Defending the Guidelines Vascular Burden of Cognitive Impairment & Dementia
|
|
- Fay Briggs
- 7 years ago
- Views:
Transcription
1 Defending the Guidelines Vascular Burden of Cognitive Impairment & Dementia Philip B. Gorelick, MD MPH FACP Medical Director Hauenstein Neuroscience Center St. Mary s Health Care Grand Rapids, Michigan Feb. 3, 2012, New Orleans, ISC, ~10 minutes
2 Disclosure Relevant to this Presentation None
3 Objectives In relation to the vascular contributions to cognitive impairment & dementia, you will be able to discuss: 1. Rationale for the AHA/ASA guidance statement 2. Key recommendations 3. Next steps
4 Gorelick PB, Scuteri A, Black SE, et al. Stroke 2011; 42:
5 Vascular Contributions to Cognitive Impairment & Dementia: Methods-1 Purpose: to provide an overview of the evidence on vascular contributions to cognitive impairment & dementia Methods: 1. Creation of an Expert Panel 2. Joint collaboration between AHA Stroke & Epidemiology & Prevention Councils 3. Systematic literature reviews covering publications from 1990 to May 1, 2010, previously published guidelines, personal files & expert opinion to summarize existent evidence, gaps in current knowledge & recommendations Source: Gorelick PB, Scuteri A, Black S, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42:
6 Table of Contents-1 1. Introduction 2. Defining Alzheimer Disease & VCI 3. Neuropathological Aspects 4. Basic Science Aspects: Neurovascular Unit, Neurovascular Dysfunction & Animal Models 5. Cerebral Amyloid Angiopathy & Hereditary Small-Vessel Syndromes 6. Pathophysiology of Arterial Structure & Function: Carotid IMT, Arterial Stiffness & Small-Artery Remodeling Source: Gorelick PB, Scuteri A, Black S, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42:
7 Table of Contents-2 7. Neuroimaging Factors 8. Impact of Cardiovascular Risk Factors at Different Ages on the Risk of Cognitive Decline: Demographic, Genetic, Lifestyle, Depression, Physiological (Blood Pressure, Hyperglycemia etc., Lipids, Inflammation) 9. Concomitant Clinical Vascular Disease: CAD, Stroke, CKD, AF, Low Cardiac Output 10. Clinical Trials & Symptomatic Treatment 11. Prospects for Prevention of VCI & Alzheimer Disease by Risk Factor Control 12. Summary & Course of Action Source: Gorelick PB, Scuteri A, Black S, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42:
8 Rationale for the AHA/ASA Guidance Statement Vascular Contributions to Cognitive Impairment & Dementia Source: Gorelick PB, Scuteri A, Black S, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42:
9 Why the Need for This AHA/ASA Guidance Statement? 1. Occurrence of stroke and vascular risk factors are common as we age 2. Vascular risk factors have been linked to vascular cognitive impairment (VCI) & Alzheimer s disease (AD) 3. VCI & AD are common forms of cognitive impairment 3. An evidence-based review is needed to guide health care professionals on management of these vascular factors in the possible prevention and treatment of cognitive impairment Source: Gorelick PB, Scuteri A, Black S, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42:
10 Complex Web of Causation: Cognitive Impairment & Neurovascular Unit A-beta Potent vasoconstrictor CADASIL Amyloid angiopathy Oxidative stress Genetic defects Risk factors Inflammation Hypertension Diabetes Aging Impair endothelial responses in cerebral microcirc. & blunted functional hyperemia (neuronal activity increases CBF) In Alzheimer Dis. Hypercontractile Vessels Microglia Neurovascular dysfunction Demyelination/Hyp ermetabolism Neuron Cerebral Arteriole Hypoxia ischemia Astrocyte BBB alteration Oligo precursors/rep -air potential Other Vasc Associations -Retinal narrowing, arterial stiffness & small vessel disease -Aortic stiffness & microvascular brain damage -Carotid intimal media thickness White matter damage Bystander damage Brain atrophy Increased stroke risk, poor outcome Vascular cognitive impairment Alzheimer s dementia Iadecola, Acta. Neuropath. Sept. 2010
11 Common Genetic and Environmental Risk Factors for AD and Atherosclerosis Epidemiological Factor ApoEe4 polymorphism Hypercholesterolemia Hypertension Hyperhomocysteinemia Diabetes mellitus Metabolic syndrome Smoking Systemic inflammation Increased fat intake and obesity Source: Casserly I, Topol E. Lancet 2004; 363:
12 Illustrative Example of Role of Vascular Risk Factors in AD Midlife vascular risk factors and role in AD BMI>30 SBP>140 mm Hg Cholesterol> 251mg/dL Odds ratio for each factor on risk of AD Approximately 2 fold Odds ratio for all 3 factors on risk of AD Approximately 6 fold AD= Alzheimer disease BMI= body mass index SBP= systolic blood pressure Source: Kivipelto M et al. Arch Neurol 2005; 62: (also cited in Michel J-P et al. JAMA 2008; 299: )
13 Key Recommendations Vascular Contributions to Cognitive Impairment & Dementia Source: Gorelick PB, Scuteri A, Black S, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42:
14 Lifestyle Factor Recommendations The following lifestyle intervention in persons at risk for VCI is reasonable: 1. Smoking cessation (Class IIa, Level of Evidence A) 2011 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited.
15 Lifestyle Factor Recommendations The following lifestyle interventions in persons at risk for VCI may be reasonable: 1. Moderation of alcohol intake (Class IIb, Level of Evidence B) 2.Weight Control (Class Ilb, Level of Evidence B) 3.Physical Activity (Class IIb, Level of Evidence B) The following is not recommended: The use of antioxidants and B vitamins in persons at risk for VCI are not useful based on current evidence ( Class III, Level of Evidence A) 2011 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited.
16 Physiologic Risk Factors VCI Treatment Recommendations Treatment of the following physiologic factor in persons at risk for VCI is recommended: Hypertension (Class I, Level of Evidence A) Treatment of the following physiologic factors in persons at risk for VCI may be reasonable: Hyperglycemia (Class IIb, Level of Evidence C) Hypercholesterolemia (Class IIb, Level of Evidence A) It is uncertain if treatment of inflammation will reduce the risk of VCI in persons at risk of VCI. (Class IIb, Level of Evidence C) Source: Gorelick PB, Scuteri A, Black S, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42: American Heart Association, Inc. All rights reserved. Unauthorized use prohibited.
17 Recommendations Regarding Blood Pressure Lowering and Cognition 1. In patients with stroke, lowering blood pressure is effective for reducing the risk of post-stroke dementia (Class I, Level of Evidence: B) 2. There is reasonable evidence that, in middleaged and young-elderly, lowering blood pressure can be useful for the prevention of late-life dementia (Class IIa, Level of Evidence: B) 3. The usefulness of lowering blood pressure in individuals age 80+ is not well-established (Class IIb, Level of Evidence: B) 2011 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited. Source: Gorelick PB, Scuteri A, Black S, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42:
18 Other Interventions on Vascular Factors: Recommendations 1. A Mediterranean-type dietary pattern has been associated with less cognitive decline in several studies and may be reasonable (Class IIb, Level of Evidence B). 2. Vitamin supplementation is not proven to improve cognitive function, even if homocysteine levels have been positively influenced, and its usefulness is not well established. (Class IIb, Level of Evidence B). 3. Physical activity might be considered for the prevention of cognitive impairment (Class IIb, Level of Evidence B), but the usefulness of other lifestyle or vitamin interventions are uncertain (Class IIb, Level of Evidence B). 4. Effectiveness of antiaggregant therapy for VCI is not well established (Class IIb, Level of Evidence B) American Heart Association, Inc. All rights reserved. Unauthorized use prohibited.
19 National Institute of Health State-of-the- Science Conference Statement on Preventing AD & Cognitive Decline-4 Conclusions 1. No association of even moderate evidence that a modifiable risk factor reduced risk of AD 2. Most studies showed no association, inconclusive evidence & quality of evidence was generally low 3. Evidence inadequate to conclude any therapeutic intervention delayed onset of AD 4. RCTs had not identified positive treatment benefits 5. Inconsistent & varied methodological assessments prevented clear & concise answers to questions 6. These gaps need to be bridged Source: Daviglus ML et al Ann Intern Med 2010; 153:
20 Next Steps in Research Vascular Contributions to Cognitive Impairment & Dementia Source: Gorelick PB, Scuteri A, Black S, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42:
21 Research Agenda 1. Develop & validate practicable cognitive batteries 2. Pursue novel neuroimaging methods to identify biomarkers & risks for CVBI 3. Longitudinal clinical-neuropathological & neuroradiological studies 4. Centers of excellence for study of CVBI 5. RCTs targeting vascular risk factors 6. Preclinical and clinical studies of aging of arteries & neurovascular unit 7. Identify novel risk markers for CVBI 8. Search for genetic & other novel factors for prevention CVBI= cerebral vascular brain injury RCTs= randomized controlled trials Source: Gorelick PB, Scuteri A, Black S, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42:
22 Summary Vascular cognitive impairment (VCI) may occur when there is clinical or subclinical cerebral vascular brain injury (CVBI) Clinical and subclinical CVBI may lead to VCI via strategically placed small and large brain strokes and white matter lesions (leukoaraiosis) Cardiovascular risks such as hypertension and other factors are linked not only to VCI risk but also to Alzheimer s disease risk Blood pressure lowering is recommended in persons at risk for VCI prevention
DISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD
STROKE AND HEART DISEASE IS THERE A LINK BEYOND RISK FACTORS? D AN IE L T. L AC K L AN D DISCLOSURES Member of NHLBI Risk Assessment Workgroup RISK ASSESSMENT Count major risk factors For patients with
More informationThe International Agenda for Stroke
1st Global Conference on Healthy Lifestyles and Noncommunicable Diseases Control Moscow, 28-29 April, 2011 The International Agenda for Stroke Marc Fisher MD, University of Massachusetts Editor-in-Chief,
More informationMild Cognitive Impairment
Mild Cognitive Impairment Claudia Cooper UCL Clinical Reader Honorary consultant old age psychiatrist, Camden and Islington NHS FT Talk plan Diagnosis Treating MCI: Evidence from RCTs Evidence from prospective
More informationListen to your heart: Good Cardiovascular Health for Life
Listen to your heart: Good Cardiovascular Health for Life Luis R. Castellanos MD, MPH Assistant Clinical Professor of Medicine University of California San Diego School of Medicine Sulpizio Family Cardiovascular
More informationTYPE 2 DIABETES MELLITUS: NEW HOPE FOR PREVENTION. Robert Dobbins, M.D. Ph.D.
TYPE 2 DIABETES MELLITUS: NEW HOPE FOR PREVENTION Robert Dobbins, M.D. Ph.D. Learning Objectives Recognize current trends in the prevalence of type 2 diabetes. Learn differences between type 1 and type
More informationThe Link Between Obesity and Diabetes The Rapid Evolution and Positive Results of Bariatric Surgery
The Link Between Obesity and Diabetes The Rapid Evolution and Positive Results of Bariatric Surgery Michael E. Farkouh, MD, MSc Peter Munk Chair in Multinational Clinical Trials Director, Heart and Stroke
More informationMetabolic Syndrome Overview: Easy Living, Bitter Harvest. Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007
Metabolic Syndrome Overview: Easy Living, Bitter Harvest Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007 Evolution of Metabolic Syndrome 1923: Kylin describes clustering
More informationNeal Rouzier responds to the JAMA article on Men and Testosterone
Neal Rouzier responds to the JAMA article on Men and Testosterone On the first day the JAMA article was released I received 500 emails from physicians and patients requesting my opinion of the article
More informationTHEORIES OF NEUROLOGICAL AGING AND DEMENTIA
THEORIES OF NEUROLOGICAL AGING AND DEMENTIA Aging Overview The primary care physician must advise middle-age and older patients about ways to age successfully. Dementia is a common disabling illness that
More informationHow To Treat Dyslipidemia
An International Atherosclerosis Society Position Paper: Global Recommendations for the Management of Dyslipidemia Introduction Executive Summary The International Atherosclerosis Society (IAS) here updates
More informationΗ δίαιτα στην πρόληψη του αγγειακού εγκεφαλικού επεισοδίου
ΠΡΟΓΡΑΜΜΑ ΜΕΤΑΠΤΥΧΙΑΚΩΝ ΣΠΟΥΔΩΝ «Η ΔΙΑΤΡΟΦΗ ΣΤΗΝ ΥΓΕΙΑ ΚΑΙ ΣΤΗ ΝΟΣΟ» Η δίαιτα στην πρόληψη του αγγειακού εγκεφαλικού επεισοδίου Γεώργιος Ντάιος Παθολογική Κλινική Πανεπιστημίου Θεσσαλίας Stroke Statistics
More informationDCCT and EDIC: The Diabetes Control and Complications Trial and Follow-up Study
DCCT and EDIC: The Diabetes Control and Complications Trial and Follow-up Study National Diabetes Information Clearinghouse U.S. Department of Health and Human Services NATIONAL INSTITUTES OF HEALTH What
More informationJNC-8 Blood Pressure and ACC/AHA Cholesterol Guideline Updates. January 30, 2014
JNC-8 Blood Pressure and ACC/AHA Cholesterol Guideline Updates January 30, 2014 GOALS Review key recommendations from recently published guidelines on blood pressure and cholesterol management Discuss
More informationStroke Prevention in Primary Care
Stroke Prevention in Primary Care ANNE LINDSTROM, APN, FNP-BC, SCRN Disclosures I have no disclosures. Objectives Describe tools available to estimate patient risk of stroke Review non-modifiable risk
More informationVertebrobasilar Disease
The Vascular Surgery team at the University of Michigan is dedicated to providing exceptional treatments for in the U-M Cardiovascular Center (CVC), our new state-of-the-art clinical facility. Treatment
More informationPsoriasis Co-morbidities: Changing Clinical Practice. Theresa Schroeder Devere, MD Assistant Professor, OHSU Dermatology. Psoriatic Arthritis
Psoriasis Co-morbidities: Changing Clinical Practice Theresa Schroeder Devere, MD Assistant Professor, OHSU Dermatology Psoriatic Arthritis Psoriatic Arthritis! 11-31% of patients with psoriasis have psoriatic
More informationDIET AND EXERCISE STRATEGIES FOR WEIGHT LOSS AND WEIGHT MAINTENANCE
DIET AND EXERCISE STRATEGIES FOR WEIGHT LOSS AND WEIGHT MAINTENANCE 40 yo woman, BMI 36. Motivated to begin diet therapy. Which of the following is contraindicated: Robert B. Baron MD MS Professor and
More informationSystolic Blood Pressure Intervention Trial (SPRINT) Principal Results
Systolic Blood Pressure Intervention Trial (SPRINT) Principal Results Paul K. Whelton, MB, MD, MSc Chair, SPRINT Steering Committee Tulane University School of Public Health and Tropical Medicine, and
More informationMY TYPE 2 DIABETES NUMBERS
BLOOD SUGAR MANAGEMENT GUIDE MY TYPE 2 DIABETES NUMBERS Understanding and Tracking the ABCs of Type 2 Diabetes 1 BLOOD MY TYPE SUGAR 2 DIABETES MANAGEMENT ABC NUMBERS GUIDE When you have type 2 diabetes,
More information4/4/2013. Mike Rizo, Pharm D, MBA, ABAAHP THE PHARMACIST OF THE FUTURE? METABOLIC SYNDROME AN INTEGRATIVE APPROACH
METABOLIC SYNDROME AN INTEGRATIVE APPROACH AN OPPORTUNITY FOR PHARMACISTS TO MAKE A DIFFERENCE Mike Rizo, Pharm D, MBA, ABAAHP THE EVOLUTION OF THE PHARMACIST 1920s 1960s 2000s THE PHARMACIST OF THE FUTURE?
More informationROLE OF LDL CHOLESTEROL, HDL CHOLESTEROL AND TRIGLYCERIDES IN THE PREVENTION OF CORONARY HEART DISEASE AND STROKE
ROLE OF LDL CHOLESTEROL, HDL CHOLESTEROL AND TRIGLYCERIDES IN THE PREVENTION OF CORONARY HEART DISEASE AND STROKE I- BACKGROUND: Coronary artery disease and stoke are the major killers in the United States.
More informationCoronary Heart Disease (CHD) Brief
Coronary Heart Disease (CHD) Brief What is Coronary Heart Disease? Coronary Heart Disease (CHD), also called coronary artery disease 1, is the most common heart condition in the United States. It occurs
More informationGuidelines for the management of hypertension in patients with diabetes mellitus
Guidelines for the management of hypertension in patients with diabetes mellitus Quick reference guide In the Eastern Mediterranean Region, there has been a rapid increase in the incidence of diabetes
More informationSecondary Stroke Prevention Luke Bradbury, MD 10/4/14 Fall WAPA Conferfence
Guidelines Secondary Stroke Prevention Luke Bradbury, MD 10/4/14 Fall WAPA Conferfence Stroke/TIA Nearly 700,000 ischemic strokes and 240,000 TIAs every year in the United States Currently, the risk for
More informationBody Composition & Longevity. Ohan Karatoprak, MD, AAFP Clinical Assistant Professor, UMDNJ
Body Composition & Longevity Ohan Karatoprak, MD, AAFP Clinical Assistant Professor, UMDNJ LONGEVITY Genetic 25% Environmental Lifestyle Stress 75% BMI >30 OBESE 25-30 OVERWEIGHT 18-25 NORMAL WEIGHT 18
More informationAtherosclerosis of the aorta. Artur Evangelista
Atherosclerosis of the aorta Artur Evangelista Atherosclerosis of the aorta Diagnosis Classification Prevalence Risk factors Marker of generalized atherosclerosis Risk of embolism Therapy Diagnosis Atherosclerosis
More informationEvidence-Based Secondary Stroke Prevention and Adherence to Guidelines
Evidence-Based Secondary Stroke Prevention and Adherence to Guidelines Mitchell S.V. Elkind, MD, MS Associate Professor of Neurology Columbia University New York, NY Presenter Disclosure Information Mitchell
More informationLIPID PANEL CHOLESTEROL LIPOPROTEIN, ELECTROPHORETIC SEPARATION LIPOPROTEIN, DIRECT MEASUREMENT (HDL) LDL DIRECT TRIGLYCERIDES
Test Code Test Name CPT CHOL Cholesterol, Serum 82465 HDL HDL, (High Density Lipoprotein) 83718 TRIG Triglycerides, Serum 84478 FTRIG Triglycerides (Fluid) 84478 LIPID Lipid Panel 80061 LDL LDL (Low Density
More informationPrimary Care Management of Women with Hyperlipidemia. Julie Marfell, DNP, BC, FNP, Chairperson, Department of Family Nursing
Primary Care Management of Women with Hyperlipidemia Julie Marfell, DNP, BC, FNP, Chairperson, Department of Family Nursing Objectives: Define dyslipidemia in women Discuss the investigation process leading
More informationAppendix: Description of the DIETRON model
Appendix: Description of the DIETRON model Much of the description of the DIETRON model that appears in this appendix is taken from an earlier publication outlining the development of the model (Scarborough
More informationHigh Blood Pressure (Essential Hypertension)
Sacramento Heart & Vascular Medical Associates February 18, 2012 500 University Ave. Sacramento, CA 95825 Page 1 916-830-2000 Fax: 916-830-2001 What is essential hypertension? Blood pressure is the force
More informationCardiovascular Disease Risk Factors Part XII Insulin Resistance By James L. Holly, MD Your Life Your Health The Examiner September 15, 2005
Cardiovascular Disease Risk Factors Part XII By James L. Holly, MD Your Life Your Health The Examiner September 15, 2005 As we approach the end of our extended series on cardiovascular disease risk factors,
More informationMaking Sense of the New Statin guidelines. They are more than just lowering your cholesterol!
Making Sense of the New Statin guidelines They are more than just lowering your cholesterol! No Disclosures Margaret (Peg) O Donnell DNPs, FNP, ANP B-C, FAANP Senior Nurse Practitioner South Nassau Communities
More informationEducation. Panel. Triglycerides & HDL-C
Triglycerides & HDL-C Thomas Dayspring, MD, ACP Clinical Assistant Professor of Medicine University of Medicine and Dentistry of New Jersey Attending in Medicine: St Joseph s s Hospital, Paterson, NJ Certified
More informationWellness for People with MS: What do we know about Diet, Exercise and Mood And what do we still need to learn? March 2015
Wellness for People with MS: What do we know about Diet, Exercise and Mood And what do we still need to learn? March 2015 Introduction Wellness and the strategies needed to achieve it is a high priority
More informationRole of Body Weight Reduction in Obesity-Associated Co-Morbidities
Obesity Role of Body Weight Reduction in JMAJ 48(1): 47 1, 2 Hideaki BUJO Professor, Department of Genome Research and Clinical Application (M6) Graduate School of Medicine, Chiba University Abstract:
More informationMain Effect of Screening for Coronary Artery Disease Using CT
Main Effect of Screening for Coronary Artery Disease Using CT Angiography on Mortality and Cardiac Events in High risk Patients with Diabetes: The FACTOR-64 Randomized Clinical Trial Joseph B. Muhlestein,
More informationClinical Research on Lifestyle Interventions to Treat Obesity and Asthma in Primary Care Jun Ma, M.D., Ph.D.
Clinical Research on Lifestyle Interventions to Treat Obesity and Asthma in Primary Care Jun Ma, M.D., Ph.D. Associate Investigator Palo Alto Medical Foundation Research Institute Consulting Assistant
More informationEmerging therapies for Intracerebral Hemorrhage
Emerging therapies for Intracerebral Hemorrhage Chitra Venkat, MBBS, MD, MSc. Associate Professor of Neurology and Neurological Sciences Stroke and Neurocritical Care. Stanford University Learning objectives
More informationStroke: Major Public Health Burden. Stroke: Major Public Health Burden. Stroke: Major Public Health Burden 5/21/2012
Faculty Prevention Sharon Ewer, RN, BSN, CNRN Stroke Program Coordinator Baptist Health Montgomery, Alabama Satellite Conference and Live Webcast Monday, May 21, 2012 2:00 4:00 p.m. Central Time Produced
More informationRisk Factors for Fire Fighter Cardiovascular Disease
Risk Factors for Fire Fighter Cardiovascular Disease EXECUTIVE SUMMARY Prepared by: Jefferey L. Burgess, MD, MS, MPH Mel and Enid Zuckerman College of Public Health The University of Arizona The Fire Protection
More informationCardiovascular Disease Risk Factors
Cardiovascular Disease Risk Factors Risk factors are traits and life-style habits that increase a person's chances of having coronary artery and vascular disease. Some risk factors cannot be changed or
More informationStroke & Alzheimer s Disease: An Inflammatory Duo
Stroke & Alzheimer s Disease: An Inflammatory Duo Stroke and Dementia One in 3 will experience a stroke, dementia or both 64% of persons with a stroke have some degree of cognitive impairment and up to
More informationCopywrite - Eric Freitag, Psy.D., 2012
Diagnosis, Intervention and Care for Patients With Cognitive Impairment Eric J. Freitag, Psy.D, FACPN Diplomate, American College of Professional Neuropsychology Mt. Diablo Memory Center Founder/Executive
More informationThe Influence of Infant Health on Adult Chronic Disease
The Influence of Infant Health on Adult Chronic Disease Womb to Tomb Dr Clare MacVicar Introduction Many diseases in adulthood are related to growth patterns during early life Maternal nutrition important
More informationNCD for Lipids Testing
Applicable CPT Code(s): NCD for Lipids Testing 80061 Lipid panel 82465 Cholesterol, serum or whole blood, total 83700 Lipoprotein, blood; electrophoretic separation and quantitation 83701 Lipoprotein blood;
More informationDementia One Day Essentials 2015
Dementia One Day Essentials 2015 1 Dementia One Day Essentials 2015 2 At Risk of Dementia: Mild Cognitive Impairment and Other Non-Dementia Diagnoses Dr Jill Rasmussen Declaration of Interests NHS: GP
More informationINTRODUCTION TO EECP THERAPY
INTRODUCTION TO EECP THERAPY is an FDA cleared, Medicare approved, non-invasive medical therapy for the treatment of stable and unstable angina, congestive heart failure, acute myocardial infarction, and
More informationCardiovascular disease physiology. Linda Lowe-Krentz Bioscience in the 21 st Century October 14, 2011
Cardiovascular disease physiology Linda Lowe-Krentz Bioscience in the 21 st Century October 14, 2011 Content Introduction The number 1 killer in America Some statistics Recommendations The disease process
More informationTABLE OF CONTENTS. The Cost of Diabesity... 3. Employer Solutions... 4 Provide a Worksite Weight Loss Program Tailored for Diabetes...
TH E TABLE OF CONTENTS The Cost of Diabesity... 3 Employer Solutions... 4 Provide a Worksite Weight Loss Program Tailored for Diabetes... 4 Provide Healthy Food Options at the Workplace... 4 Make it Easy
More informationStress is linked to exaggerated cardiovascular reactivity. 1) Stress 2) Hostility 3) Social Support. Evidence of association between these
Psychosocial Factors & CHD Health Psychology Psychosocial Factors 1) Stress 2) Hostility 3) Social Support Evidence of association between these psychosocial factors and CHD Physiological Mechanisms Stress
More informationCholinesterase inhibitors and memantine use for Alzheimer s disease TOPIC REVIEW
Cholinesterase inhibitors and memantine use for Alzheimer s disease TOPIC REVIEW Diagnosis of Dementia : DSM-IV criteria Loss of memory and one or more other cognitive abilities Aphasia Apraxia Agnosia
More informationDiabetes and Heart Disease
Diabetes and Heart Disease Diabetes and Heart Disease According to the American Heart Association, diabetes is one of the six major risk factors of cardiovascular disease. Affecting more than 7% of the
More informationImproving cardiometabolic health in Major Mental Illness
Improving cardiometabolic health in Major Mental Illness Dr. Adrian Heald Consultant in Endocrinology and Diabetes Leighton Hospital, Crewe and Macclesfield Research Fellow, Manchester University Metabolic
More informationSTROKE PREVENTION AND TREATMENT MARK FISHER, MD PROFESSOR OF NEUROLOGY UC IRVINE
STROKE PREVENTION AND TREATMENT MARK FISHER, MD PROFESSOR OF NEUROLOGY UC IRVINE CASE REPORT: ACUTE STROKE MANAGEMENT 90 YEAR OLD WOMAN, PREVIOUSLY ACTIVE AND INDEPENDENT, CHRONIC ATRIAL FIBRILLATION,
More informationDo You Know the Health Risks of Being Overweight?
Do You Know the Health Risks of Being Overweight? U.S. Department of Health and Human Services NATIONAL INSTITUTES OF HEALTH WIN Weight-control Information Network What are the risks to my health from
More informationAlzheimer s disease. What is Alzheimer s disease?
Alzheimer s disease What is Alzheimer s disease? What we know about dementia and Alzheimer s disease Alzheimer s disease is the most common of a large group of disorders known as dementias. It is an irreversible
More informationStrokes and High Blood Pressure
Strokes and High Blood Pressure Quick Review from last Week: What is a Stroke Stroke: blood supply to the brain is severely limited or cut off With no blood to carry oxygen to them, brain cells will die
More informationMethyl groups, like vitamins, are
Methyl groups are essential for the body to function properly and must be obtained from the diet The need for methyl groups increases under stress Chapter 11 Betaine a new B vitamin Methyl groups reduce
More informationObstructive sleep apnea and type 2 diabetes Obstructive Sleep Apnea (OSA) may contribute to or exacerbate type 2 diabetes for some of your patients.
Obstructive sleep apnea and type 2 diabetes Obstructive Sleep Apnea (OSA) may contribute to or exacerbate type 2 diabetes for some of your patients. Prevalence of OSA and diabetes Prevalence of OSA Five
More informationBarriers to Healthcare Services for People with Mental Disorders. Cardiovascular disorders and diabetes in people with severe mental illness
Barriers to Healthcare Services for People with Mental Disorders Cardiovascular disorders and diabetes in people with severe mental illness Dr. med. J. Cordes LVR- Klinikum Düsseldorf Kliniken der Heinrich-Heine-Universität
More informationUnderstanding the Pain Trajectory During Treadmill Testing in Peripheral Artery Disease
Understanding the Pain Trajectory During Treadmill Testing in Peripheral Artery Disease Diane Treat-Jacobson, PhD, RN, FAHA, FAAN Susan J. Henly, PhD, RN Ulf G. Bronas, PhD, ATC, ATR Arthur S. Leon, MD,
More information1. PATHOPHYSIOLOGY OF METABOLIC SYNDROME
1. PATHOPHYSIOLOGY OF METABOLIC SYNDROME Izet Aganović, Tina Dušek Department of Internal Medicine, Division of Endocrinology, University Hospital Center Zagreb, Croatia 1 Introduction The metabolic syndrome
More informationMedical Fitness. Annual Meeting December 2012. By: Deb Riggs, MEd, General Manager
Exercise is Medicine Referral Process Utilizing an EMR Medical Fitness Association Annual Meeting December 2012 By: Deb Riggs, MEd, General Manager Faculty Disclosure Deb Riggs Deb Riggs has listed no
More informationPrevention of and the Screening for Diabetes Part I Insulin Resistance By James L. Holly, MD Your Life Your Health The Examiner January 19, 2012
Prevention of and the Screening for Diabetes Part I Insulin Resistance By James L. Holly, MD Your Life Your Health The Examiner January 19, 2012 In 2002, SETMA began a relationship with Joslin Diabetes
More informationMultiple comorbidities: additive and predictive of cardiovascular risk. Peter M. Nilsson Lund University University Hospital Malmö, Sweden
Multiple comorbidities: additive and predictive of cardiovascular risk Peter M. Nilsson Lund University University Hospital Malmö, Sweden Clinical outcomes: major complications of CVD Heart Attack/ACS
More informationUnmet Needs for Parkinson s Disease Therapeutics
Unmet Needs for Parkinson s Disease Therapeutics Coalition Against Major Diseases & FDA Workshop October 20, 2014 Caroline M Tanner MD, PhD Director, Parkinson's Disease Research Education and Clinical
More informationYour healthcare provider has ordered a Boston Heart Cardiac Risk Assessment
Your healthcare provider has ordered a Boston Heart Cardiac Risk Assessment What does that mean for you? Your healthcare provider has determined that you may be at risk for cardiovascular disease (CVD).
More informationHigh Blood Pressure. Dr. Rath s Cellular Health Recommendations for Prevention and Adjunct Therapy
4 High Blood Pressure Dr. Rath s Cellular Health Recommendations for Prevention and Adjunct Therapy The Facts About High Blood Pressure Dr. Rath s Cellular Health Recommendations: - Documented Health Benefits
More informationJournal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators
Journal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators Shaikha Al Naimi Doctor of Pharmacy Student College of Pharmacy Qatar University
More informationCME Test for AMDA Clinical Practice Guideline. Diabetes Mellitus
CME Test for AMDA Clinical Practice Guideline Diabetes Mellitus Part I: 1. Which one of the following statements about type 2 diabetes is not accurate? a. Diabetics are at increased risk of experiencing
More informationExchange solutes and water with cells of the body
Chapter 8 Heart and Blood Vessels Three Types of Blood Vessels Transport Blood Arteries Carry blood away from the heart Transport blood under high pressure Capillaries Exchange solutes and water with cells
More informationMULTIMODAL THERAPY FOR MS- ASSOCIATED COGNITIVE DYSFUNCTION
MULTIMODAL THERAPY FOR MS- ASSOCIATED COGNITIVE DYSFUNCTION Michael K. Racke, MD Professor and Chairman in Neurology The Helen C. Kurtz Chair in Neurology Department of Neurology Ohio State University
More informationIntroduction. Pathogenesis of type 2 diabetes
Introduction Type 2 diabetes mellitus (t2dm) is the most prevalent form of diabetes worldwide. It is characterised by high fasting and high postprandial blood glucose concentrations (hyperglycemia). Chronic
More informationPEER REVIEW HISTORY ARTICLE DETAILS VERSION 1 - REVIEW. Hongcai Shang Beijing university of Chinese medicine, China 11-Nov-2015
PEER REVIEW HISTORY BMJ Open publishes all reviews undertaken for accepted manuscripts. Reviewers are asked to complete a checklist review form (http://bmjopen.bmj.com/site/about/resources/checklist.pdf)
More informationTreatment of High Blood Cholesterol in Adults (Adult Treatment Panel II).
Complete Summary GUIDELINE TITLE (1)Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment
More informationGuidance for Industry Diabetes Mellitus Evaluating Cardiovascular Risk in New Antidiabetic Therapies to Treat Type 2 Diabetes
Guidance for Industry Diabetes Mellitus Evaluating Cardiovascular Risk in New Antidiabetic Therapies to Treat Type 2 Diabetes U.S. Department of Health and Human Services Food and Drug Administration Center
More informationfor reviewing the information in this booklet.
Alzheimer s Australia would like to thank Associate Professor Michael Woodward Medical Director, Aged & Residential Care Services, Austin Health Chief Medical Advisor, Alzheimer s Australia Vic for reviewing
More informationYour Life Your Health Cariodmetabolic Risk Syndrome Part VII Inflammation chronic, low-grade By James L. Holly, MD The Examiner January 25, 2007
Your Life Your Health Cariodmetabolic Risk Syndrome Part VII Inflammation chronic, low-grade By James L. Holly, MD The Examiner January 25, 2007 The cardiometabolic risk syndrome is increasingly recognized
More informationCardiac Assessment for Renal Transplantation: Pre-Operative Clearance is Only the Tip of the Iceberg
Cardiac Assessment for Renal Transplantation: Pre-Operative Clearance is Only the Tip of the Iceberg 2 nd Annual Duke Renal Transplant Symposium March 1, 2014 Durham, NC Joseph G. Rogers, M.D. Associate
More informationCOMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP) GUIDELINE ON THE EVALUATION OF MEDICINAL PRODUCTS FOR CARDIOVASCULAR DISEASE PREVENTION
European Medicines Agency Pre-Authorisation Evaluation of Medicines for Human Use London, 25 September 2008 Doc. Ref. EMEA/CHMP/EWP/311890/2007 COMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP) GUIDELINE
More informationWill The Coronary Calcium Score Affect the Decision To Treat With Statins?
Will The Coronary Calcium Score Affect the Decision To Treat With Statins? Amresh Raina M.D. Division of Cardiology University of Pennsylvania Disclosures No financial relationships relevant to this presentation
More informationYour Results. For more information visit: www.sutton.gov.uk/healthchecks. Name: Date: In partnership with
Your Results Name: Date: For more information visit: www.sutton.gov.uk/healthchecks In partnership with Introduction Everyone is at risk of developing diabetes, heart disease, kidney disease, stroke and
More informationThe WHI 12 Years Later: What Have We Learned about Postmenopausal HRT?
AACE 23 rd Annual Scientific and Clinical Congress (2014) Syllabus Materials: The WHI 12 Years Later: What Have We Learned about Postmenopausal HRT? JoAnn E. Manson, MD, DrPH, FACP, FACE Chief, Division
More informationDiabetes, hypertension and a lot more `in the elderly` JORIS SCHAKEL INTERNIST- CLINICAL GERIATRICIAN JGSCHAKEL@SEHOS.CW
Diabetes, hypertension and a lot more `in the elderly` JORIS SCHAKEL INTERNIST- CLINICAL GERIATRICIAN JGSCHAKEL@SEHOS.CW IT`S HARD TO GIVE GENERAL ADVICE! ``The Elderly`` Heterogeneous group ;widely varying
More informationAtrial Fibrillation: A Different Perspective. Michael Heffernan MD PhD FRCPC FACC Staff Cardiologist Oakville Hospital
Atrial Fibrillation: A Different Perspective Michael Heffernan MD PhD FRCPC FACC Staff Cardiologist Oakville Hospital Faculty/Presenter Disclosure Faculty: Dr. Michael Heffernan Relationships with commercial
More informationCohort Studies. Sukon Kanchanaraksa, PhD Johns Hopkins University
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this
More informationHigh Blood Cholesterol
National Cholesterol Education Program ATP III Guidelines At-A-Glance Quick Desk Reference 1 Step 1 2 Step 2 3 Step 3 Determine lipoprotein levels obtain complete lipoprotein profile after 9- to 12-hour
More informationStroke is a major source of mortality and morbidity in the
AHA/ASA Guideline Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack A Guideline for Healthcare Professionals From the American Heart Association/American Stroke
More informationAtrial Fibrillation in the ICU: Attempting to defend 4 controversial statements
Atrial Fibrillation in the ICU: Attempting to defend 4 controversial statements Salmaan Kanji, Pharm.D. The Ottawa Hospital The Ottawa Hospital Research Institute Conflict of Interest No financial, proprietary
More information6/5/2014. Objectives. Acute Coronary Syndromes. Epidemiology. Epidemiology. Epidemiology and Health Care Impact Pathophysiology
Objectives Acute Coronary Syndromes Epidemiology and Health Care Impact Pathophysiology Unstable Angina NSTEMI STEMI Clinical Clues Pre-hospital Spokane County EMS Epidemiology About 600,000 people die
More informationObjectives. Evaluation of Memory Loss. Cognitive Impairment. Clinical Questions. Medicare Wellness Visit
Evaluation of Memory Loss and Mild Cognitive Impairment Skotti Church, MD Geriatrics Grand Rounds 4/3/2014 Objectives 1. Describe recommendations and tools for evaluation of cognitive impairment 2. Define
More informationTherapeutic Approach in Patients with Diabetes and Coronary Artery Disease
Home SVCC Area: English - Español - Português Therapeutic Approach in Patients with Diabetes and Coronary Artery Disease Martial G. Bourassa, MD Research Center, Montreal Heart Institute, Montreal, Quebec,
More informationCardiovascular Disease and the Endothelium
Cardiovascular Disease and the Endothelium by Jeffrey Porro A series of articles for general audiences This series of essays was developed as part of FASEB s efforts to educate the general public, and
More informationBlood Pressure Assessment Program Screening Guidelines
Blood Pressure Assessment Program Screening Guidelines Assessment Pre-Assessment Prior to/during assessment, explain to client the following: What is meant by high blood pressure; What are the effects
More informationComplicanze del diabete nel bambino e nell adolescente
Clinica Pediatrica Università di Chieti Complicanze del diabete nel bambino e nell adolescente Franco Chiarelli XVII Congresso Nazionale SIPPS Parma, 25 Novembre 2005 Type 1 diabetes in childhood: Only
More informationImproving drug prescription in elderly diabetic patients. FRANCESC FORMIGA Hospital Universitari de Bellvitge
Improving drug prescription in elderly diabetic patients FRANCESC FORMIGA Hospital Universitari de Bellvitge High prevalence, but also increases the incidence. The older the patients, the higher the percentages
More informationPrimary Endpoints in Alzheimer s Dementia
Primary Endpoints in Alzheimer s Dementia Dr. Karl Broich Federal Institute for Drugs and Medical Devices (BfArM) Kurt-Georg-Kiesinger-Allee 38, D-53175 Bonn Germany Critique on Regulatory Decisions in
More informationImproving Diabetes Care for All New Yorkers
Improving Diabetes Care for All New Yorkers Lynn D. Silver, MD, MPH Assistant Commissioner Bureau of Chronic Disease Prevention and Control Diana K. Berger, MD, MSc Medical Director Diabetes Prevention
More informationThe Canadian Association of Cardiac
Reinventing Cardiac Rehabilitation Outside of acute care institutions, cardiovascular disease is a chronic, inflammatory process; the reduction or elimination of recurrent acute coronary syndromes is a
More information