Renaud Péquignot

Renal Function in Older Hospital Patients Is More Accurately Estimated Using the Cockcroft-Gault Formula Than the Modification Diet in Renal Disease Formula

OBJECTIVES: To compare the accuracy of the two most popular creatinine clearance (CrCl) estimation formulae (Cockcroft‐Gault (CG) and Modification Diet in Renal Disease (MDRD)) in older hospitalized patients.

Relationship between antihypertensive drug therapy and cognitive function in elderly hypertensive patients with memory complaints.

Objective To evaluate the relationship between antihypertensive treatments and cognitive function in elderly hypertensive patients with memory complaints. Methods The association between cognitive function and antihypertensive drug therapy was studied in 1241 hypertensive elderly patients with memory complaints attending a geriatric outpatient clinic. Cognitive function was assessed using the Mini Mental State Examination (MMSE) and validated neuropsychological tests (Cognitive Efficiency Profile; CEP). Patients were classified into four categories according to their cognitive status: normal cognitive function, mild cognitive impairment (MCI), Alzheimers disease (AD) or vascular dementia (VaD). Results In this population aged 78 ± 8 years, with a mean blood pressure of 152 ± 19/86 ± 12 mmHg, antihypertensive treatment was prescribed for 57% of patients. After adjustment for age, sex and education, treated hypertensive patients had better cognitive function than untreated patients (MMSE score 23.9 ± 5.6/30 versus 22.7 ± 6.4/30, P < 0.001, CEP score 49.1 ± 24.9/100 versus 45.4 ± 23.7/100, P < 0.001). This association was observed independently of the cognitive status, both in normal, MCI, AD and VaD hypertensive patients. The odds ratio (OR) for AD was 0.58 [95% confidence interval (CI) 0.42–0.81] in treated compared with untreated hypertensive patients. In patients on antihypertensive therapy, higher cognitive function was observed in patients using calcium antagonists compared with those without calcium antagonists (CEP 52.9 ± 24.6/100 versus 46.4 ± 23.4/100, P < 0.001; OR for AD 0.67; 95% CI 0.45–0.99), independently of blood pressure level. Conclusions Antihypertensive therapy was associated with a lower risk of cognitive impairment and AD. In particular, the use of calcium antagonists was associated with a decreased risk of cognitive impairment and AD independently of the blood pressure level, suggesting a specific neuroprotective effect of these antihypertensive agents.

RESPONSE LETTER TO DRS. LAGRO AND CLAASSEN

lection are a ready source of bias. Collecting urine for longer than 24 hours will result in an overestimation, whereas missing urine samples will underestimate creatine clearance. In conclusion, there are many reasons why estimating renal function in hospitalized geriatric patients is difficult and prone to errors. Further research is necessary, preferably using gold standard methods to measure GFR (for example, using inulin, Cr-labeled ethylenediaminetetraacetic acid, or I-iothalamate), before the conclusion is drawn that the CG formula is a better estimate of renal function than the MDRD formula.

Relations entre troubles cognitifs et lésions de la substance blanche cérébrale

Methods: We studied the association between WML on CT brain scan and cognitive functions in 136 consecutive elderly subjects attending a geriatric outpatient clinic, suffering from MCI. The global cognitive assessment was based on Mini Mental State Examination (MMSE), a validated comprehensive battery of neuropsychological tests, the Cognitive Efficiency Profile (CEP), a CT brain scan and a complete biological screening. WML on CT brain scan was evaluated by a blinded investigator.

Tratamiento de la demencia

Durante estos ultimos anos, se han realizado ensayos terapeuticos para el tratamiento de la enfermedad de Alzheimer (EA) y de las demencias vasculares. En concreto, el tratamiento sintomatico de la enfermedad de Alzheimer ha experimentado considerables progresos con la comercializacion de los anticolinesterasicos. En el campo de la prevencion, el beneficio de los inhibidores del calcio, de los tratamientos antirradicales, antiinflamatorios e inmunitarios, todavia esta en estudio. Las sustancias que actuan sobre la via beta-amiloide (por ejemplo, inhibidores de las beta y de las gamma-secretasas), los factores de crecimiento neuronal, las terapias genicas y los trasplantes neuronales son otras vias con un futuro prometedor. Por otra parte, se ha subrayado recientemente la relacion entre la enfermedad de Alzheimer y la demencia vascular. Los datos epidemiologicos han demostrado una correlacion entre la presencia de factores de riesgo vascular (hipertension arterial, diabetes, hipercolesterolemia o arritmia completa por fibrilacion auricular) y la posterior aparicion de declive cognitivo, e incluso de demencias, tanto vasculares como degenerativas. La identificacion de estos factores permite plantearse para los proximos anos una posible prevencion de las demencias mediante un tratamiento adecuado que comprenda tratamientos antihipertensores, hipocolesterolemiantes, antidiabeticos o antiagregantes plaquetarios. Los datos recientes de los grandes ensayos terapeuticos convergen en senalar el papel preventivo del tratamiento antihipertensor en la aparicion de la enfermedad de Alzheimer y de las demencias vasculares.