Statins reduce risk of incident Alzheimer’s disease?

I recently read an editorial in the Journal of Neurology Neurosurgery and Psychiatryby Dr. Larry Sparks about statins and cognitive function. Multiple studies have hinted at reduced risk of incident Alzheimer’s disease with elective statin use. I thought this would be worthwhile to share with the readers of my blog and website (http://braindiseases.info).

As I stated above, multiple studies have linked a high fat/ high cholesteroldiet with increased risk of Alzhemier’s dementia. Hence many studies have been carried out to determine if lowering cholesterol levels with the use of statin group of medications (these are popular cholesterol lowering medications with names like atorvastatin (Lipitor), simvastatin (Zocor) among others) reduces the risk of Alzhemier’s dementia. While some studies have indicated a benefit others have provided contradictory results indicating little to no benefit on cognitive functioning.

As Dr. Larry Sparks states in his editorial there is likely a small subset of patients who will benefit from statin therapy. The trick lies in identifying these patients early on in their disease course from others in whom there is little or no benefit from statin therapy. Also it seems that some statins may be more beneficial than others when it comes to reducing the risk of Alzheimer’s dementia. This difference is likely due to their individual differences in blood brain barrier permeability (meaning to what extent they are able to penetrate the brain).

Till we are better able to identify this subgroup of individuals, there are certain things which we can implement in our own lives to tilt the scales in our favor. A low fat, low cholesterol diet should be encouraged. The cardiovascular (lowering the risk of myocardial infarction)and possible neurological benefits (with respect to possibly reducing the risk of incident Alzheimer’s dementia and stroke) makes this a very attractive proposition. Moreover this is a relatively cheap intervention. It though needs a comprehensive strategy to educate the public about the benefits of a low fat/ low cholesterol diet ( about the benefits of eating right {more vegetables, less of red meat and saturated fats} and incorporating a regular exercise schedule. People who already have cardiovascular risk factors like hypertension, diabetes mellitus and high cholesterol (dyslipidemia) should talk to their doctors about possible statin therapy.

I want to add that statins just like any other medication do have their own risk of side-effects. They thus should only be taken under the supervision of a physician.

The adage ” Eat right, live long and happy” still holds good!!! To that I would add ” EAT RIGHT, SAVE A BRAIN!!!”

Nitin Sethi, MD

Not quite dementia? red flags to watch out for

Not quite dementia?  red flags to watch out for

Nitin K Sethi, MD

Assistant Professor of Neurology

New York-Presbyterian Hospital

Weill Cornell Medical Center

New York, NY 10065

I get many patients who tell me during their office visit that they are worried they may be getting dementia. The thought of Alzheimer’s disease with its progressive neurocognitive decline and memory loss is a frightening thought indeed and patients are justifiably worried.

SO LETS GET DOWN TO THE BASICS. What are the red flags/ warning sings that you indeed do have Alzheimer’s dementia starting off?

Patients who have Alzheimer’s dementia are usually not aware that they have a memory problem. In the initial stages of the disease, social graces are maintained. These early patients may be able to hold down a job, socialize with friends and no one is aware that they have a memory problem.  Small problems may be starting off though. Losing keys, misplacing things, having problems with numbers, having problems balancing the cheque books and in counting change, forgetting names etc. As you can imagine these are not “major issues” and may not be noticed by the patient or family initially.

So usually when a patient hinself comes to me and tells me, he feels he may be getting demented, I approach it with a healthy dose of skepticism. Most of the times these patients do not have dementia, rather they may be depressed. Depression at times can lead to dementia like symptoms with loss of energy and drive and feelings of self-doubt. It is hence sometimes referred to as pseudo-dementia. You treat their depression and the patient feels much better and the memory problems resolve.

But when the patient is brought to my attention by a family member with complaints of memory problems, getting lost in the neighbourhood, change in personality, becoming indifferent to his personal appearance and grooming, apathy and lost of interest in activities previously enjoyed, in such patients the possibility of dementia crosses my mind.

One must remember that in dementias like Alzheimer’s disease (there are many different types of dementia), the problem is not just with memory. Dementias like Alzheimer’s disease affect a range of neuro-cognitive abilities. Thes patients have problems with language (we call this aphasia–there are many different kinds of aphasia), calculation, ability to sustain attention, ability of abstract thinking, of planning for the future (what I shall do next week) and in executitive functioning. They also suffer from what we call apraxias. Let me explain what apraxia is. Lets assume I can button and unbutton my shirt. Now this is a learned act, which I learned as a small child. Now suppose I get demented. Even though I am not weak (meaning the strength in my arms is intact), I forget how to button and unbutton my shirt. This loss of ability to carry out learned tasks despite intact motor/ muscle strength is called apraxia. Patients who have Alzheimer’s dementia forget how to tie their shoes laces, how to drive a car, how to eat with a spoon and so on. Hence in a way they become totally dependent on care-givers for all activities of daily living. Memory loss is just a component of a much bigger problem. Even when it comes to memory, they have problems in short term memory (what they ate for breakfast, who is the current President elect, whom did he defeat in the elections etc),  long term memory (what is your name, your wife’s name, your child’s name, where you were born, what date) may remain intact in the initial stages of the disease.

 So watch out for the red flags, not everything is dementia!!!

Pearls and perils of cyberchondria

Pearls and perils of cyberchondria

 

Nitin K Sethi, MD

Assistant Professor of Neurology

New York-Presbyterian Hospital

Weill Cornell Medical Center

New York, NY 10065

 

 

Cyberchondria is a relatively new term used at times to describe the behavior of some individuals who use the Internet to gather information about health or a disease which they feel they may have based on their signs and symptoms. The Internet search results leads to an unfounded concern, preoccupation and worry about their health status.

The term is derived from the more commonly used term hypochondria. Hypochondriasis is excessive preoccupation or concern about having a serious often incurable illness.

Nowadays more and more people are turning to the Internet for health and disease related information. In my practice I frequently come across patients who have already “Googled” their diagnosis even before they come to see me. Some even “Google” their MRI results.

Cyberchondria can have its pearls as well as its perils. Let us start with the pearls first. No one doubts the power of the Internet. It has and continues to revolutionize the way medicine is practiced. There is an abundance of information on the Internet about common and even esoteric neurological conditions. All one has to do is type the relevant key words into a popular search engine like Google and low and behold, Dr. Google starts churning out answers-pages and pages of it. The Internet houses many blogs and sites exclusively devoted to a particular condition. Some of these sites are run by reputable organizations like American Academy of Neurology (www.aan.com) and Centers for Disease Control and Prevention (www.cdc.gov). Thus sitting in the comfort of one’s home, useful and credible information can be readily accessed. Is there any new treatment for multiple sclerosis or ALS? If yes, where is it been offered? Where are the best doctors in NYC? Which is the nearest hospital for acute stroke care? Are there any caregiver organizations for neurodegenerative conditions like Alzheimer’s disease? Pretty much whatever you type in, Dr. Google shall have an answer.

But in this pearl itself, are the perils of the Internet. There are ample sites where in the information content is not standardized. These include blogs run by patients themselves, some by care-givers and yet others by pharmaceutical companies or companies which manufacture medical equipment. The abundance of information leads to many falling prey to cyberchondria. Let us take an example. Your doctor gets a MRI scan done because you have headaches. The MRI report reads “non-specific white matter hyperintensities are seen. These have been noted in ischemic, inflammatory and demyelinating conditions like multiple sclerosis. Clinical correlation is advised.” Now you get this report in front of you and of course what do you do? You go to the Internet and page Dr. Google for help. In you type “white matter lesions, headache and multiple sclerosis” Dr. Google hums for a nanosecond and churns out pages and pages which talk about multiple sclerosis, white matter lesions on MRI and at times headache.

THERE THE GROUND HAS BEEN SET FOR CYBERCHONDRIA!!! You are now convinced you have multiple sclerosis and spend another couple of hours in cyberspace getting worried, confused and finally panicky.

It is indeed easy to get cyberchondria. The Internet is a powerful tool. By all means use it to get health and disease related information. It is way easier than going to a library and searching for it there. BUT THE CATCH IS TO USE IT WISELY!!! If rightly used it is a slave working tirelessly on our behalf. Random searches with random key words about signs and symptoms of a disease you feel you have, risk leading to cyberchondria giving you many sleepless nights and needless worry.

Disclaimer

This blog is my own endeavor and project. Though I work in New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, the blog is in no way connected to the hospital.

The information provided in this blog should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 if you have a medical emergency.

Links to other sites are provided for information only — they do not constitute my endorsements of those  sites.

 Any duplication or distribution of the information contained herein is strictly prohibited.

 

Nitin Sethi, MD