Tykf-Aabmss Monthly Medical Forum 271-275

Every month, the Tan Yan Kee Foundation, Inc. and the Association of Asia Brewery Medical Specialty Scholars (AABMSS) hold a medical forum designed for laymen. The forum provides people with a venue to learn about the latest medical issues, trends, and available treatment options.  Asia Brewery medical scholars render free consultations and discuss pertinent matters in layman’s language.  The forum is held at the Century Park Sheraton.

Medical Forum No. 271
Neurologic Diseases Not To Be Ignored
Herminigildo Gan, M.D.

Dementia: decline in cognitive abilities that interferes daily life
Symptoms: 
decline in memory and at least one of the following cognitive abilities:

• recognize or identify objects        
• speak fluently or understand spoken or written language
• sensory function 
• perform motor activities and comprehension of the required task
• think abstractly, make sound judgments, plan and carry out complex tasks

Causes:
Metabolic: will improve when conditions below are treated:

• depression
• excess use of alcohol
• thyroid problems    
•  medication side effects
• vitamin deficiencies 

Structural: permanent damage of brain cells that will worsen overtime


Diagnosis: to determine it’s cause and look for evidence of focal neurologic deficits and examine for extrapyramidal signs, movement disorders and gait abnormalities

• Complete Blood Count    
• Liver Function Tests    
• Thyroid Function Tests    
• Vitamin B12 Levels    
• Fasting Blood Sugar (FBS)    
• Blood Urea Nitrogen (BUN) / Creatinine Test    n    Serum Calcium    
• Electrolytes        
• Mini Mental Status Examination: practical screening tool for grading cognitive state of the patients            

Types:

• Alzheimer’s Disease
• Mixed Dementia
• Vascular Dementia
• Parkinson’s Disease
• Dementia with Lewy Bodies(DLB)
• Creutzfeldt-Jakob Disease
• Frontotemporal Lobar Degeneration (FTLD)    
• Normal Pressure Hydrocephalus (NPH)

Alzheimer’s Disease: irreversible and progressive brain changes that slowly destroys memory and thinking skills, affects behavior and impairs the ability to function


Symptoms:

• Memory loss that disrupts daily life    
• New problems in speaking and writing words 
• Difficulty completing familiar tasks    
• Challenges in planning and judging or solving problems
• Confusion with time or place    
• Trouble understanding visual images and spatial relationships
• Changes in mood and personality that can cause withdrawal from work or social activities

Risk Factors:

• advancing age    
• family history    
• APOE 4 genotype    Down syndrome
• obesity    
• insulin resistance    
• vascular factors    
• traumatic brain injury
• dyslipidemia    
• hypertension     
• inflammatory markers    

Stages:
Mild Cognitive Impairment (MCI) caused by physiological changes: mild, noticeable changes in thinking abilities of the patient, but that doesn’t affect the ability to carry out everyday activities

• diagnosis of the changes in the brain, cerebrospinal fluid (CSF) and blood is recommended
• Dementia due to brain changes

Diagnosis:
Imaging of the structure, biochemistry, metabolic state and functional capacity of the brain

• to rule out reversible and treatable causes of dementia
• major neurodegenerative disorders have relatively specific imaging findings

Three Coronal T1-weighted Studies: done every other year


Treatment:
Symptomatic

• Acetylcholine Esterase Inhibitors: Donepezil, Rivastigmine, Galantamine    
• NMDA Antagonist: Memantine
• Behavioral and Psychiatric Symptoms of Dementia    
• Movement disorders in Dementia with Lewy Bodies
• Pharmacotherapy: must be in conjunction with non-pharmacological management including education and counseling of both patient and caregiver

Prevention:

• Do more mentally and physically challenging tasks    
• Frequent social interactions