Ask the Doctor: Energy Drinks; Dreams & Dementia; Depression & Cognitive Decline

Q: Are energy drinks safe for older adults? How do they affect the brain?

A: I’d recommend caution when it comes to these powerful pick-me-ups. Energy drinks such as 5-Hour Energy and Monster Energy are loaded with caffeine and other stimulants. Most studies suggest consumption of two or more cans per day can cause undesirable side effects, especially in older adults. Between 2007 and 2011, the number of energy drink-related visits to hospital emergency rooms in this age group jumped 279 percent. Negative side effects include agitation, shakiness, irritability, insomnia, headache, and anxiety. A study presented at a March 21, 2013 American Heart Association Scientific Session linked energy drinks to increased risk for disturbances in heart rhythms, including potentially life-threatening arrhythmias that can trigger sudden cardiac arrest. Researchers also found that energy drinks increased systolic blood pressure by an average of 3.5 points, and warned that older people, or people with heart problems, should think twice before consuming en-ergy drinks.

Q: My husband often acts out his dreams at night. Is it true that acting out dreams is linked with a higher risk for dementia?

A: Acting out dreams is usually associated with a condition called rapid eye movement (REM) sleep be-havior disorder, or RBD, the precise cause of which is unknown. Normally people do not move while dreaming during the REM stage of sleep; however, people with RBD tend to move and vocalize—sometimes violently. RBD may be associated with neurological conditions such as Parkinson’s disease or dementia with Lewy bodies (DLB, the second most common type of dementia). A recent study analyzing the medical records of 75 men with DLB revealed that up to 80 percent of them had a history of RBD. RBD may develop many years before diagnosis with a neurological disorder, and does not in-dicate that a person will develop such a disorder. About 45 percent of cases are linked to withdrawal from alcohol or sedative-hypnotic drugs, or associated with the use of certain antidepressants, including tricyclic antidepressants such as imipramine, and selective serotonin reuptake inhibitor (SSRI) drugs such as fluoxetine, sertraline, or paroxetine. I suggest that your husband see his physician for a medical assessment. RBD can be treated with benzodiazepines such as clonazepam, the dietary supplement melatonin, or a combination of the two.

Q: My mother suffers from depression, and is increasingly forgetful and confused. Does depression cause cognitive decline?

A: A number of studies have shown certain cognitive changes in patients with depression, but the link between mood disorders and cognitive decline is as yet unclear. However a large study published in the March 2013 is-sue of the Archives of Neurology may help shed light on the subject. An analysis of the association between late-life depression and performance on cognitive tests of 2,160 Medicare recipients suggested that depression shows up in people who already have symptoms of mild cognitive impairment (MCI) and increases the risk that these individuals will progress to dementia. Depressed study participants were 40 percent more likely to have symptoms of MCI than those without depression, and more than twice as likely to have full-blown dementia. More work is necessary to determine whether depression is a risk factor for dementia, an early dementia symptom, a reaction to increasing cognitive disability, or a symptom of an underlying condition common to both depression and dementia. Whatever the link between your mother’s depression and her mental confusion, it’s important that she seek treatment for her mood disorder if she has not already done so.

—Editor-in-Chief Maurizio Fava, MD

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