Functional Movement Disorders in the Elderly

Introduction

Functional movement disorders (FMDs) are health issues related to body movement. They make up about three percent of all movement disorders. These problems are mostly found in younger adults, those 50 years or younger, and are rarely thought about in older people.

What Are Functional Movement Disorders and How Does It Affect Older People?

Functional movement disorder (FMD) arises when there are abnormal, involuntary movements or body positions due to disruptions in signal transmission within the brain. Synonymous terms for this condition include psychogenic movement disorders and conversion disorders. Functional movement disorder can affect older individuals in various ways, presenting unique challenges and considerations. FMD affects the older population in the following ways:

• Motor Symptoms:

  • Tremors: Older individuals with FMD may experience involuntary shaking movements resembling essential tremors or Parkinson's disease tremors, a neurodegenerative disorder that primarily affects movement.

  • Dystonia: Unintentional muscle contractions resulting in atypical postures or repetitive movements can affect mobility.

• Functional Impairment: FMD can lead to difficulties in performing daily activities, walking, or maintaining balance, impacting the overall functional independence of older individuals.

• Psychological Impact: Emotional distress (intense emotional suffering), anxiety (excessive worry), or depression (prolonged sadness) may accompany FMD, affecting the mental well-being of older individuals.

• Cognitive Factors: Older adults may face challenges related to cognitive decline, and the interplay between FMD and cognitive factors may complicate the clinical presentation and management.

• Comorbidities: Older individuals often have various medical comorbidities, and FMD can coexist with other health conditions, necessitating a comprehensive and tailored approach to care.

• Impact on Caregivers: The condition can have implications for caregivers, requiring additional support and education to manage the challenges associated with FMD in older adults.

• Quality of Life: FMD can significantly impact the quality of life for older individuals, affecting the ability to engage in social activities, maintain relationships, and enjoy a fulfilling lifestyle.

• Diagnosis Challenges: Diagnosing FMD in older individuals can be challenging due to the potential overlap with age-related neurological changes and other movement disorders.

What Are the Signs and Symptoms of FMD?

The following are signs and symptoms:

1. Motor Symptoms:

• Tremors: Involuntary shaking movements, often resembling essential or Parkinson's disease tremors.

• Dystonia: Unintentional muscle contractions resulting in abnormal postures or repetitive movements.

• Gait Disturbances: Difficulty walking, with abnormalities in coordination or balance.

• Weakness or Paralysis: Episodes of apparent muscle weakness or paralysis (loss or impairment of muscle function) that neurological conditions cannot explain.

2. Non-Motor Symptoms:

• Psychological Distress: Anxiety, depression, or emotional distress may be present, often preceding or accompanying the onset of motor symptoms.

• Sensory Symptoms: Abnormal sensations, such as numbness, tingling, or pain, without clear neurological explanations.

• Speech Issues: Dysphonia (difficulty speaking) or other speech abnormalities.

• Attacks or Episodes: Sudden, intermittent episodes of abnormal movements or postures.

3. Variable Symptoms:

• Symptoms with Stress or Distraction: The severity of symptoms may fluctuate and can be influenced by stress (tension), emotional states, or distraction.

• Suggestibility: Symptoms may change based on healthcare professionals' or others' suggestions or observations.

• Relief During Sleep: Symptoms may improve or disappear during sleep.

4. Inconsistent Features:

• Lack of Organic Neurological Signs: The absence of physical signs typically associated with structural neurological abnormalities or diseases.

• Inconsistencies in Examination: Clinical examinations may reveal inconsistencies, such as variability in the presentation of symptoms during assessments.

It is crucial to note that FMD is a diagnosis made by excluding other neurological or medical conditions before making a definitive diagnosis. Additionally, individuals with FMD may not have conscious or intentional control over the symptoms, and these symptoms are considered to have a functional or psychological origin.

How to Diagnose FMD?

Diagnosing functional movement disorders (FMD) in the older population involves a comprehensive evaluation considering the unique aging challenges. A detailed medical history, encompassing symptom onset and progression, is coupled with a meticulous physical and neurological examination, accounting for age-related changes. Applying specific diagnostic criteria for FMD, clinicians rigorously exclude other neurological or medical conditions through testing and imaging studies. Specialized tests, such as electromyography (EMG) or neuroimaging, may be utilized for enhanced diagnostic precision. Given the interplay of physical and psychological factors in older adults, a psychiatric evaluation is often incorporated. Collaboration among specialists, including neurologists, geriatric specialists, psychiatrists, and physical therapists, ensures a holistic understanding of the individual's condition. The diagnostic process is tailored to the individual's overall health, cognitive status, and any limitations associated with aging, aiming for an accurate diagnosis and an appropriate treatment plan.

What Is the Treatment Plan for FMD?

The treatment plan for functional movement disorder (FMD) in older individuals involves a comprehensive and individualized approach, considering the unique challenges associated with aging. Key components of the treatment plan for FMD in elders may include:

• Physical Therapy: Tailored exercise programs to address movement-related issues, improve mobility, and enhance overall physical function.

• Cognitive Behavioral Therapy (CBT) or Dialectical Behavioral Therapy (DBT): CBT and DBT are psychotherapeutic interventions to help manage psychological aspects, reduce distress, and enhance coping mechanisms.

• Medication Management: Pharmacological interventions may be considered to alleviate specific symptoms associated with FMD. Medication choices are carefully made, considering the individual's overall health and potential interactions with existing medications.

• Holistic Geriatric Care: A holistic approach that considers the elderly's overall health, coexisting medical conditions, and age-related factors when developing the treatment plan.

• Psychiatric Support: Collaboration with psychiatrists to address any underlying psychiatric factors contributing to FMD in the older population.

• Education and Counseling: Providing education about FMD and counseling to the individual and the caregivers, fostering understanding, and offering support.

• Support Groups for Elders: Encouraging participation in support groups tailored to older individuals, fostering a sense of community and shared experiences.

• Caregiver Support: Providing resources and support for caregivers to help them understand and cope with the challenges associated with FMD in the elderly population.

• Regular Follow-ups and Monitoring: Regularly scheduled follow-up visits to track advancements, evaluate the efficacy of the treatment strategy, and make any necessary adjustments as needed.

• Environmental Adaptations: Considering modifications to the living environment to enhance safety and accommodate mobility challenges associated with FMD.

• Geriatric Rehabilitation Services: Involving geriatric rehabilitation services to address the unique needs of older individuals, focusing on functional independence and overall well-being.

Conclusion

Addressing functional movement disorders (FMD) in the elderly necessitates a nuanced and comprehensive approach that considers the unique challenges associated with aging. A personalized treatment plan can be crafted by adopting a multidisciplinary strategy involving geriatric specialists, neurologists, psychiatrists, and physical therapists. This plan should encompass tailored physical therapies, psychotherapeutic interventions, and judicious medication management. Additionally, caregiver support, education, and regular follow-ups are vital components. Recognizing the intricate interplay between physical and psychological factors ensuring the well-being of individuals contending with FMD in the later years is essential for enhancing the quality of care and overall health in the elderly population.