Ask Dr. Etingin: Low-dose aspirin; Dementia symptoms; Antidepressants and sexual side effects
Why is low-dose aspirin recommended for prevention of cardiovascular events like heart attack and stroke? Wouldn’t regular strength aspirin be more effective?
Aspirin can cause internal bleeding, and bleeding risk is lower with low-dose “baby” aspirin (81 milligrams) than full-strength aspirin (325 milligrams). Research has shown that low-dose aspirin is just as effective at preventing cardiovascular events as full-strength aspirin, and it won’t raise your bleeding risk as much.
Aspirin helps prevent platelets in the bloodstream from clumping together and forming a clot, so it is called an antiplatelet drug; prescription antiplatelet drugs include clopidogrel (Plavix) and ticagrelor (Brilinta). Other medications that help prevent blood clots work by inactivating or inhibiting the production of clotting factors. These drugs, called anticoagulants, include warfarin (Coumadin), apixaban (Eliquis), rivaroxaban (Xarelto), and dabigatran (Pradaxa).
If you take any of these medications, be alert for signs of internal bleeding, such as blood in your stool, black, tarry stools, rectal bleeding, or vomiting blood (vomit may be red or dark brown and look like coffee grounds). Other symptoms include lightheadedness, difficulty breathing, fainting, and pain in the chest or abdomen. If you have any of these symptoms, report them to your doctor immediately. Internal bleeding also may cause iron-deficiency anemia, so check the results of blood work. Low levels of ferritin, hemoglobin, and hematocrit are possible indicators of iron-deficiency anemia.
Do Alzheimer’s disease and vascular dementia have different symptoms?
Alzheimer’s disease (AD) and vascular dementia do have many common symptoms, but there are some notable distinctions, especially in the early stages.
Memory loss is one of the hallmark signs of AD. People with AD may have trouble remembering recent conversations, forgetting important dates or events, or asking the same question repeatedly. Other symptoms include difficulty completing familiar tasks, problems speaking or writing, getting confused about time or place, misplacing items in unusual places and/or being unable to retrace steps to find them, poor judgment, withdrawing from social activities, and personality and mood changes, such as becoming suspicious, anxious, depressed, or fearful.
Initial signs of vascular dementia often include difficulties with planning, decision-making, and problem-solving, disorganized thinking, and trouble concentrating, but memory impairment also is common. Other symptoms include restlessness, agitation, confusion, depression, and apathy.
In some cases, vascular dementia is caused by a stroke or transient ischemic attack (often referred to as a “mini-stroke”) that impairs blood flow in the brain. In these cases, changes in thinking and perception may happen suddenly. If vascular dementia is present, imaging tests of the brain may reveal blocked blood vessels or areas where bleeding has occurred. However, vascular dementia also can develop gradually. Risk factors for vascular dementia include heart disease, diabetes, high blood pressure, high cholesterol, obesity, and smoking.
I recently started taking an antidepressant, and I’ve noticed that my interest in sex has decreased. Could this be a side effect?
Yes, sexual side effects are common with many antidepressant medications. In addition to a loss of interest in sex, difficulty becoming and staying sexually aroused and reaching orgasm may occur. Some people are unable to have an orgasm while taking an antidepressant.
Sexual health is an important topic that’s often overlooked as we get older. Report your decreased interest in sex to your doctor, and ask about medication options that may help restore your libido.
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