Speak Out: Cognitive decline

Tuesday, February 21, 2012

AT ALMOST this same time last year, I came across a family that did not believe that their mother may have Alzheimer’s Dementia. She had subtle signs of the neurodegenerative disease so much so that denial would be expected. I revisit the illness and point out that cognitive decline may be detectable in the early middle age population of 45 to 49 years of age.

There is currently a debate as to when cognitive decline begins in dementia of a neurodegenerative etiology. At present, we now know that the pathologic hallmarks of Alzheimer’s Disease – neurofibrillary tangles and amyloid plaques, may already be evident in the brains of the aforementioned age range. To refresh one’s memory, let me once more state that to definitely say that one has Alzheimer’s Disease, one has to perform an autopsy on the brain of the deceased. Of course, waiting for the death of the patient in order to truly find out if such an individual indeed has it, in my opinion, is poorly justified when there are already medications that may help the symptoms of patients suspected of having it – the population labeled as having probable Alzheimer’s Disease, such as the case already mentioned. So, with medications already available which were not present two decades ago, identifying these individuals early in their disease course would greatly benefit them in their daily activities.

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Currently, cognitive scores in memory, reasoning, and phenomic and semantic fluency may decline is the early middle aged population. This new finding recently published a month ago has important ramifications. The challenge posed by the study is whether we should now screen for dementia at an earlier age than what is currently being done.

Furthermore, this puts more pressure on the healthcare sector. Evidence has shown that controlling cardiovascular risk factors has beneficial effects in the prevention of dementia. A healthy lifestyle should more vigorously promoted. The control of hypertension and diabetes should be continually be reinforced among patients as the understanding that having normalized one’s blood pressure or sugar levels already clears you of the diagnosis when in truth, what has happened is that medications have controlled the illness but has not necessarily rid one of the problem.

When medications are stopped, naturally, both the previously controlled blood pressure and blood sugar levels would once more rise to uncontrolled levels. Furthermore, cholesterol levels have to be decreased to normal values. Exercise has to be part of one’s lifestyle as well as eating healthy foods. Preventing the development of such lifestyle-associated diseases would curb the rise in the number of cases of dementia in the future. The pediatric problem of obesity in children has to be vigorously addressed. The Department of Health and the Department of Education should disallow unhealthy foods in schools. I would even venture to extend this to all government offices. From there, probably even to private institutions and corporations. Where would you be able to eat all those fatty chips and cookies as well as all those colas? We have our homes to do that in.

For now, Alzheimer’s dementia is often screened in people above the age of 60 years. There will be a dementia screening activity at the Baguio General Hospital and Medical Center (BGHMC) on the 29th of this month starting at one in the afternoon. If you wish to have yourself or a loved one screened, just go to BGHMC on the said date.

Remember the date: February 29, 2012.

Remember the place: Baguio General Hospital and Medical Center.

Oh, did I mention middle-aged individuals may have a decline in their cognition? Oh, sorry, I did mention it already.