DEAR DR. DONOHUE: What is the difference between hardening of the arteries in the brain and Alzheimer’s disease? My husband has hardening of his arteries. I am devastated and will not tell my husband. Is hardening of brain arteries fatal? He has had dementia for more than a year now. – V.B.

ANSWER: “Dementia” is a word that covers many ills. It is a persistent impairment in brain function with a decline of memory and of one or more of the following mental processes: language, visuospatial ability, personality, cognition, calculation and judgment.

A language deficit is groping for words or using words incorrectly. Visuospatial ability is the skill to recognize the relationship of objects to each other. Working a jigsaw puzzle requires visuospatial ability. Asking a person to copy intersecting pentagons is one test of this ability.

Alzheimer’s disease is the No. 1 cause of dementia, accounting for 50 percent to 70 percent of all cases. It is not the only cause. There are at least 50 others. Hardening of brain arteries – vascular disease – comes in second place as a dementia cause, accounting for up to 20 percent of cases.

In third place is an illness that most people do not know – Lewy body disease. The other 47-plus causes account for only a fraction of the remaining cases.

Alzheimer’s disease proceeds with a steady, slow decline in mental function. Artery hardening, on the other hand, is characterized by a sudden decline in thinking and memory with stabilization at that level for a good period of time. Then there comes another sudden downward step. Alzheimer’s is like riding a down escalator that makes no stops. Artery hardening is like riding a down escalator that makes a two-step descent and then stalls until another two-step descent takes place.

Treatment for brain artery hardening is the treatment for artery hardening that occurs in any body organ, such as the heart. Blood pressure must be controlled. Cholesterol and triglyceride levels have to be lowered with diet change, exercise and medicine. Blood sugar must stay in the normal range. Cigarette smoking has to be butted out. Some doctors put their artery-hardening patients on daily aspirin.

Brain artery hardening shortens life if there is concomitant heart artery hardening, which there usually is.

DEAR DR. DONOHUE: My friend and I are the same age (73), take the same diabetes medicine and take heart medicine. Her doctor just put her on a different diabetes medicine; mine did not. Why? – T.R.

People with diabetes who also have moderate to severe congestive heart failure have to be careful about using two classes of diabetes medicines – the sulfonylurea drugs and the thiazolidinediones, two unpronounceable names.

Examples of the first drug category are Glucovance, Glucotrol, Amaryl, Diabinese and Orinase. This family of oral diabetes drugs can make a few – very few – users of the drugs come down with a serious problem called lactic acidosis if they also have congestive heart failure.

Examples of the second drug category are Avandia, Actos and Avandamet. Some congestive heart failure patients can retain fluid when they take these medicines. Fluid retention worsens congestive heart failure.

While you and your friend have heart problems, my guess is that you do not have the same kind of heart problem. She likely suffers from congestive heart failure.

Congestive heart failure is a common and poorly understood illness.

Readers who would like more information on it can obtain the pamphlet that deals with this condition. Write to: Dr. Donohue – No. 103, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: They say to chew an aspirin when you think you are having a heart attack. They never say which kind of aspirin – baby or adult? – L.M.

Chew a 325-mg aspirin when you believe you are having a heart attack. That’s the dose of aspirin that used to be called “adult.”

An 80-mg aspirin can be taken on a daily basis for prevention of heart attacks. That’s the dose that used to be called a “baby” aspirin.

DEAR DR. DONOHUE: Could you discuss the three medical conditions that, when they occur together, are known as Saint’s triad? – N.Y.

The three conditions, named for Dr. Saint, are a hiatal hernia, diverticulosis and gallstones.

Hiatal hernia is a protrusion of the stomach into the chest cavity, and its main symptom is often heartburn. Control of acid production is the treatment for heartburn.

Diverticulosis consists of pea-sized protrusions of the colon lining through the colon wall. A high-fiber diet stops formation of new diverticula but does not remove old ones. If they are not causing trouble, they can be ignored.

Gallstones are familiar to all. Many people have them without any symptoms. In those instances, they too can be ignored.

I have never seen a person who was so unlucky as to have these three conditions at the same time. One would be more than enough to handle.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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