Dear Dr. Roach: Our local newspaper just ran the obituary of a 59-year-old woman who died from Alzheimer鈥檚 disease. I didn鈥檛 know her, but I鈥檝e known at least two other people with that illness. One has passed away, the other is in a memory-care unit. How does Alzheimer鈥檚 cause or contribute to death?
A.
Alzheimer鈥檚 disease is a common degenerative disease of the brain. It鈥檚 unfortunately very likely that in the years ahead, you will know many more people diagnosed, as the risk increases with age.
Its exact cause is unknown. We often think of Alzheimer鈥檚 as being a disease of memory, however, personality changes, loss of insight, impaired visual skills and language dysfunction are other cardinal signs of the disease, though any of these may show more clearly as the disease progresses.
Alzheimer鈥檚 can progress in individuals at very different rates, but the mean survival after diagnosis has been reported as three to eight years. People with Alzheimer鈥檚 disease usually become debilitated due to poor nutrition and hydration, which leads to increased risk for infection, one of the most common causes of death in Alzheimer鈥檚.
I don鈥檛 mean to suggest that debility is the fault of the caregivers of people with advanced dementia.
Caring for a person with Alzheimer鈥檚 disease is a difficult and demanding task -- physically, mentally and emotionally.
But no matter how devoted and skilful the care is, there is no preventing the physical decline that happens as the Alzheimer鈥檚 progresses; we can only slow it down.
It has been my experience that in patients with advanced dementia, the caregiver becomes the most important part of the team to get information from and give guidance on care and provide support to.
听
Dear Dr. Roach: In your recent column regarding a 54-year-old man鈥檚 sexual difficulties, you neglected to include what could be the most significant cause for erectile dysfunction in older American males: circumcision.
Indeed, circumcised males are four to five times more likely to use Viagra than intact males.
R.A.
Circumcision, like any medical procedure, has potential for both benefit and harm. Potential benefits include reduction in lifetime risk of urinary infection (32 per cent in uncircumcised versus nine per cent in circumcised), a small decrease in penile and partner鈥檚 cervical cancer risk and decreased risk of sexually transmitted disease (50 per cent to 60 per cent reduction in HIV).
Potential harms include surgical complications (0.2听per cent for in-hospital circumcisions), possible sexual dysfunction and pain during the procedure. This pain can and, in my opinion, should be prevented by a nerve block or anesthetic cream.
Although one study did show a large increase in the risk for sexual dysfunction for circumcised men, the study had a key flaw: recruiting subjects who already had complaints about circumcision.
The preponderance of data on sexual dysfunction does not support circumcision being a large risk factor.
In a 2013 review of 2,675 publications, the authors found that the 鈥渉ighest-quality evidence suggests that medical male circumcision has no adverse effect on sexual function, sensitivity, sexual sensation or satisfaction.鈥�
Although there may be some health benefits for routine circumcision, I agree with the American Academy of Pediatrics that parents should weigh the health benefits and risks in light of their own religious, cultural and personal preferences, 鈥渁s the medical benefits alone may not outweigh these other considerations for individual families.鈥�
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
