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Practitioners’ Corner (continued from page 18)
clude cognitive deterioration, gait disturbance (imbalance, fall, short-stepped gait), urinary dysfunction, and dysarthria. Behav- ioral and cognitive changes include mental slowness, emotional lability, personality changes, and depression. Depression is com- mon in vascular dementia, occurring in up to 20% of cases, and is disproportionately prominent in those cases with small amounts of infarction. Silent infarcts double the likelihood of frank de- mentia, including Alzheimer’s disease, as well as vascular demen- tia, and increase the likelihood of clinical depression. Cerebral amyloid angiopathy (CAA), a small vessel vasculopathy due to deposition of a variant form of beta-amyloid in cerebral blood vessels, is often found in the brains of individuals with Alzheim- er’s disease. Silent infarcts might be associated with vascular Par- kinsonism, as well.
What should we do when our patient’s brain CT or MRI scan shows he or she has chronic small vessel ischemic changes, i.e. silent infarctions”? First, we should carefully examine the patient
for subtle cognitive and physical deficits. Consider the investi- gation for common vascular risk factors, such as hypertension, diabetes, hyperlipidemia, or atrial fibrillation. Consider carotid imaging when there is silent brain infarction in the carotid terri- tory. Consider cardiac event monitoring and echocardiography with bobble study when there is an embolic-appearing pattern of silent infarction. In addition, consider laboratory testing for hypercoagulable disorders and the risk for atherosclerosis and thromboembolism. Therapeutic strategies to reduce the stroke risk should be applied to reduce their incidence and the potential progressive nature of silent infarctions and potential functional and cognitive decline. Treatment options with antihypertensive agents or antiplatelets, anticoagulation, or lipid lowering thera- pies, revascularization for carotid stenosis and patent foramen ovale closures, should be considered when indicated. Strokes are the leading cause of adult disability. It is preventable. Let’s all remember “Little Strokes Fell Great Oaks.”
NON- MEMBERS WELCOME!
HCMA Membership Dinner Meetings are held four times per year. Introduce a non-member colleague to the HCMA by inviting them as your guest to a dinner meeting, at no cost to you.
RSVP to the next dinner meeting for you and your guest!
Call the HCMA for details: 813.253.0471
Bring a Physician Colleague to an HCMA Dinner Meeting...
THREE for FREE
If you recruit three physicians prior to August 31st , your HCMA dues for the following year will be waived!
0% INCREASE!
We are pleased to announce...
This year, participants in the HCMA health insurance co- op will benefit from a 0% increase in health insurance premi- ums! In addition, two plan options have been added beginning with 2019 renewals and enrollment.
Contact you plan representative, Jeremy Enns, GCD Insur- ance Consultants, jeremy@gcdinsurance.com, or (813) 818- 8805, x 232.
Advocating for physicians and the health of the communi- ties we serve.
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HCMA BULLETIN, Vol 64, No. 6 – March/April 2019