Recently an elderly man with significant cognitive impairment was brought to my office by his wife in the hope that there might be something to be done to improve his condition. Although on the surface he appeared cheerful, attentive and able to understand what was being said, it was the lack of coherence in his speech that betrayed how confused he really was. Most any question that was posed him would be answered with a reply that started off well, but inevitably devolved into a sequence of words that made little sense.
His story was that about 5 years earlier, he had suffered a massive heart attack that he barely survived but since that time he no longer could think straight. Previous to that he had a history of colon cancer about 15 years earlier, but there was no history of dementia.
The timing of onset suggested that perhaps his condition may have been brought on by a stroke or oxygen deprivation to the brain secondary to the heart attack. No such diagnosis had been made - the man's doctors offered no possible explanations at all, but to his wife it seemed as good an explanation as any.
Through experience I've learned that in cases where there are puzzling symptoms, one of the first areas to explore is the list of pharmaceutical prescriptions. Any number of times it has happened that a quick review of side-effects will reveal that a patient's complaint is byproduct of one or more prescriptions and not the result of an 'illness', per se.
So, with this in mind I found that this man was only on two medications. I say 'only' because it would be common to find someone of his age and medical history to be taking more drugs. As it turned out, the lack of more prescriptions was probably due to his wife's conscientiousness in providing her husband a broad array of nutritional supplements - a habit she had begun since his bout with cancer.
Both drugs were routine prescriptions for anyone who has suffered a heart attack where current practice is to aggressively control both cholesterol levels and blood pressure. Unfortunately though, both of the prescriptions - a statin to inhibit cholesterol and a beta-blocker to control the blood pressure - are associated with a risk of dementia.
A 2010 article published in Scientific Amercian entitled "It's Not Dementia, It's Your Heart Medication: Cholesterol Drugs and Memory" 1 reviews the link between cholesterol and proper cognitive function, and evidence that for some there are significant cognitive side-effects when cholesterol production becomes impaired via the use of statins.
As the author states, "In the brain, however, cholesterol plays a crucial role in the formation of neuronal connections—the vital links that underlie memory and learning. Quick thinking and rapid reaction times depend on cholesterol, too, because the waxy molecules are the building blocks of the sheaths that insulate neurons and speed up electrical transmissions. “We can’t understand how a drug that affects such an important pathway would not have adverse reactions,” says Ralph Edwards, former director of the World Health Organization’s drug-monitoring center in Uppsala, Sweden."2
Beta-blockers, often the 'go-to' drug for people who have survived a heart attack, are used to treat high blood pressure, congestive heart failure and abnormal heart rhythms. But they are also associated with a one third higher risk of some form of cognitive impairment.3It is thought that the mechanism by which his occurs also relates to interference of mormal chemical messaging in the brain.
An interesting corollary to the research on drug related dementia, is research on the effects of low blood pressure on the elderly. Joe Graedon, cofounder of the health advocacy website "People's Pharmacy" (peoplespharmacy.com) recently published a comprehensive article citing evidence that aggressive treatment in the elderly to regulate blood pressure to within 'normal limits' is associated with increased cognitive impairment.4
In the same article, he describes a study done at a California retirement community that showed that hypertension in 80- and 90-year old persons seemed to have a positive effect on cognitive function. Researchers worked with over 1500 volunteers and found that"those who developed hypertension (pressure above 140/90) after age 80 were 42 percent less likely to be diagnosed with dementia in their nineties. If their blood pressure didn’t rise until after they turned 90, they were 63 percent less likely to experience severe cognitive difficulties."5 Their conclusion was that, " hypertension onset late in life was associated with a lower dementia risk compared with those with no hypertension".
Graedon cites a similar study published in the Journal of American Geriatrics Society showing cognitive benefit for older adults with elevated blood pressure.6
Conversely, two other studies done in Europe indicate that low diastolic pressure in the elderly is associated with both greater brain atrophy7 and an increased risk of dementia. The latter study concluded that, "the risk effect of low diastolic pressure on dementia was pronounced particularly among antihypertensive drug users.”8
As is so common with pharmaceutical medications, the use of statins and blood pressure medications comes with a trade-off. To achieve desired levels of cholesterol and blood pressure, patients may have to sacrifice their ability to think.
5. . Ibid
6. <https://www.ncbi.nlm.nih.gov/pubmed/?term=age-varying+association+blood+pressure> ).
7. JAMA Neurology, Aug., 2013 <https://www.ncbi.nlm.nih.gov/pubmed/23753860>
8.JAMA Neurology, Feb., 2003 <https://www.ncbi.nlm.nih.gov/pubmed/12580707
Julian Jonas, CCH, Lic. Ac. is a homeopathic practitioner and teacher in Brattleboro, VT and maintains office hours in Keene and Lebanon, NH as well. For more details, contact him at 802-254-2928, via e-mail at email@example.com or at www.centerforhomeopathy.com.