Dear Doctors: I know therapists use music to get through to people with Alzheimer’s disease who don’t really connect with anything else anymore. I just saw on the news that music might also help protect your cognition. I’m curious about both of those things and want to hear more about them.

Dear Reader: You are asking about a healing practice that, while making headlines today, dates back centuries. We're tempted to cite the use of music in psychiatric hospitals in the early 1800s as one of the earliest formal uses of it to improve mental and emotional health. However, when you consider the role of music in our own daily lives, this approach reaches back to the dawn of humanity. We sing babies to sleep with lullabies and hum to ourselves when we’re content. We chant or sing in groups to share emotions and select melodies to mirror or shift our moods. These practices reveal how the link between music and our mental and emotional well-being is hardwired into the brain.

In exploring the effects of music on cognition, researchers have found some surprises. Brain imaging scans show that music engages broader and more diverse neural networks than speech does. Studies have shown music reaches auditory, emotion, motor and memory circuits at the same time. This helps explain its resonance for people living with Alzheimer's disease. Some areas of the brain seem to remain accessible to music even as other cognitive abilities fade. People who can no longer recognize familiar faces or orient themselves in time or space are often able to sing along to the soundtracks from their youth. These moments of musical recognition can have a therapeutic effect. They can calm or soothe a person and even connect them to the present moment.

This same dynamic may offer clues in newer research, which suggests listening to music may have a protective effect on cognition. This includes the study you asked about from researchers in Australia who specialize in neuropsychiatry and dementia. They analyzed a decade of data collected from 10,800 healthy adults in their 70s. They found that people who reported listening to music almost every day lowered their risk of dementia by nearly 40%. The protective effect also extended to general cognitive decline. When assessed separately, the music group outperformed the nonmusic group on cognitive function and memory tests.

As always with observational studies, it is important to remember the findings can only point to an if-then connection. They do not definitively prove that connection, and they cannot explain it. Still, the results here are striking and are likely to spur more research. For now, they suggest a simple, cheap and enjoyable routine that older adults can add to their day. And if any readers have experiences with this phenomenon of music and cognition, whether in your own lives or in your circle of family and friends, we would love to hear about them.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: After getting a pacemaker, my 90-year-old mother was diagnosed with A-fib. She resisted taking a blood thinner for stroke risk but finally agreed. Not 90 minutes after the first pill, she had a major stroke. Who can I notify that this is a possible side effect of the medication?

Dear Reader: We understand how, due to the timing of the events, it can seem like the blood thinner your mother took contributed to the stroke. In looking at the details of her medical condition and the typical effects of these medications, this is not as simple as it seems. Blood thinners do not have an immediate effect. Because of this, it is more likely the stroke was related to an underlying condition. That said, it is appropriate for you to report the event so it can be reviewed as a possible adverse reaction. In this column, we will address each of these issues.

Let’s begin with the pacemaker your mother received. It is a small device implanted in the body. It uses electrical pulses to regulate abnormal or problematic heart rhythms. As happened in her case, the internal sensors can lead to finding atrial fibrillation, or A-fib. This is an arrhythmia in the upper chambers of the heart, known as atria. The fluttering, quivering heartbeat of A-fib can cause blood to pool in the atria. This can lead to the formation of blood clots. This puts the person at increased risk of an ischemic stroke, when a clot impedes or completely blocks blood flow to the brain.

To reduce risk of clotting and ischemic stroke, people with A-fib are often prescribed medications known as anticoagulants, or blood thinners. Different anticoagulants work by either slowing or interfering with the cascade of biochemical events that lead to blood clots. Some take three to four hours to begin working. Some can take several days. But since they prevent the formation of blood clots, anticoagulants are not associated with causing an ischemic stroke. However, data show that blood thinners may increase the risk of a different type of stroke called hemorrhagic stroke. This is when a blood vessel in the brain ruptures and the resulting bleeding disrupts normal blood flow.

Because only about 90 minutes passed between your mother's initial dose of the anticoagulant and the stroke, it is more likely the cause was a preexisting condition rather than an immediate effect of the medication. Still, because anticoagulants can raise the risk of hemorrhagic stroke, it is impossible to determine the cause. For that reason, you are justified in reporting the event as a possible medication interaction. Reports can be submitted to the U.S. Food and Drug Administration (FDA) through its MedWatch program, either online or by phone. You can also speak with the doctor who prescribed the medication. Drug manufacturers also maintain help lines to document and review this type of event. Your vigilance is the kind of response that helps improve medication safety for everyone.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: My husband is 74 and has congestive heart failure. He has what look like burns on his left leg. There is a lot of swelling, and his leg is leaking blood and fluid. He sees a cardiologist and has been told he should see a vascular surgeon. Why a surgeon? How would that help?

Dear Reader: Congestive heart failure is a condition where the heart is no longer able to pump blood efficiently. It struggles to send enough oxygen and nutrients to the tissues of the body. This may be due to mechanical issues, such as malfunctions in the chambers or valves of the heart. It could also be that the muscle itself is weak. Either way, the result is a range of symptoms. These can include shortness of breath, weakness and fatigue, irregular heartbeat, wheezing, a persistent cough and swelling in the ankles, feet and legs.

The swelling that you described is a common effect of heart failure. Known as edema, it is part of a chain reaction that begins with the heart's decreased pumping strength. As blood lingers in the veins, pressure builds up. This, in turn, forces fluid into the surrounding tissues, a condition known as peripheral edema. This swelling stretches the skin and causes inflammation. It can make the skin fragile enough to break open and form the burnlike wounds you’ve observed.

This type of weeping wound indicates a critical problem below the surface of the skin. More specifically, it signals serious circulatory issues. That’s why your husband is being referred to a vascular surgeon. This specialty focuses on the veins and arteries that carry blood throughout the body. A vascular surgeon can determine the tests needed to pinpoint the cause of the extreme edema your husband is experiencing. These tests can map and measure blood flow, detect blockages, evaluate valve function and assess how well circulation is reaching the lower limbs.

Although the title of this specialty includes the word “surgeon,” it doesn’t necessarily mean a patient is being referred for a surgical procedure. Treatment options for this type of edema may include medication to reduce fluid buildup. Compression therapy can be used to improve circulation. There are also minimally invasive procedures designed to restore normal blood flow. Major surgery is considered only when there is severe blockage or when structural problems in the veins or arteries cannot be managed in any other way.

There is hope if your husband undergoes a thorough evaluation by a vascular surgeon and then follows up with appropriate treatment. Circulation in his legs and the edema and skin wounds can improve. He’ll likely work with additional specialists to manage his congestive heart failure. These may include a wound care specialist, a cardiologist to monitor heart function and adjust medications, a nutritionist or physical therapist to support appropriate lifestyle changes and a primary care physician to coordinate overall care. This may sound daunting, but congestive heart failure is a systemic condition that benefits from a team-based approach.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

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