1. Lost at Sea … Karl E Misulis MD,PhD www.misulis.net

2. Speaking engagements…

3. Street physicians…

4. Entertainment! Watch for the next performance of: Hearts & Minds

5. Expert medical care…

6. Have you lost your mind?

7. Have to write everything down…

8. Coming soon …

9. Cognitive changes with aging: Names Calculations Multi-tasking Attention and concentration Verbal IQ

10. Psychological causes of cognitive changes …

11. First signs of dementia: Memory loss Difficulty with names Repetition Spatial disorientation Judgment errors

12. Diagnosis of dementia: Neuropsychologic testing Scan – CT or MRI Blood – thyroid, B12. Urine – toxic metals.

13. Prevention of dementia: Multivitamins, E, C. Medical care: Hypertension Diabetes Lipid disorders. No specific meds. NSAIDs? Statins? Mental activity

14. Medical conditions: Diabetes increases the risk of dementia 2-times. Hypertension increases the risk of dementia 4-times. Cholesterol effects are complex and controversial.

15. How are we doing with BP?

16. Diet …

17. Fruit and veges… Japanese-American study followed 2,000 people People 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.

18. 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.

19. 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.

20. Vitamins and AD

21. Other interventions …

22. NSAIDs Rheumatoid arthritis Chronic use of anti-inflammatory agents. Reduction in development of dementia. Steroids have been tried. Analogs of NSAIDs have been tried.

23. Estrogen and other hormones:

24. 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.

25. Estrogen – men vs. women Estrogen may protect nerve cells Females have more estrogen Males get their brain estrogen from testosterone Females lose most of their estrogen in senior years Males continue to produce testosterone, and therefore estrogen, without the drop.

26. 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.

27. Drinking…

28. Smoking …

29. Exercise …

30. 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).

31. Logic

32. Butterfly wings move the air and … Air movement drives sailboats therefore … Butterflies power sailboats.

33. Dealing with memory loss …

34. Dealing with cognitive changes: Notes PDA and wrist watch alarms Keep mentally stimulated Books Games Travel Activities

35. When we diagnose dementia, what is the cause?

36. Treatment of dementia: Stop the progression Improve the memory Aricept, Exelon, Razadyne Namenda Improve behavioral problems.

37. Implications of memory loss: Make decisions Competency Capacity to consent Make wills Interact with others Do things for one-self.

38. 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.

39. Life’s little surprises …

40. Ultimate answer to life’s eternal questions …

41. Take-home messages … Not every mistake indicates dementia. Normal errors. Cognitive changes with aging You can lower your risk of dementia Lifestyle changes - diet and exercise Medical management. Dementia can be treated.

42. Nothing lasts forever …

43. Snowball’s chance …

44. Enjoy life …

45. Bored yet?