Ask the Doctor: Cerebral Amyloid Angiopathy; Heartburn Drugs & Dementia; Exercise & ADHD

Find out how cerebral amyloid angiopathy can cause stroke.

Q: My husband recently had a hemorrhagic stroke, which the doctors told us was caused by a condition called cerebral amyloid angiopathy. What is cerebral amyloid angiopathy and how does it cause stroke?

A: Cerebral amyloid angiopathy (CAA) is characterized by the accumulation of abnormal amyloid protein deposits in the walls of the brain’s blood vessels. The condition is estimated to affect as many as one-third of all people over 75 and is thought to trigger at least 30 percent of hemorrhagic, or bleeding, strokes. The deposits usually first appear when people are in their mid-to-late 50s and build up over time. They are similar to the amyloid deposits seen in Alzheimer’s disease, but instead of forming in brain tissue, they develop in the walls of cerebral arteries. CAA causes blood vessels to become more brittle and susceptible to rupturing, and deposits may block the flow of blood to brain tissue. Often, the condition goes unrecognized until the person suffers a major bleeding stroke. People who recover from CAA-related hemorrhagic stroke have about a 10 percent chance of having a second bleeding stroke in any given year. While there is currently no treatment for CAA, doctors may recommend controlling hypertension and avoiding blood-thinning medications such as aspirin.

Q: I take Prilosec for stomach problems, and now I read that the medication has been linked to dementia. Can you tell me more?

A: Some recent research has linked medications used to treat heartburn and excess stomach acid with greater risk for cognitive impairment and/or dementia, especially in older adults. A study of more than 73,000 seniors over age 75 published Feb. 15, 2016 in the journal JAMA Neurology found an association between frequent use of proton pump inhibitors (PPIs, which include Prilosec, Nexium and Prevacid) and increased risk for dementia. The study found that, compared to nonusers, male study participants who regularly used PPIs faced a 52-percent greater risk for dementia over a five-year period, and female participants faced a 42-percent greater risk. The study did not prove a causal relationship between PPIs—which reduce the amount of acid produced by the stomach—and dementia, but only an association. Another large study, published in 2007, found a 2.5 times greater risk for cognitive impairment among older users of a different type of antacid, a class of drugs called histamine2 receptor antagonists, or H2 blockers, which include the medications Pepcid, Zantac, Axid and Tagamet. Additional research is needed to determine whether the negative cognitive effects linked to antacid use in older adults is a direct result of these medications, or is related to other issues, such as excess body weight or diet. Meanwhile, you might consider contacting your doctor to determine whether substituting another type of medication or making lifestyle changes might work for you.

Q: I am 37 years old and have been told that I have adult ADHD. Would regular exercise help improve my symptoms?

A: Attention deficit hyperactivity disorder, or ADHD, is characterized by symptoms such as fidgeting, impulsivity, difficulty maintaining focus, low motivation, poor work performance, and lack of energy. A small study published in June 2016 in the journal Medicine and Science in Sports and Exercise suggests that exercise may help improve motivation and energy, and reduce feelings of fatigue and confusion. Although the study did not make clear exactly how exercise might cause these psychological benefits, the researchers theorized that exercise-related changes in brain chemicals called neurotransmitters might underlie the positive effects. The findings suggest that exercise might provide a helpful adjunct to other ADHD treatments, such as medications and cognitive behavioral therapy.

—Maurizio Fava, MD, Editor-in-Chief 

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