Neurology
The Department of Neurology has six consultants, three in each unit. Together we run free outpatient service on Monday/ Wednesday/ Thursday/ Saturday from 9am to 10:30 am. Besides free OPDs the paid OPD starts at 10am in morning and go on till 8:00pm daily except on Sunday and national holidays.
The emergency services are available 24/07/365 where all kinds of Neuro emergencies are dealt with utmost care and dedication. Pulse Super Speciality Hospital is possibly one of few institutes where casualty is manned by dedicated Neurology staff. This is backed by a very strong and state of the art Intensive Care Unit and department of critical care medicine. Thus we offer a very comprehensive outdoor facility on one hand to round the clock emergency services on the other. On the academic front we have a very robust teaching programme and a strong force of 6 post graduates. Ours is possibly the first institute to be recognized by Diplomate of National Board for post graduate degree in Neurology.
After trying to achieve excellence in the most fundamental tenets of any health care facility that is patient care and education, comes research. With the help of a strong impetus and motivation from the department of research, we are also exploring this avenue and have some interesting ongoing collaborative projects with them. In the following section, an attempt has been made to discuss some of the major categories of Neurological disorders. It is not all inclusive, but only a very broad look at the conceptual framework about these disorders.
Dementia
Dementia is defined as an acquired global cognitive decline meaning thereby that there is a progressive worsening of intellectual abilities and memory which is severe enough to affect simple and routine day to day activities.
Symptoms
- Memory loss
- Difficulty communicating
- Difficulty with complex tasks
- Difficulty with planning and organizing
- Difficulty with coordination and motor functions
- Problems with orientation, such as getting lost
- Personality changes
- Inability to reason
- Inappropriate behavior
- Paranoia
- Agitation
- Hallucinations
A word of caution
Many of us often experience forgetfulness. We may forget where we put the car keys or repeat the same story to a friend or family member. These behaviours are usually caused by the information overload of our busy, stressful lives – it doesn’t mean that we’re developing dementia. As people age, they may experience memory changes such as slowing of information processing. This type of change is normal. By contrast, dementia is progressive and disabling and not a normal part of aging.
Classification
From a pragmatic point of view it is better to classify dementias as Treatable and Untreatable.
Treatable Dementias
- Vitamin B12 deficiency
- Hypothyroidism
- Subdural Hematoma
- Meningitis and encephalitis
- Depression
- AIDS
- Brain Tumors
- Exposure to heavy metals
It is very important to identify these treatable causes in all patients as a correct diagnosis can make a huge difference in the lives of both the patient and the care giver.
Untreatable Dementias
- Alzheimer’s disease
- Fronto Temporal Dementia
- Lewy Body Disease
- Prion Disease
(The possible cause for these Dementias is Neurodegeneration ,which we will discuss separately.)
When to see a doctor?
- If you or a loved one experiences memory problems or other dementia symptoms. Some treatable medical conditions can cause dementia symptoms, so it’s important that a doctor determine the underlying cause.
- Alzheimer’s disease and several other types of dementia worsen over time. Early diagnosis gives you time to plan for the future and also in treatment
How is dementia diagnosed?
The first step is to pick up the treatable ones with the help of some simple investigations like Brain Scan, EEG and Laboratory work up for Vitamin B12, Thyroid etc. Once the treatable causes have been ruled out then the next step is to proceed for the evaluation of rest of the dementing illnesses, which is done as follows.
- Historical analysis from the patients and their family
- Physical examination
- Neurological assessments
The Mini Mental status exam (MMSE)
It is a brief, structured test of mental status that takes about 10 minutes to complete. It can be used by clinicians to help diagnose dementia and to help assess its progression and severity.
Cognitive and neuropsychological tests
- Pencil-and-paper tests and interviews that evaluate cognition and try to identify specific areas of strength and weakness. Testing includes measures of memory, concentration, visual-spatial, problem solving, basic math and language skills.
- They can differentiate depression from dementia, and can help in the diagnosis of specific types of dementia or brain disorders.
PET Scan (Positron Emission Tomography)
A type of nuclear scanning that involves capturing cross-sectional images of the brain, much like CT scanning. Functional images capture how various parts of the brain are working, which makes it a diagnostic tool for neurodegenerative conditions.
SPECT (Single Photon Emission Computed Tomography)
A type of nuclear scanning that is very similar to PET. SPECT measures blood flow and activity levels in the brain, which make it a diagnostic tool for identifying behavioral and cognitive problems in persons with neurodegenerative conditions.
FMRI (Functional MRI)
A specialized type of MRI scan that shows changes in blood flow in the brain. Unlike PET and SPECT scans, MRI is non-invasive and is done on an MRI scanner.
Others
- EEG (Electroencephalogram)
- Lumbar Puncture
- Psychiatric evaluations
- Etc
- Can dementia be prevented?
Research has revealed a number of factors that may be able to prevent or delay the onset of dementia in some people. Among them are:
Healthy life style-Balanced diet,Regular sleep schedule and Regular exercises.
Engagement in intellectually s timulating exercises.
Meticulous control of diseases like Diabetes, Hypertension and Dyslipidemia.
How are untreatable dementias managed?
Most treatments for dementia can control symptoms and thereby reduce the burden of disease. Many researchers are also examining whether these drugs can be used for the treatment of different types of dementia.
Many people with dementia, especially in the early stages, can practice some activities to improve the performance of cognitive functioning like test mnemonics, computerized recall devices, or take notes.
Many studies have also shown that cholinesterase inhibitors help slow the decline of mental function , and that may help to reduce behavioral problems.
An important phenomena of “sun downing” in these patients wherein there is worsening of symptoms by night can also be dealt with by accomadating them with their surroundings and providing a friendly family atmosphere.
It is important to note here that in the Indian scenario due to the availability of a good family & social support system these patients can be looked after much more appropriately unlike the west where such cases might be socially isolated.