Distinguishing Normal “Senior Moments”

Concerned about memory? Johns Hopkins doctors compare symptoms of normal aging with those of more serious dementia.Occasional memory lapses, such as forgetting why you walked into a room or having difficulty recalling a person’s name, become more common as we approach our 50s and 60s. It’s comforting to know that this minor forgetfulness is a normal sign of aging, not a sign of dementia.

Here are examples of the types of memory problems common in normal age-related forgetfulness, mild cognitive impairment and dementia.

Normal Age-Related Forgetfulness:

Sometimes misplaces keys, eyeglasses, or other items.
Momentarily forgets an acquaintances’s name.
Occasionally has to “search” for a word.
Occasionally forgets to run an errand.
May forget an event from the distant past.
When driving, may momentarily forget where to turn. Quickly orients self.
Jokes about memory loss.

Mild Cognitive Impairment:

Frequently misplaces items.
Frequently forgets people’s names and is slow to recall.
Finding the desired word becomes more difficult.
Begins to forget important events and appointments.
May forget more recent events or newly learned information.
May temporarily become lost more often.
May have trouble understanding and following a map.
Worries about memory loss. Family and friends notice the lapses.


Forgets what an item is used for or puts it in an inappropriate place.
May not remember having known a person.
Begins to lose language skills. May withdraw from social interaction.
Loses sense of time. Doesn’t know what day it is.
Short-term memory is seriously impaired. Has difficulty learning and remembering new information.
May have little or no awareness of cognitive problems.

Johns Hopkins Health Alerts


Nonprescription Decongestant-type Nasal Sprays

Often people want to know whether nonprescription nasal sprays are addictive. Technically, the answer is no they’re not addictive; however, they can cause problems that lead to a vicious cycle of using one on a daily basis. In general, they’re best reserved for short-term use of no more than two or three days.Here’s why:
Nasal congestion occurs when the blood vessles in the lining of your nose expand due to a cold or allergies. nonprescription decongestaant nasal sprays such as phenylephrine (Vicks Sinex, others) and oxymetazoline (Afrin, others) reduce that congestion by narrowing those blood vessles.The problem is that after a few days of relief, your nasal membranes become tolerant and less responsive to the spray. The typical response is to use more spray more frequently. Not using the spray can result in rebound congestion – a period of brief relief followed by severe nasal obstruction.

To reverse tolerance to these sprays stop using them for several weeks. Instead, try using saline nasal sprays which don’t cause rebound congestion. If your congestion is related to allergies, try a nonprescription antihistimine decongestant tablet or ask your doctor about prescription nasal sprays, such as azelastine (Astelin), budesonide (Rhinocort Aqua), fluticasone (Flonase),ipratropium bromide (Atrovent), mometasone (Nasonex) and triamcinolone acetonide (Nasacort AQ). These sprays are generally safe for extended use and do not cause rebound congestion.

Mayo Clinic Health Letter

Johns Hopkins Medicine and Johns Hopkins Health AlertsDetecting DeliriumRed Flag For WomenJohns Hopkins Health Alerts

Gastroesophageal Reflux Disease (GERD)

Many people, including some 79% of those with gastroesophageal reflux disease suffer heartburn that awakens them during the night. While this is by far the most common symptom of GERD, there are about 10-15% of people with gastroesophageal disease who do NOT have heartburn! Instead, they experience asthma, a chronic cough, chest pain, or laryngitis. These symptoms result when stomach acid refluxes into organs connected to the esophagus, such as the larynx, trachea and lungs.Research reported in the journal Chest (Volume 127, page 1658 May 2005) shows that people who are overweight, drink a lot of carbonated beverages, snore, experience daytime sleepiness or insomnia, have a high blood pressure or asthma, or use anti-anxiety medications such as diazepam (Valium) are most likely to experience the problem.

The subjects were part of the Sleep Heart Health Study, a national trial that enrolled 15,314 people to investigate the link between breathing problems during sleep and cardiovascular disease. Among the questions was “how often in the past year, on average, have you been awakened during the night with heartburn or indigestion?” The responses indicated that 1/4 or 3,806 people, in this group reported the symptom at least twice a month. People with nighttime heartburn are at greater risk for more serious esophageal problems such as erosive esophagitis, Barrett’s esophagus, and esophageal cancer.

If you experience nighttime heartburn on a regular basis, or have bouts of asthma, a nagging cough or episodes of chest pain, talk with your doctor. In addition, try to control the risk factors identified in this study – for example, keep your weight and blood pressure under control and cut down on your soda intake.

It Could Be A Warning of A Stroke

Recent research from the Journal Neurology explains why acting promptly at the first sign of a transient ischemic attack (TIA) may prevent a major stroke.You probably know the symptoms of a heart attack, but it’s just as important to know the symptoms of a stroke. Like a heart attack, a stroke is an emergency that requires immediate medical attention. Even a TIA, in which the stroke symptoms appear suddenly and quickly subside, is a medical emergency.

Whether you are having an ischemic or hemorrhagic stroke, the symptoms are the same. With a TIA,the symptoms are transitory, often lasting only minutes. If you or someone you are with experiences the sudden onset of any of the stroke symptoms listed below – even if the symptoms start to subside – you MUST call 911 or go straight to the hospital. Rapid diagnosis and treatment of a stroke may minimize damage to the brain tissue and improve the chances of survival. Stroke symptoms include:

Sudden weakness or numbness in the face, arm, or leg on one side of the body.
Sudden loss, blurring,or dimness of vision.
Mental confusion, loss of memory, or sudden loss of consciousness.
Slurred speech, loss of speech, or problems understanding others.
A sudden, severe headache with no apparent cause.
Unexplained dizziness, drowsiness, or lack of coordination.
Nausea and vomiting, especially when accompanied by any of the preceding symptoms.

The importance of responding immediately to symptoms of a stroke is underscored by a study in the journal Neurology(Volume 64, page 817). Note that the warning signs of an ischemic stroke may occur up to seven days before the event itself, according to researchers, and these signs should be taken seriously to minimize the chance of a major stroke.

Johns Hopkins Medicine

Delerium may be difficult to detect, particularly in people with memory problems or dementia. Be sure to make allowances for certain personality traits – tell the doctor if a loved one is typically restless or introverted, for instance.There is no universal rating system to help determine if a patient has delerium; however, the reliability of the following criteria tested positively in a study published in the Journal of Geriatric Psychology. Some central characteristics that researchers identified are listed below. Examples of the type of behavior that might indicate each characteristic are also included.

Shifting attention
Unable to concentrate during conversations.
Switches topics frequently.
Easily distracted.
Completely inattentive.

Poor orientation
Has problems articulating the date.
Doesn’t know the days of the week.
Doesn’t know where he or she is.
Has trouble recognizing family members.

Speech is difficult to understand.
Stops in the middle of a sentence.
Cannot express thoughts.

Restlessness and anxiety
Jumpy, edgy, or fidgety.
Suspicious of others.
Anxious and afraid.
Requires frequent reassurance.

Delusions and hallucinations
Perception is distorted or completely wrong.
Sees shapes or objects incorrectly.
Smells scents that are not there.

Poor cognition
Cannot spell simple words backwards.
Cannot do simple math.
Cannot recognize simple patterns of words or numbers.

Johns Hopkins Medical Letter

Contrary to typical portrayals in movies and on TV, heart attacks don’t always have a sudden, intense onset. A recent study finds that for women, chronic chest pain may signal a future heart problem.Although no one likes to think about having a heart attack,would you know what to do if you were? Even if you know what to do, would you follow through and more importantly, would you do it quickly?

According to the National Heart, Lung, and Blood Institute close to one million people in the United States have heart attacks each year; and, about one fifth of them die. Half of the deaths occur in the first hour after heart attack symptoms start and before the person reaches a hospital. These numbers underscore the importance of recognizing heart attack symptoms quickly and responding to these symptoms just as quickly,

Now a study in the European Heart Journal (Volume 27, page 1408) reports that for women, persistent chest pain may be a waning of future heart problems – even when a woman has no evidence of blockages in her coronary arteries.

The findings come from a study known as WISE, a government-funded project designed to evaluate chest pain in women – a task that is less straightforward than in men. The central isue is that women are much more likely than men to suffer long-term chest pain in the absence of any large artery blockages. But that doesn’t mean their chest pain is innocuous.

Among women in the study with no signs of clogged arteries, those with persistent chest pain for at least a year were more that twice as likely to suffer a heart attack, stroke or other cardiovascular complication over the next five years. The study included 637 women whose chest pain and other potential symptoms of coronary heart disease were evaluated by angiography (an x-ray examination of blood vessls that can detect blockages).

The take home message is if you are a woman, you should not simply live with chronic chest pain if angiography fails to detect artery blockages. Instead, you should ask your doctor about ways you can reduce any heart risk factors you have. Remember, a healthy diet and regular physical activity are two of the most important ways.

Sleep and your Blood Pressure

Another reason to catch your Z’s has to do with healthier blood pressure. In 90-95% of people with high blood pressure, doctors are unable to pinpoint the exact cause. In these cases, the condition is called essential or primary hypertension, In the remaining 5-10% of people, doctors are able to identifly a cause, and this type of high blood pressure is called secondary hypertension.Now researchers may have found a connection between sleep habits and high blood pressure. In a study reported in the Journal Hypertension(Volume 47, page 833) researchers studied more than 4,800 Americans and found that young and middle-aged adults who clocked five or fewer hours of sleep each night were 60% more likely than their well-rested peers to develop hypertension over the next decade. Lack of sleep did not appear to raise blood pressure in adults older than age 59, however.

The link between sleep habits and blood pressure remained even agter the researchers controlled for weght, depression, smoking, and physical activity levels. This means there may be something about chronic sleep deprivation that raises a person’s blood pressure.

One possibility us that people who get little sleep have more exposure to the elevations in heart rate, blood pressure, and nervous system activity that come with being awake. As a result, the body may adapt to these chronic elevations by operating at anew, higher level. Chronic sleep deprivation might also throw a wrench in the central “clock” in your brain, which governs the rythem of bodily processes, including blood pressure control. People vary in the amount of sleep they need, but experts recommend that adults get at least a good six hours of sleep a night.

John Hopkins Health Alerts
Viagra and Sleep Apnea

Sleep apnea is a disorder characterized by repeated episodes of breathing cessation (apnea) during sleep. These episodes last from 10 seconds to nearly a minute, ending with a brief partial arousal. Episodes of sleep apnea can occur and disrupt sleep hundreds of times throughout the night. An estimated 18 million Americans hve obstructive sleep apne, yet 95% of them are undiagnosed and untreated. Sleep apnea is about twice as common among men as among women.A report in the Archives of Internal Medicine(9Volume 166, page 1763) suggests that taking Viagra at bedtime may worsen severe obstructive sleep apnea. This may be disturbing news to many men, because erectile dysfunction is particularily common among those with sleep apnea. Viagra prolongs the action of nitric oxide, which promotes upper airway congestion, thereby contributing to sleep apnea. The researchers studied 14 men with severe sleep apnea, who spent a night in a sleep lab having their breath and blood oxygen monitored after they took a single 50-mg dose of Viagra or a placebo.

Just one dose of Viagra significantly increased the amount of sleep time with a lower blood oxygen saturation level; while asleep, men who took Viagra were not getting as much oxygen as those wo took a placebo. They also had more breathing pauses per hour.

Bottom line advice on Viagra and sleep apnea is if you take Viagra and have sleep apnea, talk with your doctor about whether the pleasures you derive from taking the drug outweigh the risks of worsening your nighttime breathing problems.

Johns Hopkins Health Alerts
Primer on Cataracts

If you’re in your forties or fifties, you probably know someone who has cataracts. That’s because cataracts can occur at any age (in fact, babies can be born with them), they are most common later in life. About 50% of people age 65-74 and 70% of those age 75 and older have cataracts. In 2004, an estimated 20.5 million Americans over age 40 (approximately 17%) had a cataract. Cataract surgery is the most commonly performed surgical procedure in the United States. More than 1.5 million cataract operations are performed each year.The cause of most cataracts is unknown, but at least two factors associated with aging contribute to their development. First, clumping of proteins in the lens leads to scattering of light and a decrease in the transparency of the lens. Second, the breakdown of lens proteins leads to the accumulation of a yellow-brown pigment that clouds the lens.

Researchers have found certain chemical changes in the eyes of people with cataracts. These changes include a reduced uptake of oxygen by the lens and a rise in the water content of the lens, which is later followed by dehydration. When cataracts form, levels of calcium and sodium in the lens increase, and levels of potassium, vitamin C, and protein decrease. In addition, lenses with cataracts appear to be deficient in the antioxidant glutathione; however, studies on the use of medications or vitamins to alter the levels of these substances in the lens have not produced promising results. Currently, there is no effective drug therapy to prevent cataracts from forming. But cigarette smoking, certain drugs, eye injuries, sunlight, diabetes and even obesity can increase the risk of cataracts.

Cataracts are an opacification (cloudiness) of the eye’s normally clear crystalline lens and they form painlessly. The most common symptom is cloudy or blurry vision and everything becomes dimmer, as if seen through glasses that need cleaning. Most often, both eyes are affected, though vision is usually worse in one eye than in the other. Other symptoms include glare, halos, poor night vision, a perception that colors are faded or that objects are yellowish, and the need for brighter light when reading. Symptoms can develop rapidly (in a matter of months) or almost imperceptibly over many years.

Johns Hopkins Medicine
Antidepressant-Induced Sexual Dysfunction

Karen L. Schwartz, M.D., Director of Clinical Programs at the Johns Hopkins Mood Disorders Center weighs in on this all too common cause of decreased libido. Unfortunately, sexual dysfunction includes diminished libido, inability to orgasm, decreased sensation in the genitals, vaginal dryness, and erectile dysfunction.If you report sexual dysfunction, the first thing your doctor will do is a thorough medical workup to rule out such physical problems as hypertension, diabetes, urological problems and neurological problems, all of which can cause such dysfunction.

If antidepressants are the likely cause, there are several possible remedies. First, you and your doctor may consider switching to an antidepressant with a low rate of sexual side effects, such as Wellbutrin (bupropion). This would be done carefully to minimize the risk of a relapse of depression. Your doctor may also suggest adding Wellbutrin to your current antidepressant regimen. Research has shown that small doses of Wellbutrin in combination with other antidepressants can be helpful in alleviating the sexual side effects of those antidepressants. There are a number of other remedies that you and your doctor might try such as adding sildenafil which is effective for combating antidepressant-induced sexual dysfunction in both men and women. Perhaps your doctor may decrease your antidepressant dose to some slight degree or change the time you take your medication. Dividing the medication dose and taking it twice a day may also diminish side effects. Finally, your doctor may have you take a “drug holiday” for a two day period which will lower the rate of sexual side effects without increasing the risk of a recurrence of depressive symptoms.

All remedies discussed above should be implemented only with physician support and supervision to prevent relapse of depressive symptoms and drug withdrawl reactions.

Depression and Anxiety