Problems in basic brain functions can be highly debilitating, and getworse over time writes Meera Murugesan
LAI (not his real name), 63, struggled with memory problems. But when he walked into a specialist centre for a neurological assessment, to his relief, his results were normal.
However, two years later, Lai left his job. He also handed over payment of household bills to his children because he kept forgetting to settle the bills. He could also no longer drive as he kept getting lost. He was eventually diagnosed with Alzheimer’s disease.
Stories like Lai’s are common. It is believed that there are currently 50,000 Malaysians suffering from Alzheimer’s disease. This is concerning enough, but even more worrying is the fact that many of them are not only undiagnosed, but are also not aware that they need cognitive rehabilitation instead of relying on medication alone.
THE PROBLEM WITHIN
Dr Lydia Abdul Latif, chief medical officer at ReGen Rehabilitation International (ReGen Rehab) says neurocognitive disorder refers to a spectrum of disorders 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 such as major neurocognitive disorder, which is another name for dementia.
“Cognitive impairment such as memory problems can be caused by medical disorders, or they can also be caused by injury to the brain,” adds Dr Lydia. “Here at ReGen Rehab, we have had patients come in with severe memory problems due to traumatic brain injury following road accidents, sports injuries or even concussions that went ignored.”
Ultimately, she says the key to ensuring cognitive wellbeing is to know what symptoms to look out for, know what assessments to do and to seek rehabilitative treatment as early as possible.
IDENTIFYING THE ISSUE
There are many symptoms of cognitive impairment. Besides the obvious ones like memory and attention problems, they can sometimes manifest as impulsive behaviour, depression, anxiety and apathy. But if these problems are so varied and subtle in nature, how can one know if someone has it?
Dr Lydia says there are several ways to determine if someone has cognitive issues. Because the symptoms of neurocognitive disorders can sometimes appear vague, there are tests that can determine whether an individual is experiencing neurocognitive abnormalities.
These include brain imaging (cranial CT and MRI scans), Electroencephalogram (EEG), which measures the brain’s electrical activity and the Montreal Cognitive Assessment Test. The “clock-drawing” test is also a form of assessment.
TREATING NEUROLOGICAL DISORDERS
There is a lack of awareness about cognitive rehabilitation amongst the general public,” says Dr Judy Ranka, director and principal occupational therapist from Sydney, Australia as well as the techniques that can, and should, be used to target these dysfunctions.
Cognitive rehabilitation she stresses is the key to treating any abnormality pertaining to brain function.
Rehabilitation medicine is a branch of medicine that is concerned with the treatment of people with disabling medical conditions, due to either injury or diseases such as Parkinson’s, stroke, traumatic brain injury, arthritis etc.
Rehabilitation helps people regain functions that may be temporarily or permanently lost. The process of rehabilitation involves the whole medical team, such as the physiotherapist, speech therapist, nurses, occupational therapist, and psychologist.
Medication alone (although medication can keep symptoms at bay for a period of time) does not halt the progression of degenerative conditions nor does it work for everyone.
Different people may need different medications and dosages so it is important to incorporate lifestyle approaches to combat cognitive decline as well.
Exercise is important for everyone, as well as a holistic rehabilitative treatment model that targets the patient’s specific individual needs and problem areas.
NEUROCOGNITIVE ISSUES
Can affect functions such as:
• Memory
• Attention
• Language
• Judgment (e.g. impulse control; decision-making)
• Learning (retaining new information)
FACTS ABOUT NEUROCOGNITIVE CONDITIONS
• They can come as a result of tumours, infection, or genetics. Others may be caused by brain injury.
• A person is more at risk of developing neurocognitive problems if they are over 60, have substance abuse problems, or play sports that involve possible head trauma such as rugby.
• There is no cure for cognitive disorders stemming from permanent medical conditions; however, the effects can be slowed through rehabilitation.
ASSESSMENT: THE CLOCK-DRAWING TEST
THE clock-drawing test is a very simple assessment that clinicians can ask their patients to do, in order to make judgments about whether they are facing cognitive impairments.
The patient is asked to draw a clock, showing a certain time of day. They are given no clues about how to draw the clock, and based upon their drawings, clinicians can get an idea of how their cognitive function is.