Dementia Management: Slowing Progression, Not Reversal
Dr Anmol Singh Rai, Neurologist at Fortis, Jalandhar, explains that medicines can slow dementia but will not stop or reverse it. For an 86-year-old patient with progressive memory loss over two years, he recommends a detailed re-evaluation to identify factors that may increase confusion. Cognitive testing with MoCA (Montreal Cognitive Assessment) is advised to establish the current level of decline. Brain imaging, preferably an MRI, is suggested to detect stroke, atrophy, or pressure changes. At this age, the brain responds more slowly to treatment and recovery may be limited; the best approach is to remove any possible triggers.
Thyroid and Anxiety: A Common Overlap
Dr Vibha Goel, Psychiatrist at Livasa Hospital, Mohali, addresses a 56-year-old woman on thyroid medication (Methimez 5 mg) for 20 years who experiences sudden anxiety. She notes that anxiety and thyroid disorders frequently co-exist, with overlapping symptoms like low mood, fatigue, restlessness, sleep disturbances, and palpitations. Thyroid hormone imbalance can influence serotonin and dopamine signalling and autonomic nervous system activity, causing anxiety. She recommends testing thyroid hormone levels to check if symptoms stem from fluctuating thyroid function or an independent anxiety disorder. A psychiatric evaluation is also recommended. For an anxiety disorder, treatment may include medicines, psychotherapy, stress management, regular physical activity, proper sleep, and family support.
Double Vision After Cataract Surgery: Possible Sagging Eye Syndrome
Dr Parveen Rani, Ophthalmologist at Fortis, Ludhiana, addresses an 85-year-old patient with double vision starting six months ago, ten years after cataract surgery. She suggests this may be due to sagging eye syndrome, where ageing tissues shift the eyes. Driving worsens the condition because eyes work harder to track objects at varying distances. At age 85, prism glasses are an effective first step as they bend light to compensate for misalignment, giving immediate relief. Surgery is an option only if absolutely necessary and after careful evaluation. She advises consulting a senior neuro-ophthalmology specialist for detailed assessment and tailored treatment.
Long-Term Statin Use: Safety and Monitoring
Dr HK Bali, Chairman of Cardiac Sciences at Livasa Hospital, Mohali, responds to a 50-year-old patient who has taken Rosuvastatin (10-20 mg) for 14 years. He states that Rosuvastatin is reasonably safe for long-term use, but liver function tests and CPK enzymes should be monitored once every three months. Most patients have no side effects, though occasionally muscle aches may occur and rarely a mild increase in liver enzymes that revert to normal on stopping the drug. Statins do not affect memory or cognitive functions. Patients on long-term statin use can take Co Enzyme Q (Cap Co Q 333 mg) once daily, which is very safe. Periodic medical consultation is needed to monitor lipid levels and adjust dosage.
Morning Diarrhoea: Gastrocolic Reflex and Caffeine
Dr Vivek Prakash, Hepatologist at Fortis, Ludhiana, addresses a 65-year-old patient who experiences loose stools after morning tea with rusks. He describes this as morning diarrhoea caused by the gastrocolic reflex — the gut's urge to empty after eating or drinking. Caffeine in tea likely causes the colon to contract rapidly, pushing waste out before water absorption, resulting in loose stools. He advises not to drink tea on an empty stomach; instead, eat a solid meal first and take tea at least 30 minutes after eating. If the problem persists beyond two weeks, a stool test is recommended to rule out food intolerances or age-related gut changes.
