Better Health 25 Eng

p2 Ad Heathy Max

W e l c o m e
Welcome to
, the magazine
for patients and friends of Bumrungrad
International Hospital.
The world’s population is getting older.
Thailand’s seniors now account for over ten
percent of the Thai population; by 2027, that
figure is likely to reach 20 percent.
This issue of
focuses special
attention on the important health issues affecting
senior adults. While some may equate getting
older with a decline in health, many seniors are
living healthy, active lives well into their 80s and 90s
thanks to good nutrition and exercise habits and
getting recommended check-ups and screenings.
Beginning on page 4, we look at age-associated
diseases and how to prevent them through
healthier diets and regular exercise. Exercise
is one of the best things we can do for our
health as we age; the feature on page 8 makes
a compelling case for exercise’s numerous
health benefits that are just as powerful for
seniors as everyone else.
Many people worry their senior years will
be marked by declining memory and mental
function. Everyone forgets things sometimes; but
more than the occasional lapse may point to a
more serious condition such as dementia or
Alzheimer’s disease. On page 15 we look closely
at these and other brain conditions and offer
advice on how to lessen aging’s impact on
brain health.
As always, we welcome your feedback, ideas
and comments about
. Please feel
free to e-mail us at betterhealth@bumrungrad.com.
We look forward to hearing from you, and
here’s wishing you better health.
Dr. Num Tanthuwanit
Medical Director &
Contributing Editor
C o n t e n t s
4 Healthy aging
Aging without disease
8 Active at every age
Exercise is the key to healthier
retirement years
12 M.D. Focus
Get to know our doctors
15 Aging brain
Normal memory lapse or a sign of
something serious?
18 Q & A
20 Health Briefs
22 News from Bumrungrad International
4 15 20
Better Health magazine is published by Bumrungrad Hospital Public Company Limited and is produced
for Bumrungrad Hospital Public Company Limited by Oakins and Stone Limited, 16 Asoke Court,
Suite 2-A, Sukhumvit 21 Road (Asoke), Klongtoey-nua, Wattana, Bangkok 10110. Tel: +66 (0) 2261 1211
Fax: +66 (0) 2261 1213. www.oakinsandstone.com
No part of this magazine may be reproduced without the written permission of Bumrungrad Hospital
Public Company Limited. 2012 by Bumrungrad Hospital Public Company Limited. All rights reserved.
Publication of advertisements or sponsorships shall not constitute an endorsement by Bumrungrad
Hospital Public Company Limited of the products or services promoted, of the company or organization,
nor of the claims made.
Telephone:
Facsimile:
Out-patient
appointment:
Website:
66 (0) 2667 1000
66 (0) 2667 2525
66 (0) 2667 1555
www.bumrungrad.com

HEALTHY AGING
Aging without disease
Healthier senior years depend on preventing
age-associated diseases.
The world keeps getting older. Demographics and
longevity gains have expanded the size of the
senior population in most parts of the world,
including Thailand. Thailand’s senior population, those
aged 60 or older, has surpassed 8 million – about 11
percent of the total population – an increase of almost
one million since 1997.
The population has been “graying” in large part
because people are living longer; a study by the Institute
for Population and Social Research at Thailand’s Mahidol
University reported the average life expectancy
for Thai children born in 2010 is 73 years – 13 years
longer compared to children born in 1975. And it’s
expected to increase further to nearly 80 years
within another decade.
The gift of long life is more precious when
those extra years are lived in good health. But
many still spend their golden years confronting
one health problem after another. For expert
insight on healthier aging,
turned to
Dr. Lily Chaisompong, a Bumrungrad specialist
in geriatric health with many years of experience
helping patients enjoy healthier, higher quality
senior years.
Beyond the numbers
In chronological terms, 60 is the commonly
accepted age when an adult becomes a senior.
But from a medical perspective, chronological age
doesn’t tell the full story of an individual’s overall
health or level of physical fitness. “Each person
ages at his or her own pace, so chronological age
alone doesn’t reveal a lot,” says Dr. Lily. “The body
begins its decline around the age of 40. While many
factors affect the aging process, it’s clear that taking
better care of one’s health slows the rate of decline.”
Some of the most serious health problems pose greater
threats as we age. These health problems related to age
fall into one of two categories. Age-associated conditions,
such as cardiovascular disease, increase in frequency
with age. The other category, age-specific diseases,
includes conditions such as osteoporosis and Alzheimer's
disease that affect only older age groups. (A related
article can be found on page 15).
Vascular threats
Vascular-related disorders such as diabetes, high
blood pressure and stroke are not directly associated
with aging. They typically affect people whose prolonged,
unhealthy habits – especially poor diets and lack of
exercise – lead to high blood sugar and high cholesterol,
key risk factors for vascular diseases. Reducing these

isks can usually be accomplished through
lifestyle modification, i.e. adopting healthier
diet and exercise habits. Dr. Lily cautions
seniors to avoid extreme changes, such
as totally cutting out dietary fat or meat
from one’s diet. Our bodies need fat; foods
including meat are important sources of
energy, protein and nutrients that help
repair damage caused by the aging process.
“Many seniors make the mistake of avoiding
high-protein foods as they assume their bodies
are too old to chew and digest meat,” Dr. Lily
explains. “In actual fact, protein is important
to counter loss of muscle mass and brain shrink-
age. Without enough protein, they’re at greater
risk of seeing their health deteriorate more quickly.”
For seniors already diagnosed with a vascular
disease, fish and nuts are healthier protein sources
than beef, pork or chicken. Fiber from nuts promotes
the removal of bodily waste through the excretory
system. It also facilitates the release of cholesterol and
helps control blood sugar. Fish containing omega-3
fatty acids are one of the best sources of the so-called
“good fats” believed to help lower blood cholesterol.
Osteoporosis dangers
The impact of the aging process is marked by a decline
in bone density, greater risk of bone fractures, and
eventually having to deal with osteoporosis. Dr. Lily
cautions women to be especially watchful for potential
bone threats as their risk for osteoporosis is significantly
higher than men. “Women naturally have thinner
bones than men,” notes Dr. Lily. “At the onset of
menopause, a woman’s body abruptly stops producing
the sex hormones which were helping maintain
stronger bones; the abrupt end to hormone production
accelerates the decline in bone density. For men,
osteoporosis poses less of a threat because the decline
in male sex hormones happens gradually – and some
men actually don’t suffer any decline.”
Osteoporosis is a disease which gradually worsens
“
Managing and treating
age-associated diseases
depends largely on patients
taking an active role in
managing their health by
making healthier lifestyle
choices.
”
Dr. Lily Chaisompong
over the course of many years. It progresses quietly;
symptoms usually don’t appear until years later.
Osteoporosis tends to be diagnosed after significant
decline in a patient’s bone density or, in some cases,
after a serious fracture-causing fall. Adopting
preventive measures earlier in life is one of the best
ways to reduce your risk of a future osteoporosis
diagnosis and for limiting the condition’s severity.
Calcium plays a critical role in keeping bones
healthy and strong. Adults should take in about
1,000 mg of calcium a day. In Thailand, most people
don’t get enough calcium from their diet, even when
including calcium-rich foods like fish, nuts, tofu and
leafy green vegetables. That’s because most Thais,
especially seniors, don’t consume enough milk and
other dairy products that are rich in calcium.
Bladder control ailments differ by gender
H
ealth issues affecting bladder control are more prevalent in older adults.
But the chief complaints depend on gender; the problems of senior men
tend to be the opposite of senior women.
Prostate problems
Men are most likely to experience difficulty passing
urine, with prostate enlargement the most common
cause of the problem. When the prostate gland becomes
enlarged, it presses against the urethra, making it more
difficult – or, in severe cases, impossible – for urine
to pass through the urethra.
For men with milder cases, doctors typically prescribe
anti-spastic medication which reduces the size of the
prostate to the point where symptoms dissipate and
normal bladder function is restored. In more serious
cases, surgery to remove a portion of the prostate may
be recommended.
Female incontinence
Incontinence is the most pre-
valent bladder-related health
problem for senior women. It’s
typically caused by pelvic organ
prolapse, a condition that makes
it difficult to prevent urine from
leaking through the urethra.
Exercising the pelvic muscles can help relieve the problem;
contracting the pelvic floor muscles 100 times a day will tighten
pelvic muscles and reduce incontinence. In more serious cases,
your doctor may recommend surgical treatment to correct the
problem.

Calcium supplements can offset some of the shortfall.
But they can be difficult for the body to absorb, especially
calcium carbonate; its absorption rate can be as low
as 40 percent. One way to compensate is by dividing
the supplement into smaller doses of 500-600 mg,
and take with meals for better absorption.
Drug interaction dangers
As many seniors know from personal experience, dealing
with age-related health problems usually means taking
more medications. Prescriptions can come from multiple
sources, with different doctors treating different health
problems, additional advice from caring friends and
relatives on top of one's own research and knowledge.
Besides medicines prescribed by doctors, many seniors
also take various vitamins, supplements and/or traditional
Thai and Chinese remedies.
Unfortunately, many don’t fully understand the potential
dangers of drug interactions occurring when certain
medications are taken together. Dr. Lily notes that, in theory,
medication should be taken only when necessary, and
all things being equal, as seldom as possible. “Seniors
should consult a specialist, either a doctor or pharmacist,
for advice on a medication’s necessity and potential drug
interactions,” she explains. “And at every consultation,
inform your doctor or pharmacist of any medications
you’re currently taking, to avoid possible duplication.”
NSAIDs caution
Seniors need to be cautious with certain drugs such
as non-steroidal anti-inflammatory drugs (NSAIDs).
NSAIDs including aspirin and ibuprofen can cause serious
side effects, especially perforation of the stomach lining,
kidney problems and high blood pressure. These drugs
should only be taken when necessary under a doctor’s
direction, and prolonged use should be avoided.
Caution should also be taken with cold medicines,
antihistamines and certain types of sleep aids. These
medicines affect the central nervous system and, especially
if taken in too large a dose, can cause blurred vision and
drowsiness, potentially leading to an accident or dangerous
fall. Strong sleeping medications such as diazepam interact
with chemicals in the brain and are known to cause
depression when taken for an extended period of time.
Managing and treating age-associated diseases depends
largely on patients taking an active role in managing
their health. That includes making healthier lifestyle
choices when it comes to nutrition and exercise. Good
mental and emotional health is also important in dealing
with symptoms and managing chronic illnesses. And a
strong support system can make a significant difference.
As Dr. Lily says, “the caring and support of the family’s
younger generations and close friends truly helps seniors
live happier, healthier lives.”
p6 Ad BBL

p7 Ad Roche

ACTIVE AT EVERY AGE
Exercise is the key to
healthier retirement years
Seniors who exercise can look forward to the rewards of
active living: longer, healthier lives and fewer threats
of serious illness.
Retirement is supposed to be the beginning of a more
carefree stage of life, as the responsibilities of career
and raising children give way to freedom and free time
to pursue favorite hobbies, travel to new places and devotion to
grandchildren. But retirement reality often turns out quite
different; many seniors spend more time with their doctors than
their grandkids as they deal with frequent health problems,
bouts of depression or declining cognitive abilities.
While most people
have gotten the message
about the numerous
health benefits of
regular exercise, not
everyone takes the
message seriously
enough to give up their
sedentary ways.
Seniors have as much
to gain from exercise
as any age group, but
they can be tough to
convince, and they have
more reasons and
excuses, legitimate and
otherwise, for not exercising – difficulty walking, feeling
tired, stiffness of the joints, aches and pains, to name a few.
Staying mobile
According to Dr. Suthee Siriwechdaruk, a board certified
specialist in physical medicine and rehabilitation at
Bumrungrad, exercise is a proven way to strengthen disease
prevention, promote healing and slow or reverse damage
brought on by the aging process and other causes.
Though they may have the most to gain from physical
activity, seniors often require more of a push to exercise
as their physical condition may be less than optimal.
“Senior adults may need some encouragement to become
motivated to start exercising,” says Dr. Suthee. “Helping
them understand the benefits of exercise and the risks of
inactivity is enough motivation for many seniors to make
the difference. Having reduced mobility doesn’t mean you
can’t exercise – it’s a good reminder of the need to exercise
so you can pursue a happier, healthier senior life with the
freedom to go where you want and take part in activities
that make you happy.”
Our body’s mobility
during our senior years
“
Seniors should include
exercises targeting
different areas of the
body, and be sure their
exercise routine is ‘slow
but consistent’ and ‘low
resistance’.”
Dr. Suthee Siriwechdaruk
can be affected by a
number of factors: the
aging process; chronic
diseases such as diabetes
that lead to artery damage,
impaired vision, inflam-
mation of bones and joints;
muscle weakness or
muscle atrophy due to
nutritional deficiencies
and lack of exercise; and
balance and coordination
problems including
feinting spells, dizziness
and disorientation that are more likely to affect stroke victims
and those with Parkinson’s or other diseases.
Dr. Suthee stresses that exercise should be considered
a necessity instead of something optional. “Exercise is a
must because it provides so many health benefits,” he says.
“For seniors, exercise increases joint mobility, builds
muscle strength, improves balance and coordination, and
boosts heart and lung function. Seniors with joint stiffness
can quickly see results from specific joint exercises. Regular
aerobic exercise helps diabetes patients burn calories more
efficiently and lowers the amount of sugar and fat in the
blood. Some diabetic seniors achieve such dramatic results
from exercise that their disease can be managed without
the need for medication.”

Senior-suitable exercises
The right types of exercise for younger adults aren’t
necessarily appropriate for seniors, especially those being
treated for certain medical conditions. “It’s important that
seniors avoid high-resistance and high-intensity exercises,”
Dr. Suthee advises. “I always recommend my senior patients
include exercises targeting different areas of the body, and
be sure their exercise routine is ‘slow but consistent’ and
‘low resistance’.”
Following are some of the best, most comprehensive
exercises to boost senior body performance and improve
overall health and fitness:
Increased joint mobility. Range-of-motion exercises
can be performed by moving each joint through its full
range of motion. For example, for shoulder mobility,
slowly raise one arm above the head as high as possible;
repeat five to ten times for each shoulder.
Stronger muscles. Resistance training strengthens the
core muscles involved in body movement. These include
leg, hip and back muscles. Light weightlifting, push-ups
done against a wall, and hand- and leg-raisers are all
effective muscle builders for seniors.
Exercise exertion: Is your workout too intense?
Exercise is fundamental to healthier living. But pushing yourself too hard or for too long can turn a good thing
into something harmful, especially for senior adults. One way to measure your level of exercise exertion is to use
the Borg Rating of Perceived Exertion (RPE). The Borg Scale assigns a numerical value from 6 to 20, as detailed
below, based on the physical sensations a person feels during exercise.
Perceived
Exertion
Score
Exercise intensity Physical sensations Target Heart Rate
6-7
8-9
10-11
No exertion at all
Very light exertion
Light exertion
How you feel when lying in bed, watching
TV, or relaxing in a comfortable chair.
Little or no effort.
60% of maximum heart rate
12-13 Moderate/Medium exertion Feels like you can exercise for hours, easy
to breathe and to speak.
14-15 Hard / Heavy exertion Feels energetic enough to exercise for hours,
breathes heavily, can only carry on brief
conversation.
16-17 Very strenuous exertion Discomfort, very difficult to maintain exercise
intensity, barely able to breathe or speak.
60% of maximum heart rate
70% of maximum heart rate
80% of maximum heart rate
18-20 Extremely hard to
maximum exertion
Feels almost impossible to keep exercising,
feels completely out of breath. You are exercising
dangerously hard.
90% of maximum heart rate
DANGER! DO NOT EXERCISE AT
THIS LEVEL OF INTENSITY!
REMINDER: For seniors planning to check their exercise intensity using the Borg Scale, it’s
important that workout intensity be maintained within the “Moderate/Medium exertion” or
“Hard/Heavy exertion” ranges, i.e. within a rating range of 12 to 15.

Better flexibility and balance. Exercising an individual
body part through its full range of motion helps stretch
muscles. At the same time, the shifting of weight forward
and back improves balance, a benefit that reduces the
risk of falls, injuries and muscle pain. Yoga and tai chi
are two of the best basic movement exercises.
Improved heart and lung function. Aerobic exercise is
one of the best ways for seniors to improve the function
of their heart and lungs. For maximum results, increase
the intensity level of each workout gradually until you
reach your target heart rate (THR). For seniors, the target
heart rate ranges from 60 to 70 percent of one’s maximum
heart rate, a level that is lower than the THR for younger
adults. During exercise, try to maintain your THR for
about 15 minutes, and include aerobic workouts three
times each week, or about every other day.
“ Having reduced mobility doesn’t
mean you can’t exercise–it’s a
good reminder of the need to
exercise so you can pursue a
happier, healthier senior life.”
Target heart rate
= Maximum heart
rate x 60% or 70%
Maximum heart rate = 220 – age
“An optimal exercise program encompasses these four
categories, giving seniors a full range of benefits to health
and physical fitness,” notes Dr. Suthee.
Limited-mobility exercises
Limited physical mobility doesn’t preclude most seniors
from exercising; there are plenty of ways to achieve better
health by exercising while seated or lying down. Lessstrenuous
exercise is always better than no exercise at all.
Seniors still have a great deal of influence over their postretirement
health and happiness, beginning with a conscious
choice to start living more active lives.
Exercise made safer
Many seniors worry about exercise jeopardizing
their safety and increasing their risk for injuries
and accidents. Whatever one’s age, there’s a right
way to exercise and a wrong way. Exercising the wrong
way causes painful injuries and potential health problems.
Before starting any exercise program, be sure to follow
these recommendations:
Consult your doctor to confirm that it’s safe to start
exercising; your doctor can recommend specific exercises
best suited to your individual situation while ruling out
the presence of any medical problems that may be
aggravated by exercise.
Build intensity gradually, starting with simple, short
exercises that gradually increase endurance until your
body can tolerate a 15- to 30-minute workout.
Choose proper shoes and wear comfortable but not
overly-loose clothing.
Exercise in a safe environment; the floor should be flat
and firm, and room temperature should be moderate,
neither too hot nor too cold.
10
Choose exercises that you find enjoyable and that suit
your physical fitness level. Early on, avoid resistance
exercises in favor of low-impact activities like walking,
cycling and swimming.
Keep breathing normally; holding your breath or speeding
up your breathing increases peripheral vascular resistance,
which forces the heart to work harder and puts you at
risk of high blood pressure.
Allow sufficient recovery time between workouts. Consider
switching to lighter exercises until muscle soreness subsides.
Before beginning each workout, always warm up for about
ten minutes to stretch your muscles. And don’t end your
workout without cooling down for five to ten minutes. This
reduces the risk of dizziness and fainting while allowing
blood flow to gradually return to its normal rate.
Avoid working out when you’re feeling tired. And it’s a good
idea to end a workout if you feel overly tired, such as when
breathing heavily makes it difficult to speak normally.
Stop your workout and get medical help if you experience
shortness of breath, chest pain or dizziness.

p11 Ad Modernform

M.D. FOCUS
Get to know our doctors
Meet four Bumrungrad physicians as they share their thoughts on
a range of health care topics.
Providing the highest standards of patient care requires a hospital-wide commitment and
professional expertise. Bumrungrad’s medical staff includes over 900 world class doctors
of the highest caliber, with outstanding professional credentials and advanced training
across the full spectrum of medical sub-specialties.
Dr. Ketchai Suavansri Neurologist
After graduating from Mahidol University’s Faculty of Neurology, Dr. Ketchai began
his medical practice as the sole neurologist in the province of Samut Sakhon. He
gained a wealth of practical experience while fulfilling his tuition waiver commitment.
Dr. Ketchai later joined the Prasat Neurological Institute and eventually headed
to the US to continue his medical training in Alzheimer’s disease.
Q: In your experience,
what aspect of your work
has been the most
challenging?
A: As a doctor in the
suburbs, it can be difficult
to correct people’s misconceptions
and false beliefs
about medicine. I once had to deal with a patient whose
paralysis got better after a rinsing with “magic” water.
Despite my attempts to show that paralysis can sometimes
heal by itself, word quickly spread about the wonders of
magic water.
Dealing with patients who brew their own home-made
medicine poses a real challenge. Sometimes the home
brew contains steroids, giving the patient the impression
they’re feeling better at first, and the serious side effects
only crop up later. There is still much to be done to change
these mistaken beliefs.
Q: What made you decide to join the medical team
at Bumrungrad?
A: Although Bumrungrad operates as a private hospital,
the management doesn’t focus solely on the business side.
The hospital has a good academic atmosphere that
encourages learning and collaboration, and there is a
strong emphasis on staying true to medical ethics. I feel
proud to be a part of the team here.
Dr. Tanawat Jirakulaporn Hematologist and oncologist
While studying at Washington University in the US, Dr. Tanawat had the
opportunity to take part an important research in the field of hematology
and oncology. That spurred him to expand his knowledge and gain experience
treating patients in this field, and he went on to earn a number of board
certifications from international institutes.
Q: Are there cases that you find most memorable?
A: I once had a patient from Ethiopia who had been
diagnosed with stomach cancer by another hospital.
After we ran some tests on his condition, we discovered
he was actually suffering from a rare disease called myeloid
sarcoma, where leukemia cells combine together to form
a solid mass.
Preparing for the treatment was quite frantic, but
there was no choice but to rush because of leukemia’s
fast-developing nature. There are cases like this from
time to time, where the original diagnosis is not correct
and where you really see how having fully competent
medical staff and advanced technology makes a difference
in producing an accurate
diagnosis.
Q: What challenges
you the most in your
work in oncology?
A: It is always difficult
when a patient’s cancer
is not treatable and the
prognosis is terminal. We oncologists, need not only to
provide end-of-life care for patients but also to assist
families and loved ones. It is a difficult time for everyone
involved, and we have a duty to alleviate as much of the
pain and grief as possible.
12

Dr. Suwatchai Pornratanarangsi Cardiologist
More than ten years’ teaching at one of Thailand’s leading medical institutions
helped establish Dr. Suwatchai as one of the Kingdom’s leading authorities in cardiology.
He also earned certification in interventional cardiology at New Zealand’s
Auckland University.
Q: What made you
decide to become a
cardiologist?
A: Back when I was a
medical student, my grand-
mother suffered an acute
myocardial infarction.
Despite my newly-aquired
medical knowledge, there
was nothing I could do but
stand and watch. That
sealed my decision to become a cardiologist; I didn’t want
to feel that powerlessness again.
Q: What types of cases leave the most lasting
impression?
A: I once met a patient suffering terribly from advanced
cardiovascular disease. Before coming to see me, several
hospitals had told him they could do nothing to help.
My diagnosis confirmed that treating him would be quite
risky, and that he might live longer by skipping treatment.
But the patient couldn’t bear the symptoms and asked
to proceed with the treatment anyway. It was very difficult
indeed, but in the end it was successful. As a smile returned
to the patient’s face, I felt so proud that I was able to help
give him a new lease on life.
Q: What interests you most about interventional
cardiology?
A: I’m very intrigued with how the procedure involving
catheterization to restore narrowed coronary arteries
may also have applications for other blood vessels in
the brain, kidney or legs. Being well-versed in all the
body’s veins and arteries gives me the opportunity to
collaborate with other specialists, and I get a fuller
picture of each patient’s overall health.
Dr. Yot Navalitloha Neurosurgeon
Dr. Yot graduated from the Faculty of Neurosurgery at Chulalongkorn University
before heading to the US for specialized study in brain and spine medicine. His
advanced training and years of practical experience are put to good use in the
complex field of neurosurgery.
Q: What is the most challenging aspect of being a
neurosurgeon?
A: I’ve found that the most challenging part of neurosurgery
comes when deciding whether or not to proceed with
surgery. In cases where a patient’s tumor is in contact
or very near a critical area of the brain, attempting a
complete removal may risk impairing the patient or, in the
most serious cases, the patient may not make it through.
It’s vital that the neurosurgeon be able to judge whether
surgery will successfully remove the tumor or if other,
safer methods such as radiation therapy or chemotherapy
should be performed instead.
Q: What types of cases leave the most lasting
impressions?
A: One of the most vivid cases involved a woman during
her eighth month of pregnancy. After she fainted, we
discovered she had a large brain tumor that required
immediate surgery.
We couldn’t operate with her lying on her back because
the baby’s weight would prevent proper blood flow. So we
had no choice but to operate with her lying on her side.
The surgery was successful,
and we safely delivered the
baby the following morning.
Originally we thought we
might have to make a choice
between the mother and the
baby surviving, so it was a
great relief that we were
able to save them both.
Q: What principles guide you in your work as a
surgeon?
A: I always strive for perfection in each and every case.
Medical errors can be major setbacks; the risks can
be higher when complex procedures and multiple
professionals are involved. My style might be seen by
some as uncompromising, but there’s no room for
compromise when it comes to the safety of patients.
Neurosurgery requires that I stay completely focused
on what I am doing at the moment I’m doing it; that’s
the only way that the treatment can even come close to
perfection.
13

p14 Ad BH

AGING BRAIN
Normal memory lapse, or a sign
of something serious?
Every senior forgets things now and then. But when is a memory
problem a sign of something more serious such as dementia or
Alzheimer’s disease?
Nothing escapes the aging process, the brain included.
The brain’s normal aging process means the older
we get, the more memory lapses we experience. We
can also expect the brain’s speed and sharpness to continue
their gradual, normal decline. But forgetfulness that affects
a senior’s daily activities may be a sign of the more serious
medical problem known as dementia.
According to Dr. Ketchai Suavansri, a cognitive and
behavioral neurologist at Bumrungrad with many years’
experience helping patients with dementia and other
cognitive impairments, dementia poses a greater risk the
older we are: After age 65, dementia’s rate of prevalence is
about eight percent; after age 75, the rate nearly doubles
(to 15%); after age 90, the rate is nearly 50 percent.
Understanding dementia
Dementia is the medical term for a collection of disorders
affecting brain function which have certain symptoms in
common. People with dementia experience brain impairment
which interferes significantly with their daily lives and their
socialization. “Dementia itself is not a disease,” Dr. Ketchai
explains. “It’s the result of other diseases affecting the areas
of the brain that control various bodily functions.”
There are many disorders known to cause dementia.
“While about 80 percent of the disorders cause permanent
loss of brain function,” notes Dr. Ketchai, “early intervention
can slow the progression and help dementia patients
maintain a good life quality. The progression can be reversed
for about 20 percent of patients, if the specific disease causing
the dementia is identified and treatment begins earlier.”
Degenerative brain-cell diseases, such as Alzheimer’s
disease, cause progressive, irreversible damage to the
brain. So-called reversible dementia, also known as
secondary dementia, is caused by other treatable
disorders, such as brain tumors, thyroid diseases, vitamin
B12 deficiency or as a side effect from taking certain
medications.
Diagnosing dementia
Since dementia has a number of possible causes,
diagnosing it properly is a complex process requiring
specialized training and expertise. “Even though memory
loss is a common early-stage symptom of dementia, memory
loss by itself isn’t enough to confirm a diagnosis of dementia,”
Dr. Ketchai explains. “Dementia is only diagnosed after
impairment is confirmed for at least two brain functions –
usually memory plus something else such as language or
perception impairment. Diagnosis also requires that the
symptoms be ongoing for at least six months and are
affecting daily activities.”
To diagnose dementia, the doctor typically begins with
a physical examination and a review of the patient’s health
history. Caregivers and family members may be consulted,
as early-stage dementia patients may not be aware of their
symptoms. Blood testing may also be carried out to rule out
15

the presence of certain diseases known to cause dementia.
To ensure diagnostic accuracy, the doctor may conduct
further tests; brain scans, neurological evaluations and
neuropsychological tests are used to confirm whether or not
the patient has dementia, and if so, whether it is reversible.
“It is very important to identify the type of dementia and
its underlying causes,” says Dr. Ketchai. “Doctors need to be
sure to leave nothing out, so the patient won’t miss an opportunity
to treat the diseases contributing to the dementia.”
“By way of example, a relative brought their family
member to see me about memory problems. After asking
some questions, it was apparent that the patient was normal
until the few days before we met, when suddenly he became
unable to recognize family members. This didn’t match the
profile of dementia caused by Alzheimer’s, but it fit the profile
of secondary dementia caused by stroke. Based on that, by
treating the stroke first, brain function might eventually return.”
Leading cause: Alzheimer’s
After ruling out other treatable causes, the next diagnostic
step involves identifying the specific brain disorder causing
the dementia, and then determining the best course of
treatment such as medication.
By far the most common cause of irreversible dementia
is Alzheimer’s disease; it accounts for about 60 to 80 percent
of all cases of dementia. Typically, symptoms of Alzheimer’s
only become apparent around the age of 60 to 65. [Cases
of earlier onset Alzheimer’s are rare and can usually be
traced to gene mutations.]
“Alzheimer’s disease is believed to be caused by the buildup
of plaque in the brain which interferes with brain cell
connections,” Dr. Ketchai explains. “The cells die or lose
control over functions such as memory, perception, behavior,
and cognitive and language skills.”
Maintaining good brain health
T
hough some cases of dementia cannot be prevented,
most people can reduce their dementia risk by
incorporating these brain-healthy habits into their daily
lifestyle:
Maintain a healthy weight; obesity causes a number of
chronic conditions that lead to dementia;
Make brain-healthy food and supplement choices,
including omega-3 in the form of DHA, which helps
protect nerve cells;
Be sure to get enough sleep every night;
Stay socially active and keep contact with family
and friends;
Learn new things and do something different, e.g.
practice using your other hand during meals;
Do 30 minutes of aerobic exercise at least four times
a week.
Courtesy of Sallaya Kongsomboonvej, a US board-certified dietician
at the Vitallife Wellness Center.
“
Earlier detection of Alzheimer’s
disease and progressive dementia
can slow disease progression
while allowing patients and
caregivers to maintain
a better quality of life.”
Dr. Ketchai Suavansri
Alzheimer’s is a progressive disease categorized in
three stages:
Mild/Early stage Frequent recent memory loss,
particularly involving recent conversations and events.
Depression and apathy may occur and may be accom-
panied by mood swings as patients start to notice their
own symptoms. “At this first stage, the caregiver may
not know how best to deal with the situation,” says
Dr. Ketchai. “It’s fine to remind the patient once or twice
if they forget something or their speech rambles on. But
don’t pressure the patient to the point where they suffer
stress which can lead to depression.”
Moderate/Middle stage Symptoms have become more
noticeable, making it impossible for the patient to cover
up the problem. Patients may fail to recognize their
spouse and family members. Mood and behavioral
changes are usually seen. “At this stage, patients have
become more dependent with everyday activities,”
Dr. Ketchai notes. “Pay close attention to the patient’s
safety; watch them when they go outside and restrict
access to dangerous objects such as knives and fire
sources.”
Severe/Late stage Symptoms have worsened, with the
patient gradually losing ability to remember, communicate,
move around or care for himself. “The patient’s health
continues to decline,” adds Dr. Ketchai. “The patient
cannot be left alone.” Brain cell decline reaches extensive
levels, causing grave damage to brain function. The
patient’s condition continues weakening, putting them
at serious risk for malnutrition and infections, some
potentially fatal.
Alzheimer’s disease remains incurable at the moment,
and current treatments are only able to slow the speed of
16

progression. “It’s very important to detect and diagnose
Alzheimer’s disease as early as possible,” says Dr, Ketchai.
“Earlier intervention slows disease progression while
boosting quality of life for patients and caregivers. It
also helps reduce the risk of complications from injury,
infection and the patient becoming unable to conduct
daily activities. The medical community continues working
to develop new medications and potential cures. I believe
the chances are good that those efforts will succeed during
the next five or ten years.”
The importance of caregivers
Caregivers play such an important role in helping patients
with dementia maintain a quality of life as normal as is
possible. Caregivers make numerous sacrifices for the good
of their patients; their dedication often requires changes to
their schedules and normal daily activities, and the demands
that come with caregiving can cause a great deal of physical,
mental and emotional stress.
“It’s very important that caregivers develop a solid base
of knowledge about dementia. The patient’s doctor can help
prepare the caregiver to know what to expect and how to
Did you know?
Among seniors, some symptoms
of depression can be difficult to
distinguish from symptoms of
dementia. These include memory
loss, confusion and hallucinations.
Neuropsychological testing is used
to diagnose depression.
handle specific problems,” Dr. Ketchai notes.
“More importantly, caregivers must not forget about taking
care of their own health, both physical and mental. Caring
for a dementia patient is never easy, and it can quickly
take a toll on a caregiver’s well-being. “
Dr. Ketchai continues: “Providing loving care requires
patience and understanding. Remind yourself that the
frustrating symptoms and behaviors you must deal with
are not coming from the patient; they are coming from the
illness. It also helps to divide up the responsibilities; having
at least two caregivers for a patient provides time to rest
and relax. That’s a good thing for caregivers, and for their
patients, too.”
10 Alzheimer’s disease symptoms
you should not ignore
1. Frequent and worrisome forgetfulness
2. Inability to recall recent events
3. Communication difficulties, e.g. inability to use
correct wording that people will comprehend
4. Lost away from home – can’t find the way
back home after going out
5. Dressing improperly or not taking care of
personal hygiene
6. Inability to perform simple math functions
like addition or
subtraction
7. Irrational misplacement of things, e.g.
placing shoes in the refrigerator
8. Unexplained mood swings
9. Rapid changes in personality
10. Rarely responsive or pervasive loss
of interest
17

Q & A
The aging process is a catalyst for many
physical changes, including some that
cause health problems. For this edition
of Q&A, Dr. Lily Chaisompong, a specialist
in geriatric medicine at Bumrungrad, answers
readers’ questions on age-related health
issues.
Q: I’ve heard several people say that if your vision is nearsighted
when you’re young, it eventually shifts back toward normal, or even to
farsightedness, when you’re older.
Is this true?
A: This is a fairly common misconception.
Myopia (nearsightedness)
and hyperopia (farsightedness) result
from improper shaping of the eyes
which affects the way light focuses
on the retina. Another eye disorder,
presbyopia (farsightedness resulting
from aging), causes the eyes to lose
their ability to reshape the lens
accurately, making it difficult to focus clearly on close objects.
If you have myopia, presbyopia provides no help in reducing nearsightedness.
In fact, correcting the two conditions requires concave lenses
for nearsightedness and convex lenses for farsightedness. That’s why
many seniors wear bifocal glasses incorporating two lenses, so the
eyes can focus on objects both near and far.
Q: My mother has trouble sleeping at night and usually takes a nap
during the day. Could napping cause her poor nighttime sleep? Or is
napping good for catching up on lost sleep?
A: Research suggests that napping during the day can alleviate fatigue
and boost energy while helping support proper brain function. A
daytime nap can also improve the quality of nighttime sleep.
It’s best to nap for no more than two hours, and avoid napping after
3 p.m. to prevent affecting nighttime sleep. Napping aside, sleeping well
at night remains very important to good health. As day turns to night,
the darker atmosphere prompts the pituitary gland to produce hormones
that control a number of body functions.
Ask your mother how she feels after a
night’s sleep. Instead of feeling refreshed,
if she feels tired when waking up, and
the feeling continues throughout the
day, she should be evaluated
by a doctor.
Dr. Lily Chaisompong
Q: My father will soon turn 60, and
recently he’s been complaining about
having to urinate frequently and feeling
listless. Is this normal for a man his age?
A: It’s normal to urinate about four to eight
times a day. If your frequency is higher, or
if you wake up in the middle of the night
to urinate, it may simply be that you drank
too much before bedtime.
In other cases, the symptoms may
indicate a medical problem such as earlystage
diabetes, an overactive or inflamed
bladder, a prostate condition, or in rare
cases, bladder cancer.
For a more complete picture of your
father’s situation, ask him the following
questions:
Is he taking any medications that increase
urination frequency? Certain medications,
including some anti-hypertensive drugs,
contain diuretic substances which can
increase urine discharge;
Does his urine contain blood, or is it dark
or cloudy?
Does he have other symptoms such as
fatigue, pain while urinating, fever,
chills, or pain originating from his back
or abdomen?
Has he experienced other urinary hesitancy
such as dribbling, weaker flow, leakage,
or the need for more time and effort to
empty his bladder?
Has his thirst or appetite increased
noticeably?
If your father answers “yes” to any of
these questions, he should consult a doctor.
If he’s diagnosed with a medical condition,
the doctor will recommend the best course
of treatment for your father’s individual
situation.
18
Have a question? You can submit your question for possible inclusion in future issues of , by e-mail
betterhealth@bumrungrad.com or by mail to Editor, Magazine, Bumrungrad International Hospital,
33 Sukhumvit 3, Wattana, Bangkok 10110, Thailand.

p19 Ad Arrow Bedding

HEALTH BRIEFS
Damaging duo of diabetes and
heart failure
On their own, heart failure and diabetes are serious,
potentially fatal diseases. Even worse, a new research study
offers evidence that the two diseases go hand-in-hand –
having one increases a patient’s risk of becoming afflicted
with the other.
The results of the study, conducted by researchers at
Japan’s Chiba University Graduate School of Medicine and
published in the journal Cell Metabolism, help explain why
patients with diabetes are more prone to suffer heart failure,
and why heart failure patients have higher rates of insulinresistant
diabetes.
The connection between the two age-related diseases –
their incidence increases with age – involves a domino
effect that prompts the body’s p53 protein (which also acts
as a tumor suppressor) to produce a stress response that
increases cell inflammation, a precursor to both heart
failure and systemic insulin resistance, i.e. diabetes.
The findings of the study suggest that developing more
effective treatments depends upon figuring out a way to keep
inflammation in check before the p53 protein response is
triggered, and to accomplish this without suppressing the
protein’s important tumor-fighting capabilities.
Osteoporosis added to
obesity’s heavy toll
The long list of diseases shown to be caused by
obesity keeps growing. A recent Swedish study by
researchers at the University of Gothenburg has led
to osteoporosis joining the list.
The study found that adiponectin, a hormone
involved in weight control, is associated with the
development of osteoporosis, the disease that makes
bones weaker and more susceptible to fractures. The
research findings were revealed following the study’s
examination of osteoporosis risk factors among
11,000 men in the US, Sweden and Hong Kong.
The human skeletal system is far more complex
than just bones, joints and
vertebrae. It is an important
part of the body’s inter-
connected systems that
are closely involved in
the function of the brain
and central nervous system.
The skeletal system is also
responsible for producing
hormones that send signals
to organs that regulate blood
sugar and body weight.
The study’s results
showed that high adipo-
nectin levels exacerbate
skeletal fragility and impair
the proper functioning of the
body’s complex muscular
system. The resulting decline
in muscle mass increases a
person’s risk of dangerous falls
and bone fractures.
Silent strokes a leading cause of memory loss in seniors
A US study of seniors revealed that silent strokes are the cause
of roughly 25 percent of episodes of memory loss. Results of the
study, published in a recent issue of the journal Neurology, chronicled
the significant impact on memory resulting from strokes which
produce no noticeable symptoms.
The study was conducted among a group of over 600 men
and women aged 65 or older with no history of dementia. Each
senior underwent an MRI brain scan and participated in tests
measuring memory, language, speed of thought and visual
perception capabilities.
Brain scans revealed that about one in four study participants
had suffered silent strokes, and their resulting memory test scores
were lower than those who had not suffered silent strokes.
This study adds to the growing body of research on memoryrelated
conditions that affect a significant segment of the senior
population, while highlighting the importance of stroke prevention
in helping preserve memory function.
20

p21 Ad BH

22

p23 Ad Mothercare

p24 Ad Arrow Bedding