Early Detection and Management of Mild Cognitive Impairment
Summary
TLDRThis 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
- ๐ง The risk of developing dementia increases with age, but there's a stage known as 'normal aging' where cognitive functions remain intact.
- ๐ 'Pathological aging' or dementia is characterized by a decline in independence in activities of daily living.
- ๐ฅ '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.
- ๐ 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.
- ๐ 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.
- ๐ EGb 761, a pharmaceutical agent, is recommended for the symptomatic treatment of MCI, with evidence supporting its efficacy in improving cognitive function.
- ๐งช The mechanism of action of EGb 761 includes increased neurogenesis, mitochondrial protection, improved neurotransmission, and modulation of Tau protein, which is associated with dementia.
- ๐ Systematic reviews and studies demonstrate significant cognitive improvements in MCI patients treated with EGb 761, particularly in memory, attention, and executive functions.
- ๐๏ธโโ๏ธ Non-pharmacological interventions, such as cognitive training and physical exercise, can also improve or maintain cognitive function and delay the progression of dementia.
- โฐ 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
๐ง 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.
๐ 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.
๐ 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.
๐ฟ 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 orๅ่ก factors, even at double the recommended dose, and does not interact negatively with antiplatelet agents or aspirin, confirming its safety for patients.
๐๏ธโโ๏ธ 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.
Mindmap
Keywords
๐กCognitive Impairment
๐กMild Cognitive Impairment (MCI)
๐กEGB 761
๐กDementia
๐กNormal Aging
๐กNeuroprotective
๐กPharmacological Interventions
๐กNon-Pharmacological Interventions
๐กRisk Factors
๐กCognitive Domains
๐กNeurotransmission
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
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