Day 1 :
Suny Upstate Medical University, USA
Time : 10:00-10:40
Antonio Culebras is a Professor of Neurology, SUNY Upstate Medical University, and consultant in the Sleep Center of Upstate Medical University, Syracuse, New York.rnHe is Certified by the American Board of Psychiatry and Neurology and received his Doctorate of Medicine (PhD equivalent) from the University of Alicante, Spain. He isrnCertified by the American Board of Psychiatry and Neurology, Sleep Medicine. He has lectured in English and Spanish in over 40 countries. He has published 7 books onrnsleep disorders, co-edited 2 books on cerebrovascular disease, published over 200 articles in professional journals, and has served or serves in the editorial board of 15rnnational and international neurological publications.
Clinical evidence suggests that moderate to severe obstructive sleep apnea (OSA) is a risk factor for development of vascular cognitive impairment as a result of cerebral subcortical small vessel disease expressed as leukoaraiosis and silent infarctions. A recent studyrnshowed that old women with OSA AHI>15 were more likely to develop cognitive impairment (AOR, 1.85; [95% (CI), 1.11-3.08].rnOther authors have shown that. OSA AHI>15 is a risk factor for cerebral white matter changes in middle-aged and older patientsrn(OR:2.08 [95% (CI):1.05-4.13]) and for silent cerebral infarction in > 65 y/o patients (OR:2.44 [95% (CI):1.03-5.80]). Intermittentrnnocturnal hypoxia in patients with moderate to severe OSA contributes to ischemic damage in the cerebral periventricular territoryrnof long penetrating terminal arteries. Blood flow may be already precarious as a result of diabetic vascular autonomic dysregulationrnand poorly controlled hypertension. Ischemic damage to the cerebral periventricular white matter disturbs the connections of therncortex with the thalamus leading to subcortical dementia characterized by apathy, decreased executive functions, poor memory andrnin later difficulty walking and urinary incontinence. Treatment of OSA with CPAP may lower cerebrovascular risk by decreasing 24-hrnurinary catecholamine excretion, improving arterial stiffness, improving baroreflex sensitivity and reducing mean 24-h ambulatory blood pressure. CPAP applications may delay onset of dementia. However, CPAP applications will not modify structural lesions ofrnthe brain and therefore early diagnosis and treatment of sleep apnea before structural brain damage ensues is strongly recommended,particularly in patients with several risk factors for stroke.
De Montfort University, UK
Time : 10:40-11:20
Karan Jutlla has completed her PhD in 2011 at Keele University. She has worked as a Senior Lecturer in Dementia studies at the University of Worcester for five years. Shernrecently joined the School of Nursing and Midwifery at De Montfort University in Leicester as a Lecturer in Health and Social Care. Alongside her employment, she alsornworks as an Independent Consultant in Dementia Care supporting services to be culturally competent.
Vascular dementia has been reported as the most common form of dementia in South Asian communities living in the UK due tornhigher incidences of hypertension and diabetes. Research on dementia care in these communities has highlighted the need forrnthe need for cultural competency training for those working professionally with people with dementia and their families. It has been evidenced that while many health professionals feel that they need more training to both improve their knowledge about dementiarnand the cultural norms and religious practices of South Asian people with dementia, access to this sort of training is variable. Because of the acute lack of quantitative and qualitative data about the health and social care needs of South Asian communities and how theyrnare best met, training to improve cultural competency in services is difficult. This paper reports the findings of research with Sikhrncarers of a family member with vascular dementia living in Wolverhampton in the UK highlighting evidence that demonstrates therndiversity of the Sikh community and challenges assumptions of homogeneity. The evidence base presented highlights the importancernfor understanding the psycho-social perspectives of living with vascular dementia for migrant communities and the need for healthrncare professionals and service managers to apply a person-centered approach to care. This paper will help participants to considerrnperson centered care as a model for practice for achieving cultural competency with migrant communities living with dementia inrntheir countries of work.
Trakia University, Bulgaria
Keynote: Asymptomatic carotid stenosis, arterial hypertension and cognitive impairment: A longitudinal population-based epidemiological study
Time : 11:40-12:20
Petya Mineva has completed her PhD in 2006 from the Medical University, Sofia and Post-doctoral studies from the Trakia University, Medical Faculty, Stara Zagora. She is a Head of the Healthcare Department at the Medical College of the Asen Zlatarov University, Burgas and an Associate Professor and a Lecturer in Neurology at the TrakiarnUniversity, Medical Faculty, Stara Zagora. She has published more than 20 papers in reputed journals.
The aim of this epidemiological study is to estimate the significance of asymptomatic carotid stenosis (ACS≥50%) andrnarterial hypertension (AH) for cognitive impairment (CI) in a population without signs and symptoms of stroke or TIA.
A total of 500 volunteers, aged 50-79 years, were enrolled and followed-up for cognitive performance. CI has been definedrnas a score between 24 and 27 of MMSE. Additional neuropsychological tests have also been conducted.
CI in persons without any degree of ACS has been detected at only 13.85% (27/195). In comparison to the whole grouprninvestigated (p<0.012), as well as to the subgroup without ACS, CI has significantly increased in participants with ACS<50% (22.3% -rn61/273, p<0.01) and especially with ACS≥50% (40.6% - 13/32, p<0.001). Significant differences in the prevalence of CI have also beenrnfound between the two subgroups with ASC<50% or ACS≥50% (p<0.05). Logistic regression analysis has been conducted betweenrnthe group with ASC≥50% and an age and sex adjusted control group. It has revealed no relation between CI and ACS≥50%. However,rnmultiple logistic regression analysis has shown that the combination of ACS≥50% and systolic AH (SAH) attributes to CI (OR=10.7;rn95%CI: 3.36-34.14; p=0.0001). CI has been presented as a declinein attention, verbal fluency and verbal working memory at the endrnof the study.
This pattern of CI, which is specific for a cerebral small vessel disease in long lasting AH, has supported the thesis thatrnSAH and ACS≥50%, not only ACS≥50%, are attributable for CI.
Saperstein & Salomon, USA
Time : 12:20-13:00
Steven Benvenisti is a partner at one of the largest personal injury law firms in the United States of America, with offices in New York and New Jersey. For the past fivern(5) years, he has been included on the list of the National Trial Lawyers “Top 100 Trial Lawyers”.He is honored to be the Vice-Chairman of the Board of Directors forrnMothers Against Drunk Driving National and is also one of the directors of the Brain Injury Alliance. Steven has received over 30 awards, including a US CongressionalrnCitation, US House of Representatives Certificate of Special Congressional Recognition and “Citizen of the Year”. Steven authored Spring Break: A True Story of Hopernand Determination about a famous case he handled involving a severely brain injured college student who received long-term inpatient and outpatient acute care and rehabilitation. Spring Break credits the doctors, nurses and rehabilitation professionals for the wonderful work that they do in improving the lives of patients and their families.rnHe has been a keynote speaker at over 100 conferences and gladly donates 100% of his honoraria to charity.
Traumatic brain injury is the silent epidemic of our time. In spite of the millions who sustain a T.B.I. every year, very few medicalrnprofessionals, legal scholars, employers and educators understand the reality of what the survivor and family members experience.rnThe most powerful way to get a full understanding of the impact of T.B.I. is directly from the perspective of a survivor. I present thisrnprogram as an attorney regarding a “law case” of an “All American” college student on vacation with his college friends. One nightrnhe was walking and was struck by a drunk driver’s vehicle. His parents were called in the middle of the night and asked to consent tornorgan donation due to their son’s severe traumatic brain injury and other catastrophic injuries. The parents’ declined to consent tornorgan donation and instead got a room in the hospital to be with their son 24/7. After seeing the powerful photographs of the studentrnin a coma, the audience is delighted to learn that he awoke after almost two (2) weeks, survived and had a full recovery. They arernthen astounded by the announcement that the attorney speaker before them is actually the T.B.I. survivor who is the feature of thernprogram. The remainder of the program educates the audience about T.B.I. from the perspective of the survivor and family, while alsornproviding valuable tools to help them in their own professional and personal capacities when dealing with Traumatic Brain Injury.