Alzheimer's Disease Archive

A portable ultrasound device that detects plaque buildup in arteries may offer a simple, cost-effective way to detect heart disease before it causes any symptoms. A report in the December 2014 Global Heart journal describes findings from a large-scale test of the technology in India, the United States, and Canada.

The innermost layer of an artery's wall (the intima) provides a smooth surface for blood to flow through. The middle layer (the media) contains muscle and elastic fibers that let the vessel expand and contract with each heartbeat. The thicker the intima and the media, the more likely the artery is choked with cholesterol-filled plaque. Using ultrasound, a doctor can easily measure the intima-media thickness in the arteries of the neck and upper leg.

The telltale sign is leg pain and fatigue that comes on with activity and goes away with rest.

Anticholinergics, a group of medications that includes many over-the-counter and prescription drugs, are well known for causing confusion in older adults. Common medications with anticholinergic properties include medications to treat overactive bladder, such as oxybutynin (Ditropan); medications to treat allergies and sleeping problems, such as diphenhydramine (Benadryl, Sominex, Unisom); and medications used to treat depression, such as amitriptyline (Elavil). It's generally believed that confusion that may develop from anticholinergics clears up when someone stops taking the drugs. But now it appears that the medications are associated with a more permanent effect. A study published online Jan. 26, 2015, in JAMA Internal Medicine linked daily anticholinergic use among older adults for three or more years to an increased risk for developing dementia and Alzheimer's disease.

The study didn't prove that anticholinergics cause dementia; it only found an association between people who take the medications and people who develop dementia. Nevertheless, the researchers suggest that doctors avoid prescribing anticholinergics when possible, or at least limiting the medications to the lowest doses possible. If you're taking an anticholinergic, talk to your doctor about the risks the medication poses, including the risk of falls as a result of confusion.

Although these powerful pain relievers can be addictive, opioids are safe for most people when used properly.

Q. My doctor has recommended a bone density screening, but the medical center with the full-body scanner is a 45-minute drive from my house. A health fair at a neighborhood church offers a bone density test using a foot scanner. Would that be as accurate?

A. The foot scan is called a quantitative ultrasound, and it usually measures the bone density of the heel bone.
It appears to be at least as good as clinical risk factors—such as older age, family history of bone fractures, low body mass index, smoking, corticosteroid use, and excessive alcohol consumption—for identifying people at high risk for osteoporosis.

For most people, there is no advantage to tests that measure cholesterol and triglyceride particle size.

At middle age, the brain begins to draw on more of its capacity for improved judgment and decision making.

If you forget a name or two, take longer to finish the crossword, or find it hard to manage two tasks at once, you're not on the road to dementia. What you're experiencing is your brain changing the way it works as you get older. And in many ways it's actually working better. Studies have shown that older people have better judgment, are better at making rational decisions, and are better able to screen out negativity than their juniors are.

Medications called anticholinergics are used to treat a host of conditions—overactive bladder, depression, allergies, and Parkinson's disease. They usually aren't recommended for older adults because one of the most common side effects is confusion and difficulty reasoning. Early studies have also indicated that long-term anticholinergic use is associated with an increased risk of dementia, and a recent study by researchers at the University of Washington adds more evidence to support that connection. The results were published online Jan. 26, 2015, by JAMA Internal Medicine.

The researchers tracked almost 3,500 men and women ages 65 and older who were free of dementia. When they matched prescription data for the previous 10 years with the participants' health outcomes, they determined that using anticholinergics was associated with an increased risk of developing dementia. Moreover, dementia risk increased with the dosage of the drugs and the length of time they were used. While people who had taken these drugs daily for the equivalent of three months had no increase in risk, those who had used them for over three years had a 54% greater risk than nonusers.

Long trips come with an increased risk of blood clots deep in the leg veins, which can have serious complications.

Q. My doctor, an internist, just retired, and my health plan is asking me to designate a new primary care physician. I'm 75. Would there be advantages to choosing a geriatrician as my new doctor?

A. First, a disclaimer: I am a geriatrician. So my short answer is, "Yes, of course!" But my reasoned, unbiased answer would be, "It depends." If you are a generally healthy 75-year-old woman, a family physician or internist will be able to take excellent care of you. Geriatricians are trained to care for older adults with complex illnesses and are expert in managing the care of people who are frail. Improving your ability to function, and the quality of your life, are the guiding principles of geriatric medicine. We are expert at managing complexity and uncertainty, working with families, and caring for people with serious illnesses who are approaching the end of life. A geriatrician would be a good choice if you have physical or cognitive impairment, if you take a lot of medications, or if your friends and family are involved in your medical care. For people who have several medical problems, we emphasize the role of patient and family preference in making medical decisions, with the patient's goals as our primary focus.