Dementia unlikely to erase trauma

Dear Dr. Roach: My brother-in-law (age 78) recently developed dementia. Everything after the age of about 20 is gone for him, and he lives in the past, though he does still connect with my sister. For some time now, he has taken a psychopharmaceutical (Zoloft) for PTSD, stemming from earlier experiences. My question is, what is there to do in cases when past trauma(s) may have been erased from memory? Is there still a need to continue the medication?

U.T.

Answer: I don’t think that past trauma entirely disappears from memory, even in people with dementia. Furthermore, years of learned behaviors due to past trauma, or to mood disorders like anxiety and depression, will not change very easily. Still, in people with very severe dementia, psychiatric medications a person has used should be re-evaluated to see whether they are still needed.

The idea that depression and anxiety are caused by a chemical imbalance — specifically with the brain neurotransmitter serotonin — may be an oversimplified explanation of a very complex issue. However, the medications we have remain moderately effective for depression.

Dear Dr Roach: I’m a 63-year-old male with controlled blood pressure using five different meds, as well as a prescription for Synthroid due to Grave’s disease, for which I was treated with radioactive iodine. In late April, I experienced my first episode of AFib, which stopped by itself. Since then, I have had several AFib events, and all were self-converted to a normal rhythm. Is AFib life-limiting or a condition to be controlled?

H.C.

Answer: Well-controlled atrial fibrillation isn’t lifelimiting. Everybody with atrial fibrillation should have an evaluation as to the cause behind it, but often a cause is never found. They should also consider medication to control the heart rate and anticoagulation medication to prevent stroke.

Your case is unusual, because you have a low risk for a stroke. Some experts would treat you, but I think most would not treat you beyond aspirin. You should definitely have a close follow-up.