Sunday, September 23, 2007

Dementia Dialing

I commented to a friend recently on my mother's habit of pulling out her personal phone book on good days and dialing friends and family. She informs us, then, of her latest whereabouts on an art museum tour, in a motel, or in a research facility, and then chats of the ordinary as if nothing about the call is extraordinary.

My friend noted that this reminded her of her mother's 'drunk dialing,' and others have also remarked on the similarities with phone tears they've been on when inebriated. I wonder what short circuits underlie this habit, and whether or not the two conditions--dementia and drunkeness--are at all alike in a brain sort of sense. Maybe the common denominator is simply a lack of impulse control.

Tuesday, September 18, 2007

Brainstorms: The aftermath

Mom's latest stroke event on Sunday left her immobile and speechless that day. As always, and to my ongoing amazement, she recovered her speech and movement by the next day, although each function was just a bit more impaired. But this time, she returned profoundly depressed.

After sitting around with her for an hour, quietly inspecting the scene out the window (no point in talking--all conversational gambits met with 'I don't care'), I cornered her doctor in the hallway to come discuss med adjustments.

He entered the room with nary a greeting nor a glance in her direction, talking all the while to me about the difficulty of treating post-stroke depression. Even when I specifically asked him to include her in the discussion, he never once spoke or looked at her. I seriously considered the possibility that he himself was neurologically impaired so bizarre his behavior.

As he examined mom, remarking about her lack of breath sounds (had the man not read her chart nor examined her before?!?), my mom and I started making faces at one another. At least his visit lightened the day, along with the chocolate cake on the dinner tray and a couple of Advil for the stiff joints from sitting all day.

On searching Medline tonight, I find that post-stroke depression can be treated, and not just with cake and Advil. I don't know how anyone survives medical care without an advocate on their case.

Tuesday, September 11, 2007

The dangers of low HDL

High density lipoprotein (HDL) is a carrier protein that takes cholesterol out of tissues such as your blood vessel walls (where you do NOT want it) and carts it back to the liver for elimination. Low density lipoprotein, on the other hand, carries cholesterol from the liver where it has been manufactured or the gut where it has been absorbed from dietary sources and moves it out to the cells. Some cholesterol is essential to life (we make cellular membranes and hormones out of it for example), but too much in the wrong place can lead to an unwanted build-up of fatty schmutz in the arteries.

The 'my oh my will you look at that low LDL' attitude that caused us doctors to beam at you patients is starting to change. A study out of the Palo Alto VA medical Center* emphasizes the importance of HDL levels to cardiovascular health.

Researchers there retrospectively studied the old vets (average age 65) to correlate HDL levels with the incidence of hospitalization for ischemic heart disease including heart attack. All of the 6,357 subjects had an enviable LDL level below 60 mg/dl.

Those patients in the lowest HDL quartile with HDL levels of 28 or below had a 1-year incidence of ischemic heart related troubles of 8.5% compared with those in the top HDL quartile whose HDL levels were 64 or above.

Too bad its currently very difficult to boost HDL levels. Clinical trials of Pfizer's HDL-raising torcetrapib were abruptly halted at the end of last year due to a pesky 60% increased risk of death in the groups receiving the drug plus Lipitor compared to those on Lipitor alone. Meanwhile, weight loss, exercise, and a whiff of alcohol as part of a healthy lifestyle are helpful in nudging HDL levels upward.
deGoma, EM. Presentation at the annual session of the American Heart Association

Sunday, September 09, 2007

Shining light on prostate cancer risk...

UV light that is. I've mentioned previously that vitamin D is a chemopreventive agent against several types of cancers. North Carolina investigators wondered if exposure to sunlight early in life has a more potent protective effect against prostate cancer than fun in the sun later in life.

They examined data from the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study*. Using solar radiation in the state of birth as a measure of sun exposure in early life, the researchers looked for correlation between childhood sun exposure and subsequent development of prostate cancer in adulthood.

Men born in regions with high solar radiation had half the prostate cancer risk compared with men born in cloudier regions. Those who moved away from overcast skies to sunnier climes as adults halved their risk of fatal prostate cancer although their overall prostate cancer risk remained the same as peers who stayed with the gray.

*Cancer Epidemiology Biomarkers & Prevention 16, 1283-1286, June 1, 2007.

Thursday, September 06, 2007

Got Cake?

Mauigirl commented on a previous post about weight loss in dementia about the possible correlation between lost pounds and diminished taste perception. Here's an item of interest:

Turkish researchers have discovered the reason why aging women might cut themselves a big piece for breakfast. Their study, published several years ago in the British Dental Journal, found that postmenopausal women had a significantly diminished ability to sense sweets rolling over their palates.

While the women demonstrated no altered sensitivity to salt, sour, or bitter tastes compared to an age-matched group of old guys, they were not near so moved by a gob of Turkish taffy crammed in their mouths as the gents were. Nearly half the female test subjects noted that they had changed their eating habits in favor of sweeter food.

If you are enjoying your a.m. pastry and coffee with nary a care for the consequences, the researchers warn, "The crucial issue to be aware of is that the possible changes due to menopause can lead to more serious health problems, although these changes may not be uncomfortable to the patient."

Monday, September 03, 2007

Flax Facts

Apparently giving us fifty-something ladies with hot flashes our daily crushed flax seed may decrease the heat by half.

Investigators took a group of our colleagues* with at least 14 flashes per week and fed them crushed flax seed. The phytoestrogenic facets of flax--i.e. its ability to occupy cellular estrogen receptors and tweak them in an estrogenic sort of way--made this strategy an appealing one for temperature control. Indeed, those ladies who did not find themselves distended and gassy from the addition of flax were pleased to find an improvement in their symptoms.

One observation about hot flashes from years of personal and professional experience: When I ask women if they are flashing, and they hedge and say well perhaps maybe occasionally they might feel something like that, they are NOT having hot flashes. If it's a hot flash, you KNOW it.
*Pruthi S, et al "Pilot Evaluation of Flaxseed for the Management of Hot Flashes" J Soc for Integrative Oncology 2007; 5: doi 10.2310/7200.2007.007.

Sunday, September 02, 2007

Weight loss and dementia

Women who develop dementia are much more likely than men to be involved in making meals, and, therefore, it is likely a loss of interest in food preparation and eating during the prodromal phase of the disease has an impact on their weight.
---David Knopman, MD Mayo Clinic

Calorie deprivation prolongs life. Skinny yeast cells, fruit flies, threadworms, monkeys, and women are more likely to become skinny old yeast cells, fruit flies, etc. The problem, however, with skinny old ladies is that they are more likely to be demented when old than their fleshier colleagues.

Mayo Clinic investigators reported in Neurology* that women who lost cognitive functioning lost significantly more weight in the decade prior to the dementia diagnosis than a control group of aging women who maintained brain function through the years. Interestingly, there was no such correlation for old guys getting goofy, suggesting that the problem was not so much eating well when presented with food as buying and preparing the food period.

Dr. Knopman notes that this obseravation is not useful for diagnosis as "the weight loss was so subtle and so small and nonspecific." So skinniness does not beget dementia, but rather the first glimmering of dementia (a loss of interest in usual activities such as food preparation) leads to weight loss.

Shoot, I lost interest in food preparation after number one child left home. I am completely enthusiastic, however, about food prepared by others.
Knopman, D et al. Neurology. 2007;69:739-746.

Saturday, September 01, 2007

Estrogen for neuroprotection

My Dad died with Alzheimer's some years back, and now my Mom is checking out with multi-stroke dementia. As a result, my interest in neuroprotection--i.e. strategies to bring all neurons to the finish line along with the rest of me--is stronger than ever. A new study from the Mayo Clinic confirms my belief that estrogen is an important part of my save-the-brain program.

After the Women's Health Initiative rocked the menopausal set with the news that hormone therapy may increase risk of dementia, neurobiologists were disturbed that these results did not fit with hundreds of studies on cells, lab animals, and humans that suggested otherwise. They conjectured that estrogen has a different effect on healthy brain cells compared to its effects on brains already gummed up with the effects of Alzheimer's or compromised blood supply.

Dr. Walter Rocca and his Minnesota colleagues identified a group of women who had their ovaries removed before age 50 twenty or more years earlier. The incidence of dementia in those women who did not receive estrogen post-oopherectomy was 10% compared with a 6.6% rate in the sub-group who did take estrogen after surgery. The researchers concluded that estrogen replacement therapy is beneficial to brains in this younger population.

Per Dr. Rocca: Where and when estrogen switches from being protective to harmful is the next big question. One of my patients would say most definitely that the benefits extend to the after-50 newly menopausal set. She is a media spokeswoman for a large organization. Prior to starting estrogen, we began to work her up for early dementia as she lost the ability to find the right word at the right time during press releases. We called off the work-up, however, after she began estrogen therapy and regained her ease at interviews. And that's just one of many stories I have to support the estrogen-brain connection.