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Lost at Sea … Karl E Misulis MD,PhD
www.misulis.net
Speaking engagements…
Street physicians…
Entertainment!Watch for the next performance of: Hearts & Minds
Expert medical care…
Have you lost your mind?
Have to writeeverything down…
Coming soon …
Cognitive changes with aging:
Names
Calculations
Multi-tasking
Attention and concentration
Verbal IQ
Psychological causes of cognitive changes …
First signs of dementia:
Memory loss
Difficulty with names
Repetition
Spatial disorientation
Judgment errors
Diagnosis of dementia:
Neuropsychologic testing
Scan – CT or MRI
Blood – thyroid, B12.
Urine – toxic metals.
Prevention of dementia:
Multivitamins, E, C.Medical care:
HypertensionDiabetesLipid disorders.
No specific meds.NSAIDs?Statins?
Mental activity
Medical conditions:
Diabetes increases the risk of dementia 2-times.
Hypertension increases the risk of dementia 4-times.
Cholesterol effects are complex and controversial.
How are we doing with BP?
Uncontrolled18%
Controlled17%
Unaware31%
Aware & Untreated
34%
Diet …
Fruit and veges…
Japanese-American study followed 2,000 peoplePeople who had 3 or more glasses of vegetable juice had a 75% lower incidence of developing dementia than those who did not.May be related to antioxidant polyphenols.
Folate and B12
Folate administration reduces development of dementia in 3 years.
B12 should probably be administered with folate, even in people with normal B12 levels.
We know that folate lowers the risk of neural tube defects.
Multivitamins + E + C
Administration of multivitamins + E + C reduced the development of dementia by 40% in one study.
Individual agents did not seem to be effective.
Vitamins and AD
0
0.2
0.4
0.6
0.8
1
1.2
Other interventions …
NSAIDs
Rheumatoid arthritisChronic use of anti-inflammatory agents.
Reduction in development of dementia.
Steroids have been tried.
Analogs of NSAIDs have been tried.
Estrogen and other hormones:
Estrogen
Of the 4 million Americans with Alzheimer’s, more than 2/3 are women.
Estrogen has no benefit in progression of AD.
There may be an effect on development of disease.
Estrogen – men vs. women
Estrogen may protect nerve cellsFemales have more estrogenMales get their brain estrogen from testosteroneFemales lose most of their estrogen in senior yearsMales continue to produce testosterone, and therefore estrogen, without the drop.
More about men and estrogen:
Males with higher estrogen seem to have better memories (though no improvement in cognitive functioning)
Males taking anabolic steroids have reduced memory and cognition, and more mood disturbance.
Drinking…
Smoking …
Exercise …
Physical and mental exercise
Physical activity in women 40-60 reduces AD more than 20% (don’t take this to the bank, yet).
Mental activity is associated with a marked reduction in AD, up to 70% (but part of this may be selection).
Logic
Logic
Butterfly wings move the airand …
Air movement drives sailboatstherefore …
Butterflies power sailboats.
Dealing with memory loss …
Dealing with cognitive changes:
Notes
PDA and wrist watch alarms
Keep mentally stimulatedBooks
Games
Travel
Activities
When we diagnose dementia,what is the cause?
Alzheimer'sFTDVascularPDNPHTumorMetabolicMeds
Treatment of dementia:
Stop the progression
Improve the memoryAricept,
Exelon,
Razadyne
Namenda
Improve behavioral problems.
Implications of memory loss:
Make decisionsCompetency
Capacity to consent
Make wills
Interact with others
Do things for one-self.
How do we deal with a loved one with memory loss?
Get medical attention.
Treat them the same as you did previously.
Allow them to do as much as possible.
Consider safety issues.
Consider the legal manifestations.
Plan for the future.
Life’s little surprises …
Ultimate answer to life’s eternal questions …
Take-home messages …
Not every mistake indicates dementia.Normal errors.
Cognitive changes with aging
You can lower your risk of dementiaLifestyle changes - diet and exercise
Medical management.
Dementia can be treated.
Nothing lasts forever …
Snowball’s chance …
Enjoy life …
Bored yet?
