AFib., bisoprolol and memory/cognition decline

My 73 y/o wife is suffering some alarming memory loss/cognitive decline and has had an occasional attack of AFib. over the years. Fairly recently the GP has been prescribing bisoprolol (2.5mg) and Pradaxa and I now read that these can have an effect on memory/cognition. The GP is very reluctant (refuses?) to take her off these medications even with our suggestion that she try a calcium channel blocker as an alternative. Can anyone offer advice ? The medical profession seems very reluctant to stop medications due to the possibility of a stroke occurring, but our plant based diet (+ B12 and fish oil) hopefully alleviates this as a likely scenario. A friend takes Flecainide when an attack on AFib occurs which seems a perfect way of managing the intermittent problem. Any thoughts on this?

The GP is trying to keep your wife alive with the Pradaxa. It's extremely unlikely that it explains her cognitive decline. Not sure why you think a calcium channel blocker will be a big improvement over the bisoprolol but it probably wouldn't be any worse.

But mainly I think you need to move beyond a GP. She needs a neurologist and a cardiologist.

Thanks Carey, I have read of others who have experienced memory problems with bisoprolol and have heard suggested the calcium channel blocker avoids this. Yes, I feel unimpressed with the GP's lack of understanding of the memory/cognitive problems (the MoCA test was ok) but can't get him to refer us to a specialist. Maybe just have to go privately. The change of medication is just an avenue currently unexplored and may be having some detrimental effect - worth a try I think.

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Koli
Yes, I feel unimpressed with the GP's lack of understanding of the memory/cognitive problems (the MoCA test was ok) but can't get him to refer us to a specialist. Maybe just have to go privately.

Carey is right on: "But mainly I think you need to move beyond a GP. She needs a neurologist and a cardiologist."

Let your GP know that unfortunately, he/she is seriously underqualified to handle your mother's situation, and his refusal to refer constitutes malpractice. Threaten your insurance company if necessary.

I think Koli is probably in the UK?

Koli, you might want to add some Coenzyme Q10 to her supplement program since beta blockers deplete Coenzyme Q10.

My wife has had a blood test which didn't show up anything abnormal, although CoQ10 wasn't mentioned. I read that CoQ10 may make blood 'thinners' less effective so that may require some thought. With the plant based diet she has plenty of lentils, soy beans, green leafy vegetables, and occasional sardines so I would think the diet is ok for CoQ10. I believe the GP suffers from the traditional attitude that this kind of memory/cognition decline is 'normal' ('age and stage') but he doesn't live with her 24/7 and therefore not aware of some of the unbelievable out of character memory lapses or lack of 'normal' cognition. However, things could be worse, but I'm hoping we can at least stop further deterioration by maybe changing/stopping the current medications - just a possible link we must try - if we're allowed!

Pradaxa has caused short term memory loss, but probably not dementia. Some studies report they actually prevent dementia, but Im not buying all of that report. So she was fine before Pradaxa and now showing signs of dementia? Gee, what a coincident! Key word here posters is ALARMING SIGNS.

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hwkmn05
Pradaxa has caused short term memory loss, but probably not dementia. Some studies report they actually prevent dementia, but Im not buying all of that report. So she was fine before Pradaxa and now showing signs of dementia? Gee, what a coincident! Key word here posters is ALARMING SIGNS.

Medicine is full of coincidences. She's also taking a beta blocker, and Koli didn't really give us a timeline of when the drugs were started and when the decline was noticed, so if you're looking for unproven cause and effect that's just as likely, probably more likely.

Frankly I think trying to diagnose this woman's problem is far beyond our abilities. All anyone on the internet can do is speculate and speculation is worthless.

Timelines are important. When was the Pradaxa started? How many episodes of AF, if any, preceded the anticoagulation? It is possible that TIEs (transient ischemic events) may have occurred, and that they are responsible for the cognitive issues. Coincidence with the medication could just be unfortunate timing. We just don’t know without details, and even then maybe not.

I agree, though, in the need to move beyond a general practitioner in this case. If the poster is in fact a UK citizen then I would defer to our overseas membership as to how exactly one “rattles the cages” in that system as opposed to ours.

I really appreciate your help guys. She has seen the GP again today and, with a bit of pressure, has agreed to take her off the medications (for three months) but without any alternative medications. That now worries me as I read one should not just stop taking them (pradaxa and bisoprolol) the risk of stroke apparently elevated? I wonder about a "pill in the pocket" approach (flecainide) and whether this would be a suitable action when/if she gets the next attack? GP didn't mention it ! Any ideas on this?

For the record, my wife has had paroxysmal AFib attacks irregularly, 2010, 2013, 2017 and until the last one last year, was only treated in the hospital (with bisoprolol I think) with no subsequent antiarrhythmic/anticoagulant medications, only since the last attack was she on regular medications as far as I am aware, (even my memory is failing!). (I really question the daily medication for such infrequent attacks). However, the memory/cognitive problems go back a bit beyond last year, and so the question becomes whether the intermittent administration of bisoprolol/metoprolol/eliquis on previous AF attacks has had an effect. I find it impossible to just accept this deterioration is just something we have to accept without trying all alternatives. In the short term I'm hovering on your thoughts on Flecainide. Thanks again.

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Koli
I really appreciate your help guys. She has seen the GP again today and, with a bit of pressure, has agreed to take her off the medications (for three months) but without any alternative medications. That now worries me as I read one should not just stop taking them (pradaxa and bisoprolol) the risk of stroke apparently elevated? I wonder about a "pill in the pocket" approach (flecainide) and whether this would be a suitable action when/if she gets the next attack? GP didn't mention it ! Any ideas on this?

Yes, stroke risk goes way up. I'd recommend you take her off the GP ASAP.

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Koli
She has seen the GP again today and, with a bit of pressure, has agreed to take her off the medications (for three months) but without any alternative medications. That now worries me as I read one should not just stop taking them

What you've read is correct. She should not stop the Pradaxa. You need to find another GP because this individual is going to kill your wife.

I'm going to repeat again that you need to do what it takes to get her seen by a cardiologist and then a neurologist.

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Carey

Pradaxa has caused short term memory loss, but probably not dementia. Some studies report they actually prevent dementia, but Im not buying all of that report. So she was fine before Pradaxa and now showing signs of dementia? Gee, what a coincident! Key word here posters is ALARMING SIGNS.

Medicine is full of coincidences. She's also taking a beta blocker, and Koli didn't really give us a timeline of when the drugs were started and when the decline was noticed, so if you're looking for unproven cause and effect that's just as likely, probably more likely.

Frankly I think trying to diagnose this woman's problem is far beyond our abilities. All anyone on the internet can do is speculate and speculation is worthless.

Could be a Ko ink a dink with meds and that would be a maze of double blind studies not even Einstein could figure out. It could involve eliminating, adding, changing and testing that may not change a thing. If someone could safely cease from a med and qualify the results, we would have a perfect world scenario. But of course there are just too many variables. I did not see the GP as the "specialist" until after. I know more about my condition that most GPs simply from using cardios for a decade. However I was stating a fact about one side effect of Pradaxa, "Short term memory loss". Rare, 1 in thousands maybe, but possible.

Sidebar.....Carey? the guy from another site I no longer use who had 5 average ablations and a 6th that worked? Congrats to you and good to see you again.

Pradaxa (Dabigatran) is an anticoagulant used to prevent clots forming in the atrium during an episode of AFib due to inconsistent/irregular blood flow. So my question is, why has this not been the first treatment administered when my wife has been admitted to hospital? It has only been metoprolol or bisoprolol which is designed primarily to correct arrhythmias and high blood pressure. It does not make any sense to me, after her past history of 3 or 4 year intervals of AFib, to say "don't stop taking it" when it has not been prescribed before last years attack. Daily meds, with possible side effects, for such an intermittent problem.

Secondly, what's wrong with a "pill in the pocket" (flecainide) approach, backed up with pradaxa if you wish, when and if the next episode occurs? That would alleviate the possibility of these medications possibly causing her other problems. No-one had answered this yet although I do appreciate your comments. And yes, we're aiming to see a cardio soon (I don't like the 'traditional' GP approach).

This seems to be new information about the frequency. I couldnt agree more with your recent post, but we're all different so dont take this as gospel from my own personal decision I made over 9 years ago at a much younger age. I demanded the PIP and when I was told no by a Carido, I walked in the next week and announced to the nurse, "Im off the Flecainide, Metorprolol and Warfarin this week. She laughed and said, thats very funny. When she knew I was serious she ran for the doctor. I walked out with a PIP and never went back on any thinners since that day. I have heard there is still that slight 1.75% chance I am at risk of a stroke even while I m in NSR, but its one Im willing to take vs brain bleeds and dementia, IMHO.

This is an old story but worth mentioning again.

My meds history is similar... AF started in 1995... meds were somewhat different.... only had warfarin for the anticoag.
and was given Betapace which did nothing. I changed to a cardiologist connected with the EP department of the CCF and was prescribed metoprolol, flecainide and continuing on the warfarin. When I had a problem with the warfarin, I just went off that and switched to nattokinase for the next 7 years. I told the cardiologist I would sign a waver but I wasn't going to continue because the side effects were so severe. He said... no need to sign. Eventually, I had far less Afib and decided to use the PIP-only approach for when AF surfaced. That was a great improvement for how I felt overall.

The NK kept me clot free during many prolonged events lasting 24 hours and often longer. Of course, I had to resume the warfarin when I had the first ablation... but after the blanking period... went back on the NK and remained on that for 11 years until ablation #2 and then #3 requiring ongoing Eliquis.

At 103 days after my first ablation I went into AF and had to be cardioverted. Apparently, I did have a clot form in my LAA which showed on a CT scan which was the standard procedure back then post-ablation...either from the long duration of the AF or the cardioversion. I didn't learn of the clot until I received the written results about 6 weeks later...and the conclusion was that the Nattokinase had done its job as I was still alive and totally functional... even though the clot was indicated on the CT report, I wasn't notified about it.

That convinced me that I could rely on NK.

Jackie.

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Jackie
I didn't learn of the clot until I received the written results about 6 weeks later...and the conclusion was that the Nattokinase had done its job as I was still alive and totally functional... even though the clot was indicated on the CT report, I wasn't notified about it.

That convinced me that I could rely on NK.

Jackie.

I'm not understanding. The Nattokinase removed the clot you found, or it worked because the clot didn't kill you?

Koli,

If you took your wife to an ER because of a-fib, then there's a really good chance they won't even deal with the anticoagulation. They'll just do rate control and tell you to see a cardiologist. ER's are really bad places to treat AF. They exist to treat life-threatening medical conditions or acute injury and AF just isn't among them.

Metoprolol and bisoprolol are beta- blockers that do rate control. They slow the heart, but do nothing to correct arrhythmia. Anti-arrhythmic drugs would include propafenone, flecainide, or tikosyn and they work to control the heart rhythm.

There is nothing wrong with a PIP approach for any of the medications, including anti-coagulants, if you work with a cardiologist to establish a plan. Again, the number one thing for you to do at this point is have your wife seen by a cardiologist and not a general practitioner any longer as it relates to atrial fibrillation. This is an absolute must, in my opinion.

jpeters. - Sorry - So, when I asked about that, the comment was: the NK must have done its job and dissolved the clot… although I didn’t have a follow-up scan to prove that. (I think because I didn’t have a stroke in the interim, there was no need to do a scan.)

Now to help clarify the potency and useful of nattokinase .... In initial the research by Dr. Sumi, it was found that NK completely lysed clots in 18 hours and he is quoted as saying… “the active enzyme in natto showed a potency matched by no other enzyme”… meaning the only other enzymes available then were the t-PA’s (tissue plasminogen activators) such as activase, urokinase and streptokinase (drugs) used by hospitals for stroke and heart attack victims…. But those are very expensive so not all patients get them and they are short- lived. Urokinase begins to lose effectiveness rapidly after it’s given…like 4 to 20 minutes… (I’ve read).

One comment from a discussion about the efficacy of NK from my very large file on this topic mentions the superiority of NK over t-PAs like urokinase which are only effective when given intravenously and often fail simply because a stroke or heart attack victim’s arteries have been hardened to the point where they can’t be treated by any clot-dissolving agent.

The good news is, however, that nattokinase can help prevent that hardening.

Hope this helps clarify.

Jackie

PS - I should have mentioned that there is a lot more info on the history, use, benefits of Nattokinase in Conference Room Sessions 39 and 40.... although it's from 2005... an update would certainly add more benefits

[www.afibbers.org]
[www.afibbers.org]



Edited 1 time(s). Last edit at 06/23/2018 06:11PM by Jackie.

Thanks Jackie, for now I'll try NK with the MK-7 suppliment (although I would rather take less vs more warfarin). Looks great!



Edited 1 time(s). Last edit at 06/23/2018 07:11PM by jpeters.

Good news, have now managed to get an appointment with a cardio so hope to report back here early next week. Thanks for everyone's input meanwhile. I still anguish over the need for the medications (if they are causing the grey matter problems) with such intermittent AFib when our diet includes anticoags such as grapefruit, turmeric, cinnamon, ginger, ginkgo, sunflower, walnuts. etc etc. and a plant based diet generally. Hopefully next week we will have some 'expert' opinion from the cardio and get on a PIP approach for at least a trial.