My husband is 70 this year and is having episodes of memory loss. Once, when we visited a restaurant we’ve been to several times (and which he’d booked), he asked if we’d been there before. He’s had two brain scans which showed signs of brain shrinkage. Could this be the start of dementia?
Name and address supplied.
Dr Scurr replies: I am sorry to hear that you are facing this uncertainty, and I share your anxiety that your husband appears to be progressing to dementia.
There are a number of types of dementia but they all manifest in similar ways, which makes precise diagnosis difficult – not least because, in many patients, causes can co-exist.
While 60 to 80 per cent of dementia patients have Alzheimer’s disease, many will also have vascular dementia (caused by reduced blood flow to the brain).
In your longer letter you say your husband has heart disease as well as type 2 diabetes, and this can also be an indicator of damage to the arteries that supply blood to the brain.
When a reader visited a restaurant that she had been to several times, her husband asked if they had been there before (picture posed by model)
A proper diagnosis requires a careful assessment. You say he has been referred to a neurologist and it’s important you are present for this consultation, as it’s nearly always the spouse who notices symptoms first.
You say he sometimes suffers longer bouts of memory impairment – these may be due to epileptic episodes that occur in dementia.
These often go unrecognised, as the seizures are subtle. They do, however, need to be diagnosed and treated as they accelerate the cognitive decline.
Rather than wait for a neurologist appointment, it may be possible for him to be seen sooner by a physician for the elderly (or geriatrician) – ask your GP.
The first step to diagnosis is taking the Mini Mental State Examination, which assesses recall, short-term memory and ability to complete simple mental tasks. After that, there may be more formal testing by a psychologist, plus brain scans.
His earlier scans showed signs of brain shrinkage, but it’s the extent which matters – the brain loses 0.5 per cent of volume each year with normal ageing, up to 2 per cent in mild cognitive impairment and between 2 and 4 per cent in Alzheimer’s.
Your husband should be seen as soon as possible – the sooner investigations start, the more likely it is that he can be found medication to delay any further deterioration.
I recently took Nurofen for a pulled muscle. It eased the pain but a day later my shoulders, knee and wrist became swollen and sore. I read on the NHS website that Nurofen shouldn’t be taken by anyone over 65, but there is no mention of that on the leaflet in the packet. I am 74.
Clive Phillips, Royston, Herts.
Dr Scurr replies: Nurofen (the generic name is ibuprofen) is a non-steroidal anti-inflammatory drug (NSAID) which blocks the creation of prostaglandins, hormone-like compounds that cause swelling, fever and pain.
Prostaglandins also protect the stomach’s lining from gastric acid, and high doses of NSAIDs taken over a long period of time can cause heartburn, nausea, abdominal ulcers and bleeds. These side-effects are more common in the elderly.
The NHS website does not state that ibuprofen should not be taken by older patients. It says that the over-65s are more susceptible to developing stomach ulcers when taking it.
Someone taking them long-term may be prescribed medication to protect the stomach.
Ibuprofen is not forbidden for older patients but it should be used with caution and an awareness of the potential risks.
In my view… The simple way to stop norovirus spreading
When I was overcome with nausea during my journey to work recently, then began vomiting within the hour, I knew I almost certainly had norovirus.
I’d seen two patients with the ‘winter vomiting bug’ the previous week – indeed, there have been more than double the expected number of cases so far this year, the UK Health Security Agency warned last month.
Norovirus is highly contagious, spread directly from person to person and indirectly via contaminated water or food. The virus can also survive on hard surfaces. It is now established that it can be spread via the air, too – in particular the aerosol formed when flushing a loo without having first closed the lid.
During the pandemic, we all saw the video representations of the cloud that forms when a person sneezes or coughs. The aerosol formed when flushing is no different, and anyone using the facility immediately after another will be breathing in multiple organisms.
So, as well as hand-washing, good food hygiene and avoiding contact with those who have norovirus, a critical point when it comes to infection control is to lower the lid before flushing.
