I recently came across an article on the topic of isolated systolic hypertension, in which a physician pointed out that this form of hypertension can lead to serious problems — stroke, heart disease, chronic kidney disease and dementia. The doctors and nurses who have taken my blood pressure have universally said that the diastolic reading was not a consideration; however, this report indicated that medications to control systolic hypertension should not be allowed to cause the diastolic pressure to go below 70 mmHg.

I am an 82-year-old diabetic male off medications for three years now due to exercise and diet. I also have symptom-free bradycardia. I would very much appreciate your comments on this report.

DEAR READER: I am a little confused. You indicate you are a diabetic and have hypertension that was treated with two medications. You then go on to state that you have been off medications for three years. Does this mean the antihypertensives, diabetes meds or both? In any case, I congratulate you on taking control and maintaining a healthier lifestyle.

Isolated systolic hypertension is defined as a systolic reading of greater than 140 and a diastolic reading of less than 90. The condition can result from hyperthyroidism, a leaky heart valve or other causes.

There was a time when doctors devoted their attention to the second number, the diastolic, with the thought the body could tolerate fluctuations in the first reading. Then there was the “blanket rule” that the first reading would be normal at 100 plus the age of the patient, i.e., 175 in a 75-year-old male. Both schools of thought have been modified. Today, the systolic and diastolic are of equal importance, and the 100-plus reading has been totally abandoned.

Of concern in patients with isolated systolic hypertension is that prescribed medications may affect the second number, lowering it to the point that it might increase the risk of heart attack or stroke. The fine line then becomes keeping the diastolic at no less than 70 mmHg, while simultaneously keeping the systolic at an appropriate figure, just as the report indicated.

My guess is that your diastolic readings are too low, and that you might require medication to bring both numbers into line. Take a copy of the article to your physician for his or her review. A determination can then be made about whether you should be back on the two medications or not. No matter what, I would continue the exercise and diet modification.

The lisinopril you are/were taking is an ACE inhibitor used to treat hypertension and congestive heart failure. It can be used alone or in conjunction with other drugs for the same purpose. The amlodipine is a calcium channel blocker that works to lower blood pressure and decrease the heart rate. It, too, can be used in conjunction with other drugs for best results.

To provide related information, I am sending you a copy of my Health Report “Hypertension.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

Many of the residents have had to take pills for high blood pressure and were never on them before. Some of these people are over 70 years old. Many of our residents are in the early stages of dementia and Alzheimer’s. It is scary knowing that possibly the salt water in our water system could be causing these problems. A faucet in the basement of our building isn’t connected to the system, so residents go there for a supply. The complex owner says he checked with a doctor who says the amount of salt in the water would not be harmful to us. Do we have a chance of having a real problem here? Should the water be changed?

DEAR READER: Hard water causes a buildup of chemicals in household pipes, stains sinks, discolors laundry, and dries out skin following bathing. That said, the National Research Council has gone on record stating that drinking hard water does not pose health risks. While I don’t know what the condition of the water is in your area, obviously the owner of your complex determined that installing a water-softener system was the best way to go financially in the long run.

The amount of sodium added to any system depends on the hardness of the water, but treated water doesn’t appear to add any significant amount of salt to the diet. Generally speaking, an 8-ounce glass of treated water contains less than 13 milligrams of sodium. The average adult without a history of hypertension requires between 1,500 and 2,400 milligrams of sodium each day. With a history of high blood pressure, the recommended amount holds at 1,500 milligrams.

A more likely cause of excessive sodium comes from a person’s diet. One teaspoon of salt contains 230 milligrams of sodium. Adding to that many processed foods, cold cuts, canned goods and soups brings the potential for excessive salt consumption far above the recommended daily allowance.

There is an association between Alzheimer’s dementia and aluminum. Perhaps this is what some of your residents refer to. I cannot find any confirming reports of memory loss, Alzheimer’s or neuropathy caused by water-softening systems. A more likely consideration is that the residents of your establishment are aging and are developing diseases and disorders common to an advanced age. That said, it appears that by making a trip to the basement for drinking water, residents who fear potential side effects can bypass the problem. I would also recommend that residents request a sodium test be added to their next routine lab work when they visit their physicians. Providing they eat a healthful diet and do not cook with or add salt to their meals, this will be one surefire way to resolve one of the issues.

Because of the concerns you raise, I am sending you copies of my Health Reports “Hypertension” and “Alzheimer’s Disease.” Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a $2 check or money order for each report to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title(s) or print an order form off my website at www.AskDrGottMD.com.

My wife is 82 years old and has had dementia for many years. She was diagnosed with Alzheimer’s and given many different medications to try but nothing worked. When she started getting worse her physician prescribed Seroquel.
About four or five weeks into taking the medication, she became really confused. She would wake up at night and want to go home without realizing that she already was home. It scared me so much that I was afraid to go to sleep in case I didn’t hear her get up.

After reading your column, I took my wife off the Seroquel and noticed a dramatic change within a week. She has told me that she is feeling better than ever. She now takes 3 mg of melatonin which helps her sleep all night and she has no more confusion during the day.

DEAR READER:
I am glad to hear that my column helped your wife; however, if she has dementia, she should never have been prescribed the medication.

Seroquel is an anti-psychotic medication used to treat conditions such as bipolar disorder, not Alzheimer’s. There is even a black box warning stating that it should not be used in elderly dementia patients. Assuming your wife really has Alzheimer’s, her physician made a potentially dangerous error.

You say that your wife is feeling better, no longer confused and sleeping all night thanks to stopping the Seroquel and starting melatonin. If she is no longer having symptoms of dementia, perhaps she doesn’t really have Alzheimer’s.

There are several disorders that can cause dementia and other neurological changes. Vitamin deficiencies, normal pressure hydrocephalus, Alzheimer’s, even depression or sleeping abnormalities and more are possible culprits. Some are reversible, others are treatable but until there is a positive diagnosis, there is no way to knowing what will help her.

I urge your wife to undergo testing to determine the cause of her dementia. She should also be under the care of a neurologist if she isn’t already. If she is seeing such a specialist, ask for a referral for a second opinion. If it was her primary care physician who prescribed the Seroquel, perhaps it would be appropriate to find another since he or she has already shown disregard for medication warning labels.

If symptoms persist, but are mild she may be fine without medication, but be sure to speak with her specialist about this. It is also important that you take proper care of yourself. Providing full time care for a dementia patient can be incredibly difficult. You may find it easier and more rewarding if you bring in occasional help from a local visiting nurse association. This type of organization can provide assistance to the care taker as well as the patient.

To give you related information, I am sending you copies of my Health Reports “Alzheimer’s Disease” and “Medical Specialists”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

My physically healthy husband has no memory of our past 59 years, including yesterday. However, he keeps up his hygiene, does his daily chores, fixes his own meals and more. Out sons are not recognized and our dogs are nameless. I am now the “nice lady” who stays here. He refuses all mental tests claiming that all old men have memory problems and periods of confusion. He seems very serene but nearly every evening he makes bizarre exclamations such as “Those two men came in and said I can’t use the shower”, “Am I supposed to stay overnight?”, “Where did my wife go?” or “This building (meaning our home) is condemned, we have to move.” A few minutes later he won’t even remember saying anything.

Dr. Gott, what is causing these “episodes”?

DEAR READER:
Not all memory loss and confusion leads to Alzheimer’s disease. In fact, I highly doubt that this is what your husband is suffering from because Alzheimer’s patients generally remember the past quite clearly but forget names, dates, and current goings-on.

Dementia is defined as an organic loss of intellectual function. This means that, due to natural causes, memory, cognition, personality and other mental changes occur.

Your husband clearly is having some sort of mental faculty change and, in my opinion, needs to be seen by a neurologist. Given his specific symptoms, there are likely only a few disorders that could cause his situation. It is important that you create a list of his symptoms, when they started and if they were preceded by an accident, injury or other abnormal event.

If you have power of attorney, you should have no problem getting him the testing he desperately needs. However, if you do not, this could become a bit of a sticky situation. He clearly does not want to be seen, but in fact, should be. You may need to prove to a judge that he is incapable of making important decisions and should get a court-approved power-of-attorney.

While this does not sound pleasant, it could be the very thing that saves his life. If his memory loss is the result of a simple, reversible disorder, the longer it goes untreated, the more permanent damage he could be inflicting upon himself. If it is not reversible, however, it is still vital to know what the disorder is. You say you have sons. If not for your husband, find out what it is for them, as many types of dementia can be carried down from family member to family member. As with Alzheimer’s patients, close blood relatives (aunts, uncles, mothers, fathers, children, and siblings) could be at an increased risk.

Your husband does not have age-related memory loss and confusion, but without testing, I cannot tell you what the cause is. Get him the help and testing he won’t get for himself.

To give you related information, I am sending you copies of my Health Reports “Alzheimer’s Disease” and “Medical Specialists”. Other readers who would like a copy should send a self-addressed, stamped envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

Our family doctor put her on Aricept tablets initially but then switched her to Exelon patches about a year ago. Not seeing any improvement, I stopped her patch and requested a referral to a dementia specialist.

While waiting for the appointment, I heard some people have good results from taking two tablespoons of double virgin coconut oil daily. I began experimenting a week ago with two teaspoons daily added to my wife’s oatmeal. I think it is working. My wife even knows what day of the week it is now. What is your opinion on this alternative treatment?

DEAR READER:
There are numerous herbal remedies, supplements and vitamins promoted as memory enhancers. They include coenzyme Q10, coral calcium, ginkgo biloba and omega-3 fatty acids. Issues that come in to play with supplements are that purity and effectiveness are unknown and may vary between manufacturers or even batches. Makers of these over-the-counter remedies are not required to provide the Food and Drug Administration (FDA) evidence on which they base claims. Further, the suppliers are not required to report any adverse reactions to the FDA. Therefore, while a product might work for one individual, we fail to hear of those on whom it doesn’t work. Claims regarding safety and efficacy are based on testimonials such as yours.

Since the Alzheimer’s Association doesn’t address virgin coconut oil as a recommended supplement to be taken with or in place of FDA approved drugs, I must defer. I recommend you speak with her new specialist and be guided accordingly.

Because your wife is under the care of a cardiologist, you should also speak with him or her to be assured there will be adverse reaction between any prescription medication and over-the-counter supplements.

To give you related information, I am sending you a copy of my Health Report “Alzheimer’s Disease”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Also, should this drug be given long term?

DEAR READER:
Seroquel is an anti-psychotic medication used to treat conditions such as bipolar disorder. It is not approved for behavioral problems related to dementia. Black box warnings for elderly patients with a dementia-related psychosis indicate an increased risk of serious side effects, including pneumonia, heart attack, stroke, and death.

The product is available in doses from 25 to 300 mg tablets or capsules by prescription only. When the drug is prescribed for the elderly, the recommended initial dose is 25 mg daily. Contraindications are noted for those individuals with a history of hypertension, stroke, thyroid disorder, diabetes, high cholesterol, seizures, or heart attack.

Side effects can include fever, sweating, uncontrolled muscle movements, severe headaches, visual and gait disturbances, and more. Be sure to speak with the prescribing physician should any symptoms occur.

Seroquel XR extended release tablets also contain black box warnings because of an increased mortality rate in elderly patients with dementia. XR is indicated for the treatment of schizophrenia, a name given to a group of mental disorders in which a patient loses touch with reality and is unable to think or act in a rational manner. The condition is often treated with tranquilizers and specific drugs to lessen the degree of depression. Extended release tabs are not recommended for the elderly.

Adverse reactions include dry mouth, dizziness, orthostatic hypotension, constipation, a feeling of sedation, and more.

There are a number of interactions with this drug. Be sure to advise your physician of any medications you are taking to assure there will not be a negative response should he or she choose to prescribe Seroquel XR.

The long-term effectiveness (more than six weeks) has not been fully evaluated. All prescribing physicians should re-evaluate patients on a regular basis.

You are correct that the drug can be dangerous for elderly patients with dementia. I can only hope the prescribing physician fully researched all the options before prescribing it and that the dose is a reasonable one.

All patients regardless of age that are treated with anti-depressants or anti-psychotics for any condition should be carefully monitored for negative alterations in behavior, especially during the early stages of a new medication. Family and caregivers must be observant and should report those changes accordingly

If you continue to have unanswered questions and have the legal right to be involved with the care of the individual in question, return to the prescribing physician with a list and request answers. If you remain dissatisfied, seek a second opinion.

To give you related information, I am sending you a copy of my Health Report “Consumer Tips on Medicines”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

My father suffered from some of these symptoms, particularly increasing rigidity. He was later diagnosed at autopsy with Lewy body dementia. He, too, was on Aricept for several years with little or no difference in the condition.

DEAR READER:
Lewy body dementia is a relatively common form of dementia. It is characterized by the loss of the ability to think, reason and remember. This is due to the development of abnormal round structures (Lewy bodies) in the areas of the brain that control thinking and movement. It is unknown why these anomalies develop in the first place.

Symptoms are similar to both Parkinson’s disease and Alzheimer’s disease. A distinctive symptom is hallucinations that can appear very realistic. These can include sounds, shadows, colors, shapes, animals, people and more. Hallucinations are often the first sign of Lewy body dementia. Like Parkinson’s, it can also cause a shuffling gait, slowed movement, tremors and rigid muscles. Like Alzheimer’s, symptoms can include depression, memory loss, confusion, decreased cognition, and delusions.

Unlike other forms of dementia, sufferers of Lewy body dementia can experience large fluctuations in symptoms. They may awaken in the morning and be completely lucid and by late morning be inattentive or unable to stay awake. Symptoms can also worsen based on medication. If initial symptoms present as Parkinson’s disease and medicines designed to treat that condition are given, confusion, delusions, and hallucinations may worsen.

Lewy body dementia primarily affects individuals between the ages of 50 and 85 with a predominance toward men. You are at higher risk of developing this condition if you have a family member who had it. (Diagnosis can only be confirmed at autopsy.)

Unfortunately, there is no cure; however, treatments are available. Alzheimer’s medications seem to have the best results, but for some, like your father, do little good. Using memory aids and providing well structured environments often improve symptoms. Physical therapy, massage and even aromatherapy may also help. Reducing stress and situations that cause agitation, anger and fear are important and it is equally important to provide stimulating activities such as playing games that encourage memory, walking or another physical activity. Anyone with impaired memory needs to be closely monitored during outside activities to ensure they do not wander off and get lost or injured.

Most sufferers of dementia, regardless of the cause, have less drastic changes in mood, behavior and symptoms if given proper care. In the same way you care for a child, such as with bedtime rituals, proper communication, and more, so you should with the sufferer. In essence, rather than growing up, dementia causes people to “grow down”, reverting to childhood, toddler-hood and eventually infancy. It is a devastating process, but until more research is done and causes are found, we can only do our best to provide care, safety and most importantly, love.

Thank you for writing to remind me and my readers of this disorder.

Anyone who is interested in learning more about this form of dementia can go online to www.MayoClinic.com/health/lewy-body-dementia/DS00795. The Alzheimer’s Association also has information on several forms of dementia and can be found at www.Alz.org.

To give you related information, I am sending you a copy of my Health Report “Alzheimer’s Disease”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

My wife is 80 years old and we have been married for more than 50 years. Until four years ago she was outgoing, energetic and of sound mind, body and spirit. Since then she has become a shell of her former self. I remember this change was precipitated by her no longer wanting to drive. She came to me, out of the blue and said she no longer felt comfortable driving and wanted to see a neurologist. My wife is a very guarded person and is not fond of going to the doctor so I surmised that she had been experiencing some type of problem. She was diagnosed as having dementia and placed on Aricept, Namenda and (despite telling him she wasn’t depressed) Zoloft. She has since been removed from these medications because they were not helping her. She was switched to Lexapro (for depression I don’t believe she has) and Ibuprofen liquid (for acute pain).

From that point on she began a rapid deterioration, physically, emotionally and mentally. She started complaining of acute pain that radiated from the back of her thighs throughout her lower extremities. I took her to a total of six neurologist and countless other specialists but none could find the cause of her pain. She had had a host of tests including MRIs and CT scans but all they showed was normal aging. She hasn’t had any strokes or other brain damage.

Six months after all this started, she became totally incapacitated. She is no longer able to walk, sit upright (without assistance), move her arms and legs, speak (she does mumble), chew food or feed herself, or perform any routine activities of daily living. Her food has to be pureed and fed to her. She is incontinent and cannot move of her own volition. She remains in whatever position she was last placed in and has to be moved manually. Her vital signs and appetite, however, are excellent.

It has been four very difficult and frustrating years. I love my wife dearly and it greatly pains me to see her like this. I believe that she understands what is being said to her but is unable to respond or express herself. On rare occasions she will say something clearly (often someone’s name or will callout) but then retreats back into silence. She is also very rigid. She keeps her arms and legs tight as if she is tense and resistant to being moved. I see this as her being fearful of what is going on around her so she is guarded and trying to protect herself.

I have exhausted all of my alternatives to finding help for my wife. Can you please assist me?

DEAR READER:
You wife appears to have advanced Alzheimer’s disease, a progressive and fatal neurological disorder. The first stages often include minor memory loss and language problems. As it progresses, memory loss becomes severe with the patient often failing to remember names of loved ones, time, location, and more. Eventually walking, sitting, eating, daily activities, and personal hygiene become impossible without assistance. Finally, speech and the ability to respond are lost, as is all voluntary movement. Muscles become rigid, incontinence occurs and swallowing will be impaired. The body remains intact and in generally good health but the brain and its associated functions fail.

Unfortunately, Alzheimer’s disease is incurable and the treatments available can only slow the progression. Your wife appears to be in the last stages and, in my opinion, is no longer a candidate for treatment. The best thing you can do for your wife at this point is to place her in an assisted living facility or hire 24-hour nursing care for her. You may wish to start her on comfort only care. You also state that you believe that she understands what is going on and is simply unable to respond. However, with Alzheimer’s this is not the case. Patients’ memory and cognitive abilities often decline so much that they simply do not remember where they are, who is around them, and what is happening from one minute to the next. The prognosis is very grim and I am very sorry for you and every other family that has to go through this difficult process. However, research is on going and many breakthroughs have been made. I believe it is only a matter of time before the mechanisms of this disease are better understand and we learn ways to effectively diagnose, treat and even cure this horrendous condition.

We’ve said a few things to his wife, but don’t want to discuss it too much with her any more because she’s a hypochondriac. She just goes to church, falls down and says the Lord has healed her. She is no help in this situation, even though she’s 10 years younger than our brother.

Do you have any suggestions on how we can help him without alienating them both? Could his problem be early stage Alzheimer’s, medications or just aging? He has diabetes, consults several herbalists and takes herbs that we think are questionable and unnecessary.

I know this isn’t giving you enough information but our main concern is the blank looks like he’s gone from us for a few seconds and then snaps back like nothing happened. Any information you can give us will be greatly appreciated.

DEAR READER: Your brother needs a diagnosis from his primary care physician who should have a complete record of his medical history. I would recommend your brother be referred to a neurologist as the next step.

While you mention diabetes and medications, you don’t indicate if he is on something for his diabetes or if there are other conditions that might have a bearing.

If he were on more than one medication, the combination might have an adverse effect and present with periods of confusion.

He is 75 and could have early stage dementia, Alzheimer’s disease, epilepsy (or similar seizure disorder) or others. Dementia is a deterioration of a mental state with a variety of causes. Some herbs can cause dementia-like symptoms. Epilepsy may consist only of a fleeting loss of consciousness, rather than seizure activity. Lacking other symptoms, I believe Parkinson’s can be ruled out. As you can see, a diagnosis must be made.

Because of Health Insurance Portability and Accountability Act (HIPAA) rules, you probably will not be able to discuss this with your brother’s physician (you can write a letter of concern and report his symptoms, etc., however). Therefore, I suggest you both get your sister-in-law off the floor, in a good frame of mind and express your concerns. Perhaps you can then accompany your brother to his next doctor’s visit where you can speak freely with his physician. I am sure he will ultimately appreciate the caring position you’ve taken.

To give you related information, I am sending you a copy of my Health Report “Alzheimer’s Disease”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR READER: The cause of Alzheimer’s remains a mystery but much active research is in progress. To my knowledge, Alzheimer’s is not related to aspartame. Some individuals are sensitive to aspartame and may experience symptoms from ingestion of it.

To give you related information, I am sending you a copy of my Health Report “Alzheimer’s Disease”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.