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Neuropsychiatric Symptoms and Drugs in Dementia

Dec 22 | 1:30 PM

The manifestation of neurological and psychiatric symptoms (NPS) has given birth to the field of neuropsychiatry, which includes conditions such as apathy, depression, sleep disorders, hallucinations, delusions, psychosis, agitation, aggression, and dementia. The rates of NPS have been shown to increase as cognitive ability declines and may be useful in predicting transition from mild cognitive impairment (MCI) to dementia. A variety of factors such as age, genetic predisposition, medication side effects, and traumatic brain injury, to name a few, can cause NPS to emerge. Consequently, to better identify the symptomatology and understand the treatment modalities for dementia, join Dr. Payal Sharma Kamath live on Medflix!

[Music] so good evening everyone i'm dr naveed and on behalf of netflix i welcome you all to today's session um this evening uh we have with us dr pyle sharma kama she's a neuropsychiatrist and a psychotherapist at ask eurocare and mind clinic with an extensive experience of working in hospitals and healthcare settings her areas of expertise include child adolescent and geriatric psychiatry as well as counseling psychology thank you so much thank you for having me today uh so today's uh session is all about near psychiatric aspect of dementia i hope for most of the people who are attending today are very well versed about what exactly is in europe a little about at least what is neurocognitive disorders i'm going to give a little more detail about it so in today's session we'll discuss a little uh sneak peek about what is dementia what are the different types of dementia to start with and uh also we were going to talk about the uh psychiatric companies that we see with our elderly patients respectfully who are suffering from dementia and as a psychiatrist what are the treatment that we can do in terms of psychotherapy in terms of psychoeducating the family members and also in terms of the pharmacotherapy ah when we look into neurocognitive disorder we see there is a heart a lot of population who is now going to suffer or in future in the next 10 15 years are going to have the complaints of dementia the reason being daily life expectancy has been increasing and the treatment for a lot of medical problems have improved so we are seeing that uh all of us are going to live a little longer a good news and bad news because since we all are living longer we may have to face a problem of memory loss because that's a reality so why it's a reality because more than 30 to 40 percent of the population who is above 65 years can have some or the other symptoms of neurocognitive issues so when i see neurocognitive issues we're basically dealing with symptoms relating to memory we are dealing with something which is related to executive functioning what exactly is executive functioning it's related to the planning organizing our actions our daily routine and taking decisions and judgments so these are uh basic uh parameters that we're doing on a daily basis but we still are unable to figure that this is what the uh brain is actually doing and this is what is going to get affected something which is something that we do in a daily basis so these things get disturbed in our in aging patient and along with the executive functioning we see a lot of different difficulties with language meaning um also in terms of their daily functioning like dressing up taking their own their like pc patients have problem with you know calculating their money going to the bank doing a routine work uh which they were able to do it previously so there are every patient will have completely different story it can start with a mild memory changes so when i memory changes it means that the first and the foremost memory which is going to be impaired is the recent memory something that has happened in today's or in a week's time so why this goes first and not the older memories is because we read something whenever we learn something new there is a protein which is generated and these proteins and ambry helps us to keep this memory for long term so every time when you revise your course the there is protein which is generated which leads us to stay for a longer time and get it stored as a long term memory so since there has been a long time revision has happened about the remote memories like their wedding and kids and their neighbors that they were living for last 15 years so they remember all of that and something that has happened today an hour before those are the which are first affected so decent is the memory that is going to be affected and the image approach so most of the time the family members are coming to i'm sure that you are going to see these patients i'm going to come and tell you you know she's doing all drama and her memories the patient is all doing rubbish nothing of that sort when i say you know she's losing their memory nothing like that she remembers everything when my father was working who was our neighbor where they got married she even remembers the neighbor's birthday so it's difficult for us to explain that how the memory system works so we make them understand that how many times you have you know revised abcd so now the moment that you say e a it anybody any child says a you know a for apple why it is stored in a memory because you've revised it so many times revision is not happening the retention is not happening because she's not that capacity to learn something new to retain it and to again to register it and to retain it after some time so this is which we need to educate the patients so there is going to be a recent and the immediate memory which is going to be lost when we see a lot of language issues when i say language you will not see patients you know forgetting how they speak no the first language that they have learned is going to be retained meaning their mother tongue is the was going to be at the last something that you know you all are staying in the metropolitan cities we've been learning so many new languages and and i'm sure that i started with india and i've learned marathi and gujarati since i'm working in bombay so if i will have a symptom that's the gujarati is the first which is i'm going to forget and then this so the first there is the mother tongue is something which which stays for a longer time the first thing that starts happening is the word finding difficulty meaning um if you will ask them if you have a pro if you call as in what is this not remember and say this is pen they will say something which you know with which we write or they'll say something real very much related to pencil or it's a blue object with a black object with a blue cap and it's a hard object so finding a word is difficult whereas they try to describe the object or a theme or a person or a place but they cannot find the right word i have a few of the time people saying that when they want to say stomach or these figures they say it as you know a food vessel so they use different terminology for this word so this is what grip gets replaced with a non meaningful word or a meaningful word which resembles uh the word they want to use or they can't find the word which they want to use it starts normally like that and slowly slowly it starts affecting the pronunciation the uh difficulty in finishing the sentence and the meaning then there is meaningless sentences and slowly slowly uh there will be complete laws of language all together uh language is the second thing that starts getting affected apart from the memory then there are a lot of motor symptoms so you will find there is rigidity there is tremors there are difficulty to get up from the bed there are you know sometimes we also see there's a lot of falls and accidents because we see a lot of symptoms of parkinson's in these patients so along with the motor symptoms you will basically also find is the psychological symptoms we need to understand that since the brain is also no controlling our feelings and behavior it is one of the factors which is very uh one of the factors which we fail to understand that uh it's it's not a rule for a elderly patient to have a depressed uh mind a lot of time is down because people say say or think that you know this is part of aging this is bound to happen and you know you know they may feel a little more depressed it is okay as they're aging which is not the reality the patients with dementia have uh 50 chances to be depressed i'm talking about patients with dementia i'm not talking about elderly so this is not the reality so we need to unders depression is not a part of normal aging but patients who start to have dementia symptoms start having depression as a byproduct of a the brain changes b because they're not able to be independent because they still need somebody's help because they are aware of that they cannot uh they are losing their capacity to which they were able to do few years before a few years back so hence it leads to secondary depression and uh there are 40 percent of dementia patients who have uh paranoia so it's generally what we've seen in our patients it starts off with losing certain things so because there are memory changes we see that they well you know don't remember where they keep kept their spectacles or they don't remember where they pull it and they keep on searching for that when they are not able to find it they start feeling that somebody is intentionally doing it so that uh you know to bother them or it goes generally towards the daughter in law very managed position it goes towards the maids and the caretakers of the house and it it is something that you know we see every demand sharp patient it starts off 80 percent of the chances it starts off like that unfortunate but this is how it is so they blame it to somebody whom they feel you know is capable of bothering me and it becomes so intense over the period of time that it becomes like a firm delusion which they feel that they are trying to bother me and you know that it can be to referential um ideas it can be to uh persecutory ideas and it can also lead to the fair fear that somebody's trying to make something in my food they're trying to poison me they want to kill me they want my property and hence they are doing all of that you know and it leads to uh also we see a lot of time hallucinations orders rehab destination so sometimes there are people singing there are sometimes or old relatives who are not there anymore they can hear their voices or visual hallucinations remember visual hallucinations are very rare uh even in our you know patients with psychiatric problem it's rare it is mostly the auditory haggis nation that we see if you uh see any visual hallucination patient in your practice you need to first rule out any organic causes remember they visual hallucinations is generally and generally associated with the organics organic causes you do do a ct scan mri in these cases and then we need to see if there is some kind of tubers or there's some kind of infarct which can be the major cause of it also dementia is one of the reasons if there is uh you know they can be very complex hallucinations or complex kind of delusions or you know a fleeting kind of behavior where we also see because of depression and hallucinatory behavior we see a lot of times people wandering away from the house they leave their house they go out of the house and they get confused they don't remember they pay back to home and uh they don't even at the end of sometimes we also see a lot of you know even not remembering their close relatives which leads to a which happens in the severe cases so always uh apart from these two major causes we also see a lot of disinhibited behavior so there are times where because of the brain uh involvement we see because our temporal vein is involved in frontal atrophies involved we see a lot of disturbing you know become very disorganized or also sexually uh they start making advances especially which is not a part of their personality so they sexual needs become high they or if their partners are there then the partner starts complaining of it otherwise with unknown people they start becoming very friendly or you know they want certain kind of sexual needs from them or exhibiting their private parts to them so a lot of time these things happen where the sexual disinhibition is is one of the causes one of the things that we see in the patients apart from that we see um sometime very the very unique behavior like uh we see some some certain kind of mannerism is more uh collecting few things meaning they start collecting certain tools and keeping it with them which they don't know why they're doing it what is the reason but they keep start doing that uh collecting screwdrivers or certain wanted sharp objects with them and it is like a behavior that we see in these patients also we see a lot of uh you know catastrophic reactions so because they know that they are unable to answer and they remember that their skills have been you know they are getting deteriorated on a daily basis uh if you ask any question which seems to be very challenging uh a lot of time the patient starts reacting in in a very inappropriate manner either they start crying like you know something really bad has happened or they start feeling that you know their world is just collapsing or see inappropriate laughing inappropriate because they try to compensate for the memory loss they have so when you see see such behaviors in appropriate behavior you basically need to find what is the cause of it it can be just not a part of uh destinations or diffusion or dyslexic behavior but also has a psychological over complexity behavior where they know okay they want to divert the talk a lot of time i have i just share an experience so i have one patient who is having dementia with parkinson's disease so whenever i start asking and you know checking his um mmsc score so he starts to divert the topic so whenever i think you know um what is uh tell me what you had for lunch and how was your day tell me what on what does today say that he's telling me about the songs that you know used to say musical instruments that he knows he start cracking some jokes so i first i thought he's just trying to you know have a builder then then slowly slowly i start realizing that every question that i ask he's trying to divert me and goes take me somewhere else that particular session i feel is very persistent that you i should ask and then he became very dear person that he doesn't remember so uh because in the moderate cases of dementia they're very well aware of the disabilities that they have seen hence you know they were trying they tried to compensate for it by things that they know so don't get carried away when you're seeing such these patients you know and you go over the floor no try and bring them to the point so that you can complete your testings it is and uh in terms of um if you will see that what are what are the grades of dementia see uh there was basically divided into mild moderate and severe so mild is where there where we find certain uh difficulties with memory and the weather language difficulty starts to happen but uh the patient has difficulty with doing complex things like calculations or banking or you know not learn unable to learn new technology or new uh ways that you know you're trying to teach them but there is a little restriction but they are still able to daily choose the second is when the person has a little difficulty with their daily chores which is moderate when the eating starts to get affected when bathing and dressing starts to get affected meaning something which is necessary for the daily activities of a person so this is moderate third is the severe one when they are completely dependent on the caretaker for everything so then this is a stage where the person loses all the skills become completely bedridden so there can be a lot of motor symptoms and behavioral symptoms at this point of time and those patients are in the severe grade so how do you basically test these patients when you when you see a patient who is coming to you with a dementia and you can suspect that there are dementia symptoms so the first and foremost thing that you need to do is flow up the blood test like normal whatever we do complete blood test weight uh b 12 serium electrolyte levels renal function test liver function test um and apart from that you need to do a ct scan or the mri mri is obviously preferable but if it's a patient who is very aggressive and very violent or claustrophobia is a problem within anxiety it is not advisable just go ahead and do a ct scan brain because we want to get ruler any kind of um reversible causes of nature which is again a detail of it and then we need to do a urine test or urine routine and microscopy uh all that is necessary uh we also do hiv and bdrl why we are doing all those tests is because there are many medical causes which can present as a dementia related symptoms so we need to do that so mostly the patients who and the relatives and patients that which are who are going to come to you are going to bring the a patient in a in a moderate to severe condition understand so in our culture when it's it's difficult to live with the patient that is when they are taken to the second yeah otherwise yes so they will come to the they'll first go to this i can't just see that he's not sleeping at night he's bothering the whole family he might just have exams and you know he's just spotting everyone and they said that and you know he's just running away and i can't do it and i can't hold it so just giving some medicine so that he comes down so we need to understand that we are basically going to come to the moderate to severe cases so in those uh what is our aim when we are starting with any kind of tree a is that always remember all these hydrotropic medications have side effects like all the other medicines they have side effects we is that the patient have very less metabolism very low metabolism and very high propensity to have side effects so in this we cannot over treat the patient so the most the most important thing that we can do is to ah we can't reverse the symptoms because it's an aging process so what we need to do is to uh curtail the damage as much as possible and explain the patient what is the reality of the illness and healthy patients so that the patient does not harm themselves or become aggressive towards other person but we can't completely reverse the disorder unfortunately it is uh this is the reality that we can't reverse the disorder we can help the patient to calm down a little so our is nice to behaviorally manage the patient so when a patient comes your way comes to you with a um problem how to if let's just take an example a patient who's coming to you we'll take two three cases and based on that i'll i'll explain it to you let's not keep it like that to one patient who is 70 years old has come to you and he came up with a gadget decline in their memory he was uh they say that last three four years say you know he was forgetting little little but it was all fine and when he came to you he um was his language was perfect but he couldn't remember that what is today's date and he doesn't remember uh that where all his details about the battery and he and the family members came to realize that they first took him to the bank for some details and he couldn't function there so that is when they realized there's a problem and so that happened a month ago and then slowly slowly he said they started noticing that he has saw uh he's speaking very less with the family then they noticed that you know he's becoming a little uh irritated very easily irritated he doesn't like the maid anymore he's in there she's just you know she's bothering us and she's taking my money and i don't like her i don't want her to come anymore she's basically taking the grocery item from the house and it's missing so then uh later later he became very aggressive towards the sun saying that i'm telling you you know you have to keep her out of the house and he became very there's a monday evening started using everybody's house so this is a classic case of alzheimer's disease how do we diagnose this patient with alzheimer's disease a is if there's a gradual progression always remember if there is a gradual progression we can figure it out that it is most common dementia is alzheimer's dimension we are seeing that there was a gradual decline in the memory second there were certain changes in the language and third is the behavior symptoms came but it came very last in the last few months okay so there is a gradual progression of the illness the patient is more than 65 years old with all those symptoms and the personalities symptoms meaning the changes in the passati started to happen a month so in the later stages of the disease before we came to but in the latest stages of the disease so this is a classic case of zionism alzheimer's dementia it will be more clear when you see the second most common cause of dimension okay this is the second case so today um is a very lucky dnd hopefully and this old lady is coming to you and she's literally shouting and she's hardly there is any clothing there on her body the family members has brought her literally you know pulling her inside the opening she doesn't want to sit anymore and she's does not uh she's not taking care of her dresses she's just smiling and laughing and uh a lot of time the family members specifically the husband says no she's uh she's just 52 years old and she runs away from the house for glass for five years and uh you know she sits behind any any person uh on the bike and she tells me take me for a round and this bike people are enjoying no it's a lady sitting here they know so they are taking her for a round so and uh so this lady has uh two kids who are always searching for her and this is last two three years so in last two three years they had not shown it to anyone when they realized that to today she's not coming back home and she doesn't remember anything and on d-day i got to know that now last one year she stopped doing all the household work she does she doesn't know how to cook she says that i don't remember she doesn't know how to do uh cleaning she's unable to do anything even if she's forced upon to do something she makes a mess when she has while talking ah there is no clarity in the language the only and only expression that i could see or was on a face was a silly smile so we went ahead and i started employing more about the memory so we found there was a lot of impairment in there was a immediate memory was impaired the reason memory was impaired but the remote variation was refusing to answer so we went ahead and we did a ct scat of the patient ah it it showed there was a lot of atrophy in the frontal and the temporal portion of the brain so this is a classic case of dementia with frontal or temporal uh which was a classical frontal temporal dementia so there's a another classic uh dimension that we see in the patient where if there's an environment of a young patient younger than what we normally see with dementia as i said 60 60 normal age for starting dementia a younger patient with more of personality changes that happens early so this lady had a disinhibited behavior sitting behind any person just asking them to take her around somewhere not giving money with someone fighting whenever you know they are just to fight with them so this was a disinhibited not expected trauma lady was too kids a good family something which was not her usual behavior so this inhibited behavior started second is her language was very uh disturbing she whatever she was speaking there was no uh meaning we could not make out what she was trying to speak so they were basically words but no meaning attached to it so the there is an involvement of the frontal and the temporal or location uh region of the brain our frontal area is related to our decisions our planning control of our behavior what to do what not to do judgments what is right what is not right so when it is affected we will see a lot of aggressiveness uh meaning we will see apathy we will see inappropriate behavior so what happens with the frontal proportion the temporal is more associated with the memory and language so we saw this involvement also in the patient but remember young patient with the the behavioral changes coming first and then the uh memory changes very common with front temporal dementia a very common uh problem that we see let's go ahead with the third okay the third patient is who comes to you saying um and 56-year-old man into you say everything that you know um the family member is saying that few months before a long time six seven months before he's being uh seeing um his father come into his house every night or twenty years back so he comes to him and then he talks with him he can see him he tells us he's standing in front of us you know you should go touch his feet you should take blessings so they said it's a spiritual of you they expect then it started uh and the whole family started to come mama is also coming now everybody else so he could see everybody so when and then uh he started the behavior i mean when everybody's coming so he's asking the daughter to cook food for them then he's distribute everyone then it is too much now and then um they came to us we evaluated but this guy when uh last a few days this saturday year before a few few days when i saw when he came to us he was not able to walk properly so when you okay he was basically bending down like this and he was walking so he was walking very very slow and his his hands were always very close to his body and uh there was constant tremors in one's one hand and the other hand was shaking but it was lesser but there was a constant shaking in the one hand and he was continuously bowed down like this and as then he is since when he is uh walking like that and he's been walking like this only because he was an old man so he said no no no this just happened uh i don't know why he's doing it he's doing all that too we asked him we have been telling him to stand straight but he's not yesterday we told him to walk a little faster we had to go to a wedding but he couldn't and he fell so now we couldn't go to the wedding also so i said okay so when we examined i saw that he there is an inability to walk independently and he has difficulty in taking returns so when you ask normally how we dictate we take a turn like this so when he has to take a turn he basically take two three steps extra and turns his body and then come back so he's thick so he's taking not able to turn his body like that he has to take a full turn with the steps and come yeah so this is uh uh there are basically extra pyramidal sign symptoms which were there so a person who has visual hallucination always remember if you see a person having visual hallucinations and uh later on it also progresses into an extraordinary symptoms where the patient has tremors rigidity uh presenting great store posture something which is very similar to parkinson's disease okay and those patients this is dementia with lewy body very common which you're going to see again third most common dimension that we are normally going to see all these patients dementia with lewy body always remember the person who presents with visual hallucination and uh later comes the exceptional middle symptoms will be could be a very fair cases of dementia with everybody who should do all the respective tests so why i am telling you three most common cases because these are the three mormon presentations which i am going to see very commonly in the practice and always remember to differentiate dementia with the way bodily diseases the parkinson's disease because parkinson's disease patients will also have dementia behavioral problems uh hallucinations delusions depression but how will you differentiate the person has parkinson's disease or dementia with body is to one and the most important thing is that visual hallucination will start first with the nature with your body whereas with parkinson's disease the motor symptoms will start first what are the motorcycles like resting tremors the pin rolling tremors like this constantly in the literature and the let pipe rigidity all of that stats first and then in few patients we will see visual highlights so these are the common three problems where ah relatives are going to bring uh the patient first to a psychiatrist rather than going to a neurologist why because these have a very common presentation with behavior right so if you are any of lucky people over to become a psychiatrist will be loaded with these kind of cases coming to you first uh how do you basically treat these patients i hope you have time yeah so the first and foremost thing is like education uh we need to educate people uh that it is a condition which is progressive uh with a good treatment patient can even survive for 15 10 to 15 years and in those cases uh you know what all thing that you know we miss out telling patients is the brain exercises which you if you will start telling your patients you will have an x-ray over your patients but what are the basic exercises that you can tell them is to ask about today's day ask them what is the date which year that we are in today uh what is the month as them pitch festival went few weeks before what we did showing them begin showing them the different albums and asking them the relate names of all the relatives asking little extra questions related to what happened this thing where we went who all were there so basically doing certain things where the brain is getting used so we all tell our family members and relatives go for a walk exercise and yoga but we forget to tell them to do brain exercises because we don't have see imagine you have this capacity of intelligence and by 65 you're going to lose it of course that's a rule so you lose it and then it will come down to 20 percent imagine you have a you have developed holy capacity to 20 and it is going to go by the same rule where the other person is going so you're going to follow the same thing but the cognitive reserve of a person who has less used his brain is going to be much lower than somebody who's been using it on a daily basis like people at home everybody so you are we all are using our brain regularly and now we have committed to the eye that we have to use our brain for a very long time uh by learning and relearning so uh that is something which is an advantage so this will definitely help us uh so we have to basically tell the patients to learn something new they might not be able to take it as you know they should but learning a new and learning a few dance moves um learning knitting painting a new language or reading few books if not at least doing that small crossover that comes in the newspaper every day that's something that we can do those things or ask them if they are uh you know and educated people or who have very high uh you know the cognitive reserve is very less in those cases what you can tell them is get many beads uh colorful beads red blue green and yellow big big beads which you know they can hold easily because with the tremors the patience will not so tell them to put those things and enough different different orders keep first red blue yellow green then red yellow red blue yellow green red yellow green so this you have to tell them regularly so you have to make such sets and make a string of beads next to red red to green green blue blue yellow yellow so keep on changing the patterns and tell them to do that so it's basically like a good exercise or if it's like that is not available or not feasible to tell them to play cards so uh [Laughter] daddy [Music] so this is like an executive exercises if not uh i you know if family members are available to tell them you you know play that uh pairing card pairing game so i put two you also put so you when the uh two comes you also have to put the same thing so that kind of pairing means so that you can play so simple something that you know you can do it at home without bringing doing something extra so this is a way you will do a brain exercises so what i said is a memory thing uh oh you can please name please enable thing also you know ask them i'll tell her please and then you see so depending on what is the intellectual level and the family's involvement you can do all of the other brain exercises uh crossword if they so these are the brain exercises where you know you can get an extra edge over the patient you know nobody tells this so this might not be all of that so this is something that can help so then we have a dementia related or medication i'm sure that you know aware of donor stigma tackling all of those medications but donovan has to be more has been found to be most easily without with very less side effects and uh that you can use with and then apart from that it's generally used with mild to modern cases then we have cvr in this ebay cases when we um i'll just finish wrap it up drugs and just take two minutes of yours so when we start with uh psychotic symptoms and illusions always remember that there are more chances of side effects like sedation drowsiness fall and extrapyramidal side effect which is very common with psychiatric medication so you have to make few rules that you have to start very slow now very very low doses and you have to go very slow with the medicines and uh the preferred medications are basically all anthropine quite terrified and in the cases where there are nothing works then close up very low doses of close up close up works wonderful especially with patients with uh visual the one with the case with dementia with the visual hallucination i started them directly with uh close up dementia with lewy body why close-up pain because it's found to be the most with the medications which has a maximum amount of side effect and people are very much scared of using it uh but remember dementia because they have already parkinson's related symptoms so they are very sensitive to extrapyramidal cytokines so close-up pain has the least amount of uh extrapyramidal side effect and so in those cases low doses of close-up pain is the best so mostly that tightness rigidity tremors and we see with most of all the other medication that can be avoided but why uh olanzapine very propresal quite a pain and close-up being only because with all the other typical antipsychotics that we start we'll have to add acetone there's sebastian is basically a anticholinergic remember we cannot give any antibiotic patients with dementia why because there is acetylcholine which is associated so if what happens is the style line is lesson in the being of patients dementia and what we try to do is with the help of donor puzzle we are trying to correct that balance okay so if you are adding an anticholinergic in the patient who already has dementia we are basically depleting the acetylcholine levels of library so we're basically worsening their cognitive abilities okay so something where uh the typical psychotic uh antipsychotics cannot be used the atypical one the second generation the newer ones that you see are the ones which are preferred any kind of antidepressants and anxiety can be given to the patients uh if they have depressive symptoms uh but always remember one thing that um you have to go with a very less dose because you are only scared that you should not have a lot of drowsiness because we can't afford uh elderly patient to have a fall and have any injury with their bones because you know that the bone healings become very slow at that process so that is something that is necessary i will finish up here i don't i would like if you want to have a few questions uh yes we can do the polls so you'll see the question on your screen and i'll start the poll uh you'll have uh two options so y'all can select the right one and uh submit it so we get the record your votes for them okay so we have 93 of the words for acetylcholine uh so that's that is the right answer and we've done the second uh poll uh so the question is if a person has psychomotor difficulty lost skills uh uh i think lost skills to speak and is and needs help of caretaker all the time what is the severity of dementia so these are your options you can select the options and submit the words in sixty-five percent uh say it's severe dementia which is uh the right answer i guess doctor rajat rani who's asked what can be done as prophylaxis uh to prevent early onset off for dementia yes as i told you the brain exercises and learning and you know learning of new things challenging yourself with some of the other new activities or something where we can build up our cognitive resources basically we can work on this result we cannot uh stop it from happening if it uh big you know after at a later stages we can't stop it but the prophylaxis is the only thing that we can do prevention basically so controlling your hypertension diabetes cholesterol having a healthy lifestyle of course really work smoking and alcohol should be curtailed as much as possible all the other measures for all the other diseases that we are doing but we also need to the most important thing is the corporate results we all have to continue to learn something new challenge ourselves or if you have any anxiety depression any other psychiatric problem if you feel that somebody is having it if you treat it early you will be able to um prevent that damage to happen because uh when you have any psychological or psychiatric problem it also leads to a lot of neuronal death so if you treat them on time you can save that also apart from that a lot of there is few research which says that hormonal replacement therapy during the amino acids uh really helps there are a few positive results about it but still has not yet uh started with that so if a person has a lot of menopausal symptoms so if they can start with hrt it also in a few studies than a comparative study they found to be very versatile positive and i think these are few things that we all can do uh if you uh continue to have uh you know have regular exercises all that really helps you these are these are these are enough for to prevent to prevent the onset thank you uh we have another question by dr maloney barry what are the normal symptoms for the elderly that are related to aging and how do we differentiate them from dementia symptoms see the thing is um the most important thing that the aging is of course there are few things that has expected just to mild changes in terms of memory but you can't uh that when it becomes severe meaning when it starts affecting your daily routine that is when the dementia symptoms are happening aging is uh is not always associated with uh you know it's not a rule that everybody is about to have a memory change it's not a rule that everybody is going to have limitations in their daily activities or have sadness or depression or sleep reversals on and off if you have these symptoms it is fine but when the symptoms become very severe meaning when it starts affecting their daily routine when it start affecting their family members which means that it has it has leased to a disease or a disorder so um in terms of memory changes i can say you know i may take a little time to remember uh the same thing but ultimately it comes up in my head meaning i i know that this is this is what i wanted to say or it it may create a little confusion or new learning may take a little one or two days the same thing that you know how to if you're teaching your grandparents about how to use a whatsapp video it may take them seven or eight revisions but even with 708 revisions it does not happen which means that new learning has stopped so it will take a little more time but there is a possibility that you will be able to train them with talking or a new new technology related thing so this is a part of it a little sloane is a little problem with retention more efforts has to be put a little hair in there more changes but when it starts being persistent remember anything in everything which is consistent and persistently present and is disturbing them anything if you see that these symptoms are more than two weeks we need to take it seriously and get it evaluated as early as possible thank you i hope that answers your questions uh dr pirik um okay uh the next question is by dr akila saleem uh how can we manage the extrapyramidal side effects see the extra bit meaning that you're asking about the patients with dementia are you asking about in general they accept within the side of it because that will take another session but i'll try and conceive that so uh so generally the exam to prevent the extraphenomenal side effects we basically add anticoagulants along with all the uh all these psychotropic medications basically antipsychotics so those are of two types which is atypical and typical the typical was the first generation which have more extra pyramidal side effects in those cases to prevention as i said the anticholinergics like acetate has to be added or or trihexal penetrate we basically add it along with the mints so the atypical we don't require so much but when we go on a higher doses it has to be added second if we see a patient has developed an acceptable side effect the first and foremost important thing is to withdraw the psychotropic medications second is to give them uh antihistamine to relieve the extravagant side effect the preferable method is to give it in the form of im or iv im is preferable uh like uh fin argan we give basically to reduce the symptoms of the uh extraordinary mental issue if uh you can also use benzodiazepine like luna japan to relieve the mental and anxiety also and also the vegetative relief the rigidity of the body also the fourth and the if that also does not work there is another extraordinary side effect like ekiti is extremely restless where propylene oil can use so to be in a shot to prevent it you have to always start you know trihexyl phenyl along with the psychotropic medications with the patient and if the patient has already developed the symptoms of extraordinary stop the medication give him an argument let him settle down a little and switch to atypical where the chances of extrapolating symptoms are lesser i hope i could help you oh yeah thank you uh yeah doctor i hope that's uh answered the question but the question is uh why are atypical antidepressants not so compatible as compared to atypical antipsychotics in terms of epf uh see this is completely different to a groups of medicines that we're trying to compare you can't uh basically depression is a completely different illness and uh schizophrenia is a completely different release and the treatment is different so we can't compare psychotic because just because you're using typical and atypical does not mean that they are comparable uh atypical depression now we don't have such kind of terminologies in terms of adidas because now it is completely divided into ssris snris uh tcads and uh and the uh like mao inhibitors and all so uh when you're saying typical maybe i think you're talking about tcads now which we don't use it anymore because they have more side effects in fact the newer medications like ssis and allies are more effective that doesn't really thought of atypical antidepressants now that is not used anymore okay uh this is asked why so how do you prevent dementia and scissors can it be prevented or sorry about that we'll be giving you the answer of how to prevent dementia a b is uh schizophrenia prevention is uh uh honestly uh it's because it's a genetic illness like most of the illnesses are genetics if you're born with those unfortunately uh you are more prone you have more risk factors to have uh such mental illnesses but does not mean that it's a short rule that you're able to have it depends on the personality depends on the stress level of a person the stress hypothesis is a reality so we all are faced with a lot of stress on a daily basis so everybody has a threshold which basically basically if all we find that the stress level along with um has crossed our threshold and because of our external factors and the environment we [Music] management skills like taking some breaks from work uh starting with psychotherapy writing having a thought log relaxation yoga and understanding that life is very simple as you wanted you are we are capable of making it as complicated as we wanted to so uh making few rules uh and trying to curtail our stress levels can prevent us from any kind of weaknesses not just schizophrenia but sometimes the genitives um are very powerful so you know a small blue person can have an episode of schizophrenia okay and i will take one last question we have uh uh can dementia occur at an early age due to excessive depression since an early age yes uh see what happens no i just i told you that um since it's a biological illness like depression means still unfortunately people are still not accepting in this country we have so much of research showing that you know there are now there are tests where you can test your serotonin levels norepinephrine and dopamine levels in your blood and go very expensive but you can still do it and reassure the patient that you know these are the levels which are less so you can go ahead you need to take medications for that which are which can enhance the total levels in your brain so basically even with all the evidences people are refusing to accept depression as a biological illness and hence they don't uh take treatment for that when it's a long untreated depression or anxiety it leads to a lot of you know um cortical atrophy so your brain is working in an overcompensated way where because it does not have the serotonin levels that it requires so imagine you eating again a very simple example imagine you're eating uh two chapatis every day okay so you have energy for two chapatis but then you have to run and you continue to run for five kilometers with two chapati is equal to five kilometers from the water you have to start running for 15 kilometers every day but you still continue to eat your two chapatis or even lesser than that so what are what is happening after a month that you will start having weakness giddiness hair loss you know and you will not be able to run anymore the same happens with brain understand the brain is working with very less serotonin levels which are not providing it so if you want the brain to function with under such a stressful condition you basically have to give it uh what it requires is acetone level so given the capacity of filtropathy so that it can run for 15 kilometers it's a very simple example i tell my patients every day because too for them to relate to it is difficult why like how our body has symptoms of weakness when you're not giving it the required support the brain also has the symptoms it is in terms of medical changes uh cognitive changes decision power and and early dementia as we rightly asked i think uh you've answered most of the questions if there are any questions that have remained unanswered um we'll surely try to get them answered and we'll get back to you is basically a mood stabilizer it is an anticonvulsant and a mood stabilizer it's not an anti-psychotic maybe the best person must be uh who you're talking about must be having some symptoms of mood irritation mania or regression and hence it has been started or a convulsion as a possibility but it's it's a mood stimulus not an antipsychotic so what really can happen with these patients very rare but uh but we see a little dizziness or uh gi side effects which is very common with lemon region and along with that we are very there but uh something that we need to always encounter patient is about the skin rashes um so steven johnson's skin rashes and it can lead to you know ten and sd syndrome so we basically inform the patient at the any time you will develop any kind of skin rashes you basically have to discontinue the medications immediately and uh get it get yourself admitted and the mad people basically take very good care of them and when once they recover from those symptoms then we withhold we don't ever start with lemon triggering it's a precaution that has to be taken every time and then we can start with any other mold stabilizer like the eye valve or you can start them with olanzapine oxidant combination my favorite awkward type so there are many other formulations that can be used as a mood stabilizer in the patient but that's a anticonvulsant and a mood stabilizer start for patients who have mania related or thank you so much for answering all these questions and for the wonderful thoughts that we had uh they well upwardly simply put with very easy to understand examples and i love the part about the brain exercises it's yeah i think that's the place that you can really get innovative and it just it's you just get the give the best to the patients possible uh thank you so much for coming on to netflix and um i'm very sure that the users also have like the session and i want to take back a lot of key takeaways from this session thank you so much ma'am for coming up on two metrics and we hope to have you on netflix again soon thank you so much thank you thank you thank you

BEING ATTENDED BY

Dr. Darius Justus & 492 others

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dr. Payal Sharma

Dr. Payal Sharma

Neuropsychiatrist and psychotherapist at ASK urocare and mind clinic, Mumbai

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dr. Roma Kumar

Dr. Roma Kumar

Senior Consultant, Max Super Specialty Hospital Gurgaon & Institute of Child Health at Sir Ganga Ram Hospital, New Delhi

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dr. Payal Sharma

Dr. Payal Sharma

Neuropsychiatrist and psychotherapist at ASK ...

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dr. Roma Kumar

Dr. Roma Kumar

Senior Consultant, Max Super Specialty Hospit...

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