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Do small brain aneurysms rupture? ... Cynicism and dementia risk ... will my chemo brain fade?

Q I have a small brain aneurysm, and my doctor has urged me to consider surgery for it. I know that brain aneurysms can burst and cause bleeding strokes, but isn't it true that only larger aneurysms are likely to burst?

A Although in the past the size of a brain aneurysm--a weakened area of a blood vessel that balloons out into surrounding tissue--was considered to be the most important factor in predicting the likelihood of a rupture, new information has caused a change in thinking. Traditionally, aneurysms smaller than 7 millimeters (mm) in size have often been left untreated. Researchers followed a group of aneurysm patients over their lifetimes--much longer than earlier studies, which had monitored participants for only one to five years. According to a report published May 22,2014 in the journal Stroke, they found that over a lifetime, approximately one-third of all brain aneurysms eventually ruptured, including about 25 percent of smaller aneurysms. Size had little effect on rupture risk, especially among men. Instead, the total number of an individuals risk factors, such as smoking, age, hypertension, location of the aneurysm, and alcohol consumption appeared to play a more important role. Women who smoked and had aneurysms that measured 7 millimeters or more in diameter were particularly at risk for a rupture, while non-smoking men with low blood pressure had a very low risk of rupture.

Q Is it true that an attitude of distrust toward others can increase risk for dementia? Is it possible to change such an attitude?

A Cynical individuals who believe that other people are mainly motivated by selfish concerns have been shown to be more susceptible to heart disease and inflammation, and the first study to assess the association between cynicism and dementia suggests that they may have a higher risk of developing dementia in older age, as well. Researchers measured the level of cynicism in a group of 1,450 older adults and divided them into groups characterized by high, low, or moderate cynicism. After controlling for other dementia risk factors, such as smoking and high blood pressure, the researchers found that participants with the highest scores for cynical distrust were three times more likely to develop dementia than were those with the lowest scores. These findings, published in the May 28,2014 online issue of Neurology, suggest that challenging cynical thoughts might help people improve their brain health. Becoming aware of ones own cynicism and questioning it, becoming more socially involved with others, and trying to adopt a more positive view of people and events may help ease feelings of distrust and cynicism. Just as we can modify our diets and exercise routines, we can modify our attitudes.

Q I had chemotherapy for breast cancer six months ago, and I don't seem to be as mentally sharp as I was before chemo. Will I return to normal cognitive functioning?

A Research suggests that the negative cognitive effects associated with chemo eventually disappear, with about 80 percent of women returning to normal within one or two years. What's more, a new study published online May 27, 2014 in the Journal of Clinical Oncology found that the cognitive effects appear to be related to changes in brain functioning during multitasking activities. Researchers compared brain scans of breast cancer patients who underwent chemotherapy, similar patients who did not undergo chemotherapy, and a group of healthy women without breast cancer. The scans showed that chemotherapy patients experienced diminished brain activity while multitasking, a difficulty that was linked to complaints about diminished concentration and poorer memory. The good news is that the cognitive changes weren't lasting. The study authors noted that despite their impact on day-to-day activities, the observed cognitive changes were often of small magnitude and fell mostly within the normal range.

Editor-in-Chief Maurizio Fava, MD

Executive Vice Chair, Department of Psychiatry Massachusetts General Hospital

Director, Clinical Research Program

Slater Family Professor of Psychiatry

Harvard Medical School
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Title Annotation:ASK THE DOCTOR
Author:Fava, Maurizio
Publication:Mind, Mood & Memory
Article Type:Column
Geographic Code:1USA
Date:Aug 1, 2014
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