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?