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I came back recently from attending the 4th Singapore Neurocognitive Symposium. The focus on the symposium was Dementia the prevalence of which is most often seen in Alziehmer’s disease (AD).

The speakers came from various countries in Asia such as Singapore, Malaysia, Japan, Hong Kong and the Philippines. There were 2 speakers from the US, one from the Netherlands, one from the UK and one from Spain. It was most informative and what follows is a summary of the main points taken up by the various speakers:

-Dementia is the final stage of a long pre-clinical or asymptomatic period Alziehmer’s Disease (AD);

-AD actually starts 15-20 years before symptoms appear;

-Certain tests can indicate if a person is “at risk” for getting AD;

-The presence of Amyloid B and Tau pathologies in the brain indicate a high probability of getting the condition;

– These substances can be seen via PET scan and by extraction of cerebral spinal fluid (CSF);

-AD is an age related disease, the older a person is, the greater the risk of getting this disorder;

-The incidence of AD is increasing as the population ages, all over the world;

-Dementia is reportedly now a global health priority of the World Health Organization (WHO);

-We cannot stop dementia, the aim of current research is to find pharmacological and non-pharmacological ways to delay, as well as minimize, its effect and improve the quality of life;

-Research is now underway to improve as well as to formulate new medicines to treat AD. Studies are also underway to find non-pharmacological intervention for the condition.

Source: taken from information given by the various speakers of the symposium. The speakers were Adeline Ng, Alvin Cenina, Kinjal Doshi, Wiesje M. Van der Flier, Jose Luis Molinuevo, Oscar Lopez, Koji Abe, Christopher Chen, Claude Wischik

The brain is the most important part of our body. One of the best ways we can take care of it is through exercise. Why is exercise good for you?

Exercise can take various forms depending on whatever a person is comfortable with.

Some people like to work out at the gym or play a sport, do yoga, take aerobics classes or do a combination of these.

Whatever the exercise is, a good cardio workout is essential. A good cardio workout will get the blood and oxygen circulating to your brain, nourishing and stimulating it. You will notice that your mind is clearer, more alert and sharper after exercising.

Exercise will not only give your brain a healthy dose of oxygen, but will give your body a chance to sweat and remove toxins as well.

You also get to stretch and move your body and keep it limber and coordinated.

Exercise will also cheer you up and improve your mood and outlook.

It is a great stress buster!

My top 5 neuropsychological Stress Busters:

1. Physical exercise in whatever form. Exercise increases blood flow (and oxygen) to the brain, stimulating and energizing it. Stretching, twisting and moving your body keeps away the aches and pains of stiff joints.

2. Breathing deeply. This not only puts more oxygen in your brain but also has a calming effect on it.

3. Taking breaks as often as needed & short naps if possible.

4. Eating well but only just enough so that you do not overeat and gain unnecessary weight.

5. Taking a few minutes each day to reflect and meditate. A good way to end each day is to go over three things or events that day for which you are grateful.

A number of my clients are people in their 50s, 60s and 70s referred to me by their neurologist to help find out why they are having memory difficulties.

Are the difficulties related to advancing age?

Or secondary to a neurological condition (such as Alzheimer’s Disease)? Or due to depression?

Neuropsychological assessment will help find out the reasons behind a person’s memory problems. Standardized, normed tests are used to assess cognitive, memory, adaptive and emotional functioning. The scores from the different tests will give a good picture of how the client is doing compared to other persons of the same age range.

I have had a number of clients complaining of memory difficulties who, upon neuropsychological assessment, exhibited normal or average memory functioning. Although they have noticed their capacity to retain information was no longer as good as they used to, they are not any worse off than their peers. I had one client who was so immensely relieved of such assessment finding because she had been afraid of the big “A” (Alzheimer’s Desease). Instead of a memory impairment, testing uncovered a mild depression, a condition that often looks much like memory impairment.

Memory difficulties could be due to any one or a combination of the following:

1. Age related memory decline— with advancing age, the brain is less able to retain as much information as it used to. Neuropsychological assessment will help determine if memory functioning is still “normal” compared to peers.

2. Memory decline secondary to a neurocognitive disorder— Memory decline also happens when the brain suffers an injury during a traumatic event (e.g. vehicular accident) or neurological insult (e.g. a stroke), or a degenerative disease (Alzheimer’s Disease). In this case, neuropsychological testing will assess and document the nature and depth of the memory difficulty.

3. Depression— Memory difficulties also happen during a depression. I have seen this in some of my clients. Retirees, formerly busy executives or entrepreneurs, who find themselves with nothing to do and with limited social contact. Neuropsychological assessment will help determine if the difficulties are due to depression and recommend strategies to help manage them.

The following are red flags of LD in older children, adolescents and adults:

Grade School

-Reverses letter sequences (soiled/solid, left/felt)
-Slow to learn prefixes, suffixes, root words, and other spelling strategies
-Avoids reading aloud
-Trouble with word problems
-Difficulty with handwriting
-Awkward, fist-like, or tight pencil grip
-Avoids writing assignments
-Slow or poor recall of facts
-Difficulty making friends
-Trouble understanding body language and facial expressions

High School Students and Adults

-Continues to spell incorrectly, frequently spells the same word differently in a single piece of writing
-Avoids reading and writing tasks
-Trouble summarizing
-Trouble with open-ended questions on tests
-Weak memory skills
-Difficulty adjusting to new settings
-Works slowly
-Poor grasp of abstract concepts
-Either pays too little attention to details or focuses on them too much
-Misreads information

Children and adolescents who exhibit a combination of these behaviors have a good chance of having a learning disability. When this happens it is best to consult your child’s pediatrician or a developmental pediatrician or a child psychologist. It is difficult to get an appointment especially with a developmental pediatrician, so as soon as you suspect LD, make an appointment with one already. In the meantime, you can also talk to your child’s teacher(s) regarding their own observations and recommendations.

Children with learning problems are often referred to a psychologist for a psychoeducational or neuropsychological assessment. The referrals usually come from developmental pediatricians or teachers/schools. What the assessment does is to determine the level of cognitive functioning (IQ) and achievement levels in reading, math, spelling and writing. A learning disability is identified when the achievement level in a specific area of learning is significantly lower than the IQ (which, at the very least, would be in the average range).

A learning disability (LD) is a neurological disorder that is lifelong. Children with LD have average or above average intelligence but have difficulty performing as well as their peers in school. Their difficulties could be in one or a combination of the following:

1. Dyslexia— a language based disability where a child has difficulty in reading; this manifests itself as difficulty reading words (decoding) or understanding what is being read (reading comprehension).

2. Dyscalculia— a learning disability that involves difficulty understanding math concepts and solving arithmetic problems.

3. Dysgraphia–a writing disability that involves difficulty in forming letters or writing within a defined space.

4. Auditory and Visual Processing Disorder— a disability that involves difficulty making sense out of auditory and visual information even as child has normal hearing and vision.

The following are “red flags” for possible existence of LD in younger children (taken from LD Basics on ldonline). The earlier LD is identified, and interventions started, the better the chances of the child to overcome their difficulties and succeed in school.

Preschool
-Speaks later than most children
-Pronunciation problems
-Slow vocabulary growth, often unable to find the right word
-Difficulty rhyming words
-Trouble learning numbers, alphabet, days of the week, colors, shapes
-Extremely restless and easily distracted
-Trouble interacting with peers
-Difficulty following directions or routines
-Fine motor skills slow to develop

Grades K-4
-Slow to learn the connection between letters and sounds
-Confuses basic words (run, eat, want)
-Makes consistent reading and spelling errors including letter reversals (b/d), inversions (m/w), transpositions (felt/left), and substitutions (house/home)
-Transposes number sequences and confuses arithmetic signs (+, -, x, /, =)
-Slow to remember facts
-Slow to learn new skills, relies heavily on memorization
-Impulsive, difficulty planning
-Unstable pencil grip
-Trouble learning about time
-Poor coordination, unaware of physical surroundings, prone to accidents

More next week….