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January 22, 2004
Alzheimer’s unanswered
Q :My mother and two aunts on her side were diagnosed with Alzheimer’s disease. How early should a person start taking medicine to ward off this disease?
Q :I am a 52 year-old male. My mother’s father and her aunt both died from Alzheimer’s. My father is alive, but he has it. What signs should I look for in myself? What are my chances of getting it? Are there any tests I can take to determine my chances?
A :Right from the start, be aware that medical science does not have all the answers to questions about Alzheimer’s disease, so take my answer to be tentative at best.
The age when a relative develops Alzheimer’s is an indication of how likely it is that a family carries genes that contain the seeds of Alzheimer’s disease. When it makes an appearance at a young age - the 40s - then the influence of genetic factors on its transmission is high.
When it comes on later in life, the gene connection is not so clear. Exact predictions cannot be made. As an extreme example, say a mother or father shows signs of Alzheimer’s at age 85. The chances that her or his children will also have Alzheimer’s are slight.
There is no test for Alzheimer’s., doctors had hoped that testing for a gene called ApoE would predict a person’s susceptibility to Alzheimer’s, but that has not panned out.
Early signs of Alzheimer’s include an inability to learn new information, an inability to recognize familiar faces and a change in personality. An easygoing person changes into a gruff, irascible person. Significant memory lapses are common.
No medicine prevents Alzheimer’s. Memantine, a drug available in Europe, shows a flicker of success. A low-fat, low-calorie diet might delay its onset.
Q :I have a hernia. One surgeon says to have an operation now. Another says that if it doesn’t bother me, leave it alone. I am 94. How do I decide which of the two doctors is correct?
A :Hernias are protrusions of organs or tissues through defects in the muscular wall that usually keeps them in their place. Because the testicles are formed in the abdomen and because, during fetal development, they travel down to the scrotum by passing through the abdominal wall, that passageway constitutes an inherent weakness in the muscle wall. That’s why so many men get hernias.
A hernia in itself is not a clear and present danger if it can be gently pushed back into place. If it cannot, the hernia is trapped. Trapped hernias can suffer a cutoff blood supply.
When that happens, it is an emergency. It is probably wiser to operate on a trapped hernia. An older man with a painless hernia that can be maneuvered back into the abdomen does not have to run to an operating room. He can delay making a decision.
Surgery, however, is the only cure for a hernia. Keep in mind that pain is a warning sign that action must be taken quickly.
Q :My brother is convinced that eye doctors give you stronger prescriptions in order to have you come back for new glasses every other year. What makes a nearsighted or farsighted person get worse even when that person wears corrective lenses?
A :Your brother is deadwrong. Eye doctors prescribe lenses that permit a person to see clearly. Too strong a lens distorts vision.
The shape of the eye determines if a person is near- or farsighted. An elongated eye makes a person nearsighted unable to see distant things. An eye with a diameter shorter than normal causes farsightedness the inability to see things up close.
As the eye changes shape, stronger lenses are required. Usually a plateau is reached where there is no more change in vision or eye shape.
Dr Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write to him or request an order form of available health newsletters at P.O. Box 536475, Orlando, Fl, 32853-6475.
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