Would you like to Log In or Register and ask a question

	Date Posted: 09-Feb-2006
	Question:
	My wife is curently receiving treatment with Aricept. Will this continue to be provided given the new NICE guidance?
	Answer:
	The recent announcement from NICE regarding the future provision of the currently available treatments for Alzheimer's disease suggests that patients currently on treatment with either Aricept, Reminyl or Exelon will continue to receive treatment. This detail is still only in draft form and the final guidance will be published within the next few months. The current position is certainly an improvent on the position faced last year when it was suggested the treatments would no longer be available. What has also changed is the suggestion that these treatments will only become available when the condition has progressed to the moderate stage of the illness and that patients in the early phase will not receive treatment. In addition treatment with memantine is no longer being recommended and further research on mementine is recommended. Please refer to the news section of memoryclinic.com and the NICE website.
	Answered By: Dr Fraser Inglis, Consultant Physician, Glasgow Memory Clinic

	Date Posted: 09-Feb-2006
	Question:
	My wife is curently receiving treatment with Aricept. Will this continue to be provided given the new NICE guidance?
	Answer:
	The recent announcement from NICE regarding the future provision of the currently available treatments for Alzheimer's disease suggests that patients currently on treatment with either Aricept, Reminyl or Exelon will continue to receive treatment. This detail is still only in draft form and the final guidance will be published within the next few months. The current position is certainly an improvent on the position faced last year when it was suggested the treatments would no longer be available. What has also changed is the suggestion that these treatments will only become available when the condition has progressed to the moderate stage of the illness and that patients in the early phase will not receive treatment. In addition treatment with memantine is no longer being recommended and further research on memantine is recommended. Please refer to the news section of memoryclinic.com and the NICE website.
	Answered By: Dr Fraser Inglis, Consultant Physician, Glasgow Memory Clinic

	Date Posted: 01-Feb-2004
	Question:
	Is there a memory clinic in South Wales?
	Answer:
	The are several memory clinics in Wales. They are usually run by Consultants in Old Age Psychiatry, Geriatric medicine or occassionally Neurology. If you contact your local health authority they should be able to point you in the right direction bearing in mind that referral to a memory clinic is normally via a General Practitioner.
	Answered By: Dr Fraser Inglis, Consultant Physician, Glasgow Memory Clinic

	Date Posted: 01-Feb-2004
	Question:
	How does having a stroke affect your memory? What is it exactly that causes memory loss?
	Answer:
	Stroke can affect memory for example by damaging areas of the brain involved in memory such as the temporal lobe of the brain. It is more common for multiple strokes to lead to memory loss and dementia than a single stroke. The term multi-infarct dementia is used to describe this condition. Multi-infarct dementia or vascular dementia is the second commonest cause of dementia, the commonest being Alzheimer's disease. Detailed assessment is required to clarify the diagnosis. Some people who suffer a stroke can have their ability to speak affected. They may have difficulty either in expressing themselves, understanding speech or a combination of both. This can make assessing memory function difficult. It is very important for anyone who has suffered a stroke to take measures to try and prevent another stroke from happening. To do this risk factors such as blood pressure, smoking, cholesterol, blood glucose, alcohol, diet weight and excercise are considered. Medication may be started to treat these risk factors and for example aspirin started to try and prevent further blood clots from forming and causing another stroke.
	Answered By: Dr Fraser Inglis, Consultant Physician, Glasgow Memory Clinic

	Date Posted: 31-Jan-2004
	Question:
	Is it possible for a person from the United States to receive treatment at a clinic in the Europe where more advanced medications are available? How would I go about finding a physician who could possibly prescribe memantine? My mother is currently taking aricept, but her condition is declining rapidly. Thank you for your help.
	Answer:
	At the present time in the U.K there are three treatments in the acetylcholinesterase class avaiable for the treatment of Alzheimer's disease. These treatments are also available in the U.S.A. Unfortunately patients do deteriorate despite treatment and our knowledge of why certain individuals can respond and benefit from a treatment yet others do not is limited. In relation to the situation you describe the first option would be to ensure that the dose of Aricept has been maximised. If it has and there is ongoing evidence of deterioration switching to an alternative treatment such as Reminyl ( Galantamine) or Exelon (Rivastigmine) could be considered. Memantine has now been approved for use in Alzheimer's disease in the U.S.A. by the FDA. This could potentially given either in addition to existing treatment or as a single treatment and this could be discussed with your mothers physician.
	Answered By: Dr Fraser Inglis, Consultant Physician, Glasgow Memory Clinic

	Date Posted: 20-Oct-2003
	Question:
	Can you clarify the roles and responsibilities of the involved multi- disciplinary team members within the memory clinic?
	Answer:
	The multi-disciplinary team in a memory clinic will vary from clinic to clinic depending on what service they are providing from assessment through to intervention, treatment and support. Most Teams consist of a consultant (Psychiatrist, Physician or Neurologist) a mental health or memory clinic nurse and a sometimes a psychologist. Some teams will also have an occupational therapist. The consultant role is initially to establish a diagnosis with all the information collected by the team and where appropriate prescribe medication. It is vitally important as part of the assessment that an in depth history is taken about the patient and their life, this is usually taken by the consultant from both the patient and the carer.The consultant may as part of the assessment arrange for a range of tests such as blood tests and a brain scan. The role of the mental health or memory clinic nurse is to assist in the assessment and offer support to the patient and there carer. Their role within the team will depend on the structure of the team and what other professional support they have as part of the team. Many clinics operate a Triage system, which means when a referral is first made to a memory clinic the nurse will often be the first point of contact. The nurse will often carry out a screening assessment to see if the referral is appropriate for the memory clinic or if the referral needs to be sign posted through to the CMHT, Social Services or the voluntary sector. If the referral is appropriate for the memory clinic, the nurse will explain the process of what will happen to the patient and their carer. The nurse's role will be to offer on going support to the patient and their carer and will often co-ordinate the care as well as taking part in ongoing assessment. The level of cognitive fuctioning a person may have will be assessed by either a psychologist or memory clinic nurse. They will carry out a range of tests that will measure a persons cognitive function, the tests usually consist of the patient being asked a range of questions or getting the patient to complete a range of tasks, they may as part of the testing measure the patients IQ as a baseline assessment. The occupational therapist will focus on a persons ability to attend to their activities of daily living such as washiong, dressing , shopping etc. Other aspects will include leisure time interests, social contacts, and any other support mechanisms. A collection of all the information from the different professions will assist in making a diagnosis. If a social worker is not attatched to the team then the team should work closely with social service so any aspects such as employment if the patient is under 65yrs can be addressed.
	Answered By: Cathie Sammon, Nurse Consultant, Epsom, Surrey

	Date Posted: 16-Sep-2003
	Question:
	My 85 year old father had been diagnosed with early stages of MND and the doctors were not sure at what speed it would progress, he has recently seen his neurologist for a check up who is now talking about Alzheimer's and not MND. I have been unable to talk with him direct and am unsure if or what connection there is between the two, can you please help?
	Answer:
	Motor neurone disease does not normally produce dementia although there is a rare association with dementia of the frontal areas of the brain. This is even rarer in a man of your father’s age. Alzheimer’s disease is unfortunately common and co-exists with many unrelated conditions. Although in advanced cases, Alzheimer’s can mimic numerous other neurological disorders such as stroke and Parkinson’s disease, it doesn’t produce symptoms that are normally confused with MND. The distinction is important as both conditions have licensed treatments. Particularly with Alzheimer’s disease, evidence is appearing to say the earlier it’s treated the better.
	Answered By: Dr David Craig, Lecturer in Geriatric Medicine, Queen's University, Belfast

	Date Posted: 16-Sep-2003
	Question:
	I am 71 years old and have always had a reasonable short term memory. Reasonable ,too, on names and isolated facts (good for quizzes). I scored 41 on the National Memory Test. I have always, however, had difficulties with certain types of remembering (or rather reecall). These difficulties have noticeably increased over the past few years. Putting it simply, it seems to do with stories: ie bundles of interconnected facts. Such stories are often connected with my own past life (recent or otherwise). What it often amounts to is that family and friends hkave significantly better recall of shared events than I do. This can often lead me into pretending that I remember things out of embarrassment. I don't imagine that this sort of problem is rare but I am wondering if there is any test I could take to give me some idea how I compare with others. Better still is there any recommended treatment? Tony Sims
	Answer:
	With increasing age we are all at risk of mental slowing. This can manifest itself as the symptoms you have described. Understandable worry regarding one’s memory can worsen the problem by creating stress and thus ‘raising the stakes’ each time the situation develops. Dementia is more than simply forgetfulness (which often isn’t realized by the patient – as you have done!) but involves personality change, loss of independence and disruption of judgement. People with dementia who forget tend to forget in a sinister way – leaving the cooker burning overnight, misplacing pension books repeatedly, forgetting loved one’s birthdays. To keep the mind healthy, exercise it! And until we have an Alzheimer’s vaccine, a good diet, plenty of sleep, physical activity and attention to health matters such as high blood pressure and diabetes are important.
	Answered By: Dr David Craig, Lecturer in Geriatric Medicine, Queen's University, Belfast

	Date Posted: 16-Sep-2003
	Question:
	I have tourettes syndrome and respiratory dyskinesia. I had a capsulotomy - brain operation - to try to help. It was unsuccessful. But my memory is now poor. Is there anything I can do?
	Answer:
	Virtually any form of brain trauma (i.e. operations and head injury) can produce forgetfulness as can most forms of major surgery requiring anaesthesia. Your symptoms may settle down with time but perhaps the best approach is to make sure another explanation for memory loss or impaired concentration isn’t to blame (e.g. any new medications?) and to think of ways of maintaining good mental functioning to prevent any worsening of your memory in future i.e. exercise your mind with puzzles, reading etc., and stay physically healthy.
	Answered By: Dr David Craig, Lecturer in Geriatric Medicine, Queen's University, Belfast

	Date Posted: 16-Sep-2003
	Question:
	Which vitamins have a positive effect on a person suffering with vascular dementia and can herbal remedies help or hinder?
	Answer:
	Unfortunately, vitamins have not been properly tested for use in vascular dementia (or indeed other dementia types). Some vitamin-deficient illnesses such as pernicious anaemia can progress to dementia and treatment with vitamin B12 can help. Vascular dementia resembles stroke disease in many ways and for that reason folic acid supplements are recommended by some specialists as a way of encouraging healthy blood flow through the brain. Herbal remedies are of some value but again have not been subject to proper testing. If a herbal preparation works for you or your loved one then great. There may have been a biological effect or simply a placebo response (the value of which should not be underestimated!). Caution is needed with some herbal remedies such as St John’s Wort (which is used by some people to lift mood in dementia) as they may combine dangerously with prescribed medicines. A well publicized study reporting positive benefits of Ginseng in dementia after stroke has been criticized but is something to explore in the future.
	Answered By: Dr David Craig, Lecturer in Geriatric Medicine, Queen's University, Belfast

	Date Posted: 16-Sep-2003
	Question:
	What is the thinking around the use of folic acid in Alzheimer's disease?
	Answer:
	Folate seems generally safe and evidence is accumulating that it may help prevent most types of dementia (and depression, heart disease, stomach cancer and leukaemia!). It is dangerous only when used in people with a deficiency of vitamin B12 which has gone unrecognized. Therefore, elderly people who neglect their diet should not be prescribed folate routinely. Should everyone be on it? Good question, a large research investigation, the Oxford Project to Investigate Memory and Ageing (Optima Study), seems to implicate vitamin B12, and to a lesser extent foliate deficiency in producing Alzheimer’s disease so the answer’s probably “yes” but this theory hasn’t been proven.
	Answered By: Dr David Craig, Lecturer in Geriatric Medicine, Queen's University, Belfast

	Date Posted: 16-Sep-2003
	Question:
	I have a professional job and occasionally have to speak in public, but more often I meet my clients on a one to one basis. I have always been a bit "scatty" but in the last two or three years, word recall has been a particular problem, so much so that in discussions, my colleagues are forever filling in the missing word for me. The words I can't locate are simple words like pen, mouse, or shoe. Names are difficult - sometimes I have forgotten the word "dad" or my husbands name. I have also lost most of my sense of smell for the last two years. Over the years I have mentioned it to my doctor who assumes it is do with leading a busy and stressed life! It is an aggravation and an embarrassment but could it be a sign of dementia or something?
	Answer:
	Stress is the best explanation for this. Are your symptoms as noticeable at weekends or holidays? Do you suffer anxiety or depression generally? If so treatment may help. If your symptoms are worsening and there is no other explanation for your word finding difficulties and loss of smell then your doctor should consider a neurology consult which will hopefully set your mind at rest.
	Answered By: Dr David Craig, Lecturer in Geriatric Medicine, Queen's University, Belfast

	Date Posted: 16-Sep-2003
	Question:
	I am 71 years old and have always had a reasonable short term memory. Reasonable ,too, on names and isolated facts (good for quizzes). I scored 41 on the National Memory Test. I have always, however, had difficulties with certain types of remembering (or rather recall). These difficulties have noticeably increased over the past few years. Putting it simply, it seems to do with stories: ie bundles of interconnected facts. Such stories are often connected with my own past life (recent or otherwise). What it often amounts to is that family and friends hkave significantly better recall of shared events than I do. This can often lead me into pretending that I remember things out of embarrassment. I don't imagine that this sort of problem is rare but I am wondering if there is any test I could take to give me some idea how I compare with others. Better still is there any recommended treatment? Tony Sims
	Answer:
	With increasing age we are all at risk of mental slowing. This can manifest itself as the symptoms you have described. Understandable worry regarding one’s memory can worsen the problem by creating stress and thus ‘raising the stakes’ each time the situation develops. Dementia is more than simply forgetfulness (which often isn’t realized by the patient – as you have done!) but involves personality change, loss of independence and disruption of judgement. People with dementia who forget tend to forget in a sinister way – leaving the cooker burning overnight, misplacing pension books repeatedly, forgetting loved one’s birthdays. To keep the mind healthy, exercise it! And until we have an Alzheimer’s vaccine, a good diet, plenty of sleep, physical activity and attention to health matters such as high blood pressure and diabetes are important.
	Answered By: Dr David Craig, Lecturer in Geriatric Medicine, Queen's University, Belfast

	Date Posted: 21-Apr-2003
	Question:
	How can an individual get reassurance that their memory loss does not relate to Alzheimer's, but to depression or other illness?
	Answer:
	The best thing here is to go through the normal medical channels. The first stop is with the GP who may well be able to check the situation fully and determine what any perceived memory loss may be due to. That might be all that is required. If there is any doubt then an onward referral to an appropriate specialist in memory problems might be necessary. Alternatively a referral to a psychiatrist may be necessary if there is a major issue with depression. If any other confounding illness seems to be apparent, then a referral to the appropriate specialist may be necessary if the GP cannot deal with the situation in a primary care setting.
	Answered By: Dr Peter Passmore, Senior Lecturer, Queens University Belfast

	Date Posted: 21-Apr-2003
	Question:
	following a head injury suffered in 1977, have been left with memory problems which have led to my unemployment for the entire period as I'm (apparently) a graduate now ex-EWO. I would like any advice you could offer as to how to improve my recall on a day-to-day basis.
	Answer:
	Certainly head injury can cause significant problems with memory and this does sound like an unfortunate situation. There is a need to make a definitive diagnosis which sounds like it has happened here. There may be some improvement but that usually would happen long before this question would have arisen. The memory loss is due to a structural abnormality in the brain and as such is likely to be a situation where there is little chance of change at this time. It is useful to have had the chance to see an occupational therapist and neuropsychologist to examine issues of brain rehabilitation and retraining. They are the most helpful in this situation.
	Answered By: Dr Peter Passmore, Senior Lecturer, Queens University Belfast

	Date Posted: 21-Apr-2003
	Question:
	When a patient with Alzheimer's disease who previously responded to an acetylcholinesterase inhibitor (AchI)deteriorates such that the AChI would normally be withdrawn should one consider adding memantine? Stop the AChI and switch to memantine? What's the current thinking about memantine - add on or switch ?
	Answer:
	I think the consensus is that memantine should be added to a cholinesterase inhibitor. This is because we have a greater knowledge of the effects of cholinesterase inhibitors in declining dementia. Withdrawal of a cholinesterase inhibitor can lead to abrupt onset of clinical difficulties in terms of deterioration in symptoms. This is very unpredictable. Many clinicians are wary of inducing these problems for families and for colleagues in primary care. Certainly there are parts of the UK where there is no option but to discontinue the cholinesterase inhibitor. In that situation, if the patient has moderate to severe dementia and there are no contraindications, then memantine can be looked at as an option.
	Answered By: Dr Peter Passmore, Senior Lecturer, Queens University Belfast

	Date Posted: 21-Apr-2003
	Question:
	Can individuals who percieve themselves to be experiencing significant memory loss be referred to a memory clinic by their Dr via the NHS?
	Answer:
	Anyone with complaints of memory loss should attend their GP to discuss the complaint. There should be no difficulty with an onward referral to a memory clinic through the NHS. The availability of "memory clinics" is not uniform throughout the NHS and memory clinics vary in their personnel and how they operate. In general we do encourage people with memory loss to present themselves early for assessment. There may be no problem at all in which case the person can be reassured or if there is a significant problem with memory detected then that indiviidual can have the situation fully assessed and treated if necessary.
	Answered By: Dr Peter Passmore, Senior Lecturer, Queens University Belfast

	Date Posted: 21-Apr-2003
	Question:
	Is significant memory loss associated with Viral Meningitis? Is there any way to restore memory percieved to have been lost as a result
	Answer:
	It is certainly possible that memory could be affected by this, although this might be thought to produce a memory loss which was related in time to the event and which would recover to a degree after the problem settles down. In terms of restoration of any perceived memory loss, that ought to be a spontaneous event. In general the more "brain stimulation" in the setting of any memory loss, the better that it is thought to be.
	Answered By: Dr Peter Passmore, Senior Lecturer, Queens University Belfast

	Date Posted: 02-Apr-2003
	Question:
	How would early onset dementia be diagnosed?
	Answer:
	Early onset dementia simply refers to the age of onset, usually under 60 years of age. The symptoms of memory loss, language disturbance, numeracy problems and impact on daily activities are the same as as those experienced by older individuals. The diagnostic process is the same. Very early symptoms can be difficult to detect. The diagnostic process may be facilitated by computerised cognitive assessment although such testing systems are not yet used routinely.
	Answered By: Dr Fraser Inglis, Consultant Physician, Glasgow Memory Clinic

	Date Posted: 02-Apr-2003
	Question:
	Are there any clinics in the Derby area? I am a 48 year old woman who has been experiencing memory loss for a couple of years. My memory was assessed by a psychologist last May as having significant "holes" in some areas, but he refuses to undertake another assessment until 12 months have passed despite me becoming increasingly confused and dis-orientated. I am sure that my memory has deteriorated a lot further although my IQ seems not to have suffered so much. I have recently given up my teaching job as I cannot cope with training courses and the stress. My GP wants to wait until the test results before he refers me to a neurologist (another 12 month wait) but I need some answers before then. Any ideas?
	Answer:
	It might be helpful to you to learn of the areas of your memory function that are good and the areas that are not performing as well. Stress can adversely affect memory function and for some reducing stress is beneficial. Time is often needed to gain an accurate insight into the memory difficulties someone is experiencing and this is presumably the reason why you are waiting for further assessment. In the meantime you might find it helpful to list the sorts of problems you have been experiencing. 'The National Memory Test' available on this web site tests certain aspects of memory function and you may find it helpful to take this test and repeat it again in say 3-6 months. Remember that this is not a diagnostic test. However you will be able to see your performace relative to others of a similar age who have taken the test.
	Answered By: Dr Fraser Inglis, Consultant Physician, Glasgow Memory Clinic