The American Heart Association and the American Stroke Association have issued a 42 page statement regarding the vascular contributions to cognitive impairment and dementia that was published in the July issue of Stroke. Although Alzheimer’s disease has received the most attention vascular changes make significant contributions to cognitive decline and should be routinely addressed in clinical practice. The statement suggests a new term, “vascular cognitive impairment,” to incorporate the varied cognitive disorders associated with stroke ranging from mild cognitive disorders through dementia. Don’t be confused by the introduction of a new term as accumulating evidence indicates that vascular factors also play a role in neurodegenerative cognitive disorders such as Alzheimer’s disease that develops latter in life and the recommendations below apply to all of us. Two criteria are needed to diagnose vascular cognitive impairment: (1) neuropsychological evaluation to demonstrate cognitive […]
Sleep apnea is characterized by reductions or pauses (10 seconds or more) in breathing during sleep. Sleep apnea is more common in men than women before age 50 and the same after age 50. It is more common with obesity (maybe as high as 70%), heart disease (30-50%), and stroke (60%). Estimates suggest that only 10% of those with sleep apnea receive treatment. Untreated sleep apnea is associated with increased accidents at work and while driving. Sleep apnea induces daytime fatigue and sleepiness, headache upon awakening, and insomnia. It also affects mental functions including poor concentration, impaired attention, and poor memory. It contributes to irritability and anxiety. Those with sleep apnea may exibit loud snoring and abrupt awakenings with shortness of breath. If you have this constellation of symptoms, consult your doctor who may order a sleep study to definitively […]
Caregiving takes an enormous emotional and physical toll even when it is a labor of love and/or obligation. In the case of caring for someone with progressive memory loss, a spouse or child often has to parent their partner or parent. This sets up a natural and sad antagonism. The caregiver must set limits and enforce rules (nag and be bossy) and the care receiver isn’t aware that they need the guidance as they forget that they forget and resent and resist rather than appreciate the efforts on their behalf. Take for example the case of a caregiver (partner or child) who is caring for her very forgetful but very bright husband/father. He is so forgetful that he cannot monitor how much money he spends in any given month and is prone to overspend. His partner/daughter has to put him […]
