Ask the Doctor: Mixed Dementia; Sleep Apnea; Masked Hypertension
Q: My father has mixed dementia. What is mixed dementia? Can it be treated?
A: The term mixed dementia is often used to describe a combination of vascular dementia (caused by reduced blood flow to the brain) and Alzheimer’s disease (AD). It had been thought that about one in five Americans with dementia had this type of mixed form. Recent research suggests, however, that other pathologies linked with dementia—such as Lewy bodies (abnormal deposits of a protein inside brain cells), hippocampal sclerosis (a severe loss of brain cells in a key memory region called the hippocampus), microinfarcts (small mini-strokes) and low brain weight—are also commonly present in the brains of individuals with dementia. According to data tracking changes in the brains of more than 1,100 older participants in long-term studies, most participants who developed dementia showed signs of a blend of pathologies. In a report published in the March 2016 issue of Neurology, the researchers concluded that the impact on clinical dementia and impairment was largely unrelated to the type or combination of pathologies, but rather to the total burden of disease. Treatment for these different disease combinations often centers on addressing hypertension, or high blood pressure, which is a contributing factor in most of these ailments. Antihypertensive and statin drugs, a healthy low-fat diet, exercise, and lifestyle changes that affect the cardiovascular system, such as quitting smoking, may help reduce the rate of cognitive decline. AD medications may also be helpful in slowing the progression of cognitive decline in people with mixed dementia.
Q: I am worried that I may have sleep apnea, but I have no specific symptoms. I am overweight and have diabetes, both of which put me at risk. Do I need a sleep test?
A: By all means, ask for a referral to a sleep medicine professional for a comprehensive evaluation if you believe you may be at risk for obstructive sleep apnea (OSA). The sleep disorder, which involves periodic collapses of the airway during sleep and frequent brief halts in breathing, is associated with adverse structural and chemical changes in the brain linked to lack of oxygen. These changes often result in symptoms such as daytime sleepiness, fatigue, confusion, memory problems, difficulty with decision-making, depression, and stress. People who are obese, or have type 2 diabetes or cardiovascular problems such as treatment-resistant hypertension, atrial fibrillation (irregular heartbeat), congestive heart failure, or a history of stroke are at high risk for the sleep disorder, and should have an assessment even without symptoms. Sleep apnea is usually treated with continuous positive airway pressure, or CPAP, which involves wearing a special breathing mask during sleep to keep the airway from collapsing. In the Jan. 24, 2017 Journal of the American Medical Association, the U.S. Preventive Services Task Force considered whether to recommend screening for all adults, but concluded that the benefits of such a broad-based approach were not yet clear. In response, the American Academy of Sleep Medicine, an organization of sleep physicians, recommended “screening patients who have a high risk for obstructive sleep apnea, even if they don’t have any sleep-related symptoms.”
Q: What is masked hypertension? Is it very common?
A: Masked hypertension is hypertension that is not apparent during visits to a doctor’s office, yet raises risk for stroke, heart disease, or damage to the brain and other organs. Research published Jan. 18, 2017 in the American Journal of Epidemiology suggests that about 17 million otherwise healthy U.S. adults have the condition, which is more common in seniors and people with diabetes. Masked hypertension can be identified through self-monitoring or by wearing an ambulatory blood pressure monitor for 24 hours under medical supervision.
—Editor-in-Chief Maurizio Fava, MD
The post Ask the Doctor: Mixed Dementia; Sleep Apnea; Masked Hypertension appeared first on University Health News.
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