V. HIPERTENSIÓN ARTERIAL HIPERTENSIÓN ARTERIAL HTA de “ Bata Blanca “ o HTA clínica aislada. Crisis Hipertensivas: Urgencia y Emergencia hipertensiva. HTA en edades comprendidas entre los 6 y 18 años. Recomendaciones sobre la medida de la Presión Arterial. Clasificación según la etiología. Modificación de los estilos de vida. Actitud ante urgencia y emergencia hiper
T H E M E M O R Y B U L L E T I N
MEDICATIONS AND THE BRAIN
Majid Fotuhi, M.D., M.P.H.,
Forgetting things is common among people of all ages; however, 75 percent of people over age 50 report having problems with memor y in the past year. It turns out that some of these memor y failure prob- lems are directly caused by medication.
Many of the patients I see at Johns Hopkins Hospital complain about their memor y. After per forming various tests, I often find a specific cause of these memor y problems. In some cases, it may be linked to low thyroid levels or poor nutrition. In other cases, we learn that depression is the rea- The good news is that in many cases, these memory-debilitating causes can be eliminated. Some patients, however, may be taking a new medica- tion, or too much of a particular drug. In both instances, these drugs may Due to public misconceptions and the way Alzheimer’s disease is depicted in the media, many people believe that memor y loss and Alzheimer’s dis- The truth is that more than 90 percent of those who complain about poor memory and worry they may be developing Alzheimer’s do not have it. Just as a headache is a symptom that can have a variety of causes, ranging from the flu to a brain tumor, memory loss is a symptom that can be caused by a number of different illnesses—alcoholism among them—or may arise as a side effect from a particular medication. Alzheimer’s is only one explanation of why a person can’t remember things.
While it is not as rare as brain tumors, it’s not as widespread as either heart The majority of people concerned about Alzheimer’s disease actually have mild to moderate depression. In contrast, patients who actually have Alzheimer’s may not be aware of their total memor y loss.
Common Causes of Memor y Loss
Memor y loss can be caused by illness, as well as medication that is taken to treat the illness or ailment. In addition to medication, other common • Alcoholism and related vitamin deficiency Don’t Forget About Medication Side Ef fects
Most elderly people take multiple medications—most people are taking as many as five different prescription drugs. And many people of all ages take some form of prescription drug. A number of common drugs are known to dull the memor y, including medication for blood pressure, sleep, pain, If the onset of memor y problems coincides with the use of a new medica- tion, chances are the two are related. Primar y care physicians pay partic- ular attention to patients who develop new symptoms after a new medication Changing or stopping the medication often stops the memor y problems, but this must be done under the super vision of a physician.
I point out to patients that if a certain drug makes you groggy, your mem- or y won’t work well. In this case, you may have registered certain infor- mation in your brain, but now have difficulty mostly with retrieval of that Fortunately, memory problems associated with new medications go away soon If memor y problems are starting to surface, it is important that you bring all your medication bottles and dosage instructions to the doctor’s office Many drugs—particularly when taken at high doses or for an extended time— Medications That May Slow Your Memory
Older adults, who are more prone to dementia, are also more likely to experience adverse reactions to drugs. Luck-
ily, dementia caused by medication can be treated by halting (if possible) or switching drugs, or lowering the dosage.
The following are some of the more common medications that may cause memory loss (listed by their generic names).
If you are taking one of these drugs and are concerned about memory side effects, talk to your doctor before mak-ing any changes.
Type of Drug
The Alcohol Factor
Millions of people enjoy an occasional alcoholic beverage, and for most adults, moderate drinking—whether of beer, wine, or spirits-—is not asso- ciated with any health risk. Some people, unfortunately, drink because of When consumed in excess, alcohol acts as a toxic drug, with pronounced short-term and long-term consequences. After tobacco, alcohol abuse is the leading cause of premature death in the United States—and the drinker Alcohol’s effect on the mind and body depends on how much of it is con- sumed over what period of time. The amounts of different alcoholic bev- erages usually designated as one drink—five or six ounces of wine, twelve ounces of beer, and an ounce and a half of 80-proof spirits—all put the same amount of pure alcohol into the bloodstream—about two-thirds of an ounce.
Because all cells in the body can absorb alcohol, its immediate effects (only partially described here) can be wide-ranging. Of all the changes it causes, none is more dramatic than the ef fect of alcohol on the central ner vous system. Some experts have suggested that the effects of alcohol on human behavior are caused by “disorders” of cell molecules. At first the drinker gets a feeling of ease and exhilaration, usually short-lived.
As blood alcohol content rises, judgment, memor y, and sensor y percep- tion are all progressively impaired. Alcohol depresses the parts of the brain that integrate behavior. Thoughts begin to get jumbled; concentration and insight are dulled. The exhilaration of the first drink or two may turn into profound depression. Some people get angr y or violent. Alcohol causes sleepiness, but at the same time disrupts normal patterns of sleeping and dreaming. It also adversely affects sexual performance.
According to the National Institute on Alcohol Abuse and Alcoholism, a person who averages more than two drinks a day can be considered a heavy drinker. As consumption increases beyond two drinks, so do the risks to health; indeed, chronic, excessive use of alcohol can seriously damage nearly ever y function and organ of the body. These physical consequences of drinking cannot be reversed, but many of them can at least be halted Alcoholism is a disease that causes memory decline for life. One of the organs most damaged by alcohol is the brain. CAT (computer- ized axial tomography) scans of the head show that heavy, prolonged alco- hol consumption can actually cause the brain to shrink and the ventricles, or cavities, within the brain to enlarge. A person who drinks ten alcoholic beverages a day ends up consuming one ton of alcohol over thirty years, enough to fill a large swimming pool. Such enormous amounts can directly damage the brain and especially those parts necessar y for hand-eye coordination, walking, and memor y. If you were to see an inebriated person stagger out of a bar and then speak to him the following day, you’d know that it’s possible he would not remem- ber what had happened to him. The term “alcohol dementia” refers to loss of cognition in alcoholics, and it’s different from vascular dementia or In addition to excessive drinking, most alcoholics have a poor diet.
Many don’t get enough B vitamins, especially thiamine, folate, and B12. Thiamine deficiency by itself can af fect some of the memor y parts of the brain; even laborator y animals lose their memor y if their Folate and B12 are also needed if the memor y parts of the brain are to work properly. One reason alcoholics develop poor memor y is the direct damage done by alcohol and another is the scarcity of essen- Although alcoholism is not curable, we now know that the condition can be successfully managed. Positive long-term results can be achieved when doctors and patients realize that keeping the disease of alcoholism in “remission” involves medication, psychotherapy, and support from family, friends, and physicians.
The information contained in this
Memor y Bulletin is not intended as
a substitute for the advice of a
physician. Readers who suspect
they may have specific medical
problems should consult a physi-
cian about any suggestions made.
reproduced or transmitted in any form or by any means electronic, mechanical, photocopy- ing, recording, or other wise, without the prior For all subscription information, bulk orders, and permission to reproduce sections of this The Johns Hopkins Memory Bulletin, Printed in the United States of America
California Prescription Pads Approved Wilmer Distributors (sorted alphabetically) 5 Star Office Products Co A-1 Distributors A. Wait Business Systems Abe Printing & Copy Accuwrite Forms & Systems Inc Advantage Bus Systems, Inc. Allan F. Clark Alliance Allegra Print & Imaging Alpha Office Products Fax:firstname.lastname@example.org Ameri C