Dementia Risk Factor

I was pleased to see the information about ways to guard against dementia in your cover story on Lynda Carter ("Wonder Work," February/March 2020). However, I think it's missing an important recommendation. By age 50, everyone should have a hearing evaluation by an audiologist. If there is a family history of hearing loss or a history of noise exposure, people should be evaluated earlier. As an audiologist, I know that untreated hearing loss is associated with increased incidence of depression, social isolation, balance problems and falls, cardiovascular disease, diabetes—and dementia. - Patrice Rifkind, AUD, Valencia, CA

THE EDITOR RESPONDS: Thank you for the excellent recommendation of getting a hearing evaluation after age 50. As we note in our story on hearing loss in the October/November 2018 issue, those with severe hearing loss have five times the risk of developing dementia compared with people with normal hearing.

Other Team Players

The article about different members of a medical team ("Team Roster," February/March 2020) doesn't mention rehabilitation psychologists, who are integral to care provision. Psychologists can conduct neuropsychological testing, and their understanding and treatment of emotional complications of neurologic conditions are unmatched. If you want a strong medical team, such professionals must be included. - Mary F. Zemansky, PhD, Prescott, AZ

Speech-language pathologists (SLPs) were not mentioned in "Team Roster," despite the multiple areas discussed that are within the scope of SLP practice, such as tracheotomy and ventilator care. While an occupational or physical therapist may assist in selecting and positioning an alternative communication device, the SLP is responsible for evaluating and using it for treatment. Additionally, while a dietitian plays a role in the nutrition of patients, diet modifications are the responsibility of an SLP. An SLP evaluates, diagnoses, and treats difficulty swallowing. While I understand that this article is based on a single individual's experience, I find it misleading that other disciplines are credited with duties of an SLP and that an SLP is not included. This lack of representation makes it challenging for a patient or family to get help from the most appropriate professional for communication- and nutrition-related problems. - Lauren Torisky, MS, CCC-SLP, Fredericksburg, VA

The “Team Roster” article omits the speech-language pathologist (SLP) and states that a dietitian provides guidance for patients who have trouble swallowing. According to the American Speech & Hearing Association (asha.org), that role should be performed by an SLP. As an SLP with more than 35 years’ experience in diagnosing and treating swallowing disorders (dysphagia), I can attest to the importance of teamwork, and a dietitian is an essential part of that team. But dietitians do not have the training and expertise to do clinical exams or recommend dietary modifications and swallowing strategies. I suggest a future article on the role of SLPs, dietitians, and occupational therapists in diagnosing and managing swallowing and feeding disorders. - Roberta A. Hittner, MS, CCC-SLP, Jamison, PA

You neglected to include a speech-language pathologist (SLP) in “Team Roster.” In nearly every neurologic disease, difficulty swallowing and communicating are often significant symptoms that affect patient safety and well-being. In some cases, subtle changes in speech may be one of the first symptoms, and early referral to an SLP can often help the neurologist with a differential diagnosis, as well as provide an opportunity for education and symptom management. SLPs play an important role in helping patients recover or maintain swallowing function, and when necessary, help clarify patient preferences for alternate routes of nutrition when swallowing is impaired. Additionally, at the heart of our work is the desire to restore, preserve, or augment communication so that patients can continue to interact with their physicians and family, whether recovering from a neurologic event or living with a progressive neurodegenerative disease. - Mary Spremulli, MA, CCC-SLP, Punta Gorda, FL

THE EDITOR RESPONDS: Thank you for writing in about other specialties integral to neurologic team care. We heard from several SLPs. While our story focused on team members at specific medical centers, your letters underscore the comprehensive nature of neurologic care. We will consider your excellent suggestions for future stories.

Mineral Amount

The article on magnesium ("Magnesium and Your Brain," February/March 2020) is very good. However, I am confused about what kind of magnesium is recommended. I take 500 mg a day of magnesium oxide. My husband takes a combination of magnesium (143 mg), chloride (416 mg), and calcium carbonate (238 mg). The RDA [Recommended Dietary Allowance] chart lists 420 mg for men and 320 mg for women 31 years or older. We are 83 years old. So who is taking too much and who is taking too little? - Kathleen Bryan, New Braunfels, TX

THE EDITOR RESPONDS: We contacted Kathleen Holton, PhD, MPH, assistant professor of health studies at American University in Washington, DC, who provided this response: "It's important to consult your doctor about the right amount and kind of supplemental magnesium for you. The tolerable dose is 350 milligrams a day for adults age 19 and older, according to the National Institutes of Health's Office of Dietary Supplements. The RDA, which refers to the amount of magnesium from food that people need, is 320 and 420 milligrams a day for women and men ages 51 and older, respectively. Too much magnesium from supplements can cause diarrhea; extremely high levels can cause nausea, vomiting, low blood pressure, breathing problems, and an irregular heartbeat."

Huntington's Disease

I was grateful for your article on Huntington's disease ("Help for Huntington's Disease," February/March 2020). One of my dearest friends died from it 17 years after diagnosis. She has three children who have a 50 percent chance of also having it, so I was thrilled to know that research has not been forgotten and that there is some hope for their future. - Terri Galvin, Apex, NC

Sleep Suggestions

In your sleep story ("Sound Sleep," February/March 2020), one problem was not included: having to urinate frequently. This means sleep is interrupted five or six times a night. - Louise Heselbarth, Palatine, IL

As a sleep health advocate and patient, I am suggesting that you add rapid eye movement (REM) sleep behavior disorder to your list of disorders. This condition may be a biomarker for Lewy body dementia, Parkinson's disease, and multiple system atrophy. The International REM Sleep Behavior Disorder Study Group (IRBD-SG), which has established it as a degenerative neurologic condition, should be recognized for its research into slowing down the progression of this disorder. - Ray Merrell, Hackettstown, NJ

Migraine Mysteries

The Speak Up essay about migraines ("Quitting Time," February/March 2020) could be my story. Migraines have disrupted my life since I was a teenager. In 2013, I was diagnosed with multiple sclerosis (MS) and prescribed glatiramer acetate, and within a few months my migraines disappeared. Is it possible a migraine drug could be developed from an MS one? - Janice Buneo, Oneida, NY

My husband, Don, had migraine attacks for nearly 30 years, starting in his late teens. He sometimes had the warning aura or nausea. In his late thirties, his ear, nose, and throat (ENT) doctor discovered that Don had a histamine imbalance. The ENT prescribed histamine shots over several weeks, increasing the dose gradually. He then prescribed liquid histamine drops on his tongue, increasing the strength for another few weeks. At the end of the treatment, the headaches disappeared. Don is now in his eighties and hasn't had a migraine attack in 40 years. - Judy Josephson, Lake Forest, CA

THE EDITOR RESPONDS: We asked editorial board member Tesha Monteith, MD, FAAN, chief of the headache division at the University of Miami Miller School of Medicine, to respond. "As these two letters indicate, research on migraine treatment is still needed. Although there is no evidence that glatiramer acetate treats migraine, we do know that migraine is more common in people with multiple sclerosis. Without large studies, we can't know if your migraines resolved over time or because of the medication. Evidence for histamine, which may hypothetically modulate the migraine response, comes from a small clinical trial and is considered 'probably effective' in the 2012 American Academy of Neurology Guidelines for Prevention of Episodic Migraine. Your tips remind us to consider designing large placebo-controlled trials to assess potential treatments and their side effects."

Supplement Tip

Brain & Life is a great source of information and written in a readable and understandable format. The selection of topics is great and nicely presented. I particularly liked the review of supplements. A related topic is the effect of supplements on medications. For example, vitamin B-6 helps decrease the side effects of levetiracetam (Keppra), possibly by replacing depleted vitamin B-6. - William Crouthamel, PhD, West Milford, NJ

Dog Days

I am a recent subscriber to Brain & Life, which I find very informative. I wonder if you have written about service dogs and how they can help people with neurologic challenges. I am a volunteer puppy-raiser with Canine Companions for Independence, a nonprofit organization that enhances the lives of people with disabilities by providing highly trained assistance dogs and ongoing support to ensure quality partnerships at no charge to the recipient. They also provide facility dogs to institutions that assist people with disabilities, as well as other unique placements. - Jill Goldman, San Juan, TX

THE EDITOR RESPONDS: For a story on service and therapy dogs, please read Epilepsy, Autism, and Alzheimer’s." href="/link/385b06edf6994240b60f1366f716fb78.aspx" target="_blank" rel="noopener">How Therapy Dogs Help People with Epilepsy, Autism, and Alzheimer’s.

Rare Disorder

Thank you for your wonderful fact-filled articles on ataxia and multiple sclerosis. Although I don’t have either condition, their symptoms sound all too familiar. What I do have seems to be some sort of hidden form of B-12 deficiency. Although B-12 deficiency is not a neurologic disorder, many of its debilitating symptoms are. I’d like to see an article on the hard-to-detect causes of this condition. - Janet McHaddad, Panorama City, CA

Fibromyalgia 411

I really enjoy your articles, which I find helpful, informative, and presented in a positive way. I’m writing to request an article on fibromyalgia. So many people have this disease, and yet the knowledge base is limited. And there seems to be a negative stigma around it. - Nancy Bailey, Davenport, FL

THE EDITOR RESPONDS: To review our articles on fibromyalgia, please search BrainandLife.org for “fibromyalgia.”