DEAR DR. ROACH: A current fall break up the pores and skin beneath my left eye. I went to the emergency room to see if it required stitches. Since I complained of a headache behind my head on the left facet, they ordered an MRI, which confirmed “atherosclerotic vascular illness with gentle small vessel ischemic illness.” They additionally noticed plaque inside my inner carotid arteries.
The ER docs stated I ought to see a vascular specialist quickly. Of course, I’m scared. I’m a 76-year-old girl on Bystolic, rosuvastatin, benazepril and thyroid alternative. I additionally take sulfasalazine for my inflammatory arthritis. I’m skinny, take many nutritional vitamins and dietary supplements, and train 4 instances every week. Does the MRI imply I’ve dementia or Alzheimer’s? What does it imply? — R.M.
ANSWER: No, the MRI can not make a prognosis of dementia. Dementia is recognized presumptively by a scientific examination that notes impairments in cognitive functioning, akin to reminiscence, language and a focus. (A definitive prognosis of Alzheimer’s is made by a pathological analysis of mind tissue, which is sort of by no means obtained whereas an individual is alive.)
What the MRI reveals is a illness of the blood vessels of the mind attributable to ldl cholesterol plaque. High blood strain, smoking, excessive blood ldl cholesterol, household historical past, and different components put individuals in danger for this situation. Some, however not all, individuals with the sorts of blood vessel illness you have got will develop dementia, which is attributable to cumulative injury to the mind tissue by a number of small strokes. In your case, each the big vessels (carotids) and small vessels are affected, suggesting that your ldl cholesterol and blood strain haven’t been best.
Your physician has already taken some steps to gradual or forestall the worsening of this situation. Careful management of your blood strain (with Bystolic and benazepril) is important. A statin drug (rosuvastatin) has been proven to cut back stroke danger and your general dementia danger. I don’t know whether or not these are the most effective medicines for you or whether or not they’re on the proper doses, since solely your physician is aware of you effectively sufficient, however it’s clear that your physician is taking steps to guard your coronary heart and mind.
Inflammatory arthritis (particularly rheumatoid arthritis and lupus) will increase the chance of blood vessel injury within the mind and coronary heart, so early therapy is extra vital with individuals who have these circumstances. Unfortunately, not all main care docs know the way vital inflammatory arthritis is in terms of coronary heart assault and stroke danger.
I don’t consider there are any dietary supplements or nutritional vitamins which can be each protected and efficient at stopping stroke general, however there are a handful of people that might profit from them. For instance, individuals with excessive homocysteine of their blood might profit from nutritional vitamins B12, folic acid, or their methylated counterparts.
A cautious evaluate of your general well being situation and eating regimen is crucial. You could also be referred to a specialist for cognitive testing if there may be any proof of a change in your pondering capability. A number of blood checks will assist additional stratify your danger and will present a necessity for extra therapy.
Dr. Roach regrets that he’s unable to reply particular person letters, however will incorporate them within the column every time doable. Readers might e-mail inquiries to ToYourGoodHealth@med.cornell.edu or ship mail to 628 Virginia Dr., Orlando, FL 32803.
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