Significant cognitive decline - will high dose steroids help

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MomhasMS
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Significant cognitive decline - will high dose steroids help

Post by MomhasMS » Sat Dec 15, 2018 8:36 am

My mother is a 77 year old MS patient who was diagnosed with PPMS when she was 70. Looking back she'd had it for many years undiagnosed. Last December she was hospitalized and given 3 days high dose steroids which helped with her mobility (one leg was completely immobile). In the last 6 weeks I have noticed a significant cognitive decline and a bit of a flare on mobility as well. Her doc has written a prescription for 3 days of Solu-Cortef @500 mg. I have been trying to find research to indicate whether high dose steroids will help with cognitive decline. I am worried that the side effects will do more harm and it won't be worth it. Does anyone have any knowledge of whether steroids help with cognitive issues during an exacerbation? I don't even really know if it is an exacerbation or just part of the regular decline. I've just joined the community and have been learning a lot. Thank you in advance!

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Re: Significant cognitive decline - will high dose steroids

Post by NHE » Sat Dec 15, 2018 10:34 pm

MomhasMS wrote:My mother is a 77 year old MS patient who was diagnosed with PPMS when she was 70. Looking back she'd had it for many years undiagnosed. Last December she was hospitalized and given 3 days high dose steroids which helped with her mobility (one leg was completely immobile). In the last 6 weeks I have noticed a significant cognitive decline and a bit of a flare on mobility as well. Her doc has written a prescription for 3 days of Solu-Cortef @500 mg. I have been trying to find research to indicate whether high dose steroids will help with cognitive decline. I am worried that the side effects will do more harm and it won't be worth it. Does anyone have any knowledge of whether steroids help with cognitive issues during an exacerbation? I don't even really know if it is an exacerbation or just part of the regular decline. I've just joined the community and have been learning a lot. Thank you in advance!
High dose steroids are given as an anti-inflammatory agent as they induce white blood cells to undergo apoptosis and die off. As inflammation is limited in progressive MS, I'm not sure how helpful they'll be in the long run.

What supplements, if any, does your mother take? What about other medications?

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Re: Significant cognitive decline - will high dose steroids

Post by MomhasMS » Sun Dec 16, 2018 4:46 am

Thanks very much for your reply NHE. She isn't taking very many supplements, just Vitamin D, Salmon Oil, and Alpha Lipoic Acid. I'm open to any suggestions for other supplements that many help.

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Re: Significant cognitive decline - will high dose steroids

Post by MomhasMS » Sun Dec 16, 2018 4:49 am

And, the only medications are Celebrex and Duloxetine (Cymbalta).

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Re: Significant cognitive decline - will high dose steroids

Post by NHE » Sun Dec 16, 2018 6:39 am

MomhasMS wrote:And, the only medications are Celebrex and Duloxetine (Cymbalta).
Common side effects of Cymbalta include: dizziness, drowsiness, fatigue, sedated state and others.
https://www.drugs.com/sfx/cymbalta-side-effects.html

You might want to check with her doctor if the Cymbalta could be a contributing factor to her apparent cognitive decline.

Why is she taking it? If it's for neuropathic pain, then there might be other options available.

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Re: Significant cognitive decline - will high dose steroids

Post by MomhasMS » Sun Dec 16, 2018 3:38 pm

Thank you very much for your reply, I will look into other options. She's been taking Cymbalta for pain for many years, prior to being diagnosed with MS.

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Re: Significant cognitive decline - will high dose steroids

Post by jimmylegs » Sun Dec 16, 2018 5:26 pm

for whatever it might be worth, my own worst cognitive issues were related to zinc deficit. zinc is commonly low normal in ms patients, high normal in healthy controls.

i notice that both celebrex and cymbalta deplete folic acid, which may be the more relevant issue in your mum's case

Folic acid supplementation improves cognitive function by reducing the levels of peripheral inflammatory cytokines in elderly Chinese subjects with MCI (2016)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5120319/

likely better addressed via multivitamin/mineral than via folic acid alone. that will at least make a start on providing other essential nutrients absent from current supplement regimen (eg no magnesium with the vitamin d). in diet, essentials may also be below public health recommendations. a divided dose three per day multi vit min product should help maximize absorption.
take control of your own health
pursue optimal self care at least as actively as a diagnosis
ask for referrals to preventive health care specialists eg dietitians
don't let suboptimal self care muddy any underlying diagnostic picture!

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Re: Significant cognitive decline - will high dose steroids

Post by NHE » Sun Dec 16, 2018 6:17 pm

MomhasMS wrote:Thank you very much for your reply, I will look into other options. She's been taking Cymbalta for pain for many years, prior to being diagnosed with MS.
Neurontin (gabapentin) is commonly prescribed to MS patients for treating neuropathic pain. There is also palmitoylethanolamide (PEA) which is a non-prescription option for neuropathic pain. These are options you can discuss with her doctor. Note that if a decision is made to stop the cymbalta, then it will likely need to be done slowly tapering down the dose over time especially since cymbalta is also used for depression, i.e., a selective serotonin and norepinephrine reuptake inhibitor antidepressant (SSNRI). See the following page for a discussion of stopping cymbalta. For some patients it was a slow process that took 2-3 months. https://www.peoplespharmacy.com/2017/06 ... -symptoms/

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Re: Significant cognitive decline - will high dose steroids

Post by MomhasMS » Mon Dec 17, 2018 7:28 am

Those are excellent suggestions, thank you. Both the additional supplements and the weaning of Cymbalta is something I need to look into.

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Re: Significant cognitive decline - will high dose steroids

Post by jimmylegs » Mon Dec 17, 2018 9:28 am

again for whatever it may be worth, i prefer optimizing essential nutrient status to whatever degree possible, before getting into products that normally result from endogenous biosynthesis.
for example, i am glad i never found an inosine supplement during the time i was struggling with ms-characteristic low uric acid. if i had, i might never have identified the causal underlying zinc deficiency.
  • Longitudinal study of serum zinc and copper levels in hemodialysis patients and their relation to biochemical markers (2006)
    https://link.springer.com/article/10.13 ... :113:3:209

    "Uric acid and parathyroid hormone ... were significantly (p<0.05) and linearly related with serum zinc ... concentrations"
for that reason i personally would avoid products like PEA until all potential sources of pain related to essential nutrition had been excluded. the magnesium example is top of mind here. i personally use magnesium on the rare occasion when pain management is needed. taking vitamin d3 without managing for magnesium status could be expected to exacerbate an individual's experience of pain. magnesium supplement quality varies widely.
i personally try to emphasize healthy sources from diet, and augment with
magnesium glycinate ..... https://pubchem.ncbi.nlm.nih.gov/compou ... ection=Top
or magnesium citrate ..... https://pubchem.ncbi.nlm.nih.gov/compound/57507849 (this latter being more likely to induce a laxative effect)
  • The safety and efficacy of a single dose (500 mg or 1 g) of intravenous magnesium sulfate in neuropathic pain poorly responsive to strong opioid analgesics in patients with cancer (2000)
    https://www.ncbi.nlm.nih.gov/pubmed/10687324
have recently been helping a friend manage pain associated with chemotherapy and radical mastectomy, via magnesium. the chemo tanked her mag status badly enough that they did some iv replacement at one stage, while she was in hospital with an infection. the mag replacement really helps minimize her need for painkilling meds. she uses diet, supplements, and epsom salt baths to good effect.
take control of your own health
pursue optimal self care at least as actively as a diagnosis
ask for referrals to preventive health care specialists eg dietitians
don't let suboptimal self care muddy any underlying diagnostic picture!

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