Ask the Doctor: MCI; Hypertension; Hormone Therapy and Depression

Q: My doctor says my fading memory may indicate mild cognitive impairment. How can I lower my risk of developing dementia?

A: Mild cognitive impairment (MCI) is usually defined as memory loss that is worse than normal age-related memory changes, but does not interfere with activities of daily living. Although many individuals with MCI go on to develop dementia, not all do. Some people remain static or even improve. A review of 62 studies published in the Feb. 20, 2015 issue of the American Journal of Psychiatry may offer some clues to factors that are associated with increased risk for progressing from MCI to dementia. The research, which looked at progression among almost 16,000 people with MCI, revealed that diabetes mellitus, depression, heavy alcohol use, and low levels of vitamin B12 (folate) predicted greater risk of conversion from MCI to dementia. Other factors thought to increase the risk of developing MCI include cardiovascular disease and poor diet.

You may be able to slow or stop the progression of dementia by managing medical problems such as diabetes, hypertension, and other cardiovascular problems, and adopting lifestyle changes that help protect brain health—such as eating a nutritious, low-fat diet, with plenty of fresh fruits and vegetables, getting regular exercise, staying socially and mentally active, and getting at least seven hours of sleep at night.

Q:I have treatment-resistant hypertension. Do I have to restrict my salt intake even though I’m taking several blood pressure medications?

A: Yes. American Heart Association guidelines say that for the 20 percent of people with high blood pressure who have treatment-resistant hypertension (high blood pressure that remains high despite taking at least three medications to control it) reducing dietary salt intake can lower systolic blood pressure (the top number in the blood pressure ratio) by 5 to 10 mm Hg, and diastolic blood pressure (the bottom number) by 2 to 6 mm Hg. What’s more, research suggests that too much dietary salt not only contributes to hypertension, but may reduce the effectiveness of blood pressure drugs as well. In people with resistant hypertension, researchers have found that those who restrict salt intake to about a half teaspoon a day have an average systolic blood pressure reading of 130 mm Hg, compared to about 150 mm Hg for individuals who do not follow a low-salt diet.

Q:Does hormone therapy for prostate cancer increase risk for depression?

A: A recent study suggests that one widely used type of prostate cancer therapy may heighten depression risk. The therapy, called androgen deprivation therapy (ADT), aims to limit the spread of prostate cancer cells by reducing levels of testosterone and other male hormones. The research revealed that among 78,000 older men treated for prostate cancer between 1992 and 2006, those who received the hormone therapy were 23 percent more likely to be diagnosed with depression and 29 percent more likely to receive inpatient treatment for depression than those who received other types of therapy. The study, which was published online April 11, 2016 in the Journal of Clinical Oncology, also found that depression risk grows over the course of hormone treatment. In view of these recent findings, I would advise individuals who have been diagnosed with prostate cancer to discuss with their doctor the potential benefits and drawbacks of ADT. If ADT is recommended, the importance of prompt diagnosis and treatment of possible depression should be stressed. Other possible therapies for prostate cancer include radiation, surgery to remove the prostate, chemotherapy, freezing prostate tissue (cryosurgery) and immunotherapy.

—Maurizio Fava, MD, Editor-in-Chief

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