Page 11 - Boca Club News - March '22

Medical Matters: Dementia Revisited from page 10
Boca Club News, Page 11
Medical Matters: Dementia Revisited (Part Two)

By Richard Nagler, M.D., a member headaches, weakness and depression, which can be severe stimulate the mind and improve and preserve cognizant
of Broken Sound Club and retired enough to warrant discontinuing these medications. The function is important. For example, keeping close ties with
physician. After graduating from the bottom line is that any benefits are temporary, and have no family and friends, staying connected to young people,
University of Pennsylvania and New effect on the relentless destruction of brain cells. having a stimulating job, hobbies, doing brain training such
York University’s School of Medicine, Treatments with anti-inflammatory drugs—such as as problem-solving skills, crossword puzzles, reading books,
Dr. Nagler served his internship and NSAIDS like Advil, Aleve, etc.—are no better than a magazines and newspapers, improving math skills and verbal
residency at Baltimore City Hospital placebo. Supplements such as vitamins B, C, E, folic acid, reasoning, learning how to answer obscure questions, doing
and Johns Hopkins. He followed that beta carotene, coconut oil, coenzymes, calcium, ginko biloba volunteer work, playing a musical instrument and being
with a Fellowship in Gastroenterology and omega fatty acids are not recommended, as there is no involved in continuing education such as that offered in the
at Yale University School of Medicine, and was then Chief documented benefit, and there are safety concerns about lifelong education programs at FAU which, by the way, is
of Gastroenterology at Fitzimmons General Army Hospital serious interactions with other medications. Highly advertised the largest of its kind in the country.
in Denver. He returned to the Yale Medical School for one endorsements for over-the-counter medications such as However, what can we realistically expect from the
year as an Assistant Professor of Medicine before opening Prevegin—alleging to have beneficial effects on memory engagement of these endeavors by those individuals who
his own successful private practice in Internal Medicine and loss—have not been verified by any FDA-approved clinical have Alzheimer’s and already have symptoms of dementia?
Gastroenterology. During that time, he also served for ten years studies to validate these claims made by actors on TV posing We know that an ongoing progressive massive destruction of
as Chief of Medicine at Huntington Hospital in Huntington, N.Y. to be helped by these products. However, because demented brain cells is taking place, which has already overwhelmed
In the February Medical Matters column, I emphasized patients eat irregularly, their diets should be supplemented the remaining viable brain cells, resulting in dementia.
that dementia is a general term and Alzheimer’s is the major with smoothies, shakes and plenty of fluids. Engaging in these activities will not be of any discernable
cause of this devastating disease. For more than 100 years, scientists have maintained value because they have no effect on stopping brain cell death,
Most of the risk factors in Alzheimer’s are associated that brain cells once destroyed cannot regenerate. There is and the dementia will progress unimpeded. Second, and more
with arteriosclerosis, and the appearance of symptoms may now ample evidence that—in people who exhibit mild loss important, is to consider those people who have Alzheimer’s,
be accelerated by events such as a heart attack, stroke and of cognitive ability through normal ageing—stimulation but who have not as yet developed any symptoms of
bypass surgery. Obesity increases the risk of Alzheimer’s and by mental challenging efforts and aerobic physical dementia. In this situation, massive destruction of brain
to develop it at an earlier age. Smoking, uncontrolled high activity, regeneration of brain cells has been observed and cells is also ongoing, but has not as yet overwhelmed the
blood pressure, high LDL cholesterol and type 2 Diabetes documented in one area of the brain called the hippocampus, remaining viable brain cells; hence, there are no symptoms.
are all implicated. To complicate matters, diabetics have a which may be responsible for their improvement in Stimulating the remaining viable brain cells will at best delay
much higher incidence of vascular disease, with diminished mental acuity. However, if researchers can develop a symptoms of dementia, but it is only a matter of time before
oxygen reaching the brain due to obstructed arterial blood way to achieve regeneration of brain cells throughout the symptoms will appear as this has no effect on stopping the
flow after major strokes and multiple mini strokes, which brain to replace them in people with dementia caused by relentless continuing destruction of brain cells. In the third
results in brain cell death and dementia. Importantly, although these neurodegenerative diseases using drugs, stem cells, group are those people who do not have these diseases, but
there is a genetic link only a tiny proportion of Alzheimer nanotechnology, or by any other means, this would represent are experiencing minor cognitive impairment due to ageing.
cases are inherited by children or grandchildren. a breakthrough in the treatment of dementia that would be Stimulating their brain cells is of unquestioned value by
There is no cure for Alzheimer’s. The deficiency of the what everyone has been striving for. increasing the efficiency of brain cell activity, resulting not
chemical enzyme Acetylcholine essential in the transmission Recently, a new treatment option was developed by only in improving cognizant function, but extending it well
of information from one brain cell to another, as seen in this Biogen called Aduhelm. It is a monoclonal antibody given into the 80s, 90s and even beyond. Possibly, regeneration of
disease, can be corrected to some extent with cholinesterase intravenously for one hour once a month over 52 weeks. brain cells may be the opportunity.
inhibitors such as Aricept, Exelon and Razadine. These It removes amyloid from the brains of patients with early Regular aerobic activity, such as walking, bike riding,
drugs have produced temporary improvement in cognizant Alzheimer’s dementia and is touted as slowing cognizant swimming and working out in a fitness center all help by
function and a slowing down of the progression of dementia impairment. Although the FDA granted controversial protecting the cardiovascular system that feeds oxygenated
in about 30% of patients, but at best this lasts six months conditional approval of the drug, it has thus far failed to show blood to the brain, which is essential for cellular viability. In
to a year, after which these drugs are ineffective. When any lasting significant benefit – and dangerous side effects several large clinical trials, 40% of people who engaged in
given in combination with Namenda (an NMDA neuro- of brain swelling and bleeding have been observed in 40 % these activities had a reduction in developing dementia over
receptor inhibitor blocking the action of glutamine in the of patients. In addition, the cost is astronomical ($56,000 a a six-year period.
brain) a longer, similarly favorable but limited response year initially, but lately reduced to $26,000) and thus far not The greatest dilemma for friends and family is how to react
has been observed in up to 50% of patients. However, there covered by Medicare or private insurance. to a person with dementia. Don’t address them using infantile
are significant side effects, such as diarrhea, constipation, It has been shown that engaging in those activities that language or raise your voice. Speak slowly and distinctly.
Remove distractions such as TV or cell phones when talking
to them; keep it simple, move to quiet surroundings, address
West Boca Medical Center OB/Ortho them by name and always identify yourself. Ask one question
at a time that requires a yes or no answer. Don’t hesitate to
repeat anything. It’s a good idea to suggest words they may
Being admitted into the hospital can be intimidating. And, West Boca is the only area hospital to offer NICView be struggling to remember. They are continuously repetitious,
Whether you’re there to deliver a baby or undergo a knee Live Streaming Cameras so patients can watch their and you should not lose patience with them or say, “You
replacement, the experience can induce anxiety. It’s for newborns in the NICU even when they can’t be there. told me that already,” or try to correct them. When they are
this reason that West Boca Medical Center has invested At the Boca Center for Orthopedics and Spine Care, confused or angry, don’t overreact, but rather give them a
significant resources into creating a seamless healthcare patients also appreciate the seamless experience provided hug, a smile and offer praise and reassurance. Focus on the
experience for their patients, meeting each person’s to them. When orthopedic patients arrive, they enter things for which they have some recall, as they have great
individual needs. To achieve this goal, they’ve addressed through a separate, private entry to the Medical Surgical difficulty remembering anything recent. If they become upset,
the major touchpoints that matter most to patients. unit. The rooms have been upgraded with new furniture change the subject. Balance problems resulting in dangerous
In the Boca Center for Women’s Care, the hospital is and orthopedically designed walk-in showers. And falls are common. Clutter and throw rugs should be removed.
proud of their OB/GYN Laborist Program. Run by Dr. orthopedic patients are cared for by dedicated staff in this They should wear comfortable shoes and slippers with good
Barry Peskin, it provides specialized OB/GYN care on- area. Most importantly, our team of caregivers is trained traction, and use a walker at all times. They should not be
site 24/7/365, providing peace-of-mind to pregnant moms. to use the hospital’s advanced technologies, including permitted to go to the bathroom at night without assistance.
“Having a Laborist Program means we’re better prepared MAKO Robotic Arm Assisted Surgical Surgery System Using a diaper, having a Porto Potty or a urinal at the bedside
to handle emergencies, with 24-hour anesthesiology and the CORI Surgical System. is a reasonable alternative. Sturdy handles on stairwells and
coverage and in-house OB/GYNs who work directly with in bathrooms are essential. They are often confused and
a woman’s personal physician. And, West Boca is a Level frightened by images in mirrors, which should be removed.
III Neonatal Intensive Care (NICU) facility, providing Things like wallets and keys should always be in the same
the highest level of care for high risk pregnancies” said place in the home.
Dr. Peskin. The hardest and most devastating effect of dementia—
especially for a spouse, children and grandchildren—is the
realization that they may no longer be recognized, or are
instead received with a blank stare or totally ignored by
someone they have loved and spent so many happy times
with for many years. The demented patient in the latter stages
of these diseases becomes nothing but a shell of their former
Dr. David Padden is a champion for West Boca’s selves. All too often, the situation becomes unmanageable at
orthopedic program. As an orthopedist with over home and there is no alternative but to institutionalize them,
three decades of experience, he’s enthusiastic about which is a very painful decision. As we live longer, we must
the hospital’s commitment to employing innovative be prepared to confront the inescapable fact that we and our
technology to improve patients’ experiences. loved ones are at risk to develop Alzheimer’s. We owe it to
Other innovations include having a Maternity “These technologies make orthopedic surgeries more ourselves to be checked for Diabetes, and if present begin
Navigator who guides patients, helping each woman exact, resulting in better outcomes for our patients,” and maintain treatment immediately. Discontinue smoking,
design her Personalized Birth Plan. Available options Padden said. “I’m impressed with West Boca’s maintain a normal weight, and make the effort to remain as
include utilizing Nitrous Oxide with or without an commitment to upgrading their systems more and more physically fit as possible. If we are fortunate enough to be
epidural, birthing tubs for water births and soothing and allowing our team to provide the best surgeries spared from this disease, we should make the effort to engage
aromatherapy. Once the baby is born, the proud mom possible.” in those mental and physical activities that stimulate the
enjoys a Celebration Breakfast and a Postpartum Snack To learn more or to find a doctor, please visit mind to improve and preserve our normal cognitive function.
Pack, along with the services of the Lactation Consultant. westbocamedctr.com Hopefully, with the well-funded and determined ongoing
research effort, especially to regenerate brain cells, there will
Paid Advertisement come the day when we have a meaningful breakthrough and
find a cure for this scourge on humanity.