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DEAR DR. ROACH: My 89-year-old husband was diagnosed with Alzheimer's disease. He does not take any medication. He is in excellent health except for the Alzheimer's. His blood pressure is 123/69 mm Hg, and his pulse is 53 bpm.

His geriatric doctor said "no" to prescribing medication to help slow down the disease. The doctor said his pulse rate is low, and the medications have a tendency to lower the pulse even more, which can be dangerous. His Alzheimer's stage is 4-5, and his MMSE score was 5 out of 30. Is there any advice you can give me? -- M.W.

ANSWER: I am sorry that your husband has moderate-to-severe Alzheimer's disease (AD). At stage 5 of the Global Deterioration Scale (a commonly used scale for AD severity), a person can't safely live without assistance. The MMSE score of 5 suggests that his AD may be even more severe than it appears. Many people with dementia are very good at getting by despite having advanced dementia, but a new or stressful situation can often be disastrous.

Unfortunately, the treatments at this stage are of limited benefit. The usual first-line treatment, which are cholinesterase inhibitors (like donepezil or rivastigmine), does have the possibility of slowing down the heart rate to dangerous levels, just as his geriatrician said. One alternative might be memantine, which is usually given with a cholinesterase inhibitor in people with AD as severe as your husband's. Even by itself, it still might have some benefit in slowing down the progression of dementia.

The new injection medicines against the amyloid protein are indicated for people with mild dementia who are proven to have amyloid buildup in their brain, either through an evaluation of their spinal fluid or a special PET scan. These medicines would not be prescribed to someone with dementia as severe as your husband's.

DEAR DR. ROACH: I was looking for long-term large studies on statins that are focused on women's health. There seems to be information but not as it relates to women. Can you suggest a reliable source of information? -- H.N.

ANSWER: There remains controversy in the scientific community about the benefit of statins in women. Women have been less studied than men, and because women have less heart disease on average than men of the same age, it has been harder to prove a benefit in women.

However, in my opinion, the data are now clear that women who are at an increased risk for heart disease do benefit from statin therapy. A very thorough study conducted by researchers at the University of Oxford and the University of Sydney reviewed 27 clinical trials that included nearly 50,000 women. It showed that although women are at a lower absolute risk for heart disease than men of the same age, women got the same reduction in heart disease risk that men do when comparing men and women at the same level of risk.

The researchers also estimated that while there are harms from statins (such as muscle aches and an increase in blood sugar levels), the benefits greatly outweigh the risks when the drugs are appropriately given to higher-risk women. Links to the study and to additional resources on heart disease in women are posted on my page at Facebook.com/KeithRoachMD.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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