With the rapid increase in the prevalence of dementia worldwide there has been significant research into modifiable risk factors for dementia. In this regard cerebrovascular diseases (CVD) represent a potential therapeutic target in the fight against the epidemic of dementia. Both large vessel CVD and small vessel disease in the form of chronic lacunes, white matter hyperintensity, microbleeds, and perivascular spaces have been strongly associated with the risk of developing dementia. These CVD factors may initiate or accelerate the amyloid and tau cascades resulting in greater rates of neurodegeneration and dementia. Understanding the precise mechanisms for the interaction between CVD and neurodegeneration will allow development of potential interventional targets. These CVD risk factors may be of particular relevance to the Asian population where a high burden of small vessel CVD has been demonstrated in Asian patients with dementia
Dementia ; Cerebrovascular Disorders

Background: Amyotrophic lateral sclerosis is one of the neurodegenerative disorders with very limited treatment options owing to its progressive course and diverse pathophysiology. Majority of patients succumb to death within three to five years after the onset of symptoms, mostly due to respiratory failure. This study aimed to determine the efficacy and safety of ultra-high dose methylcobalamin versus placebo among patients with early-stage amyotrophic lateral sclerosis in terms of slowing down functional decline. Methods: MEDLINE, CENTRAL, and Google Scholar databases were searched from inception up to September 23, 2023. The impact of treatments was measured by risk ratios with 95% confidence interval. The overall certainty of the evidence was evaluated using GRADE. Results: No significant difference was detected for the outcome median change in the ALSFRS-R score for the whole cohort. Post-hoc analyses showed that ultra-high-dose methylcobalamin decreased ALSFRS-R scores (p=0.003 for 50 mg and p=0.01 for all methylcobalamin groups) in a dose-responsive manner. Mean difference was 1.97 in favor of methylcobalamin (95% CI, 0.44- 3.50; P = .01). Conclusion Ultra-high dose methylcobalamin can reduce ALSFRS-R scores of patients in its early stage but the scarcity of clinical trials makes it difficult to support a robust conclusion. Ultra-high dose methylcobalamin therapy remains to be investigational.
Amyotrophic Lateral Sclerosis ; Systematic Review

Background: Breast cancer is the leading cause of cancer death among women worldwide. Studies showed conflicting results regarding presence of cancer, cancer treatment, and its association with dementia. Likewise, depression is often associated with cognitive problems. Objectives: This study aims to determine the prevalence and association of cognitive impairment and depression among breast cancer patients Methods: This is a prospective cross-sectional study utilizing Montreal Cognitive Assessment – Philippines (MOCA-P) and Patient Health Questionnaire (PHQ-9) Filipino version questionnaires through face-to-face interview. In analyzing the presence of cognitive impairment and depression, Chi-square was performed; all significant factors from this test underwent binary logistic regression to ascertain the statistical effect size for the presence of cognitive impairment and depression. Results: Results showed that 80.8% (97 out of 120 patients) have cognitive impairment while 27.5% of the patients have depression. Among the patients with cognitive impairment, 24.2% of them had depression. Results also showed significant association between the level of education and MOCA-P score suggesting that the higher the level of education, the better the MOCA-P score. This study showed no significant association between presence of cognitive impairment and depression. Conclusion In analyzing and managing patients with cognitive impairment, the level of educational attainment should be put into consideration since it is correlated significantly with MOCA-P results. As such, concomitant depression should be addressed accordingly since it may affect the patients’ overall health status.
Cognitive Dysfunction ; Depression ; Breast Neoplasms ; Mental Status and Dementia Tests

Background: Guillain-Barre syndrome (GBS) is an acute monophasic paralyzing illness that typically occurs after gastroenteritis and respiratory tract infection. Antecedent surgical procedures are less recognized trigger of GBS. Objectives: This paper aims to report a case of demyelinating variety of GBS that developed after appendectomy. Methods: This is a case of a 39-year-old Filipino male who was admitted due to acute appendicitis. He developed lower extremity weakness 4 days after appendectomy. His motor deficit initially presented distally from lower extremities, which advanced to the trunk, upper extremities, and muscles of speech and deglutition. Paresthesia of the fingers and toes and distal areflexia on both lower extremities were also elicited. Results: Diagnosis was done clinically. Nerve conduction study showed demyelinating variant, uncommon for a post traumatic GBS. Supportive care was rendered which resulted in complete recovery. Conclusion Surgery is a known but less identified cause of GBS. Although rare, we should consider GBS in patients presenting with ascending or progressive weakness after recent surgery because its early identification renders immediate and appropriate treatment.
Guillain-Barre Syndrome ; Guillain-Barre Syndrome ; Appendectomy

BACKGROUND

Type 2 Diabetes Mellitus (T2DM) patients are predisposed to cognitive decline and dementia. The cooccurrence of the two diseases translate to a higher medical cost. Identification of factors contributing to cognitive impairment is warranted.

OBJECTIVE

To determine the predictors of cognitive impairment among Filipino patients with Type 2 Diabetes Mellitus.

METHODS

This is a cross-sectional analytical study involving Filipino patients diagnosed with T2DM in the outpatient clinic. A total of 171 patients were included and were screened using AD8-P tool.

RESULTS

A total of 171 adult patients were included and screened for cognitive impairment.19.3% were cognitively impaired, with mean age of 59.6 years old (vs. 55.5 years old, p < 0.029), and two-thirds were female. The mean duration of the patient’s diabetes was 11.2 years. After adjusting for confounders and multi-collinearity, the duration of diabetes was significantly associated with cognitive impairment with odds of developing cognitive impairment increasing as the duration reach 10 years above. Those with T2DM for at least ten years were 2.5 times more likely to develop cognitive impairment, holding the age constant. (OR = 2.5, 95% CI – 1.0 to 5.8, p < 0.043).

CONCLUSION

19.3% of Filipino patients with Type 2 Diabetes Mellitus in a tertiary government hospital are cognitively impaired and this can occur even in less than 65 years old. The ten years or longer duration of T2DM increases the risk of developing cognitive impairment by 2.5%.

Diabetes Mellitus, Type 2 ; Dementia ; Cognitive Dysfunction ; Cognitive Impairment ; Aging