Q: I AM 81 years old and in good health, but my short-term memory is not good. Is there medication I can take?
DW
A: PROBLEMS WITH short-term memory are usually a normal part of ageing, but they can also be a sign of mild cognitive impairment (MCI).
This is the state in between normal mental capacity and dementia. More than a quarter of people around your age - aged 80 to 84 - will have MCI, according to a review of 34 studies published by the American Academy of Neurology in 2018.
Some of those will go on to develop dementia, but there are steps you can take to minimise brain function worsening.
MCI is diagnosed with a series of tests to check if your memory and thinking skills are below the norm for someone of your age. It might also involve a brain scan.
Diagnosis can be a complex process as there are no standard tests, so it’s difficult to say what ‘normal’ is.
Those at greatest risk have risk factors such as hypertension, diabetes, obesity, a history of stroke or heart disease and low mood.
Whether you have a diagnosis of mild cognitive impairment or not, the treatment is the same.
But, regrettably, no medication is proven to help - whether conventional drugs or herbal and nutritional supplements.
However, tackling risk factors is vital. This includes looking at any medications that might impair cognitive function. If you’re taking benzodiazepines (e.g. diazepam), anticholinergic antidepressants (e.g. amitriptyline), antihistamines (e.g. chlorphenamine) or opioids (e.g. codeine), this should be assessed by your GP to see if they can be stopped.
The focus then is looking after yourself. Ensure you’re sleeping properly - sleep is the time the brain clears out waste products that build up during waking hours, which are linked to Alzheimer’s.
Exercise is also important. In a number of small trials, exercise has been shown to improve both immediate and delayed recall.
Even a daily walk, as much as you can manage on a regular basis, will have a beneficial effect.
Q: MY PARTNER has had cysts in his testicles for several years. He had surgery but they have come back. They’re not painful, but do they need to be monitored with regular scans?
AS
A: WHAT YOU are describing are epididymal cysts - harmless, fluid-filled growths.
They can vary in number (some men will have just a single lump, while others have a cluster of several cysts, either within the scrotum or testicles) and in size (some grow to 2cm or more).
They develop in the epididymis, a coiled tube that lies at the exit of each testicle. Its job is to transport and store sperm cells, to allow them to mature.
Why these cysts develop is not clear. One theory is that they could be triggered by inflammation after an infection, or they might be due to some sort of developmental abnormality.
Although epididymal cysts are relatively common, understandably, when you find them, it can cause alarm, the fear being it might be testicular cancer. And men are generally advised to have ultrasound scans to check them.
If there are multiple cysts, they’re usually removed in a short procedure performed as a day case in hospital (in some cases they can then recur).
But please be reassured, these cysts do not become cancerous or infected. So there is no need for a regular follow-up scan.
However, I would always encourage men to check themselves regularly and to see their GP if they find a new lump they are concerned about.
My advice to your partner is to accept the current state of affairs - he only needs to seek further surgery if the recurrent cysts become a problem by virtue of their size and bulk.
Q: I'VE BEEN diagnosed with glaucoma in my right eye and my vision is slightly fuzzy. But tests show my eye pressure readings are in the normal range. What could be the cause?
GL
A: GLAUCOMA IS a common eye condition where the optic nerve is damaged, causing a loss of vision.
We often speak of glaucoma as if it’s a single condition, but in fact there are actually four types. The most common form of it is primary open-angle glaucoma.
The damage to the optic nerve occurs in the main because the eye isn’t able to drain fluid properly. A key factor is the angle between the iris and the cornea, the clear window at the front.
The degree of this angle, which can be affected by age, injury and other factors, determines how well the eye is able to drain.
With the primary open-angle form, which develops very slowly, the drainage angle is still open, but other parts of the drainage system are not working properly.
There is also angle-closure glaucoma, which is rare and may develop rapidly. Here, the angle narrows because the iris has bulged and the eye cannot drain.
The other two types are congenital glaucoma, usually present at birth and caused by an abnormality of the eye, and secondary glaucoma, caused by an injury or other eye condition.
The traditional view is that the damage to the optic nerve is caused by increased pressure from a build-up of fluid.
But it’s now thought that it can also be caused by a disease affecting the axons, the cells of the optic nerve.
So while raised eye pressure is associated with most cases of glaucoma, it’s not always so.
In fact, as many as 40 per cent of patients with open-angle glaucoma have normal eye pressure.
Vision loss caused by glaucoma can’t be reversed, but treatments - including eye drops and surgery - can prevent it worsening. The goal is to lower eye pressure to 30 per cent below the initial reading when diagnosed, even in patients such as yourself who don’t have raised pressure.
This is because lowering the pressure is the only established method for slowing the progress of the disease and preventing loss of sight. We don’t know why, but it helps.
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