scholarly journals 487 Instrumental evaluation of mild cognitive decline in hypertensive patients: the role of transcranial doppler

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Germano Junior Ferruzzi ◽  
Valeria Visco ◽  
Francesco Loria ◽  
Sofia Donnarumma ◽  
Gennaro Galasso ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cognitive Decline ◽  
Transcranial Doppler ◽  
Inverse Relationship ◽  
Temporal Orientation ◽  
Inverse Association ◽  
Delayed Recall ◽  
Hypertensive Patients ◽  
Logical Memory ◽  
Diagnosis Of Dementia

Abstract Aims Hypertension is a known risk factor for stroke and vascular dementia. Recent studies have also shown that arterial hypertension represents a clear risk factor for mild cognitive decline and its evolution into Alzheimer’s disease. Really, mild cognitive decline significantly compromises the patient’s quality of life, reducing compliance with therapy and increasing mortality and hospitalization. Diagnosis of dementia is challenging and requires both ruling out potentially treatable underlying causes and ruling in a diagnosis of dementia subtype. Currently, this diagnosis is based on the execution of second-level investigations (e.g. neuroimaging), that are expensive and not always available. For this reason, we analysed a population of hypertensive patients without atrial fibrillation and/or cerebrovascular and/or neurodegenerative diseases, with the aim of verifying the existence of an association between cognitive impairment and flows on the middle cerebral artery (MCA). Methods We considered 33 hypertensive patients (age 64.90 co1.40 years; 72% male). Specifically, we considered anthropometric, clinical, laboratory, and echocardiographic parameters. Also, we administered: an accurate, sensitive, and specific screening test (QMCI) for the assessment of intermediate cognitive decline (MCI), which explores spatial and temporal orientation, registration, delayed recall, clock design, logical memory and verbal fluency in a concise time (5 min—score 0–100); a compliance questionnaire (Morisky medication adherence scale); a questionnaire on nutritional status (MNA). Finally, we recorded transcranial Doppler flows on the MCA. Results There is no QMCItot score compatible with dementia (<20) among the patients analysed. A statistically significant inverse association emerged between total QMCI score and Morisky score (P < 0.0001); in addition, the analysis of the different sections of the QMCI questionnaire showed: an inverse relationship between the Morisky score and the clock test (P 0.013), delayed recall (P 0.024) and logical memory (P 0.028). By comparing the Doppler velocities sampled on the MCA with QMCI scores, a statistically significant inverse relationship was found between mean flow velocity and orientation at QMCI (P 0.023), between PSV and orientation (P 0.017) and between EDV and orientation (P 0.049) (Figure). Conclusions In conclusion, our study demonstrates for the first time the existence of a significant association between the QMCI and the sampling of the MCA at the ultrasound Doppler. Studies on a larger population will be needed to confirm this association and to test the translational relevance, in particular to tailor therapeutic approach in patients with abnormal MCA Doppler.

scholarly journals Greater cardiorespiratory fitness reduces incidence of atrial fibrillation: a meta-analysis

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
C Verdicchio ◽  
A Elliott ◽  
R Mahajan ◽  
D Linz ◽  
D Lau ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Risk Factor ◽  
Cardiorespiratory Fitness ◽  
Meta Analysis ◽  
Exercise Stress ◽  
Inverse Association ◽  
Exercise Interventions ◽  
Increased Risk ◽  
Statistical Heterogeneity

Abstract Funding Acknowledgements Type of funding sources: None. Introduction  Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia affecting 1-2% of the global population, with the prevalence of AF increasing dramatically over the past two decades. Although low levels of cardiorespiratory fitness (CRF) and physical activity are predictive of cardiovascular disease onset and mortality, only recently has this emerged as a potential risk factor for AF. Purpose The aim of this meta-analysis was therefore to quantify the relationship between CRF, measured by a symptom limited exercise stress test, and incident AF. We hypothesised that there would be an inverse relationship between CRF and the incidence of AF. Methods The systematic literature review was conducted using PUBMED, MEDLINE and EMBASE databases, with seven studies meeting the inclusion criteria. A random-effects meta-analysis was then used to compare the multivariate risk estimates of the lowest CRF group from each cohort with the group of the highest CRF. Results Data from 206,925 individuals (55.8% males) was used for analysis with a mean age of 55 ± 2.5 years and a mean follow-up period of 10.3 ± 5 years. The total number of AF events across the studies was 19,913. The overall pooled risk of AF in the high-CRF group versus the low-CRF group showed a significant lower risk of incident AF in those with high-CRF (OR: 0.52, 95% CI, 0.44-0.605, p < 0.001). There was evidence of statistical heterogeneity between the studies (I2 = 81%, p < 0.001). AF incidence rates demonstrated an overall decline in rates across the CRF quartiles from low to high. The mean incidence rate for low-CRF was 21 ± 13.4 compared to 6.9 ± 0.7 per 1000 person-years for the high CRF group (p = 0.03). Conclusion There is an inverse association between a lower CRF and an increased risk of AF, with a higher level of CRF protective against AF. This study highlights that low-CRF may be an additional risk factor for AF along with already other established lifestyle-based risk factors such as obesity and hypertension. Exercise interventions should be promoted as a primary prevention strategy in those at risk of developing AF with known risk factors. Future studies are warranted to identify the mechanism(s) through which improved CRF confers a reduction in AF incidence. Abstract Figure. AF risk between high and low-CRF

scholarly journals The Role of Vitamin D as a Biomarker in Alzheimer’s Disease

2021 ◽  
Vol 11 (3) ◽  
pp. 334
Author(s):  
Giulia Bivona ◽  
Bruna Lo Sasso ◽  
Caterina Maria Gambino ◽  
Rosaria Vincenza Giglio ◽  
Concetta Scazzone ◽  
...  
Keyword(s):  
Vitamin D ◽  
Risk Factor ◽  
Cognitive Decline ◽  
Immune Cell ◽  
Response To Treatment ◽  
Cellular Processes ◽  
Vitamin D Levels ◽  
The Brain ◽  
Key Questions

Vitamin D and cognition is a popular association, which led to a remarkable body of literature data in the past 50 years. The brain can synthesize, catabolize, and receive Vitamin D, which has been proved to regulate many cellular processes in neurons and microglia. Vitamin D helps synaptic plasticity and neurotransmission in dopaminergic neural circuits and exerts anti-inflammatory and neuroprotective activities within the brain by reducing the synthesis of pro-inflammatory cytokines and the oxidative stress load. Further, Vitamin D action in the brain has been related to the clearance of amyloid plaques, which represent a feature of Alzheimer Disease (AD), by the immune cell. Based on these considerations, many studies have investigated the role of circulating Vitamin D levels in patients affected by a cognitive decline to assess Vitamin D’s eventual role as a biomarker or a risk factor in AD. An association between low Vitamin D levels and the onset and progression of AD has been reported, and some interventional studies to evaluate the role of Vitamin D in preventing AD onset have been performed. However, many pitfalls affected the studies available, including substantial discrepancies in the methods used and the lack of standardized data. Despite many studies, it remains unclear whether Vitamin D can have a role in cognitive decline and AD. This narrative review aims to answer two key questions: whether Vitamin D can be used as a reliable tool for diagnosing, predicting prognosis and response to treatment in AD patients, and whether it is a modifiable risk factor for preventing AD onset.

Cerebrovascular reactivity in hypertensive patients: A transcranial doppler study

1997 ◽  
Vol 25 (7) ◽  
pp. 383-389 ◽  
Author(s):  
Andrea Ficzere ◽  
Attila Valikovics ◽  
Béla Fülesdi ◽  
Attila Juhász ◽  
István Czuriga ◽  
...  
Keyword(s):  
Transcranial Doppler ◽  
Cerebrovascular Reactivity ◽  
Hypertensive Patients ◽  
Doppler Study

scholarly journals Fear of Falling and Cognitive Decline in Healthy Aging Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 265-265
Author(s):  
Rebecca Kraut ◽  
Roee Holtzer
Keyword(s):  
Older Adults ◽  
Executive Functions ◽  
Cognitive Decline ◽  
Healthy Aging ◽  
Fear Of Falling ◽  
Composite Score ◽  
Cognitive Measures ◽  
Delayed Recall ◽  
Memory And Attention ◽  
Aging Adults

Abstract Fear of Falling (FOF) is common and associated with poor mobility in aging but whether persistence of FOF endorsement influences cognitive decline has not been reported. Here we determined the effect of FOF, measured dichotomously and after accounting for persistence, on decline in global cognitive function (GCF), memory, and attention/executive functions. Older adults with persistent FOF (n=81; mean age=77.63±6.67 yrs; %female=74.1), transient FOF (n=60; mean age=76.93±6.01 yrs; %female=61.7), and no FOF (n=286; mean age=75.77±6.42 yrs; %female=49.3) were included. FOF was assessed through yes/no responses to “do you have a fear of falling?” at baseline. GCF was assessed using RBANS; memory was assessed using a composite score comprising the immediate and delayed recall index scores from RBANS; attention/executive functions were assessed via a composite score comprising TMT A & B, letter and category fluency tasks, and digit symbol modalities. Cognitive measures were administered annually for up to six years. Linear mixed effects models revealed that persistent FOF was associated with a worse decline in GCF compared to both transient FOF (estimate=0.78, p=.022) and no FOF (estimate=0.75, p=.004). Persistent FOF was also associated with a worse decline in memory compared to those with transient FOF (estimate=0.08, p=.004) and those with no FOF (estimate=0.06, p=.006). Associations between FOF status and decline in attention/executive functions were not significant. These findings demonstrate that persistent FOF is a risk factor for cognitive decline in community-residing older adults.

scholarly journals Women have Farther to Fall: Gender Differences Between Normal Elderly and Alzheimer's Disease in Verbal Memory Engender Better Detection of Alzheimer's Disease in Women

2011 ◽  
Vol 17 (4) ◽  
pp. 654-662 ◽  
Author(s):  
Robert M. Chapman ◽  
Mark Mapstone ◽  
Margaret N. Gardner ◽  
Tiffany C. Sandoval ◽  
John W. McCrary ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Gender Differences ◽  
Verbal Memory ◽  
Control Group ◽  
Large Drop ◽  
Delayed Recall ◽  
Logical Memory ◽  
Wechsler Memory Scale ◽  
Immediate Recall

AbstractWe analyzed verbal episodic memory learning and recall using the Logical Memory (LM) subtest of the Wechsler Memory Scale-III to determine how gender differences in AD compare to those seen in normal elderly and whether or not these differences impact assessment of AD. We administered the LM to both an AD and a Control group, each comprised of 21 men and 21 women, and found a large drop in performance from normal elders to AD. Of interest was a gender interaction whereby the women's scores dropped 1.6 times more than the men's did. Control women on average outperformed Control men on every aspect of the test, including immediate recall, delayed recall, and learning. Conversely, AD women tended to perform worse than AD men. Additionally, the LM achieved perfect diagnostic accuracy in discriminant analysis of AD versus Control women, a statistically significantly higher result than for men. The results indicate the LM is a more powerful and reliable tool in detecting AD in women than in men. (JINS, 2011, 17, 654–662)

Inverse association between type 2 diabetes and aortic root dimension in hypertensive patients

2017 ◽  
Vol 228 ◽  
pp. 233-237 ◽  
Author(s):  
Emilio Nardi ◽  
Giuseppe Mulè ◽  
Chiara Nardi ◽  
Giulio Geraci ◽  
Maurizio Averna
Keyword(s):  
Type 2 Diabetes ◽  
Aortic Root ◽  
Inverse Association ◽  
Hypertensive Patients

Abstract 3050: Assessment of Genetic Risk for Thoracic Aortic Aneurysm Among Hypertensive Patients

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Kimihiko Kato ◽  
Mitsutoshi Oguri ◽  
Tetsuro Yoshida ◽  
Takeshi Hibino ◽  
Kazuhiro Yajima ◽  
...  
Keyword(s):  
Risk Factor ◽  
Genetic Risk ◽  
Odds Ratio ◽  
The United States ◽  
Multivariable Logistic Regression Analysis ◽  
Forward Selection ◽  
Structural Formation ◽  
Hypertensive Patients ◽  
Mortality And Morbidity ◽  
Suspension Array

Introduction: Aneurysms and dissections at the thoracic aorta (TAA) are the leading causes of mortality and morbidity in the United States and Japan. Although hypertension is a major risk for TAA, several studies have indicated that genetic factors also influence the structural formation of TAA. The purpose of the present study was to identify gene polymorphisms associated with TAA among hypertensive patients for assessment of the genetic risk for this condition. Methods: This case-control study comprised 1351 hypertensive individuals, including 88 subjects with TAA and 1263 without any cardiovascular complications. The genotypes for 142 polymorphisms of 121 candidate genes were determined by a method that combines the polymerase chain reaction and sequence-specific oligonucleotide probes with suspension array technology. Results: Evaluation of genotype distributions by the chi-square test and subsequent multivariable logistic regression analysis with adjustment for age, sex, body mass index, and prevalence of smoking, diabetes mellitus, hypercholesterolemia, and metabolic syndrome revealed that the T→G (3′ UTR) polymorphism of the thrombospondin 2 gene ( THBS2 ; odds ratio, 4.7) is significantly (P < 0.05) associated with TAA in hypertensive subjects, with the variant G allele representing a risk factor for this condition. Furthermore, the -110A→C polymorphism of heat-shock 70-kD protein 8 gene ( HSPA8 ; odd ratio, 0.3), the C→T (Pro198Leu) polymorphism of the glutathione peroxidase gene ( GPX1 ; odds ratio, 0.3), the -6G→A polymorphism of angiotensin 1 gene ( AGT ; odds ratio, 0.3), and the -850C→T polymorphism of tumor necrosis factor gene ( TNF ; odds ratio, 0.5) were significantly associated with this condition, with the variant allele of each polymorphism being protective against this condition. A stepwise forward selection procedure revealed that polymorphisms of THBS2 , HSPA8 , GPX1 , AGT , and TNF significantly affected the prevalence of TAA. Conclusions: Genetic variant of THBS2 may be a risk factor for TAA in hypertensive patients, whereas variants of HSPA8 , GPX1 , AGT , and TNF may be protective against this condition. Determination of genotypes for these polymorphisms may prove informative for assessment of the genetic risk for TAA.

Long-Term Blood Pressure Variability Increases Risks of Dementia and Cognitive Decline: A Meta-Analysis of Longitudinal Studies

Hypertension ◽  
2021 ◽  
Author(s):  
Pingping Jia ◽  
Helen W.Y. Lee ◽  
Joyce Y.C. Chan ◽  
Karen K.L. Yiu ◽  
Kelvin K.F. Tsoi
Keyword(s):  
Blood Pressure ◽  
Risk Factor ◽  
Cognitive Impairment ◽  
Cognitive Decline ◽  
Longitudinal Studies ◽  
Meta Analysis ◽  
Hazard Ratio ◽  
Literature Searches ◽  
Meta Regression

High blood pressure (BP) is considered as an important risk factor for cognitive impairment and dementia. BP variability (BPV) may contribute to cognitive function decline or even dementia regardless of BP level. This study aims to investigate whether BPV is an independent predictor for cognitive impairment or dementia. Literature searches were performed in MEDLINE, Embase, PsycINFO, CINAHL, and Web of Science to May 2021. Longitudinal studies that assessed the risk of dementia or cognitive impairment with BPV as the predictor was included. Meta-analysis and meta-regression were performed to evaluate the effect of BPV on the risk of dementia or cognitive impairment. A total of 5919 papers were identified, and 16 longitudinal studies were included, which had >7 million participants and a median age from 50.9 to 79.9 years and a median follow-up of around 4 years. Thirteen studies reported visit-to-visit BPV and concluded that systolic BPV increases the risk of dementia with a pooled hazard ratio of 1.11 (95% CI, 1.05–1.17), and increases the risk of cognitive impairment with a pooled hazard ratio of 1.10 (95% CI, 1.06–1.15). Visit-to-visit diastolic BPV also increased the risk of dementia and cognitive decline. A meta-regression revealed a linear relationship between higher BPV and risks of dementia and cognitive impairment. Similar findings were observed in the studies with day-to-day BPV. This study suggests that long-term BPV is an independent risk factor for cognitive impairment or dementia, so an intervention plan for reducing BPV can be a target for early prevention of dementia.

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