The authors of the study noted that it was the largest of its type to date. “Both systemic and inhaled glucocorticoid use were associated with reduced white matter integrity,” the study concluded. White matter is the connective tissue between brain cells and the rest of the nervous system, and it may be found in the deeper brain tissues. Damage to white matter has been linked to difficulties with learning, memory, and gait. Depression, anxiety, and even bipolar disease have all been related to white matter damage. The implications of this result and how it affects glucocorticoid use are discussed in further detail below. Oral and Inhaled Glucocorticoids Both Trigger Brain Decline Glucocorticoids, commonly prescribed drugs with immunosuppressive properties, are widely used to treat conditions such as allergies, asthma, and autoimmune disorders. However, a recent study examined the effects of glucocorticoid use on the brain and found a link between the medication and reduced white matter. The study analyzed data from individuals who used oral or inhaled glucocorticoids and compared it to a control group of individuals who did not use these medications. The participants underwent cognitive and mental health tests as well as brain MRIs. The results revealed that taking either oral or inhaled glucocorticoids was associated with a reduction in white matter in the brain. This reduction in white matter has the potential to lead to neuropsychiatric side effects, especially in individuals who use these medications regularly. The study noted that the impact on white matter was more significant in those who used glucocorticoid tablets or injections over a long period of time, while those who used inhalers or nasal glucocorticoids experienced a smaller impact. The exact reasons behind the impact of glucocorticoids on white brain matter are not yet clear, according to the study’s lead author. However, the findings suggest that chronic exposure to glucocorticoids may have detrimental effects on white matter in various organs of the body, including the brain. Further research is needed to better understand the underlying mechanisms and implications of these findings. In the meantime, it is important for healthcare professionals to consider the potential neuropsychiatric effects of glucocorticoid use, especially with long-term or high-dose administration. Are the Findings Cause for Concern? While the recent study suggests a link between glucocorticoid use and reduced white matter in the brain, experts have emphasized that the results should not cause undue concern. According to Dr. Kesari, white matter can potentially repair itself even in the presence of glucocorticoids, and the brain appears to recover when patients are taken off these medications. It is important to note that the study did not specifically investigate the long-term impacts of glucocorticoid use on white brain matter. Previous research has associated long-term oral glucocorticoid use with brain shrinkage in certain areas and changes in brain structure. Mental health issues have also been linked to this class of drugs. The consequences of the observed changes in white matter and their impact on patients are still unknown. The reversibility of these changes remains to be determined. As Jamie Alan, PhD, an associate professor of pharmacology and toxicology, pointed out, there is still much to learn about the effects of glucocorticoids on the brain. What Should You Do if You Use Glucocorticoids? Given the minimal changes observed in white matter, Van der Meulen advised against patients abruptly changing their medication based on the study findings. The small structural changes found in the study are likely to have no significant functional side effects for many individuals with asthma. Other medical professionals echoed similar advice. They emphasized the importance of using glucocorticoids for the shortest duration possible due to their known side effects. The study supports the clinical guideline of minimizing the use of glucocorticoids when feasible. Dr. Kesari acknowledged the beneficial anti-inflammatory properties of glucocorticoids and their widespread use in treating various conditions. He highlighted the need for a better understanding of their side effects and more effective mitigation strategies. If a person is on a high dose of glucocorticoids for an extended period, Dr. Kesari suggested discussing with their doctor the possibility of reducing the dosage or exploring alternative treatments that may have less impact on the body and brain. However, it is important to note that van der Meulen strongly advised against making changes to medication without consulting a healthcare provider. If a person requires the medication, they should continue taking it as prescribed until they have discussed any concerns with their doctor.

Dec 14

Creutzfeldt-Jakob Disease

Creutzfeldt-Jakob disease (CJD) is a rare and devastating brain disorder that belongs to a group of human and animal diseases known as prion disorders. This condition is characterized by rapid deterioration of mental abilities and typically leads to dementia. While the symptoms of CJD can bear some resemblance to those of Alzheimer’s disease, the progression of CJD is far more rapid and almost invariably leads to death. CJD gained public attention in the 1990s when some individuals in the United Kingdom developed a variant form of the disease known as vCJD. This variant was linked to the consumption of meat from diseased cattle, raising concerns about food safety. However, it’s essential to note that the majority of CJD cases have not been linked to beef consumption. All types of CJD are extremely serious, but they are also exceedingly rare. Only about 1 to 2 cases of CJD are diagnosed per million people worldwide each year. The disease predominantly affects older adults. Symptoms and Disease Progression Creutzfeldt-Jakob disease is primarily characterized by rapid cognitive decline. Symptoms tend to worsen quickly, usually progressing within several weeks to a few months. The early symptoms of CJD can include personality changes, memory loss, impaired thinking, blurry vision or blindness, insomnia, problems with coordination, trouble speaking, trouble swallowing, and sudden, jerky movements. Sadly, death usually occurs within a year of the onset of symptoms. In the case of variant CJD (vCJD), changes in mental abilities may be more evident in the initial stages of the disease, with dementia often developing later in the illness. vCJD typically affects individuals at a younger age than classical CJD and has a relatively shorter course, usually lasting 12 to 14 months. There’s also another rare form of prion disease called variably protease-sensitive prionopathy (VPSPr). VPSPr can mimic other forms of dementia, causing changes in mental abilities, as well as speech and thinking problems. However, the disease’s course is longer than other prion disorders, spanning around 24 months. Causes and Transmission Creutzfeldt-Jakob disease and related prion disorders are believed to be caused by abnormal proteins known as prions. While prions are typically produced in the body, they can become misshapen when they encounter infectious prions. These misshapen prions can trigger a chain reaction in which they induce other normally shaped prions to change into the infectious form. This misfolding of prion proteins ultimately disrupts normal cellular processes. The risk of developing CJD is low, and the disease cannot be transmitted through casual means like coughing, sneezing, touching, or sexual contact. CJD can develop in three primary ways: 1. Sporadically: The majority of individuals with CJD develop the disease spontaneously, without any identifiable cause. This form is referred to as sporadic CJD and accounts for most cases. 2. By Inheritance: In a smaller percentage of CJD cases (less than 15%), individuals have a family history of the disease. In these familial cases, genetic changes related to the prion protein are typically responsible. These genetic forms are collectively referred to as familial CJD. 3. By Contamination: A limited number of people have contracted CJD as a result of medical procedures. Such procedures have included injections of human growth hormone derived from infected sources, cornea and skin transplants from CJD patients, and brain surgery with contaminated instruments. Today, strict measures are in place to reduce the risk of these iatrogenic transmissions. Additionally, a small number of individuals developed variant CJD after consuming beef from cattle infected with bovine spongiform encephalopathy (mad cow disease). However, it’s essential to note that the risk of contracting variant CJD from consuming contaminated beef is very low, especially in countries that have implemented effective public health measures. Risk Factors Most cases of Creutzfeldt-Jakob disease occur spontaneously and without an identifiable cause. Consequently, specific risk factors for this form of the disease cannot be pinpointed. However, certain factors are associated with different types of CJD: 1. Age: Sporadic CJD typically occurs later in life, around the age of 60. Familial CJD tends to appear slightly earlier, and vCJD affects people at a much younger age, usually in their late 20s. 2. Genetics: Individuals with familial CJD have specific genetic mutations that cause the disease. To inherit this form of the disease, a child must receive one copy of the mutated gene from either parent. The chance of passing this gene to offspring is 50%. 3. Exposure to Contaminated Tissue: People who’ve received infected human growth hormone or dura mater (tissue covering the brain) transplants from CJD patients may be at risk of developing iatrogenic CJD. Complications Creutzfeldt-Jakob disease has devastating effects on the brain and body. The disease progresses rapidly, leading to social withdrawal, loss of self-care abilities, and often, a comatose state. CJD is invariably fatal, and individuals with this disease experience extreme suffering throughout its course. Prevention There is no known way to prevent sporadic CJD since its cause is generally unknown. However, if you have a family history of neurological disease, consulting a genetic counselor can be beneficial. Such professionals can help assess your risk and provide guidance based on your genetic background. Preventing CJD related to medical procedures, known as iatrogenic CJD, is a critical aspect of medical safety. Measures to minimize this risk include using human-made human growth hormone instead of extracting it from human pituitary glands and destroying surgical instruments that may have come into contact with CJD-infected tissue. Single-use kits for certain procedures like spinal taps (lumbar punctures) can also be employed to mitigate risk. To protect the safety of the blood supply, individuals at risk of CJD or vCJD exposure, including those with a blood relative diagnosed with familial CJD and those who’ve received dura mater brain grafts or human growth hormone from cadavers, are not eligible to donate blood in the United States. The United Kingdom and other countries also have specific regulations regarding blood donations from individuals at risk of CJD or vCJD exposure. Preventing variant Creutzfeldt-Jakob disease, the form linked to consuming contaminated beef, is primarily accomplished

Dec 10

Meningitis

Meningitis is a relatively rare but severe infection that targets the delicate membranes, known as meninges, enveloping the brain and spinal cord. This infectious ailment can affect both children and adults. In this comprehensive guide, we will explore various aspects of meningitis, including its types, causes, symptoms, diagnostic procedures, treatment options, and prevention strategies. Unraveling the Types of Meningitis Meningitis exists in several forms, with the most common types being: 1. Bacterial Meningitis: Bacterial meningitis is a highly critical form of the disease that necessitates immediate medical attention. If left untreated, it can be life-threatening or result in significant brain damage. The primary bacterial culprits behind this form of meningitis in the United States are Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus), and Listeria monocytogenes (often affecting older individuals, pregnant women, or those with compromised immune systems). In the past, Haemophilus influenzae type b (Hib) was a common cause, especially in babies and young children. However, the introduction of the Hib vaccine for infants has significantly reduced its prevalence. Vaccines are now available for Neisseria meningitidis and Streptococcus pneumoniae, with experts recommending them for all children and adults at higher risk for the disease. 2. Viral Meningitis: This variant of meningitis is more common than the bacterial form and is generally less severe. Numerous viruses can trigger viral meningitis, some of which can also cause conditions like diarrhea. 3. Fungal Meningitis: Fungal meningitis is far less common than bacterial or viral forms and typically affects individuals with compromised immune systems, such as those with AIDS. 4. Parasitic Meningitis: This form of meningitis is exceptionally rare and is caused by parasites that usually affect animals. Human infections typically occur through the consumption of contaminated food products, particularly undercooked or raw items. 5. Amoebic Meningitis: Amoebic meningitis is an exceedingly rare, usually fatal infection caused by a single-celled organism known as Naegleria fowleri. This amoeba resides in soil or warm, fresh water but is not found in saltwater. Infection primarily occurs when individuals swim in water where the amoeba is present. 6. Non-Infectious Meningitis: Non-infectious meningitis is driven by underlying diseases like lupus, cancer, head injuries, brain surgeries, or certain medications. Unlike infectious forms of meningitis, non-infectious meningitis is not contagious. 7. Chronic Meningitis: Chronic meningitis shares symptoms with acute meningitis but develops more gradually over a few weeks. It is often caused by fungal infections or mycobacteria, the bacteria responsible for tuberculosis. Deciphering Meningitis Symptoms Meningitis can manifest within hours or days and is characterized by a range of symptoms. Common symptoms include: In infants, the symptoms of meningitis may differ and can include: Identifying Risk Factors for Meningitis Meningitis can affect individuals of all ages; however, research indicates a higher prevalence in specific age groups, including: Furthermore, individuals with certain medical conditions, such as those with a damaged or absent spleen, long-term illnesses, or immune system disorders, face a heightened risk of developing meningitis. Additionally, outbreaks of the disease are more likely in areas where people live in close proximity, such as college dormitories or military barracks. Traveling to regions where meningitis is more prevalent, particularly parts of Africa, also increases the risk. Unveiling the Causes of Meningitis Meningitis predominantly occurs due to bacterial or viral infections that originate in other parts of the body, such as the ears, sinuses, or throat. Less common causes encompass autoimmune disorders, cancer medications, syphilis, and tuberculosis. Navigating the Diagnostic Process for Meningitis To diagnose meningitis, a healthcare provider will undertake a comprehensive evaluation. This process typically involves: 1. Medical History Assessment: The doctor will inquire about your medical history. 2. Physical Examination: This includes assessing neck stiffness and examining the skin for rashes that could indicate a bacterial infection. 3. Laboratory Tests: Blood tests will be conducted to detect the presence of bacteria. Additional tests, such as CT or MRI scans, may be performed to identify brain swelling or inflammation. 4. Spinal Tap: A healthcare professional will use a needle to extract fluid from around the spinal cord. This procedure, known as a spinal tap, can reveal the cause of the meningitis. Exploring Meningitis Treatment Treatment for meningitis depends on the type of meningitis diagnosed: 1. Bacterial Meningitis: Immediate administration of antibiotics is essential. A broad-spectrum antibiotic is often administered prior to identifying the specific bacteria causing the infection. Once the pathogen is identified through a spinal tap, treatment shifts to a targeted antibiotic. Corticosteroids may also be prescribed to reduce inflammation. 2. Viral Meningitis: In most cases, viral meningitis resolves without treatment. Bed rest, increased fluid intake, and over-the-counter pain relievers may be recommended if symptoms are present. For viral meningitis resulting from specific viruses like herpes or influenza, antiviral medications may be prescribed. 3. Fungal Meningitis: Antifungal medications are employed for the treatment of fungal meningitis. Hospitalization may be required in cases of severe symptoms or dehydration. Understanding the Complications of Meningitis Untreated or inadequately managed meningitis can lead to severe complications, including: Grasping Meningitis Prevention Strategies Preventing meningitis primarily revolves around minimizing the risk of infections from the viruses or bacteria responsible for the disease. Since these microorganisms can spread through close contact, it is crucial to adopt infection prevention practices: 1. Frequent Handwashing: Regular handwashing with soap and water, especially after eating, using the restroom, or being in public areas, is essential. Educating children about proper hand hygiene is also crucial. 2. Avoiding Sharing Personal Items: Do not share items like toothbrushes, eating utensils, or cosmetics, as they can harbor infectious agents. 3. Preventing Close Contact: Avoid close contact, such as kissing, with individuals who exhibit symptoms of infectious diseases. 4. Maintaining General Health: A balanced diet, regular exercise, and adequate rest can bolster overall health and immune function. 5. Food Safety: Pregnant individuals should consume well-cooked food and avoid unpasteurized milk, raw, or undercooked meat, fish, and eggs. 6. Immunization: Adhering to immunization recommendations for diseases that may lead to bacterial meningitis, such as receiving flu and pneumonia vaccines, is a preventive measure to consider. In conclusion, meningitis,

Dec 10

An Overview of Meningococcal Meningitis

Meningococcal meningitis, though rare, is a potentially life-threatening bacterial infection that causes inflammation of the membranes covering the brain and spinal cord. This condition, which encompasses both meningitis and septicemia (blood infection), afflicts approximately 1,000 individuals annually in the United States. The severity of meningococcal meningitis underscores the importance of timely treatment, as approximately one in five people who contract the infection endure severe complications. Even with antibiotics, the disease claims the lives of 10 to 15% of those infected, and of those who survive, one in five grapples with long-term disabilities, such as deafness, brain damage, neurological issues, and, in some tragic cases, limb loss. This comprehensive guide illuminates the symptoms of meningococcal meningitis, prevention strategies, and treatment options. Unpacking the Causes of Meningococcal Meningitis Meningitis is primarily caused by two factors: bacteria and viruses. Among bacterial strains, Neisseria meningitidis, colloquially known as meningococcus, is the culprit behind meningococcal meningitis. It is the leading cause of bacterial meningitis in children and teenagers, and the second most common in adults. The infection typically originates in another part of the body, such as the skin, gastrointestinal tract, or respiratory tract, from where the bacteria inexplicably journey through the bloodstream to the nervous system. This migration leads to the onset of meningococcal meningitis. In some instances, bacteria can directly access the nervous system following severe head trauma, surgical procedures, or infections. The risk of contracting meningococcal meningitis escalates in situations of exposure to the responsible bacterium, as well as after a recent upper respiratory infection. High-risk groups encompass infants, children, teenagers, the elderly, and individuals who have had such exposures. Decoding the Symptoms of Meningococcal Meningitis Symptoms of meningococcal meningitis can manifest differently from one case to another. Nevertheless, common indicators include: An especially crucial sign to watch for is a reddish or purple skin rash, often referred to as petechiae. If pressure is applied to this rash with a glass and it does not blanch (turn white), it may be indicative of bacteremia, signifying a bacterial infection in the bloodstream and constituting a medical emergency. Moreover, the infection may manifest as meningococcemia, an acute form of blood poisoning induced by Neisseria meningitidis. It can result in a pronounced rash as it damages blood vessels throughout the body. Additional symptoms associated with meningococcal meningitis or bacteremia encompass a tense or bulging soft spot in infants, high-pitched or moaning cries in babies, stiff and jerky movements or floppiness in babies or toddlers, irritability, rapid breathing, excessive drowsiness, blotchy skin turning pale or blue, shivering or cold extremities, and seizures. Exploring the Treatment for Meningococcal Meningitis Meningococcal meningitis is perilous and necessitates immediate action. If symptoms are observed, swift medical attention is imperative. Delaying treatment can lead to death or severe complications such as brain damage, paralysis, gangrene, or hearing loss. It is of utmost importance to act promptly. Seek immediate medical assistance by visiting an emergency room or dialing 911 if: Tests can definitively diagnose meningococcal meningitis, and the physician may initiate antibiotic treatment, typically with penicillin or ceftriaxone, through intravenous administration. Additional medications may be prescribed to address issues linked to elevated spinal fluid pressure. In some cases, steroids are employed. If an individual has had close contact with someone afflicted by meningococcal meningitis, it is imperative to secure antibiotics to preclude infection. Addressing the Role of Vaccination Prevention represents an indispensable strategy for tackling meningococcal meningitis due to its seriousness, even with treatment. The meningococcal vaccine plays a pivotal role in averting this infection. In the United States, three types of meningococcal vaccines are deployed: 1. Meningococcal Conjugate Vaccine (MCV4): This vaccine, encompassing Menactra (ages 9 months to 55) and Menveo (ages 2 through 55), effectively safeguards against a wide age range. 2. Meningococcal Polysaccharide Vaccine (MPSV4): Approved in the 1970s, this vaccine is suitable for individuals aged 9 months to those older than 55. It provides protection against numerous strains of meningococcal disease. 3. Serogroup B Meningococcal B (MenB): Two MenB vaccines, Trumenba (ages 10-24) and Bexsero (ages 10-24), have been licensed. They are also considered for older patients. While these vaccines may not guard against all forms of meningococcal disease, they effectively shield against many types. Approximately nine out of ten people respond positively to these vaccines. MCV4, in particular, offers extended protection and is adept at curbing disease transmission. Medical professionals recommend administering the first dose of MCV4 at the age of 11, followed by a booster at 16. However, should the initial dose be missed, individuals can receive it between the ages of 13 and 15, with a subsequent booster between 16 and 18. High-risk groups, such as people aged 16-18 or those traveling to areas where meningococcal disease is prevalent, should also contemplate receiving MenB vaccines. A second dose is advisable for everyone. Certain precautions should be exercised regarding vaccination. Individuals who are gravely ill at the time of the scheduled vaccine should defer immunization. Furthermore, if a severe allergic reaction to a prior vaccine dose is documented, or if an individual exhibits a severe allergy to any vaccine constituent, vaccination is not advised. In cases of prior Guillain-Barre Syndrome or acute disseminated encephalomyelitis, it is prudent to avoid vaccination. While mild pain or redness at the injection site is commonplace and generally benign, a strong reaction should be reported to a healthcare provider. Such reactions may encompass a high fever, weakness, or indications of an allergic response like breathing difficulties, rapid heartbeat, or dizziness. In conclusion, meningococcal meningitis is a grave concern due to its potential for severe complications and fatalities. Understanding its causes, symptoms, treatment, and prevention through vaccination is pivotal for preserving individual and public health. By adhering to vaccination recommendations and taking swift action in response to symptoms, individuals can significantly diminish their risk of contracting this perilous infection and, in turn, enhance their overall well-being.

Dec 10

What Is Your Nervous System?

The nervous system, a remarkable network of fibers and neurons, serves as the ultimate communication highway within the human body. It facilitates the transmission of vital messages between the brain and the rest of the body, regulating countless physiological processes. This intricate system is divided into two primary components: 1. Central Nervous System (CNS): Comprising the brain and spinal cord, the central nervous system serves as the command center of the body, orchestrating essential functions and cognitive processes. 2. Peripheral Nervous System (PNS): The peripheral nervous system encompasses the network of nerves that extend throughout the body, connecting various organs, muscles, and tissues to the CNS. The vital role played by the nervous system is evident in its involvement in every aspect of bodily functioning. It directs the rhythmic beat of the heart, controls the rise and fall of the chest during breathing, guides coordinated movements, shapes our speech and thought processes, and stores our memories. Furthermore, it manages our sensory perceptions and interprets the world around us. The Intricate Workings of the Nervous System The functionality of the intricate nervous system fundamentally hinges on the transmission of vital messages along an extraordinarily complex neural network. These critical messages are relayed with remarkable precision through the intricate interactions of specialized cells known as neurons, while the tiny, specialized spaces facilitating these exchanges are referred to as synapses. These neurons are astoundingly interconnected through the intricate exchange of chemical signals known as neurotransmitters, with some of the most well-known ones including dopamine and serotonin. This intricate and elegant communication process constitutes a fascinating interplay of biochemical signals, culminating in the swift and efficient transfer of crucial information throughout the body. Astonishingly, some of these messages traverse along neural pathways at remarkable speeds, surpassing speeds of 200 miles per hour. Notably, this intricate and extensive web of neural connections serves as the critical conduit for communication between the body’s peripheral nervous system and the central nervous system. When an external stimulus is encountered, such as stepping on a sharp object, the nerves within the foot initiate an elaborate and orchestrated series of neural interactions. This intricate chain reaction comprises messages being relayed from neuron to neuron with astonishing precision until the information ultimately reaches the central nervous system, where the brain and spinal cord, in their remarkable wisdom, promptly respond with a finely-tuned instruction to the foot: “Withdraw immediately to avoid injury.” This awe-inspiring symphony of neurobiological interactions underscores the intricacies of the human nervous system and its vital role in safeguarding our well-being. Challenges to the Nervous System Despite the inherent protective mechanisms surrounding the nervous system, it is not immune to disorders and damage. Just like any other part of the body, it can be subject to a range of conditions that disrupt its normal functioning. These disorders impede the effective communication between the central nervous system, peripheral nerves, and the rest of the body. Some examples of these disruptive conditions include: 1. Infections: Certain infections such as meningitis, encephalitis, or polio can target the nervous system, leading to inflammation and potential damage. 2. Physical Trauma: Injuries or conditions like Bell’s palsy and carpal tunnel syndrome can compromise the integrity of the nervous system, resulting in impaired functionality. 3. Neurodegenerative Diseases: Conditions like Parkinson’s disease, multiple sclerosis, and Alzheimer’s disease gradually erode the proper functioning of the nervous system, leading to cognitive decline, motor deficits, and other symptoms. 4. Vascular Issues: The nervous system is susceptible to problems within the vascular system, including strokes, transient ischemic attacks (TIAs), and subdural hematoma, which can disrupt blood flow or cause bleeding around the brain. While the nervous system is well-protected within the body, these disorders underscore the critical importance of maintaining its health and functionality. Promoting Nervous System Health The vitality of the nervous system necessitates a multifaceted approach to its maintenance and well-being. Just as the body requires rest for recuperation, the brain benefits immensely from a regular sleep schedule. Quality sleep allows for the repair of neural connections and the consolidation of memories. Nutrition plays a pivotal role in sustaining the nervous system. Incorporating a balanced diet rich in omega-3 fatty acids is essential. Foods such as fatty fish (e.g., salmon, albacore tuna, mackerel, herring, and farmed trout) are excellent sources of these vital nutrients, which support cognitive function and protect neural health. Stress management is another crucial element in maintaining a healthy nervous system. Chronic stress can exert a significant toll on neurological function. Implementing stress-reduction strategies such as regular exercise, taking breaks to relax, spending time with loved ones, practicing mindfulness through activities like yoga or meditation, limiting alcohol consumption, and quitting smoking can all mitigate the adverse effects of stress. Additionally, it is essential to monitor and control blood pressure and cholesterol levels, as these factors have a direct impact on the health of blood vessels that nourish the nervous system. Proper management of these cardiovascular risk factors is indispensable in preserving the vitality of the nervous system. In conclusion, safeguarding the health of the complex and intricate nervous system necessitates a holistic approach that encompasses a multitude of lifestyle adjustments. These adjustments involve not only rest and nutrition but also the active management of stress and vigilance in maintaining optimal cardiovascular health. It is crucial to recognize that the nervous system, this remarkable communication network, serves as the central hub of human existence, orchestrating a myriad of bodily functions. Therefore, by diligently adhering to these principles and embracing a lifestyle that promotes the well-being of the nervous system, individuals can significantly enhance its resilience and functionality, thus ensuring a higher quality of life and overall health.

Dec 09

Conditions That May Look Like Autism, but Aren’t

Autism, once a relatively unfamiliar term, has become increasingly prevalent in our vocabulary in recent decades. Autism, an abbreviation for Autism Spectrum Disorder (ASD), is a neurodevelopmental condition associated with various brain pathway disorders that significantly impact an individual’s behavior and communication skills. ASD typically manifests in early childhood, but it’s important to acknowledge that adults can also receive an ASD diagnosis. The hallmark of ASD is its vast and diverse spectrum, encompassing a wide range of symptoms and severity levels. While there are common behaviors linked to ASD, the condition presents uniquely in each affected individual. Some exhibit mild symptoms, hardly noticeable to others, while others experience severe manifestations that significantly affect their daily lives. Autism shares some similarities with other conditions, leading to potential misdiagnoses or confusion. This article aims to explore these conditions that might be mistaken for autism and emphasizes the necessity of accurate diagnosis, as treating an individual for autism when they have a different condition can be counterproductive. Conditions That Can Mimic Autism: A Comprehensive Overview Misdiagnosis can occur when conditions exhibit symptoms similar to those of autism. The following conditions are noteworthy for their potential to be confused with autism: 1. Developmental Delays: These delays encompass various aspects such as speech, language, and other developmental milestones. They can manifest in issues related to language, speech, hearing, fine motor skills, social interactions, and cognitive abilities. While children with autism may experience developmental delays, these delays can arise from various causes, including lead poisoning, Down syndrome, or may even have an unknown origin. 2. Narrowed Interests: Children with autism sometimes develop intense interests in specific activities or objects. These interests can appear obsessive. However, it is essential to recognize that having narrowed interests alone does not signify autism. A complete ASD diagnosis should include other co-occurring symptoms, such as difficulties in social interactions. 3. Early Reading or High Intelligence: Children who display advanced reading skills at an early age or demonstrate signs of high intelligence might receive an autism diagnosis. This is especially true for children with hyperlexia, which refers to early reading or high intelligence paired with challenges in communication. It’s important to note that high intelligence and autism do not always co-occur, and conditions like hyperlexia can exist independently. 4. Sensory or Sensory Processing Issues: Some children exhibit extreme sensitivity to sensory stimuli, such as light, sound, or touch. Actions like hugging or exposure to loud noises can distress or inhibit their communication. While these issues may also manifest in children with autism, they are typically accompanied by other autism-related symptoms, such as speech delays. 5. Psychological Disorders: Certain psychological disorders can lead to behaviors that resemble autism, encompassing obsessive tendencies, speech and communication difficulties, and other challenges. Examples of such conditions include avoidant personality disorder, obsessive-compulsive disorder (OCD), reactive attachment disorder, social (pragmatic) communication disorder, and, albeit rarely in children, schizophrenia. 6. Lead Poisoning: Lead, a toxic metal, can cause brain damage when ingested by children through sources like paint chips or contaminated water. This can lead to developmental delays and learning difficulties, mirroring symptoms associated with autism. Although some research suggests a potential connection between lead poisoning and autism, this link remains unclear. Children treated for lead poisoning often witness symptom improvement, underscoring the importance of accurate diagnosis. 7. Genetic Disorders: While some genetic disorders, such as Down syndrome or tuberous sclerosis, can co-occur with autism, others may be mistaken for autism. Recent research has indicated that as many as 50% of children with 22q11.2 deletion syndrome, a genetic disorder, received a misdiagnosis of autism. The symptoms of this syndrome, including delayed speech development, can overlap with autism. Crucial Inquiries for Accurate Diagnosis To accurately diagnose autism, healthcare providers assess a child’s development and behavior. This evaluation typically involves questions directed to parents and, in some cases, children, a comprehensive health history review, and direct observations of the child’s behavior. If the healthcare provider suspects ASD, they may recommend a comprehensive evaluation. During this evaluation, a team of experts specializing in autism, including neurologists, psychologists, psychiatrists, speech therapists, and other professionals, conducts a series of tests and screenings to determine if the child has autism or another condition, such as a psychological or speech disorder. For parents who believe their child may have been misdiagnosed with autism or might have another underlying health issue, the following key questions can be posed to the child’s healthcare provider: 1. Hearing Assessment: Has my child undergone a thorough hearing evaluation? Hearing problems can lead to speech development delays and other issues that might be misattributed to autism. 2. Additional Diagnostic Tests: Are there any other diagnostic tests or screenings worth considering? For instance, if you reside in an older home with potential lead exposure, requesting lead level testing may be crucial. 3. Specialist Referrals: Should my child be evaluated by specialists, or a team of specialists, in addition to their primary physician? If your child has received an autism diagnosis, but you have concerns or questions, obtaining additional opinions and evaluations from neurologists, psychiatrists, or other ASD specialists can offer valuable insights. 4. Initiating Treatment: Can we commence treatment, even if the specific condition is uncertain? In cases where a child has a developmental delay that may or may not be autism, treatments such as occupational therapy, speech therapy, or social skills training can be beneficial in addressing specific needs. Conclusion Autism Spectrum Disorder is an intricate and multifaceted neurodevelopmental condition characterized by a wide spectrum of symptoms that can manifest differently among individuals. Recognizing the diverse signs and obtaining a precise diagnosis are pivotal for early intervention and the development of personalized treatment plans. While some conditions may exhibit symptoms that bear similarities to those of autism, it is imperative to delve into the realm of other potential causative factors and engage in close collaboration with healthcare professionals for comprehensive evaluations. An accurate diagnosis not only brings clarity but also ensures that individuals receive the most tailored and effective interventions, which can

Dec 09

Multifocal Motor Neuropathy

Multifocal Motor Neuropathy, commonly referred to as MMN, is a neurological disorder that primarily affects the motor nerves responsible for controlling your muscles. The hallmark of MMN is the impediment in transmitting electrical signals within your body, resulting in a weakening of the hands and arms, accompanied by muscle twitches and cramps. While MMN is a chronic condition, it is not life-threatening, and most cases can be effectively managed with appropriate treatment. In this comprehensive exploration of MMN, we will delve into its causes, symptoms, diagnosis, and treatment options, shedding light on this condition to enhance understanding and awareness. Causes of Multifocal Motor Neuropathy The exact cause of MMN remains elusive. What is known, however, is that MMN is an autoimmune disease, characterized by an aberration in the immune system where it mistakenly attacks the body’s own nerve cells, perceiving them as foreign invaders. Ongoing research endeavors are dedicated to unraveling the precise triggers and mechanisms that underlie this autoimmune response. Uncovering these triggers is vital for developing more targeted and effective treatment strategies for MMN. Symptoms of Multifocal Motor Neuropathy The initial signs of MMN typically manifest in the hands and lower arms. Individuals with MMN may experience weakness, uncontrolled muscle cramping, and persistent twitching. This weakness and discomfort often commence in specific regions, such as the wrist or fingers, and tend to be more pronounced on one side of the body. Over time, MMN may progress to affect the legs. It is noteworthy that MMN is not associated with pain, and sensory functions of the hands and arms remain intact. Nevertheless, the symptoms of MMN tend to worsen gradually as individuals age. Getting a Diagnosis Diagnosing MMN is a meticulous process, as it shares symptomatic similarities with other neurological conditions, particularly Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease. To ascertain an accurate diagnosis, individuals exhibiting symptoms suggestive of MMN will typically be referred to a neurologist, a specialist in nervous system disorders. The diagnostic process involves a combination of clinical evaluation and specific tests. The neurologist will conduct a thorough physical examination and inquire about the nature and duration of the symptoms. Key questions may include: Furthermore, the diagnostic process may encompass the following tests: Treatment Options for Multifocal Motor Neuropathy The treatment of MMN is tailored to the severity of the symptoms and their impact on an individual’s daily life. In cases of mild symptoms, treatment may not be immediately necessary. However, for those who require intervention, there are several treatment options available, with the primary goal of enhancing muscle strength and minimizing the progression of the condition. Taking Care of Yourself with MMN Early diagnosis and treatment are pivotal in managing MMN and reducing the severity of symptoms. Adherence to the recommended treatment plan and open communication with your healthcare provider are essential components of managing the condition. Additionally, occupational and physical therapy may be beneficial for individuals experiencing difficulties with daily activities. These therapies can help maintain muscle strength and provide strategies for accomplishing routine tasks with greater ease. What to Expect Living with MMN The impact of MMN on an individual’s life can vary widely depending on the specific muscles affected and the severity of the condition. Many individuals with MMN are capable of maintaining most, if not all, of their normal activities. However, for some, the disease may progress to the point where daily tasks become challenging. The specific challenges faced by individuals with MMN correlate with the muscles impacted. Weakness in hand muscles can hinder activities such as eating, typing, writing, and buttoning clothes, while weakness in leg muscles may result in difficulties with walking. For those with severe MMN, these limitations can affect various aspects of daily life. In conclusion, Multifocal Motor Neuropathy is a complex neurological condition that primarily affects the motor nerves controlling muscle movements. While the exact cause remains unclear, ongoing research is shedding light on the autoimmune nature of the disease. Early diagnosis and appropriate treatment, such as IVIg, can significantly improve the quality of life for individuals living with MMN. By understanding the causes, symptoms, and available treatments, individuals and their healthcare providers can collaborate to effectively manage this condition and maintain a fulfilling and active lifestyle.