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Treatment of Type 2 Diabetes: One Extreme to Another.

 

By Sarfraz Zaidi

Arch Intern Med. 2009;169(13):1246-1247.

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Dementia ( Memory Loss )

Memory loss (also known as dementia) is probably one of the most common and terrifying diseases of the elderly. Patients with dementia have a poor quality of life. Eventually, many of them end up in nursing homes, as they are unable to care for themselves. Relatives and friends of these patients also suffer greatly.  It's heart breaking when your own spouse or parent doesn’t recognize you.  

Causes of Dementia

1.  Vitamin B12 deficiency

2.  Vitamin D deficiency

3.  Under-Active Thyroid

4.  Anger, Anxiety

5.  Narrowing of the blood vessels 

6.  Strokes

7.  Diabetes

8.  High Blood Pressure

9.  Insulin Resistance Syndrome

10. Head Trauma

11. Syphilis

12. AIDS

13. Alzheimer's dementia

Alzheimer's Dementia:

There are many misconceptions about Alzheimer's dementia. 

Alzheimer's dementia is a diagnosis of exclusion, i.e. when no treatable cause of dementia can be found such as under-active thyroid, vitamin B12 deficiency or anxiety-depression.

Only after a person has undergone extensive evaluation to exclude all of the treatable causes of dementia should a diagnosis of Alzheimer's dementia be made.  If you look at the list of the causes of dementia, all of them are treatable with the exception of Alzheimer's dementia. 

Unfortunately, most people (and sadly, even many physicians) think that memory loss automatically means Alzheimer's dementia. You can now see that there are many causes for memory loss, many of them easily treatable such as vitamin B12 deficiency, vitamin D deficiency and under-active thyroid. 

Often, I see patients who have been given the diagnosis of Alzheimer's dementia without any proper evaluation to exclude the treatable causes of dementia. Amazingly, many are even placed on drugs indicated for Alzheimer's dementia which often have a number of potential side-effects such as fatigue, nausea, vomiting, diarrhea, insomnia, muscle cramps and poor appetitie. Then these patients are placed on more medications to treat these symptoms. 

Simply diagnosing and treating the root cause of dementia such as under-active thyroid or vitamin B12 deficiency can make all the difference in the world.  

Many elderly worry a lot about the possibility of Alzheimer's dementia  without realizing that "worrying" itself causes more memory loss. 

Drugs available for Alzheimer's dementia may simply help to manage symptoms. These drugs do not treat the disease process itself. 

Vitamin B12 Deficiency

Vitamin B12 deficiency has long been known to cause memory loss. It is a common problem especially in the elderly and in vegetarians. Sadly, it often remain undiagnosed.

Vitamin B12 deficiency is easily diagnosed with a simple blood test. Treatment is pretty simple and very effective.

Click here to learn about Vitamin B12

Vitamin D Deficiency

Emerging evidence indicates that vitamin D deficiency may cause memory loss. Vitamin D deficiency is an extremely common problem.  Its diagnosis is simple and treatment is very effective.

Click here ot learn about Vitamin D

Under-active Thyroid

Under-active thyroid is a very common cause for memory loss. Often, it is not treated properly and patients continue to suffer from memory loss.

Click here to learn about under-active thyroid.

Anxiety/Anger

Anxiety and anger negatively affects your memory. People who worry a lot and/or hold a lot of anger usually end up losing their memory as they grow older. It's ironic that many people worry about "memory loss" without realizing how counter-productive this habit is. The more you worry about "memory loss," the more likely you are to lose your memory.

If you use logic, you'll realize that worrying and anger serves no useful purpose except to torment yourself.

To learn more about anxiety and anger, refer to my book, "Stress Cure Now."

Narrowing of the Blood Vessels, Strokes

It's interesting to note that narrowing of the brain vessels is the underlying cause for intellectual decline and memory loss in a majority of patients.

Transient ischemic attacks (TIAs), also known as mini strokes, take place due to transient cessation of blood circulation to a certain part of the brain. This may cause brief episodes of forgetfulness, confusion or other neurologic symptoms, such as weakness of a leg.

Multiple mini strokes over a period of time lead to the death of brain cells and eventually, a person starts experiencing a decline in intellectual function and lapses in memory. This is known as multi-infarct dementia or vascular dementia.

Click here for Stroke

 

Insulin Resistance Syndrome

Diabetes

Hypertension

The underlying cause for narrowing of blood vessels is Insulin Resistance Syndrome.  

Aging, diabetes, pre-diabetes, high blood pressure, cholesterol disorder and abdominal obesity are the main components of Insulin Resistance Syndrome.  

In a recent, large clinical study involving 10,963 people, changes in cognitive function were assessed over a six year interval. Diabetes and hypertension were found to be the strongest predictors of decline in intellectual functioning, even as early as age 47. This study was published in Neurology in 2001.  

In the famous Framingham study, diabetes and blood pressure were found to be important risk factors for a decline in intellectual functioning. This study was published in Diabetes Care in 1997 . 

Several other large clinical studies have demonstrated a strong relationship between high blood pressure and decline in intellectual functioning.  

In a recently published study in Diabetes Care, researchers looked at the impact of ingesting 50 grams of rapidly absorbing carbohydrate (one-half of a bagel and white grape juice) on the memory of diabetic patients. They found a positive correlation in carbohydrate intake and poor memory in these patients. In addition, overall poor control of diabetes was associated with poor, immediate and delayed memory.  

Unfortunately, diabetes, prediabetes, high blood pressure and cholesterol disorder are neither aggressively diagnosed nor appropriately treated in a majority of patients. Even after a patient has suffered a stroke, these risk factors are not appropriately treated. Patients are just placed on an aspirin and it is hoped that everything will be fine.

If you do not aggressively treat the underlying disease that caused a stroke in the first place, how can you prevent further strokes and their consequences, such as memory loss? Quite often, these patients are misdiagnosed with Alzheimer’s disease and are pretty much just written off.

Another common problem is that when a patient suffers a heart attack, undergoes heart bypass surgery or angioplasty, he/she is not properly evaluated or treated for the risk factors for stroke. Remember, if you have narrowing of the blood vessels in your heart, you probably also have narrowing of the blood vessels in your brain.

Any person who has memory loss, stroke (even minor stroke), heart attack, coronary angioplasty or heart bypass surgery should be evaluated for risk factors for narrowing of the blood vessels.

These risk factors include hypertension, cholesterol disorder and diabetes or prediabetes.

The proper diagnostic test for diabetes or prediabetes is a 2-hour Oral Glucose Tolerance Test. Effective treatment for narrowing of the blood vessels must include aggressive treatment of hypertension, cholesterol disorder and diabetes or prediabetes. 

Click here for Insulin Resistance Syndrome, Diabetes, Hypertension

Head Trauma

Another cause of memory loss is "subdural hematoma." In simple terms, a subdural hematoma is a collection of old blood inside your head. In the elderly, it occurs after a trivial head trauma which is often not even remembered.

Subdural hematoma is diagnosed on a CT-scan of the head.

Syphilis/AIDS

Syphilis and AIDS can also cause memory loss. Syphilis causes dementia in its late stages of neuro-syphilis. Here is the pitfall: the earlier stages of syphilis may have been subtle or missed and dementia may the first symptom of the disease.

Syphilis and AIDS are easily diagnosed on blood testing, which should be part of the work-up for dementia/memory loss.

Work-up for Memory loss / Dementia

Those suffering from memory loss/dementia should have the following diagnostic work-up as part of their clinical evaluation. 

1. Vitamin B12 level

2. 25-OH vitamin D level 

3. TSH, Free T4, Free T3 for thyroid evaluation

4. 2-hours Glucose Tolerance Test for PreDiabetes, Diabetes evaluation

5. Serology tests for Syphilis and AIDS

6. CT scan of Head to evaluate for any strokes, old blood clot.

 

 

This article was written by Sarfraz Zaidi, MD, FACE. Dr. Zaidi specializes in Diabetes, Endocrinology and Metabolism.  

Dr. Zaidi is a former assistant Clinical Professor of Medicine at UCLA and Director of the Jamila Diabetes and Endocrine Medical Center in Thousand Oaks, California.

 

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