Ask the Doctor: Hormone Therapy for Memory; Blood Pressure Variation; Depression & Dementia

Q: I’m a 66-year-old woman whose memory has declined significantly since menopause. Should I consider taking hormone therapy to improve my memory function?

A: Recent research suggests that hormone replacement therapy for postmenopausal women provides no benefit for cognition and memory function, no matter how long after the woman’s last period the treatment is initiated. Scientists divided approximately 570 healthy women whose ages ranged from 41 to 84 into two groups; one received the hormone estradiol—the main type of estrogen produced by women in their reproductive years—and the other received an inactive placebo. After about five years, the researchers found no difference between the two groups in verbal memory and thinking skills, according to a report published online July 20, 2016 in Neurology. Cognitive performance was similar among all participants, whether or not they had experienced hot flashes or undergone a hysterectomy. Given the fact that some earlier research has linked long-term use of hormone replacement therapy with increased risk for cardiovascular problems and dementia, it might be best to try other options to improve your memory, such as exercising regularly, getting at least seven hours of sleep at night, eating a healthy diet, getting plenty of mental stimulation, and practicing mindfulness meditation.

Q: Blood pressure readings in my right arm are different from the readings in my left arm. Is this anything to worry about? How do I determine which reading is accurate?

A: It is not unusual to see a small difference in the blood pressure readings taken from both arms. But readings that differ by more than about 10mmHg for diastolic blood pressure and 20mmHg for systolic blood pressure require medical assessment to rule out underlying problems such as partial obstruction of a major artery supplying the arm or peripheral vascular disease. If you have found a difference—and especially if the difference is large—ask your health care provider to measure blood pressure in both arms when taking a reading.

Smaller differences in readings between your two arms may reflect variations in the way you measure your blood pressure in each arm or the way the blood pressure cuff fits. In many people, blood pressure may be a little higher in the dominant arm—for example, if you are left-handed, pressure may be higher in your left arm. It’s best to measure blood pressure on the arm with higher readings when checking for hypertension.

Q: Is it true that older people who suffer from serious depression are more likely to develop dementia? Can this be avoided?

A: It is certainly true that there is a strong association between severe depression in older adults and increased risk for dementia. More recently, a study of 2,500 people in their 70s published in the May 2016 issue of JAMA Psychiatry suggests that steadily worsening depression may lead to worsening cognition, and nearly doubles the risk of developing dementia. While only 12 percent of participants in the study who showed minimal signs of depression over a five-year period went on to develop dementia in the next six years, 21 percent of those who consistently experienced severe and worsening symptoms of depression eventually developed thinking and memory problems.

The study did not indicate whether the depression was an early symptom of cognitive decline, or whether prolonged depression caused those changes. However, the findings suggest that older adults should be screened for depression, and raise the possibility that treatment for depression with psychotherapy or medications might lead to improved cognitive health, as well as relief from depression and improved quality of life.

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