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 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors examined the association of blood pressure with cognitive function as assessed by the Mini-Mental State Examination (MMSE) in a community-based Swedish cohort of 1,736 people aged 75-101 years. Age, sex, education, antihypertensive medication use, heart disease, and stroke were considered as covariates. Multiple linear regression analysis indicated that both systolic and diastolic blood pressure, measured in 1987-1989, were positively and significantly related to baseline MMSE score; baseline systolic pressure was also positively and significantly related to follow-up MMSE score, measured after an average period of 40.5 months among subjects who were not taking antihypertensive medication at baseline. Furthermore, in the nontreated group, multiple logistic regression showed that individuals with a baseline systolic pressure less than 130 mmHg had an odds ratio of 1.88 (p = 0.05) for follow-up cognitive impairment (MMSE score < 24) compared with those whose systolic pressure was 130-159 mmHg. An increased but not statistically significant risk of cognitive impairment was associated with high blood pressure (systolic pressure > or = 180 mmHg or diastolic pressure > or = 95 mmHg) only in persons taking antihypertensive medication at baseline. Subjects with systolic pressure of 160-179 mmHg tended to be at lower risk of cognitive impairment. These results may support the view that a certain blood pressure level, particularly a systolic pressure of at least 130 mmHg, is important to the maintenance of cognitive functioning in the very old. They also suggest that severe hypertension that is not well controlled (systolic pressure > or = 180 mmHg or diastolic pressure > or = 95 mmHg) is still a threat to cognitive function in this age group. However, the use of blood pressure measurements made at a single visit and the relatively short follow-up period should be considered when interpreting these results.
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PMID:Blood pressure and performance on the Mini-Mental State Examination in the very old. Cross-sectional and longitudinal data from the Kungsholmen Project. 919 40

While the role of diet in heart disease and cancer has received much attention, a possible role for diet in the development of cognitive impairment and dementia is just now being investigated. In this presentation, the putative mechanisms through which anti-oxidants could modulate cellular life in the brain will be briefly discussed. Epidemiologic studies that describe the relation of selected dietary nutrients to cognitive impairment and dementia will be reviewed. In particular, recent results from the analyses of community based follow-up studies, including the Rotterdam Study and the Zutphen Study will be presented. Briefly, these studies provide a mixed picture concerning the relation of anti-oxidants to cognitive impairment or dementia.
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PMID:Anti-oxidants and cognitive function: a review of clinical and epidemiologic studies. 970 Jun 41

The results of longitudinal studies in geriatric medicine were reviewed by referring to relatively recent publications. "Longidufinal studies" comprised not only cohort studies but also prospective case-control studies in the broad sense. Poor self-rated health, weight loss hypoalbuminemia, inability to perform activities of daily living, low levels of physical activity, and cognitive dysfunction, all of which could be manifestations of chronic diseases, might shorten longevity. Cardiomegaly or left ventricular hypertrophy on ECG were again found to be important risk factors for cardiovascular disease in the aged, because of their relation to atherosclerosis. There is no evidence regarding the contribution of hyperlipidemia to the risk of cardiovascular disease in the aged, although insulin resistance can increase serum triglyceride levels and reduced level of high-density lipoprotein cholesterol even in the aged. Mortality due to stroke and heart disease have been decreasing in most developed countries, and several recent community-based studies have also shown decreases in the incidence of cerebral stroke. Large-scale case-control studies on the pharmacological treatment of hyperlipidemia have resulted in both primary and secondary prevention of coronary heart disease. However, information concerning the effects of treatment for hyperlipidemia on coronary heart disease in the aged is limited. Results of large-scale case-control studies indicate that pharmacological treatment of elderly hypertensive patients can reduce cardiovascular morbidity and mortality, and angiotensin-converting enzyme inhibitors have recently been shown ot be useful.
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PMID:[Longitudinal studies in geriatric medicine]. 971 Oct 88

Geriatric patients with known dementia and suffering from an acute somatic disease are highly vulnerable to develop delirium. It is therefore essential to suspect and recognize delirium in these patients, especially in emergency wards. In the present study we evaluated activities on a dedicated delirium ward at a Swedish University Hospital. Over one and a half years 637 patients were treated for suspected delirium, the majority of patients being referred from the emergency ward at the same hospital. Infectious diseases were the main cause of delirium in 67% of cases. Other common causes were heart disease and stroke. Drug use as the only cause of delirium was found in less than 1% of cases. Approximately 70% of patients had cognitive disturbances, either dementia or mild cognitive impairment. The existence of multiple diseases as causative factors was frequent. Knowledge about delirium and how it is both diagnosed and treated is of great importance in all kinds of settings where acute somatic treatments are common.
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PMID:Delirium in clinical practice: experiences from a specialized delirium ward. 1047 45

Depression is a significant concern in elderly patients. Reported prevalence rates differ greatly depending on the definition of depression and the population of interest, with increases reported in settings where comorbid physical illnesses are more common. In community-dwelling elderly patients, prevalences of depressive symptoms and major depressive disorder are 15% and 1% to 3%, respectively. Factors associated with depression in the elderly include female gender, alcohol and substance abuse, pharmaceuticals, family history, and medical conditions such as stroke, Alzheimer's disease, cancer, and heart disease. Recognition of depression is complex because patients often deny their depression, present with somatic complaints, or may have comorbid anxiety or cognitive impairment. Depression is underrecognized and undertreated in the elderly, despite evidence that the benefits of treatment outweigh potential risks.
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PMID:Epidemiology and diagnosis of depression in late life. 1051 52

Phenylketonuria in pregnancy carries with it an increased risk of spontaneous abortion and development of a fetus that is affected by the maternal phenylketonuria syndrome. This syndrome is characterized by low birthweight, congenital heart disease, microcephaly, childhood growth failure, and cognitive impairment. It is the result of the hyperphenylalaninemia that accompanies the phenylketonuric state, and may therefore be avoided by maintaining maternal serum phenylalanine levels within the normal range. Phenylalanine is an essential amino acid and may be controlled by dietary manipulation. Presented here is a case history of a woman with phenylketonuria who was unable to satisfactorily control her serum phenylalanine levels in each of her three pregnancies. All three children were adversely affected by the fetopathy of the maternal phenylketonuria syndrome, each with evidence of growth failure and impaired neurodevelopment. This patient illustrates the difficulties that may be encountered when providing obstetric care to the woman with phenylketonuria who is not able or not willing to restrict her dietary intake of phenylalanine. The discussion includes consideration of management strategies, including dietary therapy and legal intervention.
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PMID:Repeated adverse fetal outcome in pregnancy complicated by uncontrolled maternal phenylketonuria. 1057 68

Putative risk factors accelerating mild cognitive decline and dementia were correlated with repeated measures of cerebral atrophy, CT, densitometry, perfusions, and cognitive testing among neurologically and cognitively normative aging volunteers. A total of 224 normative subjects at increased risk for cognitive decline were admitted to the study. Mean entry age was 59.5 +/- 15.8 years. Mean follow-up is 5.8 +/- 3.3 years. At follow-up, 22 developed mild cognitive impairment (41 CCSE >/= -3), 19 became demented-8 with Vascular type (VAD), 11 with Alzheimer's type (DAT)-and 183 remain cognitively unchanged. Cerebral atrophy, tissue densities, and perfusions were measured by Xe-CT. After age 60, cerebral atrophy, ventricular enlargement, and polio- and leuko-araiosis geometrically increased as perfusions declined. Risk factors accelerating perfusional decline, cerebral atrophy, polio-araiosis, and leuko-araiosis were: transient ischemic attacks (TIAs), hypertension, smoking, hyperlipidemia, and male gender. At age 71.5 +/- 11.9, mild cognitive impairment began accelerated by TIAs, hypertension and heart disease. Leuko-araiosis began before cognitive decline. TIAs, hypertension, and hyperlipidemia correlated with VAD. Excessive cortical perfusional decrease, gray and white matter hypodensities, and cerebral atrophy correlate with cognitive decline.
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PMID:Risk factors for cerebral hypoperfusion, mild cognitive impairment, and dementia. 1086 1

The term "cardiogenic dementia" was introduced a few decades ago to indicate an alteration of consciousness and cognition due to heart disease. Although this term is now disused, the relationship between cardiovascular disease and cognitive impairment is currently of great interest, not only for its potential therapeutic implications. but also for the recently recognized important role that vascular factors appear to play in Alzheimer's disease. The aims of this review are therefore 1) to show data supporting the role of cardiac disease--namely congestive heart failure, myocardial infarction and atrial fibrillation--and other vascular risk factors--i.e., hypertension and diabetes--in the development or worsening of cognitive impairment; 2) to highlight recent observations on the relationship between presence and severity of congestive heart failure/ myocardial infarction/atrial fibrillation and Alzheimer's disease: and 3) to uncover the type of studies needed in this field in order to facilitate a more precise algorithm of dementia prevention as well as intervention in demented patients with cardiovascular disease.
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PMID:Heart disease and vascular risk factors in the cognitively impaired elderly: implications for Alzheimer's dementia. 1144 5

The pathogenesis and clinical significance of cerebral white matter lesions (WML) remain controversial. Most studies have shown that age, hypertension, diabetes mellitus, and a history of stroke or heart disease are the most important factors related to the presence of cerebral WML. Moreover, some studies suggest that the presence of WML are closely related to cerebrovascular disease and cognitive impairment in elderly patients with vascular risk factors, particularly hypertension. In this review, different points of view about cerebral WML are discussed, with special focus on the presence of WML in essential hypertension. Some authors suggest that the presence of WML in hypertensive patients could be considered an early marker of brain damage.
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PMID:Cerebral white matter lesions in essential hypertension. 1155 79

Transcranial Doppler Ultrasound (TCD) may be used to detect cerebral microemboli in patient groups with an increased stroke risk and during invasive cardiovascular examinations and operations. Although these microemboli do not cause immediate symptoms, there is growing evidence which suggests that they may cause cognitive impairment if they enter the cerebral circulation in significant numbers. This has been studied in detail in patients who have had coronary artery bypass surgery. In these patients, an association has been found between the number of intraoperative cerebral microemboli detected by transcranial Doppler and postoperative neuropsychological outcome. It is also possible that cerebral microemboli may be the cause of cognitive impairment in patients with cerebrovascular disease. Cerebral microemboli are often found in patients with atherosclerosis, especially of the carotid arteries and aortic arch, and in patients with heart disease. There is also an increased risk for silent strokes and cognitive impairment in these patients. Prospective clinical studies are therefore required to determine if continuous cerebral microembolization to the brain will lead to progressive cognitive impairment.
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PMID:Cerebral microemboli and cognitive impairment. 1241 86


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