Research from America has found that men who take sildenafil (Viagra) are less likely to develop the most common form of dementia. The study, carried out by a team from the prestigious Mount Sinai Medical Center with access to the medical data of 30 million people, concluded that sildenafil use was “associated with a 60 per cent risk reduction of developing Alzheimer’s disease”.
These findings can’t confirm that sildenafil was responsible for the difference in risk between men taking the drug and their peers who did not, but there are a number of plausible mechanisms. The most exciting of which is that sildenafil may exert a protective effect through subtle changes to brain chemistry and blood flow (in women as well as men), and that this could be harnessed to slow development and progression of the disease.
Alternatively, the link could be more mundane. Could it be that men who seek medical help to boost their sex lives are a) in generally better nick than their similarly afflicted peers who don’t, and b) are less likely to be in the early stages of dementia? And sitting between these two extremes is another possibility: does consulting your doctor about erection difficulties have secondary benefits beyond improving your sex life?
• Erectile dysfunction is on the rise. Meet the men who can get your mojo back
We have known for many years that erectile dysfunction (ED) is often a precursor of serious health issues such as an early stroke or heart attack, and it is linked to dementia too. Indeed ED is often one of the first outward signs of arterial disease that will affect much more than the hydraulics responsible for engorging a penis.
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Numerous studies have highlighted a link between ED and poor long-term health. The strength of the link varies depending on which research you quote but as a rough guide ED is associated with about a 50 per cent increase in the risk of developing dementia or having an early heart attack or stroke, and about a 20 per cent increase in all-cause mortality (the risk of dying from anything over the period of the study, eg 5-10 years).
Put it this way, if you come and see me about your ED you won’t leave ten minutes later with just a prescription for the little blue pills. Protocols vary from individual to individual, and from doctor to doctor, but I regard ED as a red flag that should prompt a closer look at diet, lifestyle and weight, along with investigations to check, at the very least, for high blood pressure and to measure cholesterol, blood glucose and testosterone levels. Other tests may include prostate specific antigen (PSA), thyroid, kidney and liver assays.
It is common to find at least one worrying risk factor that warrants mitigating action, be it a better diet, stopping smoking, weight loss or medication for type 2 diabetes, high blood pressure or raised cholesterol. And often it’s far more than one problem.
No lifestyle changes, or medication, can fully protect you against the ravages of time but they can help. Take statins, for instance. Despite some initial concerns that they could impair memory and cognitive function, there is now growing evidence that they reduce the risk of developing dementia, by as much as a third according to some studies.
How statins may protect the brain in this regard is unclear. Helping to maintain a healthy circulation by reducing cholesterol levels is likely to be a factor, particularly in vascular dementia. However, as well as lowering cholesterol, they also have a secondary “anti-inflammatory” effect that might be more relevant in Alzheimer’s disease. As is so often the case, more research is needed.
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In the meantime, the take-home message is a simple one. ED can be a very distressing condition for both the individual and their partner, and one that is relatively easy to treat (see below). However, ED shouldn’t be ignored even by people who are not bothered by it. Not everyone affected will have an underlying physical problem, but many do, and the only way to be sure is to check.
For more details on the Mount Sinai Medical Center study visit pubmed.ncbi.nlm.nih.gov/37203519 and for the latest guidance on investigating and managing ED go to cks.nice.org.uk/topics/erectile-dysfunction
Erectile dysfunction: the facts
• About two thirds of men with ED respond well to treatment with Viagra-type oral drugs
• ED becomes more common with age. The most commonly quoted UK data suggests that about half of all men between the ages of 40 and 70 are affected to some degree
• German research (the Cologne Study) suggests ED affects 2.5 per cent of men at the age of 30, rising to more than half (53.4 per cent) at 80
• There is evidence that prevalence is rising in younger men, in whom psychological factors like performance anxiety and stress tend to be more common
Q&A
I am due to have my flu jab next week and have been offered a Covid booster at the same time. Is it OK to have them together?
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Despite the recent emergence of a new strain, rates of Covid infection in the UK remain low and, according to the UK Health Security Agency, have, if anything, fallen in recent weeks. And there is very little flu around too. But who knows what the next few months will bring? I certainly don’t, so as a health worker I have had both my vaccines and I advise all my patients, friends and relatives who are eligible to do the same.
I had my Covid booster and flu jab at the same time (in different arms), as is now standard practice if the surgery/pharmacy etc has supplies of both. And I had no qualms about doing so. Not much else I can add: what’s good for the goose is good for the gander.
