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Treating cognitive disorders through rehab

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IT’S heartbreaking for anyone to see a loved one become ill and physically disabled. But it may be even more devastating to live with a family member who’s in good physical health but suffers from serious cognitive impairment.

According to rehabilitation physician and ReGen Rehabilitation International Sdn Bhd chief medical officer Prof Dr Lydia Abdul Latif, neurocognitive disorder refers to a spectrum of illnesses that can impact a person’s cognitive functions.

“They can range from less severe cases such as mild cognitive impairment (MCI) or extend to more debilitating degrees like major neurocognitive disorder,” she explained.

“The condition can then affect functions such as memory, attention, language, judgment (impulse control and decision-making) as well as learning.”

Dr Lydia said the illness can be caused by all sorts of brain problems including infections, tumours, injuries as well as diseases like stroke, epilepsy, multiple sclerosis (a disabling disease of the central nervous system) and Parkinson’s disease (chronic degenerative disorder).

Other medical conditions and lifestyle factors that have been linked to an increased risk of cognitive change include diabetes, smoking, hypertension, elevated cholesterol, depression, lack of physical exercise and infrequent participation in mentally or socially stimulating activities.

Dr Lydia pointed out that some medicine, or combinations of medicines, can also affect a person’s thinking and the way the brain works.

For instance, certain drugs can cause confusion, memory loss, hallucinations and delusions in older adults.

“Drugs can also interact with food, dietary supplements, alcohol and other substances. Therefore, some of these interactions can affect how the brain functions,” she said.

Some of the drugs that may harm cognitive health in older people include anxiety and depression medications, sleeping aids, antipsychotics, muscle relaxants as well as medicines for the relief of stomach cramps, intestines and the bladder.

How neurocognitive conditions
are identified

There are many symptoms of cognitive impairments. Besides the obvious ones like memory and attention problems, they can sometimes manifest as impulsive behaviour, depression, anxiety and apathy, said Dr Lydia.

Because the symptoms of neurocognitive disorders can sometimes appear vague, she said there are several brain imaging and cognitive tests that will determine if an individual is experiencing neurocognitive abnormalities.

Mild cognitive impairment (MCI) could cause cognitive changes that are serious enough to be noticed. However, the changes are not so severe that it would interfere with daily life or independent functions.

“MCI is an intermediate stage between the expected cognitive decline of normal ageing and the more-serious decline of dementia,” said Dr Lydia.

“Patients with MCI should be able to perform normal daily activities like getting dressed or controlling sphincters, although they may experience mild deficits in instrumental activities of daily life such as job performance.”

As a result, MCI sufferers tend to forget important events or appointments, lose their train of thought or thread of conversations, feel overwhelmed about making decisions or accomplishing a task and have trouble interpreting instructions and finding their way around familiar environments.

What can be done
about neurological disorders?

Physical activities, said Dr Lydia, have been linked to improved cognitive performance and reduced risk of Alzheimer’s disease.

“Exercising on a regular basis benefits the heart and blood vessels, including those that nourish the brain. Participating in mentally stimulating and socially engaging activities may also help sustain brain functions.”

Besides lifestyle adjustments, she said cognitive rehabilitation can give patients the best possible chance of regaining physical and cognitive functions.

Australian occupational therapist Dr Judy Ranka said there is still a lack of awareness about cognitive rehabilitation among the public.

“It is a multi-disciplinary programme to help brain-injured or cognitively impaired individuals restore normal functions or compensate for cognitive deficits,” she said.

Cognitive rehabilitation includes restorative treatments, training in compensatory strategies, caregiver training, environmental manipulations and programmes that aim to enhance cognitive development.

“Cognitive rehabilitation should be tailored to the patient’s neuropsychological (structure and function of the brain) profile, premorbid cognitive characteristics as well as goals for life activities and participation for optimum result,” said Dr Ranka.

Dr Lydia and Dr Ranka offered their insights on these issues at ReGen Rehabilitation hospital’s health talk titled “Care for Your Brain: Cognition and Cognitive Rehabilitation”, held at its premises in Petaling Jaya recently.

The session was part of the hospital’s series of public health talks, aimed at creating awareness about certain health issues such as Parkinson’s disease and cognitive problems. These talks are held once a month at the hospital and open to the public.

The newly opened hospital is a one-stop centre for all kinds of impairments ranging from stroke and neurocognitive disorders to spinal injury, musculoskeletal problems, sports injuries and cardiac issues.

From the architecture and layout to the state-of-the-art treatment facilities, every part of the building has been well thought out to create a warm and therapeutic environment for patients.

The hospital also boasts designated therapy areas (for speech and occupational therapies, among others), cardiovascular fitness and rehab gym as well as treatment rooms for outpatients and inpatients.