Cerebral amyloid angiopathy (CAA) is a cerebrovascular disorder caused by the accumulation of amyloid- beta peptides in the cerebral cortical and leptomeningeal vessels. These vascular changes can lead to micro-haemorrhages and lobar intracerebral haemorrhages. CAA becomes more prevalent as age increases. According to autopsy studies, CAA tends to be associated with Alzheimer’s disease in most cases. Currently, there is no disease-modifying treatment available. Despite that, early identification may assist clinicians to guide management requiring utilization of antiplatelet, anticoagulant, or thrombolytic drugs in patients with CAA. A case of a patient with cognitive impairment and suspected CAA is described.

Dementia is a global public health priority. In Brunei, Geriatric Medicine provides dementia teaching sessions to undergraduate health science students at Universiti Brunei Darussalam (UBD). It was found that more knowledge of dementia management was needed. Thus, a dementia care skills workshop was provided. Content from a dementia care skills workshop for care workers was given in a hybrid format. UBD nursing students attended in person, while participants from Maldives joined online via zoom. Feedback on the workshop was obtained via an online form at the end of the session. There were 27 undergraduate medical students from UBD and 43 participants from Maldives, with representation from hospitals and health centres, government ministries and non-government organisations.

The aim of this retrospective study was to audit the management of transient ischaemic attack (TIA) patients admitted in 2012 compared to a previous audit (2009 to mid-2010). Data were obtained by reviewing the electronic clinical records of patients. Data on patient demographics, patient assessment and management according to TIA guidelines were collected. A total of 61 patients were admitted to hospital with primary diagnosis of TIA. One in four patients had an alternative diagnosis. TIA severity (ABCD2 score) was not calculated in 13% of the patients. Most patients had computed tomography (CT) brain imaging performed. Antiplatelet therapy was not adjusted in 10% of patients. Carotid doppler ultrasound was not considered in 20% of the patients. Most of the carotid dopplers were done within one week. Only 6.6% of the patients were referred for carotid endarterectomy. Blood pressure medications were not optimised in 57.4% of the patients. Only 27.9% were prescribed statin therapy. Not all patients had documented ECG findings or discussion regarding anticoagulation. There was a 32.8% 3-month readmission rate. In 2012 several aspects of TIA guideline management were not done appropriately compared to the previous audit. The areas of improvement identified in this assessment include optimising antiplatelet therapy and blood pressure management, as well as timely carotid ultrasound for anterior circulation TIA. Further education and reiteration of guideline-based TIA management is recommended. A follow-up audit of the service is warranted