Congratulations to all who entered the Dementia Australia Sydney Memory Walk and Jog! Much awareness and money was raised for a great cause. Running or walking for someone you love is a great way to remind us all of the importance of more support and research into dementia, as well as being a fantastic opportunity to connect with others and enjoy a great day. Look out for other events in Capital cities around Australia

We make multiple food decisions every day from waking up in the morning to going to sleep. The culmination of those choices has a tremendous effect on our health and well-being. With the rise of healthcare costs and non-communicable diseases, good nutrition has never been more critical.

Due to the onset of the digital age, food choices have been difficult to make with the media’s incessant portrayal of the latest fad diet which usually lacks scientific evidence. The reason that there have been numerous diets without one miracle diet is that it simply does not exist. A successful diet to achieve a healthy lifestyle is individualised, balanced and built for the long term.

A dietitian has the special ability to help you by educating and empowering you to create a healthy lifestyle for life. It is important to note that the credentials of a dietitian and nutritionist are not interchangeable. A dietitian has met rigorous academic and professional standards and are the foremost experts of the dietetic field who will translate science to real-life applications tailored to you.

There is a common misconception that a dietitian will prescribe a diet with no ifs, ands or buts. Each individual has a unique background which reflects upon his or her food choices-and a dietitian recognises that. There is no food off limits and indulgences are encouraged, mindfully of course.

BPPV or Benign Paroxysmal Positional Vertigo (BPPV) is a disorder of intense, brief, variable dizzy or vertigo that is often brought on by head turning. It can seemingly come out of the blue and can be very impairing. The cause is not fully understood, however it is thought to be due to tiny particles breaking loss or causing blockages in the inner ear, and this in turn stimulates the nerves wrongly, telling the brain wrong messages.

BPPV can occur in association with head injury, age, viral illness or occur for no apparent reason. It is often frustrating for patients both in achieving a diagnosis and also obtaining cure. BPPV should be both a diagnosis of exclusion once other, often more concerning disease are ruled out, and also certain signs can be detected often by your doctor.

How is it treated? There are simply exercises that your doctor or physiotherapist can take you though, and as always it may require some time and effort to resolve. It is important to seek advice on the safety of certain motion / vertigo medications as these may have side effects, or may not be helpful. Online information can be found at www.vestibular.org

When you visit your doctor it is common to have your blood pressure checked, and for good reason. We not only think about our heart health and reducing the risk of heart disease but our brain health too. High blood pressure can increase the risk of stroke, both of the blocked artery (ischaemic) and bleed in the brain (haemorrhagic) types. We now have increasing evidence too for the importance of maintaining good blood pressure control in reducing dementia risk. High blood pressure can associate with small vessel or so-called white matter changes within the brain, and lead to cognitive slowing.

The numbers are important. An ideal blood pressure depends a little on patient circumstance, however a top number of below 120 systolic and lower of 80 is deemed optimum, especially for those with diabetes or other vascular risk. Home monitoring over 24 hours is an option for those uncertain of their blood pressure with usual home measurements.

There are other benefits to be had by avoiding any smoking, heavy drinking, addressing cholesterol well, keeping active with exercise, and maintaining adequate sleep and nutrition, for optimum weight maintenance. It is good to consider reducing anxiety and obtaining assistance if needed, such as relaxation, counselling or clinical psychology, or medication in some instances.

Remember, blood pressure is most often treatable, so whenever you think of your health in general, think blood pressure.

Weight loss in dementia patients is unfortunately not a commonly addressed topic. Given that dementia is the second leading cause of death in Australians, there must be greater awareness and support for those afflicted. Good nutrition is essential to health and can positively contribute to the patient's clinical prognosis. If successfully achieved, the patient may have a less arduous journey down the path in living with dementia.

In treating the dementia patient, not only are there mental changes but also physiological changes.

Dementia may cause the individual to forget to eat at mealtimes and present in ways of a short attention span and increased agitation.

In those who experience pacing, increased nutrient needs will need to be taken into account secondary to increased physical activity. The physiological effects from ageing also may negatively contribute to the patient's well being. These effects include decreased hunger and thirst sensation, swallowing function, and the ability to feed oneself.

A nutrition plan of care may address inadequate nutrient intake through the provision of fortified foods aligned with the patient's personal food preferences. A variety of meals, drinks and snacks may also be regularly encouraged. In some advanced cases, supplementation or even an artificial tube feeding may be considered.

Despite all the potential interventions we may use, the patient's quality of life and dignity must be prioritised. Food represents much more than our body's fuel. For many individuals, it brings back beloved memories with family and friends and is a key component in social gatherings. As such, there is no one-size-fits-all approach. The multidisciplinary team and the patient's family and friends must be engaged on all fronts to ensure the patient is nourished and happy.

Many people research neurological symptoms on the internet, and one condition that can arise is brain inflammation or encephalitis. This is a serious, but fortunately rare, condition with symptoms that include headache, fever, confusion, speech trouble, seizures or loss of consciousness.

Viruses are common causes, and some of these include herpes virus and enterovirus, however not everyone with these viruses will develop neurological symptoms. Identifying the exact virus causing encephalitis can be difficult but may help with treatment. One type of encephalitis doctors no longer see, thanks to vaccination, is subacute sclerosing panencephalitis, or SSPE, an incurable and often fatal disease caused by measles virus.

Another, much rarer, cause of encephalitis is an autoimmune process, or inappropriately overactive immune system. This process could be triggered by an infection, a remote effect from cancer (known as a paraneoplastic syndrome) or idiopathic - that is, due to unknown cause.

These conditions can be difficult to diagnose, and the treatment often requires medications that suppress or modulate the immune system such as steroids.

Encephalitis can be life threatening, and some patients face prolonged admission with the prospect of an uncertain recovery. It's vital to ensure good support for patients and their loved ones, from rehabilitation to community engagement and recovery, alongside future research that may improve the lives of these patients.

A visual aura is a disturbance in vision that is often experienced by people before they have a migraine headache. It can also occur even without a headache. The appearance of a visual aura varies significantly from person to person. For example, some people may see either bright or black spots, white zig-zag lines or even bright colours. A visual aura can last anywhere from 5-60 minutes and when prolonged can interfere with activities such as driving and reading.

The treatment of visual aura is similar to that of migraine. If you have visual aura that impacts your life, make an appointment today to discuss treatment. Of course, visual changes can occur for many reasons, and you should see your doctor if concerned.

Australian's love their sport, and we want our athletes to be healthy inside and out. Concussion is not a new topic, but it is becoming one that is at the forefront of athlete's minds when considering longer term effects and their wellbeing post-sport.

A recent consideration in athletes particularly in the United States has been the disease of chronic traumatic encephalopathy, or CTE, with excellent work by the Concussion Legacy Foundation. We have much to learn about this condition, and the Australian Sports Brain Bank (ASBB) at the Brain and Mind Centre, University of Sydney in collaboration with Royal Prince Alfred Hospital is aimed at just that.

The ASBB is aimed at research into CTE that may lead to better understanding and a way forward for future management of this condition.

730 reported, Tracy Bowden, has covered the story on abc - High Stakes.

Migraine is a common condition which causes significant functional impairment. Migraine is more common in women than men, and affects up to 12% of the population. There are many different types of migraines, triggers for migraines can include sleep deprivation, stress, certain foods and hormonal changes. Migraine is much more than just a headache, people can experience cognitive changes, visual or sensory disturbances, severe nausea and many other symptoms when they have a migraine attack.

There are several different options for treatment of migraines, including both non-pharmacological and pharmacological therapies as well as injection therapies.

What triggers a migraine?

There are many different ‘triggers’ for a migraine attack. Migraine triggers are also very individual, one person with migraine may have very different triggers to another person, and some people can never identify any triggers for their migraines. Approximately 75% of people with migraine report a trigger. We do know that some triggers are more common than others. A few of the most common ones are:

Sleep deprivationNeck painWeather changesNot eatingHormonal changes in womenEmotional stress

There are many other triggers that can precipitate a migraine and it can often take some time to identify them. For more information see headacheaustralia.org.au or talk to your doctor.

Have you ever wondered, 'what is memory?'. Memory can be defined into short or long term categories but the situation is more complex. There is a large amount of research into memory but we have a lot to understand yet about different types of memory, and how the brain lays down memories.

Shorter term memories are known as working memory and can often refer to our conscious, chosen, storage and retrieval of memory according to prioritisation or meaning. During this process, we believe that individual or patterns of neurones fire and then remain stimulated even after the initial sensory message such as a social situation or hearing a familiar name. From there, the activation of different proteins within an area of the brain known as the medial temporal lobe may lead to a foundation for longer term memory, derived from our experiences and personal meaning attached to colours, sounds, smells, language, touch, patterns and symbolism that we can reminisce about years later.

There is also sensory memory, such as those which we recall only a split-second from seeing or perceiving them through sounds or language, and procedural memory or learned tasks that we no longer think in a conscious way about.

Genetic factors, and our activities such as exercise, are thought to play a role in memory. Memory is crucial to our day-to-day lives and functioning at our best and it can be important such that we should "remember memory" when it comes to better health.

Migraine is faced by many in our community and can lead to significant time away from work, family life, and difficulty with everyday tasks. Our busy lives can become greatly impacted if migraine takes hold.

Migraine is more common in women than men, and affects up to 12% of the population. There are many different types of migraine but common triggers include sleep deprivation, stress, certain foods and hormonal changes.

Migraine is much more than just a headache, people can experience cognitive changes, visual or sensory disturbances, severe nausea and many other symptoms when they have a migraine attack.

There are several different options for treatment of migraines, including both non-pharmacological and pharmacological therapies as well as injection therapies, so see your doctor if you are concerned. Headache Australia offer information to help sufferers through migraine.

Have you ever had “butterflies” in your stomach? It turns out that there is actually a scientific meaning behind this sensation. It is an exciting area in the nutrition world as research is revealing gut health to have an effect on your overall health, most notably your brain function.

It turns out bacteria is not necessarily “bad.” As humans, our bodies are composed about 50-60% microorganisms. Our gut microbiome contains most of these diverse microorganisms which play important roles in energy metabolism and immune function.

Called the “second brain,” the gut also possesses the special ability to communicate with our central nervous system. Developing research on this gut-brain axis shows a potential link between gut health and mood shifts such as depression or anxiety. Although more research is needed in this area, this may pave the way for future treatments for mental health.

Nutrition is key in nourishing our gut microbiome. The spotlight on fermented foods such as kombucha and sauerkraut has been heavily portrayed in the media. However, there is no one food product that can transform your gut health. The key to a healthy gut is a well-balanced diet with diverse fiber intake. Physical activity, medication and stress are other factors that may play a role.

The term 'Hyperhidrosis' refers to chronic sweating in amounts greater than what the body needs and, understandably, this can have a severe impact on a person’s self-confidence and their professional and social relationships. Patients usually have excessive sweating of the palms, underarms (axillae) or soles of the feet.

Those with hyperhidrosis of the hands can have loss of confidence with common activities, such as shaking another person’s hand or signing documents. Hyperhidrosis of the axillae can have a devastating effect on self-esteem, causing people to avoid certain social interactions, or even modifying their behaviour for fear of appearing socially unacceptable.

Treatment for hyperhidrosis can involve something as simple as antiperspirant deodorants as first line therapy. Botulinum toxin injection to the affected area is often recommended as second line therapy. It reduces sweating temporarily by blocking the neuronal release of the neurotransmitter acetylcholine. A response to treatment with botulinum toxin is usually seen within 2-4 days and an improvement in sweating can last 3-9 months or longer, with significant individual variation.

At Sydney Cognitive our Neurologists are experienced in the treatment of hyperhidrosis. Call us today to discuss an appointment.

Australia has just launched it's first concussion brain bank - the Australian Sports Brain Bankled by the University of Sydney's Brain and Mind Centre and Royal Prince Alfred Hospital and in international partnership with the Concussion Legacy Foundation's (CLF) Global Brain Bank, with research at Boston University. Chronic traumatic encephalopathy (CTE) is neurodegenerative condition related to repeated head trauma and concussion, and the goal is greater understanding of the condition, with opportunity for current and future research using brain tissue.

There is an emphasis on understanding more about the condition during life as well as microscopic and molecular changes studies with the help of the brain bank. The brain bank is part of a wider push to have better awareness of concussion, and that "if in doubt, sit it out" with athletes requiring care and observation, a thorough assessment, and consideration of current concussion guidelines before being permitted to play again. It is no longer considered "good" or "tough" to put up with concussion and play on through symptoms. Instead be brave through your words and 'call it out' if you are an affected player, or show support for your fellow athletes if they are concust.

Let's talk more about concussion and keep the momentum going for a better future.

Do you know you may be eating foods high in sugar without realising it? We are all aware of the main culprits such as lollies and soft drinks but there are common foods we eat on a daily basis that contain similar if not more amounts of sugar.

These hidden sugar items to look out for include:

Breakfast cerealsPrepackaged saucesSalad dressingMuesli/protein barsFlavoured watersFlavoured yogurts JuicesTomato sauceDried fruit

A high consumption of sugar has the potential to cause a variety of problems that can lead to eye, heart, and kidney problems. Another lesser discussed problem is the effect on your brain. When sugar enters your body, it triggers dopamine, a “feel good” neurotransmitter that causes a “sugar high.” This may cause an increased tolerance to sugar and jumpstart the cycle of insatiable cravings.

Eating a balanced diet containing adequate amounts of carbohydrates, protein, and fat is important. However, it is not to say that you should eliminate all sugars from your diet. Food should be enjoyable and a scoop of chocolate ice cream every now and then won’t hurt.

When we are on the go, traveling, working, we often plan everything else except what we are eating. This can have affect our health negatively as once hunger cues begin, we grab whatever we see in sight.

Even just a few minutes of planning can be very helpful in preventing us from making unhealthy choices. One way to achieve this is to choose recipes you like to eat for the week and plan a grocery list. This will not only steer you away from buying unnecessary food but also help you prevent food waste. Also, it is very important to invest time in meal preparation for meals and snacks. Ideally, this should be done on weekends, or times you are free. In doing this, you will be more likely to make healthy choices during the busy week to achieve a healthier lifestyle.

A recent study our of the University of Denver has found preliminary evidence that higher intensity exercise may benefit those with Parkinson's disease when compared with moderate exercise. Large amplitude movements are also encouraged.

There is evidence that patients can attain higher functional status and there may be a delay in symptom progression.

Already, high intensity exercise of HIIT programs are beginning to embraced by fitness enthusiasts, given the potential metabolic changes and improved overall fitness. We look forward to future research in this area.

Brain reserve, otherwise known as 'cerebral' or 'cognitive reserve' is the theory that our intellectual ability, can (but not exclusively) be represented by our education and occupational functioning in life may shield us in some way from dementia or neurodegenerative disease. It is a concept of brain protection and resilience. We now know that the brain is a dynamic organ that can change over time with some processes of repair or regeneration and some of decline or disease, and that different brains alter differently.

Whilst the concept of cerebral reserve may seem intuitive or plausible, it remains unproven. In part, this may be due to the complexities of our lives and cognitive make-up that make devising scientific studies difficult, and in part the length of time required to study such diseases. There are likely genetic, as well as environmental, factors which contribute.

What we do understand is that whilst age is the major risk factor for dementia there are ways we can reduce our risk, even slightly, with hope to enjoy health in our older years. This includes avoiding smoking, diabetes, head injury, treating depression, avoiding excessive alcohol and maintaining a healthy lifestyle with exercise, social activity and a balanced diet. This is likely to hold true for those with or without good brain reserve. As technology improves we may be able to obtain a better 'window on the brain', understand how some brains age better than others, and hope for better therapies in dementia.

Helping a person with dementia to live at home is not always easy, and can require planning and ingenuity. Depending on the individual and the stage of their illness (mild, moderate or severe) practical strategies can reduce confusion, increase comfort and enhance independence, and some useful tips are:

In general:

Keep the home environment familiar, this requires less mental processing

Use slip resistant surfaces

Make use of natural light to aid orientation

Keep the temperature comfortable

Reduce glare from shiny surfaces which can cause confusion

The lounge room can be especially problematic:

Minimise clutter, clear a path to the armchair

Use contrasting colours and avoid patterns

Reduce over-stimulation from the TV etc.

In the kitchen:

Label drawers and cupboards

Consider a gas cut off switch

Allow person to help with simple, safe tasks like washing vegetables, cleaning or setting the table

And in the garden:

Keep hose and gardening tools tidy and tucked away

Consider security measures such as locked gates if needed

Use the outdoors to reorientate the person

These are just some of the many ways we can make home life easier for the person with dementia and their carers. An occupational therapist can greatly assist in finding the right balance for each person.

Having a headache can make it hard enough during a busy day let alone any added symptoms of migraine. Migraine is extremely common and can vary widely between individuals, often with a one-sided or spreading type headache, sound or light intolerance, visual sparkles, spots or dots, nausea and sometimes vomiting. Speech, sensation or movement can be affected and people may be concerned that they are experiencing a stroke or other emergency. Migraine can in fact alter the risk of stroke and it is important to seek medical attention if there is any concern.

Interestingly, mental clouding or 'fogginess' is common and can affect a person's concentration, memory or language.

Migraine can first occur at any age. We do not yet understand what causes migraine but it is important to know that help is available as our treatments have changed greatly over the past few decades. Medication can be effective but this is often not the whole answer, and your doctor can help identify any lifestyle, dietary or other changes that may be needed. In severe cases botox therapy may be useful, which targets certain areas of the head and neck. In many cases the right treatment can be found, and headache can be resolved entirely, making that work day seem just that bit easier.

Falls in older patients are a major and preventable cause of morbidity and the requirement for higher levels of care, as well as mortality. Of the face of it, it seems simple to be able to avoid a fall; just be attentive, careful, 'watch where you are going' but falls are complex and are due to multiple factors based upon not only the physical state a person is in at the time but their environment.

Our senses are vital to avoiding a fall, from an awareness of how are bodies are located in a space, or proprioception, to vision, and balance via the vestibular system of the inner ear, which coordinates with our eye movements (vestibulo-ocular reflex). Our strength and ability to walk normally are important, as are medications such as sedatives. Dementia increases the risk of falls and a patient may be dizzy from diseases affecting the heart or vascular system.

Then there are many environmental considerations like stairs, uneven surfaces, lighting, distractions and the degree of familiarity. If a fall is seen by others, that information can be vital in preventing future falls for that individual, and it is often helpful to write what happened down and discuss this with your doctor. With so many causes, and therefore ways to reduce risk, the good news is that we all can act to prevent falls in the community.

Stroke, as the name suggests, is a sudden event where the person may literally be 'struck down' at the tick of a clock by their neurological symptoms. Two major types of stroke exist, ischaemic (a lack of blood flow) and haemorrhagic (a bleed) and their treatments are therefore very different. Time is critical in stroke, and if suspected, emergency treatment is required.

Depending on where the stroke is in the brain, abilities of thinking, or cognition, can be affected, and may occur in combination with classic symptoms such as weakness, tingling or speech difficulty. Symptoms can include altered behaviour, memory loss, mood change, lowered awareness or insight into one's environment, and difficulty with functions such as language interpretation, concentration, and visual perception.

Recovery can be complex, and it takes a dedicated team of health professionals to treat someone who is hospitalised with a major stroke. Symptoms may improve depending on the extent of the stroke, and rehabilitation is often used to stimulate new connections within the brain in order to maximise recovery, sometimes over many months.

The time to act is in fact before stroke occurs - prevention is so important, and to consider discussing steps towards this with your doctor if any concerns.

Dementia has become a key issue in our community, and many of us ask, ‘how can I prevent dementia, or at the very least delay it?’. Unfortunately, there is no easy solution. Dementia is a gradual process which, somewhat surprisingly, may begin even in mid- rather than late-life. In addition, our so-called, 'cognitive reserve' or brain "resilience" can depend on factors while in the womb and in early life.

This makes researching the condition challenging, and a major international research effort is underway to identify risk factors as well as early indicators of disease, and therefore potential targets for prevention.

Recent research has suggested 9 key risk factors for dementia at different life stages that may be helpful in reducing risk; low educational level in childhood, hearing loss, hypertension, obesity, smoking, depression, physical inactivity, social isolation, and diabetes (Frankish and Horton, 2017). Keeping a watchful eye on risk factors as they arise and early intervention could well hold the key to lowering dementia rates, and a full, active life for many.

When we think of Parkinson's disease, we often think of problems purely to do with movement, such as walking. However, it is now well recognised that Parkinson's disease can affect a person in many ways.

These span from gastrointestinal problems like constipation, sleep disturbance, loss of smell and dizziness, right through to mood alteration and memory loss. Together, these are known as "non-motor" symptoms, and are important targets in the battle to treat Parkinson's disease with the help of your doctor, as well as being the topic of much research.

Cognitive effects can go beyond memory to involve other thought processes such as attention, thinking speed and visual perception, whilst in some cases hallucinations can be problematic. Though a cure for Parkinson's disease has not yet been reached, help is available, and management can involve medication changes, psychology, physiotherapy and occupational therapy to name a few. Simply being aware and letting your support team know of non-motor symptoms is often beneficial. It may be useful to keep a diary of your symptoms so your physician can tailor management to suit your needs. Let's all keep thinking through Parkinson's disease towards a brighter future.