Part IV. Diseases

TEXT 21. ALZHEIMER`S DISEASE

Read the text and state the signs of Alzheimer`s disease.

What is it? Alzheimer’s disease is a disorder that attacks your brain and changes your life. Its main symptom is steadily increasing memory loss. Problems with vision, language, and emotional control are also common. You may have a constant decline in abilities over five to 20 years.

About four million Americans have Alzheimer’s disease. About 360,000 people are diagnosed with the disorder each year. Because people are living longer, age is the major risk factor. So the number of people with Alzheimer’s disease will probably grow as the population ages. The disorder claims more than 100,000 lives per year. It is the fourth leading cause of death for adults.

What is the cause? Although a lot of time and money goes into research, we are still trying to understand the cause of Alzheimer’s disease. Inherited or genetic factors and aging seem to play an important role. We do know it is not contagious; you can’t catch it from another person.

A brain affected with Alzheimer’s disease is filled with a waxy substance. This is called “amyloid” or “plaque.” Affected nerve cells are filled with tangles of stringy material. As these tangles spread, the brain’s nerve cell connections are reduced. This usually begins in the areas of the brain that store short-term memories. Then it works into areas that control other intellectual and physical functions.

Some of these changes happen in normal aging. A much greater amount of change is found in people with Alzheimer’s disease.

What are the symptoms? Symptoms usually begin with loss of recent memories. For example, you may repeat stories in the same conversation. Or you may forget certain events. Other symptoms include:

• Trouble learning new information

• Gradually increasing confusion and disorientation

• Trouble speaking in conversations

• Personality and behavioral changes

• Misplacing objects or becoming lost in familiar neighborhoods

• Problems with judgment and common sense

• Slow movement

Over time, people forget how to perform even the simplest tasks. They are often unable to recognize faces and use common objects. Even the names of their own children or grandchildren are forgotten. Personality changes can occur, includ

• Depression

• Loss of appetite

• Insomnia

• Moodiness

• Loss of interest in usual activities

• Progressive tameness or passivity

• Agitation and restlessness

• Suspiciousness and distrust of caregivers or family members

Unfortunately, in early stages, many people fail to see these symptoms as something wrong. They may think that such behavior is a normal part of getting older. It is not. Symptoms may develop gradually and go unnoticed for a long time. And some people do not act even when they know something is wrong.

It is important to see a doctor when you suspect Alzheimer’s disease symptoms. Only a doctor can diagnose your condition correctly.

10 warning signs of Alzheimer’s disease. The Alzheimer’s Association has created a list of warning signs that include common symptoms of the disorder.

1. Memory loss that affects job skills. It’s normal to sometimes forget an assignment, deadline, or colleague’s name. But frequent memory problems or unexplainable confusion at home or at work may mean that something is wrong.

2. Difficulty performing familiar tasks. People with Alzheimer’s disease might make a meal and not only forget to serve it, but also forget they made it.

3. Problems with language. Everyone has trouble finding the right word sometimes. A person with Alzheimer’s disease may forget simple words or substitute wrong words. This may make his or her sentences difficult to understand.

4. Disorientation to time and place. It’s normal to momentarily forget the day of the week or what you need from the store. But people with Alzheimer’s disease can become lost on their own street. They don’t know where they are, how they got there, or how to get back home.

5. Poor or decreased judgment. A person with Alzheimer’s disease may dress incorrectly in more obvious ways, wearing a bathrobe to the store or several blouses on a hot day.

6. Problems with abstract thinking. For a person with Alzheimer’s disease, recognizing numbers or doing basic math may be impossible.

7. Misplacing things. Everyone temporarily loses a wallet or keys from time to time. A person with Alzheimer’s disease may put things in wrong places – such as an iron in the freezer or a wristwatch in the sugar bowl – and then forget how they got there.

8. Changes in mood or behavior. People with Alzheimer’s disease tend to show fast mood swings more often for no known reason.

9. Changes in personality. People’s personalities may change a bit as they age. But a person with Alzheimer’s disease can change in a big way, either suddenly or over a period of time. Someone who is usually easy to get along with may become angry, suspicious, or fearful.

10. Loss of initiative. It’s normal to get tired of housework, business events, or social commitments. The person with Alzheimer’s disease may stay uninterested and detached from many or all of his usual activities.

How is it diagnosed? There is no simple test to diagnose Alzheimer’s disease. Doctors only know for sure by examining brain tissue. This usually happens after the person has died. When Alzheimer’s disease is suspected, it is important to have a complete medical and neurological evaluation. It may include:

• A complete health history and physical examination

• Neurological and mental status tests

• Tests of blood and urine

• Electrocardiogram and chest X-rays

• Computerized tomography scan (CT), electroencephalography (EEG), or magnetic resonance image scan (MRI).

What are the treatments? Currently there are no known cures for Alzheimer`s disease, but some treatments can help handle the symptoms. There are some drugs for Alzheimer`s disease:

• Donepezil hydrochloride

• Rivastigmine

• Galatamine

These drugs block a brain chemical that breaks down acetylcholine – a substance needed for brain cells to exchange information.

Many drugs can reduce behavior changes caused by the disorder. These changes include depression, insomnia, agitation, restlessness, nervousness, hallucinations and false beliefs.

Research provide great hope. Studies of anumals have led to discoveries in our understanding of Alzheimer`s and possible new treatments/ The effects of gormones, antiinflammatory drugs, vitamin E, and other common drugs are also being examined.

Prevention. There is no proven way to prevent Alzheimer’s disease. But researchers believe there are several things that you can do to help keep your brain healthy:

• Avoid harmful substances. Drinking too much alcohol and abusing drugs are damage brain cells.

• Strengthen the brain. Read books, newspapers, and magazines. Keep your brain active and learn new skills.

TEXT 22. AUTISM

Read the text and answer the question: When is autism diagnosed?

What is it? Autism is a developmental disorder that some people are born with – it’s not something you can catch or pass along to someone else. It affects the brain and makes communicating and interacting with other people difficult. People who have autism often have delayed language development, prefer to spend time alone, and show less interest in making friends. Another characteristic of autism is what some people describe as "sensory overload": Sounds seem louder, lights brighter, or smells stronger. Although many people with autism also have mental retardation, some are of average or high intelligence.

Not everybody with autism has the exact same symptoms. Some people may have autism that is mild, whereas others may have autism that is more severe. Because it affects people differently, autism is known as a spectrum disorder. Two people with the same spectrum disorder may not act alike or have the same skills.

As many as one in 500 people have autism, and it’s four times more common in guys than in girls. Although doctors do not know exactly what causes it, researchers believe autism is linked to differences in brain chemicals (neurotransmitters). These differences may be caused by something in our genes – families who have one child with autism have a higher risk of having another child with autism or a similar disorder. Research suggests that it’s probably a combination of genes that causes the disorder, not a single autism gene.

Sometimes you may hear other developmental disorders mentioned in the same way as autism, such as Asperger syndrome, Rett syndrome, and childhood disintegrative disorder. These disorders, along with autism, are all considered pervasive developmental disorders. People diagnosed with any of these disabilities have problems with social skills and communication.

What do doctors do? Autism is usually diagnosed at a very young age, when a child is 1 1/2 to 4 years old. There are no medical tests to determine whether someone has autism, although doctors may run various tests to rule out other causes of the kid’s symptoms. The best way to identify autism is to watch how a child behaves and communicates. Parents can help by telling the doctor how the child acts at home. Then a team of specialists – which may include a psychologist, a neurologist, a psychiatrist, a speech therapist, and a developmental pediatrician – will evaluate the child and compare levels of development and behavior to those of other children the same age. Together, they will decide whether the child has autism or something else.

How is autism treated? Autism is not treated with surgery or medicine (although some people with autism may take medicine to improve certain symptoms, like aggressive behavior or attention problems). Instead, people who have autism are taught skills that will help them do the things that are difficult for them. The best results are usually seen with children who begin treatment when they are very young, as soon as they are diagnosed.

Special education programs that are tailored to the child’s individual needs are usually the most effective form of treatment. These programs work on breaking down barriers by teaching the child to communicate (sometimes by pointing or using pictures or sign language) and to interact with others. Basic living skills, like how to cross a street safely or ask for directions, are also emphasized. A treatment program might also include any of the following: speech therapy, physical therapy, music therapy, changes in diet, medication, occupational therapy, and hearing or vision therapy. The same specialists who helped diagnose the condition usually work together to come up with the best combination of therapies to use in addition to the educational program.

By the time they are teens people with autism may be taking regular classes, attending special classes at the high school level, or attending a special school because of ongoing behavioral problems.

What are teens with autism like? Because their brains process information differently, teens with autism may not act like other people you know (or each other, because the severity of symptoms of autism varies from person to person). They can have trouble talking and sometimes communicate with gestures instead of words. Some spend a lot of time alone, don’t make friends easily (and may not act like they want to), and don’t react to social cues like someone smiling or scowling at them. They often do not make eye contact when you are talking to them. They also find it hard to join in a game or activity with other people. If they are sensitive to sensory stimuli, they might draw back when hugged or startle easily when they hear a sudden noise, even if it’s not very loud.

Some teens with autism are passive and withdrawn, whereas others are overactive and may have tantrums or act aggressively when they are frustrated; it’s important to realize that this is part of the disorder. Many teens with autism also continue to have intellectual limitations and learning problems. Because they don’t have the ability to express emotions like anger and frustration in more acceptable ways, teens with autism may express themselves in ways that seem inappropriate. Many have difficulty coping with change and get anxious if their daily routine is altered. In more severe cases, a teen might fixate on different objects or ideas or display repetitive motions like rocking or hand flapping.

One common misconception is that autistic people don’t feel or show emotion. Although they can feel affection, they often don’t express it the same way others do. To an outsider, this can come across as being cold or unemotional.

Living with autism. Perhaps the most difficult part of coping with autism is interacting with other people every day. Because the brain of a teen with autism works a little differently, learning to communicate can be like learning a foreign language. This can make it hard for people with autism to express themselves or for other people to understand them, so just talking with a classmate becomes stressful and frustrating.

When even a casual conversation requires so much effort, it’s obviously hard to make friends. Teens with autism may have to think constantly about how other people will perceive their actions and make a conscious effort to pay attention to social cues the rest of us handle without even thinking. Basically, it takes a lot of work for a person with autism to do what comes naturally to most people.

So if you know someone who has autism, be extra patient when you’re talking with him or her. Don’t expect a person with autism to look at things the same way you do. You should also realize that some behaviors you think are rude (like interrupting you when you’re talking) come from the autistic teen’s different perception of the world: It’s tough for people who can’t read social cues and recognize the natural pauses in a conversation to know when to jump in with their own thoughts. The more understanding and supportive you are, the more enjoyable your time together will be.

Despite all the day-to-day hurdles, though, many people with autism lead fulfilling, happy lives on their own or with help from friends and family. Most teens with autism like school, and some can attend regular classes with everyone else. They have individual tastes and enjoy different activities, just like you do. Some people with autism go on to vocational school or college, get married, and have successful careers. Consider Temple Grandin, for example. Despite having autism, she was able to earn a PhD and become a college professor. She’s even written a book about her experience called Thinking in Pictures: And Other Reports from My Life with Autism. Although she still struggles with the disorder almost daily, she leads a "normal" life, just like many other people with autism.

TEXT 23. ENCEPHALITIS

Read the text and make its summary.

Encephalitis is an inflammation (swelling) of the brain. Encephalitis is usually caused by a virus, but other things, including bacteria, may cause it as well. Although encephalitis sounds scary, it’s rarely serious.

What is encephalitis? Encephalitis is typically caused by three different groups of viruses. The herpes viruses fall into one group. They include chickenpox, EBV (Epstein-Barr virus – the virus that causes mono), and herpes simplex (the virus that causes cold sores). The second group is viruses that are transmitted by insects. Viruses like West Nile virus, which is transmitted through a mosquito bite, and Lyme disease and Rocky Mountain spotted fever, which are transmitted thorough tick bites, can also cause encephalitis. The third group of viruses is made up of common childhood viral infections. These include measles, mumps, and German measles. Because lots of countries immunize against these diseases, it’s rarer today that a person will develop encephalitis as a result of an illness like measles or mumps.

Some cases of encephalitis are mild and symptoms only last for a short time. However, it is possible to develop a severe case of encephalitis that can be serious and possibly even life threatening. When a person has encephalitis, his or her brain becomes inflamed – inflammation means swelling and redness.

Is it contagious? Many different viruses can lead to encephalitis. So how contagious the infection is depends on which virus caused it. Viruses like West Nile are only transmitted through the bite of infected insects; it’s not possible to catch them from other people. But viruses like EBV are passed from person to person.

Even if a person catches a virus that can cause encephalitis that does not mean that person will automatically develop the condition. In fact, very few people actually develop encephalitis.

What are the signs and symptoms? Encephalitis may cause fever, headache, poor appetite, loss of energy, or just a general sick feeling. In more severe cases, other symptoms may occur, including:

• high fever

• severe headache

• sensitivity to light (called photophobia, which means light hurts your eyes)

• nausea and vomiting

• stiff neck

• confusion

• sleepiness, difficulty waking, or unconsciousness

• convulsions (seizures)

When encephalitis happens after a common illness like chickenpox, the signs and symptoms of that illness come before any inflammation in the brain. But encephalitis can also appear without warning. If you have symptoms of encephalitis, get in touch with your doctor right away.

How is it diagnosed and treated? To diagnose encephalitis, the doctor may take blood samples and order a spinal tap to remove some cerebrospinal fluid (CSF) for testing. CSF is the fluid that surrounds the brain and spinal cord. A spinal tap (also called a lumbar puncture) is a procedure that involves inserting a very thin needle into the lower back to extract a small amount of CSF. The blood and CSF will then be sent to a laboratory to check for viruses or bacteria. A special brain scan (an MRI or a CT scan) may also be ordered to look for inflammation. A doctor may also order an  electroencephalogram (EEG). This test records your brain waves and can reveal whether there are abnormalities that are consistent with an encephalitis infection.

Treatment for encephalitis depends on the virus that caused it. People with mild cases of encephalitis can recover at home as long as they’re watched carefully by a parent or other adult in the household. Most cases of encephalitis just run their course and the person gets better on his or her own.

Some viruses that cause encephalitis can be treated with medication. For example, acyclovir, an antiviral drug, can help treat encephalitis caused by the herpes simplex virus. In addition, steroid medications may be used to reduce swelling in the brain (these aren’t the same as the dangerous performance-enhancing steroids that some athletes use). Because antibiotics are not effective against viruses, they’re not used to treat viral encephalitis.

Severe cases of encephalitis require a hospital stay so the patient can be carefully monitored and medical treatment is close at hand if it’s needed. For people who have had severe encephalitis that has affected some of the brain’s functions, doctors may recommend physical therapy or speech therapy to help with recovery.

How long does it last? The worst symptoms of encephalitis generally last up to 1 week, but full recovery may take weeks or longer. Because encephalitis affects the brain, people with severe cases can sometimes develop problems like seizures, difficulties with muscle coordination, and learning disabilities.

How to prevent encephalitis. The best way to prevent encephalitis is to avoid getting the viruses that can cause it. Regular hand washing will help limit the spread of some of these germs. Staying as healthy as possible by eating a balanced diet and getting plenty of rest can help keep your immune system in shape. Immunizations are also an important way to protect people from diseases like chickenpox and measles.

In areas where viruses are transmitted by insect bites, protect yourself by wearing long sleeves and pants and applying an insect repellent. Also, try to avoid unnecessary outdoor activities at dawn and dusk when mosquitoes are most likely to bite.

TEXT 24. HYPERTENSION (HIGH BLOOD PRESSURE)

Read the text and describe the causes of hyperetension.

Every person needs blood pressure to live. Without it, blood wouldn’t be able to circulate through the body to carry oxygen and fuel vital organs.

Blood pressure is the pressure your blood exerts against your blood vessel walls as your heart pumps. Blood pressure rises with each heartbeat and falls when the heart relaxes between beats, but there is always a certain amount of pressure in the arteries. That blood pressure comes from two physical forces. The heart creates one force as it pumps blood into the arteries and through the circulatory system. The other force comes from the arteries resisting the blood flow.

Blood pressure changes from minute to minute and is affected not only by activity and rest, but also by temperature, diet, emotional state, posture, and medications.

Blood pressure is measured in millimeters of mercury (written as mm Hg). For example, normal blood pressure in adults should be less than 120/80 mm Hg. The higher, or top, number – in this example it’s 120 – is called systolic pressure and represents the pressure at the peak of each heartbeat. The lower, or bottom, number (80 in this example) is called diastolic and represents the pressure when the heart is resting between beats. The systolic pressure is stated first and the diastolic pressure comes second. For example: 120/80 (120 over 80) means that the systolic pressure is 120 and the diastolic pressure is 80.

Blood preassure is measured using a medical instrument called a sphygmomanometer. A cuff is wrapped around a person’s upper arm and pumped up to create pressure. When the cuff is inflated, it compresses (squeezes on) a large artery in the arm, stopping the blood flow for a moment. Blood pressure is measured as air is gradually let out of the cuff, which allows blood to begin to flow through the artery again when the blood pressure in the artery is greater than the pressure in the cuff. Listening with a stethoscope – the instrument used to hear things like the heart beating inside the body – over the artery allows a doctor or nurse to hear the first pulse as the blood flows through. This is the systolic pressure. The diastolic pressure is noted when the sounds disappear.

What is hypertension? Hypertension is the medical term for high blood pressure. Most people associate high blood pressure with getting older, so it may seem odd that teens can have the condition. Although high blood pressure is rare in young people (only about 1 to 3 percent of kids in the United States have hypertension), it’s important to check for it – even babies can have high blood pressure!

Almost 60 million Americans age 6 and older have high blood pressure. That means about one in five Americans has the condition. Because a third to a half of the people who have high blood pressure don’t even know it, doctors are careful to check their patients for hypertension regularly.

Blood pressure of less than 120 over 80 is considered a normal reading for people 18 and over. A borderline high systolic pressure of 120 to 139 or a diastolic pressure of 80 to 89 needs to be closely monitored. A blood pressure reading equal to or greater than 140 over 90 is considered high in people over the age of 18.

Because of the way blood pressure readings are calculated for children and teens, readings that doctors consider high in teens can be lower than the blood pressure readings that are considered high in adults. In teens up to age 18, high blood pressure is defined as a blood pressure greater than the 95th percentile for their age, height, and gender (in other words, 95 percent of kids at the same age, height, and gender will have blood pressure below this number). Measurements between 90 to 95 percent of the expected range are considered high-normal or borderline.

Teens with blood pressure readings that are greater than 90 percent of the expected range are three times more likely than those with average readings to develop high blood pressure as adults.

A doctor will average at least three blood pressure measurements taken at different times before determining that a teen has hypertension. Most teens will have their blood pressure checked during an annual physical exam. Doctors recommend that older teens with normal blood pressure get their blood pressure checked at least every 2 years. If your blood pressure is near the top of the normal range or if you have a family history of high blood pressure, you’re at a higher risk for developing hypertension. Your doctor can advise you as to how often you should have your blood pressure checked in this situation.

What causes hypertension? The cause of high blood pressure often cannot be found in many teens with hypertension. When the cause is unknown, a person has what’s called essential or primary hypertension. In cases where the cause of high blood pressure is known (called secondary hypertension), it is usually the result of kidney problems, hormonal disorders, abnormalities of the aorta (the main artery that carries oxygenated blood to the body), or a narrowing of certain smaller arteries. Most teens who are diagnosed with hypertension have essential hypertension.

Some teens may inherit the tendency toward higher blood pressure from one or both parents. Although hypertension often runs in families, some people with a strong family history of high blood pressure may never develop it.

Kids and teens who are obese are at a higher risk for hypertension. Lack of exercise makes it easier to become overweight and increases the chance of high blood pressure. People who drink heavily or take illegal drugs like amphetamines and cocaine are also at risk of developing the condition. In some cases, medications like steroids or birth control pills can cause high blood pressure.

Pregnant women also may be diagnosed with hypertension. This type of hypertension is known as preeclampsia, or toxemia. It’s uncommon, though: only about 6 to 8 percent of pregnant women get this condition.

How does high blood pressure affect the body? High blood pressure adds to the workload of the heart and arteries. The heart must pump harder and the arteries must carry blood that’s moving under greater pressure. If high blood pressure continues for a long time, the heart and arteries may no longer work as well as they should. Other body organs, including the kidneys, eyes, and brain also may be affected.

People can live with hypertension for many years without having any symptoms. That’s why high blood pressure is often called "the silent killer." Though a person may not have any symptoms, it doesn’t mean that the high blood pressure isn’t affecting the body. Having high blood pressure puts a person at more risk for strokes, heart attacks, kidney failure, loss of vision, and atherosclerosis (hardening of the arteries). In rare cases, severe hypertension can sometimes cause headaches, visual changes, dizziness, nosebleeds, and nausea. If a person who has high blood pressure experiences any of these symptoms, he or she should be treated immediately.

How do doctors diagnose high blood pressure? For most teens, the only way to know if you have high blood pressure is to get your blood pressure checked. It’s painless and fast.

A single reading showing high blood pressure doesn’t necessarily mean that you have hypertension, but it is an indication that it should be watched carefully. Some people have what’s called "white coat hypertension," meaning that their blood pressure rises at a doctor’s office because they are anxious. When they feel more relaxed, their blood pressure usually decreases.

A person may need to get his or her blood pressure checked several times over a period of days or weeks to determine if they have hypertension. A doctor should recommend how to go about this.

Doctors usually ask for the following information to help determine what might cause a person to have high blood pressure:

• a complete medical history, including questions about a person’s present and past health and the health of family members

• whether that person is taking any medications

• whether that person smokes or drinks alcohol

• eating and exercise habits

The doctor will probably take a person’s weight and height measurements. He or she may also perform urine or blood tests to check for other physical problems, such as a kidney problem or a thyroid disorder that sometimes can be the underlying cause of high blood pressure. A doctor may also test for high blood cholesterol and other conditions that can increase a person’s risk for developing heart disease or stroke.

How is it treated? Hypertension can be a temporary or lifelong disease, depending on the cause. Regardless of what causes high blood pressure, the important thing is to keep it under control. People who manage their high blood pressure with a treatment program lower their risk of having serious complications as they get older.

Although in some cases medication may be necessary to control high blood pressure, in many cases it can be managed with lifestyle improvements, such as weight loss and dietary changes. If you’ve been diagnosed with hypertension, you and your doctor will work as a team to decide on the best course of action for you. Your doctor will most likely recommend that you make lifestyle changes such as eating less fat and salt, avoiding alcohol and cigarettes, and making sure you get plenty of exercise.

Exercise is important, but people with severe hypertension need to be careful about exercise. The American Academy of Pediatrics recommends that teens with severe hypertension avoid certain sports only until their hypertension is under control and there is no evidence of organ damage (e.g., heart damage). Sports on the "avoid" list include weight lifting and bodybuilding, especially if done competitively – in other words, sports that focus on building muscle mass but do not balance it with aerobic activity. People whose hypertension is less severe or under control are encouraged to participate in sports as a way of managing their condition.

How to prevent hypertension. Here are some suggestions that can lessen your chances of developing high blood pressure and help keep you healthy in many other ways, as well:

• Maintain a normal weight for your height.

• Exercise regularly. This can help prevent you from becoming overweight or help you in losing pounds if you need to. Exercise also helps keep your heart and blood vessels strong and healthy.

• Eat a healthy diet that includes lots of fruits and vegetables.

• Don’t smoke. Smoking and high blood pressure are major risk factors for having a heart attack or stroke later in life.

• Keep your stress levels in check. It may help to practice relaxation techniques such as deep breathing exercises.

• Decrease your sodium (salt) intake. Consuming less sodium has been proven to help lower blood pressure in some people and may prevent some from developing high blood pressure in the first place.

• Avoid drinking too much alcohol, which is associated with high blood pressure.

• Know your blood pressure. Have it checked regularly because, although high blood pressure is more common in adults, hypertension can occur at any age.

TEXT 25. LEARNING DISABILITIES

Read the text and answer the question: How do learning disabilities show up?

What are learning disabilities? For someone diagnosed with a learning disability, it can seem scary at first. But a learning disability doesn’t have anything to do with a person’s intelligence – after all, such successful people as Walt Disney, Alexander Graham Bell, and Winston Churchill all had learning disabilities.

Learning disabilities are problems that affect the brain’s ability to receive, process, analyze, or store information. These problems can make it difficult for a student to learn as quickly as someone who isn’t affected by learning disabilities. There are many kinds of learning disabilities. Most students affected by learning disabilities have more than one kind. Certain kinds of learning disabilities can interfere with a person’s ability to concentrate or focus and can cause someone’s mind to wander too much. Other learning disabilities can make it difficult for a student to read, write, spell, or solve math problems.

The way our brains process information is extremely complex – it’s no wonder things can get messed up sometimes. Take the simple act of looking at a picture, for example: Our brains not only have to form the lines into an image, they also have to recognize what the image stands for, relate that image to other facts stored in our memories, and then store this new information. It’s the same thing with speech – we have to recognize the words, interpret the meaning, and figure out the significance of the statement to us. Many of these activities take place in separate parts of the brain, and it’s up to our minds to link them all together.

Nearly four million school-age children and teens have learning disabilities, and at least 20 percent of them have a type of disorder that makes it difficult to focus.

What are the signs of learning disabilities? You can’t tell by looking that a person has a learning disability, which can make learning disabilities hard to diagnose. Learning disabilities typically first show up when a person has difficulty speaking, reading, writing, figuring out a math problem, communicating with a parent, or paying attention in class. Some kids’ learning disabilities are diagnosed in grade school when a parent or a teacher notices that a kid can’t follow directions for a game or is struggling to do work which he or she should be able to do easily. But other kids develop sophisticated ways of covering up their learning issues, so learning disabilities don’t show up until the teen years when schoolwork and life gets more complicated.

Most learning disabilities fall into one of two categories: verbal and nonverbal.

People with verbal learning disabilities have difficulty with words, both spoken and written. The most common and best-known verbal learning disability is dyslexia, which causes people to have trouble recognizing or processing letters and the sounds associated with them. For this reason, people with dyslexia have trouble with reading and writing tasks or assignments.

Some people with verbal learning disabilities may be able to read or write just fine but they have trouble with other aspects of language. For example, they may be able to sound out a sentence or paragraph perfectly, making them good readers, but they can’t relate to the words in ways that will allow them to make sense of what they’re reading (such as forming a picture of a thing or situation). And some people have trouble with the act of writing as their brains struggle to control the many things that go into it – from moving their hand to form letter shapes to remembering the correct grammar rules involved in writing down a sentence.

People with nonverbal learning disabilities may have difficulty processing what they see. They may have trouble making sense of visual details like numbers on a blackboard. Someone with a nonverbal learning disability may confuse the plus sign with the sign for division, for example. Some abstract concepts like fractions may be difficult to master for people with nonverbal learning disabilities.

A behavioral condition called attention deficit hyperactivity disorder (ADHD) is often associated with learning disabilities because people with ADHD may also have a hard time focusing enough to learn and study. Students with ADHD are often easily distracted and have trouble concentrating. They may also be excessively active or have trouble controlling their impulses.

What causes them? No one’s exactly sure what causes learning disabilities. But researchers do have some theories as to why they develop. They include:

• Genetic influences. Experts have noticed that learning disabilities tend to run in families and they think that heredity may play a role. However, researchers are still debating whether learning disabilities are, in fact, genetic, or if they show up in families because kids learn and model what their parents do.

• Brain development. Some experts think that learning disabilities can be traced to brain development, both before and after birth. For this reason, problems such as low birth weight, lack of oxygen, or premature birth may have something to do with learning disabilities. Young children who receive head injuries may also be at risk of developing learning disabilities.

• Environmental impacts. Infants and young children are susceptible to environmental toxins (poisons). For example, you may have heard how lead (which may be found in some old homes in the form of lead paint or lead water pipes) is sometimes thought to contribute to learning disabilities. Poor nutrition early in life may also lead to learning disabilities later in life.

How do you know if you have a learning disability? Just because you have trouble studying for a test doesn’t mean you have a learning disability. There are as many learning styles as there are individuals. For example, some people learn by doing and practicing, others learn by listening (such as in class), and others prefer to read material. Some people are just naturally slower readers or learners than others, but they still perform well for their age and abilities. Sometimes, what seems to be a learning disability is simply a delay in development; the person will eventually catch up with – and perhaps even surpass – his or her peers.

But many people with learning disabilities struggle for a long time before someone realizes that there’s a reason they’re having so much trouble learning. For most people in their teen years, the first telltale sign of most learning disabilities occurs when they notice that there’s a disconnect between how much they studied for a test and how well they performed. Or it may just be a feeling a person has that something isn’t right. If you’re worried, don’t hesitate to share your thoughts with a parent or a teacher.

The first step in diagnosing a learning disability is ruling out vision or hearing problems. A person may then work with a psychologist or a learning specialist who will use specific tests to help diagnose the disability. Often, these can help pinpoint that person’s learning strengths and weaknesses in addition to revealing a particular learning disability.

Coping with a learning disability. Although a diagnosis of a learning disability can feel upsetting, it’s actually the first step in resolving the condition. Once an expert has pinpointed a person’s particular problem, he or she can then follow strategies or take medicines to help cope with the disability. And taking steps to manage the disability can often help restore a student’s self-esteem and confidence.

Some students who have been diagnosed with a learning disability work with a special teacher or tutor for a few hours a week to learn special study skills, note-taking strategies, or organizational techniques that can help them compensate for their learning disability. If you’ve been diagnosed with a learning disability, you may need support just for the subjects that give you the most trouble. Your school may have a special classroom with a teacher who is trained to help students overcome learning problems.

Some schools develop what is called an Individualized Education Program (or IEP), which helps define a person’s learning strengths and weaknesses and make a plan for the learning activities that will help the student do his or her best in school. A student’s IEP might include some regular time with a tutor or in a specialized classroom for a certain subject, or the use of some special equipment to help with learning, such as books on tape or laptop computers for students who have dyslexia.

Medication is often prescribed to help students with ADHD. There are several medicines on the market today to help improve a student’s attention span and ability to focus and to help control impulses and other hyperactive behavior.

There’s no cure for a learning disability. And you don’t outgrow it. But it’s never too late to get help. Most people with learning disabilities learn to adapt to their learning differences, and they learn strategies that help them accomplish their goals and dreams.

TEXT 26. MULTIPLE SCLEROSIS

Read the text and find out who can suffer from multiple sclerosis.

What is it? Multiple sclerosis (MS) is a neurologic disorder that disables young adults. It is not contagious. If you have MS, you may have symptoms like numbness or tingling, weakness, or unsteady walking. After an attack, the symptoms may go away or they may stay. They may slowly get worse over time without any quick or sudden changes. It is hard to predict how bad the disorder may get. There are many differences from one person to another.

In general, MS is not life threatening. The life span of those with MS is only slightly less than the general public. The disorder affects at least 300,000 people in the United States. The average age of diagnosis is 30. Sometimes the condition appears in children or in older adults. At least twice as many women suffer from the disorder than men. It is more common in Caucasian people than other races. The number of people with MS increases the farther they live from the equator.

What is the cause? The cause of MS is unknown. It may be the result of a combination of environmental and genetic reasons. Common viruses may cause attacks or recurrences. There is strong evidence that MS is “immune-mediated.” This means your own immune system attacks the central nervous system (an auto-immune disease).

MS begins with an inflammation in your central nervous system (the brain and spinal cord). This is followed by the loss of the protective myelin sheaths that are wrapped around nerve fibers. Myelin is like the insulation that covers and protects electrical wires. When the myelin is damaged, nerve impulses are slowed, garbled, or blocked. The inflammation causes lesions (called “plaques”) to develop in your brain and spinal cord. Symptoms then begin to appear. They can range from numbness in the arms and legs to paralysis or vision problems.

You have a little higher chance of getting MS if you have a close relative with the disorder. But it is not truly inherited in the general population. Researchers think there is a 1 or 2 per 1000 chance in the United States of getting MS. However, in families where MS already exists, the risk of another family member getting the condition is about 6 in 1000. This seems like a higher risk, but it is not thought to be a major reason for getting MS.

What are the symptoms? There are several kinds of MS. Most people with MS begin with the “relapsing remitting” stage of the disorder. This means your symptoms come and go. Usually you will feel completely normal until another relapse, or MS attack, happens. Symptoms that come with relapses usually build up over a period of hours to days. They can last for a few days or weeks and then go away, sometimes even without any treatment. New attacks happen at irregular times.

Common symptoms include:

• Vision loss

• Numbness or tingling

• Weakness or fatigue

• Unsteady walking

• Double vision

• Greater sensitivity to heat

• Partial or complete paralysis

• Electric shock sensations when bending the neck

Over time, about 60 percent of people with relapsing remitting MS develop a secondary form of the disorder. It is referred to as “chronic progressive.” This means your symptoms do not completely go away at the end of an attack. You are left with some type of permanent neurological symptom. Attacks may also happen more often.

How is it diagnosed? The diagnosis of MS is based on a clinical history and examination. These procedures will show signs of several lesions in the brain or spinal cord over time. Your neurologist will order tests that will help back up the diagnosis. Usually a magnetic resonance imaging scan (MRI) of the brain (and possibly the spinal cord) is ordered to find proof of abnormal areas. Lumbar puncture, also called a “spinal tap,” is helpful to find problems with the cerebrospinal fluid. Computer assisted tests called “evoked responses” may also be used to help in diagnosis.

What are the treatments? Right now, there is no prevention or cure for MS. However, this is a promising time for people with the disorder. Several new drugs have been approved or are awaiting approval by the US Food and Drug Administration. Current treatments are divided into three categories:

Treatments for the symptoms of MS. These include drugs to decrease muscle stiffness, reduce tiredness, control bladder symptoms, ease pain, and address sexual problems.

Treatments that change attacks when they occur. These treatments are primarily ACTH (an adrenal hormone) and corticosteroids (a synthesized adrenal hormone) which can shorten an MS attack. Doctors most often recommend large doses of steroids injected into a vein for several days. Longer-term steroid use, however, does not do a good job of slowing progress of the disorder.

New drugs that change disorder activity. Three drugs are now on the market to affect development of the disorder. They are interferon beta 1b, interferon beta 1a, and glatiramer acetate. These drugs can reduce the number of attacks and long-term damage to the brain caused by MS.

Progress through research. Neurologists and neuroscientists are doing laboratory research to create better treatments. Most possible treatments are discovered and tested in an animal model of MS called “experimental allergic encephalomyelitis” before being tried in human studies.

A number of important clinical trials are in progress. These trials test promising therapies on people with the disorder. Many people find it helpful to participate in such studies. Being part of research trials can be rewarding for people with MS and their families. Trials allow them to work closely with health care providers and increase their knowledge of the condition’s process. People can learn about these trials by contacting the National Multiple Sclerosis Society.

Continued research into understanding the disorder and developing new treatments offers real hope for improvement in the lives of people affected by MS.

Living with MS can create great hardship to people with the disorder and their loved ones. The unpredictable nature of the disorder and its appearance in the prime of life increase the psychological toll. There are many ways to help reduce this toll.

You may find that MS support groups are a source of help, comfort, and information. You can also learn about research results and new treatments through these groups. Counseling can also be helpful in coping with the emotional aspects of MS.

People with MS can benefit from regular exercise. In addition to improving general health and well-being, exercise can also help manage the symptoms of MS. An exercise program should be tailored to each person. You should talk with your neurologist before starting a new exercise program.

A well-balanced diet can help maintain general good health. MS specialists recommend that people with MS eat the same low-fat, high-fiber diet that is recommended for the general population.

TEXT 27. PAIN

Read the text and describe pain syndromes.

What is it? Pain is the most common reason why people go to see a doctor. In most cases, the pain is there for a reason. It is our body’s way of telling us that something is wrong. But in some cases, the body’s alert system goes awry. Like an alarm that keeps ringing long after the danger has passed, the pain continues long after the original illness has healed. Often times, it is difficult to find the original cause of the pain.

In the past, pain was thought to be just a symptom. Now, chronic pain is considered a disease itself.

Chronic pain affects more than 50 million Americans. Chronic pain can lead to other problems. These can include depression, sleep problems, and conditions that come from lack of activity due to pain, such as high blood pressure.

It’s important to remember that treatments for pain are available. Many people think they have to live with the pain and they don’t seek help. Talk to your doctor about your pain. You can discuss what to do about it.

Any part of the body can be affected by pain. Some common pain syndromes and the areas affected include:

Head and facial pain:

Headache – Pain can be from cluster headaches, tension headaches, sinus headaches, and other types of headaches

• Migraine – Recurring, throbbing headache, usually on one side of the head

• Trigeminal neuralgia – A facial pain syndrome with episodes of intense, brief, electric shock-like pain

Neck pain. Most commonly caused by strain in the neck’s muscles, ligaments, or joints. Less frequent causes can include: injury, infection, and nerve root, spinal cord, or disk problems

Chest pain. The most serious cause of chest pain comes from problems with blood flow to the heart. Chest pain should be reported to a physician as soon as it begins. If an evaluation shows your pain is not due to heart problems, it may be the result of muscle strain, rib arthritis, or nerve problems such as reactivated chicken pox infection or a pinched nerve.

Low back pain. Back pain can occur anywhere along the spine. The most common site is the lower back. This is where we bear most of our weight.

Central pain syndrome. Trauma to the brain or spinal cord can result in central pain syndrome. Abnormal signals relayed to and from the brain can lead to intense pain. Sensitivity to hot, cold, and touch can be increased. A gentle touch can feel like intense burning. These are some of the conditions that can lead to central pain syndrome:

• Stroke