Short-term memory loss can be attributed to prescription drugs

DEAR DR. ROACH: I’m a 47-year-old male taking the following prescriptions: venlafaxine, buspirone and gemfibrozil. I am in excellent health with no other issues. I started all the meds at the same time, about six years ago.

My concern is that my short-term memory is horrible. It started at about the same time. I forget things quickly, and it is a problem not only at work but in my everyday life.

I visited my doctor with the concerns, and he ordered an Alzheimer’s disease test, which I passed. I had a brain scan, with no abnormalities.

If it’s not a physical issue, what could it be? Most importantly, how do I improve my short-term memory? Please help! I can’t seem to remember anything.

As a side note, I have no issues with my long-term memory. — N.D.

ANSWER: Medication side effects should always be in a prescriber’s mind, and when new drugs are started, a wise clinician asks about any adverse effects, and specifically about common ones.

In this case, the fact that the symptom started at about the same time as the medications makes them the most likely culprit.

Venlafaxine and buspirone are typically prescribed for anxiety or anxious depression: Mood disorders themselves can cause difficulty with concentration, which often is perceived as a short-term memory disorder. However, both of these medicines are reported to cause memory problems.

It’s sometimes hard to separate the effect of the condition (mood disorder) from the side effects of medication. This becomes more of a problem when more than one medication is prescribed at the same time.

Gemfibrozil, used for elevated cholesterol, also is reported to cause memory disorders, as are the more commonly used class of cholesterol drugs, the statins.

In a case like yours, one reasonable approach is for your doctor to stop the medications (if it is safe to do so; don’t do this without discussing with your prescriber) to see if that makes the problem go away.

If it does, then he can look for treatments for your conditions that don’t cause side effects. This may include non-drug treatment, such as cognitive-behavioral therapy for a mood disorder, or a diet and exercise plan for cholesterol.

I should note that there is no single, simple test for Alzheimer’s disease. Making the diagnosis with absolute certainty requires a brain biopsy, which is almost never done, because a comprehensive evaluation by a specialist, with appropriate laboratory, psychological and sometimes radiologic testing, is very accurate.

DEAR DR. ROACH: Diabetes runs in my family, and I recently read about a type of diabetes I had never heard of: Type 1.5 diabetes, or LADA. I do not remember you ever writing about it. — R.K.

ANSWER: Type 1 diabetes is caused by an autoimmune destruction of the insulin-producing beta cells in the pancreas. It normally occurs in children or adolescents.

Type 2 is caused by resistance to insulin, often (but not always) in people who are overweight. It normally happens in adults.

However, there are exceptions to these associations. The most important is that Type 2 diabetes is increasingly occurring in young adults, adolescents and even kids, usually alongside obesity.

Type 1.5 diabetes is a bit of a misnomer, since it is either a late-onset form of Type 1 (“LADA” is for “latent autoimmune diabetes in adults”) or closely resembles it. It tends to be slower in onset than Type 1 in children. Since it involves destruction of the beta cells, most people with LADA eventually will require insulin.

Some experts believe that early and aggressive use of insulin will slow or even prevent destruction of the beta cells in people with autoimmune diabetes, which means both Type 1 and LADA.

DEAR DR. ROACH: I recently had a PET scan. It showed that my stomach is almost completely up in my thorax with a large hiatal hernia. I have no discomfort or symptoms.

Is this dangerous? Should I have surgery? — C.V.

ANSWER: The diaphragm is a large sheet of muscle that separates the chest from the abdomen. It has a hole in it, called the diaphragmatic hiatus, that allows the esophagus to carry food into the stomach.

In some people, that hole is large enough for part of the stomach to go up into the chest. This condition is called a hiatal hernia, and it may bring on variable symptoms, especially heartburn.

Usually, it’s a “sliding” hiatal hernia — the stomach can go into the chest but later come back in the abdomen where it belongs.

In people with no symptoms, surgery rarely is required.

However, if the entire stomach is in the chest, it’s possible for it to get stuck, which predisposes a person to bleeding and, rarely, to a condition called volvulus, when the stomach twists in the chest against the part left in the abdomen.

These complications often need surgery: I have seen only two cases in my career.

DR. ROACH WRITES

A few weeks ago, M.A. wrote to me about her low blood counts. She kindly wrote me back, and after a bone marrow biopsy, was diagnosed with a low-grade marginal zone B cell lymphoma.

This particular type of blood cancer usually starts in the spleen, and the abnormal cells often can be found in the bone marrow, which I think is likely the case with M.A.

The bad news about low-grade lymphomas is that they often are not curable. The good news is that they grow very slowly.

Half all people with this type of tumor live with this condition for longer than 10 years.

Because the main reason M.A. was found to have this condition was abnormal blood test results, it may not be necessary to treat it right now.

However, it’s likely that M.A. will require blood transfusions as the disease progresses.