Doctor Q&A: Are my dreams a sign of dementia? Dr Renee Hoenderkamp answers your burning health questions

Hey Doctor Renée, forgive me if I sound ridiculous. But I'm in my early 60s and recently I've been having horrible nightmares on the regular. I cannot see any obvious changes to my lifestyle that might be triggering them. I did some Googling and read an article published a few years back that said middle-aged men who have troubling dreams at least once a week are at increased risk of dementia later on. Is there anything in this?

This is so interesting!

You say you can’t see any obvious triggers but just double check those that we know can cause nightmares. These include anything that disturbs deep sleep:

• Sudden noises at night
  
• Needing to get up and go to the loo in the night
• Being very tired
• Being unwell
• Being stressed
• Watching/reading scary things close to bedtime
• Certain medications such as antidepressants
• PTSD
• Medical conditions that affect deep sleep such as sleep apnoea, pain, restless legs
• If you have dementia

There appears to be a genetic link as nightmares are more common when you have family members who have nightmares or who sleepwalk.

Whilst having dementia does put you at risk of having nightmares, you are right in that there are some small studies demonstrating that having nightmares increases the risk of later cognitive decline or Parkinson’s Disease. However, there are lots of variables to consider and there is an argument that if there is a connection between distressing dreams and later dementia, catching it this early could allow the use of medication used in the treatment of nightmares such as prazosin, which has been shown in a small trial to prevent memory decline and reduce amyloid β generation in preclinical studies of Alzheimer's disease. The authors of this trial suggest that this means that treating distressing dreams might even help to slow cognitive decline and prevent cognitive impairment!

Additionally, if you really can’t explain this sudden change by identifying a trigger, then I would see your GP and make sure that you don’t have something else going on, something as simple as an undiagnosed sleep disorder or something more serious such as a brain tumour.

As common things are common, the most likely explanation is a trigger that you haven’t recognised, but do please have a check up!

Hello, I am 66 and was told at 50 that I had early signs of sick sinus syndrome as yet. Should I be worried about it or go for a check up?

What an interesting question. This is a rare problem with the heart that I will explain first!

The heart beats due to a complex electrical type of circuit with its generator being a small area of cells called the sinus node. It is this collection of cells that is the heart's natural pacemaker and it dictates the normal regular rhythm of the heart.

When this little node gets sick, that regular rhythm can be upset and this is where the description ‘sick sinus syndrome’ comes from, also known as sinus node disease or dysfunction. It is relatively uncommon but the older you get, the more at risk of developing it you are. It is also more associated with high cholesterol and blood pressure, obesity and lack of exercise.

Sick sinus syndrome often has no symptoms or they may come and go and so it can be difficult to recognise.

Signs and symptoms may include:

• Fainting
• Fatigue
• Palpitations (A sensation of rapid, fluttering heartbeats)
• Chest pain or discomfort
• Dizziness
• Confusion
• Shortness of breath
• Slow pulse

Those diagnosed with sick sinus syndrome eventually need a pacemaker, a device implanted in the chest which helps the heart stay in a regular rhythm.

Now to your question. If you have not had any symptoms at all in the 16 years since this was mentioned to you, then the likelihood is that things are fine. However, as I don’t know your individual case and I would prefer your heart to be checked, please go and see your GP and have a simple ECG in the first instance. AND, if you have had symptoms then also go to your GP urgently and get checked out.

Much better to have a pacemaker than risk stroke, heart attack or other serious complications!

Hey Doctor Renee, I have diabetes and my feet are playing me up. I do get numbness from time to time. I do take care of them but the thought of amputation is always going through my mind. Am I at risk of amputation?

Diabetes is a disease where your blood glucose, also called blood sugar, is too high. Glucose is the body's main source of energy. Glucose comes from the food that you eat or from your body making it by releasing it from cells. Insulin, a hormone made by the pancreas, helps glucose get into your cells to be used for energy. When you have diabetes, your body doesn’t use insulin well or doesn’t make enough. This causes glucose to stay in your blood instead of reaching your cells where it is needed. This build up of glucose raises the risk of damage to the blood vessels, heart, eyes, kidneys and nerves all over the body but especially the lower legs and feet.

Focusing on the feet, to answer your question, is key in diabetes care and there are signs to look out for that may indicate that you have diabetic foot disease and need to take action to avoid amputation which is a risk when things develop beyond repair.

You mentioned numbness which is one of several symptoms which may occur:

• Tingling sensation or pins and needles (like numbness)
• Swollen feet
• Loss of feeling
• Pain (burning)
• A dull ache
• Non-sweating feet
• Shiny, smooth skin on your feet
• Hair loss on your legs and feet
• Wounds or sores that don’t heal
• Cramp in your calves when resting or walking

People with diabetes are entitled to a yearly foot health check with their GP or diabetic nurse but, even if you are up to date with these, if any of these symptoms arise at any time please see your doctor immediately, sooner is always better in rectifying and stopping irreversible damage.

It goes without saying that careful glucose control is key to avoiding the complications of diabetes and this includes foot issues. However, diabetes-related foot conditions are quite common when people have had diabetes for a long time, even with foot checks and careful blood glucose monitoring. So acting early is key.

In addition to all of this, there has been some exciting research developments from Diabetes UK and Imperial College which seems to suggest that capsaicin patches can help reduce pain but interestingly repair nerves and grow new nerves. See the study summary here.

It is impossible for me to guarantee that anyone with diabetes can avoid an amputation but let me reassure you, because the likelihood of it happening is low with rates of 8.1 amputations per 10,000 sufferers. It is also estimated that 85 percent of all of these are avoidable with the care, attention and swift action discussed above.

So in summary, the fact that you worry is a good thing in that I am sure it means that you are doing everything you can to keep your feet in good condition and spot signs early and this will put you as far away from amputation as possible!