Thursday, 2 June 2011

Dr. Ravish Patwardhan comments on… Memory Loss: Can it be cured?



One of the most interesting and troubling areas studied in medicine, according to Dr. Ravish Patwardhan, is loss of memory. As widely described on the news, experienced by families, and supported by foundation after foundation, memory loss continues to be a problem of near-epidemic proportions.
The most common form of memory loss, or dementia, is Alzheimer’s disease. Presently incurable, the drugs which help marginally do so; in many cases, the disease progresses despite medications, and patients become completely “in their own world,” not recognizing family members or friends, receding from society. Many of such family members are reluctantly placed into nursing homes, to live out the rest of their lives. Research is being conducted at a great rate to try to find the mechanism, progression, early detection, and possibly cure of the disease.
Despite the poor prognosis presently of Alzheimer’s disease, there are other types of dementia which can be helped. For example, vitamin deficiency can be associated with memory loss. In addition, a condition called “normal pressure hydrocephalus” or NPH is associated with three findings: (1) memory loss; (2) walking difficulty; and (3) urinary incontinence. The reason this is called “NPH,” according to Dr. Ravish Patwardhan, is that many times when the pressure is measured in the brain, it is normal. However, when the pressure is monitored over several days, occasional waves called “plateau waves” can be seen. Another way to diagnose this problem is to have a patient walk in front of his or her family, and then do a spinal tap, withdrawing about 20 cc of fluid. Immediately afterward, if a marked improvement is noted in walking (by the patient, family, and clinical staff), then the patient may benefit from a shunt being placed. This shunt, called a ventriculoperitoneal shunt, connects a tube from the fluid-filled chamber within the brain to the belly (technically, the “peritoneal cavity”). To avoid over-drainage of the fluid, a valve is placed in between. Since this involves an operation under general anesthesia, albeit a short operation, there are risks involved – among them are infection, bleeding within the brain, difficulty placing the shunt (since it is essentially a blind pass), and other risks. However, the majority of such patients, even elderly ones, have appeared to tolerate this operation well, and many have improved their walking ability. This is substantiated by the literature, as the body of evidence continues to grow according to Dr. Ravish Patwardhan.

The key decisions obviously include whether a patient will likely benefit from a shunt. In some patients, marked improvement in walking is noted but not as much in memory; others have both improve; another subset may notice improvement in all three symptoms of the triad: incontinence may also improve.
Much of the cause of this type of memory loss, associated with NPH, remains unknown. Proposed theories include stretching of the brain’s memory circuit fibers, or deterioration over time. New areas of research focus upon learning more. A group at UCLA has shown, for instance, that in younger patients not necessarily suffering from NPH, stimulation of a certain part of the brain actually appears to improve memory. Further research, according to Dr. Ravish Patwardhan, may focus on the memory-related structures of the brain, including the hippocampus and surrounding regions.

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