Liliana Nicolosi

Hypertension and cognitive decline: impact on executive function.

Hypertension is a risk factor for mild cognitive deterioration and vascular dementia. Cognitive deterioration attributable to normal aging was distinguished from cognitive deterioration related to hypertension by means of neuropsychologic tests. Sixty hypertensive patients, aged 65‐80 years, were compared with 30 normotensive individuals. Patients with a history of stroke and/or transient ischemic attacks, diabetes, atrial fibrillation, hypercholesterolemia, or bypass surgery, and those diagnosed with dementia, depression, or anxiety, were excluded. Neither gender differences, duration of hypertension (10.2±8.2 years), nor prescribed antihypertensive drug treatment had an influence on study results. Immediate recall was impaired in both groups. The hypertensive patients evinced impairment in all tests vs. the normotensive subjects. Mean deferred recall scores ± SD were 5.68±2.6 vs. 7.13±2A; p<0.01. Deficits in attention speed and executive function, as measured by nonperformance on the Trail Making Test Part B, were present in 46% of hypertensive patients vs. 13% of normotensive patients (p<0.005), with more errors made by the hypertensive patients (1.15±1.54 vs. 0.46±0.9; p<0.02). Scores on the Stroop Color and Word Test also revealed deficits in the hypertensive patients (24.7±7.6 vs. 32±10.7; p<0.005). Compared with the control group, the hypertensive participants revealed more deficits in skills involving delayed recall and prefrontal‐region skills. The relevant neuropsychologic tests were sufficiently sensitive and proved easy to use in clinical practice.

Effect of Oral Hygiene and 0.12% Chlorhexidine Gluconate Oral Rinse in Preventing Ventilator-Associated Pneumonia After Cardiovascular Surgery

BACKGROUND: Ventilator-associated pneumonia (VAP) is a nosocomial infection of multifactorial etiology and has a negative influence on cardiovascular surgery (CVS) outcomes. OBJECTIVES: Determine the effect of toothbrushing plus 0.12% chlorhexidine gluconate oral rinse in preventing VAP after CVS. METHODS: In a quasi-experimental study, patients undergoing heart surgery were enrolled in a protocol for controlling dental biofilm by proper oral hygiene (toothbrushing) and oral rinses with 0.12% chlorhexidine gluconate (Group 1), and they were compared with a historical control group (Group 2), which included patients who underwent cardiac surgery between 2009 and 2010 and who received regular oral hygiene care. Seventy-two hours before surgery, a dentist provided instruction and supervised oral hygiene with toothbrushing and chlorhexidine oral rinses to patients in Group 1. RESULTS: Each group comprised 150 patients. A lower incidence of VAP (2.7% [95% CI 0.7–7.8] vs 8.7% [95% CI 4.9–14.7], P = .04) and a shorter hospital stay (9 ± 3 d [95% CI 8.5–9.5] vs 10 ± 4 d [95% CI 9.4–10.7], P = .01) were observed in Group 1. No significant differences in all-cause in-hospital death were observed between groups (5.3% vs 4.7%, P > .99). The risk for developing pneumonia after surgery was 3-fold higher in Group 2 (3.9, 95% CI 1.1–14.2). CONCLUSIONS: Oral hygiene and mouth rinses with chlorhexidine under supervision of a dentist proved effective in reducing the incidence of VAP.