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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Circulation to the brain is greatly affected by hypertension and by its treatment. Neurologic dysfunction is prominent among the complications of increased arterial pressure and is also most susceptible to preventive antihypertensive therapy. The upward resetting of the limits of autoregulation of cerebral blood flow in hypertension is probably due largely to structural thickening of the walls (hyaline arteriosclerosis) of the resistance vessels. Other consequences of hypertensive vascular lesions in the brain include increased formation of atheroma, lacunae and lacunar infarction, cerebral infarction, multi-infarct dementia and Binswanger's disease. There is also an association between hypertension and hemorrhagic strokes, namely, subarachnoid and intracerebral hemorrhage. Brain lesions are also prominent in malignant hypertension and hypertensive encephalopathy. Antihypertensive treatment, especially if intensive, can result in boundary zone ischemia in the brain if arterial pressure decreases steeply.
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PMID:Morphologic changes during hypertension. 264 56

A double-blind, placebo-controlled trial was carried out in 40 patients affected by multi-infarct dementia to see if a daily intravenous infusion of 3 mg co-dergocrine mesylate ('Hydergine') over 14 days would improve severely deteriorated elderly patients and shorten the latent period (3 months) which is observed when the drug is given orally. All the patients had severe mental impairment, psychological deficit or altered consciousness. A Hachinski score of 7 or more, and a cumulative score of at least 12 points on SCAG scale Items 1, 2 and 4 (anxiety/depression) and/or Items 5, 6 and 8 (alertness/confusion) were required for admission. After 1 week of intravenous infusion of placebo, patients were randomly allocated to treatment with co-dergocrine mesylate or placebo, from Day 1 to Day 14. The solutions were infused over a period of 2 hours. During the follow-up period from Day 15 to Day 21, the patients did not receive any treatment. Thirty-six patients (17 on co-dergocrine mesylate, 19 on placebo) completed the study. The results, as rated on the SCAG scale, indicated significant improvements, in favour of co-dergocrine mesylate, in cognitive dysfunction, mood depression, withdrawal and overall impression. Furthermore, the factor fatigue on the Nowlis scale and clinical global assessments by physicians also showed significant advantages of the co-dergocrine mesylate group over placebo. Nine out of 17 co-dergocrine mesylate patients complained of side-effects, usually experienced during infusion; they consisted mainly of nausea (6 patients), gastric discomfort (2 patients), and tremor, nasal congestion, flushing, hypotension and hypertension (1 patient each). Despite the appearance of side-effects, general tolerability was rated as 'good' by both physicians and patients. It is concluded, therefore, that intravenous high dose co-dergocrine mesylate treatment has a fast and clinically relevant effect on the key clinical symptoms of multi-infarct dementia.
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PMID:Effects of intravenous high dose co-dergocrine mesylate ('Hydergine') in elderly patients with severe multi-infarct dementia: a double-blind, placebo-controlled trial. 268 Feb 86

Duration of survival from time of first evaluation was studied in 61 patients with clinically diagnosed Alzheimer's disease (senile dementia of the Alzheimer type [SDAT]) and 34 patients with clinically diagnosed multi-infarct dementia (MID). Duration of survival did not differ significantly between MID and SDAT. However, since MID patients were younger at onset, MID patients had a lower life quotient than SDAT patients. Race, sex, and age at onset were not predictive of survival in SDAT. History of hypertension, elevated systolic blood pressure, lower scores on tests of Block Designs, and Logico-Grammatical Comprehension predicted shorter survival in SDAT. Age at onset and race were not predictive of survival in MID. Male sex, lower educational attainment, as well as low scores on tests of Logico-Grammatical Comprehension, Digit Span, Naming, Verbal Fluency, and receptive vocabulary, predicted shorter survival in MID.
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PMID:Predictors of survival in clinically diagnosed Alzheimer's disease and multi-infarct dementia. 281 56

Hypertension is a cardinal risk factor in the genesis of cardiovascular morbidity and mortality. The presence of concomitant risk factors greatly increases the incidence of vascular events, and associations of age, hypertension, obesity and smoking are particularly lethal combinations. Accelerated atherosclerotic change characterizes sustained hypertension, and ischaemic heart disease, aortic dissection, stroke and multi-infarct dementia are major sequelae. Major studies in the United States, Australia and the United Kingdom have shown that treatment of hypertension significantly reduces the occurrence of strokes. Obesity and excess alcohol consumption closely correlate with hypertension. The relative importance to hypertension of type II diabetes and obesity is difficult to evaluate.
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PMID:Hypertension and associated diseases in elderly patients. 306 91

Strokes can be due to ischemic or hemorrhagic vascular disorders. Ischemic strokes outnumber hemorrhagic strokes approximately 4:1. Although the mode of presentation and pathophysiology are different in the two conditions, the outcome is really dependent on the extent and location of brain injury. A CT scan helps in this regard and reveals surgically correctable lesions such as a subdural hematoma or normal pressure hydrocephalus. Effective rehabilitation of the stroke patient is dependent on motivation and cognitive ability even more than on remaining motor or sensory function. A team approach to assessment provides the opportunity to make an accurate appraisal of a patient's current level of functioning and an estimate of premorbid capabilities. A thorough review of the history, complete neurologic examination, mental status testing, and laboratory and radiographic data should be obtained by the treating physician. Neuropsychologic testing, speech and language evaluation, ADL assessment, nursing observations, and psychiatric consultation round off the attempts to fully learn the limitations and strengths that characterize the patient. The value in assessing cognitive abilities after a stroke should be obvious. Not only is motivation necessary, but the patient must comprehend the purpose of the rehabilitation process. Goal-setting is a combined effort of the patient and the rehabilitation team. If a patient has limited understanding and faulty memory, the efforts may be wasted. The presence of acute confusion or delirium may delay rehabilitation efforts, but the etiology may be readily treatable. When there is strong suspicion of a degenerative dementia such as Alzheimer's disease, the expectations are lowered. Occasionally, the problem is a mixed dementia in which instance the prognosis is poor. When there is evidence for multi-infarct dementia, there is a possibility for cognitive improvement when medical problems such as hypertension and embolization are treated. Much can be done for one who has limited and focal cerebral damage provided there is adequate comprehension and ability to compensate for disability.
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PMID:Dementia following stroke. 306 59

Previous reports have described 5-20% prevalence of hyponatremia in extended care facilities, due largely to drugs or inappropriate antidiuretic hormone secretion. In our 400 bed VA extended care facility, 15 men with organic brain syndrome (Alzheimer's, multi-infarct dementia, anoxic encephalopathy or alcoholism) currently receive Isocal via gastrostomy as the sole source of nutrition. We noted intermittent hyponatremia in about half of these patients, and conducted a chart review to investigate the cause. Mean age was 68 yr (range 46-92); tube feeding duration was 3 mo.-3 yr; 266 Na concentrations were obtained from the charts. Simultaneous with these Na analyses, one of three diets prevailed: (A) mixed foods (3-6 g Na/day) orally before gastrostomy; (B) Isocal supplemented with NaCl to give 2 g Na/day; (C) unsupplemented Isocal providing 1 g Na/day. (B) and (C) had been randomly varied by rotating physicians. Serum Na was directly related to Na intake. On (A), Na was within normal range (135-145 mEq/l) in all men. One patient was hyponatremic during diet (B). During (C), eight patients were hyponatremic. Na was less than 135 mEq/l in 40% of all samples during diet (C) and less than 130 mEq/l in 14%. Changing from diet (A) or (B) to diet (C) caused nearly equivalent declines in Na and Cl; K and HCO-3 were unaffected. No hyponatremic patient took drugs known to cause hyponatremia, or had congestive heart failure, hypoalbuminemia, lipemia or fasting hyperglycemia. At the end of the study, four hyponatremic men were changed from (C) to (B); serum Na became normal in all four patients, without edema or hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Hyponatremia in tube-fed elderly men. 308 Apr 61

Plasma triglycerides, total cholesterol and high-density lipoprotein cholesterol were studied in patients with Alzheimer's disease (AD, n = 57, mean age 70 years) and multi-infarct dementia (MID, n = 69, mean age 73 years) when the patients were admitted for assessment. Both total cholesterol and high-density lipoprotein cholesterol but not triglycerides were lower in MID than in AD even though there was a considerable overlap. Especially in younger patients and in patients living at home the difference was not statistically significant. Further, the plasma lipid values in neuropathologically confirmed cases with AD (n = 5) and MID (n = 16) were similar at admission. Low total cholesterol and high-density lipoprotein cholesterol were related to cardio- and cerebrovascular disorders, living in institutions, and negatively correlated to age and severity of dementia. Our results suggest that determination of total cholesterol and high-density lipoprotein cholesterol is of minor value in the differential diagnosis between AD and MID and that associated diseases, such as coronary heart disease, cardiac failure and arterial hypertension, are more important in this respect.
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PMID:Is determination of plasma lipids useful in the differentiation of multi-infarct dementia from Alzheimer's disease? 319 48

One hundred and seventy five multi-infarct dementia (MID) patients were evaluated for risk factors for stroke as well as for the types of cerebrovascular lesions that were present. The incidence of associated risk factors for stroke were as follows: hypertension (66%), heart disease (47%), cigarette smoking (37%), diabetes mellitus (20%), moderate alcohol consumption (19%) and hyperlipidaemia (21%). The most frequently occurring type of lesions were multiple lacunar infarctions of the brain (43%). These were combined with other types of stroke in an additional 21%. Atherosclerotic occlusive disease of the carotid and vertebrobasilar arteries occurred alone in 18% and was associated with other types of stroke in another 25%. Embolic cerebral infarctions were present alone in 8% and were combined with other types of stroke in 15%. MID was more frequent in men (62%) than women (p less than 0.002). Mean bihemispheric gray matter cerebral blood flow (CBF) values showed a fluctuating course and when results were pooled and compared between different types of MID, extracranial occlusive disease and/or multiple lacunar infarctions resulted in lowest CBF values. The location of cerebral infarctions was more importantly related to cognitive impairments than was the total volume of infarcted brain. Mortality rates among 125 MID patients followed for 31 months has been 5%. Correct clinical classification of the types of cerebrovascular lesions was confirmed in three necropsied cases.
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PMID:Aetiological considerations and risk factors for multi-infarct dementia. 322 Dec 15

The type, frequency, and extent of MR signal abnormalities in Alzheimer's disease and normal aging are a subject of controversy. With a 1.5-MR unit we studied 12 Alzheimer patients, four subjects suffering from multiinfarct dementia and nine age-matched controls. Punctate or early confluent high-signal abnormalities in the deep white matter, noted in 60% of both Alzheimer patients and controls, were unrelated to the presence of hypertension or other vascular risk factors. A significant number of Alzheimer patients exhibited a more extensive smooth "halo" of periventricular hyperintensity when compared with controls (p = .024). Widespread deep white-matter hyperintensity (two patients) and extensive, irregular periventricular hyperintensity (three patients) were seen in multiinfarct dementia. Areas of high signal intensity affecting hippocampal and sylvian cortex were also present in five Alzheimer and two multiinfarct dementia patients, but absent in controls. Discrete, small foci of deep white-matter hyperintensity are not characteristic of Alzheimer's disease nor do they appear to imply a vascular cause for the dementing illness. The frequently observed "halo" of periventricular hyperintensity in Alzheimer's disease may be of diagnostic importance. High-signal abnormalities in specific cortical regions are likely to reflect disease processes localized to those structures.
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PMID:MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. 349 63

Computed tomography and magnetic resonance imaging in the elderly have demonstrated the common occurrence of deep white-matter lesions in the aging brain. These radiologic lesions (leukoaraiosis) may represent an early marker of dementia. At autopsy, an ischemic periventricular leukoencephalopathy (Binswanger's disease) has been found in most cases. The clinical spectrum of Binswanger's disease appears to range from asymptomatic radiologic lesions to dementia with focal deficits, frontal signs, pseudobulbar palsy, gait difficulties, and urinary incontinence. The name senile dementia of the Binswanger type (SDBT) is proposed for this poorly recognized, vascular form of subcortical dementia. The SDBT probably results from cortical disconnection most likely caused by hypoperfusion. In contrast, multi-infarct dementia is correlated with multiple large and small strokes that cause a loss of over 50 to 100 mL of brain volume. The periventricular white matter is a watershed area irrigated by long, penetrating medullary arteries. Risk factors for SDBT are small-artery diseases, such as hypertension and amyloid angiopathy, impaired autoregulation of cerebral blood flow in the elderly, and periventricular hypoperfusion due to cardiac failure, arrhythmias, and hypotension. The SDBT may be a potentially preventable and treatable form of dementia.
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PMID:Senile dementia of the Binswanger type. A vascular form of dementia in the elderly. 362 88


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