Q: My mother has been diagnosed with mild cognitive impairment. Would she benefit from taking a medication for dementia?
A: Research involving nearly 4,500 older adults suggests that taking one of the four commonly prescribed medications for Alzheimer’s disease—rivastigmine (Exelon), donepezil (Aricept), galantamine (Razadyne) or memantine (Namenda)—does not improve the cognition of people with mild cognitive impairment (MCI), or prevent the progression of cognitive decline over time. A review of eight separate trials comparing the medications with placebo found no evidence of long-term effects on cognitive functioning associated with any of them. However, the research did link undesirable side effects, such as diarrhea, nausea, and vomiting, to the medications, according to a paper published online Sept. 23, 2013 in the Canadian Medical Association Journal. Certain lifestyle strategies may help protect your mother’s health and slow her cognitive decline. Getting regular exercise (30 minutes a day at least five days a week), consuming a healthy low-fat diet, and enjoying frequent mental stimulation and social interaction have all been linked to mood and cognitive benefits.
Q: What is intracranial arterial stenosis, and how is it treated?
A: Intracranial arterial stenosis (ICAS) is a narrowing of one or more of the arteries in-side the brain, leading to a reduction or blockage of blood flow that may result in a transient ischemic attack (TIA) or stroke. ICAS is usually caused by atherosclerosis, the inflammatory buildup of fatty plaque inside blood vessel walls. The condition is often asymptomatic, but when fragments of plaque break away from vessel walls and block blood vessels deeper inside the brain, it may make itself known through temporary TIA symptoms, such as weakness or loss of feeling in the arm, leg or trunk on one side of the body, or sudden problems with vision. Immediate medical assessment is essential after these symptoms, which usually indicate a heightened risk for an ischemic stroke. Treatment focuses on reducing this stroke risk. In addition to lifestyle changes such as smoking cessation and dietary improvements, patients may be prescribed blood-thinners, medications to lower levels of “bad” LDL cholesterol, and/or anti-hypertensive medications. If the stenosis is severe, balloon angioplasty (in which a small balloon is inflated inside the artery to compress the plaque and dilate the artery) and stenting (the insertion of an expanding tube to maintain the dilation of the artery) may be advised. A surgical bypass, in which blood flow is rerouted around the blocked portion of the artery, is sometimes recommended for severe blockages.
Q: Is it true that anxiety can increase the risk of death in people with heart disease? Are there ways to lower risk?
A: A study published in the Journal of the American Heart Association’s March 19, 2013 issue suggests that having an anxiety disorder may double the risk of mortality among individuals with heart disease, and, when combined with major depression, may triple the risk of dying. Occasional anxiety is normal and it is understandable that people who suffer from heart disease may feel anxious about their condition. However, severe anxiety that lasts for more than two weeks and interferes with the activities of daily living may indicate an anxiety disorder. Symptoms include uncontrolled worrying, restlessness and trouble relaxing, feeling constantly on edge, feelings of foreboding, heart palpitations, and irritability. Individuals with chronic anxiety should see their health care provider for a thorough assessment. Anxiety is usually addressed with cognitive behavior therapy, medication, or a combination of the two. Regular exercise is also helpful in lowering anxiety symptoms.
—Dr. Maurizio Fava, MD
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