Myasthenia Gravis and Maturity

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Myasthenia Gravis and Maturity

• What can we expect as we age, and what might be
  something else?

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Common changes as we get a bit older

• Sleep pattern changes
• Sensory Changes
• Loss of muscle mass (weakness)
• Reaction time
• Difficulty maintaining body temperature

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Changes in sleep you might experience

• Sleep is an active process
• Normally have periods of deeper sleep and more
  wakeful sleep
• Some periods of waking
• As we age, the wakeful periods become more
  frequent

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More changes you may experience

• May feel that you dont sleep well
• Tend to get tired earlier, may wake earlier
• Loss of deep sleep ? body aches and pains
• Loss of dream time ? Irritability

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What does this mean if you have MG?

• You may become tired from frequent wakings
• Obstructive sleep apnea may also occur in those
  with MG
• More likely to occur in obese, older men
• Symptoms hypoventilation more common than apnea

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Sensory Changes

• Vision
• Hearing
• Smell
• Taste

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Visual changes

• Difficulty with near vision (presbyopia)
• Visual field changes (receptors for peripheral
  vision not as sensitive
• Useful field of view

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A change that many of us are familiar with
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Visual field changes

• Vision change that might appear with stroke

• Loss of peripheral vision

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Useful field of view
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More visual changes

• Cataracts
• Macular degeneration
• Glaucoma

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More pictures of age-associated changes in vision

• Cataracts

• Macular degeneration

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What does this mean if you have MG?

• How many glasses of wine are there?
• Have you had too much?

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Do you think the problem is primarily with
vision, or primarily with the way the eyes work
together?
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Hearing loss

• High frequency hearing is first to go
• Men more than women

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Smell

• Some medications
• Nutritional deficiencies
• Sinus disorders / allergic rhinitis
• Trauma

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Medicines that may change the way you smell

• Statins (cholesterol lowering drugs)
• Antihistamines
• Some antibiotics
• Bronchodilators
• A variety of blood pressure meds

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Taste

• This is related to sense of smell about ¾ of
  those over 80 have trouble identifying a food
  from smell or taste
• Therefore, loss of interest in eating
• Safety issues cooking, gas leaks

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Perk up your food!

• Try intensifying flavors with marinades
• Add other flavors
• Cheese or bacon
• Vanilla
• Coffee or chocolate
• Gravies and sauces
• Lemon juice or other flavors

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LOSS OF MUSCLE MASS

• Loss of muscle fibers
• Reduced exercise
• Legs suffer loss before arms
• Ankle dorsiflexors (toes up), particularly,
• Then quadriceps
• Hips
• Reduced hormones
• Estrogen
• Anabolic hormones

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A common result of weakness
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Another problem

• May be slow getting across the street

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What does this mean if you have MG?

• What sorts of weakness can you expect as you age,
  and what may be MG?
• If rest restores strength, then it may be MG
• If cooling off improves strength, then it may be
  MG
• If you notice that you cannot now carry 2 sheets
  of wallboard at a time, it may be age.

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Reaction time!

• Reaction time normally slows with aging
• But-- If your muscles
• are weak, even a bear
• may not be able to get you moving!

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Maintaining body temperature

• As we age, adjusting our body temperature to the
  environment becomes less active
• May not shiver to increase body heat
• May not sweat to cool body

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What does this mean if I have MG?

• Becoming overheated my make you weaker

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Changes that you can experience with MG

• Fatigue
• Weakness
• Double vision
• Slurred speech

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Confusing MG with other disorders

• Fatigue do I fatigue more easily now than when I
  was 50?
• Am I as strong as I was when I was 50?
• Hows my vision?
• Visual field loss
• diplopia

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• What about my speech?
• Is it slurred? This really isnt much of a clue
  Does it improve after rest?
• Do I have trouble finding words?
• Not part of MG

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A little case study

• Several years ago Mr. F. began to have some
  slurred speech and went to the doctor. The doctor
  thought hed had a stroke. His daughter, a
  colleague of mine.