All Posts tagged smoking

Maintain Your Brain

            Seventy year old Mrs. Lansing drew a complete blank as I asked her if she could recall any of the five words I’d given her to remember some 4-5 minutes ago as part of her mental status exam.  Inwardly I always wince at those moments.  It feels like I’m unintentionally bullying a harassed person into looking the fearful specter of their approaching dementia directly in the eye.  Her husband quickly came to her rescue with a small white lie, “That’s alright darlin’, I don’t remember any of them either,” and we all smiled with relief.

Dementia is the common term for a set of symptoms including memory loss, mood changes, and difficulty with communication and reasoning.  Modern medicine is trying to replace the term with “major and minor neurocognitive disorder”.  Yah, for now let’s stick with the term everyone knows, dementia.  There are several types of dementia, with the most common two being Alzheimer’s disease (AD) and vascular dementia (due to atherosclerosis [plaque] on the blood vessels supplying the brain) coming in a close second.

AD currently affects about 5 million Americans.  There are a handful of approved prescription medications to treat AD.  They delay (but do not stop) the progression of the disease by about 6 to 12 months.  This is useful, but far from a cure.  Likewise various supplements and vitamin treatments have come and gone over the years.  When subjected to careful scrutiny the results have generally been disappointing.  The likelihood of AD dramatically increases with age, roughly doubling in likelihood every 5 years after age 65.  If one lives to 85 years old the likelihood of having AD is almost 50%.

So can anything be done to prevent it?  Of course certain risk factors cannot be altered, such as age, family history and genetics.  But at the same time, there is a growing body of research showing that certain lifestyle choices have a substantial impact on whether AD or vascular dementia will indeed show up in your life.  Certain treatable maladies contribute to a significant increase in dementia.  For example, dementia is:

  • 41% higher in smokers
  • 39 % higher in people with high blood pressure
  • 22% higher among whites who are obese
  • 77% higher in diabetics

So obviously there is room for better lifestyle and aggressive treatment of these

conditions to help delay or prevent the onset of dementia.  A recent article predicted that substantial improvement in lifestyle factors could reduce the risk for AD (and perhaps even more so vascular dementia) by 50%.

What lifestyle factors can substantially impact the likelihood and/or timing of you or me getting dementia?

  • Being a regular exerciser could reduce AD by 21%. A recent study showed 5% greater brain mass retention in active folks vs. inactive.  Five percent may not sound like a lot, but when it comes to the brain, it is substantial.  A reasonable goal in terms of time and activity would be a 30 minute brisk (3-4 miles per hour) walk or the equivalent 5 days per week.
  • Quit smoking
  • Avoid excess alcohol. Anything beyond one drink a day in females or two daily in males is associated with increased risk of dementia.
  • Stay socially connected and mentally active.
  • A heart-healthy diet rich in nuts, seeds, whole fruits and vegetables, olive oil, fish and other low fat meats, and low in sugars and simple carbohydrates is beneficial in reducing vascular dementia.
  • Finally, if you have diabetes, cholesterol issues, obesity, or high blood pressure, treating these well can impact the incidence of dementia.

In the end, there is no way to guarantee that you will avoid the scourge of dementia.  At the same time, we want to avoid the fatalism that assumes that nothing we do will impact its likelihood or timing.  Dementia is a grim enemy.  While more weapons against it are sought, it’s worth using every one that is available to delay or prevent it.

Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville.  Contact him at 982-0835


How’s Your Heart?

Maybe it’s the countless images of hearts everywhere I turn during this Valentine’s Day season, but it seems we should talk a little about protecting our hearts. If we were living in the U.S. in 1900, the top three causes of death would all be infectious diseases: flu and pneumonia (lumped together), tuberculosis, and gastrointestinal infections. And I probably wouldn’t be writing this article since the average life expectancy for men was 46 years old.

With the introduction of vaccinations, antibiotics, and overall better nutrition and sanitation, these infectious causes have retreated substantially. In their place, and reigning as the number one cause of death for many decades, is heart disease. It currently causes almost three out of every ten deaths.

One of the major forms of heart disease is coronary artery disease (CAD), in which the arteries supplying the muscle of the heart become blocked. When that happens, the oxygen- starved muscle generally hurts, causing a kind of chest pain we call angina. If the coronary artery is completely blocked, the part of the heart muscle it supplies dies. This is what’s going on in a heart attack (medically termed a myocardial [heart muscle] infarction [tissue death due to blocked blood supply]).

The stuff that blocks arteries is called plaque. Risk factors for plaque, and thus for heart attacks (as well as the strokes which happen by a similar process) are:

  • Smoking
  • High blood pressure
  • High cholesterol
  • Diabetes
  • Overweight
  • Physical inactivity
  • Having a family history of early heart disease
  • Increasing age

As you can see, several of these risk factors are manageable. One of the problems with prevention is that CAD is often a silent process until critical blockage occurs. Of course knowing the risk factors and working to combat lifestyle issues such as lack of exercise, overweight, smoking, and even diabetes is huge when it comes to prevention. In addition rather simple tests such as coronary calcium scores (a fairly inexpensive low dose cat scan picture of the arteries around the heart) can give further information about plaque on the coronary arteries. It’s not a perfect test, but it correlates pretty well with risk for future heart attacks or angina.

So as Valentine’s Day 2014 recedes into the past, as you ponder the status of your emotional heart, give your physical heart a little thought as well. If you have some reversible risk factors, go after them this year. And if you really don’t know the status of your cholesterol, blood sugar, or blood pressure, get them checked out. Also, see if your doctor recommends a coronary calcium score or other testing to further assess the status of your heart. All-in-all, it’s better to be aggressive with prevention now than with stents and bypasses later.

Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville. Contact him at 982-0835