MEN'S HEALTH MATTERS:Mild forgetfulness is normal we grow older. However, if in doubt, get it checked out, writes THOMAS LYNCH
Q My dad is only 66 years old and seems to be having difficulty remembering things like people’s names. He also finds that he loses the train of a conversation and his concentration is not as good as it used to be.
Do you think that he is developing dementia or Alzheimer’s disease? Is there anything that we can do to help him?
A Not being able to immediately remember names and not picking up all the details of a conversation can be a normal experience, particularly as we get older when mild forgetfulness can occur. The good news is that the memory may not deteriorate any further to any significant extent.
If, however, you are worried about your dad’s failing memory or if other members of your family or close friends are concerned that his memory is failing then you should consider him being reviewed by a specialist.
One finds that in most cases such as your dad’s, a clinical review and investigation will enable him to be reassured that his memory is normal, but it is important that a mini mental state examination is carried out by your doctor. Then, if further testing is required, this can be undertaken.
Your doctor may decide to do a number of blood tests and may also do a brain scan. An MRI of the brain is usually much more sensitive than a CT of the brain, particularly for picking up mini strokes.
Mini strokes can contribute to memory loss, and mild forgetfulness may in fact be the only manifestation of mini strokes and the person may not develop any other signs such as a facial weakness, limb weakness or a speech defect.
If there is any evidence of brain thinning, which can occur in a patient with Alzheimer’s disease, then this may also show up on a MRI brain scan.
Your doctor will also check on folic acid and B12 levels plus thyroid status and ensure that he has normal biochemistry and endocrine blood results.
It is also imperative that he has a normal clinical examination to make sure that he has normal blood pressure and no risk factors such as an irregular heart, which could contribute towards events such as mini strokes.
If your doctor discovers that he has had mini strokes then he can give him medicine that will significantly lessen the possibility of further events.
The prevention of mini strokes has been one of the great success stories of modern medicine with the focus on optimising blood pressure, stopping smoking, using blood thinning agents and cholesterol lowering therapies.
Drugs are also available that can enhance memory but your doctor will decide whether or not any such medications would be helpful in his case after all the results come to hand.
The vast majority of people who worry about memory have no cause to be concerned. However, if in doubt, particularly if it is interfering with his activities of daily living or his social interaction with others then it is important that it is fully assessed and investigated and any appropriate treatment instituted.
Q I am 47 years old and have had a lot of discomfort in my bladder area and behind my scrotum. I have discomfort when passing urine.
I saw my doctor recently and he told me that I had chronic bacterial prostatitis. I have never heard of this before. What does it mean?
A Chronic bacterial prostatitis is defined as recurrent urinary tract infections in men originating from a chronic infection in the prostate. It is a relatively rare condition that usually presents with an intermittent urinary tract infection type picture.
Symptoms may be completely absent until there is also bladder infection, and the most troublesome problem is usually recurrent cystitis.
In chronic bacterial prostatitis there are bacteria in the prostate but usually no symptoms.
The prostate infection is diagnosed by culturing urine (confirming infection in the laboratory) as well as prostate fluid (expressed prostatic secretions) which are obtained by the doctor performing a rectal examination and putting pressure on the prostate. If no fluid is recovered after this prostatic massage, a post massage urine should also contain any prostatic bacteria.
Prostate specific antigen (PSA – blood test for prostate cancer) levels may be elevated, giving rise to concerns that there may be an underlying prostate cancer which is not usually the case.
Treatment requires prolonged courses (four to eight weeks) of antibiotics that penetrate the prostate well. Persistent infections may be helped in 80 per cent of patients by the use of alpha blockers which are drugs used for urinary symptoms due to prostate enlargement or long- term low-dose antibiotic therapy.
Recurrent infections may be caused by inefficient urination (benign enlargement of the prostate, neurogenic bladder), prostatic stones or a structural abnormality that acts as a reservoir for infection.
Over time, the relapse rate is high, exceeding 50 per cent. A study in 2007 showed that repeated courses of combination antibiotics may eradicate infection in 80 per cent of patients with clinical remission extending throughout a follow-up period of 30 months for 94 per cent of these patients.
- This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James's Hospital, Dublin with a contribution from Prof Bernard Walsh, consultant physician, St James's Hospital, Dublin
