Do Self-Reported Memory Complaints Predict Dementia?

About half of people aged 60 to 80 report subjective memory complaints. In the past, it was thought that depression was the cause. More recent studies, including one published in Neurology October 7, 2014, show that these patients have almost 3 times the risk of progressing to dementia but that the conversion occurred about 10 years later. Conversion was more rapid in smokers and slower in women taking hormone replacement.

The take-home message is that subjective memory complaints are common among older adults and are often prognostic of future cognitive impairment. However, they are not cause for immediate alarm, because impairments could be many years away or preempted by death.

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Dr. Jack Florin
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Why You Don’t Need A Holter Monitor If You’re Married

Many patients with “cryptogenic” stroke, meaning of unknown cause, have a heart rhythm abnormality, atrial fibrillation, that comes and goes and is termed “paroxysmal.” These patients are often monitored for a day or two in the hospital and then another day with a 24-hour Holter monitor and perhaps another 20 to 30 days with other monitors. A new study found that of about 250 patients with this type of stroke, 25% were later found to have this abnormal rhythm. Patients’ families can be instructed to check the pulse. Healthcare professionals had a diagnostic sensitivity of 97% and relatives 77%. Self-measurements were performed by about 90% of patients, and their sensitivity was 50%.

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Dr. Jack Florin
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How to Treat a Prolonged Migraine

Almost 90% of patients with migraine who visit the emergency department with an intractable headache have a recurrence within 24 hours.

When a migraine is into its second day despite treatment with a triptan (Imitrex and others), a rescue medication is needed and if successful would prevent an emergency department visit. Most studies show that steroid medications can help. One protocol is to use a Medrol Dosepak for the first 2 days in the pack and then stop after that if improved. The second is to use an oral dose of dexamethasone 4 mg 3 times a day for the first day, then 2 times for the second, then once for the third and then stop.

If you are experiencing any of these symptoms please contact us at 714-738-0800 or visit our website to set up an appointment.

Dr. Jack Florin
Neurologist
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Should You Have Ultrasound Screening For Carotid Artery Stenosis?

This issue was discussed in a recent edition of the Annals of Internal Medicine. The conclusion was that there is no advantage in doing carotid endarterectomy or carotid stenting instead of “best medical therapy” in patients without symptoms. The guideline did not focus on management of symptomatic cases. Best medical therapy includes control of risk factors, including hypertension, diabetes, elevated cholesterol, smoking, obesity, lack of exercise, excessive alcohol.

The incidence of carotid artery stenosis is 1% in the general population. Screening would result in many false positive results, which may lead to unnecessary tests and surgery, which carries risk of stroke.

“Executive physicals” that offer carotid artery screening as well as whole body CT screening are probably unwise. According to Dr Philip Gorelick, “When the ultrasound truck pulls up to your local shopping mall or church and offers a battery of tests, a bad result can make people think they have a ticking time bomb in their neck.”

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The Family Burden of Chronic Migraine

Respondents to a survey of about 1000 patients with chronic migraine reported missing family events on a regular basis and felt guilty and sad about how this affected their relationships with their spouses and children. About 75% thought they would be better spouses if they did not have chronic migraine. About two-thirds felt guilty about being angered or annoyed by their partners or children, two-thirds avoided sexual intimacy, and about 60% felt they would be better parents if they did not have chronic migraine.

According to Dr Dawn Buse, “The effects of chronic migraine can be devastating and far-reaching.” There are effective treatments for chronic migraine, including preventative drugs and injections of Botox.

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