Start with your PCP to evaluate your heart health
Dear Doctors: I am 65 years old, and I have never been to a cardiologist. I am concerned about heart disease and the possibility that I may have blocked arteries. I would like to know what screenings -an MRI? an exercise stress test? -- I should get.
Dear Reader: As someone who has not undergone the screenings commonly used to evaluate cardiac health, it’s best to start with the basics. These can be done by your regular doctor.
The appointment typically begins with a discussion of your medical history. This includes information about any diseases or conditions for which you are currently being treated, and any in your past that may have a residual effect on general health. Family history, which can suggest a genetic predisposition for certain diseases and conditions, is an important factor, as well.
Your weight, and possibly your BMI, will be recorded, and your doctor will obtain readings for heart rate and blood pressure. Testing will also include a blood lipid profile and a blood glucose level. Taken together, this information offers important insights into health risks that you may face. If the test results suggest a problem beyond the scope of your primary health care provider, such as a heart condition or heart disease, they will refer you to a cardiologist.
When visiting a cardiologist, expect them to review the test results that brought you under their care, and to explain how the results are a factor in the health of your heart. Depending on those results, you may also be asked to undergo additional tests that assess various aspects of cardiovascular health. These can include an EKG, which measures electrical activity in the heart; echocardiography, which uses ultrasound to create moving pictures of the heart; and scans that measure blood flow in the veins or that identify the presence of calcium deposits. A test known as CCTA, or coronary computed tomography angiography, produces 3D images that can help detect abnormalities in blood flow and identify possible blockages. An exercise cardiac stress test measures heart rate and rhythm, blood pressure and electrical activity of the heart as the patient performs increasingly strenuous exercise.
The cardiologist will also discuss specific aspects of your lifestyle. This includes a review of your diet, exercise habits, use of alcohol or tobacco products and your perceived level of stress. You will be asked about medications you are currently taking. It’s important to provide the doctor with a complete and accurate list, and to also include any dietary supplements that you may be using. They will also want to know about any family history of heart disease.
Depending on the findings, you may be prescribed medications to manage high blood pressure or high cholesterol. You may also be advised to make lifestyle changes. These can include reaching a healthier weight, exercising more or more frequently, adjusting your diet, moderating the use of alcohol and quitting tobacco products. Your cardiologist will also schedule additional appointments to evaluate the efficacy of your treatment program. For the health of your heart, and your general well-being, it’s important that you follow through.
Scent therapies may help in preservation of memory
Dear Doctors: My husband and I just hit 65 and are interested in information about preserving memory. I just read about a study that says using your sense of smell more often can be helpful. Do you have any information about that study? The details have been pretty vague.
Dear Reader: You’re referring to the findings of a study published last summer in the scientific journal Frontiers in Neuroscience. Although the study was small, the results were quite intriguing. Researchers from the University of California, Irvine, found that when older adults were exposed to a range of different scents each night, their memories measurably improved.
The study looked at 43 adults ranging in age from 60 to 85. All were in good physical health, and none had any issues with cognition. Each participant was issued an odor diffuser to be placed in their bedrooms. When filled with the various liquids provided by the researchers, these devices would distribute a scent throughout the bedroom for two hours each night as the participants slept.
The study participants were also randomly divided into two groups. One group, which served as the control group, received liquids with just a trace of scent. The other group was given liquids that contained a much higher concentration of scent. Over the course of the study, all of the participants were exposed to a rotation of seven scents — rose, orange, eucalyptus, lemon, peppermint, rosemary and lavender.
At the end of the sixmonth period, each of the participants was evaluated with the same standardized memory test that had been used at the start of the study. The group of adults who had been exposed to the stronger concentrations of scent each night showed a 226% improvement over their previous test results. Brain scans also showed positive changes in that group. The same improvements were not seen in the control group, whose odor diffusers had been loaded with just a trace of scent.
Previous research has also linked having a good sense of smell to a slower loss of brain volume and a decrease in the rate of cognitive decline in older adults. At the same time, a decline in the sense of smell has been found to be an early symptom of neurodegenerative diseases such as Parkinson’s and Alzheimer’s.
As for why scent and memory are linked, anatomy appears to play a role. The area of the brain that receives scent signals from the nose is known as the olfactory bulb. It decodes those signals, then shares them with nearby structures in the brain, which are collectively known as the limbic system. These have been found to play a role in emotion, mood and, yes, memory.
The UC Irvine researchers have called the results of this new study statistically significant. However, they have also been careful to point out that larger and longer studies are needed to confirm the findings. The hope is that, with the encouraging results in this avenue of inquiry, scent therapies may someday become a viable means of enriching memory.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet. ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.