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Alzheimer’s disease is not normal forgetfulness as we age. Instead, it is a specific form of mental decline. And according to the Alzheimer’s Association it accounts for nearly 80 percent all dementia cases. Natasa Dragicevic, MD, PhD., behavioral neurologist and Alzheimer’s disease specialist with Renown Institute for Neurosciences, weighs in on diagnosing it and the importance of early medical action. How to Diagnose Alzheimer’s Disease In general, the signs of Alzheimer’s disease occur slowly, getting worse over time. For example, forgetfulness is a daily search – for shoes, keys and other misplaced items. Not only is memory affected, but also speech patterns and behavior. There is no single test for Alzheimer’s disease. “Specifically, a neurologist should be the one to diagnose Alzheimer’s disease given differences in presentation,” clarifies Dr. Dragicevic. “And ideally a behavioral neurologist (Alzheimer’s sub-specialist) will be managing the treatment,” she adds. Brain Imaging Diagnosing Alzheimer’s disease involves multiple approaches and medical providers. In short, medical history is reviewed along with a physical exam, lab tests and other diagnostic testing. “A medical workup includes a variety of tests. These include MRI and other brain imaging, as well as neurological and psychological testing. Furthermore, a lumbar puncture is performed to look for markers of the disease,” she states. What Causes Alzheimer’s disease? Although no one knows the cause, researchers think many factors play a role. Uncontrollable risk factors include your genetics and having a family member with the disease. However, the controllable risk factors include: reducing the risk of head injury and keeping your heart healthy. It’s important to realize that high blood pressure, high cholesterol, stroke and diabetes play a role in brain health. Blood loss to the brain causes vascular dementia, leading to long-term blood vessel damage. Symptoms of Alzheimer’s disease Generally speaking, the signs of this disease differ in each person. Yet noticeable behaviors include: • Losing the way to familiar places • Forgetting to pay bills • Trouble finding the right words when talking • Repeating questions • General confusion • Social withdrawal Alzheimer’s Disease – Benefits of Early Diagnosis Equally important, spotting Alzheimer’s disease early allows more time to benefit from medications and possible clinical trials. Likewise, nutrition and exercise changes can be made, increasing blood flow to the body, and perhaps delaying symptoms. Early diagnosis also allows for personal health decisions and quality-of-life conversations to take place.   According to the Alzheimer’s Association, these benefits include: 1. Medical advantage 2. Emotional and social comfort 3. Time to plan ahead 4. Cost savings A Brain Supporting Lifestyle “At the present time, treatment is limited,” explains Dr. Dragicevic. “Usually Alzheimer’s is a progressive ongoing disease – any management at this time is purely symptomatic.” However, she states the following lifestyle changes can help support brain health: • New hobbies such as painting, pottery, music classes or learning a new language • Crosswords, puzzles and playing games, such as Scrabble • Brain challenging mobile apps, such as Luminosity • 30-45 minutes of mild to moderate physical activity per day, such as walking • Eating a Mediterranean diet (primarily plant based foods)

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Despite the challenges of a pandemic, the Renown Rehabilitation Hospital continues to help their patients thrive outside of the hospital walls. On July 31, 2021, they hosted the first-ever Renown Alumni Sports Extravaganza, or RASE, a day focused on adaptive sports for all abilities. “Sports and recreation have a unique way of breaking down emotional barriers,” states Jared Worchel, DO, MS. The alumni used their skills on a climbing wall, Frisbee golf, archery, an obstacle course and bag toss. Over 20 people spent the day cruising the first adaptive mountain biking trail in the Tahoe region. “Having old friends meet up and seeing new friendships form had to be the highlight of the weekend,” says Shaun Stewart Certified Therapeutic Recreation Specialist (CTRS) with Renown Rehabilitation Hospital. “RASE was a great way to learn new methods to improve outdoor recreation engagement from both participants and the many programs involved.” Dr. Worchel agrees, “The smiles really make it worth it, and we even saw several touching moments with tears of joy when participants completed a task and finally felt like they were getting past their injury, mentally, after years of being so focused on recovery.” Adaptive Climbing and Camping One touching moment came on the adaptive climbing wall. Cassie Firchau, an occupational therapist at Renown, recalls a rehab alumni who had never been on a climbing wall (pre or post injury) conquering the wall. “Everyone was cheering him on. I was impressed with how he used the ascending pull up bar to get up the wall,” she remembers. Mark Wellman, the founder of No Limits, provided the climbing wall. “I had heard of Mark, but I had no idea that he climbed El Capitan only a few years after his spinal cord injury,” says Cassie. “Having him at the event was a great opportunity to learn how to stay active and enjoy the things you love, no matter the circumstance.” After dark, the event continued with a DJ spinning hits followed by overnight camping. That evening Shaun Stewart had the chance to talk to one of the alumni. “He spoke on how he was nervous about camping and how it would go in a new campground. He said that he was happy for an opportunity to practice with our group prior to going out on his own,” remarks Stewart. “Knowing that this event can help create opportunities even outside our events is great to know.” Adaptive camping activities allow all abilities to not only enjoy nature, but also connect. “We also saw a lot of interaction between the participants themselves, sharing their journeys with each other during the down times which was possible with the extended format,” explains Dr. Worchel. “Overall it was an overwhelming success and we are already looking forward to next year.” Northern Nevada's Adaptive Sports Community Not only did the Renown Rehab alumni come together at RASE, but so did the greater northern Nevada community. Along with the hard work of the Renown Rehabilitation employees, the City of Reno Adaptive and Inclusion Programs, Wasting Arrows, Disable Sports Eastern Sierra, No Limits, and High Fives Foundation, provided support and equipment for the alumni. “It was so great to see multiple groups, volunteers and non-profits collaborating to support alumni participants to live life to the fullest, and to experience outdoor recreation in such a dynamic way,” states Josh Patterson, Supervisor of Rehab Therapy Services at Renown Health. "The City of Reno is so grateful for this sponsorship to bring together new and old Renown alumni to learn and encourage each other. There were many firsts this weekend, and we look forward to future participation in City of Reno Adaptive programs,” says April Wolfe, CTRS, City of Reno Parks and Recreation. For more information on future alumni adaptive events, please email: shaun.stewart@renown.org.

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Colorectal cancer is the second-deadliest cancer in the United States – largely because it goes undiagnosed. Dr. Christi Matteoni, Division Chief of Gastroenterology at Renown Health, discusses the symptoms and key screenings used to detect this type of cancer, along with risk factors and lifestyle changes that could affect the likelihood of getting the disease. What are some of the signs and symptoms of colorectal cancer?  Many cases go undiagnosed because polyps can develop and become cancerous without any symptoms. Additionally, since colorectal cancer begins as small polyps, symptoms usually aren’t seen until later stages. This is why screenings are especially important.  For those who do experience symptoms, the signs are often tied to your bowel habits. This can include changes such as constipation or diarrhea, narrow or dark stool, rectal bleeding, abdominal cramping, weakness and fatigue or unintended weight loss.  What are some of the risk factors associated with this type of cancer?  There are risk factors that can and cannot be controlled. Uncontrollable factors include age, race, personal and family histories as well as certain genetic syndromes that are important to discuss with your provider.  This type of cancer is more common in people over the age of 50, African Americans and those of eastern European Jewish (Ashkenazi) descent. This type of cancer is also more common in those who have been diagnosed with polyps, Crohn’s disease, ulcerative colitis and long-term inflammatory bowel disease. important to discuss any of these risk factors with your provider.  There are also lifestyle factors that can help reduce your risk. Factors include being overweight, having a diet high in red and processed meat, as well as smoking and consuming excess alcohol.  Conversely, diets high in fruits and vegetables and a regular exercise routine can help lower your risk.  If someone has some of these risk factors, what should they do? Do they need to get tested?  If you are 45 or older and have any of these risk factors, we recommend you speak with your primary care provider about a formal colorectal risk assessment.  The most common form of screening is colonoscopy. This screening lets your doctor examine the length of your colon, map out any potential problem areas and remove polyps. For most people, colonoscopies are recommended every 10 years starting at age 50. However, depending on your results and risk factors, you may need to begin screening sooner or get screened more frequently.  What do diagnosis and treatment look like for this type of cancer?  There are several diagnostic options for colorectal cancer, including endoscopic ultrasound; CT, MRI and PET scans; and biopsy and pathology reports. These technologies allow your doctor to get images of your colon and evaluate what treatment is needed, as well as how the treatment is progressing.  Treatment varies for each individual working with their doctor. In the case of colorectal cancer treatment, the William N. Pennington Institute for Cancer offers chemotherapy, radiation therapy, surgery and clinical trials.

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