Ask The Doctor: Loneliness; Hypertensive Encephalopathy; Excessive Exercise

Expert views on healthy living.

Q. I have read that lonely older people have a higher risk for dementia. I am a 68-year-old widow who lives alone. Although I have a limited social life because of my severe arthritis, I don’t feel particularly lonesome, am content with my life, and have no memory complaints. Should I be worried about dementia?

A. Researchers have not found evidence that factors such as living alone, being socially isolated, or having little social support significantly increase a person’s risk for dementia. However, a large study published online Dec. 10, 2012 in the Journal of Neurology, Neurosurgery and Psychiatry found that older individuals who reported regularly experiencing feelings of loneliness at the outset of the study were significantly more likely to develop dementia over a three-year period than similar individuals who did not report feeling lonely. More than 13 percent of lonely participants had developed symptoms of dementia by study’s end, compared with 5.7 percent of those who did not report loneliness—a 64 percent increase in risk.  This research suggests that, since you are not bothered by loneliness, you may not need to worry about a loneliness-related heightened dementia risk.

Q. My sister was hospitalized recently with hypertensive encephalopathy. What causes this condition, and what is her long-term prognosis?

A. Hypertensive encephalopathy is a swelling of the brain caused by a sudden, severe, and persistent elevation of blood pressure in individuals who have uncontrolled high blood pressure. It is a dangerous condition requiring immediate medical care. Symptoms include restlessness, headache, seizures, nausea, visual changes, confusion, and—if not treated promptly—can end in coma or even death. Fortunately, hypertensive encephalopathy occurs only in people with uncontrolled hypertension and is relatively rare. It can be treated by the prompt administration of medications that lower blood pressure, and its effects are completely reversible in most patients. Your sister probably experienced a dramatic elevation of her normally high blood pressure levels about 12 to 48 hours before her symptoms became severe. Experts believe this excessive hypertension likely interferes with normal cerebral blood flow and triggers dilation of the blood vessels, leading to leakage of fluid into brain tissue and swelling of the brain. If your sister works closely with her medical care provider in the future to properly manage her hypertension, this type of acute hypertensive emergency is unlikely to recur.

Q. I know that exercise is helpful in avoiding depression, but isn’t it true that too much exercise can actually harm mental health?

A. Exercise is an important contributor to good mental health, but as with all things, moderation appears to be key. A recent study suggests that there are limits to the amount of exercise associated with psychological benefits. In a report published in the September 2012 issue of Preventive Medicine analyzing data on more than 7,000 adults, researchers concluded that two to four hours of exercise per week was associated with the highest levels of mental health. The researchers also concluded that more than seven-and-a-half hours per week was linked to a dramatic increase in symptoms of anxiety and depression, independent of factors such as gender, age, or physical health. Although further research is necessary to determine whether feelings of depression and anxiety may make individuals more inclined to exercise excessively, the study authors concluded that moderate levels of regular exercise are beneficial in preventing mental health disorders and improving overall mental health.

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