ANEMECON GPMHHA Giving Priority to Mental Health for Healthy Aging.pptx

ANEMECON GPMHHA Giving Priority to Mental Health for Healthy Aging

1. 3.45 PM-4.45 P M: CME : “Giving Priority to Mental Health for Healthy Aging” Dr. Nirmal Lamichhane 4.45 PM -5.00PM: Interactive sessions/closing remarks “CME: “Giving Priority to Mental Health for Healthy Aging” , 27 th ANEMECON, BPKIHS, Dharan Programs:

2. “Giving Priority to Mental Health for Healthy Aging” 1 in 4 people will be affected by mental illness - make a difference today! Keep Your Brain Healthy for the Rest of Your Life 11/11/2016 NIRMAL 2 Presenter: Dr . Nirmal Lamichhane Associate Professor Head. Dept. of Neuropsychiatry, Gandaki Medical College Teaching Hospital Consultant Fishtail Hospital and Research Center Pvt. Ltd, Gairapatan , Pokhara BG Hospital and Research Center Pvt. Ltd., Matepani , Pokhara 12 President Elect: Nepal Medical Association- Gandaki Branch General Secretary: Psychiatrists’ Association of Nepal (PAN) Member: Alzheimer’s and Related Dementia Society Nepal (ARDS-N) Executive Editor: Journal of PAN (JPAN)

3. 11/11/2016 NIRMAL 3 The greatest science in the world; in heaven and on earth; is love

4. 11/11/2016 NIRMAL 4 It is impossible for a man to learn what he thinks he already knows.

5. In the end, it's not the years in your life that count. It's the life in your years. 11/11/2016 NIRMAL 5

6. Only very foolish people are convinced that they are never wrong. Confess often ! 11/11/2016 NIRMAL 6

7. 11/11/2016 NIRMAL 7 You cannot always control what goes on outside. But you can always control what goes on inside.

8. He has achieved success who has lived well, laughed often, and loved much 11/11/2016 NIRMAL 8

9. He has achieved success who has lived well, laughed often, and loved much 11/11/2016 NIRMAL 9 Gravitation is not responsible for people falling in love.

10. Friday, November 11, 2016 Dr. Nirmal Lamichhane 10

11. Friday, November 11, 2016 Dr. Nirmal Lamichhane 11 It is impossible for a man to learn what he thinks he already knows.

12. Friday, November 11, 2016 12 Dr. Nirmal Lamichhane It is impossible for a man to learn what he thinks he already knows.

13. You will not be punished for your anger, you will be punished by your anger 11/11/2016 NIRMAL 13

14. It is impossible for a man to learn what he thinks he already knows.

15. It is impossible for a man to learn what he thinks he already knows.

16. Friday, November 11, 2016 Dr. Nirmal Lamichhane 19 Etiology It is impossible for a man to learn what he thinks he already knows.

17. Friday, November 11, 2016 Dr. Nirmal Lamichhane 20 Unknown etiology: It is impossible for a man to learn what he thinks he already knows.

18. Big goals get big results. No goals get no results or somebody else's results 11/11/2016 NIRMAL 21

19. Love does not consist in gazing at each other, but in looking outward in the same direction. 11/11/2016 NIRMAL 22

20. Friday, November 11, 2016 Dr. Nirmal Lamichhane 23 Patients are no more and no less human than your. Respect them.- Nirmal

21. Friday, November 11, 2016 24 Dr. Nirmal Lamichhane You learn taking history by taking history.- Nirmal

22. Friday, November 11, 2016 Dr. Nirmal Lamichhane 25 Things turn out best for people who make the best of the way things turn out.

23. Friday, November 11, 2016 26 Dr. Nirmal Lamichhane

24. 11/11/2016 NIRMAL 27 Duty makes us do things well, but love makes us do them beautifully

25. That some achieve great success, is proof to all that others can achieve it as well ! 11/11/2016 NIRMAL 28

26. Treat everyone you meet as though they are the most important person you'll meet that day 11/11/2016 NIRMAL 29

27. A dog is not considered a good dog because he is a good barker. A man is not considered a good man because he is a good talker 11/11/2016 NIRMAL 30 Outline Brain and aging What is normal and what is not Medical Conditions Activity Diet, supplements and drugs

28. Friday, November 11, 2016 31 Dr. Nirmal Lamichhane It is impossible for a man to learn what he thinks he already knows.

29. You will not be punished for your anger, you will be punished by your anger 11/11/2016 NIRMAL 32

30. I can't change the direction of the wind, but I can adjust my sails to always reach my destination 11/11/2016 NIRMAL 33

31. I can't change the direction of the wind, but I can adjust my sails to always reach my destination 11/11/2016 NIRMAL 34

32. Believe nothing, no matter where you read it, or who said it, no matter if I have said it, unless it agrees with your own reason and your own common sense 11/11/2016 NIRMAL 35 As a person gets older, changes occur in all parts of the brain: Certain parts of the brain shrink, especially areas important to learning, memory, planning and other complex mental activities. Changes in neurons and neurotransmitters affect communication between neurons.

33. Do not dwell in the past, do not dream of the future, concentrate the mind on the present moment 11/11/2016 NIRMAL 36 Changes in the brain’s blood vessels occur. Blood flow can be reduced because arteries narrow and less growth of new capillaries occurs. Some may notice a modest decline in their ability to learn new things and retrieve information, such as names, faces etc. They may perform worse on complex tasks of attention, learning, and memory than would a younger person.

34. What is Normal ?? Every human being is the author of his own health or disease 11/11/2016 NIRMAL 37 Who

35. 11/11/2016 NIRMAL 38 "People rarely succeed unless they have fun in what they are doing." -- Dale Carnegie What is “Successful Aging”? Living Longer, Healthier Lives Hopefully staying off Dementia…

36. To keep the body in good health is a duty...otherwise we shall not be able to keep our mind strong and clear 11/11/2016 NIRMAL 39

37. An eye for an eye only ends up making the whole world blind 11/11/2016 NIRMAL 40 Diminished ability to remember names Diminished ability to find the correct word Diminished ability to remember where objects are located Diminished ability to concentrate Typical age-related changes

38. Knowing is not enough; we must apply. Willing is not enough; we must do 11/11/2016 NIRMAL 41 No consistent, progressive deviations on testing of memory Some decline in processing and recall of new information: slower, harder Reminders work (visual tips, notes etc ) Absence of significant effects on activities of daily livings Typical age-related changes ………………………….

39. You have to learn the rules of the game. And then you have to play better than anyone else 11/11/2016 NIRMAL 42 Forgetting a person’s name, but able to recall it later in the day Sometimes forgetting which word to use Losing things from time to time, but able to retrace steps to find them Typical age-related changes……………..

40. You are never too old to set another goal or to dream a new dream 11/11/2016 NIRMAL 43 Losing things from time to time, but able to retrace steps to find them Making a bad decision once in a while Missing a monthly payment Forgetting which day it is and remembering later Typical age-related changes ………………………….

41. However many holy words you read , However many you speak , What good will they do you If you do not act on upon them? 11/11/2016 NIRMAL 44 Older adults are more distractible and have greater difficulty with multitasking.

42. 11/11/2016 NIRMAL 45 What is not Normal? Normality is an idolized fiction . ... Sigmund  Freud  

43. However many holy words you read , However many you speak , What good will they do you If you do not act on upon them? 11/11/2016 NIRMAL 46 What is not Normal ? ……………………….

44. Old Age is the most Unexpected of all the Things that happen to a human 11/11/2016 NIRMAL 47 What is not Normal ? ………………………. THE THIN LINE BETWEEN ABNORMALITY AND NORMALITY

45. Have compassion for all beings, rich and poor alike; each has their suffering. Some suffer too much, others too little. 11/11/2016 NIRMAL 48 People with dementia may have problems with short-term memory, keeping track of a purse or wallet, paying bills, planning and preparing meals, remembering appointments or travelling out of the neighborhood. Being unable to remember things Asking the same question or repeating the same story over and over What is not Normal ? ……………………….

46. To conquer oneself is a greater task than conquering others ! Keep Your Brain Healthy for the Rest of Your Life 11/11/2016 NIRMAL 49 Becoming lost in familiar places Being unable to follow directions Getting disoriented about time, place and person Neglecting personal safety, hygiene and nutrition What is not Normal ? ……………………….

47. The way you think, the way you behave, the way you eat, can influence your life by 30 to 50 years . 11/11/2016 NIRMAL 50 Dementia is a general term for a decline in mental ability severe enough to interfere with daily life Dementia is not a specific disease It is an overall term that describes a wide range of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person’s ability to perform everyday activities

48. Whenever you see a successful person  you only see the public glories, never the private sacrifices to reach them 11/11/2016 NIRMAL 51 There is no test to determine if someone has dementia. Doctors diagnose dementia based on a careful medical history, a physical examination, laboratory tests and the characteristic changes in thinking, day-to-day function and behavior associated with each type. Doctors can determine that a person has dementia with a high level of certainty. But it is harder to determine the exact dementia because the symptoms and brain changes of different dementia can overlap.

49. Things work out best for those who make the best of how things work out 11/11/2016 NIRMAL 52 While symptoms of dementia can vary greatly, at least two of the following core mental functions must be significantly impaired to be considered dementia: Memory Communication and language Ability to focus and pay attention Reasoning and judgment Visual perception

50. All our dreams can come true if we have the courage to pursue them 11/11/2016 NIRMAL 53

51. Great minds discuss ideas; average minds discuss events; small minds discuss people 11/11/2016 NIRMAL 54 Common Types of Dementia Alzheimer’s Vascular Fronto -temporal Parkinson’s Lewy bodies Creutzfeldt -Jacob Normal pressure hydrocephalus Huntington’s Wernicke- Korsakoff Syndrome

52. The ones who are crazy enough to think they can change the world, are the ones who do 11/11/2016 NIRMAL 55 Alzheimer’s Disease AD is the most common type of dementia It worsens overtime It has no current cure. Treatments for symptoms are available and research continues

53. Life is about making an impact, not making an income. –Kevin Kruse 11/11/2016 NIRMAL 56

54. Dementia: A Global Problem GBD region Population over 60 yr (millions, 2010) Dementia prevalence (% 2010) Number of people with dementia (million) % Increase 2010 2030 2050 2010-30 1010-50 Asia 406.55 3.9% 15.94 33.04 60.92 107% 282% Europe 160.18 6.2% 9.95 13.95 18.65 40% 87% Americas 120.74 6.5% 7.82 14.78 27.08 89% 246 Africa 71.07 2.6% 1.86 3.92 8.74 111% 370% World 758.54 4.7% 35.56 65.69 115.38 85% 225% 57 11/11/2016 NIRMAL Be prepared, work hard, and hope for a little luck. Recognize that the harder you work and the better prepared you are, the more luck you might have

55. Life isn’t about getting and having, it’s about giving and being. – Kevin 11/11/2016 NIRMAL 58

56. Life is 10% what happens to me and 90% of how I react to it. –Charles Swindoll 11/11/2016 NIRMAL 59

57. Challenges in Nepal Diagnostic centres – where and how many? Which diagnostic criteria – ICD-10, DSM-IV, 10/66, or WHO? Use of CT/MRI scan? Who should make the Diagnosis – psychiatrist, neurologist, physician or any primary care health worker? How many dementia specialist required nationally? Length of diagnostic consultation – 10, 30 or 60 minutes? How to communicate the diagnosis – verbal or written? 11/11/2016 NIRMAL 60 Twenty years from now you will be more disappointed by the things that you didn’t do than by the ones you did do, so throw off the bowlines, sail away from safe harbor, catch the trade winds in your sails. Explore, Dream, Discover.

58. "To accomplish great things, we must not only act, but also dream, not only plan, but also believe." - Anatole France 11/11/2016 NIRMAL 61

59. A lot of people have gone further than they thought they could because someone else thought they could  11/11/2016 NIRMAL 62

60. The best revenge is massive success. –Frank Sinatra 11/11/2016 NIRMAL 63 Steps to take Steps that people can take may help preserve healthy brain aging. Fortunately also benefits a person’s overall health.

61. "A successful man is one who can lay a firm foundation with the bricks others have thrown at him." -- David Brinkley 11/11/2016 NIRMAL 64 Management of Medical conditions and Chronic Disease Diabetes High Blood Pressure High Cholesterol Depression Hormone imbalance Obstructive Sleep Apnea

62. "A successful man is one who can lay a firm foundation with the bricks others have thrown at him." -- David Brinkley 11/11/2016 NIRMAL 65 Management of Medical conditions and Chronic Disease Diabetes High Blood Pressure High Cholesterol Depression Hormone imbalance Obstructive Sleep Apnea

63. "A successful man is one who can lay a firm foundation with the bricks others have thrown at him." -- David Brinkley 11/11/2016 NIRMAL 66 CPAP machine with two models of full face masks Uvulopalatopharyngoplasty Screenshot of a PSG system showing an obstructive apnea.

64. "Don't raise your voice, improve your argument."  11/11/2016 NIRMAL 67 Activity Evidence suggests that higher levels of physical and mental activity as well as social interaction may help maintain cognitive function during aging

65. To keep the body in good health is a duty...otherwise we shall not be able to keep our mind strong and clear 11/11/2016 NIRMAL 68

66. People often say that motivation doesn’t last. Well, neither does bathing.  That’s why we recommend it daily. – Zig Ziglar 11/11/2016 NIRMAL 69

67. There is only one way to avoid criticism: do nothing, say nothing, and be nothing. –Aristotle 11/11/2016 NIRMAL 70 Physical Activity Specially Aerobic Exercise Improves Memory, Brain Function and Physical Fitness Increased blood flow, oxygenation, release growth factors for new neurons.. Any activity is better than nothing Physical activities that require hand-eye coordination or complex motor skills are particularly beneficial for brain building

68. Believe you can and you’re halfway there. –Theodore Roosevelt 11/11/2016 NIRMAL 71 Mental Activity Regularly challenging your brain with mentally stimulating activities is associated with better brain function and reduces risk of cognitive decline and dementia. Creativity, problem solving and the learning of new skills Crosswords puzzles, Soduku Leisure and learning

69. He has achieved success who has lived well, laughed often, and loved much 11/11/2016 NIRMAL 72

70. "What seems to us as bitter trials are often blessings in disguise." --Oscar Wilde 11/11/2016 NIRMAL 73 Socialization Protective effect of social integration Social engagement is what makes you mentally engaged Strong social ties, through friends, family and community groups Creative passions and favorite activities

71. "The distance between insanity and genius is measured only by success." -- Bruce Feirstein 11/11/2016 NIRMAL 74 Diet Possible benefit for High fish consumptions and omega-3 fatty acids (conflicting date) High fruit and vegetable intake (conflicting data) Mediterranean diet: high in fruits, vegetables, whole grains, beans, nuts and seeds including olive oil Berries high in flavonoids (e.g., blueberries, strawberries)

72. "The distance between insanity and genius is measured only by success." -- Bruce Feirstein 11/11/2016 NIRMAL 75

73. "When you stop chasing the wrong things, you give the right things a chance to catch you." -- Lolly Daskal 11/11/2016 NIRMAL 76 Supplements Vitamins E,C, Beta-carotene (antioxidants) B6, B12 and Folic Acids Vitamin D Multivitamins There are no convincing data that vitamin supplementation prevents dementia

74. No masterpiece was ever created by a lazy artist- Anonymous 11/11/2016 NIRMAL 77 Ginkgo biloba 2 multi-center, randomized, double-blind placebo-controlled study in older adults 3069 and of 2854 Not associated with a reduced incidence of dementia after 5 years of treatment There are no convincing data that using it prevents dementia

75.  "Knowledge is being aware of what you can do. Wisdom is knowing when not to do it." 11/11/2016 NIRMAL 78 Drugs Statins Non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, naproxen etc Conflicting data

76. "There are two types of people who will tell you that you cannot make a difference in this world: those who are afraid to try and those who are afraid you will succeed." -- Ray Goforth 11/11/2016 NIRMAL 79 Inflammation and Brain Aging Normal inflammation protects the body from infection/injury Brain inflammation associated with aging may lead to memory loss Decreasing inflammation may protect brain health Anti-inflammatory lifestyle strategies A good nights sleep Eating omega-3 fatty acids (fish oils, nuts) Physical exercise

77. "Thinking should become your capital asset, no matter whatever ups and downs you come across in your life." -- A.P.J. Abdul Kalam 11/11/2016 NIRMAL 80 Drugs Certain drugs that can impair cognition Painkillers-morphine, codeine. Sleeping pills- Zolpidem , Zopiclone Benzodiazepines-Diazepam, Lorazepam , Alprazolam Anti-Acid Medications- Ranitidine, Famotidine

78. "I find that the harder I work, the more luck I seem to have." --Thomas Jefferson 11/11/2016 NIRMAL 81 Alcohol Mild benefit in moderate use in some studies Mostly red wine, it is rich in resveratrol, a flavonoid that boosts blood flow in the brain Can cause more harm than actually benefit

79. "I find that the harder I work, the more luck I seem to have." --Thomas Jefferson 11/11/2016 NIRMAL 82

80. "I find that the harder I work, the more luck I seem to have." --Thomas Jefferson 11/11/2016 NIRMAL 83

81. "The starting point of all achievement is desire." --Napoleon Hill 11/11/2016 NIRMAL 84 Take Home Message Manage Chronic Conditions Stay Mentally Active Socialize Regularly Eat a healthy Diet Include Physical Activity in your daily routine

82. 11/11/2016 NIRMAL 85 Ability can take you to the top, but it takes character to keep you there

83. 11/11/2016 NIRMAL 86 Those who are free of resentful thoughts surely find peace

84.  "All progress takes place outside the comfort zone." --Michael John Bobak 11/11/2016 NIRMAL 87

85. "As we look ahead into the next century, leaders will be those who empower others." --Bill Gates 11/11/2016 NIRMAL 88 Resources: National Institute on Aging Information Centre. www.nia.nih.gov Alzheimer’s Association. www.alz.org Alzheimer’s Disease Education and Referral (ADEAR) Centre. www.nia.nih.gov/ alzheimer’s

86. "Courage is resistance to fear, mastery of fear--not absence of fear." -- Mark Twain 11/11/2016 NIRMAL 89

87. 11/11/2016 NIRMAL 90 Duty makes us do things well, but love makes us do them beautifully