Neurologist suggest atorvastatin

PanamaFarmer

I took my LO to the neurologist last week for a follow up and told the Dr. that my mom was more energetic, talking more and doing more activities. She has been less combative and more working to help us around the house. He understands that she is on no meds but takes vitamins and minerals and eats all natural organic foods from the farm. I give her an excellent quality  Nattokinase and Omega 3. But he said because of her age (87) he recommends that she takes atorvastatin 20mg (lipitor?) to prevent her from a heart attack or stroke. He did a throat exam that looked like some type of ultrasound and the comments showed placas ACCD 36% and ACCI 53%. I have no idea what this means and its in spanish. I'd like to get a second opinion but I don't know if there are neurologist that can review the records since we aren't in the USA or give us a natural alternative online. Any comments or advice is greatly appreciated.

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Emily 123

Yes, Victoria's correct-it sounds like an ultrasound report where the provider was assessing her for blockages in her carotid arteries.  The recommendations are to get her LDL down.  Has she had her lipid levels, like her cholesterol, checked since you've tweaked her diet?

 You could try niacin.  Some people don't like it because it causes hot flashes.  Additionally, there's more evidence that if you have diagnosed vascular disease that stains are benficial.  I would read around.  This was a good, fairly recent article.

https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.029429

terei

I am unsure what a statin is going to do to help your mothers’s day to day quality of life.  I would not add any meds that did not do that + also have the possibility of having side effects (muscle pain, onset of diabetes etc etc). 

I suggest the book Being Mortal for planning for end of life medical care.

It sounds like your mother is doing well + I would not add unnecessary meds.

Fairyland

A statin won’t do anything to help day to day quality of life - unless she has a non-fatal stroke or heart attack !  

Then she and you will have a worse quality of life, from then on.

I would take it, unless her quality of life is already so low that suddenly not being able to speak, or walk, would not make any difference to her or you.

My mother has recently been changed from lovastatin to atorvastatin after a stroke, fortunately she has recovered due to taking the clot-busting drug in the emergency room, or she would have been alive but unable to speak. 

She has had zero side effects like muscle pain.  She had bruising before with the lovastatin and that is better on the atorvastatin, as a side benefit.

Stuck in the middle

It sounds like your mother has a plaque of cholesterol in her arteries which, if it worsens, can cause brain damage.  Similar plaque buildup is probably occurring elsewhere, as in her coronary arteries, which can damage her heart, and in her legs, which can lead to pulmonary embolism.  If it were my mother, I would give her the medications.

You are giving her excellent care with the healthy diet.  I typically eat that way myself.  However, I also take atorvastatin and have done so for 20 years without side effects.

harshedbuzz

In the context of vascular dementia, a statin could be an excellent addition to her care depending on where she is in the disease process, risks if she doesn't take it, and your goals vis a vis extending her life. 

It sounds like she had a carotid echo (ultrasound) which confirmed plaque on the main arteries which feed the brain blood and O2. This could obviously worsen over time even with a healthy diet and lifestyle, hastening damage to the brain or a catastrophic event like stroke or heart attack.

An anecdote- YMMV.

My mom- who does not have dementia- is quite medically complex. When she was caregiver to dad, she became very hopeless and depressed in his later stages. Dad was a difficult individual at best- with dementia he was even harder. I was over there pretty much daily to check on her, I handled the logistics of selling their 2 homes and moving them into a third and took over their medical care- getting records for 3 states to a new team of PCP and a dozen or so specialists the first couple of years. Despite my involvement, I didn't realize that mom had stopped taking 3 of her prescriptions. First, she stopped the statin because her nutjob sister had the "feels" about it. Then she let her BP meds run out because the doctor's office staff left her on hold (she didn't think to ask the pharmacist to get the renewal or request it on the electronic patient portal or even ask me to fix it for her). And then she stopped her COPD daily inhaler because "it didn't bring much to the party". Dad went into a MCF and died about 2 months later and mom grieved in a similar manner to when she lost her dad and my sister after long difficult illnesses. But after a month or so, her behavior and thought processes seemed really off. Initially I felt like it was perhaps still grief, but there was a real MCI feel to it and I was crushed to think she wouldn't get to enjoy some of the freedom of stage 8 after a decade of unpleasant caregiving. 

Her behaviors got stranger. She started with conspiracy theories and ascribing dark motives to other people in situations that had nothing to do with anything. About 2 months after the funeral, she ended up in the ER in crisis- a COPD flare and BP through the roof. I explained the changes in her cognition and personality; they worked her up and her non-compliance with meds was confirmed. A carotid u/s showed an increase in blockage and her meds were restarted. Over the next several months, I noticed her thinking became more focused and clearer and she was able to take over her appointments and finances. We were fortunate that she bounced back to her baseline. 

On the other hand, when dad reached stage 6 we instituted a palliative care model. His new PCP weaned him off of some of the daily meds he'd taken long term. His BP dropped, so that medication was discontinued. His doctor also stopped the statin. We kept only his ADT for a recurrence of prostate cancer, the psychoactive medications for anxiety and aggression and the meds taken to maximize his breathing. He was found unresponsive in his bed at the MCF during a routine bed check. His death certificate says "Aspiration Pneumonia/Alzheimer's Disease" but it's just as likely he had a stroke or heart attack. I am grateful he didn't survive to stage 7 where he was immobile, nonverbal and didn't know his people- that would have been even worse.

HB

dayn2nite2

At 87, and with your emphasis on being organic and natural, I wouldn't be starting atorvastatin.  

What you can assume from the ultrasound is that she will likely die of a blockage in her carotids, which brings me to my first thought.

She is 87.

I'm sure she has had a long and wonderful life and you are taking good care of her and I'm sure she is happy in these final years of her life.

M1

Speaking with my medical hat on:  interesting that they even looked, frankly, because screening for carotid artery stenosis in aymptomatic individuals is not recommended, at any age.  Second, though I'm not familiar with the Spanish abbeviations, blockages of 35 or 51% are not considered critical--stroke risk remains trivial (far less than 1% per year) at this level and is not usually significant until the blockages are >60% (some would say 70%).

So bottom line to me---I wouldn't do it either, not in an 87 year old.  She has hardening of the arteries, which you would have predicted at her age anyway.  So I don't think you really learned anything.  

Again, can and should are two different things.  They may have billed for the test because they can and/or because they have the piece of equipment.  Now, there could be something I don't know--for instance, maybe they heard a bruit in the artery--that's a whishing sound of the blood going by the obstruction--in which case it wouldn't be considered completely asymptomatic.  If that's the case, for a blockage over 50% a statin--and aspirin--would be recommended--but given her age and other health issues, I would again come down on the side of no intervention.  And I'm generally a big fan of statins.

Marta

Statins for primary prevention of CV disease (heart attack, stroke) have not been supported in clinical trials that included the elderly (over 75years).  Very few statin trials include the very old (over 85 years).