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MLD and dementia, one OT's experience. by Delbar Mehta.

The human lymphatic system plays a crucial role in the daily clearance of metabolic waste products and toxins from the brain, including those associated with dementia and other neurodegenerative diseases.

The glial-lymph system primarily operates during sleep and relies on the movement of cerebrospinal fluid (CSF) through perivascular channels which form the g-lymphatic network. Harmful substances are channelled out of the brain towards the initial lymph vessel in the outer layers of the meninges and perineural sheaths of the cranial and spinal nerves.


Lymph from the brain passes through the deep cervical lymph nodes and jugular trunks to be returned to the subclavian vein just above the heart.

 
Impairment of the g-lymphatic system's nightly washout can have significant consequences such as the progression of Alzheimer's disease.

Characterized by the accumulation of beta-amyloid plaques and tau tangles in the brain, studies have shown that dysfunction of the glymphatic system can lead to reduced clearance of these toxic proteins, contributing to their buildup and subsequent neuronal damage. The impaired removal of beta-amyloid plaques and tau tangles accelerates the progression of Alzheimer's disease and exacerbates cognitive decline.


Sleep disturbances, which are common in neurodegenerative diseases are a vicious cycle where impaired glymphatic function leads to disrupted sleep, which in turn further impairs glymphatic clearance, ultimately accelerating disease progression.

Understanding the role of the glymphatic system in neurodegenerative diseases opens up new avenues for therapeutic interventions and reinforces decades of clinical observation on the effects of MLD in reducing cerebral oedema.
 
Clinical reasoning tells us that MLD should have a positive effect on dementia symptoms because the reduction in sympathetic tone improves sleep and digestion.

But does MLD actually increase the clearance of abnormal protein aggregates in neurodegenerative diseases? We don't know because we are not putting our research dollars into investigating questions like these. In the absence of hard research, we can turn to case reports and the clinical observation of our Therapists to determine how MLD may benefit people affected by the symptoms of dementia.

 

The following case reports are from Delbar Mehta OT, on her experience and observations using MLD to improve behaviour, appetite and sleep in patients affected by dementia.

Delbar Mehta, OT and Dr Vodder Therapist WA.

I started studying lymphology mid-2022 and attained the Dr Vodder Certificate in MLD & CDT (Lymphoedema) in March 2023.

When I started this journey, I thought I would learn about lymphoedema and ways to treat residents having issues with swelling. I had no idea of the vast range of applications for MLD.

The theory was particularly helpful because you learn about the role of the lymphatic system in the human body and its importance in clearing toxins and inflammatory markers characteristic of so many conditions. While I had learnt about this earlier, I had never really paid much attention to it with reference to pain. Studying the theory and then learning the practical techniques made me think about all the applications in a residential care setting.

In residential care, people are admitted with a range of progressive conditions that make it difficult for them to live in their own homes, and Dementia is one of the main conditions seen.

Most of the residents with dementia, also experience several other comorbidities. Due to the progression of dementia, their ability to communicate effectively is impaired and often pain or an unmet need translates into behaviours such as aggression, low mood, and loss of appetite.

MLD has a significant effect on pain relief and when I returned to work after completing the course, I thought about using what I had learned with residents experiencing different conditions, not only lymphoedema and have been amazed at the results.
 

Case 1

Male, 88 years old with dementia and moderate cognitive impairment. He used to attend most activities and was generally sociable, but therapy staff reported that he had begun to decline coming out of his room and appeared low in mood.


I went to see him and he was unable to tell me whether he had pain, but I observed that he was frowning, and his facial expressions were indicative of pain. I asked him to get up from his chair and lay on the bed and noticed that in doing this he was guarding his lower abdomen. As I began to apply MLD to his neck I noticed that he was very warm to the touch. I then worked on his face, mainly to relax him, and after this began working on his chest with broad MLD movements on both sides, followed by the basic MLD sequence for the abdomen.

As I completed the session I felt his body start to cool and noticed that he had stopped frowning. I assisted him to dress and then left him to rest.

Soon after I saw him come to lunch and he was back to his usual self. This was a one-off treatment.
 

Case 2.

Female, 78 years old with moderate cognitive impairment (not formally diagnosed with dementia) and MS.

She was bed-bound due to a Stage 4 pressure injury and I initially attended to perform MLD for wound healing. She generally has a low mood and alternates between being emotional and verbally aggressive.

There was a significant difference in mood following the first treatment.

At the start of the session she was quite emotional so after clearing her neck I moved onto her face to help her to relax. Her skin began to feel cooler to touch and her body began to relax. She started to smile and talk with me, telling me about her life as a nurse and her fashion interests. I can truly say that the effect on her mood was remarkable.

 

Case 3.

Female, 90 years old with mild Dementia and moderate cognitive impairment. She has oedema in both lower legs and was referred for MLD by her GP for this.

She is generally very active and likes to go out with her children and participate in social activities. Her biggest complaint to me was that she frequently needs to go to the toilet during the night which was affecting her sleep.


I have been treating her for leg swelling twice a week. She has reported that her legs feel much better and have stopped aching at night. But most importantly, when she goes to the toilet she is able to empty her bladder and does not need to get up as frequently.

She is now sleeping much better and would like me to see her every day!
 

Case 4

Female, 89 years old with Progressive Supranuclear Palsy and other comorbidities including kidney disease and bilateral lower limb oedema. Although she was referred by her GP for MLD I was hesitant because of the kidney disease but agreed to do an initial assessment.

During the assessment, she told me she was experiencing hypersensitivity in her legs, with a pain score of 8 on a scale of 1 to 10. She was finding it difficult to sleep at night due to this. I discussed the risks of treatment with her and her niece and we decided that I would treat her for the pain and hypersensitivity.


On the first day, I did only a short treatment for her neck and legs as I was concerned about overloading her kidneys. When I went back to see her the next day she reported that she had not expected to feel such a big difference. To be cautious, I waited two days before I treated her again and the treatments then continued twice per week.

After 6-weeks she has minimal pain hypersensitivity or discomfort in her legs.
 

MLD has many applications in residential care and can improve quality of life, mood, appetite, sleep and pain.


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