Dear Dr. Roach: I am an 84-year-old woman who increasingly is talking to herself. Wherever I am, grocery shopping or at home, I speak or murmur to myself constantly. As I type this, I am speaking it in a whisper. Is there something wrong with me? Is this the start of a serious dementia?
Dear L.B.: My experience is that talking to oneself probably is not the start of a serious dementia. Talking to oneself is common. I do see it in people with dementia, but I believe that is the minority of cases. One theory for why we talk to ourselves is that itís a way to move information from one side of the brain to the other.
Diagnosing early dementia can be a challenge. The best way we know of is neuropsychiatric testing, a battery of tests usually administered by a neurologist or psychiatrist. Most people donít need that. Your regular doctor should have the tools necessary to look for early dementia, and can refer you to a specialist if necessary.
It also is my experience that people who come in worried about dementia are at far less risk than those whose families bring them in.
Dear Dr. Roach: I would like information about dessicated porcine thyroid extract to treat a hypoactive thyroid. I saw a TV program where it was used to lose weight in a person whose thyroid tests were normal, but who had fatigue and hair loss. What do you think of this?
Dear F.B.: I have certainly seen people prescribed thyroid medication for symptoms despite absolutely normal thyroid blood tests, and I think that is a mistake. The symptoms of low thyroid hormone are vague and easily confused with many other conditions, both physical and psychological. Prescribing thyroid hormone at low levels will cause the body to make less of its own hormone, but high levels of prescribed thyroid, either natural or synthetic, will cause thyroid hormone excess. It can make people lose weight, but it has too many other side effects, including potentially toxic effects on the heart, bones and brain, to be considered a valid treatment. I donít think that any form of thyroid extract should be available without a prescription.
Dear Dr. Roach: Can high blood pressure cause blood clots, blindness and strokes? Or is this caused by taking the wrong combination of blood pressure medicines?
Dear Anon.: High blood pressure over months or years causes damage to the lining of blood vessels. This can indeed predispose a person to a stroke. Reducing blood pressure gradually reduces risk of stroke.
Blood clots also can cause strokes, but these usually are not linked to blood pressure, high or low, and instead are linked to conditions that affect the blood itself or that affect the rhythm of the heart. Some medicines, such as estrogen, make blood clots more likely.
In people with very high blood pressure, lowering it too much, too quickly can cause strokes. The blood pressure needs to be reduced gradually, which usually can be done as an outpatient. There are still a few times when people with extremely high blood pressure are admitted to the hospital, where blood pressure can be brought down very slowly in a controlled environment.
Email questions to ToYourGoodHealth@ med.cornell.edu.