DEAR DR. DONOHUE: My neighbor fell backward, and the back of her head hit a railroad tie. She unknowingly bled beneath her skull for a month until she passed out. The doctors found a crack in her skull and said she should have died.

I read that a brain injury causes something like “alkaloids” to form in the brain, and that they are the precursors of Alzheimer’s disease. This same woman’s mother died young with Alzheimer’s.

At age 11, I fell off a broken tire swing and hit the back of my head. I was in and out of consciousness all day, but my parents did not take me to a doctor for more than a week. There were no MRIs back then. Which of us has the stronger threat of getting Alzheimer’s disease? — S.S.

ANSWER: The brain changes of Alzheimer’s disease include brain shrinkage, a buildup of amyloid deposits — not “alkaloids” — and the formation of tangles of brain cells infiltrated with a peculiar protein called tau. Amyloid is another pathological protein. Advancing age is one cause of these changes. Diabetes and high blood pressure are risks for Alzheimer’s.

Family history is a risk. If a parent develops Alzheimer’s disease before age 60, the risk that the parent’s children will get it is higher than it is for the general population. If a parent develops Alzheimer’s at age 75 or later, the increase in risk is not great. If a parent does so after age 80, the increased risk is practically zero. Genes do play a role in Alzheimer’s disease, but they are not the sole risk and are not a risk in all patients.

Some studies suggest that brain trauma might lead to Alzheimer’s changes, but the evidence for that relationship is questioned by many experts. Boxers who become punch drunk from repeated blows to the head have amyloid deposits in their brains, but they lack many of the other features common in Alzheimer’s patients’ brains. Neither you nor your neighbor has a great threat of coming down with Alzheimer’s because of your head injuries. Since your neighbor’s mother died with it a young age, her risk of getting it is greater than average.

The booklet on Alzheimer’s disease explains this cruel illness and its treatment. Readers can obtain a copy by writing: Dr. Donohue — No. 903, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I am an 82-year-old woman in good health and very active. My problem is a Wenckebach’s block. It has been verified by my primary-care physician and a cardiologist. I have had it for about 35 years. No one has ever told me what it is or what causes it. I know when it is happening, because I get a catch in my throat. I gather it is not life-threatening. I would appreciate your input. — C.O.

ANSWER: A technical EKG definition of a Wenckebach block would serve only to confuse, so I’ll give you a nontechnical explanation. It’s a dropped beat. One of the electrical impulses that trigger every heartbeat doesn’t make it to the bottom heart chambers. Those chambers are the ventricles, and they’re responsible for contracting and pumping out blood. One electrical impulse in a series of impulses fails to make it to the ventricles. It’s a lost beat. It almost never creates a problem, and doesn’t usually progress to a more serious condition. You are a living example. Nothing bad has happened in 35 years, and nothing bad is likely to happen in the next 35 years. I don’t know what causes it. I never heard of it causing a catch in the throat.

DEAR DR. DONOHUE: My husband and I have trouble falling asleep. I used to use Ambien, but was concerned about long-term use. My doctor recommended melatonin for both of us. It works wonders. Can it be taken indefinitely? Is it habit-forming? — C.Z.

ANSWER: If melatonin works for you, great. It isn’t habit-forming. Studies on its long-term use haven’t been done, but evidence doesn’t suggest harm. It’s always wiser to let nature take its course. From time to time, stop using it and see what happens.

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. Readers may also order health newsletters from www.rbmamall.com.

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