Dementia Risk and Prevention

Findings from a 40 year research study found that dementia is decreasing.  The average age of occurrence, if ever, has risen from 80 t0 85.   As you get older, your chances of developing dementia increase.  Age and inheritance are two of the strongest known risk factors.  Cardiovascular risk is also associated with increased risk as are diabetes, tobacco use, and many other factors.

Of the 40 million plus people in the United States over 65 years of age (about 560 million worldwide), about 5.2 million have some type of dementia.  In the United States this is expected to double or more by 2050.  Alzheimer’s disease is the most common form of dementia.  Other types include: vascular, Lewy body, Huntington’s disease, dementia secondary to disease (e.g. Parkinson’s disease, HIV, multiple sclerosis) or trauma (usually repeatedly like sports head injury in football, boxing), nutritional deficiencies, medication induced, inherited forms, and many more. 

Signs and symptoms of dementia include memory problems, decreased cognitive ability, and decreased physical activity whereby activities of daily living (bathing, dressing, eating, household chores, etc.) may require assistance. Personality changes like agitation, inattentiveness and irritability are common.  Dementia diagnosis begins with a thorough history (of patient and family) and physical examination including blood tests.  Brain scans (MRI, CT, PET) are important in helping make the diagnosis.  Neurologic evaluation by a certified neurologist is also indicated for suspected dementia.    
Treatment includes behavioral, occupational, and physical therapy as well as medication. In some cases such as medication induced dementia from vitamin deficiency or low thyroid levels after proper medication is given.  If a drug is the cause, it will resolve by stopping the medicine. Dementia drugs can lessen the symptoms of cognitive decline, in spite of the fact that disease will usually continue to progress. Regular exercise has been shown to do improve function, also.

Preventive measures include:

• Nutritious food especially those aimed at brain health
• Physical movement and exercise
• Restful sleep
• Daily routine to include self care, meals, etc. at same time
• Intellectual stimulation like reading, conversation, brain exercises, music
• Social activities especially with family, friends
• Avoidance of smoking, too much alcohol
• Good maintenance of high blood pressure, diabetes, high cholesterol and any other diseases you may have
• Prayer and meditation

As dementia progresses, it can debilitate to the point of total disability and lack of all function to the point where care must be provided by others full time.  This is usually done in the comfort of their home, or in a fully supervised care facility.   Caregivers in the home setting may include family, friends, and hired health care providers that may be necessary.  Caregivers are very important in dementia care. They provide most of the care necessary to keep the patient functional. 

Keep your brain and body as healthy as possible in an effort to prevent dementia.  It may be decreasing, but as we live longer the likelihood increases.  Best health!

Mobile Healthcare:Telemedicine Telehealth

If you could visit your doctor 24/7 how much money and time could you save?  Telemedicine healthcare makes this possible.  Telemedicine makes virtual reality a reality as real as visiting your doctor in the office.  Through your smart phone, tablet or computer you can make a doctor visit.  No travel time. No wait time. Just quality doctor time.

Telemedicine is a billion dollar business that is becoming a trend in our connected world of convenience and crucial time management.  It entails the use of electronic communications to monitor and improve a patient’s health status.  In addition to saving money for patients and all providers (including insurance companies, hospitals, clinics), there is better access for everyone. Studies have shown that overall quality of care improves as patients are given more of the attention they deserve to make their healthcare experience more beneficial. .  It is helpful for patients in remote areas with limited or no transportation and those with chronic conditions that limit their ability to make an in person office visit.   

As telehealth develops, doctors and patients will find even greater access with connectivity via personal electronic health devices and applications (apps, for short).  Telemonitoring allows patient and doctor to check and follow together such parameters as blood pressure, blood sugar, and much more in real time together.  If that noon time blood sugar is too high, your doctor can be aware and advise accordingly at the time of occurrence instead of on the next appointment in 2 weeks.  This alone saves the patient’s health as well as travel time, office visit wait time, and the money to do all of this.  It potentially avoids an emergency room visit and hospital admission. 

In addition to patient care, doctors are able to communicate in a more timely, efficient manner with other doctors and health facilities.  The CT scan you had this morning is can be viewed by your doctor within minutes after completion instead of days after. Mobile collaboration allows your doctor to discuss your health case with other healthcare professionals like specialists (in the same or different locations) to determine the plan for your care.  This can actually happen the same day a test is done!  This eliminates delays in care that could be life threatening to a patient. 

As costs for telemedicine access decrease and more insurance companies/plans reimburse, it will become the portal of choice for many patients, doctors, and other healthcare providers.  Your doctor visit time can be more about you at your convenience in your home.  Best health!

Chronic Non-Malignant Pain Opiate Options

You got pain?  Take a pill to ease the strain.  Chronic nonmalignant pain affects everyone.  It can be a major cause of personal and family distress.  In addition to the pain of pain many live with secondary effects such as depression which leads to family chaos, work absenteeism, and decrease in activities of daily living to the point of depression.  Prescription medication like nonsteroidal anti-inflammatory drugs (NSAIDs include ibuprofen, naproxen, celebrex and more) and opiates (oxycodone, hydrocodone, codeine, morphine and more) are the gold standard for acute and chronic pain management.  Once you have seen the doctor you are most likely to get one or both of these depending on the etiology of the pain.  Once the cause of the pain is found and treated the need for pain medication may cease.  If this fails to work, the pain meds continue.  This can be a hazard to your health.

In 2012 there were about 183,000 deaths worldwide.  In 2014 there were over 47,000 lethal drug overdoses making it the leading cause of accidental death in the United States (2012 statistics: United Kingdom: 3,200, South America/Latin America/ Caribbean: 7300, European Union: 6100, Oceania: 1900).   This exceeds the number of deaths in road accidents in most countries. Research from studies done in 2013 revealed that opioid analgesics were the primary cause of most drug overdoses in the United States.  Over three-quarters of these deaths were accidental or unintentional.  Opioids (75%) were the most common drug followed by benzodiazepines, antidepressants, and antipsychotics.  Prescription pain relievers accounted for over 18,000 overdose deaths.  Misuse of these medications often leads to illicit heroin use.  Why?  It is easier to get and less expensive than prescription opioids even though the rate of prescribing opioids has almost tripled since 1994.  This has increased the mortality rate from overdosing over 400% in women and over 200% in men from 1999 to 2010.

Pain can be managed in ways that use less prescription pain medicine.  The pill may be the easiest way and is usually the first thing a patient is offered.  There are many options to finding relief while decreasing your risk of opiate dependence or overdose. Your doctor can do the following:

• advise on other treatments and refer to appropriate specialists
• discuss risks, side effects, etc of prescription pain drugs
• educate, provide resources for education on the diseases, pain management (articles, books, videos, agencies like Partnership for Drug Free America)
• prescription drug monitoring (doctor-patient contract, drug tests)
• use of non medicinal treatment
• identify risky drug use patterns
• require visits for refills
• referral to pain management specialist
• behavioral therapy consult

Opioid dependence and overdose can be prevented.  Using opioids responsibly is the patient’s responsibility.  It is up to you to recognize what these types of drugs can do to you.  Relief of pain is the objective; however, the addictive potential must be taken into consideration.  It is important to get a correct diagnosis of the pain as there is probably non opiate treatment that can make it tolerable or resolve it totally.  Make opiates the option instead of the treatment of choice.  Best health!

Personalized Precision Medicine

As we look forward to medical breakthroughs of the future, precision medicine becomes more of a reality in your medical care. Precision medicine uses treatment and intervention based on a person’s genetic and non-genetic (e.g. lifestyle, environment).  Unlike the present but ever changing protocols for wellness and disease management that are used on everyone, precision medicine is individualized just for you.  It will be your own prescription for staying well and treating your ailments. 

The basis of precision medicine is genomics.  Sequencing of your genome is done.  This molecular process identifies normal and abnormal genes.  Genomic mutations are studied and tested for different characteristics.  The results of this testing allows for prevention, diagnosis, and treatment based on your molecule makeup within your genes that have been influenced by family history, lifestyle, and environment.  DNA analysis of your genes in addition to a thorough history and physical will help your doctor determine what you have and what health risks may be present.  This information will then be used for further diagnosis and treatment.  Prevention of conditions that you are prone to develop may be less likely to develop if at all.

Precision medicine has become prevalent in drug treatment as well as disease diagnosis.  Clinical pharmacogenetics makes use of patient’s genetic data as a guide for drug therapy.  This information can then help your doctor pick the right medication for you. Pharmacogenetic information for blood thinners like coumadin and clopidogrel can be helpful in choosing which will work best for you with least complications.  Neonatal (newborn) diabetes and mature onset diabetes of the young (MODY) are rare causes of diabetes.  The cause of these types of diabetes is from an inherited mutation of one gene (monogenic).  Genetic testing can make the correct diagnosis that would otherwise be missed or misdiagnosed.  Some cancers have specific gene mutations that can be detected and treated successfully based on this information.  Drugs are made to target these and eradicate the cancer.

Thousands of disease genes and genetic tests have been discovered since the Human Genome Project of 2003.  As costs go down and precision medicine improves, personalized medicine will get more precise.  Prevention instead of treatment will be more likely.  Genetic tests and treatments for the individual will be precisely what the doctor orders for you.  Best health!