World Brain Day - July 22

Neurological problems? : Time for a healthy brain workout

By Carol Aloysius

In an age when more people are aging faster, the chances are that many of them, apart from chronic long standing diseases like diabetes, cardiac diseases and hypertension, are likely to suffer from Dementia, Parkinson’s disease and Stroke. Already, signs are in evidence that these neurological diseases are on a dramatic rise.

Advanced age is not the only cause. Other factors, such as, concussions from falls and from games such as football and boxing, as well as alcohol and tobacco abuse , poor diets and poor lifestyles have collectively done their bit to impair the brain health of most elderly persons.

President of the Association of Sri Lankan Neurologists, Dr. A. T. Alibhoy tells the Sunday Observer why a healthy brain is an integral part of a healthy lifestyle and should thus not be taken for granted.

Excerpts…

Q:World Brain Day was observed early this week. What is World Brain Day? Why is there a special day set aside for observing it?

A. The World Brain Day was first declared by the World Federation of Neurology in 2014, and it is celebrated on July 22 every year. This day is used to increase worldwide awareness of neurological illnesses and their prevention. This year’s theme will be, ‘ Brain Health in an Aging Population.’ It is quite clear that in the future, brain health will be an important factor that will determine the social and economic well-being of older persons. We wish to encourage good brain health in the younger population, so that brain damage can be prevented when they get older.

Q: At what age is a person considered ‘elderly’? What is your estimation of the world’s aging population?

A. A person over 60 years is considered an older person. The number of older people in the world is estimated to be more than 800 million, which is about 12% of the world’s population. This figure is expected to reach more than 2 billion (21%) by 2050. Older persons are projected to exceed the number of children in 2047. This trend is already seen in some developing countries. In 2015 in Japan, for the first time, there were more adult diapers sold than baby diapers!

Q: Is there a similar trend in Sri Lanka?

A. Sri Lanka’s population is also steadily aging. According to projections, the percentage of those over 60 years will have risen from 9% in 2001 to 17% by 2021 and 29% by 2051.

Q: What kind of health problems are likely as a result of aging populations?

A. The prevalence of non-communicable diseases such as, heart attacks, cancers, chronic respiratory diseases and diabetes will increase with age. The prevalence of brain disorders will also rise all over the world. Neurological diseases such as, Alzheimer’s disease, Parkinson’s disease and Stroke are going to increase dramatically with the aging population. More than 30% of people over 80 years have been found to suffer from at least one neurological disease.

Q: You mentioned three neurological diseases . What are their main clinical features?

Alzheimer’s disease is a type of dementia. It is a slowly progressive degenerative disorder of the mental functions caused by brain disease. It is characterized by memory impairment, personality changes, impaired thinking and reasoning and problems with language.

Parkinson’s disease is also a degenerative disorder, characterized by muscle rigidity or stiffness, tremors, slowness of movement and gait difficulty.

A Stroke is a disorder that either results from an interruption of the blood supply to part of the brain or when a blood vessel in the brain bursts causing a blood clot. A Stroke may present as a sudden numbness or weakness on one side of the body, sudden speech or visual impairment and sudden difficulty with walking or balance.

Q: Can lifestyle changes help to maintain good brain health? If so, share with us some ways we can do this.

A. It is important to stay mentally active and to challenge your mind. You need to continue to read, write, do puzzles, attend plays or seminars, play games, do gardening and pursue memory exercises.

It is essential to remain socially active, and engage in community and leisure activities by volunteering, travelling, or joining social clubs. Being isolated and withdrawn from society, especially, after retirement from work does not help to maintain good brain health.

Q: Does being physically active also help maintain good brain health?

Yes, definitely. It is important to stay physically active too. You should engage in activities such as walking, jogging, cycling, golfing, gardening, yoga, dancing, etc. You need to exercise daily. It’s never too late to start, as making healthy choices at any age is beneficial to health.

Q: Can head injuries undermine one’s brain health especially in the case of elderly persons? If so, how can they be prevented?

A. Yes, elderly persons must be careful to avoid frequent falls which result in repeated head injuries. Head injuries can be prevented by avoiding road accidents by following traffic rules, wearing seat belts in vehicles, and wearing helmets while riding motorbikes and also at construction sites.

You need to put objects out of the way which may increase your risk of tripping and falling, such as rugs, shoes or electrical cords.

You should turn on lights when you enter a room so you can clearly see obstacles.

Q: Can one’s occupation make one more vulnerable to head injuries? There has been a new study to say that footballers who routinely get concussed can have long term effects on their brains. Your comments?

A. Yes, those involved in construction work, in mining and in professions like boxing where the head is constantly exposed to hard knocks. To cite an example, boxing legend Muhammed Ali developed Parkinson’s disease at a young age and it is likely that the frequent head injuries played a role in the boxer’s disease.

Q: Does ingesting balanced nutritious meals play a role in brain health in elderly persons?

A. Yes. Adopting a healthy diet by reducing saturated fats, excess salt and sugar drinks and increasing whole grains, fruits and vegetables in your daily meals can definitely improve brain health.

In addition, it is essential to keep body weight, blood pressure, blood sugar and cholesterol under control. Avoid fast foods and junk foods which are high in fat, oil , starch and carbs. All those over sixty should try to maintain a healthy balanced diet, especially, in a society where fast foods are the norm. Eat home cooked food as far as possible using the minimum of oil and take plenty of local fruits. Drink water rather than sweetened drinks.

Q: What about smoking and alcohol abuse?

A. You should quit smoking and chewing tobacco and abstain from alcohol abuse as these unhealthy habits can also undermine brain health.

Q: What are the other common neurological illnesses treated by Neurologists?

A. Some of the serious disorders that Neurologists treat are brain infections like meningitis and encephalitis, epilepsy, coma, brain tumor, Multiple Sclerosis, Myasthenia gravis, spinal cord damage, motor neurone disease and Guillain Barre syndrome.

Many minor disorders such as, headache, vertigo, backache, sciatica, facial palsy, carpal tunnel syndrome, tremor and sleep disorders are managed most often in the outpatient department.

Q: How does one diagnose a brain disorder?

As in all diseases, doctors need to take a good history from the patient and at times from the accompanying person. A good detailed history is very essential in neurological illnesses as some disorders like headache and epilepsy are mainly diagnosed using the history. The doctor then does a neurological examination which includes assessing the higher functions of the brain, cranial nerves, and examination of the limbs by checking the power of muscles, reflexes, coordination and sensation.

Q:What kind of brain and nerve tests are currently available in the world? How many of them are available in Sri Lanka?

A. There are two main types of neuro diagnostic tests, namely, scans such as, CT and MRI and electrophysiology tests, such as, electroencephalogram (EEG) and electromyogram (EMG). These facilities are now available in government hospitals in most provinces in the country and also in the private sector in Colombo.

Q: 2016 is a special year for the Association of Sri Lankan Neurologists. What activities have you lined up for this special commemorative year?

A. The Association is celebrating its 10th anniversary this year and I am humbled that I have been elected as President of the Association of Sri Lankan Neurologists in this landmark year. As part of our on going activities , the Association conducts teaching programs every month for junior doctors where we discuss many different brain related problems.

Our aim is to provide an up-to-date knowledge of brain diseases to the medical personnel. We hope to have special seminars for other supporting staff, like the nurses in the future. We also have regional meetings twice a year, which have been very successful.

Q: Do you have enough trained neurologists to meet the rising demand?

A. The number of Neurologists has somewhat increased rapidly in the last few years. We had less than 15 neurologists about a decade ago, and now we have over 40. There are many junior doctors in training.

We now have neurologists covering all 9 provinces in the country to provide the public with care for their Neurological illnesses. We are encouraging junior doctors to take up neurology.

Q: Your message to our readers?

A. An aging brain is not necessarily a sick brain. It can be also a healthy brain. During this year, we hope to bring greater awareness of the neurological diseases associated with the aging population and the economic and social burdens on health systems everywhere. National health policies need to take into account this serious challenge and be prepared to face the future.