Early Detection and Management of Mild Cognitive Impairment

Summary

This lecture addresses the detection and management of mild cognitive impairment (MCI), focusing on the use of EGb 761 as a treatment. It outlines the criteria for MCI diagnosis, emphasizing the importance of early detection to delay dementia progression. The speaker discusses the prevalence of MCI in various populations, risk factors, and the benefits of EGb 761 in improving cognitive function. Additionally, the talk highlights non-pharmacological interventions like dance for cognitive improvement and the significance of a healthy lifestyle in managing MCI.

Takeaways

• 🧠 The risk of developing dementia increases with age, but there's a stage known as 'normal aging' where cognitive functions remain intact.
• 🔍 'Pathological aging' or dementia is characterized by a decline in independence in activities of daily living.
• 🏥 'Mild Cognitive Impairment' (MCI) is a pre-dementia stage identified by a noticeable decline in cognition, particularly in one cognitive domain, without significant impairment in daily functioning.
• 📊 The criteria for MCI from the National Institute on Aging and the Alzheimer's Association include cognitive decline, impairment in one cognitive domain, preserved independence, and not being demented.
• 🌐 International studies, such as those in Japan and the Philippines, show varying prevalence rates of MCI and dementia, highlighting the need for early diagnosis and intervention.
• 💊 EGb 761, a pharmaceutical agent, is recommended for the symptomatic treatment of MCI, with evidence supporting its efficacy in improving cognitive function.
• 🧪 The mechanism of action of EGb 761 includes increased neurogenesis, mitochondrial protection, improved neurotransmission, and modulation of Tau protein, which is associated with dementia.
• 📈 Systematic reviews and studies demonstrate significant cognitive improvements in MCI patients treated with EGb 761, particularly in memory, attention, and executive functions.
• 🏋️‍♀️ Non-pharmacological interventions, such as cognitive training and physical exercise, can also improve or maintain cognitive function and delay the progression of dementia.
• ⏰ Early diagnosis of MCI is crucial as it provides a window of opportunity for intervention and management, potentially delaying the onset of dementia.

Q & A

What is the primary risk factor for developing dementia mentioned in the script?

The primary risk factor for developing dementia mentioned in the script is age, which is a significant contributor to the development of the condition.

What is the term used to describe the stage where cognitive decline is noticed but independence in activities is still maintained?

The term used to describe this stage is 'Mild Cognitive Impairment' (MCI), where there is cognitive decline but the individual can still maintain their independence in daily activities.

What are the four criteria developed by the National Institute of Aging and the Alzheimer Association for MCI?

The four criteria are: 1) No concern regarding a change in cognitions, 2) Impairment in one of the cognitive domains, 3) Preservation of the independent and functional abilities, and 4) The individual is not demented.

How does MCI relate to the DSM5 criteria for mild neurocognitive disorder?

MCI in the script is equivalent to what is termed as mild neurocognitive disorder in the DSM5 criteria, indicating that both terms refer to the same condition.

What is the significance of early diagnosis and intervention in MCI?

Early diagnosis and intervention in MCI are significant because it provides a window of opportunity to potentially reverse or delay the progression to full-blown dementia, as indicated by the 7.8-year period before MCI typically progresses to Alzheimer's disease.

What are the common screening tools used for the diagnosis of MCI mentioned in the script?

The common screening tools mentioned are the Mini Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-cog).

What is the only pharmacological agent recommended for the symptomatic treatment of MCI according to the script?

The only pharmacological agent recommended for the symptomatic treatment of MCI is EGb 761, as mentioned in the script.

What are the three main neurobiological mechanisms of action of EGb 761 as described in the script?

The three main neurobiological mechanisms of action of EGb 761 are: 1) Increase in neurogenesis and cytogenesis, 2) Mitochondrial DNA oxidation prevention and stabilization of mitochondrial membrane, and 3) Improvement of neurotransmission with anti-apoptotic and anti-inflammatory effects.

How does EGb 761 affect bleeding parameters according to the studies mentioned in the script?

According to the studies, EGb 761 does not show significant changes in coagulation parameters, bleeding, or platelet aggregation, even at doubled doses or when combined with antiplatelet agents like aspirin.

What are some of the non-pharmacological interventions that can help improve or delay the progression of dementia as suggested in the script?

Non-pharmacological interventions suggested in the script include diet, exercise, cognitive training, and vascular risk management, as well as a multi-component intervention like dance, which incorporates cognitive stimulation, social stimulation, physical exercise, and integration of sensory motor skills.

What is the importance of maintaining a healthy lifestyle in relation to MCI and dementia prevention?

Maintaining a healthy lifestyle is important as it targets diet, physical exercise, and mental stimulation, which can help in the prevention of MCI progression to dementia and improve overall cognitive function.

Outlines

00:00

🧠 Understanding Cognitive Impairment and MCI

The speaker begins by discussing the importance of recognizing cognitive impairment, particularly Mild Cognitive Impairment (MCI), as a precursor to dementia. They highlight the risk factors for dementia, such as age, and differentiate between normal aging and pathological aging, which includes MCI. The speaker emphasizes the criteria established by the National Institute on Aging and the Alzheimer's Association for diagnosing MCI, which includes cognitive decline noticed by others, impairment in one cognitive domain, preservation of independence, and the individual not being demented. The comparison between MCI and mild neurocognitive disorder as per DSM5 criteria is also discussed.

05:01

🌏 Global and Local Perspectives on MCI

This paragraph delves into the prevalence of MCI and dementia in various regions, starting with a study in Japan that revealed significant percentages of the elderly population affected by MCI and dementia. The discussion then shifts to the Philippines, where a study in Marikina showed a notable prevalence of cognitive impairment. The speaker outlines the risk factors for MCI in the Filipino context, such as hypertension and diabetes, and discusses the importance of early diagnosis and intervention. The significance of education as a neuroprotective factor against dementia is also highlighted.

10:02

💊 Pharmacological Interventions for MCI

The speaker focuses on pharmacological interventions for MCI, noting the limited symptomatic treatments available and the lack of FDA-approved drugs specifically for MCI. They discuss the use of certain drugs like donepezil, galantamine, and rivastigmine for Alzheimer's disease patients with cardiovascular comorbidities, but point out that these have not shown significant benefits for MCI in randomized control trials. The speaker then highlights EGb 761, a pharmacological agent recommended for the symptomatic treatment of MCI, supported by various international guidelines and studies showing its effectiveness in improving cognitive functions in MCI patients.

15:03

🌿 Mechanisms of Action and Safety Profile of EGb 761

This section explores the neurobiological mechanisms of EGb 761, detailing its role in increasing neurogenesis, preventing mitochondrial DNA oxidation, stabilizing mitochondria membranes, and improving neurotransmission. The speaker also addresses the safety profile of EGb 761, discussing its bioavailability, half-life, and how it crosses the blood-brain barrier. They clarify that EGb 761 does not significantly affect bleeding parameters or凝血 factors, even at double the recommended dose, and does not interact negatively with antiplatelet agents or aspirin, confirming its safety for patients.

20:08

🏋️‍♂️ Non-Pharmacological Interventions and Risk Factors for Dementia

The speaker discusses non-pharmacological interventions for cognitive impairment, such as the PinE Study and a dance-based intervention called 'Inda', which incorporates cognitive, social, and physical stimulation. They report significant cognitive improvements in studies using these methods. The speaker also updates the risk factors for dementia, including recent additions like visual loss and air pollution, and emphasizes the importance of early interventions and lifestyle modifications to delay or prevent dementia onset. The paragraph concludes by reiterating the significance of MCI as a high-risk state for dementia progression and the importance of a multidomain management approach.

Keywords

💡Cognitive Impairment

Cognitive impairment refers to a decline in cognitive abilities such as memory, thinking, and reasoning that affects daily life. In the context of the video, it is a central theme as the speaker discusses its detection and management, emphasizing the importance of early diagnosis and intervention to prevent or delay the progression to dementia.

💡Mild Cognitive Impairment (MCI)

MCI is a transitional stage between the expected cognitive decline of normal aging and the more severe decline of dementia. It is characterized by noticeable cognitive problems that are greater than normal for the individual's age and education level but do not significantly interfere with daily activities. The video discusses MCI as a pre-dementia stage where individuals may experience some difficulties but still maintain functional independence.

💡EGB 761

EGB 761 is a pharmaceutical agent extracted from Ginkgo biloba leaves, which has been recommended for the symptomatic treatment of MCI. The speaker in the video highlights its use in managing cognitive impairment, suggesting that it has been documented to have cognitive and behavioral benefits, and is well-tolerated without increasing bleeding risk.

💡Dementia

Dementia is a broad term for a range of symptoms associated with a decline in memory and cognitive skills that are severe enough to affect daily functioning. The video discusses dementia as a pathological state that arises from cognitive impairment, with MCI being a precursor stage where early interventions can potentially delay or prevent the onset of full-blown dementia.

💡Normal Aging

Normal aging refers to the natural process of growing older, which may involve some cognitive decline but does not significantly affect memory or behavior. The video script differentiates normal aging from pathological aging, where cognitive functions are more severely impacted, leading to a diagnosis of dementia.

💡Neuroprotective

Neuroprotective refers to measures or treatments designed to protect the nervous system from damage, promoting its health and function. In the video, higher education is mentioned as a neuroprotective factor that can reduce the risk of developing dementia.

💡Pharmacological Interventions

Pharmacological interventions involve the use of drugs or medications to treat or manage a medical condition. The video discusses EGB 761 as a recommended pharmacological treatment for MCI, suggesting its efficacy in improving cognitive functions.

💡Non-Pharmacological Interventions

Non-pharmacological interventions encompass a variety of approaches to managing health conditions without the use of drugs. The video mentions lifestyle modifications, cognitive training, and physical exercise as examples of non-pharmacological interventions that can help delay or prevent the onset of dementia.

💡Risk Factors

Risk factors are attributes, conditions, or behaviors that increase the likelihood of developing a disease or condition. The video identifies various risk factors for dementia, including hypertension, diabetes, and low education levels, and emphasizes the importance of early interventions to mitigate these risks.

💡Cognitive Domains

Cognitive domains refer to the different areas of cognitive function, including memory, executive function, attention, language, and visuospatial skills. The video discusses the assessment of impairment in these domains as part of the diagnostic criteria for MCI.

💡Neurotransmission

Neurotransmission is the process by which nerve cells (neurons) communicate with each other by transmitting chemical and electrical signals. The video mentions the improvement of neurotransmission as one of the neurobiological mechanisms by which EGB 761 may exert its beneficial effects on cognitive function.

Highlights

EGB 761 is recommended for symptomatic treatment of MCI according to guidelines and consensus of the Philippine FDA.

Multiple countries have published guidelines supporting the use of EGB 761 for MCI treatment.

Three well-known studies show EGB 761 significantly improves cognitive functions in MCI patients.

EGB 761 has four main neurobiological mechanisms of action, including increased neurogenesis and mitochondrial protection.

EGB 761 has been shown to improve both memory and cognitive flexibility in MCI patients.

A systematic review indicates significant cognitive function improvement with EGB 761 use in MCI patients.

EGB 761 is well-tolerated and does not negatively affect bleeding parameters even at double the dose.

EGB 761 does not affect pharmacokinetics or pharmacodynamics when combined with other medications.

Non-pharmacological interventions, such as multi-domain approaches, can improve or maintain cognitive function in the elderly.

A study by Dr. Jacqueline Dominguez shows dance can significantly improve cognition in Filipinos with MCI.

A combination of pharmacological and non-pharmacological management has a significant effect on patients with MCI.

MCI is a clinical state at high risk for progression to dementia, emphasizing the importance of early identification and management.

Risk factors for dementia include less education, hearing loss, hypertension, obesity, and more.

Lifestyle modifications and early interventions can delay or prevent the onset of dementia.

A recent update from the Lancet Commission in July 2024 added visual loss and air pollution as new risk factors for dementia.

EGB 761 has cognitive and behavioral benefits and is safe to use, even in combination with antiplatelet agents.

Transcripts

good evening everyone so again

thank you for

inviting me here again

to give a short of a view regarding the detections

and management of my cognitive impairment

as well as the use of the egb 7

6 1 in the management of MCI

so let me begin with this line

so as we all know

one of the risk factories in developing dimentia is age

or age

very important respectories in the developing dimentia

but we call but there is a stage when they

we call it as normal aging

where individual status are still the same

the memory are still intact and uh behaviour or no

I still uh okay but there are some stage where

in the independence of activities

of DVD being already been affected

and it is called the pathological aging or dementia

now we have the uh pre dementia stage where

which we call the malcognitive impairment

and this is where we're going to concentrate tonight

again it is the malcognitive pyramid

now the National Institute of aging

and Alzheimer Association

develop a criteria for malcognitive impairment

so we have four criteria coming from the Nia and the AA

so this area the following

no concern regarding a change in cognitions

wherein there is a cognitive decline

we have been noticed by the relative

or the great keeper

or even the doctor who are familiar to the patients

that there are some form of declines

in terms of a cognitive from the previous FL

No.2 impairment in one of my cognitive domains

as we all know

the cognitive domains are composed of the memory

executive function attention

language

and teacher spatial and one of these common uh

cognitive domains have evidence of dysfunction

which should be objectively demonstrated

No.2 is the preservation of the independents

and functional abilities

you all know that individuals with malcognitive

impairment

they usually experience some difficult peace in hiding

complex situation a good example

for example of this time in the financial operations

the way they go shopping

but they need more time and be less efficient

or make more errors during activities

but just the same

be able to preserve their functional independence

despite of having a mild cognitive experiment

No.4 KTR is those patient that are not demented

we observe

cognitive dysfunction is usually mild at this level

and doesn't

affect any social or occupational activities

among this patient

and this should be an investigated properly

clinical assessment should be done

so that proper diagnosis of malcognitive

impairment could be labeled to this population

now if you going to compare this criteria

to the DSM5 criteria you notice the amount

that the MCI here is

what does being term as mild neurocognitive disorder

they are still the same

no MCI and my neurocognitive disorders are the same

just that in the DSM pypdia

the MCI Western mild neurocognitive disorder

you will notice also that

all of the descriptions in the uh

by TMI by

the

Simon's Association and the Nia are almost the same

except that there are more uh

streak on the context or the presence of delirium

and we know that delirium is

a fluctuating of behavior of our patients

and then they also be

streak on the presence of the mental disorder

such as the process of major disorder

depressive disorders is schizophrenia

so it should that be present on those patients

being diagnosed malcognitive impairment

now there's a place in Japan known as nad Nakajima

where in

there was a study under prevalence of dementia

and malcognitive experiment

they made a prospective longitudinal study for area

detections and prevention of dementia

and among the samples of 1,839

15.5 are found out to be having an MCI

and 13.3% are having dementia

no you will notice on the graph that as the one

each diaries of developing dementia

and MCI is very high so in that place

they develop an institute or foundations

where in an early diagnosis and interpassion

should be done under

each individuals that have symptoms of dementia

now here in the Philippines

we have the prevalence of the mercia

associated with factories

it is a population based study in the Philippines

a research done with Latora Jacqueline Dominguez

the research was done specifically in selected area

of Marikina

where is she able to register 1,367 seniors

or equivalent of 93.6%

and she found out that 905 abnormal cognitions or 3

and 317 have cognitive impairment

not dementia which also the same as the MCI

and dementia was approximately 145

and among this dementia

the most common is Alzheimer disease

and followed by the vascrite type of dementia

now

what are the profile of the malcognitive impairment

here in the Philippines

in the community at the prevalence uh is 23.2%

1 in the memory center of Saint Luke's

among those patient with mci

uh the risk factors they found

we found out at the hypertension 68.8% and islepidina

64.1% and of those patients undergo Mr MRI

they have a pasakha score of 1 which is fever to 59.4%

now pasakhas is very important

especially if you're entertaining

patients with vascular dementia

wherein they study not depress

they study the white matter changes

of the patients with malcognitive impairment

actually there are three stages of your paseca

so paseca

zero means zero or no changes in the white matter

for Circus 1

there is a small bound date in the white mother region

uh for Circus 2

there is moderate uh

uh confluence on the white matter and then uh

a circus uh 3

there is the significant or severe confluency

on the press uh in the white matter

now under the clinic of

the General Medicine and Therapeutic Clinic

45 percents are presents to having a diabetes

as one of the respectors

and there are less than 12 years of education

significantly lower the ads of MCI

we all know also that education is one of

that is factories that development

that will develop it to dementia

we all know that

education will act as a neuroprotective

the higher the education that you have

the lesser the chance of going to have dementia

now this is a hypothetical outcomes

according to different distinct subtypes of MCI

we have the amnestic MCI and then an amnestic MCI

when you say amnestic MCI

it is basically affecting the memory

so if you have

this may lead to your alzheimer's disease

and for diagnostic MCI where in aside from the memory

it affects the language

the behavior and the psychological symptoms

and it may lead to the

dual body front of temporal dementia

and the psychiatic depression

or psychiatic diagnosis

particularly depression and uh schizophrenia

now there's a multiple domain MCI

such as the I'm nasty and I'm nasty

where indomnastic may be either an Alzheimer

or the vascular type of dementia

and the I'm nasty

could either be a vascular type of dementia

or the dewy body type of dementia

now uh this flight only tell us

that it will only take 7.8 years

from the time of pretent

clinical Alzheimer disease to MCI

that will develop

to eat a full blown alzheimer's disease

so it will take a very long

long

period before it will develop the alzheimer's disease

so it is a very important

that early diagnosis and treatment could be done

because some will be reversed

especially if you got it early

now uh

and some will be uh we delay it progressions of uh

developing into a full grown dimension

what are the screening tools that we use

for the diagnosis of MCI basically there are four

but only three are the most common uh

screening tools that we use

we have the Mini Mental State Examination

which is the most common uh screening tool that we use

then we have the Montreal Cognitive Assessment

or the Mocha P these are assessment or the screen tool

we use for highly educated patients

or those patients score high in MSE

but based on history and symptoms

they showed symptoms of dementia

and we have the Alzheimer disease disease 8 or the 88

when we use the collatera or the caregiver uh

to evaluate patients with the measure photo

and we use the

we use this for those patients together to the MSE

or the more copy then we have also the informant

question and cognitive tech line

the elderly IQ code which is

we also use for the informant or the carekeeper

but basically the first three are the phone

when we use the screening tools that we use for MCI

and you can assess it no

or you can access it for free at the

our Dimension organization website

which is double w d double w dimension dot org dot p h

now here is example of your Ada

we have the Tagalog version and a scores of 3 to 4

probably your patient is suffering

with alzheimer's disease

so why is it very important to diagnose MCI

because you could identify the risk

for developing dementia we can give patients an early

access to evidence based treatment

and support we can give them education

support and plan for the future

and it is a window which

may be possible to intervene and delay Progression

Supermarket if you remember the past night

it will take 7.8 years before we

before it proceed to a full blunt in Nashia

so we could optimize the treatment

and at this stage

it is most likely your patient still comply

and to take the medicine

so that's why it is very

important that the diagnosis should be done early

what are the pharmaclogic interventions that we use

in malcognitive environment

now

remember that symptomatic treatment is only limited

with no FDA uproot HN

now the asset of colonistry

such as the nepacele or your galantamine or your Liba

stigmine Alzheimer disease

and Alzheimer disease plus cardiovascular disease

in Asia shows no raw boost

evidence in randomized control tires of MCI

and it is only the egb 7 6

1 is the only pharmacological

agent that had been recommended

for the symptomatic treatment of MCI

and it and it's already been uh

been published

and in the guidelines and consensus of the Philippine

FDA for the management of MCI

now there are some countries that already been

have published their guidelines for the MCI

these are your China's treatment guidelines

the check Consensus Guidelines

the Swiss Expert Recommendation

the Spanish Consensus Document

and the 2015 European Medicine Agency

Assessment Report all of these uh

uh showed uh

effective treatment of uh MCI by using the EGP 7 6 1

what are the effect of your MCI in uh

what is the effect of your egb 7

6 1 in MCI particularly it's cognition

now there are three no common uh three studies

well known studies that have been published

No.1 is the glass compound key

which showed significant improvement

in both visual and verbal memory

free recall and recognition

as well as improvement attention and concentration

we have the shower which has studied done in China

which shows significant improvement

and logical memory and picture recognition

and the back study

which shows improvement in cognitive flexibility

now these are the three studies that will

shows that a good effect of your EGB service 6

1 in terms of improvement cognitions

in patients with mild cognitive impairment

now we have a systematic review using the gingobiloba

extra oil egb 7 6

1

in the treatment of patients with mild neurocognitive

impairment of MCI

and it shows that uh there is significant improvement

in cognitive functions

new psychiatic symptoms including your uh anxiety

uh depressions and also

there's an improvement in overall periodic assessment

and global rate ratings of change were also reported

now uh dome several domains including the memory

attention processing speed

executive punctures

noted to have a significant improvement

in using this uh extract e G B 7 6 1

what are the mechanism of options of your Egb 7 6 1

we have four main neurobiological mechanism

No.1 increase in neurogeneses and cycrg Genesis

No. 2 mitochondrial DNA oxidant oxidation preventions

followed by stabilizations of mitochondria membrane

which slows down the aging

so it will act as a protective effect on mitochondria

we have a neurotransmission improvement

by acting as supple radical

is car binging and anti apoptotic effect

and also as well as the inflammatory effect

but what is more important is the actions of the uh

gingo below about through modulations of

prosperulations of Thao protein

we all know that Thao protein is the protein

that act as uh autologicna uh

in the formations of the uh dementia syndrome

so what are the profile of your egb 7 6 1

the egb 7 6 1 is well observed orderly

it has a bio availability

it has a half life of 2 to 3 hours

that's why we have to give it twice a day

to maximum dose of 240 kilogram

because of our low uh have life

it has a low plasma protein binding

does not influence food update

and most importantly

it processes the blood brain barrier

so

a standardite extra from Ginga

below by lips is the egb 7 6

1 wherein it is the active component

it has an optimal content of beneficial

active ingredients

and minimal and wanted toxic sub success

now on this slide will show you that the egb 7

6 1

it has a game called uh

property

wherein it has a less than 5 million per million per

uh 5 per million in colic acid

which meet uh

the specifications of addressing the uh MCI

so meaning uh less than 5 that does not possess any uh

CTV's as compared to your competitor product

or in does not need a specification

it processes a theories and cannot be considered

as a equivalent of your egb 7

6 1 in terms in addressing the MCI

so the most common question is

uh that with the three encounter is ingobilopa

can affect the bleeding parameters

because we all know that gingo below

but affects our plated activated factories

as well as the

collagen so that's why it

it's been afraid that it may cause

leading to some of those patients

especially those with uh antiplate cleat

but there are some study that will shows that egb 7

6 1

did that show significant changes in coagulations

parameters

as well as the bleeding and created aggregation

even if you doubled up the dose up to 480 m

gram per day and it has no

statistically significant difference

of blood clot relations parameters

as well as a piglet functions in MCI patients

and even at the dose of 240 milligram

in combination with wire wirefarine

it does not does not change the INR

the plated aggregations

and water for the informal of genetics

so therefore you can see that egb 7

6 1 is very safe

especially if your patient is taking antiplate agent

now even in combinations of your aspirin

which is the most common Antiqua

Antiqua gland that we give to our patient

in combination with aspirin

it does not

have clinical relevant effect on blood quaculations

though even with the combination with ASP

so it is very safe

now uh

it also uh does not affect the pharmacokinetic

as well as the pharmacodynamics of Lebarox

Sabine with the single dose effect of your egb 7 6 1

now uh we have uh restock toys that determine

that had been deported

in the 2020 report of the last set permissions

these are the restock toys that we can prepare

that we could use as an intervention in order to delay

prevent the onset of dimension

so in early life

one of the respoptories is less education

as I said a while ago the higher the education

the less likely your patients will develop dementia

in midlife one of the respoptories are the following

hearing loss hypertension

obesity traumatic brain injury

and alcohol of more than 21 units per week

now there is factories in late life smoking

depression physical inactivity so social isolation

air pollutions and diabetes

now if you're going to summit oil

there is a probability of 39% this factor that will

this that will put you to develop our dementia

so it's better to have an early

interventions

or our lifestyle modifications before we acquire this

39% this was published on 2020 Landset Commission

but lately this July of 2024

the landset came out with a new respectors for dementia

and the one that is being added here is your visual

visual visual loss

if a patient have a a

visual problem it may add approximately 2%

as well as air pollution is also added here

as one of the risk factories in the late life

late life so if you sum it summit all mustum ASPA no

you risk factories started to develop the measure

and it turn out to be 45%

so this was a delayed as this park toys in decess

that was

that was published in last seconds may need in it

but also it was popped it came out this July 2024

so

there was a Pinterest ID around the mice control trial

actually this is a non pharmacological interventions

not involving diet exercise

cognitive training and vascular risk monetary

for those patients with symptoms of uh

my cognitive impairment now with these interventions

they found out that a multi

domain intervention

could improve or maintain cognitive function uh

in at least elderly from the genital population

so we could say that

through non pharmacological intervention

you can also improve non or delay the progression of uh

dementia

now uh there was a study done again by Doctora

Jacques Dominguez uh

he called

she called it improving cognition through dance

in other Filipinos with my cognitive impairment

so she called it Inda and it does uh

it is a multi component intervention

incorporating cognitive stimulation

social stimulation physical exercise

and integration of sensory motor skills

again this is a non pharmacological intervention

so it involves an eight types of ballroom dances

with increasing complexity

for one hour twice a week for 48 weeks

and based on this study

she found out that there is significant improvement in

ages ages go MSE Mocha and Boston naming test

so you can also use it for those patients

no uh

aside from medicine you can give the non pharmacology

but based on the study our combinations of uh

pharmacology and non pharmacology

management

have a significant effect for those patients with ah

dementia or with ah beginning my cognitive impairment

so what is important here

not the important point is

MCI is a clinical state

at high risk for progression to dementia

so early identification close observations

and early management is very important

because we have a window period again of 7.8 years

multidomin management is recommended

so pharmacological treatment with egb 7

6 1

which is the only recommended treatment

not for MCI are you have to address

that is factors for the mashup preventions

the previous lie that uh

a flash a while ago that had been partitioned and said

so healthy lifestyle targeting the diet

physical exercise

and mental stimulation is also very important

and Egb 7

6 1 has proven cognitive and behavioral benefits

which has been documented in the previous studies

egb 7 6

1 is well tolerated and has no opera or increase

um breeding list which had also been uh

validated and being uh published independent

uh join us that uh

egb 7 6

1 does not affect uh population factors for even our

in combinations with anti plateland

so I think this is the last light

so thank you very much

Good evening ulit sa lahat

Salamat sa

Inimbitahan ulit ako dito

upang magbigay ng maikling pananaw tungkol sa mga pagtuklas

at pamamahala ng aking cognitive impairment

pati na rin ang paggamit ng egb 7

6 1 sa pamamahala ng MCI

Kaya hayaan mo akong magsimula sa linyang ito

So as we all know

isa sa mga panganib na pabrika sa pagbuo ng dimentia ay edad

o edad

napakahalagang paggalang sa pagbuo ng dimentia

But we call pero may stage na sila

Tinatawag namin itong normal na pagtanda

kung saan ang indibidwal na katayuan ay pareho pa rin

buo pa rin ang memorya at uh pag-uugali o hindi

Okay pa rin ako pero may ilang stage kung saan

sa pagsasarili ng mga aktibidad

ng DVD na naapektuhan na

at ito ay tinatawag na pathological aging o dementia

ngayon ay mayroon tayong uh pre dementia stage kung saan

na tinatawag nating malcognitive impairment

at dito tayo magko-concentrate ngayong gabi

muli ito ay ang malcognitive pyramid

ngayon ang National Institute of aging

at Samahan ng Alzheimer

bumuo ng pamantayan para sa malcognitive impairment

So meron tayong apat na criteria na galing sa Nia at AA

kaya ang lugar na ito ang mga sumusunod

Walang pag-aalala tungkol sa pagbabago sa mga cognition

kung saan mayroong pagbaba ng cognitive

Napansin kami ng kamag-anak

o ang dakilang tagabantay

o kahit na ang doktor na pamilyar sa mga pasyente

na mayroong ilang anyo ng pagtanggi

sa mga tuntunin ng isang nagbibigay-malay mula sa nakaraang FL

No.2 na kapansanan sa isa sa aking mga cognitive domain

gaya ng alam nating lahat

ang mga cognitive domain ay binubuo ng memorya

pansin ng executive function

wika

at spatial ng guro at isa sa mga karaniwang ito uh

Ang mga cognitive domain ay may katibayan ng dysfunction

na dapat na obhetibong ipakita

Ang No.2 ay ang pangangalaga ng mga independyente

at mga kakayahan sa pagganap

alam mo lahat na ang mga indibidwal na may malcognitive

kapansanan

Karaniwan silang nakakaranas ng ilang mahirap na kapayapaan sa pagtatago

kumplikadong sitwasyon isang magandang halimbawa

halimbawa ng oras na ito sa mga operasyon sa pananalapi

ang paraan ng pamimili nila

ngunit kailangan nila ng mas maraming oras at hindi gaanong mahusay

o gumawa ng higit pang mga error sa panahon ng mga aktibidad

pero pareho lang

mapangalagaan ang kanilang functional independence

sa kabila ng pagkakaroon ng banayad na eksperimento sa pag-iisip

Ang No.4 KTR ay ang mga pasyenteng hindi dementado

nagmamasid kami

Ang cognitive dysfunction ay karaniwang banayad sa antas na ito

at hindi

makakaapekto sa anumang aktibidad sa lipunan o trabaho

sa pasyenteng ito

at ito ay dapat na maimbestigahan nang maayos

Dapat gawin ang klinikal na pagtatasa

upang ang tamang diagnosis ng malcognitive

Ang kapansanan ay maaaring mamarkahan sa populasyon na ito

ngayon kung ihahambing mo ang pamantayang ito

sa pamantayan ng DSM5 napapansin mo ang halaga

na ang MCI dito ay

ano ang tinatawag na mild neurocognitive disorder

pareho pa rin sila

walang MCI at ang aking mga neurocognitive disorder ay pareho

lang yan sa DSM pypdia

ang MCI Western banayad na neurocognitive disorder

mapapansin mo rin yan

lahat ng paglalarawan sa uh

ng TMI ni

ang

Ang Samahan ni Simon at ang Nia ay halos pareho

maliban sa marami pa uh

streak sa konteksto o pagkakaroon ng delirium

at alam natin na ang delirium ay

isang pabagu-bagong pag-uugali ng aming mga pasyente

at pagkatapos ay maging sila rin

streak sa pagkakaroon ng mental disorder

tulad ng proseso ng major disorder

Ang mga depressive disorder ay schizophrenia

So dapat nasa mga pasyente yan

na-diagnose na may kapansanan sa malcognitive

ngayon ay may isang lugar sa Japan na kilala bilang nad Nakajima

kung saan sa

nagkaroon ng pag-aaral sa ilalim ng prevalence ng dementia

at malcognitive na eksperimento

Gumawa sila ng isang prospective na longitudinal na pag-aaral para sa lugar

Mga pagtuklas at pag-iwas sa demensya

at kabilang sa mga sample ng 1,839

15.5 ay napag-alamang may MCI

at 13.3% ay nagkakaroon ng dementia

hindi mo mapapansin sa graph na bilang isa

bawat talaarawan ng pagbuo ng demensya

And MCI is very high kaya sa lugar na yun

bumuo sila ng isang institusyon o pundasyon

kung saan sa isang maagang pagsusuri at interpassion

dapat gawin sa ilalim

bawat indibidwal na may sintomas ng demensya

ngayon dito sa Pilipinas

mayroon tayong prevalence ng mercia

nauugnay sa mga pabrika

ito ay isang population based study sa Pilipinas

isang pananaliksik na ginawa kasama si Latora Jacqueline Dominguez

partikular na ginawa ang pananaliksik sa napiling lugar

ng Marikina

saan siya makakapagrehistro ng 1,367 seniors

o katumbas ng 93.6%

at nalaman niya na 905 abnormal cognitions o 3

at 317 ay may kapansanan sa pag-iisip

hindi dementia na kapareho din ng MCI

at ang demensya ay humigit-kumulang 145

at kabilang sa dementia na ito

ang pinakakaraniwan ay Alzheimer disease

at sinusundan ng vascrite type ng dementia

ngayon

ano ang profile ng malcognitive impairment

dito sa Pilipinas

sa komunidad sa prevalence uh ay 23.2%

1 sa memory center ng Saint Luke 's

sa mga pasyenteng may mci

uh ang mga risk factor na nakita nila

nalaman namin sa hypertension 68.8% at islepidina

64.1% at sa mga pasyenteng iyon ay sumasailalim sa Mr MRI

mayroon silang pasakha score na 1 na lagnat hanggang 59.4%

Napakahalaga ngayon ng Pasakhas

lalo na kung nakakaaliw ka

mga pasyente na may vascular dementia

kung saan nag-aaral sila hindi depress

pinag-aaralan nila ang mga pagbabago sa puting bagay

ng mga pasyente na may kapansanan sa malcognitive

actually may tatlong stages ng paseca mo

Paseca ng Sobra

Ang ibig sabihin ng zero ay zero o walang pagbabago sa white matter

para sa Circus 1

mayroong isang maliit na nakatali na petsa sa rehiyon ng puting ina

uh para sa Circus 2

may katamtaman uh

uh confluence sa white matter tapos uh

isang sirko uh 3

mayroong makabuluhan o matinding pagsasama

sa press uh sa puting bagay

ngayon sa ilalim ng klinika ng

ang Pangkalahatang Medisina at Therapeutic Clinic

45 porsiyento ay naroroon sa pagkakaroon ng diyabetis

bilang isa sa mga gumagalang

at wala pang 12 taong edukasyon

makabuluhang babaan ang mga ad ng MCI

Alam din nating lahat na ang edukasyon ay isa sa

na mga pabrika na pag-unlad

na bubuo nito sa dementia

alam nating lahat yan

Ang edukasyon ay magsisilbing neuroprotective

mas mataas ang edukasyon na mayroon ka

mas maliit ang pagkakataong magkaroon ng dementia

ngayon ito ay isang hypothetical na kinalabasan

ayon sa iba 't ibang natatanging mga subtype ng MCI

mayroon kaming amnestic MCI at pagkatapos ay isang amnestic MCI

kapag sinabi mong amnestic MCI

ito ay karaniwang nakakaapekto sa memorya

kaya kung meron ka

ito ay maaaring humantong sa iyong alzheimer 's disease

at para sa diagnostic MCI kung saan bukod sa memorya

ito ay nakakaapekto sa wika

ang pag-uugali at ang mga sikolohikal na sintomas

at maaari itong humantong sa

Dalawahang katawan sa harap ng temporal na demensya

at ang psychiatic depression

o diagnosis ng psychiatic

partikular na ang depresyon at uh schizophrenia

ngayon ay mayroong maraming domain na MCI

tulad ng ako ay makukulit at ako ay makukulit

kung saan ang indomnastic ay maaaring alinman sa isang Alzheimer

o ang vascular type ng dementia

at ang pangit ko

maaaring isang vascular na uri ng demensya

o ang dewy body na uri ng dementia

ngayon uh ang flight na ito ay sabihin lamang sa amin

na aabutin lamang ng 7.8 taon

mula sa panahon ng pagpapanggap

klinikal na sakit na Alzheimer sa MCI

bubuo yan

kumain ng full blown alzheimer 's disease

kaya magtatagal ito

mahaba

panahon bago ito magkaroon ng sakit na alzheimer

kaya ito ay isang napakahalaga

na maaaring gawin ang maagang pagsusuri at paggamot

dahil ang ilan ay mababaligtad

lalo na kung maaga kang nakakuha

ngayon uh

at ang ilan ay uh antalahin namin ito progressions ng uh

pagbuo sa isang ganap na lumaki na dimensyon

ano ang mga tool sa screening na ginagamit namin

Para sa diagnosis ng MCI karaniwang mayroong apat

pero tatlo lang ang pinakakaraniwan uh

Mga tool sa screening na ginagamit namin

mayroon tayong Mini Mental State Examination

alin ang pinakakaraniwang uh screening tool na ginagamit namin

pagkatapos ay mayroon kaming Montreal Cognitive Assessment

o ang Mocha P ito ay pagtatasa o ang tool sa screen

ginagamit namin para sa mga pasyenteng may mataas na pinag-aralan

o ang mga pasyenteng iyon ay mataas ang marka sa MSE

ngunit batay sa kasaysayan at sintomas

nagpakita sila ng mga sintomas ng demensya

at mayroon tayong Alzheimer disease 8 o ang 88

kapag ginamit namin ang collatera o ang caregiver uh

upang suriin ang mga pasyente na may sukat na larawan

at ginagamit namin ang

Ginagamit namin ito para sa mga pasyenteng magkasama sa MSE

Or the more copy tapos meron din kaming informant

tanong at linya ng cognitive tech

ang matatandang IQ code na

ginagamit din namin para sa impormante o sa tagapag-alaga

ngunit karaniwang ang unang tatlo ay ang telepono

kapag ginagamit namin ang mga tool sa screening na ginagamit namin para sa MCI

at maaari mong tasahin ito hindi

o maaari mo itong ma-access nang libre sa

website ng aming organisasyon ng Dimensyon

na doble w d double w dimensyon tuldok org tuldok p h

ngayon narito ang halimbawa ng iyong Ada

mayroon kaming bersyon ng Tagalog at mga marka na 3 hanggang 4

Malamang naghihirap ang pasyente mo

may sakit na alzheimer

kaya bakit napakahalaga na masuri ang MCI

dahil maaari mong matukoy ang panganib

Para sa pagbuo ng demensya maaari naming bigyan ang mga pasyente ng maaga

Access sa paggamot batay sa ebidensya

at suporta ay mabibigyan natin sila ng edukasyon

suporta at plano para sa hinaharap

at ito ay isang bintana na

Maaaring posible na mamagitan at maantala ang Progression

Supermarket kung naaalala mo ang nakaraang gabi

aabutin ng 7.8 taon bago tayo

Bago ito magpatuloy sa isang ganap na mapurol sa Nashia

para ma-optimize namin ang paggamot

at sa yugtong ito

malamang na sumusunod pa rin ang iyong pasyente

at uminom ng gamot

kaya iyon ang dahilan kung bakit ito ay napaka

mahalaga na ang diagnosis ay dapat gawin nang maaga

ano ang mga pharmaclogic intervention na ginagamit namin

sa malcognitive na kapaligiran

ngayon

Tandaan na ang sintomas na paggamot ay limitado lamang

na walang FDA bunutin HN

ngayon ang asset ng kolonista

tulad ng nepacele o iyong galantamine o iyong Liba

sakit na Alzheimer ng stigmine

and Alzheimer disease plus cardiovascular disease

in Asia shows no raw boost

evidence in randomized control tires of MCI

and it is only the egb 7 6

1 is the only pharmacological

agent that had been recommended

for the symptomatic treatment of MCI

and it and it's already been uh

been published

and in the guidelines and consensus of the Philippine

FDA for the management of MCI

now there are some countries that already been

have published their guidelines for the MCI

these are your China's treatment guidelines

the check Consensus Guidelines

the Swiss Expert Recommendation

the Spanish Consensus Document

and the 2015 European Medicine Agency

Assessment Report all of these uh

uh showed uh

effective treatment of uh MCI by using the EGP 7 6 1

what are the effect of your MCI in uh

what is the effect of your egb 7

6 1 in MCI particularly it's cognition

now there are three no common uh three studies

well known studies that have been published

No.1 is the glass compound key

which showed significant improvement

in both visual and verbal memory

free recall and recognition

as well as improvement attention and concentration

we have the shower which has studied done in China

which shows significant improvement

and logical memory and picture recognition

and the back study

which shows improvement in cognitive flexibility

now these are the three studies that will

shows that a good effect of your EGB service 6

1 in terms of improvement cognitions

in patients with mild cognitive impairment

now we have a systematic review using the gingobiloba

extra oil egb 7 6

1

in the treatment of patients with mild neurocognitive

impairment of MCI

and it shows that uh there is significant improvement

in cognitive functions

new psychiatic symptoms including your uh anxiety

uh depressions and also

there's an improvement in overall periodic assessment

and global rate ratings of change were also reported

now uh dome several domains including the memory

attention processing speed

executive punctures

noted to have a significant improvement

in using this uh extract e G B 7 6 1

what are the mechanism of options of your Egb 7 6 1

we have four main neurobiological mechanism

No.1 increase in neurogeneses and cycrg Genesis

No. 2 mitochondrial DNA oxidant oxidation preventions

followed by stabilizations of mitochondria membrane

which slows down the aging

so it will act as a protective effect on mitochondria

we have a neurotransmission improvement

by acting as supple radical

is car binging and anti apoptotic effect

and also as well as the inflammatory effect

but what is more important is the actions of the uh

gingo below about through modulations of

prosperulations of Thao protein

we all know that Thao protein is the protein

that act as uh autologicna uh

in the formations of the uh dementia syndrome

so what are the profile of your egb 7 6 1

the egb 7 6 1 is well observed orderly

it has a bio availability

it has a half life of 2 to 3 hours

that's why we have to give it twice a day

to maximum dose of 240 kilogram

because of our low uh have life

it has a low plasma protein binding

does not influence food update

and most importantly

it processes the blood brain barrier

so

a standardite extra from Ginga

below by lips is the egb 7 6

1 wherein it is the active component

it has an optimal content of beneficial

active ingredients

and minimal and wanted toxic sub success

now on this slide will show you that the egb 7

6 1

it has a game called uh

property

wherein it has a less than 5 million per million per

uh 5 per million in colic acid

which meet uh

the specifications of addressing the uh MCI

so meaning uh less than 5 that does not possess any uh

CTV's as compared to your competitor product

or in does not need a specification

it processes a theories and cannot be considered

as a equivalent of your egb 7

6 1 in terms in addressing the MCI

so the most common question is

uh that with the three encounter is ingobilopa

can affect the bleeding parameters

because we all know that gingo below

but affects our plated activated factories

as well as the

collagen so that's why it

it's been afraid that it may cause

leading to some of those patients

especially those with uh antiplate cleat

but there are some study that will shows that egb 7

6 1

did that show significant changes in coagulations

parameters

as well as the bleeding and created aggregation

even if you doubled up the dose up to 480 m

gram per day and it has no

statistically significant difference

of blood clot relations parameters

as well as a piglet functions in MCI patients

and even at the dose of 240 milligram

in combination with wire wirefarine

it does not does not change the INR

the plated aggregations

and water for the informal of genetics

so therefore you can see that egb 7

6 1 is very safe

especially if your patient is taking antiplate agent

now even in combinations of your aspirin

which is the most common Antiqua

Antiqua gland that we give to our patient

in combination with aspirin

it does not

have clinical relevant effect on blood quaculations

though even with the combination with ASP

so it is very safe

now uh

it also uh does not affect the pharmacokinetic

as well as the pharmacodynamics of Lebarox

Sabine with the single dose effect of your egb 7 6 1

now uh we have uh restock toys that determine

that had been deported

in the 2020 report of the last set permissions

these are the restock toys that we can prepare

that we could use as an intervention in order to delay

prevent the onset of dimension

so in early life

one of the respoptories is less education

as I said a while ago the higher the education

the less likely your patients will develop dementia

in midlife one of the respoptories are the following

hearing loss hypertension

obesity traumatic brain injury

and alcohol of more than 21 units per week

now there is factories in late life smoking

depression physical inactivity so social isolation

air pollutions and diabetes

now if you're going to summit oil

there is a probability of 39% this factor that will

this that will put you to develop our dementia

so it's better to have an early

interventions

or our lifestyle modifications before we acquire this

39% this was published on 2020 Landset Commission

but lately this July of 2024

the landset came out with a new respectors for dementia

and the one that is being added here is your visual

visual visual loss

if a patient have a a

visual problem it may add approximately 2%

as well as air pollution is also added here

as one of the risk factories in the late life

late life so if you sum it summit all mustum ASPA no

you risk factories started to develop the measure

and it turn out to be 45%

so this was a delayed as this park toys in decess

that was

that was published in last seconds may need in it

but also it was popped it came out this July 2024

so

there was a Pinterest ID around the mice control trial

actually this is a non pharmacological interventions

not involving diet exercise

cognitive training and vascular risk monetary

for those patients with symptoms of uh

my cognitive impairment now with these interventions

they found out that a multi

domain intervention

could improve or maintain cognitive function uh

in at least elderly from the genital population

so we could say that

through non pharmacological intervention

you can also improve non or delay the progression of uh

dementia

now uh there was a study done again by Doctora

Jacques Dominguez uh

he called

she called it improving cognition through dance

in other Filipinos with my cognitive impairment

so she called it Inda and it does uh

it is a multi component intervention

incorporating cognitive stimulation

social stimulation physical exercise

and integration of sensory motor skills

again this is a non pharmacological intervention

so it involves an eight types of ballroom dances

with increasing complexity

for one hour twice a week for 48 weeks

and based on this study

she found out that there is significant improvement in

ages ages go MSE Mocha and Boston naming test

so you can also use it for those patients

no uh

aside from medicine you can give the non pharmacology

but based on the study our combinations of uh

pharmacology and non pharmacology

management

have a significant effect for those patients with ah

dementia or with ah beginning my cognitive impairment

so what is important here

not the important point is

MCI is a clinical state

at high risk for progression to dementia

so early identification close observations

and early management is very important

because we have a window period again of 7.8 years

multidomin management is recommended

so pharmacological treatment with egb 7

6 1

which is the only recommended treatment

not for MCI are you have to address

that is factors for the mashup preventions

the previous lie that uh

a flash a while ago that had been partitioned and said

so healthy lifestyle targeting the diet

physical exercise

and mental stimulation is also very important

and Egb 7

6 1 has proven cognitive and behavioral benefits

which has been documented in the previous studies

egb 7 6

1 is well tolerated and has no opera or increase

um breeding list which had also been uh

validated and being uh published independent

uh join us that uh

egb 7 6

1 does not affect uh population factors for even our

in combinations with anti plateland

so I think this is the last light

so thank you very much