Augusto Vicario

Cognition and Vascular Risk Factors: An Epidemiological Study

We conducted an epidemiological approach to identify the negative impact of the vascular risk factors (such as hypertension, diabetes and hypercholesterolemia) over cognition. The interesting aspect of this study was that the survey was conducted in all age groups through a voluntary call (n = 1365; ≥18 years old, both sexes; age 49 ± 15 y, female 75.7%). Thus, we demonstrated that the use of a Minimum Cognitive Examination (MCE), a brief, simple, and easy managed neuropsychological evaluation, detected a greater number of people with cognitive decline surpassing to the Minimal Mental Statement Examination alone (14.5% of the participants showed MMSE ≤24, 34,6% showed dys-executive function, and 45,8% memory impairment. Out of the 4 studied RF, the only one that was not related to cognitive impairment was dyslipemia. Finally, we noted the importance of cognitive state early detection in all age groups, even in the youngest group. Acting in the middle of the life stages, we can prevent or delay the onset of a disease in adults, nowadays incurable: dementia.

cognitive evolution in hypertensive patients: a six-year follow-up

Background: Several studies have examined the links between hypertension, vascular damage, and cognitive impairment. The functions most commonly involved seem to be those associated with memory and executive function. Aims: 1) to report the cognitive evolution in a cohort of hypertensive patients, 2) to identify the affected domains, and 3) to correlate the results obtained with blood pressure measurements. Materials and Methods: Observational 6-year follow-up cohort study including both males and females aged ≥65 and ≤80 years, and hypertensive patients under treatment. Patients with a history of any of the following conditions were excluded: stroke, transient ischemic attack, diabetes mellitus, atrial fibrillation, cardiac surgery, dementia, or depression. Four neurocognitive evaluations were performed (at baseline and every 2 years). The tests used evaluated memory and executive function domain. Blood pressure was measured on every cognitive evaluation. Results: Sixty patients were followed for 76.4 ± 2.8 months. The average age at baseline was 72.5 ± 4.2 and 77.9 ± 4.6 at 6 years (65% were women). Two patients were lost to follow up (3.3%) and 8 patients died (13.3%).The density incidence for dementia was 0.6% patients per year (pt/y) (n = 3) and for depression was 1.6% pt/y (n = 12). No changes were observed in either memory impairment or the Mini Mental State Examination (MMSE) results (p = ns) during follow-up. A progressive impairment of the executive function was shown regardless of the blood pressure measurements. Conclusion: 1) the incidence of dementia doubled to general population, 2) the initial memory impairment did not change during the evaluation period, 3) cognitive impairment worsened in the areas related to executive function (prefrontal cortex) regardless of the adequacy of anti-hypertensive treatment and blood pressure values.

Association Between Hypertension, Menopause, and Cognition in Women

The aim of this study was to investigate the cognitive state in women and its relation to menopause and hypertension (HTN). The authors included 1034 women aged 47.13±15.71 years. The prevalence of HTN was 47.1%, with 67.8% of patients treated and 48.6% controlled. Cognitive impairment was higher among hypertensive menopausal (mini‐Boston Naming Test: 7.4±3.1 vs 8.5±2.4, P<.001; Clock‐Drawing Test: 5.2±2 vs 5.6±1.6, P<.01). Using logistic regression adjusted by age and education level, statistical differences were found in the results from the mini‐Boston Naming Test between menopausal hypertensive vs menopausal normotensive women (odds ratio, 1.48; 95% confidence interval, 1.06–2.07; P=.021), and no difference between nonmenopausal hypertensive vs menopausal normotensive women (odds ratio, 0.89; 95% confidence interval, 0.51–1.57; P=.697). The P interaction between both groups was significant (P=.038). The possibility of alteration in cortical functions in menopausal hypertensive woman showed a relative increment of 48% (P=.021). The association between HTN and menopause increases the possibility of compromising the semantic memory by 50%.

National Registry of Hypertension. Epidemiological Characteristics of Hypertension in Argentina. The RENATA 2 study

Background: Hypertension is the main risk factor for cardiovascular disease and cardiovascular mortality. As the prevalence of hypertension is increasing, it is necessary to know the updated information in Argentina. Objective: The aim of this study was to evaluate the prevalence, awareness, treatment and control of hypertension in Argentina. Methods: A cross-sectional study was conducted including subjects ≥ 18 years from 25 cities in Argentina. The participants were surveyed and blood pressure was measured using validated automated sphygmomanometers. Results: A total of 5.931 subjects were surveyed. Mean age was 43.5±17.1 years. The prevalence of hypertension was 36.3% (95% CI, 35.1-37.6), was higher in men (43.7% vs. 30.4%; p < 0.0001), and increased with age in both sexes. Among subjects with hypertension, 38.8% were unaware of their condition while 5.7% knew it but were not receiving treatment. In 55.5% of cases, subjects were receiving therapy, and only 24.2% were well controlled, particularly women. In treated subjects, 73.4% were receiving monotherapy and hypertension was controlled in only 43.6%. Patients who adhered to treatment had better blood pressure control than those who did not (46.9% vs. 40.1%; p=0.01). Conclusions: The prevalence of hypertension in Argentina is 36.3%, in agreement with the reports of the World Health Organization for the region. In 38.8% of cases, participants were unaware of their condition. Half of the subjects with hypertension were receiving drug therapy and only 25% were controlled. Three out of four patients treated were receiving monotherapy. Blood pressure control was associated with better adherence to treatment.

At the Heart of Brain Disorders – Preventing Cognitive Decline and Dementia

Vascular risk factors are shared by heart and brain. Vascular brain injury (small vessel disease, stroke) alone or combined with neurodegenerative pathology (β-amyloid depositions) brings about either cognitive decline and vascular dementia or Alzheimers disease. Long-term exposure to vascular risk factors precedes the onset of neurocognitive diseases by one or two decades. Early detection and control of modifiable vascular risk factors seem to be the only current strategies to prevent cognitive impairment and dementia.

Hipertensión arterial: otro camino hacia el deterioro cognitivo, la demencia y las alteraciones conductuales

Resumen Introduccion La hipertension arterial, el mas prevalente y menos controlado de los factores de riesgo vascular, afecta a todas las arterias y entre ellas a las cerebrales. Este dano, subclinico por largos periodos de tiempo, causa isquemia subcortical e “infartos silentes”, comprometiendo el funcionamiento de varios dominios cognitivos y deviniendo en algunos casos en compromiso irreversible de las funciones intelectuales superiores. Objetivo Aunque la causalidad entre la enfermedad vascular y la patologia cognitiva fue definida, esta revision pretende exponer nuestra experiencia y actualizar el estado del conocimiento sobre el tema. Desarrollo Los pacientes con dano vascular del cerebro y deterioro cognitivo incrementan cinco veces el riesgo de desarrollar sindromes demenciales (demencia tipo vascular o demencia tipo Alzheimer), y ademas son proclives a presentar trastornos animicos (depresion). El compromiso vascular en la enfermedad de Alzheimer impacta en forma negativa sobre el pronostico, acelerando su evolucion. Conclusion El establecimiento de patrones de conducta interdisciplinarios que operen con una actitud preventiva efectiva logra tanto el control de la hipertension arterial y otros factores de riesgo como la deteccion del compromiso cognitivo.