#dementia - Shift.ms

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MS and Dementia

I haven’t been diagnosed with Dementia but i have symptoms of it. I regularly have cognitive issues, difficulty completing familiar tasks, recalling information about what was discussed a few hours back, trouble with speaking amongst other things. My friends and family have commented about my tr...

London Borough of Ealing, England, United Kingdom

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@show

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Gabapentin -does it cause dementia?

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@michael_washburn

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Dementia due to MS?

After nearly 3 years of searching for answers to my wife's rapid cognitive decline, multiple tests and MRIs and second opinions it is clear she has a the syndrome of Dementia. Our local neurologist as well as the team at UCLA agree that the cause is MS. Images show significant brain atrophy. I ...

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@PumaPie

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Gut Microbiome Likely Influences Neurodegenerative DisordersChristine KilgoreApril 02, 20252584WASHINGTON, DC — Age-related neurodegenerative disorders — motor neuron diseases, demyelinating diseases, Alzheimer’s disease, and other proteinopathies — are at an “inflection point,” said researcher Andrea R. Merchak, PhD, with a fuller understanding of disease pathophysiology but an overall dearth of effective disease-modifying treatments. And this, Merchak said at the Gut Microbiota for Health (GMFH) World Summit 2025, is where the gut microbiome comes in. “The gut-brain axis is important to take into consideration,” she urged, both for gut microbiome researchers — whose collaboration with neurologists and neuroscientists is essential — and for practicing gastroenterologists.“We are the sum of our environmental exposures,” said Merchak, assistant research professor of neurology at the Indiana University School of Medicine, in Indianapolis. “So for your patient populations, remember you’re not only treating the diseases they’re coming to you with, you’re also treating them for a lifetime of healthy [brain] aging.”At the center of a healthy aging brain are the brain-residing microglia and peripheral monocytes, she said. These immune cell populations are directly influenced by blood-brain barrier breakdown, inflammation, and gut permeability — and indirectly influenced by microbial products, gastrointestinal (GI) function, and bacterial diversity, Merchak said at the meeting, which was convened by the American Gastroenterological Association and the European Society of Neurogastroenterology and Motility. immune-privileged site, but we’ve been establishing that this is fundamentally not true,” she said. “While the brain does have a privileged status, there are interactions with the blood, with the peripheral immune cells.”Merchak coauthored a 2024 review in Neurotherapeutics in which she and her colleagues explained that the brain is “heavily connected with peripheral immune dynamics,” and that the gut — as the largest immune organ in the body — is a critical place for peripheral immune development, “thus influencing brain health.” Gut microbiota interact with the brain via several mechanisms including microbiota-derived metabolites that enter circulation, direct communication via the vagus nerve, and modulation of the immune system, Merchak and her coauthors wrote. Leaky gut, they noted, can lead to an accumulation of inflammatory signals and cells that can exacerbate or induce the onset of neurodegenerative conditions. As researchers better understand the role that GI dysfunction plays in neurodegenerative disease — as they identify microbiome signatures for predicting risk, for instance — there will be “opportunities to target the microbiome to prevent or reverse dysbiosis as a way to delay, arrest or prevent the onset and progression of neurodegenerative diseases,” they wrote.At the GMFH meeting, Merchak described both ongoing preclinical research that is dissecting gut-brain communication, and preliminary clinical evidence for the use of gut microbiota-modulating therapies in neurodegenerative disease.Support for a Gut-Focused ApproachResearch on bile acid metabolism in multiple sclerosis (MS) and on peripheral inflammation in dementia exemplify the ongoing preclinical research uncovering the mechanisms of gut-brain communication, Merchak said The finding that bile acid metabolism modulates MS autoimmunity comes from research done by Merchak and a team at the University of Virginia, Charlottesville, Virginia, several years ago in which mice with experimental autoimmune encephalomyelitis (EAE) — an animal model of MS — were engineered for T cell specific knockout of the aryl hydrocarbon receptor (AHR). The AHR has been directly tied to MS, and T lymphocytes are known to play a central role in MS pathophysiology.Blocking the activity of AHR in CD4-positive T cells significantly affected the production of bile acids and other metabolites in the microbiome — and the outcome of central nervous system autoimmunity. “Mice with high levels of bile acids, both primary and secondary, actually recovered from this EAE” and regained motor function, Merchak said at the GMFH meeting.The potential impact of genetic manipulation on recovery was ruled out — and the role of bile acids confirmed — when, using the EAE model, gut bacteria from mice without AHR were transplanted into mice with AHR. The mice with AHR were able to recover, confirming that AHR can reprogram the gut microbiome and that “high levels of bile acid can lead to reduced autoimmunity in an MS model,” she said.Other elements and stages of the research, which was published in PLOS Biology in 2023, showed increased apoptosis of CD4-positive immune cells in AHR-deficient mice and the ability of oral taurocholic acid — a bile acid that was especially high in mice without AHR — to reduce the severity of EAE, Merchak said.Evidence for the role of gut and peripheral inflammation on neurodegeneration is building on numerous fronts, Merchak said. Unpublished research using spatial transcriptomics of colon biopsies from patients with inflammatory bowel disease (IBD), patients with Parkinson’s disease (PD), and neurologically healthy control individuals, for instance, showed similar cell communication patterns in patients with IBD or PD (and no history of IBD) compared with healthy control individuals.And in research using a single-cell genomics approach and a mouse model of lipopolysaccharide (LPS)-induced system neuroinflammation, microglia were found to preferentially communicate with peripheral myeloid cells rather than other microglia after peripheral LPS exposure.“In saline-treated mice, the microglia are talking primarily to microglia, but in LPS-treated mice, microglia spend more time communicating with monocytes and T cells,” Merchak explained. “We see communication going from inside the brain to cells coming in from the periphery.”In another experiment, 2 months of a high-fat, high-sugar diet in mice with an engineered predisposition to frontotemporal dementia led to significant upregulation of major histocompatibility complex class II (MHC II) expression on monocytes in the brain, she said, describing unpublished research. Because MHC II handles antigen presentation in the brain, the change signals increased central-peripheral immune crosstalk and increased brain inflammation.State of Clinical ResearchOn the clinical side, Merchak said studies of gut microbiome-modulating therapies are currently not longitudinal enough to accurately study neurodegenerative diseases that may develop over decades. Still, her review of the literature — part of her 2024 article — suggests there is at least some preliminary clinical evidence for the use of probiotics/prebiotics/diet and fecal microbiota transplant (FMT) in several diseases.Parkinson’s Disease: “There has been some evidence,” Merchak said at the meeting, “for the treatment [with probiotics, prebiotics and diet] of nonmotor symptoms — things like gastrointestinal distress and mood changes — but no real evidence that such treatments can help with the motor symptoms we see in Parkinson’s.” Over 60 patients with PD have been treated with FMT, she said, with reduced GI distress and mixed results with motor symptoms.Alzheimer’s and related dementias: “Diet shows promise for cognitive outcomes, but there hasn’t been much evidence for probiotics,” she said. Her review found 17 patients diagnosed with dementia who were treated with FMT, “and for many of them, maintenance of cognitive function was reported — so no further decline — which is excellent.”Multiple Sclerosis: “We see higher quality-of-life measures in patients getting probiotics, prebiotics, and changes in diet,” Merchak said. “Again, most of this [relates to] mood and digestion, but some studies show a slowing of neurological damage as measured by MRI.” There are reports of 15 patients treated with FMT, and “three of these document full functional recovery,” she said, noting that longer follow-up is necessary as MS is characterized by relapsed and periods of recovery.Merchak reported no financial disclosures.2584CreditsLead image: iStock/Getty ImagesMedscape Medical News © 2025 WebMD, LLCSend comments and news tips to [email protected] this: Gut Microbiome Likely Influences Neurodegenerative Disorders - Medscape - April 02, 2025.CommentsWhat to Read Next on MedscapeBUSINESS OF MEDICINEUnlocking Longevity: Aging ReimaginedUS FDA Warns Four Firms Over Unapproved Fluoride Drugs for ChildrenLong COVID and Mental Illness: New GuidanceRecommended ReadingNEWSWhere Is the 'Microbiome Revolution' Headed Next?NEWSThe Long, Controversial Search for a 'Cancer Microbiome'NEWSHypothyroidism Linked to Gut Microbiome DisturbancesNEWSInfant Microbiome Drives Immune DevelopmentRelated Conditions & ProceduresInfective EndocarditisTrending Clinical Topics for February 2019Fast Five Quiz: Alzheimer's Disease ComorbiditiesFast Five Quiz: Can You Advise Nutrition and Diet for Patients With Crohn's Disease?EpinephrineA Man With Hypertension and Recent Personality ChangesSLIDESHOWPhysicians of the Year 2022: Best and WorstExpert CommentaryWhere Is the 'Microbiome Revolution' Headed Next?The Long, Controversial Search for a 'Cancer Microbiome'Hypothyroidism Linked to Gut Microbiome DisturbancesLog in or register for free to unlock more Medscape contentUnlimited access to our entire network of sites and services

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@mutley64

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Amitriptyline

Morning all I've been prescribed Amitriptyline for neuropathic pain in feet and hands which seems to be getting worse and I'm getting on a daily basis. Having read about possible side effects I am really reluctant to start taking this. Chronic fatigue is my most difficult symptom together with p...

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@josiej8

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Bad memory

Anyone else get hurrendous memory like it’s not just the oh I forgot this. It’s I forgot my name, forgot my age, forgot where I live and of course always forgetting to take medications even with alarms and reminders and it’s gradually getting worse. I feel like a walking dementia patient right now...

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@DominicS

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PIP Assessment Appeals/Difficulties

I don't yet need PIP, but in researching the Bus Pass concession and Blue Badge entitlement criteria I came across a very negative (good for an appeal) remark in government documents about the ability of PIP assessors. From the Disabled Persons Transport Advisory Committee of Aug 2018 ( https://w...

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@Sonia1984

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ALS vs MS?

Can one be accidently diagnosed with Ms but actually have ALS? My uncle who had PPMS at 67 passed away from Pneumonia and my other uncle within a year of his death passed away at 70 from ALS, his ALS was diagnosed at 69. Both their blood work came back as positive for the gene "C9" which is apparent...

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@Houdini

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Getting used to diagnosis :-/

Hi all, 5 weeks post diagnosis and start of DMT, Tecfidera. I knew on first symptoms in the shower 18 months ago of the water on my arm Feeling different, progressing to pins and needles and numbness in arm and hand. Fighting with GP to take me seriously that it was not a trapped nerve! And I am a n...

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@ItsMewithMS

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Genetics and MS...finally

After years of seeing reports of no genetic markers found or genetic ties it sounds like this is being looked into. I can't think of any of my relatives with MS but in this group there are constant references to a grandpa that had it or cousins, etc. For a disease that is relatively rare it seem lik...

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