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Q What is the current thinking about daily aspirin therapy to prevent a heart attack or stroke? I know the risk of bleeding and a hemorrhagic stroke is higher among people who take aspirin routinely.

A The advice doctors give their patients about aspirin has certainly changed a lot through the years. A daily low-dose or "baby" aspirin was seen as an easy and relatively inexpensive way to help prevent blood clots that could lead to a stroke or heart attack. But in recent years, the case against a daily aspirin for certain people has grown stronger, primarily because of the bleeding risks you describe.

The current guidelines from the American Heart Association and American College of Cardiology say that if you have survived a stroke or heart attack or have diagnosed heart disease, daily aspirin therapy may be advisable. Other health concerns, however, may apply. If you take a blood thinner, for instance, then adding a daily aspirin could be dangerous.

For people who are otherwise healthy and not at a high risk for a heart attack or stroke, the newest guidelines say bleeding risks do not out-weigh whatever protective benefits you can gain from daily aspirin. If you have questions about your risks, discuss them with your physician.

Q I know that some people have an increase in blood pressure at doctor appointments, but is there a similar problem with memory? My husband has mild cognitive impairment (MCI), but can recall things much better at home than he does when seeing the doctor.

A "White coat hypertension" is, as you describe, a spike in blood pressure that tends to coincide with a doctors appointment and is not reflective of a persons normal blood pressure. The change is usually ascribed to the stress or anxiety that can accompany a trip to the doctor, though many experts believe that white coat hypertension also may be an early sign of long-term cardiovascular trouble.

While there isn't a similar name for a change in cognition that occurs when seeing a health-care provider, it's not uncommon for nerves or stress to affect performance on a memory test, for example. If someone is worried that a poor score will lead to a dementia diagnosis, for example, anxiety may lead to confusion or other thinking problems that affect test results.

For this reason it's important that a person with MCI or who is suspected of cognitive decline be accompanied to doctor appointments to present an accurate picture of how the individual behaves day to day. In-office cognition tests can be helpful, but they are only part of what a doctor uses in assessing cognitive health.

Q Is someone who has been a "worrier" all her life more likely to have increased anxiety as she gets older, or can age ease anxiety?

A An individuals health and major life events tend have a lot to do with whether she or he becomes more or less anxious over time. Chronic illness, financial struggles, the loss of a spouse or other loved one, and other challenges are common stressors later in life. They can increase anxiety levels in people who were worriers as well as those who tended to be more relaxed when they were younger.

However, research has shown that many older adults are actually less stressed than they were when they were younger, a phenomenon that may develop when the challenges of working full time and raising children have passed. Researchers also note that with age comes perspective that allows older adults to "go with the flow" a little more readily than they did when life's little obstacles or setbacks could be especially upsetting. If you worry more than you used to, or are becoming increasingly anxious about things you know are beyond your control, consider talking with a mental health professional. Recognizing an anxiety disorder early on can often help prevent it from becoming a condition that harms your quality of life.

Editor-in-Chief Maurizio Fava, MD

Psychiatrist-in-Chief Massachusetts General Hospital (MGH) Director of the Division of Clinical Research MGH Research Institute Slater Family Professor of Psychiatry Harvard Medical School
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Author:Fava, Maurizio
Publication:Mind, Mood & Memory
Date:Jan 30, 2020
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